Belton ISD 2025-2026

2025-2026

INSPIRING DREAMS. EMPOWERING FUTURES

BELTON ISD BENEFITS YOUR HEALTH. YOUR FAMIL.Y. YOUR LIFE

09/1/2025-08/31/2026

District Contacts Dana Reed Employee Benefits Office Office: (254)215-2074 Fax: (254) 215-2038 Email: Dana.Reed@bisd.net Erica Ramos Employee Benefits Office Office: (254)215-2072 Fax: (254)215-2038 Email: Erica.Ramos@bisd.net Tanya Bane Employee Benefits Office Office: (254) 215-2019 Fax: (254) 215-2038 Email: Tanya.Bane@bisd.net

Table of Content Page Medical – TRS Activecare

9-23

Health Savings Account – HSABank

24 - 25 26 - 31

Disability – The Standard

32- 34 35

Texas Life - Permanent Life Basic (District Paid) Life -MetLife Voluntary Life - MetLife

36- 40

Cancer – Guardian/ Grandfathered Plan

41- 50

Accident - MetLife

51 - 52 53- 54 55 - 59 60 - 65

Critical Illness - MetLife Hospital Indemnity - MetLife Dental - MetLife (NEW)

66 - 67 68 69- 70

Vision – Vision Service Plan (VSP) Medical Transportation - MASA Section 125 Plan – TASC EAP – The Standard

71 - 72

Benefit Contacts Benefit

Phone

Website

TRS ACTIVECARE

1-866-355-5999 WWW. BCBSTX.COM/TRSACTIVECARE

HEALTH SAVING ACCT (HSABANK) THE STANDARD - DISABILITY TEXAS LIFE – PERMANENT LIFE METLIFE – BASIC & VOL LIFE

1-800-357-6246 WWW.HSABANK.COM 1-800-368-1135 WWW.STANDARD.COM 1-800-283-9233 WWW.TEXASLIFE.COM 1-800-638-5433 WWW.METLIFE.COM

CANCER – GUARDIAN

1-888-600-1600 WWW.GUARDIANANYTIME.COM

METLIFE – ACCIDENT METLIFE – CRITICAL ILLNESS

1-800-638-5433 WWW.METLIFE.COM 1-800-638-5433 WWW.METLIFE.COM

METLIFE – HOSPITAL INDEMNITY DENTAL – METLIFE (NEW) VSP – VISION MASA – MEDICAL TRANSPORT TASC – FLEXIBLE SPENDING ACCT THE STANDARD – EAP

1-800-638-5433 WWW.METLIFE.COM 1-800-638-5433WWW.METLIFE.COM 1-800-216-6248 WWW.VSP.COM 1-954-334-8261 WWW.MASAMTS.COM 1-800-422-4661 WWW.TASCONLINE.COM 1-888-293-6948 WWW.STANDARD.COM

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On the login page, you will enter your Last Name, Date of Birth, and Last Four (4) of Social Security Number.

THEbenefitsHUB checks behind the scenes to confirm employment status.

Once confirmed, the Additional Security Verification page will list the contact options from your profile.

Select either Text, Email, Call, or Ask Admin options to get a code to complete the final verification step.

Enter the code that you receive and click Verify.

You can now complete your benefits enrollment!

Please contact the benefit office for additional login support at 254-215-2074 or 254-215-2072

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INTRODUCTION

Enrollment FAQs à Äã & YÝ

ProvidŝŶŐ great beneĮt choices to you and your family is just ŽŶĞ ŽĨ ƚŚĞ ŵĂŶLJ ǁĂLJƐ /^ ůŽŽŬƐ ĂŌĞƌ ƚŚĞ ŚĞĂůƚŚ ĂŶĚ ĮŶĂŶcial welfare of the people who make our district work so well.

KƵƌ ŐŽĂů Ăƚ /^ ŝƐ ƚŽ ƉƌŽǀŝĚĞ LJŽƵ ǁŝƚŚ ĂŶ ĂƌƌĂLJ ŽĨ ďĞŶĞĮƚ ŽƉƟŽŶƐ ƚŚĂƚ ǁŝůů ŵĞĞƚ LJŽƵƌ ƉĞƌƐŽŶĂů ŶĞĞĚƐ ĂƐ ƉĂƌƚ ŽĨ LJŽƵƌ ƚŽƚĂů ĐŽŵƉĞŶƐĂƟŽŶ ĂŶĚ ƌĞǁĂƌĚƐ͘

HOW DO I ENROLL? Visit ǁǁǁ͘ŵLJďĞŶĞĮƚƐŚƵď͘ĐŽŵͬďĞůƚŽŶŝƐĚ  On the login page, you will enter your Last Name, Date of Birth, and Last Four (4) of Social Security Number then click Login  Select either Text, Email, Call, or Ask Admin options to get a code to complete the final verification step.  Enter the code, then click VERIFY YOU ARE NOW READY TO ENROLL IN YOUR BENEFITS.

WHO IS ELIGIBLE? • zŽƵ ĂƌĞ ĞůŝŐŝďůĞ ƚŽ ĞŶƌŽůů ŝŶ ƚŚĞ /^ ĞŶĞĮƚƐ WƌŽŐƌĂŵ ŝĨ LJŽƵ ĂƌĞ Ă ƌĞŐƵůĂƌ ĞŵƉůŽLJĞĞ ǁŽƌŬŝŶŐ Ăƚ ůĞĂƐƚ ϭϱ ŚŽƵƌƐ ƉĞƌ ǁĞĞŬ ŝŶ Ă ƉĞƌŵĂŶĞŶƚ ƉŽƐŝƟŽŶ͘ • ůů ŽƚŚĞƌ ĞŵƉůŽLJĞĞ͕ ƚŽ ŝŶĐůƵĚĞ ƐƵďƐƟƚƵƚĞƐ͕ ǁŚŽ ǁŽƌŬ ůĞƐƐ ƚŚĂŶ ϭϱ ŚŽƵƌƐ ƉĞƌ ǁĞĞŬ͕ ĂƌĞ ĞůŝŐŝďůĞ ƚŽ ĞŶƌŽůů ŝŶ ŵĞĚŝĐĂů insurance at full cost.

WHO IS AN ELIGIBLE DEPENDENT? • zŽƵƌ ůĞŐĂů ƐƉŽƵƐĞ • ŚŝůĚƌĞŶ ƵŶĚĞƌ ƚŚĞ ĂŐĞ ŽĨ Ϯϲ͕ LJŽƵƌƐ KZ LJŽƵƌ ƐƉŽƵƐĞ͛Ɛ • Dependent children of any age who are disabled • Children under your legal guardianship tŚĞŶ ĂĚĚŝŶŐ ĚĞƉĞŶĚĞŶƚƐ ĨŽƌ ƚŚĞ ĮƌƐƚ ƟŵĞ͕ ƉůĞĂƐĞ ƉƌŽǀŝĚĞ͕ ĚĂƚĞ ŽĨ ďŝƌƚŚ͕ ŐĞŶĚĞƌ ĂŶĚ ƐŽĐŝĂů ƐĞĐƵƌŝƚLJ ŶƵŵďĞƌ͘

NEW HIRE ENROLLMENT KŶůŝŶĞ ďĞŶĞĮƚ ĞŶƌŽůůŵĞŶƚ ŵƵƐƚ ďĞ ĐŽŵƉůĞƚĞĚ ǁŝƚŚŝŶ ϯϬ ĚĂLJƐ ŽĨ LJŽƵƌ ƐƚĂƌƚ ĚĂƚĞ͘ ůĞĐƚĞĚ ďĞŶĞĮƚƐ ǁŝůů ƚĂŬĞ ĞīĞĐƚ ŽŶ ƚŚĞ ϭƐƚ of the following month.

MID-YEAR CHANGES

dŚĞ ďĞŶĞĮƚƐ LJŽƵ ĐŚŽŽƐĞ ǁŝůů ƌĞŵĂŝŶ ŝŶ ĞīĞĐƚ ƚŚƌŽƵŐŚŽƵƚ ƚŚĞ ƉůĂŶ LJĞĂƌ ;ĨƌŽŵ ^ĞƉƚĞŵďĞƌ ϭ Ͳ ƵŐƵƐƚ ϯϭͿ͘ zŽƵ ŵĂLJ ŽŶůLJ ĂĚĚ or cancel coverage during the year if you have a qualifying change in the family or employment status that causes you to ŐĂŝŶ Žƌ ůŽƐĞ ĞůŝŐŝďŝůŝƚLJ ĨŽƌ ďĞŶĞĮƚƐ͘ YƵĂůŝĨLJŝŶŐ ĐŚĂŶŐĞƐ ŵĂLJ include: • ĐŚĂŶŐĞ ŝŶ LJŽƵƌ ůĞŐĂů ŵĂƌŝƚĂů ƐƚĂƚƵƐ • ĐŚĂŶŐĞ ŝŶ LJŽƵƌ ŶƵŵďĞƌ ŽĨ ĚĞƉĞŶĚĞŶƚƐ ĂƐ Ă ƌĞƐƵůƚ ŽĨ ďŝƌƚŚ͕ ĂĚŽƉƟŽŶ͕ ůĞŐĂů ĐƵƐƚŽĚLJ͕ Žƌ ŝĨ LJŽƵƌ ĚĞƉĞŶĚĞŶƚ ĐŚŝůĚ ƐĂƟƐĮĞƐ Žƌ ĐĞĂƐĞƐ ƚŽ ƐĂƟƐĨLJ ĞůŝŐŝďŝůŝƚLJ ƌĞƋƵŝƌĞŵĞŶƚƐ ĨŽƌ ĐŽǀĞƌĂŐĞ͕ Žƌ ƚŚĞ ĚĞĂƚŚ ŽĨ Ă ĚĞƉĞŶĚĞŶƚ ĐŚŝůĚ Žƌ ƐƉŽƵƐĞ • ĐŚĂŶŐĞ ŝŶ ĞŵƉůŽLJŵĞŶƚ ƐƚĂƚƵƐ ĨŽƌ LJŽƵ Žƌ LJŽƵƌ ƐƉŽƵƐĞ • Loss or gain of eligibility for other insurance (including ,/W Θ DĞĚŝĐĂŝĚͿ zŽƵ ŵƵƐƚ ŶŽƟĨLJ ƚŚĞ ĞůƚŽŶ /^ ĞŶĞĨŝƚ KĸĐĞ ŽĨ ƚŚĞ ƌĞƋƵĞƐƚĞĚ ĐŚĂŶŐĞ ǁŝƚŚŝŶ ϯϬ ĐĂůĞŶĚĂƌ ĚĂLJƐ ŽĨ ƚŚĞ ĐŚĂŶŐĞ ŝŶ ƐƚĂƚƵƐ͘ dŚĞƌĞ ĂƌĞ ŶŽ ĞdžĐĞƉƟŽŶƐ ƚŽ ƚŚŝƐ ƌƵůĞ͘

WHEN WILL I RECEIVE ID CARDS? KŶůLJ ŶĞǁ ĞŶƌŽůůĞĚ DĞĚŝĐĂů WůĂŶƐ ĂŶĚ ƉůĂŶ ĐŚĂŶŐĞ ǁŝůů ƌĞĐĞŝǀĞ ŶĞǁ ŵĞĚŝĐĂů ĐĂƌĚƐ͘ ŶƌŽůůĞĚ ƉĂƌƟĐŝƉĂŶƚ ǁŝůů ƌĞĐĞŝǀĞ ,^ ĂŶĚ &^ ĐĂƌĚƐ ƉƌŝŽƌ ƚŽ ƚŚĞ ĞīĞĐtiǀĞ ĚĂƚĞ ŽĨ ƚŚĞ ŶĞǁ ĐŽǀĞƌĂŐĞ͘ &Žƌ ŵŽƐƚ ƉůĂŶƐ͕ LJŽƵ ĐĂŶ ůŽŐŝŶ ƚŽ ƚŚĞ ĐĂƌƌŝĞƌ ǁĞďƐŝƚĞ ĂŶĚ ƉƌŝŶƚ Ă ƚĞŵƉŽrary ID card or give your provider the insurance company’s phone number to call and verify your coverage if you do not have an ID card at the time of service. VISION cards are NOT provided.

WHO DO I CONTACT WITH QUESTIONS? &Žƌ ƋƵĞƐƟŽŶƐ͕ LJŽƵ ĐĂŶ ĐŽŶƚĂĐƚ LJŽƵƌ /^ ĞŶĞĮƚƐ Department

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HELPFUL DEFINITIONS Annual Open Enrollment

In- and- Out of Network Coverage

The period once per year during which existing employees are given the opportunity to enroll in or change their current elections.

In-network doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider. Lowers charges and reduces out pocket expenses. Out of network charges a higher payment and higher out of pocket cost. Check your plan to ensure they provide out-of-network coverage.

Enrollment Plan Year September 1 – August 31

st

New Hire Eligibility You have 31 days from your new hire date to make your benefit elections.

Qualifying Event IRS guidelines allow you to make changes outside of Open Enrollment for the following defined reasons: Marriage/Divorce Birth or Adoption Death of spouse or covered dependent Change in your spouse’s work status that affects eligibility Medicare eligibility Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.

Co- Insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.

Co-Payment Specific dollar amount you must pay your provider per visit.

Balance Billing Occurs when providers bill a patient for the difference between the amount they charge and the amount that the patient’s insurance pays. This normally happens when using services out of network. If this happens please call your medical insurance provider to reconcile the charges.

Out- of- Pocket/Out- of- Pocket Maximum Out-of-Pocket: expenses you must pay for health related services that are above your monthly premium. Out-ofPocket Maximum: the most an eligible or insured person can pay in co-insurance for covered expenses per plan year.

High Deductible Plan Plan does not pay until deductible is met Pay less out of each paycheck Pay more out of pocket at doctor until deductible is met Higher Deductible Wellness visits 100% Same deductible for medical and prescription Enroll in HAS/Flexible Spending to help pay for out of pocket cost In and out of network coverage – with two separate deductibles HMO/PPO Plans Pay more out of paycheck Pay less at doctor Lower deductible Medical and prescription may have different deductibles Co-payments for office visits Must use a provider within the network Facility Fee A facility fee is a charge that you have to pay when you see a doctor at a clinic that is not owned by that doctor.

Facility fees are charged in addition to any other charges for the visit. Not all clinics or hospital charges a facility fee.

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TRS Active Care Monthly Premiums 2025-2026 Monthly Premium District Contribution Employee Cost TRS Active Care 1-HD $521.00 $111.00 $410.00 Employee Only $1,407.00 $997.00 Employee & Spouse $410.00 $886.00 $476.00 Employee & Child(ren) $410.00 $1,772.00 $1,362.00 Employee & Family $410.00 Active Care Primary + $598.00 $188.00 $410.00 Employee Only $1,555.00 $1,145.00 Employee & Spouse $410.00 $1,017.00 $607.00 $410.00 Employee & Child(ren) $1,974.00 $1,564.00 Employee & Family $410.00 Active Care 2 (Grandfather plan only) Employee Only $1,013.00 $410.00 $603.00 Employee & Spouse $2,402.00 $410.00 $1,992.00 Employee & Child(ren) $1,507.00 $410.00 $1,097.00 Employee & Family $2,841.00 $410.00 $2,431.00 Active Care Primary $509.00 $99.00 Employee Only $410.00 $1,375.00 $965.00 Employee & Spouse $410.00 $866.00 $456.00 Employee & Child(ren) $410.00 $1,731.00 $1,321.00 Employee & Family $410.00 9

2025-26 TRS-ActiveCare Plan Highlights Sept. 1, 2025 – Aug. 31, 2026 How to Calculate Your Monthly Premium

All TRS-ActiveCare participants have three plan options. Each includes a wide range of wellness benefts.

