2025-26 Colorado Springs Charter Academy Benefit Guide by Higginbotham Public Sector

Benefit Contact Information

COLORADO SPRINGS CHARTER ACADEMY BENEFITS

Higginbotham Public Sector (833) 869-1368

www.mybenefitshub.com/ cscharteracademy

Kaiser Permanente (303) 338-3800

https://about.kaiserpermanente.org

HEALTH SAVINGS ACCOUNT (HSA) HOSPITAL CASH

Kaiser Permanente (800) 632-9700

https://about.kaiserpermanente.org

Chubb Group #100000250 (888) 499-0425

educatorclaims@chubb.com

TELEHEALTH

Recuro Health (855) 673-2876

www.recurohealth.com

DENTAL

MetLife (800) 275-4638

www.metlife.com/dental Network: PDP Plus

VISION DISABILITY ACCIDENT

MetLife (800) 275-4638

www.metlife.com/vision Network: VSP Choice

Lincoln Financial Group Group #1213109 (800) 423-2756 www.lfg.com

CRITICAL ILLNESS LIFE AND AD&D

Chubb Group #100000250 (888) 499-0425 educatorclaims@chubb.com

FLEXIBLE SPENDING ACCOUNT (FSA)

Higginbotham (866) 419-3519

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

Don’t Forget!

Lincoln Financial Group Group #1213109 (800) 423-2756 custservsupportteam@lfg.com

Chubb Group #100000250 (888) 499-0425

educatorclaims@chubb.com

INDIVIDUAL LIFE

5Star Life Insurance Company (866) 863-9753 www.5starlifeinsurance.com

• Login and complete your benefit enrollment from 05/02/2025 - 05/31/2025

• Enrollment assistance is available by calling Higginbotham Public Sector at (833) 869-1368.

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

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

Mobile Enrollment

Enrollment made easy with your smartphone or tablet.

Text “BENEFITS” to (214) 831- 4313 to opt into important text message* enrollment reminders. Scan the QR code to go to your benefit website for:

• Benefit Resources

• Online Enrollment

• Interactive Tools

• And more!

*Standard message rates may apply. OR SCAN

Login Process

1 www.mybenefitshub.com/cscharteracademy

CLICK LOGIN

Enter your Information

• Last Name

• Date of Birth

• Last Four (4) of Social Security Number

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

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

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

Annual Benefit Enrollment

Annual Enrollment

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

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

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

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

New Hire Enrollment

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

Q&A

Who do I contact with Questions?

For supplemental benefit questions, you can contact your Benefits Office or you can call Higginbotham Public Sector at (833) 869-1368 for assistance.

Where can I find forms?

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

How can I find a Network Provider?

For benefit summaries and claim forms, go to the Colorado Springs Charter Academy benefit website: www.mybenefitshub.com/cscharteracademy. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section.

When will I receive ID cards?

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

If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.

What is Guaranteed Coverage?

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

What is a Pre-Existing Conditions?

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

Section 125 Cafeteria Plan Guidelines

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

CHANGES IN STATUS (CIS):

Marital Status

Change in Number of Tax Dependents

Change in Status of Employment Affecting Coverage Eligibility

Gain/Loss of Dependents’ Eligibility Status

Judgment/ Decree/Order

Eligibility for Government Programs

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

QUALIFYING EVENTS

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

A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.

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

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

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

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

Annual Benefit Enrollment

Employee Eligibility Requirements

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

Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2025 benefits become effective on September 1, 2025, you must be actively-at-work on September 1, 2025 to be eligible for your new benefits.

Dependent Eligibility Requirements

Dependent Eligibility: You can cover eligible dependent

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

Actively-at-Work

You are performing your regular occupation for the employer on a full-time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2025 please notify your benefits administrator.

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

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

FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse’s FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance.

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

Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Higginbotham Public Sector from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee’s enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.

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

Description

Health Savings Account (HSA)

(IRC Sec. 223)

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

Employer Eligibility A qualified high deductible health plan

Contribution Source Employee and/or employer

Account Owner Individual

Underlying Insurance

Requirement High deductible health plan

Minimum Deductible

Maximum Contribution

Permissible Use Of Funds

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

Year-to-year rollover of account balance?

