2022-23 WTXEBC Benefit Guide (TRS)

Page 1

2022 - 2023 Plan Year

WTXEBC

BENEFIT GUIDE EFFECTIVE: 09/01/2022 - 8/31/2023 WWW.WTXEBC.COM


Table of Contents How to Enroll Annual Benefit Enrollment 1. Section 125 Cafeteria Plan Guidelines 2. Annual Enrollment 3. Eligibility Requirements 4. Helpful Definitions 5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) Medical: Region 9 Medical: Region 14 Medical: Region 15 Medical: Region 16 Medical: Region 17 Medical: Region 18 Medical: Region 19 Health Savings Account (HSA) Hospital Indemnity Telehealth Dental Vision Disability Life and AD&D Individual Life Emergency Medical Transportation Cancer Accident Critical Illness Identity Theft Flexible Spending Account (FSA) FBS Benefits App Group # Index

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HOW TO ENROLL

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SUMMARY PAGES

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YOUR BENEFITS


Benefit Contact Information WTXEBC BENEFITS

MEDICAL - TRS ACTIVECARE

MEDICAL - TRS HMO

Financial Benefit Services (866) 914-5202 www.wtxebc.com

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

Scott & White HMO (844) 633-5325 www.trs.swhp.org

HEALTH SAVINGS ACCOUNT (HSA)

TELEHEALTH

LIFE AND AD&D Unum (866) 679-3054 www.unum.com

HOSPITAL INDEMNITY Aetna Group #802466 (800) 607-3366 https://www.aetna.com VISION Superior Vision Group #28790 (800) 507-3800 www.superiorvision.com INDIVIDUAL LIFE 5Star Life Insurance Company (866) 863-9753 www.5starlifeinsurance.com

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

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

CRITICAL ILLNESS Aetna Group #802466 (800) 607-3366 https://www.aetna.com

IDENTITY THEFT IDWatchdog (800) 774-3772 www.IDWatchdog.com

FLEXIBLE SPENDING ACCOUNT (FSA) NBS (855) 399-3035 www.nbsbenefits.com

EECU (817) 882-0800 www.eecu.org DENTAL Lincoln Financial Group (800) 423-2765 https://www.lfg.com

MDLIVE (888) 365-1663 www.consultmdlive.com DISABILITY Unum (866) 679-3054 www.unum.com EMERGENCY MEDICAL TRANSPORTATION MASA (800) 423-3226 www.masamts.com


All Your Benefits One App Employee benefits made easy through the FBS Benefits App! Text “FBS WTX” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment: •

Benefit Resources

Online Enrollment

Interactive Tools

And more!

App Group #: Go to PAGE 76 to find your district’s group #

Text

“FBS WTX”

to (800) 583-6908 OR SCAN


How to Log In 1

www.wtxebc.com

2

CLICK LOGIN

3

ENTER USERNAME & PASSWORD Username: The first six (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number. If you have six (6) or less characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number. Default Password: Last Name* (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number.


Annual Benefit Enrollment

SUMMARY PAGES

Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.

CHANGES IN STATUS (CIS): Marital Status

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 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 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 Change in Number of adoption. You can add existing dependents not previously enrolled whenever a dependent Tax Dependents gains eligibility as a result of a valid change in status event. Change in Status of Change in employment status of the employee, or a spouse or dependent of the employee, Employment Affecting that affects the individual's eligibility under an employer's plan includes commencement or Coverage Eligibility termination of employment. Gain/Loss of Dependents' Eligibility Status

Judgment/Decree/ Order

An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements under an employer's plan may include change in age, student, marital, employment or tax dependent status. If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order 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

Eligibility for Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Government Programs


Annual Benefit Enrollment

SUMMARY PAGES

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 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 benefit questions, you can contact your Benefit Office 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.wtxebc.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 your benefit website: www.wtxebc.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.


Annual Benefit Enrollment

SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

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

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.

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 Flex

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

Individual Life

Issue through 23; Keep to 100

Healthcare FSA

Through 25 or IRS Tax Dependent

Health Savings Account

IRS Tax Dependent

Identity Theft

Through 25

Medical Supplement

Through 25

Telehealth

Through 25

Vision

Through 25

Life and AD&D

Through 25

Medical Transportation

Through 25

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

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 Benefit Office to request a continuation of coverage.


SUMMARY PAGES

Helpful Definitions Actively-at-Work

In-Network

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.

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

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.

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 prescriptions 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

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

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

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

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

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source Account Owner Underlying Insurance Requirement

Employee Individual

Employee Employer

High deductible health plan

None

Description

Minimum Deductible

Maximum Contribution

$1,400 single (2022) $2,800 family (2022) $3,650 single (2022) $7,300 family (2022) 55+ catch up +$1,000

N/A

$2,850 (2022)

Permissible Use Of Funds

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).

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 $550 rollover provision.

Does the account earn interest?

Yes

No

Portable?

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

No

FLIP TO FOR HSA INFORMATION

PG. 54

FLIP TO FOR FSA INFORMATION

PG. 74


Notes


Medical Insurance

EMPLOYEE BENEFITS

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.wtxebc.com

Effective 9/1/2022, rates for ActiveCare Plans for 2022-23 have decreased or remained the same! Blue Cross and Blue Shield of Texas (BCBSTX) will continue to offer the following plans. Refer to TRS Plan Highlights for full details. TRS-ActiveCare Primary (requires Primary Care Physician*): This plan has the lowest premiums, $30 copays for primary care visits; $70 for specialist. There is no out-ofnetwork coverage. $12 Teladoc (change from $0) and $0 RediMD Virtual Health visits. New Specialty Drug program through PrudentRx. Out-of-pocket for insulin — capped at $25 for 31-day supply; $75 for 61 - 90-day supply. TRS-ActiveCare Primary+ (requires Primary Care Physician*): This plan has lower deductibles and copays for many services and drugs. There is no out-of-network coverage. $12 Teladoc (change from $0) and $0 RediMD Virtual Health visits. New Specialty Drug program through PrudentRx. Out-of-pocket for insulin — capped at $25 for 31day supply; $75 for 61 - 90-day supply. TRS-ActiveCare HD: This plan works with a Health Savings Account (HSA), has out-ofnetwork coverage, and coinsurance rates instead of copays. You must meet the deductible before the plan will pay for non-preventive services. Includes nationwide network and out-of-network coverage. $42 Teladoc Virtual Health (was $30) and $0 RediMD Virtual Health visits. The out-of-pocket in-network amount increased by $50 for individual and $100 for family. Blue Essentials– West Texas HMO: Premiums have increased for this plan as of 9/1/2022. *To update your Primary Care Provider (PCP), call TRS-ActiveCare Customer Service: (866) 355-5999 or log into your Blue Access for Members portal. When will I get my ID Card? Everyone on ActiveCare plans should receive a new ID card by mid-September. If you do not have your ID card by Sept 1st you can access your ID card using Blue Access for Members (BAM). Member ID numbers do not change for ActiveCare participants. Therefore, you can use your existing ID card for appointments until your new one is received.

