Burnet Consolidated ISD Employee Benefits Guide by Riata245

Contact Information Page(s) 3-4 TRS ActiveCare - Blue Cross Blue Shield 5 Phone: Website: 866.355.5999 www.bcbstx.com/trsactivecare TeleMedicine - 1.800MD 6-7 Phone: 800.530.8666 Website: www.1800md.com 8-9 Phone: Website: 10-11 Phone: Website: 12-19 Phone: Website: Vision - VSP 20 Phone: Website: 21-32 Phone: Website: 33-40 Phone: Website: 41-42 Phone: Website: www.5starlifeinsurance.com Group Life Insurance & AD&D - Lincoln Financial Permament Life Insurance - 5 Star Life Flexible Spending Accounts - NBS 855.399.3035 www.nbsbenefits.com 866.863.9753 This guide contains a summary of the benefits offered by Burnet Consolidated ISD. If there is a conflict between the terms of this outline of benefits and the actual contracts, the terms of the contracts will prevail. TABLE OF CONTENTS 800.423.2765 www.lincolnfinancial.com 2022-2023 Benefit Summary and Important Information Dental - MetLife 800.438.6388 www.metlife.com/mybenefits Disability - Lincoln 800.423.2765 www.lincolnfinancial.com Health Savings Acount - HSA Bank 800.357.6246 www.hsabank.com 800.877.7195 www.vsp.com 1

This guide contains a summary of the benefits offered by Burnet Consolidated ISD. If there is a conflict between the terms of this outline of benefits and the actual contracts, the terms of the contracts will prevail.

Contact Information Accident - MetLife 43-45 Phone: 800.438.6388 Website: www.metlife.com/mybenefits Hospital Indemnity - MetLife 46-48 Phone: 800.438.6388 Website: www.metlife.com/mybenefits 49-51 Phone: Website: www.ampublic.com Medical Transport - MASA 52 Phone: 800.423.3226 Website: www.masamts.com 53-54 Phone: Website: www.idwatchdog.com 55 Phone: Website: Scott & White Phone: 800.321.7947 Website: www.trs.swhp.org Phone: Website: Rusty Freeman, Managing Partner Email: rfreeman@usebsg.com ADDITIONAL CONTACT INFORMATION Retirement Plan Information - The Omni Group Cancer - American Public 800.256.8606

TABLE OF CONTENTS 877.544.6664 www.omni403b.com BCISD TPA - U.S. Employee Benefits Services Group 888.836.5100 www.mybenefitshub.com/burnetcisd 800.774.3772 Identity Theft - ID Watchdog 2

2022-2023 Benefits Summary

Medical Insurance by TRS

BCISD contributes $364.00 a month toward plan election

See back for details; plan descriptions located on the TRS website.

Telehealth by 1800MD - FREE FOR ENTIRE FAMILY!

Provided to all eligible employees & their families by BCISD

Plan allows employees and household members access to a national network of licensed doctors that can diagnose, recommend treatment, and prescribe medication all over the phone 24/7/365 for non-emergencies.

Vision Insurance by VSP—NEW CARRIER

BCISD contributes $5.98 a month

Members pay a co-pay for in-network benefits. Exam co-pay is $10.00 & materials co-pay is $25.00. Exams & lenses are covered innetwork once every 12 months. Additional frames may be purchased at a 20% discount. In-Network providers include Burnet Eye Care, Poole Eye Associates, Dr. Drinkard, Wal-Mart.

Dental Insurance by MetLife

BCISD contributes $28.59 a month

Don’t wait until the deadline.

Complete today!

Low Option PPO - Plan includes a $750 calendar year maximum; $50 deductible for individuals and $150 deductible for families. Class I expenses are paid at 100%; Class II expenses are paid at 60%; & Class III expenses are paid at 40%. Class IX & Orthodontia expenses are not covered. Plan includes contracted fees/max allowable charges.

High Option PPO - Plan includes a $1,500 calendar year maximum; $50 deductible for individuals and $150 deductible for families. Class 1 expenses are paid at 100%; Class II expenses are paid at 80%; Class III and IX expenses are paid at 50%. Orthodontia expenses are paid at 50% up to $1,000 (to age 19).

Group Term Life / AD&D by Lincoln

BCISD provides a $30,000 policy - FREE Group Term Life offers you an opportunity to purchase affordable term life insurance on a payroll deduction basis. Employees can also take additional voluntary life insurance. Rates are based on age / plan options. Employee Assistance Program through LifeKeys.

Hospital Indemnity Plan by MetLife

Plan supplements your medical coverage by covering some of the additional expenses of a hospital stay; benefits paid directly to you.

Permanent Life Insurance by 5 Star

Plan provides a death benefit to age 100. Individual policies can be purchased on the employee, their spouse, children, grandchildren.

Short & Long Term Disability by Lincoln

Plan protects one of your most valuable assets, your ability to earn a living. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury.

403(b) Plan Administration by Omni

BCISD offers voluntary participation in 403(b) plans which are administered by The Omni Group. BCISD contributes $1 for every $2 contributed by the employee up to a max amount of 2% of the employee’s monthly salary. Contact HR office for more details.

Flexible Spending Accounts by NBS

Allows an individual to set aside dollars pre-tax to pay for future health care &/or dependent care expenses on a “use it or lose it” basis. Medical reimbursement max is $2,850/plan year; dependent care reimbursement max is $5,000/plan year. NO fee to participate. Must re-enroll every year.

Health Savings Account (HSA) by HSABank

Allows an employee to accumulate pre-tax dollars in an account to assist with expenses for High Deductible (HD) health plans. Participant must be enrolled in an HD plan. Funds in this account DO roll over from year to year Annual maximum for an individual is $3,650 and family maximum is $7,300. 55 years and older can contribute an additional $1,000 per year. $1.75 monthly fee deducted from participants account each month.

Emergency Transportation by MASA

MASA provides medical emergency transportation solutions and covers your out of pocket medical transport cost when your insurance falls short. Zero out of pocket expenses for emergent air or ground transport, regardless of transport provider. $14.00 a month for the entire family.

Accident Insurance by MetLife

Benefits for hospital admission, ambulance, ER visits and more.

