Eustace ISD Benefit Guide 2023-2024 by Riata245

2023-2024 Rusty Freeman & Associates, LLC U.S. Employee Benefits Services Group 245 Landa Street New Braunfels, Texas 78130 Phone:(830)606-5100 Mybenefitshub.com/eustaceisd

Support Contacts Debra Meyners Employee Benefits Office Office: (903) 425-5125 Email: dmeyners@eustaceisd.net Tracy Hamel Senior Account Manager Office: (830) 606-5100 Email: Thamel@usebsg.com Marlene Freeman Senior Account Manager Office: (830) 606-5100 Email: mfreeman@usebsg.com

Page Enroll Instructions 4 - 5 Medical Transportation - MASA 6 -7 Accident - MetLife 8 - 13 Critical Illness - Unum 14 - 19 Cancer – Colonial Life 20 - 23 Disability – The Standard 24 - 29 Dental - Lincoln 30 - 37 Vision – Superior 38 Basic (District Paid) Life - Lincoln 39 Voluntary Life - Lincoln 40 - 43 Texas Life - Permanent Life 44 - 46 Flexible Spending Account - FSA 47 - 50 Benefit Contacts Benefit Phone Website THE STANDARD - DISABILITY 1-800-368-1135 WWW.STANDARD.COM TEXAS LIFE – PERMANENT LIFE 1-800-283-9233 WWW.TEXASLIFE.COM METLIFE – ACCIDENT 1-800-638-5433 WWW.METLIFE.COM CANCER – COLONIAL LIFE 1-212-598-8000 WWW.COLONIALLIFE.COM LINCOLN – GROUP LIFE 1-800-423-2765 WWW.LINCOLNFINANCIAL.COM LINCOLN – VOLUNTARY LIFE 1-800-423-2765 WWW.LINCOLNFINANCIAL.COM UNUM – CRITICAL ILLNESS 1-866-679-3054 WWW.UNUM.COM LINCOLN – DENTAL 1-800-507-3800 WWW.LINCOLNFINANCIAL.COM SUPERIOR – VISION 1-800-507-3800 WWW.SUPERIORVISION.COM MASA – MEDICAL TRANSPORT 1-954-334-8261 WWW.MASAMTS.COM NBS – FLEXIBLE SPENDING ACCOUNT 1800-274-0503 WWW.NBSBENEFITS.COM

Table of Content

Enrollment Instructions for THEbenefitsHUB

Site Access: To access your employer online enrollment site, THEbenefitsHUB, you can login to the following website www.mybenefitshub.com/Eustaceisd

245 Landa Street New Braunfels, Texas 78130 Phone: (830) 606-5100 4

The2023-2024 Section 125 Cafeteria Plan year begins 09/01/2023 and ends

08/31/2024. All beneﬁts elected during the annual open enrollment will be effective 09/01/2023.

Know Your Benefits! Below is asummary of benefits offered through EISD.

Medical Transportation - MASA provides emergency transportation for ground, emergency air, and non-emergency hospital to hospital transportation anywhere in the US/Canada.

Standard Disability- Plan includes both short and long term disability coverage. Plan is designed to protect up to 66.66 percent of your gross EISD income.

Texas Life Permanent Life– Portable, permanent life insurance available for employees, their spouses and dependents. Employees can keep the coverage upon termination or retirement from EISD.

UNUM Term Life - Group term life insurance that ends when you terminate employment with EISD. Coverage is also available for spouses and dependent children.

UNUM Critical Illness - This benefit pays a lump sum if the insured is diagnosed with a critical illness

Colonial Cancer – pays benefits for internal cancer diagnosis. Guarantee issued, pre-existing conditions may apply.

Wellfleet Accident (NEW) - Pays Benefits for off-the-job accidents. Includes physical/wellness reimbursement. $200 Wellness Benefit.

Lincoln Financial–Coverage for preventative, basic, major and orthodontia services.

Superior Vision - Includes coverage for eye exams, materials (such as frames and lenses), and discounts for laser vision correction. The plan has a defined network of providers. Out of network benefits are available on a reimbursement basis only.

NBS Flexible Spending – NBS will be the new provider for Flexible Spending Account effective 9/1/2023, you will be receiving a new card. If you currently have an FSA card please spend your funds prior to 8/31/2023.

2023 OPEN ENROLLMENT INFORMATION

The Ultimate Peace of Mind for Employees and Their Families

The Harrison’s Story

• Jim and his family were at a local festival when his daughter, Sara, suddenly began experiencing horrible abdominal and back pain, after a fall from earlier in the day.

• His wife, Heather, called 911 and Sara was transported to a local hospital, when it was decided that she needed to be flown to another hospital.

• Upon arrival, Sara underwent multiple procedures and her condition was stabilized.

• After further testing, it was discovered that Sara needed additional specialized treatment at another hospital requiring transport on a non-emergent basis.

Based on a true story. Names were changed to protect identities in compliance with HIPAA.

And then, the Bills came!

Any Ground. Any Air. Anywhere.TM

No matter how comprehensive your local in-network coverage may be, you still have significant exposure to out-of-network emergency transportation. Moreover, when you and your family travel outside your area, there is an 80% chance of being picked up by an out-of-network provider.

A MASA Membership prepares you for the unexpected. ONLY MASA MTS provides you with:

• Coverage ANYWHERE in all 50 states and Canada whether at home or away

• Coverage for BOTH emergent ground ambulance and air ambulance transport REGARDLESS of the provider

• Non-emergent transport services, which are frequently covered inadequately by your insurance, if at all For more information, please contact your local MASA MTS representative or visit www.masamts.com

As a MASA Member If a Non-MASA Member Sara would pay*If In-Network**If Out-of-Network** 911 Ground Ambulance Cost: $1,800 $0$300$1,600 Emergent Air Ambulance Cost: $45,000 $0$4,000$30,000 Non-Emergent Air Transport† Cost: $20,000 $0$20,000$20,000 Total Out-of-Pocket Cost $0$24,300$51,600

*Benefit is dependent

Membership Enrolled. **Out-of-pocket dollars vary dependent on provider, distance, health plan design, current status of deductible and out-of pocket max. These figures are an example of the costs one may incur. †More and more health plans are not covering interfacility transports on a non-emergent basis.

FLYER_COMP_B2B

EMERGENCY TRANSPORTATION COSTS

MASA MTS is hereto protect its members andtheir families from the shortcomings of health insurance coverageby providingthem with comprehensivefinancial protectionfor lifesaving emergency transportation services, both at home and away fromhome.

Many American employers and employees believe that their health insurance policies cover most, if notall ambulance expenses

Thetruth is, they DONOT!

Even after insurance payments for emergency transportation, you couldreceive a bill up to $5,000 for ground ambulanceand as high as $70,000 for air ambulance. The financial burdens for medical transportation costs are veryreal.

HOW MASA IS DIFFERENT

Across the US there are thousands of ground ambulance providers and hundreds of air ambulance carriers. ONLYMASA offers comprehensive coverage since MASA is a PAYERand not aPROVIDER!

ONLY MASA provides over 1.6million members with coverage for BOTH ground ambulance and air ambulance transport, REGARDLESS of which provider transports them.

Members are covered ANYWHEREin all50 states andCanada!

Additionally, MASA provides a repatriation benefit: if a member is hospitalized more than 100 miles from home, MASA can arrangeand pay to have them transported to a hospital closer to their place of residence.

Any

BENEFITS

A MASA Membership prepares you for the unexpectedandgives you the peaceof mind to access vital emergency medical transportation no matter where you live, for a minimal monthlyfee.

• Onelow fee for the entire family

• NO deductibles

• NO health questions

• Easy claims process

For more information, pleasecontact

Your Broker or MASA Representative

EmergentGround Transportation EmergentAir Transportation Non-EmergentAir Transportation Repatriation U.S./Canada U.S./Canada U.S./Canada U.S./Canada Emergent Plus $14/mo.

EVERY FAMILY DESERVES AMASA MEMBERSHIP OUR

Benefit*

* Please refer to the MSA for a detailed explanation of benefits and eligibility, 7

Ground. Any Air. Anywhere.™

Accident

Insurance

ScheduleofBenefits&Features

• Unlimitedlifetimemaximumbenefitwithnoage-relatedbenefitreductions

• Benefitspaidbasedonthescheduleofbenefitsprovidedforeachcoveredaccident

• WaiverofPremium:Premiumiswaivedfollowinga60-dayperiodofdisabilityduetoacovered accidentforaslongasthecoveredpersonremainsdisabled.

• Portabilityisincluded.

SpecificInjuryBenefit

Fractures

Closed/Non-SurgicalTreatment

Hip,Thigh(Femur)

Vertebrae,Bodyof(excludingVertebral Process)

Pelvis

Leg(Tibiaand/orFibula)

UpperArm(Humerus) $3,000.00

ShoulderBlade $3,000.00

Collarbone $3,000.00

UpperJaw,Maxilla(exceptAlveolarProcess) $2,500.00

AI-2 MP0000822785

ACCIDENTPLANBENEFITS Custom Accident EmergencyandInitialAccidentTreatmentBenefits Ambulance Ground $200.00 Air $600.00 Water $600.00 EmergencyRoomTreatment $200.00 UrgentCare $75.00 MajorDiagnosticImaging $200.00 X-ray $75.00 HospitalBenefits HospitalAdmission $1,000.00 HospitalConfinement $200.00 Maximumperaccident 365days IntensiveCareAdmission $1,000.00 ICUConfinement $200.00 Maximumperaccident 365days ObservationUnit $100.00

