Eustace ISD Benefit Guide 2023-2024

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

Table of Content 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

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

2023 OPEN ENROLLMENT INFORMATION The 2023-2024 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 a summary 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.

5

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!

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 on 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.

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 6

FLYER_COMP_B2B

EMERGENCY TRANSPORTATION COSTS

HOW MASA IS DIFFERENT Across the US there are thousands of ground ambulance providers and hundreds of air ambulance carriers. ONLY MASA offers comprehensive coverage since MASA is a PAYER and not a PROVIDER!

MASA MTS is here to protect its members and their families from the shortcomings of health insurance coverage by providing them with comprehensive financial protection for lifesaving emergency transportation services, both at home and away fromhome.

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

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

The truth is, they DO NOT!

Members are covered ANYWHERE in all 50 states and Canada!

Even after insurance payments for emergency transportation, you could receive a bill up to $5,000 for ground ambulance and as high as $70,000 for air ambulance. The financial burdens for medical transportation costs are very real.

Any Ground. Any Air. Anywhere.™

OUR BENEFITS Benefit*

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.

Emergent Plus $14/mo.

Emergent Ground Transportation

U.S./Canada

Emergent Air Transportation

U.S./Canada

Non-Emergent Air Transportation

U.S./Canada

Repatriation

U.S./Canada

A MASA Membership prepares you for the unexpected and gives you the peace of mind to access vital emergency medical transportation no matter where you live, for a minimal monthly fee.

• One low fee for the entire family • NO deductibles • NO health questions • Easy claims process

For more information, pleasecontact Your Broker or MASA Representative 7 * Please refer to the MSA for a detailed explanation of benefits and eligibility,

EVERY FAMILY DESERVES A MASA MEMBERSHIP

Accident Insurance

8

Schedule of Benefits & Features • • • •

Unlimited lifetime maximum benefit with no age-related benefit reductions Benefits paid based on the schedule of benefits provided for each covered accident Waiver of Premium: Premium is waived following a 60-day period of disability due to a covered accident for as long as the covered person remains disabled.

Portability is included.

ACCIDENT PLAN BENEFITS

Custom Accident

Emergency and Initial Accident Treatment Benefits Ambulance Ground Air Water Emergency Room Treatment Urgent Care Major Diagnostic Imaging X-ray

$200.00 $600.00 $600.00 $200.00 $75.00 $200.00 $75.00

Hospital Benefits Hospital Admission Hospital Confinement Maximum per accident Intensive Care Admission ICU Confinement Maximum per accident Observation Unit

$1,000.00 $200.00 365 days $1,000.00 $200.00 365 days $100.00

Specific Injury Benefit Fractures Closed/Non-Surgical Treatment Skull (except Bones of Face or Nose) Depressed

$4,000.00

Hip, Thigh (Femur) Vertebrae, Body of (excluding Vertebral Process)

$4,000.00 $4,000.00

Pelvis Leg (Tibia and/or Fibula) Upper Arm (Humerus) Shoulder Blade Collarbone Upper Jaw, Maxilla (except Alveolar Process)

$4,000.00

$4,000.00 $3,000.00 $3,000.00 $3,000.00 $2,500.00

AI-2 MP0000822785 9

Lower Jaw, Mandible (except Alveolar Process)

$2,500.00

Vertebral Process Forearm (Ulna and/or Radius) Hand, Wrist (except Fingers) Kneecap Foot (except Toes) Ankle Rib Coccyx Finger, Toe Enhancement for Open/Surgical Reduction Chip Fractures Dislocations Closed/Non-Surgical Treatment Hip Knee (other than Kneecap) Shoulder Kneecap Ankle bone or bones of the foot Elbow Wrist Bone or bones of the hand Jawbone Collarbone One toe or finger Enhancement for Open/Surgical Reduction Partial Dislocations Lacerations No Repair Repair - up to 2 inches Repair - over 2 inches, up to 6 inches Repair - over 6 inches Burns 2nd Degree Burns At least 1%, but less than 20% of skin surface 20% or greater of skin surface 3rd Degree Burns Less than 5% of skin surface At least 5%, but less than 20% of skin surface 20% or greater of skin surface Skin Graft Due to Burns (% of applicable Burn benefit)

$1,600.00 $1,600.00 $1,600.00 $1,600.00 $1,600.00 $1,600.00 $300.00 $300.00 $300.00 2X 25%

10

$4,000.00 $2,250.00 $2,250.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $300.00 2X 25% $50.00 $50.00 $200.00 $400.00

$100.00 $500.00 $500.00 $5,000.00 $10,000.00 50%

Not due to Burns At least 1%, but less than 20% of skin surface 20% or greater of skin surface Concussion and Other Brain Injuries Dental Benefit Eye Injury Benefit

