2020-21 Eanes ISD Benefit Guide

EANES ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2020 - 8/31/2021 WWW.MYBENEFITSHUB.COM/EANESISD 1

Table of Contents Benefit Contact Sheet How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) TRS Medical Texas Schools Health Benefits (TSHB) Program MDLIVE Telehealth Cigna Dental PPO & DHMO Superior Vision AUL a OneAmerica Company Disability Loyal American Cancer Aflac Critical Illness Aetna Hospital Indemnity APL Accident AUL a OneAmerica Company Life and AD&D ComPsych Employee Assistance Program (EAP) 5Star Family Protection Plan Term Life Insurance with Quality of Life Rider NBS Flexible Spending Account (FSA) HSA Bank Health Savings Account (HSA) ID Watchdog Identity Theft MASA Medical Transport 2

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12-13 14-17 18-19 20-35 36-37 38-47 48-51 52-57 58-63 64-67 68-71 72-73

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PG. 4

HOW TO ENROLL

PG. 6

SUMMARY PAGES

PG. 12

YOUR BENEFITS

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78-81 82-85 86-87 88-89

Benefit Contact Information ACCOUNT EXECUTIVE

BENEFITS ADMINISTRATOR

CONSULTANT

Ann Brownlee (210) 243-1337 annb@fbsbenefits.com

Tori Spurgeon-Chen 512-732-9190 vspurgeon@eanesisd.net

Norma Hutchinson (512) 258-1141 nhbenefits@austin.rr.com

TRS ACTIVECARE MEDICAL

DISABILITY

FAMILY PROTECTION PLAN

Blue Cross Blue Shield (866) 355-5999 www.bcbstx.com/trsactivecare

OneAmerica Company (800) 537-6442 www.oneamerica.com

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

TRS HMO MEDICAL

CANCER

FLEXIBLE SPENDING ACCOUNT

Scott & White HMO (800) 321-7947 www.trs.swhp.org

Loyal American (800) 366-8354

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

TEXAS SCHOOLS HEALTH BENEFITS (TSHB) PROGRAM

CRITICAL ILLNESS

HEALTH SAVINGS ACCOUNT

90 Degree Benefits (888) 803-0081 www.tshbp.org

Aflac (800) 433-3036 www.aflacgroupinsurance.com

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

TELEHEALTH

ACCIDENT

IDENTITY THEFT

MDLIVE (866) 365-1663 www.consultmdlive.com

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

ID Watchdog (800) 970-5182 www.idwatchdog.com

DENTAL

LIFE AND AD&D

COBRA

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

OneAmerica Company (800) 537-6442 www.oneamerica.com

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

VISION

MEDICAL TRANSPORT

HOSPITAL INDEMNITY

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

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

Aetna (800) 872-3862 www.aetna.com 3

MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet.

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

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•

Benefit Information

•

Online Support

•

Interactive Tools

•

And more.

Text “FBS EISD” to 313131 OR SCAN

How to Log In

1 BENEFIT INFO

2 3

www.mybenefitshub.com/eanesisd

CLICK LOGIN

ENTER USERNAME & PASSWORD

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

If you have six (6) or less characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.

ONLINE SUPPORT

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

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Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New MEDICAL Effective 9/1/2020, the health plan administrator for TRSActiveCare medical benefits will change. Benefit and premium changes will apply to all TRS-ActiveCare plans for the next plan year.

Plan Options: • TRS-ActiveCare Primary NEW Plan- Primary Care Provider (PCP), and PCP referrals to Specialist required • TRS-ActiveCare HD (formerly 1-HD)- If currently enrolled in TRSAC1HD and make no changes, you will be enrolled in this plan.

• TRS-ActiveCare Primary+ (formerly Select)- If currently enrolled in TRS-AC Select and make no changes, you will be enrolled in this plan. Primary Care Provider (PCP), and PCP referrals to Specialist required.

HMO Plan Options • Scott & White HMO -If currently enrolled in BSW and make no changes, you will be enrolled in this plan.

Refer to 2020-21 TRS-ActiveCare Plan Highlights on your benefit website for premium and plan option details.

TSHBP ALTERNATIVE MEDICAL New Plan! This year you have the option to join the Texas Schools Health Benefits Program (TSHBP) as a medical option in addition to TRS medical plans. Two plan options are available, a High Deductible HSA Compatible plan and a CoPay plan. On both plans, there are no benefits if you go out -of-network. However, TSHBP has a National Network and the plan does not require a primary care provider or referral to a specialist. Telehealth is provided at no cost for the CoPay plan and consults are $30 for the High Deductible plan. On both plans, once your deductible is met all other eligible medical expenses are covered at 100%, and preventative services are always covered at 100%. Specialty drugs are not covered unless at a facility setting (at the hospital) and if they are less than $670.

All hospital and other medical facility-based services must be accessed and scheduled via your assigned Care Coordinator. Review your benefits website for additional details.

DENTAL CHANGE Effective 9/1/2020, the dental rates for the High Dental plans will have an increase in premiums for 2020-2021.

VISION CHANGE Effective 9/1/2020, the vision plan will now cover Frames every 12 months and their is a slight increase in premiums.

CRITICAL ILLNESS Change Effective 9/1,2020, Critical Illness Plan will have a decrease in premium cost and more plan options.

FLEXIBLE SPENDING ACCOUNT ACTION REQUIRED: If you currently participate in a Healthcare of Dependent Care FSA, you must re-elect a new contribution amount every year to continue participation. Employees who currently participate must spend current plan year funds by the grace-period deadline of 11/15/2020 to avoid forfeiture. You can review your account balance using the CHECKFSA link on your Benefits Hub website or use the NBS smart phone app. Please remember, the FSA is a "use it or lose it" account. The new 2020-2021 Plan Year maximum is $2750.

ENROLLMENT OPTIONS- SUMMER 2020 1. Self Enroll on the Benefits Hub (or Eanes Benefits Mobile App).

Please go step-by-step until you get to the “Congratulations” page.

2. July 15th- Aug 21st: Contact the FBS Call Center at (866) 914-5202; M-F 8:00am - 7:00pm.

3. Summer 2020- Set a 20 minute phone consult on the FBS Scheduler (more info on this to come from your Human Resources in July)

Important Enrollment assistance is available by calling Financial Benefit Services at (469) 385-4685 to speak to a representative. Spanish speaking representatives are also available.

Annual Open Enrollment Benefit elections will become effective 9/1/2020 (elections requiring evidence of insurability, such as life Insurance, may have a later effective date, if approved). After annual enrollment closes, benefit changes can only be made if you experience a qualifying event (and changes must be made within 30 days of event).

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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 STATUS (CIS):

Enrollment Changes - When a Life Event Occurs Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

QUALIFYING EVENTS

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

Government Programs

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SUMMARY PAGES

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

Where can I find forms?

to review, change or continue benefit elections each year.

For benefit summaries and claim forms, go to your benefit

Changes are not permitted during the plan year (outside of

website: www.mybenefitshub.com/eanesisd. Click the benefit

annual enrollment) unless a Section 125 qualifying event occurs.

plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms section.

•

Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.

How can I find a Network Provider?

For benefit summaries and claim forms, go to the Eanes ISD

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

benefit website: www.mybenefitshub.com/eanesisd. Click on the benefit plan you need information on (i.e., Dental) and

included in the dependent profile. Additionally, you must

you can find provider search links under the Quick Links

notify your employer of any discrepancy in personal and/or

section.

benefit information.

When will I receive ID cards?

•

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.

If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and verify your coverage if you do not have an ID card at that

New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

Q&A Who do I contact with Questions?

For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.

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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.

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 Eanes ISD 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 2020 benefits become effective on September 1, 2020, you must be actively-at-work on September 1, 2020 to be eligible for

your new benefits.

PLAN

CARRIER

MAXIMUM AGE

Medical

TRS-BCBS or TSHB

25

Telehealth

MDLIVE

25

Dental

Cigna

25

Vision

Superior Vision

25

Cancer

Loyal American

25

Critical Illness

Aflac

25

Accident

American Public Life

21 or 25 if Full Time Student

Life and AD&D

AUL a OneAmerica Company

25

Identity Theft

ID Watchdog

25

Individual Life

5STAR Life Insurance Company

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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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Helpful Definitions

SUMMARY PAGES

Actively-at-Work

In-Network

You are performing your regular occupation for the employer

Doctors, hospitals, optometrists, dentists and other providers

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

who have contracted with the plan as a network provider.

places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2020 please notify your benefits administrator.

Annual Enrollment The period during which existing employees are given the

opportunity to enroll in or change their current elections.

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

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

Plan Year September 1st through August 31st

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

Calendar Year January 1st through December 31st

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

Guaranteed Coverage The amount of coverage you can elect without answering any

medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period.

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

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(including diagnostic and/or consultation services).

SUMMARY PAGES

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

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

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

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

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source Account Owner Underlying Insurance Requirement

Employee and/or employer Individual

Employee and/or employer Employer

High deductible health plan

None

Description

Minimum Deductible Maximum Contribution

$1,400 single (2020) $2,800 family (2020) $3,550 single (2020) $7,100 family (2020)

N/A $2,750

Permissible Use Of Funds

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

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

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

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

Not permitted

Year-to-year rollover of account balance?

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

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

Does the account earn interest?

Yes

No

Portable?

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

No

FLIP TO FOR HSA INFORMATION

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FLIP TO FOR FSA INFORMATION

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2020-21 TRS-ActiveCare Plan Highlights Sept. 1, 2020 — Aug. 31, 2021 All TRS-ActiveCare participants have three plan options. Each is designed with the unique needs of our members in mind.

TRS-ActiveCare 2 NEW: TRS-ActiveCare Primary • Lower premium • Copays for doctor visits

TRS-ActiveCare 1-HD • Similar to current 1-HD • Lower premium • Compatible with health savings

TRS-ActiveCare Primary+ • Simpler version of the current Select

plan before you meet deductible • Lower deductible than HD and primary • Statewide network account (HSA) plans • PCP referrals required to see • Nationwide network with out-of- • Copays for many services and drugs specialists network coverage • Higher premium Plan summary • Not compatible with health • No requirement for PCPs or • Statewide network savings account (HSA) referrals • PCP referrals required to see specialists • No out-of-network coverage • Must meet deductible before • Not compatible with a health savings plan pays for non-preventive account (HSA) care • No out-of-network coverage If you make no changes Only employees that choose If you’re currently in TRSIf you’re currently in TRS-ActiveCare Select during Annual this new plan during Annual ActiveCare 1-HD and you make no and you make no changes during Annual Enrollment, you’ll have Enrollment will be enrolled in it. change during Annual Enrollment, Enrollment, this will be your plan next the following plan... this will be your plan next year. year.

(This plan is closed and not accepting new enrollees. If you’re currently enrolled in TRS-ActiveCare 2, you can remain in this plan.)

• Closed to new enrollees • Current enrollees can choose to

stay in plan

• Lower deductible • Copays for many drugs and

services

• Nationwide network with out-of-

network coverage

• No requirement for PCPs or

referrals If you’re currently in TRS-ActiveCare 2, and you make no changes during Annual Enrollment, you will remain in TRS-ActiveCare 2 next year.

Total Monthly Premiums Employee Only Employee and Spouse Employee and Children Employee and Family

$386 $1,089 $695 $1,301

$397 $1,120 $715 $1,338

$514 $1,264 $834 $1,588

$937 $2,222 $1,393 $2,627

Plan Features Type of Coverage Individual/Family Deductible Coinsurance Individual/Family Maximum Out-of-Pocket Network Primary Care Provider (PCP) Required

In-Network Coverage Only

In-Network

Out-of-Network

In-Network Coverage Only

$2,500/$5,000

$2,800/$5,600

$5,500/$11,000

$1,200/$3,600

In-Network

Out-of-Network

$1,000/$3,000

$2,000/$6,000

You pay 30% after deductible

You pay 20% You pay 40% after after deductible deductible

You pay 20% after You pay 40% after deductible deductible

You pay 20% after deductible

$8,150/$16,300

$6,900/$13,800 $20,250/$40,500

$6,900/$13,800

Statewide Network

Nationwide Network

Statewide Network

Nationwide Network

Yes

No

Yes

No

$7,900/$15,800

$23,700/$47,400

Doctor Visits Primary Care

$30 copay

Specialist

$70 copay

TRS Virtual Health

$0 per consultation

You pay 20% You pay 40% after after deductible deductible You pay 20% You pay 40% after after deductible deductible $30 per consultation

$30 copay $70 copay $0 per consultation

You pay 40% after deductible You pay 40% after $70 copay deductible $0 per consultation $30 copay

Immediate Care Urgent Care Emergency Care TRS Virtual Health

$50 copay

You pay 20% You pay 40% after after deductible deductible

$50 copay

You pay 30% after deductible

You pay 20% after deductible

You pay 20% after deductible

$0 per consultation

$30 per consultation

$0 per consultation

You pay 40% after deductible You pay a $250 copay plus 20% after deductible $0 per consultation

Integrated with medical

Integrated with medical

$200 brand deductible

$200 brand deductible

$15/$45 copay

You pay 20% after deductible

$15/$45 copay

$50 copay

Prescription Drugs Drug Deductible Generics (30-Day Supply / 90-Day Supply) Preferred Brand

You pay 30% after deductible

You pay 25% after deductible

You pay 25% after deductible

Non-preferred Brand

You pay 50% after deductible

You pay 50% after deductible

You pay 50% after deductible

Specialty

You pay 30% after deductible

You pay 20% after deductible

You pay 20% after deductible

What’s New

Leverage Your $0 Preventive Care*

• • • •

• • • • • • • • •

Primary plan with a lower premium and copays Primary+ (formerly Select) decreased premiums by up to 8% Broader networks of health care providers Lower premiums for families with children

Did You Know • • •

Our provider search tool will be available in June.

Choosing a PCP helps you meet your health goals faster.

Generic medications save money! Ask your provider if your medicine has a generic.

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$20/$45 copay You pay 25% after deductible ($40 min/$80 max)/ You pay 25% after deductible ($105 min/$210 max) You pay 50% after deductible ($100 min/$200 max)/ You pay 50% after deductible ($215 min/$430 max) You pay 20% after deductible ($200 min/$900 max)/ No 90-Day Supply of Specialty Medications

Annual routine physicals (ages 12+) Annual mammogram (ages 40+) Annual OBGYN exam & pap smear (ages 18+) Annual prostate cancer screening (ages 45+) Well-child care (unlimited up to age 12) Healthy diet/obesity counseling (unlimited to age 22; ages 22+ get twenty-six visits per year) Smoking cessation counseling (8 visits per year) Breastfeeding support (six per year) Colonoscopy (ages 50+ once every ten years)

*Available for all plans. See benefits guides for more details.

2020-21 Health Maintenance Organization Plans and Premiums for Select Regions of the State Remember: Remember that when you choose an HMO, you’re choosing a regional network.

TRS also contracts with HMOs in certain regions of the state to bring participants in those areas another regional plan option.

Central and North Texas Baylor Scott & White HMO

South Texas Blue Essentials HMO

Brought to you by TRS-ActiveCare

Brought to you by TRS-ActiveCare

You can choose this plan if you live in You can choose this plan if you live in one these counties: Austin, Bastrop, one these counties: Cameron, Hildalgo, Bell, Blanco, Bosque, Brazos, Burleson, Starr, Willacy Burnet, Caldwell, Collin, Coryell, Dallas, Denton, Ellis, Erath, Falls, Freestone, Grimes, Hamilton, Hays, Hill, Hood, Houston, Johnson, Lampasas, Lee, Leon, Limestone, Madison, McLennan, Milam, Mills, Navarro, Robertson, Rockwall, Somervell, Tarrant, Travis, Walker, Waller, Washington, Williamson

West Texas Blue Essentials HMO Brought to you by TRS-ActiveCare You can choose this plan if you live in one these counties: Andrews, Armstrong, Bailey, Borden, Brewster, Briscoe, Callahan, Carson, Castro, Childress, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, Fisher, Floyd, Gaines, Garza, Glasscock, Gray, Hale, Hall, Hansford, Hartley, Haskell, Hemphill, Hockley, Howard, Hutchinson, Irion, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Llano, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, San Saba, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Winkler, Yoakum

Total Monthly Premiums Employee Only

$551.10

$491.54

$534.42

Employee and Spouse

$1,382.06

$1,182.52

$1,287.58

Employee and Children

$883.50

$766.96

$835.68

$1,478.56

$1,258.52

$1,370.12

In-Network Coverage Only

In-Network Coverage Only

In-Network Coverage Only

$950/$2,850

$500/$1,000

$950/$2,850

You pay 20% after deductible

You pay 20% after deductible

You pay 25% after deductible

$7,450/$14,900

$4,500/$9,000

$7,450/$14,900

Primary Care

$20 copay

$25 copay

$20 copay

Specialist

$70 copay

$60 copay

$70 copay

$50 copay

$75 copay

$500 copay after deductible

You pay 20% after deductible

$50 copay $500 copay before deductible plus 25% after deductible

Employee and Family

Plan Features Type of Coverage Individual/Family Deductible Coinsurance Individual/Family Maximum Out-of-Pocket

Doctor Visits

Immediate Care Urgent Care Emergency Care

Prescription Drugs Drug Deductible Days Supply Generics Preferred Brand Non-preferred Brand Specialty

$150 (excl. generics)

$100

$150

30-Day Supply / 90-Day Supply

30-Day Supply / 90-Day Supply

30-Day Supply / 90-Day Supply

$5/$12.50 copay

$10/$30 copay

$5/$12.50 copay ACA Preventative: $0

30% after deductible

$40/$120 copay

30% after deductible

50% after deductible

$65/$195 copay

50% after deductible

15%/25% after deductible (preferred/ nonpreferred)

You pay 20% after deductible

15%/25% after deductible (preferred/nonpreferred)

trs.texas.gov 13

TSHBP

Alternative Medical Plan

YOUR BENEFITS PACKAGE

About this Benefit The TSHBP is proud to offer a variety of plans and benefits to meet school district needs. Plans for 2020-21 include our High Deductible Health Plan (HDHP) and our CoPay Plan (CPP). Both plans are designed so members can easily navigate through their health medical needs.

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 14 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

Texas Schools Health Benefits Plan About Texas Schools Health Benefits Program (TSHBP) The Texas Schools Health Benefits Program is a regionally rated, fully-funded, guaranteed cost program developed for Texas school districts. Our purpose is to support the school children of Texas. We do this by providing health benefit solutions to our dedicated teachers, administrators, and support staff so they can concentrate on what they do best – teaching and supporting our kids. It is our desire to increase member health and well-being and provide tools necessary to identify and manage the health of each and every member.

TSHBP plans are available for school district employees who are employed by participating districts and are active, contributing TRS members.

Both TSHBP Plans Include •

A large National network to provide physician and ancillary services access to all members

•

No primary care provider required or referral to a specialist. A member can use any provider in the network

•

A Care Coordinator service (personal concierge) to support members with all their medical needs and specifically assist them with all facility care

•

Specialty drugs over $670 (30 day supply) are not covered, but the plan offers Patient Assistance and Co-Pay assistance

•

A patient advocate to help members with any balance bill and to pay the bill on the members behalf if necessary

•

Preventative Services are paid at 100% and all copays and deductibles are waived

TSHBP High Deductible Highlights •

Significantly lower premium rates compared to the TRS-

TSHBP Co-Pay Highlights •

service. All copayments apply to the deductible

ActiveCare HD plan •

Lower out-of-pocket maximums since a member-only have

A unique plan that members pay only copayments for

•

Lower out-of-pocket maximums since a member-only have to meet their deductible (no coinsurance)

to meet their deductible (no coinsurance) •

TSHBP HD - $3,000

•

TSHBP CoPay - $3,500

•

TRSAC HD - $6,900

•

TRSAC Primary - $8,150

•

Telehealth at a $30 Copay

•

Telehealth at $0 Copay

•

All eligible prescriptions are paid at 100% after the

•

$0 copay for generic drugs at CVS, HEB, Wal-Mart, and

deductible

Costco ($10 copay at other network pharmacies)

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Texas Schools Health Benefits Plan TSHBP HD Plan

Plan Summary HOW DOES TSHBP COMPARE TO TRS? Our unique embedded deductible health plans offer members lower out-of pocket maximums, bringing substantial savings without sacrificing care or quality.

The Care Coordinators act as a personal concierge for all TSHBP plans and members, and their job is to support the member as their healthcare advocate. Watch the below video to learn more.

•Unique plan where members pay copayments for service • All co-pays apply to the deductible • Low Out-of-Pocket Expense • Nationwide network for Physician and Ancillary Services • Care Coordinator Service for Hospital and Surgical Services • No requirement for PCP or Referrals • No Drug Deductible • $0 Generic Drug Benefit at CVS, HEB, Wal-Mart, Sam's, and Costco • Once deductible is met, the plan pays 100% (no coinsurance) • No out-of-network coverage

Plan Features Type of Coverage Individual/Family Deductible Coinsurance Individual/Family Maximum Out-ofPocket Network Required - Primary Care Provider (PCP) Required - PCP Referral to Specialist

WHAT ARE CARE COORDINATORS?

• Lowest HD Premium Plan • Low Out-of-Pocket Expense • Compatible with health savings account (HSA) • Nationwide network for Physician and Ancillary Services • Care Coordinator Service for Hospital and Surgical Services • No requirement for PCP or Referrals • Must meet deductible before plan pays for non-preventive care • Once deductible is met, the plan pays 100% (no coinsurance) • No out-of-network coverage

TSHBP CoPay Plan

In-Network Coverage Only

In-Network Coverage Only

$3,000/$9,000 None - Plan Pays 100% after deductible

$3,500/$10,500 None - Plan Pays 100% after deductible

$3,000/$9,000

$3,500/$10,500

National Network

National Network

No

No

No

No

Doctor Visits Preventive Care

Yes - Paid at 100%

Yes - $0 copay

Primary Care

Deductible, then Plan pays 100%

$35 copay

Specialist

Deductible, then Plan pays 100%

$35 copay

$30 Consultation Fee

$0 per consultation

Virtual Health

Care Facilities Urgent Care

Deductible, then Plan pays 100%

$50 copay

Emergency Care

Deductible, then Plan pays 100%

$500 copay

Outpatient Surgery

Deductible, then Plan pays 100%

$500 copay

Hospital Services

Deductible, then Plan pays 100%

$500 copay

Prescription Drug Benefits Drug Deductible

Integrated with medical

No deductible

30-Day Supply

30-Day Supply

Generic

Deductible, then Plan pays 100%

$0 at selected pharmacies; others $10/$20 copay

Preferred Brand

Deductible, then Plan pays 100%

$35 or 50% copay to $100

Non-Preferred Brand

Deductible, then Plan pays 100%

$70 or 50% copay to $200

Not Covered (90-Day Funding, then Patient and Copay Assistance)

Not Covered (90-Day Funding, then Patient and Copay Assistance)

Days Supply

https://tshbp.info/CCVideo

Specialty

Have Questions?

Call us at (888) 803-0081 or visit your benefits website for more information.

16

Eanes ISD Medical Rates 2020‐21 The rates below are not inclusive of your district’s medical contribuƟon. Please visit your benefit website for more informaƟon regarding your district’s medical contribuƟon amounts.

EO

EC

ES

EF

TSHBP

EO

EC

ES

EF

TRS‐Ac veCare HD

$397

$715

$1,120

$1,338

HD Plan

$345

$659

$965

$1,274

TRS‐Ac veCare Primary +

$514

$834

$1,264

$1,588

CoPay Plan

$386

$750

$1,095

$1,450

$386

$695

$1,089

$1,301

$551

$884

$1,382

$1,478

TRS‐Ac veCare Primary Central and North Texas BSW HMO

Maximum Out‐of‐Pocket Costs For 2020‐21 Cost for Families

Cost for Individuals $3,000 $3,500

TSHBP HD Plan TSHBP CoPay Plan

$9,000 $10,500

$6,900

TRS‐Ac veCare HD

$13,800

$6,900

TRS‐Ac veCare Primary +

$13,800

$8,150

$7,450

TRS‐Ac veCare Primary

Central and North Texas BSW HMO

$16,300

$14,900

17

MDLIVE

Telehealth

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

YOUR BENEFITS PACKAGE

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 18 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

Telehealth Need a doctor?