$1,650 single (2025)

Flexible

Spending Account (FSA)

(IRC Sec. 125)

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

All employers

Employee and/or employer

Employer

None

$3,300 family (2025) N/A

$4,300 single (2025)

$8,550 family (2025)

55+ catch up +$1,000

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

$3,300 (2025)

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

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

Yes, will roll over to use for subsequent year’s health coverage. No. CSCA will have a 30 day grace period.

Does the account earn interest? Yes No

Portable?

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

Medical Insurance

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

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

Summary of Benefits and Coverage: What this Plan Covers & What You Pay for

Coverage for: Individual / Family | Plan Type: HDHP

7500/100% HSA

Coverage Period: Beginning on or after 01/01/2025 : KP S e l e c t CO Bronze

The Summary of Benefits and Coverage (SBC) document will help you choose a health plan . The SBC shows you how you and the plan would share the cost for covered health care services.

NOTE: Information about the cost of this plan (called the premium ) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage see https://kp.org/plandocuments or call 1-855-249-5005 (TTY:711). For general definitions of common terms, such as allowed amount , balance billing , coinsurance , copayment , deductible , provider , or other underlined terms, see the Glossary. You can view the Glossary at www.healthcare.gov/sbc-glossary/ or call 1-855-249-5005 (TTY:711) to request a copy. Important Questions Answers Why this Matters: What is the overall deductible ? $ 7,500 Individual / $ 15,000 Family

Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan , each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible . Are there services covered before you meet your deductible ? Yes. Preventive care and services indicated in chart starting on page 2.

Yes . $ 50 Individual for Pediatric Dental in network . There are no other specific deductibles . You must pay all of the costs for these services up to the specific deductible amount before this plan begins to pay for these services.

This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible . See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/ . Are there other deductibles for specific services?

The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan , they have to meet their own out-ofpocket limits until the overall family out-of-pocket limit has been met.

What is the out-of-pocket limit for this plan ? $ 7,500 Individual / $ 15,000 Family

Premiums , health care this plan doesn’t cover, and services indicated in chart starting on page 2. Even though you pay these expenses, they don't count toward the out-of-pocket limit .

What is not included in the out-of-pocket limit ?

This plan uses a provider network . You will pay less if you use a provider in the plan’s network . You will pay the most if you use an out-of-network provider , and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays ( balance billing ). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.

Will you pay less if you use a network provider ? Yes. See www.kp.org or call 1-855-249-5005 (TTY: 711)for a list of network providers .

Why this Matters:

Important QuestionsAnswers

Do you need a referral to see a specialist ? Yes, but you may self-refer to certain specialists . This plan will pay some or all of the costs to see a specialist for covered services but only if you have a referral before you see the specialist .

chart are after your deductible has been met, if a deductible applies.

shown in

You may have to pay for services that aren't preventive . Ask your provider if the services needed are preventive . Then check what your plan will pay for.

You Will Pay Non-Plan Provider (You will pay the most)

Up to a 30-day supply (retail); up to a 90-day supply (mail order). Prescription refills of ongoing maintenance medications must be filled at a Kaiser Permanente Pharmacy. Subject to formulary guidelines. Formulary preventive and contraceptive drugs in all tiers are no charge, deductible does not apply.

Up to a 30-day supply (retail); up to a 90-day supply (mail order). Subject to formulary guidelines.

Up to a 30-day supply (retail); up to a 90-day supply (mail order). Subject to formulary guidelines, when approved through the exception process.

will pay the least)

If you need drugs to treat your illness or condition More information about prescription drug coverage is available at http:// www.kp.org/formulary

Up to a 30-day supply (retail). Subject to formulary guidelines, when approved through the exception process. If you have

Non-Plan Providers are not covered when inside the service area. If you have a hospital stay

You Will Pay Non-Plan Provider (You will pay the most) Limitations, Exceptions & Other

Annual Wellness Visit: No charge, deductible does not apply. Virtual Care Services: No charge.

You Will Pay Plan Provider (You will pay the least)

Services You May Need

If you need mental health, behavioral health, or substance abuse services Outpatient services No charge Not covered

Depending on the type of services, a copayment , coinsurance , or deductible may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound.) Childbirth/delivery professional services No charge

Outpatient: 20 visit limit / therapy / year (autism spectrum disorders are not subject to visit limit). Virtual Care Services: No charge. Inpatient: Limited to 60 days / condition / year. Habilitation services Outpatient services: No charge Not covered 20 visit limit / therapy / year (autism spectrum disorders are not subject to visit limit). Virtual Care Services: No charge. Skilled nursing care No charge Not covered 100-day limit / year. Durable medical equipment No charge Not covered Subject to formulary guidelines. Hospice service No charge Not covered

None

Limitations, Exceptions & Other Important Information

What You Will Pay Non-Plan Provider (Y ou will pay the most)

Limited to members up to the end of the year in which the member turns 19.

