2022-23 TIPSEBC Benefit Guide (TRS)

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REGION VIII TIPS EBC BENEFIT GUIDE EFFECTIVE: 09/01/2022 - 8/31/2023 WWW.TIPSEBC.COM 2022 - 2023 PlanYear 1
Table of Contents FLIP TO... How to Enroll 4-5 Annual Benefit Enrollment 6-11 1. Benefit Updates 6 2. Section 125 Cafeteria Plan Guidelines 7 3. Annual Enrollment 8 4. Eligibility Requirements 9 5. Helpful Definitions 10 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 11 Medical 12-17 Dental 18-19 Vision 20 Disability 21 Health Savings Account (HSA) 22-23 Cancer 24 Accident 25 Telehealth 26 Life and AD&D 27 Individual Life 28 Identity Theft 29 Emergency Medical Transportation 30 Critical Illness 31-32 Flexible Spending Accounts (FSA) 33-34 Hospital Indemnity 35 FBS Benefits App Group # Index 36 HOW TO ENROLL PG. 4 SUMMARY PAGES PG. 6 YOUR BENEFITS PG. 12 2

Benefit Contact Information

TIPS EBC BENEFITS

Financial Benefit Services (469) 385-4685 www.tipsebc.com

MEDICAL - TRS ACTIVECARE DENTAL

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

VISION DISABILITY

Superior Vision Group # 320560 (800) 507-3800 www.superiorvision.com

The Hartford Group # 395317 (866) 278-2655 www.thehartford.com

CANCER ACCIDENT

American Public Life Group # 13041 (800) 256-8606 www.ampublic.com

American Public Life Group # 13041 (800) 256-8606 www.ampublic.com

LIFE AND AD&D INDIVIDUAL LIFE

UNUM Group #467283 (800) 583-6908 www.unum.com

5Star Life Insurance Company (800) 776-2322 http://5starlifeinsurance.com

EMERGENCY MEDICAL TRANSPORT CRITICAL ILLNESS

MASA Group #MKTR8 (800) 423-3226 www.masamts.com

Aetna Group #802469 (888) 772-9682 www.aetna.com

HOSPITAL INDEMNITY PLAN EMPLOYEE ASSISTANCE PROGRAM

Aetna Group #802469 (888) 772-9682 www.aetna.com

UNUM (800) 854-1446 www.unum.com/lifebalance

Cigna Group # 3338828 (800) 244-6224 www.mycigna.com

HEALTH SAVINGS ACCOUNT (HSA)

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

TELEHEALTH

MDLIVE (888) 365-1663 www.mdlive.com/fbs

IDENTITY THEFT

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

FLEXIBLE SPENDING ACCOUNT (FSA)

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

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Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS TIPS” to (800) 583-6908 App Group #: Go to PAGE 36 to find your district’s group # Text “FBS TIPS” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment: • Benefit Resources • Online Enrollment • Interactive Tools • And more! 4
1 WWW.TIPSEBC.COM How to Log In 2 CLICK LOGIN 3 ENTER USERNAME & PASSWORD Your Username Is: Your email in THEbenefitsHUB. (Typically your work email) Your Password Is: Four (4) digits of your birth year followed by the last four (4) digits of your Social Security Number 5

Annual Benefit Enrollment

Benefit Updates - What’s New:

Dental Deductible Increasing: Dental deductibles are increasing to $75 for individual coverage and $225 for family coverage.

Benefit Care Line: Call (833) 453-1680 to speak with a licensed enrollment counselor regarding:

• Your employee benefits

• Filing a claim

• Continuing benefits after leaving employment

Monday – Thursday: 8:00 AM – 5:30 Friday: 8:00 – 3:00 PM CT

• Login and complete your benefit enrollment from 05/23/2022-06/03/2022

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

• Update your information: home address, phone numbers, email, and beneficiaries.

• REQUIRED!! Due to the Affordable Care Act (ACA) reporting requirements, you must add your dependent’s CORRECT social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator.

Don’t Forget!
SUMMARY PAGES
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Annual Benefit Enrollment

Section 125 Cafeteria Plan Guidelines

A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.

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

CHANGES IN STATUS

(CIS): QUALIFYING EVENTS

Marital Status

Change in Number of Tax Dependents

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

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

Gain/Loss of Dependents' Eligibility Status

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 under an employer's plan may include change in age, student, marital, employment or tax dependent status.

Judgment/Decree/ Order

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 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.

SUMMARY PAGES
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Annual Benefit Enrollment

Annual Enrollment

During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.

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

• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.

• 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.

New Hire Enrollment

All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligible 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.

Where can I find forms?

For benefit summaries and claim forms, go to your benefit website: www.tipsebc.com. Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms section.

How can I find a Network Provider?

For benefit summaries and claim forms, go to the TIPSEBC benefit website: www.tipsebc.com. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section.

When will I receive ID cards?

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

Employee Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.

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 your 2022 benefits become effective on September 1, 2022, you must be actively-at-work on September 1, 2022 to be eligible for your new benefits.

PLAN MAXIMUM AGE

Accident Through 25 Cancer Through 25 Critical Illness Through 25 Dental Through 25

Dependent Care FSA

12 or younger or qualified individual unable to care for themselves & claimed as a dependent on your taxes

Flexible Spending Account (FSA) Through 25 or IRS Tax Dependent Health Savings Account (HSA) IRS Tax Dependent

Individual Life Through 23

Life and AD&D Through 25

Hospital Indemnity Plan Through 25

Telehealth Through 25

Vision Through 25 Emergency Medical Transport Through 25

Dependent Eligibility Requirements

Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, 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.

