2025-26 CTXEBC Benefit Guide

2025 2026

CENTRAL TEXAS EBC

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.ctxebc.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.

Please see Important Legal Notices for details.

YO UR N EW BE NEF I TS B EGI N A ND EN D

September 1, 2025 August 31, 2026

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Contents FLIP TO...

4 Important Contacts

HOW TO ENROLL

5 How to Enroll

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6 Enrollment FAQ

7 Eligibility 8 HSA and FSA Comparison 9 Medical Coverage 13 Prescription Savings

FREQUENTLY ASKED QUESTIONS

14 Health Savings Account (HSA)

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18 Hospital Indemnity 20 Telehealth 22 Dental 24 Vision

YOUR BENEFITS

25 Disability

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28 Life and AD&D 31 Individual Life 33 Cancer 39 Accident

41 Critical Illness 45 Identity Theft 47 Emergency Medical Transportation 49 Flexible Spending Account (FSA) 53 Legal Services

54 Glossary of Terms 55 Important Legal Notices

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Important Contacts CTXEBC Benefits Higginbotham Public Sector 833-931-6514 www.ctxebc.com ctxebc@hps.higginbotham.net

Prescription Savings

Hospital Indemnity CHUBB

Telehealth

888-499-0425 www.chubb.com Vision Superior Vision 800-507-3800 www.superiorvision.com Individual Life 5 Star Life Insurance 866-863-9753

Clever RX

Group #1085 800-873-1195 https://cleverrx.com/

Health Savings Account (HSA) EECU 817-882-0800 www.eecu.org Dental

FCL Dental

Recuro 855-673-2876

www.recurohealth.com

877-493-6282

www.fcldental.com Life And AD&D

Disability

UNUM

UNUM 800-858-6843

www.unum.com

800-445-0402

www.unum.com Accident

Cancer

CHUBB

CHUBB 888-499-0425

www.chubb.com

www.5starlifeinsurance.com Identity Theft

Critical Illness

ID Watchdog

CHUBB 888-499-0425 www.chubb.com

800-774-3772 www.idwatchdog.com

Legal Services

Flexible Spending Account (FSA) National Benefit Services

LegalShield

855-399-3035

www.legalshield.com

800-654-7757

www.nbsbenefits.com

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888-499-0425

www.chubb.com Emergency Medical Transport MASA Group #MKTR8

800-970-5182 www.masamts.com

How to Enroll LOGIN PROCESS

1

Go to www.ctxebc.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.

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Enrollment FAQ What if I miss the enrollment deadline?

When will I get my ID cards?

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

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.

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

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?

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.

Access www.ctxebc.com, click on benefit information, and then on the benefit you need (e.g., Dental).

Benefit questions?

How do I find an in-network provider?

Call 833-931-6514

Access www.ctxebc.com and click on the provider search option.

Email ctxebc@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.

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 a Health Savings Account as a married couple.

You, the enrollee, shall hold harmless, defend, and indemnify Higginbotham Public Sector, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of your enrollment in spouse and/or dependent coverage, including enrollment in an FSA and HSA.

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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 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

• 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 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

When to Enroll

• QLE: Ask Human Resources

• When covering dependents, you must enroll for and be on the same plans

MAXIMUM DEPENDENT ELIGIBILITY AGE BY PLAN Plan Hospital Indemnity, Dental, Vision, Life, Cancer, Critical Illness, AD&D, Individual Life, Accident, Identity Theft, Emergency Transportation

To Age

• Child(ren) under age 26, regardless of student, dependency, or marital status

• You must enroll the dependent(s) during OE or when you have a QLE

• 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

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Dependent Care Flexible Spending Account

Under the age of 13 or a qualified individual who is unable to care for themselves and claimed as a dependent on your taxes

Flexible Spending Account

Through age 25 or IRS tax dependent

Health Savings Account

IRS tax dependent

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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.

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

Description

An FSA allows you to pay out-ofpocket expenses tax-free for: • 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

2025 • $1,650 single

2026 • $1,650 single

N/A

• $3,300 family

• $3,300 family

2025 • $4,300 single

2026 • $4,400 single

• $8,550 family

• $8,750 family

• $1,000 age 55 + catch-up

• $1,000 age 55+ catch-up

Maximum Contribution

$3,300

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?

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

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

Does the account earn interest?

Yes

No

Portable?

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

No

Permissible Use of Funds

FLIP TO...

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HSA

49 8

FSA

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TRS-ActiveCare

PLAN HIGHLIGHTS 2025-26

LEARN THE TERMS • PREMIUM: The monthly amount you pay for health care coverage.

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

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

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

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

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765393.0225

2025-26 TRS-ActiveCare Plan Highlights Sept. 1, 2025 – How to Calculate Your Monthly Premium

All TRS-ActiveCare participants have three plan options. E TRS-ActiveCare Primary • Lowest premium of all three plans • Copays for doctor visits before you meet your deductible • Statewide network • Primary Care Provider referrals required to see specialists • Not compatible with a Health Savings Account • No out-of-network coverage

Total Monthly Premium Your Employer Contribution

Plan Summary

Your Premium Ask your Benefts Administrator for your district’s specifc premiums.

Monthly Premiums

Wellness Benefts at No Extra Cost* Being healthy is easy with: • $0 preventive care • 24/7 customer service • One-on-one health coaches

Total Premium Employee Only

$509

Employer Contribution

Your Premium

TRS-

• Lower deductible t • Copays for many s • Higher premium • Statewide network • Primary Care Provi • Not compatible wit • No out-of-network

Total Premium $598

Employee and Spouse

$1,375

$1,555

Employee and Children

$866

$1,017

Employee and Family

$1,731

$1,974

Plan Features Type of Coverage Individual/Family Deductible Coinsurance

In-Network Coverage Only You pay 30% after deductible

Individual/Family Maximum Out of Pocket

$8,050/$16,100

Network

Statewide Network

• Weight loss programs

In

$2,500/$5,000

PCP Required

Yes

Primary Care

$30 copay

Specialist

$70 copay

Urgent Care

$50 copay

You

• Nutrition programs • OviaTM pregnancy support

Doctor Visits

• TRS Virtual Health • Mental health benefts • And much more! *Available for all plans.

See the benefts guide for more details.

Immediate Care Emergency Care

You pay 30% after deductible

Yo

TRS Virtual Health-RediMDTM

$0 per medical consultation

$0

TRS Virtual Health-Teladoc

$12 per medical consultation

$1

®

Primary Plans & Mental Health • Both Primary and Primary+ offer $0 virtual mental health visits with any in-network provider.

Prescription Drugs Drug Deductible

Integrated with medical

$200 deducti

Generics (31-Day Supply/90-Day Supply)

$15/$45 copay; $0 copay for certain generics

Preferred (Max does not apply if brand is selected and generic is available)

You pay 30% after deductible

You pay 2 You pay 2

Non-preferred

You pay 50% after deductible

You

Specialty (31-Day Max)

$0 if SaveOnSP eligible; You pay 30% after deductible

$0 if SaveOnSP

Insulin Out-of-Pocket Costs

$25 copay for 31-day supply; $75 for 61-90 day supply

$25 copay for 3

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Aug. 31, 2026

Each includes a wide range of wellness benefts.

This plan is closed and not accepting new enrollees. If you’re currently enrolled in TRS-ActiveCare 2, you can remain in this plan.

-ActiveCare Primary+

TRS-ActiveCare HD

than the HD and Primary plans services and drugs

• Compatible with a Health Savings Account • Nationwide network with out-of-network coverage • No requirement for Primary Care Providers or referrals • Must meet your deductible before plan pays for non-preventive care

k ider referrals required to see specialists th a Health Savings Account coverage

Employer Contribution

Your Premium

Employer Contribution

Total Premium

TRS-ActiveCare 2

Your Premium

• Closed to new enrollees • Current enrollees can choose to stay in plan • Lower deductible • Copays for many services and drugs • Nationwide network with out-of-network coverage • No requirement for Primary Care Providers or referrals

Employer Contribution

Total Premium

$521

$1,013

$1,407

$2,402

$886

$1,507

$1,772

$2,841

Your Premium

n-Network Coverage Only

In-Network

Out-of-Network

In-Network

$1,200/$2,400

$3,300/$6,600

$6,600/$13,200

$1,000/$3,000

Out-of-Network $2,000/$6,000 You pay 40% after deductible $23,700/$47,400

u pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible

$6,900/$13,800

$8,300/$16,600

$20,500/$41,000

$7,900/$15,800

Statewide Network

Nationwide Network

Nationwide Network

Yes

No

No

$15 copay

You pay 30% after deductible

You pay 50% after deductible

$30 copay

You pay 40% after deductible

$70 copay

You pay 30% after deductible

You pay 50% after deductible

$70 copay

You pay 40% after deductible

$50 copay

You pay 30% after deductible

You pay 50% after deductible

$50 copay

You pay 40% after deductible

ou pay 20% after deductible

You pay 30% after deductible

You pay a $250 copay plus 20% after deductible

0 per medical consultation

$30 per medical consultation

$0 per medical consultation

12 per medical consultation

$42 per medical consultation

$12 per medical consultation

Integrated with medical

$200 brand deductible

ible per participant (brand drugs only)

You pay 20% after deductible; $0 coinsurance for certain generics

$20/$45 copay

25% after deductible ($100 max)/ 25% after deductible ($265 max)

You pay 25% after deductible

You pay 25% after deductible ($40 min/$80 max)/ You pay 25% after deductible ($105 min/$210 max)

u pay 50% after deductible

You pay 50% after deductible

You pay 50% after deductible ($100 min/$200 max)/ You pay 50% after deductible ($215 min/$430 max)

P eligible; You pay 30% after deductible

You pay 20% after deductible

$0 if SaveOnSP eligible; You pay 30% after deductible ($200 min/$900 max)/ No 90-day supply of specialty medications

31-day supply; $75 for 61-90 day supply

You pay 25% after deductible

$15/$45 copay

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$25 copay for 31-day supply; $75 for 61-90 day supply

Compare Prices for Common Medical Services

REMEMBER: Beneft

Call a Personal Health Guide 24/7 to help you fnd the best price for a medical service.

Reach them at 1-866-355-5999.

TRS-ActiveCare Primary

TRS-ActiveCare Primary+

In-Network Only

In-Network Only

Offce/Indpendent Lab: You pay $0

Offce/Indpendent Lab: You pay $0

TRS-ActiveCare HD In-Network

In-Network

Out-of-Network

Offce/Indpendent Lab: You pay $0 You pay 30% after deductible

Diagnostic Labs**

Out-of-Network

TRS-ActiveCare 2

You pay 50% after deductible

You pay 40% after deductible

Outpatient: You pay 30% after deductible

Outpatient: You pay 20% after deductible

High-Tech Radiology

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible + $100 copay per procedure

You pay 40% after deductible + $100 copay per procedure

Outpatient Costs

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible ($150 facility copay per incident)

You pay 40% after deductible ($150 facility copay per incident)

Inpatient Hospital Costs

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible ($500 facility per day maximum)

You pay 20% after deductible ($150 facility copay per day)

You pay 40% after deductible ($500 facility copay per incident)

Freestanding Emergency Room

You pay $500 copay + 30% after deductible

You pay $500 copay + 20% after deductible

You pay $500 copay + 30% after deductible

You pay $500 copay + 50% after deductible

You pay $500 copay + 20% after deductible

You pay $500 copay + 40% after deductible

Facility: You pay 30% after deductible

Facility: You pay 20% after deductible

Facility: You pay 20% after deductible ($150 facility copay per day)

Professional Services: You pay $5,000 copay + 30% after deductible

Professional Services: You pay $5,000 copay + 20% after deductible

Professional Services: You pay $5,000 copay + 20% after deductible

Only covered if rendered at a BDC+ facility

Only covered if rendered at a BDC+ facility

Annual Vision Exam (one per plan year; performed by an ophthalmologist or optometrist)

You pay $70 copay

You pay $70 copay

You pay 30% after deductible

You pay 50% after deductible

You pay $70 copay

You pay 40% after deductible

Annual Hearing Exam (one per plan year)

$30 PCP copay $70 specialist copay

$15 PCP copay $70 specialist copay

You pay 30% after deductible

You pay 50% after deductible

$30 PCP copay $70 specialist copay

You pay 40% after deductible

Bariatric Surgery

Outpatient: You pay 20% after deductible

Not Covered

Not Covered

Only covered if rendered at a BDC+ facility

**Pre-certifcation for genetic and specialty testing may apply. Contact a PHG at 1-866-355-5999 with questions.

www.trs.texas.gov Revised 05/30/25

Not Covered

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13

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EECU Health Savings Account

EECU Makes It Easy For You To Make The Most Of Your HSA Enclosed is everything you need to learn how to use your HSA.

Getting Started Maximize savings for your healthcare and your future with an EECU HSA, getting started is easy.

Step 1: Log In for Online Account Access

Step 2: Activate Your Debit Card

Step 3: Read This Guide

A “Register for EECU Online Banking” email will be sent to the email address associated with your account, or call us and ask for one to be sent to you. Open the email and click the “Register” button to easily complete registration. Then, you can check your balance, pay bills, transfer funds, retrieve online account statements and more.

Activate your new HSA Mastercard® Debit Card immediately by following the instructions on the sticker affixed to the front of the card.

Learn how to make contributions, payments and manage your account.

Now you’re ready to maximize your savings!

Online/Mobile: Log in for 24/7 account access to check your balance, pay bills and more.

