2026-27 CBEBC Benefit Guide v2

26 27

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

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

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

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

YO UR N EW B EN EFI TS BEGI N AND END

September 1, 2026 – August 31, 2027

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

Contents FLIP TO...

4 Important Contacts

HOW TO ENROLL

5 How to Enroll

5

6 Enrollment FAQ

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

FREQUENTLY ASKED QUESTIONS

12 Pharmacy

6

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

MEDICAL

18 Dental Coverage

9

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

26 Disability Insurance 27 Hospital Indemnity Insurance 28 Accident Insurance 29 Critical Illness Insurance 30 Cancer Insurance

31 Emergency Transport Services 32 ID Theft Protection 33 Legal Assistance Program 34 Employee Assistance Program

35 Glossary of Terms 39 Important Legal Notices

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

Important Contacts CBEBC BENEFITS

HEALTH SAVINGS ACCOUNT (HSA)

VISION

Higginbotham Public Sector 833 852-1706 www.cbebc.com cbebc@hps.higginbotham.net

Gulf Coast Educators FCU 281-487-9333 https://www.texaseducatorshsa.com

Eyetopia 800-662-8264 www.eyetopia.org

FLEXIBLE SPENDING ACCOUNT (FSA)

DENTAL

MEDICAL TRS ACTIVECARE BCBSTX 866-355-5999 www.bcbstx.com/trsactivecare

National Benefit Services 855-399-3035 www.nbsbenefits.com

HOSPITAL INDEMNITY EMERGENCY MEDICAL TRANSPORT

TRS HMO BCBSTX: Blue Essentials HMO 888-378-1633 www.bcbstx.com/trshmo

MASA Group #MKCBEBC 800-423-3226 www.masamts.com

CURATIVE HEALTH 855-428-7284 www.curative.com/for-members

DISABILITY

BCBS OF TEXAS: Blue Advantage and Blue Choice 972-766-6900 www.bcbstx.com

PRESCRIPTION SAVINGS Clever RX Group ID: 1085 - Member ID: 3953 800-873-1195 www.cleverrx.com/cbebc

TELEHEALTH RECURO Health Group ID - CBEBC 855-673-2876 www.recurohealth.com

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

CHUBB Group ID 100000142 888-499-0425 www.chubb.com

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

Policy #715966 The Hartford 866-278-2655 www.thehartford.com

CANCER IDENTITY THEFT-LEGAL ASSISTANCE LegalShield 800-654-7757 www.shieldbenefits.com/cbebc

CHUBB Group ID 100000142 888-499-0425 www.chubb.com educatorclaims@chubb.com

INDIVIDUAL LIFE

CRITICAL ILLNESS

CHUBB 888-499-0425 www.chubb.com

Policy #715966 The Hartford 866-278-2655 www.thehartford.com

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

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

VOLUNTARY LIFE AND AD&D CHUBB Group ID 100000224 888-499-0425 www.chubb.com educatorclaims@chubb.com

How to Enroll LOGIN PROCESS

1

Go to www.cbebc.com.

2

Click Login.

Enter your information: • Last name

3

• Date of birth

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

4

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

5

Enter the code that you receive and click Verify to begin your benefits enrollment.

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

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

When will I get my ID cards?

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

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

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

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

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

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

Where do I find benefit summaries and forms?

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

Benefit questions?

How do I find an in-network provider?

Call 833-852-1706

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

Email cbebc@hps.higginbotham.net

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

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

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

Are there FSA/HSA limitations for married couples?

Yes, generally. Married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses, then you and your spouse are not HSA-eligible – even if you would not use your spouse’s FSA to reimburse your expenses. However, there are some exceptions to the general limitation for specific types of FSAs. Contact the FSA and/or HSA provider before you enroll or reach out to your tax advisor for further guidance.

Discl aim er: You acknowle dge th at y ou hav e rea d t he limitat ions an d exclusion s that may apply to obt aining spouse an d de pend ent coverage , including limitat ions an d exclusion s th at may apply to enro llment in Flexible Spe nding Accou nt s an d a Health Savings Acco un t as a marrie d couple.

You, t he enrollee, shall hold harmles s , defe nd, an d indemnif y Higginbo th am Public Sector, LL C f rom any an d all c laims , ac tions , suits, charge s, an d judg ment s whats oev er th at arise out of your enro llment in spouse and /or de pend ent coverage , inc lu ding enro llment in an FSA an d HSA.

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

Eligibility Who is Eligible for Benefits You are eligible for coverage if you are a regular, full-time employee. You may only enroll for coverage when: • You are a new hire

• It is Open Enrollment (OE) • You have a Qualifying Life Event (QLE) See Important Exclusions and Limitations section for details.

New Hire

Employee

Dependent(s)

Who is Eligible

Who is Eligible

Who is Eligible

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

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

• Your legal spouse

When to Enroll

When to Enroll

• Enroll by the deadline given

by Human Resources

• Enroll during OE or when you have a QLE

When Coverage Starts

When Coverage Starts

• First day of work concurrent with the plan effective date

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

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

• Child(ren) over age 26 who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return When to Enroll • You must enroll the dependent(s) during OE or when you have a QLE • When covering dependents, you must enroll for and be on the same plans

MAXIMUM DEPENDENT ELIGIBILITY AGE BY PLAN Plan

To Age

Plan

To Age

Accident

26

Hospital Indemnity

26

Cancer

26

Telehealth

26

Critical Illness

26

Vision

26

Dental

26

Voluntary Life and AD&D

26

Identity Theft

26

Emergency Transportation

26

Individual Life

26

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

• Based on OE or QLE effective dates

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

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

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

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

Marriage

Birth

Divorce

Adoption

Legal separation Annulment

Undergoing FMLA, COBRA event, court judgment, or decree

Placement for adoption

Becoming eligible for Medicare, Medicaid, or TRICARE

Change in benefits eligibility Death

Receiving a Qualified Medical Child Support Order

You have 31 days from the event to notify Human Resources and complete your changes. You may need to provide documents to verify the change.

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

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

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

• REGION 1 - 26-27 Pla n Hi ghlig hts • REGION 2 - 26-27 Pla n Hi ghlig hts • REGION 3 - 26-27 Pla n Hi ghlig hts

• REGION 4 - 26-27 Pla n Hi ghlig hts

Watch and learn more!

High-Deductible Health Plan (HDHP)

Preferred Provider Organization (PPO)

An HDHP lets you see any provider, but you pay less when using in-network care. It has lower premiums but a higher deductible that applies to most services, including prescriptions. You may also be eligible to open a Health Savings Account (HSA).

A PPO lets you see any provider, but you pay less when using in-network providers. In-network visits, urgent care, and prescriptions usually have copays, while other services apply to your deductible and coinsurance. Out-of-network care costs more.

Health Maintenance Organization (HMO) An HMO requires you to use in-network providers.

You must choose a primary care physician and get referrals to see specialists. Always confirm your providers are in-network before receiving care.

Find an In-Network Provider Visit: www.bcbstx.com

Call: 866-355-5999

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

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

www.mybenefitshub.com/ezzellisd/26-27/Benefits/Medical Freer ISD www.mybenefitshub.com/freerisd/26-27/Benefits/Medical

Ingleside ISD http://www.mybenefitshub.com/inglesideisd/26-27/Benefits/Medical Pettus ISD http://www.mybenefitshub.com/pettusisd/26-27/Benefits/Medical

Waelder ISD https://web.mybenefitshub.com/waelderisd/26-27/Benefits/Medical

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

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

HEALTH CARE PROVIDER

SYMPTOMS

AVERAGE COST

AVERAGE WAIT

$

2-5 minutes

$

15-20 minutes

$

15 minutes

$$

15-30 minutes

$$$$

4+ hours

$$$$$$

Minimal

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

Telemedicine

24 hours a day, 7 days a week

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

Doctor’s Office

Rash Stomachache

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

Office hours vary

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

Retail Clinic

Allergies Cough/cold/flu

Hours vary based on store hours

Common infections Minor injuries Pregnancy tests Vaccinations

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

Urgent Care

Generally includes evening, weekend and holiday hours

Minor broken bones Small cuts that may require stitches Minor burns and infections

Emergency Care Chest pain

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

Hospital ER

24 hours a day, 7 days a week

Severe bleeding Blurred or sudden loss of vision Major broken bones

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

Freestanding ER

Difficulty breathing

24 hours a day, 7 days a week

Most major injuries

except trauma Severe pain

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

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

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

Step 1

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

Step 3

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

Questions?

Call Clever RX Customer Service.

Need More Details?

Visit www.clever rx.co m/cbeb c

Call 800-873-1195.

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

Health Savings Account An HSA is a type of personal savings account that is always yours even if you change health plans or jobs.

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

You Decide How To Use Your HSA Funds Use it Now

Let it Grow

• Make annual HSA contributions.

• Make annual HSA contributions.

• Pay for eligible medical costs.

• Pay for medical costs with other funds.

• Keep HSA funds in cash.

• Invest HSA funds.

Benefits of an HSA • No monthly service charges

• Instantly issued VISA debit card to access your money • Online portal and mobile app to monitor your saving and spending

HSA Eligibility You are eligible to open and contribute to an HSA if you are:

• Enrolled in an HSA-eligible HDHP

HSA Contacts Learn more about Gulf Coast Educators FCU or Health Savings Accounts:

• Visit https://texaseducatorshsa.com/ • Call – 281-487-9333

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

• Not enrolled in a Health Care Flexible Spending Account • Not eligible to be claimed as a dependent on someone else’s tax return

• Not enrolled in Medicare, Medicaid, or TRICARE • Not receiving Veterans Administration benefits

MAXIMUM HSA CONTRIBUTIONS

2026

2027

$4,400 Individual

$4,500 Individual

$8,750 Family

$8,950 Family

HSA contributions are tax-deductible and grow tax-deferred.