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REGION 9

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REGION 14

PG. 25

REGION 15

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REGION 16

PG. 37

REGION 17

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REGION 18

PG. 49

REGION 19











































Health Savings Account (HSA) EECU

EMPLOYEE BENEFITS

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.wtxebc.com

A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs – it is also a taxexempt 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 (High Deductible Health Plan) • 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.


Health Savings Account (HSA) EECU

EMPLOYEE BENEFITS

Opening an HSA 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.


Hospital Indemnity

EMPLOYEE BENEFITS

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.wtxebc.com

Inpatient Stays Covered Benefit

Option 1 Option 2

Hospital stay - Admission $1,500 $2,500 Provides a lump sum benefit for the initial day of your stay in a hospital. Maximum 1 stay per plan year Hospital stay - Daily $100 $200 Pays a daily benefit, beginning on day two of your stay in a non-ICU room of a hospital. Maximum 30 days per plan year Hospital stay - (ICU) Daily $150 $250 Pays a daily benefit, beginning on day two of your stay in an ICU room of a hospital. Maximum 30 days per plan year Newborn routine care $100 $200 Provides a lump-sum benefit after the birth of your newborn. This will not pay for an outpatient birth. Observation unit Provides a lump sum benefit for the $100 $200 initial day of your stay in an observation unit as the result of an illness or accidental injury. Maximum 1 day per plan year Important Note: All daily inpatient stay benefits begin on day two and count toward the plan year maximum. Important information about your benefits IN ORDER FOR THE HOSPITAL INDEMNITY BENEFITS TO BE PAYABLE, THE INITIAL DAY OF YOUR STAY AND OTHER SERVICES MUST BE ON OR AFTER YOUR EFFECTIVE DATE OF COVERAGE.

Portability Your plan includes a Portability option which allows you to keep your existing coverage by making direct payments to the carrier. You may exercise this option if your employment ceases for any reason. Refer to your Certificate for additional Portability provisions.

Waiver of premium If you are in a hospital for more than 30 days in a row, we will waive the premium beginning on the first premium due date that occurs after the 30th day of your stay, through the next 6 months of coverage. During your stay, you must remain employed with the policyholder. Exclusions and Limitations This plan has exclusions and limitations. Refer to the actual policy and certificate to determine which benefits are not payable. The following is a partial list of services and supplies that are generally not covered. However, the plan may contain exceptions to this list based on state mandates or the plan design purchased. What is considered a hospital stay? A stay is a period during which you are admitted as an inpatient; and are confined in a hospital or non-hospital residential facility; and are charged for room, board and general nursing services. A stay does not include time in the hospital because of custodial or personal needs that do not require medical skills or training. A stay specifically excludes time in the hospital for observation or in the emergency room unless this leads to a stay. How do I file a claim? Go to myaetnasupplemental.com and either “Log In” or “Register”, depending on if you’ve set up your account. Click the “Create a new claim” button and answer a few quick questions. You can even save your claim to finish later. You can also print/ mail in form(s) to: Aetna Voluntary Plans, PO Box 14079, Lexington, KY 40512- 4079, or you can ask us to mail you a printed form. Hospital Indemnity Employee Only Employee and Spouse Employee and Child(ren)

$1,500 $21.47 $43.17 $30.71

$2,500 $37.36 $75.46 $53.40

Employee and Family

$50.12

$87.33


Telehealth

EMPLOYEE BENEFITS

MDLive 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.wtxebc.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 & Family

$9.00


Dental Insurance

EMPLOYEE BENEFITS

Lincoln Financial Group 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.wtxebc.com

The Lincoln DentalConnect® PPO Plans: • Cover many preventive, basic, and major dental care services • Also cover orthodontic treatment for children • Feature group rates for WTXEBC employees • Let you choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a contracting dentist • Do not make you and your loved ones wait six months between routine cleanings

Dental Low Plan High Plan Employee Only

$20.10

$34.87

Employee and Spouse

$38.49

$66.66

Employee and Child(ren)

$48.83

$84.88

Employee and Family

$67.33

$116.77

Benefit Highlights* Low

Calendar (Annual) Deductible

Annual Maximum Lifetime Orthodontic Max Waiting Period

Base/High

Individual: $50 Individual: $50 Family: $150 Family: $150 Waived for Preventive Waived for Preventive Deductibles are combined for basic and major Contracting Dentists’ services. Deductibles are combined for basic and major Non-Contracting Dentists’ services. $1,500

$1,500

$1,000

$1,000

Orthodontic Coverage is available for dependent children. There are no benefit waiting periods for any service types

Visit LincolnFinancial.com/FindADentist You can search by: •Location •Dentist name or office name •Distance you are willing to travel •Specialty, language and more Your search will automatically provide up to 100 dentists that most closely match your criteria. If your search does not locate the dentist you prefer, you can nominate one—just click the Nominate a Dentist link and complete the online form. * Benefit Offerings vary by employer. Visit your benefit website or contact your Benefit Office for questions regarding the Dental plan(s) offered with your employer.