Call/Text: (817) 882-0800. Our dedicated member service representatives are available to assist you with any questions. Our hours of operation are Monday through Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. – 1:00 p.m. CT and closed on Sunday.

Lost/Stolen Debit Card: Call our 24/7 debit card hotline at (800) 333-9934.

Stop by: a local EECU financial center for in-person assistance; find EECU locations & service hours at www.eecu.org/locations.

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TCN3S3ZFQAYU-1656369029-372

Have a question? We’re here for you! Connect with us your way.

EECU Health Savings Account

Here’s How We Make Saving For Healthcare Expenses Easy, Convenient and Valuable

HSA Overview • Requires a qualifying high deductible health plan (HDHP) • Used to pay for qualified medical expenses • Funded by you, your employer or others • Account funds belong to you

Qualified Medical Expenses Use your HSA to pay for qualified medical expenses, as defined by the Internal Revenue Service, for yourself, your spouse or tax dependents1. Here are some examples:

Making It Easy

• Acupuncture

Easy to Contribute

• Ambulance Service

You can make pre-tax, current year contributions through your employer payroll deduction or make post-tax, current year contributions directly online, through a mailed deposit or at an EECU financial center.

• Chiropractor

Easy to Make Payments

• Laboratory Fees

EECU offers three easy ways. You can pay qualified medical expenses1 with your EECU HSA Debit Mastercard® through EECU’s free online banking and bill pay or by writing an HSA check (optional, fees apply2).

You can also pay out-of-pocket for eligible medical expenses and then reimburse yourself from your HSA.

• Prescription Drugs

• Dental Care • Doctor’s Fees • Hearing Aids

• Surgery • Vaccines • Vision Care • Wheel Chairs

Easy to Manage Your Account

• X-Rays

You can easily access your EECU HSA anytime, anywhere online or from your smartphone or tablet at eecu.org and manage your account on the go. Have a question or need help with a transaction, we’re here to help on the phone, online, chat or in person at a financial center.

A list of Eligible Medical Expenses can be found in IRS Publication 502 - Medical and Dental Expenses.1

Save your receipts –

Easy to Grow Your EECU HSA is federally insured, pays a dividend rate based on balance amount and has no monthly fees, so you can maximize your savings.

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for all qualified medical expenses.

EECU does not verify eligibility.

You are responsible for making sure payments are for qualified medical expenses.

EECU Health Savings Account Making It Convenient Here’s How To Contribute Payroll Deductions – your HSA contributions can be deducted from your paycheck on a pre-tax basis. For more information, please contact your employer.

Online Contribution – use our online banking Transfer tool to contribute to your account. Simply log in at eecu.org, then hover over “Move Money” in the top menu, then select the type of transfer from an EECU or external checking or savings account to your HSA. (All contributions are classified as current year contributions unless directed otherwise.)

Check – use EECU’s mobile deposit feature to deposit a check from your mobile device. You can also stop by an EECU financial center or one of our 5,000 shared financial centers to make a check deposit.

Transfer / Rollover – to make a transfer complete our Direct Transfer form and send it to your other HSA provider; and, for a rollover, withdraw your HSA funds from your other HSA and deposit them into your EECU HSA. See FAQs for details on Transfers & Rollovers.

Here’s How To Make Payments HSA Debit Card – use your EECU HSA Mastercard® debit card to pay healthcare providers at point-of-sale after you receive a bill.

Online Bill Pay – use EECU’s free online banking and bill pay to make payments to medical providers directly from your HSA. Online Transfers – use EECU’s online banking or mobile app to reimburse yourself for out-of-pocket expenses by making a transfer from your HSA to your personal checking or savings account.

Check – optional HSA checks can be ordered upon request for a fee2. You can use these checks to pay healthcare providers and suppliers.

Here’s How To Manage Your Account Online - check your balance, pay healthcare providers and arrange deposits.

Mobile - EECU’s mobile app allows you to manage your account on the go; download “EECU Mobile Banking” in Apple’s App Store and Google Play.

Contact Member Service – call (817) 882-0800. Our dedicated member service representatives are available to assist you with any questions. Our hours of operation are Monday through Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. – 1:00 p.m. CT and closed on Sunday. If your debit card is lost or stolen, call our 24-hour debit card hotline at (800) 333-9934.

Account Statements – monthly account statements show all your account activity for that period. You can receive free online statements or printed statements. You will also receive an IRS 1099 form and a 5498-SA form if you had any contributions or distributions (withdrawals) during the year.

Thank you for choosing EECU for your Health Savings Account.

For more information about HSAs, visit www.eecu.org/HSA, call one of our Member Service Representatives at (817) 882-0800 or stop by a local EECU financial center.

Your Benefits Administrator will also be able to provide you information about your HSA. 1 A list of Eligible Medical Expenses be found in IRS Publication 502, http://www.irs.gov/pub/irs-pdf/p502.pdf. As described in IRS publication 969, http://www.irs.gov/pub/irs-pdf/p969.pdf, over-the-counter medications (when prescribed by a doctor) are considered Eligible Medical Expenses for HSA purposes.

2 Call 817-882-0800 or stop by a financial center to order Standard checks at no charge, excludes shipping & handling or order custom checks, prices vary.

EECU - January 2024

16

EECU Health Savings Account Frequently Asked Questions HSA Basics Q What is a Health Savings Account (HSA)?

A A Health Savings Account allows you to save money, earn interest and spend money on a tax-free basis as long as the money being spent is on qualified medical expenses1. Unused HSA funds roll over from year to year, no “use it or lose it”. You own your HSA and can take it with you when you change medical plans, change jobs or retire. be eligible to set up an HSA and contribute to an HSA, you must be covered by a qualified High Deductible To Health Plan, have no other coverage (e.g. Medicare) and cannot be claimed as a dependent on someone else’s taxes.

Q What is a High Deductible Health Plan (HDHP)?

A For 2024, a High Deductible Health Plan is a plan with an annual deductible of at least $1,600 for an Individual or $3,200 for Family coverage; and, the maximum out of pocket expenses must be no more than $8,050 for Individuals and no more than $16,100 for Family coverage.

For 2025, a High Deductible Health Plan is a plan with an annual deductible of at least $1,650 for an Individual or $3,300 for Family coverage; and, the maximum out of pocket expenses must be no more than $8,300 for Individuals and no more than $16,600 for Family coverage.

Q Who is eligible to open an HSA? A To be an eligible and qualify for an HSA, you must meet the following requirements.

• You are covered under a high deductible health plan (HDHP), described above.

• You have no other health coverage.

• You aren’t enrolled in Medicare.

• You can’t be claimed as a dependent on someone else’s tax return.

Q How does an HSA work?

A Health Savings Accounts work with high deductible health insurance plans. This enables consumers to save money on health insurance premiums, since HDHP’s typically cost less than traditional health insurance, while allowing account holders to contribute money to the account to pay out-of-pocket medical expenses up to the deductible.

• Contribute: you can make contributions (pre-tax and after-tax) to your HSA. Pre-tax contributions can reduce your taxable income and after-tax contributions are deductible. Contributions can be made by you, your employer or a third party via payroll deduction, online banking transfer or depositing a paper check.

Contributions to your HSA as well as any earnings on those contributions grow tax deferred2.

• Make Payments: you can pay for qualified medical expenses with your EECU HSA Mastercard® debit card, EECU Online Banking or HSA check (optional3). Payments or withdrawals from your HSA that are used for qualified medical expenses are tax-free. In addition, withdrawals can also be used for your deductible and co-pays.

17

| Workplace Benefits

Central Texas Employee Benefits Cooperative

Hospital Cash 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.

$30,000 average three-day hospitalization cost.¹

5.4 days average hospital stay.²

Choose from 1 of 2 plans Plan 1

Plan 2

Hospitalization Benefits

Payable Benefit

Payable Benefit

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

• $1,500

• $3,000

• Maximum Benefit Per Calendar Year: 3

• Maximum Benefit Per Calendar Year: 3

Hospital Admission ICU Benefit This benefit is for admission to a hospital intensive care unit.

• $3,000

• $6,000

• Maximum Benefit Per Calendar Year: 3

• Maximum Benefit Per Calendar Year: 3

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

• $200 Per Day

• $200 Per Day

• Maximum Days Per Calendar Year: 30

• Maximum Days Per Calendar Year: 30

Hospital Confinement ICU Benefit The benefit for confinement in a hospital intensive care unit.

• $400 Per Day

• $400 Per Day

• Maximum Days Per Calendar Year: 30

• Maximum Days Per Calendar Year: 30

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.

• $500 Per Day

• $500 Per Day

• Maximum Days per Confinement - Normal Delivery: 2

• Maximum Days per Confinement - Normal Delivery: 2

• Maximum Days per Confinement - Caesarean Section: 2

• Maximum Days per Confinement - Caesarean Section: 2

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

• $500

• $500

• Maximum Benefit Per Calendar Year: 2

• Maximum Benefit Per Calendar Year: 2

Rehabilitation Unit Admission Benefit This benefit is for admission to a rehabilitation unit as an inpatient.

• $200

• $500

• Maximum Benefit Per Calendar Year: 3

• Maximum Benefit Per Calendar Year: 3

¹ www.healthcare.gov; accessed Jan. 2023 ² data.oecd.org; accessed Jan. 2023

18

Plan 1

Plan 2

Hospitalization Benefits (cont.)

Payable Benefit

Payable Benefit

Rehabilitation Unit Confinement Benefit This benefit is for confinement in a rehabilitation unit.

• $200 Per Day

• $400 Per Day

• Payable Per Day for Days 2 Through 11

• Payable Per Day for Days 2 Through 11

• Maximum Days Per Calendar Year: 10

• Maximum Days Per Calendar Year: 10

Waiver of Premium Benefits

Payable Benefit

Payable Benefit

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

Included

Included

Plan 1

Plan 2

Employee

$14.09

$26.77

Employee + Spouse

$29.81

$55.92

Employee + Children

$19.89

$37.98

Family

$32.51

$61.52

Rates Monthly Premiums

Questions?

Contact the FBS Benefits CareLine via the QR code or (833) 453-1680.

Please refer to your Certificate of Insurance at https://www.ctxebc.com 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.

19

CWB-HIVL-CETX-0323

Common Conditions Treated Sore Throat

Don’t wait to speak with a doctor, get the care when you need it

Congestion

Cough Getting sick is never planned. Here at Recuro we provide quality care around the clock to fit within your busy lifestyle.

Cold & Flu Yeast Infection

Call 1.855.6RECURO Insect Bites Allergies More

Call us, or download our app to speak with a doctor today!

Visit Us Online

Speak With an Agent

Download Our App

20

customerservice@recurohealth.com | 855.6RECURO | Scan QR Code to Download

24/7/365 Access to U.S. Board Certified, State Licensed Doctors

 Primary Care  Pediatrics  Urgent Care

Phone Call

Type of Visit

Mobile App

Online Portal

Common Conditions Treated

Average Cost

Acid Reflux

Bladder Infection

Primary Care

$100

Allergies

Rashes

Urgent Care

$150

Asthma

Sinus Conditions

Emergency Room

$1400

Nausea

Sore Throat

$0

Bronchitis

Thyroid Conditions

Cold & Flu

UTIs

Infections

And More…

2013 Medical Expenditure Panel Survey / MEPS

Call 1.855.6RECURO

Disclaimer: Recuro services are for non-emergency conditions only. Recuro does not replace the primary care physician, services are not considered insurance or a Qualified Health Plan under the Patient Protection and Affordable Care Act. Recuro doctors do not prescribe DEA controlled substances (schedule IIV) and does not guarantee that a prescription will be written. For updated full disclosures, please visit www.recurohealth.com

Visit www.recurohealth.com

21

customerservice@recurohealth.com | 855.6RECURO | Scan QR Code to Download

Texas- DenteMax

Passive PPO Dental Plan (100/80/50)

Annual Benefit - Per Person . . . . . . . . . . . . . . . . $1,000 Percentage of Covered Benefits Per Policy Year TYPE I TYPE II TYPE III* DURING THE 1ST YEAR 100% 80% 0% 2ND YEAR AND THEREAFTER 100% 80% 50% * 12-month waiting period Calendar Year Deductible, Per Person $50/150 This deductible applies to Type II and III services Dependent Children Covered to Age 26 Payment is based upon allowable charges in the area in which service is rendered.

Services provided at a non-contracting provider are paid at the 90th percentile.

TYPE I (PREVENTIVE SERVICES)

TYPE III (MAJOR SERVICES)

TYPE II (BASIC SERVICES)

ORTHODONTIC SERVICES

Including:  No waiting period  Routine Exams ( one per 6 months)  Prophylaxis (cleanings-one per 6 months)  Emergency exams for dental pain (minor procedures)  Fluoride treatments for dependent children under age 19 (one per 12 months)  Bitewing X-rays (once per 6 months)

Including:  12 month waiting period  Major restorative services (crowns and inlays)  Prosthetics (bridges, dentures)  Replacement of prosthodontics, dentures, crowns and inlays  Denture relines  General anesthesia (for services dentally necessary)  Space Maintainers

Including:   No waiting period   Periapical X-rays   Simple restorative services (fillings)  Simple extractions  Palliative treatment for dental pain, local anesthesia  Endodontics/root canal therapy  Periodontics  Oral Surgery  Sealants for children ages 6-15 (one per tooth)  Periapical X-rays  Full mouth or panorex X-rays (one per 36 months)

12 month waiting period 50% coverage – children under 19 $1,000 lifetime maximum benefit Renewal Date: September 1, 2019 Employee $24.84 Employee + Spouse $51.75 Employee +Child(ren) $57.36 Employee + Family $88.51

Marketed, Administered and Underwritten By:

——————————————————————————————

FIRST CONTINENTAL LIFE & ACCIDENT INSURANCE CO.