$4,000.00

Skull(exceptBonesofFaceorNose) Depressed

$4,000.00

LowerJaw,Mandible(exceptAlveolar Process) $2,500.00 VertebralProcess $1,600.00 Forearm(Ulnaand/orRadius) $1,600.00 Hand,Wrist(exceptFingers) $1,600.00 Kneecap $1,600.00 Foot(exceptToes) $1,600.00 Ankle $1,600.00 Rib $300.00 Coccyx $300.00 Finger,Toe $300.00 EnhancementforOpen/SurgicalReduction 2X ChipFractures 25% Dislocations Closed/Non-SurgicalTreatment Hip $4,000.00 Knee(otherthanKneecap) $2,250.00 Shoulder $2,250.00 Kneecap $1,000.00 Ankleboneorbonesofthefoot $1,000.00 Elbow $1,000.00 Wrist $1,000.00 Boneorbonesofthehand $1,000.00 Jawbone $1,000.00 Collarbone $1,000.00 Onetoeorfinger $300.00 EnhancementforOpen/SurgicalReduction 2X PartialDislocations 25% Lacerations NoRepair $50.00 Repair-upto2inches $50.00 Repair-over2inches,upto6inches $200.00 Repair-over6inches $400.00 Burns 2ndDegreeBurns Atleast1%,butlessthan20%ofskinsurface $100.00 20%orgreaterofskinsurface $500.00 3rdDegreeBurns Lessthan5%ofskinsurface $500.00 Atleast5%,butlessthan20%ofskinsurface $5,000.00 20%orgreaterofskinsurface $10,000.00 SkinGraft DuetoBurns(%ofapplicableBurnbenefit) 50% 10

NotduetoBurns Atleast1%,butlessthan20%ofskinsurface $100.00 20%orgreaterofskinsurface $200.00 ConcussionandOtherBrainInjuries $300.00 DentalBenefit $250.00 EyeInjuryBenefit $200.00 SurgeryBenefits OutpatientSurgeryBenefit FacilitiesotherthanPhysicianOfficeor EmergencyRoom $300.00 PhysicianOfficeorEmergencyRoom $300.00 InternalInjuriesSurgicalBenefits OpenAbdominal&Thoracic $2,000.00 Hernia $200.00 ExploratorywithoutRepair $150.00 Tendon/Ligament/RotatorCuffSurgicalBenefit Single $700.00 Multiple $1,050.00 ExploratorywithoutRepair $150.00 TornKneeCartilageSurgeryBenefit TornwithSurgicalRepair $600.00 ExploratorywithoutRepair $150.00 Diagnosisonlywithnosurgeryorrepair $100.00 RupturedDiscwithSurgicalRepair $600.00 AnesthesiaBenefit GeneralAnesthesia $200.00 EpiduralorRegionalAnesthesia $200.00 MedicalBenefits Blood,Plasma&PlateletsBenefit $500.00 ProstheticDeviceBenefit Oneonly $1,000.00 Twoormore $2,000.00 Appliances $300.00 PainManagementBenefit $200.00 Follow-UpCareandTransportationBenefits PhysicianOfficeVisit $75.00 Maximumnumberofvisits 4 TherapyServicesBenefit(Occupational,Physical, SpeechTherapy) $60.00 Maximumnumberofvisits 12 RehabilitationUnitConfinement $200.00 Maximumnumberofdays 90 11

Residence/VehicleModificationBenefit $1,000.00 Transportation(minimumof100milesfrom residence,upto3roundtrips) $.60/mile Lodging $200.00 Maximumnumberofdays 30 AccidentalDeathBenefits AccidentalDeath Employee $40,000.00 Spouse $20,000.00 Child(ren) $20,000.00 CommonCarrierAccidentalDeath Employee $200,000.00 Spouse $100,000.00 Child(ren) $100,000.00 OrganDonorBenefit $5,000.00 AccidentalDismembermentBenefits Dismemberment LossofBothHands,orLossofBothFeet,orLossof OneHandandOneFoot $40,000.00 LossofOneHandorLossofOneFoot $20,000.00 PartialDismemberment LossofOneorMoreFingersorToes $600.00 PartialAmputationofFingerorToe $200.00 CatastrophicBenefits CatastrophicLoss LossofSightinbotheyesorHearinginbothears $20,000.00 LossofSpeechorSightinoneeyeorHearingin oneear $5,000.00 Coma $20,000.00 Paralysis Paraplegia $15,000.00 Quadriplegia $30,000.00 Riders HealthScreeningBenefitRider: $200.00 Numberofpaymentsperyear,percovered person. 1 Monthly Rates Employee Only Employee & SpouseEmployee & Child(ren)Family Custom Accident $14.00 $24.00 $29.00 $39.00 12

EXCLUSIONS*

Inadditiontoanybenefit-specificexclusion,benefitswillnotbepaidforanylosswhich,directlyorindirectly,in wholeorinpart,iscausedbyorresultsfromanyofthefollowingunlesscoverageisspecificallyprovidedforby nameinthisCertificate:

1.Aninjuryincurredwhileworkingforpayorprofit;

2.Intentionallyself-inflictedinjury,suicide,oranyattemptorthreatwhilesaneorinsane;

3.Participatinginwaroranyactofwarwhetherdeclaredorundeclared;

4.Commissionorattempttocommitafelony;

5.Commissionoforactiveparticipationinariot,insurrection,orterroristactivity;

6.Engaginginanillegalactivityoroccupation;

7.Flightin,boarding,oralightingfromanaircraftoranycraftdesignedtoflyabovetheearth’ssurface,including anytravelbeyondtheearth’satmosphereexceptafare-payingpassengeronaregularlyscheduledcommercial orcharterairline;

8.Practicingfororparticipatinginanysemi-professionalorprofessionalcompetitiveathleticcontest,including officiatingorcoaching,forwhichthecoveredpersonreceivesanycompensationorremuneration;

9.Sickness,exceptforanybacterialinfectionresultingfromanaccidentalexternalcutorwoundoraccidental ingestionofcontaminatedfood;

10.Voluntaryingestionorinhalationofanynarcotic,drug,poison,gasorfumes,unlessprescribedortakenunder thedirectionofaphysicianandtakeninaccordancewiththeprescribeddosage;

11.Operatinganytypeofvehiclewhileundertheinfluenceofalcoholoranydrug,narcoticorotherintoxicant includinganyprescribeddrugforwhichthecoveredpersonhasbeenprovidedawrittenwarningagainst operatingavehiclewhiletakingit.Undertheinfluenceofalcohol,forpurposesofthisexclusion,means intoxicated,asdefinedbythelawoftheStateinwhichthecoveredaccidentoccurred;

12.Carethatisnotrecommendedandapprovedbyaphysician.

Eustace Independent School District Critical Illness Plan Highlights Policy Number 474651

Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness.

Who is eligible for this coverage?

What are the Critical Illness coverage amounts?

All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status).

The following coverage amounts are available.

For you: Select one of the following $10,000, $15,000 or $20,000

For your Spouse: 100% of employee coverage amount

For your Children: 50% of employee coverage amount Can I be denied coverage?

When is coverage effective?

Coverage is guarantee issue.

Please see your Plan Administrator for your effective date of coverage.

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

What critical illness conditions are covered? Covered Conditions* Percentage of Coverage Amount Critical Illnesses Coronary Artery Disease (major) 50% Coronary Artery Disease (minor) 10% End Stage Renal (Kidney) Failure 100% Heart Attack (Myocardial Infarction) 100% Major Organ Failure Requiring Transplant 100% Stroke 100% Cancer Invasive Cancer (including all Breast Cancer) 100% Non-Invasive Cancer 25% Skin Cancer $500 Supplemental Critical Illnesses Benign Brain Tumor 100% Coma 100% Loss of Hearing 100% Loss of Sight 100% Loss of Speech 100% Infectious Disease 25% Occupational Human Immunodeficiency Virus (HIV) or Hepatitis 100% Permanent Paralysis 100%

Are wellness screenings covered?

*Please refer to the policy for complete definitions of covered conditions.

Covered Condition Benefit

The covered condition benefit is payable once per covered condition per insured.

Unum will pay a covered condition benefit for a different covered condition if: - the new covered condition is medically unrelated to the first covered condition; or

- the dates of diagnosis are separated by more than 180 days.

Reoccurring Condition Benefit

We will pay the reoccurring condition benefit for the diagnosis of the same covered condition if the covered condition benefit was previously paid and the new date of diagnosis is more than 180 days after the prior date of diagnosis.

The benefit amount for any reoccurring condition benefit is 100% of the percentage of coverage amount for that condition.

The following Covered Conditions are eligible for a reoccurring condition benefit:

Benign Brain Tumor Heart Attack (Myocardial Infarction)

Coma

Invasive Cancer (includes all Breast Cancer)

Coronary Artery Disease (Major) Major Organ Failure Requiring Transplant

Coronary Artery Disease (Minor) Non-Invasive Cancer

End Stage Renal (Kidney) Failure Stroke

Each insured is eligible to receive one Be Well Benefit per calendar year.

Be Well Benefit

For you, your spouse and your children: $50

If the employee’s Critical Illness Coverage Amount is: The Be Well Benefit Amount for you, your spouse and your children is:

Be Well Screenings include tests for the following: cholesterol and diabetes, cancer and cardiovascular function. They also include imaging studies, immunizations and annual examinations by a Physician. See certificate for details.

Progressive Diseases Amyotrophic Lateral Sclerosis (ALS) 100% Dementia (including Alzheimer’s Disease) 100% Functional Loss 100% Multiple Sclerosis (MS) 100% Parkinson’s Disease 100% Additional Critical Illnesses for your Children Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Down Syndrome 100% Spina Bifida 100%

$10,000 $50 $15,000 $50 $20,000 $50

How

much does the coverage cost? Option 1 Monthly Critical Illness Cost $10,000 EE, $10,000 SP, $50 Be Well Benefit Age Employee Cost Spouse Cost Less than age 25 $3.96 $3.96 25-29 $4.86 $4.86 30-34 $6.06 $6.06 35-39 $8.16 $8.16 40-44 $10.66 $10.66 45-49 $13.86 $13.86 50-54 $17.66 $17.66 55-59 $23.86 $23.86 60-64 $33.26 $33.26 65-69 $48.06 $48.06 70-74 $74.36 $74.36 75-79 $108.96 $108.96 80-84 $157.96 $157.96 85 or over $253.66 $253.66 Option 2 Monthly Critical Illness Cost $15,000 EE, $15,000 SP, $50 Be Well Benefit Age Employee Cost Spouse Cost Less than age 25 $5.01 $5.01 25-29 $6.36 $6.36 30-34 $8.16 $8.16 35-39 $11.31 $11.31 40-44 $15.06 $15.06 45-49 $19.86 $19.86 50-54 $25.56 $25.56 55-59 $34.86 $34.86 60-64 $48.96 $48.96 65-69 $71.16 $71.16 70-74 $110.61 $110.61 75-79 $162.51 $162.51 80-84 $236.01 $236.01 85 or over $379.56 $379.56 16

Do my critical illness insurance benefits decrease with age?