Withdrawals for qualifying medical expenses are tax-free.

Watch and learn more!

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

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

Health Care FSA

NBS Participant Portal and Mobile App

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

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

• Dental and vision expenses

• Access plan documents and account information.

• Medical deductibles and coinsurance

• Update your personal information.

• Prescription copays

• Look up qualified expenses.

• Hearing aids and batteries

• Submit claims.

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

• Check balances.

2026 ANNUAL MAXIMUM FSA CONTRIBUTIONS

Maximum

$3,400

Carryover

$680 *Varies by district

• And more.

Visit http://mynbsbenefits.com and click Register.

Your employee ID is your Social Security Number.

Questions?

If you have any questions or concerns, contact the NBS Service Center: • Call 85 5-39 9-30 35, option 2.

• Email service@nbsbenefits.com

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

• Fax 84 4-43 8-14 96.

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

How the Health Care FSA Works You ca n a ccess th e fun ds in your Hea lth Ca re FSA tw o di ffe re nt ways: • Use your Benefits Debit Card to pay for qualified expenses, doctor visits, and prescription copays.

• Pay out-of-pocket and submit your receipts for reimbursement.

» Fax 844-438-1496. » Email service@nbsbenefits.com.

Watch and learn more!

» Visit https://mynbsbenefits.com Note : Som e e mpl oyers a llo w you to use your Be nefi ts Deb it Card to pa y yo ur de pen den t ca re prov ide r.

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

Flexible Spending Accounts Health Care FSA

Dependent Care FSA

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

The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full-time.

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

• Dental and vision expenses • Medical deductibles and coinsurance

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

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

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

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

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

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

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

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

» Visit http://mynbsbenefits.com

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

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

HEALTHCARE FLEXIBLE SPENDING ACCOUNT (FSA)

HEALTH SAVINGS ACCOUNT (HSA) • Acts as a personal savings account.

• Funds can be used to pay for current or future health care expenses with pretax dollars; or funds can be saved for retirement.

Description

• Funds can also be used for your dependents, even if they are not covered by the HDHP.

• HealthCare FSA: Use funds to pay qualified medical, dental, and vision expenses.

• Limited Purpose HealthCare FSA: Use funds to pay qualified dental and vision expenses only.

• Dependent Care FSA: Use funds to pay qualified dependent care expenses and services.

Contribution Source

Employee (You) and/or your employer

Employee (You) and/or your employer

Account Owner

Employee (You)

Employer

Underlying Insurance Requirement

High-Deductible Health Plan

None

• HealthCare FSA: $3,400

• Individual: $4,400 2026 - Maximum Contribution

• Limited Purpose HealthCare FSA: $3,400

• Family: $8,750

• Dependent Care FSA: $7,500 (Single parent filing head of household, or married filing jointly) or $3,750 (Married filing separately)

• Age 55+ Additional Catch Up $1,000

• Pay for qualified out-of-pocket medical, dental, and vision expenses.

Permissible Use of Funds

Year-to-year rollover of account balance?

• If used on nonqualified expenses prior to age 65, subject to income tax plus a 20% penalty.

See details in the Description box above.

2026 • HealthCare FSA: Allows for carryover of $680 to the next plan year OR an extended grace period after the end of the plan year (typically 2 ½ months) to spend remaining funds.

• Limited Purpose HealthCare FSA: Same as Health Care FSA

Yes. Funds roll over and can be used anytime or saved for future use.

• Dependent Care FSA: N/A

Does the account earn interest?

Yes

No

Portable?

Yes. It is always yours to keep, even if you change jobs or medical plans.

No

FLIP TO...

13

HSA

14

FSA

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

Qualified HSA and FSA Expenses

The products and servi ces listed bel ow are examples of medical expenses eligible for payment under your Health Care FS A or HS A. This list is not all-inclusive; additional expenses may qualify, and the items listed are subject to change in accordance with IRS regulations.

Please refer to IRS Publication 502 Medic al and Dental Expenses at www.ir s.g ov for a complete description of eligible medical and dental expenses.

Abdominal supports

Diagnostic fees

Ophthalmologist/Optician/ Optometrist

Acupuncture Ambulance

Eyeglasses

Orthopedic shoes

Anesthetist

Gynecologist

Orthopedist

Arch supports

Healing services

Osteopath Physician

Artificial limbs

Hearing aids and batteries

Postnatal treatments

Blood tests

Hospital bills

Prenatal care

Braces

Insulin treatment

Prescription medicines

Cardiographs Chiropractor

Lab tests

Psychiatrist

Crutches

Metabolism tests

Therapy equipment

Dental treatment

Neurologist

Wheelchair

Dentures

Nursing

X-rays

Dermatologist

Obstetrician Operating room costs

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

Dental Coverage Dental Benefits Summaries Our dental plans help you maintain good oral

LINCOLN FINANCIAL GROUP

health through affordable options for preventive care, including regular checkups and other

High Plan

Middle Plan

Low Plan

dental work.

In-Network or Out-ofNetwork

In-Network or Out-ofNetwork

In-Network or Out-ofNetwork

$50 $150

$50 $150

$50 $150

$2,000

$1,500

$1,000

You Pay

You Pay

You Pay

Preventive Services

$0

$0

20%

Basic Services

20%1

40%1

50%1

Major Services

50%1

60%1

75%1

Orthodontia Dependent children $1,000 lifetime max

50%1

60%1

Not Covered

Employee Only

$43.82

$33.20

$17.96

Employee and Spouse

$84.30

$63.86

$35.90

Employee and Child(ren)

$86.61

$65.61

$39.43

Employee and Family

$122.14

$92.53

$57.38

DPPO Plans Calendar Year Deductible • Individual • Family

Two levels of benefits are available with the

DPPO plans: in-network and out-of-network.

You may select any dental provider for care,

Calendar Year Benefit Maximum Per Individual

but you will pay less and get the highest level of benefits with in-network providers. You could pay more if you use an out-of-network provider.

Find a Lincoln Financial Group

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

Call 800-423-2765.

Employee Contributions

Watch and learn more!

1

The amount you pay after the deductible is met.

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

Vision Coverage Vision plans help protect your eyesight and overall health. Regular eye exams can also detect conditions like diabetes and high cholesterol. You can see any provider, but you’ll receive the highest benefits when using in-network providers.

Vision Benefits Summary VISION PLAN Low Plan

High Plan

Exam

$10

$5

Lenses • Single vision • Lined bifocals • Lined trifocal

$20 $20 $20

$0 $0 $0

Frames

$130 allowance

$180 allowance

Contacts In lieu of frames

$150 allowance

$300 allowance

Find an In-Network Provider Visit www.eyetopia.org.

Call 800-662-8264.

Benefit Frequency Exam

Once every 12 months

Lenses

Once every 12 months

Frames

Once every 12 months

Contacts

Once every 12 months

Employee Contributions

Watch and learn more!

Employee Only

$6.50

$20.00

Employee and Spouse

$12.00

$39.00

Employee and Child(ren)

$14.00

$44.00

Employee and Family

$22.00

$54.00

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

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

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

Visit www.recurohealth.com.

While telemedicine does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:

• Have a non-emergency issue and are considering an after-hours health care clinic, urgent care clinic, or emergency room for treatment • Are on a business trip, vacation, or away from home • Are unable to see your primary care physician

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

Call 844-979-0313.

Download the app to your mobile device.

When to Use Telemedicine Use telemedicine for minor conditions such as: • Sore throat

• Mental health issues

• Headache

• Allergies

• Stomachache

• Fever

• Cold

• Urinary tract infections

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

EMPLOYEE CONTRIBUTIONS Employee

$14.00

Employee and Family

$14.00

Watch and learn more!

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

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

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

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

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

You and your eligible dependents may enroll in amounts up to $250,000 for employee and $75,000 for spouse without answering health questions. Amounts over the Guaranteed Issue will require medical underwriting. If you buy at least $10,000 of coverage during initial enrollment, you may buy up to the Guaranteed Issue in subsequent re-enrollments without medical underwriting. Benefits will reduce 50% at age 70.

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

Watch and learn more!

Designating a Beneficiary A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary, and you can change beneficiaries at any time. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%) of the death benefit.

Term Life and AD&D Coverage Highlights • Portable – keep your supplemental coverage if leave your current employer

you

• Convertible – convert your group term life insurance benefits to an individual whole life policy if your coverage ends • Accelerated Benefits Option – get up to 50% of your life insurance benefit • Employee Assistance Program – get six visits.

• Financial Wellness – this program is included.

