2021-22 Frisco ISD Benefit Guide

FRISCO ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2021 - 8/31/2022 WWW.MYBENEFITSHUB.COM/FRISCOISD 1

Table of Contents Benefit Contact Information How to Enroll 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 Premium Costs TRS ActiveCare Medical TRS Scott & White Medical HMO TSHB Program Alternative Medical Metlife Hospital Indemnity EECU Health Savings Account (HSA) Telehealth MDLive Cigna Dental EyeMed Vision Care MetLife Legal Services AUL a OneAmerica Company Disability, Life, and AD&D APL Cancer UNUM Critical Illness 5 Star Individual Life Identity Guard ID Theft Protection MASA Emergency Medical Transportation GotZoom Student Loan Assistance NBS Flexible Spending Account (FSA) Section 125 Cafeteria Plan Rules FISD Wellness Program Retirement Planning FISD Additional Benefits

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PG. 4

HOW TO ENROLL

PG. 8

SUMMARY PAGES

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YOUR BENEFITS

Benefit Contact Information FRISCO ISD BENEFIT ADMINISTRATORS

DENTAL

MEDICAL TRANSPORT

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

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

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

FRISCO ISD BENEFITS OFFICE

DISABILTY

INDVIDUAL LIFE

Frisco ISD Benefits Admin.

Brenna Rose (469) 633-6361 rosebr@friscoisd.org

AUL a OneAmerica Company Policy#: G614159 (800) 537-6442 www.oneamerica.com

5Star Life Insurance Company (866) 863-9753 Policy # 02484 http://5starlifeinsurance.com

FRISCO ISD CSR

LEGAL PLANS

VOLUNTARY LIFE AND AD&D

Frisco ISD CSR Mary Kempa (469) 633-6373 kempam@friscoisd.org

MetLife Legal Plans (800) 821-6400 members.legalplans.com Access Code: 9310010

AUL a OneAmerica Company Policy#: 614159 (800) 537-6442 www.oneamerica.com

TRS ACTIVECARE MEDICAL

VISION

FLEXIBLE SPENDING ACCOUNT

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

EyeMed Vision Care (888) 581-3648 www.eyemedvisioncare.com

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

TRS HMO MEDICAL

CANCER

COBRA (MEDICAL)

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

APL (800) 256-8606 www.ampublic.com

bSwift (877) 927-9438

TEXAS SCHOOLS HEALTH BENEFITS (TSHB)

IDENTITY THEFT

COBRA (DENTAL & VISION)

(888) 803-0081 https://thsbp.info/HSNetwork

Identity Guard (855) 443-7748 www.identityguard.com

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

TELEHEALTH

CRITICAL ILLNESS

CAREMARK

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

UNUM Policy # R0595033 (800) 583-6908 www.unum.com

Employee: (800) 552-8159 Specialty Drugs: (800) 237-2767 https://info.caremark.com/trsactivecare

HEALTH SAVINGS ACCOUNT (HSA)

STUDENT LOAN ASSISTANCE

RETIREMENT PLANNING

EECU (800) 333-9934 www.eecu.org

GotZoom (866) 317-0631 www.gotzoom.com

TCG (800) 943-9179 tcgservices.com

HOSPITAL INDEMNITY Metlife (800) 638-5433 www.metlife.com 3

MOBILE APP DOWNLOAD Enrollment made simple through the new FBS Benefits App! Text “FBS FRISCOISD” to (800) 583-6908

and get access to everything you need to complete your benefits

“FBS FRISCOISD” to (800) 583-6908

enrollment: •

Enrollment Resources

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Online Support

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Interactive Tools

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And more!

App Group #: FBSFRISCOISD

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Text

OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

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www.mybenefitshub.com/friscoisd

CLICK LOGIN

ENTER USERNAME & PASSWORD Please use your District Username and Password to begin your insurance enrollment.

If you do not know your FISD Network login, contact the FISD Help Desk at

ONLINE SUPPORT

(469) 633-6222.

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Enrollment Instructions

Please make sure to indicate if your child is a full-time student and/or claimed on your tax return as this could affect eligibility on some benefit plans.

To revisit any of the sections mentioned select the button to return to the previous section.

Employee Guide to Enroll in Benefits with THEbenefitsHUB THEbenefitsHUB gives you access to your benefits 24 hours a day, 7 days a week from anywhere that you have Internet access.

This guide is meant to see you through the simple enrollment process page-by-page, taking you through your enrollment screens and providing information on how to efficiently complete your enrollment walkthrough.

Logging In Employee Usage Agreement: The Employee Usage Agreement is displayed when you login to the system as an employee. Read this section carefully as it contains disclaimer information and requires an “Electronic Signature”. By clicking the button, you are agreeing to the terms.

If you have login issues, you will need to contact the FISD Benefits office at 469-633-6369 or 6360.

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Benefits Enrollment When you have completely entered all of your personal and dependent information, you will begin your online enrollment for any of the benefits in which you are eligible. Each benefit will appear on individual pages for your review. Choose your election and then click the button to proceed to the next benefit.

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Demographic Information The Employee Information Entry process requires you to enter demographic information. You will need to review any pre-filled information for accuracy. Complete new or missing information and click on the button when you are ready to proceed to the next step.

Please Note: All •

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fields in BOLD are required.

Personal Information: Enter an email address if you have one. If you need to use the Forgot Password link on the Login page, the system will deliver your new login credentials to this email address.

Emergency Information: Enter an emergency contact and the preferred contact method.

Dependent Information: To add a dependent, click on the icon. To edit an existing dependent, click on the icon or the name of the dependent listed. Click on the button after successfully adding information for each dependent. Dependents name in THEbenefitsHUB must match 6 exactly the name on the social security card.

HOW TO ENROLL

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View Benefit Descriptions: To view, click on the View Plan Outline of Benefit link or the icon next to the name of the plan you would like to review. This shows a plan summary and any available links or documentation related to this plan.

View Plan Cost: Click on the checkbox next to each eligible family member or choose the coverage level you would like. The cost will automatically appear in the box to the right of the members’ names. Additionally, the “Election Summary” box will be updated as coverage adjustments are made.

View Total Plan Cost: While selecting plans, the cost will automatically adjust in the “Election Summary” box in response to your selections.

Forms: One or more of your Benefit Plans may require a paper form to be submitted with the Insurance Carrier. If this is the case, THEbenefitsHUB will prompt you to print the necessary forms during your online enrollment session.

View Important Plan Information: Your benefits administrator will spotlight the importance of specific features in a plan or add any disclaimers that may be necessary in the “Plan Information” section. You may expand/collapse this information by clicking anywhere on the section.

Product Summary Video: Videos are placed throughout the benefit election process. You can access product videos that explain the purpose, function and importance by clicking on the icon when available.

HOW TO ENROLL

Beneficiary Information Beneficiaries are required if you enroll in any of the life plans only. The designation page will come up only if you elect a plan that requires it.

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Consolidated Enrollment Form Consolidated Enrollment Form: This form signals the end of your enrollment walkthrough and will display information from each of the sections listed above, including personal and enrollment information. If you need to make changes after you’ve clicked finished, you will need to click on the Benefit Plan information icon on your home page and then select the Benefit Plan Enrollment and click on the plan you wish to change. If you need assistance, please call 866-914-5202. Once you are finished with the enrollment process, you will be sent to the “Employee Menu” where you may make changes. (See Employee Menu section)

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login at a later time. When you login again, you will walk through the same process. The information previously entered will be stored.

WHAT ARE THOSE SYMBOLS? If you “toggle” the cursor/ arrow on the icons, the definition of the icons will be revealed. = Edit = View LINKS… Any words, names or phrases with your company’s primary color that becomes underlined when you click the highlighted link it will take you to designated section.

SCREEN NAVIGATOR: This line is at the top of your screen.

You may click on the links to quickly jump back to those previous screens.

When you have completed your benefit selections, click the button and you will be redirected to the Employee Menu screen.

Navigation and Information Entry Tips Below are tips to help you familiarize yourself with the THEbenefitsHUB: • • •

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HELP? If you need assistance during the enrollment process, select HELP located at the upper right corner of the screen.

BACK & FORTH: Please do not use the web browser’s “back” or “forward” arrows while in the system. Use the navigation buttons in the THEbenefitsHUB instead: REQUIRED INFORMATION: As noted on each screen, the BOLD items are required to allow continuation to the next page. The more information entered, the better the system will work for you; but you may skip non-bolded items if they do not apply.

MOVING ON: When each election page is complete, go to the bottom of the page and select the button.

UNABLE TO FINISH? If for any reason you are unable to complete the enrollment process you may LOGOUT and 7

Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New: MEDICAL Effective 9/1/2021 Blue Cross and Blue Shield of Texas (BCBSTX) will continue as the health plan administrator for TRS- ActiveCare medical benefits. The TSHBP plans are offered again as well with plan enhancements at the same cost.

Benefit and premium changes will apply to all TRSActiveCare plans for the next plan year. Plan Options • TRS-ActiveCare Primary (PCP Required) • TRS-ActiveCare HD • TRS-ActiveCare Primary+ (PCP Required) To review premiums and plan options, refer to pgs 16-17.

TSHBP MEDICAL PLAN OPTION This year again, 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%.

NEW CANCER PLAN Specialty drugs are not covered unless at a facility setting American Public Life, APL, is replacing the current Loyal (at the hospital) and if they are less than $670. All hospital American plan. The new carrier offers two options to select and other medical facility-based services must be accessed from and the coverage is guaranteed issue. Pre-existing and scheduled via your as- signed Care Coordinator. limitations apply. A lump sum benefit is included for heart attack or stroke as well as an ICU benefit on both options.

See the plan summary for more information DISABILITY INSURANCE Disability insurance protects your paycheck if you are unable to work due to illness or accident. A limited benefit will be paid if you are not able to work due to a pre-existing condition, (ex. maternity). The cost will increase 5% effective 9/1/2021.

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 9/1/2021 (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 benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

CHANGES IN STATUS (CIS):

QUALIFYING EVENTS

Marital Status

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

Change in Number of Tax Dependents

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

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

Change in Status of Employment Affecting Coverage Eligibility

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

Gain/Loss of Dependents' Eligibility Status

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

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

Eligibility for Government Programs

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

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SUMMARY PAGES

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

Where can I find forms?

to review, change or continue benefit elections each year.

For benefit summaries and claim forms, go to your benefit

Changes are not permitted during the plan year (outside of

website: www.mybenefitshub.com/friscoisd. 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.

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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 Frisco ISD

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

benefit website: www.mybenefitshub.com/friscoisd. 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?

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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 31 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

Q&A Who do I contact with Questions?

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

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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,

Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if

provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.

your 2021 benefits become effective on September 1, 2021, you must be actively-at-work on September 1, 2021 to be eligible for

your new benefits.

PLAN

CARRIER

MAXIMUM AGE

Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.

Medical

BCBS

To age 26

Medical

Scott and White

To age 26

Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse eligibility.

TSHBP/

Alternative Medical

90° Benefits

Dental

Cigna

To age 26

Vision

EyeMed Vision Care

To age 26

Life

AUL a OneAmerica Company

To age 26

Cancer

APL

To age 26

Critical Illness

UNUM

To age 26

AD&D

OneAmerica

To age 25

Individual Life

5Star

To age 26

To age 26

FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance.

Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent eligibility.

Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee's enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.

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 9/1/2021 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

Employee and/or employer

Employee and/or employer

Account Owner

Individual

Employer

Underlying Insurance Requirement

High deductible health plan

None

Minimum Deductible

$1,400 single (2021) $2,800 family (2021)

N/A

Maximum Contribution

$3,600 single (2021) $7,000 family (2021)

$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

Description

FLIP TO FOR HSA INFORMATION

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FLIP TO FOR FSA INFORMATION

PG. 80 13

BCBSTX

TRS Medical

YOUR BENEFITS PACKAGE

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

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 14 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Frisco ISD Benefits Website: www.mybenefitshub.com/friscoisd

Employee Monthly Cost - Frisco ISD SEPTEMBER 1, 2021 - AUGUST 31, 2022 FRISCO ISD MEDICAL PREMIUMS Monthly Premium

Employee Cost

TRS ActiveCare Primary Employee Only Employee & Spouse Employee & Child(ren) Employee & Family

$417.00

$67.00

$1,176.00

$826.00

$751.00

$401.00

$1,405.00

$1,055.00

TRS ActiveCare HD Employee Only Employee & Spouse Employee & Child(ren) Employee & Family

$429.00

$79.00

$1,209.00

$859.00

$772.00

$422.00

$1,445.00

$1,095.00

TRS ActiveCare Primary+ Employee Only Employee & Spouse Employee & Child(ren) Employee & Family

$542.00

$192.00

$1,334.00

$984.00

$879.00

$529.00

$1,675.00

$1,325.00

TRS ActiveCare 2 Employee Only

$1,013.00

$663.00

Employee & Spouse

$2,402.00

$2,052.00

Employee & Child(ren)

$1,507.00

$1,157.00

Employee & Family

$2,841.00

$2,491.00

North Texas Scott and White HMO Employee Only Employee & Spouse Employee & Child(ren) Employee & Family

$542.48

$192.48

$1,362.70

$1,012.70

$872.16

$522.16

$1,568.42

$1,218.42

TSHBP HD Employee Only

$348.00

$0.00

Employee & Spouse

$988.00

$638.00

Employee & Child(ren)

$660.00

$310.00

$1,285.00

$935.00

Employee & Family

TSHBP Co-Pay

Employee Only Employee & Spouse Employee & Child(ren) Employee & Family

$385.00

$35.00

$1,099.00

$749.00

$752.00

$402.00

$1,475.00

$1,125.00 15

2021-22 TRS-ActiveCare Plan Highlights Sept. 1, 2021 — Aug. 31, 2022 All TRS-ActiveCare participants have three plan options. Each includes a wide range of wellness benefits.

TRS-ActiveCare 2 TRS-ActiveCare Primary • Lowest premium of the • • •

Plan summary

• •

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

plans Copays for doctor visits before you meet deductible Statewide network PCP referrals required to see specialists Not compatible with a health savings account (HSA) No out-of-network coverage

Total Premium $417 $1,176 $751 $1,405

Your Premium $ $ $ $

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

TRS-ActiveCare Primary+

TRS-ActiveCare HD

• Lower deductible than the HD and

• Compatible with a health savings

• • • • • •

Primary plans Copays for many services and drugs Higher premium than the other plans Statewide network PCP referrals required to see specialists Not compatible with a health savings account (HSA) No out-of-network coverage

Total Premium $542 $1,334 $879 $1,675

account (HSA) • Nationwide network with out-ofnetwork coverage • No requirement for PCPs or referrals • Must meet your deductible before plan pays for non-preventive care

stay in this plan

• Lower deductible • Copays for many drugs and

services

• Nationwide network with out-of-

network coverage

• No requirement for PCPs or

referrals

Your Premium $ $ $ $

• Closed to new enrollees • Current enrollees can choose to

Total Premium $429 $1,209 $772 $1,445

Your Premium $ $ $ $

Total Premium $1,013 $2,402 $1,507 $2,841

Your Premium $ $ $ $

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 Coverage Only

In-Network

Out-of-Network

In-Network

Out-of-Network

$2,500/$5,000

$1,200/$3,600

$3,000/$6,000

$5,500/$11,000

$1,000/$3,000

$2,000/$6,000

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 20% after deductible

$8,150/$16,300

$6,900/$13,800

Statewide Network

Statewide Network

You pay 50% after deductible $20,250/ $7,000/$14,000 $40,500 Nationwide Network

You pay 40% after deductible $23,700/ $7,900/$15,800 $47,400 Nationwide Network

Yes

Yes

No

No

$30 copay

$30 copay

Doctor Visits Primary Care Specialist

You pay 30% You pay 50% after deductible after deductible You pay 30% You pay 50% after deductible after deductible $30 per consultation

$70 copay

$70 copay

$0 per consultation

$0 per consultation

$50 copay

$50 copay

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

$0 per consultation

$0 per consultation

$30 per consultation

Drug Deductible Generics (30-Day Supply/ 90-Day Supply)

Integrated with medical $15/$45 copay; $0 for certain generics

$200 brand deductible

Integrated with medical You pay 20% after deductible; $0 for certain generics

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

TRS Virtual Health

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

Immediate Care Urgent Care Emergency Care TRS Virtual Health

You pay 30% after deductible

You pay 50% after deductible

You pay 40% after deductible You pay a $250 copay plus 20% after deductible $0 per consultation $50 copay

Prescription Drugs $15/$45 copay

How to Calculate Your Monthly Premium

Wellness Benefits at No Extra Cost

Total Monthly Premium

Being healthy is easy with:

Your District and State Contributions

Your Premium Ask your Benefits Administrator for your district’s premiums.