Are there any exclusions or limitations?

Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date.

Spouse rate is based on your Spouse’s insurance age, which is their age immediately prior to and including the anniversary/effective date.

Critical Illness benefits do not decrease due to age.

We will not pay benefits for a claim that is caused by, contributed to by, or occurs as a result of any of the following:

- committing or attempting to commit a felony;

- being engaged in an illegal occupation or activity;

- injuring oneself intentionally or attempting or committing suicide, whether sane or not;

- active participation in a riot, insurrection, or terrorist activity. This does not include civil commotion or disorder, injury as an innocent bystander, or Injury for self-defense;

- participating in war or any act of war, whether declared or undeclared;

- combat or training for combat while serving in the armed forces of any nation or authority, including the National Guard, or similar government organizations;

- voluntary use of or treatment for voluntary use of any prescription or nonprescription drug, alcohol, poison, fume, or other chemical substance unless taken as prescribed or directed by the Insured’s Physician;

- being intoxicated; and

- a Date of Diagnosis that occurs while an Insured is legally incarcerated in a penal or correctional institution.

Additionally, no benefits will be paid for a Date of Diagnosis that occurs prior to the coverage effective date.

Monthly Critical Illness Cost $20,000 EE, $20,000 SP, $50 Be Well Benefit Age Employee Cost Spouse Cost Less than age 25 $6.06 $6.06 25-29 $7.86 $7.86 30-34 $10.26 $10.26 35-39 $14.46 $14.46 40-44 $19.46 $19.46 45-49 $25.86 $25.86 50-54 $33.46 $33.46 55-59 $45.86 $45.86 60-64 $64.66 $64.66 65-69 $94.26 $94.26 70-74 $146.86 $146.86 75-79 $216.06 $216.06 80-84 $314.06 $314.06 85 or over $505.46 $505.46

Option 3

Is the coverage portable (can I keep it if I leave my employer)?

Pre-existing Conditions

We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following:

- a pre-existing condition; or

- complications arising from treatment or surgery for, or medications taken for, a pre-existing condition.

An insured has a pre-existing condition if, within the 3 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which:

- medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period;

- drugs or medications were taken, or prescribed to be taken during that period; or

- symptoms existed.

Pre-existing Condition requirements are not applicable to children who are newly acquired after your Coverage Effective Date.

The pre-existing condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date any initial coverage or increases in coverage become effective.

If your employment with your employer ends or you are no longer in an eligible group you can apply for ported coverage and pay the first premium within 31 days to continue coverage for yourself, your spouse and your children.

If your spouse’s coverage ends as a result of your death, divorce or annulment, your spouse may elect to continue spouse and children coverage, as long as premium is paid as required.

When does my coverage end?

If you choose to cancel coverage, it will end on the first of the month following the date you provide notification to your employer.

Otherwise, coverage ends on the earliest of:

- the date the policy is cancelled by your employer;

- the date you no longer are in an eligible group;

- the date your eligible group is no longer covered;

- the date of your death

- the last day of the period any required contributions are made;

- the last day you are in active employment

If you choose to cancel your Spouse’s coverage, it will end on the first of the month following the date you provide notification to your employer.

Otherwise, your spouse’s coverage will end on the earliest of:

- the date your coverage ends;

- the date your spouse is no longer eligible for coverage;

- the date your spouse no longer meets the definition of a spouse;

- the date of your spouse’s death; or

- the date of divorce or annulment.

Your children’s coverage will end on the earliest of:

- the date your coverage ends;

- the date your children are no longer eligible for coverage; or

- the date your children no longer meet the definition of children.

The limited benefits provided are a supplement to major medical coverage and are not a substitute for major medical coverage or other minimal essential coverage as required by federal law. Lack of minimal essential coverage may result in an additional tax payment being due.

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form GCIP16-1 et al or contact your Unum representative.

Underwritten by Unum Insurance Company, Portland, Maine

AE-1226 FOR EMPLOYEES

Nearly everyone has experienced or knows somebody who has experienced a cancer diagnosis in their family. The good news is that cancer screenings and cancer-fighting technologies have gotten a lot better in recent years. However, with advanced technology come high costs. Major medical health insurance is a great start, but even with this essential safety net, cancer sufferers can still be hit with unexpected medical and non-medical expenses.

Cancer coverage from Colonial Life offers the protection you need to concentrate on what is most important — your care.

Features of Colonial Life’s Cancer Insurance:

1. Pays benefits to help with the cost of cancer screening and cancer treatment.

2. Provides benefits to help pay for the indirect costs associated with cancer, such as:

l Loss of wages or salary

l Deductibles and coinsurance

l Travel expenses to and from treatment centers

l Lodging and meals

l Child care

3. Pays regardless of any other insurance you have with other insurance companies.

4. Provides a cancer screening benefit that you can use even if you are never diagnosed with cancer.

5. Benefits paid directly to you unless you specify otherwise.

6. Flexible coverage options for employees and their families.

Group Cancer 1000 With Additional Benefits 20

This is a brief description of some available benefits.

We will pay benefits if one of the following routine cancer screening tests is performed or if cancer is diagnosed while your coverage is in force.

Cancer Screening Benefit Tests

This benefit is payable once per calendar year per covered person.

l Pap Smear

l ThinPrep Pap Test1

l CA125 (Blood test for ovarian cancer)

l Mammography

l Breast Ultrasound

l CA 15-3 (Blood test for breast cancer)

l PSA (Blood test for prostate cancer)

l Chest X-ray

l Biopsy of Skin Lesion

l Colonoscopy

l Virtual Colonoscopy

l Hemoccult Stool Analysis

l Flexible Sigmoidoscopy

l CEA (Blood test for colon cancer)

l Bone Marrow Aspiration/Biopsy

l Thermography

l Serum Protein Electrophoresis (Blood test for Myeloma)

To file a claim for a covered cancer screening/wellness test, it is not necessary to complete a claim form. Call our toll-free Customer Service number, 1.800.325.4368, with the medical information

Inpatient Benefits

l Hospital and Hospital Intensive Care Unit Confinement

l Ambulance

l Private Full-Time Nursing Services

l Attending Physician

Treatment Benefits (In -or Outpatient)

l Radiation/Chemotherapy

l Antinausea Medication

l Blood/Plasma/Platelets/Immunoglobulins

l Experimental Treatment

l Hair Prosthesis/External Breast/Voice Box Prosthesis

l Supportive/Protective Care Drugs and Colony

Stimulating Factors

l Bone Marrow Stem Cell Transplant

l Peripheral Stem Cell Transplant

Surgery Benefits

l Surgery Procedures (including skin cancer)

l Anesthesia (including skin cancer)

l Second Medical Opinion

l Reconstructive Surgery

l Prosthesis/Artificial Limb

l Outpatient Surgical Center

Transportation/Lodging Benefits

l Transportation

l Transportation for Companion

l Lodging

Extended Care Benefits

l Skilled Nursing Care Facility

l Hospice

l Home Health Care Service

Waiver of Premium

THIS IS A CANCER ONLY POLICY.

This policy has exclusions and limitations. For cost and complete details of the coverage, see your Colonial Life benefits counselor. Coverage may vary by state and may not be available in all states. Applicable to policy form GCAN-MP and certificate form GCAN-C (including state abbreviations where used, for example GCAN-C-TX.)

1ThinPrep is a registered trademark of Cytyc Corporation.

Level 2 with $2,000

Level 4 with $2,000

Colonial Life 1200 Colonial Life Boulevard Columbia, South Carolina 29210 coloniallife.com

Initial Diagnosis Benefit & Specified Disease

Initial Diagnosis Benefit & Specified Disease Employee $13.50 $26.70 Family $22.45 $44.30 Group Cancer 1000 With Additional Benefits 21

Group Cancer Insurance— Initial Diagnosis of Cancer Rider

The diagnosis of internal cancer can be an upsetting time. You do not need to add financial worry to what is already a very difficult situation. When you add an Initial Diagnosis of Cancer rider to your group cancer insurance coverage, you add a little more financial protection at the point you or an insured family member is diagnosed with internal cancer—a time before many medical costs are incurred.

Rider Benefits

This rider pays a lump sum benefit for the initial diagnosis of internal (not skin) cancer. Use the benefit any way you choose, such as to help pay for deductibles and coinsurance on your major medical insurance or settle any outstanding debts.

Rider Features

l Guaranteed renewable as long as your cancer insurance policy is in force.

l Covers the same family members as your cancer insurance policy.

l Pays benefits regardless of any other insurance you have with other insurance companies.

l Pays benefits directly to you, unless you specify otherwise.

This rider has exclusions and limitations. For cost and complete details of the coverage, see your Colonial Life benefits counselor. Coverage may vary by state and may not be available in all states. Applicable to rider form R-GCAN-Indx (including state abbreviations where used - for example: R-GCAN-Indx-TX).

Group Cancer 1000— Initial Diagnosis of Cancer Rider

62614-3 Colonial Life 1200 Colonial Life Boulevard Columbia, South Carolina 29210 coloniallife.com ©2011 Colonial Life & Accident Insurance Company. Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. Colonial Life and Making benefits count are registered service marks of Colonial Life & Accident Insurance Company. 22

Group Cancer Insurance— Specified Disease Rider

When you add this rider to your group cancer insurance coverage, you add valuable coverage related to the following specified diseases.