Dental Insurance

EMPLOYEE BENEFITS

Lincoln Financial Group

Plan Features Some plans may not be offered at every district within WTXEBC. Check your district benefit website for details. Preventive Services

Low

Base/High

90% No Deductible

100% No Deductible

Low

Base/High

50% After Deductible

80% After Deductible

Low

Base/High

50% After Deductible

50% After Deductible

Orthodontics

Low

Base/High

Orthodontic exams X-rays Extractions Study models Appliances

50%

50%

Routine oral exams Bitewing X-rays Full-mouth or panoramic X-rays Other dental X-rays - including periapical films Routine cleanings Fluoride treatments Space maintainers for children Palliative treatment - including emergency relief of dental pain Sealants Basic Services

Problem focused exams Injections of antibiotics and other therapeutic medications Fillings Simple extractions General anesthesia and I.V. sedation Major Services

Consultations Prefabricated stainless steel and resin crowns Surgical extractions Oral surgery Biopsy and examination of oral tissue - including brush biopsy Prosthetic repair and recementation services Endodontics - including root canal treatment

Contracting Dentists/Non-Contracting Dentists

To find a contracting dentist near you, visit www.LincolnFinancial.com/FindADentist. This plan lets you choose any dentist you wish. However, your out-of-pocket costs are likely to be lower when you choose a contracting dentist. For example, if you need a crown…

Contracting Dentists

Non-Contracting Dentists

…you pay a deductible (if … you pay a deductible (if applicable), applicable), then 50% of the then 50% of the usual and customary remaining discounted fee for fee, which is the maximum expense PPO members. This is known covered by the plan. You are as a PPO contracted fee. responsible for the different between the usual and customary fee and the dentist’s billed charge.


Vision Insurance

EMPLOYEE BENEFITS

Superior Vision ABOUT VISION 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.wtxebc.com

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.

Copays Exam Materials1 Contact lens fitting (standard & specialty)

$10 $25 $0

Exam (ophthalmologist) Exam (optometrist) Frames Contact lens fitting (standard2) Contact lens fitting (specialty2) Lenses (standard) per pair Single vision Bifocal Trifocal Scratch Coat (factory) Progressives lens upgrade Contact lenses4

Services/frequency Exam 12 months Frame 12 months Contact lens fitting 12 months Lenses 12 months Contact lenses 12 months

Monthly Premiums Employee Only $7.80 Employee and Spouse $15.46 Employee and Child(ren) $15.17 Employee and Family $22.95

In-network

Out-of-network

Covered in full Covered in full $125 retail allowance Covered in full $50 retail allowance

Up to $42 retail Up to $37 retail Up to $68 retail Not covered Not covered

Covered in full Covered in full Covered in full Covered in full See description3 $120 retail allowance

Up to $32 retail Up to $46 retail Up to $61 retail Not covered Up to $61 retail Up to $100 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. See your benefits materials for definitions of standard and specialty contact lens fittings 3. Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay. 4. Contact lenses are in lieu of eyeglass lenses and frames benefit


Vision Insurance

EMPLOYEE BENEFITS

Superior Vision Discount Features

Look for providers in the provider directory who accept discounts, as some do not; please verify their services and discounts (range from 10%-40%) prior to service as they vary. Discounts on covered materials Frames:

20% off amount over allowance

Lens options:

20% off retail

Progressives:

20% off amount over retail lined trifocal lens, including lens options

Discounts on non-covered exam, services and materials Exams, frames, and prescription lenses:

30% off retail

Lens options, contacts, prescription materials options:

20% off retail

Disposable contact lenses:

10% off retail

Maximum member out-of-pocket The following options have out-of-pocket maximums5 on standard (not premium, brand, or progressive) lenses.

Single Vision

Bifocal & Trifocals

Ultraviolet coat

$15

$15

Tints, solid or gradients

$25

$25

Anti-reflective coat

$50

$50

High index 1.6

$55

20% off retail

Photochromics

$80

20% off retail

5. Discounts and maximums may vary by lens type. Please check with your provider.

Refractive Surgery Superior Vision has a nationwide network of independent refractive surgeons and partnerships with leading LASIK networks who offer members a discount. These discounts range from 5%-50%, and are the best possible discounts available to Superior Vision. Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Benefit Office if you have any questions.


Disability Insurance

EMPLOYEE BENEFITS

Unum 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.wtxebc.com

Who is eligible? You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. You are considered in active employment, if on the day you apply for coverage, you are being paid regularly by your employer for the required minimum hours each week and you are performing the material and substantial duties of your regular occupation.

benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. Your admission and discharge dates and time must be 23 or more consecutive hours apart. (Applies to Elimination Periods of 30 days or less.)

What is my maximum monthly benefit amount? Your total monthly benefit (including all benefits provided under this plan) will not exceed 100% of your monthly earnings unless the excess amount is payable as a Cost-of-Living Adjustment.

When does my coverage end? Your coverage under the policy ends on the earliest of the following: • 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 except as provided under the covered layoff or leave of absence provision. Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan.

What is considered a pre-existing condition? You have a pre-existing condition if: How can I apply for coverage? • You received medical treatment, consultation, care or services To apply for coverage, complete your enrollment online by the including diagnostic measures, or took prescribed drugs or enrollment deadline. If you were hired after 9/1/2022, check with your medicines in the 3 months just prior to your effective date of plan administrator for your eligibility date, and complete your coverage; and enrollment online within 31 days of that date. • The disability begins in the first 12 months after your effective date of coverage. What if I am out of work when insurance goes into effect? Benefits under this provision are payable for no more than 90 days of Insurance will be delayed if you are not in active employment because of benefit from the date of disability. After 90 days, benefits are subject to an injury, sickness, temporary layoff, or leave of absence on the date a 3/12 pre-existing condition exclusion. In no event will benefits be paid that insurance would otherwise become effective. beyond the applicable benefit duration. This applies to the 9/1/2021 enrollment only and new hires. 4-week pre-ex benefit included in years 2 What is my monthly benefit amount? You can elect to purchase a benefit of 30% 40% 50% 60% or 70% of your and beyond. Please refer to policy for a detailed description of this provision. monthly earnings.

