Page 1

LEWISVILLE ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2021 - 8/31/2022 WWW.LISD.NET/BENEFITS 1


Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 2021-22 LISD Medical Rates TRS Medical Aflac Hospital Indemnity MetLife Dental UnitedHealthCare Vision EECU Health Savings Account (HSA) Cigna Disability UNUM Life and AD&D Texas Life Individual Life Insurance Cigna Critical Illness MASA MTS Emergency Medical Transportation LegalEase Legal Services NBS Flexible Spending Account (FSA) LISD Sick Leave Bank 2

3 4-5 6-11 6 7 8 9 10

FLIP TO... PG. 4

HOW TO ENROLL

PG. 6

SUMMARY PAGES

PG. 12

YOUR BENEFITS

11 12-13 14-15 16-19 20-25 26-29 30-31 32-37 38-43 44-45 46-51 52-53 54-55 56-59 60-61


Benefit Contact Information LEWISVILLE ISD BENEFITS

DENTAL

LIFE AND AD&D

Financial Benefit Services (469) 385-4640 www.LISD.net/Benefits

MetLife (800) 942-0854 www.metlife.com/dental

Unum (800) 583-6908 www.unum.com

MEDICAL: TRS ACTIVECARE

VISION

FLEXIBLE SPENDING ACCOUNT

BCBSTX (866) 355-5999 www.bcbstx.com/trsactivecare

UnitedHealthCare (800) 638-3120 www.myuhcvision.com

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

MEDICAL: HMO

DISABILITY

HEALTHCARE SAVINGS ACCOUNT

North and Central Texas Scott & White HMO (800) 321-7947 www.trs.swhp.org

Cigna (800) 362-4462 www.cigna.com

EECU (817) 882-0800 www.eecu.org

HOSPITAL INDEMNITY

EMERGENCY MEDICAL TRANSPORTATION

COBRA (DENTAL & VISION)

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

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

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

CRITICAL ILLNESS

INDIVIDUAL LIFE

COBRA (TRS MEDICAL)

Cigna (800) 362-4462 www.cigna.com

Texas Life (800) 283-9233 www.texaslife.com

bswift (833) 682-8972

LEGAL SERVICES LegalEase (800) 248-9000 https://www.legaleaseplan.com/lisd

TRS-Care Standard for Non-Medicare Retirees: https://www.trs.texas.gov/Pages/ healthcare_trs_care.aspx TRS-Care for Medicare Retirees: https://www.trs.texas.gov/Pages/ healthcare_trs_care_medicare.aspx

3


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

and get access to everything you need to complete your benefits enrollment:

“FBS LISD” to (800) 583-6908 OR SCAN

Enrollment Resources

Online Support

Interactive Tools

And more!

App Group #: FBSLISD

4

Text


How to Log In Login Instructions: 1) Go to: www.LISD.net/Benefits 2) Click the “My Benefits Logo” or under the BENEFIT INFO

“Access Online” box in blue click on “click here to use the Online Benefit System” 3) Enter your LISD username and password

4) Select THEbenefitsHUB icon If you have difficulty accessing the system please contact 469-948-8104 or email: INTERACTIVE TOOLS

benefits@lisd.net

Username: District Username ONLINE SUPPORT

Default Password: District Password

5


Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New: TRS-ACTIVECARE - KEY PLAN CHANGES AC Primary: This plan still has the lowest monthly costs and copays. Your Primary Care Provider copay is $30 and TRS Virtual Health is $0.

We are excited to announce that LISD is able to offer lower rates for dental, disability, critical illness and hospital indemnity. Also, all benefit eligible employees are eligible to elect or increase life insurance up to the Guarantee Issue amount without having to answer health questions.

AC Primary+: This plan still has copays and the lowest deductibles, maximum out-of-pockets, and coinsurance rates. Your Primary Care Provider copay is Metlife Dental (New) Cigna Disability $30 and TRS Virtual Health is $0.

AC HD: In-network deductible rose by $200 for individuals and $400 for families. In-network coinsurance increased rose from 20% to 30% and Outof-network rates increased from 40% to 50%. Innetwork maximum out-of-pocket rose by $100 for individuals and $200 for families. AC 2: Remains closed to new enrollees. Central and North Texas Scott & White Care Plan: EO and EC - $9/ month premium decrease! Deductible increasing to $1,150 Individual/$3,450 Family. Rx Deductible increasing to $200 (excludes generics). Generic copay increase to $10/$25.

Rate Decrease Rate Decrease

(New) Cigna Critical Illness

Rate Decrease

Aflac Hospital Indemnity

Rate Decrease

Unum Group Term Life

Enhanced Coverage Options

UHC Vision

No Rate or Plan Changes

Texas Life Insurance

No Rate or Plan Changes

LegalEase Legal Services

No Rate or Plan Changes

MASA Medical Transportation No Rate or Plan Changes Sick Leave Bank

No Change for 2021-2022

FSA/Dependent Care

NBS New Plan Administrator

Health Savings Account

EECU New Plan Administrator

Important Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202 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).

6


SUMMARY PAGES

Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. The funds are automatically deducted from your paycheck on a pre-tax basis. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.

CHANGES IN STATUS (CIS):

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 31 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

QUALIFYING EVENTS

Marital Status

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

Change in Number of Tax Dependents

A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.

Change in Status of Employment Affecting Coverage Eligibility

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

An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements Gain/Loss of Dependents' under an employer's plan may include change in age, student, marital, employment or tax dependent Eligibility Status status. If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order Judgment/Decree/Order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage. Eligibility for Government Programs

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

7


SUMMARY PAGES

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

Where can I find forms?

to review, change or continue benefit elections each year.

For benefit summaries and claim forms, go to your school

Changes are not permitted during the plan year (outside of

district’s benefit website:

annual enrollment) unless a Section 125 qualifying event occurs.

www.LISD.net/Benefits. Click on the benefit plan you need information on (i.e., Dental) and you can find the forms you

Changes, additions or drops may be made only during the

need under the Benefits and Forms section.

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

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

For Network Providers go to district's benefit website: www.LISD.net/Benefits. Click on the benefit plan you need

included in the dependent profile. Additionally, you must

information on (i.e., Dental) and you can find provider search

notify your employer of any discrepancy in personal and/or

links under the Quick Links section.

benefit information. When will I receive ID cards?

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

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

New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 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. For medical benefit questions, please contact TRS ActiveCare at 866-355-5999 or Baylor Scott White at 844-633-5325 for assistance. 8

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 15 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

BCBSTX

26

Dental

MetLife

26

Vision

UHC

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.

Hospital Indemnity

Aflac

26

Life and AD&D

UNUM

26

Individual Life

Texas Life

26

Critical Illness

UNUM

26

Emergency Medical Transport

MASA MTS

26

HSA

EECU

IRS Dependent covered on your HDHP.

FSA

NBS

IRS Dependent

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. 9


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

either at one of the employer’s usual places of business or at

who have contracted with the plan as a network provider.

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

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

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.

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

Calendar Year

orders to take drugs, or received medical care or services

January 1st through December 31st

(including diagnostic and/or consultation services).

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.

10


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) $7,200 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

PG. 30

FLIP TO FOR FSA INFORMATION

PG. 56 11


2021-22 LISD Medical Rates TRS ActiveCare Medical Plan Name

TRS Total (Monthly)

District Contribution (Monthly)

Employee Rate (Monthly)

Employee Rate Employee Rate (Semi-Monthly) (19 Pay)

ActiveCare HD EE (employee only) ES (employee + spouse) EC (employee + child(ren) FAM (family) ActiveCare HD Split Premium Primary (Family) ActiveCare HD Pooling Primary Secondary

$429.00

$326.00

$103.00

$51.50

$65.05

$1,209.00

$388.00

$821.00

$410.50

$518.53

$772.00

$372.00

$400.00

$200.00

$252.63

$1,445.00

$393.00

$1,052.00

$526.00

$664.42

SPOUSE WORKS IN A DIFFERENT PARTICIPATING DISTRICT $722.50

$393.00

$329.50

$164.75

$208.11

BOTH WORK FOR LISD AND ONE DECLINES COVERAGE $1,445.00

$393.00

$717.00

$358.50

$452.84

$0.00

$335.00

$0.00

$0.00

$0.00

$417.00

$326.00

$91.00

$45.50

$57.47

$1,176.00

$388.00

$788.00

$394.00

$497.68

$751.00

$372.00

$379.00

$189.50

$239.37

$1,405.00

$393.00

$1,012.00

$506.00

$639.16

ActiveCare Primary EE (employee only) ES (employee + spouse) EC (employee + child(ren) FAM (family) ActiveCare Primary Split Premium Primary (Family) ActiveCare Primary Pooling

Primary Secondary

SPOUSE WORKS IN A DIFFERENT PARTICIPATING DISTRICT $702.50

$393.00

$309.50

$154.75

$195.47

BOTH WORK FOR LISD AND ONE DECLINES COVERAGE

$1,405.00

$393.00

$677.00

$338.50

$427.58

$0.00

$335.00

$0.00

$0.00

$0.00

$542.00

$358.00

$184.00

$92.00

$116.21

$1,334.00

$388.00

$946.00

$473.00

$597.47

$879.00

$372.00

$507.00

$253.50

$320.21

$1,675.00

$393.00

$1,282.00

$641.00

$809.68

ActiveCare Primary+ EE (employee only) ES (employee + spouse) EC ( employee + child(ren) FAM (family) ActiveCare Primary+ Split Premium Primary (Family) ActiveCare Primary+ Pooling Primary

SPOUSE WORKS IN A DIFFERENT PARTICIPATING DISTRICT $837.50

$393.00

$444.50

$222.25

$280.74

BOTH WORK FOR LISD AND ONE DECLINES COVERAGE $1,675.00

$393.00

$947.00

$473.50

$598.11

$0.00

$335.00

$0.00

$0.00

$0.00

EE (employee only)

$1,013.00

$358.00

$655.00

$327.50

$413.68

ES (employee + spouse)

$2,402.00

$388.00

$2,014.00

$1,007.00

$1,272.00

EC (employee + child(ren)

$1,507.00

$372.00

$1,135.00

$567.50

$716.84

FAM (family)

$2,841.00

$393.00

$2,448.00

$1,224.00

$1,546.11

Secondary ActiveCare 2

ActiveCare 2 Split Premiums Primary (Family) ActiveCare 2 Pooling Primary Secondary

12

SPOUSE WORKS IN A DIFFERENT PARTICIPATING DISTRICT $1,420.50

$393.00

$1,027.50

$513.75

$648.95

BOTH WORK FOR LISD AND ONE DECLINES COVERAGE $2,841.00

$393.00

$2,113.00

$1,056.50

$1,334.53

$0.00

$335.00

$0.00

$0.00

$0.00


2021-22 LISD Medical Rates TRS Medical Plan Name

TRS Total (Monthly)

District Contribution (Monthly)

Employee Rate (Monthly)

$542.48

$358.00

$184.48

$92.24

$116.51

$1,362.70

$388.00

$974.70

$487.35

$615.60

$872.16

$372.00

$500.16

$250.08

$315.89

$1,568.42

$393.00

$1,175.42

$587.71

$742.37

$195.61

$247.08

Employee Rate Employee Rate (Semi-Monthly) (19 Pay)

HMO - Scott & White Health Plan EE (employee only) ES (employee + spouse) EC (employee + child(ren) FAM (family) Scott & White Split Premiums Primary (Family) Scott & White Pooling Primary Secondary

SPOUSE WORKS IN A DIFFERENT PARTICIPATING DISTRICT $784.21

$393.00

$391.21

BOTH WORK FOR LISD AND ONE DECLINES COVERAGE $1,568.42

$393.00

$840.42

$420.21

$530.79

$0.00

$335.00

$0.00

$0.00

$0.00

13


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.

14

• • • • •

$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 15


AFLAC 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 16 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Lewisville ISD Benefits Website: www.LISD.net/Benefits


Hospital Indemnity Plan Aflac Hospital Indemnity Plan Monthly Rates for Lewisville ISD Premium Rates Monthly Premiums Coverage

Premiums

Employee

$17.44

Employee and Spouse

$33.09

Employee and Child(ren)

$26.78

Family

$42.43

Aflac Group Hospital Indemnity Insurance Even a small trip to the hospital can have a major impact on your finances. Here’s a way to help make your visit a little more affordable.