Specified Diseases

•Adrenal Hypofunction (Addison’s Disease)

•Botulism

•Bubonic Plague

•Cerebral Palsy

•Cholera

•Cystic Fibrosis

•Diphtheria

•Encephalitis (including Encephalitis contracted from West Nile Virus)

•Huntington’s Chorea

•Legionnaires’ Disease

Rider Benefits

•Lou Gehrig’s Disease (Amyotrophic Lateral Sclerosis)

•Lyme Disease

•Malaria

•Meningitis (bacterial)

•Multiple Sclerosis

•Muscular Dystrophy

•Myasthenia Gravis

•Necrotizing Fasciitis

•Osteomyelitis

•Poliomyelitis

•Rabies

•Reye’s Syndrome

•Scleroderma

•Scarlet Fever

•Sickle Cell Anemia

•Systemic Lupus

•Tetanus

•Toxic Epidermal Necrolysis

•Toxic Shock Syndrome

•Tuberculosis (Mycobacterial)

•Tularemia

•Typhoid Fever

•Variant Creutzfeldt-Jakob Disease (Mad Cow Disease)

•Yellow Fever

l Hospital Confinement –We will pay this benefit if you incur charges for and are confined to a hospital for treatment of one of the specified diseases listed above.

l Ambulance – We will pay this benefit if you incur charges for and use a professional ambulance to transport you, on the advice of a doctor, to or from a hospital where you are confined as an inpatient for the treatment of a specified disease listed above. Limit 2 one way trips per confinement.

l Attending Physician– We will pay this benefit if you incur charges for and use the services of an attending physician while confined to a hospital for the treatment of a specified disease listed above.

Rider Features

l Covers the same family members as your cancer insurance coverage.

l Pays benefits regardless of any other insurance you have with other insurance companies.

l Pays benefits directly to you, unless you specify otherwise.

This rider has exclusions and limitations. For cost and complete details of the coverage, see your Colonial Life benefits counselor. Coverage may vary by state and may not be available in all states. Applicable to Rider form R-GCAN-SpDis (including state abbreviation where used - for example: R-GCAN-SpDis-TX).

Group Cancer 1000— Specified Disease Rider

are underwritten by Colonial Life & Accident Insurance

Life

the marketing

products

Company, for which Colonial

brand.

Voluntary Long Term Disability Insurance

Standard Insurance Company has developed this document to provide you with information about the optional insurance coverage you may select through the Eustace Independent School District. Written in non-technical language, this is not intended as a complete description of the coverage. If you have additional questions, please check with your human resources representative.

Employer Plan Effective Date

The group policy effective date is September 1, 2021.

Eligibility

To become insured, you must be:

• A regular employee of Eustace Independent School District, excluding temporary or seasonal employees, fulltime members of the armed forces, leased employees or independent contractors

• Actively at work at least 15 hours each week

• A citizen or resident of the United States or Canada

Employee Coverage Effective Date

Please contact your human resources representative for more information regarding the following requirements that must be satisfied for your insurance to become effective. You must satisfy:

• Eligibility requirements

• An eligibility waiting period of 0 days

• An evidence of insurability requirement, if applicable

• An active work requirement. This means that if you are not actively at work on the day before the scheduled effective date of insurance, your insurance will not become effective until the day after you complete one full day of active work as an eligible employee.

Benefit Amount

You may select a monthly benefit amount in $100 increments from $200 to $8,000; based on the tables and guidelines presented in the Rates section of these Coverage Highlights. The monthly benefit amount must not exceed 66 2/3 percent of your monthly earnings.

Benefits are payable for non-occupational disabilities only. Occupational disabilities are not covered.

Plan Maximum Monthly Benefit: 66 2/3 percent of predisability earnings

Plan Minimum Monthly Benefit: 10 percent of your LTD benefit before reduction by deductible income

Eustace Independent School District

Benefit Waiting Period and Maximum Benefit Period

The benefit waiting period is the period of time that you must be continuously disabled before benefits become payable. Benefits are not payable during the benefit waiting period. The maximum benefit period is the period for which benefits are payable. The benefit waiting period and maximum benefit period associated with your plan options are shown below:

Options 1-6: Maximum Benefit Period of 5 years for Sickness

If you become disabled before age 62, LTD benefits may continue during disability for 5 years. If you become disabled at age 62 or older, the benefit duration is determined by your age when disability begins:

Options

1-6:

Maximum Benefit Period To Age 65 for Accident

If you become disabled before age 62, LTD benefits may continue during disability until you reach age 65. If you become disabled at age 62 or older, the benefit duration is determined by your age when disability begins:

First Day Hospital Benefit

With this benefit, if an insured employee is admitted as a hospital inpatient for at least four hours during the benefit waiting period, the benefit waiting period will be satisfied. Benefits become payable on the date of hospitalization; the maximum benefit period also begins on that date. This feature is included only on LTD plans with benefit waiting periods of 30 days or less.

Option Accidental Injury Other Disability Maximum Benefit Period 1 0 days 7 days 5 Years for Sickness & To Age 65 for Accident 2 14 days 14 days 5 Years for Sickness & To Age 65 for Accident 3 30 days 30 days 5 Years for Sickness & To Age 65 for Accident 4 60 days 60 days 5 Years for Sickness & To Age 65 for Accident 5 90 days 90 days 5 Years for Sickness & To Age 65 for Accident 6 180 days 180 days 5 Years for Sickness & To Age 65 for Accident

Age Maximum Benefit Period 62 3 years 6 months 63 3 years 64 2 years 6 months 65 2 years 66 1 year 9 months 67 1 year 6 months 68 1 year 3 months 69+ 1 year

Preexisting Condition Exclusion

A general description of the preexisting condition exclusion is included in the Group Voluntary Long Term Disability Insurance for Educators and Administrators brochure. If you have questions, please check with your human resources representative.

Preexisting Condition Period: The 90-day period just before your insurance becomes effective Exclusion Period: 12 months

Preexisting Condition Waiver

For the first 90 days of disability, The Standard will pay full benefits even if you have a preexisting condition. After 90 days, The Standard will continue benefits only if the preexisting condition exclusion does not apply.

Own Occupation Period

For the plan’s definition of disability, as described in your brochure, the own occupation period is the first 24 months for which LTD benefits are paid.

Any Occupation Period

The any occupation period begins at the end of the own occupation period and continues until the end of the maximum benefit period.

Other LTD Features

• Employee Assistance Program (EAP) – This program offers support, guidance and resources that can help an employee resolve personal issues and meet life’s challenges.

• Family Care Expense Adjustment – Disabled employees faced with the added expense of family care when returning to work may receive combined income from LTD benefits and work earnings in excess of 100 percent of indexed predisability earnings during the first 12 months immediately after a disabled employee’s return to work.

• Special Dismemberment Provision – If an employee suffers a lost as a result of an accident, the employee will be considered disabled for the applicable Minimum Benefit Period and can extend beyond the end of the Maximum Benefit Period

• Reasonable Accommodation Expense Benefit – Subject to The Standard’s prior approval, this benefit allows us to pay up to $25,000 of an employer’s expenses toward work-site modifications that result in a disabled employee’s return to work.

• Survivor Benefit – A Survivor Benefit may also be payable. This benefit can help to address a family’s financial need in the event of the employee’s death.

• Return to Work (RTW) Incentive – The Standard’s RTW Incentive is one of the most comprehensive in the employee benefits history. For the first 12 months after returning to work, the employee’s LTD benefit will not be reduced by work earnings until work earnings plus the LTD benefit exceed 100 percent of predisability earnings. After that period, only 50 percent of work earnings are deducted.

• Rehabilitation Plan Provision – Subject to The Standard’s prior approval, rehabilitation incentives may include training and education expense, family (child and elder) care expenses, and job-related and job search expenses.

When Benefits End

LTD benefits end automatically on the earliest of:

• The date you are no longer disabled

• The date your maximum benefit period ends

• The date you die

• The date benefits become payable under any other LTD plan under which you become insured through employment during a period of temporary recovery

• The date you fail to provide proof of continued disability and entitlement to benefits

Rates

Employees can select a monthly LTD benefit ranging from a minimum of $200 to a maximum amount based on how much they earn. Referencing the appropriate attached charts, follow these steps to find the monthly cost for your desired level of monthly LTD benefit and benefit waiting period:

1. Find the maximum LTD benefit by locating the amount of your earnings in either the Annual Earnings or Monthly Earnings column. The LTD benefit amount shown associated with these earnings is the maximum amount you can receive. If your earnings fall between two amounts, you must select the lower amount.

2. Select the desired monthly LTD benefit between the minimum of $200 and the determined maximum amount, making sure not to exceed the maximum for your earnings.

3. In the same row, select the desired benefit waiting period to see the monthly cost for that selection.

If you have questions regarding how to determine your monthly LTD benefit, the benefit waiting period, or the premium payment of your desired benefit, please contact your human resources representative.

Group Insurance Certificate

If you become insured, you will receive a group insurance certificate containing a detailed description of the insurance coverage. The information presented above is controlled by the group policy and does not modify it in any way. The controlling provisions are in the group policy issued by Standard Insurance Company.

