2022 LGBS Benefit Guide

LGBS

BENEFIT GUIDE EFFECTIVE: 01/01/2022 - 12/31/2022 WWW.MYBENEFITSHUB.COM/LGBS 1

Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Eligibility Requirements AUL a OneAmerica Company Life and AD&D Voya Hospital Indemnity AUL OneAmerica Company Disability Voya Accident Voya Critical Illness 5Star Individual Life

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3 4-5 6-7 6 7 8-13 14-17 18-21 22-27 28-31 32-35

FLIP TO...

PG. 4

HOW TO ENROLL

PG. 6

SUMMARY PAGES

PG. 8

YOUR BENEFITS

Benefit Contact Information BENEFIT ADMINISTRATORS

HOSPITAL INDEMNITY

CRITICAL ILLNESS

Financial Benefit Services Ann Brownlee, Account Executive 210-243-1337 annb@fbsbenefits.com

VOYA Group #694819 (800) 955-7736 www.voya.com

VOYA Group #694819 (800) 955-7736 www.voya.com

LGBS BENEFITS COORDINATOR

DISABILITY

VOLUNTARY LIFE

Patricia Crowell (512) 634-3786 patricia.crowell@lgbs.com

AUL a OneAmerica Company Group #614838 (800) 553-5318 Claims: (855) 517-6365 www.oneamerica.com

AUL a OneAmerica Company Group #614838 (800) 583-6908 www.oneamerica.com

LGBS DEPUTY DIRECTOR

ACCIDENT

INDIVIDUAL LIFE

Christine Stromme (512) 634-3745 christine.stromme@lgbs.com

VOYA Group #694819 (800) 955-7736 www.voya.com

5Star Life Insurance Company (800) 776-2322 www.5starlifeinsurance.com

BASIC LIFE AUL a OneAmerica Company Group #614838 (800) 553-5318 www.oneamerica.com

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

access to everything you need to complete your benefits

“FBS LGBS” to (800) 583-6908

enrollment: •

Enrollment Resources

•

Online Support

•

Interactive Tools

•

And more!

App Group #: FBSLGBS

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Text

OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

2 3

www.mybenefitshub.com/lgbs

CLICK LOGIN

ENTER USERNAME & PASSWORD All login credentials have been RESET to the default described below:

Username: Email address - typically your work email. If this does not work, try your personal email address.

ONLINE SUPPORT

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

Security Number.

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Annual Benefit Enrollment

SUMMARY PAGES

2022 Benefits Enrollment

No Changes in Plans or Rates

The supplemental benefits you elected last year will “rollover” and remain in effect for the next plan year (1/1/2022—12/31/2022).

However, we suggest that you log into THEbenefitsHUB and verify your profile information such as name, address, phone numbers, email addresses and dependent information to avoid any unnecessary delays. Should there be any missing or inaccurate information, it is possible that your benefits could be delayed or denied.

There are no changes or premium increases in any of the products this year. Please take advantage of these savings and benefit plans.

Election of a Beneficiary All eligible employees of LGBS are given a $15,000 Basic Life Policy at no cost to the employee. This employer-paid life insurance policy requires you to designate a beneficiary for this plan. If you also select additional life coverage for yourself or eligible family members you will also need to designate a beneficiary for that product also. If you do not designate a beneficiary, your life insurance benefits will be paid to your estate.

CALL CENTER INFORMATION (866) 914-5202 Hours: Monday - Thursday, 8:00 A.M. - 5:30 P.M. and Friday, 8:00 A.M. - 3:00 P.M.

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SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more

Dependent Eligibility: You can cover eligible dependent

regularly scheduled hours each work week.

children under a benefit that offers dependent coverage,

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

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

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

Dependent Child Age Limits

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

PLAN

CARRIER

MAXIMUM AGE that some benefits may not allow you to cover your spouse as a dependent if your spouse

Accident

VOYA

Up to 26

Hospital Indemnity

VOYA

Up to 26

Critical Illness

VOYA

Up to 26

Voluntary Life

AUL a OneAmerica Company

Up to 26

Individual Life

5Star

Up to 23

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.

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.

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AUL A ONEAMERICA COMPANY

Life and AD&D

YOUR BENEFITS PACKAGE

About this Benefit Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family.

Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

Motor vehicle crashes are the

#1

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 8 details on covered expenses, limitations and exclusions are included in the summary plan description located on the LGBS Benefits Website: www.mybenefitshub.com/lgbs

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

Life and AD&D insurance coverage amount of $15,000 at no cost to you Waiver of premium benefit Accelerated life benefit Additional AD&D Benefits: Seat Belt, Air Bag, Repatriation, Child Higher Education, Child Care, Paralysis/Loss of Use, Severe Burns

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

Wh

•       • • •

• • • •

Convenient payroll deduction

1 in 4 adult Americans wish their spouse or partner would purchase some or more life insurance.

(Source: LIMRA, Insurance Barometer Study, 2015)

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

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Life and AD&D AUL's Group Voluntary Term Life and AD&D Insurance Terms and Definitions Eligible Employees:

Life Event Benefit: You may be able to add coverage or increase your benefit amount if you apply within 31 days from the date of a life event.

Examples of a life event include marriage, the birth of a child, or adoption.

Continuation of Coverage Options: Portability

Flexible Choices:

Accidental Death & Dismemberment (AD&D): OR Conversion

Guaranteed Issue Amounts:

Accelerated Life Benefit: If diagnosed with a terminal illness and have less than 12 Employee Guaranteed Issue Amount $250,000 months to live , you may apply to receive 25%, 50% or 75% of Spouse Guaranteed Issue Amount $50,000 your life insurance benefit to use for whatever you choose.

Waiver of Premium: Child Guaranteed Issue Amount $10,000 If approved, this benefit waives your and your dependents ' insurance premium in case you become totally disabled and are Timely Enrollment: unable to collect a paycheck .

Enrolling timely means you have enrolled during the initial enrollment period when benefits were first offered by AUL, or as Reductions: a newly hired employee within 31 days following completion of Upon reaching certain ages, your original benefit amount will reduce to a percentage as shown in the following schedule. The any applicable waiting period. amounts of Dependent Life Insurance and Dependent AD&D Evidence of Insurability: If you elect a benefit amount over the Guaranteed Issue Amount Principal Sum will reduce according to shown above for you or your eligible dependents, or you do not the Employee's reduction schedule. enroll timely, you will need to submit a Statement of Insurability Age: 65 70 75 80 form for review. Based on health history, you and / or your dependents will be approved or declined for insurance coverage Reduces To: 65% 40% 25% 15%

by AUL. Guaranteed Increase in Benefit: If eligible , this benefit allows you to increase your coverage every year as your life insurance needs change. You may be able This invitation to inquire allows eligible employees an opportunity to inquire further about AUL's group insurance and to increase your benefit amount by $10,000 every year until is limited to a brief description of any losses for which benefits you reach your maximum amount, without providing Evidence of . If Evidence of is applied for are payable. The contract has exclusions, limitations reduction of benefits, and terms under which the contract may be and denied , please be aware Guaranteed Increase in Benefits continued in force or discontinued. will not be made available to you in the future.