Limited to members up to the end of the year in which the member turns 19. One pair of frames and lenses or contact lenses / 24 months.

Limited to members up to the end of the month in which the member turns 19; limited coverage for diagnostic and preventive service s, minor restorative (fillings), simple extractions and crowns.

What You Will Pay Plan Provider (Y ou will pay the least)

Services You May Need

Event

Children's eye exam No charge Not covered

Children's glasses No charge Not covered

Children's dental check-up No charge for preventive / diagnostic services after pediatric dental deductible . 50% coinsurance for basic / major services after pediatric dental deductible . Not covered

If your child needs dental or eye care

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services .)

● Routine foot care

● Weight loss programs

● Long-term care

● Non-emergency care when traveling outside the U.S.

● Cosmetic surgery

● Hearing aids (Adult)

Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)

● Infertility treatment

● Private-duty nursing (Inpatient)

● Routine eye care (Adult)

● Chiropractic care (20 visit limit/year)

● Dental care (Adult)

● Hearing aids (Up to age 18)

● Abortion

● Acupuncture (10 visit limit/year)

● Bariatric surgery

Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is shown in the chart below . Other coverage options may be available to you too, including buying individual insurance coverage through the Health

Insurance Marketplace . For more information about the Marketplace , visit www.HealthCare.gov or call 1-800-318-2596.

Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim . This complaint is called a grievance or appeal . For more information about your rights, look at the explanation of benefits you will receive for that medical claim . Your plan documents also provide complete information on how to submit a claim , appeal , or a grievance for any reason to your plan . For more information about your rights, this notice, or assistance, contact the agencies in the chart below .

Contact Information for Your Rights to Continue Coverage & Your Grievance and Appeals Rights:

1-855-249-5005 (TTY: 711) or www.kp.org/memberservices

1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform

Kaiser Permanente Member Services

Department of Labor’s Employee Benefits Security Administration

examples are based on self-only coverage.

About these Coverage Examples: This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost sharing amounts ( deductibles , copayments and coinsurance ) and excluded services under the plan . Use this information to compare the portion of costs you might pay under dif ferent health plans . Please note these

Mia's Simple Fracture

The plan would be responsible for the other costs of these

The Summary of Benefits and Coverage (SBC) document will help you choose a health plan . The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium ) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage see https://kp.org/plandocuments or call 1-855-249-5005 (TTY:711). For general definitions of common terms, such as allowed amount , balance billing , coinsurance , copayment , deductible , provider , or other underlined terms, see the Glossary. You can view the Glossary at www.healthcare.gov/sbc-glossary/ or call 1-855-249-5005 (TTY:711) to request a copy.

$ 9,000 Individual / $ 18,000 Family

What is the out-of-pocket limit for this plan ?

Premiums , health care this plan doesn’t cover, and services indicated in chart starting on page 2. Even though you pay these expenses, they don't count toward the out-of-pocket limit .

What is not included in the out-of-pocket limit ?

This plan will pay some or all of the costs to see a specialist for covered services but only if you have a referral before you see the specialist .

Will you pay less if you use a network provider ? Yes. See www.kp.org/co-option or call 1-855-249-5005 (TTY: 711) for a list of network providers .

Do you need a referral to see a specialist ? Yes, but you may self-refer to certain specialists .

All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.

Limitations, Exceptions & Other Important Information

What You Will Pay Plan Provider (You will pay the least) What You Will Pay Non-Plan Provider (You will pay the most)

Services You May Need

Virtual Care Services: No charge, deductible does not apply

You may have to pay for services that aren't preventive . Ask your provider if the services needed are preventive . Then check what your plan will pay for.

Diagnostic lab services: 40% coinsurance in the outpatient department of a hospital.

Primary care visit to treat an injury or illness No charge, deductible does not apply Not

Specialist visit $80 / visit, deductible does not apply. 40% coinsurance for other covered services received during a visit. Not covered

If you visit a health care provider's office or clinic

Preventive care / screening / immunization No charge, deductible does not apply Not covered

None

You Will Pay Non-Plan Provider (You will pay the most)

Services You May Need What You Will Pay Plan Provider (You will pay the least)

Up to a 30-day supply (retail); up to 90-day supply (mail order). Subject to formulary guidelines.