The plan that can help with expenses and protect your savings. Does your major medical insurance cover all of your bills? Even a minor trip to the hospital can present you with unexpected expenses and medical bills. And even with major medical insurance, your plan may only pay a portion of your entire stay. That’s how the Aflac Group Hospital Indemnity plan can help. It provides financial assistance to enhance your current coverage. It may help avoid dipping into savings or having to borrow to address out-ofpocket-expenses major medical insurance was never intended to cover. Like transportation and meals for family members, help with child care, or time away from work, for instance. The Aflac Group Hospital Indemnity plan benefits include the following: • Hospital Confinement Benefit • Hospital Admission Benefit • Successor Insured Benefit and more

How it works

$1,400 Amount payable was generated based on benefit amounts for: Hospital Admission ($1,000), and Hospital Confinement ($100 per day).

BENEFITS OVERVIEW BENEFIT AMOUNT HOSPITAL ADMISSION BENEFIT per confinement (once per covered sickness or accident per calendar year for each insured) Payable when an insured is admitted to a hospital and confined as an in-patient because of a covered accidental injury or covered sickness. We will not pay benefits for confinement to an observation unit, or for emergency room $1,000 treatment or outpatient treatment. We will not pay benefits for admission of a newborn child following his birth; however, we will pay for a newborn’s admission to a Hospital Intensive Care Unit if, following birth, he is confined as an inpatient as a result of a covered accidental injury or covered sickness (including congenital defects, birth abnormalities, and/or premature birth). HOSPITAL CONFINEMENT per day (maximum of 31 days per confinement for each covered sickness or accident for each insured) Payable for each day that an insured is confined to a hospital as an in-patient as the result of a covered accidental injury or covered sickness. If we pay benefits for confinement and the insured becomes confined again within six $100 months because of the same or related condition, we will treat this confinement as the same period of confinement. This benefit is payable for only one hospital confinement at a time even if caused by more than one covered accidental injury, more than one covered sickness, or a covered accidental injury and a covered sickness. HOSPITAL INTENSIVE CARE BENEFIT per day (maximum of 10 days per confinement for each covered sickness or accident for each insured) Payable for each day when an insured is confined in a Hospital Intensive Care Unit because of a covered accidental injury or covered sickness. We will pay benefits for only one confinement in a Hospital's Intensive Care Unit at a $200 time. Once benefits are paid, if an insured becomes confined to a Hospital's Intensive Care Unit again within six months because of the same or related condition, we will treat this confinement as the same period of confinement. This benefit is payable in addition to the Hospital Confinement Benefit. SUCCESSOR INSURED BENEFIT If spouse coverage is in force at the time of the employee’s death, the surviving spouse may elect to continue coverage. Coverage would continue according to the existing plan and would also include any dependent child coverage in force at the time. The plan has limitations and exclusions that may affect benefits payable. This brochure is for illustrative purposes only. Refer to your certificate for complete details, definitions, limitations, and exclusions. 17


Hospital Indemnity Plan Sports – participating in any organized sport in a professional or semi-professional capacity. Custodial Care – this is non-medical care that helps individuals with the basic tasks of everyday life, the preparation of special diets, and the self-administration of medication which does not LIMITATIONS AND EXCLUSIONS require the constant attention of medical personnel. (in Montana: EXCLUSIONS) Treatment for being overweight, gastric bypass or stapling, EXCLUSIONS intestinal bypass, and any related procedures, including any We will not pay for loss due to: War – voluntarily participating in war, any act of war, or military resulting complications. conflicts, declared or undeclared, or voluntarily participating or Services performed by a family member. serving in the military, armed forces, or an auxiliary unit thereto, • In Arizona: this exclusion does not apply. or contracting with any country or international authority. (We • In South Dakota: this exclusion does not apply. will return the prorated premium for any period not covered by Services related to sex or gender change, sterilization, in vitro fertilization, vasectomy or reversal of a vasectomy, or tubal the certificate when the insured is in such service.) War also ligation. includes voluntary participation in an insurrection, riot, civil • In Washington D.C. and Washington: Services related to commotion or civil state of belligerence. War does not include sterilization, in vitro fertilization, vasectomy or reversal of a acts of terrorism (except in Illinois). vasectomy, or tubal ligation. • In Connecticut: a riot is not excluded. Elective Abortion – an abortion for any reason other than to • In Oklahoma: War, or any act of war, declared or preserve the life of the person upon whom the abortion is undeclared, when serving in the military, armed forces, or performed. an auxiliary unit thereto. (We will return the prorated • In Tennessee, or if the pregnancy was the result of rape or premium for any period not covered by the certificate incest, or if the fetus is non-viable. when the insured is in such service.) War does not include Dental Services or Treatment. acts of terrorism. Cosmetic Surgery, except when due to: Suicide – committing or attempting to commit suicide, while Reconstructive surgery, when the service is related to or follows sane or insane. surgery resulting from a Covered Accidental Injury or a Covered • In Missouri, Montana, and Vermont: committing or Sickness, or is related to or results from a congenital disease or attempting to commit suicide, while sane. anomaly of a covered dependent child. • In Minnesota: this exclusion does not apply. Congenital defects in newborns. Self-Inflicted Injuries – injuring or attempting to injure oneself TERMS YOU NEED TO KNOW intentionally. A Covered Accident is an accident that occurs on or after an • In Missouri: injuring or attempting to injure oneself insured’s effective date while coverage is in force, and that is intentionally which is obviously not an attempted suicide. not specifically excluded by the plan. • In Vermont: injuring or attempting to injure oneself Dependent means your spouse or dependent children, as intentionally, while sane. defined in the applicable rider, who have been accepted for Racing – riding in or driving any motor-driven vehicle in a race, stunt show or speed test in a professional or semi-professional coverage. Spouse is your legal wife, husband, or partner in a legally recognized union. Refer to your certificate for details. capacity. Dependent Children are your or your spouse’s natural children, Illegal Occupation – voluntarily participating in, committing, or step-children, grandchildren who are in your legal custody and attempting to commit a felony or illegal act or activity, or voluntarily working at, or being engaged in, an illegal occupation residing with you, foster children, children subject to legal guardianship, legally adopted children (in Texas, adopted or job. children), or children placed for adoption. (In Florida, coverage • In Connecticut: voluntarily participating in, committing, or may be provided for the children of custodial and non-custodial attempting to commit a felony. parents.) Newborn children are automatically covered from the • In Illinois: committing or attempting to commit a felony or moment of birth for 60 days. Newly adopted children are being engaged in an illegal occupation. automatically covered for 60 days also. See certificate for • In Nebraska and Tennessee: voluntarily participating in, details. Dependent children must be younger than age 26 (and committing, or attempting to commit a felony or voluntarily in Louisiana and Illinois, unmarried). See certificate for details. working at, or being engaged in, an illegal occupation or Doctor is a person who is duly qualified as a practitioner of the job. healing arts acting within the scope of his license, and: is • In Pennsylvania: committing or attempting to commit a licensed to practice medicine; prescribe and administer drugs; felony, or being engaged in an illegal occupation. or to perform surgery, or is a duly qualified medical practitioner • In South Dakota: voluntarily committing a felony. according to the laws and regulations in the state in which In order to receive benefits for accidental injuries due to a covered accident, an insured must be admitted within six months of the date of the covered accident (in Washington, twelve months).

18


Hospital Indemnity Plan treatment is made. In Montana: For purposes of treatment, the insured has full freedom of choice in the selection of any licensed physician, physician assistant, dentist, osteopath, chiropractor, optometrist, podiatrist, licensed social worker, psychologist, licensed professional counselor, acupuncturist, naturopathic physician, physical therapist, or advanced practice registered nurse. A Doctor does not include you or any of your Family Members. For the purposes of this definition, Family Member includes your spouse as well as the following members of your immediate family: son, daughter, mother, father, sister, or brother. In Arizona, however, a doctor who is your family member may treat you. In South Dakota, however, a doctor who is your family member may treat you if that doctor is the only doctor in the area and acts within the scope of his or her practice. A Hospital is not a nursing home; an extended care facility; a skilled nursing facility; a rest home or home for the aged; a rehabilitation facility; a facility for the treatment of alcoholism or drug addiction (except in Vermont); an assisted living facility; or any facility not meeting the definition of a Hospital as defined in the certificate. Sickness means an illness, infection, disease, or any other abnormal physical condition or pregnancy that is not caused solely by, or the result of, any injury (In Maine, illness or disease of an insured). A Covered Sickness is one that is not excluded by name, specific description, or any other provision in this plan. For a benefit to be payable, loss arising from the covered sickness must occur while the applicable insured’s coverage is in force (except in Montana). Treatment is the consultation, care, or services provided by a doctor. This includes receiving any diagnostic measures and taking prescribed drugs and medicines. Treatment does not include telemedicine services (except in Kansas). You May Continue Your Coverage Your coverage may be continued with certain stipulations. See certificate for details. Termination of Coverage Your insurance may terminate when the plan is terminated; the 31st day after the premium due date if the premium has not been paid; or the date you no longer belong to an eligible class. If your coverage terminates, we will provide benefits for valid claims that arose while your coverage was in force. See certificate for details.

minimum essential coverage under the Affordable Care Act. CAIC coverage is not intended to replace or be issued in lieu of major medical coverage. It is designed to supplement a major medical program. For more information, ask your insurance agent/producer, call 1.800.433.3036, or visit aflacgroupinsurance.com.

Continental American Insurance Company (CAIC ), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. Continental American Insurance Company • Columbia, South Carolina The certificate to which this sales material pertains may be written only in English; the certificate prevails if interpretation of this material varies. This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions. You’re welcome to request a full copy of the plan certificate through your employer or by reaching out to our Customer Service Center. Benefits, terms, and conditions may vary by state. This brochure is subject to the terms, conditions, and limitations of Policy Series C80000. In Arkansas, C80100AR. In Oklahoma, C80100OK. In Oregon, C80100OR. In Pennsylvania, C80100PA. In Texas, C80100TX. In Virginia, C80100VA.

NOTICES If this coverage will replace any existing individual policy, please be aware that it may be in your best interest to maintain your individual guaranteed-renewable policy. Notice to Consumer: The coverages provided by Continental American Insurance Company (CAIC) represent supplemental benefits only. They do not constitute comprehensive health insurance coverage and do not satisfy the requirement of 19


METLIFE

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 20 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 Lewisville ISD Benefits Website: www.LISD.net/Benefits


Dental Metropolitan Life Insurance Company Effective 9/1/2021 PDP Plus PLAN OPTION 1 Standard

PLAN OPTION 2 Basic

In-Network % of Maximum Allowable Charge3

Out-of-Network % of Maximum Allowable Charge3

In-Network % of Maximum Allowable Charge3

Out-of-Network % of Maximum Allowable Charge3

Type A: Preventive (cleanings, exams, X-rays)

100%

100%

50%

50%

Type B: Basic Restorative (fillings, extractions)

80%

80%

50%

50%

Type C: Major Restorative (bridges, dentures)

50%

50%

50%

50%

Type D: Orthodontia

50%

50%

Not Covered

Not Covered

Individual

$50

$50

N/A

N/A

Family

$150

$150

N/A

N/A

$1,500

$1,500

$1,000

$1,000

$1,500

$1,500

Not Covered

Not Covered

Coverage Type

Deductible†

Annual Maximum Benefit Per Person Orthodontia Lifetime Maximum Per Person

Child(ren)’s eligibility for dental coverage is from birth up to age 25. *Negotiated Fee refers to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. 3Reimbursement for out-of-network services is based on the lesser of the dentist’s actual fee or the Maximum Allowable Charge (MAC). The out-of-network Maximum Allowable Charge is a scheduled amount determined by MetLife. †Applies to Type B and C Services in the Basic Plan. Does not apply to the Standard Plan.

Monthly Cost The following monthly costs are effective through 8/31/2022. Your premium will be paid through convenient payroll deduction. The Monthly costs shown below for “Employee + Spouse + Child(ren)” and “Employee + Family” include the cost for all eligible children.