Download the MDLIVE Mobile App

No long wait. No big bill. Always open.

With MDLIVE, you can visit with a doctor 24/7 from your home, office or on-the-go.

Quality care now goes where you do.

With MDLIVE, you can visit with a doctor or counselor 24/7 from your home, office or on-the-go.

Welcome to MDLIVE! Your anytime, anywhere doctor’s office.

Welcome to MDLIVE!

We treat over 50 routine medical conditions including:

Your virtual doctor is here. Join for free today!

Your anytime, anywhere doctor’s office.

Avoid waiting rooms and the inconvenience of going to the Avoid waiting rooms and the inconvenience of going to the doctor’s office. Visit a doctor or counselor by phone, secure video doctor’s office. Visit a doctor by phone, secure video, or MDLIVE or MDLIVE app. Pediatricians are available 24/7, and family App. Pediatricians are available 24/7, and family members are also members are also eligible. eligible.

• U.S. board-certified doctors with an average of 15 years of • U.S. board certified doctors and licensed counselors with an experience. average of 15 years of experience.

• Consultations are convenient, private and secure.

• Consultations are convenient, private and secure • Prescriptions can be sent to your nearest pharmacy, if • Prescriptions can be sent to your nearest pharmacy, if medically necessary. medically necessary.

• • • • • • •

Acne Allergies Cold / Flu Constipation Cough Diarrhea Ear Problems

• • • • • •

Fever Headache Insect Bites Nausea / Vomiting Pink Eye Rash

•

• • • •

Respiratory Problems Sore Throats Urinary Problems / UTI Vaginitis And More

Your Monthly Premium is

The MDLIVE mobile app makes connecting with doctors and behavioral health counselors fast, easy and convenient.

No smartphone? No worries!

Register your account using a computer or phone.

Download the app.

Join for free. Visit a doctor. consultmdlive.com 888-365-1663

$8 (District paid if enrolled in HD or HMO plan) Join for free. Visit a doctor. consulmdlive.com 888-365-1663

Copyright © 2019 MDLIVE Inc. All Rights Reserved. MDLIVE may not be available in certain states and is subject to state regulations. MDLIVE does not replace the primary care physician, is not an insurance product and may not be able to substitute for traditional in person care in every case or for every condition. MDLIVE does not prescribe DEA controlled substances and may not prescribe non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE does not guarantee patients will receive a prescription. Healthcare professionals using the platform have the right to deny care if based on professional judgment a case is inappropriate for telehealth or for misuse of services. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission. For complete terms of use visit https://www.MDLIVE.com/terms-of-use/.

19

CIGNA

Dental

YOUR BENEFITS PACKAGE

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

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 20 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

Dental PPO– High Benefits

Cigna Dental PPO - Low Option

Network Options

Reimbursement Levels

In-Network: Total Cigna DPPO Network Based on Contracted Fees

Out-of-Network: See Non-Network Reimbursement Maximum Reimbursable Charge

$1,500 $75 $225

Policy Year Benefits Maximum Applies to: Class I, II, III & IX expenses Policy Year Deductible Individual Family Benefit Highlights

Plan Pays

Class I: Diagnostic & Preventive Oral Evaluations Prophylaxis: routine cleanings X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain Class II: Basic Restorative Restorative: fillings Endodontics: minor and major Oral Surgery: minor and major Anesthesia: general and IV sedation Repairs: Bridges, Crowns and Inlays Repairs: Dentures Denture Relines, Rebases and Adjustments Class III: Major Restorative Periodontics: minor and major Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures Class IV: Orthodontia Coverage for Dependent Children to age 19 Lifetime Benefits Maximum: $1,000 Class IX: Implants

Monthly PPO Premiums

You Pay

Tier

Rate

EE Only

$53.89

$1,500

EE + 1 Dep

$102.38

$75 $225

EE + 2 or more Dep

$139.53

Plan Pays

You Pay

Cigna Dental 100% No Deductible

No Charge

100% No Deductible

No Charge

Benefit Summary Eanes ISD # 3335907 High Plan Renewal Date: 09/01/2020

80% After Deductible

20% After Deductible

80% After Deductible

20% After Deductible

50% After Deductible

50% After Deductible

50% After Deductible

50% After Deductible

50% No Deductible 50% After Deductible

50% 50% No Deductible No Deductible 50% After Deductible

50% After Deductible

50% No Deductible 50% After Deductible

Insured by: Cigna Health and Life Insurance Company This material is for informational purposes only and is designed to highlight some of the benefits available under this plan. Consult the plan documents to determine specific terms of coverage relating to your plan.

Terms include covered procedures, applicable waiting periods, exclusions and limitations.

Benefit Plan Provisions:

In-Network Reimbursement Non-Network Reimbursement Cross Accumulation Policy Year Benefits Maximum

Policy Year Deductible Late Entrant Limitation Provision

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

For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Reimbursable Charge. The MRC is calculated at the 80th percentile of all provider charges in the geographic area. The dentist may balance bill up to their usual fees.

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

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

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

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

21

Dental PPO– High Pretreatment Review

Alternate Benefit Provision

Oral Health Integration Program (OHIP)

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

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

When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses.

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

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

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

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

Reviewed if more than once Covered if more than 6 months after installation

Prosthesis Over Implant

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

Restorative: fillings

Includes composite fillings on molars.

Benefit Exclusions: Covered Expenses will not include, and no payment will be made for the following: • Procedures and services not included in the list of covered dental expenses; • Diagnostic: cone beam imaging; Preventive Services: instruction for plaque control, oral hygiene and diet; • Restorative: veneers of porcelain, ceramic, resin, or acrylic materials on crowns or pontics on or replacing the upper and or lower first, second and/or third molars; Periodontics: bite registrations; splinting; • Prosthodontics: precision or semi-precision attachments; initial placement of a complete or partial denture per plan guidelines; • Implants: implants or implant related services; • Procedures, appliances or restorations, except full dentures, whose main purpose is to: change vertical dimension; diagnose or treat conditions or dysfunction of the temporomandibular joint (TMJ); stabilize periodontally involved teeth; or restore occlusion; • Athletic mouth guards; services performed primarily for cosmetic reasons; personalization; replacement of an appliance per benefit guidelines; • Services that are deemed to be medical in nature; services and supplies received from a hospital; Drugs: prescription drugs • Charges in excess of the Maximum Allowable Charge.

This document provides a summary only. It is not a contract. If there are any differences between this summary and the official plan documents, the terms of the official plan documents will prevail. Cigna Dental PPO plans are insured and/or administered by Cigna Health and Life Insurance Company (CHLIC) or Connecticut General Life Insurance Company (CGLIC), with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Texas, the insured dental plan is known as Cigna Dental Choice, and this plan uses the national Cigna DPPO network. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. Policy forms (for insured dental plans) in OK: HP-POL99 (CHLIC), GM6000 ELI288 et al (CGLIC); OR: HP-POL68; TN: HP-POL69/HC-CER2V1 et al (CHLIC).

The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. © 2017 Cigna / version 06192017

22

Dental PPO– Low Benefits

Cigna Dental PPO - Low Option Monthly PPO Premiums In-Network: Out-of-Network: Tier Rate Cigna DPPO Advantage Network See Non-Network Reimbursement EE Only Based on Contracted Fees Maximum Allowable Charge $36.93

Network Options

Reimbursement Levels Policy Year Benefits Maximum Applies to: Class I, II, III & IX expenses Policy Year Deductible Individual Family Benefit Highlights Class I: Diagnostic & Preventive Oral Evaluations Prophylaxis: routine cleanings X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain Class II: Basic Restorative Restorative: fillings Endodontics: minor and major Periodontics: minor and major Oral Surgery: minor and major Anesthesia: general and IV sedation Repairs: Bridges, Crowns and Inlays Repairs: Dentures Denture Relines, Rebases and Adjustments

$1,000

$1,000

EE + 1 Dep

$70.15

$50 $150

$50 $150

EE + 2 or more Dep

$95.62

Plan Pays

You Pay

Plan Pays

You Pay

Cigna Dental 100% No Deductible

No Charge

100% No Deductible

No Charge

Benefit Summary Eanes ISD # 3335907 Low Plan Renewal Date: 09/01/2020 Insured by: Cigna Health and Life Insurance Company

80% After Deductible

20% After Deductible

80% After Deductible

20% After Deductible

Class III: Major Restorative Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures

50% After Deductible

50% After Deductible

50% After Deductible

50% After Deductible

Class IX: Implants

50% After Deductible

50% After Deductible

50% After Deductible

50% After Deductible

This material is for informational purposes only and is designed to highlight some of the benefits available under this plan.

Consult the plan documents to determine specific terms of coverage relating to your plan. Terms include covered procedures, applicable waiting periods, exclusions and limitations.

Benefit Plan Provisions:

In-Network Reimbursement Non-Network Reimbursement Cross Accumulation Policy Year Benefits Maximum Policy Year Deductible

Late Entrant Limitation Provision

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

For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Allowable Charge. The dentist may balance bill up to their usual fees.

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

The plan will only pay for covered charges up to the yearly Benefits Maximum, when applicable.

Benefit-specific Maximums may also apply.

This is the amount you must pay before the plan begins to pay for covered charges, when applicable.

Benefit-specific deductibles may also apply.

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

Pretreatment Review

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

Alternate Benefit Provision

When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses.

23

Dental PPO– Low

Oral Health Integration Program (OHIP)

Timely Filing Benefit Limitations: Missing Tooth Limitation

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

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

Cleanings Fluoride Application Sealants (per tooth) Space Maintainers

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

2 per policy year Bitewings: 2 per policy year Complete series of radiographic images and panoramic radiographic images: Limited to a combined total of 1 per 36 months 2 per policy year, including periodontal maintenance procedures following active therapy 1 per policy year for children under age 19 Limited to posterior tooth. 1 treatment per tooth every 36 months for children under age 14 Limited to non-orthodontic treatment for children under age 19

Inlays, Crowns, Bridges, Dentures and Partials

Replacement every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth-colored material on molar crowns or bridges.

Denture and Bridge Repairs

Reviewed if more than once

Denture Adjustments, Rebases and Relines Prosthesis Over Implant

Covered if more than 6 months after installation

Oral Evaluations X-rays (routine) X-rays (non-routine)

Restorative: fillings

1 every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for nonprecious metals. No porcelain or white/tooth colored material on molar crowns or bridges.

Includes composite fillings on molars.

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

• • • • • • • • •

Procedures and services not included in the list of covered dental expenses; Diagnostic: cone beam imaging; Preventive Services: instruction for plaque control, oral hygiene and diet; Restorative: veneers of porcelain, ceramic, resin, or acrylic materials on crowns or pontics on or replacing the upper and or lower first, second and/or third molars; Periodontics: bite registrations; splinting; Prosthodontics: precision or semi-precision attachments; initial placement of a complete or partial denture per plan guidelines; Orthodontics: orthodontic treatment; Procedures, appliances or restorations, except full dentures, whose main purpose is to: change vertical dimension; diagnose or treat conditions or dysfunction of the temporomandibular joint (TMJ); stabilize periodontally involved teeth; or restore occlusion; Athletic mouth guards; services performed primarily for cosmetic reasons; personalization; replacement of an appliance per benefit guidelines; Services that are deemed to be medical in nature; services and supplies received from a hospital; Drugs: prescription drugs Charges in excess of the Maximum Allowable Charge.

This document provides a summary only. It is not a contract. If there are any differences between this summary and the official plan documents, the terms of the official plan documents will prevail. Cigna Dental PPO plans are insured and/or administered by Cigna Health and Life Insurance Company (CHLIC) or Connecticut General Life Insurance Company (CGLIC), with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Texas, the insured dental plan is known as Cigna Dental Choice, and this plan uses the national Cigna DPPO network. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. Policy forms (for insured dental plans) in OK: HP-POL99 (CHLIC), GM6000 ELI288 et al (CGLIC); OR: HP-POL68; TN: HP-POL69/HC-CER2V1 et al (CHLIC).

The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.© 2017 Cigna / version 06192017

24

Dental DHMO Monthly DHMO Premiums

P7XV0 TX

Tier

CIGNA DENTAL CARE® (*DHMO) PATIENT CHARGE SCHEDULE This Patient Charge Schedule lists the benefits of the Dental Plan including covered procedures and patient charges.

Rate

Employee Only

$15.14

Employee + 1 Dep

$27.40

Employee + 2 or more Deps

$38.63

Important Highlights •

•

• • • • • • •

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

This Patient Charge Schedule applies to Specialty Care when an appropriate referral is made to a Network Specialty Periodontist or Oral Surgeon. You should verify with the Network Specialty Dentist that your treatment plan has been authorized for payment by Cigna Dental. Prior authorization is not required for specialty referrals for Pediatric, Orthodontic and Endodontic services. You may select a Network Pediatric Dentist for your child under the age of 7 by calling Customer Service at 1.800.Cigna24 to get a list of Network Pediatric Dentists in your area. Coverage for treatment by a Pediatric Dentist ends on your child’s 7th birthday; however, exceptions for medical reasons may be considered on an individual basis. Your Network General Dentist will provide care upon your child’s 7th birthday.

Procedures not listed on this Patient Charge Schedule are not covered and are the patient’s responsibility at the dentist’s usual fees.

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

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

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

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

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

The American Dental Association may periodically change CDT Codes or definitions. Different codes may be used to describe these covered procedures. The language in italics is intended to clarify the members’ benefit.

Code

Procedure Description

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

Patient Charge $5.00

Diagnostic/preventive – Oral evaluations are limited to a combined total of 4 of the following evaluations during a 12 consecutive month period: periodic oral evaluations (D0120), comprehensive oral evaluations (D0150), comprehensive periodontal evaluations (D0180), and oral evaluations for patients under 3 years of age (D0145). The frequency of certain Covered Services, like cleanings, is limited. If your Network General Dentist certifies to Cigna Dental that, due to medical necessity, you require certain Covered Services more frequently than the limitation allows, Cigna Dental will waive the applicable limitation. The relevant Covered Services are identified with a ∆.

D9310 D9430 D9450 D0120 D0140 D0145 D0150 D0160 D0170 D0171 D0180 D0210 D0220

Consultation (diagnostic service provided by dentist or physician other than requesting dentist or physician) Office visit for observation – No other services performed Case presentation – Detailed and extensive treatment planning Periodic oral evaluation – Established patient Limited oral evaluation – Problem focused Oral evaluation for a patient under 3 years of age and counseling with primary caregiver Comprehensive oral evaluation – New or established patient Detailed and extensive oral evaluation - Problem focused, by report (limit 2 per calendar year; only covered in conjunction with Temporomandibular Joint (TMJ) evaluation) Re-evaluation – Limited, problem focused (established patient; not post-operative visit) Re-evaluation – Post-operative office visit Comprehensive periodontal evaluation – New or established patient X-rays intraoral – Complete series of radiographic images (limit 1 every 3 years) ∆ X-rays intraoral – Periapical – First radiographic image

$12.00 $6.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25 $0.00

Dental DHMO Code

Procedure Description

D0230 D0240 D0250 D0251 D0270 D0272 D0273 D0274 D0277 D0330 D0350 D0351

X-rays intraoral – Periapical – Each additional radiographic image X-rays intraoral – Occlusal radiographic image X-rays extraoral – 2D projection radiographic image created using a stationary radiation source, and detector Extra-oral posterior dental radiographic image (limit 1 per calendar year) X-rays (bitewing) – Single radiographic image X-rays (bitewings) – 2 radiographic images X-rays (bitewings) – 3 radiographic images X-rays (bitewings) – 4 radiographic images X-rays (bitewings, vertical) – 7 to 8 radiographic images X-rays (panoramic radiographic image) – (limit 1 every 3 years) ∆ 2D oral/facial photographic images obtained intra-orally or extra-orally 3D photographic image Cone beam CT capture and interpretation for TMJ series including two or more exposures (limit 1 per calendar year; D0368 only covered in conjunction with Temporomandibular Joint (TMJ) evaluation) D0415 Collection of microorganisms for culture and sensitivity D0425 Caries susceptibility tests D0431 Oral cancer screening using a special light source D0460 Pulp vitality tests D0470 Diagnostic casts D0472 Pathology report – Gross examination of lesion (only when tooth related) D0473 Pathology report – Microscopic examination of lesion (only when tooth related) D0474 Pathology report – Microscopic examination of lesion and area (only when tooth related) D0486 Laboratory accession of brush biopsy sample, microscopic examination, preparation and transmission of written report D1110 Prophylaxis (cleaning) – Adult (limit 2 per calendar year) ∆ Additional prophylaxis (cleaning) – In addition to the 2 prophylaxes (cleanings) allowed per calendar year D1120 Prophylaxis (cleaning) – Child (limit 2 per calendar year) ∆ Additional prophylaxis (cleaning) – In addition to the 2 prophylaxes (cleanings) allowed per calendar year Topical application of fluoride varnish (limit 2 per calendar year). There is a combined limit of a total of 2 D1206s and/ D1206 or D1208s per calendar year. ∆ Additional topical application of fluoride varnish in addition to any combination of two (2) D1206s (topical application of fluoride varnish) and/or D1208s (topical application of fluoride - excluding varnish) per calendar year Topical application of fluoride - Excluding varnish (limit 2 per calendar year) There is a combined limit of a total of 2 D1208 D1208s and/ or D1206s per calendar year. ∆ Additional topical application of fluoride - Excluding varnish - In addition to any combination of two (2) D1206s (topical applications of fluoride varnish) and/or D1208s (topical application of fluoride - excluding varnish) per calendar year D1310 Nutritional counseling for control of dental disease D1320 Tobacco counseling for the control and prevention of oral disease D1330 Oral hygiene instructions D1351 Sealant – Per tooth D1352 Preventive resin restoration in a moderate to high caries risk patient – Permanent tooth D1353 Sealant repair – Per tooth D1354 Interim caries arresting medicament application D1510 Space maintainer – Fixed – Unilateral D1515 Space maintainer – Fixed – Bilateral D1520 Space maintainer – Removable – Unilateral D1525 Space maintainer – Removable – Bilateral D1550 Re-cement or re-bond space maintainer D1555 Removal of fixed space maintainer D1575 Distal shoe space maintainer – Fixed – Unilateral Restorative (fillings, including polishing) D2140 D2150 D2160 26

Amalgam – 1 surface, primary or permanent Amalgam – 2 surfaces, primary or permanent Amalgam – 3 surfaces, primary or permanent

Patient Charge $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $240.00 $0.00 $0.00 $50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $55.00 $0.00 $45.00 $0.00 $15.00 $0.00 $15.00 $0.00 $0.00 $0.00 $12.00 $12.00 $8.00 $0.00 $35.00 $35.00 $45.00 $45.00 $6.00 $6.00 $30.00 $0.00 $0.00 $0.00

Dental DHMO Code

Procedure Description

Patient Charge D2161 Amalgam – 4 or more surfaces, primary or permanent $0.00 D2330 Resin-based composite – 1 surface, anterior (primary or permanent) $0.00 D2331 Resin-based composite – 2 surfaces, anterior (primary or permanent) $0.00 D2332 Resin-based composite – 3 surfaces, anterior (primary or permanent) $0.00 D2335 Resin-based composite – 4 or more surfaces or involving incisal angle, anterior (primary or permanent) $0.00 D2390 Resin-based composite crown, anterior $45.00 D2391 Resin-based composite – 1 surface, posterior $70.00 D2392 Resin-based composite – 2 surfaces, posterior $80.00 D2393 Resin-based composite – 3 surfaces, posterior $95.00 D2394 Resin-based composite – 4 or more surfaces, posterior $105.00 Crown and bridge – All charges for crowns and bridges (fixed partial dentures) are per unit (each replacement or supporting tooth equals 1 unit).

Coverage for replacement of crowns and bridges is limited to 1 every 5 years.

For single crowns, retainer (“abutment”) crowns, and pontics: The charges below include the cost of predominantly base metal alloy. You may be charged up to these additional amounts, based on the type of material the dentist uses for your restoration: • No more than $150.00 per tooth for any noble metal alloys, high noble metal alloys, titanium or titanium alloys • No more than $75.00 per tooth for any porcelain fused to metal (only on molar teeth) • Porcelain/ceramic substrate crowns on molar teeth are not covered. In addition, you may be charged up to these additional amounts: • No more than $100.00 per tooth if an indirectly fabricated (“cast”) post and core is made of high noble metal alloy • No more than $150.00 per tooth/unit for crowns, inlays, onlays, post and cores, and veneers if your dentist uses same day in-office CAD/CAM (ceramic) services. Same day in-office CAD/CAM (ceramic) services refer to dental restorations that are created in the dental office by the use of a digital impression and an in-office CAD/CAM milling machine. Complex rehabilitation – An additional $125 charge per unit for multiple crown units/ complex rehabilitation (6 or more units of crown and/or bridge in same treatment plan requires complex rehabilitation for each unit – ask your dentist for the guidelines) D2510 Inlay – Metallic – 1 surface $260.00 D2520 Inlay – Metallic – 2 surfaces $260.00 D2530 Inlay – Metallic – 3 or more surfaces $260.00 D2542 Onlay – Metallic – 2 surfaces $260.00 D2543 Onlay – Metallic – 3 surfaces $260.00 D2544 Onlay – Metallic – 4 or more surfaces $260.00 D2610 Inlay – Porcelain/ceramic, 1 surface $240.00 D2620 Inlay – Porcelain/ceramic, 2 surfaces $240.00 D2630 Inlay – Porcelain/ceramic, 3 or more surfaces $240.00 D2642 Onlay – Porcelain/ceramic, 2 surfaces $240.00 D2643 Onlay – Porcelain/ceramic, 3 surfaces $240.00 D2644 Onlay – Porcelain/ceramic, 4 or more surfaces $240.00 D2650 Inlay – Resin-based composite, 1 surface $225.00 D2651 Inlay – Resin-based composite, 2 surfaces $225.00 D2652 Inlay – Resin-based composite, 3 or more surfaces $225.00 D2662 Onlay – Resin-based composite, 2 surfaces $225.00 D2663 Onlay – Resin-based composite, 3 surfaces $225.00 D2664 Onlay – Resin-based composite, 4 or more surfaces $225.00 D2710 Crown – Resin-based composite, indirect $225.00 D2712 Crown – 3/4 resin-based composite, indirect $225.00 D2720 Crown – Resin with high noble metal $260.00 D2721 Crown – Resin with predominantly base metal $225.00 D2722 Crown – Resin with noble metal $260.00 D2740 Crown – Porcelain/ceramic substrate $285.00 D2750 Crown – Porcelain fused to high noble metal $270.00 D2751 Crown – Porcelain fused to predominantly base metal $240.00 D2752 Crown – Porcelain fused to noble metal $270.00 D2780 Crown – 3/4 cast high noble metal $260.00 D2781 Crown – 3/4 cast predominantly base metal $225.00 D2782 Crown – 3/4 cast noble metal $260.00 D2783 Crown – 3/4 porcelain/ceramic $240.00 D2790 Crown – Full cast high noble metal $260.00 27

Dental DHMO Code

Procedure Description

D2791 D2792 D2794 D2799 D2910 D2915 D2920 D2929 D2930 D2931 D2932 D2933 D2934 D2940 D2941 D2950 D2951 D2952 D2953 D2954 D2957 D2960 D2971 D2980 D6210 D6211 D6212 D6214 D6240 D6241 D6242 D6245 D6250 D6251 D6252 D6253 D6545 D6600 D6601 D6602 D6603 D6604 D6605 D6606 D6607 D6608 D6609 D6610 D6611 D6612 D6613 D6614 D6615 D662428