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

TERM LIFE INSURANCE Employee

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

Spouse

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

Child(ren)

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

TERM AD&D INSURANCE Term AD&D Monthly Rates Employee

$0.30 per $10,000

Spouse

$0.10 per $5,000

Child(ren)

$0.30 per $10,000

Term Life Monthly Rates Age

Employee (per $10,000)

Spouse1 (per $5,000)

<29

$0.480

$0.240

30-34

$0.670

$0.335

35-39

$0.760

$0.380

40-44

$0.950

$0.475

45-49

$1.430

$0.715

50-54

$2.280

$1.140

55-59

$3.710

$1.855

60-64

$5.610

$2.805

65-69

$10.830

$5.415

70-74

$17.580

$8.790

75+

$24.800

$12.400

Calculate Your Monthly Cost Term Life Insurance $_____ (coverage amount) $10,000 = $_____ X $_____ (rate) = $______ (monthly cost) Term AD&D Insurance - Employee $_____ (coverage amount) $10,000 = $_____ X $_____ (rate) = $______ (monthly cost) Term AD&D Insurance - Spouse $_____ (coverage amount) $5,000 = $_____ X $_____ (rate) = $______ (monthly cost)

Child(ren) Rate per $10,000 To age 26 1

$1.60

Spou se rate is based on spo use’s age.

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

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

Visit: www.chubb.com Call: (888) 499-0425

You decide how much coverage is appropriate for you, and who you would like to cover. Employee, spouse,

children and grandchildren are eligible. For less than a cup of coffee, a premium of $3.71 a week, a 35-yearold employee can purchase $25,000 of life insurance coverage through ChubbGuaranteed Life (CGL).

Watch and learn more!

Guaranteed issue up to $150,000: NO MEDICAL EXAM!

Monthly Premium Rate With ADB - Non-Tobacco

This benefit provides a 6% Accelerated Long-Term Care or Chronic Illness Care Benefit and a Terminal Illness Benefit. If an employee is diagnosed with a

Age

terminal illness, they may be eligible to receive up to

Face Amount $25,000

$50,000

$75,000

25

$11.62

$20.37

$29.12

75% of their life insurance benefit early, up to $150,000,

35

$16.11

$29.35

$42.59

helping provide financial support when it is needed

45

$26.50

$50.12

$73.74

most.

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

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

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Educator Disability FAQ What is disability insurance?

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

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

Percentage of Earnings You Receive

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

Does this plan have pre-existing condition limitations?

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

Up to 66 2/3%

Maximum Weekly Benefit

Between $200 and $8,000

Maximum Benefit Period

Social Security Normal Retirement Age

Pre-existing Condition Exclusion

3/122

Will I get all of my disability benefit?

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

If your elimination period is 30 days or less and you are confined to a hospital for 24 hours or more, the elimination period will be waived, and benefits will be payable from the first day of hospitalization.

1

• Social Security disability insurance • State teacher retirement disability plans

Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for 12 months. If your disability is a result of a pre-existing condition, we will pay benefits for a maximum of one month.

2

• Workers’ Compensation

• Other employer-based disability insurance coverage you may have

File a Disability Claim Email educatorclaims@chubb.com.

• Unemployment benefits

Call 888-499-0425.

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

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

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

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

Step One

Step Two

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

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

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

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

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

EDUCATOR DISABILITY RATES

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

Elimination Period

Rate per $100 of Benefit

Elimination Period

Rate per $100 of Benefit

0/7

$3.32

60/60

$1.99

14/14

$2.82

90/90

$1.15

30/30

$2.44

180/180

$0.84

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

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

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

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

Short Term Disability FAQ

Long Term Disability FAQ

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

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

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

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

How is STD different than Workers’ Compensation?

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

When do disability benefits begin?

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

Will I get all of my disability benefit?

You will get a percentage of your income – typically 60%. However, your disability benefit may be reduced by other income you receive or are eligible to receive due to your disability, such as unemployment benefits.

Some limitations and exclusions may apply so read your plan documents or contact Human Resources for details.

Will I get all of my disability benefit?

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

How long will the disability benefits last?

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

How do I apply for Short Term Disability?

Contact your Human Resources department to begin STD benefits.

What else is included with my disability coverage?

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

Watch and learn more!

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

Hospital Indemnity Insurance The Hospital Indemnity plan helps you with the high cost of medical care by paying you a cash benefit when you have an inpatient hospital stay. Unlike traditional insurance which pays a benefit to the hospital or doctor, this plan pays you directly. It is up to you how you want to use the cash benefit.

These costs may include meals, travel, childcare or eldercare, deductibles, coinsurance, medication, or time away from work. See the plan document for full details.

CLAIM FORM – HI Claim Form

Self-Service Portal: chubb.com/workplacebenefitsclaims Email: CWBSpecialMarketService@chubb.com Telephonic: 888-499-0425 HOSPITAL INDEMNITY INSURANCE Low Plan

High Plan

Hospital Admission

$1,500

$3,000

Hospital Confinement

$100 per day up to 30 days

$200 per day up to 30 days

ICU Admission

$3,000

$6,000

ICU Confinement

$200 per day up to 30 days

$400 per day up to 30 days

Wellness Benefit / Health Screening

$75 per covered individual - per calendar year

Employee Contributions Employee Only

$15.70

$29.24

Employee and Spouse

$29.88

$59.06

Employee and Child(ren)

$24.16

$46.04

Employee and Family

$38.30

$75.88

Watch and learn more!

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

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

ACCIDENT INSURANCE

Low Plan

High Plan

Ambulance • Ground • Air

$750 $2,000

$1,000 $3,000

Emergency Room

$200

$300

Hospital Admission

$1,500

$2,000

$200 per day

$400 per day

$400 per day

$600 per day

Up to $50,000

Up to $75,000

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

Wellness Benefit Health Screening

$75 per calendar year Watch and learn more!

Employee Contributions Employee Only

$5.54

$8.58

Employee and Spouse

$8.74

$13.50

Employee and Child(ren)

$8.96

$14.26

Employee and Family

$14.08

$23.26

1

CLAIM FORM – Accident Claim Form

Percentage of benefit paid for dismemberment is dependent on type of loss.

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

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

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

CRITICAL ILLNESS INSURANCE Employee

Increments of $10,000 up to $50,000

Spouse

Increments of $10,000 up to $50,000 not to exceed 100% of employee amount

Children

Up to $25,000 not to exceed 50% of employee amount

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

100% of benefit amount

Childhood Diseases Cerebral palsy, cleft lip/palate, cystic fibrosis, Type 1 diabetes, Down syndrome

100% of benefit amount

Wellness Benefit Health Screening/Wellness Benefit

$75 per covered individual – per calendar year

MONTHLY COST PER $1,000 Age

Employee

Spouse

<29

$0.20

$0.20

30-39

$0.34

$0.34

40-49

$0.52

$0.52

50-59

$1.10

$1.10

60+

$3.00

$3.00

CLAIM FORM – CI Claim Form

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

Cancer Insurance Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town treatments, special diets, daily living, and household upkeep. In addition to these nonmedical expenses, you are responsible for paying your health plan deductibles and/or coinsurance.

Cancer insurance helps pay for these direct and indirect treatment costs so you can focus on your health. Exclusions and limitations apply. See the plan documents for details.

CLAIM FORM – Cancer Claim Form

Self Service Portal: chubb.com/workplacebenefitsclaims E-mail: CWBSpecialMarketService@chubb.com Telephonic: 888-499-0425 CANCER INSURANCE Low Plan

High Plan

$5,000 $7,500

$10,000 $15,000

$10,000

$20,000

$100 per day up to 30 days per confinement

$200 per day up to 30 days per confinement

Cancer Diagnosis • Employee/Spouse • Child(ren) Radiation and Chemotherapy Per covered individual per calendar year

Hospital Confinement Cancer Wellness

$50 per covered individual - per calendar year

Employee Contributions Employee Only

$15.00

$27.92

Employee and Spouse

$28.46

$53.10

Employee and Child(ren)

$18.78

$34.80

Employee and Family

$31.16

$58.66

Watch and learn more!

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

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

For More Details Visit www.masamts.com.

Call 800-423-3226.

EMERGENCY TRANSPORT SERVICES

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

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Emergent Plus

Platinum Plan

Emergency Air Transportation

x

x

Emergency Ground Transportation

x

x

Non-Emergency Inter-Facility Transportation

x

x

Repatriation/ Recuperation

x

x

Escort Transportation

x

Visitor Transportation

x

Return Transportation

x

Mortal Remains Transportation

x

Minor Return

x

Organ Retrieval/Organ Recipient Transportation

x

Vehicle Return

x

Pet Return

x

Worldwide Coverage

x

Employee Contributions Employee

$14.00

$24.50

Employee and Family

$14.00

$32.50

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

360° Identity Theft Protection Identity theft is one of the fastest-growing crimes in the country. Millions of people have their identity stolen each year.

Full-Service Restoration With IDShield You Will Receive:

For More Information Visit www.legalshield.com.

Call (800) 654-7757.

✓ $5 Million Identity Fraud Protection Plan ✓ Online Privacy and Reputation Management ✓ Device Protection ✓ Financial Account Monitoring ✓ Identity, Credit and Social Media Monitoring

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EMPLOYEE CONTRIBUTIONS

✓ Credit Score Tracker ✓ Real-Time Alerts

Employee

$6.50

Employee and Family

$11.25

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

Legal Assistance LegalShield estimates members could save up to $1,500 per year on personal legal matters compared to paying standard attorney hourly rates.

Included Services ✓ Unlimited legal advice and consultation ✓ Direct access to a dedicated provider law firm ✓ Document review and preparation ✓ Will preparation ✓ Speeding ticket assistance

✓ Debt collection assistance ✓ Health care directives and powers of attorney ✓ Elder care legal services ✓ Additional covered personal legal services This benefit is designed to provide affordable access to legal assistance for common personal and family legal needs without the expense of paying attorney fees each time services are needed.