Standard Plan Employee Only

$42.68

Employee + Child(ren)

$87.10

Employee + Spouse

$85.38

Employee + Family

$129.80

Basic Plan

Employee Only

$22.46

Employee + Child(ren)

$45.82

Employee + Spouse

$44.90

Employee + Family

$68.28

21


Dental LIST OF PRIMARY COVERED SERVICES & LIMITATIONS The service categories and plan limitations shown represent an overview of your Plan Benefits. This document presents the majority of services within each category, but is not a complete description of the Plan. Plan Option 1: Standard Plan

Plan Option 2: Basic Plan

Type A – Preventive

How Many/How Often

Type A – Preventive

How Many/How Often

Prophylaxis (cleanings)

• Two per year

Prophylaxis (cleanings)

• Two per year

Oral Examinations

• Two exams per year

Oral Examinations

• Two exams per year

Topical Fluoride Applications

• One fluoride treatment per calendar year

Topical Fluoride Applications

• One fluoride treatment per calendar year

X-rays

• Full mouth X-rays; one per 36 months • Bitewings X-rays; two sets per year

X-rays

• Full mouth X-rays; one per 36 months • Bitewings X-rays; two sets per year

Sealants

• One application of sealant material every

Sealants

• One application of sealant material every

for dependent children up to his/her 16th birthday

36 months for each non-restored, nondecayed 1st and 2nd molar of a dependent child up to his/her 17th birthday Type B – Basic Restorative

How Many/How Often

36 months for each non-restored, nondecayed 1st and 2nd molar of a dependent child up to his/her 17th birthday Type B – Basic Restorative

Fillings

Fillings

Simple Extractions

Simple Extractions

Crown, Denture and Bridge Repair/ Recementations

• One replacement for the same tooth surface, every 60 months

Oral Surgery Endodontics

• Root canal treatment limited to once per • When dentally necessary in connection

• One replacement for the same tooth

Oral Surgery

N/A

Endodontics

• Root canal treatment limited to once per

• Periodontal scaling and root planning for

surface, every 60 months

tooth per 24 months General Anesthesia

with oral surgery,extractions or other covered dental services Periodontics

How Many/How Often

Crown, Denture and Bridge Repair/ Recementations

tooth per 24 months General Anesthesia

for dependent children up to his/her 16th birthday

• When dentally necessary in connection with oral surgery,extractions or other covered dental services

Periodontics

• N/A

Space Maintainers

• Space maintainers for dependent children up to his/her 14th birthday, once per lifetime per tooth area.

covered person over age 14, once per quadrant,every 24 months • Periodontal surgery once per quadrant, every 36 months • Total number of periodontal maintenance treatments and prophylaxis cannot exceed fourtreatments in a calendar year

Space Maintainers

22

• Space maintainers for dependent children up to his/her 14th birthday, once per lifetime per tooth area.


Dental Plan Option 1: Standard Plan Plan Option 1: Standard Plan

Plan Option 2: Basic Plan Plan Option 2: Basic Plan

Type C – Major Restorative

How Many/How Often

Type C – Major Restorative

How Many/How Often

Bridges and Dentures

• Initial placement to replace one or more

Bridges and Dentures

• Initial placement to replace one or more

natural teeth for covered person over age 14, which are lost while covered by the plan • Dentures and bridgework replacement; one every 60 months • Replacement of an existing temporary full denture if the temporary denture cannot be repaired and the permanent denture is installed within 12 months after the temporary denture was installed

natural teeth for covered person over age 14, which are lost while covered by the plan • Dentures and bridgework replacement; one every 60 months • Replacement of an existing temporary full denture if the temporary denture cannot be repaired and the permanent denture is installed within 12 months after the temporary denture was installed

Crowns, Inlays and Onlays

• Replacement once every 60 months, for

Crown, Denture and Bridge Repair/ Recementations

• One replacement for the same tooth

• One replacement for the same tooth

surface, every 60 months • Repairs once in 12 month period • Re-cementation once in 12 month period

• Repairs once in 12 month period • Re-cementation once in 12 month period

Implants

• Repair once every 12 months • Replacement once every 60 months

Implants

Oral Surgery

• N/A

Oral Surgery

Periodontics

• N/A

Periodontics

covered person over age 14

Crowns, Inlays and Onlays

• Replacement once every 60 months, for covered person over age 14 surface, every 60 months

• Repair once every 12 months • Replacement once every 60 months

• Periodontal scaling and root planning for covered person over age 14, once per quadrant, every 24 months • Periodontal surgery once per quadrant, every 36 months • Total number of periodontal maintenance treatments and prophylaxis cannot exceed four treatments in a calendar year

Type D – Orthodontia

How Many/How Often

• You, your spouse and your children, up to • • •

Type D – Orthodontia

How Many/How Often N/A

age 25, are covered while Dental insurance is in effect All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia Payments are on a repetitive basis 20% of the Orthodontia Lifetime Maximum will be considered at initial placement of the appliance and paid based on the plan benefit’s coinsurance level for Orthodontia as defined in the plan summary Orthodontic benefits end at cancellation of coverage

The service categories and plan limitations shown above represent an overview of your plan benefits. This document presents the majority of services within each category but is not a complete description of the plan.

23


Dental FREQUENTLY ASKED QUESTIONS Who is a participating dentist? A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for covered services provided to plan members. Negotiated fees typically range from 30%-45% below the average fees charged in a dentist’s community for the same or substantially similar services.† How do I find a participating dentist? There are thousands of general dentists and specialists to choose from nationwide --so you are sure to find one that meets your needs. You can receive a list of these participating dentists online at www.metlife.com/ mybenefits or call 1-800-942-0854 to have a list faxed or mailed to you. What services are covered under this plan? The certificate of insurance sets forth the covered services under the plan. Please review the enclosed plan benefits to learn more. May I choose a non-participating dentist? Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating dentist your out-of-pocket costs may be higher. Can my dentist apply for participation in the network? Yes. If your current dentist does not participate in the network and you would like to encourage him/her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application.†† The website and phone number are for use by dental professionals only.

will pay benefits. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan, subject to applicable law. If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law. Do I need an ID card? No. You do not need to present an ID card to confirm that you are eligible. You should notify your dentist that you are enrolled in the MetLife Preferred Dentist Program. Your dentist can easily verify information about your coverage through a toll-free automated Computer Voice Response system. †Based on internal analysis by MetLife. Negotiated fees refer to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. ††Due to contractual requirements, MetLife is prevented from soliciting certain providers. * AXA Assistance USA, Inc. provides Dental referral services only. AXA Assistance is not affiliated with MetLife, and the services and benefits they provide are separate and apart from the insurance provided by MetLife. Referral services are not available in all locations. **Refer to your dental benefits plan summary for your out-of-network dental coverage.

EXCLUSIONS This plan does not cover the following services, treatments and supplies: • Services which are not Dentally Necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which we deem experimental in nature; How are claims processed? • Services for which you would not be required to pay in the absence of Dentists may submit your claims for you which means you have little or Dental Insurance; no paperwork. You can track your claims online and even receive email • Services or supplies received by you or your Dependent before the alerts when a claim has been processed. If you need a claim form, visit Dental Insurance starts for that person; www.metlife.com/mybenefits or request one by calling 1-800-942-0854. • Services which are primarily cosmetic (for Texas residents, see notice Can I get an estimate of what my out-of-pocket expenses will be before page section in Certificate); receiving a service? • Services which are neither performed nor prescribed by a Dentist Yes. You can ask for a pretreatment estimate. Your general dentist or except for those services of a licensed dental hygienist which are specialist usually sends MetLife a plan for your care and requests an supervised and billed by a Dentist and which are for: estimate of benefits. The estimate helps you prepare for the cost of  Scaling and polishing of teeth; or dental services. We recommend that you request a pre-treatment  Fluoride treatments; estimate for services in excess of $300. Simply have your dentist submit • Services or appliances which restore or alter occlusion or vertical a request online at www.metdental.com or call 1-877-MET-DDS9. You dimension; and your dentist will receive a benefit estimate for most procedures while you are still in the office. Actual payments may vary depending • Restoration of tooth structure damaged by attrition, abrasion or upon plan maximums, deductibles, frequency limits and other conditions erosion; at time of payment. • Restorations or appliances used for the purpose of periodontal splinting; Can MetLife help me find a dentist outside of the U.S. if I am traveling? • Counseling or instruction about oral hygiene, plaque control, nutrition Yes. Through international dental travel assistance services* you can and tobacco; obtain a referral to a local dentist by calling +1-312-356-5970 (collect) • Personal supplies or devices including, but not limited to: water picks, when outside the U.S. to receive immediate care until you can see your toothbrushes, or dental floss; dentist. Coverage will be considered under your out-of-network • Decoration, personalization or inscription of any tooth, device, benefits.** Please remember to hold on to all receipts to submit a appliance, crown or other dental work; dental claim. • Missed appointments; • Services: How does MetLife coordinate benefits with other insurance plans? Coordination of benefits provisions in dental benefits plans are a set of  Covered under any workers’ compensation or occupational rules that are followed when a patient is covered by more than one disease law; dental benefits plan. These rules determine the order in which the plans  Covered under any employer liability law; 24


Dental  For which the employer of the person receiving such services is not required to pay; or

 Received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital; Services covered under other coverage provided by the Employer; Temporary or provisional restorations; Temporary or provisional appliances; Prescription drugs; Services for which the submitted documentation indicates a poor prognosis; • The following when charged by the Dentist on a separate basis:

• • • • •

 Claim form completion;  Infection control such as gloves, masks, and sterilization of supplies; or

 Local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.

• Dental services arising out of accidental injury to the teeth and • • • • • • • • • • • • • • • •

supporting structures, except for injuries to the teeth due to chewing or biting of food; Other fixed Denture prosthetic services not described elsewhere in the certificate; Precision attachments, except when the precision attachment is related to implant prosthetics; Initial installation of a Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance; Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance; Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it; Implants including, but not limited to any related surgery, placement, restorations, maintenance, and removal; —Standard Plan Only Repair of implants; —Standard Plan Only Implants supported prosthetics Fixed and removable appliances for correction of harmful habits; Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards; Diagnosis and treatment of temporomandibular joint (TMJ) disorders. Repair or replacement of an orthodontic device; Duplicate prosthetic devices or appliances; Replacement of a lost or stolen appliance, Cast Restoration, or Denture; Intra and extraoral photographic images Orthodontia – Basic Plan Only

dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plan’s reimbursement for those services, and your out-of-pocket expense. Procedure charge schedules are subject to change each plan year. You can obtain an updated procedure charge schedule for your area via fax by calling 1-800-942-0854 and using the MetLife Dental Automated Information Service. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. Cancellation/Termination of Benefits: Coverage is provided under a group insurance policy Policy form GPNP99 issued by Metropolitan Life Insurance Company (MetLife). Coverage terminates when your membership ceases, when your dental contributions cease or upon termination of the group policy by the Policyholder or MetLife. The group policy terminates for non-payment of premium and may terminate if participation requirements are not met or if the Policyholder fails to perform any obligations under the policy. The following services that are in progress while coverage is in effect will be paid after the coverage ends, if the applicable installment or the treatment is finished within 31 days after individual termination of coverage: Completion of a prosthetic device, crown or root canal therapy. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. For complete details of coverage and availability, please refer to the certificate of insurance. Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 L0520003788 [exp0521][xNM] © 2020 MetLife Services and Solutions, LLC DN-ANY-PPO-DUAL

LIMITATIONS Alternate Benefits: Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. To avoid any misunderstandings, we suggest you discuss treatment options with your dentist before services are rendered, and obtain a pre-treatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. You and your 25


UNITEDHEALTHCARE

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 26 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 Lewisville ISD Benefits Website: www.LISD.net/Benefits


Vision Vision Benefit Summary Powered by Spectera Eyecare Networks

Customer Service and Provider Locator: (800) 638-3120 myuhcvision.com

UnitedHealthcare vision has been trusted for more than 50 years to deliver affordable, innovative vision care solutions to the nation’s leading employers through experienced, customerfocused people and the nation’s most accessible, diversified vision care network.