Things to Know • •

TRS’s Texas-sized purchasing power creates broad networks without county boundaries.

Specialty drug insurance means you’re covered, no matter what life throws at you.

16

• • • • •

$0 preventive care 24/7 customer service One-on-one health coaches Weight loss programs Nutrition programs

$200 brand deductible $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)

• • • •

Ovia® pregnancy support TRS Virtual Health Mental health support And much more!

Available for all plans. See your Benefits Booklet for more details.

2021-22 Health Maintenance Organizations: Premiums for Regional Plans Remember: 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 option.

Central and North Texas Scott and White Care Plan

Blue Essentials — South Texas HMOSM

Brought to you by TRS-ActiveCare

Brought to you by TRS-ActiveCare

You can choose this plan if you live in one of these counties: Austin, Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, 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

Total Monthly Premiums Employee Only

Total Premium

Your Premium

You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy

Total Premium

Your Premium

Blue Essentials — West Texas HMOSM Brought to you by TRS-ActiveCare You can choose this plan if you live in one of 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 Premium

Your Premium

$542.48

$

$524.00

$

$596.54

$

Employee and Spouse

$1,362.70

$

$1,264.28

$

$1,443.66

$

Employee and Children

$872.16

$

$819.60

$

$936.18

$

$1,568.42

$

$1,345.58

$

$1,532.74

$

Employee and Family

Plan Features Type of Coverage

In-Network Coverage Only

In-Network Coverage Only

$1,150/$3,450

$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

$50 copay

$500 copay after deductible

You pay 20% after deductible

$500 copay before deductible and 25% after deductible

$200 (excl. generics)

$100

$150

30-day supply/90-day supply

30-day supply/90-day supply

30-day supply/90-day supply

Individual/Family Deductible Coinsurance Individual/Family Maximum Outof-Pocket

In-Network Coverage Only

Doctor Visits

Immediate Care Urgent Care Emergency Care

Prescription Drugs Drug Deductible Day Supply Generics

$10/$25 copay

$10/$30 copay

$5/$12.50 copay; $0 for certain generics

Preferred Brand

You pay 30% after deductible

$40/$120 copay

You pay 30% after deductible

Non-preferred Brand

You pay 50% after deductible

$65/$195 copay

You pay 50% after deductible

You pay 15%/25% after deductible (preferred/non-preferred)

You pay 20% after deductible

You pay 15%/25% after deductible (preferred/non-preferred)

Specialty

trs.texas.gov 17

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 2021-22 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 18 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Frisco ISD Benefits Website: www.mybenefitshub.com/friscoisd

Texas Schools Health Benefits Plan About Texas Schools Health Benefits Program (TSHBP) The Texas Schools Health Benefits Program is a regionally rated 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 Nationwide Network for Physician and Ancillary Services.

Both In and Out of Network physician and Ancillary Services are covered

•

No primary care provider required or referral to a specialist.

A member can use any provider in the network or out of 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

•

ACA 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 •

ActiveCare HD plan •

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

A unique plan that members pay only copayments for service. All copayments apply to the deductible

•

to meet their deductible (no coinsurance)

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

•

TSHBP HD - $3,000

•

TSHBP CoPay - $3,500

•

In comparison with TRSAC HD - $7,000

•

In comparison with TRSAC Primary - $8,150

•

Telehealth at a $30 Consultation Fee

•

Telehealth at $0 Copay

•

All eligible prescriptions are paid at 100% after the

•

$0 copay for generic drugs at CVS, HEB, Wal-Mart, Sam’s,

deductible

and Costco ($10 copay at other network pharmacies)

19

Texas Schools Health Benefits Plan—HD Plan Plan Plan Summary TSHBP HD Plan Plan Features

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.

Network Plan Deductible Feature Individual/Family Deductible Individual/Family Maximum Out-of- Pocket Health Savings Account (HSA) Eligible Required - Primary Care Provider (PCP) Required - PCP Referral to Specialist Prescription Drug Benefits

In-Network Coverage

Out-of-Network Coverage

HealthSmart - National Deductible, then Plan pays 100% $3,000/$9,000

N/A Deductible, then Plan pays 100% $3,500/$9,500

$3,000/$9,000

$3,500/$9,500

Yes

Yes

No

No

No

No

Yes - Deductible, then Plan pays 100%

Yes - Deductible, then Plan pays 100%

Yes - $0 copay $30 per consultation Deductible, then Plan pays 100% Deductible, then Plan pays 100%

Yes - $0 copay $30 per consultation Deductible, then Plan pays 100% Deductible, then Plan pays 100%

Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100%

Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100%

Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100%

Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% In-Network Only In-Network Only In-Network Only

Deductible, then Plan pays 100%

In-Network Only

Deductible, then Plan pays 100%

In-Network Only

Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100%

Deductible, then Plan pays 100%* Deductible, then Plan pays 100%* Deductible, then Plan pays 100%* Deductible, then Plan pays 100%* In-Network Only

Doctor Visits Preventive Care Virtual Health - Teladoc Primary Care Specialist

Office Services

WHAT ARE CARE COORDINATORS? 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.

Allergy Injections Allergy Serum Chiropractic Services Office Surgery MRI’s, Cat Scans, and Pet Scans Urgent Care Facility

Care Facilities Urgent Care Facility Freestanding Emergency Room Hospital Emergency Room Ambulance Services Outpatient Surgery Hospital Services Surgeon Fees

Maternity and Newborn Services Maternity Charges (prenatal and postnatal care) Routine Newborn Care

Rehabilitation/Therapy

https://tshbp.info/CCVideo

Occupational/Speech/Physical Cardiac Rehabilitation Chemotherapy, Radiation, Dialysis Home Health Care Skilled Nursing

Care Coordinator* The Care Coordinator program must be used to access facility services or no benefits will be available under the Plan.

These services include routine colonoscopy and related services; hospital providers for MRIs, Cat Scans, and Pet Scans; hospital providers for outpatient Lab/Radiology Services; Inpatient Hospital Admissions; Outpatient Hospital/Ambulatory Surgical Facility Services; Maternity and Newborn Services; Rehabilitation/Therapy Services; Extended Care Services; and Other Services including durable medical equipment/supplies, orthotics/ prosthetics, facilities for diabetic self-management training, and sleep disorder services. To review the complete plan document and services that require access through the Care Coordinator program, please call 888-803-0081.

20

Texas Schools Health Benefits Plan—CoPay Plan Plan Summary TSHBP CoPay Plan Plan Features

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.

Network Plan Deductible Feature Individual/Family Deductible Individual/Family Maximum Out-of- Pocket Health Savings Account (HSA) Eligible Required - Primary Care Provider (PCP) Required - PCP Referral to Specialist Prescription Drug Benefits

In-Network Coverage

Out-of-Network Coverage

HealthSmart - National Copayments, then Plan pays 100% $3,500/$10,500

N/A Copayments, then Plan pays 100% $4,000/$11,000

$3,500/$10,500

$4,000/$11,000

No

No

No

No

No

No

Yes - Copayments, then Plan pays 100%

Yes - Copayments, then Plan pays 100%

Yes - $0 copay $0 per consultation $35 copay $35 copay

Yes - $0 copay $0 per consultation $40 copay $40 copay

$5 copay $35 copay $35 copay $110 copay $275 copay $50 copay

$10 copay $40 copay $40 copay $125 copay $325 copay $75 copay

$50 copay $500 copay $500 copay $220 copay $500 copay $500 copay $100 copay

$75 copay $500 copay $500 copay $220 copay In-Network Only In-Network Only In-Network Only

$500 copay

In-Network Only

$250 copay

In-Network Only

$55 copay $110 copay $110 copay $55 copay $500 copay

$65 copay* $125 copay* $125 copay* $75 copay* In-Network Only

Doctor Visits Preventive Care Virtual Health - Teladoc Primary Care Specialist

Office Services

WHAT ARE CARE COORDINATORS? 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.

Allergy Injections Allergy Serum Chiropractic Services Office Surgery MRI’s, Cat Scans, and Pet Scans Urgent Care Facility

Care Facilities Urgent Care Facility Freestanding Emergency Room Hospital Emergency Room Ambulance Services Outpatient Surgery Hospital Services Surgeon Fees

Maternity and Newborn Services Maternity Charges (prenatal and postnatal care) Routine Newborn Care

Rehabilitation/Therapy

https://tshbp.info/CCVideo

Occupational/Speech/Physical Cardiac Rehabilitation Chemotherapy, Radiation, Dialysis Home Health Care Skilled Nursing

Care Coordinator* The Care Coordinator program must be used to access facility services or no benefits will be available under the Plan.

These services include routine colonoscopy and related services; hospital providers for MRIs, Cat Scans, and Pet Scans; hospital providers for outpatient Lab/Radiology Services; Inpatient Hospital Admissions; Outpatient Hospital/Ambulatory Surgical Facility Services; Maternity and Newborn Services; Rehabilitation/Therapy Services; Extended Care Services; and Other Services including durable medical equipment/supplies, orthotics/ prosthetics, facilities for diabetic self-management training, and sleep disorder services. To review the complete plan document and services that require access through the Care Coordinator program, please call 888-803-0081.

21

Frisco ISD Medical Rates 2021-22 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

$429

$772

$1,209

$1,445

HD Plan

$348

$660

$988

$1,285

TRS‐Ac veCare Primary +

$542

$879

$1,334

$1,675

CoPay Plan

$385

$752

$1,099

$1,475

$417

$751

$1,176

$1,405

$542

$872

$1,363

$1,568

TRS‐Ac veCare Primary Central and North Texas BSW HMO

Maximum Out‐of‐Pocket Costs (In-Network) For 2021‐22 Cost for Families

Cost for Individuals $3,000 $3,500

TSHBP CoPay Plan

$9,000 $10,500

$7,000

TRS‐Ac veCare HD

$14,000

$6,900

TRS‐Ac veCare Primary +

$13,800

$8,150 $7,450

22

TSHBP HD Plan

TRS‐Ac veCare Primary

Central and North Texas BSW HMO

$16,300 $14,900

Texas Schools Health Benefits Cost Examples TRS

PEG IS HAVING A BABY

HD

Deductible

TSHBP

Primary Primary+

HD

Co Pay

$3,000

$2,500

$1,200

$3,000

$3,500

Specialist Coinsurance/Copayment

30%

$70

$70

0%

$35

Hospital Coinsurance/Copayment

30%

30%

20%

0%

$500

Other Coinsurance/Copayment

30%

30%

20%

0%

$250

Total Example Cost

$12,800

$12,800

$12,800

$12,800

$12,800

Deductibles

$3,000

$2,500

$1,200

$3,000

$0

Copayments

$0

$70

$70

$0

$1,285

Coinsurance

$2,940

$3,000

$2,300

$0

$0

$60

$60

$60

$0

$0

$6,000

$5,630

$3,630

$3,000

$1,285

Limits or Exclusions Total Cost

Compared to TRS-AC HD (savings)

$3,000

Compared to TRS-AC Primary (savings)

$2,345

Compared to TRS-AC Primary + (savings)

$4,345

TOM’S KNEE REPLACEMENT Deductible

TRS HD

TSHBP

Primary Primary+

HD

Co Pay

$3,000

$2,500

$1,200

$3,000

$3,500

Specialist Coinsurance/Copayment

30%

$70

$70

0%

$35

Hospital Coinsurance/Copayment

30%

30%

20%

0%

$500

Other Coinsurance/Copayment

30%

30%

20%

0%

$250

Total Example Cost

$38,000

$38,000

$38,000

$38,000

$38,000

Deductibles

$3,000

$2,500

$1,200

$3,000

$0

Copayments

$0

$70

$70

$0

$1,385

Coinsurance

$10,500

$10,650

$7,360

$0

$0

$60

$60

$60

$0

$0

$7,000*

$8,150*

$6,900*

$3,000

$1,385

Limits or Exclusions Total Cost

Compared to TRS-AC HD (savings)

$4,000

Compared to TRS-AC Primary (savings)

$6,785

Compared to TRS-AC Primary + (savings)

$5,535

*Out-of-pocket limit

23

METLIFE

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

Hospital Indemnity Insurance Benefits With MetLife, you’ll have a choice of two comprehensive plans which provide payments in addition to any other insurance payments you may receive. Here are just some of the covered benefits/services, when an accident or illness puts you in the hospital.A

COVERED BENEFITS *Benefit requires prior Admission or Confinement Subcategory Admission Benefit

Confinement Benefit

Health Screening Benefit

Hospital Benefits Benefit Limits (Applies to Subcategory) 1 time(s) per calendar year

30 days per year ICU Supplemental Confinement will pay an additional benefit for 30 of those days

Low Plan

Highest Plan

$1,000

$2,500

Confinement²

$100

$200

ICU Supplemental Confinement (Benefit paid concurrently with the Confinement benefit when a Covered Person is admitted to ICU)

$100

$200

$50

$50

Benefit

Admission

Other Benefits 1 time(s) per calendar year per covered Health Screening3 person

2

If the Admission Benefit is payable for a Confinement, the Confinement Benefit will begin to be payable the day after Admission.

The Health Screening Benefit is not available in all states.

3

OTHER BENEFIT DETAILS MetLife provides coverage for the Supplemental Benefits listed below. This coverage would be in addition to the benefit payments for the previously mentioned Benefit Categories.

Health Screening Benefit MetLife will provide an annual benefit of $50 per calendar year for taking one of the eligible screening/prevention measures. MetLife will pay only one health screening benefit per covered person per calendar year. Eligible screening/prevention measures include:

• • • • • • • • • • • •

• • • • • •

routine health check-up exam biopsies for cancer blood chemistry panel blood test to determine total cholesterol blood test to determine triglycerides bone marrow testing breast MRI breast ultrasound breast sonogram cancer antigen 15-3 blood test for breast cancer (CA 15-3) cancer antigen 125 blood test for ovarian cancer (CA 125) carcinoembryonic antigen blood test for colon cancer (CEA) carotid doppler chest x-rays clinical testicular exam colonoscopy complete blood count (CBC) dental exam

• • • • • • • • • • • • • • • • • • • •

digital rectal exam (DRE) Doppler screening for cancer Doppler screening for peripheral vascular disease echocardiogram electrocardiogram (EKG) electroencephalogram (EEG) endoscopy eye exam fasting blood glucose test fasting plasma glucose test flexible sigmoidoscopy hearing test hemoccult stool specimen hemoglobin A1C human papillomavirus (HPV) vaccination immunization lipid panel mammogram oral cancer screening pap smears or thin prep pap test

• • • • • • • • • • • • • •

prostate-specific antigen (PSA) test serum cholesterol test to determine LDL and HDL levels serum protein electrophoresis skin cancer biopsy skin cancer screening skin exam stress test on bicycle or treadmill successful completion of smoking cessation program tests for sexually transmitted infections (STIs) thermography two hour post-load plasma glucose test ultrasounds for cancer detection ultrasound screening of the abdominal aorta for abdominal aortic aneurysms virtual colonoscopy

25

Hospital Indemnity Insurance Benefits INSURANCE RATES MetLife offers competitive group rates and convenient payroll deduction so you don’t have to worry about writing a check or missing a payment! Your employee rates are outlined below.