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

Total Monthly Premium Your Employer Contribution

TRS-ActiveCare Primary+

Plan Summary

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

Monthly Premiums

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

Total Premium Employee Only

$509

Employee and Spouse

$1,375

Employee and Children

$866

Employee and Family

$1,731

Employer Contribution

$410 $410 $410 $410

Your Premium

$99 $965 $456 $1,321

TRS-ActiveCare HD

• Lower deductible than the HD and Primary plans • Copays for many services and drugs • Higher premium • Statewide network • Primary Care Provider referrals required to see specialists • Not compatible with a Health Savings Account • No out-of-network coverage

Employer Contribution

Total Premium

Your Premium

$410 $410 $410 $410

$598 $1,555 $1,017 $1,974

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

$188 $1,145 $607 $1,564

TRS-ActiveCare 2

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

Employer Contribution

Total Premium

Your Premium

$111 $997 $476 $1,362

$410 $410 $410 $410

$521 $1,407 $886 $1,772

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

Employer Contribution

Total Premium

Your Premium

$603 $1,992 $1,097 $2,431

$410 $410 $410 $410

$1,013 $2,402 $1,507 $2,841

Plan Features Type of Coverage Individual/Family Deductible Coinsurance Individual/Family Maximum Out of Pocket

In-Network Coverage Only

In-Network

Out-of-Network

In-Network

$2,500/$5,000

$1,200/$2,400

$3,300/$6,600

$6,600/$13,200

$1,000/$3,000

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

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible

$8,050/$16,100

$6,900/$13,800

$8,300/$16,600

$20,500/$41,000

$7,900/$15,800

Statewide Network

Statewide Network

Nationwide Network

Nationwide Network

PCP Required

Yes

Yes

No

No

Primary Care

$30 copay

$15 copay

You pay 30% after deductible

You pay 50% after deductible

$30 copay

You pay 40% after deductible

Specialist

$70 copay

$70 copay

You pay 30% after deductible

You pay 50% after deductible

$70 copay

You pay 40% after deductible

Urgent Care

$50 copay

$50 copay

You pay 30% after deductible

You pay 50% after deductible

$50 copay

You pay 40% after deductible

Network

• Weight loss programs

In-Network Coverage Only

• Nutrition programs • OviaTM pregnancy support

Doctor Visits

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

See the benefts guide for more details.

Immediate Care Emergency Care

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay a $250 copay plus 20% after deductible

TRS Virtual Health-RediMDTM

$0 per medical consultation

$0 per medical consultation

$30 per medical consultation

$0 per medical consultation

TRS Virtual Health-Teladoc

$12 per medical consultation

$12 per medical consultation

$42 per medical consultation

$12 per medical consultation

Integrated with medical

$200 deductible per participant (brand drugs only)

Integrated with medical

$200 brand deductible

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

$15/$45 copay

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

$20/$45 copay

®

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

Prescription Drugs Drug Deductible Generics (31-Day Supply/90-Day Supply) Preferred (Max does not apply if brand is selected and generic is available)

You pay 30% after deductible

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

You pay 25% after deductible

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

Non-preferred

You pay 50% after deductible

You pay 50% after deductible

You pay 50% after deductible

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

Specialty (31-Day Max)

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

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

You pay 20% after deductible

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

Insulin Out-of-Pocket Costs

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

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

You pay 25% after deductible

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

10

Compare Prices for Common Medical Services

REMEMBER: Beneft

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

Reach them at 1-866-355-5999.

TRS-ActiveCare Primary

TRS-ActiveCare Primary+

In-Network Only

In-Network Only

Offce/Indpendent Lab: You pay $0

Offce/Indpendent Lab: You pay $0

TRS-ActiveCare HD In-Network

In-Network

Out-of-Network

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

Diagnostic Labs**

Out-of-Network

TRS-ActiveCare 2

You pay 50% after deductible

You pay 40% after deductible

Outpatient: You pay 30% after deductible

Outpatient: You pay 20% after deductible

High-Tech Radiology

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

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

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

Outpatient Costs

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

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

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

Inpatient Hospital Costs

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

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

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

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

Freestanding Emergency Room

You pay $500 copay + 30% after deductible

You pay $500 copay + 20% after deductible

You pay $500 copay + 30% after deductible

You pay $500 copay + 50% after deductible

You pay $500 copay + 20% after deductible

You pay $500 copay + 40% after deductible

Facility: You pay 30% after deductible

Facility: You pay 20% after deductible

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

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

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

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

Only covered if rendered at a BDC+ facility

Only covered if rendered at a BDC+ facility

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

You pay $70 copay

You pay $70 copay

You pay 30% after deductible

You pay 50% after deductible

You pay $70 copay

You pay 40% after deductible

Annual Hearing Exam (one per plan year)

$30 PCP copay $70 specialist copay

$15 PCP copay $70 specialist copay

You pay 30% after deductible

You pay 50% after deductible

$30 PCP copay $70 specialist copay

You pay 40% after deductible

Bariatric Surgery

Outpatient: You pay 20% after deductible

Not Covered

Not Covered

Only covered if rendered at a BDC+ facility

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

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

Not Covered

11

eCare

ctiv TRS-A

As a TRS-ActiveCare participant, your coverage includes TRS Virtual Health choices powered by Teladoc® and RediMDTM. You and your family can get convenient, quality health care from the comfort of home, on your lunch break, or while traveling without having to go to a doctor’s office.

Medical Virtual Visits With virtual medical visits through either Teladoc or RediMD, you and your covered family members** have access to licensed board-certified doctors, 24 hours a day, seven days a week.

You can also get prescriptions sent to your pharmacy if needed.

RediMD

Teladoc

TRS-ActiveCare Primary TRS-ActiveCare Primary+ TRS-ActiveCare 2

TRS-ActiveCare Primary TRS-ActiveCare Primary+ TRS-ActiveCare 2

$0*

$12*

TRS-ActiveCare HD

TRS-ActiveCare HD

$30*

$42*

Conditions treated include: • allergies

• cold

• flu

• skin issues

• asthma

• cough

• headaches

• sore throat

• back and shoulder strains

• contusions/bruises

• infections

• stomach problems

• blood pressure

• diabetes

• sinus infection

• stress

*$0 copay for participants and covered family members on the TRS-ActiveCare Primary, TRS-ActiveCare Primary+, and TRS-ActiveCare 2 plans through RediMD. For participants with TRS-ActiveCare HD, medical telehealth visits through RediMD apply to the deductible. Once the deductible is met, the plan pays 70% of the Medical Consult Fee of $30. Participant would pay 30% after deductible. $12 copay for participants and covered family members on the TRS-ActiveCare Primary, TRS-ActiveCare Primary+ and TRS-ActiveCare 2 plans through Teladoc. $42 medical consult fee for TRS-ActiveCare HD participants through Teladoc. Immediate family members who don’t have a TRS-ActiveCare health plan can also use TRS Virtual Health at a fixed rate. RediMD = $35/visit; Teladoc = $55/visit **If the patient is 17 or younger, a parent or guardian must be present during the virtual visit.

Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 12

DRAF T

Mental Health Virtual Visits Teladoc also offers confidential m ental h ealth s ervices f rom l icensed therapists, psychologists, psychiatrists, or certified d rug a nd a lcohol abuse counselors for adults 18 and older.

Mental health conditions treated include: • alcoholism, addiction, and substance-related disorders

• eating disorders

• attention disorders

• neurocognitive disorders and dementia

• bipolar, schizophrenia and psychotic disorders

• obsessive compulsive and related disorders

• depressive and anxiety disorders

• personality disorders

*$70 copay for participants and covered family members on the TRS-ActiveCare Primary, TRS-ActiveCare Primary+, and TRS-ActiveCare 2 plans. 30% coinsurance (after deductible) for TRS-ActiveCare HD participants, and depending on whether a consultation is with a psychiatrist, psychologist, or social worker, additional costs may be incurred. Visit www.bcbstx.com/trsactivecare/coverage for more detailed information.

Registering for Teladoc and RediMD is easy!

Visit www.teladoc.com/trsactivecare and follow the instructions to set up your account. You can also download the Teladoc app from the Apple App Store or Google Play Store or call 1-855-Teladoc (1-855-835-2362) for help from a customer service representative.

Visit www.redimd.com/trsactivecare and click Register. Enter code trsactivecare, click Next and follow directions to complete your profile. You can also register by calling RediMD customer service at 1-866-989-CURE (1-866-989-2873), option 3.

Virtual and telephonic visits are powered by exclusive software owned and operated by RediMD. It is important to verify and understand the terms and conditions of your benefit plan. Terms and conditions may apply based on plan design with limitations and exclusions. Virtual and telephonic services provided are not to be accepted as a health plan or act as a pharmacy distributor or prescription manager. RediMD reserves the sole right to deny care when it believes the risk of possible abuse is present. A virtual visit with RediMD does not provide assurances prescription orders will be issued. RediMD does not prescribe DEA-controlled substances, non-therapeutic drugs, or drugs that may harm or lead to abuse. RediMD operates in many different states and is subject to regulatory rules and jurisdictional limitations. Oversight and program management, including contracted providers, of the virtual medicine services provided are solely controlled

by RediMD. RediMD and the RediMD logo are registered trademarks of RediMD LLC and may not be used without written permission.

Teladoc and the Teladoc logo are trademarks of Teladoc, Inc. and may not be used without written permission.

Teladoc is being provided to TRS-ActiveCare members and members of plans administered by TRS-ActiveCare. Teladoc and Teladoc physicians are independent contractors and are neither agents nor employees of TRS-ActiveCare or plans administered by TRS-ActiveCare. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs, and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.

BCBSTX makes no endorsement, representations, or warranties regarding third-party vendors and the products and services offered by them. Blue Cross®, Blue Shield®, and the Cross and Shield Symbols are registered 13 service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans

756468.0622

Retrain Your Brain

See how much better life can feel with digital mental health programs from Learn to Live.1 More than half of people will struggle with a mental health concern at some point in their lives.2 But you can learn new skills to break old patterns that may be holding you back. Digital mental health programs from Learn to Live can help you get your mental health on track so you can feel better and enjoy life more.

Find out where you may need support An online assessment helps pinpoint the right programs to help with your concerns, such as:

a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

• social anxiety

• depression

• substance use

• insomnia

Learn to Live is included in your TRS-ActiveCare health plan at no added cost.

Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation,

• stress, anxiety and worry

14

Get a mental health tune-up — online Learn to adjust unhelpful thoughts and control your moods Explore quick and easy lessons whenever it fits your schedule. A little homework between sessions helps you keep up your progress. Activities are based on therapy techniques with a track record of helping people get better.

An expert coach can guide you If you need one-on-one support to reach your goals, connect with a coach by phone, text or email.

They’ll lift you up, cheer you on and help you master your new skills.

Your personal details are private Your personal results, program progress and messages with your coach are private. We won’t share these details with your employer.

To check out Learn to Live: 1. Log in to Blue Access for MembersSM at www.bcbstx.com/trsactivecare.

2. Click Wellness.

3. Choose Digital Mental Health.

If you have questions or need help registering for Learn to Live, call a Personal Health Guide at 1-866-355-5999.

1. Learn to Live provides educational behavioral health programs; members considering further medical treatment should consult with a physician.

2. https://www.cdc.gov/mentalhealth/learn/index.htm Learn to Live, Inc. is an independent company that provides online behavioral health programs and tools for members with coverage through Blue Cross and Blue Shield of Texas.

BCBSTX makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them.

15 758515.0322

e r a C e Activ

TRS-

We understand how hard it can be to maintain a healthy lifestyle. Sometimes, you may need a little motivation. That’s why your TRS-ActiveCare plan includes the Blue Points program.1 This program may help you get on track — and stay on track — to reach your wellness goals.

With the Blue Points program, you can earn points for regularly participating in many different healthy activities.

You can redeem your points in an online shopping mall, which offers a variety of merchandise, such as electronics and home goods.

Blue Points has many convenient and personalized features: EARN POINTS INSTANTLY

The program gives you points immediately, so you can start using them right away.2 GET EXTRA POINTS

Don’t have enough points yet for that reward you really want?

No problem! You can apply the points you have and use a credit card to pay the balance.

EASILY MANAGE YOUR POINTS

The Well onTarget portal at www.wellontarget.com lets you see all your points information in one place. It's easy to see how many points you can earn and how many you've earned year to date.

16

Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

CHOOSE FROM A LARGE SELECTION OF REWARDS

Redeem your points in an online shopping mall. Reward categories include apparel, books, health and personal care, jewelry, electronics, music, and sporting goods.3 PARTICIPATE IN ACTIVITIES THAT MATCH YOUR GOALS

Look how quickly your Blue Points can add up! Here are some sample activities you can complete to earn Blue Points:

ACTIVITIES

POTENTIAL BLUE POINTS AMOUNTS

Complete a health assessment4

2,500 points every six months

Complete a self-management program

1,000 points per quarter

Use trackers to see your progress toward goals

10 points, up to a maximum of 70 points per week

Enroll in the fitness program5

2,500 points

Add weekly fitness program center visits to your routine

Up to 300 points each week

Complete progress check ins

Up to 250 points per month

Connect a compatible fitness device or app to the portal

2,675 points

Track activity using a synced fitness device or app

55 points per day

Log in to www.wellontarget.com today to find the interactive tools and resources you need to start earning Blue Points. Keep yourself motivated to earn more points by heading over to the online shopping mall and checking out all the rewards you can earn for adopting — and continuing — healthy habits.

Blue Points Program Rules are subject to change without prior notice. See the Program Rules on the Well onTarget Member Wellness Portal at wellontarget.com for further information. The Well onTarget member rewards redemption service is provided by an independent third party.

2 This does not apply to points you earn for completing Fitness Program activities.

3 Member agrees to comply with all applicable federal, state and local laws, including making all disclosures and paying all taxes with respect to their receipt of any reward.

4 Well onTarget is a voluntary wellness program. Completion of the Health Assessment is not required for participation in the program.

5 The Fitness Program is provided by Tivity Health®, an independent contractor that administers the Prime Network of fitness centers.

The Prime Network is made up of independently owned and operated fitness centers.

1

Blue Cross and Blue Shield of Texas makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them.

759022.0522

17

E H T N I JO

Make Your Fitness Program Membership Work for You The Fitness Program has flexible options to help you live a healthy lifestyle.

As a TRS-ActiveCare participant, the Fitness Program is available to you and your covered dependents age 16 and older.* The program gives you access to a nationwide network of fitness locations.

Stay active from home with the virtual fitness program.

Get on-demand workout videos, live streams, nutrition and wellness guidance and more.

Other program perks include: • Flexible Gym Network: A choice of gym networks to fit your budget and preferences.** Base

Core

Power

Elite

Pro

Signature

Premier

$19/mo

$29/mo

$39/mo

$129/mo

$159/mo

$199/mo

$239/mo

3,000+ Classic Gyms†

7,500+ Classic Gyms

11,000+ Classic Gyms

Access to 1 Luxury Gym + All 11,000+ Classic Gyms (Luxury Gyms differ by tier, 100+ available)† $19 Enrollment fee

Digital content only: video and live stream ($10/mo)

• Studio Class Network: Boutique-style classes and specialty gyms with a pay-asyou-go option and 30% off every 10th class.

• Family Friendly: Get a bundled price discount when your covered dependents join.

• Convenient Payment: Pay your monthly fees with automatic credit card or bank account withdrawals. † Represents possible network locations. Check local listings for exact network options as some locations may not participate. Network locations are subject to change without notice.

18 Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Features

Are You Ready for Fitness?

• Mobile App: Search locations, register for classes, check in at the gym and see your activity history.

Check out the Well onTarget Fitness Program mobile app, available from Apple® or Google PlayTM. It can help you work on your fitness goals.

It’s easy to sign up:

• Real-Time Data: Provided to the mobile app and Well onTarget portal.

• Blue PointsSM : Get 2,500 points for joining the Fitness Program. Earn additional points for weekly visits.*** • Web Resources: Find fitness locations and track your visits.

• Digital Fitness: Digital access is included with all memberships and tiers.

• Complementary and Alternative Medicine Discounts on a Variety of Products and Services through Choices by WholeHealth Living: Save money through a nationwide network of 40,000 health and well-being providers, such as acupuncturists, massage therapists and personal trainers.

1. Go to www.bcbstx.com/trsactivecare and log in to Blue Access for MembersSM. 2. Select the My Health tab, then Wellness on the top navigation bar of the Dashboard page. Then scroll down to the Fitness Program section and click on Learn More.

3. Complete the registration form.

4. Verify your personal information and method of payment. Print or download your Fitness Program membership ID card. You may also ask us to mail your ID card.