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

Life and AD&D Monthly Payroll Deduction Illustration About your benefit options: • •

• •

You may select a minimum benefit of $10,000 up to a maximum amount of $1,000,000, in increments of $10,000, not to exceed 5 times your annual base salary only, rounded to the next higher $10,000. AD&D coverage is not included for dependents.

Amounts requested above $250,000 for an Employee, $50,000 for a Spouse, or any amount not requested timely will require Evidence of Insurability.

Employee must select coverage to select any Dependent coverage.

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

EMPLOYEE ONLY OPTIONS (based on Employee's age as of 01/01) Life & AD&D

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

$10,000

$.50

$.50

$.50

$.70

$.90

$1.50

$2.60

$4.10

$7.30

$12.90

$20.40

$29.90

$29.90

$20,000

$1.00

$1.00

$1.00

$1.40

$1.80

$3.00

$5.20

$8.20

$14.60

$25.80

$40.80

$59.80

$59.80

$30,000

$1.50

$1.50

$1.50

$2.10

$2.70

$4.50

$7.80

$12.30

$21.90

$38.70

$61.20

$89.70

$89.70

$40,000

$2.00

$2.00

$2.00

$2.80

$3.60

$6.00

$10.40

$16.40

$29.20

$51.60

$81.60

$119.60 $119.60

$50,000

$2.50

$2.50

$2.50

$3.50

$4.50

$7.50

$13.00

$20.50

$36.50

$64.50

$102.00 $149.50 $149.50

$90,000

$4.50

$4.50

$4.50

$6.30

$8.10

$13.50 $23.40

$36.90

$65.70

$116.10 $183.60 $269.10 $269.10

$100,000

$5.00

$5.00

$5.00

$7.00

$9.00

$15.00 $26.00

$41.00

$73.00

$129.00 $204.00 $299.00 $299.00

$150,000

$7.50

$7.50

$7.50

$10.50 $13.50 $22.50 $39.00

$61.50

$109.50 $193.50 $306.00 $448.50 $448.50

$200,000

$10.00 $10.00 $10.00

$14.00 $18.00 $30.00 $52.00

$82.00

$146.00 $258.00 $408.00 $598.00 $598.00

$250,000

$12.50 $12.50 $12.50

$17.50 $22.50 $37.50 $65.00 $102.50 $182.50 $322.50 $510.00 $747.50 $747.50

SPOUSE ONLY OPTIONS (based on Employee's Age as of 01/01) Life Options

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

$10,000

$.30

$.30

$.30

$.50

$.70

$1.30

$2.40

$3.90

$7.10

$12.70

$20.20

$29.70

$29.70

$20,000

$.60

$.60

$.60

$1.00

$1.40

$2.60

$4.80

$7.80

$14.20

$25.40

$40.40

$59.40

$59.40

$30,000

$.90

$.90

$.90

$1.50

$2.10

$3.90

$7.20

$11.70

$21.30

$38.10

$60.60

$89.10

$89.10

$40,000

$1.20

$1.20

$1.20

$2.00

$2.80

$5.20

$9.60

$15.60

$28.40

$50.80

$80.80

$118.80 $118.80

$50,000

$1.50

$1.50

$1.50

$2.50

$3.50

$6.50

$12.00

$19.50

$35.50

$63.50

$101.00 $148.50 $148.50

CHILD(REN) OPTIONS (Premium shown for Child(ren) reflects the cost for all eligible dependent children) Child(ren) 6 months to age 26 Option 1:

Child(ren) live birth to 6 months

$10,000

$1,000

Monthly Payroll Deduction Life Amount $1.70

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

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

Products and financial services provided by American United Life Insurance Company®

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Life and AD&D NEEDS ASSESSMENT WORKSHEET Life insurance protection: How much is enough?

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13

VOYA YOUR BENEFITS PACKAGE

Hospital Indemnity

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

The median hospital costs per stay have steadily grown to over $10,000.

$8,800

9,600

10,400

2003

2008

2012

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

Hospital Indemnity Benefits at a Glance A simple way to help protect against the financial stress of a hospital stay For the employees of: Linebarger Googan Blair & Sampson, LLP

What Hospital Confinement Indemnity Insurance benefits are available?

The following list includes the benefits provided by Hospital Confinement Indemnity Insurance. The benefit amounts paid depend on the type of facility and number of days of What is Hospital Confinement Indemnity confinement. For a list of standard exclusions and limitations, go Insurance? to the end of this document. For a complete description of your Hospital Confinement Indemnity Insurance pays a daily benefit if available benefits, along with applicable provisions, conditions on benefit determination, exclusions and limitations, see your you have a covered stay in a hospital*, critical care unit and certificate of insurance and any riders. rehabilitation facility. The benefit amount is determined based on the type of facility and the number of days you stay. Hospital Confinement Indemnity Insurance is a limited benefit policy. It is You employer offers you the opportunity to purchase a daily benefit amount of $100 or $300. The benefit amount is not health insurance and does not satisfy the requirement of determined by the type of facility in which you are confined: minimum essential coverage under the Affordable Care Act. • Hospital—The benefit is 1x the daily benefit amount ($100 or $300), up to 30 days per confinement.

Features of Hospital Confinement Indemnity Insurance include: • Critical care unit (CCU)—The benefit is 2x the daily benefit • Guaranteed Issue: No medical questions or tests required amount ($200 or $600), up to 15 days per confinement. for coverage.

• Rehabilitation facility—The benefit is one-half of the daily • Flexible: You can use the benefit money for any purpose benefit amount ($50 or $150), up to 30 days per you like. confinement.

• Payroll deductions: Premiums paid through convenient payroll deductions.

What does my Hospital Confinement • Affordable coverage: Rates are typically lower when you purchase coverage through your employer.

Indemnity Insurance include?

• Portable: Should you leave your current employer or retire, The benefits listed below are included with your Hospital you can take the policy with you and select from a variety of Confinement Indemnity Insurance. There may be some variation payment plans. by state. For a list of standard exclusions and limitations, please *A hospital does not include an institution or part of an institution used as: a hospice care unit; a convalescent home; a rest or nursing facility; a freestanding surgical center; a rehabilitative center; an extended care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction. “Critical care unit” and “rehabilitative facility” are specifically defined in this policy. See the certificate for details.