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

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.

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.

SUMMARY PAGES
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Helpful Definitions

Actively-at-Work

You are performing your regular occupation for the employer on a full-time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel If you will not be actively at work beginning 9/1/2022 please notify your benefits administrator.

Annual Enrollment

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

Annual Deductible

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

Calendar Year

January 1st through December 31st

Co-insurance

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

Guaranteed Coverage

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

In-Network

Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.

Out-of-Pocket Maximum

The most an eligible or insured person can pay in coinsurance for covered expenses.

Plan Year

September 1st through August 31st

Pre-Existing Conditions

Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescription drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).

SUMMARY PAGES
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Description

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 taxfree.

Minimum

Maximum

$1,400 single (2022) $2,800 family (2022) N/A

$3,650 single (2022) $7,300 family (2022) $2,850 (2022)

Permissible Use Of Funds

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

Year-to-year rollover of account balance?

Employees may use funds any way they wish. 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).

Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65). Not permitted

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

Savings
Health
Account (HSA) (IRC Sec. 223) Flexible Spending Account (FSA) (IRC Sec. 125)
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
Deductible
Contribution
SUMMARY PAGES HSA vs. FSA
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INFORMATION PG. 22 FLIP TO FOR
INFORMATION PG. 33 11
FLIP
HSA
FSA

Medical Insurance

TRS

ABOUT MEDICAL

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

For full plan details, please visit your benefit website: www.tipsebc.com

Medical Rates are shown without employer contribution.

TRS ActiveCare HD

Employee Only $418.00

Employee & Spouse $1,176.00

Employee & Child(ren) $750.00

Employee & Family $1,407.00

TRS ActiveCare 2

Employee Only

$1,013.00

Employee & Spouse $2,402.00

Employee & Child(ren) $1,507.00

Employee & Family $2,841.00

TRS ActiveCare Primary

Employee Only $406.00

Employee & Spouse $1,144.00

Employee & Child(ren) $730.00

Employee & Family $1,370.00

TRS ActiveCare Primary+

Employee Only $510.00

Employee & Spouse $1,246.00

Employee & Child(ren) $820.00

Employee & Family $1,567.00

BENEFITS

EMPLOYEE
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Dental

ABOUT DENTAL

Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease. For full plan details, please visit your benefit website: www.tipsebc.com

DENTAL - HIGH

Class I: Diagnostic & Preventive

Oral Evaluations

Prophylaxis: routine cleanings

X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain

Class II: Basic Restorative

Restorative: fillings

Oral Surgery: minor

Oral Surgery: oral surgical procedures

Anesthesia: general and IV sedation Repairs: bridges, crowns and inlays Repairs: dentures Denture Relines, Rebases and Adjustments

Class III: Major Restorative

Inlays and Onlays

Prosthesis Over Implant

Crowns: prefabricated stainless steel / resin

Crowns: permanent cast and porcelain Bridges and Dentures

Oral Surgery: extractions of impacted teeth Endodontics: minor and major Periodontics: minor and major

Class IV: Orthodontia

Coverage for Dependent Children to age 19 Lifetime Benefits

Maximum: $1,000

Class V: TMJ

100% No Deductible No Charge 100%

80% After Deductible 20% After Deductible 80% After Deductible 20% After Deductible

50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible

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

Occlusal orthotic device and adjustment 50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible

Class

IX: Implants

50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible

Insurance Cigna EMPLOYEE BENEFITS
PLAN Network Options In-Network: Total Cigna DPPO Network Out-of-Network: See Non-Network Reimbursement Reimbursement Levels Based on Contracted Fees Maximum Reimbursable Charge Policy Year Benefits Maximum Applies to: Class I, II, III, V & IX expenses $1,500 $1,500 Policy Year Deductible Individual Family $75 $225 $75 $225 Benefit Highlights Plan Pays You Pay Plan Pays You Pay
No Deductible Any amount over the Maximum Reimbursable Charge
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Dental Insurance Cigna

Class I: Diagnostic & Preventive

Oral Evaluations

Prophylaxis: routine cleanings

X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain

Class II: Basic Restorative

Restorative: fillings

Oral Surgery: minor

Oral Surgery: oral surgical procedures

Anesthesia: general and IV sedation

Repairs: bridges, crowns and inlays

Repairs: dentures

Denture Relines, Rebases and Adjustments

Class III: Major Restorative Inlays and Onlays

Prosthesis Over Implant

Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures

Oral Surgery: extractions of impacted teeth Endodontics: minor and major Periodontics: minor and major

Class IV: Orthodontia

Coverage for Dependent Children to age 19 Lifetime Benefits Maximum: $1,000

Class V: TMJ

100% No Deductible No Charge 100% No Deductible

80% After Deductible 20% After Deductible 80% After Deductible 20% After Deductible

50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible

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

Occlusal orthotic device and adjustment 50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible

Class IX: Implants 50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible

Dental High Option Low (MAC) Option Employee $32.60 $23.91 Employee + Spouse $81.10 $59.48 Employee + Child(ren) $79.01 $57.96 Family $125.59 $92.12
Network Options In-Network: Total Cigna DPPO Network Out-of-Network: See Non-Network Reimbursement Reimbursement Levels Based on Contracted Fees Maximum Allowable Charge Policy Year Benefits Maximum Applies to: Class I, II, III, V & IX expenses $1,000 $1,000 Policy Year Deductible Individual Family $75 $225 $75 $225 Benefit Highlights Plan Pays You Pay Plan Pays You Pay
DENTAL - LOW PLAN
Any amount over the Maximum Allowable Charge
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BENEFITS

ABOUT VISION

How to Print your Vision ID Card:

You can request your vision id card by contacting Superior Vision directly at 800-507-3800. You can also go to www.superiorvision.com and register/login to access your account by clicking on “Members” at the top of the page. You can also download the Superior Vision mobile app on your smart phone.