Who Is Covered? ✓ Employee (participant) ✓ Spouse/domestic partner ✓ Dependent children up to age 26 ✓ Dependent children over age 26 living in the participant's home (advice and consultation only) ✓ Parents and step-parents of the participant and/or spouse/domestic

Affordable Legal Protection Cost: $12.45 monthly

partner (eligible for advice,

NEW! Premiums waived for active military personnel.

consultation, document review, and

Learn More: shieldbenefits.com/cbebc

certain elder care services) 33

Visit www.cbebc.com for full plan details.

Employee Assistance Program An Employee Assistance Program (EAP) helps you and family members cope with a variety of personal or work-related issues. Get confidential counseling and support services from licensed professionals at little or no cost to help with: • Relationships

• Work/life balance • Stress and anxiety

• Child and elder care resources

Get 24/7 Support Visit: guidanceresources.com

• Substance abuse

App: GuidanceNow

• Addiction

Web ID: CHUBB

• And more

• Grief and loss Call: (844) 266-0712 24/ 7 L i ve A ssi stan ce T T Y – D ial 711

Watch and learn more!

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

Glossary of Terms ACA (Affordable Care Act) – The ACA is a comprehensive health care reform law enacted in March Coinsurance – After you have met your deductible, this is 2010. References to ACA at HPS typically involve reporting your share of the cost of a covered health care service, requirements, specifically, that obligate employers to report which is calculated as a percent of the allowed amount for medical coverage for employees and to provide documents the service. For example, your coinsurance is 20% (while for employee tax preparation. HPS partners with ACA the insurer pays the remaining 80%). service providers to assist clients in meeting these Contingent Beneficiary – This is who will receive a benefit requirements. in the event of the beneficiary’s (aka the primary Actively-at-work – This term refers to being at work as beneficiary) death. A policy may have more than one opposed to being on vacation, leave, or away from work for contingent beneficiary. any other reason. Companywide or position-wide reporting dates (like summer breaks or winter breaks for teachers) do Contingent Plans – Contingent plans make benefits available to participants only when another specific benefit not apply here. has been elected. Examples of contingent plans include ADL (Activities of Daily Living) – This is a concept related voluntary life for dependents (contingent on the election of to eligibility for Long Term Care (LTC) benefits. There are employee voluntary life) and a Health Savings Account six ADLs: bathing, dressing, toileting, transferring, eating, (contingent on the election of a High Deductible Health and continence. Most LTC plans require that the covered Plan). individual be unable to perform a certain number of these Continuation of Coverage – Many plans offered by HPS tasks to be eligible for benefits. clients are continuable under COBRA or portability Beneficiary – This is who will receive a benefit in the event or conversion options. Standalone clients of the insured’s death. A policy may have more than one and cooperatives will have “continuation of coverage” beneficiary. documents that detail plan continuation availability.

Benefit Duration – This is the maximum period of time in Conversion – Conversion is a benefit continuation option which a claimant can receive benefits. that transforms group coverage into individual coverage, Benefit Reduction – Some plans may include percentage separate from the group policy. This typically comes with reductions in benefit amounts when participants reach a much higher premiums. certain age.

Covered Expenses – These are health care expenses Cafeteria/Section 125 Plan – This plan provides covered under your health plan. participants an opportunity to pay for qualified benefits on a Deductible – This is the amount a participant must cover pretax basis. Premiums for most medical, dental, vision, for health care services before the insurer will share costs FSA, HSA, accident, and cancer plans are deducted on a and provide coinsurance. pretax basis, which reduces participants’ taxable income.

Dental Reimbursement Types – Various types of dental Certificate of Benefits (Certificate of Coverage) – The plans (except DHMO plans) will pay out-of-network benefits certificate serves as the primary official plan document for differently. participants of group benefits, as they are not enrolled in an • MAC/MRC/NAP (Maximum Allowable individual policy.

Charge/Maximum Reimbursable Charge/Network COBRA – COBRA allows participants who lose their health Access Plan): Participants will receive the same benefits the right to continue group health benefits for payouts (contracted fees) for services whether they go in limited periods of time under certain circumstances or out of network; and they may be balance billed when including voluntary or involuntary job loss, reduction in the going out of network. hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals will have to pay the • UCR/R&C(Usual, Customary, and Reasonable/Reasonable & Customary): When going full premium (including any employer contribution applied when employed) up to 102% of the cost to the plan. out of network, the plan will pay an amount determined by the usual cost charged for the service by dentists in a Coverage is typically available for 18 months but can be extended in certain situations. certain geographical area.

Copay – Also known as a copayment, this is the fixed amount you pay for health care services received at the time of service. A copay typically goes toward your 35 deductible.

Visit www.cbebc.com for full plan details.

Glossary of Terms Eligibility Waiting Period – This period is the amount of time new hires must wait before they are eligible for benefits. Most HPS clients will allow for new hires to be eligible the first of the month following (or coincident with) their date of hire.

Elimination Period – Also known as a waiting period, this is the number of calendar days that participants in a Disability plan must be disabled before they are eligible to receive benefits.

HDHP (High Deductible Health Plan) – A qualified health plan that combines lower monthly premiums in exchange for higher deductibles and out-of-pocket limits. These plans are often coupled with an HSA. HMO/DHMO (Health Maintenance Organization/Dental Health Maintenance Organization) – Medical plans labeled as HMO plans have a specified network of providers, and benefits are generally not available outside of that network except in an emergency. DHMO plans follow this same model for dental coverage.

Employer Contribution – The amount of premium or financial contribution an employer provides to participants HPS (Higginbotham Public Sector) – HPS is the for insurance, spending accounts, or retirement. insurance broker that represents your account.

EOB (Explanation of Benefits) – This statement from your HRA (Health Reimbursement Arrangement) – This is an insurance carrier explains which procedures and services employer-owned savings account to which the company were provided, how much they cost, what portion of the deposits pretax dollars for each of its covered employees. claim was paid by the plan, and what portion of the claim is Employees can then use the funds in their HRA to your responsibility. It also includes information on how you reimburse themselves for incurred qualified health care can appeal the insurer’s decision. These statements are expenses. also posted on the carrier’s website for your review.

HSA (Health Savings Account) – This is an employeeEOI (Evidence of Insurability)/Statement of Health owned savings account used to pay for eligible health care (SOH) – Some plans require an application or a “proof of expenses with pretax dollars. Funds in the account do not good health” type of statement to obtain coverage. This is have to be used within a specified time period. An HSA commonly referred to as EOI (Evidence of Insurability). must be coupled with qualified HDHP. Such applications or statements must be submitted In-network – Doctors (e.g., a primary care physician or electronically or by mail to the carrier for approval. specialist), hospitals, and other providers that contract with Evergreen Clause – This clause, written into a client’s your insurance company provide health care services at Cafeteria/Section 125 Plan, allows a client to roll over discounted rates. These providers are on an outlined list of Flexible Spending Account elections into the new plan year. health care practitioners.

FMLA (Family and Medical Leave Act) – This act ensures Inpatient – A person who is treated as a registered patient employees have job-protected and unpaid leave for in a hospital or other health care facility. qualified medical and family reasons.

Medically Necessary – Services or supplies provided by a FSA (Flexible Spending Account) – An option that allows hospital, health care facility, or physician that meet the participants to set aside pretax dollars to pay for qualified following criteria: (1) are appropriate for the symptoms and expenses (e.g., certain medical care or dependent care diagnosis and/or treatment of the condition, illness, disease, expenses) during a specific period (usually a 12-month or injury; (2) serve to provide diagnosis or direct care and/or period). Participants determine how much to contribute to treatment of the condition, illness, disease, or injury; (3) are their FSA at the beginning of the plan year. Most funds in accordance with standards of good medical practice; (4) must be used by the end of the year, depending upon the are not primarily serving as convenience; and (5) are type of FSA, as there is a limited carryover amount. considered the most appropriate care available.

Grace Period – As it pertains to FSAs, this is the period Medicare – An insurance program administered by the immediately following the end of the plan year during which federal government to provide health coverage to participants can incur new claims to use their remaining individuals age 65 or older, or who have certain disabilities FSA funds. or illnesses.

Guaranteed Issue – Some plans may include Guaranteed Member – You and those covered become members when Issue coverage to new enrollees without EOI. you enroll in a health plan. This includes eligible employees, their dependents, COBRA beneficiaries, and surviving spouses.

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

Glossary of Terms Open Enrollment – Open Enrollment refers to the annual Pre-existing Condition – A pre-existing condition is a period during which employees may enroll in available medical event, treatment, or diagnosis that occurs prior to benefits or make coverage changes without a Qualifying the effective date of insurance coverage.

Life Event.

Pre-existing Condition Limitation – Some plans may limit Out-of-network – Doctors, hospitals, and other providers benefits due to pre-existing conditions for a set period of that are not contracted with your insurance company. If you time. choose an out-of-network provider, you may be responsible Premium – A reference to the cost (usually monthly) of for costs over the amount allowed by your insurance carrier. insurance/benefits paid by the employer or employee.

Out-of-pocket Expense – Amount that you must pay QLE (Qualifying Life Event) – These are events that allow toward the cost of health care services. This includes changes to pretax benefits outside of Open Enrollment. deductibles, copayments, and coinsurance.

