2025-26 CBEBC Benefit Guide

1 Visit www.cbebc.com for full plan details.

Welcome We are pleased to offer a full benefits package to you and your eligible dependents. Read this guide to know what benefits are available to you. You may only enroll for or make changes to your benefits during Open Enrollment or when you have a Qualifying Life Event.

Availability Of Summary Health Information Your plan offers medical coverage options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage (SBC) available by accessing www.cbebc.com.

If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, federal law gives you more choices for your prescription drug coverage. See Important Legal Notices section for details.

Y OUR NE W BE NEF I TS BEGIN A ND EN D

September 1, 2025 – August 31, 2026 2 Visit www.cbebc.com for full plan details.

Contents FLIP TO...

4 Important Contacts

HOW TO ENROLL

5 How to Enroll

5

6 Enrollment FAQ 7 Eligibility 8 Qualifying Life Events 9 Medical Coverage 11 Health Care Options

FREQUENTLY ASKED QUESTIONS

12 Pharmacy

6

13 Health Savings Account 14 Flexible Spending Account 16 HSA and FSA Comparison 17 Qualified HSA and FSA Expenses

MEDICAL

18 Dental Coverage

9

19 Vision Coverage 20 Telemedicine 21 Term Life and AD&D Insurance 23 Individual Life 24 Educator Disability Insurance

26 Disability Insurance 27 Hospital Indemnity Insurance 28 Accident Insurance 29 Critical Illness Insurance 30 Cancer Insurance 31 Emergency Transport Services

32 ID Theft Protection 33 Employee Assistance Program 34 Glossary of Terms 35 Important Legal Notices

3 Visit www.cbebc.com for full plan details.

Important Contacts CBEBC BENEFITS Higginbotham Public Sector (833) 852-1706 www.cbebc.com cbebc@hps.higginbotham.net MEDICAL TRS ACTIVECARE BCBSTX 866-355-5999 www.bcbstx.com/trsactivecare

TRS HMO BCBSTX: Blue Essentials HMO 888-378-1633 www.bcbstx.com/trshmo CURATIVE HEALTH 855-428-7284 www.curative.com/for-members

HEALTH SAVINGS ACCOUNT (HSA) EECU 817-882-0800 https://www.eecu.org

VISION Eyetopia 800-662-8264 www.eyetopia.org

FLEXIBLE SPENDING ACCOUNT (FSA) National Benefit Services 855-399-3035 www.nbsbenefits.com

DENTAL Lincoln Financial Group 800-423-2765 www.lfg.com

EMERGENCY MEDICAL TRANSPORT MASA Group #MCKBEBC 800-438-6388 www.masamts.com

UNITED HEALTHCARE 866-566-8298 www.UHC.com

DISABILITY CHUBB 888-499-0425 www.chubb.com educatorclaims@chubb.com

UNITED HEALTHCARE 866-566-8298 www.UHC.com

Lincoln Financial Group 800-423-2765 www.lfg.com BCBS OF TEXAS: Blue Advantage disabilityclaims@lfg.com and Blue Choice 972-766-6900 IDENTITY THEFT www.bcbstx.com Experian PRESCRIPTION SAVINGS Clever RX 800-873-1195 www.cleverrx.com

TELEHEALTH RECURO Health 855-673-2876 www.recurohealth.com

855-797-0052 www.experian.myfinancialexpert.com/login UNIVERSAL LIFE Texas Republic Life 512-330-0099 www.texasrepubliclife.com

EAP – EMPLOYEE ASSISTANCE PROGRAM CHUBB 844-266-0712 www.guidanceresources.com

4 Visit www.cbebc.com for full plan details.

HOSPITAL IDEMNITY Lincoln Financial Group 800-423-2765 www.lfg.com ACCIDENT CHUBB 888-499-0425 www.chubb.com CANCER CHUBB 888-499-0435 www.chubb.com educatorclaims@chubb.com CRITICAL ILLNESS Lincoln Financial Group 800-423-2765 www.lfg.com VOLUNTARY LIFE AND AD&D CHUBB 888-499-0425 www.chubb.com educatorclaims@chubb.com

All Your Benefits – One App! Employee benefits made easy through HiggOnTheGo! Text BENEFITS to 214-831-4294 to receive the app download link and opt into important text message* enrollment reminders. Scan the QR code to only download HiggOnTheGo. • Benefits resources • Online enrollment

• Interactive tools • And more! * Standard message rates may apply.

How to Enroll LOGIN PROCESS

1

Go to www.cbebc.com.

2

Click Login.

Enter your information: • Last name

3

• Date of birth

• Last four digits of your Social Security number Note: THEbenefitsHUB uses this information to check behind the scenes to confirm your employment status.

4

Once confirmed, the Additional Security Verification page will list the contact options from your profile. Select either the 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 to begin your benefits enrollment.

5 Visit www.cbebc.com for full plan details.

Enrollment FAQ Enrollment FAQs What if I miss the enrollment deadline?

When will I get my ID cards?

If the medical carrier provides ID cards and there is a plan change, new cards usually arrive within four weeks of your effective date. If there are no plan changes, a new card may not be issued.

You may only enroll for or change your benefits during Open Enrollment or if you have a Qualifying Life Event.

Is there an age limit for dependents to be covered under my benefits?

You may not need a card for dental and vision plans.

Simply give your provider the insurance company’s name and phone number to verify benefits. You can also print a temporary card by visiting the insurance company’s website.

You may cover dependents up to age 26 on most benefit plans, but there are exceptions. See the Eligibility section for more details.

Where do I find benefit summaries and forms?

Access www.cbebc.com and click on the benefit plan you need (i.e., Dental). Forms and benefits information are under the Benefits and Form section.

Benefit questions?

How do I find an in-network provider?

Call 833-852-1706

Access www.cbebc.com and click on the benefit plan for the provider you need to find. Click on the Quick Links section to find provider search links.

Email cbebc@hps.higginbotham.net

Important Limitations and Exclusions Information The following limitations and exclusions may apply when obtaining coverage as a married couple or for your dependents.

Can I cover my family — a spouse or a dependent — as dependents on my benefits if we work for the same employer?

Some benefits may not allow you to do this if you work for the same employer. Review the applicable plan documents, contact Higginbotham Public Sector, or contact the insurance carrier for spouse and dependent eligibility.

Are there FSA/HSA limitations for married couples?

Yes, generally. 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 for specific types of FSAs. Contact the FSA and/or HSA provider before you enroll or reach out to your tax advisor for further guidance.

Di s cl a im e r: You a c kn o w l e d g e th a t yo u h a ve r e a d th e l im it at io n s a n d e xc lu si o n s t h at m a y a p p ly to o b ta i n in g sp o u s e a n d d e p e n d e n t co v e r a g e , i nc lu d in g l im it at io n s a n d e xc lu si o n s th a t m a y a p p ly to e n r o ll m e nt in Fle xibl e S p e n d i n g A c co u n ts a n d a He a l th S a vi n g s A c c o u n t a s a m a r r ie d co u p l e .

Yo u, th e e nr o lle e , shal l h o l d h a r ml e ss , de f e n d, a n d i n d em n i fy Hi g g i n b o th a m P u b li c S e cto r , L L C fr o m a n y a n d all cl a i ms, a ct io n s, suits, ch a r g e s , a n d j u d g me n t s wh a ts o ev e r th a t a r is e o u t of yo u r e n r o ll m e nt in sp o u s e a n d /o r d e p e n d e n t co v e r a g e , i n cl u d in g e n r o ll m e nt in a n FS A a n d HS A .

6 Visit www.cbebc.com for full plan details.

Eligibility Who is Eligible for Benefits You are eligible for coverage if you are a regular, full-time employee. You may only enroll for coverage when: • You are a new hire • It is Open Enrollment (OE) • You have a Qualifying Life Event (QLE) See Important Exclusions and Limitations section for details.

New Hire

Employee

Dependent(s)

Who is Eligible

Who is Eligible

Who is Eligible

• A regular, full-time employee working an average of 20 hours per week

• A regular, full-time employee working an average of 20 hours per week

• Your legal spouse

When to Enroll

When to Enroll

• Enroll by the deadline given

by Human Resources

• Enroll during OE or when you have a QLE

When Coverage Starts

When Coverage Starts

• First day of work concurrent with the plan effective date

• You must be actively at work on the plan effective date for new benefits to be effective • QLE: Ask Human Resources

• Child(ren) under age 26, regardless of student, dependency, or marital status • Child(ren) over age 26 who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return When to Enroll

• You must enroll the dependent(s) during OE or when you have a QLE • When covering dependents, you must enroll for and be on the same plans

MAXIMUM DEPENDENT ELIGIBILITY AGE BY PLAN Plan

To Age

Plan

To Age

Accident

26

Hospital Indemnity

26

Cancer

26

Telehealth

26

Critical Illness

26

Vision

26

Dental

26

Voluntary Life and AD&D

26

Identity Theft

26

Emergency Transportation

26

Individual Life

26

• Dependents cannot be double-covered by married spouses within the district as both employees and dependents When Coverage Starts

• Based on OE or QLE effective dates

About Your Coverage Effective Date You must be Actively at Work on the date your coverage becomes effective.

Your coverage must be in effect for your spouse’s and eligible children’s coverage to take effect. See plan documents for specific details.

7 Visit www.cbebc.com for full plan details.

Qualifying Life Events You may only change coverage during the plan year if you have a Qualifying Life Event, such as:

Marriage

Birth

Divorce

Adoption

Legal separation

Annulment

Undergoing FMLA, COBRA event, court judgment, or decree

Placement for adoption

Becoming eligible for Medicare, Medicaid, or TRICARE

Change in benefits eligibility

Death

Receiving a Qualified Medical Child Support Order

You have 30 days from the event to notify Human Resources and complete your changes. You may ne ed to provide do cume nts to verify the ch ange.

8 Visit www.cbebc.com for full plan details.

Gain or loss of benefits coverage Change in employment status affecting benefits

Significant change in cost of spouse’s coverage

Medical Coverage Our medical plans protect you and your family from major financial har dship in the event of illness or injury.

• REGION 1 - 25-26 Plan Highlights • REGION 2 – 25-26 Plan Highlights

• REGION 3 – 25-26 Plan Highlights • REGION 4 – 25-26 Plan Highlights

Preferred Provider Organization (PPO)

Health Maintenance Organization (HMO)

A PPO allows you to see any provider when you need care. When you see in-network providers for care, you will pay less and get the highest level of benefits. You will pay more for care if you use out-ofnetwork providers.

When you see in-network providers, your office visits, urgent care visits, and prescription drugs are covered with a copay, and most other network services are covered at the deductible and coinsurance level.

With an HMO, you must seek care from in-network providers in the HMO network. The selection of a primary care physician is required, and you need a referral to see a specialist. Always confirm that your doctors and specialists are in-network before seeking care.

Exclusive Provider Organization (EPO) With an EPO plan, you must only see in-network providers for your care. With the exception of a true emergency, benefits are only payable if you go to innetwork providers or facilities for care. If you go to a non-network provider or facility, you will be responsible for all costs.

You do not have to select a primary care physician or get a referral to see a specialist. Always confirm that your doctors and specialists are in-network before seeking care.

Watch and learn more!

High-Deductible Health Plan (HDHP) An HDHP allows you to see any provider when you need care, and you will pay less for care when you go to innetwork providers. In exchange for a lower per-paycheck cost for medical benefits, you must satisfy a higher plan deductible that applies to almost all health care expenses, including prescription drugs. If you enroll in the HDHP, you may be eligible to open a Health Savings Account.