5. Visit a fitness location today!

If you have questions or prefer to enroll over the phone, call 1-888-762-BLUE (2583) Monday through Friday, between 7 a.m. and 7 p.m., CT.

* Individuals must be 18 years old to purchase a membership. Dependents, 16-17 years old, can join but must be accompanied to the location by a parent/guardian who is also a Fitness Program member.

Check your preferred location to see their membership age policy. Underage dependents can log in and join through the primary member’s account as an “additional member.” **Taxes may apply. Individuals must be at least 18 years old to purchase a membership.

Blue Points Program Rules are subject to change without prior notice. See the Program Rules on the Well onTarget Member Wellness Portal for more information. ***Member agrees to comply with all applicable federal, state and local laws, including making all disclosures and paying all taxes with respect to their receipt of any reward.

The Fitness Program is provided by Tivity HealthTM, an independent contractor that administers the Prime Network of fitness locations. The Prime Network is made up of independently owned and operated fitness locations.

The WholeHealth Living Choices program is administered by Tivity Health™ Services, LLC. This is NOT insurance. Some of the services offered through this program may be covered by a health plan. The relationship between these vendors and Blue Cross and Blue Shield of Texas is that of independent contractors.

Participation in the Well onTarget program, including the completion of a Health Assessment, is voluntary and you are not required to participate. Visit Well onTarget for complete details and terms and conditions.

BCBSTX makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them.

Well onTarget is an informational resource provided to members and is not a substitute for the independent medical judgment of a health care provider. Members are instructed to consult with their health care provider before beginning their journey toward wellness.

768024.0125

19

Download the

BCBSTX App!

Stay connected with Blue Cross and Blue Shield of Texas (BCBSTX) so you can easily get to your TRS-ActiveCare health plan information, wherever you are.

Also available in Spanish • View and email your member ID card.

• Find an in-network doctor, hospital or urgent care facility.

• Access your claims, coverage and deductible information.

• Download and share your Explanation of Benefits.

• Get push notifications and access to the Message Center.

Text* BCBSTXAPP to 33633 to get the app. * Message and data rates may apply. Terms and conditions and privacy policy at bcbstx.com/mobile/text-messaging.

Questions?

Call a Personal Health Guide at 1-866-355-5999, anytime.

Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

20

753946.0820

Dental Employee Only

$36.60

Employee and Spouse

$74.02

Employee and Child(ren)

$68.02

Employee and Family

$114.56 Vision

Employee Only

$7.44

Employee + 1

$14.30

Employee and Child(ren)

$23.88

Employee and Family

$23.88 Accident

Employee Only

$13.47

Employee and Spouse

$19.38

Employee and Child(ren)

$27.37

Employee and Family

$34.23

Employee Only Employee and Spouse Employee and Children Employee and Family

Cancer Advantage Plan $26.40 $50.11 $32.07 $55.78

Premier Plan $45.03 $85.76 $53.87 $94.60

Disability (per $200 Monthly Benefit) 0/7

$5.24

14/14

$4.08

30/30

$3.00

60/60

$2.84

90/90

$2.28

180/180

$2.16

21

Voluntary Life (per $1,000 in coverage) Employee Age

Employee

Spouse

Under 30

$.066

$.086

30-34

$.095

$.114

35-39

$.099

$.129

40-44

$.127

$.200

45-49

$.198

$.286

50-54

$.304

$.429

55-59

$.475

$.858

60-64

$.792

$1.287

65-69

$1.584

$2.431

70 +

$2.719

$3.003

Children Voluntary Life (per $10,000) Age 0-18 $2.86 Emergency Transportation Employee and Family

Employee Only Employee and Spouse Employee and Child(ren) Employee and Family

$14 Hospital Indemnity Low Option $14.33 $27.17 $23.80 $36.64

High Option $22.93 $43.03 $37.65 $57.75

FSA Maximum Contribution Healthcare

$3,300.00

Dependent Care

$5,000.00

HSA Maximum Contribution Individual

$4,300.00

Family

$8,550.00

22

Critical Illness NON-TABACCO USE (per $1,000 in coverage) Employee Age

Employee

Employee and Spouse

Employee and Children

Employee and Family

<25

$0.62

$1.09

$1.01

$1.48

25-29

$0.62

$1.12

$1.01

$1.51

30-34

$0.78

$1.37

$1.17

$1.77

35-39

$0.99

$1.74

$1.38

$2.14

40-44

$1.39

$2.39

$1.78

$2.78

45-49

$1.83

$3.14

$2.23

$3.53

50-54

$2.38

$4.03

$2.78

$4.43

55-59

$2.96

$4.98

$3.35

$5.37

60-64

$3.61

$5.96

$4.00

$6.35

65-69

$4.09

$6.73

$4.48

$7.12

70+

$4.93

$8.10

$5.33

$8.49

Critical Illness TABACCO USE (per $1,000 in coverage) Employee Age

Employee

Employee and Spouse

Employee and Children

Employee and Family

<25

$0.83

$1.40

$1.22

$1.79

25-29

$0.83

$1.44

$1.22

$1.83

30-34

$1.09

$1.87

$1.48

$2.26

35-39

$1.45

$2.50

$1.85

$2.89

40-44

$2.13

$3.60

$2.52

$3.99

45-49

$2.89

$4.86

$3.28

$5.26

50-54

$3.81

$6.39

$4.21

$6.78

55-59

$4.79

$8.00

$5.19

$8.39

60-64

$5.90

$9.70

$6.29

$10.09

65-69

$6.76

$11.11

$7.16

$11.50

70+

$8.31

$13.61

$8.70

$14.01

23

Health Savings Accounts Maximize your savings

A Health Savings Account, or HSA, is a tax-advantaged savings account you can use for healthcare expenses. Along with saving you money on taxes, HSAs can help you grow your nest egg for retirement.

How an HSA works:

What’s covered?

• Contribute to your HSA by payroll deduction, online banking transfer or personal check.

You can use your HSA funds to pay for any IRS-qualified medical expenses, like doctor visits, hospital fees, prescriptions, dental exams, vision appointments, over-the-counter medications and more.

• P ay for qualified medical expenses for yourself, your spouse and your dependents. Both current and past expenses are covered if they’re from after you opened your HSA.

Visit hsabank.com/QME for a full list.

• U se your HSA Bank Health Benefits Debit Card to pay directly, or pay out of pocket for reimbursement or to grow your HSA funds.

Am I eligible for an HSA? You’re most likely eligible to open an HSA if:

• R oll over any unused funds year to year. It’s your money — for life.

• Y ou have a qualified high-deductible health plan (HDHP).

• Y ou’re not covered by any other non-HSA-compatible health plan, like Medicare Parts A and B.

• I nvest your HSA funds and potentially grow your savings.¹

• Y ou’re not covered by TriCare.

24

• N o one (other than your spouse) claims you as a dependent on their tax return.

How much can I contribute?

The IRS limits how much you can contribute to your HSA every year. This includes contributions from your employer, spouse, parents and anyone else.2

2024 - 2025

2025 - 2026 FAMILY PLAN

SINGLE PLAN Maximum contribution limit

$4,150

FAMILY PLAN

SINGLE PLAN

$8,300

Maximum contribution limit

$4,300

$8,550

Catch-up contributions You may be eligible to make a $1,000 HSA catch-up contribution if you’re: • O ver 55.

• A n HSA accountholder.

• N ot enrolled in Medicare (if you enroll mid-year, annual contributions are prorated).

Triple tax savings A huge way that HSAs can benefit you is they let you save on taxes in three ways.

1

You don’t pay federal taxes on contributions to your HSA.3

2

Earnings from interest and investments are tax-free.

3

Distributions are tax free when used for qualified medical expenses.

¹ Investment accounts are not FDIC insured, may lose value and are not a deposit or other obligation of, or guarantee by the bank. Investment losses which are replaced are subject to the annual contribution limits of the HSA. 2 HSA contributions in excess of IRS limits are subject to penalty and tax unless the excess and earnings are withdrawn prior to the tax filing deadline as explained in IRS Publication 969.

3 F ederal tax savings are available regardless of your state. State tax laws may vary. Consult a tax professional for more information.

Visit www.hsabank.com or call the number on the back of your debit card for more information. © 2022 HSA Bank. HSA Bank is a division of Webster Bank, N.A., Member FDIC. Plan Administrative Services and Benefit Services are administered by Webster Servicing LLC. HSA_Overview_050522

25

Educator Options Voluntary Long Term Disability Coverage Highlights – Texas Belton 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 Belton 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.

Eligibility To become insured, you must be: x A regular employee of Belton Independent School District, excluding temporary or seasonal employees, full-time members of the armed forces, leased employees or independent contractors x Actively at work at least 15 hours each week x 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: x Eligibility requirements x An eligibility waiting period of 0 days x An evidence of insurability requirement, if applicable x 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

26

Educator Options Voluntary Long Term Disability Coverage Highlights – Texas Belton Independent School District Benefit Waiting Period and Maximum Benefit Period The benefit waiting period is the period of time that you must be continuously disabled before benefits become payable. Benefits are not payable during the benefit waiting period. The maximum benefit period is the period for which benefits are payable. The benefit waiting period and maximum benefit period associated with your plan options are shown below: 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 3 Years for Sickness & To Age 65 for Accident 3 Years for Sickness & To Age 65 for Accident 3 Years for Sickness & To Age 65 for Accident 3 Years for Sickness & To Age 65 for Accident 3 Years for Sickness & To Age 65 for Accident 3 Years for Sickness & To Age 65 for Accident

Options 1-6: Maximum Benefit Period of 3 years for Sickness If you become disabled before age 64, LTD benefits may continue during disability for 3 years. If you become disabled at age 64 or older, the benefit duration is determined by your age when disability begins: Age 64 65 66 67 68

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

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

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 30 days of disability, The Standard will pay full benefits even if you have a preexisting condition. After 30 days, The Standard will continue benefits only if the preexisting condition exclusion does not apply.

27

Educator Options Voluntary Long Term Disability Coverage Highlights – Texas Belton Independent School District 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 x Employee Assistance Program (EAP) – This program offers support, guidance and resources that can help an employee resolve personal issues and meet life’s challenges. x 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. x 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 x 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. x 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. x 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. x 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: x The date you are no longer disabled x The date your maximum benefit period ends x The date you die x The date benefits become payable under any other LTD plan under which you become insured through employment during a period of temporary recovery x The date you fail to provide proof of continued disability and entitlement to benefits

28

Educator Options Voluntary Long Term Disability Coverage Highlights – Texas Belton Independent School District 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.

29

Educator Options Voluntary Long Term Disability Coverage Highlights – Texas Belton Independent School District If your gross annual salary is at least: $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

You are eligible for a maximum monthly benefit of: $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

0/7

14/14

30/30

60/60

90/90

180/180

Elimination Period

Elimination Period

Elimination Period

Elimination Period

Elimination Period

Elimination Period

$5.24 $7.86 $10.48 $13.10 $15.72 $18.34 $20.96 $23.58 $26.20 $28.82 $31.44 $34.06 $36.68 $39.30 $41.92 $44.54 $47.16 $49.78 $52.40 $55.02 $57.64 $60.26 $62.88 $65.50 $68.12 $70.74 $73.36 $75.98 $78.60 $81.22 $83.84 $86.46 $89.08 $91.70 $94.32 $96.94 $99.56 $102.18 $104.80

$4.08 $6.12 $8.16 $10.20 $12.24 $14.28 $16.32 $18.36 $20.40 $22.44 $24.48 $26.52 $28.56 $30.60 $32.64 $34.68 $36.72 $38.76 $40.80 $42.84 $44.88 $46.92 $48.96 $51.00 $53.04 $55.08 $57.12 $59.16 $61.20 $63.24 $65.28 $67.32 $69.36 $71.40 $73.44 $75.48 $77.52 $79.56 $81.60

$3.00 $4.50 $6.00 $7.50 $9.00 $10.50 $12.00 $13.50 $15.00 $16.50 $18.00 $19.50 $21.00 $22.50 $24.00 $25.50 $27.00 $28.50 $30.00 $31.50 $33.00 $34.50 $36.00 $37.50 $39.00 $40.50 $42.00 $43.50 $45.00 $46.50 $48.00 $49.50 $51.00 $52.50 $54.00 $55.50 $57.00 $58.50 $60.00

$2.84 $4.26 $5.68 $7.10 $8.52 $9.94 $11.36 $12.78 $14.20 $15.62 $17.04 $18.46 $19.88 $21.30 $22.72 $24.14 $25.56 $26.98 $28.40 $29.82 $31.24 $32.66 $34.08 $35.50 $36.92 $38.34 $39.76 $41.18 $42.60 $44.02 $45.44 $46.86 $48.28 $49.70 $51.12 $52.54 $53.96 $55.38 $56.80

$2.28 $3.42 $4.56 $5.70 $6.84 $7.98 $9.12 $10.26 $11.40 $12.54 $13.68 $14.82 $15.96 $17.10 $18.24 $19.38 $20.52 $21.66 $22.80 $23.94 $25.08 $26.22 $27.36 $28.50 $29.64 $30.78 $31.92 $33.06 $34.20 $35.34 $36.48 $37.62 $38.76 $39.90 $41.04 $42.18 $43.32 $44.46 $45.60

$2.16 $3.24 $4.32 $5.40 $6.48 $7.56 $8.64 $9.72 $10.80 $11.88 $12.96 $14.04 $15.12 $16.20 $17.28 $18.36 $19.44 $20.52 $21.60 $22.68 $23.76 $24.84 $25.92 $27.00 $28.08 $29.16 $30.24 $31.32 $32.40 $33.48 $34.56 $35.64 $36.72 $37.80 $38.88 $39.96 $41.04 $42.12 $43.20

30

Educator Options Voluntary Long Term Disability Coverage Highlights – Texas Belton Independent School District If your gross annual salary is at least: $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

You are eligible for a maximum monthly benefit of: $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

0/7 Eliminatio n Period

14/14 Eliminatio n Period

30/30 Eliminatio n Period

60/60 Eliminatio n Period

90/90 Eliminatio n Period

180/180 Eliminatio n Period

$107.42 $110.04 $112.66 $115.28 $117.90 $120.52 $123.14 $125.76 $128.38 $131.00 $133.62 $136.24 $138.86 $141.48 $144.10 $146.72 $149.34 $151.96 $154.58 $157.20 $159.82 $162.44 $165.06 $167.68 $170.30 $172.92 $175.54 $178.16 $180.78 $183.40 $186.02 $188.64 $191.26 $193.88 $196.50 $199.12 $201.74 $204.36 $206.98 $209.60

$83.64 $85.68 $87.72 $89.76 $91.80 $93.84 $95.88 $97.92 $99.96 $102.00 $104.04 $106.08 $108.12 $110.16 $112.20 $114.24 $116.28 $118.32 $120.36 $122.40 $124.44 $126.48 $128.52 $130.56 $132.60 $134.64 $136.68 $138.72 $140.76 $142.80 $144.84 $146.88 $148.92 $150.96 $153.00 $155.04 $157.08 $159.12 $161.16 $163.20

$61.50 $63.00 $64.50 $66.00 $67.50 $69.00 $70.50 $72.00 $73.50 $75.00 $76.50 $78.00 $79.50 $81.00 $82.50 $84.00 $85.50 $87.00 $88.50 $90.00 $91.50 $93.00 $94.50 $96.00 $97.50 $99.00 $100.50 $102.00 $103.50 $105.00 $106.50 $108.00 $109.50 $111.00 $112.50 $114.00 $115.50 $117.00 $118.50 $120.00

$58.22 $59.64 $61.06 $62.48 $63.90 $65.32 $66.74 $68.16 $69.58 $71.00 $72.42 $73.84 $75.26 $76.68 $78.10 $79.52 $80.94 $82.36 $83.78 $85.20 $86.62 $88.04 $89.46 $90.88 $92.30 $93.72 $95.14 $96.56 $97.98 $99.40 $100.82 $102.24 $103.66 $105.08 $106.50 $107.92 $109.34 $110.76 $112.18 $113.60

$46.74 $47.88 $49.02 $50.16 $51.30 $52.44 $53.58 $54.72 $55.86 $57.00 $58.14 $59.28 $60.42 $61.56 $62.70 $63.84 $64.98 $66.12 $67.26 $68.40 $69.54 $70.68 $71.82 $72.96 $74.10 $75.24 $76.38 $77.52 $78.66 $79.80 $80.94 $82.08 $83.22 $84.36 $85.50 $86.64 $87.78 $88.92 $90.06 $91.20

$44.28 $45.36 $46.44 $47.52 $48.60 $49.68 $50.76 $51.84 $52.92 $54.00 $55.08 $56.16 $57.24 $58.32 $59.40 $60.48 $61.56 $62.64 $63.72 $64.80 $65.88 $66.96 $68.04 $69.12 $70.20 $71.28 $72.36 $73.44 $74.52 $75.60 $76.68 $77.76 $78.84 $79.92 $81.00 $82.08 $83.16 $84.24 $85.32 $86.40

31

life insurance you can keep!

purelife-plus

Life insurance can be an ideal way to provide money for your family when they need it most. purelife-plus offers permanent insurance with a high death benefit and long guarantees1 that can provide financial peace of mind for you and your loved ones. purelife-plus is an ideal complement to any group term and optional term life insurance your employer might provide and has the following features:

You own it

You can take it with you when you change jobs or retire

You pay for it through convenient payroll deductions

You can cover your spouse, children and grandchildren, too2

You can get a living benefit if you become terminally ill3

It’s Affordable

3 QUICK QUESTIONS You can qualify by answering just 3 questions – no exams or needles.

DURING THE LAST SIX MONTHS, HAS THE PROPOSED INSURED: 1. Been actively at work on a full time basis, performing usual duties?