Crown – Full cast predominantly base metal Crown – Full cast noble metal Crown – Titanium Provisional crown Re-cement or re-bond inlay, onlay, veneer or partial coverage Re-cement or re-bond indirectly fabricated or prefabricated post Re-cement or re-bond crown Prefabricated porcelain/ceramic crown - Primary tooth Prefabricated stainless steel crown – Primary tooth Prefabricated stainless steel crown – Permanent tooth Prefabricated resin crown Prefabricated stainless steel crown with resin window Prefabricated esthetic coated stainless steel crown – Primary tooth Protective restoration Interim therapeutic restoration - Primary dentition Core buildup – Including any pins Pin retention – Per tooth – In addition to restoration Post and core – In addition to crown, indirectly fabricated Each additional indirectly prefabricated post – Same tooth Prefabricated post and core – In addition to crown Each additional prefabricated post – Same tooth Labial veneer (resin laminate) – Chairside Additional procedures to construct new crown under existing partial denture framework Crown repair, necessitated by restorative material failure Pontic – Cast high noble metal Pontic – Cast predominantly base metal Pontic – Cast noble metal Pontic – Titanium Pontic – Porcelain fused to high noble metal Pontic – Porcelain fused to predominantly base metal Pontic – Porcelain fused to noble metal Pontic – Porcelain/ceramic Pontic – Resin with high noble metal Pontic – Resin with predominantly base metal Pontic – Resin with noble metal Provisional Pontic Retainer – Cast metal for resin bonded fixed prosthesis Retainer inlay – Porcelain/ceramic, 2 surfaces Retainer inlay – Porcelain/ceramic, 3 or more surfaces Retainer inlay – Cast high noble metal, 2 surfaces Retainer inlay – Cast high noble metal, 3 or more surfaces Retainer inlay – Cast predominantly base metal, 2 surfaces Retainer inlay – Cast predominantly base metal, 3 or more surfaces Retainer inlay – Cast noble metal, 2 surfaces Retainer inlay – Cast noble metal, 3 or more surfaces Retainer onlay – Porcelain/ceramic, 2 surfaces Retainer onlay – Porcelain/ceramic, 3 or more surfaces Retainer onlay – Cast high noble metal, 2 surfaces Retainer onlay – Cast high noble metal, 3 or more surfaces Retainer onlay – Cast predominantly base metal, 2 surfaces Retainer onlay – Cast predominantly base metal, 3 or more surfaces Retainer onlay – Cast noble metal, 2 surfaces Retainer onlay – Cast noble metal, 3 or more surfaces Retainer inlay – Titanium

Patient Charge $225.00 $260.00 $260.00 $100.00 $0.00 $0.00 $0.00 $130.00 $35.00 $35.00 $45.00 $45.00 $130.00 $6.00 $6.00 $65.00 $10.00 $65.00 $65.00 $40.00 $40.00 $250.00 $65.00 $18.00 $260.00 $225.00 $260.00 $260.00 $250.00 $220.00 $250.00 $220.00 $260.00 $225.00 $260.00 $225.00 $225.00 $240.00 $240.00 $260.00 $260.00 $225.00 $225.00 $260.00 $260.00 $240.00 $240.00 $260.00 $260.00 $225.00 $225.00 $260.00 $260.00 $250.00

Dental DHMO Code

Procedure Description

Patient Charge $220.00 $225.00 $260.00 $225.00 $260.00 $220.00 $250.00 $220.00 $250.00 $260.00 $225.00 $260.00 $220.00 $260.00 $225.00 $260.00 $260.00 $0.00 $195.00

D6634 Retainer onlay – Titanium D6710 Retainer crown – Indirect resin based composite D6720 Retainer crown – Resin with high noble metal D6721 Retainer crown – Resin with predominantly base metal D6722 Retainer crown – Resin with noble metal D6740 Retainer crown – Porcelain/ceramic D6750 Retainer crown – Porcelain fused to high noble metal D6751 Retainer crown – Porcelain fused to predominantly base metal D6752 Retainer crown – Porcelain fused to noble metal D6780 Retainer crown – 3/4 cast high noble metal D6781 Retainer crown – 3/4 cast predominantly base metal D6782 Retainer crown – 3/4 cast noble metal D6783 Retainer crown – 3/4 porcelain/ceramic D6790 Retainer crown – Full cast high noble metal D6791 Retainer crown – Full cast predominantly base metal D6792 Retainer crown – Full cast noble metal D6794 Retainer crown – Titanium D6930 Re-cement or re-bond fixed partial denture D6950 Precision attachment Endodontics (root canal treatment, excluding final restorations) D3110 Pulp cap – Direct (excluding final restoration) $0.00 D3120 Pulp cap – Indirect (excluding final restoration) $0.00 D3220 Pulpotomy – Removal of pulp, not part of a root canal $12.00 D3221 Pulpal debridement (not to be used when root canal is done on the same day) $55.00 D3222 Partial pulpotomy for apexogenesis – Permanent tooth with incomplete root development $17.00 D3230 Pulpal therapy (resorbable filling) – Anterior, primary tooth (excluding final restoration) $40.00 D3240 Pulpal therapy (resorbable filling) – Posterior, primary tooth (excluding final restoration) $45.00 D3310 Anterior root canal – Permanent tooth (excluding final restoration) $100.00 D3320 Bicuspid root canal – Permanent tooth (excluding final restoration) $150.00 D3330 Molar root canal – Permanent tooth (excluding final restoration) $305.00 D3331 Treatment of root canal obstruction – Nonsurgical access $105.00 D3332 Incomplete endodontic therapy – Inoperable, unrestorable or fractured tooth $85.00 D3333 Internal root repair of perforation defects $105.00 D3346 Retreatment of previous root canal therapy – Anterior $165.00 D3347 Retreatment of previous root canal therapy – Bicuspid $215.00 D3348 Retreatment of previous root canal therapy – Molar $340.00 D3351 Apexification/recalcification – Initial visit (apical closure/calcific $95.00 D3352 Apexification/recalcification – Interim medication replacement $80.00 D3353 Apexification/recalcification – Final visit (includes completed root canal therapy – Apical closure/calcific repair of per$80.00 forations, root resorption, etc.)

D3410 Apicoectomy/periradicular surgery – Anterior $115.00 D3421 Apicoectomy/periradicular surgery – Bicuspid (first root) $115.00 D3425 Apicoectomy/periradicular surgery – Molar (first root) $115.00 D3426 Apicoectomy/periradicular surgery (each additional root) $75.00 D3427 Periradicular surgery without apicoectomy $115.00 D3430 Retrograde filling per root $75.00 D3450 Root amputation – Per root $115.00 D3920 Hemisection (including any root removal), not including root canal therapy $110.00 Periodontics (treatment of supporting tissues (gum and bone) of the teeth) - Periodontal regenerative procedures are limited to 1 regenerative procedure per site (or per tooth, if applicable), when covered on the patient charge schedule. The relevant procedure codes are D4263, D4264, D4266 and D4267. Localized delivery of antimicrobial agents is limited to 8 teeth (or 8 sites, if applicable) per 12 consecutive months when covered on the patient charge schedule. If your Network Dentist certifies to Cigna Dental that, due to medical necessity, you require certain Covered Services more frequently than the limitation allows, Cigna Dental will waive the applicable limitation. The relevant Covered Services are identified with a ∆.

29

Dental DHMO Code

D4210 D4211 D4212 D4240 D4241 D4245 D4249 D4260 D4261 D4263 D4264 D4265 D4266 D4267 D4270 D4273

Procedure Description

Patient Charge $160.00 $100.00 $100.00 $185.00 $140.00 $200.00 $155.00 $360.00 $275.00 $250.00 $115.00 $95.00 $215.00 $255.00 $300.00 $75.00

Gingivectomy or gingivoplasty – 4 or more teeth per quadrant Gingivectomy or gingivoplasty – 1 to 3 teeth per quadrant Gingivectomy or gingivoplasty to allow access for restorative procedure, per tooth Gingival flap (including root planing) – 4 or more teeth per quadrant Gingival flap (including root planing) – 1 to 3 teeth per quadrant Apically positioned flap Clinical crown lengthening – Hard tissue Osseous surgery – 4 or more teeth per quadrant Osseous surgery – 1 to 3 teeth per quadrant Bone replacement graft – Retained natural tooth - First site in quadrant Bone replacement graft – Retained natural tooth - Each additional site in quadrant Biologic materials to aid in soft and osseous tissue regeneration Guided tissue regeneration – Resorbable barrier per site Guided tissue regeneration – Nonresorbable barrier per site (includes membrane removal) Pedicle soft tissue graft procedure Autogenous connective tissue graft procedure (including donor and recipient surgical sites) first tooth, implant or edentulous tooth position D4274 Mesial/distal wedge procedure single tooth (when not performed in conjunction with surgical procedures in the same $85.00 anatomical area) D4275 Non-autogenous connective tissue graft (including recipient site and donor material) first tooth, implant, or edentu$460.00 lous tooth position in graft D4277 Free soft tissue graft procedure (including recipient and donor surgical sites), first tooth, implant or edentulous $300.00 (missing) tooth position in graft D4278 Free soft tissue graft procedure (including recipient and donor surgical sites), each additional contiguous tooth, im$150.00 plant or edentulous (missing) tooth position in same graft site D4283 Autogenous connective tissue graft procedure (including donor and recipient surgical sites) – Each additional contigu$38.00 ous tooth, implant or edentulous tooth position in same graft site D4285 Non-autogenous connective tissue graft procedure (including recipient surgical site and donor materials) – Each addi$230.00 tional contiguous tooth, implant or edentulous tooth position in same graft site D4341 Periodontal scaling and root planing – 4 or more teeth per quadrant (limit 4 quadrants per consecutive 12 months) ∆ $50.00 D4342 Periodontal scaling and root planing – 1 to 3 teeth per quadrant (limit 4 quadrants per consecutive 12 months) ∆ $40.00 D4346 Scaling in presence of generalized moderate or severe gingival inflammation – Full mouth, after oral evaluation (limit 1 $0.00 per calendar year) Additional scaling in presence of generalized moderate or severe gingival inflammation – Full mouth, after oral evalua$55.00 tion (limit 2 per calendar year) D4355 Full mouth debridement to allow evaluation and diagnosis (1 per lifetime) $50.00 D4381 Localized delivery of antimicrobial agents per tooth $60.00 D4910 Periodontal maintenance (limit 4 per calendar year) (only covered after active therapy) ∆ $40.00 Additional periodontal maintenance procedures (beyond 4 per calendar year) $70.00 Periodontal charting for planning treatment of periodontal disease $0.00 Periodontal hygiene instruction $0.00 Prosthetics (removable tooth replacement – dentures) - Includes up to 4 adjustments within first 6 months after insertion – Replacement limit 1 every 5 years. Characterization is considered an upgrade with maximum additional charge to the member of $200.00 per denture.

D5110 Full upper denture $225.00 D5120 Full lower denture $225.00 D5130 Immediate full upper denture $245.00 D5140 Immediate full lower denture $245.00 D5211 Upper partial denture – Resin base (including clasps, rests and teeth) $225.00 D5212 Lower partial denture – Resin base (including clasps, rests and teeth) $225.00 D5213 Upper partial denture – Cast metal famework (including clasps, rests and teeth) $240.00 D5214 Lower partial denture – Cast metal framework (including clasps, rests and teeth) $240.00 D5221 Immediate maxillary partial denture – Resin base (including any conventional clasps, rests and teeth) $225.00 D5222 Immediate mandibular partial denture – Resin base (including conventional clasps, rests and teeth) $225.00 D5223 Immediate maxillary partial denture – Cast metal framework with resin denture base (including any conventional $240.00 30 clasps, rests and teeth

Dental DHMO Code

D5224

Procedure Description

Patient Charge $240.00

Immediate mandibular partial denture – Cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) D5225 $165.00 Upper partial denture – Flexible base (including clasps, rests and teeth) D5226 $165.00 Lower partial denture – Flexible base (including clasps, rests and teeth) D5281 $225.00 Removable unilateral partial denture – One piece cast metal including clasps and teeth) D5410 $12.00 Adjust complete denture – Upper D5411 $12.00 Adjust complete denture – Lower D5421 $12.00 Adjust partial denture – Upper D5422 $12.00 Adjust partial denture – Lower D5850 $12.00 Tissue conditioning – Upper D5851 $12.00 Tissue conditioning – Lower D5862 $160.00 Precision attachment – By report Repairs to prosthetics D5510 Repair broken complete denture base $40.00 D5520 Replace missing or broken teeth – Complete denture (each tooth) $40.00 D5610 Repair resin denture base $40.00 D5620 Repair cast framework $40.00 D5630 Repair or replace broken clasp - Per tooth $45.00 D5640 Replace broken teeth – Per tooth $40.00 D5650 Add tooth to existing partial denture $40.00 D5660 Add clasp to existing partial denture - Per tooth $45.00 D5670 Replace all teeth and acrylic on cast metal framework – Upper $200.00 D5671 Replace all teeth and acrylic on cast metal framework – Lower $200.00 Denture relining (limit 1 every 36 months) D5710 Rebase complete upper denture $75.00 D5711 Rebase complete lower denture $75.00 D5720 Rebase upper partial denture $75.00 D5721 Rebase lower partial denture $75.00 D5730 Reline complete upper denture – Chairside $45.00 D5731 Reline complete lower denture – Chairside $45.00 D5740 Reline upper partial denture – Chairside $45.00 D5741 Reline lower partial denture – Chairside $45.00 D5750 Reline complete upper denture – Laboratory $75.00 D5751 Reline complete lower denture – Laboratory $75.00 D5760 Reline upper partial denture – Laboratory $75.00 D5761 Reline lower partial denture – Laboratory $75.00 Interim dentures (limit 1 every 5 years) D5810 Interim complete denture – Upper $280.00 D5811 Interim complete denture – Lower $280.00 D5820 Interim partial denture – Upper $95.00 D5821 Interim partial denture – Lower $95.00 Implant/abutment supported prosthetics – All charges for crowns and bridges (fixed partial dentures) are per unit (each replacement on a supporting implant(s) equals 1 unit). Coverage for replacement of crowns and bridges and implant supported dentures is limited to 1 every 5 years.

For single crowns, retainer (“abutment”) crowns, and pontics: The charges below include the cost of predominantly base metal alloy. You may be charged up to these additional amounts, based on the type of material the dentist uses for your restoration: • No more than $150.00 per tooth for any noble metal alloys, high noble metal alloys, titanium or titanium alloys • No more than $75.00 per tooth for any porcelain fused to metal (only on molar teeth) Porcelain/ceramic substrate crowns on molar teeth are not covered. In addition, you may be charged up to these additional amounts: • No more than $100.00 per tooth if an indirectly fabricated (“cast”) post and core is made of high noble metal alloy • No more than $150.00 per tooth/unit for crowns, inlays, onlays, post and cores, and veneers if your dentist uses same day in-office CAD/CAM (ceramic) services. Same day in-office CAD/CAM (ceramic) services refer to dental restorations that are created in the dental office by the use of a digital impression and an in-office CAD/CAM milling machine. Complex rehabilitation on implant/abutment supported prosthetic procedures – An additional $125 charge per unit for multiple crown units/complex rehabilitation (6 or more units of crown and/or bridge in same treatment plan requires complex rehabilitation for each unit – ask your dentist for the guidelines) 31 D6058 Abutment supported porcelain/ceramic crown $625.00

Dental DHMO Procedure Description

Code

D6059 D6060 D6061 D6062 D6063 D6064 D6065 D6066 D6067 D6068 D6069 D6070 D6071 D6072 D6073 D6074 D6075 D6076

Patient Charge $760.00 $580.00 $760.00 $710.00 $525.00 $710.00 $625.00 $760.00 $710.00 $560.00 $740.00 $560.00 $740.00 $710.00 $525.00 $710.00 $560.00 $740.00

Abutment supported porcelain fused to metal crown (high noble metal) Abutment supported porcelain fused to metal crown (predominantly base metal) Abutment supported porcelain fused to metal crown (noble metal) Abutment supported cast metal crown (high noble metal) Abutment supported cast metal crown (predominantly base metal) Abutment supported cast metal crown (noble metal) Implant supported porcelain/ceramic crown Implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal) Implant supported metal crown (titanium, titanium alloy, high noble metal) Abutment supported retainer for porcelain/ceramic fixed partial denture Abutment supported retainer for porcelain fused to metal fixed partial denture (high noble metal) Abutment supported retainer for porcelain fused to metal fixed partial denture (predominantly base metal) Abutment supported retainer for porcelain fused to metal fixed partial denture (noble metal) Abutment supported retainer for cast metal fixed partial denture (high noble metal) Abutment supported retainer for cast metal fixed partial denture (predominantly base metal) Abutment supported retainer for cast metal fixed partial denture (noble metal) Implant supported retainer for ceramic fixed partial denture Implant supported retainer for porcelain fused to metal fixed partial denture (titanium, titanium alloy, high noble metal) D6077 Implant supported retainer for cast metal fixed partial denture (titanium, titanium alloy, high noble metal) $710.00 D6085 Provisional implant crown $100.00 D6092 Re-cement implant/abutment supported crown $40.00 D6093 Re-cement implant/abutment supported fixed partial denture $40.00 D6094 Abutment supported crown (titanium) $710.00 D6110 Implant /abutment supported removable denture for edentulous arch – Maxillary $725.00 D6111 Implant /abutment supported removable denture for edentulous arch – Mandibular $725.00 D6112 Implant /abutment supported removable denture for partially edentulous arch – Maxillary $740.00 D6113 Implant /abutment supported removable denture for partially edentulous arch – Mandibular $740.00 D6114 Implant /abutment supported fixed denture for edentulous arch – Maxillary $725.00 D6115 Implant /abutment supported fixed denture for edentulous arch – Mandibular $725.00 D6116 Implant /abutment supported fixed denture for partially edentulous arch – Maxillary $740.00 D6117 Implant /abutment supported fixed denture for partially edentulous arch – Mandibular $740.00 D6194 Abutment supported retainer crown for fixed partial denture (titanium) $710.00 Oral surgery (includes routine postoperative treatment) - Surgical removal of impacted tooth – Not covered for ages below 15 unless pathology (disease) exists.

D7111 Extraction of coronal remnants – Deciduous tooth $6.00 D7140 Extraction, erupted tooth or exposed root – Elevation and/or forceps removal $6.00 D7210 Extraction, erupted tooth – Removal of bone and/or section of tooth $40.00 D7220 Removal of impacted tooth – Soft tissue $65.00 D7230 Removal of impacted tooth – Partially bony $85.00 D7240 Removal of impacted tooth – Completely bony $110.00 D7241 Removal of impacted tooth – Completely bony, unusual complications (narrative required) $135.00 D7250 Removal of residual tooth roots – Cutting procedure $50.00 D7251 Coronectomy - Intentional partial tooth removal $85.00 D7260 Oroantral fistula closure $135.00 D7261 Primary closure of a sinus perforation $135.00 D7270 Tooth stabilization of accidentally evulsed or displaced tooth $105.00 D7280 Exposure of an unerupted tooth (excluding wisdom teeth) $110.00 D7283 Placement of device to facilitate eruption of impacted tooth $110.00 Incisional biopsy of oral tissue – Hard (bone, tooth) (tooth related – not allowed when in conjunction with another D7285 $0.00 surgical procedure)

32

Dental DHMO Code

D7286 D7287 D7288 D7310 D7311 D7320 D7321 D7450 D7451 D7471 D7472 D7473 D7485 D7510 D7511 D7520 D7521

Procedure Description

Incisional biopsy of oral tissue – Soft (all others) (tooth related – not allowed when in conjunction with another surgical procedure) Exfoliative cytological sample collection Brush biopsy – Transepithelial sample collection Alveoloplasty in conjunction with extractions – 4 or more teeth or tooth spaces per quadrant Alveoloplasty in conjunction with extractions – 1 to 3 teeth or tooth spaces per quadrant Alveoloplasty not in conjunction with extractions – 4 or more teeth or tooth spaces per quadrant Alveoloplasty not in conjunction with extractions – 1 to 3 teeth or tooth spaces per quadrant Removal of benign odontogenic cyst or tumor – Up to 1.25 cm Removal of benign odontogenic cyst or tumor – Greater than 1.25 cm Removal of lateral exostosis – Maxilla or mandible Removal of torus palatinus Removal of torus mandibularis Reduction of osseous tuberosity Incision and drainage of abscess – Intraoral soft tissue Incision and drainage of abscess – Intraoral soft tissue complicated Incision and drainage of abscess – Extraoral soft tissue Incision and drainage of abscess – Extraoral soft tissue – Complicated (includes drainage of multiple fascial spaces)

Patient Charge $0.00 $50.00 $50.00 $65.00 $65.00 $85.00 $85.00 $0.00 $0.00 $100.00 $75.00 $75.00 $60.00 $40.00 $40.00 $40.00 $40.00

D7880

Occlusal orthotic device, by report - (limit 1 per 24 months; only covered in conjunction with Temporomandibular $200.00 Joint (TMJ) treatment) D7881 Occlusal orthotic device adjustment $12.00 D7910 Suture of recent small wounds up to 5cm $35.00 D7960 Frenulectomy – Also known as frenectomy or frenotomy – Separate procedure not incidental to another procedure $50.00 D7963 Frenuloplasty $50.00 Orthodontics (tooth movement) - Orthodontic treatment (Maximum benefit of 24 months of interceptive and/or comprehensive treatment. Atypical cases or cases beyond 24 months require an additional payment by the patient.)

D8050 Interceptive orthodontic treatment of the primary dentition – Banding $485.00 D8060 Interceptive orthodontic treatment of the transitional dentition – Banding $485.00 D8070 Comprehensive orthodontic treatment of the transitional dentition – Banding $485.00 D8080 Comprehensive orthodontic treatment of the adolescent dentition – Banding $485.00 D8090 Comprehensive orthodontic treatment of the adult dentition – Banding $485.00 D8210 Removable appliance therapy $0.00 D8220 Fixed appliance therapy $0.00 D8660 Pre-orthodontic treatment examination to monitor growth and development $125.00 D8670 Periodic orthodontic treatment visit Children – Up to 19th birthday: 24-month treatment fee $1,608.00 Charge per month for 24 months $67.00 Adults: 24-month treatment fee $2,592.00 Charge per month for 24 months $108.00 D8680 Orthodontic retention – Removal of appliances, construction and placement of retainer(s) $295.00 D8681 Removable orthodontic retainer adjustment $0.00 D8693 Re-cement or re-bond fixed retainer $0.00 D8694 Repair of fixed retainers, includes reattachment $0.00 D8999 Unspecified orthodontic procedure – By report (orthodontic treatment plan and records) $290.00 General anesthesia/IV sedation – General anesthesia is covered when performed by an oral surgeon when medically necessary for covered procedures listed on the Patient Charge Schedule. IV sedation is covered when performed by a periodontist or oral surgeon when medically necessary for covered procedures listed on the Patient Charge Schedule. There is no coverage for general anesthesia or IV sedation when used for the purpose of anxiety control or patient management.