Vision insurance provides coverage for routine eye examinations and can help with covering some of the costs for eyeglass frames, lenses or contact lenses. For full plan details, please visit your benefit website: www.tipsebc.com Vision Insurance Superior Vision EMPLOYEE BENEFITS Benefits through Superior National network In-network Out-of-network Exam (ophthalmologist) Covered in full Up to $35 retail Frames $125 retail allowance Up to $70 retail Lenses (standard) per pair Single vision Covered in full Up to $25 retail Bifocal Covered in full Up to $40 retail Trifocal Covered in full Up to $45 retail Progressives lens upgrade See description3 Up to $45 retail Lenticular Covered in full Up to $80 retail Contact lenses4 $120 retail allowance Up to $80 retail Medically Necessary Contact Lenses Covered in full UP to $150 retail Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1. Materials co-pay applies to lenses and frames only, not contact lenses 2. Standard contact lens fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty contact lens fitting applies to new contact wearers and/or a member who wear toric, gas permeable, or multi-focal lenses. Discount features Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual
Services/frequency
$25
and customary fees for eyewear purchase which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e, progressives) and les “extras” such a tints and coatings. Eyewear purchase from a Walmart Vision Center does not qualify for this addition discount because of Walmart’s “Always Low Prices” policy. Copays
Vision Exam $10 Exam 12 months Employee $8.13 Materials1
Frame 24 months Employee + Spouse $13.85 Lenses 12 months Employee + Child(ren) $14.67 Contact lenses 12 months Family $21.99 (based on date of service)
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Disability Insurance The Hartford EMPLOYEE BENEFITS

ABOUT DISABILITY

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.

For full plan details, please visit your benefit website: www.tipsebc.com

What is Educator Disability Insurance?

Educator Disability insurance is a hybrid that combines features of short-term and long-term disability into one plan. Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. The plan gives you flexibility to be able to choose an amount of coverage and waiting period that suits your needs.

Eligibility: You are eligible if you are an active employee who works at least 15 hours per week on a regularly scheduled basis.

Enrollment: You can enroll in coverage within 31 days of your date of hire or during your annual enrollment period.

Effective Date: Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.

Actively at Work: You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session.

Benefit Amount: You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $7,500 that cannot exceed 66 2/3% of your current monthly earnings. Earnings are defined in The Hartford’s contract with your employer

Elimination Period: You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a disability benefit payment. The elimination period that you select consists of two numbers. The first number shows the number of days you must be disabled by an accident

before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin. For those employees electing an elimination period of 30 days or less, if you are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization.

Definition of Disability: Disability is defined as The Hartford’s contract with your employer. Typically, disability means that you cannot perform one or more of the essential duties of your occupation due to injury, sickness, pregnancy or other medical conditions covered by the insurance, and as a result, your current monthly earnings are 80% or less of your pre-disability earnings. One you have been disabled for 24 months, you must be prevented from performing one or more essential duties of any occupation, and as a result, your monthly earnings are 66 2/3% or less of your pre-disability earnings

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

Disability Elimination Period (per $100 in coverage)

0/7
14/14
30/30 $2.59 60/60 $2.11 90/90 $1.22 180/180 $0.87 21
$3.52
$2.98

Health Savings Account (HSA)

EECU

ABOUT HSA

A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used.

Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP).

For full plan details, please visit your benefit website: www.tipsebc.com

BENEFITS

A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs; it is a tax-exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.

A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule you do not lose your money if you do not spend it in the calendar year and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.

HSA Eligibility

You are eligible to open and contribute to an HSA if you are:

• Enrolled in an HSA-eligible HDHP (TSHBP HD).

• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan

• Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account

• Not eligible to be claimed as a dependent on someone else’s tax return

• Not enrolled in Medicare or TRICARE

• Not receiving Veterans Administration benefits

You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered under your HDHP.

Maximum Contributions

Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2022 is based on the coverage option you elect:

• Individual – $3,650

• Family (filing jointly) – $7,300

You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch-up contribution for the entire plan year.

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Health Savings Account (HSA) EECU

Opening an HSA

BENEFITS

If you meet the eligibility requirements, you may open an HSA administered by EECU. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA.

Important HSA Information

• Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.

• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.

• You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.

How to Use your HSA

• Online/Mobile: Sign-in for 24/7 account access to check your balance, pay bills and more.

• Call/Text: (817) 882-0800. EECU’s dedicated member service representatives are available to assist you with any questions. Their hours of operation are Monday through Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. –1:00 p.m. CT and closed on Sunday.

• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333-9934

• Stop by a local EECU financial center for in-person assistance; find EECU locations & service hours a www.eecu.org/ locations

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Cancer

American Public Life

ABOUT CANCER

Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.