2. Been absent from work due to illness or medical treatment for a period of more than 5 consecutive working days?

3. 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, dialysis treatment, or treatment for alcohol or drug abuse?

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

2 Coverage not available on children in WA or on grandchildren in WA or MD. In MD, children must reside with the applicant to be eligible for coverage.

3 Conditions apply. Accelerated Death Benefit Due to Terminal Illness Rider Form ICC07-ULABR-07 or Form Series ULABR-07 PureLife-plus is a Flexible Premium Adjustable Life Insurance to Age 121. As with most life insurance products, Texas Life contracts and riders contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative or see the PureLife-plus brochure for costs and complete details. Contract form ICC18PRFNG-NI-18 or Form Series PRFNG-NI-18. Texas Life is licensed to do business in the District of Columbia and every state but New York.

21M058-C Generic 2001 (exp0523)

32

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

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

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

n-T o

$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

bac co

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

33

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

34

Supplemental Term Life Insurance Coverage Options For You

For Your Spouse

For Your Dependent Children*

Choice of $10,000 increments up to 5 times your Basic Annual Earnings or $500,000

Choice of $10,000 increments up to 100% of your Supplemental Life election or $100,000

$10,000

*Child(ren)’s Eligibility: Dependent children ages from birth to age 26 years old.

What’s Not Covered?

Like most insurance plans, this plan has exclusions. Supplemental and Dependent Life Insurance does not provide payment of benefits for death caused by suicide within the first two years (one year for group policies issued in Missouri, North Dakota and Colorado) of the effective date of the certificate or an increase in coverage. This exclusionary period is one year for residents of Missouri and North Dakota. If the group policy was issued in Massachusetts, the suicide exclusion does not apply to dependent life coverage. The suicide exclusion does not apply to residents of Washington, or to individuals covered under a group policy issued in Washington.

Please note that a reduction schedule may apply. Please see your employer or certificate for specific details.

Additional Coverage Information How to Apply* •

Complete your enrollment today! Be sure to indicate your Beneficiary

* All applications for coverage are subject to review and approval by MetLife. If you choose to apply for increased coverage, the increase may be subject to underwriting. MetLife will review your information and evaluate your request for coverage based upon your answers to the health questions, MetLife’s underwriting rules and other information you authorize us to review. In certain cases, MetLife may request additional information to evaluate your request for coverage.

For Employee Coverage Enrollment in this Supplemental Term Life insurance plan is available without providing medical information as long as: For Annual Enrollment •

The enrollment takes place prior to the enrollment deadline, and

•

You are continuing the coverage you had in the last year, or

•

You are requesting to increase existing coverage by two increments, and the total amount of coverage does not exceed 4 times your basic annual earnings or $200,000.

For New Hires •

The enrollment takes place within 31 days from the date you become eligible for benefits, and

•

You are enrolling for coverage equal to/less than 4 times your basic annual earnings or $200,000

If you do not meet all of the conditions stated above, you will need to provide additional medical information by completing a Statement of Health form.13

For Dependent Coverage† You must be covered in order to obtain coverage for your Spouse and child(ren).

Your Spouse and dependent children do not need to provide medical information as long as: For Annual Enrollment •

The enrollment takes place prior to the enrollment deadline, and

35

•

You are continuing the coverage you had for your Spouse and child(ren) in the last year

•

You are requesting to increase existing coverage for your Spouse by one increment, and the total amount of coverage does not exceed $50,000.

For New Hires •

The enrollment takes place within 31 days from the date you become eligible for benefits, and

•

You are enrolling for Spouse coverage equal to/less than $50,000.

If you do not meet all of the conditions stated above, you will need to provide additional medical information by completing a Statement of Health form. 13

About Your Coverage Effective Date You must be Actively at Work on the date your coverage becomes effective. Your coverage must be in effect in order for your Spouse and eligible children’s coverage to take effect. In addition, your Spouse and eligible child(ren) must not be home or hospital confined or receiving or applying to receive disability benefits from any source when their coverage becomes effective.

If Actively at Work requirements are met, coverage will become effective on the first of the month following the receipt of your completed application for all requests that do not require additional medical information. A request for your amount that requires additional medical information and is not approved by the date listed above will not be effective until the later of the date that notice is received that MetLife has approved the coverage or increase if you meet Actively at Work requirements on that date, or the date that Actively at Work requirements are met after MetLife has approved the coverage or increase. The coverage for your Spouse and eligible child(ren) will take effect on the date they are no longer confined, receiving or applying for disability benefits from any source or hospitalized.

Who Can Be A Designated Beneficiary?

You can select any beneficiary(ies) other than your employer for your Basic and Supplemental coverages, and you may change your beneficiary(ies) at any time. You can also designate more than one beneficiary. You are the beneficiary for your Dependent coverage.

Once Enrolled, You have Access to MetLife AdvantagesSM — Services to Help Navigate What Life May Bring Grief Counseling (all states except NY)1 To help you, your dependents, and your beneficiaries cope with loss You, your dependents, and your beneficiaries have access to grief counseling1 sessions and funeral related concierge services to help cope with a loss — at no extra cost. Grief counseling services provide confidential and professional support during a difficult time to help address personal and funeral planning needs. At your time of need, you and your dependents have 24/7 access to a work/life counselor. You simply call a dedicated 24/7 toll-free number to speak with a licensed professional experienced in helping individuals who have suffered a loss. Sessions can either take place in-person or by phone. You can have up to five face-to-face grief counseling sessions per event to discuss any situation you perceive as a major loss, including but not limited to death, bankruptcy, divorce, terminal illness, or losing a pet.1 In addition, you have access to funeral assistance for locating funeral homes and cemetery options, obtaining funeral cost estimates and comparisons, and more. You can access these services by calling 1-888-319-7819 or log on to www.metlifegc.lifeworks.com (Username: metlifeassist; Password: support).

Download this helpful Funeral Planning Guide at https://www.metlife.com/funeralplanning/funeral-guide/.

Funeral Discounts and Planning Services2 Ensuring your final wishes are honored As a MetLife group life policyholder, you and your family may have access to funeral discounts, planning and support to help honor a loved one’s life — at no additional cost to you. Dignity Memorial provides you and your loved ones access to discounts of up to 10% off of funeral, cremation and cemetery services through the largest network of funeral homes and cemeteries in the United States.

When using a Dignity Memorial Network you have access to convenient planning services — either online at www.finalwishesplanning.com, by phone (1-866-853-0954), or by paper — to help make final wishes easier to manage. You also have access to assistance from compassionate funeral planning experts to help guide you.

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Beneficiary Claim Assistance3 For support when beneficiaries need it most This program is designed to help beneficiaries sort through the details and serious questions about claims and financial needs during a difficult time. MetLife has arranged for specially trained third party financial professionals to be available for assistance in-person or by telephone to help with filing life insurance claims, government benefits and help with financial questions.

Life Settlement Account5 For immediate access to death proceeds The Total Control Account® (TCA) settlement option provides your loved ones with a safe and convenient way to manage the proceeds of a life claim payments of $5,000 or more, backed by the financial strength and claims paying ability of Metropolitan Life Insurance Company. TCA death claim payments relieve beneficiaries of the need to make immediate decisions about what to do with a lumpsum check and enable them to have the flexibility to access funds as needed while earning a guaranteed minimum interest rate on the proceeds as they assess their financial situations. Call 1-800-638-7283 for more information about options available to you.

Estate Planning Services8,11 To help ensure your decisions are carried out When you enroll for Supplemental term life coverage, you will automatically receive access to Estate Planning Services at no extra cost to you. Estate Planning Service offers unlimited access to complete wills and other important estate planning documents quickly and easily online with access to online notary services, or work one-on-one with a MetLife Legal Plans’ attorney, in-person or on the phone, to prepare or update a will, living will, or power of attorney.

Visit legalplans.com/estateplanning to get started.

Will Preparation8 To help ensure your decisions are carried out When you enroll for Supplemental term life coverage, you will automatically receive access to Will Preparation Services at no extra cost to you. Both you and your Spouse will have unlimited in-person or telephone access to one of MetLife Legal Plans, Inc nationwide network of 18,000+ participating attorneys for preparation of or updating a will, living will or power of attorney.* When you use a participating plan attorney, there will be no charge for the services.* Like life insurance, a carefully prepared will (simple or complex), living will and power of attorney are important.

• A will lets you define your most important decisions, such as who will care for your children or inherit your property.

• A living will ensures your wishes are carried out and protects your loved ones from having to make very difficult and personal medical decisions by themselves. Also called an “advanced directive,” it is a document authorized by statutes in all states that allows you to provide written instructions regarding use of extraordinary life-support measures and to appoint someone as your proxy or representative to make decisions on maintaining extraordinary life-support if you should become incapacitated and unable to communicate your wishes.

• Powers of attorney allow you to plan ahead by designating someone you know and trust to act on your behalf in the event of unexpected occurrences or if you become incapacitated Visit legalplans.com/estateplanning to get started. * You also have the flexibility of using an attorney who is not participating in the MetLife Legal Plans, Inc. network and being reimbursed for covered services according to a set fee schedule. In that case you will be responsible for any attorney’s fees that exceed the reimbursed amount.

Estate Resolution ServicesSM7 (ERS) Personal service and compassion assistance to help probate your and your spouse’s estates.

MetLife Estate Resolution ServicesSM provides probate services in person or over the phone to the representative (executor or administrator) of the deceased employee's estate and the estate of the employee's Spouse. Estate Resolution Services include preparation of documents and representation at court proceedings needed to transfer the probate assets from the estate to the heirs and completion of correspondence necessary to transfer non-probate assets. ERS covers participating plan attorneys’ fees for telephone and face-to-face consultations or for the administrator or executor to discuss general questions about the probate process.

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WillsCenter.com9 Self-service online legal document preparation Employees and spouses have access to WillsCenter.com, an online document service to prepare and update a will, living will, power of attorney, funeral directive, memorandum of wishes or HIPAA authorization form in a secure 24/7 environment at no additional cost.

This service is available with all life coverages. Log on to www.willscenter.com to register as a new user.

Portability So you can keep your coverage even if you leave your current employer Should you leave Belton ISD for any reason, and your Supplemental and Dependent Term Life insurance under this plan terminates, you will have an opportunity to continue group term coverage (“portability”) under a different policy, subject to plan design and state availability. Rates will be based on the experience of the ported group and MetLife will bill you directly. Rates may be higher than your current rates. To take advantage of this feature, you must have coverage of at least $10,000 up to a maximum of $500,000.

Portability is also available on coverage you’ve selected for your Spouse and dependent child(ren). The maximum amount of coverage for Spouses is $100,000; the maximum amount of dependent child coverage is $1-,000. Increases, decreases and maximums are subject to state availability.

Generally, there is no minimum time for you to be covered by the plan before you can take advantage of the portability feature. Please see your employer or certificate for specific details.

Please note that if you experience an event that makes you eligible for portable coverage, please call a MetLife representative at 1888-252-3607 or contact your employer for more information.

Accelerate Benefits Option10 For access to funds during a difficult time If you become terminally ill and are diagnosed with 24 months or less to live, you have the option to receive up to 80% of your life insurance proceeds. This can go a long way towards helping your family meet medical and other expenses at a difficult time. Amounts not accelerated will continue under your employer’s plan for as long as you remain eligible per the certificate requirements and the group policy remains in effect.

The accelerated life insurance benefits offered under your certificate are intended to qualify for favorable tax treatment under Section 101(g) of the Internal Revenue Code (26 U.S.C.Sec 101(g)).10 Accelerated Benefits Option is not the same as long term care insurance (LTC). LTC provides nursing home care, home-health care, personal or adult day care for individuals above age 65 or with chronic or disabling conditions that require constant supervision.

The Accelerated Benefits Option is also available to spouses insured under Dependent Life insurance plans. This option is not available for dependent child coverage.

Conversion For protection after your coverage terminates You can generally convert your group term life insurance benefits to an individual whole life insurance policy if your coverage terminates in whole or in part due to your retirement, termination of employment, or change in employee class. Conversion is available on all group life insurance coverages. Please note that conversion is not available on AD&D coverage. If you experience an event that makes you eligible to convert your coverage, please call 1-877-275-6387 to begin the conversion process. Please contact your employer for more information.

Waiver of Premiums for Total Disability (Continued Protection) Offering continued coverage when you need it most If you become Totally Disabled, you may qualify to continue certain insurance. You may also be eligible for waiver of your Supplemental and dependent term life insurance premium until you reach age 65, die, or recover from your disability, whichever is sooner.

Total Disability or Totally Disabled means you are unable to do your job and any other job for which you are fit by education, training or experience due to injury or sickness. The Total Disability must begin before age 60, and your waiver will begin after you have satisfied 38

a 9-month waiting period of continuous disability. The waiver of premium will end when you turn age 65, die, or recover. Please note that this benefit is only available after you have participated in the Supplementalterm life plan for 12 months and it is not available on dependent coverage. This 12 month requirement applies to new participants in the plan.

1- Grief Counseling services are provided through an agreement with LifeWorks US Inc. LifeWorks is not an affiliate of MetLife, and the services LifeWorks provides are separate and apart from the insurance provided by MetLife. LifeWorks has a nationwide network of over 30,000 counselors. Counselors have master’s or doctoral degrees and are licensed professionals. The Grief Counseling program does not provide support for issues such as: domestic issues, parenting issues, or marital/relationship issues (other than a finalized divorce). For such issues, members should inquire with their human resources department about available company resources. This program is available to insureds, their dependents and beneficiaries who have received a serious medical diagnosis or suffered a loss. Events that may result in a loss are not covered under this program unless and until such loss has occurred. Services are not available in all jurisdictions and are subject to regulatory approval. Not available on all policy forms.

2-Funeral Discounts Services and discounts are provided through a member of the Dignity Memorial® Network, a brand name used to identify a network of licensed funeral, cremation and cemetery providers that are affiliates of Service Corporation International (together with its affiliates, “SCI”), 1929 Allen Parkway, Houston, Texas. The online planning site is provided by SCI Shared Resources, LLC. SCI is not affiliated with MetLife, and the services provided by Dignity Memorial members are separate and apart from the insurance provided by MetLife. Not available in some states. Planning services, expert assistance, and bereavement travel services are available to anyone regardless of affiliation with MetLife. Discounts through Dignity Memorial’s network of funeral providers have been pre-negotiated. Not available where prohibited by law. The discount is available for services offered in any state except KY and NY, or where there is no Dignity Memorial presence (AK, MT, ND, SD, and WY). For MI and TN, the discount is available for “At Need” services only. For coverage issued under a multiple-employer trust, services are not available for WA residents.