$100.00 $200.00 $300.00 $250.00 $200.00

Surgery Benefits Outpatient Surgery Benefit Facilities other than Physician Office or Emergency Room Physician Office or Emergency Room Internal Injuries Surgical Benefits Open Abdominal & Thoracic Hernia Exploratory without Repair Tendon/Ligament/Rotator Cuff Surgical Benefit Single Multiple Exploratory without Repair Torn Knee Cartilage Surgery Benefit Torn with Surgical Repair Exploratory without Repair Diagnosis only with no surgery or repair Ruptured Disc with Surgical Repair Anesthesia Benefit General Anesthesia Epidural or Regional Anesthesia

$300.00 $300.00 $2,000.00 $200.00 $150.00 $700.00 $1,050.00 $150.00 $600.00 $150.00 $100.00 $600.00 $200.00 $200.00

Medical Benefits Blood, Plasma & Platelets Benefit Prosthetic Device Benefit One only Two or more Appliances Pain Management Benefit

$500.00 $1,000.00 $2,000.00 $300.00 $200.00

Follow-Up Care and Transportation Benefits Physician Office Visit Maximum number of visits Therapy Services Benefit (Occupational, Physical, Speech Therapy) Maximum number of visits Rehabilitation Unit Confinement Maximum number of days

11

$75.00 4 $60.00 12 $200.00 90

Residence/Vehicle Modification Benefit Transportation (minimum of 100 miles from residence, up to 3 round trips) Lodging Maximum number of days

$1,000.00 $.60/mile $200.00 30

Accidental Death Benefits Accidental Death Employee Spouse Child(ren) Common Carrier Accidental Death Employee Spouse Child(ren) Organ Donor Benefit

$40,000.00 $20,000.00 $20,000.00 $200,000.00 $100,000.00 $100,000.00 $5,000.00

Accidental Dismemberment Benefits Dismemberment Loss of Both Hands, or Loss of Both Feet, or Loss of One Hand and One Foot Loss of One Hand or Loss of One Foot Partial Dismemberment Loss of One or More Fingers or Toes Partial Amputation of Finger or Toe

$40,000.00 $20,000.00 $600.00 $200.00

Catastrophic Benefits Catastrophic Loss Loss of Sight in both eyes or Hearing in both ears Loss of Speech or Sight in one eye or Hearing in one ear Coma Paralysis Paraplegia Quadriplegia

$20,000.00 $5,000.00 $20,000.00 $15,000.00 $30,000.00

Riders Health Screening Benefit Rider: Number of payments per year, per covered person.

$200.00 1

Monthly Rates Custom Accident

Employee Only

Employee & Spouse

Employee & Child(ren)

Family

$14.00

$24.00

$29.00

$39.00

12

EXCLUSIONS* In addition to any benefit-specific exclusion, benefits will not be paid for any loss which, directly or indirectly, in whole or in part, is caused by or results from any of the following unless coverage is specifically provided for by name in this Certificate: 1.

An injury incurred while working for pay or profit;

2.

Intentionally self-inflicted injury, suicide, or any attempt or threat while sane or insane;

3.

Participating in war or any act of war whether declared or undeclared;

4.

Commission or attempt to commit a felony;

5.

Commission of or active participation in a riot, insurrection, or terrorist activity;

6.

Engaging in an illegal activity or occupation;

7.

Flight in, boarding, or alighting from an aircraft or any craft designed to fly above the earth’s surface,including any travel beyond the earth’s atmosphere except a fare-paying passenger on a regularly scheduled commercial or charter airline;

8.

Practicing for or participating in any semi-professional or professional competitive athletic contest, including officiating or coaching, for which the covered person receives any compensation or remuneration;

9.

Sickness, except for any bacterial infection resulting from an accidental external cut or wound or accidental ingestion of contaminated food;

10.

Voluntary ingestion or inhalation of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a physician and taken in accordance with the prescribed dosage;

11.

Operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant including any prescribed drug for which the covered person has been provided a written warning against operating a vehicle while taking it. Under the influence of alcohol, for purposes of this exclusion, means intoxicated, as defined by the law of the State in which the covered accident occurred;

12.

Care that is not recommended and approved by a physician.

13

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?

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).

What are the Critical Illness coverage amounts?

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?

Coverage is guarantee issue.

When is coverage effective?

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

What critical illness conditions are covered?

Covered Conditions*

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.

Critical Illnesses Coronary Artery Disease (major) Coronary Artery Disease (minor) End Stage Renal (Kidney) Failure Heart Attack (Myocardial Infarction) Major Organ Failure Requiring Transplant Stroke Cancer Invasive Cancer (including all Breast Cancer) Non-Invasive Cancer Skin Cancer Supplemental Critical Illnesses Benign Brain Tumor Coma Loss of Hearing Loss of Sight Loss of Speech Infectious Disease Occupational Human Immunodeficiency Virus (HIV) or Hepatitis Permanent Paralysis

14

Percentage of Coverage Amount 50% 10% 100% 100% 100% 100% 100% 25% $500 100% 100% 100% 100% 100% 25% 100% 100%

Progressive Diseases Amyotrophic Lateral Sclerosis (ALS) Dementia (including Alzheimer’s Disease) Functional Loss Multiple Sclerosis (MS) Parkinson’s Disease

100% 100% 100% 100% 100%

Additional Critical Illnesses for your Children Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Down Syndrome 100% Spina Bifida 100% *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 Coma Coronary Artery Disease (Major) Coronary Artery Disease (Minor) End Stage Renal (Kidney) Failure Are wellness screenings covered?