Questions? We can help!

Vision - Monthly Premiums (Actual Payroll Deduction) EE Only FREE EE + SP $6.02 EE+ Child(ren) $5.77 EE + Family $11.90 Dental - Monthly Premiums by Plan (Actual Payroll Deductions Reduced) Tier Low Plan High Plan EE Only FREE FREE EE + SP S8.67 $44.38 EE + Child(ren) $14.24 $50.05 EE + Family $36.82 $80.93

BCISD Human Resources (512) 756-2124

Online Open Enrollment Begins July 18th!

More Important Information

Covering Dependents?

To include dependents on any of your coverages through BCISD you must provide the dependents name, date of birth, and social security number.

Making Changes During Year

Choose your benefits carefully. Several of the employee benefits plan contributions are made on a pre-tax basis and per IRS regulations, contribution amounts cannot be changed unless you experience a qualified life event. Qualifying life events include:

• Marriage, divorce, legal separation;

• Death of spouse or dependent;

• Birth or adoption of a child;

• Changes in employment for spouse or dependents;

• Significant cost or coverage changes;

You must submit your benefit change requests and include required documentation within 30 days of the event. Also note that per the IRS, only changes consistent with the life event are allowed.

New Employees

New employees must enroll within 30 days of their hire date. If employees fail to enroll within the 30 days, all benefits will be waived.

Except for health insurance, plans will be effective on the first of the month following the date of hire. Health Insurance can be effective the date of hire or the first of the month following date of hire. Please be aware that if you choose date of hire as effective date for health insurance, you will be charged for the entire month.

Very Important

Please carefully review your paycheck(s) to ensure all deductions are correct. If you find a discrepancy in your paycheck, please contact U.S. Employee Benefits or the BCISD benefits office as soon as possible to correct. Discrepancies must be communicated within 30 days from the effective date of the policy.

Benefit Related Documents

For contact information, claim forms, benefits guides and more, please visit the Burnet Consolidated ISD website at www.mybenefitshub.com/burnetcisd

https://www.bcbstx.com/trsactivecare

TRS Plan Summaries

2022/2023 Online Open Enrollment July 18th - August 14th

Benefits Information Night: August 2 All Staff and Spouses Welcome! 6:00 pm, CO Board Room

Enrollment Assistance: August 10 All Staff 11:00 am–2 pm, BHS Library

Enroll Anytime, Anywhere; Research Plan Specifics: http://www.mybenefitshub.com/burnetcisd

Login Instructions: User Name: first 6 letters of last name, followed by the first letter of first name, then last 4 of social (i.e. darlinm1111) Password: full last name, followed by last four of social (i.e. darling1111)

BCISD contributes $364 a month (Premiums listed are actual payroll deductions) ActiveCare Plans by Blue Cross Blue Shield ActiveCare Primary ActiveCare HD ActiveCare Primary + ActiveCare 2 Closed to new participants Scott & White HMO https://trs.swhp.org/ EE Only FREE $12.00 $93.00 $649.00 $127.55 EE + SP $662.00 $694.00 $753.00 $2038.00 $868.58 EE + Child(ren) $290.00 $311.00 $371.00 $1143.00 $425.39 EE + Family $864.00 $901.00 $1041.00 $2477.00 $1054.42 2022

2023

Medical Insurance by TRS - Monthly Premiums by Plan

Medical Benefit Summary

All ActiveCare choices are BCBS; Caremark RX ActiveCare Primary Active Care HD ActiveCare Primary + ActiveCare 2 Closed to new participants Scott & White HMO Deductible (In-Network) $2,500 individual $5,000 family $3,000 individual $6,000 family $1,200 individual $3,600 family $1,000 individual $3,000 family $1,900 individual $4,750 family Deductible (Out-of-Network) Only ER visits covered if out-of-network. $5,500 individual $11,000 family Only ER visits covered if out-of-network. $2,000 individual $6,000 family Only ER visits covered if out-of-network. Out-Of-Pocket Max In-Network (Includes Deductible + RX) $8,150 individual $16,300 family $7,050 individual $14,100 family $6,900 individual $13,800 family $7,900 individual $15,800 family $8,000 individual $15,000 family Out-Of-Pocket Max Out-of-network (Includes Deductible + RX) $20,250 individual $40,500 family $23,700 individual $47,400 family Network Statewide in-network Nationwide Statewide in-network Nationwide Regional in-network PCP and Referrals Required Yes No Yes No No Health Savings Acct Eligible No Yes No No No Doctor Office Visits $30 copay - primary $70 copay - specialist 30% after deductible in-network; 50% after deductible out-of-network $30 copay - primary $70 copay - specialist $30 copay primary $70 copay specialist 40% after deductible outof-network $15 copay-primary $0 copay-primary for children under 19 $70 copay - specialist Preventive Care Plan Pays 100% (deductible waived) Plan Pays 100% (deductible waived) Plan Pays 100% (deductible waived) Plan Pays 100% (deductible waived) Plan Pays 100% (deductible waived) Co-Insurance 30% after deductible 30% after deductible in-network; 50% after deductible out-of-network 20% after deductible 20% after deductible innetwork; 40% after deductible out-of-network 20% after deductible Emergency Room 30% after deductible 30% after deductible in-network; 20% after deductible $250 copay + 20% per visit after deductible $500 copay per visit after deductible Urgent Care $50 copay per visit 30% after deductible in-network; 50% after deductible out-of-network $50 copay per visit $50 copay per visit innetwork; 40% after deductible out-of-network $45 copay per visit Prescription Drug Deductible integrated with medical; $15 Generic 30-day $45 Generic 90-day 30%-50% after deductible for all others NO Cost for certain generic preventative drugs (complete list on website) Deductible integrated with medical; 20%

25%

Name $15

$45

25%

Name $20 Generic 30

$45 Generic 90

25%-50% after

for all others

for Brand Name $12 Generic 30

day $30 Generic 90

day 30% -50% after deductible for all others

generic after deductible;

-50% after deductible all others NO Cost for certain generic preventative drugs (complete list on website) $200 Deductible for Brand

Generic 30-day

Generic 90-day

-50% for all others after deductible $200 Deductible for Brand

-day

deductible

$200 Deductible

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1.800MD is a fast, convenient alternative to waiting days for an appointment or spending hours sitting in the doctor’s office, urgent care or ER. Whether it is 2 a.m. from your toddler’s room or 7 p.m. from your business trip destination, our telehealth solutions save you time and money while providing peace of mind.