Below are a few examples of how your Hospital Confinement Indemnity Insurance benefit could be used (coverage amounts may vary): • Medical expenses, such as deductibles and copays • Travel, food and lodging expenses for family members • Child care • Everyday expenses like utilities and groceries

Who is eligible for Hospital Confinement Indemnity Insurance?

• • •

You±—all active employees working 20+ hours per week**.

Your spouse*— under age 70. Coverage is available only if employee coverage is elected.

Your child(ren)— to age 26. Coverage is available only if employee coverage is elected.

*The use of “spouse” in this document means a person insured as a spouse as described in the certificate of insurance or rider. Please contact your employer for more information.

refer to the end of this document. For a complete description of your available benefits, along with applicable provisions, exclusions and limitations, see your employer’s certificate of insurance and any riders.

Spouse* Hospital Confinement Indemnity Insurance: If you have coverage for yourself, you may enroll your spouse, as long as your spouse is under age 70 and is not covered under the Policy as an Employee.

• Your spouse will have the same benefits that you have.

• Guaranteed issue: No medical questions or tests required for coverage. *The use of “spouse” in this form means a person insured as a spouse as described in the certificate of insurance or benefit. Please contact your employer for more information.

Children’s Hospital Confinement Indemnity Insurance: As long as you have coverage on yourself, your natural child(ren), stepchild (ren), adopted child(ren) or child(ren) for whom you are a legal guardian are eligible to be covered under your employer’s plan, up to the age of 26.

• Your child(ren) will receive the same coverage as you.

• Guaranteed issue: No medical questions or tests required for coverage.

• One premium amount covers all of your eligible children.

• If both you and your spouse are covered under the policy as an employee, then only one, but not both, may cover 15 the

Hospital Indemnity same child(ren) under this benefit. If the parent who is covering the child(ren) stops being insured as an employee then the other parent may apply for children’s coverage.

Initial Confinement Benefit: This pays you an additional benefit of 5x the daily benefit for the first day you spend in a hospital, critical care unit or rehabilitation center.

• If your spouse and/or children are covered by Hospital Confinement Indemnity Insurance, they are also eligible for this benefit.

•

There are no health questions to answer.

Wellness Benefit: This provides an annual benefit payment if you complete a health screening test. You may only receive a benefit once per year, even if you complete multiple health screening tests. If a benefit has been paid under the Wellness Benefit, that same test on the same date is not eligible under the Diagnostic Test Benefit.

• Examples of health screening tests include but are not limited to: Pap test, serum cholesterol test for HDL and LDL levels, mammography, colonoscopy, and stress test on bicycle or treadmill.

•

The annual benefit is $50 for completing a health screening test.

•

If your spouse or children are covered for Hospital Confinement Indemnity Insurance, they are also covered by the Wellness Benefit. Your spouse’s benefit amount is also $50.The benefit for child coverage is 50% of employees wellness benefit amount, to a maximum of $100 for children’s benefits.

Portability on your Hospital Confinement Indemnity Insurance is included should you leave your current employer or retire.

How much does Hospital Confinement Indemnity Insurance cost?

All employees pay the same rate, no matter their age. See the chart below for the premium amounts.

Tier

Daily Benefit

Monthly Rate

Employee

$100

14.88

Spouse

$100

14.25

Children

$100

7.95

Tier

Daily Benefit

Monthly Rate

Employee

$300

42.13

Spouse

$300

40.26

Children

$300

21.35

16

Hospital Indemnity Exclusions and Limitations Exclusions in the Certificate, Initial Confinement Benefit, Spouse Hospital Confinement Indemnity Insurance and Child Hospital Confinement Indemnity Insurance are listed below. (These may vary by state.) Benefits are not payable for any loss caused in whole or directly by any of the following*: • Participation or attempt to participate in a felony or illegal activity.

•

Operation of a motorized vehicle while intoxicated.

•

Suicide, attempted suicide or any intentionally self-inflicted injury, while sane or insane.

•

War or any act of war, whether declared or undeclared, other than acts of terrorism.

•

Loss that occurs while on full-time active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.

•

Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor.

•

Elective surgery, except when required for appropriate care as a result of the covered person’s injury or sickness.**

•

Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.

•

Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded.

•

Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar activities.

•

Practicing for, or participating in, any semiprofessional or professional competitive athletic contests for which any type of compensation or remuneration is received.

Who do I contact with questions?

For more information, please call the Voya Employee Benefits Customer Service Team at (800) 955-7736.

This is a summary of benefits only. A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the certificate of insurance and riders. All coverage is subject to the terms and conditions of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern. To keep coverage in force, premiums are payable up to the date of coverage termination. Hospital Confinement Indemnity Insurance is underwritten by ReliaStar Life Insurance Company, a member of the Voya® family of companies. Policy Form #RL-HI-POL-12; Certificate Form #RL-HI-CERT-12; and Rider Forms: Spouse Hospital Confinement Indemnity Rider Form #RL-HI-SPR-12; Children’s Hospital Confinement Indemnity Rider Form #RL-HI-CHR-12; Initial Confinement Benefit Rider Form #RL-HI-ICN-12; Wellness Benefit Rider Form #RL-HI-WELL-12. Form numbers, provisions and availability may vary by state.

Linebarger Googan Blair and Sampson, LLP, Group #694819 Account #0001 Date Prepared: April 12, 2021 172510-04/08/2016 ReliaStar Life Insurance Company, a member of the Voya® family of companies.

17

AUL A ONEAMERICA COMPANY YOUR BENEFITS PACKAGE

Disability

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

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

34.6 months is the duration of the average disability claim.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 18 details on covered expenses, limitations and exclusions are included in the summary plan description located on the LGBS Benefits Website: www.mybenefitshub.com/lgbs

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

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

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

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

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

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

Partial Disability: You may be paid a partial disability benefit, if because of injury or sickness, you are unable to perform every material and substantial duty of your regular occupation on a full-time basis, are performing at least one of the material and substantial duties of your regular occupation, or another occupation, on a full or part-time basis, and are earning less than 50% of your pre-disability earnings due to the same injury or sickness.

Partial Disability is applicable to option 1.

Residual: The elimination period can be satisfied by total disability, partial disability, or a combination of both. Residual is applicable to option 1.

Return to Work: You may be able to return to work for a specified time period without having your partial disability benefits reduced according to the contract. The Return to Work Benefit is offered up to a maximum of 12 months. Return to Work is applicable to option 1.

Integration: The method by which your benefit may be reduced by Other Income Benefits. Integration is applicable to option 1.

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

About Your Benefits: • • •

Long Term Disability (LTD) benefits are illustrated and paid on a monthly basis.

Amounts not requested timely will require Evidence of Insurability.