101 Parklane Blvd, Suite 301 Sugar Land, TX 77478 (281) 313-7150 - (877) 493-6282 22 Fax (281) 313-7155

ODP 185 TX (MKTG)

VOLFCL (01/05)

Limitations and Exclusions

Covered Expenses Will Not Include and No Benefits Will be Payable: 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

For any treatment which is for cosmetic purposes or to correct congenital malformations, except for medically necessary care and treatment of congenital cleft lip and palate.

To replace any prosthetic appliance, crown, inlay or onlay restoration, or fixed bridge within five years of the date of the last placement of these items, unless required because of an accidental bodily injury sustained while the Insured is covered. Replacement is not covered if the item can be repaired.

For initial placement of any prosthetic appliance or fixed bridge unless such placement is needed because of the extraction of natural teeth during the same period of continuous coverage. But the extraction of a third molar (wisdom tooth) will not qualify the item for payment. Any such appliance or fixed bridge must include the replacement of the extracted tooth or teeth. Coverage does not include the part of the cost that aplies specifically to replacement of teeth extracted prior to the period of coverage.

For addition of teeth to an existing prosthetic appliance or fixed bridge unless for replacement of natural teeth extracted during the same period of continuous coverage.

For any expense incurred or procedure begun before the Insured’s current period of continuous coverage.

For any expense incurred or procedure begun after the Insured’s insurance under this section terminates, except for a prosthetic appliance, fixed bridge, crown, or inlay or onlay restoration for which both (a) the procedure begins before insurance ends and (b) the item’s final placement is within 90 days after insurance ends.

To duplicate appliances or replace lost or stolen appliances.

For appliances, restorations or procedures to: a. alter vertical dimension; b. restore or maintain occlusion; c. splint or replace tooth structure lost as a result of abrasion or attrition; or d. treat jaw fractures or disturbances of the temporomandibular joint.

For education or training in, and supplies used for, dietary or nutritional counseling, personal oral hygiene or dental plaque control.

For broken appointments or the completion of claim forms.

For orthodontia service or for any services associated with orthodontic therapy when this optional coverage is not elected and the premium is not paid.

For sealants which are: a. not applied to a permanent molar; b. applied before age 6 or after attaining age 16; or c. reapplied to a molar within three years from the date of a previous sealant application.

For subgingival curettage or root planing (procedure numbers 4220 and 4341) unless the presence of periodontal disease is confirmed by both x-rays and pocket depth summaries of each tooth involved.

Because of an Insured’s injury arising out of, or in the course of, work for wage or profit.

For an Insured’s sickness, injury or condition for which he or she is eligible for benefits under any Workers Compensation Act or similar laws.

16. For charges for which the Insured is not liable or which would not have been made had no insurance been in force.

17. For services which are not recommended by a dentist, not required for necessary care and treatment, or do not have a reasonably favorable prognosis.

18. Because of war or any act of war, declared or not, or while on full-time active duty in the armed forces of any country.

19. To an Insured if payment is not legal where the Insured is living when expenses are incurred.

20. For any services related to: equilibration, bite registration or bite analysis.

21. For crowns for the purpose of periodontal splinting.

22. For charges for: any implants; overdentures; precision or semi-precision attachments and associated endodontic treatment; other customized attachments; or specialized prosthodontic techniques or characterizations.

23. For charges for myofunctional therapy, orthognathic surgery or athletic mouthguards.

24. For procedures for which benefits are payable under the employer’s medical expense benefits plan for employees and their dependents.

25. Services or supplies provided by a family member or a member of the Insured’s household.

Note: This is a general outline of covered benefits and does not include all the benefits, limitations and exclusions of the policy. See your certificate for details.

Predetermination of Benefits: As a service to protect the Insured, First Continental Life & Accident Insurance Co. will provide predetermination of benefits for recommended treatment plans that exceed $300. This predetermination of benefits explains which of the recommended procedures will be covered and at what amount. This benefit helps Insured's better understand their coverage. The Insured should submit the treatment plan to First Continental Life & Accident Insurance Co. for review and predetermination of benefits before the service begins.

TAKEOVER BENEFITS

Takeover means that you are given credit for waiting periods for like coverage's accumulated under your existing plan. No credit is given for deductibles satisfied under your existing plan.

1. In order to provide Takeover Benefits your employer’s current dental plan must have been in effect continuously for at least 12 months prior to the effective date of this plan.

2. All employees insured on the effective date with continuous coverage from the prior group dental contract are eligible for Takeover Benefits. Waiting periods will be reduced by the amount of time insured under the prior plan.

3. A minimum of three (3) enrolled members are needed for an employer to be eligible for Takeover Benefits.

4. Takeover Benefits must be requested and are subject to the approval of First Continental Life & Accident Insurance Co.

Submission of Claims: First Continental Life & Accident Insurance Co. ATTN: Claims Department 45 23 101 Parklane Blvd, Suite 301 Sugar Land, TX. 77478

Vision plan benefits for Central Texas Employee Benefits Copays

Services/frequency

Monthly premiums

Exam1

$10

Emp. only

$6.65

Exam

12 months

Eyewear2

$25

Emp. + spouse Emp. + child(ren)

$11.36 $12.01

Frame

12 months

Lenses

12 months

Emp. + family

$18.01

Contact lenses

12 months

(Based on date of service)

Benefits through Superior Select Southwest network Exam Frames Lenses (standard) per pair Single vision Bifocal Trifocal Progressive Contact lenses4 Medically necessary contact lenses LASIK vision correction5

In-network

Covered in full $150 retail allowance

Out-of-network Up to $35 retail Up to $70 retail

Covered in full Up to $25 retail Covered in full Up to $40 retail Covered in full Up to $45 retail See description3 Up to $45 retail $150 retail allowance Up to $80 retail Covered in full Up to $150 retail $200 allowance

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1 Eye exam copay is a single payment due to the provider at the time of service 2 Eyewear copay applies to eyeglass lenses / frame and contact lenses. Eyewear copay is a single payment that applies to the entire purchase of eyeglasses (frame and lenses) 3 Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 4 Contact lenses and related professional services (fitting, evaluation and follow-up) are covered in lieu of eyeglass lenses and frames benefit 5 Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limitations

Discount features

superiorvision.com

Discounts on covered materials6

These discounts apply to the glasses and contacts that are covered under the vision benefits.

Frames: Conventional contacts Disposable contact

(800) 507-3800

20% off amount over allowance 20% off amount over allowance 10% off amount over allowance

Lens type* Scratch coat Ultraviolet coat Tints, solid Tints, gradient Polycarbonate Blue light filtering Digital single vision Progressive lenses Standard/Premium/Ultra/Ultimate Anti-reflective coating Standard/Premium/Ultra/Ultimate Polarized lenses Plastic photochromic lenses High Index (1.67 / 1.74)

Discounts on non-covered exam, services and materials6 Exams, frames, and prescription lenses: 30% off retail Contacts, miscellaneous options: 20% off retail Disposable contact lenses: 10% off retail Retinal imaging: $39 maximum out-of-pocket

Member out-of-pocket6 $15 $12 $15 $18 $40 $15 $30

Laser vision correction (LASIK)6

Laser vision correction (LASIK) is a procedure that can reduce or eliminate your dependency on glasses or contact lenses. This corrective service is available to you and your eligible dependents at a special discount (20-50%) with your Superior Vision plan.

Contact QualSight LASIK at (877) 201-3602 for more information.

$55 / $110 / $150 / $225

Hearing discounts6

$50 / $70 / $85 / $120 $75 $80 $80 / $120

A National Hearing Network of hearing care professionals, featuring Your Hearing Network, offers Superior Vision members discounts on services, hearing aids and accessories. These discounts should be verified prior to service.

* The above table highlights some of the most popular lens type and is All allowances are retail; the member is responsible for paying the provider not a complete listing. This table outlines member out-of-pocket costs5 directly for all non-covered items and/or any amount over the allowances, and are not available for premium/upgraded options unless otherwise minus available discounts. These are not covered by the plan. noted.

6 Not all providers participate in Superior Vision Discounts, including the member out-of-pocket features. Call your provider prior to scheduling an appointment to confirm if he/she offers the discount and member out-of-pocket features. The discount and member out-of-pocket features are not insurance. Discounts and member out-of-pocket are subject to change without notice and do not apply if prohibited by the manufacturer. Lens options may not be available from all Superior Vision providers/all locations.

Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan.

Please check with your Human Resources department if you have any questions.

24Linthicum, MD 21090 (800) 507-3800 superiorvision.com Superior Vision of Texas 881 Elkridge Landing Rd 24

0524-BSv2/TX

Central Texas Employee Benefits Cooperative Voluntary Disability Insurance Plan Highlights Who is eligible?

You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week.

What is my monthly benefit amount?

You can elect to purchase a benefit of 45%, 55% or 65% of your monthly earnings.

How long do I have to wait to receive benefits?

The elimination period is the length of time you must be continuously disabled before you can receive benefits.

Elimination Period Options: Option 1: 0 days/7 days first day hospital Option 2: 14 days/14 days first day hospital Option 2: 30 days/30 days first day hospital Option 3: 90 days/90 days Option 3: 180 days/180 days During your elimination period, you will be considered disabled if you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury, you are under the regular care of a physician and you are unable to perform any of the material and substantial duties of your regular occupation due to the same sickness or injury.

If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.)

How long will my benefits last?

Age at Disability Less than age 62 Age 62 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 or older

Maximum Period of Payment To Social Security Normal Retirement Age* (see table below) 60 months 48 months 42 months 36 months 30 months 24 months 18 months 12 months

Year of Birth On or before 1937 1938 1939 1940 1941 1942 1943 – 1954 1955 1956 1957 1958 1959 On or after 1960

*Social Security Normal Retirement Age (SSNRA) 65 years 65 years, 2 months 65 years, 4 months 65 years, 6 months 65 years, 8 months 65 years, 10 months 66 years 66 years, 2 months 66 years, 4 months 66 years, 6 months 66 years, 8 months 66 years, 10 months 67 years

25

When is my coverage effective?

Please see your plan administrator for your effective date.

Do I have to take a health exam to get coverage?

You may receive coverage without answering any medical questions or providing evidence of insurability if you apply for coverage within 31 days after your eligibility date. If you apply more than 31 days after your eligibility date, your coverage will be subject to a 3/12 pre-existing condition exclusion.

Please see your plan administrator for your eligibility date.

What if I am out of work when the coverage goes into effect?

Insurance will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

What is my maximum monthly benefit amount?

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

What else is included Worldwide emergency travel assistance is included with this long term disability with this policy? plan. Emergency travel assistance is available to you, your spouse* and your dependent children when you travel to any foreign country, including Canada or Mexico. It is also available anywhere in the United States when you travel just 100 or more miles from home. * A spouse traveling on business for his or her employer is not covered by the program.

Does this plan include Yes. Our work-life balance employee assistance program (EAP) provides help with work-life professional advice for a wide range of personal and work-related issues. The balance? service is available to you and your family members 24 hours a day, 365 days a year. It provides resources to help you find solutions to everyday issues — such as financing a car or selecting child care — as well as more serious problems, such as alcohol or drug addiction, divorce or relationship problems. There is no additional charge for using the program, and you do not have to have filed a disability claim or be receiving benefits to use the program.

What is not covered?

Benefits would not be paid for disabilities caused by, contributed to by, or resulting from: • • • • • • •

Intentionally self-inflicted injuries; Active participation in a riot; War, declared or undeclared, or any act of war; Commission of a crime for which you have been convicted; Loss of professional license, occupational license or certification; Pre-existing conditions (see pre-existing condition section); or Any occupational injury or sickness for Short Term Disability coverage.

The loss of a professional or occupational license does not, in itself, constitute disability.

Unum will not pay a benefit for any period of disability during which you are incarcerated.

26

What is considered a pre-existing condition?

You have a pre-existing condition if: • You received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and • The disability begins in the first 12 months after your effective date of coverage.

Benefits under this provision are payable for no more than 90 days of benefit from the date of disability. After 90 days, benefits are subject to a 3/12 preexisting condition exclusion. In no event will benefits be paid beyond the applicable benefit duration. This applies to new hires. Late entrants will be subject to a 3/12 pre-ex.

When does my coverage end?

Your coverage under the policy ends on the earliest of the following: • • • • •

The date the policy or plan is cancelled; The date you no longer are in an eligible group; The date your eligible group is no longer covered; The last day of the period for which you made any required contributions; The last day you are in active employment except as provided under the covered layoff or leave of absence provision.

Please see your plan administrator for further information on these provisions.

Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan.

How can I apply for coverage?

To apply for coverage, complete your enrollment online by the enrollment deadline.

Check with your plan administrator for your eligibility date, and complete your enrollment online within 31 days of that date.

You are considered in active employment, if on the day you apply for coverage, you are being paid regularly by your employer for the required minimum hours each week and you are performing the material and substantial duties of your regular occupation.

The work-life balance employee assistance program, provided by LifeWorks, is available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.

Worldwide emergency travel assistance services, provided by Assist America, Inc., are available with select Unum insurance offerings. Terms and availability of service are subject to change and prior notification requirements. Services are not valid after coverage terminates. Please contact your Unum representative for details.

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative.