For full plan details, please visit your benefit website: www.tipsebc.com

Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town treatments, special diets, daily living and household upkeep. In addition to these nonmedical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance through American Public Life helps pay for these direct and indirect treatment costs so you can focus on your health.

Employee & Spouse $43.80 $56.62

Employee & Child(ren) $26.70 $34.14 Employee & Family $49.80 $63.86

Should you need to file a claim contact APL at 800-256-8606 or online at www.ampublic.com. You

materials at www.mybenefitshub.com/joshuaisd

Insurance
EMPLOYEE BENEFITS
Cancer Plan Monthly Premiums PLAN 1 PLAN 2
can find additional claim forms and
Employee Only $20.64 $26.90
Plan 1 Plan 2 Internal Cancer First Occurrence $2,500 $5,000 Diagnostic Testing- 1 test per calendar year $50 per test $50 per test Follow Up-Diagnostic Testing- 1 test per calendar year $100 per test $100 per test Medical Imaging- per calendar year $500 per test/ 1 per calendar year Cancer Treatment Policy benefits Radiation and Chemotherapy, Immunotherapy Maximum Per 12month period $10,000 $20,000 Hormone Therapy- Maximum of 12 treatments per calendar year $50 per treatment $50 per treatment Surgical Rider Benefits Plan 1 Plan 2 Surgical $30 unit dollar amount Max $3,000 per operation $30 unit dollar amount Max $3,000 per operation Anesthesia 25% of amount paid for covered surgery Bone Marrow Transplant-Maximum per lifetime $6,000 $6,000 Stem Cell Transplant- Maximum per lifetime $600 $600 Miscellaneous Care Rider Benefits Plan 1 Plan 2 Hair Piece (Wig)- 1 per lifetime $150 $150 Blood, Plasma &Platelets $300 per day $300 per day Ambulance- Ground /Air-Maximum of 2 trips per Hospital Confinement for all modes of transportation combined $200/$2,000 per trip $200/$2000 per trip Heart Attack/Stroke First Occurrence Rider Benefits Plan 1 Plan 2 Lump Sum Benefit- Maximum per 1 covered person per lifetime $2,500 $2,500 Hospital Intensive Care Unit Rider Benefits Plan 1 Plan 2 Intensive Care Unit $600 per day $600 per day Pre-Existing Condition Exclusion: Review the Benefit Summary page located on your employee benefits portal for full details. 24

ABOUT ACCIDENT

Insurance American
Life EMPLOYEE BENEFITS
Benefit Description Summary of Benefits Low Option High Option Accidental Death – per unit $5,000 $15,000 Medical Expense Accidental Injury Benefit – per unit Actual charges up to $500 Actual charges up to $1,500 Daily Hospital Confinement Benefit $75 per day $225 per day Air and Ground Ambulance Benefit Actual charges up to $1,250 Actual charges
Accidental Dismemberment Benefit
finger or toe $500 $1,500
or toes $500 $1,500
or leg $2,500 $7,500
legs $5,000 $15,000
Loss of Sight Benefit – per unit Loss of sight in one eye $2,500 $7,500 Loss of sight
$5,000 $15,000 Accident Low Option High Option Employee $10.80 $21.50 Employee + Spouse $19.40 $38.90 Employee + Child(ren) $21.20 $45.20 Family $29.80 $62.60 25
Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you. For full plan details, please visit your benefit website: www.tipsebc.com Accident
Public
The Accident Plan provided through American Public Life (APL) is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or not-so-serious, injury. Accident coverage is low-cost protection available to you and your family without evidence of insurability. Should you need to file a claim contact APL at 800-256-8606 or online at www.ampublic.com. You can find additional claim forms and materials on your employee benefits portal.
up to $3,750
Single
Multiple fingers
Single hand, arm, foot
Multiple hands, arms, feet or
Accidental
in both eyes

Telehealth MDLive EMPLOYEE BENEFITS

ABOUT TELEHEALTH

Telehealth provides 24/7/365 access to board-certified doctors via telephone or video consultations that can diagnose, recommend treatment and prescribe medication. Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.

For full plan details, please visit your benefit website: www.tipsebc.com

Alongside your medical coverage is access to quality telehealth services through MDLIVE. Connect anytime day or night with a board-certified doctor via your mobile device or computer. While MDLIVE does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:

• Have a non-emergency issue and are considering a convenience care clinic, urgent care clinic or emergency room for treatment

• Are on a business trip, vacation or away from home

• Are unable to see your primary care physician

When to Use MDLIVE:

At a cost that is the same or less than a visit to your physician, use telehealth services for minor conditions such as:

• Sore throat

• Headache

• Stomachache

• Cold

• Flu

• Allergies

• Fever

• Urinary tract infections Do not use telemedicine for serious or life-threatening emergencies.

Registration is Easy

Register with MDLIVE so you are ready to use this valuable service when and where you need it.

• Online – www.mdlive.com/fbs

• Phone – 888-365-1663

• Mobile – download the MDLIVE mobile app to your smartphone or mobile device

• Select –“MDLIVE as a benefit” and “FBS” as your Employer/Organization when registering your account.

Telehealth Employee $8.00 Employee + Family $16.00 26

Life and AD&D Unum

ABOUT LIFE AND AD&D

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.

For full plan details, please visit your benefit website: www.tipsebc.com

Basic Term Life and AD&D

Your district provides full-time employees with Basic Life coverage. You benefit amount is viewable during your enrollment or on your Consolidated Enrollment Form.