Maximum benefit amounts are based upon a percentage of covered earnings. Potential benefits are reduced by other income offsets including but not limited to Social Security benefits Option 1 WDL

Benefit Percentage Maximum Monthly Benefit

60% $10,000

Elimination Period

90/90

Maximum Benefit Duration

SSFRA

Pre-Existing Condition Period

3/12

To Determine Your Estimated Monthly Benefit •

Enter your Monthly Salary: _____________________

•

Multiply Step 1 by 60%: ______________________. If this number is less than $10,000, this is your estimated Monthly Benefit. If this number is $10,000 or greater, your estimated Monthly Benefit is $10,000.

19

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

regular job, you are not working in any occupation and are under the regular attendance of a physician for that injury or sickness.

Many of us lead busy lives and seldom take time to think about life's risks. Consider the following reasons many people purchase disability insurance: • Lost wages • Daily living expenses, such as:

You may be paid a partial disability benefit, if because of injury or sickness, you are unable to perform every material and substantial duty of your regular job on a full-time basis, are performing at least one of the material and substantial duties of your regular job, or another occupation, on a full or part-time basis, and are earning less than 80% of your pre-disability earnings due to the same injury or sickness. Partial Disability is applicable to option 1.

   

Mortgage/rent Utilities Car Food

   

Childcare Eldercare Hobbies Pet care

• Ongoing medical expenses Advantages of shopping at work include: • Affordable group rates • Convenient payroll deduction • Guaranteed issue for timely applicant • Easy access Approximately every 7 seconds, a working-age American suffers a disabling injury or illness that will last for at least one month.

(Source: America's Disability Counter, DisabilityCounter.org)

65 percent of employees could not pay their bills for more than a year without an income.

(Source: CDA 2013 Employer Disability Awareness Study, p. 10)

The elimination period can be satisfied by total disability, partial disability, or a combination of both. Residual is applicable to option 1.

The method by which your benefit may be reduced by Other Income Benefits. Integration is applicable to option 1.

For every 17 working Americans, 1 is disabled.

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

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

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

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

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

•

•

Short Term Disability (STD) benefits are illustrated weekly and are paid on a weekly basis.

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

Option 1 -WDS

Benefit Percentage Maximum Weekly Benefit

$1,500

Elimination Period

14/14

Maximum Benefit Duration Pre-Existing Condition Period

If approved, this benefit waives your Disability insurance To Determine Your premium in case you become disabled and are unable to collect a Enter your Weekly Salary: paycheck.

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

You are considered disabled if, because of injury or sickness, you cannot perform the material and substantial duties of your 20

60%

11 weeks 3/12

Estimated Weekly Benefit

Multiply Step 1 by 60%: . If this number is less than $1,500, this is your estimated Weekly Benefit. If this number is $1,500 or greater, your estimated Weekly Benefit is $1,500.

Disability Rates Long Term Disability

Short Term Disability

MONTHLY PREMIUM RATES PER $100 OF COVERED MONTHLY EARNINGS (based on Employee's age as of 07/01)

MONTHLY PREMIUM RATES PER $10 OF COVERED WEEKLY EARNINGS (based on Employee's age as of 07/01)

Age Brackets

Opt 1 WDL

Age Brackets

Opt 1 WDL

0 - 19

$.135

0 - 19

$.770

20 - 24

$.135

20 - 24

$.770

25 - 29

$.135

25 - 29

$.770

30 - 34

$.194

30 - 34

$.770

35 - 39

$.303

35 - 39

$.590

40 - 44

$.438

40 - 44

$.500

45 - 49

$.565

45 - 49

$.540

50 - 54

$.793

50 - 54

$.650

55 - 59

$1.088

55 - 59

$.800

60 - 64

$1.400

60 - 64

$.930

65 - 69

$1.484

65 - 69

$1.000

70 - 74

$1.855

70 - 74

$1.000

75+

$1.855

75+

$1.000

Steps to Calculate Monthly Deduction (Class 1) *Example

Steps to Calculate Monthly Deduction (Class 1)

Opt 1

*Example

Opt 1

WDL

WDS

Note: Please use the following formula to calculate the cost for this benefit. You can only elect one WDL plan option.

Note: Please use the following formula to calculate the cost for this benefit. You can only elect one WDS plan option.

1A: Enter your Monthly Salary

$2,083

1A: Enter your Weekly Salary

1B: Maximum Covered Monthly Earnings

$16,667

$16,667

1C: Enter the lesser amount of 1A or 1B

$2,083

2. Divide Step 1C by 100

$20.83

3. Enter Rate from chart below

X $0.30

X

4. Multiply Step 2 by Step 3 (Mo Prem)

=

=

$6.31

$480

1B: 1C: Maximum Weekly Benefit

$1,500

1D: Enter the lesser amount of 1B or 1C

*Example: Based on an Employee Age 36 with an annual salary of $25,000 choosing Opt 1

$1,500

$288

2. Divide Step 1C by 100

$28.80

3. Enter Rate from chart below

X $0.59

X

$16.99

=

4. Multiply Step 2 by Step 3 (Mo Prem)

=

*Example: Based on an Employee Age 36 with an annual salary of $25,000 choosing Opt 1

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

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

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

21

VOYA YOUR BENEFITS PACKAGE

Accident

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

2/3 of disabling injuries suffered by American workers are not work related.

American workers 36% ofreport they always or

usually live paycheck

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 22 details on covered expenses, limitations and exclusions are included in the summary plan description located on the LGBS Benefits Website: www.mybenefitshub.com/lgbs

Accident Benefits at a Glance

How can Accident Insurance help?

Affordable insurance that can help you pay for the out-of-pocket Below are a few examples of how your Accident Insurance benefits could be used: costs you may experience after an accident.

• Medical expenses, such as deductibles and copays For the employees of: Linebarger Googan Blair & Sampson, LLP • Home healthcare costs • Lost income due to lost time at work • Everyday expenses like utilities and groceries Accident Insurance pays you benefits for specific injuries and events resulting from a covered accident while on/off job. The Who is eligible for Accident Insurance? amount paid depends on the type of injury and care received.

You—all active employees working 20+ hours per week**.

Accident Insurance is a limited benefit policy. It is not health Your spouse*— under age 70. Coverage is available only if insurance and does not satisfy the requirement of minimum employee coverage is elected. essential coverage under the Affordable Care Act. Your child(ren)— to age 26. Coverage is available only if You may qualify to receive benefits for items listed below, as employee coverage is elected long as they are the result of a covered accident. See the

What is Accident Insurance?

certificate of insurance and any riders for specific details.

• Accident hospital care • Follow-up care • Common Injuries • Emergency care benefits Other features of Accident Insurance include: • Guaranteed Issue: No medical questions or tests required for coverage.