Up to a 30-day supply (retail); up to 90-day supply (mail order). Subject to formulary guidelines, when approved through the exception process.

Up to a 30-day supply (retail). Subject to formulary guidelines, when approved through the exception process.

$20 retail and $40 mail order / prescription , deductible does not apply. Not covered

$125 retail and $250 mail order / prescription , deductible does not apply. Not covered

$300 retail and $600 mail order / prescription , deductible does not apply. Not covered

drugs

Generic drugs

If you need drugs to treat your illness or condition More information about prescription drug coverage is available at http:// www.kp.org/formulary

$650 retail / prescription , deductible does not apply Not covered

$80 / visit, deductible does not apply

/ visit, deductible does not

Non-Plan Providers are not covered when inside the service area. If you have a hospital stay

Group visit: No charge, deductible does not apply. Annual Wellness Visit and Virtual Care Services: No charge, deductible does not apply.

Depending on the type of services, a copayment , coinsurance , or deductible may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound.)

Outpatient: 20 visit limit / therapy / year (autism spectrum disorders not subject to visit limit). Autism spectrum disorders: No charge, deductible does not apply. Virtual Care Services: No charge, deductible does not apply. Inpatient: Limited to 60 days / condition / year.

20 visit limit / therapy / year (autism spectrum disorders not subject to visit limit). Autism spectrum disorders: No charge, deductible does not apply. Virtual Care Services: No charge, deductible does not apply.

100-day limit / year.

Subject to formulary guidelines.

None

Limitations, Exceptions & Other Important Information

What You Will Pay Non-Plan Provider (You will pay the most)

Limited to members up to the end of the year in which the member turns 19.

Limited to members up to the end of the year in which the member turns 19. One pair of frames and lenses or contact lenses / 24 months.

Limited to members up to the end of the month in which the member turns 19; limited coverage for diagnostic and preventive service s, minor restorative (fillings), simple extractions and crowns.

What You Will Pay Plan Provider (You will pay the least)

Services You May Need

Event

Children's eye exam No charge, deductible does not apply Not covered

50% coinsurance , deductible does not apply Not covered

Children's glasses

If your child needs dental or eye care

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services .)

● Routine foot care

● Weight loss programs

● Long-term care

● Non-emergency care when traveling outside the U.S.

● Routine eye care (Adult)

● Cosmetic surgery

● Dental care (Adult)

● Hearing aids (Adult)

Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)

● Infertility treatment

● Private-duty nursing (Inpatient)

● Chiropractic care (20 visit limit/year)

● Hearing aids (Up to age 18)

● Abortion

● Acupuncture (10 visit limit/year)

● Bariatric surgery

Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is shown in the chart below. Other coverage options may be available to you too, including buying individual insurance coverage through the Health

Insurance Marketplace . For more information about the Marketplace , visit www.HealthCare.gov or call 1-800-318-2596.

www.kp.org/memberservices

Contact Information for Your Rights to Continue Coverage & Your Grievance and Appeals Rights:

1-855-249-5005 (TTY: 711) or

Kaiser Permanente Member Services

examples are based on self-only coverage.

Telehealth Recuro Health

ABOUT TELEHEALTH

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

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

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

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

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

• Are unable to see your primary care physician

When to Use Telehealth:

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

• Sore throat

• Headache

• Stomachache

• Cold

• Flu

• Allergies

• Fever

• Urinary tract infections

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

Recuro Behavioral Health

Psychiatry

Therapy and Counseling Health Risk Assessment

Risk Stratification Integrated Prescriptions

Managing stress or life changes can be overwhelming but it’s easier than ever to get help right in the comfort of your own home. Visit a counselor or psychiatrist by phone, secure video, or Recuro App.

• Talk to a licensed counselor or psychiatrist from your home, office, or on the go!

• Affordable, confidential online therapy for a variety of counseling needs.

Behavioral Health and Psychiatry is only available for dependents 14 and up

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

• Online – www.recurohealth.com

• Phone – 1.855.6RECURO

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

Health Savings Account (HSA)

Kaiser Permanente

ABOUT HSA

A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP).

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

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.

• Pay for eligible medical costs.

• Keep HSA funds in cash.

• Make annual HSA contributions.

• Pay for medical costs with other funds.

• Invest HSA funds.

