2024-25 Cleveland ISD Benefit Guide

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Benefit Contact Information

Higginbotham Public Sector (866) 914-5202 www.mybenefitshub.com/clevelandisd

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

Cigna (800) 754-3207 www.cigna.com

Gulf Coast Educators Federal Credit Union (281) 487-9333 www.gcefcu.org

VSP - Vision Service Plan (800) 877-7195 www.vsp.com

CANCER

CHUBB (888) 499-0425 www.chubb.com

5Star (866) 863-9753 www.5starinsurance.com

Higginbotham (866) 419-3519

https://flexservices.higginbotham.net/ Flexclaims@higginbotham.net

Recuro Health (855) 673-2876

www.recurohealth.com

New York Life (800) 225-5695 www.newyorklife.com

Cigna (800) 244-6424 www.cigna.com

Experian (855) 797-0052 www.experian.com

Legal Shield (800) 654-7757 www.legalshield.com

Lincoln Financial Group (800) 423-2765

www.lincolnfinancial.com

CHUBB (888) 499-0425 www.chubb.com

Lincoln Financial Group (800) 423-2765 www.lincolnfinancial.com

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

1 www.mybenefitshub.com/clevelandisd

2

3

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Enter your Information

• Last Name

• Date of Birth

• Last Four (4) of Social Security Number

NOTE: THEbenefitsHUB uses this information to check behind the scenes to confirm your employment status. CLICK LOGIN

Once confirmed, the Additional Security Verification page will list the contact options from your profile. Select either Text, Email, Call, or Ask Admin options to receive a code to complete the final verification step.

5

Enter the code that you receive and click Verify. You can now complete your benefits enrollment!

Annual Benefit Enrollment

Annual Enrollment

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

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

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

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

New Hire Enrollment

All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

Q&A

Who do I contact with Questions?

For supplemental benefit questions, you can contact your Benefit Office or you can call Higginbotham Public Sector at 866-914-5202 for assistance.

Where can I find forms?

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

How can I find a Network Provider?

For benefit summaries and claim forms, go to the Cleveland ISD benefit website: www.mybenefitshub.com/clevelandisd

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 log in 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.

What is Guaranteed Coverage?

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

What is a Pre-Existing Conditions?

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

Don’t Forget!

• Login and complete your benefit enrollment from 07/08/2024 - 08/11/2024

• Enrollment assistance is available by calling Higginbotham Public Sector at (866) 914-5202.

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

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

Annual Benefit Enrollment

Section 125 Cafeteria Plan Guidelines

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

CHANGES IN STATUS

(CIS):

Marital Status

Change in Number of Tax Dependents

Change in Status of Employment Affecting Coverage Eligibility

Gain/Loss of Dependents’ Eligibility Status

Judgment/ Decree/Order

Eligibility for Government Programs

Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit 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 adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.

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

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

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

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

Annual Benefit Enrollment

Employee Eligibility Requirements

Medical and Supplemental Benefits: Eligible employees must work 30 or more regularly scheduled hours each work week.

Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2024 benefits become effective on September 1, 2024, you must be actively-at-work on September 1, 2024 to be eligible for your new benefits.

Dependent Eligibility Requirements

Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.

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

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

Life To age 26

Services To age 26

& ID

To age 18

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 Higginbotham Public Sector from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee’s enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.

If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your Benefit Office to request a continuation of coverage.

Description

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

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.

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

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

Employer Eligibility A qualified high deductible health plan All employers

Contribution Source Employee and/or employer

Account Owner Individual

Underlying Insurance Requirement High deductible health plan

Minimum Deductible

Maximum Contribution

Permissible Use Of Funds

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

Year-to-year rollover of account balance?

$1,600 single (2024)

Employee and/or employer

Employer

None

$3,200 family (2024) N/A

$4,150 single (2024)

$8,300 family (2024) 55+ catch up +$1,000

Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.

$3,200 (2024)

Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).

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

Yes, will roll over to use for subsequent year’s health coverage.

If you have a balance of $500 by 8/31 it will be rolled over to the next plan year. Funds remaining above $500 threshold are forfeited. Does not apply to your Dependent Care FSA.

Does the account earn interest? Yes No

Portable?