Heart Attack (Myocardial Infarction) Invasive Cancer (includes all Breast Cancer) Major Organ Failure Requiring Transplant Non-Invasive Cancer 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: $10,000 $15,000 $20,000

The Be Well Benefit Amount for you, your spouse and your children is: $50 $50 $50

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.

15

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

Option 3 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 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.

Do my critical illness insurance benefits decrease with age?

Are there any exclusions or limitations?

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.

17

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.

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

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.

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.

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.

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.

18

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. © 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Underwritten by Unum Insurance Company, Portland, Maine AE-1226

FOR EMPLOYEES

19

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.

Group Cancer 1000 With Additional Benefits

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.

20

Treatment Benefits (In-or Outpatient)

This is a brief description of some available benefits.

Radiation/Chemotherapy 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 l l

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

Surgery Benefits

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

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 l

Pap Smear 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) l l

Transportation/Lodging Benefits l l

l Skilled Nursing Care Facility l

Group Cancer 1000 With Additional Benefits

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.)

Inpatient Benefits l Hospital and Hospital Intensive Care Unit

Confinement Ambulance l Private Full-Time Nursing Services l Attending Physician l

coloniallife.com

Lodging

Extended Care Benefits

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

Colonial Life 1200 Colonial Life Boulevard Columbia, South Carolina 29210

Transportation

l Transportation for Companion

ThinPrep is a registered trademark of Cytyc Corporation.

1

Level 2 with $2,000 Initial Diagnosis Benefit & Specified Disease

Level 4 with $2,000 Initial Diagnosis Benefit & Specified Disease

$13.50

$26.70

$22.45

$44.30

Employee

Family

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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.

Group Cancer 1000— Initial Diagnosis of Cancer Rider

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).

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.

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Colonial Life and Making benefits count are registered service marks of Colonial Life & Accident Insurance Company.

62614-3

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

• 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

Rider Benefits l

l

Group Cancer 1000— Specified Disease Rider

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.

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.

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).

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.

23 62613-3

Eustace Independent School District

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

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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: Option 1 2 3 4 5 6

Accidental Injury 0 days 14 days 30 days 60 days 90 days 180 days

Other Disability 7 days 14 days 30 days 60 days 90 days 180 days

Maximum Benefit Period 5 Years for Sickness & To Age 65 for Accident 5 Years for Sickness & To Age 65 for Accident 5 Years for Sickness & To Age 65 for Accident 5 Years for Sickness & To Age 65 for Accident 5 Years for Sickness & To Age 65 for Accident 5 Years for Sickness & To Age 65 for Accident

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: Age 62 63 64 65 66 67 68 69+

Maximum Benefit Period 3 years 6 months 3 years 2 years 6 months 2 years 1 year 9 months 1 year 6 months 1 year 3 months 1 year

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: Age 62 63 64 65 66 67 68 69+

Maximum Benefit Period 3 years 6 months 3 years 2 years 6 months 2 years 1 year 9 months 1 year 6 months 1 year 3 months 1 year

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.

25

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.

26

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.

27

Maximum Benefit Period: 5 Years for Sickness and To Age 65 for Accident 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 $5,400 $7,200 $9,000 $10,800 $12,600 $14,400 $16,200 $18,000 $19,800 $21,600 $23,400 $25,200 $27,000 $28,800 $30,600 $32,400 $34,200 $36,000 $37,800 $39,600 $41,400 $43,200 $45,000 $46,800 $48,600 $50,400 $52,200 $54,000 $55,800 $57,600 $59,400 $61,200 $63,000 $64,800 $66,600 $68,400 $70,200 $72,000

$200 $300 $400 $500 $600 $700 $800 $900 $1,000 $1,100 $1,200 $1,300 $1,400 $1,500 $1,600 $1,700 $1,800 $1,900 $2,000 $2,100 $2,200 $2,300 $2,400 $2,500 $2,600 $2,700 $2,800 $2,900 $3,000 $3,100 $3,200 $3,300 $3,400 $3,500 $3,600 $3,700 $3,800 $3,900 $4,000

$8.34 $12.51 $16.68 $20.85 $25.02 $29.19 $33.36 $37.53 $41.70 $45.87 $50.04 $54.21 $58.38 $62.55 $66.72 $70.89 $75.06 $79.23 $83.40 $87.57 $91.74 $95.91 $100.08 $104.25 $108.42 $112.59 $116.76 $120.93 $125.10 $129.27 $133.44 $137.61 $141.78 $145.95 $150.12 $154.29 $158.46 $162.63 $166.80