If your gross annual salary is at least: You are eligible for a maximum monthly benefit of: 0/7 Elimination Period 14/14 Elimination Period 30/30 Elimination Period 60/60 Elimination Period 90/90 Elimination Period 180/180 Elimination Period $3,600 $200 $8.34 $5.68 $4.64 $2.96 $2.54 $1.88 $5,400 $300 $12.51 $8.52 $6.96 $4.44 $3.81 $2.82 $7,200 $400 $16.68 $11.36 $9.28 $5.92 $5.08 $3.76 $9,000 $500 $20.85 $14.20 $11.60 $7.40 $6.35 $4.70 $10,800 $600 $25.02 $17.04 $13.92 $8.88 $7.62 $5.64 $12,600 $700 $29.19 $19.88 $16.24 $10.36 $8.89 $6.58 $14,400 $800 $33.36 $22.72 $18.56 $11.84 $10.16 $7.52 $16,200 $900 $37.53 $25.56 $20.88 $13.32 $11.43 $8.46 $18,000 $1,000 $41.70 $28.40 $23.20 $14.80 $12.70 $9.40 $19,800 $1,100 $45.87 $31.24 $25.52 $16.28 $13.97 $10.34 $21,600 $1,200 $50.04 $34.08 $27.84 $17.76 $15.24 $11.28 $23,400 $1,300 $54.21 $36.92 $30.16 $19.24 $16.51 $12.22 $25,200 $1,400 $58.38 $39.76 $32.48 $20.72 $17.78 $13.16 $27,000 $1,500 $62.55 $42.60 $34.80 $22.20 $19.05 $14.10 $28,800 $1,600 $66.72 $45.44 $37.12 $23.68 $20.32 $15.04 $30,600 $1,700 $70.89 $48.28 $39.44 $25.16 $21.59 $15.98 $32,400 $1,800 $75.06 $51.12 $41.76 $26.64 $22.86 $16.92 $34,200 $1,900 $79.23 $53.96 $44.08 $28.12 $24.13 $17.86 $36,000 $2,000 $83.40 $56.80 $46.40 $29.60 $25.40 $18.80 $37,800 $2,100 $87.57 $59.64 $48.72 $31.08 $26.67 $19.74 $39,600 $2,200 $91.74 $62.48 $51.04 $32.56 $27.94 $20.68 $41,400 $2,300 $95.91 $65.32 $53.36 $34.04 $29.21 $21.62 $43,200 $2,400 $100.08 $68.16 $55.68 $35.52 $30.48 $22.56 $45,000 $2,500 $104.25 $71.00 $58.00 $37.00 $31.75 $23.50 $46,800 $2,600 $108.42 $73.84 $60.32 $38.48 $33.02 $24.44 $48,600 $2,700 $112.59 $76.68 $62.64 $39.96 $34.29 $25.38 $50,400 $2,800 $116.76 $79.52 $64.96 $41.44 $35.56 $26.32 $52,200 $2,900 $120.93 $82.36 $67.28 $42.92 $36.83 $27.26 $54,000 $3,000 $125.10 $85.20 $69.60 $44.40 $38.10 $28.20 $55,800 $3,100 $129.27 $88.04 $71.92 $45.88 $39.37 $29.14 $57,600 $3,200 $133.44 $90.88 $74.24 $47.36 $40.64 $30.08 $59,400 $3,300 $137.61 $93.72 $76.56 $48.84 $41.91 $31.02 $61,200 $3,400 $141.78 $96.56 $78.88 $50.32 $43.18 $31.96 $63,000 $3,500 $145.95 $99.40 $81.20 $51.80 $44.45 $32.90 $64,800 $3,600 $150.12 $102.24 $83.52 $53.28 $45.72 $33.84 $66,600 $3,700 $154.29 $105.08 $85.84 $54.76 $46.99 $34.78 $68,400 $3,800 $158.46 $107.92 $88.16 $56.24 $48.26 $35.72 $70,200 $3,900 $162.63 $110.76 $90.48 $57.72 $49.53 $36.66 $72,000 $4,000 $166.80 $113.60 $92.80 $59.20 $50.80 $37.60 28

Maximum Benefit Period: 5 Years for Sickness and To Age 65 for Accident

Maximum Benefit Period: 5 Years for Sickness and To Age 65 for Accident (Continued) If

gross annual salary is at least:

are eligible for a maximum monthly benefit of: 0/7 Elimination Period 14/14 Elimination Period 30/30 Elimination Period 60/60 Elimination Period 90/90 Elimination Period 180/180 Elimination Period $73,800 $4,100 $170.97 $116.44 $95.12 $60.68 $52.07 $38.54 $75,600 $4,200 $175.14 $119.28 $97.44 $62.16 $53.34 $39.48 $77,400 $4,300 $179.31 $122.12 $99.76 $63.64 $54.61 $40.42 $79,200 $4,400 $183.48 $124.96 $102.08 $65.12 $55.88 $41.36 $81,000 $4,500 $187.65 $127.80 $104.40 $66.60 $57.15 $42.30 $82,800 $4,600 $191.82 $130.64 $106.72 $68.08 $58.42 $43.24 $84,600 $4,700 $195.99 $133.48 $109.04 $69.56 $59.69 $44.18 $86,400 $4,800 $200.16 $136.32 $111.36 $71.04 $60.96 $45.12 $88,200 $4,900 $204.33 $139.16 $113.68 $72.52 $62.23 $46.06 $90,000 $5,000 $208.50 $142.00 $116.00 $74.00 $63.50 $47.00 $91,800 $5,100 $212.67 $144.84 $118.32 $75.48 $64.77 $47.94 $93,600 $5,200 $216.84 $147.68 $120.64 $76.96 $66.04 $48.88 $95,400 $5,300 $221.01 $150.52 $122.96 $78.44 $67.31 $49.82 $97,200 $5,400 $225.18 $153.36 $125.28 $79.92 $68.58 $50.76 $99,000 $5,500 $229.35 $156.20 $127.60 $81.40 $69.85 $51.70 $100,800 $5,600 $233.52 $159.04 $129.92 $82.88 $71.12 $52.64 $102,600 $5,700 $237.69 $161.88 $132.24 $84.36 $72.39 $53.58 $104,400 $5,800 $241.86 $164.72 $134.56 $85.84 $73.66 $54.52 $106,200 $5,900 $246.03 $167.56 $136.88 $87.32 $74.93 $55.46 $108,000 $6,000 $250.20 $170.40 $139.20 $88.80 $76.20 $56.40 $109,800 $6,100 $254.37 $173.24 $141.52 $90.28 $77.47 $57.34 $111,600 $6,200 $258.54 $176.08 $143.84 $91.76 $78.74 $58.28 $114,400 $6,300 $262.71 $178.92 $146.16 $93.24 $80.01 $59.22 $115,200 $6,400 $266.88 $181.76 $148.48 $94.72 $81.28 $60.16 $117,000 $6,500 $271.05 $184.60 $150.80 $96.20 $82.55 $61.10 $118,800 $6,600 $275.22 $187.44 $153.12 $97.68 $83.82 $62.04 $120,600 $6,700 $279.39 $190.28 $155.44 $99.16 $85.09 $62.98 $122,400 $6,800 $283.56 $193.12 $157.76 $100.64 $86.36 $63.92 $124,200 $6,900 $287.73 $195.96 $160.08 $102.12 $87.63 $64.86 $126,000 $7,000 $291.90 $198.80 $162.40 $103.60 $88.90 $65.80 $127,800 $7,100 $296.07 $201.64 $164.72 $105.08 $90.17 $66.74 $129,600 $7,200 $300.24 $204.48 $167.04 $106.56 $91.44 $67.68 $131,400 $7,300 $304.41 $207.32 $169.36 $108.04 $92.71 $68.62 $133,200 $7,400 $308.58 $210.16 $171.68 $109.52 $93.98 $69.56 $135,000 $7,500 $312.75 $213.00 $174.00 $111.00 $95.25 $70.50 $136,800 $7,600 $316.92 $215.84 $176.32 $112.48 $96.52 $71.44 $138,600 $7,700 $321.09 $218.68 $178.64 $113.96 $97.79 $72.38 $140,400 $7,800 $325.26 $221.52 $180.96 $115.44 $99.06 $73.32 $142,200 $7,900 $329.43 $224.36 $183.28 $116.92 $100.33 $74.26 $144,000 $8,000 $333.60 $227.20 $185.60 $118.40 $101.60 $75.20 29

your

You

Low Option

The Lincoln

DentalConnect® PPO

Plan:

 Covers many preventive and basic dental care services

 Features group rates for Eustace ISD employees

 Lets you choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a contracting dentist

 Does not make you and your loved ones wait six months between routine cleanings

Full-Time Employees of Eustace ISD Benefits At-A-Glance

Calendar (Annual)

Deductible

Contracting Dentists Non-Contracting Dentists

Individual: $50

Family: $150

Waived for: Preventive

Individual: $50

Family: $150

Waived for: Preventive

Annual Maximum $1,000 $1,000

Annual Maximums are combined for preventive and basic services.

Waiting Period

●0 months for basic services

If you had dental coverage through Eustace ISD’s previous group plan for 12 months or more and enroll in this plan when it is first offered, your benefit waiting period for this plan will be reduced accordingly.

This plan includes a waiting period if you do not enroll when it is first offered to you .

●12 months for basic services

The Lincoln National Life Insurance Company

Dental Insurance 30

Routine oral exams

Bitewing X-rays

Full-mouth or panoramic X-rays

Other dental X-rays - including periapical films

Problem focused exams

Consultations

Palliative treatment - including emergency relief of dental pain

Injections of antibiotics and other therapeutic medications

Fillings

Prefabricated stainless steel and resin crowns

Simple extractions

Biopsy and examination of oral tissue - including brush biopsy

Periodontal maintenance procedures

Contracting

To find a contracting dentist near you, visit www.LincolnFinancial.com/FindADentist.

This plan lets you choose any dentist you wish. However, your out-of-pocket costs are likely to be lower when you choose a contracting dentist. For example, if you need a crown…

…you pay a deductible (if applicable), then 100% of the remaining discounted fee for PPO members. This is known as a PPO contracted fee.

… you pay a deductible (if applicable), then 100% of the usual and customary fee, which is the maximum expense covered by the plan. You are responsible for the different between the usual and customary fee and the dentist’s billed charge.

DTL-ENRO-BRC001-TX Dental Insurance | At-A-Glance | Low Option

Contracting Dentists Non-Contracting Dentists

Preventive Services

Routine cleanings Fluoride treatments Space maintainers for children Sealants 100% No Deductible 100% No Deductible

Contracting Dentists Non-Contracting Dentists

Basic Services

80% After Deductible 80% After Deductible

Dentists/Non-Contracting Dentists Contracting Dentists Non-Contracting Dentists

Lincoln DentalConnect® Online Health Center

 Determine the average cost of a dental procedure

 Have your questions answered by a licensed dentist

 Find a dentist based on your home or workplace location (or even your primary language)

 Get directions to your dentist’s office

 Learn all about dental health for children, from baby’s first tooth to dental emergencies

 Take an in-depth look at dental health recommendations for seniors

 Evaluate your risk for oral cancer, periodontal disease, and tooth decay

 Check your claim status

 Print an ID card

 Switch between English and Spanish versions in just one click

Covered Family Members

When you choose coverage for yourself, you can also provide coverage for:

• Your spouse.