How long do I have to wait to receive benefits? The elimination period is the length of time you must be continuously disabled before you can receive benefits. Elimination Period Options: • Option 1: 7 days/7 days first day hospital • Option 2: 14 days/14 days first day hospital • Option 3: 30 days/30 days first day hospital • Option 4: 60 days/60 days • Option 5: 90 days/90 days During your elimination period, you will be considered disabled if you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury, you are under the regular care of a physician and you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury. If, because of your disability, you are hospital confined as an inpatient,

Disability (per $100 in benefit) Elimination Period 30% 40% 50% 7/7 $1.68 $1.76 $2.03 14/14 $1.56 $1.65 $1.91 30/30 $1.30 $1.37 $1.59 60/60 $0.80 $0.84 $0.98 90/90 $0.71 $0.75 $0.88

60% $2.34 $2.20 $1.85 $1.21 $1.09

70% $2.84 $2.79 $2.24 $1.73 $1.53


Life and AD&D

EMPLOYEE BENEFITS

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.wtxebc.com

BASIC LIFE AND AD&D Who is eligible? 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. What are the Basic Life and AD&D coverage amounts? • Life: Your employer is providing you with either $10,000, $20,000, $30,000, $40,000 or $50,000. • AD&D: Your employer is providing you with either $10,000, $20,000, $30,000, $40,000 or $50,000. Do my life insurance benefits decrease with age? Coverage amounts will reduce according to the following schedule: Age: Insurance amount reduces to: 70: 50% of original amount Coverage may not be increased after a reduction. 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 confined at home under the care of a physician for a sickness or injury; or your spouse has a life-threatening condition. Exception: Infants are insured from live birth.

who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy.

VOLUNTARY LIFE AND AD&D Who is eligible? All actively employed employees working at least 20 hours each week for your employer in the U.S. and their eligible spouses and children to age 26.

What are the Voluntary Life and AD&D coverage amounts? • 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. • Child: up to 100% of employee coverage amount in increments of $5,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and 14 days is $1,000 and 14 days to six months is $2,000. Do my life insurance benefits decrease with age? Coverage amounts will reduce according to the following schedule: Age: Insurance amount reduces to: 70: 50% of original amount Coverage may not be increased after a reduction.

Can I be denied coverage? 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 $200,000 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. If you Is this coverage portable (can I keep it when I leave my employer)? and your eligible dependents are not currently enrolled in the If you retire, reduce your hours, or leave your employer, you can plan, you may apply for coverage on or before the enrollment continue coverage for yourself your spouse and your dependent deadline and will be required to answer health questions for any children at the group rate. Portability is not available for people amount of coverage.


Life and AD&D Unum 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 much does coverage cost? Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date. Spouse rate is based on your Spouse’s insurance age, which is their age immediately prior to and including the anniversary/ effective date. Age band <25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

Employee and Spouse Rate per $10,000 $0.54 $0.54 $0.72 $0.81 $0.99 $1.53 $2.88 $4.95 $7.92 $11.04 $18.54 $18.54

Child life monthly rate is $1.00 per $5,000.

What are the AD&D coverage amounts? • Employee: up to 10 times salary in increments of $10,000; not to exceed $500,000 • Spouse: up to 50% of employee amount in increments to a maximum of $250,000 • Child: up to 10% of employee coverage amount to a maximum of $50,000

EMPLOYEE BENEFITS 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 confined at home under the care of a physician for a sickness or injury; or your spouse has a life-threatening condition. Exception: Infants are insured from live birth. 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 and • 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.

Note: You may purchase AD&D coverage for yourself regardless of Is this coverage portable (can I keep it when I leave my employer)? whether you purchase term life coverage. To purchase AD&D If you retire, reduce your hours, or leave your employer, you can coverage for your dependents, you must buy coverage for yourself. continue coverage for yourself your spouse and your dependent children at the group rate. Portability is not available for people What does AD&D insurance pay for? who have a medical condition that could shorten their life The full benefit amount is paid for loss of: expectancy — but they may be able to convert their term life • Life policy to an individual life insurance policy. • both hands or both feet or sight of both eyes • one hand and one foot Will my premiums be waived if I become disabled? • one hand or one foot and the sight of one eye If you become disabled (as defined by your plan) and are no longer able to work, your life premium payments will be waived • speech and hearing until your disability period ends. Other losses may be covered as well. Please contact your plan administrator. How much does coverage cost? • Employee: $0.40 per $10,000 in coverage • Employee and Family: $0.70 per $10,000 in coverage


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.wtxebc.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

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.

CUSTOMIZABLE: QUALITY OF LIFE: With several options to choose from, employees select the Optional benefit that accelerates a portion of the death coverage that best meets the needs of their families. benefit monthly, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following: TERMINAL ILLNESS ACCELERATION OF BENEFITS: • Permanent inability to perform at least two of the six Coverage that pays 30% (25% in CT and MI) of the coverage Activities of Daily Living (ADLs) without substantial amount in a lump sum upon the occurrence of a terminal assistance; or condition that will result in a limited life span of less than 12 months (24 months in IL). • Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of PORTABLE: senility, requiring substantial supervision. Coverage continues with no loss of benefits or increase in cost if employment terminates after the first premium is ADDITIONAL DETAILS: paid. We simply bill the employee directly. Quality of Life not available ages 66-70. CONVENIENCE: Easy payments through payroll deduction.

Quality of Life benefits not available for children.

Child life coverage available only on children and FAMILY PROTECTION: grandchildren of employee (age on application date: 14 Coverage is available for spouses and financially dependent days through 23 years). $7.15 monthly for $10,000 children, even if the employee doesn’t elect coverage on coverage per child. themselves. Should you need to file a claim, contact 5Star directly at * Financially dependent children 14 days to 23 years old. (866) 863-9753.