Find an In-Network Provider Visit: www.bcbstx/providersearch.com Call: 866-355-5999

9 Visit www.cbebc.com for full plan details.

Medical Coverage Our medical plans protect you and your family from major financial hardship in the event of illness or injury. For full plan details, options, and rates, visit www.cbebc.com or your benefit website: Brooks County ISD

www.mybenefitshub.com/brookscountyisd/25-26/Benefits/UHC/Medical Ezzell ISD

www.mybenefitshub.com/ezzellisd/25-26/Benefits/BCBSTX/Medical Freer ISD

www.mybenefitshub.com/freerisd/25-26/Benefit/UHC/Medical Ingleside ISD

www.mybenefitshub.com/inglesideisd/25-26/Benefits/UHC/Medical Lytle ISD

www.mybenefitshub.com/lytleisd/25-26/Benefit/UHC/Medical Pettus ISD

www.mybenefitshub.com/pettusisd/25-26/Benefits/BCBSTX/Medical Three Rivers ISD

www.mybenefitshub.com/threeriversisd/25-26/Benefit/Curative/Medical Waelder ISD

www.mybenefitshub.com/waelderisd/25-26?Benefits/Curative/Medical

10 Visit www.cbebc.com for full plan details.

Health Care Options Becoming familiar with your options for medical care can save you time and money.

HEALTH CARE PROVIDER

SYMPTOMS

AVERAGE COST

AVERAGE WAIT

$

2-5 minutes

$

15-20 minutes

$

15 minutes

$$

15-30 minutes

$$$$

4+ hours

$$$$$$

Minimal

Non-Emergency Care Access to care via phone, online video, or mobile app whether you are home, work, or traveling; medications can be prescribed

Telemedicine

24 hours a day, 7 days a week

Generally, the best place for routine preventive care; established relationship; able to treat based on medical history

Doctor’s Office

Rash

Stomachache

Infections Sore and strep throat Vaccinations Minor injuries/sprains/ strains

Office hours vary

Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies

Retail Clinic

Allergies

Cough/cold/flu

Hours vary based on store hours

Common infections Minor injuries Pregnancy tests Vaccinations

Sprains and strains When you need immediate attention; walk-in basis is usually accepted

Urgent Care

Generally includes evening, weekend and holiday hours

Minor broken bones Small cuts that may require stitches

Minor burns and infections

Emergency Care Chest pain

Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility

Hospital ER

24 hours a day, 7 days a week

Severe bleeding Blurred or sudden loss of vision

Major broken bones

Services do not include trauma care; can look similar to an urgent care center, but medical bills may be 10 times higher

Freestanding ER

Difficulty breathing

24 hours a day, 7 days a week

Most major injuries

except trauma Severe pain

Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only estimates. This information is not intended as medical advice. If you have questions, please call the phone number on the back of your medical ID card.

11 Visit www.cbebc.com for full plan details.

Pharmacy With Clever RX, you never have to overpay for prescriptions. When you use the Clever RX card or app, you get up to 80% off prescription drugs, discounts on thousands of medications, and usage at most pharmacies nationwide.

Step 1 Download the free Clever RX app and enter these numbers during the onboarding process: Group ID: 1085 Member ID: 3953 Step 2 Use your ZIP code to find a local pharmacy with the best price for your medication — up to 80% off!

Step 3 Click the voucher with the lowest price, closest location, and/or at your preferred pharmacy and show the voucher to the pharmacist.

Questions?

Call Clever RX Customer Service.

Need More Details?

Visit ww w. cl ev er rx. co m Call 800-873-1195.

12 Visit www.cbebc.com for full plan details.

Health Savings Account A Health Savings Account (HSA) is a tax-exempt tool to supplement your retirement savings and to cover current and future health costs.

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

You Decide How To Use Your HSA Funds Use it Now

Let it Grow

• Make annual HSA contributions.

• Make annual HSA contributions.

• Pay for eligible medical costs.

• Pay for medical costs with other funds.

• Keep HSA funds in cash.

• Invest HSA funds.

Important HSA Information • Have your in-network doctor file your claims and use your HSA debit card to pay any balance due.

• You must keep ALL your records and receipts for HSA reimbursements in case of an IRS audit.

HSA Contacts • Open an Account – Sign-up for 24/7 account access at www.eecu.org.

• Only HSA accounts opened through our plan administrator are eligible for automatic payroll deduction.

• Online/Mobile – Visit www.eecu.org or download the mobile app to find a local financial center, check your balance, pay bills, and more.

HSA Eligibility

• Call/Text – 817-882-080 0 for EECU member service.

You are eligible to open and contribute to an HSA if you are: • Enrolled in an HSA-eligible HDHP

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

• Lost/Stolen Debit Card – Call the 24/7 debit card hotline at 800-333-9934.

MAXIMUM HSA CONTRIBUTIONS

• Not enrolled in a Health Care Flexible Spending Account

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

2025

2026

$4,300 Individual

$4,400 Individual

$8,550 Family

$8,750 Family

• Not enrolled in Medicare, Medicaid, or TRICARE

• Not receiving Veterans Administration benefits

HSA contributions are tax-deductible and grow taxdeferred.

Withdrawals for qualifying medical expenses are taxfree.

13 Visit www.cbebc.com for full plan details.

Watch and learn more!

Flexible Spending Accounts A Flexible Spending Account (FSA) allows you to set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses.

Health Care FSA

NBS Participant Portal and Mobile App

The Health Care FSA covers qualified medical, dental, and vision expenses for you or your eligible dependents. Eligible expenses include:

To get the most out of your benefits, register for the NBS Participant Portal and/or download the app. On the portal and app, you can:

• Dental and vision expenses

• Access plan documents and account information.

• Medical deductibles and coinsurance

• Update your personal information.

• Prescription copays

• Look up qualified expenses.

• Hearing aids and batteries

• Submit claims.

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

• Check balances.

2025 ANNUAL MAXIMUM FSA CONTRIBUTIONS Maximum

$3,300

Carryover

$660 *Varies by district

• And more.

Visit http://my.nbsbenefits.com and click Register. Your employee ID is your Social Security Number.

Questions?

If you have any questions or concerns, contact the NBS Service Center: • Call 855-399-3035, opti on 2.

• Email service@nbsbenefits.com

You are entitled to the full election from day one of the plan year.

• Fax 844-428-1496.

Representatives are available Monday through Friday from 7:00 a.m. to 7:00 p.m. CT.

How the Health Care FSA Works You c an ac c es s t he f unds in y our H ealth C ar e FSA t w o diff erent ways : • Use your NBS Smart Debit Card to pay for qualified expenses, doctor visits, and prescription copays.

• Pay out-of-pocket and submit your receipts for reimbursement. » Fax 844-438-1496. » Email service@nbsbenefits.com.

» Visit mynbsbenefits.com

Watch and learn more!

N ote: S ome emp lo yers allow y ou t o u se your N BS S mart C ard to pay yo ur dependen t c are pro vider.

14 Visit www.cbebc.com for full plan details.

Flexible Spending Accounts Health Care FSA

Dependent Care FSA

The Health Care FSA covers qualified medical, dental, and vision expenses for you or your eligible dependents. Eligible expenses include:

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 daycare or babysitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you (and your spouse, if married) must be gainfully employed, looking for work, a full- time student, or incapable of self-care.

• Dental and vision expenses • Medical deductibles and coinsurance • Prescription copays • Hearing aids and batteries

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

Limited Purpose Health Care FSA A Limited Purpose Health Care FSA is available if you enrolled in the HDHP medical plan and contribute to an HSA. You can use a Limited Purpose Health Care FSA to pay for eligible out-ofpocket dental and vision expenses only, such as: • Dental and orthodontia care (e.g., fillings, Xrays, and braces)

• Vision care (e.g., eyeglasses, contact lenses, and LASIK surgery)

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

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

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

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

How the Health Care and Limited Purpose FSAs Works You can access the funds in your FSA two different ways: • Use your Benefits Debit Card to pay for qualified expenses, doctor visits, and prescription copays.

• Pay out-of-pocket and submit your receipts for reimbursement: » Fax 844-438-1496 » Email service@nbsbenefits.com » Visit http://mynbsbenefits.com

15 Visit www.cbebc.com for full plan details.

HSA and FSA Comparison Knowing the difference between a Health Savings Account (HSA) and Health Care Flexible Spending Account (FSA) can help you choose the best option.

HEALTH CARE FLEXIBLE SPENDING ACCOUNT (FSA)

HEALTH SAVINGS ACCOUNT (HSA) Internal Revenue Code

Section 223

Section 125 An FSA allows you to pay out-of- pocket expenses tax-free for:

An HSA is an actual bank account in your name that allow you to save and pay for unreimbursed qualified medical expenses tax-free.

Description

• copays, deductibles, and certain services not covered by medical plan • qualifying dependent care

Employer Eligibility

A qualified High-Deductible Health Plan

All employers

Contribution Source

You and/or your employer

You and/or your employer

Account Owner

Individual

Employer

Underlying Insurance Requirement

High-Deductible Health Plan

None

Insurance Plan Minimum Deductible

Maximum Contribution

2025 • $1,650 single

2026 • $1,650 single

• $3,300 family

• $3,300 family

2025 • $4,300 single

2026 • $4,400 single

• $8,500 family

• $8,750 family

• $1,000 age 55+ catch-up

• $1,000 age 55+ catch-up

N/A

$3,300

Permissible Use of Funds

Use any way you wish. If used for nonqualified medical expenses, funds are subject to the current tax rate plus a 20% penalty.

Reimbursement for qualified medical expenses as defined in Section 213(d) of the Internal Revenue Code.

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

Permitted, but subject to current tax rate plus 20% penalty (waived after age 65).

Not permitted

Year-to-year rollover of account balance?

No. Access to some funds may be extended if your employer’s plan contains a 2½-month grace period or $660 (2025) rollover provision. *Varies by District

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

Does the account earn interest?

Yes

No

Portable?

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

No

FLIP TO...

13

HSA

14

FSA

16 Visit www.cbebc.com for full plan details.

Qualified HSA and FSA Expenses

The pr od uc t s an d s er vic es lis ted be low ar e ex amp le s of me dic al ex pen se s eligible for pa ym ent un de r your H ealth C ar e FS A or H S A . This list is no t all-inclusive; addit ional ex pen se s ma y qualify , an d t he items lis ted ar e s ubjec t t o c ha nge in a cc o r da nc e w ith IRS regulat ions.

Pleas e r efer t o IRS P ublicat io n 5 0 2 Me dic al an d D enta l E xp ens es at ww w. ir s. gov for a c omplet e de sc ript ion of eligible me dic al an d dent al exp enses .

Abdominal supports

Diagnostic fees

Ophthalmologist/Optician/ Optometrist

Acupuncture Ambulance

Eyeglasses

Orthopedic shoes

Anesthetist

Gynecologist

Orthopedist

Arch supports

Healing services

Osteopath Physician

Artificial limbs

Hearing aids and batteries

Postnatal treatments

Blood tests

Hospital bills

Prenatal care

Braces

Insulin treatment

Prescription medicines

Cardiographs Chiropractor

Lab tests

Psychiatrist

Crutches

Metabolism tests

Therapy equipment

Dental treatment

Neurologist

Wheelchair

Dentures

Nursing

X-rays

Dermatologist

Obstetrician

Operating room costs

17 Visit www.cbebc.com for full plan details.

Dental Coverage Our dental plans help you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work.

Dental Benefits Summaries LINCOLN FINANCIAL GROUP High Plan

Middle Plan

Low Plan

In-Network or Out-of-Network

In-Network or Out-of-Network

In-Network or Out-of-Network

$50 $15 0

$50 $15 0

$50 $150

$2,000

$1,500

$1,000

You Pay

You Pay

You Pay

Preventive Services

$0

$0

$0

Preventative Services

0%

0%

20%

Basic Services

20% 1

40% 1

50% 1

Major Services

50% 1

60% 1

75% 1

Orthodontia Dependent children $1,000 lifetime max

50% 1

60% 1

Not Covered

DPPO Plans Two levels of benefits are available with the DPPO plans: in-network and out-of-network. You may select any dental provider for care, but you will pay less and get the highest level of benefits with in-network providers. You could pay more if you use an out-of-network provider.