Yes, portable year-to-year and between jobs. No

Medical Insurance

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.mybenefitshub.com/clevelandisd

Go ahead and sign up for the Houston rodeo – 90% of Texas emergency rooms are covered with

Learn the Terms.

• Premium: The monthly amount you pay for health care coverage.

• Deductible: The annual amount for medical expenses you’re responsible to pay before your plan begins to pay.

• Copay: The set amount you pay for a covered service at the time you receive it. The amount can vary based on the service.

• Coinsurance: The portion you’re required to pay for services after you meet your deductible. It’s often a specified percentage of the costs; e.g., you pay 20% while the health care plan pays 80%.

• Out-of-Pocket Maximum: The maximum amount you pay each year for medical costs. After reaching the out-of-pocket maximum, the plan pays 100% of allowable charges for covered services.

Compare Prices for Common Medical Services

Basic Life and AD&D

Lincoln Financial Group

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.mybenefitshub.com/clevelandisd

At a glance:

• A cash benefit of $10,000 to your loved ones in the event of your death, plus an additional cash benefit if you die in an accident.

• AD&D Plus: If you suffer an AD&D-covered loss in an accident, you may also receive benefits for the following in addition to your core AD&D benefits. Additional conditions are outlined in your policy.

• Includes LifeKeys® services, which provide access to counseling, financial, and legal support services.

• TravelConnect® services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home.

You also have the option to increase your cash benefit by securing additional coverage at affordable group rates. See the vountary life insurance section for highlights.

Additional details

Continuation of coverage for ceasing active work: You may be able to continue your coverage if you leave your job for reasons including and not limited to Family and Medical Leave, lay-off, leave of absence, leave of absence due to disability.

Waiver of premium: This provision relieves you from paying premiums during a period of disability that has lasted for a specified length of time.

Accelerated death benefit: Enables you to receive a portion of your policy death benefit while you are living. To qualify, a medical professional must diagnose you with a terminal illness with a life expectancy of fewer than 12 months.

Conversion: You may be able to convert your group term life coverage to an individual life insurance policy if your coverage decreases or you lose coverage due to leaving your job or for other reasons outlined in the plan contract.

Benefit reduction: Your employee Life/AD&D coverage amount will reduce by 50% when you reach age 70. Benefits end when you retire.

Hospital Indemnity Cigna

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.mybenefitshub.com/clevelandisd

SUMMARY OF BENEFITS

Hospital Indemnity coverage provides a benefit according to the schedule below when a Covered Person incurs a hospital stay resulting from a Covered Injury or Covered Illness.

Available Coverage:

The benefit amounts shown in this summary will be paid regardless of the actual expenses incurred and are paid on a per day basis unless otherwise specified. Benefits are only payable when all policy terms and conditions are met. Please read all the information in this summary to understand the terms, conditions, state variations, exclusions, and limitations applicable to these benefits. See your Certificate of Insurance for more information.

Benefit Waiting Period:* None, unless otherwise stated. No benefits will be paid for a loss which occurs during the Benefit Waiting Period.

NOTE: This insurance is NOT a substitute for comprehensive or major medical insurance coverage.

Elimination Period. Limited to 1 day, 1 benefit(s) every 180 days.

No Elimination Period. Limited to 1 day, 1 benefit(s) every 180 days.

Hospital Stay

No Elimination Period. Limited to 30 days. 1 benefit(s) every 180 days

Hospital Intensive Care Unit (ICU) Stay

No Elimination Period. Limited to 30 days. 1 benefit(s) every 180 days

Hospital Observation Stay

24 hour Elimination Period. Limited to 72 hours.

Newborn Nursery Care Admission

Limited to 1 day, 1 benefit per newborn child. This benefit is payable to the employee even if child coverage is not elected.

Wellness Treatment, Health Screening Test and Preventative Care Incentive Benefit* Also includes COVID-19 Immunization, Tests, and Screenings. Virtual Care accepted. $50, limited to 1 per year. $50, limited to 1 per year.

Portability Feature:* You, your spouse, and child(ren) can continue 100% of your coverage at the time your coverage ends. You must be covered under the policy and be under the age of 100 in order to continue your coverage. Rates may change and all coverage ends at age 100. Applies to United States citizens and Permanent Resident Aliens residing in the United States.