Rates Exam with Materials Employee $8.38 Employee + Spouse $15.33 Employee + Child(ren) $16.06 Employee + Family $24.78 Benefit Frequency Comprehensive Exam(s) Once every 12 months Spectacle Lenses Once every 12 months Frames Once every 24 months Contact Lenses in Lieu of Eyeglasses Once every 12 months In-Network Services Copays Exam(s) $ 10.00 Eyeglasses (lenses and frame) $ 25.00 Contact lenses instead of Eyeglasses $ 25.00 Frame Benefit (for frames that exceed the allowance, an additional 30% discount may be applied to the overage)1 Private Practice Provider $130.00 retail frame allowance Retail Chain Provider $130.00 retail frame allowance Lens Options Standard Scratch-resistant Coating,Polycarbonate Lenses for Adults, Polycarbonate Lenses for Dependent Children (up to age 19) - covered in full. Contact Lens Benefit2 (Formulary contact lenses refer to contact lenses available on our formulary contact list. Contact lenses not on this list are referred to as Non-Formulary. A copy of the list can be found at myuhcvision.com). Formulary contact lenses If you choose disposable contacts, up to 4 boxes The fitting/evaluation fees, contact lenses, and up to two follow-up visits are are included when obtained from an in-network covered in full after copay. provider. Non-Formulary contact lenses An allowance is applied toward the purchase of contact lenses outside the $125.00 Formulary. Contact lens copay is waived. Necessary contact lenses3 Covered in full after copay (if applicable). Children's and Maternity Eye Care Benefit Members age 0-12 and members pregnant or breastfeeding are eligible for a 2nd exam. Members age 0-12 and members pregnant or breastfeeding are also eligible for a replacement frame and lenses if they have a prescription change of 0.5 diopter or more. The 2nd exam and replacement benefits are the same as the initial exam, frame and lens benefits. Out-of-Network Reimbursements (Copays do not apply) Exam(s) Up to $40.00 Frames Up to $45.00 Single Vision Lenses Up to $40.00 Lined Bifocal and Progressive Lenses Up to $60.00 Lined Trifocal Lenses Up to $80.00 Lenticular Lenses Up to $80.00 Elective Contacts instead of Eyeglasses² Up to $125.00 3 Necessary Contacts instead of Eyeglasses Up to $210.00

27


Vision Discounts

UnitedHealthcare has partnered with QualSight LASIK, the largest LASIK manager in the United States, to provide our members with access to discounted laser vision correction providers. Member savings represent up to 35% off the national average price of Traditional LASIK. Contracted prices start at $945 per eye for Traditional LASIK and $1,395 per eye for Custom LASIK. Discounts are also provided on newer technologies such as Custom Bladeless (all laser) LASIK. For more information, visit myuhcvision.com. At a participating in-network provider you will receive up to a 20% discount on an additional pair of eyeglasses or contact lenses. This program isavailable after your vision benefits have been exhausted. Please note that this discount shall not be considered insurance, and that UnitedHealthcare shall neither pay nor reimburse the provider or member for any funds owed or spent. Additional materials do not have to be purchased at the time of initial material purchase. As a UnitedHealthcare vision plan member, you can save on custom-programmed hearing aids when you buy them from UnitedHealthcareHearing. To find out more go to UHCHearing.com. When placing your order use promo code MYVISION to get the special price discount.

Sample Illustration of Savings Cost

Employee Only

Monthly Premium

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

$8.38

$15.33

$16.06

$24.78

$100.56

$183.96

$192.72

$297.36

$20.11

$36.79

$38.54

$59.47

Annual Tax-Adjusted Premium

$80.45

$147.17

$154.18

$237.89

Plus Copays

$35.00

$70.00

$105.00

$140.00

Total Cost to Employee

$115.45

$217.17

$259.18

$377.89

Annual Premium Approx. Pre-Tax Savings (20%)

4

Exam and Materials Covered by Estimated Cost Without Total Savings with Less Employee Cost 5 UnitedHealthcare Vision Plan a Vision Plan UnitedHealthcare Vision Employee Only $275.00 $115.45 $159.55 Exam, Single Vision & Covered-in-Full Frames Employee + Spouse $550.00 $217.17 $332.83 Exam, Single Vision & Covered-in-Full Frames Employee + Child(ren) 6 $825.00 $259.18 $565.82 Exam, Single Vision & Covered-in-Full Frames Employee + Family7 $1,100.00 $377.89 $722.11 Exam, Single Vision & Covered-in-Full Frames ¹ 30% discount available at most participating in-network provider locations. May exclude certain frame manufacturers. Please verify all discounts with your provider. ² Contact lenses are instead of eyeglass lenses and/or eyeglass frames. Coverage for Formulary contact lenses does not apply at all in-network providers. The allowance for Non-Formulary contact lenses applies to materials. No portion will be exclusively applied to the fitting and evaluation. ³ Necessary contact lenses are determined at the provider's discretion for one or more of the following conditions: Following cataract surgery without intraocular lens implant; to correct extreme vision problems that cannot be corrected with eyeglass lenses and/or frames; with certain conditions such as anisometropia, keratoconus, irregular corneal/astigmatism, aphakia, pathological myopia, aniseikonia, aniridia, facial deformity, or corneal deformity. If your provider considers your contacts necessary, you should ask your provider to contact UnitedHealthcare vision confirming the reimbursement that UnitedHealthcare will make before you purchase such contacts. 4 Actual tax savings will depend upon your individual tax bracket. 5 Approximate retail value illustrated: Exam & Refraction ($65), Single Vision Lenses ($80), and Frames ($130). Average retail cost may vary by provider. 6 For purposes of this calculation, Employee + Child(ren) is calculated with three (3) members. 7 For purposes of this sample calculation, Employee + Family is calculated with four (4) members.

28


Vision Important to Remember: In-Network • Always identify yourself as a UnitedHealthcare vision member when making your appointment. This will assist the provider in obtaining your benefit information. • Your participating provider will help you determine which contact lenses are available in the UnitedHealthcare Formulary. • Patient lens options which are not covered-in-full may be available at a discount at participating providers. Based on state guidelines, lens materials and options may not be available at these discounted prices at all provider locations. Please ask your provider for details. The Lens Options list can be found at myuhcvision.com. Choice and Access of Vision Care Providers UnitedHealthcare offers its vision program through a national network including both private practice and retail chain providers. To access the Provider Locator service or for a printed directory, visit our website myuhcvision.com or call (800) 638-3120, 24 hours a day, seven days a week. You may also view your benefits, search for a provider or print an ID card online at myuhcvision.com. Retain this UnitedHealthcare vision benefit summary which includes detailed benefit information and instructions on how to use the program. Please refer to your Certificate of Coverage for a full explanation of benefits. In-Network Provider - Copays and non-covered patient options are paid to provider by program participant at the time of service. Out-of-Network Provider - Participant pays all billed charges to the provider, and UnitedHealthcare reimburses the participant for services rendered up to the maximum allowance. Copays do not apply to out-of-network benefits. Receipts for payments should be submitted within 90 days after the date of service to the following address: UnitedHealthcare Vision, Attn. Claims Department, P.O. Box 30978, Salt Lake City, UT 84130. If it was not reasonably possible to give written proof in the time required, the Company will not reduce or deny the claim for this reason. However, proof must be filed as soon as reasonably possible, but no later than 1 year after the date of service unless the Covered Person was legally incapacitated. This Benefit Summary is intended only to highlight your benefits and should not be relied upon to fully determine coverage. This benefit plan may not cover all of your healthcare expenses. More complete descriptions of benefits and the terms under which they are provided are contained in the certificate of coverage that you will receive upon enrolling in the plan. If this Benefit Summary conflicts in any way with the Policy issued to your employer, the Policy shall prevail. UnitedHealthcare vision coverage provided by or through UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or its affiliates. Administrative services provided by Spectera, Inc., United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number VPOL.18.TX and associated COC form number VCOC.INT.18.TX or VCOC.CER.18.TX. Plans sold in Virginia use policy form number VPOL.18.VA and associated COC form number VCOC.INT.18.VA or VCOC.CER.18.VA. If you opt to receive vision care services or vision care materialsthat are not covered benefits under this plan, a participating vision care provider may charge you their normal fee for such services or materials. Prior to providing you with vision care services or vision care materials that are not covered benefits, the vision care provider will provide you with an estimated cost for each service or material upon your request. This cost may be higher than if you had received only covered vision services and you may incur additional out-ofpocket expenses. Eyewear materials may be ordered through the Spectera Eyecare Networks lab network with which UnitedHealthcare has a business relationship. 03/21 © 2021 United HealthCare Services, Inc. 0011400001wWn9RAAS C1198 23558022-2-1-1-R-S 09/01/2019 09/01/2019 - 08/31/2022 NCA-03C (v4.0)

To print a personalized ID card, please log on to our website and select 'Group/Plan' then select 'Print ID card' from the member benefits page. 29


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 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 Lewisville ISD Benefits Website: www.LISD.net/Benefits


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 account statements show all • Health Savings accountholder your account activity for that period. You can receive free • Age 55 or older (regardless of when in the year an online statements or printed statements. 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.

31


CIGNA YOUR BENEFITS PACKAGE

Disability

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

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

34.6 months is the duration of the average disability claim.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 32 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Lewisville ISD Benefits Website: www.LISD.net/Benefits


Long Term Disability Offered by Life Insurance Company of North America (a Cigna company) EMPLOYEE-PAID LONG-TERM DISABILITY INSURANCE

SUMMARY OF BENEFITS

Prepared for: Lewisville ISD If you had an unexpected illness or injury and were unable to work, how long would you be able to pay your bills? Longterm disability pays a portion of your salary if you’re unable to work due to a covered disability. Eligibility: If you are an active Full-time Employee who works at least 15 hours per week, you are eligible on the first of the month following date of hire. . Maximum Gross Gross Monthly Benefit1 Benefit Waiting Period Maximum Benefit Period Monthly Benefit Employee Options

Select Monthly Benefit: Flat dollar benefit in $100 increments between $200 and $8,000 that cannot exceed 70% of your current monthly earnings

$8,000

Select from Six Options: Accident/Sickness 14 days/14 days 30 days/30 days 60 days/60 days 90 days/90 days

Please refer to the “Maximum Benefit Period” Schedules below for more details

Employee's Monthly Cost of Coverage2: Use the attached rate sheets Monthly Rates by Type of Plan ( Per $100 Benefit)

Duration

Accident Sickness

EP (Days)

Accident Sickness

All Ages

Select Plan NRA 5 year

Premium Plan NRA NRA

14 14

30 30

60 60

90 90

14 14

30 30

60 60

90 90

$2.42

$2.08

$1.35

$1.16

$2.74

$2.32

$1.50

$1.30

Important Definitions and Policy Provisions: Disability: “Disability” or “Disabled” means that, solely because of a covered injury or sickness, you are unable to perform the material duties of your regular occupation and you are unable to earn 80% or more of your indexed earnings from working in your regular occupation. After benefits have been payable for 24 months, you are considered disabled if solely due to your injury or sickness, you are unable to perform the material duties of any occupation for which you are (or may reasonably become) qualified by education, training or experience, and you are unable to earn 60% or more of your indexed earnings. We will require proof of earnings and continued disability. Covered Earnings: “Covered Earnings” means your wages or salary, not including bonuses, commissions, and other extra compensation. When Benefits Begin: You must be continuously Disabled for your elected benefit waiting period before benefits will be payable for a covered Disability. For any selected Benefit Waiting Period of 30 days or less, the Benefit Waiting Period will end on the date you are admitted as an inpatient in a hospital if that date is before the end of the time period specified. Maximum Benefit Period: Once you qualify for benefits under this plan, you continue to receive them until the end of the benefit or until you no longer qualify for benefits, whichever occurs first. Should you remain Disabled, your benefits continue according to one of the following schedules, depending on your age at the time you become Disabled and the plan you select. 33


Long Term Disability Premium Plan: Maximum Benefit Period Schedule The later of the Employee's SSNRA* or the Maximum Benefit Period listed below.