Basic Life and AD&D Eligibility Full-Time Employee working 15+ hours per week.

Life Benefit Amount Varies by employer AD&D Benefit Amount Varies by employer Portability & Conversion Included Survivor Support Included Benefit Reduction Scheduled 65% at age 65; 50% at age 70

Voluntary Term Life and AD&D

Your Term Life coverage options are:

Employee: Up to 7 times salary in increments of $10,000. Not to exceed $500,000.

Spouse: Up to 100% of employee amount in increments of $10,000. Not to exceed $500,000. Benefits will be paid to the employee.

Child: Up to 100% of employee coverage amount in increments of $5,000. Not to exceed $10,000.

BENEFITS

Voluntary Group Life and AD&D

0-29 $0.40 30-34 $0.60 35-39 $0.70 40-44 $1.00 45-49 $1.40 50-54 $2.50 55-59 $4.00 60-64 $6.00 65-69 $10.00 70-74 $20.00 75+ $26.00

Spouse rates are based on Employee's age and cannot exceed 100% of the employees supplemental life amount.

Voluntary Group Life and AD&D - Child(ren) per $10,000 in coverage $1.30

The maximum death benefit for a child between the ages of live birth and 6 months is $1000. Benefits will be paid to the employee. In order to purchase Life coverage for your spouse and/or child, you must purchase Life coverage for yourself. Your AD&D coverage options are:

Employee: Maximum of $500,000. Not to exceed $500,000. You may purchase AD&D coverage for yourself regardless of whether you purchase Life coverage.

Spouse: 50% of employee amount. Not to exceed $250,000. Benefits will be paid to the employee.

Child: 10% of employee amount. Not to exceed $50,000.

The maximum death benefit for a child between the ages of live birth and 6 months is $1,000. Benefits will be paid to the employee. In order to purchase AD&D coverage for your spouse and/or child, you must purchase AD&D coverage for yourself.

*UNUM allows employees that are currently enrolled in the life insurance and are below the Guaranteed Issue (GI) amount to increase the coverage to the GI without evidence of insurability. If you are a new hire, you can elect up to your GI amount within your 31 day new hire enrollment without evidence of insurability. If you are not currently enrolled, you can enroll subject to evidence of insurability for the lesser of $500,000 or 7x your annual salary for yourself and spouse, and up to $10,000 for children. For increases in coverage to take effect, employees must be actively at work and spouse/child cannot be disabled.

EMPLOYEE
Employee Age per $10,000 in coverage
27

Individual Life Insurance 5Star EMPLOYEE BENEFITS

ABOUT INDIVIDUAL LIFE

Individual insurance is a policy that covers a single person and is intended to meet the financial needs of the beneficiary, in the event of the insured’s death. This coverage is portable and can continue after you leave employment or retire.

For full plan details, please visit your benefit website: www.tipsebc.com

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

CUSTOMIZABLE With several options to choose from, employees select the coverage that best meets the needs of their families.

TERMINAL ILLNESS ACCELERATION OF BENEFITS Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL).

PORTABLE Coverage continues with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly. CONVENIENCE Easy payments through payroll deduction.

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

*Financially dependent children 14 days to 23 years old.

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

QUALITY OF LIFE Optional benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following:

• Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or

• Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.

Find full details and rates on your employee benefits portal. Should you need to file a claim, contact 5Star directly at (866) 863-9753.

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

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

28

Identity Theft IDWatchdog

ABOUT IDENTITY THEFT PROTECTION

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

For full plan details, please visit your benefit website: www.tipsebc.com

Your identity is important it’s what makes you, you. You’ve spent a lifetime building your name and financial reputation. Let us help you better protect it. And, we’ll even go one step further and help you better protect the identities of your family.

EASY & AFFORDABLE IDENTITY PROTECTION

With ID Watchdog®, you have an easy and affordable way to help better protect and monitor the identities of you and your family. You’ll be alerted to potentially suspicious activity and enjoy the peace of mind that comes with the support of dedicated resolution specialists. And, a customer care team that’s available any time, every day.

ID WATCHDOG IS HERE FOR YOU

ID Watchdog is everywhere you can’t be monitoring credit reports, social media, transaction records, public records and more to help you better protect your identity. And don’t worry, we’re always here for you. In fact,

our U.S.-based customer care team is available 24/7/365 at 866.513.1518.

WHY CHOOSE ID WATCHDOG Credit Lock

With our online and in-app feature, lock your Equifax® credit report and your child’s Equifax credit report to help provide additional protection against unauthorized access to your credit.

More for Families

Our family plan helps you better protect your loved ones, with each adult getting their own account with all plan features. And, we offer more features that help protect minors than any other provider.

Dedicated Resolution Specialists

If you become a victim, you don’t have to face it alone. One of our certified resolution specialists will fully manage the case for you until your identity is restored.