Health Savings Account (HSA)

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.mybenefitshub.com/clevelandisd

HOW YOUR HSA WORKS

Every pay period, you will have a small portion of your check deposited to your HSA pre-tax for qualified medical expenses. The maximum contribution limit to your HSA for 2024 is $4,150 for an individual and $8,300 for a family. The money that is contributed to your HSA continually rolls over every year and any dividends earned are also tax free. You can find more information regarding qualified medical contributions and FAQ by visiting the lRS's website and read Publication 969 and Publication 502.

HSA VISA DEBIT CARD

Once your HSA has been opened, you are eligible to receive a debit card to use your funds for qualified medical expenses. lf you did not place your debit card order when your account was initially opened, you may call us at 281487-9333 and we will be happy to have one shipped to your address on file.

WHAT STEPS TO TAKE NEXT

Now that you have registered for your HSA, you should also register for online banking. This will allow you to keep track of your balance and expenses. To register for online banking, you may visit our website at www.gcefcu.org and select “First Time Users Click Here” under “Online Banking Login”. To complete your registration, follow the prompts to create a username, security questions, and password. lf you experience any difficulty, please feel free to contact us at 281-487-9333.

QUESTIONS?

We are happy to help with any questions you may have regarding your new Health Savings Account. Feel free to give us a call at 281.487.9333 or visit us online at www. gcefcu.org.

FREQUENTLY ASKED QUESTIONS

Where can I use my HSA debit card?

Gulf Coast Educators is the trustee of your HSA, which means that we are not responsible for blocking charges that are not qualified medical expenses. lt is very important to view the lRS’s Publication 969 if you have questions of what may or may not qualify.

What happens when I make a purchase with my HSA card that is not a qualified medical expense?

HSA distributions not used for qualified medical expenses are subject to ordinary income tax and, if taken before age 65, a 20 percent lRS penalty tax (unless the distribution is because of death or disability).

Be sure to consult with a competent tax advisor regarding your HSA deductions and how to claim tax-free HSA distributions.

How can I check my HSA balance?

You can check your balance by logging in to your online banking or by calling us at 281-487-9333.

How much can I contribute?

You can make pretax contributions (or tax-deductible contributions, if you’re on your own) in 2024 of up to $4,150 a year if you have individual coverage, or up to $8,300 if you have family coverage.

Dental Insurance 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.mybenefitshub.com/clevelandisd

• Deductibles are combined for basic and major In-Network services.

• Deductibles are combined for basic and major Out-ofNetwork services.

Routine oral exams, Bitewing X-rays, Full-mouth or panoramic X-rays, Other dental X-rays (including periapical films), Routine cleanings, Fluoride treatments, Sealants

Other dental X-rays (including periapical films), Space maintainers for children, Problem-focused exams, Consultations, Palliative treatment (including emergency relief of dental pain)

Prefabricated stainless steel and resin crowns, Prosthetic repair and recementation services, Endodontics (including root canal treatment), Periodontal maintenance procedures

Dental Insurance Lincoln Financial Group

• Deductibles are combined for basic and major In-Network services.

• Deductibles are combined for basic and major Out-ofNetwork services.

Vision Insurance

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.mybenefitshub.com/clevelandisd

Your VSP Vision Benefits Summary CLEVELAND ISD and VSP provide you with an affordable vision plan.

PROVIDER NETWORK:VSP Advantage

EFFECTIVE DATE: 09/01/2024

Focuses on your eyes and overall wellness

• Retinal screening for members with diabetes

FRAME+

EYE CARE

LENS ENHANCEMENTS

CONTACTS (INSTEAD OF GLASSES)

LIGHTCARETM+

EXTRA SAVINGS

• Additional exams and services beyond routine care to treat immediate issues from pink eye to sudden changes in vision or to monitor ongoing conditions such as dry eye, diabetic eye disease, glaucoma, and more.

• Coordination with your medical coverage may apply. Ask your VSP doctor for details.