Changes must typically be made within 30 or 31 days of the Out-of-pocket Maximum – Also known as an out-of-pocket event. Examples of QLEs include marriage, birth, divorce, limit, this is the most you pay during a policy or benefit gain or loss of benefits coverage, and change in period (usually a 12-month period) before your health employment status affecting benefits. insurance or plan begins to pay 100% of the allowed Rate Guarantee – Plan pricing can be under a rate amount for covered services. guarantee for a certain amount of time, typically two to four PCP (Primary Care Physician) – A doctor who is selected years. The premium rates cannot be changed during this to coordinate treatment under your health plan. This time. generally includes family practice physicians, general Renewal – When a plan’s rate guarantee expires, a rate practitioners, internists, and pediatricians. renewal will be received from the carrier’s underwriter. This Plan Year – A 12-month period of benefits coverage under establishes new rates beyond the expiration of the rate a group health plan, which may or may not coincide with a guarantee. Clients can either accept the new rates, attempt calendar year. to negotiate the renewal (usually assisted by HPS), or publish an RFP (Request for Proposal) to shop for a Plan Year Maximum – The maximum amount of benefit new carrier. available to a participant for each plan year.

Rollover – As it pertains to a Health Care FSA or Limited Portability – Portability is a continuation option available Purpose Health Care FSA, a client can establish a limit of that allows participants to continue group coverage beyond $680 (for 2026) of unused funds that can be rolled over to their employment. Premiums typically remain in line with the next plan year, provided the participant re-enrolls in the active participants, but coverage depends on the FSA plan. continuation of the group policy. If the group policy terminates, portability will no longer be available.

Run-out Period – Related to FSAs, this is a period immediately following the end of the plan year in which PPO (Preferred Provider Organization) – Health plans participants can submit claims incurred within the plan year. labeled as PPO refer to the network structure and plan For new onboarding clients, this period can be managed by availability. In-network PPO plan providers have agreed to the current or new administrator. The current administrator offer services at a contracted rate, which means members may charge a fee. If the new administrator manages the generally pay less and get the highest level of benefits. Outrun-out period, it will need a report of the FSA participants of-network services and providers are also available, but and their remaining FSA balances. you may pay more for care and generally receive fewer benefits.

SSNRA (Social Security Normal Retirement Age) – This is the normal retirement age for an employee under the Preventive Care – The care you receive to help prevent federal Social Security Act. illness or disease. It also includes counseling to prevent health problems.

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

Glossary of Terms SSDI (Social Security Disability Insurance) – Disability Usual, Customary and Reasonable (UCR) Allowance – benefits are available through Social Security as long as a This is the fee paid for covered services that is; (1) a participant is “insured” (has worked long enough and paid similar amount to the fee charged by a health care into Social Security) and has been defined as disabled by provider to the majority of patients for the same the federal government. procedure; (2) the customary fee paid to providers with similar training and expertise in a similar geographic area: THEbenefitsHUB – This is the benefits enrollment system and (3) reasonable in light of any unusual clinical used by HPS. circumstances.

Underwriting – This is the process of evaluating the risks Waiver of Premium (WOP) – This is a feature in some of insuring an individual or group and establishing insurance plans that allows premiums to be suspended for premium rates and coverage for the individual or group. a participant for a period of disability.

Clients are subject to underwriting during RFPs and renewals, and their employees are subject to underwriting when submitting EOI statements for coverage.

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

Important Legal Notices Women’s Health and Cancer Rights Act of 1998 In Oc t o ber 1 99 8, C ong res s en ac te d t he Wo me n’s Healt h an d C an ce r Right s A c t of 1 99 8. This not ice explains so me impor ta nt prov is ions of t he A ct . P lease rev iew this information carefully.

A s s pecif ied in t he Wo me n’s He alth an d C an ce r Rights A ct , a plan par tic ip ant or ben efic iary w ho elect s breas t re con st ruc t ion in c onn ec tio n wit h a mas te ct omy is also ent it led t o t he following benefits : • All s tage s of re con st ruc t ion of t he bre ast on w hic h the mas te ct omy w as per for me d; • S urg ery an d re con st ruc t ion of t he ot her bre ast t o pr odu ce a s ymmetr ical ap pea ran ce ; and • P rost hes es an d t reat men t of phys ical c omplic at ions of the mas tec to my , including lymph edema.

He alth plans mus t de ter mine t he man ner of c ov era ge in co nsulta tion wit h t he at ten ding phys ician an d t he patient. C ov er age for bre ast re con st ruc t ion an d related s ervic es may b e s ubject t o ded uct ibles an d c oins uran ce amo unt s t hat are co nsist ent wit h t hos e th at app ly t o ot her bene fits un de r the plan.

Special Enrollment Rights This not ice is be in g pr ovid ed t o ens ure th at y ou und ers tand y our right t o app ly for gr ou p healt h ins uranc e c ove rag e. You s hould re ad this not ice ev en if y ou plan t o wa iv e c ov era ge at this time.

Marriage, Birth or Adoption

If y ou hav e a ne w de pe nde nt as a result of a marr ia ge, birth, ado ption , or pla ce ment for ado ption , y ou may b e able to enroll your self an d y our de pen den ts . Ho wev er, y ou must enroll within 31 day s af ter t he marr ia ge, birt h, or plac ement for adopt ion.

For More Information or Assistance

To re ques t spec ial enro llment or obt ain mor e inf ormation, c onta ct :

Distr ict Hu man Resources Depar tm en t

Your Prescription Drug Coverage and Medicare Please re ad this not ice caref ully an d k eep it w her e you c an find it. This not ice has info rma tion ab ou t y our cu rrent pre scr ipt ion dr ug c ov era ge wit h D is tr ic t an d ab ou t your opt ions un der Medic are’s pres cript ion dr ug c ove rag e. This info rma tion c an help y ou de cid e w het he r or no t y ou w ant to enroll in a Med ica re dr ug plan. In format ion ab ou t w her e you c an ge t help t o mak e dec is ions ab ou t y our pres cript ion dru g c ov era ge is at t he en d of this notice. If neit her y ou no r any of y our c ov ere d de pe nde nt s are eligible for or hav e Medic ar e, this not ice do es no t app ly t o y ou or the de pen den ts .

Ho wev er, y ou s hould keep a c op y of this not ice in t he ev ent y ou or a de pend ent s hould qualif y for c ov era ge un der Med ica re in t he future. P lease not e, how ever, th at later not ices might s upe rs ede this notice.

Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP)

1. Med ica re pres cript ion dr ug c ov era ge b ec am e available in 2 0 0 6 t o ev ery on e wit h Medic ar e. You c an ge t this c ov era ge t hro ugh a Med ica re P resc ription D ru g P lan or a Med ica re A dv an ta ge Plan th at of fers pres cript ion dru g c ove rag e. All Med ica re pres cript ion dr ug plans pro vide at least a s tan dar d level of c ov era ge se t by Medic ar e. Some plans may also of fer mor e c ov era ge for a highe r monthly premium.

If y ou are dec lining c ov era ge for your self or y our de pend ent s be c aus e of ot her healt h ins uranc e or gr ou p healt h plan c ove rag e, y ou may b e able t o later enroll your self and y our de pe nde nt s in this plan if y ou or y our de pend ent s lose eligibility for th at ot her c ov era ge (or if t he employer s tops c ontr ibutin g t owa rd y our or y our de pend ent s’ other co verag e). Ho wev er, y ou mus t enroll within 31 day s after y our or y our de pend ent s’ ot her c ov era ge en ds (or af ter the employ er th at s pons or s th at c ov era ge s tops cont ributing t owa rd t he ot her cov erage).

2. D is tr ic t has de ter mined th at t he pres cript ion dru g c ov era ge of fer ed by t he D is tr ic t medic al plan is, on av era ge for all plan part icipant s, ex pe ct ed t o pay out as mu c h as t he s tan dar d Med ica re pres cript ion dru g c ov era ge pay s an d is c ons idere d Cr edita ble Co ver age.

If y ou or y our de pe nde nt s lose eligibility un de r a Medic aid plan or CHIP, or if y ou or y our de pen den ts b ec o me eligible for a su bsidy un der Med ica id or CHIP, y ou may b e able t o enroll your self an d y our de pe nde nt s in this plan. You mus t prov ide notific ation within 6 0 day s af ter y ou or y our de pend ent is t erminat ed f rom, or de ter mined t o b e eligible for, suc h ass is tance.

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

Important Legal Notices B ec au se y our exist ing c ov era ge is, on av erag e, at least as g oo d as s tan dar d Med ica re pres cript ion dr ug c ove rag e, you c an k eep this c ov era ge an d no t pay a highe r pr emium (a pena lt y) if y ou later de cid e t o enroll in a Med ica re presc ript ion dr ug plan, as long as y ou later enroll within s pecif ic time periods.

You c an enroll in a Med ica re pres cript ion dr ug plan wh en y ou first b ec o me eligible for Medic ar e. If y ou de cid e t o wait t o enroll in a Med ica re pres cript ion dr ug plan, y ou may enroll later, du ring Med ica re P art D’s annu al enro llment period, w hic h run s ea c h ye ar f rom Oc t o ber 15 t hro ugh D ec e mbe r 7. But as a gen eral rule, if y ou delay y our enro llment in Medic are P art D af ter first be c oming eligible t o enroll, y ou may hav e to pay a highe r pr emium (a penalt y).

You s hould c omp ar e y our c urre nt c ove rag e, including which dr ugs are c ov ere d at w hat c ost , wit h t he c ov era ge an d cos t of t he plans of fering Med ica re pres cript ion dr ug c over age in y our area . S ee t he Plan’s s umma ry plan des cr ip tion for a s umma ry of t he Plan’s pres cript ion dr ug c ove rag e. If you don ’t hav e a c opy, y ou c an ge t on e by c ont ac ting Sc hoo l at t he ph on e nu mb er or ad dres s listed at t he en d of this sec tion.