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Visits to the emergency room or urgent care are costly prices to pay when many visits can be handled by calling 1.800MD. As a low-cost alternative 1.800MD physicians treat many common conditions via phone or video consultations, reducing unnecessary doctor’s visits and saving you money.

HOW DOES IT WORK?

CONVENIENCE AND QUALITY CARE

With more than a decade of experience, 1.800MD provides individuals, families, employers and groups with best of class medical care 24/7/365. Available any time day or night, our board-certified physicians are equipped to diagnose, recommend treatment and prescribe medications while in the comfort of your home, office or business trip destination.

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Independently owned, 1.800MD focuses on customer satisfaction. Our member service representatives are available any time to assist you or answer any questions you may have.

CUTTING EDGE TECHNOLOGY

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Activate your account online at www.1800md.com or by calling 1.800.530.8666. Once activated, you will need to setup your member profile and complete your electronic health record.

2.REQUEST A CONSULT

3.RECEIVE CARE

Receive diagnosis and treatment, giving you quality care and peace of mind where ever you are.

1.800.530.8666 www.

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1800MD

OVERVIEW

Call

1.800.530.8666 or visit www.1800MD.com

secure convenient care anywhere.

Quality Care When You Need It Most Frequently Asked Questions

Q: What is 1.800MD?

A: With more than a decade of experience, 1.800MD is focused on providing individuals, families, employers and groups with convenient medical care, anywhere in the United States* at any time. You can rest assured that 1.800MD’s personalized telehealth solutions are unparalleled.

How does 1.800MD improve quality of care?

A: 1.800MD provides fast, convenient care for minor medical matters from the flu to allergies to urinary tract infections. With one of the largest networks of telemedicine physicians in the nation, 1.800MD’s board-certified physicians are equipped to diagnose, recommend treatment and prescribe medications from the comfort of your home, office or travel destination (within the United States, subject to state regulations) 24/7/365.

Q: How does 1.800MD reduce health care costs?

A: 1.800MD saves you money by diagnosing and treating common ailments through our telehealth solutions, thus reducing unnecessary doctor’s office and emergency room visits. Data shows up to 70 percent of all urgent care and emergency room visits are unneeded, costly and can be handled with a 1.800MD telephone or video consultation.

Q: What about the doctors?

A: 1.800MD has one of the largest networks of telemedicine physicians in the nation to ensure convenient care anywhere. A thorough review of medical licensure, training, education, work and malpractice history is performed every two years by a national third-party credentialing agency in accordance with the National Committee for Quality Assurance and the Utilization Review Accreditation Committee guidelines. With an average of 15 years of internal medicine, family practice or pediatrics experience, you can rest assured each physician is properly licensed in your state, board-certified and verified by the National Physician Data Base and the American Medical Association.

Q: Is there a minimum age requirement?

A: There is no minimum age to consult with a 1.800MD physician. However, the patient must have the ability to communicate his or her condition to the doctor to ensure the physician can properly diagnose and treat.

Q: I have a pre-existing condition. Will 1.800MD still accept me?

A: Absolutely! 1.800MD is not insurance. We do not deny access to quality care because of pre-existing conditions.

Q: Can I get a consultation after hours or on weekends?

A: Yes. 1.800MD is available 24 hours a day, seven days a week and 365 days a year.

Q: How are prescriptions filled?

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A: Yes. While a 1.800MD physician can prescribe appropriate medications to treat your condition such as antibiotics, antihistamines and maintenance medicines, our physicians do not prescribe lifestyle drugs, medications regulated by the Drug Enforcement Agency or those that pose a potential for abuse or addiction.

For all other questions, please contact us at 1 (800) 530-8666.

Employee Benefits

Group

Offered through

U.S.

Services

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

How to Spend

Spending is easy

Partial List of Eligible Expenses:

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

Medical/Dental/Vision Copays and Deductibles

Prescription Drugs

Physical Therapy

Chiropractor

First-Aid Supplies

Lab Fees

Flexible Spending Account (FSA)

Account access is easy

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

Life’s not always flexible, but your money can be. From baby care to pain relief, shop the largest selection of guaranteed FSA-eligible products with zero guesswork at FSA Store. Is your health need FSA-eligible? Find out using our comprehensive Eligibility List . Get $10 off using code NBS1819 . Shop FSA Store at fsastore.com/nbs

Two Types of FSAs

Psychiatrist/Psychologist

Vaccinations

Dental Work/Orthodontia

Eye Exams

Laser Eye Surgery

Eyeglasses, Contact Lenses, Lens Solution

Prescribed OTC Medication

Enrollment Consideration

After the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying “change of status” (e.g. marriage, divorce, employment change, dependent change). Be conservative in the total amount you elect to avoid forfeiting money at the end of the plan year.

To take advantage of a health FSA, start by choosing an annual election amount. This amount will be available on day one of your plan year for eligible medical expenses. Payroll deductions will then be made throughout the plan year to fund your account.

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

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

What is a Cafeteria Plan?

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

Health Savings Accounts

Start saving more on healthcare.

A Health Savings Account (HSA) is an individually-owned, tax‐advantaged account that you can use to pay for current or future IRS‐qualified medical expenses. With an HSA, you’ll have the potential to build more savings for healthcare expenses or additional retirement savings through self-directed investment options¹ .

How an HSA works:

• You can contribute to your HSA via payroll deduction, online banking transfer, or by sending a personal check to HSA Bank. Your employer or third parties, such as a spouse or parent, may contribute to your account as well.

• You can pay for qualified medical expenses with your Health Benefits Debit Card directly to your medical provider or pay out-of-pocket. You can either choose to reimburse yourself or keep the funds in your HSA to grow your savings.

• Unused funds will roll over year to year. After age 65, funds can be withdrawn for any purpose without penalty (subject to ordinary income taxes).

• Check balances and account information via HSA Bank’s Member Website or mobile device 24/7.