• Flexible: You can use the benefit money for any purpose you like.

• Payroll deductions: Premiums are paid through convenient payroll deductions.

• Portable: Should you leave your current employer or retire, you can take your coverage with you.

EVENT

*The use of “spouse” in this document means a person insured as a spouse as described in the certificate of insurance or rider. Please contact your employer for more information.

What accident benefits are available?

The following list includes the benefits provided by Accident Insurance. The benefit amounts paid depend on the type of injury and care received. You may be required to seek care for your injury within a set amount of time. You must be insured under the policy for 30 days before benefits are payable. Note that there may be some variation by state. For a list of standard exclusions and limitations, go to the end of this document. For a complete description of your available benefits, along with applicable provisions, exclusions and limitations, see your certificate of insurance and any riders.

BENEFIT

Accident Hospital Care Surgery Open abdominal, thoracic

Surgery exploratory or without repair

Blood, plasma, platelets Hospital admission Hospital confinement Per day up to 365

Critical care unit confinement per day, up to 15 days

Rehabilitation facility confinement per day for 90 days

Coma Duration of 14 or more days

Transportation per trip, up to 3 per accident

Lodging Per day, up to 30 days

Family care per child, up to 45 days

$2,500 $250 $400 $1,400 $300 $600

$175 $7,000 $400 $150 $30 23

Accident EVENT Follow-up care Medical equipment duration of 14 or more days

Physical therapy

BENEFIT $250 $50

per treatment, up to 6

Prosthetic device (one) Prosthetic device (two or more)

$1,200 $2,400

Common injuries Burns second degree, at least 36% of the body Burns 3rd degree, at least 9 but less than 35 square inches of the body

Burns 3rd degree, 35 or more square inches of the body

Skin Grafts Emergency dental work while hospital confined

Eye Injury removal of foreign object

Eye Injury Torn Knee Cartilage surgery with no repair or if cartilage is shaved

Torn Knee Cartilage Laceration1 Laceration1 Laceration1

$75

$150

$480

sutures 2” – 6”

Laceration1

$960

sutures over 6”

Ruptured Disk

$600

surgical repair

Tendon/Ligament/Rotator Cuff One, surgical repair

Tendon/Ligament/Rotator Cuff Two or more, surgical repair

Tendon/Ligament/Rotator Cuff Exploratory Arthroscopic Surgery with no repair

Concussion Paralysis quadriplegia Paralysis paraplegia

Dislocations Hip joint Knee Ankle or foot bone(s)

24

$250 crown, $125 extraction

$120

sutures up to 2”

Lower jaw Collarbone Partial dislocations

25% of burn benefit

$60

treated no sutures

Other than fingers

$18,000

$750

surgical repair

Shoulder Elbow Wrist Finger/toe Hand bone(s)

$2,500

$300

surgery

Other than toes

$1,250

$600 $900 $200 $250 $15,000 $7500 Closed/open reduction2 $2,500/$5,000 $1,500/$3,000 $1,200/$2,400 $500/$1,000 $500/$1,000 $500/$1,000 $150/$300 $500/$1,000 $500/$1,000 $500/$1,000 25% of the closed reduction amount

Accident EVENT Fractures

BENEFIT Closed/open reduction3

Hip

$2,500/$5,000

Leg

$1,250/$2,500

Ankle

$500/$1,000

Kneecap Foot

$500/$1,000 $500/$1,000

Excluding toes, heel

$550/$1,100

Upper arm Forearm, Hand, Wrist

$500/$1,000

Except fingers

$100/$200

Finger, Toe

$1,200/$2,400

Vertebral body

$500/$1,000

Vertebral processes Pelvis

$1,200/$2,400

Except coccyx

$350/$700

Coccyx Bones of face

$550/$1,100

Except nose

$150/$300

Nose

Upper jaw

$550/$1,100

Lower jaw

$500/$1,000

Collarbone

$500/$1,000 $450/$900

Rib or ribs Skull – simple Except bones of face Skull – depressed Except bones of face

$1,500/$3,000 $5,000/$10,000

Sternum

$500/$1,000

Shoulder blade

$500/$1,000

Chip fractures

25% of the closed reduction amount

Emergency care benefits Ground ambulance

$200

Air ambulance

$1000

Emergency room treatment

$300

Initial doctor visit

$80

Follow-up doctor visit

$80

1

Laceration benefits are a total of all lacerations per accident.

Closed Reduction of Dislocation = Non-surgical reduction of a completely separated joint. Open Reduction of Dislocation = Surgical reduction of a completely separated joint.

3 Closed Reduction of Fracture = Non-surgical. Open Reduction of Fracture = Surgical.

2

Catastrophic Accident Rider (in$’s) Employee*

120,000

Spouse*

60,000

Children

30,000

Home Modification Benefit

5,000

Vehicle Modification Benefit

5,000

*Benefit reduces to 50% at age 65, and to 25% of the original benefit amount at age 70.

25

Accident What does my Accident Insurance include?

What optional benefits are available?

The benefits listed below are included with your accident coverage. For a list of standard exclusions and limitations, please refer to the end of this document. For a complete description of your available benefits, along with applicable provisions, exclusions and limitations, see your certificate of insurance and any riders.

You may choose to include the optional benefits below with your accident coverage. For a list of standard exclusions and limitations, please refer to the end of this document. For a complete description of your available benefits, along with applicable provisions, exclusions and limitations, see your certificate of insurance and any riders.

Accidental Death and Dismemberment (AD&D) Benefit: If you are severely injured or die as a result of a covered accident, an AD&D benefit may be payable to you or your beneficiary.

• If your spouse and/or children are/is covered for Accident Insurance, they are covered for this additional benefit.

Spouse* Accident Insurance: If you have coverage for yourself, you may enroll your spouse, as long as your spouse is under age 70 and is not covered under the Policy as an Employee.

• Your spouse will receive the same base coverage as you.

• Guaranteed Issue: No medical questions or tests required for coverage

Accidental Death Benefits

Benefit

Common Carrier: If the death occurs as a result of a covered accident on a common carrier a higher benefit will be paid.

Common carrier means any commercial transportation that operates on a regularly scheduled basis between predetermined points or cities.

Employee

$120,000

Spouse

$48,000

Children

$24,000

Other Accident Employee

$60,000

Spouse

$24,000

Children

$12,000

Accidental Dismemberment Benefits

•

Loss of both hand or both feet or sight in both eyes

$25,000

Loss of one hand or one foot AND the sight of one eye

$25,000

Loss of one hand AND one foot

$25,000

Loss of one hand OR one foot

$12,000

Loss of Two or more fingers or toes

$2,500

Loss of one finger or one toe

$1,200

Catastrophic Accident Benefit: You may be eligible for an extra benefit if the effects from certain covered losses persist for at least 365 days. This is called the Catastrophic Accident Elimination Period.  Loss includes, but is not limited to permanent loss or loss of function of any of the following: both hands or both feet, the use of both arms or both legs, one hand and one foot, one arm and one leg, the sight of both eyes, hearing in both ears and the ability to speak.