D9211 Regional block anesthesia $0.00 D9212 Trigeminal division block anesthesia $0.00 D9215 Local anesthesia $0.00 33

Dental DHMO Code

Procedure Description

Patient Charge $80.00 $80.00 $15.00 $25.00 $15.00 $15.00

D9223 Deep sedation/general anesthesia – Each 15 minute increment D9243 Intravenous moderate (conscious) sedation/analgesia – Each 15 minute increment D9610 Therapeutic parenteral drug, single administration D9612 Therapeutic parenteral drugs, 2 or more administrations, different medications D9630 Drugs or medicaments dispensed in the office for home use D9910 Application of desensitizing medicament Emergency services D9110 Palliative (emergency) treatment of dental pain – Minor procedure $6.00 D9120 Fixed partial denture sectioning $0.00 D9440 Office visit – After regularly scheduled hours $40.00 Miscellaneous services D9940 Occlusal guard – By report (limit 1 per 24 months) $125.00 D9941 Fabrication of athletic mouthguard (limit 1 per 12 months) $110.00 D9942 Repair and/or reline of occlusal guard $40.00 D9943 Occlusal guard adjustment $0.00 D9951 Occlusal adjustment – Limited $45.00 D9952 Occlusal adjustment – Complete $70.00 D9975 External bleaching for home application, per arch; includes materials and fabrication of custom trays (all other meth$125.00 ods of materials and fabrication of custom trays (all other methods of bleaching are not covered) This may contain CDT Dental Procedure Codes and/or portions of, or excerpts from the Code on Dental Procedures and Nomenclature (CDT Code) contained within the current version of the “Dental Procedure Codes”, a copyrighted publication provided by the American Dental Association. The American Dental Association does not endorse any codes which are not included in its current publication.

After your enrollment is effective: Call the dental office identified in your Welcome Kit. If you wish to change dental offices, a transfer can be arranged at no charge by calling Cigna Dental at the toll free number listed on your ID card or plan materials.

Multiple ways to locate a (*DHMO) Network General Dentist:  Online provider directory at Cigna.com  Online provider directory on myCigna.com  Call the number located on your ID card to: • Use the Dental Office Locator via Speech Recognition • Speak to a Customer Service Representative EMERGENCY: If you have a dental emergency as defined in your group’s plan documents, contact your Network General Dentist as soon as possible. If you are out of your service area or unable to contact your Network Office, emergency care can be rendered by any dental office, dental clinic, or other comparable facility. Definitive treatment (e.g., root canal) is not considered emergency care and should be performed or referred by your Network General Dentist. Consult your group’s plan documents for a complete definition of dental emergency, your emergency benefit and a listing of Exclusions and Limitations. * The term “DHMO” is used to refer to product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans, managed care plans, and plans with open access features.

“Cigna,” “Cigna Dental Care” and the “Tree of Life” logo are registered service marks, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (“CGLIC”), Cigna Health and Life Insurance Company (“CHLIC”), Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. (“CDHI”) and its subsidiaries. The Cigna Dental Care plan is provided by Cigna Dental Health Plan of Arizona, Inc.; Cigna Dental Health of California, Inc.; Cigna Dental Health of Colorado, Inc.; Cigna Dental Health of Delaware, Inc.; Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes; Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska); Cigna Dental Health of Kentucky, Inc. (Kentucky and Illinois); Cigna Dental Health of Maryland, Inc.; Cigna Dental Health of Missouri, Inc.; Cigna Dental Health of New Jersey, Inc.; Cigna Dental Health of North Carolina, Inc.; Cigna Dental Health of Ohio, Inc.; Cigna Dental Health of Pennsylvania, Inc.; Cigna Dental Health of Texas, Inc.; and Cigna Dental Health of Virginia, Inc. In other states, the Cigna Dental Care plan is underwritten by CGLIC, CHLIC, or Cigna HealthCare of Connecticut, Inc., and administered by CDHI. 864001 b 07/17 © 2017 Cigna. Some content provided under license.

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35

SUPERIOR VISION YOUR BENEFITS PACKAGE

Vision

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

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 36 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

Vision Vision plan benefits for Eanes ISD Benefits through Superior Select Southwest network Benefits In-Network Out-of-Network Exam Covered in full Up to $35 retail Frames $150 retail allowance Up to $70 retail Lenses (standard) per pair Single Vision

Covered in full

Up to $25 retail

Bifocal Covered in full Trifocal Covered in full Up to $45 retail 3 Progressive See description Up to $45 retail Lenticular Covered in full Up to $80 retail 4 Contact Lenses $175 retail allowance Up to $80 retail Medically Necessary Covered in full Up to $150 retail Contact Lenses Lasik Vision Correction5 $200 allowance Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements.

Monthly Premiums EE Only

$8.50

EE + 1 Dependent

$16.20

EE + Family

$23.62 Copays

Exam

1

Eyewear

$10 2

$25

Services/Frequency Exam

12 months

Frame

12 months

Lenses

12 months

Contact Lenses

12 months

(Based on date of service)

1

Eye exam copay is a single payment due to the provider at the time of service.

Eyewear copay applies to eyeglass lenses / frame and contact lenses. Eyewear copay is a single payment that applies to the entire purchase of eyeglasses (frame and lenses) 3 Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 4 Contact lenses and related professional services (fitting, evaluation and follow-up) are covered in lieu of eyeglass lenses and frames benefit 5 Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limitations 2

Discount Features Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.

LASIK Laser vision correction (LASIK) is a procedure that can reduce or eliminate your dependency on glasses or contact lenses. This corrective service is available to you and your eligible dependents at a special discount (20-50%) with your Superior Vision plan.

Contact QualSight LASIK at (877) 201-3602 for more information.

SuperiorVision.com 800.507.3800

The Plan discount features are not insurance.

All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan.

Discounts are subject to change without notice.

Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions Superior Vision of Texas P.O. Box 967 Rancho Cordova, CA 95741 (800) 507-3800 superiorvision.com 0420-BSv2/TX

37

AUL A ONEAMERICA COMPANY YOUR BENEFITS PACKAGE

Disability

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

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 38 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

Disability Why should you consider purchasing disability insurance protection at your workplace?

Many of us lead busy lives and seldom take time to think about life’s risks. Consider the following reasons many people purchase disability insurance: • Lost wages • Daily living expenses, such as: • Mortgage / rent • Utilities • Car • Food • Childcare • Eldercare • Hobbies • Pet care • Ongoing medical expenses Advantages of shopping at work include: • Affordable group rates • Convenient payroll deduction • Guaranteed issue for timely applicant • Easy access

Approximately every 7 seconds, a working-age American suffers aApproximately disabling injuryevery or illness that willa last for at leastAmerican one month.

7 seconds, working-age (Source: America’s Disability Counter, DisabilityCounter.org)

suffers a disabling injury or illness that will last for at least one month. (Source: America’s Disability Counter, DisabilityCounter.org) 65 percent of employees could not pay their bills for more than a year without an income. (Source: CDA 2013 Employer Disability Awareness Study, p. 10)

For every 17 working Americans, 1 is disabled.

(Source: U.S. Social Security Administration, Source: CDA 2014 Employer Disability Awareness Study, p. 6)

Products and financial services provided by American United Life Insurance Company® a ONEAMERICA® company. Visit us at www.oneamerica.com for more information.

Group Educator Disability Terms and Definitions Eligible Employees: This benefit is available for employees who are actively at work on the effective date and working a minimum of 20 hours per week.

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

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.

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

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

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

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

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

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

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

Integration: The method by which your benefit may be reduced

by Other Income Benefits.

39

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

This invitation to inquire allows eligible employees an opportunity to inquire further about AUL's group insurance and is limited to a brief description of any losses for which benefits are payable. The contract has exclusions, limitations reduction of benefits, and terms under which the contract may be continued in force or discontinued.

Products and financial services provided by American United Life Insurance Company® a ONEAMERICA® company. Visit us at www.oneamerica.com for more information.

Group Educator Disability Insurance Coverage for Eligible Employees Monthly Payroll Deduction Illustration About your benefit options: • Group Educator Disability benefits are illustrated and paid on a monthly basis.

• Maximum benefit amounts are based upon a percentage of covered earnings. Potential benefits are reduced by other income offsets including but not limited to Social Security benefits.

Benefit Percentage 40% If your Annual Salary is:

Your Monthly Benefit is:

$6,000 $9,000 $12,000 $15,000 $18,000 $21,000 $24,000 $27,000 $30,000 $33,000 $36,000 $39,000 $42,000 $45,000 $48,000 $51,000 $54,000 $57,000 $60,000 $63,000 $66,000 $69,000 $72,000 $75,000 $78,000 $81,000 $84,000 $87,000

$200 $300 $400 $500 $600 $700 $800 $900 $1,000 $1,100 $1,200 $1,300 $1,400 $1,500 $1,600 $1,700 $1,800 $1,900 $2,000 $2,100 $2,200 $2,300 $2,400 $2,500 $2,600 $2,700 $2,800 $2,900

40

Maximum Benefit Duration Accident SSFRA Sickness 3 years to Age 70 Monthly Payroll Deduction Amounts Opt 1 Opt 2 Opt 3 Opt 4 0/7 14/14 30/30 60/60 $6.32 $4.20 $2.84 $2.36 $9.48 $6.30 $4.26 $3.54 $12.64 $8.40 $5.68 $4.72 $15.80 $10.50 $7.10 $5.90 $18.96 $12.60 $8.52 $7.08 $22.12 $14.70 $9.94 $8.26 $25.28 $16.80 $11.36 $9.44 $28.44 $18.90 $12.78 $10.62 $31.60 $21.00 $14.20 $11.80 $34.76 $23.10 $15.62 $12.98 $37.92 $25.20 $17.04 $14.16 $41.08 $27.30 $18.46 $15.34 $44.24 $29.40 $19.88 $16.52 $47.40 $31.50 $21.30 $17.70 $50.56 $33.60 $22.72 $18.88 $53.72 $35.70 $24.14 $20.06 $56.88 $37.80 $25.56 $21.24 $60.04 $39.90 $26.98 $22.42 $63.20 $42.00 $28.40 $23.60 $66.36 $44.10 $29.82 $24.78 $69.52 $46.20 $31.24 $25.96 $72.68 $48.30 $32.66 $27.14 $75.84 $50.40 $34.08 $28.32 $79.00 $52.50 $35.50 $29.50 $82.16 $54.60 $36.92 $30.68 $85.32 $56.70 $38.34 $31.86 $88.48 $58.80 $39.76 $33.04 $91.64 $60.90 $41.18 $34.22

Pre-Existing Condition Period 3/12 Opt 5 90/90 $1.90 $2.85 $3.80 $4.75 $5.70 $6.65 $7.60 $8.55 $9.50 $10.45 $11.40 $12.35 $13.30 $14.25 $15.20 $16.15 $17.10 $18.05 $19.00 $19.95 $20.90 $21.85 $22.80 $23.75 $24.70 $25.65 $26.60 $27.55

Opt 6 180/180 $1.50 $2.25 $3.00 $3.75 $4.50 $5.25 $6.00 $6.75 $7.50 $8.25 $9.00 $9.75 $10.50 $11.25 $12.00 $12.75 $13.50 $14.25 $15.00 $15.75 $16.50 $17.25 $18.00 $18.75 $19.50 $20.25 $21.00 $21.75

Disability If your Annual Salary is:

Your Monthly Benefit is:

$90,000 $93,000 $96,000 $99,000 $102,000 $105,000 $108,000 $111,000 $114,000 $117,000 $120,000 $123,000 $126,000 $129,000 $132,000 $135,000 $138,000 $141,000 $144,000 $147,000 $150,000 $153,000 $156,000 $159,000 $162,000 $165,000 $168,000 $171,000 $174,000 $177,000 $180,000 $183,000 $186,000 $189,000 $192,000 $195,000 $198,000 $201,000 $204,000 $207,000 $210,000 $213,000 $216,000 $219,000 $222,000 $225,000

$3,000 $3,100 $3,200 $3,300 $3,400 $3,500 $3,600 $3,700 $3,800 $3,900 $4,000 $4,100 $4,200 $4,300 $4,400 $4,500 $4,600 $4,700 $4,800 $4,900 $5,000 $5,100 $5,200 $5,300 $5,400 $5,500 $5,600 $5,700 $5,800 $5,900 $6,000 $6,100 $6,200 $6,300 $6,400 $6,500 $6,600 $6,700 $6,800 $6,900 $7,000 $7,100 $7,200 $7,300 $7,400 $7,500

Opt 1 0/7 $94.80 $97.96 $101.12 $104.28 $107.44 $110.60 $113.76 $116.92 $120.08 $123.24 $126.40 $129.56 $132.72 $135.88 $139.04 $142.20 $145.36 $148.52 $151.68 $154.84 $158.00 $161.16 $164.32 $167.48 $170.64 $173.80 $176.96 $180.12 $183.28 $186.44 $189.60 $192.76 $195.92 $199.08 $202.24 $205.40 $208.56 $211.72 $214.88 $218.04 $221.20 $224.36 $227.52 $230.68 $233.84 $237.00

Opt 2 14/14 $63.00 $65.10 $67.20 $69.30 $71.40 $73.50 $75.60 $77.70 $79.80 $81.90 $84.00 $86.10 $88.20 $90.30 $92.40 $94.50 $96.60 $98.70 $100.80 $102.90 $105.00 $107.10 $109.20 $111.30 $113.40 $115.50 $117.60 $119.70 $121.80 $123.90 $126.00 $128.10 $130.20 $132.30 $134.40 $136.50 $138.60 $140.70 $142.80 $144.90 $147.00 $149.10 $151.20 $153.30 $155.40 $157.50

Monthly Payroll Deduction Amounts Opt 3 Opt 4 30/30 60/60 $42.60 $35.40 $44.02 $36.58 $45.44 $37.76 $46.86 $38.94 $48.28 $40.12 $49.70 $41.30 $51.12 $42.48 $52.54 $43.66 $53.96 $44.84 $55.38 $46.02 $56.80 $47.20 $58.22 $48.38 $59.64 $49.56 $61.06 $50.74 $62.48 $51.92 $63.90 $53.10 $65.32 $54.28 $66.74 $55.46 $68.16 $56.64 $69.58 $57.82 $71.00 $59.00 $72.42 $60.18 $73.84 $61.36 $75.26 $62.54 $76.68 $63.72 $78.10 $64.90 $79.52 $66.08 $80.94 $67.26 $82.36 $68.44 $83.78 $69.62 $85.20 $70.80 $86.62 $71.98 $88.04 $73.16 $89.46 $74.34 $90.88 $75.52 $92.30 $76.70 $93.72 $77.88 $95.14 $79.06 $96.56 $80.24 $97.98 $81.42 $99.40 $82.60 $100.82 $83.78 $102.24 $84.96 $103.66 $86.14 $105.08 $87.32 $106.50 $88.50

Opt 5 90/90 $28.50 $29.45 $30.40 $31.35 $32.30 $33.25 $34.20 $35.15 $36.10 $37.05 $38.00 $38.95 $39.90 $40.85 $41.80 $42.75 $43.70 $44.65 $45.60 $46.55 $47.50 $48.45 $49.40 $50.35 $51.30 $52.25 $53.20 $54.15 $55.10 $56.05 $57.00 $57.95 $58.90 $59.85 $60.80 $61.75 $62.70 $63.65 $64.60 $65.55 $66.50 $67.45 $68.40 $69.35 $70.30 $71.25

Opt 6 180/180 $22.50 $23.25 $24.00 $24.75 $25.50 $26.25 $27.00 $27.75 $28.50 $29.25 $30.00 $30.75 $31.50 $32.25 $33.00 $33.75 $34.50 $35.25 $36.00 $36.75 $37.50 $38.25 $39.00 $39.75 $40.50 $41.25 $42.00 $42.75 $43.50 $44.25 $45.00 $45.75 $46.50 $47.25 $48.00 $48.75 $49.50 $50.25 $51.00 $51.75 $52.50 $53.25 $54.00 $54.75 $55.50 $56.25

Rates Effective 9/1/2016 About Premiums: The premiums shown above may vary slightly due to rounding; actual premiums will be calculated by American United Life Insurance Company® (AUL), and may increase upon reaching certain age brackets, according to contract terms, and are subject to change. This invitation to inquire allows eligible employees an opportunity to inquire further about AUL's group insurance and is limited to a brief description of any losses for which benefits are payable. The contract has exclusions, limitations reduction of benefits, and terms under which the contract may be continued in force or discontinued.

Products and financial services provided by American United Life Insurance Company® a ONEAMERICA® company. Visit us at www.oneamerica.com for more information.

41

Disability Group Educator Disability Insurance Coverage for Eligible Employees Monthly Payroll Deduction Illustration About your benefit options: • Group Educator Disability benefits are illustrated and paid on a monthly basis. • Maximum benefit amounts are based upon a percentage of covered earnings. Potential benefits are reduced by other income offsets including but not limited to Social Security benefits.

Benefit Percentage 50% If your Annual Salary is:

Your Monthly Benefit is:

$4,800 $7,200 $9,600 $12,000 $14,400 $16,800 $19,200 $21,600 $24,000 $26,400 $28,800 $31,200 $33,600 $36,000 $38,400 $40,800 $43,200 $45,600 $48,000 $50,400 $52,800 $55,200 $57,600 $60,000 $62,400 $64,800 $67,200 $69,600

$200 $300 $400 $500 $600 $700 $800 $900 $1,000 $1,100 $1,200 $1,300 $1,400 $1,500 $1,600 $1,700 $1,800 $1,900 $2,000 $2,100 $2,200 $2,300 $2,400 $2,500 $2,600 $2,700 $2,800 $2,900

42

Maximum Benefit Duration Accident SSFRA Sickness 3 years to Age 70 Monthly Payroll Deduction Amounts Opt 1 Opt 2 Opt 3 Opt 4 0/7 14/14 30/30 60/60 $6.62 $4.38 $2.98 $2.48 $9.93 $6.57 $4.47 $3.72 $13.24 $8.76 $5.96 $4.96 $16.55 $10.95 $7.45 $6.20 $19.86 $13.14 $8.94 $7.44 $23.17 $15.33 $10.43 $8.68 $26.48 $17.52 $11.92 $9.92 $29.79 $19.71 $13.41 $11.16 $33.10 $21.90 $14.90 $12.40 $36.41 $24.09 $16.39 $13.64 $39.72 $26.28 $17.88 $14.88 $43.03 $28.47 $19.37 $16.12 $46.34 $30.66 $20.86 $17.36 $49.65 $32.85 $22.35 $18.60 $52.96 $35.04 $23.84 $19.84 $56.27 $37.23 $25.33 $21.08 $59.58 $39.42 $26.82 $22.32 $62.89 $41.61 $28.31 $23.56 $66.20 $43.80 $29.80 $24.80 $69.51 $45.99 $31.29 $26.04 $72.82 $48.18 $32.78 $27.28 $76.13 $50.37 $34.27 $28.52 $79.44 $52.56 $35.76 $29.76 $82.75 $54.75 $37.25 $31.00 $86.06 $56.94 $38.74 $32.24 $89.37 $59.13 $40.23 $33.48 $92.68 $61.32 $41.72 $34.72 $95.99 $63.51 $43.21 $35.96

Pre-Existing Condition Period 3/12 Opt 5 90/90 $1.98 $2.97 $3.96 $4.95 $5.94 $6.93 $7.92 $8.91 $9.90 $10.89 $11.88 $12.87 $13.86 $14.85 $15.84 $16.83 $17.82 $18.81 $19.80 $20.79 $21.78 $22.77 $23.76 $24.75 $25.74 $26.73 $27.72 $28.71

Opt 6 180/180 $1.58 $2.37 $3.16 $3.95 $4.74 $5.53 $6.32 $7.11 $7.90 $8.69 $9.48 $10.27 $11.06 $11.85 $12.64 $13.43 $14.22 $15.01 $15.80 $16.59 $17.38 $18.17 $18.96 $19.75 $20.54 $21.33 $22.12 $22.91

Disability If your Annual Salary is:

Your Monthly Benefit is:

$72,000 $74,400 $76,800 $79,200 $81,600 $84,000 $86,400 $88,800 $91,200 $93,600 $96,000 $98,400 $100,800 $103,200 $105,600 $108,000 $110,400 $112,800 $115,200 $117,600 $120,000 $122,400 $124,800 $127,200 $129,600 $132,000 $134,400 $136,800 $139,200 $141,600 $144,000 $146,400 $148,800 $151,200 $153,600 $156,000 $158,400 $160,800 $163,200 $165,600 $168,000 $170,400 $172,800 $175,200 $177,600 $180,000

$3,000 $3,100 $3,200 $3,300 $3,400 $3,500 $3,600 $3,700 $3,800 $3,900 $4,000 $4,100 $4,200 $4,300 $4,400 $4,500 $4,600 $4,700 $4,800 $4,900 $5,000 $5,100 $5,200 $5,300 $5,400 $5,500 $5,600 $5,700 $5,800 $5,900 $6,000 $6,100 $6,200 $6,300 $6,400 $6,500 $6,600 $6,700 $6,800 $6,900 $7,000 $7,100 $7,200 $7,300 $7,400 $7,500

Opt 1 0/7 $99.30 $102.61 $105.92 $109.23 $112.54 $115.85 $119.16 $122.47 $125.78 $129.09 $132.40 $135.71 $139.02 $142.33 $145.64 $148.95 $152.26 $155.57 $158.88 $162.19 $165.50 $168.81 $172.12 $175.43 $178.74 $182.05 $185.36 $188.67 $191.98 $195.29 $198.60 $201.91 $205.22 $208.53 $211.84 $215.15 $218.46 $221.77 $225.08 $228.39 $231.70 $235.01 $238.32 $241.63 $244.94 $248.25

Opt 2 14/14 $65.70 $67.89 $70.08 $72.27 $74.46 $76.65 $78.84 $81.03 $83.22 $85.41 $87.60 $89.79 $91.98 $94.17 $96.36 $98.55 $100.74 $102.93 $105.12 $107.31 $109.50 $111.69 $113.88 $116.07 $118.26 $120.45 $122.64 $124.83 $127.02 $129.21 $131.40 $133.59 $135.78 $137.97 $140.16 $142.35 $144.54 $146.73 $148.92 $151.11 $153.30 $155.49 $157.68 $159.87 $162.06 $164.25

Monthly Payroll Deduction Amounts Opt 3 Opt 4 30/30 60/60 $44.70 $37.20 $46.19 $38.44 $47.68 $39.68 $49.17 $40.92 $50.66 $42.16 $52.15 $43.40 $53.64 $44.64 $55.13 $45.88 $56.62 $47.12 $58.11 $48.36 $59.60 $49.60 $61.09 $50.84 $62.58 $52.08 $64.07 $53.32 $65.56 $54.56 $67.05 $55.80 $68.54 $57.04 $70.03 $58.28 $71.52 $59.52 $73.01 $60.76 $74.50 $62.00 $75.99 $63.24 $77.48 $64.48 $78.97 $65.72 $80.46 $66.96 $81.95 $68.20 $83.44 $69.44 $84.93 $70.68 $86.42 $71.92 $87.91 $73.16 $89.40 $74.40 $90.89 $75.64 $92.38 $76.88 $93.87 $78.12 $95.36 $79.36 $96.85 $80.60 $98.34 $81.84 $99.83 $83.08 $101.32 $84.32 $102.81 $85.56 $104.30 $86.80 $105.79 $88.04 $107.28 $89.28 $108.77 $90.52 $110.26 $91.76 $111.75 $93.00

Opt 5 90/90 $29.70 $30.69 $31.68 $32.67 $33.66 $34.65 $35.64 $36.63 $37.62 $38.61 $39.60 $40.59 $41.58 $42.57 $43.56 $44.55 $45.54 $46.53 $47.52 $48.51 $49.50 $50.49 $51.48 $52.47 $53.46 $54.45 $55.44 $56.43 $57.42 $58.41 $59.40 $60.39 $61.38 $62.37 $63.36 $64.35 $65.34 $66.33 $67.32 $68.31 $69.30 $70.29 $71.28 $72.27 $73.26 $74.25

Opt 6 180/180 $23.70 $24.49 $25.28 $26.07 $26.86 $27.65 $28.44 $29.23 $30.02 $30.81 $31.60 $32.39 $33.18 $33.97 $34.76 $35.55 $36.34 $37.13 $37.92 $38.71 $39.50 $40.29 $41.08 $41.87 $42.66 $43.45 $44.24 $45.03 $45.82 $46.61 $47.40 $48.19 $48.98 $49.77 $50.56 $51.35 $52.14 $52.93 $53.72 $54.51 $55.30 $56.09 $56.88 $57.67 $58.46 $59.25

Rates Effective 9/1/2016 About Premiums: The premiums shown above may vary slightly due to rounding; actual premiums will be calculated by American United Life Insurance Company® (AUL), and may increase upon reaching certain age brackets, according to contract terms, and are subject to change. This invitation to inquire allows eligible employees an opportunity to inquire further about AUL's group insurance and is limited to a brief description of any losses for which benefits are payable. The contract has exclusions, limitations reduction of benefits, and terms under which the contract may be continued in force or discontinued.