Calendar Year Deductible • Individual • Family Calendar Year Benefit Maximum Per Individual

UNITEDHEALTHCARE High Plan

Low Plan

In-Network or Out-of-Network

In-Network or Out-of-Network

$50 $15 0

$50 $15 0

Calendar Year Deductible • Individual • Family Calendar Year Benefit Maximum Per Individual

$1,500

$1,000

You Pay

You Pay

Preventive Services

$0

20% 1

Employee Contributions

Basic Services

20% 1

50% 1

Employee Only

$43.82

$33.20

$17.96

Major Services

50%

1

1

$84.30

$63.86

$35.90

Orthodontia Dependent children. $1,000 lifetime max

Employee and Spouse

50% 1

Employee and Child(ren)

$86.61

$65.61

$39.43

Employee and Family

$122.14

$92.53

$57.38

75%

50% 1

1 The amount you pa y afte r the ded uctible is met.

Find a UnitedHealthcare

1 The amount you pa y afte r the ded uctible is met.

In-Network Provider Visit www.whyuhc.com/dentalppo.

Call 888-679-8925.

Find a Lincoln Financial Group

In-Network Provider Visit www.lincolnfinancial.com/findadentist.

Call 800-423-2765.

Watch and learn more!

18 Visit www.cbebc.com for full plan details.

Vision Coverage Our vision plans offer quality care to help preserve your health and eyesight. Regular exams can detect certain medical issues such as diabetes and high cholesterol, in addition to vision and eye problems. You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see in-network providers.

Vision Benefits Summary VISION PLAN

Find an In-Network Provider

Low Plan

High Plan

Exa m

$10

$5

Visit www.eyetopia.org.

Lenses • Sing le vision • Line d b ifocals • Line d trifocal

$20 $20 $20

$0 $0 $0

Call 800-662-8264.

Fra mes

$13 0 a llowa nce

$18 0 a llowa nce

Contac ts In lieu of frames

$15 0 a llowa nce

$30 0 a llowa nce

Benefit Frequency Exa m

On ce every 12 mo nth s

Lenses

On ce every 12 mo nth s

Fra mes

On ce every 12 mo nth s

Contac ts

On ce every 12 mo nth s

Watch and learn more!

Employee Contributions Em ployee Only

$6.50

$20 .00

Em ployee and Spouse

$12 .00

$39 .00

Em ployee and Child(ren)

$14 .00

$44 .00

Em ployee and Family

$22 .00

$54 .00

19 Visit www.cbebc.com for full plan details.

Telemedicine Your benefit coverage offers access to quality telehealth services. Connect anytime day or night with a boardcertified doctor via your mobile device or computer for free or for the same or less cost than a visit to your regular physician.

Registration is Easy Register today so you are ready to use this valuable service when and where you need it.

Visit www.recurohealth.com.

While telemedicine does not replace your primary care physician, it is a convenient and cost-effective option when you need care and: • Have a non-emergency issue and are considering an after-hours health care clinic, urgent care clinic, or emergency room for treatment • Are on a business trip, vacation, or away from home

• Are unable to see your primary care physician

Virtual Mental Health Care Get comprehensive behavioral health care from therapy and counseling to psychiatry and medication management. Primary care and behavioral health doctors work together to ensure you have a coordinated treatment plan.

Call 844-979-0313.

Download the app to your mobile device.

When to Use Telemedicine Use telemedicine for minor conditions such as:

• Sore throat

• Mental health issues

• Headache

• Allergies

• Stomachache

• Fever

• Cold

• Urinary tract infections

• Flu

Do not use telemedicine for serious or life-threatening emergencies.

EMPLOYEE CONTRIBUTIONS Employee

$14.00

Employee and Family

$14.00

Watch and learn more!

Check with your district to see if your employer offers this benefit at no cost to you and your family.

20 Visit www.cbebc.com for full plan details.

Term Life and AD&D Group Term Life is the least expensive way to buy life insurance.

Term Life and Accidental Death and Dismemberment (AD&D) insurance is important to your financial security, especially if others depend on you for support or vice versa.

With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies).

Educator Group Term Life Insurance Voluntary Term Life and AD&D Insurance is available to purchase for you and your family. You must be actively at work for at least 20 hours per week to be eligible to enroll for coverage.

You and your eligible dependents may enroll in amounts up to $250,000 for employee and $75,000 for spouse without answering health questions.

Amounts over the Guaranteed Issue will require medical underwriting. If you buy at least $10,000 of coverage during initial enrollment, you may buy up to the Guaranteed Issue in subsequent re-enrollments without medical underwriting. Benefits will reduce 50% at age 70.

21 Visit www.cbebc.com for full plan details.

Watch and learn more!

Designating a Beneficiary A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary, and you can change beneficiaries at anytime.

If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%) of the death benefit.

Term Life and AD&D Coverage Highlights • Portable – keep your supplemental coverage if you leave your current employer • Convertible – convert your group term life insurance benefits to an individual whole life policy if your coverage ends

• Accelerated Benefits Option – get up to 50% of your life insurance benefit • Employee Assistance Program – get six visits.

• Financial Wellness – this program is included.

• AD&D Covered Losses and Benefits – offers additional protection for you and your family if an accidental bodily injury results in death or dismemberment.

TERM LIFE INSURANCE

TERM AD&D INSURANCE

Employee

• Increments of $10,000 up to 7 times basic annual earnings not to exceed $500,000 • Guaranteed Issue: $250,000

Spouse

• Increments of $5,000 up to 100% of the employee’s amount, not to exceed $500,000 • Guaranteed Issue: $75,000

Child(ren)

• Birth to six months: $100 • Six months to age 26: $10,000 • Guaranteed Issue: $10,000

Employee

$0.30 per $10,000

Spouse

$0.15 per $5,000

Child(ren

$0.30 per $10,000

Calculate Your Monthly Cost

Term Life Monthly Rates

1

Term AD&D Monthly Rates

Age

Employee (per $10,000)

Spouse1 (per $5,000)

<29

$0.480

$0.240

30-34

$0.670

$0.335

35-39

$0.760

$0.380

40-44

$0.950

$0.475

45-49

$1.430

$0.715

50-54

$2.280

$1.140

55-59

$3.710

$1.855

60-64

$5.610

$2.805

65-69

$10.830

$5.415

70-74

$17.580

$8.790

75+

$24.800

$12.400

Term Life Insurance $_____ (coverage amount) $10,000 = $_____ X $_____ (rate) = $______ (monthly cost) Term AD&D Insurance $_____ (coverage amount) $1,000 = $_____ X $_____ (rate) = $______ (monthly cost)

S p o u se rate is b Child(ren) a se d o n sp o u se ’s age.

Rate per $10,000

To age 26

$1.60

22 Visit www.cbebc.com for full plan details.

Individual Life Insurance Financial protection for today and tomorrow, starts at work

Visit: www.texasrepubliclife.com Call: (512) 330-0099

You decide how much coverage is appropriate for you, and who you would like to cover. Employee, spouse, children and grandchildren are eligible. For less than a cup of coffee, a premium of $3.16 a week, a 35-year-old employee can purchase $30,000 of life insurance coverage, through Texas Republic Life’s, TrueFlex Universal Life, Product.

Guaranteed issue up to $50,000: NO MEDICAL EXAM! Watch and learn more!

Qualification questions from $50,001-$150,000 During the last six months, has the proposed insured: 1.

Been at work on a full-time basis, performing usual duties?

2.

Been absent from work due to illness or medical treatment for a period of more than five consecutive working days?

3.

Been disabled or received tests, treatment or care of any kind in a hospital or nursing home or received chemotherapy, hormonal therapy for cancer, radiation therapy, dialysis treatment, or treatment for alcohol or drug abuse?

Monthly Premium Rate With ADB - Non-Tobacco Age

Face Amount $25,000

$50,000

$75,000

25

$10.75

$19.25

$27.75

35

$13.79

$25.33

$36.88

45

$25.17

$48.08

$71.00

23 Visit www.cbebc.com for full plan details.

Educator Disability Insurance Educator Disability insurance combines features of short term and long-term disability into one plan. Disability insurance protects part of your income if you are unable to work due to a covered accident, illness, or pregnancy. We offer Educator Disability insurance for you to purchase and allow you to choose the coverage amount and waiting period that best suits your needs.

Watch and learn more!

Educator Disability FAQ What is disability insurance?

Disability insurance protects one of your most valuable assets: your paycheck. This insurance replaces part of your income if you are physically unable to work due to sickness or injury for an extended period of time. The educator disability plan is unique in that it includes both short- and long-term coverage in one convenient plan.

Does this plan have pre-existing condition limitations?

EDUCATOR DISABILITY Benefits Begin The first number indicates the number of days you must be disabled due to Injury and the second number indicates the number of days you must be disabled due to Sickness.

0/71 14/141 30/301 60/60 90/90 180/180

Percentage of Earnings You Receive

Up to 66 2/3%

Maximum Weekly Benefit

Between $200 and $8,000

Maximum Benefit Period

Social Security Normal Retirement Age

Pre-existing Condition Exclusion

Yes. However, all plans will include pre-existing condition limitations that could impact you if you are a first-time enrollee in your employer’s disability plan (including your initial new hire enrollment). Review the plan documents for full details.

Will I get all of my disability benefit?

Your disability benefit may be reduced by other income you receive or are eligible to receive due to your disability, such as: • Social Security disability insurance

3/122

• State teacher retirement disability plans

1

If your elimination perio d is 30 days or less an d you are confined to a h osp ital for 24 hou rs or more, th e e limin atio n p eriod will be waived, a nd benefits will be payable from th e first da y of h osp italization.

• Workers’ Compensation

2 Ben efits may not b e p aid for an y condition tr eated within three months pr ior to

• Other employer-based disability insurance coverage you may have

your effe ctive d ate un til you have b een co ver ed under this pla n for 12 months. If your disability is a re sult of a pre-existing condition, we will pay be nefits for a maximum of one month.

• Unemployment benefits • Retirement benefits that your employer fully or partially pays for (such as a pension plan)

File a Disability Claim Email educatorclaims@chubb.com.

Call 888-499-0425.

24 Visit www.cbebc.com for full plan details.

Educator Disability Insurance What is the best way to choose which disability plan option to enroll in?

Your disability plan selection should be a two-step approach.

Step One

Step Two

Choose your elimination period or waiting period. This is how long you are disabled and unable to work before your benefit will begin. It will be displayed as two numbers, such as 0/7, 14/14, 60/60, etc.

Choose your benefit amount. This is the maximum amount of money you would get from the carrier on a monthly basis once your disability claim is approved by the carrier.

The first number indicates the number of days you must be disabled due to Injury and the second number indicates the number of days you must be disabled due to Sickness.

When choosing your monthly benefit, consider how much money you need to pay your monthly bills. Choose your monthly benefit amount based on your answer.

When choosing your elimination period, determine how long you could go without a paycheck. Choose your elimination period based on your answer.

EDUCATOR DISABILITY RATES

Note: Some plans will waive the elimination period if you choose 30/30 or less and you are confined as an inpatient to the hospital for a specific time period. Review your plan details to see if this feature is available to you.

Elimination Period

Rate per $100 of Benefit

Elimination Period

Rate per $100 of Benefit

0/7

$3.32

60/60

$1.99

14/14

$2.82

90/90

$1.15

30/30

$2.44

180/180

$0.84

25 Visit www.cbebc.com for full plan details.

Disability Insurance Traditional disability insurance provides partial income protection if you are unable to work due to a covered accident or illness.

Disability coverage pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for an extended period of time. Benefits begin after an elimination period and continue while you are disabled up to a maximum benefit period. Full plan summaries and rates are available on the benefits website.

Traditional disability benefit options may not be applicable for all groups.

Short Term Disability FAQ

Long Term Disability FAQ

How can Short Term Disability (STD) benefits help me?

How can Long Term Disability (LTD) benefits help me?