• $170 featured frame brands allowance

• $150 frame allowance

• 20% savings on the amount over your allowance

• $150 Walmart®/Sam’s Club® and $80 Costco® frame allowance

• Single vision, lined bifocal, and lined trifocal lenses

• Impact-resistant lenses for dependent children Included in Prescription Glasses Every 12 months

• Standard progressive lenses

• Premium progressive lenses

• Custom progressive lenses

• Average savings of 20-25% on other lens enhancements

• $130 allowance for contacts; copay does not apply

• Contact lens exam (fitting and evaluation)

Every 12 months

• $150 allowance for ready-made non-prescription sunglasses, or ready-made nonprescription blue light filtering glasses, instead of prescription glasses or contacts $10 Every 12 months

• Routine Retinal Screening: No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam

• Laser Vision Correction: Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities

YOUR COVERAGE GOES FURTHER IN-NETWORK - With so many in-network choices, VSP makes it easy to get the most out of your benefits. You’ll have access to preferred private practice, retail, and online in-network choices. Log in to vsp.com to find an in-network provider.

+Coverage with a retail chain may be different or not apply.

Disability Insurance

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.mybenefitshub.com/clevelandisd

Summary of Benefits

Eligibility: All active, Full-Time Employees of the Employer regularly working a minimum of 30 hours per week in the United States, who are citizens or permanent resident aliens of the United States.

Employee: You will be eligible for coverage the first of the month following date of hire.

Available Coverage

14/14, 30/30, 60/60, 90/90 Please refer to the “How Long Benefits Last” section below for more details.

Additional Features

Family Survivor Benefit: If you die while receiving

Monthly Rate by Type of Plan

Disability

New York Life

How to Calculate your Monthly Cost

Step 1: Divide your annual salary by 12 to calculate your monthly earnings.

Step 2: Multiply this amount by the benefit percentage defined above in the Available Coverage section. For example, 45% would be .45, 55% would be .55, and 65% would be .65. Now, you have your Gross Monthly Benefit.

Step 3: Use the chart above to find your Monthly rate. Multiply this rate by your Gross Monthly Benefit, or the Maximum Gross Monthly Benefit of $8,000, whichever is less.

Step 4: Divide the total by 100. The result is your Monthly cost.

Maximum Benefit Period Schedule

or the date the

To age 65 or the date the 42nd monthly benefit is payable, if later.

When Benefits Begin - You must be continuously Disabled for your elected benefit waiting period before benefits will be payable for a covered Disability.

How Long Benefits Last - Once you qualify for benefits under this plan, you continue to receive them until the end of the benefit or until you no longer qualify for benefits, whichever occurs first. Should you remain Disabled, your benefits continue according to one of the following schedules, depending on your age at the time you become Disabled and the plan you select.

Critical Illness Insurance CHUBB

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.mybenefitshub.com/clevelandisd

is no pre-existing conditions limitation.

Riders are included in all the rates listed below: Waiver of Premium

Critical Illness Insurance CHUBB

Cancer Insurance

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.mybenefitshub.com/clevelandisd

Cash benefits when you need them most — Cancer Insurance from Chubb

First Cancer Benefit

Diagnosis of cancer

Hospital confinement

Hospital confinement ICU

Radiation

chemotherapy, immunotherapy

Alternative care

Medical imaging

Skin cancer initial diagnosis

$100 paid upon receipt of first covered claim for cancer; only one payment per covered person per certificate per calendar year

Employee or spouse: $5,000

Child(ren): $7,500

Waiting period: 0 days

Benefit reduction: none

$300 per day – days 1 through 30

Additional days: $600

Maximum days per confinement: 31

$600 per day – days 1 through 30

Additional days: $600

Maximum days per confinement: 31

$100 paid upon receipt of first covered claim for cancer; only one payment per covered person per certificate per calendar year

Employee or spouse: $10,000

Child(ren): $15,000

Waiting period: 0 days

Benefit reduction: none

$300 per day – days 1 through 30

Additional days: $600

Maximum days per confinement: 31

$600 per day – days 1 through 30

Additional days: $600

Maximum days per confinement: 31

$75 per visit

Maximum visits per calendar year: 4

$500 per imaging study

Maximum studies per calendar year: 2

$100 per diagnosis

Lifetime maximum: 1

$75 per visit

Maximum visits per calendar year: 4

$500 per imaging study

Maximum studies per calendar year: 2

$100 per diagnosis

Lifetime maximum: 1

Cancer Insurance CHUBB

Renewability

Portability

Conditionally Renewable Coverage is automatically renewed as long as the insured is an eligible employee, premiums are paid as due, and the Policy is in force.