Hospital Indemnity Insurance Coverage Options Employee Employee & Spouse Employee & Child(ren) Employee & Spouse/Child(ren)

Monthly Cost to You Low Plan $15.40 $27.74 $25.31 $37.66

High Plan $33.73 $60.30 $55.20 $81.77

BENEFIT PAYMENT EXAMPLES FOR HIGH & LOW PLAN Susan has chest pains at home and after contacting her doctor she is instructed to head to her local hospital. Upon arrival, the doctor examines Susan and advises that she requires immediate admission to the Intensive Care Unit for further evaluation and treatment. After 2 days in the Intensive Care Unit, Susan moves to a standard room and spends 2 additional days recovering in the hospital. Susan was released to her primary care physician for follow-up treatment and observation. Her primary doctor is now keeping a close watch over Susan’s overall health. Depending on her health insurance, Susan’s out-of-pocket costs could run into hundreds of dollars to cover expenses like insurance co-payments and deductibles. MetLife Group Hospital Indemnity Insurance payments can be used to help cover these unexpected costs or in any other way Susan sees fit.

26

BENEFIT PAYMENT EXAMPLES Covered Benefit2

Low Plan BenefitAmountB

High Plan BenefitAmountB

Admission

$1,000

$2,500

Confinement for 2 days Intensive Care Unit $200 Coverage (payable on day 2)

$400

Confinement for 2 days – Hospital Coverage (payable on days 2 through 4)

$300

$600

Benefits paid by MetLife Group Hospital Indemnity Insurance

$1,500

$3,500

Hospital Indemnity Insurance Benefits QUESTIONS & ANSWERS How do I enroll?

Enroll for coverage at www.thebenefitshub.com/friscoisd Who is eligible to enroll for this Hospital Indemnity coverage?

You are eligible to enroll yourself and your eligible family members.C You need to enroll during your Enrollment Period and be actively at work for your coverage to be effective. Dependents to be enrolled may not be subject to a medical restriction as set forth in the Certificate. Some states require the insured to have medical coverage.

How do I pay for my Hospital Indemnity coverage?

Premiums will be conveniently paid through payroll deduction, so you don’t have to worry about writing a check or missing a payment.

What happens if my employment status changes? Can I take my coverage with me?

Yes, you can take your coverage with you. You will need to continue to pay your premiums to keep your coverage in force. Your coverage will only end if you stop paying your premium or if your employer cancels the group policy or offers you similar coverage with a different insurance carrier.D What is the coverage effective date?

The coverage effective date is 09/01/2019.

Who do I call for assistance?

Please call MetLife directly at 1-800-GET-MET8 (1-800-438-6388) and talk with a benefits consultant. Or visit our website: mybenefits.metlife.com A

Hospital does not include certain facilities such as nursing homes, convalescent care or extended care facilities. See your Disclosure Statement or Outline of Coverage/Disclosure Document for full details.

B Benefit amount is based on a sample MetLife plan design. Plan design and plan benefits may vary.

C Coverage is guaranteed provided (1) the employee is actively at work and (2) dependents to be covered are not subject to medical restrictions as set forth in the Certificate. Some states require the insured to have medical coverage. Additional restrictions apply to dependents serving in the armed forces or living overseas.

D Eligibility for portability through the Continuation of Insurance with Premium Payment provision may be subject to certain eligibility requirements and limitations.

For more information, contact your MetLife representative.

METLIFE'S HOSPITAL INDEMNITY INSURANCE IS A LIMITED BENEFIT GROUP INSURANCE POLICY. The policy is not intended to be a substitute for medical coverage and certain states may require the insured to have medical coverage to enroll for the coverage. The policy or its provisions may vary or be unavailable in some states. Prior hospital confinement may be required to receive certain benefits. There is a preexisting condition limitation for hospital sickness benefits. MetLife’s Hospital Indemnity Insurance may be subject to benefit reductions that begin at age 65. Like most group accident and health insurance policies, policies offered by MetLife may contain certain exclusions, limitations and terms for keeping them in force. For complete details of coverage and availability, please refer to the group policy form GPNP16-HI, or contact MetLife. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. In certain states, availability of MetLife’s Group Hospital Indemnity Insurance is pending regulatory approval.

27

EECU

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-deductible health plan. The funds contributed to the account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent.

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. Additional plan details on covered expenses, limitations and exclusions are included This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 28 details on covered expenses,Frisco limitations and exclusions included in the summary plan description located on the ISD Benefits Website:are www.mybenefitshub.com/friscoisd Frisco ISD Benefits Website: www.mybenefitshub.com/friscoisd

HSA (Health Savings Account) What is an HSA?

How to Use Your Funds

Health Savings Account (HSA) enables you to save for and conveniently pay for qualified healthcare expenses, while you earn tax-free interest and pay no monthly service fees.

Opening a Health Savings Account provides both immediate and long term benefits. The money in your HSA is always yours, even if you change jobs, switch your health plan, become unemployed or retire. Your unused HSA balance rolls over from year to year. And best of all, HSAs have tax-free deposits, tax-free earnings and tax-free withdrawals. And after age 65, you can withdraw funds from your HSA penalty-free for any purpose*.

•

HSA Debit Card – use your EECU HSA Mastercard® debit card to pay healthcare providers at point-of-sale or by following the instructions provided on a bill from a medical provider.

•

Online Bill Pay – sign up, at eecu.org, and use EECU’s free online banking and bill pay to make payments to medical providers directly from your HSA. Online Transfers – use EECU’s online banking or mobile app; reimburse yourself for out-of-pocket expenses by making a transfer from your HSA to your personal checking or savings account.

Check – optional HSA checks can be ordered upon request for a fee. You can use these checks to pay healthcare providers and suppliers.

EECU HSA Benefits •

•

Save money tax-free for healthcare expenses – contributions are not subject to federal income taxes and can be made by • you, your employer or a third party* • No monthly service fee – so you can save more and earn more • Earn competitive dividends on your entire balance – Save your receipts – for all qualified medical expenses. compounded daily and paid monthly from deposit to EECU does not verify eligibility. You are responsible for withdrawal making sure payments are for qualified medical expenses.

• Conveniently pay for qualified healthcare expenses – with a free, no annual fee EECU HSA Debit Mastercard® or via EECU’s free online bill pay. (HSA checks are also available How To Manage Your Account upon request, for a nominal fee**) • Online - check your balance, pay healthcare providers and • Free online, mobile and branch access – allows you to arrange deposits; sign-up for online banking at actively manage your account however you prefer www.eecu.org.

• Comprehensive service and support – to assist you in • Mobile - EECU’s mobile app allows you to manage your optimizing your healthcare saving and spending account on the go; download “EECU Mobile Banking” in • Federally insured – to at least $250,000 by NCUA Apple’s App Store and Google Play.

• Contact Member Service – call 817-882-0800 for help with 2021 Annual HSA Contribution Limits your HSA questions or transactions. You can also chat with Individual: $3,600 us online at eecu.org or use our secure email. Member Family: $7,200 Service is available Monday through Friday from 8:00am – Catch-Up Contributions: Accountholders who meet the 7:00pm CT, Saturdays from 9am – 1pm CT and closed on qualifications noted below are eligible to make an HSA Sunday. catch-up contribution of an additional $1,000.

• Account Statements – monthly statements show all your • Health Savings accountholder account activity for that period. You can receive free online • Age 55 or older (regardless of when in the year an statements or pay $2 per printed statement. accountholder turns 55) * Contributions, investment earnings, and distributions are tax free for federal tax purposes if • Not enrolled in Medicare (if an accountholder enrolls in used to pay for qualified medical expenses, and may or may not be subject to state taxation.

Medicare mid-year, catch-up contributions should be A list of Eligible Medical Expenses can be found in IRS Publication 502, http://www.irs.gov/ pub/irs-pdf/p502.pdf. As described in IRS publication 969, http://www.irs.gov/pub/irs-pdf/ prorated) p969.pdf, certain over-the-counter medications (when prescribed by a doctor) are Authorized Signers who are 55 or older must have their own considered eligible medical expenses for HSA purposes. If an individual is 65 or older, there is no penalty to withdraw HSA funds. However, income taxes will apply if the distribution is not HSA in order to make the catch-up contribution used for qualified medical expenses. For more information consult a tax adviser or your state department of revenue. All contributions and distributions are your responsibility and must be within IRS regulatory limits. ** Call 817-882-0800 or stop-by an EECU branch to order standard checks at no charge (excludes shipping and handling) or order custom checks - prices vary.

29

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 details on covered expenses, limitations and exclusions are included This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 30 details on covered expenses,Frisco limitations and exclusions included in the summary plan description located on the ISD Benefits Website:are www.mybenefitshub.com/friscoisd Frisco ISD Benefits Website: www.mybenefitshub.com/friscoisd

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

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

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

• Consultations are convenient, private and secure.

• Prescriptions can be sent to your nearest pharmacy, if medically necessary.

Need a doctor? 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.

We treat over 50 routine medical conditions including: • • • • • • •

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

Welcome to MDLIVE Behavioral Health!

Managing stress or life changes can be overwhelming but it’s easier than ever to get help right in the comfort of your own home. Visit a counselor or psychiatrist by phone, secure video, or MDLIVE App. • Talk to a licensed counselor or psychiatrist from your home, office, or on the go!

• Affordable, confidential online therapy for a variety of counseling needs.

• The MDLIVE app helps you stay connected with appointment reminders, important notifications and secure messaging.

Confidential, convenient online therapy.

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

We can help you address:

• • • • •

Addictions Bipolar Disorders Child and Adolescent Issues Depression Eating Disorders

• • • • • •

Introducing the MDLIVE App Sick in bed? Sick at work? Got a smartphone? Doctor visits are easier than ever with the MDLIVE App. • Access to a doctor anywhere: at home, at work, or on the go • Choose doctors from one of the nation's largest telehealth networks • Available 24/7 by video or phone Private, secure and confidential visits • Connect instantly with MDLIVE Assist

• • • • •

Relationship and Marriage Issues Stress Trauma and PTSD Women’s Issues And more

3 Visits $0

Your Monthly Premium is $11.50 Join for free. Visit a doctor. consultmdlive.com 888-365-1663

Grief and Loss Life Changes Men’s Issues Panic Disorders Parenting Issues Postpartum Depression

Refer to fee schedule for additional visit copays.

Your doctor will send prescriptions (if medically necessary) to your nearest pharmacy. www.consultmdlive.com (888) 365-1663

mdlive.com/getapp No smartphone? No worries!

• Activate your account online or over the phone at: consultmdlive.com • 1-888-365-1663 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 MDLIVE, INC. CONFIDENTIALITY NOTICE: This e-mail and any attachments are for the substances and may not prescribe non-therapeutic drugs and certain other drugs which may exclusive and confidential use of the intended recipient. If you are not the intended recipient, be harmful because of their potential for abuse. MDLIVE does not guarantee patients will please do not read, distribute or take action in reliance on this message. If you have received receive a prescription. Healthcare professionals using the platform have the right to deny this message in error, please notify us immediately by return e-mail and promptly delete this care if based on professional judgment a case is inappropriate for telehealth or for misuse of message and its attachments from your computer system. We do not waive attorney-client, services. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may work product, doctor-patient, therapist-client or intellectual property privileges by the not be used without written permission. For complete terms of use visit https:// transmission of this message. www.MDLIVE.com/terms-of-use/.

31

CIGNA | Group # 3339989

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 details on covered expenses, limitations and exclusions are included This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 32 details on covered expenses,Frisco limitations and exclusions included in the summary plan description located on the ISD Benefits Website:are www.mybenefitshub.com/friscoisd Frisco ISD Benefits Website: www.mybenefitshub.com/friscoisd

Dental PPO - Basic Plan Network Options

Cigna Dental Choice Plan In-Network: Total Cigna DPPO Network

Reimbursement Levels Policy Year Benefits Maximum Applies to: Class I, II, III & IX expenses

Out-of-Network: See Non-Network Reimbursement

Based on Contracted Fees

Maximum Allowable Charge

$1,000

$1,000

$50 $150

$50 $150

Monthly Premium EE Only EE + 1 Dependent EE + 2 or more Dependents

$21.18 $43.13 $74.88

Policy Year Deductible Individual Family

Benefit Highlights Class I: Diagnostic & Preventive Oral Evaluations Prophylaxis: routine cleanings X-rays: routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic

Class II: Basic Restorative Restorative: fillings Oral Surgery: minor X-rays: non-routine Emergency Care to Relieve Pain

Class III: Major Restorative Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures Oral Surgery: major Anesthesia: general and IV sedation Endodontics: minor and major Periodontics: minor and major Denture Relines, Rebases and Adjustments Repairs: Bridges, Crowns and Inlays Repairs: Dentures

Class IX: Implants

Plan Pays

You Pay

Plan Pays

You Pay

100% No Deductible

No Charge

100% No Deductible

No Charge

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% After Deductible

50% After Deductible

50% After Deductible

50% After Deductible

Cigna Dental Benefit Summary Frisco ISD #3339989 – Basic Plan Plan Renewal Date: 09/01/2021 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 Pretreatment Review Alternate Benefit 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 24 months for eligible members that are allowed to enroll in this plan outside of the designated open enrollment period. This provision does not apply to new hires.

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

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

33

Dental PPO - Low Plan

Oral Health Integration Program (OHIP)

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

Denture and Bridge Repairs Denture Adjustments, Rebases and Relines Prosthesis Over Implant

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

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

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; 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

34

Dental PPO - Enhanced Plan Cigna Dental Choice Plan In-Network:

Network Options

Total Cigna DPPO Network Based on Contracted Fees

Reimbursement Levels Policy Year Benefits Maximum Applies to: Class I, II, III & IX expenses

Monthly Premium

Out-of-Network: See Non-Network Reimbursement EE Only Maximum Reimbursable Charge EE + 1

$1,500

$1,500

$50 $150

$50 $150

$92.12 Dependent EE + 2 or more $132.17 Dependents

Policy Year Deductible Individual Family

Benefit Highlights Class I: Diagnostic & Preventive Oral Evaluations Prophylaxis: routine cleanings X-rays: routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic

Class II: Basic Restorative Restorative: fillings Oral Surgery: minor X-rays: non-routine Emergency Care to Relieve Pain

Class III: Major Restorative Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures Oral Surgery: major Anesthesia: general and IV sedation Endodontics: minor and major Periodontics: minor and major Denture Relines, Rebases and Adjustments Repairs: Bridges, Crowns and Inlays Repairs: Dentures

Class IV: Orthodontia Coverage for Dependent Children to age 19

$47.66

Plan Pays

You Pay

Plan Pays

You Pay

100% No Deductible

No Charge

100% No Deductible

No Charge

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% 50% 50% No Deductible No Deductible No Deductible

50% No Deductible

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

50% No Deductible

Cigna Dental Benefit Summary Frisco ISD #3339989 – Enhanced Plan Plan Renewal Date: 09/01/2021 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.

Lifetime Benefits Maximum: $1,000

Class IX: Implants Benefit Plan Provisions: In-Network Reimbursement Non-Network Reimbursement

Cross Accumulation

Policy Year Benefits Maximum Policy Year Deductible Pretreatment Review 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 90th percentile of all provider charges in the geographic area. The dentist may balance bill up to their usual fees.