Are you eligible for an HSA?

If you have a qualified High Deductible Health Plan (HDHP) - either through your employer, through your spouse, or one you’ve purchased on your own - chances are you can open an HSA. Additionally:

• You cannot be covered by any other non-HSA-compatible health plan, including Medicare Parts A and B.

• You cannot be covered by TriCare.

• You cannot be claimed as a dependent on another person’s tax return (unless it’s your spouse).

• You must be covered by the qualified HDHP on the first day of the month.

When you open an account, HSA Bank will request certain information to verify your identity and to process your application.

What are the annual IRS contribution limits?

Contributions made by all parties to an HSA cannot exceed the annual HSA limit set by the Internal Revenue Service (IRS). Anyone can contribute to your HSA, but only the accountholder and employer can receive tax deductions on those contributions. Combined annual contributions for the accountholder, employer, and third parties (i.e., parent, spouse, or anyone else) must not exceed these limits.2

2022

Contribution

Individual = $3,650

Family = $7,300

2023

Individual = $3,850

Family = $7,600

Catch-up Contributions

According to IRS guidelines, each year you have until the tax filing deadline to contribute to your HSA (typically April 15 of the following year). Online contributions must be submitted by 2:00 p.m., Central Time, the business day before the tax filing deadline. Wire contributions must be received by noon, Central Time, on the tax filing deadline, and contribution forms with checks must be received by the tax filing deadline.

Accountholders who meet these qualifications are eligible to make an HSA catch-up contribution of $1,000: Health Savings accountholder; age 55 or older (regardless of when in the year an accountholder turns 55); not enrolled in Medicare (if an accountholder enrolls in Medicare mid-year, catch-up contributions should be prorated). Spouses who are 55 or older and covered under the accountholder’s medical insurance can also make a catch-up contribution into a separate HSA in their own name.

Annual HSA Limits Annual HSA Contribution Limits

How can you benefit from tax savings?

An HSA provides triple tax savings.3 Here’s how:

• Contributions to your HSA can be made with pre-tax dollars and any after-tax contributions that you make to your HSA are tax deductible.

• HSA funds earn interest and investment earnings are tax free.

• When used for IRS-qualified medical expenses, distributions are free from tax.

IRS-Qualified Medical Expenses

You can use your HSA to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse, or tax dependents. An IRSqualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free.

HSA funds can be used to reimburse yourself for past medical expenses if the expense was incurred after your HSA was established. While you do not need to submit any receipts to HSA Bank, you must save your bills and receipts for tax purposes.

Examples of IRS-Qualified Medical Expenses4:

Acupuncture

Alcoholism treatment

Ambulance services

Annual physical examination

Artificial limb or prosthesis

Birth control pills (by prescription)

Chiropractor

Childbirth/delivery

Convalescent home (for medical treatment only)

Crutches

Doctor’s fees

Dental treatments (including x-rays, braces, dentures, fillings, oral surgery)

Dermatologist

Diagnostic services

Disabled dependent care

Drug addiction therapy

Fertility enhancement (including in-vitro fertilization)

Guide dog (or other service animal)

Gynecologist

Hearing aids and batteries

Hospital bills

Insurance premiums5

Laboratory fees

Lactation expenses

Lodging (away from home for outpatient care)

Nursing home

Nursing services

Obstetrician

Osteopath

Oxygen

Pregnancy test kit

Podiatrist

Prescription drugs and medicines (over-the-counter drugs are not IRS-qualified medical expenses unless prescribed by a doctor)

Prenatal care & postnatal treatments

Psychiatrist

Psychologist

Smoking cessation programs

Special education tutoring

Surgery

Telephone or TV equipment to assist the hearing or vision

impaired

Therapy or counseling

Medical transportation expenses

Transplants

Vaccines

Vasectomy

Vision care (including eyeglasses, contact lenses, lasik surgery)

Weight loss programs (for a specific disease diagnosed by a physician – such as obesity, hypertension, or heart disease)

Wheelchairs

X-rays

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 funds contributed in excess of these limits are subject to penalty and tax unless the excess and earnings are withdrawn prior to the due date, including any extensions for filing Federal Tax returns. Accountholders should consult with a qualified tax advisor in connection with excess contribution removal. The Internal Revenue Service requires HSA Bank to report withdrawals that are considered refunds of excess contributions. In order for the withdrawal to be accurately reported, accountholders may not withdraw the excess directly. Instead, an excess contribution refund must be requested from HSA Bank and an Excess Contribution Removal Form completed.

3 Federal Tax savings are available no matter where you live and HSAs are taxable in AL, CA, and NJ. HSA Bank does not provide tax advice. Consult your tax professional for tax‐related questions.

4 This list is not comprehensive. It is provided to you with the understanding that HSA Bank is not engaged in rendering tax advice. The information provided is not intended to be used to avoid Federal tax penalties. For more detailed information, please refer to IRS Publication 502 titled, “Medical and Dental Expenses”. Publications can be ordered directly from the IRS by calling 1-800-TAXFORM. If tax advice is required, you should seek the services of a professional.

5 Insurance premiums only qualify as an IRS-qualified medical expense: while continuing coverage under COBRA; for qualified long-term care coverage; coverage while receiving unemployment compensation; for any healthcare coverage for those over age 65 including Medicare (except Medicare supplemental coverage).

Please call the number on the back of your HSA Bank debit card or visit us at www.hsabank.com

Dental

Metropolitan Life Insurance Company

Plan Design for: Burnet CISD

Original Plan Effective Date: September 1, 2020

Network: PDP Plus

The Preferred Dentist Program was designed to help you get the dental care you need and help lower your costs. You get benefits for a wide range of covered services — both in and out of the network. The goal is to deliver affordable protection for a healthier smile and a healthier you.

