La Grange ISD Benefits Guide

INTRODUCTION

Provid great bene t choices to you and your family is justcial welfare of the people who make our district work so well.

HOW DO I ENROLL?

Visit last 4 digits of your SSN. (EX: John Sanderson SSN: Complete last name (excluding any special

WHO IS ELIGIBLE?

insurance at full cost.

WHO IS AN ELIGIBLE DEPENDENT?

Dependent children of any age who are disabled

Children under your legal guardianship

NEW HIRE ENROLLMENT

of the following month.

MID-YEAR CHANGES

or cancel coverage during the year if you have a qualifying change in the family or employment status that causes you to include:

Loss or gain of eligibility for other insurance (including

WHEN WILL I RECEIVE ID CARDS?

Everyone enrolled in Medical will receive a new Medical Card.

rary ID card or give your provider the insurance company’s phonenumber to call and verify your coverage if you do not havean ID card at the time of service.

WHO DO I CONTACT WITH QUESTIONS?

Site Access To access your employer online enrollment site, , you can ebsite

mployee ame Robert Smith, SS# 123-45-6789

Default Password

User Name: smith 6789

Password password once you enter the site.

Full-Time Employees

Safeguard the most important people in your life.

Think about what your loved ones may face afteryou’re gone. Term life insurance can help them in so many ways, like covering everyday expenses, paying off debt, and protecting savings. AD&D provides even more coverage if you die or suffer a covered loss in an a ccident.

AT A GLANCE:

• A cash benefit of $10,000toyourlovedonesintheeventofyourdeath,plusa matching cash benefit if you die in anaccident

• A cash benefit to you if you suffer a covered loss in an accident, suchas losing a limb or your eyesight

• Accident Plus -If you suffer an AD&D loss in an accident, you may also receive benefits for the following on top of your core AD&D benefits: coma, plegia, education, childcare, spouse training, and more.

• LifeKeys® services, which provide accessto counseling, financial, and legalsupport

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

You also have the option to increase your cash benefit by securing additional coverage at affordable group rates. See the enclosed life insurance information for details.

ADDITIONAL DETAILS

Conversion: You can convert your group term life coverage to an individual life insurance policy without providing evidence of insurability if you lose coverage due to leaving your job or for another reason outlined in the plan contract. AD&D benefits cannot be conve rted.

Benefit Reduction: Coverage amounts begin to reduce at age 65and benefits terminate at retirement. See the plan certificate for details.

For complete benefit descriptions, limitations, and exclusions, refer to the certificate of coverage.

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 diffe rence between this summary and the contract, the contract will govern.

LifeKeys®servicesareprovidedbyComPsych®Corporation,Chicago,IL.ComPsych®,EstateGuidance®andGuidanceResources®are registered trademarks of ComPsych® Corporation. TravelConnect® services are provided by On Call International, Salem, NH. ComPsych® and On Call Internationalare not Lincoln Financial Group® companies. Coverage is subject to actual contract language. Each independent company is solely respo nsible for its own obligations.

Insurance products (policy series GL1101) 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 app ly. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affi liates. Affiliates are separately responsible for their own f inancial and contractual obligations. Limitations and exclusions apply.

La Grange ISDprovides this valuable benefitat no cost to you.

Term Lifeand AD&DInsurance

REMEMBER:

Compare Prices for Common Medical Services

Log into Blue Access for MembersSM at www.bcbstx.com/trsactivecare to use the cost estimator tool. This will help you find the best prices through different providers.

*Pre-certification for genetic and specialty testing may apply. Contact a Personal Health Guide at 1-866-355-5999 with questions.

www.trs.texas.gov

TRS also contracts with HMOs in certain regions of the state to bring participants in those areas additional options. Not all HMOs are available in all regions. Please verify your eligibility.

You can choose this plan if you live in one of these counties: Austin, Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Collin, Coryell, Dallas, Denton, Ellis, Erath, Falls, Freestone, Grimes, Hamilton, Hays, Hill, Hood, Houston, Johnson, Lampasas, Lee, Leon, Limestone, Madison, McLennan, Milam, Mills, Navarro, Robertson, Rockwall, Somervell, Tarrant, Travis, Walker, Waller, Washington, Williamson

You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy

You can choose this plan if you live in one of these counties: Andrews, Armstrong, Bailey, Borden, Brewster, Briscoe, Callahan, Carson, Castro, Childress, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, Fisher, Floyd, Gaines, Garza, Glasscock, Gray, Hale, Hall, Hansford, Hartley, Haskell, Hemphill, Hockley, Howard, Hutchinson, Irion, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Llano, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, San Saba, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Winkler, Yoakum

$2841.00

La Grange Independent School District 20222023 TRS Medical Rates

$1405.00

Health Savings Account – Fact Sheet

An EECU Health Savings Account (HSA) enables you to save and conveniently pay for qualified medical expenses while you earn tax-free interest and pay no monthly service fees.