$5.68 $8.52 $11.36 $14.20 $17.04 $19.88 $22.72 $25.56 $28.40 $31.24 $34.08 $36.92 $39.76 $42.60 $45.44 $48.28 $51.12 $53.96 $56.80 $59.64 $62.48 $65.32 $68.16 $71.00 $73.84 $76.68 $79.52 $82.36 $85.20 $88.04 $90.88 $93.72 $96.56 $99.40 $102.24 $105.08 $107.92 $110.76 $113.60

$4.64 $6.96 $9.28 $11.60 $13.92 $16.24 $18.56 $20.88 $23.20 $25.52 $27.84 $30.16 $32.48 $34.80 $37.12 $39.44 $41.76 $44.08 $46.40 $48.72 $51.04 $53.36 $55.68 $58.00 $60.32 $62.64 $64.96 $67.28 $69.60 $71.92 $74.24 $76.56 $78.88 $81.20 $83.52 $85.84 $88.16 $90.48 $92.80

$2.96 $4.44 $5.92 $7.40 $8.88 $10.36 $11.84 $13.32 $14.80 $16.28 $17.76 $19.24 $20.72 $22.20 $23.68 $25.16 $26.64 $28.12 $29.60 $31.08 $32.56 $34.04 $35.52 $37.00 $38.48 $39.96 $41.44 $42.92 $44.40 $45.88 $47.36 $48.84 $50.32 $51.80 $53.28 $54.76 $56.24 $57.72 $59.20

$2.54 $3.81 $5.08 $6.35 $7.62 $8.89 $10.16 $11.43 $12.70 $13.97 $15.24 $16.51 $17.78 $19.05 $20.32 $21.59 $22.86 $24.13 $25.40 $26.67 $27.94 $29.21 $30.48 $31.75 $33.02 $34.29 $35.56 $36.83 $38.10 $39.37 $40.64 $41.91 $43.18 $44.45 $45.72 $46.99 $48.26 $49.53 $50.80

$1.88 $2.82 $3.76 $4.70 $5.64 $6.58 $7.52 $8.46 $9.40 $10.34 $11.28 $12.22 $13.16 $14.10 $15.04 $15.98 $16.92 $17.86 $18.80 $19.74 $20.68 $21.62 $22.56 $23.50 $24.44 $25.38 $26.32 $27.26 $28.20 $29.14 $30.08 $31.02 $31.96 $32.90 $33.84 $34.78 $35.72 $36.66 $37.60

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

$73,800 $75,600 $77,400 $79,200 $81,000 $82,800 $84,600 $86,400 $88,200 $90,000 $91,800 $93,600 $95,400 $97,200 $99,000 $100,800 $102,600 $104,400 $106,200 $108,000 $109,800 $111,600 $114,400 $115,200 $117,000 $118,800 $120,600 $122,400 $124,200 $126,000 $127,800 $129,600 $131,400 $133,200 $135,000 $136,800 $138,600 $140,400 $142,200 $144,000

$4,100 $4,200 $4,300 $4,400 $4,500 $4,600 $4,700 $4,800 $4,900 $5,000 $5,100 $5,200 $5,300 $5,400 $5,500 $5,600 $5,700 $5,800 $5,900 $6,000 $6,100 $6,200 $6,300 $6,400 $6,500 $6,600 $6,700 $6,800 $6,900 $7,000 $7,100 $7,200 $7,300 $7,400 $7,500 $7,600 $7,700 $7,800 $7,900 $8,000

$170.97 $175.14 $179.31 $183.48 $187.65 $191.82 $195.99 $200.16 $204.33 $208.50 $212.67 $216.84 $221.01 $225.18 $229.35 $233.52 $237.69 $241.86 $246.03 $250.20 $254.37 $258.54 $262.71 $266.88 $271.05 $275.22 $279.39 $283.56 $287.73 $291.90 $296.07 $300.24 $304.41 $308.58 $312.75 $316.92 $321.09 $325.26 $329.43 $333.60

$116.44 $119.28 $122.12 $124.96 $127.80 $130.64 $133.48 $136.32 $139.16 $142.00 $144.84 $147.68 $150.52 $153.36 $156.20 $159.04 $161.88 $164.72 $167.56 $170.40 $173.24 $176.08 $178.92 $181.76 $184.60 $187.44 $190.28 $193.12 $195.96 $198.80 $201.64 $204.48 $207.32 $210.16 $213.00 $215.84 $218.68 $221.52 $224.36 $227.20

$95.12 $97.44 $99.76 $102.08 $104.40 $106.72 $109.04 $111.36 $113.68 $116.00 $118.32 $120.64 $122.96 $125.28 $127.60 $129.92 $132.24 $134.56 $136.88 $139.20 $141.52 $143.84 $146.16 $148.48 $150.80 $153.12 $155.44 $157.76 $160.08 $162.40 $164.72 $167.04 $169.36 $171.68 $174.00 $176.32 $178.64 $180.96 $183.28 $185.60