Ortho applies to Child Only Child to age 19

In-Network1 Out-of-Network1

Plan Coverage Type: In-Network % of Negotiated Fee2 Out-of-Network1 % of R&C Fee4 Type A - Preventive 100% 100% Type B - Basic Restorative 80% 80% Type C - Major Restorative 50% 50% Type D – Orthodontia 50% 50% Deductible3 Individual $50 $50 Family $150 $150 Annual Maximum Benefit: Per Individual $1500 $1500 Orthodontia Lifetime Maximum

High

$1000 per Person $1000 per Person Dependent Age: Eligible

Coverage Type: In-Network % of Negotiated Fee2 Out-of-Network1 % of Negotiated Fee2 Type A - Preventive 100% 100% Type B - Basic Restorative 60% 60% Type C - Major Restorative 40% 40% Type D – Orthodontia NA NA Deductible3 Individual $50 $50 Family $150 $150 Annual Maximum Benefit: Per Individual $750 $750 Dependent Age: Eligible for benefits

she

26. 12

for benefits until the day that he or she turns 26. Low Plan

until the day that he or

turns

Understanding Your Dental Benefits Plan

The Preferred Dentist Program is designed to provide the dental coverage you need with the features you want. Like the freedom to visit the dentist of your choice – in or out of the network. .

If you receive in-network services, you will be responsible for any applicable deductibles, cost sharing, negotiated charges after benefit maximums are met, and costs for non-covered services. If you receive out-of-network services, you will be responsible for any applicable deductibles, cost sharing, charges in excess of the benefit maximum, charges in excess of the negotiated fee schedule amount or R&C Fee, and charges for non-covered services.

• Certain plan benefits are based on a percentage of the negotiated fee. This is the amount that participating dentists have agreed to accept as payment in full. If your plan benefits are based on a percentage of the Reasonable and Customary (R&C) charges, your out-of-pocket expenses may be more, since you will be responsible for paying any difference between the dentist's fee and your plan's payment for the approved service.

Take advantage of online self-service capabilities with MyBenefits.

• Check the status of your claims

• Locate a participating PDP dentist

• Access MetLife’s Oral Health Library

• Elect to view your Explanation of Benefits online

If you are not already registered, just go to www.metlife.com/mybenefits and follow the easy registration instructions.

High Plan  Employee Only $0.00  Employee + Spouse $44.38  Employee + Child(ren) $50.05  Employee + Family $80.93 Low Plan  Employee Only $0.00  Employee + Spouse $8.67  Employee + Child(ren) $14.24  Employee + Family $36.82

Selected Covered Services and Frequency Limitations*

• Dependent children up to age 19. Age limitations may vary by state. Please see your Plan description for complete details. In the event of a conflict with this summary, the terms of the certificate will govern.

• All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia.

• Benefits for the initial placement will not exceed 20% of the Lifetime Maximum Benefit Amount for Orthodontia. Periodic follow-up visits will be payable on a monthly basis during the scheduled course of the orthodontic treatment. Allowable expenses for the initial placement, periodic follow-up visits and procedures performed in connection with the orthodontic treatment, are all subject to the Orthodontia coinsurance level and Lifetime Maximum Benefit Amount as defined in the Plan Summary.

• Orthodontic benefits end at cancellation of coverage

*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.

The service categories and plan limitations shown above represent an overview of your Plan of Benefits. This document presents many services within each category, but is not a complete description of the Plan. Please see your Plan description/Insurance certificate for complete details. In the event of a conflict with this summary, the terms of your insurance certificate will govern.

Plan

A - Preventive

Many/How Often: Oral Examinations 1 in 6 months Full Mouth X-rays 1 in 60 months Bitewing X-rays (Adult/Child) 1 in 12 months Prophylaxis - Cleanings 1 in 6 months

Fluoride Applications 1 in 12 months - Children to age 14 Sealants 1 in a lifetime - Children to age 14 Space Maintainers 1 per lifetime per tooth area - Children up to age 14 Periodontal Maintenance 2 in 1 year, includes 2 cleanings Emergency Palliative Treatment Type B - Basic Restorative How Many/How Often: Amalgam and Composite Fillings 1 in 24 months. Prefabricated Crowns 1 per tooth in 10 years Oral Surgery (Simple Extractions) Oral Surgery (Surgical Extractions) Other Oral Surgery General Anesthesia Consultations 1 in 12 months

C - Major Restorative How Many/How Often: Crowns/Inlays/Onlays 1 per tooth in 10 years Endodontics Root Canal 1 per tooth per lifetime Periodontal Surgery 1 in 36 months per quadrant Periodontal Scaling & Root Planing 1 in 24 months per quadrant Bridges 1 in 10 years Dentures 1 in 10 years Implant Services 1 service per tooth in 10 years - 1 repair per 10 years

High

Type

How

Topical

Type

Orthodontia

Type D –

Selected Covered Services and Frequency Limitations*

Low Plan Type A - Preventive How Many/How Often: Oral Examinations 1 in 6 months Full Mouth X-rays 1 in 60 months Bitewing X-rays (Adult/Child) 1 in 12 months Prophylaxis - Cleanings 1 in 6 months Topical Fluoride Applications 1 in 12 months - Children to age 14 Sealants 1 in a lifetime - Children to age 14 Space Maintainers 1 per lifetime per tooth area - Children up to age 14 Periodontal Maintenance 2 in 1 year, includes 2 cleanings Emergency Palliative Treatment Type B - Basic Restorative How Many/How Often: Amalgam and Composite Fillings 1 in 24 months. Prefabricated Crowns 1 per tooth in 10 years Oral Surgery (Simple Extractions) Consultations 1 in 12 months Type C - Major Restorative How Many/How Often: Crowns/Inlays/Onlays 1 per tooth in 10 years Repairs 1 in 24 months Endodontics Root Canal 1 per tooth per lifetime Periodontal Surgery 1 in 36 months per quadrant Periodontal Scaling & Root Planing 1 in 24 months per quadrant Oral Surgery (Surgical Extractions) Other Oral Surgery Bridges 1 in 10 years Dentures 1 in 10 years General Anesthesia Implant Services 1 service per tooth in 10 years - 1 repair per 10 years

We will not pay Dental Insurance benefits for charges incurred for:

1. 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;

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

3. Services or supplies received by You or Your Dependent before the Dental Insurance starts for that person;

4. Services which are primarily cosmetic (For residents of Texas, see notice page section in your certificate).

5.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:

• scaling and polishing of teeth; or

• fluoride treatments.

For NY Sitused Groups, this exclusion does not apply.

