Copperas Cove ISD 24-25 Guide by Riata245

OPEN ENROLLMENT INFORMATION

Know Your Benefits! Below is a summary of benefits offered through CCISD.

Medical Insurance –

CCISD Alternate Plan – The district offers the employee only dental and vision plans but the employee has to actively elect the vision and/or dental plan.

TeleMedicine – Redi-MD & TelaDoc, Access to physicians for non-emergency treatment/prescriptions is currently

Ameritas Dental – Coverage for preventive, basic, major, and ortho services. The plan does not contain waiting periods. Remember that annual maximums reset on January 1st . Only new employees will receive new cards.

Davis Vision – Plan includes coverage for eye exams, materials (such as frames and lenses), and discounts for laser vision correction. The plan has a defined network of providers. Out of network benefits are available on a reimbursement basis only. For more information, including a list of providers visit www.davisvision.com. The client code for CCISD is 3797.

NY Life Disability – Plan includes both short and long term disability coverage. Plan is designed to protect 60% of your gross CCISD income.

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

Lincoln Group Life –Group term life insurance that ends when you terminate employment with CCISD. Coverage is also available for spouses and dependent children.

Lincoln Critical Illness – Critical Illness pays a lump sum benefit if the insured is diagnosed with a covered critical illness.

Allstate Cancer – Pays benefits for internal cancer diagnosis. Includes an annual cancer screening benefit.

Lincoln Accident – Pays benefits for off the job accidents and related treatments. Includes a physical/wellness exam reimbursement.

OMNI Retirement Plans – CCISD offers tax advantaged retirement plans designed to help supplement your TRS retirement benefits. Visit www.omni403b.com for more information.

More Important Information

Covering Dependents?

If you cover dependents on any of your coverages through CCISD you must provide the dependents name, date of birth, and social security number. You must have all of this information before dependents can be added to the system.

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 voluntary 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 immediately at (830)606-5100. Discrepancies must be identified within the first 30 days from the effective date of the policy.

Benefit Related Documents

For contact information, claim forms, benefits guides and more please visit the CCISD Portal. Once on the portal, select “Staff” followed by “Employee Resources icon,” log in and select "Employee Benefits."

Login Process

CopperasCoveISD

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!

Learn the Terms.

• Premium: The monthly amount you pay for health care coverage.

• Deductible: The annual amount for medical expenses you’re responsible to pay before your plan begins to pay.

• Copay: The set amount you pay for a covered service at the time you receive it. The amount can vary based on the service.

• Coinsurance: The portion you’re required to pay for services after you meet your deductible. It’s often a specified percentage of the costs; e.g., you pay 20% while the health care plan pays 80%.

• Out-of-Pocket Maximum: The maximum amount you pay each year for medical costs.After reaching the out-of-pocket maximum, the plan pays 100% of allowable charges for covered services. While you can’t see Dr. Pepper for your annual check-up, you can find a great one

Dental Plan Summary

Plan Benefit

Type 1

Type 2

Type 3

Deductible

Maximum (per person)

Allowance

Dental Rewards®

Waiting Period

Orthodontia Summary - Child Only Coverage

Allowance

Plan Benefit

Lifetime Maximum (per person)

Waiting Period

100%/90%/80%

80%/70%/60%

50%/40%/30%

$50/Calendar Year Type 2 & 3

Waived Type 1 3 Family Maximum

$1,000 per calendar year

U&C

Included

None

U&C

50%

$1,000

None

Sample Procedure Listing (Current Dental Terminology © American Dental Association.) Type 1 Type 2 Type 3

Routine Exams

(2 per benefit period)

Bitewing X-rays

(1 per benefit period)

Cleanings

(2 per benefit period)

Fluoride for Children 13 and under (1 per benefit period)

Sealants (age 13 and under)

Monthly Rates

Employee Only (EE)

Full Mouth/Panoramic X-rays (1 in 5 years)

Periapical X-rays Space Maintainers

Restorative Amalgams

Restorative Composites (anterior and posterior teeth) Simple Extractions

Onlays

Crowns (1 in 10 years per tooth)

Crown Repair

Endodontics (nonsurgical)

Endodontics (surgical)

Periodontics (nonsurgical)

Periodontics (surgical)

Denture Repair

Prosthodontics (fixed bridge; removable complete/partial dentures) (1 in 10 years)

Complex Extractions

Anesthesia

EE + Spouse $

EE + Children $

EE + Spouse & Children $

Ameritas Information

Dental Health Scorecard

How would you rate your dental health?

In 2016, you can receive your Dental Health Report Card by signing into your secure member account online. Your assessment is based on claims submitted. The report card also offers suggestions if you strive to improve your dental health. Ameritas members can access the personalized report card by going to ameritas.com, click Account Access in the top right corner and choose the Dental/Vision/Hearing drop down. Select the Secure Member Account link and sign in to see your report.

Rx Savings

Our valued plan members and their covered dependents can save on prescription medications at over 60,000 pharmacies across the nation including CVS, Walgreens, Rite Aid and Walmart. This Rx discount is offered at no additional cost, and it is not insurance.

To receive this Rx discount, Ameritas plan members just need to visit us at ameritas.com and sign into (or create) a secure member account where they can access and print an online-only Rx discount savings ID card.

Eyewear Savings

Ameritas plan members may receive up to 10% off eyewear frames and lenses purchased at any Walmart Vision Center nationwide. Members may also bring in their current vision prescription from any vision care provider and purchase eyewear at Walmart. This savings arrangement is not insurance: it is available to members at no additional cost to their plan premium.

To receive the eyewear savings identification card, Ameritas plan members can visit ameritas.com and sign-in (or create) a secure member account. Members must present the Ameritas Eyewear Savings Card at time of purchase to receive the discount.

Dental Rewards®

This dental plan includes a valuable feature that allows qualifying plan members to carryover part of their unused annual maximum. A member earns dental rewards by submitting at least one claim for dental expenses incurred during the benefit year, while staying at or under the threshold amount for benefits received for that year. Employees and their covered dependents may accumulate rewards up to the stated maximum carryover amount, and then use those rewards for any covered dental procedures subject to applicable coinsurance and plan provisions. If a plan member doesn't submit a dental claim during a benefit year, all accumulated rewards are lost. But he or she can begin earning rewar ds again the very next year.

Benefit Threshold

$500

Dental benefits received for the year cannot exceed this amount

$250 Dental Rewards amount is added to the following year's maximum

Carryover $1,000 Maximum possible accumulation for Dental Rewards

Dental Network Information

To find a provider, visit ameritas.com and select F F IND A PROVIDER, then D DENTAL. Enter your criteria to search by location or for a specific dentist or practice. California Residents: When prompted to select your network, choose the Ameritas Network found on your ID Card or contact Customer Connections at 800-487-5553.

Pretreatment

While we don't require a pretreatment authorization form for any procedure, we recommend them for any dental work you consider expensive. As a smart consumer, it's best for you to know your share of the cost up front. Simply ask your dentist to submit the information for a pretreatment estimate to our customer relations department. We'll inform both you and your dentist of the exact amount your insurance will cover and the amount that you will be responsible for. That way, there won't be any surprises once the work has been completed.

Open Enrollment

If a member does not elect to participate when initially eligible, the member may elect to participate at the policyholder's next enrollment period. This enrollment period will be held each year and those who elect to participate in this policy at that time will have their insurance become effective on September 1. If you do not enroll during your company's open enrollment period, then you will be subject to the Late Entrant Provision.

Section 125

This plan is provided as part of the Policyholder's Section 125 Plan. Each employee has the option under the Section 125 Plan of participating or not participating in this plan. If an employee does not elect to participate when initially eligible, he/she may elect to participate at the Policyholder's next Annual Election Period.

Dental Cost Estimator

Ever wonder what a dental procedure usually costs? The answer can be found using the Ameritas group division’s Dental Cost Estimator tool located in our Secure Member Account portal.

Members can search by ZIP Code for a specific dental procedure and see fee range estimates for out-of-network general dentists in that area. Of course, we always suggest that members partner with their dentists, so they know what’s involved in any recommended treatment plan.

The estimator tool is powered by Go2Dental and uses FAIR Health data that is updated annually. Please note, cost estimates do not reflect discounted rates available through provider networks, and the estimator does not include orthodontic estimates at this time.

In addition, when members are in their Secure Member Account, they can:

Go paperless with electronic Explanation of Benefits statements and reduce the clutter in their mailboxes

View their certificate of insurance and specific plan benefits information

Access value-added extras like the Rx discount ID card

Worldwide Support

When our members travel abroad, they’ll have peace of mind knowing that should a dental or vision need arise, help is just a phone call away. Through AXA Assistance, Ameritas offers its dental and vision plan members 24-hour access to dental or vision provider referrals when traveling outside the U.S.

Immediately after a call is made to AXA, an assistance coordinator assesses the situation, provides credible provider referrals and can even assist with making the appointment. Within 48 hours following the appointment, the coordinator calls the member to find out if additional assistance is needed. If all is well, the case is closed. Then, the plan member may submit a claim to Ameritas for reimbursement consideration based on applicable plan benefits. Contact AXA Assistance USA toll free by calling 866-662-2731, or call collect from anywhere in the world by dialing 1-312-935-3727.

Language Services

We recognize the importance of communicating with our growing number of multilingual customers. That is why we offer a language assistance program that gives you access to: Spanish-speaking claims contact center representatives, telephone interpretation services in a wide range of languages, online dental network provider search in Spanish and a variety of Spanish documents such as enrollment forms, claim forms and certificates of insurance.