Emergency Medical Transport MASA

EMPLOYEE BENEFITS

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.wtxebc.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. Should you need assistance with a claim contact MASA at (800) 643-9023. Emergency Medical Transportation Employee & Family $14.00


Cancer Insurance

EMPLOYEE BENEFITS

APL 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.wtxebc.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 non-medical 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. Summary of Benefits Cancer Treatment Policy Benefits Radiation Therapy, Chemotherapy, Immunotherapy - Maximum per 12month period Hormone Therapy - Maximum of 12 treatments per calendar year Experimental Treatment Surgical Rider Benefits Surgical Anesthesia Bone Marrow Transplant - Maximum per lifetime Stem Cell Transplant - Maximum per lifetime Prosthesis - Surgical Implantation/Non-Surgical (not Hair Piece) 1 device per site, per lifetime Miscellaneous Care Rider Benefits Cancer Treatment Center Evaluation or Consultation - 1 per lifetime Evaluation or Consultation Travel and Lodging - 1 per lifetime Second / Third Surgical Opinion - per diagnosis of cancer Drugs and Medicine - Inpatient / Outpatient (maximum $150 per month) Hair Piece (Wig) - 1 per lifetime Transportation - Maximum 12 trips per calendar year for all modes of transportation combined. Travel by bus, plane, or train Travel by car Lodging - up to a maximum of 100 days per calendar year Family Transportation - Maximum 12 trips per calendar year for all modes of transportation combined. Travel by bus, plane or train Travel by car Family Lodging - up to a maximum of 100 days per calendar year

Low Level 3

High Level 4

$15,000

$20,000

$50 per treatment paid in same manner and under the same maximums as any other benefit Level 1 Level 4 $30 unit dollar amount $60 unit dollar amount Max $3,000 per operation Max $6,000 per operation 25% of amount paid for covered surgery $6,000 $12,000 $600 $1,200 $1,000 / $100

$3,000 / $300

Level 4 Level 4 $750 $750 $350 $350 $300 / $300 $300 / $300 $150 per confinement $50 per prescription $150 $150 actual coach fare or $0.75 per mile $0.75 per mile $100 per day actual coach fare or $0.75 per mile $0.75 per mile $100 per day


Cancer Insurance

EMPLOYEE BENEFITS

APL Miscellaneous Care Rider Benefits (cont’d) Blood, Plasma and Platelets Ambulance - Ground/Air - Maximum of 2 trips per Hospital Confinement for all modes of transportation combined Inpatient Special Nursing Services - per day of Hospital Confinement Outpatient Special Nursing Services - Up to same number of Hospital Confinement days Medical Equipment - Maximum of 1 benefit per calendar year Physical, Occupational, Speech, Audio Therapy & Psychotherapy / Maximum per calendar year Waiver of Premium Internal Cancer First Occurrence Rider Benefits Lump Sum Benefit - Maximum 1 per Covered Person per lifetime Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime Heart Attack/Stroke First Occurrence Rider Benefits Lump Sum Benefit - Maximum 1 per Covered Person per lifetime Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime Hospital Intensive Care Unit Rider Benefits Intensive Care Unit

Level 4

Level 4

$300 per day $200 / $2,000 per trip $150 per day $150 per day $150 $25 per visit / $1,000 Waive Premium Level 2 $5,000

Level 4 $10,000

$7,500

$15,000

Level 1

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

Hospital Indemnity Employee Only Employee and Spouse Employee and Child(ren) Employee and Family

$3,750

$600 per day

$300 per day

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

Low $21.24 $38.10 $26.24 $39.94

Level 1 $2,500

High $34.30 $61.40 $42.30 $64.48


Accident Insurance

EMPLOYEE BENEFITS

APL ABOUT ACCIDENT 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.wtxebc.com

Summary of Benefits* Benefit Description

Level 1 - 1 Unit

Level 2 - 2 Units

Level 3 - 3 Units

Level 4 - 4 Units

$5,000

$10,000

$15,000

$20,000

actual charges up to $500

actual charges up to $1,000

actual charges up to $1,500

actual charges up to $2,000

Daily Hospital Confinement Benefit

$75 per day

$150 per day

$225 per day

$300 per day

Air and Ground Ambulance Benefit

actual charges up to $1,250

actual charges up to $2,500

actual charges up to $3,750

actual charges up to $5,000

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

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

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

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

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

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

$2,500 $5,000

$5,000 $10,000

$7,500 $15,000

$10,000 $20,000

$100 upon admission

$100 upon admission

$100 upon admission

$100 upon admission

$150 per day

$150 per day

$150 per day

$150 per day

1 Unit

2 Units

3 Units

4 Units

Employee Only

$11.70

$18.00

$22.40

$25.40

Employee and Spouse

$20.70

$31.10

$40.20

$46.20

Employee and Child(ren)

$22.70

$36.40

$46.70

$53.50

Employee and Family

$31.70

$49.50

$64.50

$74.30

Accidental Death - per unit Medical Expense Accidental Injury Benefit - per unit

Benefit Rider Hospital Admission Benefit Accident Only—Intensive Care Benefit

Accident


Accident Insurance

EMPLOYEE BENEFITS

APL

natural teeth; war or any act of war (whether declared or undeclared) or participating in a riot or felony; Eligibility alcoholism or drug addiction; This policy will be issued to only those persons who meet travel or flight in or descent from any aircraft or American Public Life Insurance Company’s insurability device which can fly above the earth’s surface in any requirements. Persons not meeting APL’s insurability capacity other than as a fare paying passenger on a requirements will be excluded from coverage by an regularly scheduled airline; endorsement attached to the policy. 9. Injury originating prior to the effective date of the Policy; Base Policy and Optional Benefits 10. Injury occurring while intoxicated (Intoxication means that No benefits are payable for a pre-existing condition. Prewhich is determined and defined by the laws and existing condition means an Injury that pertains solely to an jurisdiction of the geographical area in which the loss or Accidental Bodily Injury which resulted from an accident cause of loss is incurred.); sustained before the Effective Date of coverage. Pre-Existing 11. Voluntary inhalation of gas or fumes or taking of poison or Conditions specifically named or described as permanently asphyxiation; excluded in any part of this contract are never covered. 12. Voluntary ingestion or injection of any drug, narcotic or sedative, unless administered on the advice and taken in A Hospital is not an institution which is primarily a place for such doses as prescribed by a Physician; alcoholics or drug addicts; the aged; a nursing, rest or convalescent nursing home; a mental institution or sanitarium; a 13. Injury sustained or sickness which first manifests itself while on full-time duty in the armed forces; (Upon notice, We will facility contracted for or operated by the United States refund the proportion of Government for treatment of members or ex-members of the 14. unearned premium while in such forces.) armed forces (unless You are legally required to pay for services 15. Injury incurred while engaging in an illegal occupation; rendered in the absence of insurance); or, a long-term nursing 16. Injury incurred while attempting to commit a felony or an unit or geriatrics ward. assault; 17. Injury to a covered person while practicing for or being a Medical Expense Accidental Injury Benefit part of organized or competitive rodeo, sky diving, Expenses must commence within 60 days of the covered 18. hang gliding, parachuting or scuba diving; accident. The maximum benefit amount payable for any one 19. driving in any race or speed test or while testing an accident for the Insured Person shall not exceed the Medical automobile or any vehicle on any racetrack or Expense Benefit. 20. speedway; Air and Ground Ambulance Benefit 21. hernia, carpal tunnel syndrome or any complication Emergency transportation must occur within 21 calendar days therefrom; of the accident causing such Injury. If You are entitled to benefits under this Policy as a result of sprained or lame back, or any intervertebral disk conditions, Daily Hospital Confinement Benefit such benefits shall be payable for a maximum period of time, The maximum benefit period for this benefit is 30 days per not exceeding in the aggregate three (3) months for any Injury. covered accident.