• Unmarried dependent children, up to age 26.

Benefit Exclusions

Like any insurance, this dental insurance plan does have some exclusions.

 The plan does not cover services started before coverage begins or after it ends. Benefits are limited to appropriate and necessary procedures listed in the policy, along with any procedures required by state law. Benefits are not payable for duplication of services. Covered expenses will not exceed the policy’s allowances.

 Plan benefits are not payable for a condition that is covered under Workers’ Compensation or a similar law; that occurs during the course of employment or military service or involvement in an illegal occupation, felony, or riot; or that results from a self-inflicted injury.

 In certain situations, there may be more than one method of treating a dental condition. This policy includes an alternative benefits provision that may reduce benefits to the lowest-cost, generally effective, and necessary form of treatment.

 Certain conditions, such as age and frequency limitations, may impact your coverage. See the plan policy for details.

A complete list of benefit exclusions is included in the policy. State variations apply.

This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater detail. Refer to your certificate for your maximum benefit amounts. Should there be a difference between this summary and the contract, the contract will govern.

Lincoln DentalConnect® health center Web content is provided by go2dental.com, Santa Clara, CA. Go2dental.com is not a Lincoln Financial Group® company. Coverage is subject to actual contract language. Each independent company is solely responsible for its own obligations.

Insurance products (policy series GL11) are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit business in New York, nor is it licensed to do so. Product availability and/or features may vary by state. Network access plans for specific states are located on LincolnFinancial.com under the Forms section. Limitations and exclusions apply.

Dental Premium

Here’s how little you pay with grouprates.

As an Eustace ISD employee, you can take advantage of this dental insurance plan for less than $1.00 a day. Plus, you can add loved ones to the plan for just a little more.

Your estimated cost is itemized below.

The Lincoln National Life Insurance Company

Please see prior page for product information.

Dental Insurance | Premium Calculation | Low Option

DTL-ENRO-BRC001-TX

Coverage Monthly Premium Employee only $29.94 Employee & spouse $59.98 Employee & child/children $58.56 Employee & family $89.90 33

Dental Insurance

High Option

The Lincoln

DentalConnect® PPO

Plan:

 Covers many preventive, basic, and major dental care services

 Also covers orthodontic treatment for children

 Features group rates for Eustace ISD employees

 Lets you choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a contracting dentist

 Does not make you and your loved ones wait six months between routine cleanings

Full-Time Employees of Eustace ISD Benefits At-A-Glance

Calendar (Annual)

Deductible

Contracting Dentists Non-Contracting Dentists

Individual: $50

Family: $150

Waived for: Preventive

Individual: $50

Family: $150

Waived for: Preventive

Deductibles are combined for basic and major Contracting Dentists’ services. Deductibles are combined for basic and major Non-Contracting Dentists’ services.

Annual Maximum $1,000 $1,000

MaxRewards® lets you and your covered family members roll a portion of unused dental benefits from one year into the next. So you have extra benefit dollars available when you need them most.

●Eligible Range (claim threshold): $500

●Rollover Amount: $250 per calendar year

●Rollover Amount with Preferred Provider: $250 per calendar year

●Maximum Rollover Account Balance: $1,000

Orthodontic Coverage is available for dependent children.

Waiting Period

●0 months for basic services

●0 months for major services

●0 months for orthodontic services

This plan includes a waiting period if you do not enroll when it is first offered to you .

●12 months for basic services

●12 months for major services

●12 months for orthodontic services

The Lincoln National Life Insurance Company

Lifetime Orthodontic

$1,000 $1,000

Max

Preventive Services

Routine oral exams

Bitewing X-rays

Full-mouth or panoramic X-rays

Other dental X-rays - including periapical films

Basic Services

Problem focused exams

Consultations

Palliative treatment - including emergency relief of dental pain

Injections of antibiotics and other therapeutic medications

Fillings

Prefabricated stainless steel and resin crowns

Simple extractions

Biopsy and examination of oral tissue - including brush biopsy

Major Services

Surgical extractions

Oral surgery

General anesthesia and I.V. sedation

Prosthetic repair and recementation services

Endodontics - including root canal treatment

Non-surgical periodontal therapy

Periodontal surgery

Bridges

Full and partial dentures

Denture reline and rebase services

Crowns, inlays, onlays and related services

Harmful habit appliances

Contracting Dentists/Non-Contracting Dentists

To find a contracting dentist near you, visit www.LincolnFinancial.com/FindADentist

This plan lets you choose any dentist you wish. However, your out-of-pocket costs are likely to be lower when you choose a contracting dentist. For example, if you need a crown…

…you pay a deductible (if applicable), then 50% of the remaining discounted fee for PPO members. This is known as a PPO contracted fee.

… you pay a deductible (if applicable), then 50% of the usual and customary fee, which is the maximum expense covered by the plan. You are responsible for the different between the usual and customary fee and the dentist’s billed charge.

DTL-ENRO-BRC001-TX Dental Insurance | At-A-Glance | High Option

Contracting Dentists Non-Contracting Dentists

Fluoride treatments Space

Sealants 100% No Deductible 100% No Deductible

Routine cleanings

maintainers for children

Contracting Dentists Non-Contracting Dentists

80% After Deductible 80% After Deductible

Contracting Dentists Non-Contracting Dentists

Periodontal maintenance procedures

50% After Deductible 50% After Deductible Orthodontics Contracting Dentists Non-Contracting Dentists Orthodontic

X-rays Extractions Study

Appliances 50% 50%

exams

models

Contracting Dentists Non-Contracting Dentists

Lincoln DentalConnect® Online Health Center

 Determine the average cost of a dental procedure

 Have your questions answered by a licensed dentist

 Find a dentist based on your home or workplace location (or even your primary language)

 Get directions to your dentist’s office

 Learn all about dental health for children, from baby’s first tooth to dental emergencies

 Take an in-depth look at dental health recommendations for seniors

 Evaluate your risk for oral cancer, periodontal disease, and tooth decay

 Check your claim status

 Print an ID card

 Switch between English and Spanish versions in just one click

Covered Family Members

When you choose coverage for yourself, you can also provide coverage for:

• Your spouse.

• Unmarried dependent children, up to age 26.

Benefit Exclusions

Like any insurance, this dental insurance plan does have some exclusions.

 The plan does not cover an orthodontia treatment plan started before coverage begins unless the member was receiving orthodontia benefits from the employer’s previous group dental policy. In this case, Lincoln Financial will continue orthodontia benefits until the combined benefit paid by both policies is equal to this policy’s lifetime orthodontia maximum. Plan benefits are not payable if the orthodontic appliance was installed after the age of 19.

 Certain conditions, such as age and frequency limitations, may impact your coverage. See the plan policy for details.

A complete list of benefit exclusions is included in the policy. State variations apply.

Dental Premium

Here’s how little you pay with grouprates.

As an Eustace ISD employee, you can take advantage of this dental insurance plan for less than $1.35 a day. Plus, you can add loved ones to the plan for just a little more.

Your estimated cost is itemized below.

The Lincoln National Life Insurance Company

Please see prior page for product information.

Dental Insurance | Premium Calculation | High Option

DTL-ENRO-BRC001-TX

Coverage Monthly Premium Employee only $40.48 Employee & spouse $81.10 Employee & child/children $79.16 Employee & family $121.60 37

Vision Plan Benefits for Eustace ISD

Co-Pays Monthly Premiums

Benefits through Superior Select Southwest Network

1Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive

standard retail lined trifocal, plus applicable co-pay

2 Contact lenses and related professional services (fitting, evaluation and follow-up) are covered in lieu of eyeglass lenses and frames benefit

Discount Features

Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.

The Plan discount features are not insurance.

All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan. Discounts are subject to change without notice.

Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions

Superior Vision of Texas P.O. Box 967 Rancho Cordova, CA 95741 800.507 3800 SuperiorVision.com 0417-BSv2/TX

Services/Frequency Exam $10 Emp. only $7.51 Exam 12 months Materials $25 Emp. + spouse $12.80 Frame 12 months Emp. + child(ren) $13.56 Lenses 12 months Emp. + family $20.33 Contact Lenses 12 months (Based on date of service)

In-Network Out-of-Network Exam Covered in full Up to $35 retail Frames $100 retail allowance Up to $55 retail Lenses (standard) per pair Single Vision Covered in full Up to $25 retail Bifocal Covered in full Up to $40 retail Trifocal Covered in full Up to $45 retail Progressive See description1 Up to $45 retail Lenticular Covered in full Up to $80 retail Contact Lenses2 $125 retail allowance Up to $65 retail Medically Necessary Contact Lenses Covered in full Up to $125 retail

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements

and

SuperiorVision.com Customer Service 800.507.3800 38

Who is eligible for this coverage?

What is the coverage amount?

Is it portable (can I keep it if I leave my employer)?

When is coverage effective?*

What does my AD&D insurance pay for?

Eustace Independent School District

Life and AD&D Insurance Plan Highlights

Policy Number 474649

All actively employed employees working at least 20 hours each week for your employer in the U.S.

Your employer is providing you with $20,000 of term life insurance. You will also receive $20,000 of Accidental Death and Dismemberment insurance

If you retire, reduce your hours or leave your employer, you can continue coverage at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy.

Please see your plan administrator for your effective date.

The full benefit amount is paid for loss of:

- Life

- Both hands or both feet or sight of both eyes

- One hand and one foot

- One hand and the sight of one eye

- Speech and hearing

Do my life insurance benefits decrease with age?

Coverage amounts will reduce according to the following schedule:

Age: Insurance amount reduces to: 70 50% of original amount

Coverage may not be increased after a reduction.

*Delayed effective date of coverage

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

The policy provisions may vary or not be available in all states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage, please refer to Policy Form C.FP-1 et al or contact your Unum representative.

Underwritten by Unum Life Insurance Company of America, Portland, Maine

EN-1771 (6-18) FOR EMPLOYEES

Who is eligible for this coverage?

What are the coverage amounts?

Eustace Independent School District

Voluntary Life and AD&D Insurance Plan Highlights

Policy Number 474650

All actively employed employees working at least 20 hours each week for your employer in the U.S. and their eligible spouses and children to age 26.