UNIQUE FEATURES INCLUDED IN

ALL ID WATCHDOG PLANS

Monitor & Detect

• Dark Web Monitoring1 ✓

• High-Risk Transactions Monitoring2 ✓

• Subprime Loan Monitoring2 ✓

• Public Records Monitoring ✓

• USPS Change of Address Monitoring

• Identity Profile Report

Manage & Alert

• Child Credit Lock3 | 1 Bureau ✓

• Financial Accounts Monitoring

• Social Network Alerts ✓

• Registered Sex Offender Reporting ✓

• Customizable Alert Options

• Breach Alert Emails

• Mobile App

Support & Restore

• Identity Theft Resolution Specialists (Resolution for Preexisting Conditions)✓

• 24/7/365 U.S.-based Customer Care Center

• Lost Wallet Vault & Assistance • Deceased Family Member Fraud Remediation

• Fraud Alert & Credit Freeze Assistance ✓ Helps better protect children 1 Bureau = Equifax® 2 Multi-Bureau = Equifax, TransUnion® 3 Bureau = Equifax, Experian®, TransUnion

EMPLOYEE
BENEFITS
WHAT YOU NEED TO KNOW Plan Options ID WATCHDOG® 1B ID WATCHDOG® PLATINUM Credit Report(s)& VantageScore Credit Score(s) 1 Bureau Monthly 1 Bureau Daily & 3 Bureau Annually Credit Score Tracker 1 Bureau Monthly 1 Bureau Daily Credit Report Monitoring 1 Bureau Multi-Bureau Credit Report Lock 1 Bureau $54.40 Identity Theft Insurance Up to $1M Up to $1M 401K/HSA Stolen Funds Reimbursement - Included MONTHLY PREMIUMS Employee (Includes 1 child <18) $7.95 $11.95 Employee and Family $14.95 $22.95 29

Emergency Medical Transport MASA MTS

ABOUT MEDICAL TRANSPORT

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 can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan.

For full plan details, please visit your benefit website: www.tipsebc.com

A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. If a member has a high deductible health plan that is compatible with a health savings account, benefits will become available under the MASA membership for expenses incurred for medical care (as defined under Internal Revenue Code (“IRC”) section 213 (d)) once a member satisfies the applicable statutory minimum deductible under IRC section 223(c) for high-deductible health plan coverage that is compatible with a health savings account.

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.

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.

Non-Emergency 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-emergency air or ground transportation between medical facilities.

Repatriation/Recuperation Suppose you or a family member is hospitalized more than 100-miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for recuperation.

Escort Transportation If you or a family member requires medical transportation, you may elect to have a family member or friend accompany you during the medical transport. This benefit is limited to space availability within the vehicle, giving due priority to medical personnel and equipment.

Visitor Transportation If you or a family member is hospitalized more than 100-miles away from home for more than 7-days (consecutively), you may elect to have a family member or friend transported (by commercial airline) to be present while you recover.

Return Transportation In the event a Member is hospitalized more

than 100-miles away from home for more than 24-hours, Member has access to return transportation, upon their release, to the commercial airport nearest their home.

Mortal Remains Transportation If you or a family member dies more than 100-miles from home, MASA shall pay (on behalf of the Member’s estate) the airway bill associated with the return of the Member’s mortal remains.

Minor Return Suppose you require the use of one or more of the transportation benefits and, as a result of your need, a minor child (who is in your custody) is left unattended. Even if this occurs, the minor child will be covered for return transportation (by commercial airline) to the commercial airport nearest the child’s home.

Organ Retrieval/Organ Transportation In the event of an organ transplant procedure, MASA will arrange for the transportation of you or the transplant organ to the transplant site.

Vehicle Return Suppose you use one or more of the member transportation benefits. As a result of using the benefit, you may elect to have MASA transport your ground vehicle to your home or rental return location.

Pet Return If you use one or more of the member transportation benefits while with your pet, you may elect to have MASA MTS transport your pet home.

Worldwide Coverage Contingent on a 10-day prior notice to MASA MTS of your travel plans, you have coverage for worldwide nonemergent air transportation, repatriation/recuperation, return transportation, escort transportation, visitor transportation, and mortal remains transportation. Coverage is limited to 90 days or less of travel.

Should you need assistance with a claim contact MASA at 800-6439023. You can find full benefit details on your employee benefits portal. Emergency Medical

EMPLOYEE
BENEFITS
30
Transportation Emergent Emergent Plus Platinum Employee & Family $9.00 $14.00 $39.00

Critical Illness Insurance Aetna

ABOUT CRITICAL ILLNESS

Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non-medical costs related to the illness, including transportation, child care, etc.

For full plan details, please visit your benefit website: www.tipsebc.com

Be prepared for what happens next

Critical illness coverage can help you keep your focus on your health when it mattes most. This extra coverage can hep ease some financial worries during a difficult time

What is the Critical Illness Plan?

The Aetna Critical Illness Plan pays benefits when a doctor disagnoses you with a covered serious illness or condition, like heart attack, stroke, cancer and more. You can use the benefits to help pay out-of-pocket medical costs or towards personal expenses.

How is this different from a major medical plan?

Medical plans help pay providers for services and treatment. But, they don’t cover unexpected costs that come with a serious illness. The Aetna Critical Illness Plan pays benefits directly to you giving you extra cash when you need it most. It can help fill in the gaps, making it a great companion to your major medical plan.

How can you use the cash benefits?

It’s completely up to you. You can use the money any way you want, like:

• Deductibles or copays

• Mortgage or rent

• Groceries or utility bills

• Anything else you choose

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

BENEFIT SUMMARY

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

Insurance plans are underwritten by Aetna Life Insurance Company.