Opening an HSA provides both immediate and long-term benefits. The money in your HSA is yours even if you change jobs, switch your health plan, or retire. Your unused HSA balance rolls over from year to year. And, best of all, HSAs allow for tax-free deposits, tax-free earnings and tax-free withdrawals (for qualified medical expenses).1 Also, after age 65, you can withdraw funds from your HSA penalty-free.1

Benefits

• Save money tax-free for healthcare expenses – contributions are not subject to federal income taxes and can be made by you, your employer or a third party1

• No monthly service fee – so you can save more

• Competitive Dividends paid on your entire HSA balance, so you can earn more

• Free EECU HSA Debit Mastercard® to conveniently pay for your qualified healthcare expenses. (HSA checks are also available upon request.2)

• Free Online & Mobile Banking and Free Bill Pay & Mobile Deposit to manage your account from anywhere, at anytime

• Comprehensive service and support – to assist you in optimizing your healthcare saving and spending

• Federally insured by NCUA – to at least $250,000

Dividend Rates

Membership in EECU is required - membership information available at eecu.org

1 Contributions, investment earnings, and distributions are tax free for federal tax purposes if used to pay for qualified medical expenses, and may or may not be subject to state taxation. A list of Eligible Medical Expenses can be found in IRS Publication 502, http://www.irs.gov/pub/irs-pdf/p502.pdf

As described in IRS publication 969, http://www.irs.gov/pub/irs-pdf/p969.pdf, certain over-the-counter medications (when prescribed by a doctor) are considered eligible medical expenses for HSA purposes. If an individual is 65 or older, there is no penalty to withdraw HSA funds. However, income taxes will apply if the distribution is not used for qualified medical expenses. For more information consult a tax adviser or your state department of revenue. All contributions and distributions are your responsibility and must be within IRS regulatory limits.

2 Call 817-882-0800 or stop-by an EECU financial center to order standard checks at no charge (excludes shipping and handling) or order custom checks - prices vary.

3 Minimum opening deposit and balance of $.01 required. You will receive a Health Savings Account Agreement and Disclosures at enrollment. Please refer to those documents for complete terms and conditions. A free, no annual fee EECU HSA Debit Mastercard® will be sent to you separately. And, an EECU Health Savings Account Specialist is available to assist you with any questions you may have about your EECU HSA.

4 APY (Annual Percentage Yield) is accurate as of April 3, 2020 and is subject to change at any time. Average daily balance is required to earn the disclosed Annual Percentage Yield. Fees could reduce the earnings on the account. Dividend and interest is compounded daily and credited monthly. See Truth-In-Savings for Health Savings Account for more details.

HOSPITAL CARE COVERAGE

SUMMARY OF BENEFITS

Prepared for: La Grange Independent School District

Hospital Care coverage provides a benefit according to the schedule below when a Covered Person incurs a Hospital stay resulting from a Covered Injury or Covered Illness See State Variations (marked by *) below.

Who Can Elect Coverage:

You: All active, full-time Employees of the Employer who are regularly working in the United States a minimum of 18.75 hours per week and regularly residing in the United States and who are United States citizens or permanent resident aliens or non-United States citizens legally working and living in the United States (Inpats) and their Spouse and Dependent Children who are United States citizens or permanent resident aliens or Spouse or Dependent Child Inpats and who are legally residing in the United States. You will be eligible for coverage the first of the month following date of hire. Your Spouse:* Up to age 100, as long as you apply for and are approved for coverage yourself. Your Child(ren): Birth to age 26; 26+ if disabled, as long as you apply for and are approv ed for coverage yourself.

Available Coverage:

The benefit amounts shown in this summary will be paid regardless of the actual expenses incurred and are paid on a per day basis unless otherwise specified. Benefits are only payable when all policy terms and conditions are met. Please read all the information in this summary to understand the terms, conditions, state variations, exclusions and limitations applicable to these benefits. See your Certificate of Insurance for more information. Benefit Waiting Period:* None, unless otherwise stated. No benefits will be paid for a loss which occurs during the Benefit Waiting Period.

child. This benefit is payable to the employee even if child coverage is not elected.

Examples include (but are not limited to) mammography, and certain blood tests. Also includes COVID-19 Immunization. Virtual Care accepted.