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

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

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.

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

Payment will be reduced by 50% for Class III, IV and IX services for 24 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.

35

Dental PPO - High Plan 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 Prosthesis Over Implant

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 24 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 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.

Benefit Exclusions: Covered Expenses will not include, and no payment will be made for the following: Procedures and services not listed under Benefit Highlights; Diagnostic: cone beam imaging; Preventive Services: instruction for plaque control, oral hygiene and diet; Restorative: Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and/or third molars; Periodontic: bite registrations; splinting; Prosthodontic: precision or semi-precision attachments; Implants: implants or implant related services; Procedures, appliances or restorations, except full dentures, whose main purpose is to: change vertical dimension; diagnose or treat conditions or dysfunction of the temporomandibular joint (TMJ); stabilize periodontally involved teeth; or restore occlusion; Athletic mouth guards; Replacement of a lost or stolen appliance; Services performed primarily for cosmetic reasons; Personalization; Services that are deemed to be medical in nature; Services and supplies received from a hospital; Drugs: prescription drugs Charges in excess of the Maximum Reimbursable Charge.

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

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

36

Dental - DHMO •

This Patient Charge Schedule lists the benefits of the Dental Plan including covered procedures and patient charges

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.

Code

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.

• • • • •

DHMO Monthly Premiums Tier EE Only EE + 1 Dependent EE + 2 or more Dependents

Procedure Description

Low Plan $10.72 $20.37 $30.56

Patient Charge

Office Visit Fee (Per patient, per office visit in addition to any other applicable patient charges) Office Visit Fee

$5.00

Diagnostic/Preventive - Oral evaluations are limited to a combined total of 4 of the following evaluations during a 12 consecutive month period: periodic oral evaluations (D0120), comprehensive oral evaluations (D0150), comprehensive periodontal evaluations (D0180), and oral evaluations for patients under 3 years of age (D0145). 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 ∆. $11.00 $6.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

1 every 3 years) ∆

$0.00 $0.00 $0.00 $0.00

year)

37

Dental - DHMO Code

Procedure Description

Patient Charge

$0.00 $0.00 $0.00 $0.00 $50.00

Prophylaxis (cleaning) – Adult (limit 2 per calendar year) ∆ Prophylaxis (cleaning) – Child (limit 2 per calendar year) ∆ There is a combined limit of a total of 2 D1206s and/or

$0.00 $40.00 $0.00

D1208s per calendar year. ∆ $0.00 $0.00 $0.00 $0.00

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

• • • • •

No more than $75.00 per tooth for any porcelain fused to metal (only on molar teeth) 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)

38

Dental - DHMO Code

Procedure Description

Patient Charge

39

Dental - DHMO Code

Endodontics (root canal treatment, excluding final restorations)

40

Procedure Description

Patient Charge

Dental - DHMO Code

Procedure Description

Patient Charge

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 ∆.

D4210 Gingivectomy or gingivoplasty – 4 or more teeth per quadrant $145.00 D4211 Gingivectomy or gingivoplasty – 1 to 3 teeth per quadrant $90.00 D4212 Gingivectomy or gingivoplasty to allow access for restorative procedure, per tooth $90.00 D4240 Gingival flap (including root planing) – 4 or more teeth per quadrant $165.00 D4241 Gingival flap (including root planing) – 1 to 3 teeth per quadrant $125.00 $185.00 D4245 Apically positioned flap $140.00 D4249 Clinical crown lengthening – Hard tissue D4260 Osseous surgery – 4 or more teeth per quadrant $325.00 D4261 Osseous surgery – 1 to 3 teeth per quadrant $250.00 D4263 Bone replacement graft – Retained natural tooth - First site in quadrant $230.00 D4264 Bone replacement graft – Retained natural tooth - Each additional site in quadrant $105.00 D4265 Biologic materials to aid in soft and osseous tissue regeneration $95.00 D4266 Guided tissue regeneration – Resorbable barrier per site $215.00 D4267 Guided tissue regeneration – Nonresorbable barrier per site (includes membrane removal) $255.00 D4270 Pedicle soft tissue graft procedure $270.00 Autogenous connective tissue graft procedure (including donor and recipient surgical sites) first tooth, implant or D4273 $75.00 edentulous tooth position Mesial/distal wedge procedure single tooth (when not performed in conjunction with surgical procedures in the same D4274 $80.00 anatomical area) Non-autogenous connective tissue graft (including recipient site and donor material) first tooth, implant, or edentulous D4275 $420.00 tooth position in graft Free soft tissue graft procedure (including recipient and donor surgical sites), first tooth, implant or edentulous (missing) D4277 $270.00 toothposition in graft Free soft tissue graft procedure (including recipient and donor surgical sites), each additional contiguous tooth, implant or D4278 $135.00 edentulous (missing) tooth position in same graft site Autogenous connective tissue graft procedure (including donor and recipient surgical sites) – Each additional contiguous D4283 $38.00 tooth, implant or edentulous tooth position in same graft site Non-autogenous connective tissue graft procedure (including recipient surgical site and donor materials) – Each additional D4285 $210.00 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) ∆ $45.00 D4342 Periodontal scaling and root planing – 1 to 3 teeth per quadrant (limit 4 quadrants per consecutive 12 months) ∆ $35.00 $0.00 Scaling in presence of generalized moderate or severe gingival inflammation – Full mouth, after oral evaluation (limit 1 per calendar year) D4346 $50.00 Additional scaling in presence of generalized moderate or severe gingival inflammation – Full mouth, after oral evaluation (limit 2 per calendar year) D4355 Full mouth debridement to allow evaluation and diagnosis (1 per lifetime) $45.00 D4381 Localized delivery of antimicrobial agents per tooth $60.00 - Periodontal maintenance (limit 4 per calendar year) (only covered after active therapy) ∆ $35.00 - Additional periodontal maintenance procedures (beyond 4 per calendar year) $65.00 D4910 - 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 $185.00 D5120 Full lower denture $185.00 D5130 Immediate full upper denture $205.00 D5140 Immediate full lower denture $205.00 D5211 Upper partial denture – Resin base (including clasps, rests and teeth) $185.00 D5212 Lower partial denture – Resin base (including clasps, rests and teeth) $185.00 D5213 Upper partial denture – Cast metal famework (including clasps, rests and teeth) $200.00 D5214 Lower partial denture – Cast metal framework (including clasps, rests and teeth) $200.00 D5221 Immediate maxillary partial denture – Resin base (including any conventional clasps, rests and teeth) $185.00 D5222 Immediate mandibular partial denture – Resin base (including conventional clasps, rests and teeth) $185.00 Immediate maxillary partial denture – Cast metal framework with resin denture base (including any conventional clasps, D5223 $200.00 rests and teeth Immediate mandibular partial denture – Cast metal framework with resin denture bases (including any conventional clasps, D5224 $200.00 rests and teeth) D5225 Upper partial denture – Flexible base (including clasps, rests and teeth) $165.00 D5226 Lower partial denture – Flexible base (including clasps, rests and teeth) $165.00 D5281 Removable unilateral partial denture – One piece cast metal including clasps and teeth) $185.00 41 D5410 Adjust complete denture – Upper $11.00

Dental - DHMO Code

Procedure Description

Patient Charge

D5411 Adjust complete denture – Lower $11.00 D5421 Adjust partial denture – Upper $11.00 D5422 Adjust partial denture – Lower $11.00 D5850 Tissue conditioning – Upper $11.00 D5851 Tissue conditioning – Lower $11.00 $160.00 D5862 Precision attachment – By report Repairs to prosthetics D5510 Repair broken complete denture base $35.00 D5520 Replace missing or broken teeth – Complete denture (each tooth) $35.00 D5610 Repair resin denture base $35.00 D5620 Repair cast framework $35.00 D5630 Repair or replace broken clasp - Per tooth $40.00 D5640 Replace broken teeth – Per tooth $35.00 D5650 Add tooth to existing partial denture $35.00 D5660 Add clasp to existing partial denture - Per tooth $40.00 D5670 Replace all teeth and acrylic on cast metal framework – Upper $185.00 D5671 Replace all teeth and acrylic on cast metal framework – Lower $185.00 Denture relining (limit 1 every 36 months) D5710 Rebase complete upper denture $70.00 D5711 Rebase complete lower denture $70.00 D5720 Rebase upper partial denture $70.00 D5721 Rebase lower partial denture $70.00 D5730 Reline complete upper denture – Chairside $40.00 D5731 Reline complete lower denture – Chairside $40.00 D5740 Reline upper partial denture – Chairside $40.00 D5741 Reline lower partial denture – Chairside $40.00 D5750 Reline complete upper denture – Laboratory $70.00 D5751 Reline complete lower denture – Laboratory $70.00 D5760 Reline upper partial denture – Laboratory $70.00 D5761 Reline lower partial denture – Laboratory $70.00 Interim dentures (limit 1 every 5 years) D5810 Interim complete denture – Upper $255.00 D5811 Interim complete denture – Lower $255.00 D5820 Interim partial denture – Upper $85.00 D5821 Interim partial denture – Lower $85.00 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) D6058 Abutment supported porcelain/ceramic crown $595.00 D6059 Abutment supported porcelain fused to metal crown (high noble metal) $720.00 D6060 Abutment supported porcelain fused to metal crown (predominantly base metal) $555.00 D6061 Abutment supported porcelain fused to metal crown (noble metal) $720.00 D6062 Abutment supported cast metal crown (high noble metal) $670.00 D6063 Abutment supported cast metal crown (predominantly base metal) $505.00 D6064 Abutment supported cast metal crown (noble metal) $670.00 D6065 Implant supported porcelain/ceramic crown $595.00 D6066 Implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal) $720.00 D6067 Implant supported metal crown (titanium, titanium alloy, high noble metal) $670.00 D6068 Abutment supported retainer for porcelain/ceramic fixed partial denture $535.00 D6069 Abutment supported retainer for porcelain fused to metal fixed partial denture (high noble metal) $700.00 D6070 Abutment supported retainer for porcelain fused to metal fixed partial denture (predominantly base metal) $535.00 D6071 Abutment supported retainer for porcelain fused to metal fixed partial denture (noble metal) $700.00 D6072 Abutment supported retainer for cast metal fixed partial denture (high noble metal) $670.00 42

Dental - DHMO Code

Procedure Description

Patient Charge

D6073 Abutment supported retainer for cast metal fixed partial denture (predominantly base metal) $505.00 D6074 Abutment supported retainer for cast metal fixed partial denture (noble metal) $670.00 D6075 Implant supported retainer for ceramic fixed partial denture $535.00 D6076 Implant supported retainer for porcelain fused to metal fixed partial denture (titanium, titanium alloy, high noble metal) $700.00 $670.00 D6077 Implant supported retainer for cast metal fixed partial denture (titanium, titanium alloy, high noble metal) $100.00 D6085 Provisional implant crown 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) $670.00 D6110 Implant /abutment supported removable denture for edentulous arch – Maxillary $685.00 D6111 Implant /abutment supported removable denture for edentulous arch – Mandibular $685.00 D6112 Implant /abutment supported removable denture for partially edentulous arch – Maxillary $700.00 D6113 Implant /abutment supported removable denture for partially edentulous arch – Mandibular $700.00 D6114 Implant /abutment supported fixed denture for edentulous arch – Maxillary $685.00 D6115 Implant /abutment supported fixed denture for edentulous arch – Mandibular $685.00 D6116 Implant /abutment supported fixed denture for partially edentulous arch – Maxillary $700.00 D6117 Implant /abutment supported fixed denture for partially edentulous arch – Mandibular $700.00 D6194 Abutment supported retainer crown for fixed partial denture (titanium) $670.00 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 $35.00 D7220 Removal of impacted tooth – Soft tissue $55.00 D7230 Removal of impacted tooth – Partially bony $80.00 D7240 Removal of impacted tooth – Completely bony $100.00 D7241 Removal of impacted tooth – Completely bony, unusual complications (narrative required) $125.00 D7250 Removal of residual tooth roots – Cutting procedure $45.00 D7251 Coronectomy - Intentional partial tooth removal $80.00 D7260 Oroantral fistula closure $125.00 D7261 Primary closure of a sinus perforation $125.00 D7270 Tooth stabilization of accidentally evulsed or displaced tooth $95.00 D7280 Exposure of an unerupted tooth (excluding wisdom teeth) $100.00 D7283 Placement of device to facilitate eruption of impacted tooth $100.00 Incisional biopsy of oral tissue – Hard (bone, tooth) (tooth related – not allowed when in conjunction with another surgical D7285 $0.00 procedure) Incisional biopsy of oral tissue – Soft (all others) (tooth related – not allowed when in conjunction with another surgical D7286 $0.00 procedure) D7287 Exfoliative cytological sample collection $50.00 D7288 Brush biopsy – Transepithelial sample collection $50.00 D7310 Alveoloplasty in conjunction with extractions – 4 or more teeth or tooth spaces per quadrant $55.00 D7311 Alveoloplasty in conjunction with extractions – 1 to 3 teeth or tooth spaces per quadrant $55.00 D7320 Alveoloplasty not in conjunction with extractions – 4 or more teeth or tooth spaces per quadrant $80.00 D7321 Alveoloplasty not in conjunction with extractions – 1 to 3 teeth or tooth spaces per quadrant $80.00 D7450 Removal of benign odontogenic cyst or tumor – Up to 1.25 cm $0.00 D7451 Removal of benign odontogenic cyst or tumor – Greater than 1.25 cm $0.00 D7471 Removal of lateral exostosis – Maxilla or mandible $90.00 D7472 Removal of torus palatinus $70.00 D7473 Removal of torus mandibularis $70.00 D7485 Reduction of osseous tuberosity $60.00 D7510 Incision and drainage of abscess – Intraoral soft tissue $35.00 D7511 Incision and drainage of abscess – Intraoral soft tissue complicated $35.00 D7520 Incision and drainage of abscess – Extraoral soft tissue $35.00 D7521 Incision and drainage of abscess – Extraoral soft tissue – Complicated (includes drainage of multiple fascial spaces) $35.00 Occlusal orthotic device, by report - (limit 1 per 24 months; only covered in conjunction with Temporomandibular Joint D7880 $175.00 (TMJ) treatment) D7881 Occlusal orthotic device adjustment $11.00 D7910 Suture of recent small wounds up to 5cm $30.00 D7960 Frenulectomy – Also known as frenectomy or frenotomy – Separate procedure not incidental to another procedure $45.00 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.)

43

Dental - DHMO Code

Procedure Description

Patient Charge

$2,160.00 $285.00

$280.00 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.

Miscellaneous services Occlusal guard – By report (limit 1 per 24 months)

44

Dental - DHMO 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.

45

EYEMED | Group # 1000760 | Insight Network

Vision

YOUR BENEFITS PACKAGE

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

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 46 details on covered expenses,Frisco limitations and exclusions included in the summary plan description located on the ISD Benefits Website:are www.mybenefitshub.com/friscoisd Frisco ISD Benefits Website: www.mybenefitshub.com/friscoisd

Vision Additional discounts

40% off Complete pair of prescription eyeglasses

20% off Non-prescription sunglasses

20% off Remaining balance beyond plan coverage These discounts are not insured benefits and are for innetwork providers only

Take a sneak peek before enrolling • You’re on the INSIGHT Network

• For a complete list of in-network providers near you, use our Enhanced Provider Locator on eyemed. com or call 1.866.804.0982

• For LASIK providers, call 1.877.5LASER6.