$60.68 $62.16 $63.64 $65.12 $66.60 $68.08 $69.56 $71.04 $72.52 $74.00 $75.48 $76.96 $78.44 $79.92 $81.40 $82.88 $84.36 $85.84 $87.32 $88.80 $90.28 $91.76 $93.24 $94.72 $96.20 $97.68 $99.16 $100.64 $102.12 $103.60 $105.08 $106.56 $108.04 $109.52 $111.00 $112.48 $113.96 $115.44 $116.92 $118.40

$52.07 $53.34 $54.61 $55.88 $57.15 $58.42 $59.69 $60.96 $62.23 $63.50 $64.77 $66.04 $67.31 $68.58 $69.85 $71.12 $72.39 $73.66 $74.93 $76.20 $77.47 $78.74 $80.01 $81.28 $82.55 $83.82 $85.09 $86.36 $87.63 $88.90 $90.17 $91.44 $92.71 $93.98 $95.25 $96.52 $97.79 $99.06 $100.33 $101.60

$38.54 $39.48 $40.42 $41.36 $42.30 $43.24 $44.18 $45.12 $46.06 $47.00 $47.94 $48.88 $49.82 $50.76 $51.70 $52.64 $53.58 $54.52 $55.46 $56.40 $57.34 $58.28 $59.22 $60.16 $61.10 $62.04 $62.98 $63.92 $64.86 $65.80 $66.74 $67.68 $68.62 $69.56 $70.50 $71.44 $72.38 $73.32 $74.26 $75.20

29

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

Low Option The Lincoln DentalConnect® PPO Plan:  Covers many preventive and basic dental care services

Contracting Dentists

Non-Contracting Dentists

Calendar (Annual) Deductible

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.

 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

This plan includes a waiting period if you do not enroll when it is first offered to you . ●12 months for basic services

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

30

The Lincoln National Life Insurance Company

Preventive Services Routine oral exams Bitewing X-rays Full-mouth or panoramic X-rays Other dental X-rays - including periapical films Routine cleanings Fluoride treatments Space maintainers for children Sealants 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 Periodontal maintenance procedures 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…

Contracting Dentists

Non-Contracting Dentists

100% No Deductible

100% No Deductible

Contracting Dentists

Non-Contracting Dentists

80% After Deductible

80% After Deductible

Contracting Dentists

Non-Contracting Dentists

…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.

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

31

Lincoln DentalConnect® Online Health Center

Benefit Exclusions

 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

 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.

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

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

Covered Family Members When you choose coverage for yourself, you can also provide coverage for: • Your spouse.

• Unmarried dependent children, up to age 26.

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.

©2018 Lincoln National Corporation LCN-2012491-013118 R 1.0 – Group ID: EUSTACEISD

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

32

Dental Premium Here’s how little you pay with group rates.

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.

Coverage

Monthly Premium

Employee only

$29.94

Employee & spouse

$59.98

Employee & child/children

$58.56

Employee & family

$89.90

The Lincoln National Life Insurance Company Please see prior page for product information.

Dental Insurance | Premium Calculation | Low Option DTL-ENRO-BRC001-TX

33

Full-Time Employees of Eustace ISD Benefits At-A-Glance Dental Insurance Contracting Dentists

Non-Contracting Dentists

Individual: $50 Family: $150 Waived for: Preventive

Individual: $50 Family: $150 Waived for: Preventive

High Option

Calendar (Annual) Deductible

The Lincoln DentalConnect® PPO Plan:

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

 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

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 Lifetime Orthodontic Max

$1,000

$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 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.

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

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

34

The Lincoln National Life Insurance Company

Contracting Dentists

Non-Contracting Dentists

100% No Deductible

100% No Deductible

Contracting Dentists

Non-Contracting Dentists

80% After Deductible

80% After Deductible

Contracting Dentists

Non-Contracting Dentists

50% After Deductible

50% After Deductible

Orthodontics

Contracting Dentists

Non-Contracting Dentists

Orthodontic exams X-rays Extractions Study models Appliances

50%

Contracting Dentists/Non-Contracting Dentists

Contracting Dentists

Non-Contracting Dentists

…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.

Preventive Services Routine oral exams Bitewing X-rays Full-mouth or panoramic X-rays Other dental X-rays - including periapical films Routine cleanings Fluoride treatments Space maintainers for children Sealants 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 Periodontal maintenance procedures 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

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…

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

35

50%

Lincoln DentalConnect® Online Health Center

Benefit Exclusions

 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

 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.  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.  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.

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

Covered Family Members When you choose coverage for yourself, you can also provide coverage for: • Your spouse.

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

• Unmarried dependent children, up to age 26.

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.

©2018 Lincoln National Corporation LCN-2012491-013118 R 1.0 – Group ID: EUSTACEISD

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

36

Dental Premium Here’s how little you pay with group rates.