Products and financial services provided by American United Life Insurance Company® a ONEAMERICA® company. Visit us at www.oneamerica.com for more information.

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Disability Group Educator Disability Insurance Coverage for Eligible Employees Monthly Payroll Deduction Illustration About your benefit options: • Group Educator Disability benefits are illustrated and paid on a monthly basis. • Maximum benefit amounts are based upon a percentage of covered earnings. Potential benefits are reduced by other income offsets including but not limited to Social Security benefits.

Benefit Percentage 60% If your Annual Salary is:

Your Monthly Benefit is:

$4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 $18,000 $20,000 $22,000 $24,000 $26,000 $28,000 $30,000 $32,000 $34,000 $36,000 $38,000 $40,000 $42,000 $44,000 $46,000 $48,000 $50,000 $52,000 $54,000 $56,000 $58,000

$200 $300 $400 $500 $600 $700 $800 $900 $1,000 $1,100 $1,200 $1,300 $1,400 $1,500 $1,600 $1,700 $1,800 $1,900 $2,000 $2,100 $2,200 $2,300 $2,400 $2,500 $2,600 $2,700 $2,800 $2,900

44

Maximum Benefit Duration Accident SSFRA Sickness 3 years to Age 70 Monthly Payroll Deduction Amounts Opt 1 Opt 2 Opt 3 Opt 4 0/7 14/14 30/30 60/60 $6.72 $4.44 $3.02 $2.52 $10.08 $6.66 $4.53 $3.78 $13.44 $8.88 $6.04 $5.04 $16.80 $11.10 $7.55 $6.30 $20.16 $13.32 $9.06 $7.56 $23.52 $15.54 $10.57 $8.82 $26.88 $17.76 $12.08 $10.08 $30.24 $19.98 $13.59 $11.34 $33.60 $22.20 $15.10 $12.60 $36.96 $24.42 $16.61 $13.86 $40.32 $26.64 $18.12 $15.12 $43.68 $28.86 $19.63 $16.38 $47.04 $31.08 $21.14 $17.64 $50.40 $33.30 $22.65 $18.90 $53.76 $35.52 $24.16 $20.16 $57.12 $37.74 $25.67 $21.42 $60.48 $39.96 $27.18 $22.68 $63.84 $42.18 $28.69 $23.94 $67.20 $44.40 $30.20 $25.20 $70.56 $46.62 $31.71 $26.46 $73.92 $48.84 $33.22 $27.72 $77.28 $51.06 $34.73 $28.98 $80.64 $53.28 $36.24 $30.24 $84.00 $55.50 $37.75 $31.50 $87.36 $57.72 $39.26 $32.76 $90.72 $59.94 $40.77 $34.02 $94.08 $62.16 $42.28 $35.28 $97.44 $64.38 $43.79 $36.54

Pre-Existing Condition Period 3/12 Opt 5 90/90 $2.02 $3.03 $4.04 $5.05 $6.06 $7.07 $8.08 $9.09 $10.10 $11.11 $12.12 $13.13 $14.14 $15.15 $16.16 $17.17 $18.18 $19.19 $20.20 $21.21 $22.22 $23.23 $24.24 $25.25 $26.26 $27.27 $28.28 $29.29

Opt 6 180/180 $1.60 $2.40 $3.20 $4.00 $4.80 $5.60 $6.40 $7.20 $8.00 $8.80 $9.60 $10.40 $11.20 $12.00 $12.80 $13.60 $14.40 $15.20 $16.00 $16.80 $17.60 $18.40 $19.20 $20.00 $20.80 $21.60 $22.40 $23.20

Disability If your Annual Salary is:

Your Monthly Benefit is:

$60,000 $62,000 $64,000 $66,000 $68,000 $70,000 $72,000 $74,000 $76,000 $78,000 $80,000 $82,000 $84,000 $86,000 $88,000 $90,000 $92,000 $94,000 $96,000 $98,000 $100,000 $102,000 $104,000 $106,000 $108,000 $110,000 $112,000 $114,000 $116,000 $118,000 $120,000 $122,000 $124,000 $126,000 $128,000 $130,000 $132,000 $134,000 $136,000 $138,000 $140,000 $142,000 $144,000 $146,000 $148,000 $150,000

$3,000 $3,100 $3,200 $3,300 $3,400 $3,500 $3,600 $3,700 $3,800 $3,900 $4,000 $4,100 $4,200 $4,300 $4,400 $4,500 $4,600 $4,700 $4,800 $4,900 $5,000 $5,100 $5,200 $5,300 $5,400 $5,500 $5,600 $5,700 $5,800 $5,900 $6,000 $6,100 $6,200 $6,300 $6,400 $6,500 $6,600 $6,700 $6,800 $6,900 $7,000 $7,100 $7,200 $7,300 $7,400 $7,500

Opt 1 0/7 $100.80 $104.16 $107.52 $110.88 $114.24 $117.60 $120.96 $124.32 $127.68 $131.04 $134.40 $137.76 $141.12 $144.48 $147.84 $151.20 $154.56 $157.92 $161.28 $164.64 $168.00 $171.36 $174.72 $178.08 $181.44 $184.80 $188.16 $191.52 $194.88 $198.24 $201.60 $204.96 $208.32 $211.68 $215.04 $218.40 $221.76 $225.12 $228.48 $231.84 $235.20 $238.56 $241.92 $245.28 $248.64 $252.00

Opt 2 14/14 $66.60 $68.82 $71.04 $73.26 $75.48 $77.70 $79.92 $82.14 $84.36 $86.58 $88.80 $91.02 $93.24 $95.46 $97.68 $99.90 $102.12 $104.34 $106.56 $108.78 $111.00 $113.22 $115.44 $117.66 $119.88 $122.10 $124.32 $126.54 $128.76 $130.98 $133.20 $135.42 $137.64 $139.86 $142.08 $144.30 $146.52 $148.74 $150.96 $153.18 $155.40 $157.62 $159.84 $162.06 $164.28 $166.50

Monthly Payroll Deduction Amounts Opt 3 Opt 4 30/30 60/60 $45.30 $37.80 $46.81 $39.06 $48.32 $40.32 $49.83 $41.58 $51.34 $42.84 $52.85 $44.10 $54.36 $45.36 $55.87 $46.62 $57.38 $47.88 $58.89 $49.14 $60.40 $50.40 $61.91 $51.66 $63.42 $52.92 $64.93 $54.18 $66.44 $55.44 $67.95 $56.70 $69.46 $57.96 $70.97 $59.22 $72.48 $60.48 $73.99 $61.74 $75.50 $63.00 $77.01 $64.26 $78.52 $65.52 $80.03 $66.78 $81.54 $68.04 $83.05 $69.30 $84.56 $70.56 $86.07 $71.82 $87.58 $73.08 $89.09 $74.34 $90.60 $75.60 $92.11 $76.86 $93.62 $78.12 $95.13 $79.38 $96.64 $80.64 $98.15 $81.90 $99.66 $83.16 $101.17 $84.42 $102.68 $85.68 $104.19 $86.94 $105.70 $88.20 $107.21 $89.46 $108.72 $90.72 $110.23 $91.98 $111.74 $93.24 $113.25 $94.50

Opt 5 90/90 $30.30 $31.31 $32.32 $33.33 $34.34 $35.35 $36.36 $37.37 $38.38 $39.39 $40.40 $41.41 $42.42 $43.43 $44.44 $45.45 $46.46 $47.47 $48.48 $49.49 $50.50 $51.51 $52.52 $53.53 $54.54 $55.55 $56.56 $57.57 $58.58 $59.59 $60.60 $61.61 $62.62 $63.63 $64.64 $65.65 $66.66 $67.67 $68.68 $69.69 $70.70 $71.71 $72.72 $73.73 $74.74 $75.75

Opt 6 180/180 $24.00 $24.80 $25.60 $26.40 $27.20 $28.00 $28.80 $29.60 $30.40 $31.20 $32.00 $32.80 $33.60 $34.40 $35.20 $36.00 $36.80 $37.60 $38.40 $39.20 $40.00 $40.80 $41.60 $42.40 $43.20 $44.00 $44.80 $45.60 $46.40 $47.20 $48.00 $48.80 $49.60 $50.40 $51.20 $52.00 $52.80 $53.60 $54.40 $55.20 $56.00 $56.80 $57.60 $58.40 $59.20 $60.00

Rates Effective 9/1/2016 About Premiums: The premiums shown above may vary slightly due to rounding; actual premiums will be calculated by American United Life Insurance Company® (AUL), and may increase upon reaching certain age brackets, according to contract terms, and are subject to change. This invitation to inquire allows eligible employees an opportunity to inquire further about AUL's group insurance and is limited to a brief description of any losses for which benefits are payable. The contract has exclusions, limitations reduction of benefits, and terms under which the contract may be continued in force or discontinued.

Products and financial services provided by American United Life Insurance Company® a ONEAMERICA® company. Visit us at www.oneamerica.com for more information.

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Disability TRAVEL ASSISTANCE BY EUROP ASSISTANCE USA

3 Reasons to stop and consider before 3 things to know about Travel Assistance you decide not to apply for coverage For a list of additional travel assistance services , please refer to EA USA’s brochure or visit their website at www.europassistancenow: usa.com.

4

5

American United Life Insurance Company® (AUL), a OneAmerica® company, realizes emergencies can happen when you are traveling away from home on business or for pleasure. When an emergency occurs, we understand you need help that is dependable and fast.

With a phone call to Europ Assistance USA (EA USA)1, covered persons have access to worldwide 24-hour medical and transportation services. When traveling 100 or more miles away from home, EA will be there in the event of an emergency during a covered trip at no additional premium cost to the covered policyholder2.

1. Who is covered?

A covered person is an individual who receives coverage under a covered policyholder’s AUL group life insurance contract and the individual’s spouse, domestic partner and children. The Travel Assistance benefit applies to covered persons who are traveling 100 miles or more away from home during a covered trip.

2. What is a covered trip?

A covered trip is defined as a business or pleasure trip not more than 90 days in length and 100 or more miles away from home.

EA USA offers and administers the program and services in most countries3 and can also provide pre-trip assistance services to help you prepare and plan ahead of time.

3. How to utilize EA USA services 1. Call an EA USA representative.

From the US/Canada: 1-866-294-2469 All other locations: +1 240 330 1509 2. Verify eligibility Provide the name of the covered policyholder’s employer in order to verify eligibility and a phone number where you may be reached.

1. EA USA is neither affiliated nor under common control with OneAmerica or AUL, and AUL only markets the EA USA program.

2. A covered person does not include an individual who has been approved for continuation of insurance or portability benefits, an individual insured under AUL’s 2+ Protector contract or an individual insured under AUL’s Voluntary Universal Life insurance contract.

The program and services are not offered or available to individuals who are not covered persons and may be terminated or discontinued at any time.

3. However, conditions and events such as force majeure, war, natural disasters or political instability may occur or exist that render assistance and services difficult or impossible in some areas. Therefore, availability of services cannot always be guaranteed or offered.

4. Neither EA USA nor AUL shall have responsibility for the nature, content or quality of any medical advice or legal counsel given by any medical professional or attorney, nor shall EA USA or AUL be liable for the negligence or other wrongful acts or omissions of any healthcare or legal professionals providing direct services to covered persons.

5. Eligibility must always first be verified by EA USA through the covered policyholder’s designated contract. © 2013 OneAmerica Financial Partners, Inc. All rights reserved.G-21420 11/22/13 PRODUCTS AND FINANCIAL SERVICES PROVIDED BY AMERICAN UNITED LIFE INSURANCE COMPANY®, A ONEAMERICA® COMPANY

46

1. A missed opportunity You will lose your only chance to apply for group insurance coverage without having to first undergo medical underwriting.

2. You may not be approved If you have any current or future medical conditions, you may not be approved for any type of coverage at a later date. Evidence of Insurability will be required.

3. A longer waiting period If you decide in the future you want to apply for group insurance coverage, you will have to wait until the next enrollment period to apply.

PRODUCTS AND FINANCIAL SERVICES PROVIDED BY AMERICAN UNITED LIFE INSURANCE COMPANY®, A ONEAMERICA® COMPANY © 2014 OneAmerica Financial Partners, Inc. All rights reserved.

G-17963 05/30/14

47

LOYAL AMERICAN

Cancer

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.

YOUR BENEFITS PACKAGE

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 48 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

Cancer ADDITIONAL BENEFIT AMOUNTS

LEVEL A Maximum

LEVEL B Maximum

ANNUAL CANCER SCREENING BENEFIT RIDER (form LG-6041) A. Basic Benefit We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule, once per calendar year per Insured Person for screening tests performed to determine whether Cancer exists in an Insured Person. $75 Covered annual Cancer screening tests include but are not limited to: mammogram, pap smear, breast ultrasound, ThinPrep, Per Calendar biopsy, chest x-ray, thermography, colonoscopy, flexible sigmoidoscopy, hemocult stool specimen, PSA (blood test for prostate Year cancer), CEA (blood tests for colon cancer), CA125 (blood test for ovarian cancer), CA15-3 (blood test for breast cancer), serum protein electrophesis (blood test for myeloma).

B.

Additional Benefit

We will pay the expense incurred, but not to exceed two times the maximum benefit amount per calendar year as shown on the Certificate Schedule, for one additional invasive diagnostic procedure required as the result of an abnormal cancer screening test for which benefits are payable under the Basic Benefit above for an Insured Person. This additional benefit is payable regardless of the results of the additional diagnostic procedure. However, the amount payable will be reduced dollar for dollar for any amount payable under the Positive Diagnosis Benefit contained in the base Certificate.

FIRST OCCURRENCE BENEFIT RIDER (form LG-6043) If an Insured Person receives a positive diagnosis of Internal Cancer, We will pay the First Occurrence benefit amount shown on the Certificate Schedule.

If the Insured Person receiving the positive diagnosis of Internal Cancer is a child under the age of 21, we will pay one and onehalf times the First Occurrence benefit amount shown on the Certificate Schedule.

$100 Per Calendar Year

$150 Per Calendar Year

$200 Per Calendar Year

$2,000 Once per Lifetime $3,000 Once per Lifetime

$5,000 Once per Lifetime $7,500 Once per Lifetime

$10,000 Per Calendar Year

$20,000 Per Calendar Year

$3,000 Procedure Maximum

$3,000 Procedure Maximum

$750 Procedure Maximum

$750 Procedure Maximum

$2,700 Procedure Maximum

$2,700 Procedure Maximum

ANNUAL RADIATION, CHEMOTHERAPY, IMMUNOTHERAPY and EXPERIMENTAL TREATMENT BENEFIT RIDER (form LG-6045) 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 Surgical Schedule shown in this rider. However, in no event will the amount payable exceed the maximum Surgical Expense benefit shown on the Certificate Schedule, nor will it exceed the expense incurred.

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

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

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

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

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

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

Per Procedure Per Procedure

$200 Per Day

$400 Per Day

$400 Per Day

$800 Per Day

$400/ $800 Per Day

$800/ $1,600 Per Day

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 Policy (form LG-6040) apply to these riders. THESE ARE LIMITED RIDERS

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

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

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

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

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

Initial Hospitalization Benefit We will pay a benefit of $1,500 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 day per unit of coverage selected when an Insured Person is hospitalized during any continuous period of 30 days or less for the treatment of a covered Specified Disease. Benefits will double per day beginning with the 31st day of continuous confinement.

If the hospital confinement follows a previously covered confinement, it will be deemed a continuation of the first confinement unless it is the result of an entirely different Specified Disease, or unless the confinements are separated by 30 days or more. *SPECIFIED DISEASE BENEFIT RIDER IS NOT INCLUDED IN PLAN A

Monthly Rates

Employee

Single Parent

Family

Base Plan A

$23.02

$28.10

$38.74

Base Plan B

$37.74

$45.15

$62.62

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.

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

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.

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

$500 Per Day

$1,000 Per Day

$1,000 Per Day

$2,000 Per Day

$250 Per Day

$500 Per Day

Additional Limitations and Exclusions for the Hospital Intensive 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 INTENSIVE CARE UNIT BENEFIT RIDER REDUCE BY ONE-HALF AT AGE 75.

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

THIS IS A LIMITED RIDER. Monthly Rates

Employee

Single Parent

Family

Base Plan A + ICU 500

$25.35

$31.30

$43.14

Base Plan A + ICU 1,000

$27.67

$34.49

$47.53

Base Plan B + ICU 500

$40.06

$48.34

$67.01

Base Plan B + ICU 1,000

$42.39

$51.54

$71.41

51

AFLAC YOUR BENEFITS PACKAGE

Critical Illness

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 52 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

Group Critical Illness INSURANCE – PLAN INCLUDES BENEFITS FOR CANCER We help take care of your expenses while you take care of yourself.

But it doesn’t stop there. Having group Critical Illness insurance from Aflac means that you may have added financial resources to help with medical costs or ongoing living expenses.

The Aflac group Critical Illness plan benefits include: • Critical Illness Benefit payable for:  Cancer AFLAC GROUP CRITICAL ILLNESS INSURANCE  Heart Attack (Myocardial Infarction) Aflac can help ease the financial stress of surviving a critical  Stroke illness.

Chances are you may know someone who’s been diagnosed  Kidney Failure (End-Stage Renal Failure) with a critical illness. You can’t help but notice the strain it’s  Major Organ Transplant placed on the person’s life—both physically and emotionally.  Bone Marrow Transplant (Stem Cell Transplant) What’s not so obvious is the impact a critical illness may have  Sudden Cardiac Arrest on someone’s personal finances.

That’s because while a major medical plan may pay for a good  Coronary Artery Bypass Surgery portion of the costs associated with a critical illness, there are a  Non-Invasive Cancer lot of expenses that just aren’t covered. And, during recovery,  Skin Cancer having to worry about out-of-pocket expenses is the last thing  Coma anyone needs.  Severe Burn That’s the benefit of an Aflac group Critical Illness plan.  Paralysis  Loss of Sight / Hearing / Speech It can help with the treatment costs of covered critical illnesses, • Health Screening Benefit such as cancer, a heart attack or a stroke.

More importantly, the plan helps you focus on recuperation Features: instead of the distraction and stress over out-of-pocket costs.

With the Critical Illness plan, you receive cash benefits directly • Benefits are paid directly to you, unless otherwise assigned. (unless otherwise assigned)—giving you the flexibility to help • Coverage is available for you, your spouse, and dependent pay bills related to treatment or to help with everyday living children. expenses.

• Coverage may be continued (with certain stipulations).

What you need, when you need it.

That means you can take it with you if you change jobs or Group critical illness insurance pays cash benefits that you can retire. use any way you see fit.

Here’s why the Aflac group Critical Illness plan may be right for you.

For more than 60 years, Aflac has been dedicated to helping provide individuals and families peace of mind and financial security when they’ve needed it most. The Aflac group Critical Illness plan is just another innovative way to help make sure you’re well protected under our wing.

How it works:

$20,000 Amount payable based on $20,000 First Occurrence Benefit.

The plan has limitations and exclusions that may affect benefits payable. This brochure is for illustrative purposes only.

Refer to your certificate for complete details, definitions, limitations, and exclusions.

For more information, ask your insurance agent/producer, call 1.800.433.3036, or visit aflacgroupinsurance.com.

53

Critical Illness BENEFITS OVERVIEW

COVERED CRITICAL ILLNESSES CANCER (Internal or Invasive)

100%

HEART ATTACK (Myocardial Infarction)

100%

STROKE (Apoplexy or Cerebral Vascular Accident)

100%

KIDNEY FAILURE (End-Stage Renal Failure)

100%

BONE MARROW TRANSPLANT (Stem Cell Transplant)

100%

SUDDEN CARDIAC ARREST

100%

MAJOR ORGAN TRANSPLANT (25% of this benefit is payable for insureds placed on a transplant list for a major organ transplant)

100%

SEVERE BURN*

100 %

PARALYSIS**

100 %

COMA**

100 %

LOSS OF SPEECH / SIGHT / HEARING**

100 %

NON-INVASIVE CANCER

25%

CORONARY ARTERY BYPASS SURGERY

25%

*This benefit is only payable for a burn due to, caused by, and attributed to, a covered accident. **These benefits are payable for loss due to a covered underlying disease or a covered accident.

The plan has limitations and exclusions that may affect benefits payable. This brochure is for illustrative purposes only. Refer to your certificate for complete details, definitions, limitations, and exclusions.

CHILD COVERAGE AT NO ADDITIONAL COST Each dependent child is covered at 50 percent of the primary insured’s benefit amount at no additional charge. Children-only coverage is not available.

SKIN CANCER BENEFIT We will pay $250 for the diagnosis of skin cancer. We will pay this benefit once per calendar year.

WAIVER OF PREMIUM If you become totally disabled due to a covered critical illness prior to age 65, after 90 continuous days of total disability, we will waive premiums for you and any of your covered dependents. As long as you remain totally disabled, premiums will be waived up to 24 months, subject to the terms of the plan.

SUCCESSOR INSURED BENEFIT If spouse coverage is in force at the time of the primary insured’s death, the surviving spouse may elect to continue coverage.

Coverage would continue at the existing spouse face amount and would also include any dependent child coverage in force at the time.

HEALTH SCREENING BENEFIT (Employee and Spouse only) We will pay $50 for health screening tests performed while an insured’s coverage is in force. We will pay this benefit once per calendar year.

This benefit is only payable for health screening tests performed as the result of preventive care, including tests and diagnostic procedures ordered in connection with routine examinations.

This benefit is payable for the covered employee and spouse.

This benefit is not paid for dependent children.

The plan is age-banded. That means your rates may increase on the policy anniversary date.

All limitations and exclusions that apply to the critical illness plan also apply to all riders, if applicable, unless amended by the riders.

LIMITATIONS AND EXCLUSIONS INITIAL DIAGNOSIS We will pay a lump sum benefit upon initial diagnosis of a covered critical illness when such diagnoses is caused by or solely attributed to an underlying disease. Cancer diagnoses are subject to the cancer diagnosis limitation. Benefits will be based on the face amount in effect on the critical illness date of diagnosis.

Cancer Diagnosis Limitation Benefits are payable for cancer and/or noninvasive cancer as long as the insured: • Is treatment-free from cancer for at least 12 months before the diagnosis date; and • Is in complete remission prior to the date of a subsequent diagnosis, as evidenced by the absence of all clinical, radiological, biological, and biochemical proof of the presence of the cancer.

EXCLUSIONS ADDITIONAL DIAGNOSIS We will not pay for loss due to: We will pay benefits for each different critical illness after the first when the two dates of diagnoses are separated by at least 6 • Self-Inflicted Injuries – injuring or attempting to injure oneself intentionally or taking action that causes oneself to become consecutive months. Cancer diagnoses are subject to the cancer injured; diagnosis limitation.

• In Alaska: injuring or attempting to injure oneself REOCCURRENCE We will pay benefits for the same critical illness after the first when the two dates of diagnoses are separated by at least 6 consecutive months. Cancer diagnoses are subject to the cancer diagnosis limitation.

54

• •

intentionally Suicide – committing or attempting to commit suicide, while sane or insane; • In Illinois and Minnesota: this exclusion does not apply Illegal Acts – participating or attempting to participate in an illegal activity, or working at an illegal job:

Critical Illness •

considered skin cancers: • Basal cell carcinoma • Squamous cell carcinoma of the skin • Melanoma in Situ • Melanoma that is diagnosed as • Clark’s Level I or II, • Breslow depth less than 0.77mm, or • Stage 1A melanomas under TNM Staging Critical Illness is a disease or a sickness as defined in the plan that first manifests while your coverage is in force. Date of Diagnosis is defined as follows: • Cancer: The day tissue specimens, blood samples, or titer(s) are taken (diagnosis of cancer and/or carcinoma in situ is based on such specimens).