If you are age 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch-up contribution for the entire plan year.

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.

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

HSA Eligibility

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

• Not enrolled in a Health Care Flexible Spending Account

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

• Not enrolled in Medicare, Medicaid, or TRICARE

• Not receiving Veterans Administration benefits

Maximum HSA Contributions

2025: $4,300 Individual

$8,550 Family

HSA contributions are tax-deductible and grow tax-deferred. Withdrawals for qualifying medical expenses are tax-free.

HSA Contacts

• Register for an account at https://healthy. kaiserpermanente.org/.

• Call (800) 632-9700

Hospital Cash Chubb

ABOUT HOSPITAL INDEMNITY

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

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

It’s not easy to pay hospital bills, especially if you have a high-deductible medical plan. Chubb Hospital Cash pays money directly to you if you are hospitalized so you can focus on your recovery. And since the cash goes directly to you, there are no restrictions on how you use your money.

Choose from 1 of 2 plans Plan 1

and Rehabilitation

First Hospitalization Benefit

This benefit is payable for the first covered hospital confinement per certificate.

Hospital Admission Benefit

This benefit is for admission to a hospital or hospital sub-acute intensive care unit.

Hospital Admission ICU Benefit

This benefit is for admission to a hospital intensive care unit.

Hospital Confinement Benefit

This benefit is for confinement in hospital or hospital sub-acute intensive care unit.

Hospital Confinement ICU Benefit

This benefit is for confinement in a hospital intensive care unit.

Newborn Nursery Benefit

This benefit is payable for an insured newborn baby receiving newborn nursery care and who is not confined for treatment of a physical illness, infirmity, disease, or injury.

Observation Unit Benefit

This benefit is for treatment in a hospital observation unit for a period of less than 20 hours.

• $500

• Maximum benefit per certificate: 1

• $1,500

• Maximum benefit per calendar year: 5

• $3,000

• Maximum benefit per calendar year: 3

• $100 per day

• Maximum days per calendar year: 30

• $200 per day

• Maximum days per calendar year: 30

• $500 per day

• Maximum days per confinementnormal delivery: 2

• Maximum days per confinementcaesarean section: 2

• $500

• Maximum benefit per calendar year: 2

$30,000 average three-day hospitalization cost.¹ 5.4 days average hospital stay.²

• $500

• Maximum benefit per certificate: 1

• $3,000

• Maximum benefit per calendar year: 5

• $6,000

• Maximum benefit per calendar year: 3

• $200 per day

• Maximum days per calendar year: 30

• $400 per day

• Maximum days per calendar year: 30

• $500 per day

• Maximum days per confinementnormal delivery: 2

• Maximum days per confinementcaesarean section: 2

• $500

• Maximum benefit per calendar year: 2

Hospital Cash Chubb

Choose from 1 of 2 plans

Waiver of Premium for Hospital Confinement

This benefit waives premium when the employee or spouse is confined for more than 30 continuous days.

Exclusions and Limitations*

We will not pay for any Covered Accident or Covered Sickness that is caused by, or occurs as a result of 1) committing or attempting to commit suicide or intentionally injuring oneself; 2) war or serving in any of the armed forces or its auxiliary units; 3) participating in an illegal occupation or attempting to commit or actually committing a felony; 4) sky diving, hang gliding, parachuting, bungee jumping, parasailing, or scuba diving; 5) being intoxicated or being under the influence or any narcotic or other prescription drug unless taken in accordance with Physician’s instructions 6) alcoholism; 7) cosmetic surgery, except for reconstructive surgery needed as the result of an Injury or Sickness or is related to or results from a congenital disease or anomaly of a covered Dependent Child; 8) services related to sterilization, reversal of a vasectomy or tubal ligation, in vitro fertilization, and diagnostic treatment of infertility or other related problems.

A Physician cannot be You or a member of Your Immediate Family, Your business or professional partner, or any person who has a financial affiliation or business interest with You.

*If the employee waives medical coverage, the district will pay the $23.66 employee cost for Plan 2, and if the employee elects any other tier on Plan 2, the $23.66 will be credited toward the employee’s coverage.

Questions?