Age at Start of Disability

Maximum Benefit Duration

age 62 or younger age 63 age 64

the Employee’s 65th birthday or the 42nd monthly disability benefit the 36th monthly disability benefit the 30th monthly disability benefit

age 65 age 66 age 67

the 24th monthly disability benefit the 21st monthly disability benefit the 18th monthly disability benefit

age 68 Age 69 and older

the 15th monthly disability benefit the 12th monthly disability benefit

Select Plan: Maximum Benefit Period Schedule Age at Disability - Sickness

Prior to age 65

Age 65 - 69

Age 70 and over

Duration of Payments

60 months

To age 70, but not less than 12 months

12 Months

Age at Start of Disability - Injury

Maximum Benefit Duration

age 62 or younger age 63 age 64

the Employee’s 65th birthday or the 42nd monthly disability benefit the 36th monthly disability benefit the 30th monthly disability benefit

age 65 age 66 age 67

the 24th monthly disability benefit the 21st monthly disability benefit the 18th monthly disability benefit

age 68 Age 69 and older

the 15th monthly disability benefit the 12th monthly disability benefit

When Coverage Takes Effect: Your coverage takes effect on the later of the policy’s effective date, the date you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. If you’re not actively at work on the date your coverage would otherwise take effect, your coverage will take effect on the date you return to work. If you have to submit evidence of good health, your coverage takes effect on the date we agree, in writing, to cover you. Benefit Reductions, Conditions, Limitations and Exclusions: Effects of Other Income Benefits: This plan is structured to prevent your total benefits and post-disability earnings from equaling or exceeding pre-disability earnings. Therefore, we reduce this plan’s benefits by Other Income Benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Disability benefits may be reduced by amounts received through Social Security disability benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Your disability benefits will not be reduced by any Social Security disability benefits you are not receiving as long as you cooperate fully in efforts to obtain them and agree to repay any overpayment when and if you do receive them. Disability benefits will also be reduced by amounts received through other government programs, sick leave, employer’s sabbatical leave, employer’s assault leave plan, employer funded retirement benefits, workers’ compensation, franchise/group insurance, auto no-fault, and damages for wage loss. For details, see your outline of coverage, policy certificate, or your employer’s summary plan description. Note: Some of the Other Income Benefits, as defined in the group policy, will not be considered until after disability benefits are payable for 6 months. 34


Long Term Disability Earnings While Disabled: During the first 24 months that benefits are payable, benefits will be reduced if benefits plus income from employment exceeds 100% of pre-disability Covered Earnings. After that, benefits will be reduced by 50% of earnings from employment. Limited Benefit Period: Disabilities caused by or contributed to by any one or more of the following conditions are subject to a lifetime limit of 24 months for outpatient treatment: Anxiety-disorders, delusional (paranoid) or depressive disorders, eating disorders, mental illness, somatoform disorders (including psychosomatic illnesses) ,alcoholism, drug addiction or abuse. Benefits are payable during periods of hospital confinement for these conditions for hospitalizations lasting more than 14 consecutive days that occur before the 24-month lifetime outpatient limit is exhausted. Pre-existing Condition Limitation: Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, received medical treatment, care or services (including diagnostic measures,) during the 3 months just prior to the most recent effective date of insurance. Benefits are not payable for any disability resulting from a preexisting condition unless the disability occurs after you have been insured under this plan for at least 12 months after your most recent effective date of insurance. Termination of Disability Benefits: Your benefits will terminate when your Disability ceases, when your benefit duration period is exceeded, or on the following events: (1) the date you earn from any occupation more than 60% of your Covered Earnings, or the date you fail to cooperate with us in a rehabilitation plan, or transitional work arrangement, or the administration of the claim. Rehabilitation Requirement: To be eligible for Disability benefits under this plan, you may be required to participate in a rehabilitation plan at the sole discretion and expense of the insurance company or company administering benefits under this plan. If you fail to fully cooperate with the rehabilitation plan, no Disability benefits will be paid, and coverage will end. For details, see your Certificate of Insurance.

Exclusions: This plan does not pay benefits for a Disability which results, directly or indirectly, from any of the following: • Suicide, attempted suicide, or intentionally self-inflicted injury while sane or insane. • war or any act of war, whether or not declared. • active participation in a riot; • commission of a felony; • the revocation, restriction or non-renewal of an Employee’s license, permit or certification necessary to perform the duties of his or her occupation unless due solely to Injury or Sickness otherwise covered by the Policy; • any cosmetic surgery or surgical procedure that is not Medically Necessary; • an Injury or Sickness for which the Employee is entitled to benefits from Workers’ Compensation or occupational disease law; • an Injury or Sickness that is work related. In addition, the plan does not pay disability benefits any period of Disability during which you are incarcerated in a penal or corrections institution. 1

2

Your benefit amount will be reduced by any amounts payable to you by any of the sources listed under the “Effects of Other Income Benefits” section. Costs are subject to change.

Terms and conditions of coverage for Long-Term Disability insurance are set forth in Group Policy No. SLH100028. This is not intended as a complete description of the insurance coverage offered. This is not a contract. Complete coverage details, including premiums, are contained in the Policy Certificate. If there are any differences between this summary and the group policy, the information in the group policy takes precedence. Product availability and/or features may vary by state. Please keep this material as a reference. Insurance coverage is issued on group policy form number: Policy Form TL-004700. Coverage is underwritten by Life Insurance Company of North America, 1601 Chestnut St. Philadelphia, PA 19192. “Cigna” 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, including Life Insurance Company of North America and Cigna Life Insurance Company of New York, and not by Cigna Corporation. 882862 08/18 © 2018 Cigna. Some content provided under license.

35


Injury Sickness Monthly Benefit $200.00 $300.00 $400.00 $500.00 $600.00 $700.00 $800.00 $900.00 $1,000.00 $1,100.00 $1,200.00 $1,300.00 $1,400.00 $1,500.00 $1,600.00 $1,700.00 $1,800.00 $1,900.00 $2,000.00 $2,100.00 $2,200.00 $2,300.00 $2,400.00 $2,500.00 $2,600.00 $2,700.00 $2,800.00 $2,900.00 $3,000.00 $3,100.00 $3,200.00 $3,300.00 $3,400.00 $3,500.00 $3,600.00 $3,700.00 $3,800.00 $3,900.00 $4,000.00 $4,100.00 $4,200.00

36

14 14 $5.48 $8.22 $10.96 $13.70 $16.44 $19.18 $21.92 $24.66 $27.40 $30.14 $32.88 $35.62 $38.36 $41.10 $43.84 $46.58 $49.32 $52.06 $54.80 $57.54 $60.28 $63.02 $65.76 $68.50 $71.24 $73.98 $76.72 $79.46 $82.20 $84.94 $87.68 $90.42 $93.16 $95.90 $98.64 $101.38 $104.12 $106.86 $109.60 $112.34 $115.08

Premium Plan NRA Elimination Period 30 60 30 60 $4.64 $6.96 $9.28 $11.60 $13.92 $16.24 $18.56 $20.88 $23.20 $25.52 $27.84 $30.16 $32.48 $34.80 $37.12 $39.44 $41.76 $44.08 $46.40 $48.72 $51.04 $53.36 $55.68 $58.00 $60.32 $62.64 $64.96 $67.28 $69.60 $71.92 $74.24 $76.56 $78.88 $81.20 $83.52 $85.84 $88.16 $90.48 $92.80 $95.12 $97.44

$3.00 $4.50 $6.00 $7.50 $9.00 $10.50 $12.00 $13.50 $15.00 $16.50 $18.00 $19.50 $21.00 $22.50 $24.00 $25.50 $27.00 $28.50 $30.00 $31.50 $33.00 $34.50 $36.00 $37.50 $39.00 $40.50 $42.00 $43.50 $45.00 $46.50 $48.00 $49.50 $51.00 $52.50 $54.00 $55.50 $57.00 $58.50 $60.00 $61.50 $63.00

Lewisville ISD (Monthly Rates)

Select Plan

90 90

14 14

$2.60 $3.90 $5.20 $6.50 $7.80 $9.10 $10.40 $11.70 $13.00 $14.30 $15.60 $16.90 $18.20 $19.50 $20.80 $22.10 $23.40 $24.70 $26.00 $27.30 $28.60 $29.90 $31.20 $32.50 $33.80 $35.10 $36.40 $37.70 $39.00 $40.30 $41.60 $42.90 $44.20 $45.50 $46.80 $48.10 $49.40 $50.70 $52.00 $53.30 $54.60

$4.84 $7.26 $9.68 $12.10 $14.52 $16.94 $19.36 $21.78 $24.20 $26.62 $29.04 $31.46 $33.88 $36.30 $38.72 $41.14 $43.56 $45.98 $48.40 $50.82 $53.24 $55.66 $58.08 $60.50 $62.92 $65.34 $67.76 $70.18 $72.60 $75.02 $77.44 $79.86 $82.28 $84.70 $87.12 $89.54 $91.96 $94.38 $96.80 $99.22 $101.64

NRA/5 Year Duration Elimination Period 30 60 30 60 $4.16 $6.24 $8.32 $10.40 $12.48 $14.56 $16.64 $18.72 $20.80 $22.88 $24.96 $27.04 $29.12 $31.20 $33.28 $35.36 $37.44 $39.52 $41.60 $43.68 $45.76 $47.84 $49.92 $52.00 $54.08 $56.16 $58.24 $60.32 $62.40 $64.48 $66.56 $68.64 $70.72 $72.80 $74.88 $76.96 $79.04 $81.12 $83.20 $85.28 $87.36

$2.70 $4.05 $5.40 $6.75 $8.10 $9.45 $10.80 $12.15 $13.50 $14.85 $16.20 $17.55 $18.90 $20.25 $21.60 $22.95 $24.30 $25.65 $27.00 $28.35 $29.70 $31.05 $32.40 $33.75 $35.10 $36.45 $37.80 $39.15 $40.50 $41.85 $43.20 $44.55 $45.90 $47.25 $48.60 $49.95 $51.30 $52.65 $54.00 $55.35 $56.70

90 90 $2.32 $3.48 $4.64 $5.80 $6.96 $8.12 $9.28 $10.44 $11.60 $12.76 $13.92 $15.08 $16.24 $17.40 $18.56 $19.72 $20.88 $22.04 $23.20 $24.36 $25.52 $26.68 $27.84 $29.00 $30.16 $31.32 $32.48 $33.64 $34.80 $35.96 $37.12 $38.28 $39.44 $40.60 $41.76 $42.92 $44.08 $45.24 $46.40 $47.56 $48.72


$4,300.00 $4,400.00 $4,500.00 $4,600.00 $4,700.00 $4,800.00 $4,900.00 $5,000.00 $5,100.00 $5,200.00 $5,300.00 $5,400.00 $5,500.00 $5,600.00 $5,700.00 $5,800.00 $5,900.00 $6,000.00 $6,100.00 $6,200.00 $6,300.00 $6,400.00 $6,500.00 $6,600.00 $6,700.00 $6,800.00 $6,900.00 $7,000.00 $7,100.00 $7,200.00 $7,300.00 $7,400.00 $7,500.00 $7,600.00 $7,700.00 $7,800.00 $7,900.00 $8,000.00

$117.82 $120.56 $123.30 $126.04 $128.78 $131.52 $134.26 $137.00 $139.74 $142.48 $145.22 $147.96 $150.70 $153.44 $156.18 $158.92 $161.66 $164.40 $167.14 $169.88 $172.62 $175.36 $178.10 $180.84 $183.58 $186.32 $189.06 $191.80 $194.54 $197.28 $200.02 $202.76 $205.50 $208.24 $210.98 $213.72 $216.46 $219.20

$99.76 $102.08 $104.40 $106.72 $109.04 $111.36 $113.68 $116.00 $118.32 $120.64 $122.96 $125.28 $127.60 $129.92 $132.24 $134.56 $136.88 $139.20 $141.52 $143.84 $146.16 $148.48 $150.80 $153.12 $155.44 $157.76 $160.08 $162.40 $164.72 $167.04 $169.36 $171.68 $174.00 $176.32 $178.64 $180.96 $183.28 $185.60

$64.50 $66.00 $67.50 $69.00 $70.50 $72.00 $73.50 $75.00 $76.50 $78.00 $79.50 $81.00 $82.50 $84.00 $85.50 $87.00 $88.50 $90.00 $91.50 $93.00 $94.50 $96.00 $97.50 $99.00 $100.50 $102.00 $103.50 $105.00 $106.50 $108.00 $109.50 $111.00 $112.50 $114.00 $115.50 $117.00 $118.50 $120.00

$55.90 $57.20 $58.50 $59.80 $61.10 $62.40 $63.70 $65.00 $66.30 $67.60 $68.90 $70.20 $71.50 $72.80 $74.10 $75.40 $76.70 $78.00 $79.30 $80.60 $81.90 $83.20 $84.50 $85.80 $87.10 $88.40 $89.70 $91.00 $92.30 $93.60 $94.90 $96.20 $97.50 $98.80 $100.10 $101.40 $102.70 $104.00

$104.06 $106.48 $108.90 $111.32 $113.74 $116.16 $118.58 $121.00 $123.42 $125.84 $128.26 $130.68 $133.10 $135.52 $137.94 $140.36 $142.78 $145.20 $147.62 $150.04 $152.46 $154.88 $157.30 $159.72 $162.14 $164.56 $166.98 $169.40 $171.82 $174.24 $176.66 $179.08 $181.50 $183.92 $186.34 $188.76 $191.18 $193.60

$89.44 $91.52 $93.60 $95.68 $97.76 $99.84 $101.92 $104.00 $106.08 $108.16 $110.24 $112.32 $114.40 $116.48 $118.56 $120.64 $122.72 $124.80 $126.88 $128.96 $131.04 $133.12 $135.20 $137.28 $139.36 $141.44 $143.52 $145.60 $147.68 $149.76 $151.84 $153.92 $156.00 $158.08 $160.16 $162.24 $164.32 $166.40

$58.05 $59.40 $60.75 $62.10 $63.45 $64.80 $66.15 $67.50 $68.85 $70.20 $71.55 $72.90 $74.25 $75.60 $76.95 $78.30 $79.65 $81.00 $82.35 $83.70 $85.05 $86.40 $87.75 $89.10 $90.45 $91.80 $93.15 $94.50 $95.85 $97.20 $98.55 $99.90 $101.25 $102.60 $103.95 $105.30 $106.65 $108.00

$49.88 $51.04 $52.20 $53.36 $54.52 $55.68 $56.84 $58.00 $59.16 $60.32 $61.48 $62.64 $63.80 $64.96 $66.12 $67.28 $68.44 $69.60 $70.76 $71.92 $73.08 $74.24 $75.40 $76.56 $77.72 $78.88 $80.04 $81.20 $82.36 $83.52 $84.68 $85.84 $87.00 $88.16 $89.32 $90.48 $91.64 $92.80

37


UNUM

Life and AD&D

YOUR BENEFITS PACKAGE

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

Motor vehicle crashes are the

#1

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

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


Basic Life and AD&D Lewisville Independent School District Voluntary Life and AD&D Insurance Plan Highlights Policy Number 547646 Who is eligible for this coverage?