If y ou c ho os e t o enroll in a Med ica re pres cript ion dru g plan an d c anc el y our c urre nt S c ho ol pres cript ion dru g c ove rag e, b e aw are th at y ou an d y our de pe nde nt s may not b e able t o ge t this c ov era ge ba ck . To rega in c ove rag e, you w ould hav e t o re -enroll in t he Plan, pu rsu ant t o t he Plan’s eligibility an d enro llment rules. You s hould rev iew t he Plan’s s umma ry plan des cr ip tion t o de ter mine if an d w he n y ou are allowed t o a dd co verag e.

For more information about your options under Medicare prescription drug coverage: Mo re det aile d info rma tion ab ou t Med ica re plans t hat offer pres cript ion dr ug c ov era ge is in t he “M edic ar e & You” ha ndb ook . You will ge t a c op y of t he ha nd boo k in t he mail ev ery ye ar f rom Medic ar e.

You may also b e c ont ac ted direct ly by Med ica re pres cript ion dr ug plans. For more in format ion ab ou t Med ica re pres cript ion dr ug co verag e:

• Visit www. medi care. gov.

• Call y our S tat e He alth I nsur anc e A ss ist anc e Program (see t he inside ba c k c ove r of y our c op y of t he “Med ica re & Y ou” ha nd boo k for the ir t eleph one nu mber ) for pers onalized help.

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

If y ou hav e limited inc ome an d res our ces , ex tra help paying for Med ica re pres cript ion dr ug c ov era ge is available. In format ion ab ou t this ex tra help is available f rom t he Soc ial S ecu rity A dminis trat ion (S S A) online at www.soci alsecurit y. gov, or y ou c an call t he m at 800-772-1213. TTY users s hould call 800-325-0778.

Remember: K ee p this Cr edita ble C ov er age not ice. If you enroll in on e of t he ne w plans ap pro ve d by Med ica re which of fer pres cript ion dr ug c ove rag e, y ou may b e req uired to pro vide a c op y of this not ice w he n y ou join t o s how wh eth er or no t y ou hav e maintained c redit able c ov era ge an d wh eth er or no t y ou are req uired t o pay a highe r pr emium (a penalt y).

Distr ict Hu man Resources Depar tm en t

If y ou c anc el or lose y our c urre nt c ov era ge an d d o no t have pres cript ion dr ug c ov era ge for 6 3 day s or longe r prior to enrolling in t he Med ica re pres cript ion dr ug c ove rag e, your mont hly pr emium will b e at least 1 % pe r mon t h gre ate r for ev ery mon t h th at y ou did no t hav e c ov era ge for as long as y ou hav e Med ica re pres cript ion dr ug c ove rag e. For example, if ninet een mon th s lapse w it ho ut c ove rag e, y our pre miu m will always b e at least 1 9 % highe r t han it w ould hav e bee n w it ho ut t he lapse in co verag e.

For more information about this notice or your current prescription drug coverage: C ont a ct t he H uma n Re sou rces D epa rt me nt .

NOTE: You will rec eive this not ice annually an d at ot her times in t he fut ure, s uc h as bef ore t he ne xt pe riod y ou c an enroll in Med ica re pres cript ion dr ug c ov era ge an d if this c over age c hang es. You may also re ques t a copy.

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

Important Legal Notices Notice of HIPAA Privacy Practices

Treatment is t he prov is ion, c oordina tion or man ag eme nt of healt h c are an d related s ervic es. It also include s bu t is not limited t o co nsulta tions an d referrals be t w een on e or mor e of y our providers.

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.

For ex amp le, t he P lan may disclos e t o a tr eating phys ician the na me of y our tr eating radiologist s o th at t he phys ician may as k for y our X-rays f rom t he tr eating radiologist .

Effective Date of Notice: September 23, 2013 S c hoo l P lan is req uired by law t o ta ke rea son able steps t o ens ure t he priv acy of y our pers onally identifiable health info rma tion an d t o info rm y ou abo ut: 1.

t he Plan’s us es an d disclos ures of P rot ect ed Healt h In format ion (PHI);

2.

y our priv acy rights wit h re spe ct t o y our PHI;

3.

t he Plan’s dut ies wit h re spe ct t o y our PHI;

4.

y our right t o file a c omplaint wit h t he P lan an d t o the S ec ret ary of t he U. S . D epa rt me nt of He alth an d Hu ma n S ervic es; and

Payment include s bu t is no t limited t o ac tions t o make c ov era ge det erminations an d pa yme nt (inc lud ing billing, claims pro ces sing , s ubrog ation , rev iews for medical nec es sity an d app ropria tene ss of c are, utilization rev iew and preauthorizat ions).

For ex amp le, t he P lan may tell a tr eating do ct or w het he r you are eligible for c ov era ge or w hat pe rc ent ag e of t he bill will be paid by t he Plan.

Health care operations include bu t are no t limited t o quality as ses smen t an d impro ve me nt , rev iewing c omp et e nc e or qualificat ions of healt h c are prof essionals, unde rwriting , pr emium rat ing an d ot her ins uranc e act iv it ies relat ing to c reat ing or re new ing ins uranc e c ont rac ts . It also includes c ase man age ment , c ond uc tin g or arr anging for medical review, legal s ervic es an d audit in g fu nct io ns including

5. t he pe rs on or of fic e t o c on ta ct for f urt her information ab ou t t he Plan’s priv acy prac tices.

The t erm “Pro te ct ed He alth In format ion” (PHI) include s all individually identifiable healt h info rma tion t rans mit te d or maintained by t he Plan, rega rdless of f orm (oral, writ ten, elec tronic).

f raud an d ab us e c omplia nc e pr ogra ms, bus in ess planning an d de velo pment , bus in ess man ag eme nt an d general administ rative act iv it ies. Ho wev er, no ge net ic info rma tion ca n b e us ed or disc losed for un derw rit ing purp oses .

Section 1 – Notice of PHI Uses and Disclosures Required PHI Uses and Disclosures U po n y our req ues t, t he Plan is req uired t o give y ou ac c es s to y our P HI in or der t o ins pect an d c op y it.

For ex amp le, t he P lan may us e info rma tion t o pr ojec t fut ure ben efit c ost s or audit t he ac c ura cy of its claims proc ess ing func tions.

U se an d disclos ure of y our PHI may b e req uired by the S ec ret ary of t he D epa rt me nt of He alth an d H uma n Services t o invest igate or de ter mine th e Plan’s c omplia nc e wit h the priv acy regulations.

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

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

Un less y ou objec t, t he P lan may pro vide relevant port ions of y our pr ot ec te d healt h info rma tion t o a family member , fr ie nd or ot her pe rs on y ou indicate is involved in y our health c are or in helping y ou rec eive pa yme nt for y our healt h care.

The Plan an d its bus in ess as soc iat es will us e PHI w it ho ut your aut horizat ion t o c arr y ou t t reat ment , pa yme nt an d healt h car e ope rat io ns. The Plan an d its bus in ess as soc iat es (and any healt h insurers pro viding bene fits t o P lan part icipant s) may also disclos e t he following t o t he Plan’s Boa rd of Trust ees: (1) PHI for pu rpo se s related t o P lan adminis trat ion (pay ment an d healt h c are operat io ns); (2) s umma ry healt h information for pu rpo se s of healt h or s top loss ins uranc e unde rwriting or for pu rpo se s of modif ying t he Plan; an d (3) enrollment

A ls o, if y ou c annot a gree or objec t t o these disclos ures be c aus e of, for inst anc e, an eme rg en cy situation, t he P lan will disc lose pr ot ec te d healt h info rma tion (as the P lan det ermines) in y our be st interest . A ft er t he emergen cy, t he Plan will give y ou t he op por tu nit y t o ob je ct t o fut ure disclos ures t o family an d friends.

info rma tion (w het he r an indiv idual is eligible for bene fits und er t he Plan). The Trustees hav e am en ded t he P lan t o prot ect y our P HI as req uired by fed eral law.

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

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

9.

The Plan is allowed to use and disclose your PHI without your authorization under the following circ umst ances: 1.

For treat ment, payment and health care operations.

2.

Enrollment inf ormation ca n be provided to the Trustees.

3.

Su mmary health inf ormation ca n be provided to the Trustees for the purposes designated above.

4.

When required by law.

5. When permit ted for purposes of public health activities, including when neces sary to report produc t defect s and to permit produc t recalls. PHI may also be disc losed if you have been expos ed to a communicable disease or are at risk of spreading a disease or condit ion, if required by law.

6.

When required by law to report inf ormation about abuse, neglec t or domes tic violence to public aut horities if there exists a reasonable belief that you may be a victim of abuse, neglec t or domest ic violence. In which case, the Plan will prompt ly inf orm you that suc h a disclosure has been or will be made unless that not ice would caus e a risk of serious harm. For the purpose of reporting child abuse or neglect , it is not necessary to inf orm the minor that suc h a disclosure has been or will be made.

Dis closure may generally be made to the minor’s parent s or other representatives although there may be circumstances under federal or state law when the parent s or other representatives may not be given acc ess to the minor’s PHI.

7.