STD insurance pays cash benefits for covered injuries and illness if you are not able to work for a short period of time due to a non-work-related injury or illness. It provides a percentage of pre-disability earnings on a weekly basis when you are out on a disability claim. You can use the money however you see fit.

Disability insurance pays cash benefits for covered injuries and illness if you are not able to work for an extended period of time due to a chronic injury or illness.

It provides a percentage of pre-disability earnings when you are out on a disability claim. You can use the money however you see fit.

How is STD different than Worker’s Compensation?

When do disability benefits begin?

Workers’ Compensation applies to a job-related injury or illness. STD benefits may apply if you are unable to work due to pregnancy or non-work-related illness or injury.

The start of your disability insurance depends on the specifics of your policy and your disability. LTD usually begins after a pre-determined waiting period (such as 90 to 180 days from the onset of the disability).

Will I get all of my disability benefit?

Will I get all of my disability benefit?

Your disability benefit may be reduced by other income you receive or are eligible to receive due to your disability. Some of these income sources may include Social Security disability insurance, Workers’ Compensation, unemployment benefits, etc. Some limitations and exclusions may apply so read your plan documents for details.

You will get a percentage of your income – typically 60%.

However, your disability benefit may be reduced by other income you receive or are eligible to receive due to your disability, such as unemployment benefits. Some limitations and exclusions may apply so read your plan documents or contact Human Resources for details.

How do I apply for Short Term Disability?

Refer to your specific policy for term limits. Some policies pay benefits until age 65, while others have a fixed number of years.

How long will the disability benefits last?

Contact your Human Resources department to begin STD benefits.

What else is included with my disability coverage?

Your policy includes worldwide emergency travel assistance if you or a family member needs help anywhere in the world. See your plan documents for details.

Watch and learn more!

26 Visit www.cbebc.com for full plan details.

Hospital Indemnity Insurance The Hospital Indemnity plan helps you with the high cost of medical care by paying you a cash benefit when you have an inpatient hospital stay. Unlike traditional insurance which pays a benefit to the hospital or doctor, this plan pays you directly. It is up to you how you want to use the cash benefit. These costs may include meals, travel, childcare or eldercare, deductibles, coinsurance, medication, or time away from work. See the plan document for full details.

Watch and learn more!

CLAIM FORM – HI Claim Form HOSPITAL INDEMNITY INSURANCE

Low Plan

High Plan

Hospital Admission

$1,000

$3,000

Hospital Confinement

$100 per day up to 30 days

$200 per day up to 30 days

ICU Admission

$2,000

$6,000

ICU Confinement

$200 per day up to 30 days

$400 per day up to 30 days

Employee Only

$16.57

$30.78

Employee and Spouse

$31.45

$62.19

Employee and Child(ren)

$25.44

$48.47

Employee and Family

$40.32

$79.88

Employee Contributions

27 Visit www.cbebc.com for full plan details.

Accident Insurance Accident insurance provides affordable protection against a sudden, unforeseen accident. The Accident plan helps offset the direct and indirect expenses resulting from an accident such as copayments, deductible, ambulance, physical therapy, childcare, rent, and other costs not covered by traditional health plans. See the plan document for full details.

ACCIDENT INSURANCE Low Plan

High Plan

Ambulance • Ground • Air

$500 $1,500

$750 $2,000

Emergency Room

$150

$200

Hospital Admission

$1,000

$1,500

$200 per day

$400 per day

$400 day

$600 per day

$30-$50,000

$60-$50,000

Confinement • Hospital – up to 365 days • ICU – up to 30 days Specific Sum Injuries Dislocations, ruptured discs, eye injuries, fractures, lacerations, concussions, and more

Employee Contributions

Employee Only

$6.94

$10.73

Employee and Spouse

$10.92

$16.89

Employee and Child(ren)

$11.52

$17.82

Employee and Family

$17.59

$29.08

Watch and learn more!

CLAIM FORM – Accident Claim Form

1 Per cen tag e o f bene fit paid fo r d ismember me nt is d epende nt on typ e o f loss.

28 Visit www.cbebc.com for full plan details.

Critical Illness Insurance Critical Illness insurance helps pay the cost of non-medical expenses related to a covered critical illness or cancer. The plan provides a lump sum benefit payment to you upon first and second diagnosis of any covered critical illness or cancer. The benefit can help cover expenses such as lost income, out-of- town treatments, special diets, daily living, and household upkeep costs. This coverage is portable. See the plan document for full details.

Watch and learn more!

No benefit will be paid for a date of diagnosis that occurs prior to the coverage effective date. You must be treatment free from cancer for 12 months prior to diagnosis date and in complete remission. There is no pre-existing condition limitation. All amounts are Guaranteed Issue. No medical questions are required for coverage to be issued.

CRITICAL ILLNESS INSURANCE Employee

Increments of $5,000 up to $40,000

Spouse

Increments of $5,000 up to $40,000 not to exceed 100% of employee amount

Children

Up to $20,000 not to exceed 50% of employee amount

First Occurrence Benefit Full Coverage Heart attack, stroke, invasive cancer, end stage renal failure, major organ failure, advanced Huntington’s disease, advanced ALS, advanced Alzheimer’s disease, benign brain tumor, severe burn

100% of benefit amount

Partial Coverage Arterial/vascular disease, non-invasive cancer in situ, advanced multiple sclerosis, loss of sight, loss of hearing, loss of speech

25% of benefit amount

Childhood Diseases Cerebral palsy, cleft lip/palate, cystic fibrosis, Type 1 diabetes, Down Syndrome, muscular dystrophy

100% of benefit amount

MONTHLY COST PER $1,000 Age

Employee

Spouse

<29

$0.260

$0.260

30-39

$0.424

$0.424

40-49

$0.646

$0.646

50-59

$1.182

$1.182

60+

$3.183

$3.183

CLAIM FORM – CI Claim Form

29 Visit www.cbebc.com for full plan details.

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

CLAIM FORM – Cancer Claim Form

Watch and learn more!

CANCER INSURANCE Low Plan

High Plan

$5,000 $7,500

$10,000 $15,000

$10,000

$20,000

$100 per day up to 30 days per confinement

$200 per day up to 30 days per confinement

Employee Only

$15.00

$27.92

Employee and Spouse

$28.46

$53.10

Employee and Child(ren)

$18.78

$34.80

Employee and Family

$31.16

$58.66

Cancer Diagnosis • Employee/Spouse • Child(ren)

Radiation and Chemotherapy Per covered individual per calendar year Hospital Confinement

Employee Contributions

30 Visit www.cbebc.com for full plan details.

Emergency Transport Services Did you know that a ground ambulance ride can cost more than $1,200 and an air ambulance ride can cost up to $70,000? If you or a family member is in need of an emergency medical transport, your insurance coverage and Medicare may not cover all of the costs.

For More Details Visit www.masamts.com.

Call 800-423-3226.

EMERGENCY TRANSPORT SERVICES

Consider buying emergency transport services to greatly reduce or completely cover the cost of emergency transportation. After your medical crisis, contact MASA MTS to negotiate with your medical plan provider and cover the balance on your medical transportation bills.

Watch and learn more!

Emergent Plus

Platinum Plan

Emergency Air Transportation

x

x

Emergent Ground Transportation

x

x

Non-Emergency InterFacility Transportation

x

x

Repatriation/ Recuperation

x

x

Escort Transportation

x

Visitor Transportation

x

Return Transportation

x

Mortal Remains Transportation

x

Minor Return

x

Organ Retrieval/Organ Recipient Transportation

x

Vehicle Return

x

Pet Return

x

Worldwide Coverage

x

Employee Contributions Employee

$14.00

$24.50

Employee and Family

$14.00

$32.50

31 Visit www.cbebc.com for full plan details.

ID Theft Protection Identity theft is one of the fastest-growing crimes in the country. Millions of people have their identity stolen each year.

Protect yourself and restore your identity with coverage that includes:

• Identity restoration • CreditLock • Dark web monitoring

• Digital identity manager

For More Information Visit www.experian.com.

Call 866-617-1894.

• Secure VPN and safe browser • Password manager • Mobile app

EMPLOYEE CONTRIBUTIONS Employee

$7.00

Employee and Family

$14.00

Watch and learn more!

32 Visit www.cbebc.com for full plan details.

Employee Assistance Program An Employee Assistance Program (EAP) helps you and family mem bers cope with a var iety of per sonal or wor k-related issues. Get confidential counseling and support services from licensed professionals at little or no cost to help with: • Relationships

• Child and elder care resources

• Work/life balance

• Substance abuse

• Stress and anxiety

• Addiction

Get 24/7 Support Visit: guidanceresources.com App: GuidanceNow

• And more

• Grief and loss

Web ID: CHUBB

Watch and learn more!

Call: (844) 266-0712 2 4 / 7 Li v e A s s i s t a nc e T TY – D i a l 7 1 1

33 Visit www.cbebc.com for full plan details.

Glossary of Terms Beneficiary – Who will receive a benefit in the event of the insured’s death. A policy may have more than one beneficiary.

Coinsurance – Your share of the cost of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service, typically after you meet your deductible.

Copay – The fixed amount you pay for health care services received.

Deductible – The amount you owe for health care services before your health insurance begins to pay its portion. For example, if your deductible is $1,000, your plan does not pay anything until you meet your $1,000 deductible for covered health care services. The deductible may not apply to all services, including preventive care.

Employee Contribution – The amount you pay for your insurance coverage.

Employer Contribution – The amount your employer contributes to the cost of your benefits.

Explanation of Benefits (EOB) – A statement sent by your insurance carrier that explains which procedures and services were provided, how much they cost, what portion of the claim was paid by the plan, what portion of the claim is your responsibility, and information on how you can appeal the insurer’s decision. These statements are also posted on the carrier’s website for your review.

Flexible Spending Account (FSA) – An option that allows participants to set aside pretax dollars to pay for certain qualified expenses during a specific time period (usually a 12-month period).

High-Deductible Health Plan (HDHP) – A medical plan with a higher deductible in exchange for a lower monthly premium. You must meet the annual deductible before any benefits are paid by the plan.

In-Network – Doctors, hospitals, and other providers that contract with your insurance company to provide health care services at discounted rates.

Out-of-Network – Doctors, hospitals, and other providers that are not contracted with your insurance company. If you choose an out-of-network provider, you may be responsible for costs over the amount allowed by your insurance carrier.

Over-the-Counter (OTC) Medications – Medications typically made available without a prescription.

Prescription Medications – Medications prescribed by a doctor. Cost of these medications is determined by their assigned tier.

Preventive Care – The care you receive to prevent illness or disease. It also includes counseling to prevent health problems.

Reasonable and Customary (R&C) Allowance – Also known as an eligible expense or the Usual and Customary (U&C). The amount your insurance company will pay for a medical service in a geographic region based on what providers in the area usually charge for the same or similar medical service.

SSNRA – Social Security Normal Retirement Age.

Generic Drugs – Drugs approved by the U.S. Food and Drug Administration (FDA) to be chemically identical to corresponding brand name versions. The color or flavor of a generic medicine may be different, but the active ingredient is the same. Generic drugs are usually the most cost- effective version of any medication.

Health Savings Account (HSA) – A personal savings account that allows you to pay for qualified medical expenses with pretax dollars.

34 Visit www.cbebc.com for full plan details.

Important Legal Notices Women’s Health and Cancer Rights Act of 1998

Marriage, Birth or Adoption

If yo u h ave a n e w d ep e n de n t as a result of a marri ag e, bi rth , a do pti on , o r p la ce men t for a do pti on , yo u ma y b e ab le to en ro ll you rsel f a nd you r d ep e nd e nt s. H ow eve r, yo u must en ro ll wi thi n 3 1 da ys af ter th e marri ag e, bi rth, o r p la ce men t for ad op tion .

In Oc to b er 1 9 9 8, C on g ress e na cte d th e Wo men ’s He al th a nd C a nc er Ri gh ts Act of 1 9 9 8. Thi s n oti ce expl ain s some i mpo rta nt pro vi si on s of th e Act. Plea se revi ew thi s in forma tion carefully.