Underwritten by Unum Life Insurance Company of America, Portland, Maine © 2017 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

EN-1776 (1-17) FOR EMPLOYEES 27

Central Texas Employee Benefits Cooperative

Term Life and Accidental Death & Dismemberment (AD&D) Insurance How does it work?

Who can get Term Life coverage?

You choose the amount of coverage that’s right for you, and you keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more.

If you are actively at work at least 20 hours per week, you may apply for coverage for: You:

AD&D Insurance is also available, which pays a benefit if you survive an accident but have certain serious injuries. It pays an additional amount if you die from a covered accident.

Why is this coverage so valuable?

Your spouse: Your spouse:

If you previously purchased coverage, you can increase it up to $250,000 to meet your growing needs — with no medical underwriting.

What else is included?

A ‘Living’ Benefit — If you are diagnosed with a terminal illness with less than 12 months to live, you can request 75% of your life insurance benefit (up to $500,000) while you are still living. This amount will be taken out of the death benefit, and may be taxable. These benefit payments may adversely affect the recipient’s eligibility for Medicaid or other government benefits or entitlements, and may be taxable.

Recipients should consult their tax attorney or advisor before utilizing living benefit payments.

Your children:

Your children:

Choose in in $10,000 Choosefrom from$10,000 $10,000toto$500,000 $500,000 $10,000 increments, earnings. increments,up uptoto77times timesyour your earnings.

If you previously purchased coverage, you can If you previously purchased you can increase it up to $250,000 withcoverage, no medical increase it upIftoyou $250,000 with no medical underwriting. previously declined coverage, you may have to answer some health underwriting.

If you previously declined questions.

coverage, you may have to answer some health questions.

Get up to $500,000 of coverage in $5,000

increments. Spouse coverage cannot exceed Get up $500,000 coverage $5,000 for 100% ofto the coverageofamount youinpurchase yourself. increments. Spouse coverage cannot exceed If you previously purchased coverage for your 100% of the coverage amount you purchase spouse, they can increase their coverage up to for yourself. $50,000 with no medical underwriting, if eligible (see delayed effective date). If coverage you previously If you previously purchased for your declined spouse coverage, some health spouse, they can increase their coverage up questions may be required.

to $50,000 with no medical underwriting, if eligible (see delayed effectiveindate).

If you Get up to $10,000 of coverage $1,000 increments if eligible spouse (see delayed effective date). previously declined coverage, some One policy covers all of your children until their health questions may be required.

26th birthday.

The maximum benefit for children live birth to 6 Get up to $10,000 of coverage in $10,000 months is $1,000.

increments if eligible (see delayed effective date). One policy covers all of your children Who can getuntil Accidental & Dismemberment their 26thDeath birthday.

Waiver of premium — Your cost may be waived if you are totally disabled for a period of time.

(AD&D) coverage?

The maximum benefit for children live birth to

Portability — You may be able to keep coverage if you leave the company, retire or change the number of hours you work.

You:

Employees or dependents who have a sickness or injury having a material effect on life expectancy at the time their group coverage ends are not eligible for portability.

Get up to $500,00 of AD&D coverage for yourself in $10,000 increments.

Your spouse:

Get 50% of employee coverage amount up to $250,000 of AD&D coverage for your spouse in $5,000 increments if eligible (see delayed effective date).

Your children:

Get 10% of employee coverage up to $50,000 of AD&D coverage for your children if eligible (see delayed effective date).

The maximum benefit for children live birth to 6 months is $1,000.

No medical underwriting is required for AD&D coverage.

EN-1976

FOR EMPLOYEES

(6-22)

28

Unum | Term Life Insurance

How much coverage can I get?

Calculate your costs 1. Enter the coverage amount you want.

2. Divide by the amount shown.

1

2

Employee

$______,000

÷ $10,000 = $________

X $______

= $_______

Spouse

$______,000

÷ $5,000 = $________

X $______

= $_______

Child

$______,000

÷ $10,000 = $________

X $______

= $_______

3. Multiply by the rate.

Use the rate table (at right) to find the rate based on age.

3

4

Total cost

Employee monthly rate

(Choose the age you will be when your coverage becomes effective.

See your plan administrator for your plan effective date. To determine your spouse rate, choose the age the employee will be when coverage becomes effective. See your plan administrator for your plan effective date.)

Age

Spouse monthly rate

monthly rate

Per $10,000 of coverage

Per $5,000 of coverage

$1.800 per $10,000 of coverage

Cost

Cost

$0.600 $0.600 $0.700 $0.900 $1.000 $1.600 $2.700 $4.200 $6.800 $12.600 $20.400 $30.200

$0.300 $0.300 $0.350 $0.450 $0.500 $0.800 $1.350 $2.100 $3.400 $6.300 $10.200 $15.100

15-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

4. Enter your cost.

1. Enter the AD&D coverage amount you want.

Child

AD&D

2. Divide by the amount shown.

3. Multiply by the rate.

Use the AD&D rate table (at right) to find the rate.

1

2

3

4

Employee

$______,000

÷ $1,000 = $________

X $0.040

= $_______

Family

$______,000

÷ $1,000 = $________

X $0.070

= $_______

Total cost

4. Enter your cost.

AD&D monthly rates Coverage amount

Rate

Employee

per $1,000 of coverage

$0.040

Family

per $1,000 of coverage

$0.070

Billed amount may vary slightly.

If you apply for coverage above the guaranteed issue amount, you may be subject to medical underwriting which may affect your ability to get the larger coverage amount. In order to purchase coverage for your dependents, you must buy coverage for yourself. Coverage amounts cannot exceed 100% of your coverage amounts.

EN-1976

FOR EMPLOYEES

(6-22)

29

Unum | Term Life Insurance

Exclusions and limitations Actively at work Eligible employees must be actively at work to apply for coverage. Being actively at work means on the day the employee applies for coverage, the individual must be working at one of his/her company’s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the employee will be considered actively at work as of his/her last scheduled workday. Employees are not considered actively at work if they are on a leave of absence or lay off.

An unmarried handicapped dependent child who becomes handicapped prior to the child’s attainment age of 26 may be eligible for benefits. Please see your plan administrator for details on eligibility.

Employees must be U.S. citizens or legally authorized to work in the U.S. to receive coverage. Employees must be actively employed in the United States with the Employer to receive coverage. Employees must be insured under the plan for spouses and dependents to be eligible for coverage.

Exclusions and limitations Life insurance benefits will not be paid for deaths caused by suicide occurring within 24 months after the effective date of coverage. The same applies for increased or additional benefits.

AD&D specific exclusions and limitations: Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from: • Disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) • Suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane • War, declared or undeclared, or any act of war • Active participation in a riot • Committing or attempting to commit a crime under state or federal law • The voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol.

• Intoxication – ‘Being intoxicated’ means your or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.

Delayed effective date of coverage Insurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

Delayed Effective Date: if your spouse or child has a serious injury, sickness, or disorder, or is confined, their coverage may not take effect. Payment of premium does not guarantee coverage. Please refer to your policy contract or see your plan administrator for an explanation of the delayed effective date provision that applies to your plan.

Age Reduction Coverage amounts for Life and AD&D Insurance for you and your dependents will reduce to 50% of the original amount when you reach age 70. Coverage may not be increased after a reduction.

Termination of coverage Your coverage and your dependents’ coverage under the policy ends on the earliest of: • The date the policy or plan is cancelled • The date you no longer are in an eligible group • The date your eligible group is no longer covered • The last day of the period for which you made any required contributions • The last day you are actively employed (unless coverage is continued due to a covered layoff, leave of absence, injury or sickness), as described in the certificate of coverage In addition, coverage for any one dependent will end on the earliest of: • The date your coverage under a plan ends • The date your dependent ceases to be an eligible dependent • For a spouse, the date of a divorce or annulment • For dependents, the date of your death Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative.

Life Planning Financial & Legal Resources services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.

Unum complies with state civil union and domestic partner laws when applicable.

Underwritten by: Unum Life Insurance Company of America, Portland, Maine © 2022 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

EN-1976

FOR EMPLOYEES

(6-22)

30

Unum | Term Life Insurance

Family Protection Plan Group Term Life Insurance to age 121 with Quality of Life underwritten by 5Star Life Insurance Company

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

Life doesn’t come with a lesson plan

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

Why buy life insurance when you’re young?

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

44% of American households would encounter significant financial difficulties within six months if they lost the primary family wage earner.

28% would reach this point in one month or less.

Forbes Life Insurance Statistics, Data and Industry Trends 2024; 2022 Insurance Barometer Study, Life Happens and Limra

Portable

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

Why is portability important?

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

*As long as premiums are paid.

Underwritten and administered by 5Star Life Insurance Company (a Lincoln, Nebraska company); Mail: PO Box 5005, Batavia, IL 60510-5005. Product not available in all states. Policy #: ICC18-GFPPPOL HiggenbothemSchoolFlyerR0424

31

4/24

Family Protection Plan Group Term Life Insurance to age 121 with Quality of Life underwritten by 5Star Life Insurance Company

Terminal illness acceleration of benefits

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

Protection you can count on

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

Convenient

Easy payment through payroll deduction.

Quality of Life benefit

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

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

•

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

How does Quality of Life help?

Many individuals who can’t take care of themselves require special accommodations to perform ADLs and would need to make modifications to continue to live at home with physical limitation.

The proceeds from the Quality of Life benefit can be used for any purpose, including costs for infacility care, home healthcare professionals, home modifications, and more.

2025 Enrollment Plan Year

Guaranteed Issue is offered to all eligible applicants regardless of health status.

No Doctor exams or physicals.

Employee: $150,000 | Spouse: $50,000 | Child: $10,000 Enroll to provide peace of mind for your family

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

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

* Accelerated benefits may, or may not, be taxable. If so, you or your beneficiary may incur a tax obligation. As with all tax matters, you should consult your personal tax advisor to assess any potential impacts of this benefit. Underwritten and administered by 5Star Life Insurance Company (a Lincoln, Nebraska company); Mail: PO Box 5005, Batavia, IL 60510-5005. Product not available in all32 states. Policy #: ICC18-GFPPPOL HiggenbothemSchoolFlyerR0424

4/24

Central Texas Employee Benefits Cooperative | Workplace Benefits

Cash benefits when you need them most — Cancer Insurance from Chubb A cancer diagnosis and treatment can be an emotionally and physically difficult time. Chubb is there to help support you by providing cash benefits paid directly to you. Benefits are paid if you are diagnosed with cancer, but also help cover many other cancer-related services such as doctor’s visits, treatments, specialty care, and recovery. However, there are no restrictions on how to use these cash benefits—so you can use them as you see fit.

Choose the right level of coverage during the enrollment period to better protect your family.

Cash benefits for every step of the way Cancer Insurance Benefits

Low Plan

High Plan

First cancer benefit

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

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

Diagnosis of cancer

$5,000 employee or spouse $7,500 child(ren) Waiting period: 0 days Benefit reduction: none

$10,000 employee or spouse $15,000 child(ren) Waiting period: 0 days Benefit reduction: none

Hospital confinement

$100 per day – days 1 through 30 Additional days: $200 Maximum days per confinement: 31

$200 per day – days 1 through 30 Additional days: $400 Maximum days per confinement: 31

Hospital confinement ICU

$600 per day – days 1 through 30 Additional days: $600 Maximum days per confinement: 31

$600 per day – days 1 through 30 Additional days: $600 Maximum days per confinement: 31

Radiation therapy, chemotherapy, immunotherapy

Maximum per covered person per calendar year per 12-month period: $10,000

Maximum per covered person per calendar year per 12-month period: $20,000

$75 per visit Maximum visits per calendar year: 4

$75 per visit Maximum visits per calendar year: 4

Medical imaging

$500 per imaging study Maximum studies per calendar year: 2

$500 per imaging study Maximum studies per calendar year: 2

Skin cancer initial diagnosis

$100 per diagnosis Lifetime maximum: 1 33

$100 per diagnosis Lifetime maximum: 1

Alternative care

Cash benefits for every step of the way (cont.)

Cancer Insurance Benefits

Low Plan

High Plan

Attending physician

$30 per visit Maximum visits per calendar year: 4

$50 per visit Maximum visits per calendar year: 4

Hospital confinement sub-acute ICU

$300 per day – days 1 through 30 Additional days: $300 Maximum days per confinement: 31

$300 per day – days 1 through 30 Additional days: $300 Maximum days per confinement: 31

Family care

Childcare: $100 per day per child Maximum days per calendar year: 30 Adult day care or home healthcare: $100 per day Maximum days per calendar year: 30

Childcare: $100 per day per child Maximum days per calendar year: 30 Adult day care or home healthcare: $100 per day Maximum days per calendar year: 30

Prescription drug in-patient

Per confinement: $150 Maximum confinements per calendar year: 6

Per confinement: $150 Maximum confinements per calendar year: 6

Private full-time nursing services

$150 per day Maximum days per confinement: 5

$150 per day Maximum days per confinement: 5

U.S. government or charity hospital

Days 1 through 30: $100 Additional days: $100 Maximum days per confinement: 15

Days 1 through 30: $200 Additional days: $400 Maximum days per confinement: 15

Specialty Care Benefits

Low Plan

High Plan

Family member transportation and lodging

Family transportation: $100 per trip Maximum trips per calendar year: 12 Family lodging: $100 per day Maximum days per calendar year: 100

Family transportation: $100 per trip Maximum trips per calendar year: 12 Family lodging: $100 per day Maximum days per calendar year: 100

Home health care

$100 per day not to exceed the number of days confined Maximum days per calendar year: 30

$200 per day not to exceed the number of days confined Maximum days per calendar year: 30

Hospice care

$100 per day

$200 per day

Skilled nursing care facility

$100 per day Maximum days per calendar year: 30

$200 per day Maximum days per calendar year: 30

Cancer Treatment Benefits

Low Plan

High Plan

Air ambulance

$2,000 per trip Maximum trips per confinement: 2

$2,000 per trip Maximum trips per confinement: 2

Ambulance

$200 per trip Maximum trips per confinement: 2

$200 per trip Maximum trips per confinement: 2

Blood, plasma, and platelets

$300 per transfusion Maximum transfusions per calendar year: 2

$300 per transfusion Maximum transfusions per calendar year: 2

Bone marrow or stem cell donation

$200 per confinement Lifetime maximum donations: 2

$300 per confinement Lifetime maximum donations: 2

34

Cash benefits for every step of the way (cont.)