• Non-Invasive Cancer: The day tissue specimens, blood samples, or titer(s) are taken (diagnosis of cancer and/or carcinoma in situ is based on such specimens).

• Skin Cancer: The date the skin biopsy samples are taken for microscopic examination.

• Bone Marrow Transplant (Stem Cell Transplant): The date the surgery occurs.

• Coronary Artery Bypass Surgery: The date the surgery occurs.

• Heart Attack (Myocardial Infarction): The date the infarction (death) of a portion of the heart muscle occurs. This is based on the criteria listed under the heart attack (myocardial Infarction) definition.

• Kidney Failure (End-Stage Renal Failure): The date a doctor recommends that an insured begin renal dialysis.

• Major Organ Transplant: The date the surgery occurs.

• Stroke: The date the stroke occurs (based on documented neurological deficits and neuroimaging studies).

• Sudden Cardiac Arrest: The date the pumping action of the heart Pre-Existing Conditions Limitation fails (based on the sudden cardiac arrest definition).

Pre-existing Condition is a sickness or physical condition that existed • Coma: The first day of the period for which a doctor confirms a within the 12-month period before the insured’s effective date. A coma that is due to one of the underlying diseases and that has medical professional must have advised, diagnosed, or treated the lasted for at least seven consecutive days. insured for the condition to be considered pre-existing.

• Loss of Sight, Speech, or Hearing: The date the loss due to one of We will not pay benefits for any critical illness resulting from or affected the underlying diseases is objectively determined by a doctor to be by a pre- existing condition if the critical illness was diagnosed within total and irreversible. the 12-month period after the insured’s effective date.

• Paralysis: The date a doctor diagnoses an insured with paralysis TERMS YOU NEED TO KNOW due to one of the underlying diseases as specified in this plan, The Bone Marrow Transplant (Stem Cell Transplant) benefit is not where such diagnosis is based on clinical and/or laboratory payable if the transplant findings as supported by the insured’s medical records. results from a covered critical illness for which a benefit has been paid • Severe Burn: The date the burn takes place. under this plan. The following are not considered internal or invasive Dependent means your spouse or your dependent child. Spouse is your cancers: legal wife, husband, or partner in a legally recognized union. Dependent • Pre-malignant tumors or polyps children are your or your spouse’s natural children, step-children, • Carcinomas in Situ foster children, children subject to legal guardianship, legally adopted • Any superficial, non-invasive skin cancers including basal cell and children, or children placed for adoption, who are younger than age 26 squamous cell carcinoma of the skin (In Arizona, on the effective date of coverage). Newborn children are • Melanoma in Situ automatically covered from the moment of birth. Refer to your • Melanoma that is diagnosed as certificate for details.

A doctor does not include you or any of your family members. In • Clark’s Level I or II, Arizona, however, a doctor who is your family member may treat you.

• Breslow depth less than 0.77mm, or For the purposes of this definition, family member includes your spouse • Stage 1A melanomas under TNM Staging as well as the following members of your immediate family: Son, Skin cancers are not payable under the Cancer (internal or invasive) Daughter, Mother, Father, Sister, Brother Benefit or the Non- Invasive Cancer Benefit. The following are In Arizona: participating in or attempting to commit a felony, or being engaged in an illegal occupation; • In Illinois and Pennsylvania: Illegal Occupation committing or attempting to commit a felony or being engaged in an illegal occupation; • In Michigan: Illegal Occupation – the commission of or attempt to commit a felony, or being engaged in an illegal occupation; • In Nebraska: being engaged in an illegal occupation, or commission of or attempting to commit a felony; • In Ohio: committing or attempting to commit a felony, or working at an illegal job • Participation in Aggressive Conflict: • War (declared or undeclared) or military conflicts; In Oklahoma: War, or act of war, declared or undeclared when serving in the military service or an auxiliary unit thereto • Insurrection or riot • Civil commotion or civil state of belligerence • Illegal Substance Abuse: • Abuse of legally-obtained prescription medication • Illegal use of non-prescription drugs • In Arizona: Being intoxicated or under the influence of any narcotic unless administered on the advice of a physician • In Michigan, Nevada, and South Dakota: this exclusion does not apply Diagnosis, treatment, testing, and confinement must be in the United States or its territories.

All benefits under the plan, including benefits for diagnoses, treatment, confinement and covered tests, are payable only while coverage is in force.

55

Critical Illness This includes step-family members and family-members-in-law.

Employee is a person who meets eligibility requirements and who is covered under the plan. The employee is the primary insured under the plan.

Diagnosis of a Heart Attack (Myocardial Infarction) must include the following: • New and serial electrocardiographic (ECG) findings consistent with heart attack (myocardial infarction), and • Elevation of cardiac enzymes above generally accepted laboratory levels of normal. (In the case of creatine physphokinase (CPK) a CPK-MB measurement must be used.)

Confirmatory imaging studies, such as thallium scans, MUGA scans, or stress echocardiograms may also be used.

Kidney Failure (End-Stage Renal Failure) is covered only under the following conditions: • A doctor advises that regular renal dialysis, hemo-dialysis, or peritoneal dialysis (at least weekly) is necessary to treat the kidney failure (end-stage renal failure); or • The kidney failure (end-stage renal failure) results in kidney transplantation.

Maintenance Drug Therapy is meant to decrease the risk of cancer recurrence; it is not meant to treat a cancer that is still present.

A Major Organ Transplant benefit is not payable if the major organ transplant results from a covered critical illness for which a benefit has been paid.

Stroke does not include: • Transient Ischemic Attacks (TIAs) • Head injury • Chronic cerebrovascular insufficiency • Reversible ischemic neurological deficits unless brain tissue damage is confirmed by neurological imaging Sudden Cardiac Arrest is not a heart attack (myocardial infarction). A sudden cardiac arrest benefit is not payable if the sudden cardiac arrest is caused by or contributed to by a heart attack (myocardial infarction).

Severe Burn or Severely Burned means a burn resulting from fire, heat, caustics, electricity, or radiation. The burn must: • Be a full-thickness or third-degree burn, as determined by a doctor. A Full-Thickness Burn or Third-Degree Burn is the destruction of the skin through the entire thickness or depth of the dermis (or possibly into underlying tissues). This results in loss of fluid and sometimes shock.

• Cause cosmetic disfigurement to the body’s surface area of at least 35 square inches.

• Be caused solely by or be solely attributed to a covered accident.

Coma means a state of continuous, profound unconsciousness, lasting at least seven consecutive days, and characterized by the absence of: Spontaneous Coma means a state of continuous, profound unconsciousness, lasting at least seven consecutive days, and characterized by the absence of: • Spontaneous eye movements, • Response to painful stimuli, and • Vocalization.

Coma does not include a medically-induced coma.

To be payable as an Accident benefit, the coma must be caused solely by or be solely attributed to a covered accident.

56

To be considered a critical illness, the coma must be caused solely by or be solely attributed to one of the following diseases: • Brain Aneurysm • Diabetes • Encephalitis • Hyperglycemia • Hypoglycemia • Meningitis • Epilepsy Paralysis or Paralyzed means the permanent, total, and irreversible loss of muscle function to the whole of at least two limbs. To be payable as an Accident benefit, the paralysis must be caused solely by or be solely attributed to a covered accident. To be considered a critical illness, paralysis must be caused solely by or be solely attributed to one or more of the following diseases: • Amyotrophic lateral sclerosis • Cerebral palsy • Parkinson’s disease, • Poliomyelitis The diagnosis of paralysis must be supported by neurological evidence.

Loss of Sight means the total and irreversible loss of all sight in both eyes. To be payable as an Accident benefit, loss of sight must be caused solely by or be solely attributed to a covered accident. To be considered a critical illness, loss of sight must be caused solely by or be solely attributed to one of the following diseases: • Retinal disease • Optic nerve disease • Hypoxia Loss of Speech means the total and permanent loss of the ability to speak. To be payable as an Accident benefit, loss of speech must be caused solely by or be solely attributed to a covered accident. To be considered a critical illness, loss of speech must be caused solely by or be solely attributable to one of the following diseases: • Alzheimer’s disease • Arteriovenous malformation Loss of Hearing means the total and irreversible loss of hearing in both ears. Loss of hearing does not include hearing loss that can be corrected by the use of a hearing aid or device. To be payable as an Accident benefit, loss of hearing must be caused solely by or be solely attributed to a covered accident.

To be considered a critical illness, loss of hearing must be caused solely by or be solely attributed to one of the following diseases: • Alport syndrome • Autoimmune inner ear disease • Chicken pox • Diabetes • Goldenhar syndrome • Meniere’s disease • Meningitis • Mumps Treatment does not include maintenance drug therapy or routine follow-up visits to verify whether cancer or carcinoma in situ has returned.

Critical Illness YOU MAY CONTINUE YOUR COVERAGE Your coverage may be continued with certain stipulations. See certificate for details.

TERMINATION OF COVERAGE Your insurance may terminate when the plan is terminated; the 31st day after the premium due date if the premium has not been paid; or the date you no longer belong to an eligible class. If your coverage terminates, we will provide benefits for valid claims that arose while your coverage was in force. See certificate for details.

NOTICES If this coverage will replace any existing individual policy, please be aware that it may be in your best interest to maintain your individual guaranteed-renewable policy.

Notice to Consumer: The coverages provided by Continental American Insurance Company (CAIC) represent supplemental benefits only. They do not constitute comprehensive health insurance coverage and do not satisfy the requirement of minimum essential coverage under the Affordable Care Act. CAIC coverage is not intended to replace or be issued in lieu of major medical coverage. It is designed to supplement a major medical program.

RATES TABLE FOR: EANES ISD (TX) - GP-19914 / GROUP CRITICAL ILLNESS - PLAN-130588 DEDUCTION FREQUENCY : Monthly (12pp / yr)

18-29 30-39 40-49 50-59 60+

Employee - Uni-Tobacco $5,000 $10,000 $15,000 $2.71 $3.90 $5.09 $3.62 $5.71 $7.81 $4.85 $8.17 $11.50 $7.95 $14.38 $20.81 $18.92 $36.31 $53.71

$20,000 $6.28 $9.90 $14.82 $27.24 $71.10

18-29 30-39 40-49 50-59 60+

Spouse - Uni-Tobacco $5,000 $10,000 $15,000 $2.71 $3.90 $5.09 $3.62 $5.71 $7.81 $4.85 $8.17 $11.50 $7.95 $14.38 $20.81 $18.92 $36.31 $53.71

$20,000 $6.28 $9.90 $14.82 $27.24 $71.10

Continental American Insurance Company (CAIC ), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands.

Continental American Insurance Company • Columbia, South Carolina The certificate to which this sales material pertains may be written only in English; the certificate prevails if interpretation of this material varies.

This brochure is a brief description of coverage and is not a contract.

Read your certificate carefully for exact terms and conditions. You’re welcome to request a full copy of the plan certificate through your employer or by reaching out to our Customer Service Center.

This brochure is subject to the terms, conditions, and limitations of Policy Series C21000. In Arkansas, C21100AR. In Oklahoma, C21100OK. In Oregon, C21100OR. In Pennsylvania, C21100PA. In Texas, C21100TX. 57

AETNA YOUR BENEFITS PACKAGE

Hospital Indemnity

About this Benefit Hospital Confinement Indemnity Insurance pays a daily benefit if you have a covered stay in a hospital*, critical care unit and rehabilitation facility. The benefit amount is determined based on the type of facility and the number of days you stay. Hospital Confinement Indemnity Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

The median hospital costs per stay have steadily grown to over $10,500 per day.

$9,600

$10,400

$10,700

2008

2012

2018

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 58 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

Hospital Indemnity Rates shown are based on monthly deductions. Your payroll deductions will be taken after taxes are taken.

Hospital Indemnity Plan You may enroll in one option only.

Plan 2

Cost

Yourself only

$16.42

Yourself & spouse

$33.99

Yourself plus child(ren)

$23.57

Yourself and family

$37.99

Plan 4

Cost

Yourself only

$32.84

Yourself & spouse

$67.98

Yourself plus child(ren)

$47.13

Yourself and family

$75.98

THESE PLANS DO NOT COUNT AS MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT. THESE ARE A SUPPLEMENT TO HEALTH INSURANCE AND NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. Plans are underwritten by Aetna Life Insurance Company (Aetna). Insurance plans contain exclusions and limitations. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Policies may not be available in all states, and rates and benefits may vary by location. Supplemental health plans provide limited benefits. The benefit payments are not intended to cover the full cost of medical care.

Providers are independent contractors and are not agents of Aetna. This material is for information only and is not an offer or invitation to contract. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com.

Financial Sanctions Exclusions Clause: If coverage provided by this policy violates or will violate any US economic or trade sanctions, the coverage is immediately considered invalid.

For example, Aetna companies cannot make payments or reimburse for health care or other claims or services if it violates a financial sanction regulation. This includes sanctions related to a blocked person or entity, or a country under sanction by the United States, unless permitted under a valid written Office of Foreign Assets Control (OFAC) license. For more information on OFAC, visit http://www.treasury.gov/resource-center/sanctions/Pages/default.aspx.

Policy forms issued in Oklahoma and Idaho include: AL VOL HPOL-Hosp 01 and AL VOL HCOC -Hosp 01

Less stress Aetna Hospital Indemnity Plan Be prepared for what lies ahead Maybe you’re expecting to have a hospital stay — or maybe not.

Either way, you can plan ahead to give yourself an extra financial cushion.

What is the Hospital Indemnity Plan?

The plan pays benefits when you have a planned, or unplanned hospital stay for an illness, injury, surgery or having a baby. The plan pays a lump-sum benefit for admission and a daily benefit for a covered hospital stay. You can use the benefits to help pay out-of-pocket medical costs or personal expenses.

How is this different from a major medical plan?

Medical plans help pay providers for services and treatment.

But, they don’t cover unexpected costs that might come with a stay in the hospital.

The Aetna Hospital Indemnity Plan pays benefits directly to you, giving you extra cash when you need it most. It can help fill in the gaps, making it a great companion to your major medical plan.

How can you use the cash benefits?

It’s completely up to you. You can use the money any way you want, like: • deductibles or copays • mortgage or rent • groceries or utility bills ...or for anything else you choose.

Rest assured Enrollment is guaranteed. We don’t ask you any questions about your health. And, you get benefits paid directly to you by check or direct deposit.

Because it happens • More than 35 million Americans were hospitalized in 20161.

• The average hospital stay in the U.S. costs $10,7002.

Ready...or not Carter* is a hard worker, so he doesn’t always slow down to listen to his body. Before he knew it, a little cough turned into pneumonia — and a hospital stay.

Good thing he had the Aetna Indemnity Hospital Plan. He submitted his claim and, as an Aetna medical member, didn’t need to upload extra paperwork.

Carter’s benefits were deposited right into his bank account.

That money helped make up for the time he missed work to recover and to pay some of his deductible. Now, he can focus more on his health.

Handy online tools for you You can find everything you need in one place at our member website: myaetnasupplemental.com. Aetna medical members can also access the site from aetna.com. You can see your plan documents, submit and track the status of claims, and even sign up for direct deposit.

Filing a claim is easy. Just create or log into your account on the member website. Click “Report New Claim” and answer a few quick questions. If you have an Aetna medical plan, we’ll automatically retrieve any medical information needed to process your claim. That’s less paperwork for you.

You can also print and mail a paper claim form to Aetna Voluntary Plans. If your claim is approved, we will send you a check, or deposit your benefits directly into your bank account.

You choose.

1American Hospital Association. Fast facts on U.S. hospitals, 2018. February 2018. Available at: aha.org/research/rc/stat-studies/fastfacts.shtml. Accessed

59

Hospital Indemnity April 25, 2018.

2Michaels M. The 35 most expensive reasons you might have to visit a hospital in the US — and how much it costs if you do. Business Insider. March 1, 2018.

Available at: businessinsider.com/most-expensive-health-conditions-hospitalcosts-2018-2.

Accessed April 25, 2018. *This is a fictional example of how the plan could work.

THIS PLAN DOES NOT COUNT AS MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT. THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. The Aetna Hospital Indemnity Plan is underwritten by Aetna Life Insurance Company (Aetna). The Aetna Hospital Indemnity Plan is a hospital confinement indemnity plan. This plan provides limited benefits. It pays fixed dollar benefits for covered services without regard to the health care provider’s actual charges.

The benefits payments are not intended to cover the full cost of medical care.

You are responsible for making sure the provider’s bills get paid. These benefits are paid in addition to any other health coverage you may have. This material is for information only. Insurance plans contain exclusions and limitations. Not all health services are covered, and coverage is subject to applicable laws and regulations, including economic and trade sanctions. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features, rates, eligibility and availability may vary by location and are subject to change. For more information about Aetna plans, refer to aetna.com.

Policy forms issued in Missouri and Oklahoma include: AL VOL HPOL-Hosp 01 and AL VOL HCOC-Hosp 01, GR-96172 01.

BENEFIT SUMMARY Eanes Independent School District 802481 Aetna Hospital Indemnity Insurance plans are underwritten by Aetna Life Insurance Company.

Here’s how the plan works: 1) You have an unexpected event and have to go to the hospital.

2) You are admitted into the hospital and spend two days there.

3) You submit your hospital claim to Aetna.

4) Aetna pays benefits directly to you.

Unless otherwise indicated, all benefits and limitations are per covered person.

The Aetna Hospital Indemnity Plan is a hospital confinement indemnity plan with other fixed indemnity benefits. THESE PLANS DO NOT COUNT AS MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT. THESE PLANS ARE A SUPPLEMENT TO HEALTH INSURANCE AND ARE NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES. These plans provide limited benefits. They pay fixed dollar benefits for covered services without regard to the health care provider's actual charges. These benefit payments are not intended to cover the full cost of medical care. You are responsible for making sure the provider's bills get paid. These benefits are paid in addition to any other health coverage you may have.

THIS IS NOT A MEDICARE SUPPLEMENT (MEDIGAP) PLAN. If you are or will become eligible for Medicare, review the free Guide to Health Insurance for People with Medicare available at www.medicare.gov.

This policy, alone, does not meet Massachusetts Minimum Creditable Coverage standards.

60

Inpatient Stays Covered Benefit Hospital stay - Admission Provides a lump sum benefit for the initial day of your stay in a hospital.

Maximum 1 stay per plan year Hospital stay - Daily Pays a daily benefit, beginning on day two of your stay in a non-ICU room of a hospital.

Maximum 30 days per plan year Hospital stay - (ICU) Daily Pays a daily benefit, beginning on day two of your stay in an ICU room of a hospital.

Maximum 30 days per plan year Newborn routine care Provides a lump-sum benefit after the birth of your newborn. This will not pay for an outpatient birth.

Observation unit Provides a lump sum benefit for the initial day of your stay in an observation unit as the result of an illness or accidental injury.

Maximum 1 day per plan year

Plan 2

Plan 4

$1,000

$2,000

$100

$200

$200

$400

$100

$200

$100

$200

Important Note: All daily inpatient stay benefits begin on day two and count toward the plan year maximum.

Portability Your plan includes a Portability option which allows you to keep your existing coverage by making direct payments to the carrier.

You may exercise this option, if your employment ceases for any reason. Refer to your Certificate for additional Portability provisions.

Waiver of premium If you are in a hospital for more than 30 days in a row, we will waive the premium beginning on the first premium due date that occurs after the 30th day of your stay, through the next 6 months of coverage. During your stay, you must remain employed with the policyholder.

Exclusions and Limitations This plan has exclusions and limitations. Refer to the actual policy and certificate to determine which benefits are not payable. The following is a partial list of services and supplies that are generally not covered. However, the plan may contain exceptions to this list based on state mandates or the plan design purchased.

Benefits will not be paid for any stay or other service for an illness or accidental injury related to the following: 1. Certain competitive or recreational activities, including but not limited to: ballooning, bungee jumping, parachuting, skydiving 2. Any semi-professional or professional competitive athletic contest, including officiating or coaching, for which you receive any payment 3. Act of war, riot, war

Hospital Indemnity 4. Operating, learning to operate or serving as a pilot or crew member of any aircraft, whether motorized or not 5. Assault, felony, illegal occupation, or other criminal act 6. Care provided by a spouse, parent, child, sibling or any other household member 7. Cosmetic services and plastic surgery, with certain exceptions 8. Custodial Care 9. Hospice services, except as specifically provided in the Benefits under your plan section of the certificate 10.Self-harm, suicide, except when resulting from a diagnosed disorder 11.Violating any cellular device use laws of the state in which the accident occurred, while operating a motor vehicle 12.Care or services received outside the United States or its territories 13.Education, training or retraining services or testing 14.Mental disorders 15.Treatment of substance abuse in a hospital or substance abuse treatment facility 16.Accidental injury sustained while intoxicated or under the influence of any drug intoxicant 17.Exams except as specifically provided in the Benefits under your plan section of the certificate 18.Dental and orthodontic care and treatment 19.Family planning services 20.Any care, prescription drugs, and medicines related to infertility 21.Nutritional supplements, including but not limited to: food items, infant formulas, vitamins 22.Outpatient cognitive rehabilitation, physical therapy, occupational therapy, or speech therapy for any reason 23.Vision-related care

Questions and Answers Do I have to be actively at work to enroll in coverage?

Yes, you must be actively at work in order to enroll and for coverage to take effect. You are actively at work if you are working, or are available to work, and meet the criteria set by your employer to be eligible to enroll.

Yes, you are able to continue coverage under the Portability provision. You will need to pay premiums directly to Aetna.

How do I file a claim?

Go to myaetnasupplemental.com and either “Log In” or “Register”, depending on if you’ve set up your account. Click the “Create a new claim” button and answer a few quick questions.

You can even save your claim to finish later. You can also print/ mail in form(s) to: Aetna Voluntary Plans, PO Box 14079, Lexington, KY 40512- 4079, or you can ask us to mail you a printed form.

What should I do in case of an emergency?

In case of emergency, call 911 or your local emergency hotline, or go directly to an emergency care facility.

What if I don’t understand something I’ve read here, or have more questions?

Please call us. We want you to understand these benefits before you decide to enroll. You may reach one of our Customer Service representatives Monday through Friday, 8 a.m. to 6 p.m., by calling 1-800-607-3366. We’re here to answer questions before and after you enroll.

Important information about your benefits IN ORDER FOR THE HOSPITAL INDEMNITY BENEFITS TO BE PAYABLE, THE INITIAL DAY OF YOUR STAY AND OTHER SERVICES MUST BE ON OR AFTER YOUR EFFECTIVE DATE OF COVERAGE. Complaints and appeals Please tell us if you are not satisfied with a response you received from us or with how we do business. Call Member Services to file a verbal complaint or to ask for the address to mail a written complaint. You can also e-mail Member Services through the secure member website. If you’re not satisfied after talking to a Member Services representative, you can ask us to send your issue to the appropriate department.

If you don’t agree with a denied claim, you can file an appeal. To file an appeal, follow the directions in the letter or explanation of benefits statement that explains that your claim was denied. The letter also tells you what we need from you and how soon we will respond.

Can I enroll in the Aetna Hospital Indemnity plan even though I We protect your privacy have a Health Savings Account (HSA)?

Yes, you can still enroll in the Aetna Hospital Indemnity plan if you We consider personal information to be private. Our policies protect your personal information from unlawful use. By have a Health Savings Account. “personal information,” we mean information that can identify What is considered a hospital stay? you as a person, as well as your financial and health information.