This document is a highlight of plan benefits provided by Ameritas Life Insurance Corp. as selected by your employer. It is not a certificate of insurance and does not include exclusions and limitations. For exclusions and limitations, or a complete list of covered procedures, contact your benefits administrator.

Designer Vision Plan

Healthy eyes and clear vision are an important part of your overall health and quality of life. Your vision plan helps you care for your eyes while saving you money by offering:

Paid-in-full eye examinations, eyeglasses and contacts!

Frame Collection: Your plan includes a selection of designer, name brand frames that are completely covered in full./1

Contact Lens Collection: Select from the most popular contact lenses on the market today with Davis Vision’s Contact Lens Collection./1

One-year eyeglass breakage warranty included on plan eyewear at no additional cost!

How to locate a Network Provider...

Just log on to the Open Enrollment section of our Member site at davisvision.com and click “Find a Provider” to locate a provider near you including:

IN-NETWORK BENEFITS

Eye Examination

Eyeglasses

Spectacle Lenses

For more details about the plan, just log on to the Open Enrollment section of our Member site at davisvision.com or call 1.877.923.2847 and enter Client Code 3797.

Frames

Every 12 months, Covered in full after $10 copayment

Every 12 months, Covered in full

For standard single-vision, lined bifocal, or trifocal lenses after $25 copayment

Every 24 months, Covered in full

Any Fashion or Designer frame from Davis Vision’s Collection/1 (value up to $160) OR

$130 retail allowance toward any frame from provider, plus 20% off balance/2 OR

$180 allowance, plus 20% off balance/2 to go toward any frame from a Visionworks family of store locations./4

Contact Lenses

Contact Lens Evaluation, Fitting & Follow Up Care

Contact Lenses (in lieu of eyeglasses)

Every 12 months Collection Contacts: Covered in full after $25 copayment

Non Collection Contacts:

Standard Contacts: Covered in full after $25 copay

Specialty Contacts/5: $60 allowance with 15% off balance/2 less $25 copay

Every 12 months, Covered in full

Any contact lenses from Davis Vision’s Contact Lens Collection/1 OR

$130 retail allowance toward provider supplied contact lenses, plus 15% off balance/2

ADDITIONAL DISCOUNTED LENS OPTIONS & COATINGS

Value for our Members

pocket cost to members and their families. Our goal is 100% member satisfaction.

Convenient Network Locations

A national network of credentialed preferred providers throughout the 50 states.

Freedom of Choice

Access to care through either our network of independent, private practice doctors (optometrists and ophthalmologists) or select retail partners.

Value-Added Features:

• Mail Order Contact Lenses Replacement

DavisVisionContacts.com mail-order service ensures easy, convenient, purchasing online and quick, direct shipping to your door. Log on to our member Web site for details.

• Davis Vision provides you and your eligible dependents with the opportunity to receive discounted laser vision correction, often referred to as LASIK. For more information, visit www.davisvision.com.

Contact Info

For more details about the plan, just log on to the Open Enrollment section of our Member site at davisvision.com or call 1.877.923.2847 and enter Client Code 3797.

ADDITIONAL OPTIONS

FRAMES

Fashion Frame (from the Davis Vision Collection)$100$0

Designer Frame (from the Davis Vision Collection)$160$0

Premier Frame (from the Davis Vision Collection)$195$25

LENSES

All Ranges of Prescriptions and Sizes$90$0 Plastic Lenses$78$0

Oversized Lenses$20$0

Tinting of Plastic Lenses$25$0

Scratch-Resistant Coating$25$0

Polycarbonate Lenses$66$0/1 or $30

Ultraviolet Coating$25$12 $83$35

Premium AR Coating$104$48

Ultra AR Coating$121$60

Standard Progressive Addition Lenses$198$50

Premium Progressives Addition Lenses$247$90

Ultra Progressive Addition Lenses$369$140

High-Index Lenses$120$55

Polarized Lenses$103$75

Photochromic Lenses (i.e. Transitions®, etc.)/2 $110

Scratch Protection Plan (Single vision | Multifocal lenses)

| $40

1/ Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with prescriptions 6.00 diopters or greater.

2/ Transitions® is a registered trademark of Transitions Optical, Inc.

You may receive services from an out-of-network provider, although you will

provider who participates in the network. If you choose an out-of-network provider, you must pay the provider directly for all charges and then submit a claim for reimbursement to:

Vision Care Processing Unit

P.O. Box 1525

Latham, NY 12110

OUT-OF-NETWORK REIMBURSEMENT SCHEDULE

Eye Examination up to $40 | Frame up to $50 Spectacle Lenses (per pair) up to: Single Vision $40, Bifocal $60, Trifocal $80, Lenticular $100 Elective Contacts up to $130, Visually Required Contacts up to $225

Summary of Benefits Prepared for: Copperas Cove Independent School

Eligibility:

All active, Full-time Employees of the Employer regularly working a minimum of 15 hours per week in the United States, who are citizens or permanent resident aliens of the United States. Employee: You will be eligible for coverage The first of the month coincident with or next following the date of hire.

Tier 1: Monthly Rate per $10 of Weekly Benefit = $0.320

Actual per pay period premiums may differ slightly due to rounding. Rates may be subject to change in the future.

How to Calculate Your Monthly Cost for Tier 1:

Step 1: Divide your annual salary by 52 to calculate your weekly earnings.

Step 2: Multiply this amount by the benefit percentage defined above in the Available Coverage section. For example, 60% would be .60. Now, you have your Gross Weekly Benefit.

Step 3: Use the chart above to find your Monthly rate. Multiply this rate by your Gross Weekly Benefit, or the Maximum Gross Weekly Benefit of $1,250, whichever is less.

Step 4: Divide the total by 10. The result is your Monthly cost.

Tier 2: Monthly Rate per $10 of Weekly Benefit = $0.250

How to Calculate Your Monthly Cost for Tier 2:

Step 1: Divide your annual salary by 52 to calculate your weekly earnings.

Step 2: Multiply this amount by the benefit percentage defined above in the Available Coverage section. For example, 60% would be .60. Now, you have your Gross Weekly Benefit.

Step 3: Use the chart above to find your Monthly rate. Multiply this rate by your Gross Weekly Benefit, or the Maximum Gross Weekly Benefit of $1,250, whichever is less.

Step 4: Divide the total by 10. The result is your Monthly cost.

Important Definitions and Policy Provisions:

Disability - “Disability” or “Disabled” means if solely because of a covered injury or sickness, you are unable to perform the material duties of your regular job and you are unable to earn 80% or more of your covered earnings from working in your regular job. We will require proof of earnings and continued disability.

Covered Earnings - “Covered Earnings” means your wages or salary, not including bonuses, commissions, overtime pay and other extra compensation.

When Benefits Begin -

Tier 1 - You must be continuously Disabled for 14 days for an Accident and 14 days for a Sickness before benefits will be paid for a covered Disability.

Tier 2 - You must be continuously Disabled for 30 days for an Accident and 30 days for a Sickness before benefits will be paid for a covered Disability.

How Long Benefits Last - Once you qualify for benefits under this plan, the maximum number of weekly Disability benefits is 26 weeks for an Accident and 26 weeks for a Sickness. Disability benefits will end sooner if you no longer qualify for benefits.

When Coverage Takes Effect - Your coverage takes effect on the later of the policy’s effective date, the date you become eligible, the date we receive your completed enrollment form if required, or the date you authorize any necessary payroll deductions if applicable. If you’re not actively at work on the date your coverage would otherwise take effect, your coverage will take effect on the date you return to work. If you have to submit proof of good health, your coverage takes effect on the date we agree, in writing, to cover you.

Benefit Reductions, Conditions, Limitations and Exclusions:

Effects of Other Income Benefits - This plan is structured to prevent your total benefits and post-disability earnings from equaling or exceeding pre-disability earnings. Therefore, we reduce this plan’s benefits by an amount equal to any Social Security retirement and/or disability benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Your disability benefits will not be reduced by any Social Security disability benefits you are not receiving as long as you cooperate fully in efforts to obtain them and agree to repay any overpayment when and if you do receive them. Disability benefits will be reduced by amounts received through other government programs, sick pay, employer funded retirement benefits, workers’ compensation, franchise/group insurance, auto no-fault, and damages for wage loss. For details, see your Certificate of Insurance. Pre-existing Condition Limitation - Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, received medical treatment, care or services (including diagnostic measures), during the 3 months just prior to the most recent effective date of insurance. Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after you have been insured under this plan for at least 12 months after your most recent effective date of insurance.

Termination of Disability Benefits - Your benefits will terminate when your Disability ceases, when your benefit duration period is exceeded, you earn more than your allowable Covered Earnings, or the date benefits end because you did not comply with the terms and conditions of the policy.

Exclusions - This plan does not pay benefits for a Disability which results, directly or indirectly, from any of the following: Suicide, attempted suicide, or intentionally self-inflicted injury while sane or insane; War or any act of war, whether or not declared; Active participation in a riot; Commission of a felony; The revocation, restriction or non-renewal of an Employee’s license, permit or certification necessary to perform the duties of his or her occupation unless due solely to Injury or Sickness otherwise covered by the Policy; Any cosmetic surgery or surgical procedure that is not Medically Necessary; An Injury or Sickness for which the Employee is entitled to benefits from Workers' Compensation or occupational disease law; An Injury or Sickness that is work related.

In addition, the plan does not pay disability benefits any period of Disability during which you are incarcerated in a penal or corrections institution.

1.Your benefit amount will be reduced by any amounts payable to you by any of the sources listed under the “Effects of Other Income Benefits” section.