Portability Employees can keep their coverage if they change jobs or retire while the Policy is in-force.

Continuity of coverage Included

Pre-existing conditions limitation

A condition for which a covered person received medical advice or treatment within the 12 months preceding the certificate effective date.

Waiver of premium Included

Definitions and provisions

If the certificate replaced another cancer indemnity certificate or individual policy, your coverage under the certificate shall not limit or exclude coverage for a pre- existing condition or waiting period that would have been covered under the policy being replaced.

Continuity of coverage

Definition of cancer

Definition of cancer

Benefits payable for a pre-existing condition or during the waiting period will be the lesser of the benefits that would have been payable under the terms of the prior coverage if it had remained in force; or the benefits payable under the certificate.

Time periods applicable to pre-existing conditions and waiting periods will be waived to the extent that similar limitations or exclusions were satisfied under the coverage being replaced.

Continuity of coverage is only extended to the benefits provided under the certificate. The certificate may not include all the benefits provided under the prior coverage.

Cancer means carcinoma in situ, leukemia, or a malignant tumor characterized by uncontrolled cell growth and invasion or spread of malignant cells to distant tissue. Cancer is also defined as cancer which meets the diagnosis criteria of malignancy established by the American Board of Pathology after a study of the histocytologic architecture or pattern of the suspect tumor, tissue, or specimen. Carcinoma in situ means a malignant tumor which is typically classified as Stage 0 cancer, where the tumor cells still lie within the tissue of the site of origin without having invaded neighboring tissue.

The following are not considered cancer: Pre-malignant conditions or conditions with malignant potential; non-invasive basal cell carcinoma of the skin; non-invasive squamous cell carcinoma of the skin; or melanoma diagnosed as Clark’s Level I or II or Breslow less than .75mm.

Plan descriptions Refer to the Certificate of Coverage for details specific to each plan.

Exclusions

and limitations

No benefits will be paid for a date of diagnosis or treatment of cancer prior to the coverage effective date, except where continuity of coverage applies.

No benefits will be paid for services rendered by a member of the immediate family of a covered person.

We will not pay benefits for other conditions or diseases, except losses due directly from cancer or skin cancer.

We will not pay benefits for cancer or skin cancer if the diagnosis or treatment of cancer is received outside of the territorial limits of the United States and its possessions. Benefits will be payable if the covered person returns to the territorial limits of the United States and its possessions, and a physician confirms the diagnosis or receives treatment.

Accident Insurance Cigna

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.mybenefitshub.com/clevelandisd

SUMMARY OF BENEFITS

Accidental Injury coverage provides a fixed cash benefit according to the schedule below when a Covered Person suffers certain Injuries or undergoes a broad range of medical treatments or care resulting from a Covered Accident. See State Variations (marked by *) below.

Who Can Elect Coverage:

Eligibility for You, Your Spouse and Your Children will be considered by Your employer. You: All active, Full-time Employees of the Employer who are regularly working in the United States a minimum of 30 hours per week and regularly residing in the United States and who are United States citizens or permanent resident aliens or non-United States citizens legally working and living in the United States (Inpats) and their Spouse and Dependent Children who are United States citizens or permanent resident aliens or Spouse or Dependent Child Inpats and who are legally residing in the United States. You will be eligible for coverage the first of the month following date of hire. Your Spouse*: Up to age 100, as long as you apply for and are approved for coverage yourself. Your Child(ren): Birth to age 26; 26+ if disabled, as long as you apply for and are approved for coverage yourself.

Available Coverage: This Accidental Injury plan provides 24-hour coverage. The benefit amounts shown in this summary will be paid regardless of the actual expenses incurred and are paid on a per-day basis unless otherwise specified. Benefits are only payable when all policy terms and conditions are met. Please read all the information in this summary to understand terms, conditions, state variations, exclusions and limitations applicable to these benefits. See your Certificate of Insurance for more information.