Limitations and Exclusions

Accidental Death Accidental Death must result within 90 days of the covered accident causing the injury. Hospital Admission Benefit The maximum benefit is 4 units. Exclusions Benefits otherwise provided by this Policy will not be payable for services or expenses or any such Loss resulting from or in connection with: 1. sickness, illness or bodily infirmity; 2. suicide, attempted suicide or intentional self-inflicted Injury, whether sane or insane; 3. dental care or treatment unless due to accidental Injury to

4. 5. 6. 7. 8.

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


Critical Illness Insurance Aetna

EMPLOYEE BENEFITS

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.wtxebc.com

Covered Critical Illness Conditions

% of Face Amount (Employee):

End-Stage Renal Failure Pays a benefit when you are diagnosed with End stage renal failure, and the insured person has to undergo regular hemodialysis or peritoneal dialysis at least weekly.

100%

Paralysis Pays a benefit when you are diagnosed with Paralysis, resulting in paraplegia or quadriplegia (complete, total and permanent loss of use of two or more limbs) confirmed by the insured person’s attending physician. The paralysis has to continue for a period of 60 consecutive days:

100%

Loss of Sight (Blindness) Pays a benefit when you are diagnosed with Loss of sight (blindness) that is total and irrecoverable loss of sight in both eyes. Loss of sight (blindness), has to continue for a period of 90 consecutive days.

100%

Loss of Speech Pays a benefit when you are diagnosed with Loss of speech that cannot be corrected to any functional degree by any procedure, aid or device. Loss of speech has to continue for a period of 90 consecutive days.

100%

Loss of Hearing Pays a benefit when you are diagnosed with Loss of hearing in both ears that cannot be corrected to any functional degree by any procedure, aid or device. Loss of hearing has to continue for a period of 90 consecutive days.

100%

Occupational HIV Pays a benefit when you are diagnosed with Occupational HIV. The date of a positive antibody test for HIV subsequent to a prior negative test for the same condition with a lapse of between 180 days between the two tests.

100%

Coma Pays a benefit when you are diagnosed with Coma, characterized by the absence of eye opening, verbal response and motor response, and the individual requires intubation for respiratory assistance (a medically induced coms is not covered). The Coma must last for a period of 14 or more consecutive days.

100%

Benign Brain Tumor Pays a benefit when you are diagnosed with a Benign brain tumor by a physician.

100%

Third-Degree Burns Pays a benefit when you are diagnosed with a Third degree burn that covers more than 10% of total body surface (also called full-thickness burn).

100%

Alzheimer's Disease Pays a benefit when you are diagnosed with Alzheimer’s disease, diagnosis of the disease by a psychiatrist or neurologist.

25%

Parkinson's Disease Pays a benefit when you are diagnosed with Parkinson’s disease by a psychiatrist or neurologist.

25%

Lupus Pays a benefit when you are diagnosed with Lupus by a physician.

25%


Critical Illness Insurance

EMPLOYEE BENEFITS

Aetna Covered Benefit

% of Face Amount (Employee):

Multiple Sclerosis Pays a benefit when you are diagnosed with Multiple sclerosis by a physician.

25%

Muscular Dystrophy Pays a benefit when you are diagnosed with Muscular dystrophy by a physician.

25%

Heart Attack (Myocardial Infarction) Pays a benefit when you are diagnosed with a Heart attack (Myocardial Infarction) resulting from a blockage of one or more coronary arteries.

100%

Stroke Pays a benefit when you are diagnosed with a Stroke resulting in paralysis or other measurable objective neurological defect persisting for at least 30 days.

100%

Coronary Artery Condition Requiring Bypass Surgery Pays a benefit when you are diagnosed with a Coronary artery condition requiring bypass surgery.

25%

Major Organ Failure Pays a benefit when you are diagnosed with a Major organ failure of the heart, kidney, liver, lung, or pancreas resulting in the insured person being placed on the UNOS (United Network for Organ Sharing) list for a transplant.

100%

Covered Childhood Critical Illness Conditions

% of Face Amount (Employee):

Cerebral Palsy Pays a benefit when you are diagnosed with Cerebral palsy by a physician. Diagnosis must be made before the insured child reaches the age of 5. Other similar conditions that can be outgrown, are not included in this definition.

100%

Cleft Lip or Cleft Palate Pays a benefit when you are diagnosed with a Cleft Lip or Cleft Palate after live birth by a physician.

100%

Cystic Fibrosis Pays a benefit when you are diagnosed with Cystic fibrosis by a physician. The diagnosis must be confirmed with sweat chloride concentrations greater than 60 mmol/L.

100%

Down Syndrome Pays a benefit when you are diagnosed with Down Syndrome, the first date after live birth and based on the physician’s study of the 21st chromosome revealing trisomy 21, translocation, or mosaicism.

100%

Spina Bifida Pays a benefit when you are diagnosed with Spina bifida by a specialist physician and must be associated with neurologic symptoms including motor impairment. Spina bifida does not include spina bifida occulta.