Terms and conditions of coverage for Short Term Disability insurance are set forth in Group Policy No. VDT0963237. This is not intended as a complete description of the insurance coverage offered. This is not a contract. Complete coverage details, including premiums, are contained in the Policy Certificate. If there are any differences between this summary and the group policy, the information in the group policy takes precedence. Product availability and/or features may vary by state. Please keep this material as a reference. Insurance coverage

is issued on group policy form number: Policy Form TL-004700. Coverage is underwritten by Life Insurance Company of North America, 51 Madison Avenue, New York, NY 10010.

Group insurance products are insured by Life Insurance Company of North America and New York Life Group Insurance Company of NY, affiliates of New York Life Insurance Company. ©2024 New York Life Group Insurance Company, New York, NY. All Rights Reserved. NEW YORK LIFE and the New York Life box logo are trademarks of New York Life Insurance Company.

Created on 01/2024

Eligibility:

Please refer to the “How Long Benefits Last” section below for more details.

Additional Features

Family Survivor Benefit – If you die while receiving benefits, we will pay a survivor benefit to your lawful spouse, eligible children, or estate. The plan will pay a single lump sum equal to 3 months of benefits.

Actual per pay period premiums may differ slightly due to rounding. Rates may be subject to change in the future.

How

to Calculate Your Monthly Cost:

Step 1: Divide your annual salary by 12 to calculate your monthly earnings.

Step 2: Use the chart above to find your Monthly rate.

Step 3: Multiply this rate by your monthly earnings, or the monthly covered payroll maximum of $10,000, whichever is less.

Step 4: Divide the total by 100. The result is your Monthly cost.

Important

Definitions and Policy Provisions:

Disability - “Disability” or “Disabled” means that, solely because of a covered injury or sickness, you are unable to perform the material duties of your regular occupation/regular job and you are unable to earn 80% or more of your indexed earnings from working in your regular occupation/regular job. After benefits have been payable for 24 months, you are considered disabled if solely due to your injury or sickness, you are unable to perform the material duties of any occupation for which you are (or may reasonably become) qualified by education, training or experience, and you are unable to earn 60% or more of your indexed earnings. We will require proof of earnings and continued disability

Covered Earnings - “Covered Earnings” means your wages or salary, not including bonuses, commissions, overtime pay and other extra compensation.

When Benefits Begin - You must be continuously Disabled for 180 days before benefits will be payable for a covered Disability

How Long Benefits Last - Once you qualify for benefits under this plan, you continue to receive them until the end of the benefit or until you no longer qualify for benefits, whichever occurs first. Should you remain Disabled, your benefits continue according to the following schedule, depending on your age at the time you become Disabled.

Age at Commencement of Disability

Age 62 or younger

Duration of Benefit Period

To age 65 or the date the 42nd monthly benefit is payable, if later.

63 years 36 monthly payments

64 years 30 monthly payments

65 years 24 monthly payments

66 years 21 monthly payments

67 years 18 monthly payments

68 years 15 monthly payments

69 years or older 12 monthly payments

Benefit Reductions, Conditions, Limitations and Exclusions:

Effects of Other Income Benefits - This plan is structured to prevent your total benefits and post-disability earnings from equaling or exceeding pre-disability earnings. Therefore, we reduce this plan’s benefits by an amount equal to any Social Security retirement and/or disability benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Your disability benefits will not be reduced by any Social Security disability benefits you are not receiving as long as you cooperate fully in efforts to obtain them and agree to repay any overpayment when and if you do receive them. Disability benefits will be reduced by amounts received through other government programs, sick pay, employer funded retirement benefits, workers’ compensation, franchise/group insurance, auto no-fault, and damages for wage loss. For details, see your Certificate of Insurance. Earnings While Disabled - During the first 24 months that benefits are payable, benefits will be reduced if benefits plus income from employment exceeds 100% of pre-disability Covered Earnings. After that, benefits will be reduced by 50% of earnings from employment.

Limited Benefit Period - Disabilities caused by or contributed to by any one or more of the following conditions are subject to a lifetime limit of 24 months for outpatient treatment: Anxiety-disorders, delusional (paranoid) or depressive disorders, eating disorders, Mental Illness, somatoform disorders (including psychosomatic illnesses) or Substance Abuse. Benefits are payable during periods of hospital confinement for these conditions for hospitalizations lasting more than 14 consecutive days that occur before the 24-month lifetime outpatient limit is exhausted.

Pre-existing Condition Limitation - Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, received medical treatment, care or services (including diagnostic measures), during the 3 months just prior to the most recent effective date of insurance. Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after you have been insured under this plan for at least 12 months after your most recent effective date of insurance.

In addition, the plan does not pay disability benefits any period of Disability during which you are incarcerated in a penal or corrections institution.

Terms and conditions of coverage for Long Term Disability insurance are set forth in Group Policy No. VDT0963238. This is not intended as a complete description of the insurance coverage offered. This is not a contract. Complete coverage details, including premiums, are contained in the Policy Certificate. If there are any differences between this summary and the group policy, the information in the group policy takes precedence.

Product availability and/or features may vary by state. Please keep this material as a reference. Insurance coverage is issued on group policy form number: Policy Form TL-004700. Coverage is underwritten by Life Insurance Company of North America, 51 Madison Avenue, New York, NY 10010.

Created on 01/2024

life insurance you can keep!

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

QUICK QUESTIONS 3

You can get a living benefit if you become terminally ill3 It’s Affordable

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

DURING THE LAST SIX MONTHS, HAS THE PROPOSED INSURED:

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

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

1.Aftertheguaranteeperiod,premiumsmaygodown,staythesameorgoup.

2.CoveragenotavailableonchildreninWAorongrandchildreninWAorMD. InMD,childrenmustresidewiththeapplicanttobeeligibleforcoverage. 3.Conditionsapply.

FlexiblePremiumAdjustableLifeInsurancetoage121.PolicyFormICC18PRFNG-NI-18orFormSeriesPRFNG-NI-18.Somelimitationsapply.Seethe PureLife-plusbrochurefordetails.TexasLifeislicensedtodobusinessinthe DistrictofColumbiaandeverystatebutNewYork. 19M016-C1092(exp0321)

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?

What is it?

Copperas Cove ISD Life/AD&D insurance

Life and accidental death and dismemberment (AD&D) insurance provide cash benefits in the unfortunate event that you or a covered family member passes away or suffers a traumatic injury.

Why is this coverage valuable?

Life and AD&D insurance can offer reassurance that you, or the people you love, will have access to money to help cover expenses during a challenging time.

Your life insurance and AD&D coverage

Eligibility description

AD&D

Evidence of insurability (EOI): A health statement requiring you to answer a few medical history questions.

Benefit reductions

Conversion: Allows you to continue coverage after your group plan has terminated

LifeKeys® services: Access to counseling, financial, and legal support services.

TravelConnect® services: Access to emergency medical assistance for you and your family when you’re on a trip 100 or more miles from home.

Benefit exclusions

Life/AD&D

All active employees enrolled in CCISD medical plan

Your employer pays the cost of your coverage

Your AD&D coverage is equal to the life benefit amount.

Health statement may be required

Benefits end when you retire.

Yes, with restrictions See certificate of benefits

Included

Like any insurance, this life and AD&D insurance policy does have exclusions. Benefits won’t be paid if death or dismemberment occurs as the result of:

▪ War, declared or undeclared, or any act of war

▪ Intentionally self-inflicted injuries, while sane or insane

▪ Suicide, or suicide attempt, while sane or insane

▪ Active participation in a riot

▪ Committing or attempting to commit a felony

▪ Disease, bodily or mental illness, or medical or surgical treatment thereof

▪ Infections

▪ Controlled substances voluntarily taken, ingested, or injected, unless prescribed or administered by a physician

▪ Serving on full-time active duty in the armed forces of any country or international authority

▪ The presence of alcohol in the covered person’s blood, which raises the presumption that the covered person was under the influence of alcohol and contributed to the cause of the accident

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

LincolnFinancial.com

Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates.

Affiliates are separately responsible for their own financial and contractual obligations.

LCN-6448858-030124

PDF 5/24 Z01

Order code: GP-LADEP-FLI001

Reminder: Please review your beneficiary(ies) to ensure they’re up to date. It’s good practice to review, and if necessary update, your beneficiary(ies) annually.

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

LifeKeys® services are provided by ComPsych® Corporation, Chicago, IL. ComPsych® is not a Lincoln Financial Group® company. Coverage is subject to actual contract language. Each independent company is solely responsible for its own obligations (except in Vermont).

State limitations apply. Beneficiary grief counseling is the only benefit available to a beneficiary(ies) of policies issued in the state of New York. Online will prep is the only benefit available to insured employee and dependents of policies issued in the state of Washington.

On Call International must coordinate and provide all arrangements in order for eligible services to be covered. Coverage is subject to contract language that contains specific terms, conditions, and limitations, which can be found in the program description.

The TravelConnect® program is not available to insured employees and dependents of policies issued in the state of New York and Washington. Access only program available to insured employees and dependents of policies issued in the state of Missouri and Texas. Benefits provided under the Access only program exclude payment for paid services. Not available in New York and Washington.

Insurance products are issued by The Lincoln National Life Insurance Company, Fort Wayne, IN, which does not solicit business in New York, nor is it licensed to do so. In New York, insurance products are issued by Lincoln Life & Annuity Company of New York, Syracuse, NY. Both are Lincoln Financial Group® companies. Product availability and/or features may vary by state. Limitations and exclusions apply.

What is it?

Copperas Cove ISD Life/AD&D insurance

Life and accidental death and dismemberment (AD&D) insurance provide cash benefits in the unfortunate event that you or a covered family member passes away or suffers a traumatic injury.

Why is this coverage valuable?