6.Services or appliances which restore or alter occlusion or vertical dimension.

7. Restoration of tooth structure damaged by attrition, abrasion or erosion.

8. Restorations or appliances used for the purpose of periodontal splinting.

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

10 Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss.

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

12 Missed appointments.

13.Services

• covered under any workers’ compensation or occupational disease law;

• covered under any employer liability law;

• for which the employer of the person receiving such services is not required to pay; or

• received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital. For North Carolina and Virginia Sitused Groups, this exclusion does not apply.

14.Services paid under any worker’s compensation, occupational disease or employer liability law as follows:

• for persons who are covered in North Carolina for the treatment of an Occupational Injury or Sickness which are paid under the North Carolina Workers’ Compensation Act only to the extent such services are the liability of the employee, employer or workers’ compensation insurance carrier according to a final adjudication under the North Carolina Workers’ Compensation Act or an order of the North Carolina Industrial Commission approving a settlement agreement under the North Carolina Workers’ compensation Act;

• or for persons who are not covered in North Carolina, services paid or payable under any workers compensation or occupational disease law. This exclusion only applies for North Carolina Sitused Groups

15.Services:

• for which the employer of the person receiving such services is required to pay; or

• received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital. This exclusion only applies for North Carolina Sitused Groups

16.Services covered under any workers' compensation, occupational disease or employer liability law for which the employee/or Dependent received benefits under that law. This exclusion only applies for Virginia Sitused Groups

17.Services:

• for which the employer of the person receiving such services is not required to pay; or

• received at a facility maintained by the policyholder, labor union, mutual benefit association, or VA hospital. This exclusion only applies for Virginia Sitused Groups.

18.Services covered under other coverage provided by the Employer.

19 Temporary or provisional restorations.

20 Temporary or provisional appliances.

21 Prescription drugs.

22.Services for which the submitted documentation indicates a poor prognosis.

23 The following when charged by the Dentist on a separate basis:

• claim form completion;

• infection control such as gloves, masks, and sterilization of supplies; or

• local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.

24 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.

For NY Sitused Groups, this exclusion does not apply.

25 Caries susceptibility tests.

26 Other fixed Denture prosthetic services not described elsewhere in this certificate.

27 Precision attachments, except when the precision attachment is related to implant prosthetics.

28 Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it.

29 Fixed and removable appliances for correction of harmful habits.1

30 Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards.1

31 Diagnosis and treatment of temporomandibular joint (TMJ) disorders. This exclusion does not apply to residents of Minnesota.1

32 Orthodontic services or appliances. 1

33. Repair or replacement of an orthodontic device.1

34. Duplicate prosthetic devices or appliances.

Replacement of a lost or stolen appliance, Cast Restoration, or Denture.

36 Intra and extraoral photographic images.

37 Services or supplies furnished as a result of a referral prohibited by Section 1-302 of the Maryland Health Occupations Article. A prohibited referral is one in which a Health Care Practitioner refers You to a Health Care Entity in which the Health Care Practitioner or Health Care Practitioner’s immediate family or both own a Beneficial Interest or have a Compensation Agreement. For the purposes of this exclusion, the terms “Referral”, “Health Care Practitioner” , “Health Care Entity”, “Beneficial Interest” and Compensation Agreement have the same meaning as provided in Section 1-301 of the Maryland Health Occupations Article.

This exclusion only applies for Maryland Sitused Groups

1Some of these exclusions may not apply. Please see your Certificate of Insurance.

Common Questions … Important Answers

Who is a participating dentist?

A participating, or network, 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, subject to any deductibles, copayments, cost sharing and benefit maximums. Negotiated fees typically range from 30-45% below the average fees charged in a dentist’s community for the same or substantially similar services.*

In addition to the standard MetLife network, your employer may provide you with access to a select network of dental providers that may be unique to your employer’s dental program. When visiting these providers, you may receive a better benefit, have lower out-of-pocket costs and/or have access to care at facilities at your worksite. Please sign into MyBenefits for more details.

* Based on internal analysis by MetLife. Negotiated fees refer to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. Savings from enrolling in a dental benefits plan will depend on various factors, including the cost of the plan, how often members visit a dentist and the cost of services rendered. Negotiated fees are subject to change.

How do I find a participating dentist?

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/dental or call 1-800-275-4638 to have a list faxed or mailed to you.

What services are covered by my plan?

Please see your Certificate of Insurance for a list of covered services.

May I choose a non-participating dentist?

Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating (out-of-network) dentist, your out-of-pocket costs may be greater than your out-of-pocket costs when visiting an in-network dentist.

Can my dentist apply for participation in the network?

Yes. If your current dentist does not participate in the network and you would like to encourage him or 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.

* Due to contractual requirements, MetLife is prevented from soliciting certain providers.

How are claims processed?

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/dental or request one by calling 1-800-275-4638.

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

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.

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

Yes. Through international dental travel assistance services* you can obtain a referral to a local dentist by calling +1-312-356-5970 (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.

*International Dental Travel Assistance services are administered by AXA Assistance USA, Inc. (AXA Assistance). AXA Assistance provides dental referral services only. AXA Assistance is not affiliated with MetLife and any of its affiliates, and the services they provide are separate and apart from the benefits provided by MetLife. Referral services are not available in all locations.

** Refer to your Certificate of Insurance for your out-of-network dental coverage.

How does MetLife coordinate benefits with other insurance plans?

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. 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.

Do I need an ID card?

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 a MetLife Dental Plan. Your dentist can easily verify information about your coverage through a toll-free automated Computer Voice Response system.

Do my dependents have to visit the same dentist that I select?

No. You and your dependents each have the freedom to choose any dentist.

If I do not enroll during my initial enrollment period can I still purchase Dental Insurance at a later date?

Yes, employees who do not elect coverage during enrollment period may still elect coverage later. Dental coverage would be subject to the following waiting periods.

• No waiting period on Preventive Services

• 6 months on Basic Restorative (Fillings)

• 12 months on all other Basic Services

• 24 months on Major Services

• 24 months on Orthodontia Services (if applicable)

Like most group benefits programs, MetLife group benefits programs contain certain exclusions, waiting periods, reductions and terms for keeping them in force. The certificate of insurance sets forth the plan terms and provisions, including the exclusions and limitations.