Summary of Benefits Vision Care Services

In-Network Member Cost

Exam With Dilation as Necessary $10 Co-pay Retinal Imaging Up to $39 Frames $0 Co-pay, $150 Allowance, 20% off balance over $150 Standard Plastic Lenses Single Vision $10 Co-pay Bifocal $10 Co-pay Trifocal $10 Co-pay Lenticular $10 Co-pay Standard Progressive Lens $75 Co-pay Premium Progressive LensΔ $95 Co-pay - $120 Co-pay Tier 1 $95 Co-pay Tier 2 $105 Co-pay Tier 3 $120 Co-pay Tier 4 $75 Co-pay, 80% of charge less $120 Allowance Lens Options UV Treatment $15 Tint (Solid and Gradient) $15 Standard Plastic Scratch Coating $0 Co-pay Standard Polycarbonate—Adults $40 Standard Polycarbonate—Kids under $0 Co-pay 19 Standard Anti-Reflective Coating $45 Premium Anti-Reflective CoatingΔ $57-$68 Tier 1 $57 Tier 2 $68 Tier 3 80% of charge Photochromic/Transitions—Adults $75 Polarized 20% off retail Other Add-Ons and Services 20% off retail Contact Lens Fit and Follow-Up (Contact lens fit and follow up visits are available

Out-of-Network Reimbursement Up to $35 N/A Up to $70 Up to $25 Up to $40 Up to $45 Up to $80 Up to $40 Up to $40 Up to $40 Up to $40 Up to $40 N/A N/A Up to $8 N/A Up to $20

N/A N/A N/A N/A N/A N/A N/A N/A

once a comprehensive eye exam has been completed)

Standard Contact Lens Fit & Follow-Up Up to $55 Premium Contact Lens Fit & Follow-Up 10% off retail price Contact Lenses (Contact lens allowance includes materials only.)

Conventional $0 Co-pay, $150 Allowance, 15% off balance over $150 Disposable $0 Co-pay, $150 Allowance; plus balance over $150 Medically Necessary $0 Co-pay, paid-in-full Laser Vision Correction LASIK or PRK from U.S. Laser Network 15% off the retail price or 5% off the promotional price Frequency Examination Once every 12 months Lenses or Contact Lenses Once every 12 months Frame Once every 12 months

N/A N/A Up to $88 Up to $88 Up to $210 N/A

Premiums–by pay period Employee Employee + 1 Employee + Family

$8.94 $15.64 $23.34

Benefits are not provided from services or materials arising from: Orthopic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses, medical and/or surgical treatment of the eye, eyes or supporting structures; Any Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; safety eyewear; Services provided as a result of any workers’ compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; Plano (non-prescription) lenses; Non-prescription sunglasses; Two pair of glasses in lieu of bifocals; Services or materials provided by any other group benefit plan providing vision care; Services rendered after the date an insured person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the insured Person are within 31 days from the date of such order. Lost or broken lenses, frames, glasses or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available. Benefits may not be combined with any discount, promotional offering, or other group benefit plans.

Standard/Premium Progressive lens not covered — fund as a Bifocal lens. Standard Progressive lens covered – fund Premium Progressive as a Standard. Benefit allowance provides no remaining balance for future use within the same benefits year. Fees charged for a non-insured benefit must be paid in full to the Provider. Such fees or materials are not covered. Underwritten by Fidelity Security Life Insurance Company of Kansas City, Missouri. Fidelity Security Life Policy number VC-19/VC-20, form number M-9083. This is a snapshot of your benefits. The Certificate of Insurance is on file with your employer. ∆Premium progressives and premium anti-reflective designations are subject to annual review by EyeMed’s Medical Director and are subject to change based on market conditions. Fixed pricing is reflective of brands at the listed product level.

47All providers are not required to carry all brands at all levels. Not available in all states. Some provisions, benefits, exclusions or limitations listed herein may vary.

Vision What’s in it for me?

Options. It’s simple really. We’re dedicated to helping you see clearly — and that’s why we’ve built a network that gives you lots of choices and flexibility. You can choose from thousands of independent and retail providers to find the one that best fits your needs and schedule. No matter which one you choose, our plan is designed to be easy-to-use and help you access the care you need. Welcome to EyeMed.

Benefits Snapshot Exam, with dilation as necessary (once every 12 months) Frames (once every 12 months) Single Vision Lenses (once every 12 months) or Contacts (once every 12 months)

With EyeMed

Out-of-Network Reimbursement

$10 Co-pay

Up to $35

$0 Co-pay, $150 Allowance; 20% off balance over Up to $70 $150 $10 Co-pay Up to $25 $0 Co-pay, $150 Allowance; plus balance over $150

Up to $88

And now it’s time for the breakdown...

Here’s an example of what you might pay for a pair of glasses with us vs. what you’d pay without vision coverage. So, let’s say you get an eye exam and choose a frame that costs $163 with single vision lenses that have UV and scratch protection. Now let’s see the difference...

89% SAVINGS with us*

With EyeMed

Without Insurance**

Exam

Exam

$106

Frame $163 -$150 Allowance $13 -$2.60 (20% discount off balance) $10.40

Frame

$163

Lens

$10 Co-pay $15 UV treatment add-on +$0 scratch coating add-on $25

Lens

$78 $23 UV treatment add-on +$25 scratch coating add-on $126

Total

$45.40

Total

$395

$10 Co-pay

Download the EyeMed Members App It’s the easy way to view your ID card, see benefit details and find a provider near you.

48 *This is a snapshot of your benefits. Actual savings will depend on provider, frame and lens selections. **Based on industry averages.

49

METLIFE LEGAL PLAN YOUR BENEFITS PACKAGE

Legal Services

About this Benefit Having an affordable, qualified lawyer on your side can be an invaluable asset. Legal plans provide valuable benefits that cover the most common legal needs you may encounter - like creating a standard will, living will, healthcare power of attorney or buying a home. This plan also provides access to quality law firms for advice, consultation and representation.

55% of American adults do not have a will or other estate plan in place.

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

Legal Services Our attorneys are here to help when you’re: • Getting married • Sending kids off to college • Buying or selling a home • Caregiving for aging parents • Starting a family • Dealing with identity theft • And more

PRODUCT OVERVIEW Provides access to legal expertise for both expected and unexpected events.

Legal experts on your side, whenever you need them Quality legal assistance can be pricey. And it can be hard to know where to turn to find an attorney you trust. For a monthly fee, you can have a team of top attorneys ready to help you take care of life’s planned and unplanned legal events.

MetLife Legal Plans, formerly known as Hyatt Legal Plans, gives you access to experts who can assist you with a broad range of personal legal needs you might face throughout your life. This could be when you’re buying or selling a home, starting a family, dealing with identity theft, or caring for aging parents.

You may be thinking — why would top attorneys need or want to join a legal plan network? But even experienced attorneys need to grow their practice. By providing exceptional service to you and other plan members, they can gain more clients through your referrals. That’s how we’ve established a large network of highly experienced attorneys, averaging 25 years of experience.

Reduce the cost of legal services with MetLife Legal Plans.

How it works Our service is tailored to your needs. With network attorneys available in person, by phone, or by email and online tools to do -it-yourself or plan your next move—we make it easy to get legal help. And, you will always have a choice in which attorney to use. You can choose one from our network of prequalified attorneys, or use an attorney outside of our network and be reimbursed some of the cost.1 Best of all, you have unlimited access to our attorneys for all legal matters covered under the plan. For a monthly premium conveniently paid through payroll deduction, an expert is on your side as long as you need them.

Whatever you need to protect your family, MetLife Legal Plans is here to make life a little easier.

For added peace of mind, your spouse and dependent children are also covered.

Helping you navigate life’s planned and unplanned events.

For $19.50 a month, you get legal assistance for some of the most frequently needed personal legal matters —with no waiting periods, no deductibles and no claim forms, when using a Network Attorney for a covered matter. And, for non- covered matters that are not otherwise excluded, this benefit provides four hours of Network Attorney time and services per year.2 Money Matters

Home & Real Estate

Estate Planning

Family & Personal

Civil Lawsuits

Elder-Care Issues

• • • • • • • • • • • • • • • • • •

Debt Collection Defense Identity Management Services3 Identity Theft Defense Boundary & Title Disputes Deeds Eviction Defense Foreclosure Codicils Complex Wills Healthcare Proxies Adoption Affidavits Conservatorship Demand Letters Garnishment Defense Guardianship Administrative Hearings Civil Litigation Defense

• • • • • • • • •

Negotiations with Creditors Personal Bankruptcy Promissory Notes Home Equity Loans Mortgages Property Tax Assessments Refinancing of Home Living Wills Powers of Attorney (Healthcare, Financial, Childcare, Immigration)

• Immigration Assistance • Juvenile Court Defense, Including • • • •

Criminal Matters Name Change Parental Responsibility Matters Personal Property Protection

Disputes Over Consumer Goods & Services • Incompetency Defense

Consultation & Document Review for • Leases your parents: • Medicaid Medicare Notes • Deeds • Nursing Home Agreements

• Tax Audit Representation • Tax Collection Defense • • • • • •

Sale or Purchase of Home Security Deposit Assistance Tenant Negotiations Zoning Applications Revocable & Irrevocable Trusts Simple Wills

• Prenuptial Agreement • Protection from Domestic Violence • Review of ANY Personal Legal Document

• School Hearings

• Pet Liabilities • Small Claims Assistance • Powers of Attorney Prescription Plans Wills

51

Legal Services Vehicle & Driving

E-Services

• • • •

Defense of Traffic Tickets4 Driving Privileges Restoration Attorney Locator Financial Planning

• License Suspension Due to DUI

• Repossession

• Insurance Resources • Law Firm E-Panel

• Self-Help Legal Documents

To learn more, visit info.legalplans.com and enter access code forlaw4 or call 1-800-GET-MET8 (1-800-438-6388) Monday – Friday 7:00 am – 7:00 pm, CT. 1.

2.

3.

4.

You will be responsible to pay the difference, if any, between the plan’s payment and the out-of-network attorney’s charge for services.

No more than a combined maximum total of four hours of attorney time and service are provided for the member, spouse and qualified dependents, annually.

These benefits provide the Participant with access to LifeStages Identity Management Services provided by CyberScout, LLC. CyberScout is not a corporate affiliate of MetLife Legal Plans.

Does not cover DUI.

Group legal plans provided by MetLife Legal Plans, Inc., Cleveland, Ohio. In certain states, group legal plans are provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and affiliates, Warwick, RI. No service, including consultations, will be provided for: 1) employment-related matters, including company or statutory benefits; 2) matters involving the employer, MetLife, its affiliates, or plan attorneys; 3) matters in which there is a conflict of interest between the employee and spouse/civil union partner or dependents, in which case services are excluded for the spouse/civil union partner and dependents; 4) appeals and class actions; 5) farm and business matters, including rental issues when the participant is the landlord; 6) patent, trademark, and copyright matters; 7) costs and fines; 8) frivolous or unethical matters; 9) matters for which an attorney-client relationship exists prior to the participant becoming eligible for plan benefits. For all other personal legal matters, an advice and consultation benefit is provided. Additional representation is also included for certain matters. Please see your plan description for details. MetLife® is a registered trademark of Metropolitan Life Insurance Company, New York, NY. [ML4] MetLife Legal Plans, Inc. | 1111 Superior Avenue, Suite 800 | Cleveland, OH 44114 L0120000422[exp0421][All States][DC,PR] © 2020 MetLife Services and Solutions, LLC

52

53

AUL A ONE AMERICA COMPANY

Disability, Life, and AD&D

YOUR BENEFITS PACKAGE

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

Educator Disability What you need to know:

Protect Your Income with Disability Insurance

•

You probably have insurance for the things you depend on most. That could include protecting your home against fire or flood and protecting your vehicle in case of an accident.

You may even have life insurance to make sure that your loved ones are taken care of after you die. But have you ever considered insuring your income?

It's an important question. Your income is the cornerstone of your financial stability. It's how you afford that home's mortgage, your car's monthly payments and the food and other necessities your household needs. That stability is threatened, however, if you experience a severe injury or illness that leaves you unable to work.

•

•

•

Are you eligible? Benefits are available to employees who are actively at work on the effective date of coverage and working the minimum number of hours per week stated in the contract.

Your premiums and benefits may vary. Actual premiums and benefit amounts will be calculated by OneAmerica and may change upon reaching certain ages, according to contract terms, and are subject to change. Volumes and benefit amounts shown may be subject to reductions due to age.

Enroll timely for guaranteed issue coverage. You may be eligible for coverage without having to answer any health questions if you enroll during the initial enrollment period when benefits are first offered by OneAmerica@, or if you enroll as a newly hired employee within 31 days after any applicable waiting period.

Enrolling later requires approval. If you decline coverage now, you will lose your only chance to apply for group insurance coverage without having to first undergo medical underwriting. If you decide to enroll later, you will need to submit a Statement of Insurability form for review. OneAmerica will then decide to approve or deny your coverage based on your health history. You may not be approved for any type of coverage at a later date if you have any current or future medical conditions.

What you need to do: •

•

Carefully review the contents of this packet. Enclosed is personal information about the benefits offered to you by OneAmerica on behalf of your employer. This is your opportunity to learn more about group insurance from OneAmerica, but it is not a complete explanation of benefits. For more information, consult the contract about exclusions, limitations, reduction of benefits, and terms under which the contract may be continued in force or discontinued.

Review the Notices and Limitations. Visit www.employeebenefits.aul.com to find the Notices and Limitations, G-14320 (05 Prudent) 12/28/12. Go to Forms, Policy/Employee Admin, and Notices and Limitations.

Note: Products issued and underwritten by American United Life Insurance Company® (AUL), a OneAmerica company. Not available in all states or may vary by state. OneAmerica® is the marketing name for the companies of OneAmerica.

Worker's Compensation Might Not Be Enough Although worker's compensation does offer some protections, it only covers injuries that happen on the job.

To qualify for coverage, you also must meet certain eligibility requirements. If you have medical insurance, that can help too, but only to cover your actual medical costs. It still won't replace your lost income while you're unable to work.

16% of American workers had disability insurance coverage.1 50% of working Americans would have to tap into their savings if they couldn't work due to an injury or illness.2 Ready to learn more? Reach out to your human resources department today to get started.

If You're Not Prepared, You're Not Alone In 2020 only 16% of American workers had disability insurance coverage.1 That's probably why half of those surveyed said they'd have to turn to savings if they were disabled and could no longer work.2 At a time when most Americans would drain their bank accounts in just 10 weeks3, that's not a good long-term solution. Yet it's still better than the 20% of workers who said they just didn't know how they would make up the lost income.2 Disability Insurance Protects Your Paycheck Anyone can be affected by illness or injury, but it doesn't have to threaten your financial security. With disability insurance, a portion of your income is replaced, and you can have peace of mind knowing that your family is protected, and that you can focus on healing.

55

Educator Disability Did you know?

According to the Council for Disability Awareness4, some of the most common reasons for short-term disability claims include: • Pregnancy • Back, spine, knee and hip injuries • Fractures, sprains and muscle strains • Digestive disorders • Mental health, including anxiety and depression

What you need to know about your Group Educator Disability Benefits

If you were to face serious illness or injury, would you be financially prepared?

Pre-Existing Condition Period: 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 limited benefit will be paid if the Person's Disability begins in the first 12 months following the Person's Individual Effective Date of Insurance; and the Person's Disability is caused by, contributed to by, or the result of a condition for which the Person received medical advice or treatment in the 3 months just prior to the Person's Individual Effective Date of Insurance.

Note: Products issued and underwritten by American United Life Insurance Company® (AUL). Indianapolis, IN, a OneAmerica company. Not available in all states or may vary by state.