All active employees working at least 15 hours each week for your employer in the U.S..

What is the coverage amount?

Your employer is providing you with $15,000 of term life and accidental death and dismemberment insurance.

When is coverage effective?*

Please see your plan administrator for your effective date.

What does my AD&D insurance pay for?

The full benefit amount is paid for loss of: • Life • Both hands or both feet or sight of both eyes • One hand and one foot • One hand and the sight of one eye • Speech and hearing Coverage amounts will reduce according to the following schedule:

Do my life insurance benefits decrease with age?

Age: 70

Insurance amount reduces to: 65% of original amount

Coverage may not be increased after a reduction.

Does this plan include help with work-life balance?

Yes. Our work-life balance employee assistance program (EAP) provides professional advice for a wide range of personal and work-related issues. The service is available to you and your family members 24 hours a day, 365 days a year. It provides resources to help you find solutions to everyday issues — such as financing a car or selecting child care — as well as more serious problems, such as alcohol or drug addiction, divorce or relationship problems. There is no additional charge for using the program, and you do not have to have filed a disability claim or be receiving benefits to use the program.

Delayed effective date of coverage Insurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. The Work-life Balance Employee Assistance Program, provided by HealthAdvocate, is available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details. The policy provisions may vary or not be available in all states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage, please refer to Policy Form C.FP-1 et al or contact your Unum representative. Underwritten by Unum Life Insurance Company of America, Portland, Maine © 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. EN-1771 (6-18) FOR EMPLOYEES

39


Voluntary Life and AD&D Lewisville Independent School District Voluntary Life and AD&D Insurance Plan Highlights Policy Number 547646 Who is eligible for this coverage?

All actively employed employees working at least 15 hours each week for your employer in the U.S. and their eligible spouses and children to age 26. Employee: up to 7 times salary in increments of $10,000; not to exceed $750,000.

What are the Life coverage amounts?

Spouse: up to 50% of employee amount in increments of $5,000; not to exceed $250,000. Child: up to 50% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $100. Employee: up to 7 times salary in increments of $10,000; not to exceed $750,000. Spouse: up to 50% of employee amount in increments of $5,000; not to exceed $250,000.

What are the AD&D coverage amounts?

Child: up to 50% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $100. Note: You may purchase AD&D coverage for yourself regardless of whether you purchase term life coverage. In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself. 2021 Re-Enrollment/Open Enrollment: If you and your dependents waived Life coverage during your initial eligibility, during the 2021 annual enrollment period, you may apply for any amount of coverage (within the plan maximum allowable amount) up to $250,000 for yourself and up to $50,000 for your spouse, without answering any medical questions. If you choose coverage over these amounts, you will need to complete a medical questionnaire.

Can I be denied coverage?

2021 Re-Enrollment/Current employees: If you and your eligible dependents are enrolled in the plan and wish to increase your life insurance coverage, you may apply on or before the enrollment deadline for any amount of additional coverage up to $250,000 for yourself and any amount of additional coverage up to $50,000 for your spouse. Any life insurance coverage over the guaranteed amount(s) will be subject to answers to health questions. New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense.

How do I apply?

Please see your plan administrator.

When is coverage effective?

Please see your plan administrator for your effective date. 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. For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness or disorder, your dependent spouse and children: are confined in a hospital or similar institution; are unable to perform two or more activities of daily living (ADLs) because of a physical or mental incapacity resulting from an injury or a sickness; are cognitively impaired; have a lifethreatening condition; is unable to attend school outside of home provided your dependent is a child and of school age (ages 5-19 years of age); or is at a developmental age which is less than half the chronological age by milestones or other pediatric developmental testing (e.g., Denver Developmental Test or similar test) provided your dependent is a child and of pre-school age (up to 6 years of age). Exception: Infants are insured from live birth.

40


Voluntary Life and AD&D Term Life

How much does the coverage cost?

Age band

Employee Monthly Life rate per $10,000

Spouse Monthly Life rate per $5,000

<25

$0.36

$0.18

25-29

$0.36

$0.18

30-34

$0.45

$0.23

35-39

$0.63

$0.32

40-44

$0.99

$0.50

45-49

$1.71

$0.86

50-54

$2.97

$1.49

55-59

$4.23

$2.12

60-64

$5.04

$2.52

65-69

$9.00

$4.50

70-74

$15.39

$7.70

75+

$30.87

$15.44

Child Life monthly rate is $0.20 for $2,000. One Life premium covers all children. AD&D rate chart

AD&D cost

Monthly Cost

Employee

Per $10,000

$0.30

Spouse

Per $5,000

$0.15

Child

Per $2,000

$0.06

Your rate is based on your age as of 9/1/2021 — your coverage-anniversary date. Insurance age is calculated by subtracting your year of birth from the year your coverage becomes effective or the current anniversary date. Spouse rate is based on the employee’s insurance age as outlined above. Coverage amounts will reduce according to the following schedule: Do my life insurance benefits decrease with age?

Age: 70

Insurance amount reduces to: 65% of original amount

Coverage may not be increased after a reduction.

Does this plan include help with work-life balance?

Yes. Our work-life balance employee assistance program (EAP) provides professional advice for a wide range of personal and work-related issues. The service is available to you and your family members 24 hours a day, 365 days a year. It provides resources to help you find solutions to everyday issues — such as financing a car or selecting child care — as well as more serious problems, such as alcohol or drug addiction, divorce or relationship problems. There is no additional charge for using the program, and you do not have to have filed a disability claim or be receiving benefits to use the program.

If you retire, reduce your hours or leave your employer, you can continue coverage for yourself your Is the coverage portable spouse and your dependent children at the group rate. Portability is not available for people who have a (can I keepit if I leave my medical condition that could shorten their life expectancy employer)? — but they may be able to convert their term life policy to an individual life insurance policy.

41


Voluntary Life and AD&D Are there any life insurance exclusions or limitations?

Life insurance benefits will not be paid for deaths caused by suicide within the first 24 months after the date your coverage becomes effective. If you increase or add coverage, these enhancements will not be paid for deaths caused by suicide within the first 24 months after you make these changes.

Will my premiums be waived if I’m disabled?

If you become disabled (as defined by your plan) and are no longer able to work, your life premium payments will be waived until your disability period ends.

What does my AD&D insurance pay for?

The full benefit amount is paid for loss of: • life; • both hands or both feet or sight of both eyes; • one hand and one foot; • one hand or one foot and the sight of one eye; • speech and hearing. Other losses may be covered as well. Please contact your plan administrator.

Are there any AD&D exclusions or limitations?

Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from: • disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM); • suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane; • war, declared or undeclared, or any act of war; • active participation in a riot; • committing or attempting to commit a crime under state or federal law; • the voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol; • intoxication – “being intoxicated” means you or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.

When does my coverage end?

You and your dependents’ coverage under the Summary of Benefits ends on the earliest of: • the date the policy or plan is cancelled; • the date you no longer are in an eligible group; • the date your eligible group is no longer covered; • the last day of the period for which you made any required contributions; • the last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness, as described in the certificate of coverage. In addition, coverage for any one dependent will end on the earliest of: • the date your coverage under a plan ends; • the date your dependent ceases to be an eligible dependent; • for a spouse, the date of a divorce or annulment; • for dependent coverage, the date of your death. Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.

The Work-life Balance Employee Assistance Program, provided by HealthAdvocate, is available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details. 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 C.FP-1 et al or contact your Unum representative. Underwritten by Unum Life Insurance Company of America, Portland, Maine © 2017 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. EN-1773 (8-17) FOR EMPLOYEES 42


43


TEXAS LIFE

Individual Life

About this Benefit Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.

YOUR BENEFITS PACKAGE

Experts recommend at least

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 44 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Lewisville ISD Benefits Website: www.LISD.net/Benefits


Individual Life Additional Features • Minimal Cash Value. Designed to provide a high death benefit at a reasonable premium, purelife-plus provides peace of mind for you and your beneficiaries Voluntary permanent life insurance can be an ideal while freeing investment dollars to be directed toward complement to the group term and optional term your such tax-favored retirement plans as 403(b), 457 and employer might provide. Designed to be in force when you 401(k). die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the • Long Guarantees. Enjoy the assurance of a contract necessary premium. Group and voluntary term, on the that has a guaranteed death benefit to age 121 and other hand, typically are not portable if you change jobs level premium that guarantees coverage for a and, even if you can keep them after you retire, usually significant period of time (after the guaranteed period, cost more and decline in death benefit. premiums may go down, stay the same, or go up).4

Life Insurance Highlights For the Employee

The policy, purelife-plus, is underwritten by Texas Life Insurance Company, and it has the following features: •

High Death Benefit. With one of the highest death benefits available at the worksite,1 purelife-plus gives your loved ones peace of mind, knowing there will be life insurance in force when you die.

You may apply for this permanent coverage, not only for yourself, but also for your spouse, children and grandchildren.5

3 Quick Questions You can qualify by answering just 3 questions – no exams or needles.

Refund of Premium. Unique in the marketplace, purelife-plus offers you a refund of 10 years’ premium, DURING THE LAST SIX MONTHS, HAS THE PROPOSED should you surrender the contract if the premium you INSURED: 1. Been actively at work on a full time basis, performing pay when you buy the contract ever increases. usual duties? (Conditions apply.) 2. Been absent from work due to illness or medical Accelerated Death Benefit Due to Terminal Illness Rider. treatment for a period of more than 5 consecutive Should you be diagnosed as terminally ill with the working days? expectation of death within 12 months, you will have 3. Been disabled or received tests, treatment or care of the option to receive 92% of the death benefit, minus a any kind in a hospital or nursing home or received $150 ($100 in Florida) administrative fee. This valuable chemotherapy, hormonal therapy for cancer, radiation, living benefit gives you peace of mind knowing that, dialysis treatment, or treatment for alcohol or drug should you need it, you can take the large majority of abuse? your death benefit while still alive. (Conditions apply.) PureLife-plus is a Flexible Premium Adjustable Life Insurance to Age 121. As with (Form ICC07-ULABR-07 or Form Series ULABR-07) Accelerated Death Benefit for Chronic Illness Rider.2 Included for employees at a small extra cost, this rider will be triggered by the loss of two activities of daily living3 or permanent cognitive impairment. It pays the insured 92% of the death benefit minus a small administrative fee, should the insured decide to exercise it. This valuable living benefit can help offset the cost of either in-home care or care in a resident facility. (Conditions apply.) (Form ICC15-ULABR-CI-15 or Form Series ULABR-CI-15) 21M066-C Lewisville 2009 (exp0523) Not for use in CA. The agent/agency offering this coverage is not affiliated with Texas Life other than to market its products. Claims payments are the responsibility of Texas Life Insurance Company.

most life insurance products, Texas Life contracts and riders contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative or see the Purelife-plus brochure for costs and complete details. Contract Form ICC18PRFNG-NI-18 or Form Series PRFNG-NI-18. 1 Voluntary Whole and Universal Life Products, Eastbridge Consulting Group, December 2018 2 Chronic Illness Rider available for an additional cost for employees only. Conditions apply. Form ICC15-ULABR-CI-15 or Form Series ULABR-CI-15. 3 Six Activities of Daily Living include: bathing, continence, dressing, eating, toileting, and transferring. Severe Cognitive Impairment means a deterioration or loss in intellectual capacity that: (1) places the Insured in jeopardy of harming him/herself or others and, therefore, the Insured requires Substantial Supervision by another individual; and (2) is measured by clinical evidence and standardized tests which reliably measure impairment in: (a) short or long-term memory; (b) orientation to people, places or time; and (c) deductive or abstract reasoning. 4 Guarantees are subject to product terms, limitations, exclusions, and the insurer’s claims paying ability and financial strength 5 Coverage not available on children in WA or on grandchildren in WA or MD. In MD, children must reside with the applicant to be eligible for coverage.