A stay is a period during which you are admitted as an inpatient; Personal information does not include what is available to the and are confined in a hospital or non-hospital residential facility; public. For example, anyone can access information about what and are charged for room, board and general nursing services. A the plan covers. It also does not include reports that do not stay does not include time in the hospital because of custodial or identify you. personal needs that do not require medical skills or training. A When necessary for your care or treatment, the operation of our stay specifically excludes time in the hospital for observation or in health plans or other related activities, we use personal the emergency room unless this leads to a stay. information within our company, share it with our affiliates and may disclose it to: your doctors, dentists, pharmacies, hospitals If I lose my employment, can I take the Hospital Indemnity Plan and other caregivers, other insurers, vendors, government with me?

61

Hospital Indemnity departments and third-party administrators (TPAs).

We obtain information from many different sources — particularly you, your employer or benefits plan sponsor if applicable, other insurers, health maintenance organizations or TPAs, and health care providers.

These parties are required to keep your information private as required by law. Some of the ways in which we may use your information include: Paying claims, making decisions about what the plan covers, coordination of payments with other insurers, quality assessment, activities to improve our plans and audits.

We consider these activities key for the operation of our plans.

When allowed by law, we use and disclose your personal information in the ways explained above without your permission. Our privacy notice includes a complete explanation of the ways we use and disclose your information. It also explains when we need your permission to use or disclose your information.

We are required to give you access to your information. If you think there is something wrong or missing in your personal information, you can ask that it be changed. We must complete your request within a reasonable amount of time. If we don’t agree with the change, you can file an appeal.

If you’d like a copy of our privacy notice, call 1-800-607-3366 or visit us at www.aetna.com.

If you require language assistance, please call Member Services at 1-800-607-3366 and an Aetna representative will connect you with an interpreter. If you’re deaf or hard of hearing, use your TTY and dial 711 for the Telecommunications Relay Service. Once connected, please enter or provide the Aetna telephone number you’re calling.

Si usted necesita asistencia lingüística, por favor llame al Servicios al Miembro a 1-800-607-3366 y un representante de Aetna le conectará con un intérprete. Si usted es sordo o tiene problemas de audición, use su TTY y marcar 711 para el Servicio de Retransmisión de Telecomunicaciones (TRS). Una vez conectado, por favor entrar o proporcionar el número de teléfono de Aetna que está llamando.

ATTENTION MASSACHUSETTS RESIDENTS: As of January 1, 2009, the Massachusetts Health Care Reform Law requires that Massachusetts residents, eighteen (18) years of age and older, must have health coverage that meets the Minimum Creditable Coverage standards set by the Commonwealth Health Insurance Connector, unless waived from the health insurance requirement based on affordability or individual hardship. For more information call the Connector at 1-877-MA-ENROLL (1-877-6236765) or visit the Connector website (www.mahealthconnector.org) . THIS POLICY, ALONE, DOES NOT MEET MINIMUM CREDITABLE COVERAGE STANDARDS. If you have questions about this notice, you may contact the Division of Insurance by calling 1-617-521-7794 or visiting its website at www.mass.gov/doi.

62

Financial Sanctions Exclusions Clause If coverage provided by this policy violates or will violate any US economic or trade sanctions, the coverage is immediately considered invalid. For example, Aetna companies cannot make payments or reimburse for health care or other claims or services if it violates a financial sanction regulation. This includes sanctions related to a blocked person or entity, or a country under sanction by the United States, unless permitted under a valid written Office of Foreign Assets Control (OFAC) license. For more information on OFAC, visit http://www.treasury.gov/resourcecenter/sanctions/Pages/default.aspx.

Plans are underwritten by Aetna Life Insurance Company (Aetna).

This material is for information only and is not an offer or invitation to contract. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com.

Hospital Indemnity Policy forms issued in Idaho, Oklahoma and Missouri include: AL VOL HPOL-Hosp 01 and AL VOL HCOC-Hosp 01.

Hospital Indemnity

63

APL YOUR BENEFITS PACKAGE

Accident

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

2/3 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 64 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

A3 Supplemental Limited Benefit Accident Expense Insurance Eanes ISD

AMERICAN PUBLIC LIFE YOUR BENEFITS

Accident

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

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

DID YOU KNOW?

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

Level 2 - 2 Units

Level 3 - 3 Units

Level 4 - 4 Units

$5,000

$10,000

$15,000

$20,000

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

$150 per day

$225 per day

$300 per day

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

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

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

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

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

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

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

$2,500 $5,000

$5,000 $10,000

$7,500 $15,000

$10,000 $20,000

Individual

Individual & Spouse

1 Parent Family

2 Parent Family

$10.80 $17.10 $21.50 $24.50

$19.40

$21.20 $34.90 $45.20 $52.00

$29.80 $47.60 $62.60 $72.40

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

Level 1 - 1 Unit

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

$29.80 $38.90 $44.90

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

usually live paycheck to paycheck.

(03/16)

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

65 47

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

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

Base Policy and Optional Benefits

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

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

(4)

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

(7)

(5) (6)

(8)

(9) (10)

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

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

Daily Hospital Confinement Benefit

(11)

(12) (13) (14)

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

(15)

Accidental Death

(16)

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

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

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

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

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

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

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

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

66 48

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

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

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

Base Policy and Optional Benefits

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

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

(4)

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

(7)

(5) (6)

(8)

(9) (10)

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

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

Daily Hospital Confinement Benefit

(11)

(12) (13) (14)

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

(15)

Accidental Death

(16)

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

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

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

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

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

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

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

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

67 49

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

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

AUL A ONEAMERICA COMPANY

Life and AD&D

YOUR BENEFITS PACKAGE

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 68 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

Life and AD&D Group Term Life including matching AD&D Coverage • • • • •

Life and AD&D insurance coverage amount of $10,000 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

Why should you consider purchasing life insurance protection at your workplace?

Many of us lead busy lives and seldom take time to think about life’s risks. Consider the following reasons many people purchase group TERM life insurance: • Replacing income • Paying off mortgage • Providing funds for college education • Paying for medical / burial / final expenses • Preparing for life events, such as: • Marriage • Growing family • Home Purchase • Transferring wealth to family • Making a charitable gift • Supporting aging parents Advantages of shopping at work include: • Affordable group rates • Convenient payroll deduction • Guaranteed issue for timely applicant • Easy access Coverage options are available to eligible employees 1.

Employees find significant value in obtaining non-medical products in their workplace. (Source: Shopping on the Job: Life and Disability Insurance Sales at the Workplace, LIMRA Research Briefings, March, 2012.)

2.

3.

4.

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: Spouse Guaranteed Issue Amount: Child Guaranteed Issue Amount:

$180,000 $50,000 $10,000

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.

Evidence of Insurability: If you elect a benefit amount over the Guaranteed Issue Amount shown above for you or your eligible dependents, or you do not enroll timely, you will need to submit a Statement of Insurability form for review. Based on health history, you and / or your dependents 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.

50% of U.S. households have unmet life insurance needs: 58 million say they do not have enough life insurance. (Source: Waiver of Premium: If approved, this benefit waives your and Household Trends in the U.S. Life Insurance Ownership, LIMRA, 2010.) your dependents' insurance premium in case you become totally Nearly 1 in 5 Americans go through their workplace to disabled and are unable to collect a paycheck. purchase life insurance. For employees that have the option, Reductions: Upon reaching certain ages, your original benefit 75% ultimately decide to purchase life insurance. (Source: To Shop or Not To Shop for Life Insurance. Turning Shoppers Into Buyers, LIMRA, 2011.) amount will reduce to a percentage as shown in the following While employees have many possible resources for schedule. The amounts of Dependent Life Insurance and benefit information, they rely most on the information Dependent AD&D Principal Sum will reduce according to the created by their employer.

Employee's reduction schedule.

AUL's Group Voluntary Term Life Insurance Terms and Age: Reduces To: Definitions Eligible Employees: This benefit is available for employees who are actively at work on the effective date and working a minimum of 20 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.

65 65%

70 50%

This invitation to inquire allows eligible employees an opportunity to inquire further about AUL's group insurance and is limited to a brief description of any losses for which benefits are payable. The contract has exclusions, limitations reduction of benefits, and terms under which the contract may be continued in force or discontinued.

Products and financial services provided by American United Life Insurance Company® a ONEAMERICA® company. Visit us at www.oneamerica.com for more information.

69

Life and AD&D Voluntary Term Life Coverage Monthly Payroll Deduction Illustration About your benefit options: • You may select a minimum Life benefit of $10,000 up to a maximum amount of $560,000, in increments of $10,000. AD&D is not included for Dependents.

• Life amounts requested above $180,000 for an Employee, $50,000 for a Spouse, or any amount not requested timely will require Evidence of Insurability.

• Employee must select coverage to select any Dependent coverage.

• Dependent coverage cannot exceed 100% of the Voluntary Term Life amount selected by the Employee.

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

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

$10,000

$.52

$.52

$.52

$.68

$.84

$1.24

$1.80

$2.84

$4.36

$5.72

$9.16

$11.80 $28.30

$20,000

$1.04

$1.04

$1.04

$1.36

$1.68

$2.48

$3.60

$5.68

$8.72

$11.44 $18.32 $23.60 $56.60

$30,000

$1.56

$1.56

$1.56

$2.04

$2.52

$3.72

$5.40

$8.52

$13.08 $17.16 $27.48 $35.40 $84.90

$40,000

$2.08

$2.08

$2.08

$2.72

$3.36

$4.96

$7.20

$11.36 $17.44 $22.88 $36.64 $47.20 $113.20

$50,000

$2.60

$2.60

$2.60

$3.40

$4.20

$6.20

$9.00

$14.20 $21.80 $28.60 $45.80 $59.00 $141.50

$80,000

$4.16

$4.16

$4.16

$5.44

$6.72

$9.92

$14.40 $22.72 $34.88 $45.76 $73.28 $94.40 $226.40

$100,000

$5.20

$5.20

$5.20

$6.80

$8.40

$12.40 $18.00 $28.40 $43.60 $57.20 $91.60 $118.00 $283.00

$120,000

$6.24

$6.24

$6.24

$8.16

$10.08 $14.88 $21.60 $34.08 $52.32 $68.64 $109.92 $141.60 $339.60

$150,000

$7.80

$7.80

$7.80

$10.20 $12.60 $18.60 $27.00 $42.60 $65.40 $85.80 $137.40 $177.00 $424.50

$180,000

$9.36

$9.36

$9.36

$12.24 $15.12 $22.32 $32.40 $51.12 $78.48 $102.96 $164.88 $212.40 $509.40 SPOUSE ONLY OPTIONS (based on Employee's Age as of 09/01)

Life Options

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

$10,000

$0.32

$0.32

$0.32

$0.48

$0.64

$1.04

$1.60

$2.64

$4.16

$5.52

$8.96

$11.60 $28.10

$20,000

$0.64

$0.64

$0.64

$0.96

$1.28

$2.08

$3.20

$5.28

$8.32

$11.04 $17.92 $23.20 $56.20

$30,000

$0.96

$0.96

$0.96

$1.44

$1.92

$3.12

$4.80

$7.92

$12.48 $16.56 $26.88 $34.80 $84.30

$40,000

$1.28

$1.28

$1.28

$1.92

$2.56

$4.16

$6.40

$10.56 $16.64 $22.08 $35.84 $46.40 $112.40

$50,000

$1.60

$1.60

$1.60

$2.40

$3.20

$5.20

$8.00

$13.20 $20.80 $27.60 $44.80 $58.00 $140.50

CHILD(REN) OPTIONS (Premium shown for Child(ren) reflects the cost for all eligible dependent children)

Option 1

Child(ren) 6 months to age 26

Child(ren) live birth to 6 months

$10,000

$1,000

Monthly Payroll Deduction Life Amount $2.00

About Premiums: The premiums shown above may vary slightly due to rounding; actual premiums will be calculated by American United Life Insurance Company® (AUL), and may increase upon reaching certain age brackets, according to contract terms, and are subject to change.

This invitation to inquire allows eligible employees an opportunity to inquire further about AUL's group insurance and is limited to a brief description of any losses for which benefits are payable. The contract has exclusions, limitations reduction of benefits, and terms under which the contract may be continued in force or discontinued. Products and financial services provided by American United Life Insurance Company®

70

Life and AD&D NEEDS ASSESSMENT WORKSHEET

Life insurance protection: How much is enough?

The importance of protection Understanding the importance of and reasons for having life insurance can come from many life experiences — going through a personal loss or seeing the impact of loss on others. The question always begs, “How much life insurance do I really need?” You might have purchased insurance offered through your work, and some you may have purchased on your own, but what is that number? How much life insurance is truly enough?

Really, that answer depends on you, since your circumstances and financial goals are different from anyone else. Use the following equation and related financial considerations to help develop a ballpark figure of how much life insurance you should consider to protect those you love.

Any gap you identify through this exercise represents the amount of life insurance needed to take care of your loved ones’ financial needs should something happen to you.

Immediate Financial Obligations

$

Consider items like:

• • •

Funeral and burial costs Mortgage Car and personal loans

Ongoing/Future Financial Obligations

• • •

Credit card debt

+

Taxes Medical expenses

$

Consider items like:

• • • • •

Food, housing, utilities Transportation Health care Clothing Insurance

Ongoing/Future Sources of Income

• • • •

Child(ren)’s education expenses Retirement

-

Income Replacement

$

Consider items like:

• • • •

=

Spouse’s continued earnings Savings Investments Life Insurance you already own (group + personal)

Amount Needed

$

Though you might not be able to purchase the desired amount of life insurance all at once, making progress toward this goal over time can be a great approach.

Speak to a financial professional today — and protect the ones that matter most to you!

71

COMPSYCH

EAP (Employee Assistance Program)

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

38%

YOUR BENEFITS PACKAGE

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 72 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

ComPsych GuidanceResources® Program “Employee Assistance Program" this benefit is provided by EISD and no additional charge to the employee.

Call Your ComPsych® GuidanceResources® program anytime for confidential assistance.

Call: 855.387.9727 TDD: 800.697.0353 Go online: guidanceresources.com Your company Web ID: ONEAMERICA3 Personal issues, planning for life events or simply managing daily life can affect your work, health and family. Your GuidanceResources program provides support, resources and information for personal and work-life issues. The program is companysponsored, confidential and provided at no charge to you and your dependents. This flyer explains how GuidanceResources can help you and your family deal with everyday challenges.

Confidential Counseling

Work-Life Solutions

3 Session Plan This no-cost counseling service helps you address stress, relationship and other personal issues you and your family may face. It is staffed by GuidanceConsultantsSM—highly trained master’s and doctoral level clinicians who will listen to your concerns and quickly refer you to in-person counseling (up to 3 sessions per year) and other resources for: › Stress, anxiety and depression › Job pressures › Relationship/marital conflicts › Grief and loss › Problems with children › Substance abuse

Delegate your “to-do” list.

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

Financial Information and Resources Discover your best options.

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

Legal Support and Resources Expert info when you need it.

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

GuidanceResources® Online Knowledge at your fingertips.

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

Free Online Will Preparation Get peace of mind.

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

Your ComPsych® GuidanceResources® Program CALL ANYTIME Call: 855.387.9727 TDD: 800.697.0353 Online: guidanceresources.com Your company Web ID: ONEAMERICA3 OneAmerica is the marketing name for American United Life Insurance Company® (AUL). AUL markets ComPsych services. ComPsych Corporation is not an affiliate of AUL and is not a OneAmerica company. Copyright © 2016 ComPsych Corporation. All rights reserved. To view the ComPsych HIPAA privacy notice, please go to www.guidanceresources.com/privacy.

73

5STAR

Individual Life

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.

YOUR BENEFITS PACKAGE

Experts recommend at least

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

This This is is aa general general overview overview of of your your plan plan benefits. benefits. If If the the terms terms of of this this outline outline differ differ from from your your policy, policy, the the policy policy will will govern. govern. Additional Additional plan plan details on on covered covered expenses, expenses, limitations limitations and and exclusions exclusions are are included included in in the the summary summary plan plan description description located located on on the the 74 details Angleton ISD Benefits Benefits Website: Website: www.mybenefitshub.com/eanesisd www.mybenefitshub.com/angletonisd Eanes ISD

Term Life with Terminal Illness and Quality of Life Rider Individual and Group Term Life Insurance with Terminal Illness coverage to age 121 Enhanced coverage options for employees.

Easy and flexibile enrollment for employers.

The 5Star Life Insurance Company’s Family Protection Plan offers both Individual and Group products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your employees.

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

TERMINAL ILLNESS ACCELERATION OF BENEFITS Coverage that pays 30% (25% in CT and MI) of the 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 (24 months in IL).

PORTABLE Coverage continues with no loss of benefits or increase in cost if you terminate employment after the first premium is paid. We simply bill you directly.

Nearly

85%

of people said they thought most people need life insurance.

Yet only

59%

said that they have coverage themselves.

And

33%

wish their spouse or partner had more life insurance.*

FAMILY PROTECTION Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves.

• Financially dependent children 14 days to 23 years old.

CONVENIENCE Easy payment through payroll deduction.

PROTECTION YOU CAN COUNT ON Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two-year contestability period and/or under investigation. This coverage has no war or terrorism exclusions.

QUALITY OF LIFE Benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following: • Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or • Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.

Underwritten by 5Star Life Insurance Company (a Lincoln, Nebraska company); Administered by NTT Data at 777 Research Drive, Lincoln, NE 68521 FPPi product available in all states and some U.S. Territories except: CA, DE, FL, NY, ND. SD. Quality of Life rider not available in CA. FPPg product available in all states and some U.S. Territories except: CA, DE, FL, NY, ND. SD, VI FPPi/gQOLFlyerR1119 FPPduoQOL_MKT_FLYER_1119

75

Family Protection Plan - Terminal Illness MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT

Age on Eff. 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 76

$10,000 $9.90 $9.91 $9.98 $10.08 $10.23 $10.43 $10.64 $10.87 $11.11 $11.40 $11.72 $12.08 $12.46 $12.88 $13.33 $13.83 $14.38 $14.98 $15.60 $16.26 $16.93 $17.67 $18.43 $19.19 $20.02 $20.93 $21.94 $23.11 $24.42 $25.88 $27.44 $29.19 $30.99 $32.84 $34.74 $36.71 $38.77 $40.93 $43.22 $45.72 $48.50

$20,000 $13.28 $13.34 $13.46 $13.66 $13.95 $14.35 $14.76 $15.23 $15.72 $16.30 $16.93 $17.65 $18.44 $19.25 $20.17 $21.15 $22.25 $23.46 $24.70 $26.02 $27.37 $28.83 $30.35 $31.88 $33.55 $35.36 $37.39 $39.74 $42.33 $45.27 $48.37 $51.87 $55.49 $59.19 $62.97 $66.94 $71.05 $75.37 $79.95 $84.93 $90.50

$30,000 $16.68 $16.75 $16.96 $17.26 $17.68 $18.28 $18.90 $19.61 $20.33 $21.20 $22.16 $23.23 $24.40 $25.63 $27.00 $28.48 $30.13 $31.96 $33.81 $35.78 $37.80 $40.00 $42.28 $44.58 $47.08 $49.81 $52.83 $56.35 $60.26 $64.65 $69.31 $74.56 $79.98 $85.53 $91.21 $97.15 $103.33 $109.80 $116.68 $124.16 $132.51

Employee Coverage Amounts $40,000 $50,000 $75,000 $20.07 $23.46 $31.94 $20.16 $23.59 $32.13 $20.44 $23.92 $32.62 $20.84 $24.42 $33.37 $21.40 $25.13 $34.44 $22.20 $26.12 $35.94 $23.04 $27.16 $37.50 $23.97 $28.34 $39.25 $24.93 $29.55 $41.06 $26.10 $31.00 $43.26 $27.37 $32.59 $45.63 $28.80 $34.37 $48.31 $30.36 $36.34 $51.25 $32.00 $38.38 $54.32 $33.83 $40.67 $57.76 $35.80 $43.13 $61.44 $38.00 $45.87 $65.57 $40.44 $48.92 $70.12 $42.90 $52.00 $74.75 $45.53 $55.30 $79.69 $48.23 $58.67 $84.75 $51.17 $62.33 $90.26 $54.20 $66.13 $95.94 $57.27 $69.96 $101.69 $60.60 $74.13 $107.94 $64.24 $78.67 $114.75 $68.26 $83.71 $122.32 $72.96 $89.59 $131.13 $78.17 $96.09 $140.87 $84.03 $103.42 $151.88 $90.23 $111.17 $163.50 $97.23 $119.92 $176.63 $104.46 $128.96 $190.19 $111.86 $138.21 $204.06 $119.43 $147.67 $218.25 $127.36 $157.59 $233.13 $135.60 $167.88 $248.57 $144.23 $178.67 $264.75 $153.40 $190.13 $281.94 $163.37 $202.59 $300.62 $174.50 $216.50 $321.50

$100,000 $40.42 $40.66 $41.34 $42.34 $43.75 $45.75 $47.84 $50.17 $52.58 $55.50 $58.67 $62.25 $66.16 $70.25 $74.83 $79.75 $85.25 $91.34 $97.50 $104.08 $110.83 $118.17 $125.75 $133.42 $141.75 $150.84 $160.91 $172.66 $185.67 $200.33 $215.83 $233.33 $251.41 $269.91 $288.83 $308.66 $329.25 $350.83 $373.75 $398.67 $426.50

$125,000 $48.89 $49.21 $50.04 $51.29 $53.07 $55.56 $58.16 $61.09 $64.11 $67.75 $71.71 $76.18 $81.09 $86.19 $91.92 $98.06 $104.94 $112.54 $120.25 $128.48 $136.92 $146.09 $155.56 $165.15 $175.57 $186.92 $199.52 $214.21 $230.46 $248.80 $268.17 $290.04 $312.64 $335.77 $359.42 $384.21 $409.94 $436.92 $465.56 $496.71 $531.50

$150,000 $57.38 $57.75 $58.76 $60.26 $62.38 $65.38 $68.50 $72.01 $75.63 $80.00 $84.76 $90.13 $96.00 $102.13 $109.00 $116.38 $124.63 $133.76 $143.01 $152.88 $163.00 $174.00 $185.38 $196.88 $209.38 $223.01 $238.13 $255.75 $275.26 $297.25 $320.51 $346.76 $373.88 $401.63 $430.01 $459.75 $490.63 $523.00 $557.38 $594.76 $636.51

Family Protection Plan - Terminal Illness MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT

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

$10,000 $49.13 $52.62 $56.58 $61.09 $66.18

$20,000 $91.75 $98.73 $106.67 $115.68 $125.85

$30,000 $134.38 $144.85 $156.75 $170.28 $185.53

Employee Coverage Amounts $40,000 $50,000 $75,000 $177.00 $219.63 $326.19 $190.97 $237.08 $352.38 $206.83 $256.92 $382.13 $224.87 $279.46 $415.94 $245.20 $304.88 $454.06

$100,000 $432.75 $467.67 $507.33 $552.42 $603.25

$125,000 $539.31 $582.96 $632.54 $688.90 $752.44

$150,000 $645.88 $698.25 $757.75 $825.38 $901.63

*Quality of Life not available ages 66 - 70. Quality of Life benefits not available for children.

Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 years). $7.15 monthly for $10,000 coverage per child.

FPPiDBQOLMonthlyRates

9/18

77

NBS

FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

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

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

FLIP TO‌

PG. 11

FOR HSA VS. FSA COMPARISON

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 78 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

FSA (Flexible Spending Account) How do I receive reimbursements?

During the course of the plan year, you may submit requests for reimbursement of expenses you have incurred. Expenses are Congratulations! considered "incurred" when the service is performed, not Your employer has established a "flexible benefits plan" to help necessarily when it is paid for. You can get submit a claim online you pay for your out-of-pocket health and daycare expenses. at: my.nbsbeneits.com One of the most important features of the plan is that the Please note: Policies other than company sponsored policies (i.e. benefits being offered are paid for with a portion of your pay spouse’s or dependents’ individual policies) may not be paid before federal income or social security taxes are withheld. This through the flexible beneits plan. Furthermore, qualified longmeans that you will pay less tax and have more money to spend term care insurance plans may not be paid through the flexible and save. However, if you receive a reimbursement for an benefits plan. expense under the plan, you cannot claim a federal income tax NBS Benefits Card credit or deduction on your return.