Offered by Life Insurance Company of North America Employee-Paid

Portability Feature:* You, your spouse, and child(ren) can continue 100% of your coverage at the time your coverage ends. You must be covered under the policy and be under the age of 100 in order to continue your coverage. Rates may change and all coverage ends at age 100. Applies to United States Citizens and Permanent Resident Aliens residing in the United States.

Costs are subject to change. Actual per pay period premiums may differ slightly due to rounding.

NOTE: The following are some of the important policy provisions, terms and conditions that apply to benefits described in the policy. This is not a complete list. See your Certificate of Insurance for more information.

Benefit Amounts Payable: Benefits for all Covered Persons are payable at 100% of the Benefit Amounts shown, unless otherwise stated. Late applicants, if allowed under this plan, may be required to provide medical evidence of insurability.

Benefit-Specific Conditions, Exclusions & Limitations (Hospital Care):

Hospital Admission: Must be admitted as an Inpatient due to a Covered Injury or Covered Illness. Excludes: treatment in an emergency room, provided on an outpatient basis, or for re-admission for the same Covered Injury or Covered Illness (including chronic conditions).

Hospital Chronic Condition Admission: Must be admitted as an Inpatient due to a covered chronic condition and treatment for a covered chronic condition must be provided by a specialist in that field of medicine. Excludes: treatment in an emergency room, provided on an outpatient basis, or for re-admission for the same Covered Injury or Covered Illness (including chronic conditions).

Hospital Stay: Must be admitted as an Inpatient and confined to the Hospital, due to a Covered Injury or Covered Illness, at the direction and under the care of a physician. If also eligible for the ICU Stay Benefit, only 1 benefit will be paid for the same Covered Injury or Covered Illness, whichever is greater. Hospital stays within 90 days for the same or a related Covered Injury or Covered Illness is considered one Hospital Stay.

Intensive Care Unit (ICU) Stay: Must be admitted as an Inpatient and confined in an ICU of a Hospital, due to a Covered Injury or Covered Illness, at the direction and under the care of a physician. If also eligible for the Hospital Stay Benefit, only 1 benefit will be paid for the same Covered Injury or Covered Illness, whichever is greater. ICU stays within 90 days for the same or a related Covered Injury or Covered Illness is considered one ICU stay.

Hospital Observation Stay: Must be receiving treatment for a Covered Injury or Covered Illness in a Hospital, including an observation room, or ambulatory surgical center, for more than 24 hours on a non-inpatient basis and a charge must be incurred. This benefit is not payable if a benefit is payable under the Hospital Stay Benefit or Hospital Intensive Care Unit Stay Benefit.

Newborn Nursery Care Admission and Newborn Nursery Care Stay: Must be admitted as an Inpatient and confined in a Hospital immediately following birth at the direction and under the care of a physician.

Common Exclusions and Limitations:

Exclusions:* In addition to any benefit-specific exclusion, benefits will not be paid for any Covered Injury or Covered Illness which is caused by or results from any of the following (unless otherwise provided for in the policy): • Intentionally self-inflicted injury, suicide or any attempted threat while sane or insane; • Commission or attempt to commit a felony or an assault; • Declared or undeclared war or act of war;• A Covered Injury or Covered Illness that occurs while on active duty service in the military, naval or air force of any country or international organization. Upon our receipt of proof of service, we will refund any premium paid for this time. Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days;• Voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage (excludes WA residents);• Operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant including any prescribed drug for which the Covered Person has been provided a written warning against operating a vehicle while taking it. “Under the influence of alcohol”, for purposes of this exclusion, means intoxicated, as defined by the law of the state in which the Covered Injury or Covered Illness occurred. (excludes WA residents);• Those not necessary, as determined by Us in accordance with generally accepted standards of medical practice, for the diagnosis, care or treatment of the physical or mental condition involved. This applies even if they are prescribed, recommended, or approved by the attending physician;• Elective or cosmetic surgery. This does not include reconstructive, cosmetic surgery: a) incidental to or following surgery for trauma, infection or other disease of the involved part; or b) due to congenital disease or anomaly of a Covered Dependent child which has resulted in a functional defect;• Dental surgery, unless the surgery is the result of an accidental injury. In addition, benefits will not be paid for services or treatment rendered by a Physician, Nurse or any other person who is: employed or retained by the Subscriber or providing homeopathic, aromatherapeutic or herbal therapeutic services or living in the Covered Person’s household or a parent, sibling, spouse or child of the Covered Person.

Important Definitions:

Covered Illness: A physical or mental disease or disorder including pregnancy and complications of pregnancy that results in a covered loss. A Covered Illness includes medically-necessary quarantine in a Hospital in conjunction with medically-necessary preventive treatment due to an identifiable exposure to a life-threatening contagious and infectious disease.