1. Source: https://!ifehappens. org/b/og/is-life-insurance-tomorrowsproblemfindings-from-the-2020-insurance-barometer-study/ June 16, 2020 2. Source: https://www.limra.com/g!obalassets/!imra/newsroom/industrytrends/2020-images/D/M2020factsheet.pdf Accessed September 9, 2020 3. Source: https://www.magnifymoney.com/blog/news/paychecksurvey/ February 4, 2020 4. Source: https://disabilitycanhappen.org/disability-statistic/ March 28,2018

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

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

Group Educator Disability Options

You may select a benefit percentage of 30%, 40%, 50% or 60% of your earnings, up to a maximum monthly benefit of $7,500.

Elimination Period

Maximum Benefit Duration

Option 1: 14 days / 14 days Option 2: 30 days/ 30 days Option 3: 60 days / 60 days Option 4: 90 days /90 days Option 5: 180 days / 180 days

Pre-Existing Condition Period

Age When Total Disability Begins

Maximum Duration

3 months / 12 months

Less than age 60 60 61 62 63 64 65 66 67 68 69 and over

Greater of Social Security Full Retirement Age or to age 65 5 years 4years 3.5 years 3 years 2.5 years 2 years 21 months 18 months 15 months 12 months

Rates Per $100 of Monthly Benefit 30% Benefit Option:

Option 1 14 davs / 14 days

Option 2 30 davs / 30 days

Option 3 60 days / 60 days

Option 4 90 days / 90 days

Option 5 180 davs / 180 days

Rate:

$2.58

$2.04

$1.63

$1.34

$0.99

40% Benefit Option:

Option 1 14 davs / 14 days

Option 2 30 davs / 30 days

Option 3 60 days / 60 days

Option 4 90 days / 90 days

Option 5 180 davs / 180 days

Rate:

$2.58

$2.04

$1.63

$1.34

$0.99

50% Benefit Option:

Option 1 14 davs / 14 days

Option 2 30 davs / 30 days

Option 3 60 days / 60 days

Option 4 90 days / 90 days

Option 5 180 davs / 180 days

Rate:

$2.88

$2.27

$1.82

$1.49

$1.10

60% Benefit Option:

Option 1 14 davs / 14 days

Option 2 30 davs / 30 days

Option 3 60 days / 60 days

Option 4 90 days / 90 days

Option 5 180 davs / 180 days

Rate:

$3.38

$2.67

$2.13

$1.75

$1.29 Rate Effective 09/01/2021

56

Term Life Protecting Your Loved Ones -No Matter What "Will my loved ones be OK when I'm gone?'' It's a difficult question to ask yourself, but an important one all the same.

If you were to pass away unexpectedly, how would your loved ones cope financially? Would they be taken care of?

Or would they find themselves struggling to make ends meet while still in the midst of their grief?

A Growing Gap for Families Across the country, American families face a growing insurance gap. In early 2020, 46% of U.S. adult consumers didn't own life insurance.1 Yet, 44% also stated that their families would begin to feel the financial effects within six months of a primary wage earner passing away - and 28% would do so within just a month.1 But life insurance isn't just about protecting your loved ones in the short term. It can also be a way of providing for them for decades to come, by keeping them on track for their long-term goals, whether they be college education, home ownership or even retirement.

46% of U.S. adult consumers don't own life insurance.

44% state that their families would begin to feel the financial effects within six months of a primary wage earner passing away.

To learn more, or if you have questions about the life insurance options available through your employer, contact your human resources department today.

1. Source: https ://lifehappens.org/blog/is-life-insurance-tomorrows- problemfindings-from-the-2020-insurance-barometer-study/ June 16, 2020

Why Purchase Term Life Insurance?

• Group rates provide affordable coverage • Premium payments are easily made through payroll deduction • In some cases, you can purchase coverage for your spouse and/or dependent children • You may be able to take your coverage with you in the event you leave your employer Note: Products issued and underwritten by American United Life Insurance Company® (AUL), Indianapolis, IN, a OneAmerica company. Not available in all states or may vary by state.

How Much Do You Need?

Everyone's circumstances are different. The amount of life insurance that's appropriate for yours will depend on factors such as age, current finances and the financial needs of your loved ones. That's why it's important to start the conversation now, both with the people closest to you and with a financial professional who can help guide you down a positive path. Nobody knows what the future holds. That's why preparation is so critical. By taking steps now to secure term life insurance coverage, you and those who mean the most to you will have the peace of mind that comes with knowing that yes, they will be OK, no matter what tomorrow brings.

What you need to know about your Voluntary Term Life Benefits Flexible Options: Employee: $10,000 to$500,000, in $10,000 increments, not to exceed 7 times your annual salary Spouse: $5,000 to $200,000, in $5,000 increments, not to exceed 100% of the employee's amount

Guaranteed Issue: Employee: $400,000 Spouse: $80,000 Child: $10,000 Dependent Life Coverage: Optional dependent life coverage is available to eligible employees. You must select employee coverage in order to cover your spouse and/or child(ren).

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.

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

Reductions: Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule . The amounts of dependent life insurance will reduce according to the employee's reduction schedule Age:

65

70

Reduces To:

65%

50% 57

Term Life Payroll Deduction Illustration: Monthly Employee Options

Life

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

$10,000

$.50

$.50

$.50

$.70

$.80

$.90

$1.40

$2.10

$3.90

$6.00

$11.50 $18.50

$22.00

$20,000

$1.00

$1.00

$1.00

$1.40

$1.60

$1.80

$2.80

$4.20

$7.80

$12.00

$23.00

$37.00

$44.00

$30,000

$1.50

$1.50

$1.50

$2.10

$2-40

$2.70

$4.20

$6.30

$11.70

$18.00

$34.50

$55.50

$66.oo

$40,000

$2.00

$2.00

$2.00

$2.80

$3.20

$3.60

$5.60

$8-40

$15.60

$24.00

$46.00

$74.00

$88.oo

$50,000

$2.50

$2.50

$2.50

$3.50

$4.00

$4.50

$7.00

$10.50

$19.50

$30.00

$57.50

$92.50 $110.00

$80,000

$4.00

$4.00

$4.00

$5.60

$6.40

$7.20

$11.20

$16.80

$31.20

$48.00

$92.00 $148.00 $176.00

$100,000

$5.00

$5.00

$5.00

$7.00

$8.oo

$9.00

$14.00

$21.00

$39.00

$60.00 $115.00 $185.00 $220.00

$200,000 $10.00

$10.00

$10.00

$14.00

$16.00

$18.00

$28.00

$42.00

$78.00 $120.00 $230.00 $370.00 $440.00

$300,000 $15.00

$15.00

$15.00

$21.00

$24.00

$27.00

$42.00

$63.00 $117.00 $180.00 $345.00 $555.00 $660.00

$400,000 $20.00

$20.00

$20.00

$28.00

$32.00

$36.00

$56.00

$84.00 $156.00 $240.00 $460.00 $740.00 $880.00

SPOUSE OPTIONS Life

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+

$5,000

$.25

$.25

$.25

$.35

$.40

$.45

$.70

$1.05

$1.95

$3.00

$5.75

$9.25

$11.00

$10,000

$.50

$.50

$.50

$.70

$.80

$.90

$1.40

$2.10

$3.90

$6.oo

$11.50

$18.50

$22.00

$15,000

$.75

$.75

$.75

$1.05

$1.20

$1.35

$2.10

$3.15

$5.85

$9.00

$17.25

$27.75

$33.00

$20,000

$1.00

$1.00

$1.00

$1.40

$1.60

$1.80

$2.80

$4.20

$7.80

$12.00

$23.00

$37.00

$44.00

$25,000

$1.25

$1.25

$1.25

$1.75

$2.00

$2.25

$3.50

$5.25

$9.75

$15.00

$28.75

$46.25

$55.00

$40,000

$2.00

$2.00

$2.00

$2.80

$3.20

$3.60

$5.60

$8.40

$15.60

$24.00

$46.00

$74.00

$88.oo

$50,000

$2.50

$2.50

$2.50

$3.50

$4.00

$4.50

$7.00

$10.50

$19.50

$30.00

$57.50

$92.50 $110.00

$60,000

$3.00

$3.00

$3.00

$4.20

$4.80

$5.40

$8.40

$12.60

$23.40

$36.00

$69.00 $111.00 $132.00

$70,000

$3.50

$3.50

$3.50

$4.90

$5.60

$6.30

$9.80

$14.70

$27.30

$42.00

$80.50 $129.50 $154.00

$80,000

$4.00

$4.00

$4.00

$5.60

$6.40

$7.20

$11.20

$16.80

$31.20

$48.00

$92.00 $148.00 $176.00

Life

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

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

Deduction amount Child(ren) $1.00

Note: Employee and Spouse premiums are based on your age as of 09/01 and amount of coverage chosen. Child premiums are for all eligible children combined.

OneAmerica® is the marketing name for the companies of OneAmerica.

58

Voluntary AD&D What you need to know about your Voluntary AD&D Benefits Flexible AD&D Options: Employee: Up to $500,000, in $10,000 increments Spouse: 60% of the employee AD&D benefit, 50% if child included Child: 15% of the employee AD&D benefit, 10% if spouse included, not to exceed $30,000 AD&D Guaranteed Issue: Employee: $500,000 Spouse: $300,000 Child: $30,000 Accidental Death and Dismemberment (AD&D): If AD&D is selected, additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract.

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

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

Age:

65

70

Reduces To:

65%

50%

Payroll Deduction Illustration: Monthly AD&D Options Employee AD&D Employee Only Employee+ Family $10,000 $0.20 $0.40 $20,000 $0.40 $0.80 $30,000 $0.60 $1.20 $40,000 $0.80 $1.60 $50,000 $1.00 $2.00 $60,000 $1.20 $2.40 $70,000 $1.40 $2.80 $80,000 $1.60 $3.20 $90,000 $1.80 $3.60 $100,000 $2.00 $4.00 $110,000 $2.20 $4.40 $120,000 $2.40 $4.80 $130,000 $2.60 $5.20 $140,000 $2.80 $5.60 $150,000 $3.00 $6.00 $160,000 $3.20 $6.40 $170,000 $3.40 $6.80 $180,000 $3.60 $7.20 $190,000 $3.80 $7.60 $200,000 $4.00 $8.00 $210,000 $4.20 $8.40 $220,000 $4.40 $8.80 $230,000 $4.60 $9.20 $240,000 $4.80 $9.60 $250,000 $5.00 $10.00 $260,000 $5.20 $10.40 $270,000 $5.40 $10.80 $280,000 $5.60 $11.20 $290,000 $5.80 $11.60 $300,000 $6.00 $12.00 $310,000 $6.20 $12.40 $320,000 $6.40 $12.80 $330,000 $6.60 $13 .20 $340,000 $6.80 $13 .60 $350,000 $7.00 $14.00 $360,000 $7.20 $14 .40 $370,000 $7.40 $14.80 $380,000 $7.60 $15.20 $390,000 $7.80 $15 .60 $400,000 $8.00 $16.00 $410,000 $8.20 $16 .40 $420,000 $8.40 $16.80 $430,000 $8.60 $17.20 $440,000 $8.80 $17.60 $450,000 $9.00 $18.00 $460,000 $9.20 $18.40 $470,000 $9.40 $18.80 $480,000 $9.60 $19.20 $490,000 $9.80 $19.60 $500,000 $10.00 $20.00

OneAmerica® is the marketing name for the companies of OneAmerica.

59

APL

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

GC14

Limited Benefit Group Specified Disease Cancer Indemnity Insurance

For Employees of Frisco ISD

THE INSURANCE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. YOU SHOULD CONSULT YOUR EMPLOYER TO DETERMINE WHETHER YOUR EMPLOYER IS A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM.

Summary of Benefits

Plan 1

Plan 2

Cancer Treatment Policy Benefits

Level 1

Level 4

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

$10,000

$20,00

Hormone Therapy - Maximum of 12 treatments per calendar year

$50 per treatment

$50 per treatment

Experimental Treatment

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

Surgical Rider Benefits

Level 1

Level 3

Surgical

$30 unit dollar amount Max $3,000 per operation

Var. $45 unit dollar amount Max $4,500 per operation

Anesthesia

25% of amount paid for covered surgery

Bone Marrow Transplant - Maximum per lifetime

$6,000

$9,000

Stem Cell Transplant - Maximum per lifetime

$600

$900

Prosthesis - Surgical Implantation/Non-Surgical (not Hair Piece) 1 device per site, per lifetime

$1,000 / $100

$2,000 / $200

Patient Care Rider Benefits

Level 1

Hospital Confinement Per day of Hospital Confinement (1-30 days) Per day for Eligible Dependent Children (1-30 days) Per day of Hospital Confinement (31+ days) Per day for Eligible Dependent Children (31+ days)

$100 $200 $100 $200

$100 $200 $200 $400

Outpatient Facility - Per day surgery is performed

$200

$200

Attending Physician - Per day of Hospital Confinement

$30

$30

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

$100 /$100

$100 / $200

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

$100 per day

$100 per day

Donor

$100 per day

$100 per day

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

$100 per day

$100 per day

Hospice Care - Up to maximum of 365 days per lifetime

$100 per day

$100 per day

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

$100 /$100

$100 / $200

Internal Cancer First Occurrence Rider Benefits

Level 1

Level 1

Lump Sum Benefit - Maximum 1 per Covered Person per lifetime

$2,500

$2,500

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

$3,750

$3,750

Heart Attack/Stroke First Occurrence Rider Benefits

Level 1

Level 1

Lump Sum Benefit - Maximum 1 per Covered Person per lifetime

$2,500

$2,500

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

$3,750

$3,750

Intensive Care Unit

$600 per day

$600 per day

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

$300 per day

$300 per day

Level 2

Hospital Intensive Care Unit Rider Benefits

Total Monthly Premiums by Plan** Issue Ages 18 +

Individual

Individual & Spouse

1 Parent Family

2 Parent Family

Plan 1

Plan 2

Plan 1

Plan 2

Plan 1

Plan 2

Plan 1

Plan 2

$16.92

$23.08

$32.04

$43.14

$21.78

$29.34

$34.72

$46.52

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

61

APSB-22339(TX)-0320 FBS Frisco ISD

Page 1 of 4

GC 14 Limited Benefit Group Specified Disease Cancer Indemnity Insurance Benefits are only payable following a diagnosis of cancer for a loss incurred for the treatment of cancer while covered under the policy. A charge must be incurred for benefits to be payable. When coverage terminates for loss incurred after the coverage termination date, our obligation to pay benefits also terminates for a specified disease that manifested itself while the person was covered under the policy. All benefits are subject to the benefit maximums.

Cancer Treatment Benefits Eligibility

You and your eligible dependents are eligible to be insured under this certificate if you and your eligible dependents meet our underwriting rules and you are actively at work with the policyholder and qualify for coverage as defined in the master application. A covered person is a person who is eligible for coverage under the certificate and for whom the coverage is in force. An eligible dependent means your lawful spouse; your natural, adopted or stepchild who is under the age of 26; and/or any child under the age of 26 who is under your charge, care and control, and who has been placed in your home for adoption, or for whom you are a party in a suit in which adoption of the child is sought; or any child under the age of 26 for whom you must provide medical support under an order issued under Chapter 154 of the Texas Family Code, or enforceable by a court in Texas; or grandchildren under the age of 26 if those grandchildren are your dependents for federal income tax purposes at the time application for coverage of the grandchild is made.

Limitations and Exclusions

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

Only Loss for Cancer

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

Pre-Existing Condition Exclusion

No benefits are payable for any loss incurred during the pre-existing condition exclusion period, following the covered person’s effective date as the result of a pre-existing condition. Pre-existing conditions specifically named or described as excluded in any part of the policy are never covered. If any change to coverage after the certificate effective date results in an increase or addition to coverage, incontestability and pre-existing condition exclusion for such increase will be based on the effective date of such increase.