Your employer may Health Flexible spending account: sponsor the use of the The health flexible spending account (FSA) enables you to pay NBS Benefits Card, for expenses allowed under Section 105 and 213(d) of the making access to your Internal Revenue Code which are not covered by our insured flex dollars easier than medical plan. ever. You may use the The most that you can contribute to your Health FSA each plan card to pay merchants year is set by the IRS. This amount can be adjusted for increases or service providers in cost-of-living in accordance with Code Section 125(i)(2). that accept credit cards such as hospitals and pharmacies, so there is no need to pay cash up front then wait for Premium expense plan: reimbursement.

A premium expense portion of the plan allows you to use preOrthodontic expenses that are paid fully up-front at the time of tax dollars to pay for specific premiums under various insurance initial service are reimbursable in full after the initial service has programs we offer you. been performed and payment has been made. Ongoing orthodontia payments are reimbursable only as they are paid.

Dependent care Flexible spending account: The dependent care flexible spending account (DCFSA) enables Account Information you to pay for out-of-pocket, work-related dependent daycare Participants may call NBS and talk to a representative during our costs. Please see the Summary Plan Description for the regular business hours, Monday-Friday, 7 a.m. to 7 p.m. Central definition of an eligible dependent. The law places limits on the Time. Participants can also obtain account information using the amount of money that can be paid to you in a calendar year.

Automated Voice Response Unit, 24 hours a day, 7 days a week Generally, your reimbursement may not exceed the lesser of: at (385) 988-6423 or toll free at (800) 274-0503. For immediate (a) $5,000 (if you are married filing a joint return or you are access to your account information at any time, log on to our head of a household) or $2,500 (if you are married filing website at my.nbsbenefits.com or download the NBS Mobile separate returns); (b) your taxable compensation; (c) your App. spouse's actual or deemed earned income.

Also, in order to have the reimbursements made to you and be What can I save with an FSA? excluded from your income, you must provide a statement from FSA No FSA the service provider including the name, address and, in most cases, the taxpayer identification number of the service Annual taxable income $24,000 $24,000 provider as well as the amount of such expense and proof that Health FSA $1,500 $0 the expense has been incurred.

Dependent care FSA $1,500 $0 Determining contributions Total pre-tax contributions -$3,000 $0 Before each plan year begins, you will select the benefits you want and how much contributions should go toward each Taxable income after FSA $21,000 $24,000 benefit. It is very important that you make these choices Income taxes -$6,300 -$7,200 carefully based on what you expect to spend on each covered benefit or expense during the plan year.

After-tax income $14,700 $16,800 Generally, you cannot change the elections you have made after After-tax health and welfare expenses $0 -$3,000 the beginning of the plan year. However, there are certain limited situations when you can change your elections if you Take-home pay $14,700 $13,800 have a "change in status". Please refer to your Summary Plan You saved $900 $0 Description for a change in status listing.

Plan Highlights Flexible Spending Plans

79

FSA (Flexible Spending Account) NBS Mobile App When you're on the go, save time and hassle with the NBS Mobile App. Submit claims, check your balances, view transactions, and submit documentation using your device's camera.

Easy and convenient •

•

Designed to work just as other iOS and Android apps which makes it easy to learn and use.

Shares user authentication with the NBS portal.

Registered users can download the app and log in immediately to gain access to their benefit accounts, with no need to register their phone or your account.

It's secure •

No sensitive account information is ever stored on your mobile device and secure encryption is used to protect all transmissions.

Mobile app features The NBS mobile app supports a wide variety of features, empowering you to proactively manage your account.

• View account balances • View claims • View reimbursement history • Submit claims • Submit documentation using your device's camera • Pay providers • Setup a variety of SMS alerts • Edit your personal information • View contribution details • View plan information • View calendar deadlines • Contact a service representative • View Benefits Card information

80

FSA (Flexible Spending Account) Sample Expenses Medical expenses • • • • • • • • • • •

Acupuncture Addiction programs Adoption (medical expenses for baby birth) Alternative healer fees Ambulance Body scans Breast pumps Care for mentally handicapped Chiropractor Copayments Crutches

Dental expenses • • • • • • • •

Artificial teeth Copayments Deductible Dental work Dentures Orthodontia expenses Preventative care at dentist office Bridges, crowns, etc.

Vision expenses • • • • • • • •

Braille - books & magazines Contact lenses Contact lens solutions Eye exams Eye glasses Laser surgery Office fees Guide dog and upkeep/other animal aid

Diabetes (insulin, glucose monitor) Eye patches Fertility treatment First aid (i.e. bandages, gauze) Hearing aids & batteries Hypnosis (for treatment of illness) Incontinence products (i.e. Depends, Serene) Joint support bandages and hosiery Lab fees Monitoring device (blood pressure, cholesterol)

• • • • • • • • • •

Physical exams Pregnancy tests Prescription drugs Psychiatrist/psychologist (for mental illness) Physical therapy Speech therapy Vaccinations Vaporizers or humidifiers Weight loss program fees (if prescribed by physician) Wheelchair

• • • • • • • • • •

Items that generally do not qualify for reimbursement • • • • • • • • • • • •

• • •

Personal hygiene (deodorant, soap, body powder, sanitary products) Addiction products Allergy relief (oral meds, nasal spray) Antacids and heartburn relief Anti-itch and hydrocortisone creams Athlete's foot treatment Arthritis pain relieving creams Cold medicines (i.e. syrups, drops, tablets) Cosmetic surgery Cosmetics (i.e. makeup, lipstick, cotton swabs, cotton balls, baby oil) Counseling (i.e. marriage/family) Dental care - routine (i.e. toothpaste, toothbrushes, dental floss, anti-bacterial mouthwashes, fluoride rinses, teeth whitening/ bleaching) Exercise equipment Fever & pain reducers (i.e. Aspirin, Tylenol) Hair care (i.e. hair color, shampoo, conditioner, brushes, hair loss

• • • • • • • •

• • • • • • • •

products) Health club or fitness program fees Homeopathic supplement or herbs Household or domestic help Laser hair removal Laxatives Massage therapy Motion sickness medication Nutritional and dietary supplements (i.e. bars, milkshakes, power drinks, Pedialyte) Skin care (i.e. sun block, moisturizing lotion, lip balm) Sleep aids (i.e. oral meds, snoring strips) Smoking cessation relief (i.e. patches, gum) Stomach & digestive relief (i.e.

Pepto- Bismol, Imodium) Tooth and mouth pain relief (Orajel, Anbesol) Vitamins Wart removal medication Weight reduction aids (i.e. Slimfast, appetite suppressant

These expenses may be eligible if they are prescribed by a physician (if medically necessary for a specific condition).

8523 South Redwood Road, West Jordan, Utah 84088 (800) 274-0503 service@nbsbenefits.com www.nbsbenefits.com

81

HSA BANK

HSA (Health Savings Account)

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

YOUR BENEFITS PACKAGE

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. Addi onal plan 82 details on covered expenses, limita ons and exclusions are included in the summary plan descrip on located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

HSA (Health Savings Account) Health Savings Accounts Start saving more on healthcare.

A Health Savings Account (HSA) is an individually‐owned, tax‐ advantaged account that you can use to pay for current or future IRS‐qualified medical expenses. With an HSA, you’ll have the poten al to build more savings for healthcare expenses or addi onal re rement savings through self‐directed investment op ons¹.

How an HSA works: 







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

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

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

Check balances and account informa on via HSA Bank’s Member Website or mobile device 24/7.

Are you eligible for an HSA? If you have a qualified High Deduc ble Health Plan (HDHP) ‐ either through your employer, through your spouse, or one you’ve purchased on your own ‐ chances are you can open an HSA. Addi onally:  You cannot be covered by any other non‐HSA‐compa ble health plan, including Medicare Parts A and B.  You cannot be covered by TriCare.  You cannot be claimed as a dependent on another person’s tax return (unless it’s your spouse).  You must be covered by the qualified HDHP on the first day of the month.  When you open an account, HSA Bank will request certain informa on to verify your iden ty and to process your applica on.

What are the annual IRS contribu on limits?

2019 Annual HSA Contribu on Limits Individual = $3,500 Family = $7,000 2020 Annual HSA Contribu on Limits Individual = $3,550 Family = $7,100 Catch‐up Contribu ons Accountholders who meet these qualifica ons are eligible to make an HSA catch‐up contribu on of $1,000: Health Savings accountholder; age 55 or older (regardless of when in the year an accountholder turns 55); not enrolled in Medicare (if an accountholder enrolls in Medicare mid‐year, catch‐up contribu ons should be prorated). Authorized signers who are 55 or older must have their own HSA in order to make the catch‐up contribu on.

According to IRS guidelines, each year you have unƟl the tax filing deadline to contribute to your HSA. Online contribuƟons must be submiƩed by 2:00 p.m., Central Time, the business day before the tax filing deadline. Wire contribuƟons must be received by noon, Central Time, on the tax filing deadline, and contribuƟon forms with checks must be received by the tax filing deadline

How can you benefit from tax savings?

An HSA provides triple tax savings.3 Here’s how:  Contribu ons to your HSA can be made with pre‐tax dollars and any a er‐tax contribu ons that you make to your HSA are tax deduc ble.  HSA funds earn interest and investment earnings are tax free.  When used for IRS‐qualified medical expenses, distribu ons are free from tax.

IRS‐Qualified Medical Expenses You can use your HSA to pay for a wide range of IRS‐qualified medical expenses for yourself, your spouse, or tax dependents.

An IRS‐ qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medica ons. Funds used to pay for IRS‐qualified medical expenses are always tax‐ free.

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

Contribu ons made by all par es to an HSA cannot exceed the annual HSA limit set by the Internal Revenue Service (IRS).

Anyone can contribute to your HSA, but only the accountholder and employer can receive tax deduc ons on those contribu ons.

Combined annual contribu ons for the accountholder, employer, and third par es (i.e., parent, spouse, or anyone else) must not exceed these limits.2

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Health Savings Account (HSA) Examples of IRS-Qualified Medical Expenses4: • • • • • • • • •

• • •

• • • • •

•

Acupuncture Alcoholism treatment Ambulance services Annual physical examination Artificial limb or prosthesis Birth control products Chiropractor Childbirth/delivery Convalescent home (for medical treatment only) Crutches Doctor’s fees Dental treatments (including X-rays, braces, dentures, fillings, oral surgery) Dermatologist Diagnostic services Disabled dependent care Drug addiction therapy Fertility enhancement (including invitro fertilization) Guide dog (or other service animal)

• • • • • • •

• • • • • •

• • • • •

•

Gynecologist Hearing aids and batteries Hospital bills Insurance premiums5 Laboratory fees Lactation expenses Lodging (away from home for outpatient care) Menstrual care products Nursing home Nursing services Obstetrician Osteopath Over-the-counter medicines (visit hsabank.com/QME for details) Oxygen Pregnancy test kit Podiatrist Prescription drugs and medicines Prenatal care & postnatal treatments Psychiatrist

1

• • • • •

• • • • • •

•

• •

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

Investment accounts are not FDIC insured, may lose value and are not a deposit or other obligation of, or guarantee by the bank.

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

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

4 This list is not comprehensive. It is provided to you with the understanding that HSA Bank is not engaged in rendering tax advice.

The information provided is not intended to be used to avoid Federal tax penalties. For more detailed information, please refer to IRS Publication 502 titled, “Medical and Dental Expenses”. Publications can be ordered directly from the IRS by calling 1-800TAXFORM. If tax advice is required, you should seek the services of a professional.

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

For assistance, please contact the Client Assistance Center 800-357-6246 www.hsabank.com | 605 N. 8th Street, Ste. 320, Sheboygan, WI 53081 © 2017 HSA Bank. HSA Bank is a division of Webster Bank, N.A., Member FDIC. | HSA_EE_EV1_061917

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How to use your HSA It’s easy to manage your Health Savings Account (HSA) online.

Access real-time account balances, transaction history and statements, as well as track your expenses online. Sign up for online banking today.

• Mobile App* – Use your iOS (iPhone, iPod Touch, iPad) or Android-powered device to check available balances in your account and view HSA transaction details, save and store receipts using your device’s camera, receive account balances and configurable alerts via text message, and access customer service contact information.

• myHealth PortfolioSM – Use this tool to track your healthcare expenses, submit and retain receipts and claims from multiple insurance and financial account providers. Also view expenses by provider, description, and more.

How to deposit funds into your HSA. To maximize HSA tax and savings benefits, begin funding your account as soon as you can. HSA Bank offers several convenient methods for making contributions to your HSA. • Payroll Deductions – If your employer offers this option, HSA Bank will facilitate recurring pre-tax payroll deductions. Contact your employer to complete the appropriate paperwork.

• Online Transfers – On HSA Bank’s member website, you can transfer funds from an external bank account, such as a personal checking or savings account, to your HSA. • Check – Mail your personal check and completed Contribution Form to: HSA Bank, PO Box 939, Sheboygan, WI 53082

How to pay for healthcare expenses from your HSA.** Whether you want to reimburse yourself for an IRS-Qualified medical expense paid out-of-pocket or you want to pay directly from your HSA, HSA Bank offer multiple options for accessing your funds. NOTE: all transactions are limited to your available cash balance.

• Health Benefits Debit Card – Your HSA Bank Health Benefits Debit Card provides access to your HSA funds at point-of-sale with signature or PIN and at ATMs for withdrawals. HSA Bank imposes a daily debit card limit of $3,000 to safeguard against fraudulent activity. Transaction fees may apply when used with a PIN.† • Checks – A book of 50 checks can be ordered upon request for an additional fee.† You can use these checks to pay providers or reimburse yourself for expenses already incurred. There is no daily limit on dollar amounts.

• Online Transfers – On HSA Bank’s Member Website or mobile app, you can reimburse yourself for out-of-pocket expenses by making a one-time or reoccurring online transfer from your HSA to your personal checking or savings account. There is a daily limit of $2,500.

• Online Bill Pay – Use this feature to pay medical providers directly from your HSA. There is no daily limit.

HSA Bank’s Health Benefits Debit Card can be used for point-of-sale transactions in two ways, signature or PIN. For signature, swipe card, press credit on the keypad, and sign the receipt. To pay using a PIN (fee per PIN transaction may apply†), swipe your card, select debit on the keypad, and enter your PIN. To withdraw HSA funds from an ATM (fee per ATM withdrawal may apply†), be sure to select the “checking” option (not savings) when asked the type of account you are withdrawing from. HSA Bank limits point-of-sale debit card transactions to medical merchants. As a mechanism for fraud protection, HSA Bank has set daily limits on debit card transactions. These limits are listed in your Deposit Account Agreement and Disclosures Booklet. Debit card transactions are also limited to your current balance. *The HSA Bank Mobile App is free to download. However, you should check with your wireless provider for any associated fees for accessing the internet from your device. **You can pay for a wide range of IRS-qualified medical expenses with your HSA, including many that aren’t typically covered by health insurance plans. This includes deductibles, co-insurance, prescriptions, dental and vision care, and more. For a complete list of IRS-qualified medical expenses, visit irs.gov or hsabank.com/ IRSQualifiedExpenses. †For applicable fees, see your HSA Bank Interest and Fee Schedule or Explanation of HSA Bank Fee Changes document.

For assistance, please contact the Client Assistance Center 800-357-6246 www.hsabank.com | 605 N. 8th Street, Ste. 320, Sheboygan, WI 53081 © 2016 HSA Bank. HSA Bank is a division of Webster Bank, N.A., Member FDIC. How_to_use_your_HSA_AH_EV1_R_110916

85

ID WATCHDOG

Identity Theft

YOUR BENEFITS PACKAGE

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

An identity is stolen every 2 seconds, and takes over

300 hours

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 86 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

Identity Theft 1 in 18 consumers were victims of identity theft in 2018.1

The Powerful Features You Want — All at an Affordable Price

ID WATCHDOG® 1B+3 PLAN FEATURES

Monitor & Detect • Credit Report & VantageScore® Credit Score: 1 Bureau Monthly • Credit Score Tracker: 1 Bureau Monthly IDENTITY THEFT PROTECTION • Credit Report Monitoring1 | 3 Bureau Because There’s Only One You. • Dark Web Monitoring2 * Your identity is important — it’s what makes you, you. You’ve spent a • High-Risk Transactions Monitoring3 * lifetime building your name and financial reputation. Let us help you 3 better protect it. And, we’ll even go one step further and help you better • Subprime Loan Monitoring * • Public Records Monitoring * protect the identities of your family.

• USPS Change of Address Monitoring Easy & Affordable Identity Protection • Identity Profile Report With ID Watchdog®, you have an easy and affordable way to help better protect and monitor the identities of you and your family. You’ll be Manage & Alert alerted to potentially suspicious activity and enjoy the peace of mind • Credit Report Lock4 | 1 Bureau that comes with the support of dedicated resolution specialists.

• Child Credit Lock5 | 1 Bureau * And, a customer care team that’s available any time, every day.

• Financial Accounts Monitoring • Social Network Alerts * WHY CHOOSE ID WATCHDOG • Credit Lock: With our online and in-app feature, lock your Equifax® • Registered Sex Offender Reporting * credit report2 — and your child’s Equifax credit report — to help • Customizable Alert Options provide additional protection against unauthorized access to your • Breach Alert Emails credit.

• Mobile App • More for Families: Our family plan helps you better protect your • National Provider ID Alerts loved ones, with each adult getting their own account with all plan features. And, we offer more features that help protect minors than Support & Restore any other provider.

• Identity Theft Resolution Specialists (Resolution for Pre-existing • Dedicated Resolution Specialists: If you become a victim, you don’t Conditions) * have to face it alone. One of our certified resolution specialists will • 24/7/365 U.S.-based Customer Care Center fully manage the case for you until your identity is restored.

• Up to $1M Identity Theft Insurance6 * • Lost Wallet Vault & Assistance ID Watchdog Is Here for You • Deceased Family Member Fraud Remediation ID Watchdog is everywhere you can’t be — monitoring credit reports, • Fraud Alert & Credit Freeze Assistance social media, transaction records, public records and more — to help you better protect your identity. And don’t worry, we’re always here for * Helps better protect children | 1 Bureau = Equifax® | 3 Bureau = Equifax, Experian®, TransUnion you. In fact, our U.S.-based customer care team is available 24/7/365 at 866.513.1518.

What You Need to Know A Leader in Detection & Prevention for 3 years running The credit scores provided are based on the VantageScore 3.0 model.

Any one-bureau VantageScore uses Equifax data. Third parties use many See our unique features and pricing and take a step to help better protect your identity different types of credit scores and are likely to use a different type of today.

(Features and pricing tables on reverse.) credit score to assess your creditworthiness.

1

2019 Identity Fraud Study, Javelin Research, March 2019 Locking your Equifax credit report will prevent access to it by certain third parties. Locking your Equifax credit report will not prevent access to your credit report at any other credit reporting agency. Entities that may still have access to your Equifax credit report include: companies like ID Watchdog, which provide you with access to your credit report or credit score, or monitor your credit report as part of a subscription or similar service; companies that provide you with a copy of your credit report or credit score, upon your request; federal, state and local government agencies and courts in certain circumstances; companies using the information in connection with the underwriting of insurance, or for employment, tenant or background screening purposes; companies that have a current account or relationship with you, and collection agencies acting on behalf of those whom you owe; companies that authenticate a consumer’s identity for purposes other than granting credit, or for investigating or preventing actual or potential fraud; and companies that wish to make preapproved offers of credit or insurance to you. To opt out of such pre-approved offers, visit www.optoutprescreen.com 2

SPECIAL EMPLOYEE PRICING

PER MONTH

Employee (Includes 1 child <18) Employee + Family

$9.95 $17.95

© 2019 ID Watchdog. Other product and company names are property of their respective owners.

EE79376CG0819

Take steps to help better protect your identity. Enroll in this valuable benefit today.

1 Monitoring from TransUnion® and Experian® will take several days to begin.

2 Dark Web Monitoring scans thousands of internet sites where consumers’ personal information is suspected of being bought and sold, and is constantly adding new sites to those it searches. However, the internet addresses of these suspected internet trading sites are not published and frequently change, so there is no guarantee that ID Watchdog is able to locate and search every possible internet site where consumers’ personal information is at risk of being traded.

3The monitored network does not cover all businesses or transactions.

4 Locking your Equifax credit report will prevent access to it by certain third parties. Locking your Equifax credit report will not prevent access to your credit report at any other credit reporting agency. Entities that may still have access to your Equifax credit report include: companies like ID Watchdog, which provide you with access to your credit report or credit score, or monitor your credit report as part of a subscription or similar service; companies that provide you with a copy of your credit report or credit score, upon your request; federal, state, and local government agencies and courts in certain circumstances; companies using the information in connection with the underwriting of insurance, or for employment, tenant or background screening purposes; companies that have a current account or relationship with you, and collection agencies acting on behalf of those whom you owe; companies that authenticate a consumer’s identity for purposes other than granting credit, or for investigating or preventing actual or potential fraud; and companies that wish to make pre-approved offers of credit or insurance to you. To opt out of such pre-approved offers, visit www.optoutprescreen.com.

5 Locking your child’s Equifax credit report helps prevent access to it by lenders and creditors. It will not prevent access to your child’s credit report at any other credit reporting agency.

6 The Identity Theft Insurance is underwritten and administered by American Bankers Insurance Company of Florida, an Assurant company. Please refer to the actual policies for terms, conditions, and exclusions of coverage. Coverage may not be available in all jurisdictions. Review the Summary of Benefits (www.idwatchdog.com/terms/ insurance).

87

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 88 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Eanes ISD Benefits Website: www.mybenefitshub.com/eanesisd

Medical Transport MASA provides medical emergency What is Covered?

Helicopter Transport transportation solutions and covers your •• Emergency Emergency Ground Ambulance Transport out of pocket medical transport cost MASA MTS for Employees can provide you with complete when your insurance falls short. MASA Only protection. does not use a network, which means MASA MTS CLAIMS INSTRUCTIONS you are covered anywhere.

THE TRUTH...

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

SUBMITTING A NEW CLAIM 1. Go to www.masamts.com.

2. Click on “Member Login” located top right-hand corner and login. If you have not registered ID number already, you will need to do that.

3. Click on the Claims Tab and then click on “Submit New Claim”.

4. Upload Bill/Invoice and other documentation received.

WHAT’S NEXT? MASA MTS will need to obtain the following items: • Bill/Health Insurance Claim Form (a.k.a. HICFA) • Run notes / trip notes You face the possibility that your medical coverage will deny the • Current Explanation of Benefits (EOB) After receiving all documents and assurance of accurate billing claim leaving you responsible for the ENTIRE bill. of all responsible insurance policies and completion of all available claims, MASA MTS will work with the provider to settle We provide medical emergency transportation solutions AND the claim per the Member Services Agreement. cover your out of pocket medical transport cost when your • The length of time to settle the claim may vary dependent insurance falls short. on many factors including but not limited to the appeals “All I had to do was send the bill which was never paid by process and responsiveness of the provider to submit.

Medicare and TriCare for Life --- and the rest is history.

CONTACT INFORMATION When MASA received that bill, it was paid and all amounts For alternative method of submission, the claim may also be owed satisfied.” --- MASA Member, 2015 faxed to 877-681-2399. For help submitting a claim or to discuss a claim, please contact the claims department at: • Email: ambulanceclaims@masa.global MASA MTS for Employees Ensures...

• Phone: 954-334-8261 • NO health questions • NO age limits • NO claim forms • NO deductibles • NO provider network limitations • NO dollar limits on emergency transport 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.

MASA EMERGENT - $9/MO

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WWW.MYBENEFITSHUB.COM/EANESISD 92