3-Beneficiary Claim Assistance, Transition Solutions and Retirement Planning MetLife administers the PlanSmart program, and has arranged to have specially trained third party financial professionals to offer financial education. The financial professionals providing financial education are not affiliated with MetLife but are providing the program under a service provider contract.

Any content in this workshop or any other information provided as part of the PlanSmart program is for educational purposes only. It is not intended to provide legal, tax, investment, or financial advice or make any recommendation as to whether any investment or savings option is appropriate for you. Each individual’s legal, tax, and financial situation is unique; therefore, you should consult with your own attorney, accountant, financial professional or investment advisor regarding your specific circumstances.

MetLife does not provide legal, tax, or investment recommendations or advice.

Third-party financial professionals provide securities and investment advisory services offered through qualified registered representatives of MML Investors Services, LLC. Member SIPC. www.SIPC.org. 6 Corporate Drive, Shelton, CT 06484, Tel: 203-513-6000. MMLIS is not affiliated with MetLife Consumer Services or any of its affiliates.

5-Life Settlement Account.Subject to state law, and/or group policyholder direction, the Total Control Account is provided for all Life and AD&D benefits of $5,000 or more. The assets backing the Total Control Account (TCA) are maintained in the general account of MetLife or the Issuing Insurance Company. These general accounts are subject to the creditors of MetLife or the respective Issuing Insurance Company. MetLife or the Issuing Insurance Company bears the investment experience of such assets and expects to earn income sufficient to pay interest to TCA Accountholders and to make a profit on the operation of the TCAs. Regardless of the investment experience of such assets, the effective annual rate on the Account will not be less than the rate guaranteed on the welcome guide. The TCA and other available settlement options are not bank products and are not insured by the FDIC or any other governmental agency. In addition, while the funds in your account are not insured by the FDIC, they are guaranteed by each state’s insurance guarantee association. The coverage limits vary by state. Please contact the National Organization of Life and Health Insurance Guaranty Associations (www.NOLHGA.com or 703-481-5206) to learn more. FOR FURTHER INFORMATION, PLEASE CONTACT YOUR STATE DEPARTMENT OF INSURANCE. 7- MetLife Estate Resolution Services are offered by MetLife Legal Plans, Inc. Cleveland, Ohio. In certain states, legal services benefits are provided through insurance coverage underwritten by Metropolitan General Insurance Company , Warwick, Rhode Island. Certain services are not covered by Estate Resolution Services, including matters in which there is a conflict of interest between the executor and any beneficiary or heir and the estate; any disputes with the group policyholder, MetLife and/or any of its affiliates; any disputes involving statutory benefits; will contests or litigation outside probate court; appeals; court costs, filing fees, recording fees, transcripts, witness fees, expenses to a third party, judgments or fines; and frivolous or unethical matters.

8. Will Preparation Services are offered by MetLife Legal Plans, Inc. Cleveland, Ohio. In certain states, legal services benefits are provided through insurance coverage underwritten by Metropolitan General Insurance Company, Warwick, Rhode Island. For New York sitused cases, the Will Preparation service is an expanded offering that includes office consultations and telephone advice for certain other legal matters beyond Will Preparation. Tax Planning and preparation of Living Trusts are not covered by the Will Preparation Service.

9-WillsCenter.com is a document service provided by SmartLegalForms, Inc., an affiliate of Epoq Group, Ltd. SmartLegalForms, Inc. is not affiliated with MetLife and the WillsCenter.com service is separate and apart from any insurance or service provided by MetLife. The WillsCenter.com service does not provide access to an attorney, does not provide legal advice, and may not be suitable for your specific needs. Please consult with your financial, legal, and tax advisors for advice with respect to such matters.

10-ABOThe Accelerated Death Benefit due to Terminal Illness Rider pays up to [80]% of an insured's Life Insurance proceeds (with the balance payable upon final claim) in most states if the insured becomes terminally ill. Conditions and restrictions may apply. Any outstanding loans will reduce the cash value and death benefit.The Accelerated Benefits Option is subject to state availability and regulation. The accelerated life insurance benefits offered under your certificate are intended to qualify for favorable federal tax treatment. If the accelerated benefits qualify for favorable tax treatment, in which case the benefits will not be subject to federal taxation.

This information was written as a supplement to the marketing of life insurance products. Tax laws relating to accelerated benefits are complex and limitations may apply. You are advised to consult with and rely on an independent tax advisor about your own particular circumstances.

Receipt of accelerated benefits may affect your eligibility, or that of your spouse or your family, for public assistance programs such as medical assistance (Medicaid), Temporary Assistance to Needy Families (TANF), Supplementary Social Security Income (SSI) and drug assistance programs. You are advised to consult with social service agencies concerning the effect that receipt of accelerated benefits will have on public assistance eligibility for you, your spouse or your family.

11-Digital Estate Planning is not available for customers sitused in FL or located in GU, PR and VI. It is not included with dependent life coverages or certain GUL/GVUL policies.

Domestic Partnerships are not currently supported however members in a domestic partnership may use a MetLife Legal Plans attorney for their planning needs. Online Notary is not available in all states. If you are unable to access the legalplans.com/estateplanning website, you can find a network attorney by calling MetLife Legal Plans at 1-800-8216400, Monday through Friday, 8am-8pm EST. You will need to provide your company name, customer number and the last 4 digits of the policyholder's social security number.

Group legal plans are provided by MetLife Legal Plans, Inc., Cleveland, OH. In certain states, group legal plans are provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and Affiliates, Warwick, RI. 13. All applications for coverage are subject to review and approval by MetLife. If you choose to apply for increased coverage, the increase may be subject to underwriting.

MetLife will review your information and evaluate your request for coverage based upon your answers to the health questions, MetLife’s underwriting rules and other information you authorize us to review. In certain cases, MetLife may request additional information to evaluate your request for coverage.

This summary provides an overview of your plan’s benefits. These benefits are subject to the terms and conditions of the contract between MetLife and Belton ISD and are subject to each state’s laws and availability. Specific details regarding these provisions can be found in the booklet certificate.

39

Nothing in these materials is intended to be advice for a particular situation or individual. Please consult with your own advisors for such advice. Like most group insurance policies, insurance policies offered by MetLife contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. Please contact your benefits administrator or MetLife for costs and complete details.

Life coverages are provided under a group insurance policy (Policy Form GPNP99) issued to your employer by MetLife. Life coverages under your employer’s plan terminates, when your employment ceases, when your Life and AD&D contributions cease, or upon termination of the group insurance policy. Dependent Life coverage will terminate when a dependent no longer qualifies as a dependent. Should your life insurance coverage terminate for reasons other than non-payment of premium, you may convert it to a MetLife individual permanent policy without providing medical evidence of insurability.

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32

BELTON ISD

Cancer Benefit Summary Group Number: 00575448 A Cancer insurance plan through Guardian provides: • Lump-sum cash payments for certain procedures, screenings and treatments related to a covered cancer diagnosis, in addition to whatever your medical plan covers • Payments are made directly to you and can be used for any purpose • Ability to take the coverage with you if you change jobs or retire • Affordable group rates

About Your Benefits: CANCER COVERAGE - DETAILS Your Monthly premium

Option 1: Advantage Plan

Option 2: Premier Plan

$26.40

$45.03

You and Spouse

$50.11

$85.76

You and Child(ren)

$32.07

$53.87

You, Spouse and Child(ren)

$55.78

$94.60

INITIAL DIAGNOSIS BENEFIT - Benefit is paid when you are diagnosed with Internal cancer for the first time while insured under this Plan.

Benefit Amount(s)

Employee $5,000 Spouse $5,000 Child $5,000

Employee $10,000 Spouse $10,000 Child $10,000

Benefit Waiting Period - A specified period of time after your effective date during which the Initial Diagnosis benefits will not be payable.

30 Days

30 Days

$75; $75 for Follow-Up screening

$125; $125 for Follow-Up screening

Schedule amounts up to a $10,000 benefit year maximum.

Schedule amounts up to a $15,000 benefit year maximum.

CANCER SCREENING Benefit Amount RADIATION THERAPY OR CHEMOTHERAPY Benefit

3 months prior/ 6 months Pre-Existing Conditions Limitation: A pre-existing condition includes any condition for which you, in the specified time period prior treatment free/ 12 months after. to coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs.

3 months prior/ 6 months treatment free/ 12 months after.

Portability: Allows you to take your Cancer coverage with you if you terminate employment. Ported Cancer plan terminates at age 70.

Included

Included

Child(ren) Age Limits

Children age birth to 26 years

Children age birth to 26 years

WULS OLPLW WULSV SHU KRVSLWDO FRQILQHPHQW No Benefit

WULS OLPLW WULSV SHU KRVSLWDO FRQILQHPHQW $50/visit up to 20 visits

Ambulance

$200/trip, limit 2 trips per hospital confinement

$250/trip, limit 2 trips per hospital confinement

Anesthesia

25% of surgery benefit

25% of surgery benefit

Anti-Nausea

$50/day up to $150 per month $25/day while hospital confined.

Limit 75 visits. $100/day up to $5,000 per year

$50/day up to $250 per month $25/day while hospital confined.

Limit 75 visits. $200/day up to $10,000 per year

FEATURES Air Ambulance Alternative Care

Attending Physician Blood/Plasma/Platelets

Benefit information illustrated within this material reflects the plan covered by Guardian as of 05/21/2020 ALL ELIGIBLE EMPLOYEES Benefit Summary 41 The Guardian Life Insurance Company of America, New York, NY

FEATURES (Cont.)

Bone Marrow/Stem Cell

Experimental Treatment Extended Care Facility/Skilled Nursing care Government or Charity Hospital Home Health Care

Option 1: Advantage Plan

Option 2: Premier Plan

%RQH 0DUURZ 6WHP &HOO EHQHILW IRU QG WUDQVSODQW EHQHILW LI D GRQRU $100/day up to $1,000/month

%RQH 0DUURZ 6WHP &HOO EHQHILW IRU QG WUDQVSODQW EHQHILW LI D GRQRU $200/day up to $2,400/month

$100/day up to 90 days per year

$150/day up to 90 days per year

$300 per day in lieu of all other benefits $50/visit up to 30 visits per year

$400 per day in lieu of all other benefits $100/visit up to 30 visits per year

Hormone Therapy

$25/treatment up to 12 treatments $50/treatment up to 12 treatments per year per year

Hospice

$50/day up to 100 days/lifetime

$100/day up to 100 days/lifetime

Hospital Confinement

$300/day for first 30 days; $600/day for 31st day thereafter per confinement

$400/day for first 30 days; $800/day for 31st day thereafter per confinement

ICU Confinement

$400/day for first 30 days; $600/day for 31st day thereafter per confinement

$600/day for first 30 days; $800/day for 31st day thereafter per confinement

Inpatient Special Nursing

$500 per month, $2,500 lifetime max $100/day up to 30 days per year

$500 per month, $2500 lifetime max $150/day up to 30 days per year

Medical Imaging

LPDJH XS WR SHU \HDU

Immunotherapy

Outpatient and family member lodging - Lodging must be more than $75/day, up to 90 days per year 50 miles from your home.

Outpatient or Ambulatory Surgical Center

LPDJH XS WR SHU \HDU $100/day, up to 90 days per year

GD\ GD\V SHU SURFHGXUH

GD\ GD\V SHU SURFHGXUH

$25/visit up to 4 visits per month, $400 lifetime max Surgically Implanted: $2,000/device, $4,000 lifetime max Non-Surgically: $200/device, $400 lifetime max Breast TRAM Flap $2,000 Breast reconstruction $500 Breast Symmetry $250 Facial reconstruction $500 No Benefit

Second Surgical Opinion

$200/surgery procedure

$50/visit up to 4 visits per month, $1,000 lifetime max Surgically Implanted: $3,000/device, $6,000 lifetime max Non-Surgically: $300/device, $600 lifetime max Breast TRAM $3,000 Breast reconstruction $700 Breast Symmetry $350 Facial reconstruction $700 $1,500 egg harvesting, $500 egg or sperm storage, $2,000 lifetime max $300/surgery procedure

Skin Cancer

Biopsy Only: $100 Reconstructive Surgery: $250 Excision of a skin cancer: $375 Excision of a skin cancer with flap or graft: $600

Biopsy Only: $100 Reconstructive Surgery: $250 Excision of a skin cancer: $375 Excision of a skin cancer with flap or graft: $600

6SHFLILHG 'LVHDVH

,QFOXGHG

,QFOXGHG

Surgical Benefit

Schedule amount up to $4,125

Schedule amount up to $5,500

Physical or Speech Therapy

Prosthetic

Reconstructive Surgery

Reproductive Benefit

$0.50/mile up to $1,000 per round $0.50/mile up to $1,500 per round Transportation/Companion Transportation - Benefit is paid if you trip/equal benefit for companion have to travel more than 50 miles one way to receive treatment for trip/equal benefit for companion internal cancer.

Included Included Waiver of Premium - If you become disabled due to cancer that is diagnosed after the employee's effective date, and you remain disabled for 90 days, we will waive the premium due after such 90 days for as long as you remain disabled.

UNDERSTANDING YOUR BENEFITS : •

Alternative Care – Benefit is paid for palliative care (bio-feedback or hypnosis) or lifestyle benefits such as visits to an accredited practitioner for smoking cessation, yoga, meditation, relaxation techniques and nutritional counseling.

• ,&8 5LGHU %HQHILW SHU GD\ XS WR GD\V IRU HDFK SHULRG RI FRQILQHPHQW ,&8 FRQILQHPHQW ULGHU LV SDLG IRU WUHDWPHQW RI DQ\ VLFNQHVV RU LQMXU\ RWKHU WKDQ LQWHUQDO FDQFHU 42 ALL ELIGIBLE EMPLOYEES Benefit Summary The Guardian Life Insurance Company of America, New York, N

UNDERSTANDING YOUR BENEFITS (Cont.): •

Cancer – Cancer means you have been diagnosed with a disease manifested by the presence of a malignant tumor characterized by the uncontrolled growth and spread of malignant cells in any part of the body. This includes leukemia, Hodgkin's disease, lymphoma, sarcoma, malignant tumors and melanoma. Cancer includes carcinomas in-situ (in the natural or normal place, confined to the site of origin, without having invaded neighboring tissue). Pre-malignant conditions or conditions with malignant potential, such as myelodyplastic and myeloproliferative disorders, carcinoid, leukoplakia, hyperplasia, actinic keratosis, polycythemia, and nonmalignant melanoma, moles or similar diseases or lesions will not be considered cancer.

Cancer must be diagnosed while insured under the Guardian cancer plan.

•

Experimental Treatment – Benefits will be paid for experimental treatment prescribed by a doctor for the purpose of destroying or changing abnormal tissue. All treatment must be NCI listed as viable experimental treatment for Internal Cancer.

Manage Your Benefits:

Need Assistance?

Go to www.GuardianAnytime.com to access secure information about your Guardian benefits. Your on-line account will be set up within 30 days after your plan effective date.

Call the Guardian Helpline (888) 600-1600, weekdays, 8:00 AM to 8:30 PM, EST. Refer to your member ID (social security number) and your plan number: 00575448

LIMITATIONS AND EXCLUSIONS: A SUMMARY OF CANCER LIMITATIONS AND EXCLUSIONS:

Cancer caused by, contributed to by, or resulting from: participating in a felony, riot or insurrection; intentionally causing a self-inflicted injury; committing or attempting to commit suicide while sane or insane; a covered person’s mental or emotional disorder, alcoholism or drug addiction; engaging in any illegal activity; or serving in the armed forces or any auxiliary unit of the armed forces of any country.

Conditional Issue underwriting is required on those enrolling outside of the initial enrollment period or annual open enrollment period.

This plan will not pay benefits for: Services or treatment not included in the Features. Services or treatment provided by a family member. Services or treatment rendered for hospital confinement outside the United States. Any cancer diagnosed solely outside of the United States. Services or treatment provided primarily for cosmetic purposes. Services or treatment for premalignant conditions. Services or treatment for conditions with malignant potential. Services or treatment for non-cancer sicknesses.

If Cancer insurance premium is paid for on a pre tax basis, the benefit may be taxable.

Please contact your tax or legal advisor regarding the tax treatment of your policy benefits.