Life and AD&D insurance can offer reassurance that you, or the people you love, will have access to money to help cover expenses during a challenging time.

Your life insurance and AD&D coverage

Eligibility description

Life/AD&D

All active employees not enrolled in CCISD medical plan Contribution

Your employer pays the cost of your coverage

AD&D coverage amount

Evidence of insurability (EOI): A health statement requiring you to answer a few medical history questions.

Benefit reductions

Conversion: Allows you to continue coverage after your group plan has terminated

LifeKeys® services: Access to counseling, financial, and legal support services.

TravelConnect® services: Access to emergency medical assistance for you and your family when you’re on a trip 100 or more miles from home.

Benefit exclusions

Your AD&D coverage is equal to the life benefit amount.

Health statement may be required

Benefits end when you retire.

Yes, with restrictions See certificate of benefits

Included

Like any insurance, this life and AD&D insurance policy does have exclusions. Benefits won’t be paid if death or dismemberment occurs as the result of:

▪ War, declared or undeclared, or any act of war

▪ Intentionally self-inflicted injuries, while sane or insane

▪ Suicide, or suicide attempt, while sane or insane

▪ Active participation in a riot

▪ Committing or attempting to commit a felony

▪ Disease, bodily or mental illness, or medical or surgical treatment thereof

▪ Infections

▪ Controlled substances voluntarily taken, ingested, or injected, unless prescribed or administered by a physician

▪ Serving on full-time active duty in the armed forces of any country or international authority

▪ The presence of alcohol in the covered person’s blood, which raises the presumption that the covered person was under the influence of alcohol and contributed to the cause of the accident

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

LincolnFinancial.com

Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates.

Affiliates are separately responsible for their own financial and contractual obligations.

LCN-6448858-030124

PDF 5/24 Z01

Order code: GP-LADEP-FLI001

Reminder: Please review your beneficiary(ies) to ensure they’re up to date. It’s good practice to review, and if necessary update, your beneficiary(ies) annually.

Voluntary Life and AD&D Insurance

The Lincoln Term Life and AD&D

Insurance Plan:

• Provides a cash benefit to your loved ones in the event of your death or if you die in an accident

• Provides a cash benefit to you if you suffer a covered loss in an accident, such as losing a limb or your eyesight

• Features group rates for employees

• Includes LifeKeys® services, which provide access to counseling, financial, and legal support services

• Also includes TravelConnect® services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home

Copperas Cove ISD Benefits

At-A-Glance

All full-time employees

Employee Life and AD&D

Coverage Options

Maximum coverage amount

Minimum coverage amount

Guaranteed Life coverage amount

Optional/Voluntary AD&D coverage amount

Benefits end when you retire.

Increments of $10,000

This amount may not exceed five times Annual Earnings (rounded up to the nearest $10,000) or $150,000

$10,000

$150,000

Equal to the life insurance amount chosen

Spouse Life and AD&D The amount of Dependent Life Insurance coverage cannot be greater than 50% of the Employee Benefit.

Coverage Options Increments of $5,000

Maximum coverage amount

Minimum coverage amount

Guaranteed Life coverage amount

Voluntary AD&D coverage amount

Benefits end when you retire.

Dependent Child(ren) Life and AD&D

Day one but under six months

At least six months but under 26 years

This amount may not exceed two and one-half times employee’s Annual Earnings or 50% employee’s benefit (rounded up to the nearest $5,000) maximum of $50,000

$5,000

$50,000

Equal to the life insurance amount chosen

$500

$10,000

What your benefits cover

Employee Coverage

Guaranteed Life Insurance Coverage Amount

• Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $150,000 without providing evidence of insurability.

• Annual Limited Enrollment: If you are a continuing employee, you can increase your coverage amount by two levels without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined or withdrawn, you may be required to submit evidence of insurability.

• If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense.

Maximum Insurance Coverage Amount

• You can choose a coverage amount up to five times Annual Earnings or $150,000. Evidence of Insurability may be required for voluntary life coverage. See the Evidence of Insurability page for details

Spouse Coverage - You can secure term life insurance for your spouse if you select coverage for yourself.

Guaranteed Life Insurance Coverage Amount

• Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $50,000 for your spouse without providing evidence of insurability.

• Annual Limited Enrollment: If you are a continuing employee, you can increase the coverage amount for your spouse by two levels without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined or withdrawn, you may be required to submit evidence of insurability.

• If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense.

Maximum Insurance Coverage Amount

• You can choose a coverage amount up to two and one-half times employee’s annual earnings or 50% of employee’s benefit or $50,000 for your spouse. Evidence of Insurability may be required.

Dependent Child(ren) Coverage - You can secure term life insurance for your dependent children when you choose coverage for yourself

Guaranteed Life Insurance Coverage Options:

• You can choose a coverage amount up to $500 if day one but under six months, $10,000 if at least age six months but under 26 years for your child(ren).

Additional Plan Benefits Included with Life Coverage

Waiver of Premium Included

Portability Included

Accelerated Death Benefit Included

Conversion Included

REMINDER: Please review your beneficiary(ies) to ensure they are up to date. It’s good practice to review, and if necessary update, your beneficiary(ies) annually.

State limitations apply. Beneficiary Grief counseling is the only benefit available to a beneficiary(ies) of policies issued in the state of New York. Online will prep is the only benefit available to insured employee and dependents of policies issued in the state of Washington.

TravelConnect® services are provided by On Call International, Salem, NH. On Call International is not a Lincoln Financial Group® company and Lincoln Financial Group does not administer these services. Each independent company is solely responsible for its own obligations. On Call International must coordinate and provide all arrangements in order for eligible services to be covered. Coverage is subject to contract language that contains specific terms, conditions, and limitations, which can be found in the program description.

The TravelConnect® program is not available to insured employees and dependents of policies issued in the state of New York and Washington. Access only program available to insured employees and dependents of policies issued in the state of Missouri and Texas. Benefits provided under the Access Only program exclude payment for paid services. Not for use in New York or Washington.

Group insurance products and services described herein are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit business in New York, nor is it licensed to do so. In New York, insurance products are issued by Lincoln Life & Annuity Company of New York (Syracuse, NY). Both are Lincoln Financial Group® companies. Product availability and/or features may vary by state. Limitations and exclusions apply. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations.

Benefit Exclusions

Like any insurance, this term life and AD&D insurance policy does have exclusions. For life insurance, a suicide exclusion may apply.

For AD&D, benefits will not be paid if death results from suicide, or death/dismemberment occurs while:

• Inflicting or attempting to inflict injury to one’s self

• Participating in a riot or as a result of war or act of war

• Serving as a member of the military, including the Reserves and National Guard

• Committing or attempting to commit a felony

• Deliberately inhaling gas (such as carbon monoxide) or using drugs other than those prescribed by a physician and administered as prescribed

• Flying in a non-commercial airplane or aircraft, such as a balloon or glider

• Driving while intoxicated

In addition, the AD&D insurance policy does not cover sickness or disease, including the medical and surgical treatment of a disease.

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

Questions? Call 800-423-2765 and mention Group ID: COPPERSCIS.

REMINDER: Please review your beneficiary(ies) to ensure they are up to date. It’s good practice to review, and if necessary update, your beneficiary(ies) annually.

The TravelConnect® program is not available to insured employees and dependents of policies issued in the state of New York and Washington. Access only program available to insured employees and dependents of policies issued in the state of Missouri and Texas. Benefits provided under the Access Only program exclude payment for paid services. Not for use in New York or Washington.

Monthly Voluntary Life Insurance Premium

Calculate Your Premium.

You

Group

and AD&D Rates for Your Spouse

One affordable monthly premium covers all of your eligible dependent children.

Note: To be eligible for coverage, a spouse or dependent child cannot be confined on the date the increase or addition is to take effect, it will take effect when the confinement ends.

Calculate Your Cost

Use the appropriate rate provided in the tables above to calculate your cost based on the amount of coverage you select. The following example calculates the monthly cost for a 36-year-old employee who would like to purchase $100,000 in employee voluntary term life & voluntary ad&d insurance coverage.

Step 1

Step 2

Step 3

Step 4

Using the table above, enter the rate that corresponds with your age.

Enter the desired coverage amount in dollars.

Enter the desired coverage amount in increments of $1,000. To calculate, divide the coverage amount by $1,000.

Calculate the monthly cost. Multiply Step 1 by Step 3.

Note: Rates are subject to change and can vary over time.

Please see prior page for product information.

Full-Time Employees of Copperas Cove ISD

Benefits At-A-Glance

Coverage for you

Illness Insurance

The Lincoln Critical Illness Insurance Plan:

• Provides cash benefits if you or a covered family member is diagnosed with a critical illness or event

• Benefits are paid in addition to what is covered under your health insurance

• Features group rates for employees

• Includes access to a personal health advocate who can assist you in managing healthcare services for you and your entire family

• There are no waiting periods or overall plan maximums

Critical Illness Insurance | Employee

Guaranteed coverage amounts

$10,000, $15,000 or $20,000

Guaranteed coverage amounts

• If this is your first opportunity to enroll for coverage, you can choose from the coverage amounts above

Maximum coverage amount

• You can choose from the coverage amount of $20,000.

Coverage for your spouse

You can secure Critical Illness Insurance for your spouse when you choose coverage for yourself.

Critical Illness Insurance | Spouse

Guaranteed coverage amount

$5,000, $7,500 or $10,000 (up to 50% of the employee coverage amount)

Guaranteed coverage amounts

• You can choose from the coverage amount(s) above for your spouse

Maximum coverage amount

• You can choose a coverage amount up to 50% of your coverage amount ($10,000 maximum) for your spouse

Coverage for your dependent children

Your dependent children automatically receive 25% of your coverage amount at no extra cost.