100%

Critical Illness 35-39 40-44 45-49 50-54 55-59 60-64 $10,000 Employee Only $0.93 $1.16 $1.20 $1.60 $2.06 $2.82 $3.55 $6.14 $9.56 $15.21 Employee and Spouse $1.62 $1.97 $2.17 $2.70 $3.52 $4.89 $6.86 $10.84 $16.00 $23.33 Employee and Child(ren) $0.93 $1.16 $1.20 $1.60 $2.06 $2.82 $3.55 $6.14 $9.56 $15.21 Employee and Family $1.62 $1.97 $2.17 $2.70 $3.52 $4.89 $6.86 $10.84 $16.00 $23.33 $20,000 Employee Only $1.87 $2.32 $2.40 $3.19 $4.11 $5.63 $7.10 $12.29 $19.12 $30.41 Employee and Spouse $3.23 $3.93 $4.34 $5.40 $7.05 $9.79 $13.71 $21.68 $32.01 $46.66 Employee and Child(ren) $1.87 $2.32 $2.40 $3.19 $4.11 $5.63 $7.10 $12.29 $19.12 $30.14 Employee and Family $3.23 $3.93 $4.34 $5.40 $7.05 $9.79 $13.71 $21.68 $32.01 $46.66 $30,000 Employee Only $2.80 $3.48 $3.61 $4.79 $6.17 $8.45 $10.65 $18.43 $28.68 $45.62 Employee and Spouse $4.85 $5.90 $6.51 $8.11 $10.57 $14.68 $20.57 $32.52 $48.01 $70.00 Employee and Child(ren) $2.80 $3.48 $3.61 $4.79 $6.17 $8.45 $10.65 $18.43 $28.68 $45.62 Employee and Family $4.85 $5.90 $6.51 $8.11 $10.57 $14.68 $20.57 $32.52 $48.01 $70.00 *Rates are based on your (the subscribers) current age but will increase as you move into a higher age band. Age Band

<20

20-24 25-29

30-34

65-69

70+

$19.27 $31.34 $19.27 $31.34

$29.32 $42.49 $29.32 $42.49

$38.53 $62.69 $38.53 $62.69

$58.63 $84.97 $58.63 $84.97

$57.80 $87.95 $94.03 $127.46 $57.80 $87.95 $94.03 $127.46


Identity Theft

EMPLOYEE BENEFITS

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.wtxebc.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.

• • • •

Financial Accounts Monitoring Social Network Alerts Registered Sex Offender Reporting Customizable Alert Options Breach Alert Emails Mobile App National Provider ID Alerts

Support & Restore • Identity Theft Resolution Specialists (Resolution for Pre-existing Conditions) WHY CHOOSE ID WATCHDOG • 24/7/365 U.S.-based Customer Care Center Credit Lock: With our online and in-app feature, lock your Equifax® cred• Up to $1M Identity Theft Insurance5 it report2 — and your child’s Equifax credit report — to help provide • Lost Wallet Vault & Assistance additional protection against unauthorized access to your credit. • Deceased Family Member Fraud Remediation More for Families: Our family plan helps you better protect your loved • Fraud Alert & Credit Freeze Assistance ones, with each adult getting their own account with all plan features. And, we offer more features that help protect minors than any other 1 Dark Web Monitoring scans thousands of internet sites where consumers’ personal inforprovider. mation is suspected of being bought and sold, and is constantly adding new sites to those it Dedicated Resolution Specialists: If you become a victim, you don’t have searches. However, the internet addresses of these suspected internet trading sites are not to face it alone. One of our certified resolution specialists will fully man- published and frequently change, so there is no guarantee that ID Watchdog is able to locate and search every possible internet site where consumers’ personal information is at risk of age the case for you until your identity is restored. being traded. ID Watchdog Is Here for You: ID Watchdog is everywhere you can’t be — 2 The monitored network does not cover all businesses or transactions. monitoring credit reports, social media, transaction records, public rec- 3 Locking your Equifax credit report will prevent access to it by certain third parties. Locking your Equifax credit report will not prevent access to your credit report at any other credit ords and more — to help you better protect your identity. And don’t reporting agency. Entities that may still have access to your Equifax credit report include: worry, we’re always here for you. In fact, our U.S.-based customer care companies like ID Watchdog, which provide you with access to your credit report or credit score, or monitor your credit report as part of a subscription or similar service; companies team is available 24/7/365 at (866) 513-1518. Monitor & Detect • Credit Score Tracker 1 Bureau Monthly • Credit Report Monitoring | 1 Bureau • Dark Web Monitoring1 • High-Risk Transactions Monitoring2 • Subprime Loan Monitoring2 • Public Records Monitoring • USPS Change of Address Monitoring • Identity Profile Report Manage & Alert • Credit Report Lock3 | 1 Bureau • Child Credit Lock4 | 1 Bureau

that provide you with a copy of your credit report or credit score, upon your request; federal, state, and local government agencies and courts in certain circumstances; companies using the information in connection with the underwriting of insurance, or for employment, tenant or background screening purposes; companies that have a current account or relationship with you, and collection agencies acting on behalf of those whom you owe; companies that authenticate a consumer’s identity for purposes other than granting credit, or for investigating or preventing actual or potential fraud; and companies that wish to make preapproved offers of credit or insurance to you. To opt out of such pre-approved offers, visit www.optoutprescreen.com. 4 Locking your child’s Equifax credit report helps prevent access to it by lenders and creditors. It will not prevent access to your child’s credit report at any other credit reporting agency. 5 The Identity Theft Insurance is underwritten and administered by American Bankers Insurance Company of Florida, an Assurant company. Please refer to the actual policies for terms, conditions, and exclusions of coverage. Coverage may not be available in all jurisdictions.

Identity Theft Employee Only Employee and Family

$7.95 $14.95


Flexible Spending Account (FSA) NBS

EMPLOYEE BENEFITS

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 $550 rollover or grace period provision).

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


Flexible Spending Account (FSA) NBS

EMPLOYEE BENEFITS

single parent or you and your spouse must be employed outside the home, disabled or a full-time student.