Employee: up to 5 times salary in increments of $10,000; not to exceed $500,000. Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $250,000

Child: up to 100% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $1,000.

What are the AD&D coverage amounts?

Employee: up to 5 times salary in increments of $10,000; not to exceed $500.000.

Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $250,000.

Child: up to 100% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $1,000.

Note: You may purchase AD&D coverage for yourself regardless of whether you purchase term life coverage. In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself.

Can I be denied coverage?

Current employees: If you and your eligible dependents are enrolled in the plan and wish to increase your life insurance coverage, you may apply on or before the enrollment deadline for any amount of additional coverage up to $150,000 for yourself and any amount of additional coverage up to $50,000 for your spouse. Any life insurance coverage over the guaranteed amount(s) will be subject to answers to health questions.

If you and your eligible dependents are not currently enrolled in the plan, you may apply for coverage on or before the enrollment deadline and will be required to answer health questions for any amount of coverage.

New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense.

How do I apply?

When is coverage effective?

Please see your plan administrator.

Please see your plan administrator for your effective date.

For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness, or disorder, your dependent spouse and children: are confined in a hospital or similar institution; or are confined at

How much does the coverage cost?

home under the care of a physician for a sickness or injury. Exception: Infants are insured from live birth.

Do my life insurance benefits decrease with age?

Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date.

Spouse rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date.

Coverage amounts will reduce according to the following schedule:

Age: Insurance amount reduces to: 70 50% of original amount

Coverage may not be increased after a reduction.

Is the coverage portable (can I keep it if I leave my employer)?

Are there any life insurance exclusions or limitations?

Will my premiums be waived if I’m disabled?

If you retire, reduce your hours or leave your employer, you can continue coverage for yourself your spouse and your dependent children at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy.

Life insurance benefits will not be paid for deaths caused by suicide within the first 24 months after the date your coverage becomes effective. If you increase or add coverage, these enhancements will not be paid for deaths caused by suicide within the first 24 months after you make these changes.

If you become disabled (as defined by your plan) and are no longer able to work, your life premium payments will be waived until your disability period ends.

Term life Age band Employee rate per $10,000 Spouse rate per $5,000 <25 $0.38 $0.19 25-29 $0.70 $0.35 30-34 $1.00 $0.50 35-39 $1.00 $0.50 40-44 $1.70 $0.85 45-49 $2.30 $1.15 50-54 $4.60 $2.30 55-59 $8.40 $4.20 60-64 $12.30 $6.15 65-69 $21.30 $10.65 70-74 $37.10 $18.55 75+ $145.60 $72.80 Child life monthly rate is $0.36 per $2,000. One life premium

AD&D rate chart AD&D cost Monthly Cost Employee Per $10,000 $0.20 Spouse Per $5,000 $0.10 Child Per $2,000 $0.16

covers all children.

What does my AD&D insurance pay for?

The full benefit amount is paid for loss of:

• life;

• both hands or both feet or sight of both eyes;

• one hand and one foot;

• one hand or one foot and the sight of one eye;

• speech and hearing.

Other losses may be covered as well. Please contact your plan administrator.

Are there any AD&D exclusions or limitations?

Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from:

• disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM);

• suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane;

• war, declared or undeclared, or any act of war;

• active participation in a riot;

• committing or attempting to commit a crime under state or federal law;

• the voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol;

• intoxication – “being intoxicated” means you or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.

When does my coverage end?

You and your dependents’ coverage under the Summary of Benefits ends on the earliest of:

• the date the policy or plan is cancelled;

• the date you no longer are in an eligible group;

• the date your eligible group is no longer covered;

• the last day of the period for which you made any required contributions;

• the last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness, as described in the certificate of coverage.

In addition, coverage for any one dependent will end on the earliest of:

• the date your coverage under a plan ends;

• the date your dependent ceases to be an eligible dependent;

• for a spouse, the date of a divorce or annulment;

• for dependent coverage, the date of your death.

Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.

Underwritten by Unum Life Insurance Company of America, Portland, Maine

EN-1773 (8-17) FOR EMPLOYEES

• the date your dependent ceases to be an eligible dependent;

• for a spouse, the date of a divorce or annulment;

• for dependent coverage, the date of your death.

Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.

Underwritten by Unum Life Insurance Company of America, Portland, Maine

EN-1773 (8-17) FOR EMPLOYEES

Life Insurance Highlights For the employee

Flexible Premium Life Insurance to Age 121 Policy Form PRFNG-NI-10

For the eligible employees of EUSTACE ISD

Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. This voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually cost more and decline in death benefit.

The policy, purelife-plus, is underwritten by Texas Life Insurance Company, and it has the following features:

• High Death Benefit. With one of the highest death benefits available at the worksite,1 purelife-plus gives your loved ones peace of mind.

• Minimal Cash Value. Designed to provide a high death benefit at a reasonable premium, purelife-plus provides peace of mind for you and your beneficiaries while freeing investment dollars to be directed toward such tax-favored retirement plans as 403(b), 457 and 401(k).

• Long Guarantees.2 Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time.3

• Refund of Premium. Unique in the marketplace, purelife-plus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.)

• Accelerated Death Benefit Due to Terminal Illness Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months, you will have the option to receive 92% of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.) (Form ICC07-ULABR-07 or Form Series ULABR-07)

You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, children and grandchildren by answering just 3 questions: 4

During the last six months, has the proposed insured:

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

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

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

Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details.

1 Voluntary Whole and Universal Life Products, Eastbridge Consulting Group, December 2015

2 Guarantees are subject to product terms, exclusions and limitations and the insurer’s claims-paying ability and financial strength.

3After the guaranteed period, premiums may go down, stay the same, or go up.

4Texas Life complies with all state laws regarding marriages, domestic and civil union partnerships, and legally recognized familial relationships. Accordingly, we will treat each party to a civil union or domestic partnership that is recognized and valid under applicable state law as a spouse. Coverage not available on children and grandchildren in Washington.

See the purelife-plus brochure for details.

purelife-plus

18M007-C 1006 (exp1219)

Texas Life is licensed to do business in the District of Columbia and every state but NewYork. purelife-plus is not available in NJ,NY or PA. 44

PureLife-plusispermanentlifeinsurancetoAttainedAge121 thatcanneverbecancelledaslongasyoupaythenecessarypremiums.Afterthe GuaranteedPeriod,thepremiumscanbelower,thesame,orhigherthantheTablePremium.Seethebrochureunder”PermanentCoverage”.

monthlypremiums

ExpressIssue GUARANTEED MonthlyPremiumsforLifeInsuranceFaceAmountsShown PERIOD AgetoWhich Issue Coverageis Age Guaranteedat (ALB) $10,000 $15,000 $25,000 $40,000 $50,000 $75,000 $100,000 $125,000 $150,000 TablePremium 15D-1 9.25 81 2-4 9.50 80 5-8 9.75 79 9-10 10.00 79 11-16 10.25 77 17-20 10.25 15.05 18.25 26.25 34.25 42.25 50.25 75 21-22 10.50 15.45 18.75 27.00 35.25 43.50 51.75 74 23 10.75 15.85 19.25 27.75 36.25 44.75 53.25 75 24-25 11.00 16.25 19.75 28.50 37.25 46.00 54.75 74 26 11.50 17.05 20.75 30.00 39.25 48.50 57.75 75 27-28 11.75 17.45 21.25 30.75 40.25 49.75 59.25 74 29 12.00 17.85 21.75 31.50 41.25 51.00 60.75 74 30-31 12.25 18.25 22.25 32.25 42.25 52.25 62.25 73 32 13.00 19.45 23.75 34.50 45.25 56.00 66.75 74 33 13.50 20.25 24.75 36.00 47.25 58.50 69.75 74 34 14.25 21.45 26.25 38.25 50.25 62.25 74.25 75 35 10.05 15.25 23.05 28.25 41.25 54.25 67.25 80.25 76 36 10.35 15.75 23.85 29.25 42.75 56.25 69.75 83.25 76 37 10.80 16.50 25.05 30.75 45.00 59.25 73.50 87.75 77 38 11.25 17.25 26.25 32.25 47.25 62.25 77.25 92.25 77 39 12.00 18.50 28.25 34.75 51.00 67.25 83.50 99.75 78 40 9.25 12.75 19.75 30.25 37.25 54.75 72.25 89.75 107.25 79 41 9.95 13.80 21.50 33.05 40.75 60.00 79.25 98.50 117.75 80 42 10.75 15.00 23.50 36.25 44.75 66.00 87.25 108.50 129.75 81 43 11.45 16.05 25.25 39.05 48.25 71.25 94.25 117.25 140.25 82 44 12.15 17.10 27.00 41.85 51.75 76.50 101.25 126.00 150.75 83 45 12.85 18.15 28.75 44.65 55.25 81.75 108.25 134.75 161.25 83 46 13.65 19.35 30.75 47.85 59.25 87.75 116.25 144.75 173.25 84 47 14.35 20.40 32.50 50.65 62.75 93.00 123.25 153.50 183.75 84 48 15.05 21.45 34.25 53.45 66.25 98.25 130.25 162.25 194.25 85 49 15.95 22.80 36.50 57.05 70.75 105.00 139.25 173.50 207.75 85 50 16.95 24.30 39.00 61.05 75.75 112.50 86 51 18.15 26.10 42.00 65.85 81.75 121.50 87 52 19.45 28.05 45.25 71.05 88.25 131.25 88 53 20.45 29.55 47.75 75.05 93.25 138.75 88 54 21.45 31.05 50.25 79.05 98.25 146.25 88 55 22.55 32.70 53.00 83.45 103.75 154.50 89 56 23.55 34.20 55.50 87.45 108.75 162.00 89 57 24.75 36.00 58.50 92.25 114.75 171.00 89 58 25.85 37.65 61.25 96.65 120.25 179.25 89 59 27.05 39.45 64.25 101.45 126.25 188.25 89 60 28.55 41.70 68.00 107.45 133.75 199.50 90 61 29.85 43.65 71.25 112.65 140.25 209.25 90 62 31.45 46.05 75.25 119.05 148.25 221.25 90 63 33.05 48.45 79.25 125.45 156.25 233.25 90 64 34.75 51.00 83.50 132.25 164.75 246.00 90 65 36.65 53.85 88.25 139.85 174.25 260.25 90 66 38.75 90 67 41.05 91 68 43.55 91 69 46.05 91 70 48.65 91