Cancer

Stage Renal (kidney) Failure

Major organ failure (heart, lung, liver, pancreas, or intestine)

Arterial/vascular disease

Mitral or aortic valve disease

cancer (in situ)

Recovery Assistance Your Cash Benefit

Family Care Benefit

Lodging (when 100+ miles from home)

$25 per day for up to 30 days

$100 per day for up to 15 nights

Transportation (when 100+ miles from home) $200 per trip for up to 2 trips

Health Assessment / Wellness Benefit Your Cash Benefit

You receive a cash benefit every year you and any of your covered family members complete a single covered exam or screening

Additional Plan Benefit(s)

Level: $100

Note: See the policy for details and specific requirements for each of these benefits.

Benefit Exclusions

The plan includes only covered conditions or losses that occur when the insurance is in force. Benefits are not payable for any covered conditions or loss caused or contributed to by:

1. suicide, attempted suicide, or any intentionally self-inflicted injury, while sane or insane;

2. committing or attempting to commit a felony; participation in a felony; committing a felony;

3. war or any act of war, declared or undeclared;

4. participation in a riot, insurrection or rebellion of any kind; active participation in a riot, insurrection or rebellion; voluntary participation in a riot, insurrection or rebellion; participation in a riot or insurrection; or

5. a covered condition sustained while residing outside the United States, U.S. Territories, Canada, or Mexico for more than 12 months. A Covered Condition sustained while residing outside the United States, its possessions, Canada, or Mexico for more than 12 months, unless the Covered Condition is rediagnosed/confirmed in the United States.

Benefits will not be payable if the insured person is incarcerated in any type of penal or detention facility. A benefit for heart attack or sudden cardiac arrest is not payable if the event occurs during a medical procedure.

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

Questions? Call 800-423-2765 and mention ID: COPPERSCIS.

Some benefits have limits on the number of services provided or limit the time frame in which the services must be rendered. See your certificate booklet or policy for more information. This insurance product does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

Insurance products are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit business in New York, nor is it licensed to do so. Product availability and/or features may vary by state. Limitations and exclusions apply.

Critical Illness Insurance Premium

Here’s how little you pay with group rates.

Group Rates for You

If You are not a Tobacco User

Group Rates for You If You are a Tobacco User

The Lincoln National Life Insurance Company

Please see prior page for product information.

Group Rates for Your Spouse

If You are not a Tobacco User Spouse | Non-Tobacco User Monthly Premiums

Group Rates for Your Spouse

If You are a Tobacco User

Please see prior page for product information.

Lincoln Accident Insurance Plan:

• Provides cash benefits if you or a covered family member is accidentally injured

• Features group rates for employees

• Benefits are focused on the family, safety, and accident prevention

Full-Time Employees at Copperas Cove ISD

Surgical treatment surgery

Chip fracture

times nonsurgical benefit

of fracture benefit

*Fracture benefits listed are nonsurgical. Treatment for the fracture must occur within 90 days of the accident. The combined maximum of all fractures is two times the highest fracture payable.

No money is due at enrollment. Your premium simply comes out ofyour paycheck.

Foot (except toes)

Hand (except fingers)

Knee (except kneecap)

Shoulder

Toes

Wrist

*Dislocation benefits listed are nonsurgical. Treatment for the dislocation must occur within 90 days of the accident. The combined maximum of all dislocations is two times the highest dislocation payable.

Specific Injuries

Blood, plasma, platelets, and other non-blood substitute IV solutions

2nd degree burns: Based upon surface area burned

3rd degree burns: Based upon surface area burned

$375

$100-$1,450

$1,300-$15,000

Skin grafts 25% of burn benefit

Concussion

Dental crown

Dental extraction

Eye (surgical repair)

Eye (removal of foreign object)

Laceration: Based upon the need for and length of sutures

$300

$350

$125

$350

$250

$75-$1,500

Severe traumatic brain injury $7,500

Surgical benefits:*

Other surgery under conscious sedation

Other surgery under general anesthesia

Repair of knee cartilage $1,125

Repair of ligaments, tendons, rotator cuff $1,125 Repair of ruptured disc

$1,875

$1,125 Open abdominal or thoracic

*Benefits will be paid up to two times the highest surgical benefit payable for all surgeries.

Accident hospital admission

Accident hospital daily confinement

Accident intensive care admission

Accident intensive care daily confinement

Physical, occupational, and chiropractic therapy (up to 10 sessions)

Physician follow-up visits (up to six visits)

Alternative care/rehab facility daily confinement

Epidural/cortisone pain management (up to one injection)

Medical mobility devices

Wheelchair (expected use one year or more)

Wheelchair (expected use less than one year)

Prosthesis (per limb)

lodging (100+ miles from home)

Transportation (100+ miles from home)

$65

$140

$200

$85

$150

Accidental death

Your death

Your spouse or life partner

Your child

Common carrier death

Your death

Your spouse or life partner

Your child

A common carrier is any land, air, or water conveyance licensed to transport passengers for hire.

Transportation of remains (100+ miles)

$50,000

$25,000

$12,500

$100,000

$50,000

$25,000

$12,500

Safe driver: Seat belt 10% of accidental death and dismemberment benefit

Safe driver: Air bag 10% of accidental death and dismemberment benefit

Safe driver: Helmet 10% of accidental death and dismemberment benefit

Loss of hand, foot, arm, leg, eye, or hearing in one ear

Loss of finger, thumb, toe

Loss of sight in both eyes

Loss of hearing in both ears

Loss of speech

Loss of both arms

Loss of both legs

Loss of arm and leg

Paraplegia

Hemiplegia

Loss of both arms and both legs

Quadriplegia

Education: This benefit is paid if an insured person dies within 365 days of a covered accident and is survived by one or more full-time students.

The education benefit is payable for each full-time student.

Spouse training: This benefit is paid if a covered employee or dependent spouse dies within 365 days of a covered accident, and the surviving spouse is enrolled as a student.

The spouse training benefit covers students enrolled in any school that retrains or refreshes skills needed for employment within 365 days from the date of death.

Modification to home/auto: This benefit is payable for modifications to make the principal residence accessible or the vehicle ridable if the insured suffers a severe loss.

This benefit is payable once per person within 365 days of the accident.

$12,500

$1,625

$32,500

10% of accidental death benefit

$3,500

Health Assessment/Wellness Benefit

You receive a cash benefit every year you and any of your covered family members complete a single covered assessment test.

Additional plan benefits

Portability

Child Sports Injury Benefit

Your cash benefit

Level: $100

Included

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

Benefits may vary by state, have limits on the number of services provided, or limit the time frame in which the services must be rendered. See your certificate booklet or policy for more information.

Insurance products are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit business in New York, nor is licensed to do so. Product availability and/or features may vary by state. Limitations and exclusions apply.

Benefit exclusions

Accident insurance covers many injuries that result from a covered event. The policy exclusions are:

1. Disease, physical or mental infirmity, sickness, or medical or surgical treatment of these

2. Suicide, attempted suicide, or any intentionally self-inflicted injury, while sane or insane

3. Voluntary intake or use by any means of any drugs, poison, gas, or fumes, voluntary use of controlled substance, voluntary intake or use by any means of any drug, except when:

a. Prescribed or administered by a physician, and

b. Taken in accordance with the physician’s instructions

4. Committing or attempting to commit a felony, participation in a felony, voluntary participation in a felony, voluntary committing or attempting to commit a felony

5. War or any act of war, declared or undeclared, war or any act of war other than terrorism, declared or undeclared, war or any act of war, declared or undeclared while serving in the military or an auxiliary unit attached to the military or working in an area of war, whether voluntarily or as required by an employer

6. Participation in a riot, insurrection, or rebellion of any kind

7. Military duty, including the Reserves or National Guard

8. Travel or flight in or on any aircraft, except:

a. As a fare-paying passenger on a regularly scheduled commercial flight; or

b. As a passenger, pilot, or crew member in the group policyholder’s aircraft while flying for the group policyholder’s business, provided:

i. The aircraft has a valid U.S. airworthiness certificate or foreign equivalent; and

ii. The pilot has a valid pilot’s certificate with a nonstudent rating authorizing him to fly the aircraft

9. Driving a vehicle while intoxicated, as defined by the jurisdiction where the accident occurred. For accidental death and dismemberment only, benefits are not payable for any loss sustained or contracted in consequence of your or your insured dependent being intoxicated or under the influence of any narcotic; operating a motor vehicle while intoxicated, as defined by the law of the state in which the accident occurred, if it is a felony

10. Cosmetic or elective surgery, physician determination of cosmetic or elective surgery, cosmetic surgery, surgery to improve appearance, cosmetic or elective surgery when it is to improve appearance rather than restore function or correct a deformity resulting from an injury

11. Being incarcerated in any type of penal or detention facility, injury sustained while confined to jail, workhouse, or other corrections facility when it is due to an act of the facility and law enforcement is liable

12. Under the influence of narcotics, unless prescribed and taken in accordance with the prescription by a physician

13. Participating in, practicing for, or officiating any semi-professional or professional sport

14. Riding in or driving in any motor driven vehicle for race, stunt show, or speed test

15. An injury sustained while residing outside the U.S., U.S. territories, Canada, or Mexico for more than 12 months

16. Bungee cord jumping, mountaineering, or base jumping

17. Skydiving, parachuting, or jumping from any aircraft for recreational purposes

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

Questions? Call 800-423-2765 and mention ID COPPERSCIS.

Accident insurance premium

Here’s how little you pay with group rates

As an employee, you can take advantage of this accident insurance plan. Plus, you can add loved ones to the plan for just a little more.