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.

Coverage

Monthly Premium

Employee only

$40.48

Employee & spouse

$81.10

Employee & child/children

$79.16

Employee & family

$121.60

The Lincoln National Life Insurance Company Please see prior page for product information.

Dental Insurance | Premium Calculation | High Option DTL-ENRO-BRC001-TX

37

Vision Plan Benefits for Eustace ISD Co-Pays

Exam Materials

$10 $25

Monthly Premiums Emp. only Emp. + spouse Emp. + child(ren) Emp. + family

Services/Frequency $7.51 $12.80 $13.56 $20.33

Exam Frame Lenses Contact Lenses

12 months 12 months 12 months 12 months

(Based on date of service)

Benefits through Superior Select Southwest Network Exam Frames Lenses (standard) per pair Single Vision Bifocal Trifocal Progressive Lenticular Contact Lenses2 Medically Necessary Contact Lenses

In-Network

Out-of-Network

Covered in full Covered in full Covered in full 1 See description Covered in full $125 retail allowance Covered in full

Up to $25 retail Up to $40 retail Up to $45 retail Up to $45 retail Up to $80 retail Up to $65 retail Up to $125 retail

Covered in full $100 retail allowance

Up to $35 retail Up to $55 retail

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1 Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 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 wh ich 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.

SuperiorVision.com Customer Service 800.507.3800

.

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

38

0417-BSv2/TX

Eustace Independent School District Life and AD&D Insurance Plan Highlights Policy Number 474649 Who is eligible for this coverage?

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

What is the coverage amount?

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

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

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.

When is coverage effective?*

Please see your plan administrator for your effective date.

What does my AD&D insurance pay for?

The full benefit amount is paid for loss of:

Do my life insurance benefits decrease with age?

Coverage amounts will reduce according to the following schedule:

-

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

Age: 70

Insurance amount reduces to: 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 © 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

EN-1771 (6-18)

FOR EMPLOYEES

39

Eustace Independent School District Voluntary Life and AD&D Insurance Plan Highlights Policy Number 474650 Who is eligible for this coverage?

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.

What are the 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.

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?

Please see your plan administrator.

When is coverage effective?

Please see your plan administrator for your effective date.

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.

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 40

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

How much does the coverage cost?

Term life Age band

Employee rate Spouse rate per $10,000 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 covers all children.

AD&D rate chart Employee Spouse Child

AD&D cost Per $10,000 Per $5,000 Per $2,000

Monthly Cost $0.20 $0.10 $0.16

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.

Do my life insurance benefits decrease with age?

Coverage amounts will reduce according to the following schedule: Age: 70

Insurance amount reduces to: 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)?

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.

Are there any life insurance exclusions or limitations?

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.

Will my premiums be waived if I’m disabled?

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.

41

What does my AD&D The full benefit amount is paid for loss of: insurance pay for?

• 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: • • • • • •

•

When does my coverage end?

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.

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.

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative. © 2017 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Underwritten by Unum Life Insurance Company of America, Portland, Maine EN-1773 (8-17) FOR EMPLOYEES 42

• • •

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.

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative. © 2017 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Underwritten by Unum Life Insurance Company of America, Portland, Maine EN-1773 (8-17) FOR EMPLOYEES

43

Life Insurance Highlights For the employee

purelife-plus

For the eligible employees of EUSTACE ISD

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

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.

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

4 Texas 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.

1

See the purelife-plus brochure for details.

18M007-C 1006 (exp1219)

Texas Life is licensed to do business in the District of Columbia and every state but New York.

44

purelife-plus is not available in NJ, NY or PA.

monthly p r e m i u m s PureLife-plus — Standard Risk Table Premiums — Non-Tobacco — Express Issue GUARANTEED

Monthly Premiums for Life Insurance Face Amounts Shown

PERIOD

Age

10.05 10.35 10.80 11.25 12.00 12.75 13.80 15.00 16.05 17.10 18.15 19.35 20.40 21.45 22.80 24.30 26.10 28.05 29.55 31.05 32.70 34.20 36.00 37.65 39.45 41.70 43.65 46.05 48.45 51.00 53.85

$25,000 9.25 9.50 9.75 10.00 10.25 10.25 10.50 10.75 11.00 11.50 11.75 12.00 12.25 13.00 13.50 14.25 15.25 15.75 16.50 17.25 18.50 19.75 21.50 23.50 25.25 27.00 28.75 30.75 32.50 34.25 36.50 39.00 42.00 45.25 47.75 50.25 53.00 55.50 58.50 61.25 64.25 68.00 71.25 75.25 79.25 83.50 88.25

Coverage is Guaranteed at

$40,000

$50,000

$75,000

$100,000

$125,000

$150,000

15.05 15.45 15.85 16.25 17.05 17.45 17.85 18.25 19.45 20.25 21.45 23.05 23.85 25.05 26.25 28.25 30.25 33.05 36.25 39.05 41.85 44.65 47.85 50.65 53.45 57.05 61.05 65.85 71.05 75.05 79.05 83.45 87.45 92.25 96.65 101.45 107.45 112.65 119.05 125.45 132.25 139.85