Non-Tobacco

PureLife-plus StandardRiskTablePremiums Non-Tobacco

Form:21M013-ICCEXP-A-M-1LO 45

Tobacco monthlypremiums

GUARANTEED MonthlyPremiumsforLifeInsuranceFaceAmountsShown PERIOD AgetoWhich Issue Coverageis Age Guaranteedat (ALB) $10,000 $15,000 $25,000 $40,000 $50,000 $75,000 $100,000 $125,000 $150,000 TablePremium 15D-1 81 2-4 80 5-8 79 9-10 79 11-16 77 17-20 15.25 23.05 28.25 41.25 54.25 67.25 80.25 71 21-22 16.00 24.25 29.75 43.50 57.25 71.00 84.75 71 23 16.75 25.45 31.25 45.75 60.25 74.75 89.25 72 24-25 17.25 26.25 32.25 47.25 62.25 77.25 92.25 71 26 17.75 27.05 33.25 48.75 64.25 79.75 95.25 72 27-28 18.25 27.85 34.25 50.25 66.25 82.25 98.25 71 29 18.50 28.25 34.75 51.00 67.25 83.50 99.75 71 30-31 21.00 32.25 39.75 58.50 77.25 96.00 114.75 72 32 21.75 33.45 41.25 60.75 80.25 99.75 119.25 72 33 22.00 33.85 41.75 61.50 81.25 101.00 120.75 72 34 22.25 34.25 42.25 62.25 82.25 102.25 122.25 71 35 15.30 24.00 37.05 45.75 67.50 89.25 111.00 132.75 72 36 15.75 24.75 38.25 47.25 69.75 92.25 114.75 137.25 72 37 16.80 26.50 41.05 50.75 75.00 99.25 123.50 147.75 73 38 17.25 27.25 42.25 52.25 77.25 102.25 127.25 152.25 73 39 18.45 29.25 45.45 56.25 83.25 110.25 137.25 164.25 74 40 14.15 20.10 32.00 49.85 61.75 91.50 121.25 151.00 180.75 76 41 15.05 21.45 34.25 53.45 66.25 98.25 130.25 162.25 194.25 77 42 16.15 23.10 37.00 57.85 71.75 106.50 141.25 176.00 210.75 78 43 17.55 25.20 40.50 63.45 78.75 117.00 155.25 193.50 231.75 80 44 18.25 26.25 42.25 66.25 82.25 122.25 162.25 202.25 242.25 80 45 19.25 27.75 44.75 70.25 87.25 129.75 172.25 214.75 257.25 81 46 20.05 28.95 46.75 73.45 91.25 135.75 180.25 224.75 269.25 81 47 21.05 30.45 49.25 77.45 96.25 143.25 190.25 237.25 284.25 82 48 21.95 31.80 51.50 81.05 100.75 150.00 199.25 248.50 297.75 82 49 23.25 33.75 54.75 86.25 107.25 159.75 212.25 264.75 317.25 83 50 24.35 35.40 57.50 90.65 112.75 168.00 83 51 25.45 37.05 60.25 95.05 118.25 176.25 83 52 27.05 39.45 64.25 101.45 126.25 188.25 84 53 28.45 41.55 67.75 107.05 133.25 198.75 85 54 29.75 43.50 71.00 112.25 139.75 208.50 85 55 31.15 45.60 74.50 117.85 146.75 219.00 85 56 32.75 48.00 78.50 124.25 154.75 231.00 85 57 34.35 50.40 82.50 130.65 162.75 243.00 86 58 36.05 52.95 86.75 137.45 171.25 255.75 86 59 37.75 55.50 91.00 144.25 179.75 268.50 86 60 39.55 58.20 95.50 151.45 188.75 282.00 86 61 41.85 61.65 101.25 160.65 200.25 299.25 86 62 44.05 64.95 106.75 169.45 211.25 315.75 87 63 46.25 68.25 112.25 178.25 222.25 332.25 87 64 48.45 71.55 117.75 187.05 233.25 348.75 87 65 50.85 75.15 123.75 196.65 245.25 366.75 87 66 53.45 88 67 56.25 88 68 59.15 88 69 62.25 88 70 65.55 89 PureLife-plusispermanentlifeinsurancetoAttainedAge121 thatcanneverbecancelledaslongasyoupaythenecessarypremiums.Afterthe GuaranteedPeriod,thepremiumscanbelower,thesame,orhigherthantheTablePremium.Seethebrochureunder”PermanentCoverage”. Form:21M013-ICCEXP-A-M-1LO 46

PureLife-plus StandardRiskTablePremiums Tobacco ExpressIssue

What is a Flexible Spending Account (FSA)? Help Make Medical Costs Painless. Visit fsa.nbsbenefits.com for more info or call one of our Benefit Specialists at 800-274-0503 Salt Lake City, UTHeadquarters Dallas, TX | San Diego, CA | Honolulu, HI 800-274-0503 fsa@nbsbenefits.com How Much Can I Save with an FSA? FSA No FSA Annual Taxable Income $24,000 $24,000 Health FSA $1,500 $0 Dependent Care FSA $1,500 $0 Total Pre-tax Contributions -$3,000 $0 Taxable Income after FSA $21,000 $24,000 Income Taxes -$6,300 -$7,200 After-tax Income $14,700 $16,800 After-tax Health and Welfare Expenses $0 -$3,000 Take-home Pay $14,700 $13,800 You Saved $900 $0

can save you up to 35% on income taxes!

deductions lower your taxable income which

employer before taxes are withheld. These

are deducted from your paycheck by your

dependent care expenses. Your contributions

on group insurance, healthcare expenses, and

A cafeteria plan enables you to save money

What is a Cafeteria Plan?

— whichever is right for you.

through a cafeteria plan. Choose one or both

Both are pre-tax benefits your employer offers

dependent care expenses.

as it is contributed and can only be used for

a health FSA. Money only becomes available

A dependent care FSA works differently than

throughout the plan year to fund your account.

Payroll deductions will then be made

plan year for eligible medical expenses.

amount will be available on day one of your

choosing an annual election amount. This

To take advantage of a health FSA, start by

Two Types of FSAs

Flexible Spending Account (FSA)

avoid forfeiting money at the end of the plan year.

Be conservative in the total amount you elect to

change, dependent change).

of status” (e.g. marriage, divorce, employment

only when you experience a qualifying “change

increase, decrease, or stop your contribution

After the enrollment period ends, you may

Enrollment Consideration

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What is a Dependent Care Assistance Program (DCAP)?

The Dependent Care Assistance Program (DCAP) allows you to use tax-free dollars to pay for child day care or elder day care expenses that you incur because you and your spouse are both gainfully employed.

To participate, determine the annual amount that you want to deduct from your paycheck before taxes. The maximum amount you can elect depends on your federal tax filing status ($5,000 if you are married and filing a joint return or if you are a single parent, $2,500 if you are married but filing separately).

Your annual amount will be divided by the number of pay periods in the plan year and that amount will be deducted from each paycheck.

Who is an eligible dependent?

You can use the DCAP for expenses incurred for:

• Your qualifying child who is age twelve or younger for whom you claim a dependency exemption on your income tax return.

• Your qualifying relative (e.g. a child over twelve, your parent, a spouse’s parent) who is physically or mentally incapable of caring for himself or herself and has the same principal place of abode as you for more than half of the year.

• Your spouse who is physically or mentally incapable of caring for himself or herself and has the same principal place of abode as you for more than half of the year.

Special Rule for Parents Who Are Divorced, Separated, or Living Apart

Only the custodial parent can claim expenses from the DCAP. The custodial parent is generally the parent with whom the child resides for the greater number of nights during the calendar year. Additionally, the custodial parent cannot be reimbursed from the DCAP for child-care expenses while the child lives with the non-custodial parent because such expenses are not incurred to enable the custodial parent to be gainfully employed.

What are eligible expenses for the DCAP?

The expenses which are eligible for reimbursement must have been incurred during the plan year and in connection with you and your spouse to remain gainfully employed.

Examples of eligible expenses:

• Before and After School and/or Extended Day Programs

• Daycare in your home or elsewhere so long as the dependent regularly spends at least 8 hours a day in your home.

• Base cost of day camps or similar programs.

Examples of ineligible expenses:

• Schooling for a child in kindergarten or above

• Babysitter while you go to the movies or out to eat

• Cost of overnight camps

What does it mean to be “gainfully employed”?

This means that you are working and earning an income (i.e. not doing volunteer work). You are not considered gainfully employed during paid vacation time or sick days. Gainful employment is determined on a daily basis.

If you are married, then your spouse would also need to be gainfully employed for your day care expenses to be eligible for reimbursement.

You are also considered gainfully employed if you are unemployed but actively looking for work, you are self-employed, you are physically or mentally not capable of self-care, or you are a full-time student (must attend for the number of hours that the school considers full-time, must have been a student for some part of each of 5 calendar months during the year, cannot be attending school only at night, does not include on-the-job training courses or correspondence schools).

What are some other important IRS regulations?

• You cannot be reimbursed for dependent care expenses that were paid to (1) one of your dependents, (2) your spouse, or (3) one of your children who is under the age of nineteen.

• In the event that you use a day care center that cares for more than six children, the center must be licensed.

• You must provide the day care provider’s Social Security Number/Tax Identification Number (EIN) on form 2441 when you file your taxes.

What are some other important IRS regulations?

The IRS allows you to take a tax credit for your dependent care expenses. The tax credit may provide you with a greater benefit than the DCAP if you are in a lower tax bracket. To determine whether the tax credit or the DCAP is best for you, you will need to review your individual tax circumstances. You cannot use the same expenses for both the tax credit and the DCAP, however, you may be able to coordinate the federal dependent care tax credit with participation in the DCAP for expenses not reimbursed through DCAP.

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