For More Information or Assistance

To re qu est spe ci al en rol lmen t o r ob ta in mo re in fo rmatio n, con ta ct: D is tr ic t H um a n Re sour ce s D epa rtm ent

As spe cif ie d in th e Wo men ’s H ea lth a nd C a nc er Ri ghts Act, a p la n p arti cip an t o r b en efi cia ry w h o el ects bre ast re co n struct io n in co nn e cti on w ith a ma st ect omy is also en titl ed to th e fol lo win g be nefi ts: • All sta ge s of re co n struct io n of th e b re ast o n w hi ch the ma st ect omy w as p erfo rme d;

Your Prescription Drug Coverage and Medicare

• Su rg e ry a nd re co n struct io n of th e o the r b re ast to p rod u ce a symme tri ca l a pp e ara n ce; an d

Plea se re ad thi s n oti ce careful ly a nd ke ep it w he re you ca n fi nd it. Thi s n oti ce ha s in fo rma tio n a bo u t you r curren t p re scri pti on d ru g co vera g e w ith D i stri ct a nd a bo u t your o pti on s u nd e r Med ica re’ s pre scri pti on d ru g co ve ra ge . This in fo rma tio n ca n h el p yo u d eci d e w he th e r o r n ot yo u w an t to en ro ll in a Me di ca re d ru g pl an . In formati on a bo u t w he re you ca n g et h el p to ma ke de cisio ns a bo u t you r pre scri pti on d ru g co vera g e is at th e e n d of thi s no tice.

• Prosthe ses a nd tre at men t of ph ysi ca l comp li cati o ns of the maste cto my, in clu di ng l ymp he de ma.

H ea lth pl an s mu st d ete rmi ne th e ma nn e r of co vera g e in con sult ati on w ith th e a tten d in g ph ysi ci an a nd th e pa ti ent.

C ov era g e for b re ast re co n struct io n a nd rel ated servi ces may b e sub je ct to d ed ucti bl es a nd co in sura nce a mou n ts th at are con sisten t w ith th ose th at a pp ly to o the r be ne fit s u nd e r the p lan.

If n ei the r yo u n or an y of you r co vere d d ep e n de n ts a re elig ible for o r h ave Me di care , thi s n oti ce d oe s n ot a pp ly to yo u o r the d ep e nd e nt s, as th e ca se ma y b e. H ow eve r, yo u sho ul d still ke ep a co p y of thi s n oti ce in th e e ve nt yo u o r a d ep en d en t sho ul d qu ali fy for co vera g e u nd e r Me di ca re in th e future. Plea se no te , ho we ver, th at later n oti ces mi gh t su pe rse de this no tice.

Special Enrollment Rights Thi s n oti ce is b ei ng p rovi de d to e nsure th at yo u u nd ersta nd you r rig ht to a pp ly for g ro up he al th i nsura nce co ve ra ge . You sho ul d re ad thi s n oti ce e ve n if yo u p la n to wa ive co vera g e at thi s time.

Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP) If yo u a re de cli ni ng co vera g e for you rsel f o r you r d ep en d en ts b ec au se of o the r he al th i nsura nce o r g ro up he al th pl an co ve ra ge , yo u ma y b e ab le to later en ro ll you rsel f an d you r d ep e n de n ts in this pl an if yo u o r you r d ep en d en ts lo se eligibility for th at o the r co vera g e (or if th e emp loyer sto ps con tri bu tin g to wa rd you r o r you r d ep en d en ts’ oth er cove ra ge ). H ow eve r, yo u mu st en ro ll wi thi n 3 1 da ys after you r o r you r d ep en d en ts’ o the r co vera g e e nd s (or af ter the e mp lo yer th at sp on sors th at co vera g e sto ps con tri bu ting to wa rd th e o the r coverage ).

1.

Me di ca re pre scri pti on d ru g co vera g e b e ca me available in 2 0 0 6 to e veryo ne w ith Me di care . You ca n g et this co vera g e th ro ug h a Me di ca re Prescri pt ion D ru g Plan or a Me di ca re Ad van ta g e Plan th at of fers pre scri pti on d ru g co ve ra ge . All Me di ca re pre scri pti on d ru g pl an s p ro vid e at le ast a sta nd a rd level of co vera g e set b y Me di care . Some pl an s ma y al so of fer mo re co vera g e for a h ig he r mon thly pre mium.

2.

D i stri ct ha s d ete rmi ne d th at th e pre scri pti on d ru g co vera g e o ffere d b y th e D i stri ct med ica l pl an is, on a vera ge for all pl an pa rtici pa nts, e xpe cte d to p ay ou t as mu ch as th e sta nd a rd Me di ca re pre scri pti on d ru g co vera g e pa ys a nd is co nsi de red C re di ta bl e C overa ge . Th e H SA p la n is n ot co nsi de red C re di ta bl e C overa ge .

If yo u o r you r d ep e n de n ts lo se eligibility u nd e r a Med ica id pl an o r CHIP, o r if yo u o r you r d ep e nd e nt s b e co me el igib le for a sub sidy u nd e r Me di ca id o r CHIP, yo u ma y b e ab le to enroll you rsel f a nd you r d ep e n de n ts in this pl an .

You mu st pro vi de noti ficati on wi thi n 6 0 da ys af ter yo u o r you r d ep en d en t is te rmi n ate d fro m, o r d ete rmi ne d to b e el igib le for, such assistance.

35 Visit www.cbebc.com for full plan details.

Important Legal Notices Be cau se you r existin g co vera g e is, o n a ve rag e, at le ast as g o o d as sta nd a rd Me di ca re pre scri pti on d ru g co ve ra ge , you ca n ke ep thi s co vera g e a nd n ot p ay a h ig he r p remi u m (a pe na lty) if yo u later d eci d e to en ro ll in a Me di ca re prescri ptio n d ru g pl an , a s l on g as yo u later en ro ll wi thi n spe cif ic time pe riod s.

For more information about your options under Medicare prescription drug coverage:

You ca n en ro ll in a Me di ca re pre scri pti on d ru g pl an w he n yo u first b e co me el igib le for Me di care . If yo u d eci d e to wai t to en ro ll in a Me di ca re pre scri pti on d ru g pl an , yo u ma y enroll later, d uri ng Me di ca re Part D’ s an nu al en rol lmen t pe rio d, w hi ch run s e ac h yea r fro m Oc to b er 1 5 th ro ug h D e ce mb e r 7 b ut as a g en era l rule , if yo u de la y you r en rol lmen t in Med ica re Pa rt D af ter first b ec omi n g el igib le to en ro ll, yo u ma y h ave to p ay a h ig he r p remi u m (a pe nalty).

You sho ul d co mp a re you r cu rre n t co ve ra ge , in clu di ng wh ich d rug s a re co vere d at w ha t cost, w ith th e co vera g e a nd cost of th e pl an s of ferin g Me di ca re pre scri pti on d ru g cove rag e in you r are a. Se e th e Plan’s su mma ry pl an d escrip tio n for a su mma ry of th e Plan’s pre scri pti on d ru g co ve ra ge . If you d on ’t h ave a cop y, yo u ca n g et o ne b y co nta cti ng Sch oo l at th e p ho n e n u mb er o r a dd ress listed at th e e n d of this section .

If yo u ch o ose to en ro ll in a Me di ca re pre scri pti on d ru g pl an a nd ca nce l you r cu rre n t Sch o o l pre scri pti on d ru g co ve ra ge , b e a wa re th at yo u a nd you r d ep e n de n ts ma y no t b e ab le to g et thi s co vera g e b ack. To reg ai n co ve ra ge , you w ou ld h ave to re-en ro ll in th e Plan, p ursu an t to th e Plan’s eligibility a nd en rol lmen t rul es. You sho ul d revi ew th e Plan’s su mma ry pl an d escrip tio n to d ete rmi ne if a nd w h en yo u are al lo we d to a d d cove ra ge .

If yo u ca nce l o r lo se you r cu rre n t co vera g e a nd d o n ot ha ve pre scri pti on d ru g co vera g e for 6 3 da ys o r l on ge r p ri or to en ro lli ng in th e Me di ca re pre scri pti on d ru g co ve ra ge , your mon th ly p remi u m will b e at le ast 1 % p er mo n th g re at er for e ve ry mo n th th at yo u d id n ot h ave co vera g e for as l on g as yo u h ave Me di ca re pre scri pti on d ru g co ve ra ge . For exampl e, if n in ete en mo nt hs la pse w ith o ut co ve ra ge , you r p re miu m will al wa ys b e at le ast 1 9 % h ig he r th an it w ou ld h ave b ee n w ith o ut th e la pse in cove ra ge .

Mo re de ta ile d in fo rma tio n a bo u t Me di ca re pl an s th at offer pre scri pti on d ru g co vera g e is in th e “Me d ica re & Yo u” h an d bo o k. You will g et a co p y of th e h an d b oo k in th e mail e ve ry yea r fro m Me di care . You ma y al so b e co nta cte d di rectly b y Me di ca re pre scri pti on d ru g pl an s. For more in formati on a bo u t Me di ca re pre scri pti on d ru g cove ra ge : • Visit www. med ica re .gov.

• Ca ll you r Stat e H ea lth In sura nce Assista nce Prog ra m (se e th e in si de b ac k co ve r of you r co p y of th e “Med i care & You ” h an d b oo k for the ir te le p ho ne n umb e r) for pe rsona li zed help .

• Ca ll 1-800-MEDICARE (1-800-633-4227). TT Y users sho ul d call 877-486-2048.

If yo u h ave li mi ted i nco me a nd reso urce s, e xt ra h el p pa ying for Me di ca re pre scri pti on d ru g co vera g e is available . In formati on a bo u t thi s e xt ra h el p is avail able fro m th e Soci al Secu rity Admi nistra tio n (SSA) on li ne at www.s ocia lsec urity . gov, o r you ca n call th e m at 800772-1213. TT Y users sho ul d call 800-325-0778.

Remember: Ke ep thi s C re di ta bl e C ov era g e no ti ce . If you en ro ll in o ne of th e n e w pl an s a pp ro ved b y Me di ca re wh ich of fer pre scri pti on d ru g co ve ra ge , yo u ma y b e req ui red to p ro vid e a co p y of thi s n oti ce w h en yo u join to sh ow w he the r o r n ot yo u h ave mai nta in ed cred it ab le co vera g e a nd w he the r o r n ot yo u a re req ui red to p ay a h ig he r p remi u m (a pe nalty).

D is tri ct H um a n Re sour ce s D epa rtm ent

For more information about this notice or your current prescription drug coverage: C on t act th e H u ma n R esou rces D ep a rtme n t.

NOTE: You will rece ive thi s n oti ce an nua lly a nd at o the r times in th e fut ure, su ch as b efo re th e n ext p eri o d yo u ca n enroll in Me di ca re pre scri pti on d ru g co vera g e a nd if thi s cove rag e ch an ge s. You ma y al so re qu est a copy.

36 Visit www.cbebc.com for full plan details.

Important Legal Notices Notice of HIPAA Privacy Practices This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Effective Date of Notice: September 23, 2013 Sch oo l Plan is req ui red b y la w to ta ke rea son ab le ste ps to e nsure th e p ri vacy of you r pe rso nal ly id enti fiab le he alth in fo rma tio n a nd to in fo rm yo u a bo ut:

1.

th e Plan’s use s a nd di scl osures of Prote cte d He al th In formati on (PHI);

2.

you r p ri vacy rig hts w ith re sp e ct to you r PHI;

3.

th e Plan’s du ti es w ith re sp e ct to you r PHI;

4.

you r rig ht to file a comp la in t w ith th e Plan a nd to the Se cre ta ry of th e U. S. D ep a rtme n t of H ea lth a nd H uman Service s; an d

5.

th e p erso n o r o ffice to co n ta ct for fu rthe r in forma tion a bo u t th e Plan’s p ri vacy pra cti ce s.