18.25 18.75 19.25 19.75 20.75 21.25 21.75 22.25 23.75 24.75 26.25 28.25 29.25 30.75 32.25 34.75 37.25 40.75 44.75 48.25 51.75 55.25 59.25 62.75 66.25 70.75 75.75 81.75 88.25 93.25 98.25 103.75 108.75 114.75 120.25 126.25 133.75 140.25 148.25 156.25 164.75 174.25

26.25 27.00 27.75 28.50 30.00 30.75 31.50 32.25 34.50 36.00 38.25 41.25 42.75 45.00 47.25 51.00 54.75 60.00 66.00 71.25 76.50 81.75 87.75 93.00 98.25 105.00 112.50 121.50 131.25 138.75 146.25 154.50 162.00 171.00 179.25 188.25 199.50 209.25 221.25 233.25 246.00 260.25

34.25 35.25 36.25 37.25 39.25 40.25 41.25 42.25 45.25 47.25 50.25 54.25 56.25 59.25 62.25 67.25 72.25 79.25 87.25 94.25 101.25 108.25 116.25 123.25 130.25 139.25

42.25 43.50 44.75 46.00 48.50 49.75 51.00 52.25 56.00 58.50 62.25 67.25 69.75 73.50 77.25 83.50 89.75 98.50 108.50 117.25 126.00 134.75 144.75 153.50 162.25 173.50

50.25 51.75 53.25 54.75 57.75 59.25 60.75 62.25 66.75 69.75 74.25 80.25 83.25 87.75 92.25 99.75 107.25 117.75 129.75 140.25 150.75 161.25 173.25 183.75 194.25 207.75

oba

9.25 9.95 10.75 11.45 12.15 12.85 13.65 14.35 15.05 15.95 16.95 18.15 19.45 20.45 21.45 22.55 23.55 24.75 25.85 27.05 28.55 29.85 31.45 33.05 34.75 36.65 38.75 41.05 43.55 46.05 48.65

$15,000

n-T

$10,000

No

(ALB) 15D-1 2-4 5-8 9-10 11-16 17-20 21-22 23 24-25 26 27-28 29 30-31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70

cco

Age to Which Issue

Table Premium 81 80 79 79 77 75 74 75 74 75 74 74 73 74 74 75 76 76 77 77 78 79 80 81 82 83 83 84 84 85 85 86 87 88 88 88 89 89 89 89 89 90 90 90 90 90 90 90 91 91 91 91

PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After the Guaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under ”Permanent Coverage”.

Form: 21M013-ICC EXP-A-M-1LO

45

monthly p r e m i u m s PureLife-plus — Standard Risk Table Premiums — Tobacco — Express Issue GUARANTEED

Monthly Premiums for Life Insurance Face Amounts Shown

PERIOD

Age to Which Issue

Coverage is

Age

Guaranteed at

14.15 15.05 16.15 17.55 18.25 19.25 20.05 21.05 21.95 23.25 24.35 25.45 27.05 28.45 29.75 31.15 32.75 34.35 36.05 37.75 39.55 41.85 44.05 46.25 48.45 50.85 53.45 56.25 59.15 62.25 65.55

$25,000

$40,000

$50,000

$75,000

$100,000

$125,000

$150,000

15.30 15.75 16.80 17.25 18.45 20.10 21.45 23.10 25.20 26.25 27.75 28.95 30.45 31.80 33.75 35.40 37.05 39.45 41.55 43.50 45.60 48.00 50.40 52.95 55.50 58.20 61.65 64.95 68.25 71.55 75.15

15.25 16.00 16.75 17.25 17.75 18.25 18.50 21.00 21.75 22.00 22.25 24.00 24.75 26.50 27.25 29.25 32.00 34.25 37.00 40.50 42.25 44.75 46.75 49.25 51.50 54.75 57.50 60.25 64.25 67.75 71.00 74.50 78.50 82.50 86.75 91.00 95.50 101.25 106.75 112.25 117.75 123.75

23.05 24.25 25.45 26.25 27.05 27.85 28.25 32.25 33.45 33.85 34.25 37.05 38.25 41.05 42.25 45.45 49.85 53.45 57.85 63.45 66.25 70.25 73.45 77.45 81.05 86.25 90.65 95.05 101.45 107.05 112.25 117.85 124.25 130.65 137.45 144.25 151.45 160.65 169.45 178.25 187.05 196.65

28.25 29.75 31.25 32.25 33.25 34.25 34.75 39.75 41.25 41.75 42.25 45.75 47.25 50.75 52.25 56.25 61.75 66.25 71.75 78.75 82.25 87.25 91.25 96.25 100.75 107.25 112.75 118.25 126.25 133.25 139.75 146.75 154.75 162.75 171.25 179.75 188.75 200.25 211.25 222.25 233.25 245.25