YOUR VSP VISION BENEFITS SUMMARY

BURNET CONSOLIDATED SCHOOL DISTRICT and VSP provide you with an affordable vision plan.

PROVIDER NETWORK: VSP Advantage

EFFECTIVE DATE: 09/01/2022

COPAY DESCRIPTION BENEFIT

WELLVISION EXAM

YOUR COVERAGE WITH A VSP PROVIDER

Focuses on your eyes and overall wellness

Retinal screening for members with diabetes

ESSENTIAL MEDICAL EYE CARE

Additional exams and services beyond routine care to treat immediate issues from pink eye to sudden changes in vision or to monitor ongoing conditions such as dry eye, diabetic eye disease, glaucoma, and more.

Coordination with your medical coverage may apply. Ask your VSP doctor for details.

PRESCRIPTION GLASSES

FRAME

LENSES

LENS ENHANCEMENTS

CONTACTS (INSTEAD OF GLASSES)

$145 featured frame brands allowance

$125 frame allowance

20% savings on the amount over your allowance

$125 Walmart®/Sam's Club® frame allowance

$65 Costco® frame allowance

Single vision, lined bifocal, and lined trifocal lenses

Impact-resistant lenses for dependent children

Standard progressive lenses

Premium progressive lenses

Custom progressive lenses

Average savings of 20-25% on other lens enhancements

$120 allowance for contacts and contact lens exam (fitting and evaluation)

15% savings on a contact lens exam (fitting and evaluation)

Glasses and Sunglasses

FREQUENCY

$10

$0 per screening

$20 per exam

Every 12 months

Available as needed

$25

Included in Prescription Glasses

$95 - $105

$150 - $175

Every 12 months

Every 12 months $0

Extra $20 to spend on featured frame brands. Go to vsp.com/offers 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

Routine 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 COVERAGE WITH OUT-OF-NETWORK PROVIDERS

Get the most out of your benefits and greater savings with a VSP network doctor. Call Member Services for out-of-network plan details. Coverage with a retail chain may be different or not apply. Log in to vsp.com to check your benefits for eligibility and to confirm in-network locations based on your plan type. VSP guarantees coverage from VSP network providers only. 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. In the state of Washington, VSP Vision Care, Inc., is the legal name of the corporation through which VSP does business.

*Only available to VSP members with applicable plan benefits. Frame brands and promotions are subject to change. Savings based on doctor s retail price and vary by plan and purchase selection; average savings determined after benefits are applied. Ask your VSP network doctor for more details.

Classification: Restricted

©2022 Vision Service Plan. All rights reserved. VSP, VSP Vision Care for life, Eyeconic, and WellVision Exam are registered trademarks. Flexon is a registered trademark of Marchon Eyewear, Inc. All other brands or marks are the property of their respective owners.

Voluntary Short Term Disability Insurance

Option Two

The Lincoln Shortterm Disability Insurance Plan:

• Provides a cash benefit when you are out of work for up to 24 weeks due to injury, illness, surgery, or recovery from childbirth

• Provides a partial cash benefit if you can only do part of your job or work part time

• Features group rates for Burnet CISD employees

• Offers a fast, no-hassle claims process

Eligible Employees of Burnet CISD Benefits

At-A-Glance

Short-term Disability

Weekly benefit amount

60% of your weekly salary, limited to $1,400 per week

Sickness elimination period 14 days

Accident elimination period 14 days

First day hospitalization 0 days

Maximum coverage period 24 weeks

Sickness Elimination Period

• You must be out of work for 14 days due to an illness before you can collect disability benefits. You can begin collecting benefits on day 15.

Accident Elimination Period

• You must be out of work for 14 days due to an accidental injury before you can collect disability benefits. You can begin collecting benefits on day 15.

First Day Hospitalization

• The elimination period is reduced if you are hospitalized due to an illness or accidental injury. You can begin collecting benefits on the first day of hospitalization.

Pre-existing Condition

• If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 3 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months.

Benefits Integration

• Your short-term disability benefits can coordinate with income from other sources, such as continued income or sick pay from your employer, during your disability.

• This allows you to receive up to 100% of your pre-disability income.

Additional Plan Benefits

• When you are first offered this coverage (and during approved open enrollment periods), you can take advantage of this important coverage with no health examination.

Benefit Exclusions & Reductions

Like any insurance, this short-term disability insurance policy does have some exclusions. You will not receive benefits if:

• Your disability is the result of a self-inflicted injury or act of war

• You are not under the regular care of a doctor when you request disability benefits

Your benefits may be reduced if you are eligible to receive benefits from:

• A state disability plan or similar compulsory benefit act or law

• A retirement plan

• Social Security

• Any form of employment

• Workers’ Compensation

A complete list of benefit exclusions and reductions is included in the policy. State restrictions may apply to this plan.

5% Rehabilitation Assistance Included Premium Waiver Included Portability Included Open Enrollment

Voluntary Short Term Disability Premium

Here’s how little you pay with group rates.

Your estimated monthly premium is determined by multiplying your monthly salary amount (up to $10,111) by your age-range premium rate. If your monthly salary exceeds $10,111, multiply $10,111 by your premiumrate.

$ monthly

premium rate =$ monthly premium Age Range Premium Rate 0 - 29 0.00340 30 - 34 0.00340 35 - 39 0.00340 40 - 44 0.00510 45 - 49 0.00690 50 - 54 0.00760 55 - 59 0.01010 60 - 64 0.01170 65 - 69 0.01170 70 - 99 0.01170 23

salary X

Voluntary Short Term Disability Insurance

Option One

The Lincoln Shortterm Disability Insurance Plan:

• Provides a cash benefit when you are out of work for up to 22 weeks due to injury, illness, surgery, or recovery from childbirth

• Provides a partial cash benefit if you can only do part of your job or work part time

• Features group rates for Burnet CISD employees

• Offers a fast, no-hassle claims process

Eligible Employees of Burnet CISD Benefits

At-A-Glance

Short-term Disability

Weekly benefit amount

60% of your weekly salary, limited to $1,400 per week

Sickness elimination period 30 days

Accident elimination period 30 days

First day hospitalization 0 days

Maximum coverage period 22 weeks

Sickness Elimination Period

• You must be out of work for 30 days due to an illness before you can collect disability benefits. You can begin collecting benefits on day 31.