Note: The premiums for this coverage will not change due to your age. The premium for employee & child/children and employee & family coverage includes all children.

The Lincoln National Life Insurance Company

Please see prior page for product information.

Full-Time Employees of Copperas Cove ISD Benefits at a glance

If you or a covered family member have to go to the hospital for an accident or injury, hospital indemnity insurance provides a lump-sum cash benefit to help you take care of unexpected expenses anything from deductibles to child care to everyday bills. Because you’re selecting this coverage through your company, you can take advantage of group rates. You don’t have to answer medical questions to receive coverage; this is guaranteed coverage

Core hospital benefits Plan benefit

Hospital admission

For the initial day of admission to a hospital for treatment of a sickness/an injury

Hospital confinement

For each day of confinement in a hospital as a result of a sickness/an injury

Hospital intensive care unit (ICU) admission

For the initial day of admission to an ICU for treatment as the result of a sickness/an injury

Hospital ICU confinement

For each full or partial day of confinement in an ICU as a result of a sickness/an injury

$1,000 per day up to one day per calendar year

$200 per day up to 30 days per calendar year starting on 2nd day of confinement

$2,000 per day up to one day per calendar year

$400 per day up to 30 days per calendar year starting the 2nd day of confinement

Complications of pregnancy Included

▪ Admission or Admitted means accepted for inpatient services in a hospital or intensive care unit for a period of more than 20 hours.

▪ If admitted to a hospital or ICU within 90 days after being discharged from a preceding stay for the same or related cause, the subsequent admission will be considered part of the first admission.

▪ If both hospital and ICU admission or hospital and ICU confinement become payable for the same day, only the Hospital ICU Admission benefit will be paid

Additional confinement benefits Plan benefit

Newborn care

For each day of confinement to a hospital for routine post-natal care following birth

$100 per day up to two days per calendar year

▪ If a newborn baby is confined for treatment of an illness, infirmity, disease, or injury, we will pay the Hospital or ICU confinement benefit instead of the Newborn care benefit.

Receive a cash benefit every year you and any of your covered family members complete a single covered exam, screening, or immunization

Note: See the policy for details and specific requirements for each of these benefits

Benefit exclusions

General exclusions

The policy covers only sicknesses and injuries that occur while insurance is in force. No indemnities will be paid for a sickness or injury that occurs before the effective date of the insurance. Benefits are not payable for any loss caused or contributed to by:

1. Suicide, attempted suicide, or any intentionally self-inflicted injury, while sane or insane*

2. Voluntary intake or use by any means of any drugs, poison, gas, or fumes, except when:

a. Prescribed or administered by a physician

b. Taken in accordance with the physician’s instructions

3. Committing or attempting to commit a felony

4. War or any act of war, declared or undeclared

5. Participation in a riot, insurrection, or rebellion of any kind

6. Participation in an act of terrorism

7. Military duty, including the Reserves or National Guard

8. Travel or flight in or on any aircraft, except as a fare-paying passenger on a regularly scheduled commercial flight, or as a passenger, pilot, or crew member in the group policyholder's aircraft while flying for group policyholder business, provided:

a. The aircraft has a valid U.S. airworthiness certificate (or foreign equivalent)

b. The pilot has a valid pilot's certificate with a non-student rating authorizing them to fly the aircraft

9. Driving a vehicle while intoxicated, as defined by the jurisdiction where the accident occurred

10. Cosmetic surgery, unless the treatment is the result of a covered event

11. Treatment for dental care or dental procedures, unless the treatment is the result of a covered event

12. Treatment of a mental illness*

13. Treatment of alcoholism, drug addiction, chemical dependency, or complications thereof*

14. Treatment through experimental procedures

15. Travel outside the United States and its possessions for the sole purpose of receiving medical care ortreatment

16. Participating in, practicing for, or officiating any semi-professional or professional sport

17. Riding in or driving in any motor driven vehicle for race, stunt show, or speed test

18. Being incarcerated in any type of penal or detention facility

19. Scuba diving

20. Mountaineering or spelunking

21. Bungee cord jumping, hang gliding, sail gliding, parasailing, parakiting, kitesurfing, base jumping, or any similar activities

22. Skydiving, parachuting, jumping, or falling from any aircraft for recreational purposes

23. Residing outside the United States, U.S. Territories, Canada, or Mexico for more than 12 months

24. Injury arising out of or during employment for wage or profit

*Exceptions to the exclusions are accepted when substance abuse and mental disorder benefits are selected. This is a partial list of benefit exclusions. A complete list is included in the policy. State variations apply.

Hospital indemnity insurance premium

Affordable group rates – Monthly premiums

As an employee, you can take advantage of this accident insurance plan. Plus, you can add loved ones to the plan for just a little more.

Please see prior pages for product information.

Insurance products are issued by The Lincoln National Life Insurance Company, Fort Wayne, IN, which does not solicit business in New York, nor is it licensed to do so. Limitations and exclusions apply.

Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations.

LCN-6015745-101123

GP-HSP1P-FLI001_Z02

Are you protected from a diagnosis of cancer? There are daily living expenses you must pay for even if you are sick and cannot work.

GROCERIES SCHOOL CAR

How will you pay for them?

Group Cancer Insurance

Supplements existing coverage and can provide cash to help with medical and living expenses

Group Voluntary Cancer coverage from Allstate Benefits pays cash benefits for cancer and 29 specified diseases to help with the costs associated with treatments and expenses as they happen.

THIS IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE 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.

cancer and speciﬁed disease

Receiving a diagnosis of cancer or a specified disease can be difficult on anyone, both emotionally and financially. Having the right coverage to help when undergoing treatments for cancer or a specified disease is important. Our coverage can help provide added financial support when it is needed most.

Our coverage helps offer peace of mind when a diagnosis of cancer or a speciﬁed disease occurs. Below is an example of how benefits might be paid. *

Jane chooses beneﬁt coverage under her Employer

Approved Plan

Jane undergoes her annual wellness test and is diagnosed with cancer.

Jane’s doctor recommends pre-op testing and provides her with the location of the hospital. Jane must travel 200 miles to have pre-op testing (medical imaging) and is admitted to the hospital for surgery.

Our cancer insurance policy paid Jane the following: Wellness Exam $50

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 anti-nausea medication, and sees her doctor during her follow-up visits. Total

$15,110

*The example shown may vary from the plan your employer is offering. Your individual experience may also vary. Please see pages 2a and/or 2b for your plan details.

meeting your needs

Our cancer coverage can help offer you and your family financial support.

• Benefits paid directly to you unless otherwise assigned

• Coverage for you or your entire family

• No evidence of insurability required at initial enrollment†

• Waiver of premium after 90 days of disability due to cancer for as long as your disability lasts**

• Portable

† Enrolling after your initial enrollment period requires evidence of insurability. **Primary insured only.

beneﬁt coverage highlights

Cancer and specified disease benefits can help cover the costs of speciﬁc treatments and expenses as they happen. Terms and conditions for each benefit will vary. Benefit amounts are shown on pages 2a and/or 2b.

Speciﬁed Diseases - Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease), Muscular Dystrophy, Poliomyelitis, Multiple Sclerosis, Encephalitis, Rabies, Tetanus, Tuberculosis, Osteomyelitis, Diphtheria, Scarlet Fever, Cerebrospinal Meningitis, Brucellosis, Sickle Cell Anemia, Thalassemia, Rocky Mountain Spotted Fever, Legionnaires’ Disease, Addison’s Disease, Hansen’s Disease, Tularemia, Hepatitis (Chronic B or C), Typhoid Fever, Myasthenia Gravis, Reye’s Syndrome, Primary Sclerosing Cholangitis (Walter Payton’s Disease), Lyme Disease, Systemic Lupus Erythematosus, Cystic Fibrosis, and Primary Biliary Cirrhosis.

HOSPITAL AND RELATED BENEFITS

Continuous Hospital Confinement - Pays a benefit for each day of inpatient conﬁnement.

Government or Charity Hospital - Pays a benefit for each day of inpatient conﬁnement to a U.S. government hospital or a hospital that does not charge for its services. In lieu of all other beneﬁts.

Private Duty Nursing Services - Pays a daily beneﬁt when receiving physician-authorized inpatient private nursing services.

Extended Care Facility - Pays a daily beneﬁt for physician-authorized inpatient conﬁnement (within 14 days of a hospital stay).

At Home Nursing - Pays a daily benefit for p hysician- authorized priv ate nursing care (up to the number of days of the previous hospital stay).

Wellness

Hospice Care - Pays a beneﬁt when a physician determines terminal illness and approves hospice care at home (1 visit per day) or in a freestanding hospice care center.

RADIATION, CHEMOTHERAPY AND RELATED BENEFITS

Radiation/Chemotherapy for Cancer - Pays a beneﬁt for covered treatment to destroy or modify cancerous tissue.

Blood, Plasma, and Platelets - Pays a beneﬁt for blood, plasma, and platelets. Includes charges for transfusions, administration, processing, procurement and cross-matching. Does not include donor replaced blood or immunoglobulins.

Medical Imaging - Pays a beneﬁt for an initial diagnosis or follow-up evaluation.

Hematological Drugs - Pays a beneﬁt for drugs to boost cell lines when Radiation/Chemotherapy for Cancer beneﬁt is paid.

SURGERY AND RELATED BENEFITS

Surgery*- Pays a benefit for an inpatient or outpatient operation listed in the Schedule of Surgical Procedures.

Anesthesia - Pays 25% of surgery beneﬁt.

Ambulatory Surgical Center - Pays a beneﬁt for surgery at an ambulatory surgical center

Second Opinion - Pays a benefit for a second surgical opinion.