The Plan may disclose your PHI to a public healt h oversight agenc y for oversight activities required by law. This includes uses or disc losures in civil, administ rative or criminal investigations; inspections; licensure or disciplinary actions (for example, to investigate complaint s against providers); and other activities neces sary for appropriate oversight of government benef it programs (for example, to investigate Medic are or Medic aid fraud).

8.

The Plan may disclose your PHI when required for judicial or administ rat ive proceedings. For example, your PHI may be disc losed in response to a subp oena or discovery request.

When required for law enfor cement purposes, including for the purpos e of identif ying or locat ing a suspect, fugitive, material witness or missing person. Also, when disclosing inf ormation about an individual who is or is sus pected to be a victim of a crime but only if the individual agrees to the disc losure or the Plan is unable to obtain the individual’s agreement beca use of emergency circumstances . Furt hermore, the law enfor cement official mus t represent that the inf ormation is not int ended to be used against the individual, the immediate law enfor cement activity would be materially and adversely aff ected by wait ing to obtain the individual’s agreement and disc losure is in the best interest of the individual as deter mined by the exercise of the Plan’s best judgment.

10. When required to be given to a coroner or medical examiner for the purpos e of identif ying a deceased person, determining a caus e of death or other duties as authorized by law. Also, disclosure is permit ted to funeral direct ors, consist ent with applicable law, as neces sary to carr y out their duties with respect to the decedent.

11. When consist ent with applicable law and st andards of ethical co nduct if the Plan, in goo d faith, believes the use or disclosure is neces sary 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 neces sary to comply with workers’ compensation or other similar programs established by law.

Ex cept as otherwise indicated in this notic e, uses and disc losures will be made only with your written authorization subjec t to your right to revoke suc h authorization.

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

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

Ot h er us es or disclos ures of y our pr ot ec te d health info rma tion no t de sc rib ed ab ov e will only b e ma de wit h your wr itt en aut horiz ation. For ex amp le, in gen eral an d subjec t t o s pecif ic co nditions , t he P lan will no t us e or disclos e your ps ych iat ric not es; t he P lan will no t us e or disclos e your pr ot ec te d healt h info rma tion for mark eting; an d t he P lan will no t sell y our pr ot ec te d healt h informat ion, unles s y ou prov ide a wr itt en aut horizat ion t o d o so. You may rev oke writ ten a uthorizat io ns at any time, s o long as t he rev oc ation is in wr it ing. O nc e t he P lan rec eives y our wr itt en rev ocat ion, it will only b e ef fec tive for fu ture us es an d disclos ures. It will not b e ef fec tive for any info rma tion th at may hav e be en us ed or dis clos ed in reliance up on t he wr itt en aut horizat ion an d prior t o rec eiving y our wr itt en revoc ation.

Designated Record Set

Section 2 – Rights of Individuals Right to Request Restrictions on Uses and Disclosures of PHI

You or y our per son al repr esent ativ e will b e req uired to s ubmit a wr itt en re ques t t o re ques t ac c es s t o t he P HI in your des ignat ed re co rd set . S uc h req ues ts s hould b e ma de t o the Plan’s P riv acy Official.

You may re ques t t he Plan t o res trict t he us es an d dis clos ures of y our P HI. Ho wev er, t he P lan is no t req uired t o ag ree to y our re ques t (ex cept th at t he Plan mus t c omply wit h your re ques t t o res trict a disc losure of y our co nfident ial information for pa yme nt or healt h c are ope rat io ns if y ou paid for the s ervic es t o w hic h t he info rma tion relates in full, ou t of pock et).

If ac c es s is de nied, y ou or y our per son al repr esent ativ e will b e pr ovid ed wit h a wr itt en denial, se tt ing f ort h t he basis for t he denial, a des cr ip tion of ho w y ou may ap peal t he Plan’s dec is ion an d a des cr ip tion of ho w y ou may c omplain t o the Sec ret ary of t he U. S. D epa rt me nt of He alth an d Hu ma n S ervices .

You or y our per son al repr esent ativ e will b e req uired t o submit a wr itt en re ques t t o exer cise this right. S uc h req ues ts shou ld b e ma de t o t he Plan’s P riv acy Official.

The P lan may c har ge a reas onable, c ost -ba se d fee for c opy ing re cor ds at y our reques t.

Right to Request Confidential Communications

The Plan will ac c o mmod at e rea son able req ues ts t o rec eiv e c ommunic at io ns of P HI by alternative mea ns or at alt ernative locat ions if ne ce ss ar y t o pre ven t a disclos ure th at could en dan ger you.

You or y our per son al repr esent ativ e will b e req uired t o submit a wr itt en re ques t t o exer cise this right .

Suc h req ues ts s hould b e ma de t o t he Plan’s Priv acy Official.

Right to Inspect and Copy PHI You hav e a right t o ins pect an d obt ain a c op y of y our PHI c ont ained in a “de signa ted re co rd set ,” for as long as the P lan main tains t he P HI. If t he info rma tion y ou re ques t is in an elec tr onic des ignat ed re co rd set , y ou may re ques t that t hese re cor ds b e t rans mit te d elect ronically t o your self or a des ignat ed individual.

Protected Health Information (PHI)

In cludes t he medic al re cor ds an d billing re cor ds ab out indiv iduals maintained by or for a c ov ere d healt h car e pro vider ; enro llment , pa ymen t, billing, claims adjudic ation an d c ase or medic al man ag eme nt re co rd sy st ems maint ained by or for t he Plan; or ot her info rma tion us ed in w hole or in pa rt by or for t he P lan t o mak e dec is ions ab ou t individuals . In format ion us ed for quality c ontr ol or pe er rev iew analy ses an d no t us ed t o mak e dec is ions ab ou t indiv iduals is no t in the des ignat ed re co rd set.

The re ques t ed info rma tion will b e pr ovid ed within 3 0 day s if t he info rma tion is maintained on site or within 6 0 day s if the info rma tion is maintained off site. A single 3 0 - day ex tens ion is allowed if t he P lan is una ble t o c omply wit h t he deadline.

Right to Amend PHI You hav e t he right t o re ques t t he P lan t o am en d y our P HI or a re co rd ab ou t y ou in y our des ignat ed re co rd se t for as long as t he P HI is maint ained in t he des ignat ed re co rd set.

The P lan has 6 0 day s af ter t he re ques t is ma de t o ac t on the req ues t. A single 3 0 - day ex tens ion is allowed if t he P lan is una ble t o c omply wit h t he deadline. If t he re ques t is den ie d in w hole or pa rt, t he P lan mus t pro vide y ou wit h a writ ten d enial th at explains t he basis for t he denial. You or your per son al repr esent ativ e may t hen s ubmit a wr itt en st atement disag reeing wit h t he denial an d hav e th at s tat ement included wit h any fu ture disc losure s of y our PHI .

S uc h req ues ts s hould b e ma de t o t he Plan’s P riv acy Official.

You or y our per son al repr esent ativ e will b e req uired t o submit a wr itt en re ques t t o re ques t ame nd men t of t he P HI in your des ignat ed re co rd set.

In cludes all individually identifiable healt h information t rans mit te d or maintained by t he Plan, rega rdless of form.

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

Important Legal Notices Right to Receive an Accounting of PHI Disclosures At your reques t, the Plan will also provide you an accounting of disc losures by the Plan of your PHI during the six years prior to the date of your reques t. However, such acc ounting will not include PHI disc losures made: (1) to carr y out treat ment, payment or health care operat ions; (2) to individuals about their own PHI; (3) pursuant to your aut horizat ion; (4) prior to April 14, 20 03; and (5) where ot herwis e permis sible under the law and the Plan’s privacy practices. In addition, the Plan need not acc ount for certain incidental disclosures.

If the acc ounting cannot be provided wit hin 60 days, an additional 30 days is allowed if the individual is given a writ ten st at ement of the reasons for the delay and the date by which the acc ounting will be provided.

If you request more than one acc ounting wit hin a 12mont h period, the Plan will charge a reasonable, costbased fee for each subsequent account ing.

Su ch reques ts should be made to the Plan’s Privacy Off icial.

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

Such reques ts should be made to the Plan’s Privacy Off icial.

A Note About Personal Representatives

You may exercise your rights t hrough a personal representative. Your personal representative will be required to pro duce evidence of his/ her authority to act on your behalf before that person will be given acc ess to your PHI or allowed to take any action for you. Proof of suc h authority may take one of the following forms:

This Notice is effect ive Sept ember 23, 2013, and the Plan is required to comply with the terms of this Notice.

However, the Plan reserves the right to chan ge its privacy pract ic es and to apply the changes to any PHI received or maint ained by the Plan prior to that date. If a privacy pract ic e is changed, a revis ed version of this Notice will be provided to all partic ipants for wh om the Plan still maintains PHI . The revised Notice will be dist ributed in the same manner as the initial Notice was provided or in any other permis sible manner.

If the revis ed version of this Notice is post ed, you will also receive a copy of the Notice or inf ormation about any material chan ge and how to receive a copy of the Notice in the Plan’s next annual mailing. Otherwise, the revis ed version of this Notice will be dist ributed wit hin 60 days of the effect ive date of any material chan ge to the Plan’s policies regarding the uses or disc losures of PHI, the individual’s privacy rights, the duties of the Plan or other privacy pract ic es st at ed in this Notice.