Cancer Treatment Benefits

Low Plan

High Plan

Bone marrow or stem cell transplant

First bone marrow transplant: $6,000

First bone marrow transplant: $9,000

Additional transplant: 50%

Additional transplant: 50%

Lifetime maximum transplant(s): 2

Lifetime maximum transplant(s): 2

First stem cell transplant: $600

First stem cell transplant: $900

Additional transplant: 50%

Additional transplant: 50%

Lifetime maximum transplant(s): 2

Lifetime maximum transplant(s): 2

Hormonal therapy

$50 per treatment Maximum treatments per calendar year: 12

$50 per treatment Maximum treatments per calendar year: 12

National Cancer Institute Designated Comprehensive Cancer Treatment Center Evaluation/Consultation Benefit

$750 Lifetime maximum consultation(s): 1

$750 Lifetime maximum consultation(s): 1

Cancer Recovery Benefits

Low Plan

High Plan

Counseling

$75 per visit Maximum visits per calendar year: 6

$75 per visit Maximum visits per calendar year: 6

Hair piece

$150 per hair piece Lifetime maximum: 1

$150 per hair piece Lifetime maximum: 1

Medical equipment

$150 per piece of equipment Maximum pieces per calendar year: 2

$150 per piece of equipment Maximum pieces per calendar year: 2

Non-surgical prosthesis

$100 Lifetime maximum number of devices: 1

$100 Lifetime maximum number of devices: 1

Recovery at home

$150 per day not to exceed the number of days confined Maximum days per calendar year: 15

$150 per day not to exceed the number of days confined Maximum days per calendar year: 15

Therapy

$25 per day of therapy Maximum days per calendar year: 40

$25 per day of therapy Maximum days per calendar year: 40

Transportation and lodging

Transportation: $100 per trip Maximum trips per calendar year: 12 Lodging: $100 per day Maximum days per calendar year: 100

Transportation: $100 per trip Maximum trips per calendar year: 12 Lodging: $100 per day Maximum days per calendar year: 100

Preventative and Wellness Benefits

Low Plan

High Plan

Cancer wellness

$50 Maximum days of service, per covered person per calendar year: 1 day(s) Follow-up test benefit amount: $100 Waiting period: 0 days

$50 Maximum days of service, per covered person per calendar year: 1 day(s) Follow-up test benefit amount: $100 Waiting period: 0 days

Genetic tumor testing

$100 per test Maximum tests per calendar year: 2

$100 per test Maximum tests per calendar year: 2

35

Cash benefits for every step of the way (cont.)

Preventative and Wellness Benefits

Low Plan

High Plan

Heritable cancer screening

$100 Maximum tests per calendar year: 1

$100 Maximum tests per calendar year: 1

Pharmacogenomic (PGX) screening test

$100 per test Maximum tests per calendar year: 2

$100 per test Maximum tests per calendar year: 2

Heart Attack or Stroke Benefit

Low Plan

High Plan

Heart attack or stroke

$5,000 Recurrence benefit: $2,500 Waiting period: 0 days Benefit reduction: none

$10,000 Recurrence benefit: $5,000 Waiting period: 0 days Benefit reduction: none

Specified Disease Benefits

Low Plan

High Plan

Waiting period: 0 days Benefit reduction: None

Waiting period: 0 days Benefit reduction: None

Hospital confinement for specified disease benefit

$100 per day – days 1 through 30 Additional days: $100 Maximum days per confinement: 31

$200 per day – days 1 through 30 Additional days: $400 Maximum days per confinement: 31

Surgical Treatment Benefits

Low Plan

High Plan

Waiting period

Waiting period: 0 days

Waiting period: 0 days

Surgery

Up to $3,000

Up to $3,000

Anesthesia

General anesthesia: 25% of surgery benefit Maximum benefits per calendar year: 2

General anesthesia: 25% of surgery benefit Maximum benefits per calendar year: 2

Outpatient surgery facility service

$200 per day Maximum benefits per calendar year: 4

$400 per day Maximum benefits per calendar year: 4

Preventative surgery

$250 Lifetime maximum: 1

$250 Lifetime maximum: 1

Reconstructive surgery

Breast TRAM flap: $2,000 Breast reconstruction: $500 Breast symmetry: $500 Facial reconstruction: $500

Breast TRAM flap: $2,000 Breast reconstruction: $500 Breast symmetry: $500 Facial reconstruction: $500

Second and third opinion

$300 Maximum benefits per calendar year: 2

$300 Maximum benefits per calendar year: 2

Skin cancer surgery

$100 Maximum benefits per calendar year: 2

$100 Maximum benefits per calendar year: 2

Surgical prosthesis

$1,000 per device Lifetime maximum benefit amount: $1,000

$1,000 per device Lifetime maximum benefit amount: $1,000

36

Cash benefits for every step of the way (cont.)

Accident and Sickness Benefits

Low Plan

High Plan

Hospital intensive care for accident or sickness

Hospital confinement ICU for accident or sickness benefit: $100 Maximum number of days per confinement: 30

Hospital confinement ICU for accident or sickness benefit: $200 Maximum number of days per confinement: 30

Advocacy Package

Low Plan

High Plan

Included Kindly HumanTM Participants can talk for up to six hours total per year for pre-clinical peer-to-peer connections and navigation across real-life issues.

Included

Additional plan benefits Renewability

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

Portability

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

Continuity of coverage

Included

Pre-existing conditions limitation

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

Waiver of premium

Included

Definitions and provisions Continuity of coverage

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

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

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

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

Definition of cancer

Cancer means carcinoma in situ, leukemia, or a malignant tumor characterized by uncontrolled cell growth and invasion or spread of malignant cells to distant tissue.

Cancer is also defined as cancer which meets the diagnosis criteria of malignancy established by the American Board of Pathology after a study of the histocytologic architecture or pattern of the suspect tumor, tissue, or specimen.

Carcinoma in situ means a malignant tumor which is typically classified as Stage 0 cancer, where the tumor cells still lie within the tissue of the site of origin without having invaded neighboring tissue.

37

Definitions and provisions (cont.)

Definition of cancer

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

Plan descriptions

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

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

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

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

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

Rates Monthly Premium

Low Plan

High Plan

Employee only

$17.20

$27.92

Employee + spouse

$32.90

$53.22

Employee + child(ren)

$21.40

$34.64

Family

$32.90

$53.22

Questions?

Contact the HPS Benefits Call Center via the QR code or (833) 453-1680.

*Please refer to your Certificate of Insurance at https://www.ctxebc.com 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 policy does not constitute comprehensive health insurance coverage (often referred to as “major medical coverage”) and does not satisfy a person’s individual obligation to secure the requirement of minimum essential coverage under the Affordable Care Act (ACA). For more information about the ACA, please refer 38 to http://www.HealthCare.gov.

CWB-C-FBS-0424

| Workplace Benefits

Accident

Central Texas Employee Benefits Cooperative

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.

Accident Insurance Coverage Type

24-Hour

Sports Package

Up to $1,000 per person/ per year

First Accident

$100

Initial Care Benefits

Payable Benefit

Emergency Room

$225

Urgent Care

$225

Initial Dr. Visit

$150

Hospital/Facility Benefits

Payable Benefit

Standard Hospital Admission

$1,500

ICU Hospital Admission

$2,000

Hospital Confinement (per day, up to 365 days)

$400

ICU Confinement (per day, up to 30 days)

$600

Outpatient Surgery Facility

$225

Rehab Confinement (per day, up to 30 days)

$300

Recovery Benefit (per day)

$25

No. of Days

7

Additional Benefits

Payable Benefit

Accidental Death Employee

$50,000

Spouse

$25,000

Child

$12,500

Ambulance (air)

$2,000

Ambulance (ground)

$500

Appliance

$200

Blood, Plasma, Platelets

$600

Burns

Up to $15,000

Skin Graft

25%

Chiropractic Care (per visit)

$50

Coma

$17,000

Dislocations (up to)

$7,700

Emergency Dental

Up to $450

¹ www.healthcare.gov; accessed Jan. 2023 ² Centers for Disease Control and Prevention; Jan. 2023

39

Additional Benefits (cont.)

Payable Benefit

Eye Injury

$500

Family Care (up to 30 days)

$25 per day, per child in child care center

Follow-up Treatment (per visit)

$100

Fractures (up to)

$8,000

Herniated Disc Surgery

$1,200

Knee Cartilage - Torn

$800

Lacerations

$30-$500

Lodging (per night, 100 or more miles)

$180

Loss of Hands, Feet, Sight

$50,000

Loss of Fingers or Toes

$1,800

Major Diagnostic Exam (CT, MRI, etc.)

$300

Paralysis Two Limbs (paraplegia or hemiplegia)

$16,000

Four Limbs (quadriplegia)

$24,000

Prosthetics

$1,500

Surgery - Abdominal, Cranial, or Thoracic

$3,000

Hernia

$400

Tendon, Ligament, Rotator Cuff

$825

Therapy – Physical, Occupational, or Speech

$50

Transportation (per trip, 100 or more miles)

$750

Traumatic Brain Injury

$225

X-Ray

$100

Rates Coverage Type

24-Hour

Monthly Premiums Employee

$10.98

Employee + Spouse

$17.09

Employee + Children

$17.90

Family

$24.02

Questions?

Contact the HPS Benefits CareLine via the QR code or (833) 453-1680.

Please refer to your Certificate of Insurance at https://www.ctxebc.com 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 an accident only policy and does not pay benefits for loss from sickness.

40

CWB-ACC-CETX-23

| Workplace Benefits

Central Texas Employee Benefits Cooperative

Critical Illness Every 40 seconds

Heart attacks, cancer and strokes happen every day and often unexpectedly. They don’t give you time to prepare and can take a serious toll on both your physical and financial well-being. Chubb Critical Illness pays cash benefits directly to you that you can use to help with your bills, your mortgage, your rent, your childcare— you name it—so you can focus on recovery.

someone has a heart attack.¹

1 in 3 Americans don’t have enough money readily available to cover an unexpected $400 expense.²

Available coverage choices Employee

$10,000; $20,000; $30,000; or $40,000 face amounts

Spouse

$5,000; $10,000; $15,000; or $20,000 face amounts

Child

Included in the employee rate

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.

Critical Illness Insurance Covered conditions

Payable benefit as a percentage of face amount

ALS

100%

Alzheimer's disease

100%

Benign brain tumor

100%

Breast cancer carcinoma in situ

100%

Cancer (see below for skin cancer)

100%

Carcinoma in situ

25%

Coma

100%

Coronary artery obstruction

25%

End stage renal failure

100%

¹ Centers for Disease Control and Prevention, Jan. 2023 ² The Federal Reserve, June 2022

41

Covered conditions

Payable benefit as a percentage of face amount

Heart attack

100%

Loss of sight, speech, or hearing

100%

Major organ failure

100%

Multiple sclerosis

100%

Paralysis or dismemberment

100%

Parkinson’s disease

100%

Stroke

100%

Sudden cardiac arrest

100%

Transient ischemic attacks

10%

Skin Cancer Benefit - Payable once per insured per year

$1,000

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.

Included

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’s syndrome; Gaucher disease; muscular dystrophy; type 1 diabetes).

Included

Miscellaneous Disease Rider + COVID-19 The Miscellaneous Disease Rider is payable once per covered condition.

Covered conditions include: Addison’s disease; cerebrospinal meningistis; diptheria; Hungtington’s chorea; Legionnaire’s disease; malaria; myasthenia gravis; meningitis; necrotizing fasciitis; osteomyelitis; polio; rabies; sclerodema; systematic lupus; tetanus; tuberculosis.

100% misc. diseases excluding Covid-19 50% Covid- 19

COVID-19 means a disease resulting in a positive COVID-19 diagnostic screening and 5 consecutive days of hospital confinement.

Recurrence Benefit Benefits are payable for a subsequent diagnosis of benign brain tumor; cancer; coma; coronary artery obstruction; heart attack; major organ failure; stroke; or sudden cardiac arrest.

100%

Advocacy package Diabetes Benefit iabetes Diagnosis Benefit D Pays a benefit once for covered person’s diabetes diagnosis.

$500

Additional benefits Waiver of Premium Waives premium while the insured is totally disabled.