BENEFITS

Heart Attack (Myocardial Infarction) 100% Stroke 100%

Coronary Artery Condition Requiring Bypass Surgery 25%

Major Organ Failure 100%

End-Stage Renal Failure 100% Paralysis 100%

Loss of Sight (Blindness) 100% Loss of Speech 100% Loss of Hearing 100%

Occupational HIV 100% Coma 100%

Benign Brain Tumor 100%

Third Degree Burns 100%

Alzheimer’s Disease 25%

Parkinson’s Disease 25%

Lupus 25% Multiple Sclerosis 25% Muscular Dystrophy 25%

EMPLOYEE
The benefits in the table below will be paid when you are diagnosed with a covered Critical Illness. Unless otherwise indicated, all benefits and limitations are per covered person. Face Amounts Covered Benefit Option 1 Option 2 Option 3 Employee $10,000 $20,000 $30,000 Spouse 50% of Employee 50% of Employee 50% of Employee Child(ren) 50% of Employee 50% of Employee 50% of Employee Plan Features
Benefit
of Face Amount (Employee)
Covered
Percentage
31

Critical Illness Insurance Aetna

Plan Features (cont’d)

Childhood Critical Illness Conditions

Percentage of Face Amount (Employee)

Cerebral Palsy 100%

Cleft Lip or Palate 100%

Cystic Fibrosis 100%

Down Syndrome 100% Spina Bifida 100%

Cancer Benefits

Percentage of Face Amount (Employee)

Cancer (invasive) 100%

Carcinoma in Situ (non-invasive) 25%

Skin Cancer $1,000

(Note: Cancer is not a Critical Illness under this plan)

Additional Plan Benefits

Health Screening

Pays a lump sum for each day you receive any of the approved $75 health screening tests (maximum 1 day per plan year)

• Lipoprotien profile (serum plus HDL, LDL & triglycerides)

• Fasting blood glucose test

• Digital rectal exams

• Carotid Doppler Ultrasound

• Electrocardiogram (ECHO)

• Chest x-ray

• Thermography

• Ultrasound screening for abdominal aortic aneurysms

• Bone marrow screening

• Adult and child immunizations

• HPV vaccine

• Bone mass density measurement

• Hemoccult stool analysis

• Doppler screenings for peripheral vascular disease

• Prostate Specific Antigen Test

• Flexible sigmoidoscopy

• Colonoscopy

• Virtual colonoscopy

• Carcinoembryonic Antigen

• Cancer Antigen (CA) Test 15-3 (breast cancer)

• Mammography

• Breast ultrasound

• Cancer Antigen (CA) Test 125 (ovarian cancer)

• Pap smears

• Cytologic Screening

• ThinPrep Pap Test

• Skin cancer screening

• Serum protein electrophoresis

Employee

Critical

$10,000.00

Illness

$20,000.00

$30,000.00

>20 $3.34 $4.68 $6.03 20-24 $3.73 $5.48 $7.23 25-29 $4.37 $6.75 $9.14 30-24 $5.04 $8.10 $11.16 35-39 $6.13 $10.27 $14.41 40-44 $8.01 $14.03 $20.06 45-49 $11.16 $20.32 $29.49 50-54 $16.03 $30.07 $44.12 55-59 $22.98 $43.97 $64.96 60-64 $32.13 $62.28 $92.42 65-69 $43.19 $84.40 $125.60 70+ $53.72 $105.44 $157.17

Employee + Spouse

$10,000.00

$20,000.00

$30,000.00

>20 $6.62 $9.06 $11.50 20-24 $7.25 $10.33 $13.40 25-29 $8.16 $12.14 $16.12 30-24 $9.29 $14.40 $19.51 35-39 $11.07 $17.95 $24.84 40-44 $14.19 $24.19 $34.19 45-49 $19.29 $34.39 $49.49 50-54 $27.45 $50.71 $73.98 55-59 $38.81 $73.43 $108.05 60-64 $53.08 $101.97 $150.86 65-69 $70.05 $135.92 $201.79 70+ $85.11 $166.04 $246.96

Employee + Child(ren)

$10,000.00

$20,000.00 $30,000.00

>20 $3.34 $4.68 $6.03 20-24 $3.73 $5.48 $7.23 25-29 $4.37 $6.75 $9.14 30-24 $5.04 $8.10 $11.16 35-39 $6.13 $10.27 $14.41 40-44 $8.01 $14.03 $20.06 45-49 $11.16 $20.32 $29.49 50-54 $16.03 $30.07 $44.12 55-59 $22.98 $43.97 $64.96 60-64 $32.13 $62.28 $92.42 65-69 $43.19 $84.40 $125.60 70+ $53.72 $105.44 $157.17

Family $10,000.00 $20,000.00 $30,000.00

>20 $6.62 $9.06 $11.50 20-24 $7.25 $10.33 $13.40 25-29 $8.16 $12.14 $16.12 30-24 $9.29 $14.40 $19.51 35-39 $11.07 $17.95 $24.84 40-44 $14.19 $24.19 $34.19 45-49 $19.29 $34.39 $49.49 50-54 $27.45 $50.71 $73.98 55-59 $38.81 $73.43 $108.05 60-64 $53.08 $101.97 $150.86 65-69 $70.05 $135.92 $201.79 70+ $85.11 $166.04 $246.96

32
EMPLOYEE BENEFITS

Flexible Spending Account (FSA) NBS

ABOUT FSA

A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (unless your plan contains a $500 rollover or grace period provision).

For full plan details, please visit your benefit website: www.tipsebc.com

Health Care FSA

The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $2,850 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include:

• Dental and vision expenses

• Medical deductibles and coinsurance

• Prescription copays

• Hearing aids and batteries You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA).

How the Health Care FSAs Work

You can access the funds in your Health Care FSA two different ways:

• Use your NBS Debit Card to pay for qualified expenses, doctor visits and prescription copays.