26

*The use of “spouse” in this form means a person insured as a spouse as described in the certificate of insurance or benefit. Please contact your employer for more information.

Children’s Accident Insurance: As long as you have accident coverage on yourself, your natural child(ren), stepchild(ren), adopted child(ren) or child(ren) for whom you are a legal guardian are eligible to be covered under your employer’s plan, up to the age of 26.

• Your child(ren) will receive the same base coverage as you.

• Guaranteed Issue: No medical questions or tests required for coverage.

• One premium amount covers all of your eligible children.

• If both you and your spouse are covered under the policy as an employee, then only one, but not both, may cover the same child(ren) under this benefit. If the parent who is covering the child(ren) stops being insured as an employee then the other parent may apply for children’s coverage.

How much does Accident Insurance cost?

All employees pay the same rate, no matter their age. See the chart below for the premium amounts.

Monthly Rates Employee

$16.38

Employee and Spouse

$23.40

Employee and Children

$31.20

Family

$38.22

Accident Exclusions and Limitations Exclusions in the Certificate, Spouse Accident Insurance, Children’s Accident Insurance and AD&D Benefit are listed below. (These may vary by state.) Benefits are not payable for any loss caused in whole or directly by any of the following*: •

Participation or attempt to participate in a felony or illegal activity.

•

An accident while the covered person is operating a motorized vehicle while intoxicated. Intoxication means the covered person’s blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the accident occurred.

•

Suicide, attempted suicide or any intentionally self-inflicted injury, while sane or insane.

•

War or any act of war, whether declared or undeclared, other than acts of terrorism.

•

Loss that occurs while on full-time active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.

•

Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor.

•

Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.

•

Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded.

•

Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar activities.

•

Practicing for, or participating in, any semiprofessional or professional competitive athletic contests for which any type of compensation or remuneration is received.

•

Any sickness or declining process caused by a sickness.

*See the certificate of insurance and riders for a complete list of available benefits, along with applicable provisions, exclusions and limitations.

Exclusions and limitations in the Catastrophic Accident Benefit are the same as in the Certificate, plus : •

The catastrophic accident benefit is not payable if the covered person is in a coma at the end of the catastrophic accident elimination period.

•

The catastrophic accident benefit reduces to 50% at age 65 and to 25% of the initial benefit amount at age 70.

Who do I contact with questions?

For more information, please call the Voya Employee Benefits Customer Service Team at (800) 955-7736

This is a summary of benefits only. A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the certificate of insurance and riders. All coverage is subject to the terms and conditions of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern. To keep coverage in force, premiums are payable up to the date of coverage termination. Accident Insurance is underwritten by ReliaStar Life Insurance Company, a member of the Voya® family of companies. Policy Form #RL-ACC2-POL-12; Certificate Form #RL -ACC2-CERT-12; and Rider Forms: Spouse Accident Rider Form #RL-ACC2-SPR-12, Children's Accident Rider Form #RL-ACC2-CHR-12, Wellness Benefit Rider Form #RL-ACC2-WELL-12, Accidental Death & Dismemberment (AD&D) Rider Form #RL-ACC2-ADR-12, Catastrophic Accident Rider Form #RL-ACC2-CAR-12, Off Job Accident Disability Income Rider form #RL-ACC2-DIR-12 and Sickness Hospital Confinement Rider Form #RL-ACC2-HCR-12. Form numbers, provisions and availability may vary by state.

Linebarger Goggan Blair and Sampson, LLP, Group #694819 Account #0001 ReliaStar Life Insurance Company, a member of the Voya® family of companies.

27

VOYA

Critical Illness

YOUR BENEFITS PACKAGE

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

$16,500 Is the aggregate cost of a hospital stay for a heart attack.

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

Critical Illness Benefits at a Glance

Who is eligible for Critical Illness Insurance?

An affordable way to help protect against the financial stress of a serious illness.

For the employees of: Linebarger Goggan Blair & Sampson, LLP

*The use of “spouse” in this document means a person insured as a spouse as described in the certificate of insurance or rider. Please contact your employer for more information.

What is Critical Illness Insurance?

Critical Illness Insurance pays a lump-sum benefit if you are diagnosed with a covered illness or condition. Critical Illness Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act. Features of Critical Illness Insurance include: • Guaranteed Issue: No medical questions or tests required for coverage.

• Flexible: You can use the benefit money for any purpose you like.

• Payroll deductions: Premiums are paid through convenient payroll deductions.

• Portable: Should you leave your current employer or retire, you can take your coverage with you.

For what critical illnesses and conditions are benefits available?

Critical Illness Insurance provides a benefit for the following illnesses and conditions. Covered illnesses/conditions are broken out into groups called “modules”. Benefits are paid at 100% of the Maximum Critical Illness Benefit amount unless otherwise stated. For a complete description of your benefits, along with applicable provisions, conditions on benefit determination, exclusions and limitations, see your certificate of insurance and any riders.

Base Module • • • •

Heart attack Major organ failure Stroke Permanent paralysis

• • •

Coronary artery bypass (25%) End stage renal (kidney) failure Coma

Cancer Module • •

Cancer Skin cancer (10%)

•

Carcinoma in situ (25%)

How can Critical Illness Insurance help?

Below are a few examples of how your Critical Illness Insurance benefit could be used (coverage amounts may vary): • Medical expenses, such as deductibles and copays • Child care • Home healthcare costs • Mortgage payment/rent and home maintenance

•

You—all active employees working 20+ hours per week**.

What Maximum Critical Illness Benefit am I eligible for?

•

For you  You have the opportunity to purchase a Maximum Critical Illness Benefit of $5,000 to $30,000 in $5,000 increments.

How many times can I receive the Maximum Critical Illness Benefit?

Usually you are only able to receive the Maximum Critical Illness Benefit for one covered illness or disease within each module. Your plan includes the Restoration Benefit*, which provides a one-time restoration of 100% of the maximum benefit amount in order to pay an additional benefit if you experience a second covered illness for a different condition.

Your plan also includes the Recurrence Benefit*, which allows you to receive a benefit for the same condition a second time.

It’s important to note that in order for the second covered illness or the second occurrence of the illness to be covered, it must occur after 6 consecutive months without the occurrence of any covered critical illness named in your certificate, including the illness from the first benefit payment.