Bone Marrow or Stem Cell Transplant - Pays a benefit for transplants.

MISCELLANEOUS BENEFITS

Inpatient Drugs and Medicine - Pays a daily beneﬁt for inpatient drugs and medicine.

Physician’s Attendance - Pays a daily benefit for one inpatient visit.

Ambulance - Pays a benefit for transfer by ambulance service to or from a hospital.

Non-Local Transportation - Pays a beneﬁt for transportation for treatment not available locally (up to 700 miles).

Outpatient Lodging - Pays a daily beneﬁt for lodging when receiving radiation or chemotherapy on an outpatient basis non-locally (more than 100 miles from home).

Family Member Lodging and Transportation - Pays a beneﬁt for one adult family member when conﬁned at a non-local hospital for specialized treatment (more than 100 miles from family member’s home).

Physical or Speech Therapy - Pays a daily benefit for physical or speech therapy to restore normal body function.

New or Experimental Treatment - Pays a benefit for physician- approved new or experimental treatments not paid under other beneﬁts.

Prosthesis - Pays a benefit for a prosthetic device that requires surgical implanting.

Hair Prosthesis - Pays a beneﬁt for a wig or hairpiece when hair loss is experienced.

Nonsurgical External Breast Prosthesis - Pays a beneﬁt for the initial nonsurgical breast prosthesis after a covered mastectomy.

Anti-Nausea Beneﬁt - Pays a beneﬁt for prescribed antinausea medication administered on an outpatient basis.

Waiver of Premium (primary insured only) - Pays premiums after disabled 90 days in a row due to cancer, for as long as disability lasts.

ADDITIONAL BENEFITS

Cancer Initial Diagnosis - Pays a one-time benefit if diagnosed for the ﬁrst time with cancer (except skin cancer).

Wellness - Pays a beneﬁt each calendar year for one of the following: Biopsy for skin cancer; Blood tests for triglycerides, CA15-3 (breast cancer), CA125 (ovarian cancer), CEA (colon cancer) and PSA (prostate cancer); Bone Marrow Testing; Chest X-ray; Colonoscopy; Doppler screening for carotids or peripheral vascular disease; Echocardiogram; EKG; Flexible sigmoidoscopy; Hemoccult stool analysis; HPV (Human Papillomavirus) Vaccination; Lipid panel (total cholesterol count); Mammography, including Breast Ultrasound; Pap Smear, including ThinPrep Pap Test; Serum Protein Electrophoresis (test for myeloma); Stress test on bike or treadmill; Thermography; and Ultrasound screening for abdominal aortic aneurysms.

Intensive Care - Pays a daily benefit for Intensive Care Unit Confinements for any illness or accident (up to 45 days for each stay), Step-down Intensive Care Unit Confinements (up to 45 days for each stay) and air or surface ambulance to a hospital intensive-care unit.

CERTIFICATE SPECIFICATIONS

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

Termination of Coverage - (a) Coverage under the policy ends on the date the policy is canceled; the last day premium payments were made; the last day of active employment, unless coverage is continued due to Temporary Layoff, Leave of Absence or Family and Medical Leave of Absence; the date you or your class is no longer eligible. (b) Spouse/domestic partner coverage ends upon divorce/termination of partnership or your death. (c) Coverage for children ends when the child reaches age 26, unless he or she continues to meet the requirements of an eligible dependent.

Portability Privilege - Coverage may be continued under the Portability Provision when coverage under the policy ends.

LIMITS, EXCLUSIONS AND EXCEPTIONS

Pre-Existing Condition - (a) Allstate Beneﬁts does not pay beneﬁts for a pre-existing condition during the 12-month period beginning on the date that person’s coverage starts. (b)A pre-existing condition is a disease or condition for which symptoms existed within the 12-month period prior to the effective date; or (c) medical advice or treatment was recommended or received from a medical professional within the 12-month period prior to the effective date. (d)A pre-existing condition can exist even though a diagnosis has not yet been made.

Cancer and Specified Disease Benefits Exclusions and Limitations - (a) Allstate Benefits does not pay for any loss, exc ept for losses due to cancer or a specified disease. (b) Benefits are not paid for conditions caused or aggravated by cancer or a specified disease.

Treatment and services must be needed due to cancer or a speciﬁed disease and be received in the United States or its territories.

For the Surgery, New or Experimental Treatment and Prosthesis benefits, Allstate Benefits pays 50% of the applicable maximum when specific charges are not obtainable as proof of loss.

For the Radiation/Chemotherapy for Cancer benefit, Allstate Beneﬁts does not pay for: (a) any other chemical substance which may be administered with or in conjunction with radiation/chemotherapy; or (b) treatment planning consultation; management; or the design and construction of treatment devices; or basic radiation dosimetry calculation; or any type of laboratory tests; X-ray or other imaging used for diagnosis or monitoring; or the diagnostic tests related to these treatments; or (c) any devices or supplies including intravenous solutions and needles related to these treatments.

Intensive Care Benefits 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 a hospital 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 effective date are not covered for confinement occurring or beginning during the first 30 days of the child’s life. (f) We do not pay for ambulance if paid under the cancer and specified disease ambulance benefit.

group voluntary cancer

HOSPITAL AND RELATED BENEFITS

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 (daily) or 1.$200 1.$200 Hospice Care Team (per visit) 2.$2002.$200

RADIATION, CHEMOTHERAPY AND RELATED BENEFITS

Radiation/Chemotherapy for Cancer (every 12 mos.)

Blood, Plasma, and Platelets (every 12 mos.)

$5,000*$17,500*

Medical Imaging (yearly) $250*4 $875*4

Hematological Drugs (yearly) $100* $350*

SURGERY AND RELATED BENEFITS Surgery

Anesthesia (% of surgery)

Ambulatory Surgical Center (daily)

Second Opinion

Bone Marrow or Stem Cell Transplant

MISCELLANEOUS BENEFITS

Inpatient Drugs and Medicine (daily)

Physician’s Attendance (daily)

Ambulance (per conﬁnement)

Non-Local Transportation (per trip or mile)

Outpatient Lodging (daily)

Family Member Lodging (daily) and Transportation (per trip or mile) Coach Fare Coach

Physical or Speech Therapy (daily)

New or Experimental Treatment (every 12 mos.)

Prosthesis

Hair Prosthesis (every 2 years)

Nonsurgical External Breast Prosthesis

Anti-Nausea Beneﬁt (yearly)

Coach Fare Coach Fare or $0.40 or $0.40 $50*1 $50*1 $50* $50*

Waiver of Premium (primary insured only) Yes Yes

ADDITIONAL BENEFITS Cancer Initial Diagnosis

Wellness (yearly)

Intensive Care

1. Intensive Care Conﬁnement (daily)

$3,0005 $3,0005 $504 $1004

Listed to the left are beneﬁt amounts associated with the beneﬁts described in the brochure.

*Beneﬁtpaysfor charges/costs up to amount listed

1 Limit $2,000/ 12 mo. period

2 Based on procedure up to maximum shown

3 Per amputation 4 Payable once/ covered person/ calendar year

5 One-time beneﬁt

FLEXIBLE BENEFITS PLAN

Copperas Cove Independent School District Employer ID NBS394623

Congratulations! Copperas Cove Independent School District has established a "Flexible Benefits Plan" to help you pay for your out-ofpocket medical expenses. The benefits you elect are paid for with a portion of your pay before Federal income or Social Security taxes are withheld. This means that you will save money by paying less taxes and have more money to spend. However, if you receive a reimbursement for an expense under the Plan, you cannot claim a Federal income tax credit or deduction on your return.

GENERAL PLAN INFORMATION

Plan Year:………………… September 1st through August 31st

Maximum Health FSA Limit… ...…Current IRSlimit

See Code Section 125(i)(2) or current enrollment information

Maximum Dependent Care Limit:……..……………..……..$5,000

Carryover

If you have unused contributions in your Health Flexible Spending Account following the Plan run-out period, you may roll forward a limited dollar amount into the following plan year.

Health FSA Carryover…….Up to $500 following the Plan run-out Amounts exceeding $500 will be forfeited

Grace Period

If you have unused contributions in your Flexible Spending Accounts from the immediately preceding plan year, you may have a limited period to incur additional qualifying FSA and/or Dependent Care expenses.

Dependent Care (DCAP) ...…...75 days

Deadlines to Incur Expenses on Elected Funds

Health FSA August 31 Plan Year End

DCAP………………… .November 14 following Plan Year End

Deadlines to File for Reimbursement

Run-out Period:………………………………… 90 days

Health FSA and DCAP… November 29 following plan year end

Mid-Year Terminations

FSA 30 days following termination date

DCAP…………………....… 30 days following termination date

Orthodontic Reimbursement ……….as paid per service contract or in full at time of banding Upfront payment……………….…………..… …allowed

AM I ELIGIBLE TO PARTICIPATE

FSA

If you work 20 hours or more each week for the company, you will be eligible to join the Plan following your date of employment

You will enter the Plan on the first day of the month coinciding with or following the day in which you meet the above eligibility requirements.

Premium

Only Plan:

If you work 20 hours or more each week for the company, you will be eligible to join the Plan upon meeting eligibility requirements for our Group Medical Plan

Highly Compensated & Key Employees

Under the Internal Revenue Code, "highly compensated employees" and "key employees" generally are Participants who are officers, shareholders or highly paid. If you fall within these categories, you may be limited in the benefits or election amounts that are available to you. Please refer to your Summary Plan Description or your HR Department for more information.