Call Higginbotham Public Sector at (833) 869-1368

*Please refer to your Certificate of Insurance at www.mybenefitshub.com/cscharteracademy for a complete listing of available benefits, limitations and exclusions. Underwritten by ACE Property & Casualty Company, a Chubb company. This information is a brief description of the important benefits and features of the insurance plan. It is not an insurance contract. This is a supplement to health insurance and is not a substitute for Major Medical or other minimal essential coverage. Hospital indemnity coverage provides a benefit for covered loss; neither the product name nor benefits payable are intended to provide reimbursement for medical expenses incurred by a covered person or to result in any payment in excess of loss.

Dental Insurance

ABOUT DENTAL

Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease.

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

Dental Coverage

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

DPPO Plan

Two levels of benefits are available with the DPPO plan: 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.

Find an In-Network Provider Visit www.metlife.com/dental Call (800) 275-4638

Vision Insurance

ABOUT VISION

Vision insurance provides coverage for routine eye examinations and can help with covering some of the costs for eyeglass frames, lenses or contact lenses.

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

Network: VSP Choice

• Eye health exam, dilation, prescription and refraction for glasses: At no additional cost after a $10 copay.

• Retinal imaging: At no additional cost Up to a $39 copay on routine retinal screening when performed by a private practice provider. Frame

• Allowance: $180 after $10 eyewear copay.

• Costco, Walmart and Sam’s Club: $100 allowance after $10 eyewear copay. You will receive an additional 20% savings on the amount that you pay over your allowance. This offer is available from all participating locations except Costco, Walmart and Sam’s Club.

Standard corrective lenses

• Single vision, lined bifocal, lined trifocal, lenticular: At no additional cost after $10 eyewear copay.

Standard lens enhancements1

• Polycarbonate (child up to age 18) and Ultraviolet (UV) coating: At no additional cost after $10 eyewear copay.

• Progressive Standard, Progressive Premium/Custom, Polycarbonate (adult), Photochromic, Anti-reflective, Scratch-resistant coatings and Tints: Your cost will be limited to a copay that MetLife has negotiated for you. These copays can be viewed after enrollment at www.metlife.com/mybenefits

Contact lenses instead of eye glasses

• Contact fitting and evaluation: At no additional cost with a maximum copay of $60.

• Elective lenses: $180 allowance.

• Necessary lenses: At no additional cost after eyewear copay.

Out-of-network reimbursement*

You pay for services and then submit a claim for reimbursement. The same benefit frequencies for In-network benefits apply.

• Eye exam: up to $45

• Frames: up to $70

• Contact lenses:

• Elective up to $105

• Necessary up to $210

• Single vision lenses: up to $30

• Lined bifocal lenses: up to $50

• Lined trifocal lenses: up to $65

• Lenticular lenses: up to $100

• Progressive lenses: up to $50

*If you choose an out-of-network provider, you will have increased outof-pocket expenses, pay in full at time of service, and file a claim for reimbursement.

Disability Insurance Lincoln Financial Group

ABOUT DISABILITY

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

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

Short Term Disability Insurance can pay you a weekly benefit if you have a covered disability that keeps you from working.

Short Term Disability Benefit Overview-Please see plan documents for details.

Short Term Disability Benefits

Disability Insurance Lincoln Financial Group

Long Term Disability Insurance can replace part of your income if a disability keeps you out of work for a long period of time.

Long Term Disability Benefit Overview- please see plan documents for details.

Long Term Disability Benefits

Elimination Period

Maximum Benefit Period

of $100 or 10% of Benefit

of Age 65 or SSNRA

Pre-Existing Conditions* Subject to a 3/12 pre-existing limitation

Definition of Earnings

Return to Work Incentive

Annual Earnings Excluding Overtime, Bonuses, & Commission

of Age 65 or SSNRA

Maximum

Benefits for a disabled employee are payable to the employee’s Social Security Normal Retirement Age or the Maximum Benefit Period listed on plan documents. All employees must be actively at work on policy’s effective date. Please see plan documents for plan details, definitions and limitations.

Disability Insurance

Lincoln Financial Group

Traditional LTD and STD Disability - Definitions

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

Pre-Existing Condition Limitations - Please note that 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. This includes during your initial new hire enrollment. Please review your plan details to find more information about pre-existing condition limitations.

How do I choose which plan to enroll in during my open enrollment?

You will enroll in Long Term and Short Term Disability on two separate pages during your open enrollment walkthrough. Generally your short term coverage and long term coverage work together so that once your short term coverage ends, at that time your long term coverage would begin if you are still disabled and approved to remain on your claim. In other words, your short term coverage may continue for up to 12 weeks and your long term coverage begins the 13th week.