41.25 43.50 45.75 47.25 48.75 50.25 51.00 58.50 60.75 61.50 62.25 67.50 69.75 75.00 77.25 83.25 91.50 98.25 106.50 117.00 122.25 129.75 135.75 143.25 150.00 159.75 168.00 176.25 188.25 198.75 208.50 219.00 231.00 243.00 255.75 268.50 282.00 299.25 315.75 332.25 348.75 366.75

54.25 57.25 60.25 62.25 64.25 66.25 67.25 77.25 80.25 81.25 82.25 89.25 92.25 99.25 102.25 110.25 121.25 130.25 141.25 155.25 162.25 172.25 180.25 190.25 199.25 212.25

67.25 71.00 74.75 77.25 79.75 82.25 83.50 96.00 99.75 101.00 102.25 111.00 114.75 123.50 127.25 137.25 151.00 162.25 176.00 193.50 202.25 214.75 224.75 237.25 248.50 264.75

80.25 84.75 89.25 92.25 95.25 98.25 99.75 114.75 119.25 120.75 122.25 132.75 137.25 147.75 152.25 164.25 180.75 194.25 210.75 231.75 242.25 257.25 269.25 284.25 297.75 317.25

o

$15,000

acc

$10,000

Tob

(ALB) 15D-1 2-4 5-8 9-10 11-16 17-20 21-22 23 24-25 26 27-28 29 30-31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70

Table Premium 81 80 79 79 77 71 71 72 71 72 71 71 72 72 72 71 72 72 73 73 74 76 77 78 80 80 81 81 82 82 83 83 83 84 85 85 85 85 86 86 86 86 86 87 87 87 87 88 88 88 88 89

PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After the Guaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under ”Permanent Coverage”.

Form: 21M013-ICC EXP-A-M-1LO

46

No FSA

How Much Can I Save with an FSA? FSA $24,000

$0

$24,000

Annual Taxable Income

-$3,000 $24,000

$0

Total Pre-tax Contributions $21,000 -$7,200

$1,500

Taxable Income after FSA -$6,300

$16,800

Health FSA

Income Taxes $14,700

-$3,000

$0

After-tax Income $0

$13,800

$1,500

After-tax Health and Welfare Expenses

$14,700

$0

Dependent Care FSA

Take-home Pay

$900

You Saved

FSA Trifold, Print Version- FSAStore.indd 1

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, UT - Headquarters Dallas, TX | San Diego, CA | Honolulu, HI 800-274-0503 fsa@nbsbenefits.com

What is a Flexible Spending Account (FSA)?

9/5/2019 1:46:27 PM

47

Partial List of Eligible Expenses: Medical/Dental/Vision Copays and Deductibles Prescription Drugs Physical Therapy

How to Spend Spending is easy

Lab Fees

Our convenient NBS Smart Card allows you to avoid out-of-pocket expenses, cumbersome claim forms and reimbursement delays. You may also utilize the “pay a provider” option on our web portal.

Dental Work/Orthodontia

Account access is easy

Flexible Spending Account (FSA) Chiropractor

Two Types of FSAs

Eye Exams

First-Aid Supplies

To take advantage of a health FSA, start by choosing an annual election amount. This amount will be available on day one of your plan year for eligible medical expenses.

Laser Eye Surgery

Vaccinations

Psychiatrist/Psychologist

Payroll deductions will then be made throughout the plan year to fund your account.

Eyeglasses, Contact Lenses, Lens Solution Prescribed OTC Medication

Enrollment Consideration After the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying “change of status” (e.g. marriage, divorce, employment change, dependent change).

Be conservative in the total amount you elect to avoid forfeiting money at the end of the plan year.

Get $10 off using code NBS1819.

Shop FSA Store at fsastore.com/nbs

9/5/2019 1:46:32 PM

From baby care to pain relief, shop the largest selection of guaranteed FSA-eligible products with zero guesswork at FSA Store. Is your health need FSA-eligible? Find out using our comprehensive Eligibility List.

Life’s not always flexible, but your money can be.

Get account information from our easy-to-use online portal and mobile app. See your account balance, contributions and account history in real time.

A dependent care FSA works differently than a health FSA. Money only becomes available as it is contributed and can only be used for dependent care expenses.

Both are pre-tax benefits your employer offers through a cafeteria plan. Choose one or both — whichever is right for you.

What is a Cafeteria Plan?

A cafeteria plan enables you to save money on group insurance, healthcare expenses, and dependent care expenses. Your contributions are deducted from your paycheck by your employer before taxes are withheld. These deductions lower your taxable income which can save you up to 35% on income taxes!

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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.

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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

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

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Base cost of day camps or similar programs.

Examples of ineligible expenses: •

Schooling for a child in kindergarten or above

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Babysitter while you go to the movies or out to eat

•

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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?

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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.

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

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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.

For more information, please call

1(800) 274-0503

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

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