Contract # GP-1-CAN-IC-12

This document is a summary of the major features of the referenced insurance coverage. It is intended for illustrative purposes only and does not constitute a contract. The insurance plan documents, including the policy and certificate, comprise the contract for coverage. The full plan description, including the benefits and all terms, limitations and exclusions that apply will be contained in your insurance certificate. The plan documents are the final arbiter of coverage. Coverage terms may vary by state and actual sold plan. The premium amounts reflected in this summary are an approximation; if there is a discrepancy between this amount and the premium actually billed, the latter prevails.

ALL ELIGIBLE EMPLOYEES Benefit Summary The Guardian Life Insurance Company of America, New York, NY 43

(SBOEGBUIFSFE 1MBO /PU &MJHJCMF GPS /&8 &OSPMMFFT

Protection for the treatment of cancer and 23 specified diseases

Cancer Insurance Receiving a cancer diagnosis can be one of life’s most frightening events.

Unfortunately, statistics show you probably know someone who has been in this situation.

With Cancer insurance from Allstate Benefits, you can rest a little easier. Our coverage pays you a cash benefit to help with the costs associated with treatments, to pay for daily living expenses, and more importantly, to empower you to seek the care you need.

DID YOU

KNOW

?

Here’s How It Works You choose the coverage that’s right for you and your family. Our Cancer insurance pays cash benefits for cancer and 23 specified diseases to help with the cost of treatments and expenses as they happen. Benefits are paid directly to you unless otherwise assigned.

With the cash benefits you can receive from this coverage, you may not need to use the funds from your Health Savings Account (HSA) for cancer or specified disease treatments and expenses.

Early detection, improved treatments and access to care are factors that influence cancer survival1

Meeting Your Needs • Includes coverage for cancer and 23 specified diseases • Benefits are paid directly to you unless otherwise assigned • Coverage available for you or your entire family • Waiver of premium after 90 days of disability due to cancer for as long as your disability lasts (primary insured only) • Premiums do not increase due to age • Additional rider benefits may be added to enhance your coverage, if your employer has chosen to make them available to you With Allstate Benefits, you can protect your finances if faced with an unexpected cancer or specified disease diagnosis.

Are you in Good Hands? You can be.

THIS IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THIS POLICY, AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYER LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED. ABJ34538X

44

19 million The number of cancer survivors in the U.S. is increasing, and is expected to jump to nearly 19 million by 20242

1

http://tinyurl.com/jp8tuaq

2

Cancer Treatment & Survivorship Facts & Figures, 2014-2015

Meet Jane Jane is like anyone else who has been diagnosed with cancer. She is concerned about her family and how they will cope with her disease and its treatment. Most importantly, she worries about how she will pay for her treatment.

Here is what weighs heavily on her mind: • Major medical only pays a portion of the expenses associated with my treatment • I have copays I am responsible for until I meet my deductible • If I am not working due to treatments, I must cover my bills, rent/mortgage, groceries and my child’s education • If the right treatment is not available locally, I will have to travel to get the treatment I need

Here’s how Jane’s story of diagnosis and treatment turned into a happy ending, because she had supplemental Cancer Insurance to help with expenses.

CHOOSE Jane chooses benefits to help protect herself and her family members if diagnosed with cancer or a specified disease

USE

CLAIM

Jane undergoes her annual wellness test and is diagnosed for the first time with cancer.

Jane’s Cancer claim paid her cash benefits for the following:

Jane’s doctor reviews the results with her and recommends pre-op testing and surgery. He provides her with the location of a hospital that specializes in her cancer. However, Jane must travel 400 miles, where she undergoes pre-op testing (medical imaging) and is admitted to the hospital for surgery.

Variable Wellness Cancer Initial Diagnosis Continuous Hospital Confinement Non-Local Transportation Surgery Anesthesia Radiation and Chemotherapy Medical Imaging Inpatient Drugs and Medicine Physician Attendance

Jane undergoes surgery, anesthesia, radiation/ chemo, and is visited by a doctor during a 3-day hospital stay. And every 2 weeks she has radiation/ chemotherapy at a local facility, is given antinausea medication, and sees her doctor during her follow-up visits.

Following each visit, Jane goes online to file her claims, where she is able to track each and have the benefit payments direct deposited to her bank account.

45

Anti-Nausea

For a listing of benefits and benefit amounts, see your company’s rate insert.

Using your cash benefits

Benefits (subject to maximums as listed on the attached rate insert)

Cash benefits provide you with options, because you decide how to use them.

HOSPITAL CONFINEMENT AND RELATED BENEFITS

Finances Can help protect HSAs, savings, retirement plans and 401(k)s from being depleted.

Travel Can help pay for expenses while receiving treatment in another city.

Home Can help pay the mortgage, continue rental payments, or perform needed home repairs for after care.

Expenses Can help pay your family’s living expenses such as bills, electricity, and gas.

Continuous Hospital Confinement - inpatient confinement Government or Charity Hospital - confinements in lieu of other benefits, except Waiver of Premium Private Duty Nursing Services - nurse cannot be employed by confining hospital Extended Care Facility - within 14 days of a hospital stay, up to the number of days of the hospital stay At Home Nursing - private nursing care, up to the number of days of the previous hospital stay Hospice Care Center or Team - terminal illness care in a facility or at home; one visit per day

RADIATION/CHEMOTHERAPY AND RELATED BENEFITS Radiation/Chemotherapy for Cancer - covered treatments to destroy or modify cancerous tissue Blood, Plasma and Platelets - transfusions, administration, processing, procurement, cross matching Medical Imaging - initial diagnosis or follow-up evaluation based on covered imaging exam Hematological Drugs - boosts cell lines for white/red cell counts and platelets; payable when Radiation/ Chemotherapy for Cancer benefit is paid

SURGERY AND RELATED BENEFITS Surgery* - based on Schedule of Surgical Procedures; per operation on an inpatient/outpatient basis Anesthesia - 25% of Surgery benefit for anesthesia received by an anesthetist Ambulatory Surgical Center - payable only if Surgery benefit is paid Second Opinion - second surgery or treatment opinion by a doctor not in practice with your doctor Bone Marrow Transplant Stem Cell Transplant

MISCELLANEOUS BENEFITS Inpatient Drugs and Medicine - not including drugs/medicine covered under the Radiation/Chemotherapy for Cancer or Anti-Nausea benefits

MyBenefits: 24/7 Access allstatebenefits.com/mybenefits An easy-to-use website that offers 24/7 access to important information about your benefits.

Plus, you can submit and check your claims (including claim history), request your cash benefit to be direct deposited, make changes to personal information, and more.

Variable Wellness Benefit Category 1: Blood tests for triglycerides, CA15-3 (breast cancer), CA125 (ovarian cancer), CEA (colon cancer) and PSA (prostate cancer); Hemoccult stool analysis; HPV (Human Papillomavirus) Vaccination; Lipid panel (total cholesterol count); Pap Smear, including ThinPrep Pap Test; Serum Protein Electrophoresis (test for myeloma).

Category 2: Biopsy for skin cancer; Mammography, including Breast Ultrasound; Thermography; Doppler screening for carotids or peripheral vascular disease; Echocardiogram; EKG; Chest X-ray; Stress test on bike or treadmill.

Category 3: Bone Marrow Testing; Colonoscopy; Flexible sigmoidoscopy; Ultrasound screening for abdominal aortic aneurysms.

Physician’s Attendance - one inpatient visit by one physician Ambulance - transfer to or from hospital by licensed service or hospital-owned ambulance Non-Local Transportation - obtaining treatment not available locally Outpatient Lodging - payable only if Radiation/Chemotherapy for Cancer benefit is paid; more than 100 miles from home Family Member Lodging and Transportation - adult family member travels with you during non-local hospital stays for specialized treatment. Transportation not paid if Non-Local Transportation benefit paid

Physical or Speech Therapy - to restore normal body function New or Experimental Treatment - payable if physician judges to be necessary, and only for treatment not covered under other policy benefits

Prosthesis - surgical implantation of prosthetic device for each amputation Hair Prosthesis - wig or hairpiece every two years due to hair loss Nonsurgical External Breast Prosthesis - initial prosthesis after a covered mastectomy Anti-Nausea Drugs - prescribed anti-nausea medication administered on outpatient basis National Cancer Institute Evaluation/Consultation - evaluation/consultation as a result of cancer Egg Harvesting and Storage - harvesting of oocytes and storage of oocytes/sperm at licensed facility Waiver of Premium** - must be disabled 90 days in a row due to cancer; pays as long as disability lasts, up to 5 years

ADDITIONAL RIDER BENEFITS Cancer Initial Diagnosis Level Benefit - for first-time diagnosis of cancer other than skin cancer Variable Wellness Benefit - per day, once per category per year; see left for list of wellness services and tests OPTIONAL RIDER BENEFITS Intensive Care (ICU)

a. ICU Confinement - Illness or accident confinements up to 45 days/stay b. Step-Down ICU Confinement - Confinements up to 45 days/stay c. Ground/Air Ambulance - Not paid if the policy’s Ambulance benefit is paid

Cancer and Specified Disease Additional Benefit - increases the benefit paid on the following base policy benefits: Continuous Hospital Confinement; Government or Charity Hospital; Private Duty Nursing Services; Extended Care Facility; At Home Nursing; Hospice Care; Radiation/Chemotherapy for Cancer; Blood, Plasma and Platelets; Hematological Drugs; Medical Imaging; Surgery; Anesthesia; Bone Marrow Transplant; Stem Cell Transplant; Ambulatory Surgical Center and Second Opinion *Two or more surgeries done at the same time are considered one operation. The operation with the largest benefit will be paid. Outpatient is paid at 150% of the amount listed in the Schedule of Surgical Procedures. **Premiums waived for primary insured only.

46

POLICY SPECIFICATIONS Eligibility Coverage may include you, your spouse or domestic partner and children under age 26.

Termination of Coverage (a) Policy coverage terminates at the end of the grace period or your death (except that your covered spouse or domestic partner becomes the new insured; coverage will continue until their death). The riders terminate at the end of the grace period, if the policy terminates, or on the next renewal date after you request termination. Rider coverage under the Cancer Initial Diagnosis Rider also terminates when a benefit is paid on all covered persons. (b) Spouse/domestic partner coverage ends upon divorce/ termination of partnership. (c) Coverage for children ends when the child reaches age 26, unless he or she continues to meet the requirements of an eligible dependent.

Renewability The policy is guaranteed renewable for life, subject to change in premiums by class. All premiums may change on a class basis.

A notice is mailed in advance of any change.

23 Specified Diseases Covered - Addison’s Disease; Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease); Brucellosis; Diphtheria; Encephalitis; Hansen’s Disease; Hepatitis (Chronic B or Chronic C with liver failure or hepatoma); Legionnaires’ Disease (confirmation by culture or sputum); Lyme Disease; Multiple Sclerosis; Muscular Dystrophy; Myasthenia Gravis; Primary Biliary Cirrhosis; Rabies; Reye’s Syndrome; Rocky Mountain Spotted Fever; Sickle Cell Anemia; Systemic Lupus Erythematosus; Tetanus; Thalassemia; Tuberculosis; Tularemia; Typhoid Fever.

LIMITATIONS AND EXCLUSIONS Pre-Existing Condition Limitation (a) We do not pay benefits for a pre-existing condition during the 12-month period (6 months for persons age 65 and over) beginning on the date that person’s coverage starts. (b) A pre-existing condition is a disease or condition for which: there existed symptoms which would cause a prudent person to seek diagnosis, care, or treatment within the 12-month period prior to the effective date; or medical advice or treatment was recommended or received from a medical professional within the 12-month period prior to the effective date. (c) A pre-existing condition can exist even though a diagnosis has not yet been made.

Policy Exclusions and Limitations (a) Benefits are not paid for any loss, except for losses due to cancer or a specified disease. (b) Benefits are not paid for losses caused or aggravated by cancer or a specified disease or as a result of treatment. (c) Treatment must be received in the United States or its territories.

Hospice Care Team Limitation: Services are not covered for food or meals, well-baby care, volunteers or support for the family after covered person’s death.

Blood, Plasma and Platelets Limitation: Does not include blood replaced by donors or for immunoglobulins.

For the Radiation/Chemotherapy for Cancer; Blood, Plasma and Platelets; and New or Experimental Treatment benefits, we pay 50% of the billed amount if the actual costs are not obtainable as proof of loss.

For the Radiation/Chemotherapy for Cancer benefit, we do not pay for treatment or emergency or room charges; treatment planning, management, devices, or supplies; medications or drugs covered elsewhere in the policy; X-rays, scans, and their interpretations; or any other drug, charge or expense that does not directly modify or destroy cancerous tissues.

Intensive Care Rider Exclusions and Limitations (a) Benefits are not paid for: (1) attempted suicide or intentional self-inflicted injury; (2) intoxication or being under the influence of drugs not prescribed by a physician; or (3) alcoholism or drug addiction. (b) Benefits are not paid for confinements to a care unit that does not qualify as intensive care unit including progressive care, subacute intensive care, intermediate care, private rooms with monitoring, step-down and other lesser care units. (c) Benefits are not paid for step-down confinements in the following units: telemetry or surgical recovery rooms; post-anesthesia care; progressive care; intermediate care; private monitored rooms; observation units in emergency rooms or outpatient surgery units; beds, wards, or private or semi-private rooms; emergency, labor or delivery rooms; or other facilities that do not meet the standards for a step-down hospital intensive care unit. (d) Benefits are not paid for confinements occurring during a hospitalization prior to the effective date. (e) Children born within 10 months of the rider date are not covered for confinement occurring or beginning during the first 30 days of the child’s life.

This brochure is for use in TX and is incomplete without the accompanying rate insert.

This material is valid as long as information remains current, but in no event later than March 1, 2021.

Cancer and Specified Disease benefits are provided by policy form CP12, or state variations thereof. Cancer Rider benefits provided by the following rider forms, or state variations thereof: Variable Wellness Benefit Rider WBR7; Intensive Care Rider ICR5; Cancer Initial Diagnosis Level Benefit Rider CLR3; Cancer and Specified Disease Additional Benefit Rider CABR3.

Allstate Benefits is the marketing name used by American Heritage Life Insurance Company, a subsidiary of The Allstate Corporation. ©2018 Allstate Insurance Company. www.allstate.com or allstatebenefits.com

The policy and riders provide Limited Benefit Supplemental Cancer and Specified Disease Insurance. The policy is not a Medicare Supplement Policy. If eligible for Medicare, review the Medicare Supplement Buyer’s Guide available from Allstate Benefits. This information highlights some features of the policy but is not the insurance contract. Only the actual policy provisions control. For complete details, contact your Allstate Benefits Agent. Underwritten by American Heritage Life Insurance Company (Home Office, Jacksonville, FL).

The coverage does not constitute comprehensive health insurance coverage (often referred to as “major medical coverage”) and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act. 47

Cancer Insurance (CP12) Includes coverage for 23 Specified Diseases from Allstate Benefits BENEFIT AMOUNTS HOSPITAL CONFINEMENT/RELATED BENEFITS

PLAN 1

PLAN 2

PLAN 1 MONTHLY PREMIUMS

Continuous Hospital Confinement (daily) Government or Charity Hospital (daily) Private Duty Nursing Services (daily) Extended Care Facility (daily)† At Home Nursing (daily)† Hospice Care Center or Team

$200 $200 $200 $200 $200 $2,000 $200

$3003 $3003 $3003 $3003 $3003 $3,0003 $3003

AGES

INDIVIDUAL

FAMILY

18-64 65-69 70-74 75-80

$28.05 $63.61 $74.58 $82.93

$55.34 $125.46 $144.54 $161.48

PLAN 2 MONTHLY PREMIUMS

First Day Days 2+

RADIATION/CHEMOTHERAPY/RELATED BENEFITS

PLAN 1

PLAN 2

AGES

INDIVIDUAL

FAMILY

Radiation/Chemotherapy Up to for Cancer1 (every 12 months) Lifetime Max Blood, Plasma and Platelets1 (every 12 months) Medical Imaging (every 12 months) Hematological Drugs (every 12 months)

$10,000 $50,000 $10,000 $200 $500

$15,0003 $75,0003 $15,0003 $7503 $3003

18-64 65-69 70-74 75-80

$48.08 $111.64 $134.73 $154.01

$92.83 $210.62 $246.48 $280.16

SURGERY/RELATED BENEFITS

PLAN 1

PLAN 2

Surgery2 Anesthesia (% of Surgery benefit) Ambulatory Surgical Center (daily) Second Opinion (every 12 months) Bone Marrow Transplant (every 12 months) Stem Cell Transplant (every 12 months)

$3,000 25% $500 $200 $7,000 $7,000

$4,5003 25%3 $7503 $3003 $10,5003 $10,5003

MISCELLANEOUS BENEFITS

PLAN 1

PLAN 2

Inpatient Drugs and Medicine (daily) Physician’s Attendance (daily) Ambulance (per confinement)

$25 $50 $250 $10,000

$25 $50 $250 $10,000

Non-Local Transportation (coach fare or amount shown per mile6) Outpatient Lodging Daily Yearly Max Family Member Lodging (daily per trip; max. 60 days) and Transportation (coach fare or amount shown per mile6) Physical or Speech Therapy (daily) New or Experimental Treatment1 (every 12 months) Prosthesis (per amputation) Hair Prosthesis (every 2 years) Nonsurgical External Breast Prosthesis (initial prosthesis) Anti-Nausea Drugs (every 12 months) National Cancer Institute Evaluation/Consultation (every 12 mos.)