Termination of Certificate

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

Termination of Coverage

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

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

Surgical Benefits

Limitations and Exclusions

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

Patient Care Benefits Limitations and Exclusions

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

Only Loss for Cancer or Dread Disease

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

A hospital is not an institution, or part thereof, used as: a place of rehabilitation, a place for rest or for the aged, a nursing or convalescent home, a long-term nursing unit or geriatrics ward, or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients.

Termination of Surgical, Patient Care Benefit Riders

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

Internal Cancer First Occurrence Benefits

Pays a lump sum benefit amount when a covered person receives a first diagnosis of internal cancer. Only one benefit per covered person, per lifetime is payable under this benefit and the lump sum benefit amount will reduce by 50% at age 70.

Limitations and Exclusions

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

Pre-Existing Condition Exclusion

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

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GC 14 Limited Benefit Group Specified Disease Cancer Indemnity Insurance Termination

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

Heart Attack/Stroke First Occurrence Benefits

Pays a lump sum benefit amount when a covered person receives a first diagnosis of heart attack or stroke. Only one benefit per covered person per lifetime is payable under this benefit and the lump sum benefit amount will reduce by 50% at age 70.

Limitations and Exclusions

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

Pre-Existing Condition Exclusion

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

Termination

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

Hospital Intensive Care Unit Benefits

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

Limitations and Exclusions

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

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

Termination

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

Optionally Renewable

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

Portability Rider

When the portability rider is in effect and coverage is not continued under COBRA, you have the option to port your coverage when the policy terminated for a reason other than non-payment of premium or cancelation or termination of the policy by APL. Evidence of insurability will not be required. You must make an election to port coverage and submit the first premium due within 31 days from the date APL notified the policyholder of your termination of coverage. All future premiums will be billed directly to you. Portability coverage will be effective on the day after coverage ends under the policy and any applicable exclusion periods or incontestability periods not yet met under the current policy, will only apply for the period of time that remains.

The benefits, terms and conditions of the ported coverage will be the same as those under the policy immediately prior to the date the portability option was elected, except as stated in this paragraph. Once ported coverage is in effect, the termination of ported coverage section, as shown in the portability rider, prevails all other termination provisions of the policy, certificate and any attached riders. Your coverage levels cannot be increased or decreased. Ported coverage may include any eligible dependent(s) who were covered under the policy at the time of termination. No eligible dependent may be added to the ported coverage except as provided in the newborn and adopted child provision set out in your certificate. An eligible dependent may be removed at any time.

Premiums will be adjusted accordingly.

Termination of the policy will not terminate ported coverage. The benefits, terms and conditions of the ported coverage will be the same as if the group policy had remained in full force and effect, with no further obligation of the policyholder. Any premium collected beyond the termination date will be refunded promptly. This will not prejudice any claim that originated prior to the date termination took effect.

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APSB-22339(TX)-0320 FBS Frisco ISD

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2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606 Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete 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. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GC14 Series | TX | Limited Benefit Group Specified Disease Cancer Indemnity Insurance | (03/20) | FBS 64

APSB-22339(TX)-0320 FBS Frisco ISD

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65

UNUM

Critical Illness

YOUR BENEFITS PACKAGE

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

$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 66 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Frisco ISD Benefits Website: www.mybenefitshub.com/friscoisd

Critical Illness Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness.

Who is eligible for this coverage?

All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status).

What are the Critical The following coverage amounts are available.

Illness coverage amounts?

For you: Select one of the following Choice $10,000, $20,000 or $30,000 For your Spouse and Children: 50% of employee coverage amount Can I be denied coverage?

Coverage is guarantee issue.

When is coverage effective?

Please see your Plan Administrator for your effective date of coverage.

Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

What critical illness conditions are covered?

Covered Conditions* Percentage of Coverage Amount Critical Illnesses Coronary Artery Disease (major) 50% Coronary Artery Disease (minor) 10% End Stage Renal (Kidney) Failure 100% Heart Attack (Myocardial Infarction) 100% Major Organ Failure Requiring Transplant 100% Stroke Cancer Invasive Cancer (including all Breast Cancer) 100% Non-Invasive Cancer 25% Skin Cancer $500 Supplemental Critical Illnesses Benign Brain Tumor 100% Coma 100% Loss of Hearing 100% Loss of Sight 100% Loss of Speech 100% Infectious Disease 25% Occupational Human Immunodeficiency Virus (HIV) or Hepatitis 100% Permanent Paralysis 100% Progressive Diseases Amyotrophic Lateral Sclerosis (ALS) 100% Dementia (including Alzheimer’s Disease) 100% Functional Loss 100% Multiple Sclerosis (MS) 100% Parkinson’s Disease 100% Additional Critical Illnesses for your Children Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Down Syndrome 100% Spina Bifida 100% *Please refer to the policy for complete definitions of covered conditions.

Covered Condition Benefit The covered condition benefit is payable once per covered condition per insured.

Unum will pay a covered condition benefit for a different covered condition if: • the new covered condition is medically unrelated to the first covered condition; or • the dates of diagnosis are separated by more than 180 days.

Reoccurring Condition Benefit We will pay the reoccurring condition benefit for the diagnosis of the same covered condition if the covered condition benefit was previously paid and the new date of diagnosis is more than 180 days after the prior date of diagnosis.

The benefit amount for any reoccurring condition benefit is 100% of the percentage of coverage amount for that condition.

67

Critical Illness What critical illness conditions are covered?

The following Covered Conditions are eligible for a reoccurring condition benefit: Benign Brain Tumor Heart Attack (Myocardial Infarction) Coma Invasive Cancer (includes all Breast Cancer) Coronary Artery Disease (Major) Major Organ Failure Requiring Transplant Coronary Artery Disease (Minor) Non-Invasive Cancer End Stage Renal (Kidney) Failure Stroke Monthly Critical Illness Cost

How much does the coverage cost?

Option 1

Option 2

Option 3

$10,000 EE, $5,000 SP (Child Coverage included in Employee Cost)

$20,000 EE, $10,000 SP (Child Coverage included in Employee Cost)

$30,000 EE, $15,000 SP (Child Coverage included in Employee Cost)

Age

Employee Cost

Spouse Cost

Employee Cost

Spouse Cost

Employee Cost

Spouse Cost

Less than age 25

$1.90

$0.95

$3.80

$1.90

$5.70

$2.85

25-29

$2.70

$1.35

$5.40

$2.70

$8.10

$4.05

30-34

$3.80

$1.90

$7.60

$3.80

$11.40

$5.70

35-39

$5.70

$2.85

$11.40

$5.70

$17.10

$8.55

40-44

$8.00

$4.00

$16.00

$8.00

$24.00

$12.00

45-49

$11.00

$5.50

$22.00

$11.00

$33.00

$16.50

50-54

$14.30

$7.15

$28.60

$14.30

$42.90

$21.45

55-59

$19.80

$9.90

$39.60

$19.80

$59.40

$29.70

60-64

$28.30

$14.15

$56.60

$28.30

$84.90

$42.45

65-69

$41.50

$20.75

$83.00

$41.50

$124.50

$62.25

70-74

$65.30

$32.65

$130.60

$65.30

$195.90

$97.95

75-79

$96.80

$48.40

$193.60

$96.80

$290.40

$145.20

80-84

$141.60

$70.80

$283.20

$141.60

$424.80

$212.40

85 or over

$228.90

$114.45

$457.80

$228.90

$686.70

$343.35

Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date.

Spouse rate is based on your Spouse’s insurance age, which is their age immediately prior to and including the anniversary/ effective date.

Do my critical illness insurance benefits Critical Illness benefits do not decrease due to age. decrease with age?

Are there any exclusions or limitations?

68

We will not pay benefits for a claim that is caused by, contributed to by, or occurs as a result of any of the following: • committing or attempting to commit a felony; • being engaged in an illegal occupation or activity; • injuring oneself intentionally or attempting or committing suicide, whether sane or not; • active participation in a riot, insurrection, or terrorist activity. This does not include civil commotion or disorder, injury as an innocent bystander, or Injury for self-defense; • participating in war or any act of war, whether declared or undeclared; • combat or training for combat while serving in the armed forces of any nation or authority, including the National Guard, or similar government organizations; • voluntary use of or treatment for voluntary use of any prescription or non- prescription drug, alcohol, poison, fume, or other chemical substance unless taken as prescribed or directed by the Insured’s Physician; • being intoxicated; and • a Date of Diagnosis that occurs while an Insured is legally incarcerated in a penal or correctional institution.

Additionally, no benefits will be paid for a Date of Diagnosis that occurs prior to the coverage effective date.

Critical Illness Are there any exclusions or limitations?

Pre-existing Conditions We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following: • a pre-existing condition; or • complications arising from treatment or surgery for, or medications taken for, a pre-existing condition.

An insured has a pre-existing condition if, within the 3 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which: • medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period; • drugs or medications were taken, or prescribed to be taken during that period; or • symptoms existed.

The pre-existing condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date any initial coverage or increases in coverage become effective.

Is the coverage portable (can I keep it if I leave my employer)?

If you have been insured for at least 12 months and your employment with your employer ends or you are no longer in an eligible group you can apply for ported coverage and pay the first premium within 31 days to continue coverage for yourself, your spouse and your children.

If your spouse’s coverage ends as a result of your death, divorce or annulment, your spouse may elect to continue spouse and children coverage, as long as premium is paid as required.

When does my coverage end?

If you choose to cancel coverage, it will end on the first of the month following the date you provide notification to your employer.

Otherwise, coverage ends on the earliest of: • the date the policy is cancelled by your employer; • the date you no longer are in an eligible group; • the date your eligible group is no longer covered; • the date of your death • the last day of the period any required contributions are made; • the last day you are in active employment.

If you choose to cancel your Spouse’s coverage, it will end on the first of the month following the date you provide notification to your employer.

Otherwise, your spouse’s coverage will end on the earliest of: • the date your coverage ends; • the date your spouse is no longer eligible for coverage; • the date your spouse no longer meets the definition of a spouse; • the date of your spouse’s death; or • the date of divorce or annulment.

Your children’s coverage will end on the earliest of: • the date your coverage ends; • the date your children are no longer eligible for coverage; or • the date your children no longer meet the definition of children.

The limited benefits provided are a supplement to major medical coverage and are not a substitute for major medical coverage or other minimal essential coverage as required by federal law. Lack of minimal essential coverage may result in an additional tax payment being due.

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form GCIP16-1 et al or contact your Unum representative. © 2017 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

69

5STAR

Individual Life

YOUR BENEFITS PACKAGE

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.

1/3 of Americans would be financially impacted by the loss of the primary wage earner in just one month.

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

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

71

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 72

$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

73

IDENTITY GUARD

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

Identity Theft Help protect yourself with the most powerful, comprehensive identity theft protection available today Identity Guard combines the best of traditional identity theft monitoring solutions, with the powerful processing of IBM Watson technology.

We scan billions of online sources to assess your risk and suggest ways to reduce your exposure.

Personal Cybersecurity to Alert You to: 1) Personal habits that put you at greater risk than the average person 2) Threats due to companies getting hacked and losing your personal information, phishing scams, and more 3) Your personal information being used to open new accounts and access existing accounts We Work Around the Clock to Help Protect You • Dedicated Support: Makes a stressful situation as easy as possible to resolve.

• $1 Million Insurance with Stolen Funds Reimbursement:4 You are covered from any losses or stolen funds.

• Cover the Entire Household: Family plans cover all adults and children residing within your household.

• Leading Technology: Alerts in as few as three seconds, billions of pieces of information monitored, and IBM Watson artificial intelligence (AI) technology.

1 2014 Identity Fraud Study,” Javelin Strategy & Research 2014 2 2018 Javelin Strategy & Research, ID Fraud Study 3 2016 Cost of Data Breach Study, Ponemon Institute, 2017 4 Identity Theft Insurance underwritten by insurance company subsidiaries or affiliates of American International Group‚ Inc. The description herein is a summary and intended for informational purposes only and does not include all terms‚ conditions and exclusions of the policies described. Please refer to the actual policies for terms‚ conditions and exclusions of coverage. Coverage may not be available in all jurisdictions.

5 The score you receive with Identity Guard is provided for educational purposes to help you understand your credit. It is calculated using the information contained in your TransUnion credit file. Lenders use many different credit scoring systems, and the score you receive with Identity Guard is not the same score used by lenders to evaluate your credit.

Did You Know?

1

• ID theft happens every two seconds 2 • Account takeover fraud tripled in 2018 3 • 16.7M victims in 2017

The Essential Employee Benefit Choose the plan that works best for you.

TOTAL PREMIER All Plans Include (1 Bureau) (3Bureau) ✓ ✓ IBM Watson AI $1 Million insurance with stolen ✓ ✓ funds reimbursement4 ✓ ✓ U.S.-based customer care ✓ ✓ Risk management score ✓ ✓ Online identity dashboard ✓ ✓ Mobile application We’ll Alert You Of Your personal information on the ✓ ✓ dark web High-risk transactions like account ✓ ✓ takeovers and tax refunds Potential threats detected by IBM ✓ ✓ Watson AI Requests to open checking or ✓ ✓ savings accounts with your information ✓ ✓ Monthly credit score5 Credit Bureau Monitoring Bank ✓ ✓ account takeovers ✓ 3-bureau credit report Additional Tools for Protection ✓ ✓ Anti phishing mobile app ✓ ✓ Safe browsing extension ✓ Social insight report Family Plan Additional Features Your child’s information on the dark ✓ ✓ web ✓ ✓ Cyberbullying on social media Plan Pricing Just Yourself

You and Your Family

TOTAL $7.70 / month $13.55 / month

PREMIER $9.60/ month $17.40/ month

To learn more, go to: identItyguard.com

75

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

Medical Transport Emergency Transportation Costs

Our Benefits

MASA MTS is here to protect its members and their families from the shortcomings of health insurance coverage by providing them with comprehensive financial protection for lifesaving emergency transportation services, both at home and away from home.

Benefit*

Emergent Plus

Emergent Ground Transportation

U.S./Canada

Emergent Air Transportation

U.S./Canada

Many American employers and employees believe that their health insurance policies cover most, if not all ambulance expenses. The truth is, they DONOT!

Non-Emergent Air Transportation

U.S./Canada

Repatriation

U.S./Canada

Even after insurance payments for emergency transportation, you could receive a bill up to $5,000 for ground ambulance and as high as $70,000 for air ambulance. The financial burdens for medical transportation costs are very real.

* Please refer to the MSA for a detailed explanation of benefits and eligibility

Any Ground. Any Air. Anywhere.™

How MASA is Different

A MASA Membership prepares you for the unexpected and gives you the peace of mind to access vital emergency medical transportation no matter where you live, for a minimal monthly Across the US there are thousands of ground ambulance fee. providers and hundreds of air ambulance carriers. ONLY MASA offers comprehensive coverage since MASA is a PAYER and not a • One low fee for the entire family • NO deductibles PROVIDER! • NO health questions • Easy claims process ONLY MASA provides over 1.6 million members with coverage for BOTH ground ambulance and air ambulance transport, For more information, please contact REGARDLESS of which provider transports them.

Your Broker or MASA Representative Members are covered ANYWHERE in all 50 states and Canada!

EVERY FAMILY DESERVES A MASA MEMBERSHIP Additionally, MASA provides a repatriation benefit: if a member is hospitalized more than 100 miles from home, MASA can arrange and pay to have them transported to a hospital closer to their place of residence.

77

GotZoom

Student Loan Repayment Assistance

YOUR BENEFITS PACKAGE

About this Benefit Student Loan Debt in the United States currently exceeds $1.4 trillion dollars. If you are one of the millions of Americans that are stressed and struggling with high levels of student loan debt, GotZoom is the perfect solution to give you much needed student loan relief.