Minimum Necessary Standard When using or disclosing PHI or when reques ting PHI from another cov ered entity, the Plan will mak e reasonable effort s not to use, disclose or request more than the minimum amount of PHI neces sary to accomplish the intended purpos e of the use, disc losure or reques t, taking into considerat ion practical and technological limitations. When required by law, the Plan will restrict disc losures to the limited data set, or otherwise as necessary, to the minimum neces sary inf ormation to accomplish the intended purpos e.

However, the minimum neces sary st andard will not apply in the following situations: 1.

disclosures to or reques ts by a health care provider for treatment ;

1.

a power of att or ney for health care purposes;

2.

uses or disc losures made to the individual;

2.

a co urt order of appointment of the person as the conserv at or or guardian of the individual; or

3.

disclosures made to the Secr et ary of the U.S. Depar tment of Healt h and Human Services;

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).

4.

uses or disclosures that are required by law; and

The Plan retains disc ret ion to deny acc ess to your PHI by a personal representative to provide protect ion to those vulnerable people wh o depe nd on others to exercise their rights under these rules and who may be subjec t to abuse or neglect .

Section 3 – The Plan’s Duties

5. uses or disc losures that are required for the Plan’s complianc e with legal regulat ions.

De-Identified Information This notice does not apply to inf ormation that has been de- identif ied. De -identif ied inf ormation is inf ormation that does not identif y an individual and with respect to which there is no reasonable basis to believe that the inf ormation ca n be used to identif y an individual.

The Plan is required by law to maintain the privacy of PHI and to provide individuals (partic ipants and beneficiaries) with notice of the Plan’s legal duties and privacy pract ices.

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

Important Legal Notices Summary Health Information The P lan may disclos e “s u mmar y healt h info rma tion” t o the Trustees for obt aining ins uranc e pr emium bids or modifying, ame ndin g or te rmina ting t he Plan. “ S umma ry health info rma tion” su mmariz es t he claims history , claims ex penses or t yp e of claims ex pe rien ce d by part icipant s an d exc ludes identify in g info rma tion in ac c o rda nc e wit h HI PAA. Notification of Breach

The Plan is req uired by law t o main tain t he priv acy of part icipant s’ P HI an d t o pro vide indiv iduals wit h not ice of its legal dut ies an d priv acy pra ct ices . In t he ev ent of a br eac h of un se cu red P HI, t he P lan will not if y af f ect ed indiv iduals of the brea ch.

Section 4 – Your Right to File a Complaint With the Plan or the HHS Secretary If y ou believe th at y our priv acy rights hav e be en violated, you may c omplain t o t he Plan. Suc h c omplaints s hould b e made t o t he Plan’s P riv acy Official.

You may file a c omplaint wit h t he S ec ret ary of t he U.S. D epa rt me nt of He alth an d H uma n Serv ices , H ub er t H. H ump hre y B uilding, 2 0 0 I nd epe nd enc e A ve nue SW, Was hingt on, D .C . 20 20 1. The P lan will no t retaliate against y ou for filing a complaint.

Section 5 – Whom to Contact at the Plan for More Information If y ou hav e any que st io ns reg arding this not ice or t he subjec ts ad dre ss ed in it, y ou may c on ta ct t he Plan’s P riv acy Official.

S uc h que st io ns sh ould b e direc t ed t o t he Plan’s Privacy Off icial at: D is tri ct

H um an Resources

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If y ou or y our ch ildre n are eligible for Med ica id or C HI P and you’re eligible for healt h c ov era ge f rom y our employer, your st ate may hav e a pr emium as sist ance pr og ra m th at c an help pay for c ove rag e, us ing f unds f rom the ir Med ica id or CH IP pr ogra ms. If y ou or y our ch ildre n aren’t eligible for Medic aid or CHIP, y ou w on’t b e eligible for t hese pr emium ass is tance pr ogr ams , bu t y ou may b e able t o bu y indiv idual insuranc e c ov era ge t hro ugh t he He alth I nsur anc e Mark et plac e.

For mor e informat ion, visit www.heal thcare.gov.

If y ou or y our de pen den ts are already enro lled in Med ica id or C HI P an d y ou live in a S tat e listed below , c on ta ct y our St at e Med ica id or C HI P of fic e t o find ou t if pr emium as sist ance is available.

If y ou or y our de pen den ts are N OT cu rrent ly enrolled in Med ica id or CHIP, an d y ou th in k y ou or any of your de pe nde nt s might b e eligible for eith er of t hese prog rams, c on ta ct y our S tat e Med ica id or C HI P of fic e or dial 1-877- KIDS NOW or www. i ns ureki ds now .gov t o find ou t ho w to apply. If y ou qualify, as k y our st ate if it has a pr og ra m that might help y ou pay t he pr emiums for an employer -s pons ored plan.

If y ou or y our de pen den ts are eligible for pr emium ass is tance un der Med ica id or CHIP, as well as eligible un der your employ er plan, y our employ er mus t allow y ou t o enroll in your employ er plan if y ou aren’t already enrolled. This is called a “s pecial enr ollme nt” opp ort unity , an d you must request coverage within 60 days of being determined eligible for premium assistance.

If y ou hav e que st io ns ab out enrolling in y our employ er plan, c on ta ct t he D epa rt me nt of La bo r at www .a skebs a.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.

De partm ent

Conclusion P HI us e an d disclos ure by t he P lan is reg ulate d by a federal law k no wn as H IPAA (t he He alth I nsur anc e P ortability and A cc ount ability A ct ). You may find t hese rules at 4 5 C od e of Federal Regulat ions P arts 1 60 an d 16 4. The P lan intends t o c omply wit h t hese regulations . This N otic e at t empt s to s umma rize t he regulations . The regulations will s upers ede any dis cr epan cy be t w een t he info rma tion in this N otic e and t he regulations.

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

Important Legal Notices Texas – Medicaid Website: https://www.hhs.texas.gov/services/financial/healthinsurance-premium-payment-hipp-program Phone: 1-800-440-0493

To see if any other Stat es have add ed a premium assistance progr am sinc e March 17, 2025, or for more inf ormation on special enrollment rights, you ca n cont act either: U.S. Depar tment of Labor Employee Benefit s Security Administration www.dol. gov/ agencies/ebsa 1-866-444-EBSA (3272) U.S. Depar tment of Healt h and Human Services Centers for Medic are & Medic aid Services www.cms.hhs. gov 1-877-267-2323, Menu Option 4, Ext. 61565

Continuation of Coverage Rights Under COBRA U nd er t he Federal Co nso lida ted Omn ibu s B udg et Rec onciliat ion A c t of 1 98 5 (C OB R A ), if y ou are c over ed un de r t he D is tr ic t gr ou p healt h plan y ou an d y our eligible de pe nde nt s may b e ent it led t o c ont inue y our gr ou p health bene fits c ov era ge un de r t he D is tr ic t plan af ter you hav e left emp loy ment wit h t he c ompan y.

If y ou wis h to elec t C O B R A c ove rag e, c on ta ct y our H uma n Res ources D epa rt me nt for t he applica ble dead lines t o elec t c over age an d pay t he initial premium.

Plan Contact Information:

D is tri ct H um an Resources Adm inistrator

Your Rights and Protections Against Surprise Medical Bills W he n y ou ge t eme rg en cy c are or ge t t reat ed by an ou t-of- ne t wo rk pro vider at an in-ne t wo rk hosp it al or ambulat ory sur gic al cent er, y ou are pr ot ec te d f rom su rprise billing or ba la nc e billing.

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

W he n y ou s ee a do ct or or ot her healt h c are prov ider , you may ow e c erta in ou t-of-po ck et c ost s, s uc h as a c opay me nt, c oins uran ce, an d/o r a ded uct ible. You may hav e ot her cos ts or hav e t o pay t he ent ire bill if y ou s ee a pro vider or visit a healt h c are facility t hat isn’t in y our healt h plan’s net wo rk.

“ Ou t-of-ne t w ork ” de sc ribes pro vider s an d facilities th at have no t s ig ned a c ont ra ct wit h y our healt h plan.

Ou t-of-ne tw ork pro vider s may b e pe rmit te d t o bill y ou for t he diff erence be t w een w hat y our plan ag ree d t o pay an d t he full amou nt c ha rge d for a s ervic e. This is ca lled “b alan ce billing.” This amo un t is likely mor e t han in-ne t wo rk c ost s for t he same s ervic e an d might no t c ou nt t owa rd y our annu al ou t-of- po ck et limit.

“S ur pris e billing” is an un ex pec t ed ba la nc e bill. This ca n ha pp en w he n y ou c an’t c ontr ol w ho is involved in y our c ar e— like w he n y ou hav e an eme rg en cy or w he n y ou s che dule a visit at an in- ne t wo rk facility bu t are un exp ect ed ly t reat ed by an ou t-of-ne t wo rk provider.

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

Important Legal Notices You are protected from balance billing for:

Your health plan generally must:

• Emergency services – If you have an emergency medical condi tion and get emergency services from an out-of- netw ork provider or facility, the most the provider or facility may bill you is your plan’s in- netw ork 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 condi tion, unless you give written consent and give up your protections not to be bal anced billed for these post- stabilization services.

• Certain services at an in-netw ork hospital or ambulatory surgical center – When you get services from an in- netw ork hospital or ambul atory 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 (cost- sharing) on what it would pay an innetw ork provider or facility and show that amount in your explanation of benefits.

• Count any amount you pay for emergency services or out-of-netw ork 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.g ov/no su rp rises for more information about your rights under federal law.

If you get other services at these in-netw ork facilities, out-of- netw ork 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 out-of-netw ork providers and facilities directly.

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

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

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