45


CIGNA

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 46 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Lewisville ISD Benefits Website: www.LISD.net/Benefits


Critical Illness Offered by Life Insurance Company of North America, a Cigna Company EMPLOYEE-PAID CRITICAL ILLNESS INSURANCE

SUMMARY OF BENEFITS

Prepared for: Lewisville Independent School District Critical Illness insurance provides a cash benefit when a Covered Person is diagnosed with a covered critical illness or event after coverage is in effect. See State Variations (marked by *) below. Who Can Elect Coverage: You: All active, full-time Employees of the Employer who are regularly working in the United States a minimum of 15 hours per week and regularly residing in the United States and who are United States citizens or permanent resident aliens and their Spouse, Domestic partner, or Civil Union Partner and Dependent Children who are United States citizens or permanent resident aliens and who are residing in the United States. You will be eligible for coverage the first of the month following date of hire. Your Spouse/Domestic Partner: Up to age 100, as long as you apply for and are approved for coverage yourself. Your Child(ren): Birth to age 26; 26+ if disabled, as long as you apply for and are approved for coverage yourself. Available Coverage: The benefit amounts shown will be paid regardless of the actual expenses incurred. The benefit descriptions are a summary only. There are terms, conditions, state variations, exclusions and limitations applicable to these benefits. Please read all of the information in this Summary and your Certificate of Insurance for more information. All Covered Critical Illness Conditions must be due to disease or sickness. Benefit Amount Guaranteed Issue Amount Employee $10,000, $20,000, $30,000 Up to $30,000 Spouse 100% of employee amount Up to $30,000 Children 100% of employee amount, All guaranteed issue including Childhood Conditions. See “Guaranteed Issue” section below for more information. Covered Conditions Benefit Amount Benefit Amount Cancer Conditions Skin Cancer* $250 1x per lifetime Covered Conditions Initial Benefit Amount % Recurrence % of Initial Benefit Amount Invasive Cancer 100% 100% Carcinoma in Situ 25% 25% Vascular Conditions Heart Attack 100% 100% Stroke 100% 100% Coronary Artery Disease 100% 100% Nervous System Conditions Advanced Stage Alzheimer's Disease 25% Not Available Amyotrophic Lateral Sclerosis (ALS) 25% Not Available Parkinson's Disease 25% Not Available Multiple Sclerosis 25% Not Available Mild Stage Alzheimer's Disease 25% Not Available Huntington's Disease 25% Not Available Myasthenia Gravis 25% 25% Infectious Conditions Bacterial Meningitis 25% 25% Malaria 25% 25% Tuberculosis 25% 25% Necrotizing Fasciitis 25% 25% Osteomyelitis 25% 25% 47


Critical Illness Covered Conditions Initial Benefit Amount % Recurrence % of Initial Benefit Amount Childhood Conditions* Cerebral Palsy 25% Not Available Cystic Fibrosis 25% Not Available Muscular Dystrophy 25% Not Available Poliomyelitis 25% Not Available Other Specified Conditions Benign Brain Tumor 100% 100% Blindness 100% Not Available Coma 25% 25% End-Stage Renal (Kidney) Disease 100% 100% Major Organ Failure 100% 100% Paralysis 100% 100% Loss of Hearing 100% Not Available Loss of Speech 100% Not Available Systemic Lupus 25% 25% Systemic Sclerosis 25% 25% For Childhood Conditions please refer to the beginning of the Available Coverage section above for details on how muchcoverage is available for covered children. Health Screening Test Benefit Benefit Amount Examples includes (but are not limited to) mammography, and certain blood tests. The benefit amount shown will be paid regardless of the actual expenses incurred and is paid on a per day basis. Virtual Care accepted. Benefits Initial Critical Illness Benefit

Recurrence Benefit

Skin Cancer Benefit Maximum Lifetime Limit

$50 1 per year

Benefit for a diagnosis made after the effective date of coverage for each Covered Condition shown above. The amount payable per Covered Condition is the Initial Benefit Amount multiplied by the applicable percentage shown. Each Covered Condition will be payable one time per Covered Person, subject to the Maximum Lifetime Limit. A 180 days separation period between the dates of diagnosis is required.* Benefit for the diagnosis of a subsequent and same Covered Condition for which an Initial Critical Illness Benefit has been paid, payable after a 6 month separation period from diagnosis of a previous Covered Condition, subject to the Maximum Lifetime Limit. Pays benefit stated above. The maximum benefit payable per Covered Person is the lesser of 5 times the elected Benefit Amount or $150,000. The following benefits are not subject to this limit: Skin Cancer and Additional Benefits

Additional Benefits Hospital Indemnity* Pays when a newborn child of the Employee is confined to a hospital in the Neonatal Intensive Care Unit, payable even if the coverage for child is not elected. No other benefits are available for any other Covered Person.

25% of the issued Employee Benefit Amount Limited to 1 benefit per newborn child

Portability Feature: You can continue 100% of coverage for all Covered Persons at the time Your coverage ends. You must be covered under the policy and be under the age of 100 in order to continue your coverage. Rates may change and all coverage ends at age 100. Applies to United States Citizens and Permanent Resident Aliens residing in the United States.

48


Critical Illness Employee’s Monthly Cost of Coverage: Benefit Amount: $10,000 Employee + Spouse Employee + Children Employee + Family $4.19 $4.74 $6.88 $7.82 $6.72 $10.50 $13.35 $9.04 $15.63 $26.54 $14.15 $28.78 $46.09 $22.32 $48.51 $75.47 $36.52 $77.89 $126.98 $72.54 $129.53 $126.98 $72.54 $129.53 Benefit Amount: $20,000 Age Employee Employee + Spouse Employee + Children Employee + Family <29 $4.10 $8.38 $9.48 $13.76 30 to 39 $8.08 $15.64 $13.44 $21.00 40 to 49 $13.50 $26.70 $18.08 $31.26 50 to 59 $23.84 $53.08 $28.30 $57.56 60 to 69 $39.82 $92.18 $44.64 $97.02 70 to 79 $68.22 $150.94 $73.04 $155.78 80 to 89 $139.98 $253.96 $145.08 $259.06 90+ $139.98 $253.96 $145.08 $259.06 Benefit Amount: $30,000 Age Employee Employee + Spouse Employee + Children Employee + Family <29 $6.15 $12.57 $14.22 $20.64 30 to 39 $12.12 $23.46 $20.16 $31.50 40 to 49 $20.25 $40.05 $27.12 $46.89 50 to 59 $35.76 $79.62 $42.45 $86.34 60 to 69 $59.73 $138.27 $66.96 $145.53 70 to 79 $102.33 $226.41 $109.56 $233.67 80 to 89 $209.97 $380.94 $217.62 $388.59 90+ $209.97 $380.94 $217.62 $388.59 Costs are subject to change. Actual per pay period premiums may differ slightly due to rounding. The policy’s rate structure is based on attained age, which means the premium can increase due to the increase in your age. Age <29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80 to 89 90+

Employee $2.05 $4.04 $6.75 $11.92 $19.91 $34.11 $69.99 $69.99

Important Policy Provisions and Definitions: Covered Person: An eligible person who is enrolled for coverage under the Policy. Covered Loss: A loss that is specified in the Policy in the Schedule of Benefits section and suffered by the Covered Person within the applicable time period described in the Policy. When your coverage begins: Coverage begins on the later of the program’s effective date, the date you become eligible, the first of the month following the date your completed enrollment form is received, or if evidence of insurability is required, the first of the month after we have approved you (or your dependent) for coverage in writing, unless otherwise agreed upon by Cigna. Your coverage will not begin unless you are actively at work on the effective date. Coverage for all other Covered Persons will not begin on the effective date if the covered person is confined to a hospital, facility or at home,

disabled or receiving disability benefits or unable to perform activities of daily living. When your coverage ends: Coverage ends on the earliest of the date you and your dependents are no longer eligible, the date the group policy is no longer in force, or the date for the last period for which required premiums are paid. For your dependent, coverage also ends when your coverage ends, when their premiums are not paid or when they are no longer eligible. (Under certain circumstances, your coverage may be continued. Be sure to read the provisions in your Certificate about when coverage may continue.) 30 Day Right To Examine Certificate: If a Covered Person is not satisfied with the Certificate of Insurance for any reason, it may be returned to us within 30 days after receipt. We will return any premium that has been paid and the Certificate will be void as if it had never been issued.

49


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

disease affecting eye or optic nerve or ischemic disorders of the vestibular system. Coronary Artery Disease, heart disease/angina requiring coronary artery bypass surgery, as prescribed by a Physician. Excludes angioplasty (percutaneous coronary intervention) and stent implantation. Advanced Stage Alzheimer’s Disease, progressive degenerative disorder that attacks the brain’s nerve cells resulting in cognitive deficits interfering with independence in completion of instrumental activities of daily living and the inability to perform at least 2 physical activities of daily living. Amyotrophic Lateral Sclerosis (ALS aka Lou Gehrig’s Disease), motor neuron disease resulting in muscular weakness and atrophy. Parkinson’s Disease, progressive, degenerative neurologic disease with indicated signs of the disease. Multiple Sclerosis, disease involving damage to brain and spinal cord cells with signs of motor or sensory deficits confirmed by MRI. Includes Neuromyelitis Optica and Transverse Myelitits. Mild Stage Alzheimer’s Disease, progressive degenerative disorder that attacks the brain’s nerve cells resulting in cognitive deficits that interfere with independence in everyday activities that require assistance with at least 2 instrumental activities of Specific Definitions, Benefit Exclusions and Limitations: daily living. The date of diagnosis must occur while coverage is in force and Huntington’s Disease, progressive disorder causing breakdown of the condition definition must be satisfied. Only one Initial the nerve cells in the brain leading 1) Chorea; or 2) two of the Benefit will be paid for each Covered Condition per person and following: involuntary/impaired movement, cognitive or benefits will be subject to separation periods and Maximum psychiatric disorders. Lifetime Limits. Myasthenia Gravis, autoimmune, neuromuscular disease causing Skin Cancer, basal cell/squamous cell carcinoma or certain forms loss of muscle control. of melanoma. Bacterial Meningitis, bacterial infection in the brain and spinal Invasive Cancer, uncontrolled/abnormal growth or spread of cord. Excludes viral (aseptic) meningitis. invasive malignant cells. Excludes pre-malignant conditions or Malaria, parasitic (mosquito-borne) disease resulting in conditions with malignant potential, carcinoma in situ, basal cell infection. Excludes infection by the P. malaria, P. vivax, P. ovale. carcinoma, squamous cell carcinoma of the skin, unless Tuberculosis, airborne infectious disease with indicated signs of metastatic disease develops, melanoma that is diagnosed as the disease. Excludes latent or inactive Tuberculosis. Necrotizing Clark’s Level I or II or Breslow less than 0.75mm, or melanoma in Fasciitis (aka flesh-eating disease), bacterial infection in skin situ, or prostate tumor that is classified as T-1a, b, or c, N-0, and layers and tissue. M-0 on a TNM classification scale. Also excludes the recurrence Osteomyelitis, chronic bacterial infection that deteriorates bone/ or metastasis of an original Cancer that was diagnosed prior to bone marrow. the coverage effective date if the Insured has undergone Cerebral Palsy, brain injury or abnormality occurring within 24 treatment for such cancer within 12 months of being diagnosed hours of birth resulting in developmental brain disorder. with cancer while under this coverage. Cystic Fibrosis, progressive disorder that affects exocrine glands. Carcinoma in Situ, non-invasive malignant tumor. Excludes Muscular Dystrophy, progressive disorder that interferes with premalignant conditions or conditions with malignant potential, formation of healthy muscles. skin cancers, invasive cancer (basal/squamous cell carcinoma or Poliomyelitis, acute, infectious disease caused by the poliovirus melanoma/melanoma in situ). with indicated signs of the disease. Excludes non- paralytic polio Heart Attack, includes the following that confirms permanent or post-polio syndrome. loss of heart muscle function: 1) EKG; 2) elevation of cardia enzyme. Stroke, cerebrovascular event–for instance, cerebral hemorrhage–confirmed by neuroimaging studies and neurological deficits lasting 96 hours or more. Excludes transient Specific Definitions, Benefit Exclusions and Limitations: ischemic attack (TIAs), brain injury related to trauma or Benign Brain Tumor, non-cancerous abnormal cells in the brain. infection, brain injury associated with hypoxia or anoxia, vascular 50