The average student loan debt is around

$38,000

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

GotZoom

Reduce your student loan debt by 65% The Facts:

• Educators and Public Service employees enjoy special status with the Department of Education (DOE) and are eligible for the best available student loan repayment and loan forgiveness programs • Only 2 in 10 borrowers take advantage of the programs • $350 Million of additional DOE funding became available in Mar. 2018 (first come, first serve)

GotZoom Average Annual Student Loan Payment Reduction

The Best Solution: GotZoom was created to fill a critical void. Student loan debt is our country' second largest debt class behind mortgages • With nearly 70 federal student loan repayment and forgiveness programs in place today the options to reduce your student debt are exceptional • GotZoom finds the best program options that suit your needs, confirms eligibility and facilitates all the administration

•

What’s GotZoom? •

Where to Start

Employee Benefits

$468

$5,616

GotZoom Average Monthly Student Loan Payment Reduction

The leader in student debt reduction services An established company with a seven year track record of performance and customer satisfaction

•

Go to the enrollment page: https://mystudentloan2.net/1/?broid=00002000

•

Click on Enroll Now

•

Average student debt reduction of 65%

•

All administrative details are managed by GotZoom for the employee

•

GotZoom monitors DOE programs and reviews the employee's status annually to find any additional debt reduction options

•

Employee's loan analysis and Benefits Summary are free (no obligation)

Service Fee • •

Service fees apply only after the employee has reviewed and approved repayment/ forgiveness programs Application Fee: $307. Annual Fee: $359.40 (Monthly Option: $32.95)

79

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.

FLIP TO… FOR HSA VS. FSA COMPARISON

PG. 13

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

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 Annual taxable income $24,000 $24,000 cases, the taxpayer identification number of the service 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 Taxable income after FSA $21,000 $24,000 want and how much contributions should go toward each Income taxes -$6,300 -$7,200 benefit. It is very important that you make these choices carefully based on what you expect to spend on each covered After-tax income $14,700 $16,800 benefit or expense during the plan year. $0 -$3,000 Generally, you cannot change the elections you have made after After-tax health and welfare expenses Take-home pay $14,700 $13,800 the beginning of the plan year. However, there are certain limited situations when you can change your elections if you You saved $900 $0 have a "change in status". Please refer to your Summary Plan Description for a change in status listing.

Plan Highlights Flexible Spending Plans

81

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

82

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).

83

Section 125 Cafeteria Plan INTRODUCTION In this section you will find an overview of the district’s Section 125 Cafeteria Plan, available through Financial Benefit Services, LLC.

SPECIAL RULES REGARDING FRISCO ISD SECTION 125 CAFETERIA PLAN

Mid-year changes in benefit elections can occur only if you experience a family status change, as detailed in this benefit guide. You must present proof of a family status change to the Frisco ISD benefits office within 30 days of your family status WHAT IS A CAFETERIA PLAN? change and meet with benefit office staff to complete and sign It allows you to deduct certain premium amounts for benefits the necessary paperwork in order to make any benefit election from your gross earnings before federal withholding taxes are changes. figured. It is a way for you to pay for certain benefits while lowering your taxable income. Please see the following “sample There are two very important issues to keep in mind: 1. Although all coverage is voluntary (you may pick and paycheck,” which illustrates the benefit of participating in choose), every employee is required to sign their Section Section 125.

125 Benefit Election Form, even if they select no benefits or choose to keep current benefits the same.

WHAT BENEFITS ARE AVAILABLE? 2. All benefit elections will remain in effect and cannot be A summary of available benefits follows. Please read all revoked or changed during the current plan year, information carefully and always refer to the brochure on a September 1, 2019 through August 31, 2020, unless you particular coverage for more detailed information. have one of the following changes in family status: HOW DO I ENROLL? • Marriage An open enrollment period will take place at approximately the • Divorce same time each year at which time you may make changes to • Birth your benefits and/or add new benefits.

• Adoption • Death CHANGES TO BENEFITS • Termination or change in employee or spouse’s Mid-year changes in benefit elections can occur only if you employment. (A change in the number of hours experience a family status change, as detailed in this benefit worked per week) guide. You must present proof of a family status change to the • Change in eligibility status of a dependent.

Frisco ISD benefits office within 30 days of your family status (Dependent attains maximum age and/or ceases to change and meet with benefit office staff to complete and sign meet full-time student status) the necessary paperwork in order to make any benefit election • Loss or curtailment in health coverage of an changes. employee or spouse due to change in spouse’s employment, upon meeting a required eligibility The example below shows how a married employee claiming one period. exemption saves taxes when he/she pays for his/her insurance 3. New hires must make benefit elections within 30 days from coverages on a pre-tax basis. their date of hire. After 30 days, an employee will not be allowed to enroll in benefits until the next open enrollment WITHOUT SECTION 125 WITH SECTION 125 period without a family status change.

Monthly Salary Less TRS

$2,000 -128

Monthly Salary Less TRS Less Insurance

$2,000 -128 -250

Taxable Income Less Taxes Less Insurance

$1,872 -261 -250

Taxable Income Less Taxes

$1,622 -223

TAKE HOME PAY

$1,361

TAKE HOME PAY

$1,399

You save $38 per month in taxes by paying for your benefits on a pre-tax basis. This means more spendable income at the end of the month to use for additional benefits or to increase your take home pay.

84

TOLL-FREE HELP LINE AVAILABLE In an effort to give you a faster response to questions concerning your benefits, there is a toll-free number to call. If you have a question concerning how your benefits work, how to file a claim, or if you need other policy information, call Financial Benefit Services, LLC at 469-385-4685 / 800-583-6908. For information on the medical and dependent care reimbursement accounts, call NBS at (800) 274-0503.

Frisco ISD Wellness Program FISD will reimburse 50% of an individual fitness membership, up Reimbursement Calendar: to $22.50 per month. To be eligible for reimbursement, Eduphoria Form Reimbursement Date employees must access a fitness center or group fitness program Attendance Month Due Date at least 10 days per calendar month. The benefit will be available September October 15th November 15th to all FISD employees working in a position that guarantees 20 th October November 15 December 15th hours per week or more. th November December 15 January 15th th December January 15 February 15th Membership Reimbursement for the Frisco Athletic Center and January February 15th March 15th Frisco/McKinney YMCA: th February March 15 April 15th Frisco ISD has partnered with the Frisco Athletic Center and the th March April 15 May 15th YMCA’s located in Frisco and McKinney to offer membership th April May 15 June 15th benefits to FISD employees. Membership reimbursements for these locations will be paid monthly in the employee’s paycheck.

May June 15th July 15th th To take advantage of this benefit: June July 15 August 15th th • Enroll as a member at one of the participating facilities. Be July August 15 September 15th th sure to provide the facility with your FISD employee ID # at August September 15 October 15th the time of enrollment. An ID card will be issued by the Important Notes Regarding non-FISD partner gyms, fitness facility. centers and fitness programs: • Scan the identification card each time the facility is used.

• In order to qualify for reimbursement the gym, fitness • Access the facility a minimum of 10 days per calendar center or program must be geared towards exercise, sports, month. and/or other physical activities.

• The City of Frisco and the YMCA will monitor attendance of • Fitness centers geared towards a specific activity or FISD employees per calendar month. discipline, such as pilates or yoga, do qualify for • Attendance records will be reported to FISD Benefit reimbursement as long as documentation from the center is Department. clear regarding the type of activity provided.

• Reimbursements for participation will be paid one month in • Fitness programs, such as Camp Gladiator, will also qualify arrears. for reimbursement as long as documentation of attendance • Reimbursements will appear on checks issued on the 15th can be provided. Documentation must be provided by the of each month. program.

Membership Reimbursement for other Gyms, Fitness Centers or • Proof of payment must be a physical receipt from the gym, fitness center, or fitness program documenting the period Group Fitness Programs: covered by the payment. Screen shots of credit card or bank FISD will reimburse a portion of the cost of an individual fitness draft transactions will only be accepted if the transaction membership for fitness centers or programs that are not description matches the vendor’s name. partnered with the district. Reimbursement will be limited to the lesser of 50% or $22.50 per month and will be the responsibility • Employees may only be reimbursed for one membership per month. Employees participating in the program with the of the employee to submit paperwork for reimbursement. To Frisco Athletic Center or YMCA will not be eligible to be take advantage of this benefit: reimbursed for additional fitness programs via the employee • Enroll as a member at any gym, fitness center, or group reimbursement form. fitness program. (To be eligible for reimbursement for a fitness program, the program must be able to provide you with written documentation of attendance.)

• Each month, fill out the “Wellness Reimbursement” form in Eduphoria, available on the Resource Center, and attach proof of payment and proof of at least 10 days attendance per calendar month.

• The form and related attachments must be submitted by the 15th of each month for the prior month’s reimbursement.

Reimbursement requests must be submitted monthly.

Reimbursements will not be processed if requests are not submitted by the deadline for that month. See the calendar below for submission deadlines.

• Reimbursements will appear on checks issued on the 15th of each month.

85

Retirement Planning Frisco ISD

Summary Plan Description

Plan Type

Plan Administrator

Excluded Employees

Internal Revenue Code Section 403(b) Admin

TCG Administrators

No Exclusions

Plan Password for Enrolling Online

Written Plan Effective Date

frisc403

1/1/2009

Contribution Sources

Contribution Limit

Catch-Up Contribution Limit

Pre-Tax and Roth

$19,000

$6,000 for employees age 50+

Exchanges in Plan

Transfers Into Plan

Transfers Out of Plan

Available only with companies listed in Appendix I

Available from another employers 403(b) Admin plan

Not Available

Distributions

Loans

Automatic Distributions

Available under the following conditions: Separation of Service, Age 59 1/2, Death, Disability, or Retirement

Available, subject to availability and any additional conditions applied by individual vendors

Not available

Hardship

Disability

Beneficiaries

Available if request meets IRS definition pursuant to 1.401(k)- 1(d)(3)(iii)(B) of the Income Tax Regulations

Designated by each vendor and not by the 403(b) plan.

Designated by each vendor and not by the 403(b) Admin plan.

Administrative Fees

Fees Paid By

Texas ($1.50)

Employer

Automatic Enrollment Not Available

For more information please contact TCG Administrators, the Plan Administrator, at 800-943-9179

This document is designed to inform Participants about the Plan in non-technical language. Every attempt is made to convey the Plan accurately. If anything in this Summary Plan Description varies from the Plan Documents, Plan Documents govern.

86

Retirement Planning Frisco ISD

Summary Plan Description

Plan Type

Plan Administrator

Excluded Employees

Internal Revenue Code Section 457(b) -

TCG Administrators

No Exclusions

Plan Password for Enrolling Online

Plan Effective Date

frisc457

7/1/2007

Contribution Sources

Contribution Limit

Catch-Up Contribution Limit

Employee Only

$19,000 per year

$6,000 for employees age 50+

Rollovers Into Plan

Rollovers Out of Plan

Available from another qualified plan

Available to another qualified plan, upon termination of service

Distributions

Unforeseeable Emergency Distributions

Available for the following: - Separation - Death - Disability

Inactivity Distributions

Available as defined by the IRS for this type of plan

Available for accounts with balances of less than $5,000, and no activity for 2 years

Loans

Beneficiaries

Grandfathered Vendors

Available, see the Loan Agreement and Application Form

A Designation of Beneficiary Form is only required if Spouse is not the Primary Beneficiary

AUL/ One Source (contact AUL regarding any questions about the fees for these accounts)*

TCG Administrators, TPA $22.00 per participant per year 0.25% of assets, paid by the participants (capped at $150,000 in assets)

TCG Advisors, Investment Advisor 0.42% of assets, paid by participant

Other Fees $30 Distribution Fee $50 Loan Set up All of the above paid by participant

Matrix Trust Custodian/Trustee 0.10%, paid by participant

ESC Region 10, Plan Coordinator

Fees of Service Plan Providers

For more information please contact TCG Administrators, the Plan Administrator, at 800-943-9179

This document is designed to inform Participants about the Plan in non-technical language. Every attempt is made to convey the Plan accurately. If anything in this Summary Plan Description varies from the Plan Documents, Plan Documents govern.

87

Retirement Planning Frisco ISD

Summary Plan Description

Plan Type

Plan Administrator

Eligible Employees

Internal Revenue Code Section 401(a)

TCG Administrators a 403

Employees who contribute to (b) or 457(b) with Frisco ISD

Online Account Access

Written Plan Effective Date

Plan Year End

To view your account online:  go to www.region10rams.org click “Login” and select your Employer from the navigation bar Under the 401(a) tab, click “Login” The User ID is your SSN; the Password is your date of birth (mmddyyyy)

9/1/2006

12/31

Matching Contribution Rules Effective September 1, 2011, the Employer will match any contribution made to a 403(b) or 457(b) on behalf of the participant into the 401(a) account: Base Match is 25% of contribution up to 1% of Base Salary

Vesting Contributions made to a Plan Participant’s account are subject to vesting requirements (the ownership of the contributions and earnings). The following schedule shows when a Participant will become the owner of the account balance.

Yr 1 0%

Years of Service – Vesting % Yr 2 Yr 3 Yr 4 Yr 5 0% 50% 75% 100%

Distributions

Loans

Automatic Distributions

Available for the following conditions: InService, Separation of Service, Death, Disability, or Retirement

Not Available

Not Available

Hardship

Disability

Beneficiaries

Not Available

Determined by TRS

Record Keeper - TCG

TCG Advisors, LP – Investment Advisor paid Sliding Scale (.45%-.25% of assets) Currently .40% Paid from plan assets

ESC Region 10 - Plan Coordinator $.10 per participant per month,

by Frisco ISD

Administrative Fees TCG Administrators - Record Keeper $1.40 per participant per month Paid

by Frisco ISD Matrix Trust - Custodian .10% of assets paid by plan assets

Distribution Fee $30, paid by the participant

For more information please contact TCG Administrators, the Plan Administrator at 1 (800) 943-9179

This document is designed to inform Participants about the Plan in non -technical language. Every attempt is made to convey the Plan accurately. If anything in this Summary Plan Description varies from the Plan Documents, Plan Documents govern 88

Frisco ISD Additional Employee Benefits Retirement Benefit/State & Local Days When an employee with ten or more years of service with FISD officially retires from the Teacher Retirement System of Texas and is no longer employed by the District, the employee shall be reimbursed for unused, accumulated State and Local leave days at a rate of $50.00 per day not to exceed a maximum of $5,000.00.

Sick Leave Bank The purpose of the Sick Leave Bank is to provide additional sick leave to members of the Bank in the event of a serious extended illness, surgery, or a temporary disability due to an injury. Days may be requested from the Bank only after the member has exhausted all accumulated state and local sick leave days. All District employees who work a minimum of 20 hours per week and are in an allocated budgetary position are eligible for membership. Membership in the Sick Leave Bank is voluntary. To become a member of the bank, an employee must contribute three days from his/her accrued local leave. Please visit the Resource Center at www.friscoisd.org/staff and search for Sick Leave Bank to review the official handbook that includes detailed information on eligibility, joining and applying for leave days.

403B/457 Voluntary Retirement Information This is to inform you that Frisco ISD offers 403B and 457 Voluntary Retirement plans to its employees. These plans allow employees to save designated amounts of their paychecks before tax and place them into a variety of mutual funds, variable annuities and fixed annuities. All funds grow tax deferred until withdrawn and are intended to supplement your TRS Pension Plan.

As an FISD employee, you are eligible to participate in these plans through salary deferral. Please visit http://tcgservices.com for detailed information and enrollment instructions or contact the FISD Third Party Administrator:

TCG Group Holdings 900 South Capital of Texas Hwy, Suite 350 Austin, TX 78746 800-943-9179

89

NOTES

90

NOTES

91

WWW.MYBENEFITSHUB.COM/FRISCOISD 92