Accident Insurance Cigna

Chip Fracture (percent of fracture benefit)

Per covered surgically-repaired dislocation

Per covered non-surgically-repaired dislocation

Follow-Up Care

Follow-up Physician (or medical professional) Office Visit

Follow-up Physical Therapy Visit

Enhanced Accident Benefits Examples

Small Lacerations (Less than or equal to 6 inches long and requires 2 or more sutures)

Large Lacerations (more than 6 inches long and requires 2 or more sutures)

Concussion

Coma (lasting 7 days with no response)

Additional Accidental Injury benefits included - See certificate for details, including limitations & exclusions. Virtual Care accepted for Initial Physician Office Visit and Follow-Up Care.

Accidental Death and Dismemberment Benefit

1

Examples of benefits include (but are not limited to) payment for death from Automobile accident; total and permanent loss of speech or hearing in both ears. Actual benefit amount paid depends on the type of Covered Loss. The Spouse and Child benefit is 100% and 50% respective of the benefit shown. Loss of Life: $50,000$100,000 Dismemberment: $2,000 - $30,000 Loss of Life: $75,000$100,000 Dismemberment: $3,000 - $40,000

Wellness Treatment, Health Screening Test & Preventive Care Benefit*

Wellness Treatment, Health Screening Test and Preventive Care Benefit:* Benefit paid for all covered persons is 100% of the benefit shown. Also includes COVID-19 Immunization, Tests, and Screenings. Virtual Care accepted.

Sports Accident Benefit

Organized and Personal Sports Activity Limited to 10 per year

Portability Feature: You, your spouse, and child(ren) can continue 100% of your coverage at the time your coverage ends. You must be under the age of 100 in order to continue your coverage. Rates may change and all coverage ends at age 100. Only available to United States Citizens, Permanent Resident Aliens and non-United States Citizens working in the United States lawfully (Inpats) while residing in the United States.

Important Definitions and Policy Provisions:

Coverage Type: Benefits are paid when a Covered Injury results, directly and independently of all other causes, from a Covered Accident.

Covered Accident: A sudden, unforeseeable, external event that results, directly and independently of all other causes, in a Covered Injury or Covered Loss and occurs while the Covered Person is insured under this Policy; is not contributed to by disease, sickness, mental or bodily infirmity; and is not otherwise excluded under the terms of this Policy.

Covered Injury: Any bodily harm that results directly and independently of all other causes from a Covered Accident.

Covered Person: An eligible person who is enrolled for coverage under this Policy.

Covered Loss: A loss that is the result, directly and independently

the

of other causes, from a Covered Accident suffered by the Covered Person within the applicable time period described in the Policy.

Hospital: An institution that is licensed as a hospital pursuant to applicable law; primarily and continuously engaged in providing medical care and treatment to sick and injured persons; managed under the supervision of a staff of medical doctors; provides 24-hour nursing services by or under the supervision of a graduate Registered Nurse (R.N.); and has medical, diagnostic and treatment facilities with major surgical facilities on its premises, or available to it on a prearranged basis, and charges for its services. The term Hospital does not include a clinic, facility, or unit of a Hospital for: rehabilitation, convalescent, custodial, educational, or nursing care; the aged, treatment of drug or alcohol addiction.

When your coverage begins: Coverage begins on the later of the program’s effective date, the date you become eligible, or the first of the month following the date your completed enrollment form is received unless otherwise agreed upon by Cigna. Your coverage will not begin unless you are actively at work on the effective date. Coverage for all Covered Persons will not begin on the effective date if hospital, facility or home confined, disabled or receiving disability benefits or unable to perform activities of daily living.

Voluntary Life and AD&D Lincoln Financial Group

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.mybenefitshub.com/clevelandisd

Lincoln Financial Group

Voluntary AD&D Insurance

Employee AD&D

Coverage options

Maximum coverage amount

Increments of $10,000

This amount may not exceed $500,000

Dependent Spouse AD&D: The amount of dependent AD&D insurance coverage cannot be greater than 100% of the employee benefit.

Coverage options

Maximum coverage amount

Increments of $5,000

This amount may not exceed $500,000

You can secure AD&D insurance for your spouse if you select coverage for yourself.

Dependent Child(ren) AD&D

Coverage options

$10,000

You can secure AD&D insurance for your dependent children if you select coverage for yourself.