Your short term coverage will generally be a weekly benefit. This is the maximum amount of money you will receive from the carrier on a weekly basis once your disability claim is approved by the carrier. This is generally a flat percentage of your salary.

Your long term coverage will generally be a monthly benefit. This is the maximum amount of money you will receive from the carrier on a monthly basis once your disability claim is approved by the carrier. This is generally a flat percentage of your salary.

Accident Insurance Chubb

ABOUT ACCIDENT

Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you.

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

You do everything you can to stay active and healthy, but accidents happen every day. An injury that hurts an arm or a leg can hurt your finances too. Chubb Accident pays cash benefits directly to you regardless of any other coverage you have. Benefits can be used to help cover health plan gaps for out-of-pocket expenses like deductibles, copays, and coinsurance.

Choose from 1 of 2 plans

Accident Insurance

Two

Exclusions and Limitations*

No benefits will be paid for services rendered by a member of the immediate family of a covered person. No benefits will be paid for an injury that is caused by, contributed to, or occurs as a result of: 1) being intoxicated, or under the influence of alcohol, narcotic or other prescription drug unless taken in accordance with Physician’s instructions; 2) participating in an illegal activity or attempting to commit or committing a felony; 3) committing or attempting to commit suicide or intentionally injuring oneself; 4) having dental treatment except for such care or treatment due to injury to sound natural teeth within twelve (12) months of the covered accident; 5) war, or serving in any of the armed forces or its auxiliary units; 6) participation in any contest using a motorized vehicle. No benefits will be payable for sickness or infection including physical or mental condition that is not caused solely by or as a direct result of a Covered Accident.

Questions? Call

*Please refer to your Certificate of Insurance at

limitations and exclusions. Underwritten by ACE Property & Casualty Company, a Chubb company.

This information is a brief description of the important benefits and features of the insurance plan. It is not an insurance contract. This is an accident only policy and does not pay benefits for loss from sickness.

Critical Illness Insurance Chubb

ABOUT CRITICAL ILLNESS

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

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

Available Coverage Choices

Employee

Spouse

$10,000; $20,000; or $30,000

Child coverage Included in the employee amount

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

Sample list of Benefits, refer to plan documents for full list.

Sudden

Skin

- Payable once per insured per year

Occupational Package

Pays 100% of the face amount; benefits payable for HIV or Hepatitis B, C, or D, MRSA, Rabies, Tetanus, or Tuberculosis contracted on the job.

Childhood Conditions

Pays 100% of the dependent child face amount; Provides benefits for childhood conditions (Autism Spectrum Disorder; Cerebral Palsy; Congenital Birth Defects; Heart, Lung, Cleft Lip, Palate, etc; Cystic Fibrosis; Down Syndrome; Gaucher Disease; Muscular Dystrophy; Type 1 Diabetes).

Critical Illness Insurance

Benefits are payable for a subsequent diagnosis of Aneurysm – Cerebral or Aortic, Benign Brain Tumor, Cancer, Coma, Coronary Artery Obstruction, Heart Attack, Major Organ Failure, Severe Burns, Stroke, and Sudden Cardiac Arrest.

Wellness benefit – payable once per insured per year.

Sample Rates, refer to plan documents for full list of rates.

No benefits will be paid for losses that are caused by, contributed, or occur as a result of a Covered Person’s: 1) injuring oneself intentionally or committing or attempting to commit suicide; 2) committing or attempting to commit a felony or engaging in an illegal occupation or activity.

A Physician cannot be You or a member of Your Immediate Family, Your business or professional partner, or any person who has a financial affiliation or business with you.

Life and AD&D

Lincoln Financial Group

ABOUT LIFE AND AD&D

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

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

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

Life and AD&D Insurance

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).

Basic Term Life and AD&D

Basic Term Life and AD&D insurance are provided at no cost to you. You are automatically covered at $15,000 for each benefit.

Supplemental Term Life

If you need more coverage than Basic Term Life and AD&D, you may buy Supplemental Term Life for yourself and your dependent(s). If you do not elect Supplemental Term Life insurance when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health (Evidence of Insurability).

Supplemental AD&D

Supplemental AD&D coverage is separate and apart from your Basic and Supplemental Term Life insurance coverage. It provides benefits beyond your disability or life insurance for covered losses that are the result of an accidental injury or loss of life. The full amount of AD&D coverage you select is called the Full Amount and is equal to the benefit payable for the loss of life. Benefits for other losses — such as loss of sight, speech, or hearing; coma; or paralysis — are payable as a predetermined percentage of the full amount.