WHAT TYPE OF BENEFITS ARE AVAILABLE

Under our Plan, you can choose the following benefits. Each benefit allows you to save taxes at the same time because the amount you elect is set aside on a pre-tax basis.

Health

Flexible Spending Account:

The Health Flexible Spending Account (FSA) enables you to pay for expenses allowed under Section 105 and 213(d) of the Internal Revenue Code which are not covered by our insured medical plan. Your Plan Maximum can be found in the General Plan Information section. Please note: If you contribute to this benefit, you cannot elect a Health Savings Account (HSA) Benefit. If you participate in a Health Savings Account (HSA) benefit you cannot participate in the Full Health Flexible Spending Account benefit, but you can participate in the Limited Health Flexible Spending Account Benefit.

NBS Welfare Benefit Service Center

(855)399-3035

service@nbsbenefits.com

Flexible Benefits Plan Highlights

Limited Health Flexible Spending Account:

If you participate in a Health Savings Account, you can choose to participate in a Limited Health Flexible Spending Account which will allow you to be reimbursed for out-of-pocket dental and/or vision expenses incurred by you and your dependents. You may not, however, be reimbursed for the cost of other health care coverage maintained outside of the Plan, or for long-term care expenses.

Dependent Care Flexible Spending Account:

The Dependent Care Flexible Spending Account (DCAP) enables you to pay for out-of-pocket, work-related dependent day-care cost. Please see the Summary Plan Description for the definition of eligible dependent. The law places limits on the amount of money that can be paid to you in a calendar year. Generally, your reimbursement may not exceed the lesser of: (a) $5,000 (if you are married filing a joint return or you are head of a household) or $2,500 (if you are married filing separate returns); (b) your taxable compensation; (c) your spouse’s actual or deemed earned income.

Premium Expense Plan:

A Premium Expense portion of the Plan allows you to use pre-tax dollars to pay for specific premiums under various insurance programs that we offer you.

Please note: Policies other than company sponsored policies (i.e. spouse's or dependents' individual policies etc.) may not be paid through the Flexible Benefits Plan. Furthermore, qualified longterm care insurance plans may not be paid through the Flexible Benefits Plan.

DETERMINING CONTRIBUTIONS

Before each Plan Year begins, you will select the benefits you want and how much of the contributions should go toward each benefit. It is very important that you make these choices carefully based on what you expect to spend on each covered benefit or expense during the Plan Year.

Generally, you cannot change the elections you have made after the beginning of the Plan Year. However, there are certain limited situations when you can change your elections if you have a “change in status”. Please refer to your Summary Plan Description for a change in status listing.

HOW DO I RECEIVE REIMBURSEMENTS

Participant Portal or Mobile App

During the course of the Plan Year, you may submit requests for reimbursement of expenses you have incurred. Expenses are considered “incurred” when the service is performed, not necessarily when it is paid for. Claims may be submitted through your online account or the NBS Mobile App.

In order to have the reimbursements made to you for qualifying Dependent Care expenses, you must provide a statement from the service provider including the name, address, date of service, the amount of expense and proof that the expense has been incurred. In most cases, the taxpayer identification number of the service provider will also be necessary.

Claims for reimbursement must be submitted in accordance with the timelines provided in the General Plan Information section.

NBS Smart Debit Card – FSA Pre-paid MasterCard

Your employer may sponsor the use of the NBS Smart Debit Card to access your Health FSA dollars. You may use the card to pay merchants or service providers that accept credit cards, so there is no need to pay cash up front then wait for reimbursement.

NBS Welfare Benefit Service Center

(855)399-3035

service@nbsbenefits.com

Updated: 6/6/2024

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

2024-2025

4 1

8 30

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). Authorized signers who are 55 or older must have their own HSA in order to make the catch-up contribution.

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).

You do NOT have to be enrolled in a medical plan to sign up for MASA!

EMERGENCY TRANSPORTATIONCOSTS

MASA MTS is here toprotect its members and their families from the shortcomings of health insurance coverage by providing them with comprehensive financial protection for lifesaving emergencytransportationservices, bothathome andaway fromhome.

ManyAmericanemployersandemployees believethattheirhealthinsurancepolicies covermost,ifnotallambulanceexpenses. The truth is, they DONOT!

Even after insurance payments for emergency transportation, you couldreceive abillupto$5,000forgroundambulanceand as high as $70,000 for air ambulance. The financial burdens for medical transportation costs are veryreal.

HOW MASA ISDIFFERENT

AcrosstheUStherearethousandsofground ambulance providers andhundreds of air ambulance carriers. ONLY MASA offers comprehensive coverage since MASA is a PAYER andnotaPROVIDER!

ONLY MASA provides over 1.6million members with coverage for BOTH ground ambulance and air ambulance transport, REGARDLESS ofwhich provider transportsthem.

Members are covered ANYWHERE in all50 states andCanada!

Additionally, MASA provides arepatriation benefit:ifamemberishospitalizedmorethan 100miles from home, MASA can arrangeand pay tohave them transported toahospital closer totheir place ofresidence.

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 aminimal monthlyfee.

• One low fee for the entire family

• NO deductibles

• NO healthquestions

• Easy claims process

For more information, pleasecontact Your Broker or MASA Representative

Copperas Cove ISD

ARE YOU AWARE OF YOUR 403(b) BENEFIT?

THE OPPORTUNITY

You have the opportunity to save for retirement by participating in your Employer’s 403(b) retirement plan. A 403(b) plan is a retirement plan for certain employees of public schools, tax-exempt organizations and ministries. We recommend that all employees visit our education page which can be found here: www.omni403b.com/Employees/Education WHY SAVE WITH 403(b)?

1. You do not pay income tax on allowable contributions until you begin making withdrawals from the plan, usually after your retirement.

2. Pre-tax investment gains in the plan are not taxed until distribution and eligible ROTH investment gains are tax free.

3. Generally, retirement assets can be carried from one employer to another.

New accounts may be opened with the following approved service providers.

•American Century Services LLC

•American Fund/Capital Guardian

•Aspire Financial Services

•Equitable (formerly AXA)

•Fidelity Security Life Ins. Co.

•General American

•GWN/Employee Deposit Acct

•Industrial Alliance - (Sec.Ben.)

•Invesco OppenheimerFunds

•Lincoln National

•National Life Group (LSW)

•PlanMember Services Corp.

•ROTH - Horace Mann Life Ins. Co.

•Thrivent Financial for Lutherans

•Vanguard Fiduciary Trust Co.

•Victory Capital (USAA Mutual Funds)

HOW CAN I PARTICIPATE?

Prior to contributing you must open an account with an investment provider authorized in the Plan, a list of which is available on the right. You may then complete a Salary Reduction Agreement (SRA) online at: www.omni403b.com/SRA

If you are already contributing to your Employer’s Plan and you want to change your contribution amount or investment provider, simply complete and submit a new SRA. Once we are in receipt of the newly completed SRA, we will notify your employer to begin contributions. HOW MUCH CAN I CONTRIBUTE ANNUALLY?

In 2024, you may contribute up to $23,000 if you are 49 years of age or below and up to $30,500 if you are 50 years of age and over. You may also be entitled to additional catch-up provisions like the 15 Year Service Catch-up. Please contact OMNI’s Customer Care Center at 877.544.6664 for further details.

LOOKING FOR HELP?

Click the link below for an investment professional to reach out to you.

Copperas Cove ISD Plan Detail Page

Copperas Cove ISD 24-25 Guide

OPEN ENROLLMENT INFORMATION

More Important Information

Covering Dependents?

Making Changes During Year

New Employees

Very Important

Benefit Related Documents

TABLE OF CONTENTS

TABLE OF CONTENTS

Login Process

CopperasCoveISD

Dental Health Scorecard

Rx Savings

Eyewear Savings

Dental Rewards®

Dental Network Information

Pretreatment

Open Enrollment

Section 125

Dental Cost Estimator

Worldwide Support

Language Services

Designer Vision Plan

IN-NETWORK BENEFITS

ADDITIONAL DISCOUNTED LENS OPTIONS & COATINGS

Value for our Members

Convenient Network Locations

Freedom of Choice

Value-Added Features:

Contact Info

ADDITIONAL OPTIONS

FRAMES

LENSES

OUT-OF-NETWORK REIMBURSEMENT SCHEDULE

Important Definitions and Policy Provisions:

to Calculate Your Monthly Cost:

Definitions and Policy Provisions:

Age at Commencement of Disability

Duration of Benefit Period

life insurance you can keep!

QUICK QUESTIONS 3

DURING THE LAST SIX MONTHS, HAS THE PROPOSED INSURED:

What is it?

Copperas Cove ISD Life/AD&D insurance

Why is this coverage valuable?

Your life insurance and AD&D coverage

Benefit exclusions

Life/AD&D

What is it?

Copperas Cove ISD Life/AD&D insurance

Why is this coverage valuable?

Your life insurance and AD&D coverage

Life/AD&D

Benefit exclusions

Copperas Cove ISD Benefits

At-A-Glance

What your benefits cover

Employee Coverage

Guaranteed Life Insurance Coverage Amount

Additional Plan Benefits Included with Life Coverage

Benefit Exclusions

Monthly Voluntary Life Insurance Premium

Calculate Your Cost

Full-Time Employees of Copperas Cove ISD

Benefits At-A-Glance

Coverage for you

Coverage for your spouse

Coverage for your dependent children

Additional Plan Benefit(s)

Benefit Exclusions

Critical Illness Insurance Premium

Lincoln Accident Insurance Plan:

Full-Time Employees at Copperas Cove ISD

Specific Injuries

Health Assessment/Wellness Benefit

Additional plan benefits

Your cash benefit

Benefit exclusions

Accident insurance premium