* The monthly rate is $.018 per $1,000 or $.18 per $10,000

Family Protection Plan

Group Term Life Insurance to age 121 with Quality of Life

Make a smart choice to help protect your loved ones and your future.

Life doesn’t come with a lesson plan

Help protect your family with the Family Protection Plan Group Level Term Life Insurance to age 121. You can get coverage for your spouse even if you don’t elect coverage on yourself. And you can cover your financially dependent children and grandchildren (14 days to 26 years old). The coverage lasts until age 121 for all insured,* so no matter what the future brings, your family is protected.

Why buy life insurance when you’re young?

Buying life insurance when you’re younger allows you to take advantage of lower premium rates while you’re generally healthy, which allows you to purchase more insurance coverage for the future. This is especially important if you have dependents who rely on your income, or you have debt that would need to be paid off.

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.

Why is portability important?

Life moves fast so having a portable life insurance allows you to keep your coverage if you leave your school district. Keeping the coverage helps you ensure your family is protected even into your retirement years.

44% of American households would encounter significant financial difficulties within six months if they lost the primary family wage earner. 28% would reach this point in one month or less.

Family Protection Plan

Group Term

Terminal illness acceleration of benefits

Coverage 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).

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.

Convenient

Easy payment through payroll deduction.

Quality of Life benefit

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

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

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

How does Quality of Life help?

Many individuals who can’t take care of themselves require special accommodations to perform ADLs and would need to make modifications to continue to live at home with physical limitation. The proceeds from the Quality of Life benefit can be used for any purpose, including costs for infacility care, home healthcare professionals, home modifications, and more.

2024 Enrollment Plan Year

Guaranteed Issue is offered to all eligible applicants regardless of health status. No Doctor exams or physicals.

Employee: $100,000 | Spouse: $30,000 | Child: $10,000

Enroll to provide peace of mind for your family

To do an initial enrollment or if you have questions please call our customer service at 866-914-5202. Monday - Friday | 8:00 am-6:00 pm CST

About the coverage

The Family Protection Plan offers a lump-sum cash benefit if you die before age 121. The initial death benefit is guaranteed to be level for at least the first ten policy years. Afterward, the company intends to provide a nonguaranteed death benefit enhancement which will maintain the initial death benefit level until age 121. The company has the right to discontinue this enhancement. The death benefit enhancement cannot be discontinued on a particular insured due to a change in age, health, or employment status.

Identity Theft + Financial Wellness

Experian

ABOUT Identity Theft

As identity theft and fraud continue to increase, an evolving suite of products helps you monitor any potential threats to your identity and alerts you if there are any areas of concern. You will also have access to a full financial wellness platform and proactive digital privacy tools that can help you keep passwords and other personal information private and secure while surfing the web.

For full plan details, please visit your benefit website:www.mybenefitshub.com/clevelandisd www.mybenefitshub.com/clevelandisd

Experian

Stay prepared with MASA® AccessSM

Comprehensive coverage and care for emergency transport.

Our Emergent Plus membership plan includes:

Emergency Ground Ambulance Coverage1

Your out-of-pocket expenses for your emergency ground transportation to a medical facility are covered with MASA.

Emergency Air Ambulance Coverage1

Your out-of-pocket expenses for your emergency air transportation to a medical facility are covered with MASA.

Hospital to Hospital Ambulance Coverage1

When specialized care is required but not available at the initial emergency facility, your out-of-pocket expenses for the ground or air ambulance transfer to the nearest appropriate medical facility are covered with MASA.

Repatriation Near Home Coverage1

Should you need continued care and your care provider has approved moving you to a hospital nearer to your home, MASA coordinates and covers the expense for ambulance transportation to the approved medical facility.

Did you know?

51.3 million emergency responses occur each year

MASA protects families against uncovered costs for emergency transportation and provides connections with care services.

Source: NEMSIS, National EMS Data Report, 2023

About MASA

MASA is coverage and care you can count on to protect you from the unexpected. With us, there is no “out-of-network” ambulance. Just send us the bill when it arrives and we’ll work to ensure charges are covered. Plus, we’ll be there for you beyond your initial ride, with expert coordination services on call to manage complex transport needs during or after your emergency — such as transferring you and your loved ones home safely.

Protect yourself, your family, and your family’s financial future with MASA.