Critical Illness Blindness, irreversible sight reduction in both eyes; Best corrected single eye visual acuity less than 20/200 (E-Chart) or 6/60 (Metric) or with visual field reduction (both eyes) to 20 degrees or less. May require loss be due to specific illness. Coma, unconscious state lasting at least 96 continuous hours. Excludes any state of unconsciousness intentionally or medically induced from unconsciousness intentionally which the Covered Person is able to be aroused. End-Stage Renal (Kidney) Disease, chronic, irreversible function of both kidneys. Requires hemo or peritoneal dialysis. Major Organ Failure, includes: liver, lung, pancreas, kidney, heart or bone marrow. Happens when transplant is prescribed or recommended and placed on UNOS registry. If the Covered Person has a combination transplant (i.e. heart and lung), a single benefit amount will be payable. Recurrence Benefit not payable for same organ for which a benefit was previously paid. Paralysis, complete, permanent loss of use of two or more limbs due to a disease. Excludes loss due to Stroke and Multiple Sclerosis. Loss of Hearing, permanent hearing loss in both ears; loss greater than 90dB HL. May require loss be due to specific illness. Loss of Speech, permanent loss of speech which is irrecoverable by other means excludes loss due to specified conditions (i.e. Alzheimer’s). Systemic Lupus, chronic, inflammatory, auto-immune disease with indicated signs of the disease. Systemic Sclerosis, chronic, degenerative, auto-immune disease with indicated signs of the disease. ***Benefits-Specific Conditions, Exclusions and Limitations (Additional Benefits): Hospital Indemnity: The Common Exclusions apply to this Additional Benefit. In addition, the following applies: Newborn Neonatal Intensive Care (NICU) Stay: Must be admitted as an inpatient and confined in an NICU of a Hospital at the direction and under the care of a physician. Cannot be discharged from Hospital prior to be admitted to NICU.

Spouse definition includes civil union partners in New Hampshire and Vermont. Not all shown covered conditions may be available and the Specific Definitions, Benefit Exclusions and Limitations for some of the conditions may vary for residents of ID, MD, NH, OR, WA. Newborn Neonatal Intensive Care (NICU) Stay: may not be available for residents of ID, MD, ND, NH, OR, WA. Portability in VT is referred to as Continuation due to loss of eligibility. VT residents are not subject to the age limit to continue coverage. Exclusions may vary for residents of ID, MN, NC, SC, SD, VT and WA. THIS POLICY PAYS LIMITED BENEFITS ONLY. IT DOES NOT CONSTITUTE COMPREHENSIVE HEALTH INSURANCE COVERAGE AND IS NOT INTENDED TO COVER ALL MEDICAL EXPENSES. THIS COVERAGE DOES NOT SATISFY THE “MINIMUM ESSENTIAL COVERAGE” OR INDIVIDUAL MANDATE REQUIREMENTS OF THE AFFORDABLE CARE ACT (ACA). THIS COVERAGE IS NOT A MEDICAID OR MEDICARE SUPPLEMENT POLICY. Series 2.2 Terms and conditions of coverage for Critical Illness Insurance are set forth in Group Policy No. CI961740. This is not a contract. Please see your Plan Sponsor to obtain a copy of the Policy. If there are any differences between this summary and the Group Policy, the information in the Group Policy takes precedence. Product availability, costs, benefits, riders, covered conditions and/or features may vary by state. Please keep this material as a reference. Insurance coverage is issued on group policy form number: Policy Form GCI-02-1000. Coverage is underwritten by Life Insurance Company of North America, 1601 Chestnut St. Philadelphia, PA 19192 All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Life Insurance Company of North America. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 905808 03/20 © 2021 Cigna. Some content provided under license.

Guaranteed Issue: If you are a new hire you are not required to provide proof of good health if you enroll during your employer's eligibility waiting period and you choose an amount of coverage up to and including the Guaranteed Issue Amount. If you apply for an amount of coverage greater than the Guaranteed Issue Amount, coverage in excess of the Guaranteed Issue Amount will not be issued until the insurance company approves acceptable proof of good health. Guaranteed Issue coverage may be available at other specified periods of time. Your employer will notify you when these periods of time are available. Your Spouse must be age 18 or older to apply if evidence of insurability is required.

*State Variations

51


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 52 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Lewisville CBEBC ISD Benefits Benefits Website: Website:www.cbebc.com. www.LISD.net/Benefits


Medical Transport EMERGENT PLUS MEMBERSHIP BENEFITS Emergent Air Transportation

In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities. Please see your Member Services Agreement for the complete terms, conditions and limitations of this benefit.

Emergent Ground Transportation

In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities. Please see your Member Services Agreement for the complete terms, conditions and limitations of this benefit.

Non-Emergent Inter-Facility Transportation

In the event that a member is in stable condition in a medical facility but requires a heightened level of care that is not available at their current medical facility, Members have access to non-emergent air or ground transportation between medical facilities. Please see your Member Services Agreement for the complete terms, conditions, and limitations of this benefit.

Repatriation/ Recuperation

In the event that a Member is hospitalized more than 100-miles from their home, Members have access to air or ground medical transportation into a medical facility closer to Member’s home for the purposes of recuperation. Please see your Member Services Agreement for the complete terms, conditions and limitations of this benefit.

Did You Know? 16-Million people are sent to the emergency room through a ground or air ambulance every year.* Insurance companies typically DO NOT cover all air and ground ambulance expenses which can result in a bill in excess of $60,000.

Emergent Ground Ambulance transports can cost as much as

Non-Emergent Air Medical transports can cost more than

Emergent Air Ambulance transports often cost more than

$5,000

$20,000

$60,000

MASA MTS PROVIDES ULTIMATE PEACE OF MIND FOR ONLY $14 PER MONTH TO COVER YOU AND YOUR FAMILY! Trust MASA MTS to provide you and your family peace of mind against the financial burden of medical transport bills by enrolling in a MASA MTS membership at an affordable GROUP RATE.

*SOURCE: National Hospital Ambulatory Medical Care Survey The descriptions of the services offered by MASA are for marketing purposes only and do not represent the terms and conditions contained within each applicable Member Services Agreement. Please review the applicable Member Services Agreement for the completed terms and conditions of any service offered by MASA.

53


LEGAL EASE

YOUR BENEFITS PACKAGE

Legal Services

About this Benefit Finding the right type of attorney when a need arises can be one of the more stressful tasks when dealing with a legal matter. The right help is essential. There are many types of attorneys depending upon what type of issue someone may be facing. We help with this first step. We use our experience and relationships with our network providers to match you to the right type of attorney you need in the right location, with availability to set up a consultation with you. We see this step as a way to save you time, so you can get back to your busy schedule of work, kids or whatever may be just as important.

$1,500 Is the average cost of a basic will and estate planning package. The average yearly premium paid by Texas Legal Members is only $300.

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 Lewisville ISD Benefits Website: www.LISD.net/Benefits


Legal Services Be fully prepared and confident with Legal Benefits

Plan proudly offered to the employees of Lewisville ISD

Protect your family’s future with LegalEASE. LegalEASE offers valuable benefits to shield your family and savings from unexpected personal legal issues. What you get with a LegalEASE plan: • An attorney with expertise specific to your personal legal matter • Access to a national network of attorneys with exceptional experience that are matched to meet your needs • In- and out-of-network coverage • Concierge help navigating common individual or family legal issues Enroll in the LegalEASE Benefits Plan. To learn more: Call: 1(800) 248-9000 Visit: www.legaleaseplan.com/lisd

A legal benefits plan can ease the biggest stresses - finding and paying for legal expertise when you need it most. LegalEASE offers a legal benefits plan that provides support and protection from unexpected personal legal issues.

Plan Details: $15.18 monthly, via payroll deduction

Who’s covered: • • • •

Employee Spouse Dependent Children: Up to age 19; Age 19-26 enrolled fulltime at an accredited university Parents: Elder Benefits designed for Plan member’s and Spouse’s parents

AUTO & TRAFFIC Traffic Ticket, Serious Traffic Matters (Resulting in Suspension or Revocation of License), License Suspension (Administrative Proceeding), First-time Vehicle Buyer, Vehicle Repair & Lemon Law Litigation ESTATE PLANNING & WILLS Will or Codicil, Living Will and/or Health Care Power of Attorney, Probate of Small Estate, Living Trust Document FINANCIAL & CONSUMER Debt Collection Defense, Bankruptcy, Tax Audit, Student Loan Refinancing/Collection Defense, Document Preparation, Consumer Dispute, Small Claims Court, Mail Order/Internet Purchase Dispute, Bank Fee Dispute, Cell Phone Contract Dispute, Warranty Dispute, Healthcare Coverage Disputes, Financial Advisor, Identity Theft Defense FAMILY Separation, Divorce, Prenuptial Agreement, Name Change, Guardianship/Conservatorship, Adoptions, Juvenile Court Proceedings, Elder Law GENERAL Civil Litigation Defense, Incompetency Defense, Initial Law Office Consultation, Review of Simple Documents, Mediation, Misdemeanor Defense, Identity Theft Assistance Limitations apply. Please visit https://www.legaleaseplan.com/lisd for specific plan benefits.

For more information, visit: https://www.legaleaseplan.com/lisd To learn more, call: 1(800) 248-9000, and reference “Lewisville ISD”

The value of a LegalEASE Benefits Plan. Being a member saves costly legal fees and provides coverage for: HOME & RESIDENTIAL Purchase, Sale, Refinancing of Primary Residence/ Vacation or Investment Home, Tenant Dispute, Tenant Security Deposit Dispute, Landlord Dispute with Tenant, Security Deposit Dispute with Tenant, Construction Defect Dispute, Neighbor Dispute, Noise Reduction Dispute, Foreclosure

Limitations and exclusions apply. This benefit summary is intended only to highlight benefits and should not be relied upon to fully determine coverage. More complete descriptions of benefits and the terms under which they are provided are received upon enrolling in the plan. Group legal plans are administered by Legal Access Plans, L.L.C. or LegalEASE Home Office: 5151 San Felipe, Suite 2300, Houston, TX. This legal plan may not be regulated as insurance in some states, but is available in all states. Group legal plans are administered by The LegalEASE Group. Please contact LegalEASE for complete details. ©2021 LegalEASE All rights reserved. LASG_INS_Enroll_1PG_LewisvilleISD_2021-04

55


NBS

FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

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

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

FLIP TO…

PG. 11

FOR HSA VS. FSA COMPARISON

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 56 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Lewisville ISD Benefits Website: www.LISD.net/Benefits


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

57


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

58


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).

59


LEWISVILLE ISD

Sick Leave Bank

YOUR BENEFITS PACKAGE

34.6

months Is the average group long-term 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 60 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Lewisville ISD Benefits Website: www.LISD.net/Benefits


Sick Leave Bank ANNOUNCEMENT: 2020-21 Sick Leave Bank Members who continue their membership for 2021-22 and did not use any SLB days for 20-21, will not be required to donate a local day for 2021-22 membership. All employees working 30 hours or more per week are eligible to join the Sick Leave Bank (SLB). One local personal day is donated each year to join SLB. Enrollment is during Open Enrollment each school year or within 31 days of date of employment or eligibility for membership. An employee must be able to earn at least one local personal day from the beginning of employment to the end of that SLB year to be eligible for membership. What you need to know on Sick Leave Bank: • Bank year begins on July 1. • Members may withdraw up to 25 fully paid sick leave Bank days per year with up to 100-day lifetime maximum withdrawal. • Pregnancy has special restrictions and limitations. • Absence for personal illness or injury must be at least 10 consecutive work days. • Restricted bereavement and critical care leave for immediate family members can be Sick Leave Bank days. No minimum absence is required. • You must first use all accumulated leave before using Bank days (Except for vacation). • Elective procedures are not covered.

Sick Leave Bank rules, procedures, and applications are at lisd.net/benefits.

61


NOTES

62


NOTES

63


WWW.LISD.NET/BENEFITS 64

Profile for FBS

2021-22 Lewisville ISD Benefit Guide  

2021-22 Lewisville ISD Benefit Guide  

Recommendations could not be loaded

Recommendations could not be loaded

Recommendations could not be loaded

Recommendations could not be loaded