Included

Wellness Benefit - Payable once per insured per year

$50

42

Rates Riders are included in all the rates listed below: Waiver of Premium, Wellness Benefit, Diabetes Benefit Face amount: Employee $10,000 Spouse $5,000 Children $5,000

Employee

Attained age

Monthly premiums

18-25 26-30

Employee + spouse

Employee + children

Family

$4.50

$6.75

$4.50

$6.75

$4.50

$6.75

$4.50

$6.75

31-35

$5.20

$7.80

$5.20

$7.80

36-40

$5.20

$7.80

$5.20

$7.80

41-45

$9.50

$14.25

$9.50

$14.25

46-50

$9.50

$14.25

$9.50

$14.25

51-55

$19.70

$29.55

$19.70

$29.55

56-60

$19.70

$29.55

$19.70

$29.55

61-65

$30.90

$46.35

$30.90

$46.35

66-70

$40.00

$60.00

$40.00

$60.00

71-75

$55.90

$83.85

$55.90

$83.85

76-80

$55.90

$83.85

$55.90

$83.85

81+

$55.90

$83.85

$55.90

$83.85

Face amount: Employee $20,000 Spouse $10,000 Children $10,000

Employee

Employee + spouse

Employee + children

Family

Attained age

Monthly premiums

18-25

$9.00

$13.50

$9.00

$13.50

26-30

$9.00

$13.50

$9.00

$13.50

31-35

$10.40

$15.60

$10.40

$15.60

36-40

$10.40

$15.60

$10.40

$15.60

41-45

$19.00

$28.50

$19.00

$28.50

46-50

$19.00

$28.50

$19.00

$28.50

51-55

$39.40

$59.10

$39.40

$59.10

56-60

$39.40

$59.10

$39.40

$59.10

61-65

$61.80

$92.70

$61.80

$92.70

66-70

$80.00

$120.00

$80.00

$120.00

71-75

$111.80

$167.70

$111.80

$167.70

76-80

$111.80

$167.70

$111.80

$167.70

81+

$111.80

$167.70

$111.80

$167.70

43

Rates (continued) Riders are included in all the rates listed below: Waiver of Premium, Wellness Benefit, Diabetes Benefit Face amount: Employee $30,000 Spouse $15,000 Children $15,000

Employee

Attained age

Monthly premiums

Employee + spouse

Employee + children

Family

18-25

$13.50

$20.25

$13.50

$20.25

26-30

$13.50

$20.25

$13.50

$20.25

31-35

$15.60

$23.40

$15.60

$23.40

36-40

$15.60

$23.40

$15.60

$23.40

41-45

$28.50

$42.75

$28.50

$42.75

46-50

$28.50

$42.75

$28.50

$42.75

51-55

$59.10

$88.65

$59.10

$88.65

56-60

$59.10

$88.65

$59.10

$88.65

61-65

$92.70

$139.05

$92.70

$139.05

66-70

$120.00

$180.00

$120.00

$180.00

71-75

$167.70

$251.55

$167.70

$251.55

76-80

$167.70

$251.55

$167.70

$251.55

81+

$167.70

$251.55

$167.70

$251.55

Face amount: Employee $40,000 Spouse $20,000 Children $20,000

Employee

Employee + spouse

Employee + children

Family

Attained age

Monthly premiums

18-25

$18.00

$27.00

$18.00

$27.00

26-30

$18.00

$27.00

$18.00

$27.00

31-35

$20.80

$31.20

$20.80

$31.20

36-40

$20.80

$31.20

$20.80

$31.20

41-45

$38.00

$57.00

$38.00

$57.00

46-50

$38.00

$57.00

$38.00

$57.00

51-55

$78.80

$118.20

$78.80

$118.20

56-60

$78.80

$118.20

$78.80

$118.20

61-65

$123.60

$185.40

$123.60

$185.40

66-70

$160.00

$240.00

$160.00

$240.00

71-75

$223.60

$335.40

$223.60

$335.40

76-80

$223.60

$335.40

$223.60

$335.40

81+

$223.60

$335.40

$223.60

$335.40

Questions?

Contact the HPS Call center via the QR code or (833) 453-1680. *Please refer to your Certificate of Insurance at https://www.ctxebc.com 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 policy does not constitute comprehensive health insurance coverage (often referred to as “major medical coverage”) and does not satisfy a person’s individual obligation to secure the requirement of minimum essential coverage under the Affordable Care Act (ACA). For more information about the ACA, please refer to http://www.HealthCare.gov.

44 CWB-CI-CETX-23

No one is immune to identity theft.

Better Protect What Matters Most.

Identity theft can affect anyone—from infants to seniors. Each generation has habits that savvy criminals know how to exploit—resulting in over $50 billion lost in the US to identity fraud in 2021.1 Take action with award-winning ID Watchdog identity theft protection.

Greater Peace of Mind With ID Watchdog® as an employee benefit, you have a more convenient and affordable way to help better protect and monitor your identity. You’ll be alerted to potentially suspicious activity and enjoy greater peace of mind knowing you don't have

Awarded Best in Class Identity Protection Service Provider for Consumers

to face identity theft alone.

Why Choose ID Watchdog?

Greater Protection & Control

Fully Managed Identity Restoration

We scour billions of data points—

We've got you covered with lock

If you become a victim, you don’t

public records, transaction records,

features for added control over

have to face it alone. One of our

social media and more—to search

your credit report(s) to help keep

certified resolution specialists

for signs of potential identity theft.

identity thieves from opening

will fully manage the case for you

new accounts in your name.

until your identity is restored.

Advanced Identity Theft Detection

Extensive Family Coverage Our family plan helps you better protect your loved ones2 with personalized accounts for adult family members, family alert sharing, and exclusive features for children.

Our US-based, customer care team is here for you 24/7/365 at 866.513.1518.

1 2

Javelin Strategy & Research, 2022 Identity Fraud Study: The Virtual Battleground, Mar 2022.

Refer to your employer or ID Watchdog for family plan eligibility.

45

Powerful Features Included in Both ID Watchdog Plans Control & Manage

Monitor & Detect

Support & Restore

• Financial Accounts Monitoring

• Dark Web Monitoring1

• Social Account Monitoring

• Data Breach Notifications

• Fully Managed Resolution Services including Pre-Existing Conditions

• Registered Sex Offender Reporting

• High-Risk Transactions Monitoring2

• Online Resolution Tracker

• Customizable Alert Options

• Subprime Loan Monitoring2

• Lost Wallet Vault & Assistance

• Equifax Blocked Inquiry Alerts

• Public Records Monitoring

• National Provider ID Alerts

• USPS Change of Address Monitoring

• Deceased Family Member Fraud Remediation3 (Family Plan only)

• Identity Profile Report

• Credit Freeze Assistance

• Credit Score Tracker Help better protect children with Equifax Child Credit Lock & Equifax Child Credit Monitoring PLUS features with this icon

Plan-Specific Features

1B

Platinum

1 Bureau

3 Bureau

1 Bureau Monthly

1 Bureau Daily & 3 Bureau Annually

1 Bureau

Multi-Bureau

Up to $1 Million

Up to $2 Million

Credit Report Monitoring4 Credit Report(s)5 & VantageScore Credit Score(s) Credit Report Lock6 Identity Theft Insurance7 • Up to $1M Stolen Funds Reimbursement - Checking and savings accounts

-

- 401k/HSA/ESOP accounts • Home Title Fraud NEW • Cyber Extortion NEW

Subprime Loan Block2

-

within the monitored lending network

-

Telecom & Utility Alerts | 1 Bureau NEW Integrated Fraud Alerts

8

-

With a fraud alert, potential lenders are encouraged to take extra steps to verify your identity before extending credit.

Employee

$7.95/month

$11.95/month

Employee + Family

$14.95/month

$22.95/month

NEW

=Targeted to be available9 by Jan 2023

What You Need to Know

1 Bureau = Equifax® | Multi-Bureau = Equifax, TransUnion® | 3 Bureau = Equifax, Experian®, TransUnion

The credit scores provided are based on the VantageScore 3.0 model. For three-bureau VantageScore credit scores, data from Equifax, Experian, and TransUnion are used respectively. Any one-bureau VantageScore uses Equifax data. Third parties use many different types of credit scores and are likely to use a different type of credit score to assess your creditworthiness.

(1)Dark Web Monitoring scans thousands of internet sites where consumers’ personal information is suspected of being bought and sold, and is constantly adding new sites to those it searches. However, the internet addresses of these suspected internet trading sites are not published and frequently change, so there is no guarantee that ID Watchdog is able to locate and search every possible internet site where consumers’ personal information is at risk of being traded. (2)The monitored network does not cover all businesses or transactions. (3)Applicable for enrolled family members only. (4)Monitoring from TransUnion and Experian will take several days to begin. (5)Under certain circumstances, access to your Equifax Credit Report may not be available as certain consumer credit files maintained by Equifax contain credit histories, multiple trade accounts, and/or an extraordinary number of inquiries of a nature that prevents or delays the delivery of your Equifax Credit Report. If a remedy for the failure is not available, the product subscription will be cancelled and a full refund will be made.

(6)Locking your Equifax or TransUnion credit report will prevent access to it by certain third parties. Locking your Equifax or TransUnion credit report will not prevent access to your credit report at any other credit reporting agency. Entities that may still have access to your Equifax or TransUnion credit report include: companies like ID Watchdog and TransUnion Interactive, Inc. which provide you with access to your credit report or credit score, or monitor your credit report as part of a subscription or similar service; companies that provide you with a copy of your credit report or credit score, upon your request; federal, state, and local government agencies and courts in certain circumstances; companies using the information in connection with the underwriting of insurance, or for employment, tenant or background screening purposes; companies that have a current account or relationship with you, and collection agencies acting on behalf of those whom you owe; companies that authenticate a consumer’s identity for purposes other than granting credit, or for investigating or preventing actual or potential fraud; and companies that wish to make pre-approved offers of credit or insurance to you. To opt out of preapproved offers, visit www.optoutprescreen.com.

(7)The Identity Theft Insurance is underwritten and administered by American Bankers Insurance Company of Florida, an Assurant company. Please refer to the actual policies for terms, conditions, and exclusions of coverage. Coverage may not be available in all jurisdictions. Review the Summary of Benefits (www.idwatchdog.com/terms/insurance). (8)The Integrated Fraud Alert feature is made available to consumers by Equifax Information Services LLC and fulfilled on its behalf by Identity Rehab Corporation. (9)May be subject to delay or change.

46

© 2022 ID Watchdog. Other product and company names are property of their respective owners. EE-1BP25422-722

DID YOU KNOW?

25PEOPLE

MILLION

are sent to the emergency room through ground or air ambulance every year*.

Insurance companies may not cover all air and ground ambulance expenses which can result in max in-network out-of-pocket** costs of:

$8,700 Individual $17,400 Family Ground ambulance out-of-network transportation costs may be even higher than in-network since the No Surprises Act does not apply to ground ambulance at this time.

EMERGENT PLUS MEMBERSHIP BENEFITS A MASA MTS Membership provides the ultimate peace of mind at an aff ordable rate for emergency ground and air transportation assistance expenses within the continental United States, Alaska, Hawaii, and while traveling in Canada, regardless of whether the provider is in or out of your group healthcare bene ts network. After the group health plan pays its portion, MASA works with providers to make certain our Members have no out-of-pocket expenses~ for emergency ambulance transportation assistance and other related services.

Emergency Air Ambulance Coverage1

MASA MTS covers out-of-pocket expenses associated with emergency air transportation to a medical facility for serious medical emergencies deemed medically necessary for you or your dependent family member.

Emergency Ground Ambulance Coverage1

MASA MTS covers out-of-pocket expenses associated with emergency ground transportation to a medical facility for serious medical emergencies deemed medically necessary for you or your dependent family member.

Hospital to Hospital Ambulance Coverage1

MASA MTS covers out-of-pocket expenses that you or a dependent family member may incur for hospital transfers, due to a serious emergency, to the nearest and most appropriate medical facility when the current medical facility cannot provide the required level of specialized care by air ambulance to include medically equipped helicopter or xed-wing aircraft.

Repatriation to Hospital Near Home Coverage1

MASA MTS provides services and covers out-of-pocket expenses for the coordination of a Member’s nonemergency transportation by a medically equipped, air or ground ambulance in the event of hospitalization more than one hundred (100) miles from the Member’s home if the treating physician and MASA MTS’ Medical Director says it’s medically appropriate and possible to transfer the Member to a hospital nearer to home for continued care and recuperation.

Contact Your Representative, to learn more:

47 MASAEPLUS_B2B_CB_FLR_V2_031722

The information provided in this product information sheet is for informational purposes only. The benets listed and the descriptions thereof do not represent the full terms and conditions applicable for usage and may only be offered in some memberships. Premiums and benets vary depending on the benets selected. Commercial air and Worldwide coverage are not available in all territories. For a complete list of benets, premiums, and full terms, conditions, and restrictions, please refer to the applicable member services agreement for your territory. MASA MTS products and services are not available in AK, NY, WA, ND, and NJ. MASA MTS utilizes third-party transportation service providers for all transportation services. MASA Global, MASA MTS and MASA TRS are registered service marks of MASA Holdings, Inc., a Delaware corporation. Void where prohibited by law. ~If a member has a high deductible health plan that is compatible with a health savings account, benets will become available under the MASA membership for expenses incurred for medical care (as dened under Internal Revenue Code (“IRC”) section 213 (d)) once a member satises the applicable statutory minimum deductible under IRC section 223(c) for high-deductible health plan coverage that is compatible with a health savings account.

COVERAGE TERRITORIES: 1. All coverage provided by this membership is limited to the continental United States, Alaska, Hawaii, and Canada, and must originate and conclude therein.

SOURCES: *ACEP NOW 2014 ** Patient Protection and Affordable Care Act; HHS Notice of Benet and Payment Parameters for 2022 and Pharmacy Benet Manager Standards. May 5, 2021.