Legal Services LegalShield

ABOUT LEGAL SERVICES

Legal plans provide benefits that cover the most common legal needs you may encounter - like creating a standard will, living will, healthcare power of attorney or buying a home.

For full plan details, please visit your benefit website: www.mybenefitshub.com/clevelandisd

LegalShield provides coverage for common personal legal needs at every stage of life. The LegalShield plan provides coverage for:

FAMILY

• Bullying Protection

• Post-Nuptial/ Domestic Partnership Agreements

• Gender Identifier Change

• Elder Law Matters

• Civil and Social Discrimination

• Divorce

• Child Custody

• Enforcement and Modification of a Support Order

• Conservatorship

• Domestic Violence Protection

• Guardianship

• Name Change

• Juvenile Court Proceedings

• Adoption

• Paternity

• Immigration Assistance

• Administrative Hearing

• Incompetency Defense

• Juvenile Defense

• Prenuptial Agreements

• Reproductive Assistance

HOME

• Contractor Disputes

• Deeds

• Eviction and Tenant Issues

• Foreclosure

• Neighbor Disputes/ Easements

• Refinancing

• Purchase/Sale of House

• Real Estate Contracts/Financial Disputes

• Small Claims Assistance

• Zoning Applications

• Mortgages

• Boundary Title Disputes

• Home Equity Loans

• Property Tax Assessments

FINANCIAL

• Consumer Credit Services

• Affidavits

• Bankruptcy

• Consumer Protection

• Contracts/Financial Disputes

• Debt Collection

• IRS Audit Protection

• Rental Agreements

• Medicaid/Medicare Disputes

• Habeas Corpus

• Civil Litigation

• Identity Theft

• Promissory Notes

• Small Claims Assistance

• Personal Property Disputes

• Tax Audit Protection

• Veterans Benefit Disputes

ESTATE

PLANNING

• Living Wills/Wills

• Probate

• Living Trusts/Trusts

• Power of Attorney

• Codicils

• Physician’s Directive

AUTO

• Driver’s License Restoration

• Motor Vehicle Property Damage

• Moving Traffic Violations/Traffic Tickets

• Property Damage Claims

GENERAL

• Office Consultation

• Telephone Advice

• Document Review

• Mobile App

• 24/7 Emergency Legal Access

• Demand Letters/ Phone Calls

• 25% Preferred Member Discount

• Legal Forms

Flexible Spending Account (FSA)

Higginbotham

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.

For full plan details, please visit your benefit website: www.mybene itshub.com/sampleisd

www.mybenefitshub.com/clevelandisd

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 $3,200 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 have the option to enroll in both a HSA and FSA, however doing so will make your FSA a "Limited" FSA, which means it will only be available for dental and vision expenses. All medical expenses would need to be processed through your HSA.

Higginbotham Benefits Debit Card

The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB).

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 Depend ent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full-time student.

Things to Consider Regarding the Dependent Care FSA

• 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.

Flexible Spending Accounts

Higginbotham

Important FSA Rules

• The maximum per plan year you can contribute to a Health Care FSA is $3,200. 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.

• In most cases, you can continue to file claims incurred during the plan year for another 90 days after the plan year ends.

• 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 $640 in your Health Care FSA into the next plan year for eligible employers The carry-over rule does not apply to your Dependent Care FSA.

• Review your employer's Summary Plan Document for full details. FSA rules vary by employer.

Over-the-Counter Item Rule Reminder

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.

Higginbotham Portal

The Higginbotham Portal provides information and resources to help you manage your FSAs.

• Access plan documents, letters and notices, forms, account balances, contributions and other plan information

• Update your personal information

• Utilize Section 125 tax calculators

• Look up qualified expenses

• Submit claims

• Request a new or replacement Benefits Debit Card

Register on the Higginbotham Portal

Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information.

• Enter your Employee ID, which is your Social Security number with no dashes or spaces.

• Follow the prompts to navigate the site.

• If you have any questions or concerns, contact Higginbotham:

∗ Phone – 866-419-3519

∗ Questions – flexsupport@higginbotham.net

∗ Fax – 866-419-3516

∗ Claims- flexclaims@higginbotham.net

2024 - 2025 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 Cleveland ISD 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 Cleveland ISD 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.

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