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 Accounts Account Type

Eligible Expenses

Annual Contribution Limits

Benefit

$2,850

Saves on eligible expenses not covered by insurance, reduces your 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-the-counter medications)

Dependent Care FSA

Dependent care expenses (such as day $5,000 single care, after-school programs or elder care $2,500 if married and filing programs) so you and your spouse can separate tax returns work or attend school full-time

Reduces your taxable income


WTXEBC Mobile App Login Group #’s Use your District’s group # to login to the FBS Benefits app. District

GROUP #

District

GROUP #

Abernathy ISD

WTXA

Electra ISD

WTXAJ

Adrian ISD

WTXB

Farwell ISD

WTXAK

Amherst ISD

WTXC

Floydada ISD

WTXAL

Anthony ISD

WTXD

Follett ISD

WTXAM

Anton ISD

WTXE

Forestburg ISD

WTXAN

Archer City ISD

WTXF

Forsan ISD

WTXAO

Balmorhea ISD

WTXG

Fort Elliott CISD

WTXAP

Benjamin ISD

WTXI

Fort Stockton ISD

WTXAQ

Blackwell CISD

WTXJ

Friona ISD

WTXAR

Blanket ISD

WTXK

Garden City - Glasscock County ISD

WTXAS

Booker ISD

WTXL

Grady ISD

WTXAT

Borger ISD

WTXM

Grandview - Hopkins ISD

WTXAU

Bovina ISD

WTXN

Groom ISD

WTXAV

Brady ISD

WTXO

Gruver ISD

WTXAW

Brookesmith ISD

WTXP

Guthrie CSD

WTXAX

Bryson ISD

WTXQ

Hale Center ISD

WTXAY

Canadian ISD

WTXR

Happy ISD

WTXAZ

Channing ISD

WTXS

Harrold ISD

WTXAZZ4

Cherokee ISD

WTXT

Hart ISD

WTXHA

Childress ISD

WTXU

Hartley ISD

WTXAAA

City View ISD

WTXV

Hedley ISD

WTXABB

Clarendon CISD

WTXW

Henrietta ISD

WTXACC

Coahoma ISD

WTXX

Highland Park ISD

WTXADD

Cotton Center ISD

WTXY

Holliday ISD

WTXAEE

Crane ISD

WTXBA

Idalou ISD

WTXAFF

Crosbyton Consolidated ISD

WTXZ

Iraan-Sheffield ISD

WTXAGG3

Crowell ISD

WTXAA

Jacksboro ISD

WTXAGG

Culberson County - Allamoore ISD

WTXAB

Jayton ISD

WTXAHH

Dalhart ISD

WTXAC

Jim Ned CISD

WTXAII

Darrouzett ISD

WTXAD

Kelton ISD

WTXAJJ

Dimmitt ISD

WTXAE

Klondike ISD

WTXAKK

Dumas ISD

WTXAF

Kress ISD

WTXALL

Eden CISD

WTXAG

Lazbuddie ISD

WTXAMM

El Paso Education Initiative Inc

WTXAH

Lefors ISD

WTXANN

El Paso Leadership Academy

WTXAI

Lockney ISD

WTXAOO


WTXEBC Mobile App Login Group #’s Use your District’s group # to login to the FBS Benefits app. District

GROUP #

District

GROUP #

Loop ISD

WTXAPP

RISE Academy

WTXAYY1

Lorenzo ISD

WTXAQQ

River Road ISD

WTXAZZ1

May ISD

WTXARR

Robert Lee ISD

WTXAAA2

McLean ISD

WTXASS

Roosevelt ISD

WTXABB2

Meadow ISD

WTXATT

Ropes ISD

WTXACC2

Memphis ISD

WTXAUU

Saint Jo ISD

WTXADD2

Menard ISD

WTXAVV

Sands CISD

WTXAEE2

Sanford-Fritch ISD

WTXAFF2

Miami ISD

WTXAWW

Midland Academy Charter School

WTXAXX

Santa Anna ISD

WTXAGG2

Monahans-Wickett-Pyote ISD

WTXAYY

Seagraves ISD

WTXAHH2

Montague ISD

WTXAZZ

Shamrock ISD

WTXAII2 WTXAJJ2

Morton ISD

WTXAAA1

Sierra Blanca ISD

Munday CISD

WTXABB1

Smyer ISD

WTXAHH3

Nazareth ISD

WTXACC1

Southland ISD

WTXAKK2

New Home ISD

WTXADD1

Spring Creek ISD

WTXALL2

Newcastle ISD

WTXAEE1

Springlake-Earth ISD

WTXAFF3

Nocona ISD

WTXAFF1

Sudan ISD

WTXAMM2

Northside ISD

WTXAGG1

Sunray ISD

WTXANN2

O'Donnell ISD

WTXAHH1

Sweetwater ISD

WTXAOO2

Olfen ISD

WTXAII1

Tahoka ISD

WTXAPP2

Olton ISD

WTXAJJ1

Texline ISD

WTXAQQ2

Paducah ISD

WTXAKK1

Throckmorton ISD

WTXARR2

Paint Rock ISD

WTXALL1

Tulia ISD

WTXASS2

Panhandle ISD

WTXAMM1

Turkey-Quitaque ISD

WTXATT2

Panther Creek CISD

WTXANN1

Valentine ISD

WTXAUU2

Patton Springs ISD

WTXAOO1

Vega ISD

WTXAVV2

Petersburg ISD

WTXAPP1

Water Valley ISD

Petrolia ISD

WTXAQQ1

Wellington ISD

WTXAXX2

Plains ISD

WTXARR1

Wheeler ISD

WTXAZZ2

Post ISD

WTXASS1

White Deer ISD

WTXAAA3

Prairie Valley ISD

WTXATT1

Whitharral ISD

WTXABB3

Pringle-Morse CISD

WTXAUU1

Wildorado ISD

WTXAZZ3

Wilson ISD

WTXACC3

Windthorst ISD

WTXADD3

Zephyr ISD

WTXAEE3

PSPartners

WTXBC

Quanah ISD

WTXAVV1

Ralls ISD Rankin ISD

WTXAWW1 WTXAXX1

WTXAWW2


Notes


Notes


2022 - 2023 Plan Year

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 WTXEBC 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 WTXEBC 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.

WWW.WTXEBC.COM