1250 S. Pine Island Rd., Suite 500, Plantation, FL 33324 MASAEPLUS_B2B_CB_FLR_V2_031722

48

800-643-9023 I www.masamts.com

Flexible Spending Accounts National Benefit Services (NBS)

EMPLOYEE BENEFITS

ABOUT FSA A Flexible Spending Account (FSA) lets you set aside a portion of your paycheck—before taxes—into an account to help you pay for medical, dental, vision, and dependent care expenses. An FSA is a planning tool with great tax benefits. With an FSA, you must use the account balance in full before the end of the plan year or it will be forfeited. * For full plan details, please refer to your Summary Plan Description (SPD) and visit the NBS Participant Portal: mynbsbenefits.com

There are three types of Flexible Spending Accounts you may be able to choose from. Make sure you understand the purpose of each account before you make your elections!

Health Flexible Spending Account (FSA) The Health FSA allows you to pay for medical, dental, and vision expenses for yourself and your eligible dependents.

For plan years that start in 2025, you may contribute up to $3,300.00 to your Health FSA. This benefit is funded upfront, so you will have access to your whole annual election on the first day of the plan year. You can use your NBS Smart Debit Card to pay for expenses or pay out of pocket and submit claims for reimbursement.

Some examples of common eligible expenses are co-pays and deductibles, orthodontia, eyeglasses, prescription medicines, menstrual care products, over-the-counter medicines, chiropractor, hearing aids, monitoring devices (blood pressure, cholesterol), physical therapy, laser eye surgery, and many more. Complete lists of eligible and non-eligible expenses can be found in IRS Publication 502. *The FSA is a “use-it-or-lose-it” benefit, so plan carefully to ensure you don’t forfeit funds. Your employer may offer you a grace period or rollover option. Refer to your Summary Plan Description (SPD) for more information.

NBS Smart Debit Card If you participate in the FSA or LFSA benefits, you will receive a card in the mail. You can use this card to pay for eligible expenses, thus avoiding out-of-pocket expenses and submitting claim forms. Please make sure you keep any bills, receipts, statements, and/or explanations of benefits (EOBs) corresponding to your card purchases.

You may be asked to substantiate your purchase to show it was an eligible expense.

49

Flexible Spending Accounts

EMPLOYEE BENEFITS

National Benefit Services (NBS)

Dependent Care FSA aka Dependent Care Assistance Program (DCAP) The Dependent Care Flexible Spending Account (DCAP) enables you to pay for out-of-pocket, work-related dependent daycare expenses using pre-tax funds. Please see your Summary Plan Description (SPD) for the definition of eligible dependent. Generally, your reimbursement may not exceed the lesser of: (a) $5,000 (if you are married filing a joint return or you are head of a household) or $2,500 (if you are married filing separate returns); (b) your taxable compensation; (c) your spouse’s actual or deemed earned income.

Examples of eligible expenses: ➢ Before and after school/extended day programs ➢ Daycare in your home or elsewhere ➢ Base cost of day camps or similar programs

Examples of ineligible expenses: ➢ Schooling for a child in kindergarten or above ➢ Babysitter while you go to the movies or dinner ➢ Cost of overnight camps

DCAPs are not funded up-front like Health FSAs. You will gain access to your contributions only after they are deducted from your paycheck. You may choose to be reimbursed automatically each pay period by filling out and submitting the Continual Reimbursement form at the beginning of the plan year. Alternatively, you can choose to submit individual claims for reimbursement. Some employers may allow you to use your NBS Smart Debit card to pay your dependent care provider.

Review your Summary Plan Description (SPD) Your Summary Plan Description (SPD) will give you important information about these benefits that is specific to your employer’s plan. Please read your SPD so you understand your spending deadline, deadline to submit claims, whether you have a grace period and if so, when it ends, whether you have the option to carryover some remaining FSA funds and if so, how much, which qualifying life events may allow you to change your elections outside of open enrollment, and more.

NBS Service Center NBS Participant Portal and Mobile App Our dedicated service center is available to help with To get the most out of your benefits, register for our any of your individual needs, including accessing participant portal and/or download our mobile app. your account, questions about your benefits, and On the portal and app, you can submit claims, pay requesting new debit cards. providers, check your balance, set up direct deposit, order cards for your dependents and replacement Phone: 855-399-3035, option 2 cards, review transactions and spending deadlines, Fax: (844) 438-1496 manage your alerts, and more.

Email: service@nbsbenefits.com To register, visit http://mynbsbenefits.com/, click “Register” in the top right corner, and follow the prompts. Your employee ID is your SSN.

Hours of Operation: 7:00 a.m. - 7:00 p.m. CT Mon - Fri Scan to access the NBS portal!

50

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51

Healthcare Expense Account

Sample Expenses

Medical Expenses •

Acupuncture

•

Fertility treatment

•

Physical exams

•

Addiction programs

•

First aid (e.g., bandages, gauze)

•

Pregnancy tests

•

Adoption (medical expenses for baby birth)

•

Hearing aids & batteries

•

Prescription medicines or drugs

•

Alternative healer fees

•

Hypnosis (for treatment of illness)

•

Ambulance

Incontinence products (e.g., Depends, Serene)

Psychiatrist/psychologist (for mental illness)

•

•

•

Physical therapy

•

Body scans

•

Joint support bandages and hosiery

•

Speech therapy

•

Breast pumps

•

Lab fees

•

Vaccinations

•

Care for mentally handicapped

•

Menstrual Products*

•

Vaporizers or humidifiers

•

Chiropractor

•

Copayments

Monitoring device (blood pressure, cholesterol)

•

•

Weight loss program fees (if prescribed by physician)

•

Crutches

•

•

Wheelchair

•

Diabetes (insulin, glucose monitor)

•

Eye patches

Non-prescription medicines or drugs (vitamins/supplements without a prescription are not eligible)*

*After January 1, 2020

Dental Expenses

Vision Expenses

•

Artificial teeth

•

Dentures

•

Braille - books & magazines

•

Eyeglasses

•

Copayments

•

Orthodontia expenses

•

Contact lenses

•

Laser surgery

•

Deductible

•

Preventative care at dentist office

•

Contact lens solutions

•

Office fees

•

Dental work

•

Bridges, crown, etc.

•

Eye exams

•

Guide dog and upkeep/ other animal aid

Items that generally do not qualify for reimbursement •

Personal hygiene (e.g., deodorant, soap, body powder, sanitary products.

Does not include menstrual products)

•

Exercise equipment**

•

•

Haircare (e.g., hair color, shampoo, conditioner, brushes, hair loss products)

Nutritional and dietary supplements (e.g., bars, milkshakes, power drinks, Pedialyte)**

•

Skin care (e.g., moisturizing lotion, lip balm)

•

Sleep aids (e.g., snoring strips)**

•

Vitamins**

•

Weight reduction aids (e.g., Slimfast, appetite suppressant)**

•

Addiction products**

•

Cosmetic surgery**

•

Health club or fitness program fees**

•

Cosmetics (e.g., makeup, lipstick, cotton swabs, cotton balls, baby oil)

•

Homeopathic supplement or herbs**

•

Counseling (e.g., marriage/family)

•

Household or domestic help

•

Dental care - routine (e.g., toothpaste, toothbrushes, dental floss, antibacterial mouthwashes, fluoride rinses, teeth whitening/bleaching)**

•

Laser hair removal

•

Massage therapy**

**Portions of these expenses may be eligible for reimbursement if they are recommended by a licensed medical professional as medically necessary for treatment of a specific medical condition.

Salt Lake City, UT - Headquarters | Dallas, TX | San Diego, CA | 52 Honolulu, HI (800) 274-0503 | service@nbsbenefits.com | www.nbsbenefits.com TM

R

Save with these incredible MEMBERPERKS Your LegalShield and IDShield memberships are simply amazing. And in addition to the privileges that are already yours, we have added these MEMBERPERKS with hundreds of merchants and thousands of discounts.

Members can access savings at both national and local companies on everyday purchases such as tickets, electronics, apparel, travel and more. Members have the opportunity to save, on average, over $2,000 per year.

MEMBERPERKS can save you enough to pay for your membership for years to come!

RECEIVE EXCLUSIVE DISCOUNTS

Access your members-only discounts in categories such as: APPAREL

HOME SERVICES

AUTOMOTIVE

INSURANCE & PROTECTION SERVICES

BOOKS, MOVIES & MUSIC OFFICE & BUSINESS CELL PHONES ELECTRONICS FINANCE FLOWERS & GIFTS FOOD

REAL ESTATE & MOVING SERVICES SPORTS & OUTDOORS TICKETS & ENTERTAINMENT

WHAT MEMBERS ARE SAYING: “MEMBERPerks pays for my membership!”

— Martha S. “I saved 20% at Advance Auto and I also saved 30% on movie tickets on date night with my wife. This membership is it!”

— Andre E. “I am receiving 8% off my Verizon cell phone monthly charge!”

— Paulette M.

TRAVEL

HEALTH & WELLNESS

Enjoy preferred member pricing on some of your favorite brands and services.

AND MANY MORE!

Getting Started

To sign up, simply login at legalshield.com, click on the Resources tab, then click on MEMBERPERKS. If you don’t already have an account, follow the simple on-screen instructions to make an account with your personal or work email and LegalShield membership number.

These benefits are for LegalShield and IDShield members. All offers 53or promotions are subject to change without notice.

SHEET_MEMBERPerks_051818

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

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.

Out-of-Pocket Maximum – Also known as an out-ofpocket limit. The most you pay during a policy period (usually a 12-month period) before your health insurance or plan begins to pay 100% of the allowed amount. The limit does not include your premium, charges beyond the Reasonable and Customary (R&C) Allowance, or health care your plan does not cover. Check with your health insurance carrier to confirm what payments apply to the out-of-pocket maximum.

Plan Year – September 1 through August 31.

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.

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Important Legal Notices Women’s Health and Cancer Rights Act of 1998 In October 1998, Congress enacted the Women’s Health and Cancer benefits: All stages of reconstruction of theRights Act of 1998.

This notice explains some important provisions of the Act. Please review this information carefully.

As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; and • Prostheses and treatment of physical complications of the mastectomy, including lymphedema.

Health plans must determine the manner of coverage in consultation with the attending physician and the patient.

Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.

Special Enrollment Rights This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time.

Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP) If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage).

If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is terminated from, or determined to be eligible for, such assistance.

Marriage, Birth or Adoption If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 31 days after the marriage, birth, or placement for adoption.

For More Information or Assistance To request special enrollment or obtain more information, contact: CTXEBC 2175 N Glenville Dr. Richardson, TX 75082 833-931-6514

Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with CTXEBC and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to enroll in a Medicare drug plan.

Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future.

Please note, however, that later notices might supersede this notice.

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. CTXEBC has determined that the prescription drug coverage offered by the CTXEBC medical plan is expected to pay out as much as the standard Medicare prescription drug coverage pays on average for all plan participants and is considered Creditable Coverage.

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Important Legal Notices Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan,as long as you later enroll within specific time periods.

You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).

You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting CTXEBC at the phone number or address listed at the end of this section.

If you choose to enroll in a Medicare prescription drug plan and cancel your current CTXEBC prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back.

To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to determine if and when you are allowed to add coverage.

If you cancel or lose your current coverage and do not have prescription drug coverage for 63 days or longer prior to enrolling in the Medicare prescription drug coverage, your monthly premium will be at least 1% per month greater for every month that you did not have coverage for as long as you have Medicare prescription drug coverage.

For example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage.

For more information about your options under Medicare prescription drug coverage: More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans.

For more information about Medicare prescription drug coverage: • Visit www.medicare.gov.

• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.

• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available.

Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you can call them at 800772-1213. TTY users should call 800-325-0778.

Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).

CTXEBC 2175 N. Glenville Dr. Richardson, TX 833-931-6514

For more information about this notice or your current prescription drug coverage: Contact the Human Resources Department at 833-9316514. NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage, and if this coverage changes. You may also request a copy.

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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 CTXEBC’s Plan is required by law to take reasonable steps to ensure the privacy of your personally identifiable health information and to inform you about: 1. The Plan’s uses and disclosures of Protected Health Information (PHI); 2. Your privacy rights with respect to your PHI; 3. The Plan’s duties with respect to your PHI; 4. Your right to file a complaint with the Plan and the Secretary of the U.S. Department of Health and Human Services; and 5. . The person or office to contact for further information about the Plan’s privacy practices.

The term “Protected Health Information” (PHI) includes all individually identifiable health information transmitted or maintained by the Plan, regardless of form (oral, written, electronic).

Section 1 – Notice of PHI Uses and Disclosures Required PHI Uses and Disclosures Upon your request, the Plan is required to give you access to your PHI in order to inspect and copy it.

Use and disclosure of your PHI may be required by the Secretary of the Department of Health and Human Services to investigate or determine the Plan’s compliance with the privacy regulations.

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

The Plan and its business associates will use PHI without your authorization to carry out treatment, payment and health care operations. The Plan and its business associates (and any health insurers providing benefits to Plan participants) may also disclose the following to the Plan’s Board of Trustees: (1) PHI for purposes related to Plan administration (payment and health care operations); (2) summary health information for purposes of health or stop loss insurance underwriting or for purposes of modifying the Plan; and (3) enrollment information (whether an individual is eligible for benefits under the Plan). The Trustees have amended the Plan to protect your PHI as required by federal law.

Treatment is the provision, coordination or management of health care and related services. It also includes but is not limited to consultations and referrals between one or more of your providers.

For example, the Plan may disclose to a treating physician the name of your treating radiologist so that the physician may ask for your X-rays from the treating radiologist.