Th e te rm “Prot ecte d H ea lth In formati on ” (PH I) in clu de s all individually id enti fiab le he al th in fo rma tio n tra nsmit ted or mai nta in ed b y th e Plan, reg ardl ess of fo rm (oral, wri tten, el ectroni c).

Section 1 – Notice of PHI Uses and Disclosures

Required PHI Uses and Disclosures U p o n you r req ue st, th e Plan is req ui red to gi ve yo u a ccess to you r PHI in o rde r to i nspe ct a nd co p y it.

U se a nd di scl osure of you r PHI ma y b e req ui red b y the Se cre ta ry of th e D ep a rtme n t of H ea lth a nd H u ma n Services to in ve sti gate o r d ete rmi ne th e Plan’s co mpl i an ce w ith the p ri vacy regul ation s.

Uses and disclosures to carry out treatment, payment and health care operations.

Th e Plan a nd its bu sin ess asso ci ate s will u se PHI w ith o ut your au th oriza tio n to ca rry o ut tre atme nt, p ayme n t a nd he al th care o pe ra ti on s. Th e Plan a nd its bu sin ess asso ci ate s (an d any he al th in surers p ro vid in g be ne fit s to Plan pa rtici pa nts) may al so di scl ose th e fol lo win g to th e Plan’s Bo ard of Tru stees: (1) PHI for p urp o ses rel ated to Plan ad mini st ra tio n (pa yme nt a nd he al th ca re op erati on s); (2) su mma ry he al th in forma tion for p urp o ses of he al th o r sto p lo ss i nsura nce un de rwrit ing o r for p urp o ses of mod if yin g th e Plan; a nd (3) en ro llmen t in fo rma tio n (w he th er a n in divid ual is el igib le for be ne fit s u nd er th e Plan). Th e Trustees h ave a me n de d th e Plan to pro tect you r PHI as req ui red b y fed eral law.

Treatment is th e pro vi si on , coo rdi na ti on o r ma n ag e me nt of he al th ca re a nd rel ated servi ces. It al so in clu de s b ut is no t li mi ted to con sult ati on s a nd referrals b e tw e en o ne o r mo re of you r provid ers.

For exa mple , th e Plan ma y di scl ose to a trea tin g ph ysi ci an the n am e of you r trea tin g rad iol og ist so th at th e ph ysi ci an may ask for you r X-rays fro m th e trea tin g radio logi st.

Payment in clu de s b ut is n ot li mi ted to acti on s to make co vera g e de te rmi na tio ns a nd p ayme n t (in clud in g billing, cla ims p ro cessi ng , sub rog at io n, revi ews for med ical n ecessi ty a nd a pp ro p ri at en ess of care , utilization revi ew an d preau thorization s).

For exa mple , th e Plan ma y tell a trea tin g d oct or w he th e r you a re el igib le for co vera g e o r w ha t p erce n ta ge of th e bill will be p ai d b y th e Plan.

Health care operations in clu de b ut a re n ot li mi ted to qu ality a sse ssme nt a nd i mpro veme nt , revi ewi ng co mp e te n ce or qu al ifica tion s of he al th ca re pro fessi on als, un de rwrit ing , p remi u m rati ng a nd o the r i nsura nce activiti es re lati ng to crea ti ng o r re ne wi n g i nsura nce co ntra cts. It al so inclu des ca se ma na g eme n t, co nd u cti ng o r a rra ng in g for med ical review , leg al servi ces a nd au di tin g fu nctio ns in cl udi ng fra ud a nd a bu se co mpl i an ce p rog rams, bu sin ess pl an nin g a nd d eve lo p me n t, bu sin ess ma n ag e me nt a nd ge ne ra l a dmin istra tive activiti es. H ow eve r, n o g en et ic in fo rma tio n can b e u sed o r di sclose d for u nd erw rit in g pu rpo se s.

For exa mple , th e Plan ma y u se in fo rma tio n to p roj ect futu re b en efi t co st s o r au di t th e a ccura cy of its cla ims pro cessin g fun cti ons.

Uses and disclosures that require that you be given an opportunity to agree or disagree prior to the use or release.

U nl ess yo u o bj ect, th e Plan ma y p ro vid e rel evant po rtio ns of you r p rot ect ed he al th in fo rma tio n to a family memb er, frie nd o r o the r p erso n yo u in di ca te is in volved in you r he alth ca re o r in he lp in g yo u rece ive p ayme n t for you r he al th care .

Also, if yo u a re n ot ca pa b le of a gree i ng o r o bj ecti ng to these di scl osures b ec au se of, for in stan ce, a n e me rge n cy situation, th e Plan will di sclose p rot ect ed he al th in fo rma tio n (as the Plan de te rmi ne s) in you r b est in terest. Afte r th e eme rgen cy, th e Plan will gi ve yo u th e o pp o rtu ni ty to o bj ect to futu re di scl osures to family a nd friend s.

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Important Legal Notices Uses and disclosures for which your consent, authorization or opportunity to object is not required.

9.

Th e Plan is al lo we d to u se a nd di scl ose you r PHI w ith o ut your au th oriza tio n u nd e r th e fol lo win g circumst ances: 1.

For tre atme nt, p ayme n t a nd he al th ca re op erati on s.

2.

Enrol lmen t in fo rma tio n ca n b e p rovi de d to th e Tru stees.

3.

Su mma ry he al th in fo rma tio n ca n b e p rovi de d to the Trustees for th e p urp o ses d esig n ate d ab ove.

4.

Wh e n req ui red b y law.

5.

Wh e n p ermi tt ed for p urp o ses of p ub li c he al th activi ti es, in clu di ng w h en n ece ssa ry to re po rt p ro du ct d efe cts an d to p ermi t p ro du ct recall s. PHI ma y al so b e di sclose d if yo u h ave b e en e xpo se d to a co mmun i cab l e di sea se or a re at risk of spre ad in g a di sea se o r con di ti on , if req uired b y law.

6.

Wh e n req ui red b y la w to re po rt in fo rma tio n a bo u t ab use, n eg le ct o r d ome sti c vio le nce to p ub li c au tho ri tie s if th ere exists a rea son ab le belief th at yo u ma y b e a victim o f a bu se , n eg le ct o r d ome sti c vio le nce. In wh ich case , th e Plan will p romp tl y in fo rm yo u th at su ch a di scl osure ha s b e en o r will b e ma d e un le ss th at no tice w ou ld ca use a risk of seri ous h arm. For th e p urp ose of re po rti ng chi ld a bu se o r n eg le ct, it is n ot n ecessa ry to in fo rm th e min or th at su ch a di scl osure ha s b e en or will b e ma de .

Di sclosu re ma y ge ne ra ll y b e ma d e to the min or’s p aren ts o r o the r rep resen tati ves a lth ou gh th ere ma y b e ci rcu msta nce s u nd e r fed eral o r state la w w he n th e p aren ts o r o the r rep resen tati ves ma y n ot b e given a ccess to th e min or’s PH I.

7.

Th e Plan ma y di scl ose you r PHI to a p ub li c he alth ove rsi gh t a ge n cy for ove rsi gh t activiti es req ui red b y law. Thi s in clu de s use s o r di sclosu res in civil, ad min istrati ve o r cri mina l in ve sti gati ons; in spe ct io ns; li cen su re o r di sci pli na ry acti on s (for exa mple , to investigate comp la in ts ag ai nst pro vi ders); a nd o the r activi ti es n ece ssa ry for a pp ro p ri at e ove rsi gh t of g overn men t b en efi t p rog ra ms (for exa mple , to in ve sti gate Me di ca re or Me di ca id fraud).

8.

Th e Plan ma y di scl ose you r PHI w h en req ui red for judi cial o r ad mini st ra tive p roce ed in g s. For exa mple , you r PHI ma y b e di sclose d in re sp o nse to a su b po e na o r di sco ve ry req ue st.

Wh e n req ui red for la w e nf orce me nt p urp ose s, in cl udi ng for th e p ur po se of id en tifyin g o r lo cati ng a susp ect, fug itive, mate ri al w itn ess o r missing p erso n. Also, w he n di scl osin g in fo rma tio n a bo u t a n in divid ual w h o is or is su spe cte d to b e a victim of a crime b ut on ly if the in divid ual a gre es to th e di sclosu re o r th e Plan is u na bl e to ob ta in th e in dividua l’s a gre e men t b ec au se of e merg en cy ci rcu msta nce s. Fu rthe rmore , th e la w e nf orce me nt officia l mu st rep rese nt th at th e in fo rma tio n is n ot in te nde d to b e u sed ag ai nst th e in divid ual , th e i mme di at e law e nf orce me nt acti vi ty w ou l d b e materia lly a nd ad ve rsel y a ffe cte d b y wa it ing to o bta in th e individual’s a gree men t a nd di sclosu re is in th e b est in terest o f th e in divid ual as d et ermi n ed b y th e exe rcise of th e Plan’s b est ju dg men t.

1 0 . Wh e n req ui red to b e gi ven to a co ron e r o r med ical exa mine r for th e p ur po se of id en tifyin g a d ece ase d p erso n, d ete rmin in g a ca use of d ea th o r o the r du ti es as a uth ori zed b y law. Also, di scl osure is p ermi tt ed to fune ra l di recto rs, con sisten t w ith ap pl ica bl e law, as n ece ssa ry to ca rry o ut the ir du ti es w ith re sp e ct to th e d ece de n t.

1 1 . Wh e n con sisten t w ith ap pl ica bl e la w a nd sta nd ard s of eth ical co n d uct if th e Plan, in g o o d faith, be li eves th e use o r di scl osure is n ece ssa ry to p re ven t o r le sse n a seriou s a nd i mmi ne nt th rea t to th e he al th o r safe ty of a p erso n or th e p ub li c a nd th e di scl osure is to a p erso n reason abl y ab le to p re ven t o r le sse n th e th re at, in clu di ng th e targ et of th e threa t.

1 2 . Wh e n a uth ori zed b y a nd to th e e xt en t n ece ssa ry to co mpl y w ith wo rkers’ co mpe n sat io n o r o the r similar p rog ra ms esta bl ish ed b y law.

Excep t as o the rw ise in di cate d in thi s no ti ce , use s an d di sclosu res will b e ma d e on ly w ith you r w ri tte n au thorizati on sub je ct to you r rig ht to revo ke su ch au th oriza tion.

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Important Legal Notices Uses and disclosures that require your written authorization.

Ot h er use s o r di scl osures of you r p rot ect ed he alth in fo rma tio n n ot d escri b ed a bo ve will on ly b e ma d e w ith your w ri tte n au tho ri zatio n. For exa mple , in g en era l a nd sub ject to spe cif ic con di tio ns, th e Plan will n ot u se o r di scl ose your psychi atri c no te s; th e Plan will n ot u se o r di scl ose your p rot ect ed he al th in fo rma tio n for marketi ng ; a nd th e Plan will n ot sell you r p rot ect ed he al th in formati on, un le ss yo u pro vi de a w ri tte n au th oriza tio n to d o so. You ma y revo ke wri tten au tho ri zatio ns at an y time , so l on g as th e revo cati on is in wri tin g. O n ce th e Plan rece ives you r w ri tte n revo ca tio n, it will on ly b e ef fecti ve for fu ture uses a nd di scl osures. It will no t b e ef fecti ve for an y in fo rma tio n th at ma y h ave b e en u sed or d isclo sed in rel ian ce u p on th e w ri tte n au th oriza tio n a nd prior to rece ivin g you r w ri tte n revocatio n.

Section 2 – Rights of Individuals Right to Request Restrictions on Uses and Disclosures of PHI You ma y re qu est th e Plan to restrict th e use s a nd di sclosures of you r PHI. H ow eve r, th e Plan is n ot req ui red to a gre e to you r re qu est (excep t th at th e Plan mu st co mpl y w ith your re qu est to restrict a di sclosu re of you r con fid en tia l in forma tion for p ayme n t o r he al th ca re o pe ra ti on s if yo u p ai d for the servi ces to w hi ch th e in fo rma tio n rela tes in full, o ut of po cket).