• Pay out-of-pocket and submit your receipts for reimbursement:

• Fax – 844-438-1496

• Email – service@nbsbenefits.com

• Online – my.nbsbenefits.com

• Call for Account Balance: 855-399-3035

• Mail: PO Box 6980 West Jordan, UT 84084

Contact NBS

• Hours of Operation: 6:00 AM – 6:00 PM MST, Mon-Fri

• Phone: (800) 274-0503

• Email: service@nbsbenefits.com

• Mail: PO Box 6980 West Jordan, UT 84084

Dependent Care FSA

The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full-time student.

EMPLOYEE BENEFITS
33

Flexible

Dependent Care FSA Guidelines

• Overnight camps are not eligible for reimbursement (only day camps can be considered).

• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.

• You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.

• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.

Important FSA Rules

• The maximum per plan year you can contribute to a Health Care FSA is $2,850. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately.

• You cannot change your election during the year unless you experience a Qualifying Life Event.

• You can continue to file claims incurred during the plan year for another 30 days (up until date).

• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.

• The IRS has amended the “use it or lose it rule” to allow you to carry-over up to $570 in your Health Care FSA into the next plan year. The carry-over rule does not apply to your Dependent Care FSA.

Over-the-Counter Item Rule Reminder (OTC)

Health care reform legislation requires that certain over-the-counter (OTC) items require a prescription to qualify as an eligible Health Care FSA expense. You will only need to obtain a one-time prescription for the current plan year. You can continue to purchase your regular prescription medications with your FSA debit card. However, the FSA debit card may not be used as payment for an OTC item, even when accompanied by a prescription.

Flexible Spending

-the-counter medications)

Dependent

EMPLOYEE BENEFITS
Spending Account (FSA) NBS
Type Eligible Expenses Annual Contribution Limits Benefit
Accounts Account
$2,850 Saves on eligible expenses not covered by insurance, reduces
taxable income
Health Care FSA Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses and doctor-prescribed over
your
34
Care FSA Dependent care expenses (such as day care, after-school programs or elder care programs) so you and your spouse can work or attend school full-time $5,000 single $2,500 if married and filing separate tax returns Reduces your taxable income

Hospital Indemnity Aetna

ABOUT HOSPITAL INDEMNITY

This is an affordable supplemental plan that pays you should you be inpatient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance.

For full plan details, please visit your benefit website: www.tipsebc.com

The Hospital Indemnity Plan provided through Aetna helps with the high cost of medical care by paying you a set amount when you have an inpatient hospital stay. Unlike traditional insurance, which pays a benefit to the hospital or doctor, this plan pays you directly based on the care or treatment you receive. These costs may include meals and transportation, childcare or time away from work due to a medical issue that requires hospitalization.

If you need to submit a claim you do so on the Aetna portal at myaetnasupplemental.com

BENEFITS

Hospital Indemnity

Low High

Employee Only $15.04 $25.41

Employee and Spouse $31.23 $51.17

Employee and Child(ren) $21.51 $36.11

Employee and Family $34.86 $57.91

Service Benefit

Low High

Hospital Stay Admission- Pays a lump sum benefit for the initial day of your stay in a hospital. Maximum 1 stay per plan year.

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

$1,000 $2,000

$100 $100

Hospital Stay- (ICU) Daily- Pays a daily benefit, beginning on day two of your stay in an ICU room of a hospital. Maximum 30 days per plan year $200 $200 Newborn routine care- Provides a lump-sum benefit after the birth of your newborn. This will not pay for an outpatient birth. $100 $100 Observation unit- Provides a lump sum benefit for the initial day of your stay in an observation unit as the result of an illness or accidental injury. Maximum 1 day per plan year.

$100 $100

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

EMPLOYEE
35

TIPS Mobile App Login Group #’s

District GROUP #

Chapel Hill ISD

TIPSA

Chisum ISD TIPSB

Cumby ISD TIPSC

Detroit ISD TIPSD

ESC Region 8 TIPSE

Grand Saline ISD TIPSF

Harts Bluff ISD TIPSG

Hughes Springs ISD TIPSH

Liberty-Eylau ISD TIPSI

Linden-Kildare CISD TIPSJ

Miller Grove ISD TIPSK

District GROUP #

Mt Vernon ISD

TIPSM

North Hopkins ISD TIPSN

Paris ISD TIPSO

Prairiland ISD TIPSP

Red Lick ISD TIPSQ

Rivercrest ISD TIPSR

Saltillo ISD TIPSS

Simms ISD TIPST

Sulphur Bluff ISD TIPSU

Sulphur Springs ISD TIPSV

Mt Pleasant ISD TIPSL

your
s group # to login to the
Benefits
36
Use
District’
FBS
app.
Notes 37
Notes 38
Notes 39

Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the TIPSEBC Benefits Website. This summary does not replace or amend the underlying plan documentation. In the event of a discrepancy between this summary and the plan documentation the plan documentation governs. All plans and benefits described in this summary may be discontinued, increased, decreased, or altered at any time with or without notice.

Rate Sheet General Disclaimer: The rate information provided in this guide is subject to change at any time by your employer and/or the plan provider. The rate information included herein, does not guarantee coverage or change or otherwise interpret the terms of the specific plan documentation, available at the TIPSEBC Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.

2022 - 2023 PlanYear WWW.TIPSEBC.COM
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