Egg Harvesting and Storage (one-time benefit) Extraction Storage Waiver of Premium (primary insured only)

$0.50/mi $100 $2,000 $100 $0.50/mi $50 $5,000 $2,000 $50 $100 $200 $500 $500 $175 Yes

$0.50/mi $100 $2,000 $100 $0.50/mi $50 $5,000 $2,000 $50 $100 $200 $500 $500 $175 Yes

ADDITIONAL RIDER BENEFITS Cancer Initial Diagnosis Level Benefit (one-time benefit) Category 1 Variable Wellness Benefit

PLAN 1 $4,000

PLAN 2 $8,000

$25 $50 $100

$50 $100 $200

PLAN 1+

PLAN 2+

$600 $300 $750 $30,000

$600 $300 $750 $30,000

Ground Air

(per category, per day, once per year)

OPTIONAL RIDER BENEFITS Intensive Care (ICU)

ABJ34538X-Insert-COMAL

Category 2 Category 3

ICU (max. 45 days) Step-down (max. 45 days) Ground Ambulance Air Ambulance

48

Issue ages: 18 to 80

PLAN 1+ MONTHLY PREMIUMS

AGES

INDIVIDUAL

FAMILY

18-64 65-69 70-74 75-80

$30.33 $66.93 $78.06 $87.01

$61.12 $133.28 $152.66 $170.98

PLAN 2+ MONTHLY PREMIUMS

AGES

INDIVIDUAL

FAMILY

18-64 65-69 70-74 75-80

$50.36 $114.96 $138.21 $158.09

$98.61 $218.44 $254.60 $289.66 Issue ages: 18 to 80

†

Up to number of days of previous hospital confinement.

Pays actual cost up to amount listed.

2 Pays up to amount listed in policy Schedule of Surgical Procedures. Amount paid depends on surgery.

3 Benefit amount includes the Cancer and Specified Disease Additional Benefit Rider (CABR) which increases the base policy benefit.

6 Maximum of 700 miles.

1

For use in: TX This rate insert is part of form ABJ34538X and is not to be used on its own.

This material is valid as long as information remains current, but in no event later than March 1, 2021. Allstate Benefits is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a subsidiary of The Allstate Corporation. ©2018 Allstate Insurance Company. www.allstate.com or allstatebenefits.com

coverage specifications Conditions and Limits – When an injury results in a covered loss within 90 days (180 days for dismemberment or accidental death), unless otherwise stated, from the date of an accident, and is diagnosed by a physician, Allstate Benefits will pay benefits as stated. Treatment must be received in the United States or its territories.

Outpatient Physician’s Benefit Rider Exclusions and Limitations – Benefits are not paid for: (a) losses incurred before the effective date; (b) a loss as a result of an onthe-job accident; (c) any act of war or participation in a riot, insurrection or rebellion; (d) suicide or attempted suicide; (e) self-inflicted action; (f) being under the influence of alcohol or narcotics unless taken on the advice of a physician; (g) participation in aeronautics unless a farepaying passenger on a licensed common-carrier aircraft; (h) engaging in an illegal occupation, assault or felony; (i) driving in any race or speed test or testing any vehicle on any racetrack or speedway; (j) serving as an active member of the Military, Naval, or Air Forces of any country.

Your Eligibility – Your employer decides who is eligible for your group (such as length of service and hours worked each week). Issue ages are 18 and over.

Dependent Eligibility/Termination – (a) Coverage may include you, your spouse or domestic partner, and your children. (b) Coverage for children ends when the child reaches age 26, unless he or she continues to meet the requirements of an eligible dependent. (c) Spouse coverage ends upon valid decree of divorce or your death. (d) Domestic partner coverage ends upon termination of domestic partnership or your death.

STATE VARIATIONS Arkansas (changes affect page 4) – In the Accident and Benefit Enhancement Exclusions and Limitations paragraph, item (f) is replaced with: injury resulting from being intoxicated or under the influence of any controlled substance unless taken on the advice of a physician; items (g) and (l) are deleted. In the Outpatient Physician’s Benefit Rider Exclusions and Limitations paragraph, item (f) is replaced with: loss resulting from being intoxicated or under the influence of any controlled substance, unless taken on the advice of a physician.

When Coverage Ends – Coverage under the policy ends on the earliest of: (a) the date the policy is canceled; (b) the last day of the period for which you made any required contributions; (c) the last day you are in active employment, except as provided under the Temporary Layoff, Leave of Absence, or Family and Medical Leave of Absence provision; (d) the date you are no longer in an eligible class; (e) the date your class is no longer eligible; or (f) upon discovery of fraud or material misrepresentation when filing a claim.

Georgia (changes affect pages 3 and 4) – In the Benefit Enhancements, the Coma with Respiratory Assistance benefit is deleted. The When Coverage Ends paragraph, specification includes: (g) the date you request to discontinue coverage in writing.

Continuation of Coverage – You may be eligible to continue coverage when coverage under the policy ends. You have 60 days after coverage under the policy ends to let us know if you wish to continue coverage.

Louisiana (changes affect pages 3 and 4) – In the Physical Therapy benefit, chiropractic services are payable. In the Accident and Benefit Enhancement Exclusions and Limitations paragraph, item (f) is replaced with: injury resulting from being intoxicated or under the influence of any narcotic not prescribed or recommended by a physician.

In the Outpatient Physician’s Benefit Rider Exclusions and Limitations paragraph, item (f) is replaced with: loss resulting from being intoxicated or under the influence of any narcotic not prescribed or recommended by a physician.

Accident and Benefit Enhancement Exclusions and Limitations – Benefits are not paid for: (a) injury incurred before the effective date; (b) injury as a result of an on-the-job accident; (c) any act of war or participation in a riot, insurrection or rebellion; (d) self-inflicted injury; (e) suicide or attempted suicide; (f) being under the influence of alcohol or narcotics unless taken on the advice of a physician; (g) bacterial infection (except pyogenic infections from an accidental cut or wound); (h) participation in aeronautics unless a fare-paying passenger on a licensed common-carrier aircraft; (i) engaging in an illegal occupation, assault or felony; (j) driving in any race or speed test or testing any vehicle on any racetrack or speedway; (k) serving as an active member of the Military, Naval, or Air Forces of any country; and (l) hernia, including complications.

New Mexico (change affects page 2) – The Accident Physician Treatment benefit includes coverage for Temporomandibular joint disorders and Craniomandibular joint disorders if a result of injury. We will not pay for orthodontic appliances and treatment, crowns, bridges and dentures, unless the disorder results from an injury.

49

ABJ23842-3

Page 4 of 6

Texas (changes affect page 4) – In the Conditions and Limits paragraph, the last sentence is replaced with the following: For the Hospital Confinement, Accident Physician Treatment, X-Ray, and Emergency Room Services benefits, treatment must be received in the United States or its territories, unless the treatment is the result of an emergency.

Treatments included in all other benefits must be received in the U.S. or its territories. In the Accident and Benefit Enhancement Exclusions and Limitations paragraph, item (f) is replaced with: injury resulting from being intoxicated or under the influence of any narcotic unless taken on the advice of a physician; item (g) is replaced with: any bacterial infection (except food poisoning and pyogenic infections from an accidental cut or wound); item (i) is replaced with: engaging in an illegal occupation or felony. In the Outpatient Physician’s Benefit Rider Exclusions and Limitations paragraph, item (f) is replaced with: injury resulting from being intoxicated or under the influence of any narcotic unless taken on the advice of a physician; item (h) is replaced with: engaging in an illegal occupation or felony.

Page 5 of 6

ABJ23842-3

50

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PLAN SUMMARY

Dental Insurance Coverage that can help make it easier to visit a dentist and can help lower your dental costs.

Belton Independent School District Network: PDP Plus In-Network1 % of Negotiated Fee2 Coverage Type Type A: Preventive (cleanings, exams, X-rays) Type B: Basic Restorative (fillings, extractions) Type C: Major Restorative (bridges, dentures) Orthodontia

Out-of-Network1 % of R&C Fee**

100%

100%

80%

80%

50%

50%

50%

50%

Individual

$50

$50

Family

$150

$150

$1,450

$1,450

$1,000

$1,000

Deductible†

Annual Maximum Benefit Per Person Orthodontia Lifetime Maximum

Per Person***

Child(ren)’s eligibility for dental coverage is from birth up to age 26.

1

“In-Network Benefits" refers to benefits provided under this plan for covered dental services that are provided by a participating dentist. "Out-of-Network Benefits" refers to benefits provided under this plan for covered dental services that are not provided by a participating dentist.

2

Negotiated fees refer to the fees that in-network dentists have agreed to accept as payment in full for certain services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. Negotiated fees do not apply to non-covered services in states that prohibit limitations for services not covered under a plan. Participating providers in these states may charge their non-negotiated fees for non-covered services. **R&C fee refers to the Reasonable and Customary (R&C) charge, which is based on the lowest of (1) the dentist’s actual charge, (2) the dentist’s usual charge for the same or similar services, or (3) the charge of most dentists in the same geographic area for the same or similar services as determined by MetLife. †Applies only to Type B & C Services. *** Orthodontia excluded for adults. Available for dependent children up to age 19.

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 60

L0325047071[exp0327][xNM] © 2025 MetLife Services and Solutions, LLC DN-ANY-PPO-DUAL

PLAN SUMMARY

Dental Insurance Coverage that can help make it easier to visit a dentist and can help lower your dental costs.

Belton Independent School District List of Primary Covered Services & Limitations * The service categories and plan limitations shown represent an overview of your Plan Benefits. This document presents the majority of services within each category but is not a complete description of the Plan.

Plan Type

How Many/How Often

Type A — Preventive Prophylaxis (cleanings)

1 in 6 months

Oral Examinations

1 in 6 months

Topical Fluoride Applications

One fluoride treatment in 12 months for dependent child up to his/her 14th birthday

X-rays

 Full mouth X-rays; one per 60 months  Bitewings X-rays; 1 in 12 months for adult and children

Sealants

One application of sealant material every 3 years for each non-restored, non-decayed 1st and 2nd molar of a dependent child up to his/her 14th birthday

Type B — Basic Restorative Fillings Simple Extractions Crown, Denture and Bridge Repair/ Recementations Oral Surgery General Anesthesia

When dentally necessary in connection with oral surgery, extractions or other covered dental services

Periodontics-Perio Maintenance

 1 in 6 months

Space Maintainers

1 per lifetime per area of the mouth for dependent child up to his/her 14th birthday.

Type C — Major Restorative Simple Extractions Crown, Denture and Bridge Repair/ Recementations Oral Surgery Implants

Replacement once every 5 calendar years

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 61

L0325047071[exp0327][xNM] © 2025 MetLife Services and Solutions, LLC DN-ANY-PPO-DUAL

PLAN SUMMARY

Dental Insurance Coverage that can help make it easier to visit a dentist and can help lower your dental costs.

Belton Independent School District

Bridges and Dentures

 Dentures and bridgework replacement; one every 10 calendar years  Replacement of an existing temporary full denture if the temporary denture cannot be repaired and the permanent denture is installed within 12 months after the temporary denture was installed

Crowns, Inlays and Onlays

Replacement once every 10 calendar years

Endodontics

Root canal treatment limited to once per tooth per lifetime

Periodontics

 Periodontal scaling and root planing once per quadrant, every 24 months  Periodontal surgery once per quadrant, every 36 months

Type D — Orthodontia

 Your children, up to age 19, are covered while Dental insurance is in effect.  All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia

 Payments are on a repetitive basis  20% of the Orthodontia Lifetime Maximum will be considered at initial placement of the appliance and paid based on the plan benefit’s coinsurance level for Orthodontia as defined in the plan summary  Orthodontic benefits end at cancellation of coverage

The service categories and plan limitations shown above represent an overview of your plan benefits. This document presents the majority of services within each category but is not a complete description of the plan.

Exclusions This plan does not cover the following services, treatments and supplies: •

Services which are not Dentally Necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which we deem experimental in nature;

•

Services for which you would not be required to pay in the absence of Dental Insurance;

•

Services or supplies received by you or your Dependent before the Dental Insurance starts for that person;

•

Services which are primarily cosmetic (for Texas residents, see notice page section in Certificate);

•

Services which are neither performed nor prescribed by a Dentist except for those services of a licensed dental hygienist which are supervised and billed by a Dentist and which are for: o Scaling and polishing of teeth; or o Fluoride treatments;

•

Services or appliances which restore or alter occlusion or vertical dimension;

•

Restoration of tooth structure damaged by attrition, abrasion or erosion;

•

Restorations or appliances used for the purpose of periodontal splinting;

•

Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco;

•

Personal supplies or devices including, but not limited to: water picks, toothbrushes, or dental floss;

•

Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work;

•

Missed appointments; Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 62

L0325047071[exp0327][xNM] © 2025 MetLife Services and Solutions, LLC DN-ANY-PPO-DUAL

PLAN SUMMARY

Dental Insurance Coverage that can help make it easier to visit a dentist and can help lower your dental costs.

Belton Independent School District •

Services: o Covered under any workers’ compensation or occupational disease law; o Covered under any employer liability law; o For which the employer of the person receiving such services is not required to pay; or o Received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital;

•

Services covered under other coverage provided by the Employer;

•

Temporary or provisional restorations;

•

Temporary or provisional appliances;

•

Prescription drugs;

•

Services for which the submitted documentation indicates a poor prognosis;

•

Services, to the extent such services, or benefits for such services, are available under a government plan. This exclusion will apply whether or not the person receiving the services is enrolled for the government plan. We will not exclude payment of benefits for such services if the government plan requires that Dental Insurance under the group policy be paid first.

•

The following when charged by the Dentist on a separate basis: o Claim form completion; o Infection control such as gloves, masks, and sterilization of supplies; or o Local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.

•

Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food;

•

Caries susceptibility tests;

•

Precision attachments, except when the precision attachment is related to implant prosthetics; Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it;

•

Fixed and removable appliances for correction of harmful habits;

•

Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards;

•

Diagnosis and treatment of temporomandibular joint (TMJ) disorders. This exclusion does not apply to residents of Minnesota;

•

Duplicate prosthetic devices or appliances;

•

Replacement of a lost or stolen appliance, Cast Restoration, or Denture; and

•

Intra and extraoral photographic images

Limitations Alternate Benefits: Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. To avoid any misunderstandings, we suggest you discuss treatment options with your dentist before services are rendered, and obtain a pretreatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plan’s reimbursement for those services, and your out-of-pocket expense. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment.

Cancellation/Termination of Benefits: Coverage is provided under a group insurance policy (Policy form GPNP99) issued by Metropolitan Life Insurance Company (MetLife). Coverage terminates when your participation ceases, when your dental contributions cease or upon termination of the group policy by the Policyholder or MetLife. The group policy terminates for nonpayment of premium and may terminate if participation requirements are not met or if the Policyholder fails to perform any obligations under the policy. The following services that are in progress while coverage is in effect will be paid after the coverage ends, if the applicable installment or the treatment is finished within 31 days after individual termination of coverage: Completion of a prosthetic device, crown or root canal therapy.