You o r you r p erson al rep resen tati ve will b e req ui red to sub mi t a w ri tte n re qu est to exe rcise thi s rig ht. Su ch req ue sts sho uld b e ma d e to th e Plan’s Pri vacy Official.

Right to Request Confidential Communications

Th e Plan will a cco mmo d a te rea son ab le req ue sts to recei ve co mmu n ica ti on s of PHI b y al ternati ve me an s o r at alternative lo cati on s if n ece ssa ry to p re ven t a di scl osure th at cou ld e nd a ng e r you.

You o r you r p erson al rep resen tati ve will b e req ui red to sub mi t a w ri tte n re qu est to exe rcise thi s right.

Su ch req ue sts sh ou ld b e ma d e to th e Plan’s Pri vacy Official.

Right to Inspect and Copy PHI You h ave a rig ht to i nspe ct a nd ob ta in a co p y of you r PHI co nta i ne d in a “de sig na te d re cord set,” fo r as l on g as the Plan mai ntai ns th e PHI. If th e in fo rma tio n yo u re qu est is in a n e le ct ron ic d esig n ate d re cord set, yo u ma y re qu est that th ese re co rd s b e tra nsmit ted el ectron icall y to you rsel f o r a d esig n ate d ind ivi dual.

Designated Record Set

In cl ud es th e med ica l re co rd s a nd billing re co rd s a bo ut in divid ual s mai nta in ed b y o r for a co vere d he al th care p ro vid er; en rol lmen t, p ayme nt , billing, cla ims ad jud icatio n a nd ca se o r med ica l ma n ag e me nt re cord syst ems main tain ed b y o r for th e Plan; o r o the r in fo rma tio n u sed in w ho le o r in p ar t b y o r for th e Plan to ma ke de cisio ns a bo u t ind ivi duals. In formati on u sed for qu al ity con tro l o r p ee r revi ew an alyse s a nd n ot u sed to ma ke de cisio ns a bo u t in divid ual s is n ot in the d esig n ate d re cord se t.

Th e re qu est ed in fo rma tio n will b e p rovi de d wi thi n 3 0 da ys if th e in fo rma tio n is mai nta in ed o n site o r wi thi n 6 0 da ys if the in fo rma tio n is mai nta in ed off site. A sing le 3 0 d ay exte nsi on is al lo we d if th e Plan is u na bl e to co mpl y w ith th e de adli ne.

You o r you r p erson al rep resen tati ve will b e req ui red to sub mit a w ri tte n re qu est to re qu est a ccess to th e PHI in your d esig n ate d re cord set. Su ch req ue sts sho ul d b e ma d e to the Plan’s Pri vacy Official.

If a ccess is d en ie d , yo u o r you r p erson al rep resen tati ve will b e p rovi de d w ith a w ri tte n de nia l, sett ing fo rth th e ba si s for th e de nia l, a d escrip tio n of h o w yo u ma y a pp ea l th e Plan’s de cisio n a nd a d escrip tio n of h o w yo u ma y co mp l ai n to the Se cre ta ry of th e U. S. D ep a rtme n t of H ea lth a nd H uman Services.

Th e Plan ma y ch arg e a rea sona bl e, co st -b ase d fee for co pyi n g re co rd s at you r req uest.

Right to Amend PHI You h ave th e rig ht to re qu est th e Plan to a me n d you r PHI o r a re cord a bo u t yo u in you r d esig n ate d re cord set for as l on g as th e PHI is mai nt ai ne d in th e d esig n ate d re cord se t.

Th e Plan h as 6 0 da ys af ter th e re qu est is ma d e to a ct o n the req ue st. A sing le 3 0 - d ay exte nsi on is al lo we d if th e Plan is u na bl e to co mpl y w ith th e de ad lin e. If th e re qu est is d en ie d in w ho le o r p art, th e Plan mu st p ro vid e yo u w ith a wri tten den ia l th at expl ain s th e ba si s for th e de nia l. You o r your p erson al rep resen tati ve ma y th e n sub mit a w ri tte n state me nt di sag re ei ng w ith th e de ni al a nd h ave th at sta teme nt in clud ed w ith an y fu ture di sclosu res of you r PH I. Su ch req ue sts sh ou ld b e ma d e to th e Plan’s Pri vacy Official.

You o r you r p erson al rep resen tati ve will b e req ui red to sub mi t a w ri tte n re qu est to re qu est a me nd me n t of th e PHI in your d esig n ate d re cord se t.

Protected Health Information (PHI) In cl ud es all individually id enti fiab le he al th in forma tion tra nsmit ted o r mai nta in ed b y th e Plan, reg ardl ess of form.

39 Visit www.cbebc.com for full plan details.

Important Legal Notices Right to Receive an Accounting of PHI Disclosures

At you r req ue st, th e Plan will al so p ro vid e yo u a n a cco un ti ng of di sclosu res b y th e Plan of you r PHI d uri ng th e six yea rs p ri or to th e d ate of you r req ue st. H ow eve r, such a ccou n ti ng will n ot i nclu d e PHI di sclosu res ma de : (1) to ca rry o ut tre atme nt, p ayme n t o r he al th ca re op eratio ns; (2) to in divid ual s a bo u t the ir o w n PHI; (3) p ursu an t to your au tho ri zatio n; (4) p ri or to April 1 4, 2 0 0 3 ; a nd (5) w he re oth e rwi se pe rmissib le u nd e r th e la w a nd th e Plan’s pri va cy p ra cti ce s. In ad di tio n, th e Plan n e ed n ot a cco un t for certai n i ncid enta l di sclosures.

If th e a ccou n ti ng ca nn o t b e p rovi de d wi thi n 6 0 da ys, an ad di tion al 3 0 da ys is al lo we d if th e in divid ual is gi ven a wri tten sta teme nt of th e rea son s for th e de la y a nd th e d ate b y wh ich th e a ccou n ti ng will b e pro vi ded .

If yo u re qu est mo re th an o ne a ccou n ti ng wi thi n a 1 2mo nth p eri o d, th e Plan will ch arg e a rea sona bl e, co st b ase d fee for e ac h su bse qu en t acco unt in g.

Su ch req ue sts sh ou ld b e ma d e to th e Plan’s Pri vacy Official.

Right to Receive a Paper Copy of This Notice Upon Request You h ave th e rig ht to ob ta in a p ap e r co p y of thi s N oti ce.

Such req ue sts sh ou ld b e ma d e to th e Plan’s Pri vacy Official.

A Note About Personal Representatives You ma y exe rcise you r rig hts th ro ug h a pe rso nal rep resen tati ve. Your p erson al rep resen tati ve will b e req uired to p ro d uce e vid en ce of hi s/he r a uth ori ty to a ct o n you r be hal f b efo re th at p erso n will b e gi ven a ccess to you r PHI o r al low ed to ta ke an y a ct io n for you . Pro of of su ch a uth ori ty ma y take o ne of th e fol lo win g forms:

Thi s N oti ce is ef fecti ve Se pt emb e r 2 3 , 2 01 3 , a nd th e Plan is req ui red to co mpl y w ith th e te rms of thi s N oti ce.

H ow eve r, the Plan rese rves th e rig ht to ch a ng e its p ri vacy p racti ces an d to a pp ly th e ch an g es to an y PHI re ce i ved o r mai nta in ed by th e Plan p ri or to th at da te . If a p ri vacy p racti ce is ch an ge d , a revi se d version of thi s N oti ce will b e p rovi de d to all pa rtici pa nts for w h o m th e Plan still mai ntai ns PHI. Th e revised N oti ce will b e di strib ute d in th e sa me ma nn e r as th e initial N oti ce w as p rovi de d o r in an y o the r pe rmissib le mann er.

If th e revi se d version of thi s N oti ce is p oste d , yo u will also rece ive a co p y of th e N oti ce o r in fo rma tio n a bo u t an y material ch a ng e a nd h o w to rece ive a co p y of th e N oti ce in th e Plan’s n ext an nu al mail ing . Ot he rwi se, th e revi se d version of this N oti ce will b e di strib ute d wi thi n 6 0 da ys of th e ef fecti ve da te of an y mate ri al ch a ng e to th e Plan’s po li ci es reg ard in g the use s o r di sclosu res of PHI, th e individual’s p ri vacy rig hts, the du ti es of th e Plan o r o the r p ri vacy p racti ces sta ted in this No tice.

Minimum Necessary Standard Wh e n usi ng o r di scl osin g PHI o r w h en req ue sti ng PHI from a no th er co vere d en ti ty, th e Plan will ma ke rea son ab le effo rts n ot to use , di scl ose o r re qu est mo re th an th e min imum a mo un t of PHI n ece ssa ry to a cco mp li sh th e in ten ded p ur po se of th e use , di sclosu re o r req ue st, ta kin g into con sid era ti on pra ctical a nd te chn ol og ica l li mita tions. Wh en req ui red b y law, th e Plan will restrict di sclosu res to the li mi ted d ata set, o r o the rw ise as n ecessa ry, to th e min imum n ece ssa ry in fo rma tio n to a cco mp li sh th e i nte n de d p urpo se.

H ow eve r, th e mi ni mum n ece ssa ry sta nd a rd will n ot a pp ly in th e fol lo win g situations: 1.

di scl osures to o r req ue sts b y a he al th ca re p ro vid er for trea tme nt;

1.

a p ow e r of a ttorn ey for he al th ca re pu rpo se s;

2.

use s o r di sclosu res ma d e to th e individual;

2.

a co u rt o rde r of a pp o in tme n t of th e p erso n as the co nse rvato r o r g ua rd i an of th e individual; or

3.

di scl osures ma d e to th e Se cre ta ry of th e U.S. D ep a rtme n t of H ea lth a nd H u ma n Services;

3.

a n in divid ual w h o is th e p are nt of a n u ne ma n ci pa te d mi no r chi ld ma y ge ne ra ll y a ct as th e child ’s pe rso nal rep resen tati ve (sub ject to state law).

4.

use s o r di scl osures th at a re req ui red b y la w; an d

5.

use s o r di sclosu res th at a re req ui red for th e Plan’s co mpl i an ce w ith le gal regul ation s.

Th e Plan retai ns di scre tio n to d en y a ccess to you r PHI by a p erson al rep resen tati ve to p ro vid e p ro te ctio n to th ose vu ln erab le p eo p le w h o d e pe n d o n o the rs to exe rcise thei r rig hts u nd e r th ese rul es a nd w h o ma y b e sub je ct to a bu se or ne gl ect.

De-Identified Information

Thi s n oti ce d oe s n ot a pp ly to in fo rma tio n th at ha s b e en de - id en tifi ed. D e- id en tifi ed in fo rma tio n is in fo rma tio n th at do es n ot id en tify a n in divid ual a nd w ith re sp e ct to w hi ch th ere is no rea son ab le ba si s to be li eve th at th e in fo rma tio n ca n b e use d to id en tify a n ind ivi dual.

Section 3 – The Plan’s Duties Th e Plan is req ui red b y la w to mai ntai n th e p ri vacy of PHI an d to p ro vid e in divid ual s (pa rticip an ts a nd be ne ficia ri es) wi th n oti ce of th e Plan’s le gal du ti es a nd p ri vacy pra cti ce s.

40 Visit www.cbebc.com for full plan details.

Important Legal Notices Summary Health Information

Th e Plan ma y di scl ose “su mma ry he al th in fo rma tio n” to the Trustees for ob ta ini ng i nsura nce p remi u m b id s o r mod ifyin g, a men d in g o r te rmi na tin g th e Plan. “Su mma ry he alth in fo rma tio n” summari ze s th e cla ims hi sto ry, cla ims exp en se s o r typ e of cla ims e xpe ri en ce d b y pa rtici pa nts a nd exclud es id en tifyin g in fo rma tio n in a cco rd a nc e w ith H IPAA. Notification of Breach Th e Plan is req ui red b y la w to mai ntai n th e p ri vacy of pa rtici pa nts’ PHI a nd to p ro vid e in divid ual s w ith n oti ce of its le gal du ti es a nd p ri vacy p ra cti ce s. In th e e ve nt of a b rea ch of u nse cu red PHI, th e Plan will no tify a ffe cte d in divid ual s of the bre ach.