If a partial benefit is paid out, it will not reduce the available maximum benefit amount for the illnesses or diseases in that same module. If you have reached the benefit limit by receiving the maximum benefit in each module, you may choose to end your coverage; however, if you have coverage for your spouse and/or child(ren), you must continue your coverage in order to keep their coverage active. Please see the certificate of coverage for details. *This benefit does not apply to the cancer module.

What does my Critical Illness Insurance include?

The benefits listed below are included with your critical illness coverage. There may be some variation by state. For a list of standard exclusions and limitations, please refer to the end of this document. For a complete description of your available benefits, along with applicable provisions, exclusions and limitations, see your certificate of insurance and any riders.

Spouse* Critical Illness Insurance: If you have coverage for yourself, you may enroll your spouse, as long as your spouse is under age 70 and is not covered under the Policy as an employee.

29

Critical Illness • • •

Your spouse will receive coverage for the same covered conditions as you.

Your spouse will be able to receive a benefit the same number of times as you, as outlined above.

Guaranteed issue: No medical questions or tests required for coverage.

*The use of “spouse” in this form means a person insured as a spouse as described in the certificate of insurance or benefit Please contact your employer for more information.

Children’s Critical Illness Insurance: As long as you have critical illness coverage on yourself, your natural child(ren), stepchild(ren), adopted child(ren) or child(ren) for whom you are a legal guardian are eligible to be covered under your employer’s plan, up to the age of 26.

• Your children are covered for the same covered conditions as you are however, actual benefit amounts may vary.

• Your child(ren) will be able to receive a benefit the same number of times as you, as outlined above.

• One premium amount covers all of your eligible children.

• Guaranteed issue: No medical questions or tests required for coverage.

• In addition, there are benefits if your child(ren) is/are diagnosed after the benefit’s effective date with: Down syndrome, cerebral palsy, cystic fibrosis and congenital birth defects.

• If both you and your spouse are covered under the policy as an employee, then only one, but not both, may cover the same child(ren) under this benefit. If the parent who is covering the child(ren) stops being insured as an employee then the other parent may apply for children’s coverage.

Wellness Benefit: This provides an annual benefit payment if you complete a health screening test. You may only receive a benefit once per year, even if you complete multiple health screening tests.

• Examples of health screening tests include but are not limited to: Pap test, serum cholesterol test for HDL and LDL levels, mammography, colonoscopy, and stress test on bicycle or treadmill.

• The annual benefit is $50 for completing a health screening test.

• If your spouse and children are covered for Critical Illness Insurance, they are also covered by the Wellness Benefit. Your spouse’s benefit amount is also $50. The benefit for child coverage is 50% of your coverage with an annual maximum of $100 for children’s benefits.

30

How much does Critical Illness Insurance cost?

Employee Coverage Monthly Rates Includes Wellness Benefit Rider Issue Age Under 30 30-39 40-49 50-59 60-64 65-69 70+

$5,000 $2.25 $3.30 $6.35 $11.05 $15.45 $20.05 $29.25

Issue Age Under 30 30-39 40-49 50-59 60-64 65-69 70+

$5,000 $3.00 $5.00 $9.95 $17.90 $25.85 $30.60 $44.50

NON- TOBACCO USER $10,000 $15,000 $20,000 $4.50 $6.75 $9.00 $6.60 $9.90 $13.20 $12.70 $19.05 $25.40 $22.10 $33.15 $44.20 $30.90 $46.35 $61.80 $40.10 $60.15 $80.20 $58.50 $87.75 $117.00 TOBACCO USER $10,000 $15,000 $20,000 $6.00 $9.00 $12.00 $10.00 $15.00 $20.00 $19.90 $29.85 $39.80 $35.80 $53.70 $71.60 $51.70 $77.55 $103.40 $61.20 $91.80 $122.40 $89.00 $133.50 $178.00

$25,000 $11.25 $16.50 $31.75 $55.25 $77.25 $100.25 $146.25

$30,000 $13.50 $19.80 $38.10 $66.30 $92.70 $120.30 $175.50

$25,000 $15.00 $25.00 $49.75 $89.50 $129.25 $153.00 $222.50

$30,000 $18.00 $30.00 $59.70 $107.40 $155.10 $183.60 $267.00

Spouse Coverage* Monthly Rates Includes Wellness Benefit Rider NON-TOBACCO USER $5,000 $10,000 $15,000 $2.70 $5.40 $8.10 $3.80 $7.60 $11.40 $7.50 $15.00 $22.50 $13.45 $26.90 $40.35 $18.72 $37.43 $56.15 $25.40 $50.80 $76.20 TOBACCO USER Issue Age $5,000 $10,000 $15,000 Under 30 $3.65 $7.30 $10.95 30-39 $5.65 $11.30 $16.95 40-49 $11.70 $23.40 $35.10 50-59 $21.80 $43.60 $65.40 60-64 $31.40 $62.80 $94.20 65-69 $39.20 $78.40 $117.60 Children Coverage Monthly Rates Includes Wellness Benefit Rider Coverage Amount Rate $0.87 $1,000 $2.18 $2,500 $4.35 $5,000 $8.70 $10,000 Issue Age Under 30 30-39 40-49 50-59 60-64 65-69

Critical Illness Benefits reduce 50% for the employee and/or covered spouse on the policy anniversary following the 70th birthday, however, premiums do not reduce as a result of this benefit change.

Exclusions and Limitations Benefits are not payable for any critical illness caused in whole or directly by any of the following*: • • • • •

Participation or attempt to participate in a felony or illegal activity.

Suicide, attempted suicide or any intentionally self-inflicted injury, while sane or insane.

War or any act of war, whether declared or undeclared, other than acts of terrorism.

Loss that occurs while on full-time active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.

Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor.

Who do I contact with questions?

For more information, please call the Voya Employee Benefits Customer Service Team at (800) 955-7736

This is a summary of benefits only. A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the certificate of insurance and riders. All coverage is subject to the terms and conditions of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern. To keep coverage in force, premiums are payable up to the date of coverage termination. Critical Illness Insurance is underwritten by ReliaStar Life Insurance Company, a member of the Voya® family of companies. Policy Form #RL-CI3-POL-12; Certificate Form #RLCI3-CERT12; and Rider Forms: Spouse Critical Illness Rider Form #RL-CI3-SPR-12, Children's Critical Illness Rider Form #RL- CI3-CHR-12, Wellness Benefit Rider Form #RL- CI3-WELL-12, Restoration of Benefits Rider Form #RL- CI3-RES-12 and Recurrence Rider Form #RL- CI3-REC-12 Form numbers, provisions and availability may vary by state.

CN0208-21887-0217 Linebarger Googan Blair and Sampson, LLP, Group #694819 Account #0001 Date Prepared: April 12, 2021 172508-02/22/2016 ReliaStar Life Insurance Company, a member of the Voya® family of companies.