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 63

L0325047071[exp0327][xNM] © 2025 MetLife Services and Solutions, LLC DN-ANY-PPO-DUAL

PLAN SUMMARY

Dental Insurance Coverage that can help make it easier to visit a dentist and can help lower your dental costs.

Belton Independent School District Group dental plans featuring the Preferred Dentist Program are provided by Metropolitan Life Insurance Company, New York, NY 10166.

Like most group benefits programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. You may be financially responsible for copayments, deductibles, or any other amounts in excess of those MetLife is required to pay for covered services as described in your dental certificate and/or policy. Ask your MetLife representative for costs and complete details.

Questions & Answers Q. Who is a participating dentist?

A. A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for covered services provided to plan members. Negotiated fees typically range from 30% – 45% below the average fees charged in a dentist’s community for the same or substantially similar services. † Q. How do I find a participating dentist?

A. There are thousands of general dentists and specialists to choose from nationwide --so you are sure to find one that meets your needs. You can receive a list of these participating dentists online at www.metlife.com/mybenefits or call 1-800-9420854 to have a list faxed or mailed to you.

Q. What services are covered under this plan?

A. The Plan documents set forth the services covered by your plan. The List of Primary Covered Services & Limitations herein contains a summary of covered services. In the event of a conflict between the Plan documents and this summary, the terms of the Plan documents shall govern.

Q. May I choose a non-participating dentist?

A. Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating dentist your out-ofpocket costs may be higher.

Q. Can my dentist apply for participation in the network?

A. Yes. If your current dentist does not participate in the network and you would like to encourage him/her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application.†† The website and phone number are for use by dental professionals only.

Q. How are claims processed?

A. Dentists may submit your claims for you which means you have little or no paperwork. You can track your claims online and even receive email alerts when a claim has been processed. If you need a claim form, visit www.metlife.com/mybenefits or request one by calling 1-800-942-0854.

Q. Can I get an estimate of what my out-of-pocket expenses will be before receiving a service?

A. Yes. You can ask for a pretreatment estimate. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. The estimate helps you prepare for the cost of dental services. We recommend that you request a pre-treatment estimate for services in excess of $300. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment.

Q. Can MetLife help me find a dentist outside of the U.S. if I am traveling?

A. Yes. Through international dental travel assistance services* you can obtain a referral to a local dentist by calling +1-312356-5970 (collect) when outside the U.S. to receive immediate care until you can see your dentist. Coverage will be considered under your out-of-network benefits.** Please remember to hold on to all receipts to submit a dental claim.

Q. How does MetLife coordinate benefits with other insurance plans?

A. Coordination of benefits provisions in dental benefits plans are a set of rules that are followed when a patient is covered by more than one dental benefits plan. These rules determine the order in which the plans will pay benefits. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan, subject to applicable law. If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. The amount of benefits payable

by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law.

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 64

L0325047071[exp0327][xNM] © 2025 MetLife Services and Solutions, LLC DN-ANY-PPO-DUAL

PLAN SUMMARY

Dental Insurance Coverage that can help make it easier to visit a dentist and can help lower your dental costs.

Belton Independent School District Q. Do I need an ID card?

A. No. You do not need to present an ID card to confirm that you are eligible. You should notify your dentist that you are enrolled in the MetLife Preferred Dentist Program. Your dentist can easily verify information about your coverage through a toll-free automated Computer Voice Response system.

Monthly Cost The following monthly costs are effective through August 31, 2027. Your premium will be paid through convenient payroll deduction. The monthly costs shown below for “Employee + Spouse + Child(ren)” and “Employee + Family” include the cost for all eligible children.

Employee Only

$36.60

Employee + Child(ren)

$68.02

Employee + One

$74.02

Employee + Family

$114.56

†Negotiated fees refer to the fees that in-network dentists have agreed to accept as payment in full for certain services, subject to any co-payments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. Negotiated fees do not apply to non-covered services in states that prohibit limitations for services not covered under a plan. Participating providers in these states may charge their non-negotiated fees for non-covered services.

Savings from enrolling in a dental benefits plan [featuring the MetLife Preferred Dentist Program will depend on various factors, including the cost of the plan, how often participants visit a dentist, and the cost of services rendered. ††Due to contractual requirements, MetLife is prevented from soliciting certain providers. *AXA Assistance USA, Inc. provides Dental referral services only. AXA Assistance is not affiliated with MetLife, and the services and benefits they provide are separate and apart from the insurance provided by MetLife. Referral services are not available in all locations. Exclusions: The AXA Travel Assistance Program is available for participants in traveling status. Whenever a trip exceeds 120 days, the participant is no longer considered to be in traveling status and is therefore no longer eligible for the services. Also, AXA Assistance USA will not evacuate or repatriate participants without medical authorization; with mild lesions, simple injuries such as sprains, simple fractures or mild sickness which can be treated by local doctors and do not prevent the member from continuing his/her trip or returning home; or with infections under treatment and not yet healed. Benefits will not be paid for any loss or injury that is caused by or is the result from: pregnancy and childbirth except for complications of pregnancy, and mental and nervous disorders unless hospitalized. Reimbursements for non-medical services such as hotel, restaurant, taxi expenses or baggage loss while traveling are not covered. The maximum benefit per person for costs associated with evacuations, repatriations or the return of mortal remains is US$500,000. Treatment must be authorized and arranged by AXA Assistance’s designated personnel to be eligible for benefits under this program. All services must be provided and arranged by AXA Assistance USA, Inc. No claims for reimbursement will be accepted. **Refer to your dental benefits plan summary for your out-of-network dental coverage.

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 65

L0325047071[exp0327][xNM] © 2025 MetLife Services and Solutions, LLC DN-ANY-PPO-DUAL

Protect your vision with VSP. Get the best in eye care and eyewear with BELTON INDEPENDENT SCHOOL DISTRICT and VSP® Vision Care.

Why enroll in VSP? We invest in the things you value most— the best care at the lowest out-of-pocket costs. Because we’re the only national not-for-profit vision care company, you can trust that we’ll always put your wellness first.

You’ll like what you see with VSP. Value and Savings. You’ll enjoy more value and the lowest out-of-pocket costs.

High Quality Vision Care. You’ll get the best care from a VSP provider, including a WellVision Exam®—the most comprehensive exam designed to detect eye and health conditions.

Choice of Providers. The decision is yours to make—choose a VSP doctor, a participating retail chain, or any out-of-network provider.

Great Eyewear. It’s easy to find the perfect frame at a price that fits your budget.

Using your VSP benefit is easy.

Create an account at vsp.com. Once your plan is effective, review your benefit information.

Find an eye care provider who’s right for you. To find a VSP provider, visit vsp.com or call 800.877.7195.

At your appointment, tell them you have VSP. There’s no ID card necessary. If you’d like a card as a reference, you can print one on vsp.com.

That’s it! We’ll handle the rest—there are no claim forms to complete when you see a VSP provider.

Choice in Eyewear From classic styles to the latest designer frames, you’ll find hundreds of options. Choose from featured frame brands like bebe®, Calvin Klein, 1 Cole Haan, Flexon®, Lacoste, Nike, Nine West, and more . Visit vsp.com to find a Premier Program location that carries these brands. Prefer to shop online? Check out all of the brands at Eyeconic.com, VSP's online eyewear store.

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Enroll in VSP today.

You'll be glad you did.

Contact us. 800.877.7195 vsp.com

Your VSP Vision Benefits Summary BELTON INDEPENDENT SCHOOL DISTRICT and VSP provide you with an affordable eye care plan.

VSP Coverage Effective Date: Benefit

VSP Provider Network: VSP Choice

Description

Copay

Frequency

$10

Every 12 months

Your Coverage with a VSP Provider WellVision Exam

Focuses on your eyes and overall wellness

Prescription Glasses

$25

See frame and lenses

Frame

$150 allowance for a wide selection of frames $170 allowance for featured frame brands 20% savings on the amount over your allowance $85 Costco® frame allowance

Included in Prescription Glasses

Every 24 months

Lenses

Single vision, lined bifocal, and lined trifocal lenses Polycarbonate lenses for dependent children

Included in Prescription Glasses

Every 12 months

Lens Enhancements

Standard progressive lenses Premium progressive lenses Custom progressive lenses Average savings of 20-25% on other lens enhancements

Contacts (instead of glasses)

$150 allowance for contacts; copay does not apply Contact lens exam (fitting and evaluation)

Diabetic Eyecare Plus Program

Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD). Retinal screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details.

$55 $95 - $105 $150 - $175

Every 12 months

Up to $60

Every 12 months

$20

As needed

Glasses and Sunglasses Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details.

20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12 months of your last WellVision Exam.

Extra Savings

Retinal Screening No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam Laser Vision Correction Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities

Your Monthly Contribution

$7.44 Member only $14.30 Member + 1 $23.88 Member + family Your Coverage with Out-of-Network Providers

Visit vsp.com for details, if you plan to see a provider other than a VSP network provider.

Exam .............................................................................. up to $45 Frame ............................................................................ up to $70 Single Vision Lenses ........................................... up to $30

Lined Bifocal Lenses ........................................... up to $50 Lined Trifocal Lenses ......................................... up to $65

Progressive Lenses ............................................. up to $50 Contacts .................................................................... up to $105

Coverage with a participating retail chain may be different. Once your benefit is effective, visit vsp.com for details. Coverage information is subject to change. In the event of a conflict between this information and your organization’s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location.

Contact us. 800.877.7195 | vsp.com 1

Brands/Promotion subject to change.

©

2014 Vision Service Plan. All rights reserved. VSP, VSP Vision care for life, WellVision Exam, and eyeconic.com are registered trademarks of Vision Service Plan. Flexon is a registered trademark of Marchon Eyewear, Inc. All other company names and brands are trademarks or registered trademarks of their respective owners.

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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 PR

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

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

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EVERY FAMILY DESERVES A MASA MEMBERSHIP

EMPLOYEE EDUCATION

FSA Participant Benefits

Save money with FSA pretax benefit accounts.

A Flexible Spending Account (FSA) puts more money in your pocket by reducing your taxable income when you contribute pretax dollars to pay for common expenses like these:

HEALTHCARE $3300 Contribution Limit

DEPENDENT CARE $5000 Contribution Limit

Medical/dental office visit co-pays

Daycare expenses

Dental/orthodontic care services

Before & after school care

Prescriptions, vaccinations, and OTC

Nanny/nursery school

Eye exams; prescription glasses/lenses

Elder care

•

Determine your elections based on your estimated out-of-pocket expenses for the year

•

Your employer may offer other types of Benefit Accounts too; ask for details

•

For a complete list of eligible expenses, see IRS Publications 502 & 503 at irs.gov

Increase your take-home pay by reducing your taxable income.

Each $1 you contribute to your FSA reduces your taxable income by $1.

With less tax taken, your take-home pay increases!

Consider this example: (for illustration only) Richard has: • Gross monthly pay of $3,500 • $600 per month in eligible expenses

Here is his net monthly take-home pay:

Without FSA

With FSA

($600 spent using post-tax dollars)

($600 spent using pretax dollars)

$1,932

$2,098

That’s a net increase in take-home pay of $166 every month!

To estimate potential savings based on your income and expenses, use the Tax Savings Calculator at www.tasconline.com/tasc-calculators.

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See how easy it is to start saving with a TASC Benefit Account. See details on reverse.

FSA Participant Benefits

Page 2

How to participate.

It’s easy to start saving with an FSA. Just follow 3 simple steps:

1. D ECIDE how much you want to contribute.

Check with your employer for plan specifics and review at the IRS limits at www.tasconline.com/benefits-limits.

The more you contribute, the lower your taxable income will be.

However, it’s important to be conservative when choosing your annual contribution based on your anticipated qualified expenses since: •

he money you contribute to your benefit account can only be used T for eligible FSA expenses.

•

ny unused FSA funds at the close of the plan year are not A refundable to you. (A grace period or carryover option may be in place for your plan. Check with your employer for plan guidelines and allowances.)

2. E NROLL by completing the enrollment process.

Your contribution will be deducted in equal amounts from each paycheck, pretax, throughout the plan year.

Your total annual contribution to a Healthcare FSA will be available to you immediately at the start of the plan year. Alternatively, your Dependent Care FSA funds are only available as payroll contributions are made.

START by making a conservative estimate of how much you expect to spend on eligible out-of-pocket expenses for the year.

COMPARE your estimate to the IRS limits.

If your estimate is higher than these annual contribution limits, consider making the maximum contribution allowed.

MyCash Account: Included on your TASC Card for faster reimbursement deposits and non-benefit purchases.

TASC Mobile App: Track and manage all benefits and access numerous helpful tools, anywhere and anytime! Search for “TASC” (green icon).

3. ACCESS your funds easily using the TASC Card.

This convenient card automatically approves and deducts most eligible purchases from your benefit account with no paperwork required. Plus, for purchases made without the card, you can request reimbursement online, by mobile app, or using a paper form.

Reimbursements happen fast—within 12 hours—when you request to have them added to the MyCash balance on your TASC Card. You can use the MyCash balance on your card to get cash at ATMs or to buy anything you want anywhere Mastercard is accepted!

This Mastercard is administered by TASC, a registered agent of Pathward. Use of this card is authorized as set forth in your Cardholder Agreement. The card is issued by Pathward, N.A., Member FDIC, pursuant to license

by Mastercard International Incorporated. Mastercard and the circles design are registered trademarks of Mastercard International Incorporated.

Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC.

Questions? Ask your employer or contact your Plan Administrator: Total Administration Services Corporation • www.tasconline.com • 1-800-422-4661 FX-4245-082922

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GET IT ON

A helping hand when you need it.

Rely on the support, guidance and resources of your Employee Assistance Program.

Standard Insurance Company

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There are times in life when you might need a little help coping or figuring out what to do. Take advantage of the Employee Assistance Program1 (EAP) which includes WorkLife Services and is available to you and your family in connection with your group insurance from Standard Insurance Company (The Standard). It’s confidential — information will be released only with your permission or as required by law.

Connection to Resources, Support and Guidance You, your dependents (including children to age 26)2 and all household members can contact master’s-degreed clinicians 24/7 by phone, online, live chat, email and text. There’s even a mobile EAP app. Receive referrals to support groups, a network counselor, community resources or your health plan. If necessary, you’ll be connected to emergency services.

With EAP, assistance is immediate, personal and available when you need it.

Your program includes up to three face-to-face assessment and counseling sessions per issue. EAP services can help with: Depression, grief, loss and emotional well-being Family, marital and other relationship issues Life improvement and goal-setting Addictions such as alcohol and drug abuse

Contact EAP

Stress or anxiety with work or family

888.293.6948 TDD: 800.327.1833 24 hours a day, seven days a week

Financial and legal concerns

workhealthlife.com/Standard3

Identity theft and fraud resolution Online will preparation

WorkLife Services NOTE: It’s a violation of your company’s contract to share this information with individuals who are not eligible for this service.

WorkLife Services are included with the Employee Assistance Program. Get help with referrals for important needs like education, adoption, travel, daily living and care for your pet, child or elderly loved one.

Online Resources Visit workhealthlife.com/Standard3 to explore a wealth of information online, including videos, guides, articles, webinars, resources, self-assessments and calculators.

1 The EAP service is provided through an arrangement with Morneau Shepell, which is not affiliated with The Standard. Morneau Shepell is solely responsible for providing and administering the included service. EAP is not an insurance product and is provided to groups of 10–2,499 lives. This service is only available while insured under The Standard’s group policy.

2 Individual EAP counseling sessions area available to eligible participants 16 years and older; family sessions are available for eligible members 12 years and older, and their parent or guardian. Children under the age of 12 will not receive individual counseling sessions.

The Standard is a marketing name for StanCorp Financial Group, Inc. and subsidiaries. Insurance products are offered by Standard Insurance Company of Portland, Oregon in all states except New York. Product features and availability vary by state and are solely the responsibility of Standard Insurance Company.

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Standard Insurance Company 1100 SW Sixth Avenue Portland, OR 97204

standard.com Employee Assistance Program-3 SI 17201 (7/17) EE

Notes

Notes