Section 4 – Your Right to File a Complaint With the Plan or the HHS Secretary If yo u be li eve th at you r p ri vacy rig hts h ave b e en vio late d, you ma y co mp l ai n to th e Plan. Su ch comp la in ts sho ul d b e mad e to th e Plan’s Pri vacy Official.

You ma y file a comp la in t w ith th e Se cre ta ry of th e U.S. D ep a rtme n t of H ea lth a nd H u ma n Servi ces, H u be rt H. H um ph re y Bui ldi ng , 2 0 0 In d e pe n d en ce Aven u e SW, Wa sh in gto n, D .C. 2 02 0 1 . Th e Plan will n ot retali ate ag ain st yo u for filing a compl ain t.

Section 5 – Whom to Contact at the Plan for More Information If yo u h ave an y q ue st io ns reg ard in g thi s n oti ce o r th e sub jects a dd re ssed in it, yo u ma y co n ta ct th e Plan’s Pri vacy Official.

Su ch q ue st io ns sh ou ld b e d irect ed to th e Plan’s Privacy Offi ci al at: D is tri ct H um a n Re sour ce s D epa rtm ent Conclusion PHI u se a nd di scl osure b y th e Plan is reg ul a ted b y a fede ra l la w kn o w n as H IPAA (the H ea lth In sura nce Portabi lity an d Accou nta bi l ity Act). You ma y fi nd th ese rul es at 4 5 C o d e of Fed eral Re gu lati on s Parts 1 6 0 a nd 1 6 4. Th e Plan in tend s to co mpl y w ith th ese reg ula tio ns.

Thi s N oti ce a tte mpt s to summa rize th e reg ula tio ns.

Th e reg ula tio ns will sup erse de an y d iscre pa ncy b e tw e en th e in fo rma tio n in thi s N oti ce an d th e regul ation s.

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If yo u o r you r chi ld re n a re el igib le for Me di ca id o r C HI P an d you’ re el igib le for he al th co vera g e fro m you r emp loyer, your state ma y h ave a p remi u m assi sta nce p ro gra m th at ca n he lp p ay for co ve ra ge , usi ng fu nd s fro m the ir Me di ca id o r CH IP p rog rams. If yo u o r you r chi ld re n are n’t el igib le for Med ica id o r CHIP, yo u w on ’t b e el igib le for th ese p remi u m assistance p rog ra ms, b ut yo u ma y b e ab le to b uy in divid ual in surance co vera g e th ro ug h th e H ea lth In sura nce Ma rke tp la ce . For mo re in formati on, visit www.he althca re .gov.

If yo u o r you r d ep e nd e nt s a re al rea dy en rol le d in Me di ca id or C HI P a nd yo u live in a Stat e listed be lo w, co n ta ct you r Sta te Me di ca id o r C HI P o ffice to fi nd o ut if p remi u m assi sta nce is available .

If yo u o r you r d ep e nd e nt s a re N OT curren tly en ro lle d in Me di ca id o r CHIP, a nd yo u th in k yo u o r an y of your d ep e n de n ts mi gh t b e el igib le for ei th er of th ese pro grams, co n ta ct you r Stat e Me di ca id o r C HI P o ffice o r dial 1-877- KIDS NOW o r www .ins ure k idsn ow.go v to fi nd o ut h o w to ap pl y. If yo u qu alify, ask you r state if it ha s a p ro gra m that mi gh t h el p yo u p ay th e p remi ums for a n emp lo ye r-spo nso red pl an.

If yo u o r you r d ep e nd e nt s a re el igib le for p remi u m assistance u nd e r Me di ca id o r CHIP, as well as el igib le u nd e r your e mp lo yer pl an , you r e mp lo yer mu st al low yo u to en ro ll in your e mp lo yer p la n if yo u are n’t al rea dy en roll ed . Thi s is call ed a “spe ci al e nrol l me nt ” o pp ortu ni ty, a nd you must request coverage within 60 days of being determined eligible for premium assistance. If yo u h ave q ue st io ns a bo ut en ro lli ng in you r e mp lo yer pl an , co n ta ct th e D ep a rtme n t of L ab o r at ww w.a sk eb sa .do l.g ov o r call 1-866-444-EBSA (3272).

If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of March 17, 2025. Contact your State for more information on eligibility.

41 Visit www.cbebc.com for full plan details.

Important Legal Notices Texas – Medicaid Website: https://www.hhs.texas.gov/services/financial/healthinsurance-premium-payment-hipp-program Phone: 1-800-440-0493 To se e if an y o the r Stat es h ave a d d ed a p remi u m assistance p ro gra m sin ce March 17, 2025, o r for mo re in fo rma tio n on spe ci al en rol lmen t rig hts, yo u ca n co n ta ct ei ther: U. S. D ep a rtme n t of L ab or Empl oye e Ben efi ts Secu rity Admini strati on www. dol.gov /ag enc ies /ebs a 1-866-444-EBSA (3272) U. S. D ep a rtme n t of H ea lth a nd H u ma n Services C en te rs for Me di ca re & Me di ca id Services www .cm s. hhs .gov 1-877-267-2323, Menu Option 4, Ext. 61565

Continuation of Coverage Rights Under COBRA U n de r th e Fed eral C on so l id ate d Omn i b us Bu dg et Re concil ia tio n Act of 1 9 8 5 (C OBR A), if yo u a re cove red u nd e r th e D i stri ct g ro up he al th pl an yo u a nd you r elig ible d ep e n de n ts ma y b e en titl ed to co nti n ue you r g ro up he alth be ne fit s co vera g e u nd e r th e D i stri ct p la n af ter you h ave le ft e mpl o ymen t w ith th e co mp a ny. If yo u wi sh to e le ct C O BR A co ve ra ge , co n ta ct you r H u ma n Re sources D ep a rtme n t for th e ap pl ica bl e de ad li ne s to e le ct cove rag e a nd p ay th e initial pre mium.

Plan Contact Information: D is tri ct H um a n Re sour ce s Adm inistr ator

Your Rights and Protections Against Surprise Medical Bills Wh e n yo u g et e me rge n cy ca re o r g et tre ate d b y a n o ut -of- n et w ork p ro vid er at a n in-n et w ork ho spita l o r amb ul ato ry surgi ca l cen ter, yo u a re p rot ect ed fro m surp ri se billing or b al an ce billing.

What is “balance billing” (sometimes called “surprise billing”)?

Wh e n yo u se e a d oct or o r o the r he al th ca re pro vi der, you ma y o we certa i n o ut-of-p ocke t costs, su ch as a cop ayme nt, coi nsu ran ce, a nd /o r a d ed ucti bl e. You ma y h ave o the r costs o r h ave to p ay th e en tire bill if yo u se e a p ro vid er o r visit a he al th ca re facility th at isn’t in you r he al th plan’s n etw ork.

“O u t- of-n e tw o rk” d escri be s p ro vid ers a nd facilities th at ha ve n ot sig ne d a co nt ract w ith you r he al th pl an . Ou t of-n etw o rk p ro vid ers ma y b e p ermi tt ed to bill yo u for th e di fferen ce b e tw e en w ha t you r p la n a gre e d to p ay a nd th e full a mou nt ch a rge d for a servi ce. Thi s is cal le d “b al a nce billing.” This a mo un t is likely mo re th an inn et w ork co st s for th e same servi ce a nd mi gh t n ot co u nt to wa rd you r an nu al o ut-of- p ocke t limit.

“Surp ri se bi llin g” is a n u ne xp ect ed b al an ce bill. Thi s can h ap p e n w h en yo u can ’t con tro l w h o is in volved in you r ca re — like w h en yo u h ave a n e me rge n cy o r w h en yo u sche d ul e a visit at a n in- n et w ork facility b ut a re u ne xpe cte dl y tre ate d by a n o ut -of-n et w ork provide r.

42 Visit www.cbebc.com for full plan details.

Important Legal Notices You are protected from balance billing for:

Y our healt h plan gener ally must :

• E mer genc y s erv ices – If y ou hav e an em er gen c y medical c ondit io n an d ge t em er gen c y s erv ices f rom an out-of- ne t wo rk pr ovide r or facility, t he mo st t he pr ovide r or facility may bill y ou is y our plan’s in- ne t wo rk c ost -shar ing am oun t (s uch as c opa ym ent s an d co in sura nce) . You c ann ot b e ba la nc e billed for t hese em er gen c y ser vices .

This include s s erv ices y ou may ge t af ter y ou ar e in st able c ondit io n, unles s y ou give w ritt en c ons en t an d give up y our pr ote ct io ns no t t o b e ba lanc ed billed for t hese post- st abilizat ion ser vices .

• C ert ain s erv ices at an in-ne t wo rk hos pit al or ambulat ory sur gical c ent er – W he n y ou ge t s erv ices f rom an in- ne t wo rk hos pit al or amb ulat ory sur gical cen ter, cer tain pr ovide rs t her e may b e ou t-of-ne tw or k . In t hese c ases , the mo st t hos e pr ovide rs may bill y ou is y our plan’s in-ne tw ork c ost -sh aring am oun t. This applies t o em er gen c y medicine, anes the sia, pat hology , radiology, laborat ory , neonatology, ass istan t s urg eon, hospitalist, or intensivis t ser vices .

Thes e pr ovide rs c ann ot ba la nc e bill y ou an d may no t ask y ou t o give up y our pr ote ct io ns no t t o b e ba la nc e billed.

• C ov er em er gen c y s erv ices w itho ut req uiring y ou t o get app rov al for s erv ices in ad v anc e (pr ior authorizat ion).

• C ov er em er gen c y s erv ices by ou t-ofne tw ork prov iders .

• Bas e w hat y ou ow e t he pr ovide r or facility (cos t- sha ring) on w hat it w ould pay an inne t wo rk prov ider or facility an d s how th at am oun t in y our ex planation of benefits .

• C ou nt any am oun t y ou pay for em er gen c y s erv ices or ou t-of-ne t wo rk s erv ices t owa rd y our de duc tible and ou t-of-po ck et limit.

If y ou believe y ou hav e be en w ron gly billed, y ou may c ont ac t y our ins uran ce prov ider. Visit ww w.c ms .go v/no surpri ses for mo re info rmation ab ou t y our right s un de r fed eral law.

If y ou ge t ot her s erv ices at t hese in-ne t wo rk facilities, ou t-of- ne t wo rk pr ovide rs c ann ot ba la nc e bill yo u, unles s y ou give w ritt en c ons en t an d give up y our prot ect ion s.

You ar e nev er re quired t o give up y our pr ote ct io ns fr om ba la nc e billing. You also ar e no t re quired t o ge t c ar e ou t-of- ne tw or k . You c an c ho os e a pr ovide r or facility in y our plan’s net wo rk .

When balance billing is not allowed, you also have the following protections: • You ar e only res pons ible for pay ing y our sh are of t he cos t (like t he c opa ym ent s , c oinsu ranc e, an d ded uct ibles that y ou w ould pay if t he pr ovide r or facility w as in-net work ). Your healt h plan will pay ou t-of-ne t wo rk pr ovide rs and facilities direc tly.

43 Visit www.cbebc.com for full plan details.

This brochure highlights the main features of the CBEBC employee benefits program. It does not include all plan rules, details, limitations, and exclusions. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be an inconsistency between this brochure and the legal plan documents, the plan documents are the final authority. CBEBC reserves the right to change or discontinue its employee benefits plans at anytime.

44 Visit www.cbebc.com for full plan details.