Supplemental AD&D Coverage Amounts

Your Supplemental AD&D amount is equal to your Supplemental Term Life amount. You can also cover your dependent spouse and child(ren). Dependent coverage amounts will be equal to their Dependent Term Life coverage amounts.

Supplemental 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 80% of your life insurance benefit if you (or your spouse) are terminally ill and have less than 24 months to live. Note: this benefit is not the same as long term care insurance.

Some limitations and exclusions apply. See the plan documents for details.

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 any time. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%). The total must add up to 100%.

Life and AD&D

Lincoln Financial Group

Voluntary Life/AD&D Rates

Spouse

Child(ren)

• Increments of $10,000 up to 5 times salary up to $500,000

• New hire Guaranteed Issue $100,00

• Increments of $10,000 up to $250,000 not to exceed 50% of your election

• New hire Guaranteed Issue $xx

• 1 month to age 26 - Increments of $20,000 up to $20,000

• Guaranteed Issue $20,000

OE GI is approved for existing employees not previously enrolled.

• Employee – $20,000

• Spouse – $10,000

Existing employees previously enrolled:

• Employees – $20,000 auto increase

• Spouse – $10,000 auto increase

Individual Life Insurance

5Star Life Insurance

ABOUT INDIVIDUAL LIFE

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

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

Individual Life by 5Star

Offers level premium and level death benefit to age 121. An individual’s plan cannot be adjusted on individual age, health, or employment status.

Accelerated Death Benefit

For diagnosis of terminal illness by a physician with life expectancy of 12 months (24 months or less in KS, MA, and TX) or less, 30% of the life insurance in force will be paid in a lump sum not to exceed $50,000. The acceleration of life benefits will reduce the amount of life benefits paid upon death by the amount of the terminal illness benefit paid.

Portability

Coverage is fully portable. Employees and their family members can elect to continue coverage with no loss of benefits or increase of premium should the employee terminate employment after the first premium is paid.

Emergency Death Benefit

Within one business day of notification, payment of 50%

of coverage or $10,000, whichever is less, is mailed to the beneficiary, unless the death is within the two-year contestability period and/ or under investigation. There are no war or terrorism exclusions.

Quality of Life Rider

This rider accelerates 4% of the death benefit on a monthly basis each month up to 75% of the total death benefit, payable directly to the insured on a tax favored basis. Benefits are paid for the following:

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

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

In case of a qualifying condition, an employee who is enrolled in a $50,000 death benefit would receive $2,000 each month up to $37,500. The remaining benefit amount of $12,500 would be payable to the beneficiary upon the insured’s death.

Flexible Spending Account (FSA)

Higginbotham

Flexible Account Higginbotham

ABOUT FSA

A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from y our p aycheck ever y plan ye ar, b ased o n your employer’s annual plan limit. This money is use-it-or-lose-it with a 30 day grace period.

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

www.mybenefitshub.com/cscharteracademy

Health Care FSA

The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $3,300 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include:

• Dental and vision expenses

• Medical deductibles and coinsurance

• Prescription copays

• Hearing aids and batteries

You may not contribute to a Health Care FSA if you contribute to a Health Savings Account (HSA).

Higginbotham Benefits Debit Card

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

Important FSA Rules

• The maximum per plan year you can contribute to a Health Care FSA is $3,300.

• Elections are evergreen and will roll from one plan year to the next unless changes are made during Open Enrollment.

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

• In most cases, you can continue to file claims incurred during the plan year for another 30 days after the plan year ends.

• Your Health Care FSA debit card can be used for health care expenses only.

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

• The money in your FSA is use-it-or-lose-it within the plan year, a 30 day grace period is offered

Over-the -Counter Item Rule Reminder

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

Flexible Spending Accounts

Higginbotham

Higginbotham Portal

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

• Update your personal information

• Utilize Section 125 tax calculators

• Look up qualified expenses

• Submit claims

• Request a new or replacement Benefits Debit Card

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

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

• Follow the prompts to navigate the site.

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

∗ Phone – 866- 419- 3519

∗ Questions – flexsupport@higginbotham.net

flexsupport@higginbotham.net

∗ Fax – 866- 419- 3516

∗ Claims- flexclaims@higginbotham.net

flexsupport@higginbotham.net

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

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