31

5STAR

Individual Life

About this Benefit Group termlife lifeis isa policy the most to Individual thatinexpensive provides a way specified purchase life insurance.

You have at thethe freedom death benefit to your beneficiary time ofto select amount of lifeofinsurance death.an The advantage having ancoverage individualyou lifeneed to help protect theopposed well-being your family. insurance plan as to aofgroup supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.

YOUR BENEFITS PACKAGE

Experts recommend at least

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

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

Term Life with Terminal Illness and Quality of Life Rider Family Protection Plan with Terminal Illness Term Life Insurance to age 100 Prepare for the future. Protect your loved ones.

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

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

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

Nearly

85%

of people said they thought most people need life insurance.

Yet only

59%

said that they have coverage themselves.

And

33%

wish their spouse or partner had more life insurance.*

FAMILY PROTECTION You can get coverage for your spouse and financially dependent children 14 days through 23 years old, even if you don’t elect coverage on yourself. No matter what the future brings, you and your family are protected.

CONVENIENT Easy payment through payroll deduction.

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

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

Underwritten by 5Star Life Insurance Company (a Lincoln, Nebraska company); Administered

by NTT Data at 777 Research Drive, Lincoln, NE 68521 FPPi product available in all states and some U.S. Territories except: CA, DE, FL, NY, ND. SD. Quality of Life rider not available in CA. FPPg product available in all states and some U.S. Territories except: CA, DE, FL, NY, ND. SD, VI FPPi/gQOLFlyerR1119 FPPduoQOL_MKT_FLYER_1119

33

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

18-25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46

$10,000 $9.90 $9.91 $9.98 $10.08 $10.23 $10.43 $10.64 $10.87 $11.11 $11.40 $11.72 $12.08 $12.46 $12.88 $13.33 $13.83 $14.38 $14.98 $15.60 $16.26 $16.93 $17.67

$20,000 $13.28 $13.34 $13.46 $13.66 $13.95 $14.35 $14.76 $15.23 $15.72 $16.30 $16.93 $17.65 $18.44 $19.25 $20.17 $21.15 $22.25 $23.46 $24.70 $26.02 $27.37 $28.83

$30,000 $16.68 $16.75 $16.96 $17.26 $17.68 $18.28 $18.90 $19.61 $20.33 $21.20 $22.16 $23.23 $24.40 $25.63 $27.00 $28.48 $30.13 $31.96 $33.81 $35.78 $37.80 $40.00

Employee Coverage Amounts $40,000 $50,000 $75,000 $20.07 $23.46 $31.94 $20.16 $23.59 $32.13 $20.44 $23.92 $32.62 $20.84 $24.42 $33.37 $21.40 $25.13 $34.44 $22.20 $26.12 $35.94 $23.04 $27.16 $37.50 $23.97 $28.34 $39.25 $24.93 $29.55 $41.06 $26.10 $31.00 $43.26 $27.37 $32.59 $45.63 $28.80 $34.37 $48.31 $30.36 $36.34 $51.25 $32.00 $38.38 $54.32 $33.83 $40.67 $57.76 $35.80 $43.13 $61.44 $38.00 $45.87 $65.57 $40.44 $48.92 $70.12 $42.90 $52.00 $74.75 $45.53 $55.30 $79.69 $48.23 $58.67 $84.75 $51.17 $62.33 $90.26

47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64

$18.43 $19.19 $20.02 $20.93 $21.94 $23.11 $24.42 $25.88 $27.44 $29.19 $30.99 $32.84 $34.74 $36.71 $38.77 $40.93 $43.22 $45.72

$30.35 $31.88 $33.55 $35.36 $37.39 $39.74 $42.33 $45.27 $48.37 $51.87 $55.49 $59.19 $62.97 $66.94 $71.05 $75.37 $79.95 $84.93

$42.28 $44.58 $47.08 $49.81 $52.83 $56.35 $60.26 $64.65 $69.31 $74.56 $79.98 $85.53 $91.21 $97.15 $103.33 $109.80 $116.68 $124.16

$54.20 $57.27 $60.60 $64.24 $68.26 $72.96 $78.17 $84.03 $90.23 $97.23 $104.46 $111.86 $119.43 $127.36 $135.60 $144.23 $153.40 $163.37

$66.13 $69.96 $74.13 $78.67 $83.71 $89.59 $96.09 $103.42 $111.17 $119.92 $128.96 $138.21 $147.67 $157.59 $167.88 $178.67 $190.13 $202.59

$95.94 $101.69 $107.94 $114.75 $122.32 $131.13 $140.87 $151.88 $163.50 $176.63 $190.19 $204.06 $218.25 $233.13 $248.57 $264.75 $281.94 $300.62

$125.75 $133.42 $141.75 $150.84 $160.91 $172.66 $185.67 $200.33 $215.83 $233.33 $251.41 $269.91 $288.83 $308.66 $329.25 $350.83 $373.75 $398.67

$155.56 $165.15 $175.57 $186.92 $199.52 $214.21 $230.46 $248.80 $268.17 $290.04 $312.64 $335.77 $359.42 $384.21 $409.94 $436.92 $465.56 $496.71

$185.38 $196.88 $209.38 $223.01 $238.13 $255.75 $275.26 $297.25 $320.51 $346.76 $373.88 $401.63 $430.01 $459.75 $490.63 $523.00 $557.38 $594.76

65

$48.50

$90.50

$132.51

$174.50

$216.50

$321.50

$426.50

$531.50

$636.51

Age on Eff. Date

34

$100,000 $40.42 $40.66 $41.34 $42.34 $43.75 $45.75 $47.84 $50.17 $52.58 $55.50 $58.67 $62.25 $66.16 $70.25 $74.83 $79.75 $85.25 $91.34 $97.50 $104.08 $110.83 $118.17

$125,000 $48.89 $49.21 $50.04 $51.29 $53.07 $55.56 $58.16 $61.09 $64.11 $67.75 $71.71 $76.18 $81.09 $86.19 $91.92 $98.06 $104.94 $112.54 $120.25 $128.48 $136.92 $146.09

$150,000 $57.38 $57.75 $58.76 $60.26 $62.38 $65.38 $68.50 $72.01 $75.63 $80.00 $84.76 $90.13 $96.00 $102.13 $109.00 $116.38 $124.63 $133.76 $143.01 $152.88 $163.00 $174.00

Family Protection Plan - Terminal Illness MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT Age on Eff. Date 66* 67* 68* 69* 70*

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

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

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

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

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

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

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

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

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

FPPiDBQOLMonthlyRates

9/18 35

WWW.MYBENEFITSHUB.COM/LGBS 36