Accident Elimination Period

• You must be out of work for 30 days due to an accidental injury before you can collect disability benefits. You can begin collecting benefits on day 31.

First Day Hospitalization

• The elimination period is reduced if you are hospitalized due to an illness or accidental injury. You can begin collecting benefits on the first day of hospitalization.

Pre-existing Condition

Benefits Integration

• Your short-term disability benefits can coordinate with income from other sources, such as continued income or sick pay from your employer, during your disability.

• This allows you to receive up to 100% of your pre-disability income.

Additional Plan Benefits

• When you are first offered this coverage (and during approved open enrollment periods), you can take advantage of this important coverage with no health examination.

Benefit Exclusions & Reductions

Like any insurance, this short-term disability insurance policy does have some exclusions. You will not receive benefits if:

• Your disability is the result of a self-inflicted injury or act of war

• You are not under the regular care of a doctor when you request disability benefits

Your benefits may be reduced if you are eligible to receive benefits from:

• A state disability plan or similar compulsory benefit act or law

• A retirement plan

• Social Security

• Any form of employment

• Workers’ Compensation

A complete list of benefit exclusions and reductions is included in the policy. State restrictions may apply to this plan.

5% Rehabilitation Assistance Included Premium Waiver Included Portability Included Open Enrollment

Voluntary Short Term Disability Premium

Here’s how little you pay with group rates.

Your estimated monthly premium is determined by multiplying your monthly salary amount (up to $10,111) by your age-range premium rate. If yourmonthly salary exceeds $10,111, multiply $10,111 by your premiumrate.

premium rate

monthly premium Age Range Premium Rate 0 - 29 0.00260 30 - 34 0.00260 35 - 39 0.00260 40 - 44 0.00380 45 - 49 0.00510 50 - 54 0.00760 55 - 59 0.01010 60 - 64 0.01170 65 - 69 0.01170 70 - 99 0.01170 26

monthly salary X

Voluntary Long Term Disability Insurance

Option One

The Lincoln Long-term Disability Insurance

Advantage Plan:

• Provides a cash benefit after you are out of work for 90 days or more due to injury, illness, or surgery

• Features group rates for Burnet CISD employees

• Includes EmployeeConnectSM services, which give you and your family confidential access to counselors as well as personal, legal, and financial assistance

Eligible Employees of Burnet CISD Benefits

At-A-Glance

Long-term Disability

Monthly benefit amount

Elimination period

Coverage period for your occupation

Maximum coverage period

Elimination Period

60% of your monthly salary, limited to $6,000 per month

90 days

24 months

Up to age 65 or Social Security

Normal Retirement Age (SSNRA), whichever is later

• This is the number of days you must be disabled before you can collect disability benefits.

• The 90-day elimination period can be met through either total disability (out of work entirely) or partial disability (working with a reduced schedule or performing different types of duties).

Coverage Period for Your Occupation

• This is the coverage period for the trade or profession in which you were employed at the time of your disability (also known as your own occupation).

• You may be eligible to continue receiving benefits if your disability prohibits you from any employment for which you are reasonably suited through your training, education, and experience. In this case, your benefits are extended through the end of your maximum coverage period (benefit duration).

Maximum Coverage Period

• This is the total amount of time you can collect disability benefits (also known as the benefit duration).

• Benefits are limited to 24 months for mental illness; 24 months for substance abuse.

Pre-existing Condition

Additional Plan Benefits

Benefit Exclusions & Reductions

Like any insurance, this long-term disability insurance policy does have some exclusions. You will not receive benefits if:

• Your disability is the result of a self-inflicted injury or act of war

• You are not under the regular care of a doctor when you request disability benefits

• Your disability occurs while you are committing a felony or participating in a riot

• Your disability occurs while you are imprisoned for committing a felony

• When you are first offered this coverage (and during approved open enrollment periods), you can take advantage of this important coverage with no health examination.

• Your disability occurs while you are residing outside of the United States or Canada for more than 12 consecutive months for a purpose other than work

Your benefits may be reduced if you are eligible to receive benefits from:

• A state disability plan or similar compulsory benefit act or law

• A retirement plan

• Social Security

• Any form of employment

• Workers’ Compensation

• Salary continuance

• Sick leave

A complete list of benefit exclusions and reductions is included in the policy. State restrictions may apply to this plan.

Premium Waiver Included Progressive Income Benefit Included Family Care Expense Benefit Included Family Income Benefit Included Portability Included Open Enrollment

Voluntary Long Term Disability Insurance

Here’s how little you pay with grouprates.

Your estimated monthly premium is determined by multiplying your monthly salary amount (up to $10,000) by your age-range premium rate. If your monthly salary exceeds $10,000, multiply $10,000 by your premiumrate.

$ monthly salary X premium rate =$ monthly premium Age Range Premium Rate 0 - 29 0.00126 30 - 34 0.00180 35 - 39 0.00270 40 - 44 0.00432 45 - 49 0.00612 50 - 54 0.00900 55 - 59 0.01206 60 - 64 0.01431 65 - 69 0.01431 70 - 99 0.01431 29

Voluntary Long Term Disability Insurance

Option Two

The Lincoln Long-term Disability Insurance

Advantage Plan:

• Provides a cash benefit after you are out of work for 180 days or more due to injury, illness, or surgery

• Features group rates for Burnet CISD employees

• Includes EmployeeConnectSM services, which give you and your family confidential access to counselors as well as personal, legal, and financial assistance

Eligible Employees of Burnet CISD Benefits At-A-Glance

Long-term Disability

Monthly benefit amount

Elimination period

Coverage period for your occupation

Maximum coverage period

Elimination Period

60% of your monthly salary, limited to $6,000 per month

180 days

24 months

Up to age 65 or Social Security

Normal Retirement Age (SSNRA), whichever is later

• This is the number of days you must be disabled before you can collect disability benefits.

• The 180-day elimination period can be met through either total disability (out of work entirely) or partial disability (working with a reduced schedule or performing different types of duties).