Payment includes but is not limited to actions to make coverage determinations and payment (including billing, claims processing, subrogation, reviews for medical necessity and appropriateness of care, utilization review and preauthorizations).

For example, the Plan may tell a treating doctor whether you are eligible for coverage or what percentage of the bill will be paid by the Plan.

Health care operations include but are not limited to quality assessment and improvement, reviewing competence or qualifications of health care professionals, underwriting, premium rating and other insurance activities relating to creating or renewing insurance contracts. It also includes case management, conducting or arranging for medical review, legal services and auditing functions including fraud and abuse compliance programs, business planning and development, business management and general administrative activities. However, no genetic information can be used or disclosed for underwriting purposes.

For example, the Plan may use information to project future benefit costs or audit the accuracy of its claims processing functions.

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

Unless you object, the Plan may provide relevant portions of your protected health information to a family member, friend or other person you indicate is involved in your health care or in helping you receive payment for your health care.

Also, if you are not capable of agreeing or objecting to these disclosures because of, for instance, an emergency situation, the Plan will disclose protected health information (as the Plan determines) in your best interest. After the emergency, the Plan will give you the opportunity to object to future disclosures to family and friends.

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

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Important Legal Notices The Plan is allowed to use and disclose your PHI without your authorization under the following circumstances:

When required for law enforcement purposes, including for the purpose of identifying or locating a suspect, fugitive, material witness or missing person. Also, when disclosing information about an individual who is or is suspected to be a victim of a crime but only if the individual agrees to the disclosure or the Plan is unable to obtain the individual’s agreement because of emergency circumstances. Furthermore, the law enforcement official must represent that the information is not intended to be used against the individual, the immediate law enforcement activity would be materially and adversely affected by waiting to obtain the individual’s agreement and disclosure is in the best interest of the individual as determined by the exercise of the Plan’s best judgment.

1. For treatment, payment and health care operations.

2. Enrollment information can be provided to the Trustees.

3. Summary health information can be provided to the Trustees for the purposes designated above.

4. When required by law.

5. When permitted for purposes of public health activities, including when necessary to report product defects and to permit product recalls. PHI may also be disclosed if you have been exposed to a communicable disease or are at risk of spreading a disease or condition, if required by law.

10. When required to be given to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or other duties as authorized by law. Also, disclosure is permitted to funeral directors, consistent with applicable law, as necessary to carry out their duties with respect to the decedent.

6. When required by law to report information about abuse, neglect or domestic violence to public authorities if there exists a reasonable belief that you may be a victim of abuse, neglect or domestic violence. In which case, the Plan will promptly inform you that such a disclosure has been or will be made unless that notice would cause a risk of serious harm. For the purpose of reporting child abuse or neglect, it is not necessary to inform the minor that such a disclosure has been or will be made.

Disclosure may generally be made to the minor’s parents or other representatives although there may be circumstances under federal or state law when the parents or other representatives may not be given access to the minor’s PHI.

11. When consistent with applicable law and standards of ethical conduct if the Plan, in good faith, believes the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to a person reasonably able to prevent or lessen the threat, including the target of the threat.

12. When authorized by and to the extent necessary to comply with workers’ compensation or other similar programs established by law.

7. The Plan may disclose your PHI to a public health oversight agency for oversight activities required by law. This includes uses or disclosures in civil, administrative or criminal investigations; inspections; licensure or disciplinary actions (for example, to investigate complaints against providers); and other activities necessary for appropriate oversight of government benefit programs (for example, to investigate Medicare or Medicaid fraud).

Except as otherwise indicated in this notice, uses and disclosures will be made only with your written authorization subject to your right to revoke such authorization.

Uses and disclosures that require your written authorization.

8. The Plan may disclose your PHI when required for judicial or administrative proceedings. For example, your PHI may be disclosed in response to a subpoena or discovery request.

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Important Legal Notices Other uses or disclosures of your protected health information not described above will only be made with your written authorization. For example, in general and subject to specific conditions, the Plan will not use or disclose your psychiatric notes; the Plan will not use or disclose your protected health information for marketing; and the Plan will not sell your protected health information, unless you provide a written authorization to do so. You may revoke written authorizations at any time, so long as the revocation is in writing. Once the Plan receives your written revocation, it will only be effective for future uses and disclosures. It will not be effective for any information that may have been used or disclosed in reliance upon the written authorization and prior to receiving your written revocation.

Section 2 – Rights of Individuals Right to Request Restrictions on Uses and Disclosures of PHI You may request the Plan to restrict the uses and disclosures of your PHI. However, the Plan is not required to agree to your request (except that the Plan must comply with your request to restrict a disclosure of your confidential information for payment or health care operations if you paid for the services to which the information relates in full, out of pocket).

You or your personal representative will be required to submit a written request to exercise this right. Such requests should be made to the Plan’s Privacy Official.

Right to Request Confidential Communications The Plan will accommodate reasonable requests to receive communications of PHI by alternative means or at alternative locations if necessary to prevent a disclosure that could endanger you.

You or your personal representative will be required to submit a written request to exercise this right.

Such requests should be made to the Plan’s Privacy Official.

Right to Inspect and Copy PHI You have a right to inspect and obtain a copy of your PHI contained in a “designated record set,” for as long as the Plan maintains the PHI. If the information you request is in an electronic designated record set, you may request that these records be transmitted electronically to yourself or a designated individual.

Designated Record Set Includes the medical records and billing records about individuals maintained by or for a covered health care provider; enrollment, payment, billing, claims adjudication and case or medical management record systems maintained by or for the Plan; or other information used in whole or in part by or for the Plan to make decisions about individuals. Information used for quality control or peer review analyses and not used to make decisions about individuals is not in the designated record set.

The requested information will be provided within 30 days if the information is maintained on site or within 60 days if the information is maintained off site. A single 30-day extension is allowed if the Plan is unable to comply with the deadline.

You or your personal representative will be required to submit a written request to request access to the PHI in your designated record set. Such requests should be made to the Plan’s Privacy Official.

If access is denied, you or your personal representative will be provided with a written denial, setting forth the basis for the denial, a description of how you may appeal the Plan’s decision and a description of how you may complain to the Secretary of the U.S. Department of Health and Human Services.

The Plan may charge a reasonable, cost-based fee for copying records at your request.

Right to Amend PHI You have the right to request the Plan to amend your PHI or a record about you in your designated record set for as long as the PHI is maintained in the designated record set.

The Plan has 60 days after the request is made to act on the request. A single 30-day extension is allowed if the Plan is unable to comply with the deadline. If the request is denied in whole or part, the Plan must provide you with a written denial that explains the basis for the denial. You or your personal representative may then submit a written statement disagreeing with the denial and have that statement included with any future disclosures of your PHI. Such requests should be made to the Plan’s Privacy Official.

You or your personal representative will be required to submit a written request to request amendment of the PHI in your designated record set.

Protected Health Information (PHI) Includes all individually identifiable health information transmitted or maintained by the Plan, regardless of form.

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Important Legal Notices Right to Receive an Accounting of PHI Disclosures At your request, the Plan will also provide you an accounting of disclosures by the Plan of your PHI during the six years prior to the date of your request. However, such accounting will not include PHI disclosures made: (1) to carry out treatment, payment or health care operations; (2) to individuals about their own PHI; (3) pursuant to your authorization; (4) prior to April 14, 2003; and (5) where otherwise permissible under the law and the Plan’s privacy practices. In addition, the Plan need not account for certain incidental disclosures.

If the accounting cannot be provided within 60 days, an additional 30 days is allowed if the individual is given a written statement of the reasons for the delay and the date by which the accounting will be provided.

If you request more than one accounting within a 12month period, the Plan will charge a reasonable, costbased fee for each subsequent accounting.

Such requests should be made to the Plan’s Privacy Official.

Right to Receive a Paper Copy of This Notice Upon Request You have the right to obtain a paper copy of this Notice.

Such requests should be made to the Plan’s Privacy Official.

A Note About Personal Representatives You may exercise your rights through a personal representative. Your personal representative will be required to produce evidence of his/her authority to act on your behalf before that person will be given access to your PHI or allowed to take any action for you. Proof of such authority may take one of the following forms: 1. a power of attorney for health care purposes; 2. a court order of appointment of the person as the conservator or guardian of the individual; or 3. an individual who is the parent of an unemancipated minor child may generally act as the child’s personal representative (subject to state law).

The Plan retains discretion to deny access to your PHI by a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect.

Section 3 – The Plan’s Duties The Plan is required by law to maintain the privacy of PHI and to provide individuals (participants and beneficiaries) with notice of the Plan’s legal duties and privacy practices.

This Notice is effective September 23, 2013, and the Plan is required to comply with the terms of this Notice. However, the Plan reserves the right to change its privacy practices and to apply the changes to any PHI received or maintained by the Plan prior to that date. If a privacy practice is changed, a revised version of this Notice will be provided to all participants for whom the Plan still maintains PHI. The revised Notice will be distributed in the same manner as the initial Notice was provided or in any other permissible manner.

If the revised version of this Notice is posted, you will also receive a copy of the Notice or information about any material change and how to receive a copy of the Notice in the Plan’s next annual mailing. Otherwise, the revised version of this Notice will be distributed within 60 days of the effective date of any material change to the Plan’s policies regarding the uses or disclosures of PHI, the individual’s privacy rights, the duties of the Plan or other privacy practices stated in this Notice.

Minimum Necessary Standard When using or disclosing PHI or when requesting PHI from another covered entity, the Plan will make reasonable efforts not to use, disclose or request more than the minimum amount of PHI necessary to accomplish the intended purpose of the use, disclosure or request, taking into consideration practical and technological limitations. When required by law, the Plan will restrict disclosures to the limited data set, or otherwise as necessary, to the minimum necessary information to accomplish the intended purpose.

However, the minimum necessary standard will not apply in the following situations: 1. disclosures to or requests by a health care provider for treatment; 2. uses or disclosures made to the individual; 3. disclosures made to the Secretary of the U.S. Department of Health and Human Services; 4. uses or disclosures that are required by law; and 5. uses or disclosures that are required for the Plan’s compliance with legal regulations.

De-Identified Information This notice does not apply to information that has been deidentified. De-identified information is information that does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual.

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Important Legal Notices Summary Health Information The Plan may disclose “summary health information” to the Trustees for obtaining insurance premium bids or modifying, amending or terminating the Plan. “Summary health information” summarizes the claims history, claims expenses or type of claims experienced by participants and excludes identifying information in accordance with HIPAA. Notification of Breach The Plan is required by law to maintain the privacy of participants’ PHI and to provide individuals with notice of its legal duties and privacy practices. In the event of a breach of unsecured PHI, the Plan will notify affected individuals of the breach.

Section 4 – Your Right to File a Complaint With the Plan or the HHS Secretary If you believe that your privacy rights have been violated, you may complain to the Plan. Such complaints should be made to the Plan’s Privacy Official.

You may file a complaint with the Secretary of the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, D.C. 20201. The Plan will not retaliate against you for filing a complaint.

Section 5 – Whom to Contact at the Plan for More Information If you have any questions regarding this notice or the subjects addressed in it, you may contact the Plan’s Privacy Official. Such questions should be directed to the Plan’s Privacy Official at:

Conclusion

CTXEBC 2175 N Glenville Dr. Richardson, TX 75082 833-931-6514

PHI use and disclosure by the Plan is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. The Plan intends to comply with these regulations.

This Notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this Notice and the regulations.

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs, but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877- KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or 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.

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Important Legal Notices Colorado – Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+) Health First Colorado website: https://www.healthfirstcolorado. com/ Health First Colorado Member Contact Center: 1800-221- 3943/State Relay 711 CHP+: https://hcpf.colorado.gov/child-health-planplus CHP+ Customer Service: 1-800-359-1991/State Rlay 711 Health Insurance Buy-In Program (HIBI) https://www.mycohibi.com/ HIBI Customer Service: 1-855-692-6442 Texas – Medicaid

Continuation of Coverage Rights Under COBRA Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the CTXEBC group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the CTXEBC plan after you have left employment with the company. If you wish to elect COBRA coverage, contact your Human Resources Department for the applicable deadlines to elect coverage and pay the initial premium.

Plan Contact Information: CTXEBC 2175 N. Glenville Dr. Richardson, TX 75082 833-931-6514

Website: https://www.hhs.texas.gov/services/financial/healthinsurance-premium-payment-hipp-program Phone: 1-800-440-0493 To see if any other States have added a premium assistance program since March 17, 2025, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565

Your Rights and Protections Against Surprise Medical Bills When you get emergency care or get treated by an outof- network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

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

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-ofnetwork providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. It can happen when you can’t control who is involved in your care, like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

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Important Legal Notices You are protected from balance billing for:

Your health plan generally must:

• Emergency services – If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s innetwork cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

• Certain services at an in-network hospital or ambulatory surgical center – When you get services from an in- network hospital or ambulatory surgical center, certain providers there may be out-of-network.

In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.

• Cover emergency services without requiring you to get approval for services in advance (prior authorization).

• Cover emergency services by out-ofnetwork providers.

• Base what you owe the provider or facility (costsharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.

• Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/nosurprises for more information about your rights under federal law.

If you get other services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections.

You are never required to give up your protections from balance billing. You also are not required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing is not allowed, you also have the following protections: • You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay outof-network providers and facilities directly.

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This brochure highlights the main features of the CTXEBC 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. CTXEBC reserves the right to change or discontinue its employee benefits plans at anytime.

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