Group Cancer Insurance— Specified Disease Rider

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

Specified Diseases

•Adrenal Hypofunction (Addison’s Disease)

•Botulism

•Bubonic Plague

•Cerebral Palsy

•Cholera

•Cystic Fibrosis

•Diphtheria

•Encephalitis (including Encephalitis contracted from West Nile Virus)

•Huntington’s Chorea

•Legionnaires’ Disease

Rider Benefits

•Lou Gehrig’s Disease (Amyotrophic Lateral Sclerosis)

•Lyme Disease

•Malaria

•Meningitis (bacterial)

•Multiple Sclerosis

•Muscular Dystrophy

•Myasthenia Gravis

•Necrotizing Fasciitis

•Osteomyelitis

•Poliomyelitis

•Rabies

•Reye’s Syndrome

•Scleroderma

•Scarlet Fever

•Sickle Cell Anemia

•Systemic Lupus

•Tetanus

•Toxic Epidermal Necrolysis

•Toxic Shock Syndrome

•Tuberculosis (Mycobacterial)

•Tularemia

•Typhoid Fever

•Variant Creutzfeldt-Jakob Disease (Mad Cow Disease)

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

Rider Features

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

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

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

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

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

Benefit Waiting Period and Maximum Benefit Period

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

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

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

Options

1-6:

Maximum Benefit Period To Age 65 for Accident

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

First Day Hospital Benefit

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

Preexisting Condition Exclusion

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

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

Preexisting Condition Waiver

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

Own Occupation Period

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

Any Occupation Period

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

Other LTD Features

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

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

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

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

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

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

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

When Benefits End

LTD benefits end automatically on the earliest of:

• The date you are no longer disabled

• The date your maximum benefit period ends

• The date you die

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

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

Rates

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

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

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

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

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

Group Insurance Certificate

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

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

Low Option

The Lincoln

DentalConnect® PPO

Plan:

 Covers many preventive and basic dental care services

 Features group rates for Eustace ISD employees

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

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

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

Calendar (Annual)

Deductible

Contracting Dentists Non-Contracting Dentists

Individual: $50

Family: $150

Waived for: Preventive

Individual: $50

Family: $150

Waived for: Preventive

Annual Maximum $1,000 $1,000

Annual Maximums are combined for preventive and basic services.

Waiting Period

●0 months for basic services

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

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

●12 months for basic services

Routine oral exams

Bitewing X-rays

Full-mouth or panoramic X-rays

Other dental X-rays - including periapical films

Problem focused exams

Consultations

Palliative treatment - including emergency relief of dental pain

Injections of antibiotics and other therapeutic medications

Fillings

Prefabricated stainless steel and resin crowns

Simple extractions

Biopsy and examination of oral tissue - including brush biopsy

Periodontal maintenance procedures

Contracting

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

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

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

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

Lincoln DentalConnect® Online Health Center

 Determine the average cost of a dental procedure

 Have your questions answered by a licensed dentist

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

 Get directions to your dentist’s office

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

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

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

 Check your claim status

 Print an ID card

 Switch between English and Spanish versions in just one click

Covered Family Members

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

• Your spouse.

• Unmarried dependent children, up to age 26.

Benefit Exclusions

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

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

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

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

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

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

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

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

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

Dental Premium

Here’s how little you pay with grouprates.

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

Your estimated cost is itemized below.

The Lincoln National Life Insurance Company

Please see prior page for product information.

Dental Insurance

High Option

The Lincoln

DentalConnect® PPO

Plan:

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

 Also covers orthodontic treatment for children

 Features group rates for Eustace ISD employees

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

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

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

Calendar (Annual)

Deductible

Contracting Dentists Non-Contracting Dentists

Individual: $50

Family: $150

Waived for: Preventive

Individual: $50

Family: $150

Waived for: Preventive

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

Annual Maximum $1,000 $1,000

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

●Eligible Range (claim threshold): $500

●Rollover Amount: $250 per calendar year

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

●Maximum Rollover Account Balance: $1,000

Orthodontic Coverage is available for dependent children.

Waiting Period

●0 months for basic services

●0 months for major services

●0 months for orthodontic services

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

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

●12 months for basic services

●12 months for major services

●12 months for orthodontic services

Preventive Services

Routine oral exams

Bitewing X-rays

Full-mouth or panoramic X-rays

Other dental X-rays - including periapical films

Basic Services

Problem focused exams

Consultations

Palliative treatment - including emergency relief of dental pain

Injections of antibiotics and other therapeutic medications

Fillings

Prefabricated stainless steel and resin crowns

Simple extractions

Biopsy and examination of oral tissue - including brush biopsy

Major Services

Surgical extractions

Oral surgery

General anesthesia and I.V. sedation

Prosthetic repair and recementation services

Endodontics - including root canal treatment

Non-surgical periodontal therapy

Periodontal surgery

Bridges

Full and partial dentures

Denture reline and rebase services

Crowns, inlays, onlays and related services

Harmful habit appliances

Contracting Dentists/Non-Contracting Dentists

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

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

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

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

Lincoln DentalConnect® Online Health Center

 Determine the average cost of a dental procedure

 Have your questions answered by a licensed dentist

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

 Get directions to your dentist’s office

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

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

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

 Check your claim status

 Print an ID card

 Switch between English and Spanish versions in just one click

Covered Family Members

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

• Your spouse.

• Unmarried dependent children, up to age 26.

Benefit Exclusions

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

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

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

 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.

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

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

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

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

Dental Premium

Here’s how little you pay with grouprates.

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

Your estimated cost is itemized below.

The Lincoln National Life Insurance Company

Please see prior page for product information.