Covered Injury: Any bodily harm that results in a covered loss.

Covered Person: An eligible person, as defined in the Schedule of Benefits, who is enrolled and for whom Evidence of Insurability, where required, has been accepted by Us, required premium has been paid when due, and coverage under this Policy remains in force.

Elimination Period: The continuous period of time that must be satisfied before a benefit shown in the Schedule of Benefits is payable. An Elimination Period may be satisfied during the Policy’s Benefit Waiting Period.

Hospital:* An institution that is licensed as a hospital pursuant to applicable law; primarily and continuously engaged in providing medical care and treatment to sick and injured persons; managed under the supervision of a staff of physicians; provides 24-hour nursing services by or under the supervision of a graduate registered Nurse (R.N.); and has medical, diagnostic and treatment facilities with major surgical facilities on its premises, or available to it on a prearranged basis. The term Hospital does not include a clinic or facility for: (1) rehabilitation, convalescent, custodial, educational, hospice, or skilled nursing care; (2) the aged, drug addiction or alcoholism; or (3) a facility primarily or solely providing psychiatric services to mentally ill patients. The term Hospital also does not include a unit of a Hospital for rehabilitation, convalescent, custodial, educational, hospice, or skilled nursing care.

Policy Provisions:

When your coverage begins: Coverage begins on the later of the program’s effective date, the date you become eligible, the first of the month following the date your completed enrollment form is received or if evidence of insurability is required , the first of the month after we have approved you (or your dependent) for coverage in writing unless otherwise agreed upon by Cigna. Your coverage will not begin unless you are actively at work on the effective date. Coverage for Covered Persons will not begin on the effective date if the covered person is confined to a hospital, facility or at home; disabled or receiving disability benefits or unable to perform activities of daily living. Deferral of the effective date will not apply to the Newborn Nursery Care Admission and Stay Benefit.

When your coverage ends: Coverage for any Covered Person ends on the earliest of the date they are no longer eligible, the date the group policy is no longer in force, or the date for the last period for which required premiums are paid. For your Spouse and Dependent Child(ren), if applicable, coverage also ends when your coverage ends, when their premiums are not paid or when they are no longer eligible. (Under certain circumstances, your coverage may be continued if you stop working. Be sure to read the Continuation of Insurance provisions in your Certificate.)

30 Day Right To Examine Certificate: If a Covered Person is not satisfied with the Certificate for any reason, it may be returned to us within 30 days after receipt. We will return any premium that has been paid and the Certificate will be void as if it had never been issued.

*State Variations

For purposes of this brochure, wherever the term Spouse appears, it shall also include Domestic Partner registered under any state which legally recognizes Domestic Partnerships or Civil Unions.Spouse definition includes civil union partners in New Hampshire and Vermont. Newborn Nursery Care Admission and Stay Benefits are not available to residents in ID, NH, OR, and WA. Portability in VT is referred to as Continuation due to loss of eligibility. VT residents are not subject to the age limit to continue coverage. Exclusions may vary for residents of MN, SC, SD, and WA. Important Definitions (Hospital) may vary for residents of ID, NH, OR, WA and VT. Covid- 19 benefits are not available to residents of ID, OR and WA.

THESE POLICIES PAY LIMITED BENEFITS ONLY. THEY ARE NOT COMPREHENSIVE HEALTH INSURANCE COVERAGE AND DO NOT COVER ALL MEDICAL EXPENSES. THIS COVERAGE DOES NOT SATISFY THE “MINIMUM ESSENTIAL COVERAGE” OR INDIVIDUAL MANDATE REQUIREMENTS OF THE AFFORDABLE CARE ACT (ACA). THIS COVERAGE IS NOT MEDICAID OR MEDICARE SUPPLEMENT INSURANCE.

Series 1.0/1.1/1.2

This is not intended as a complete description of the insurance coverage offered. This is not a contract. Full terms and conditions of coverage are defined by and governed by Group Policy No.HC962330. This is not intended as a complete description of the insurance coverage offered. This is not a contract. Please see your Plan Sponsor to obtain a copy of the Group Policy. If there are any differences between this summary and the Group Policy, the information in the Group Policy takes precedence. Product availability may vary by location and plan type and is subject to change. All group insurance policies may contain exclusions, limitations, reduction in benefits, and terms under which the policy may be continued in force or discontinued. For costs and details of coverage, review your plan documents or contact a Cigna representative. Please see your Plan Sponsor to obtain a copy of the Policy. If there are any differences between this summary and the Group Policy, the information in the Group Policy takes precedence. Product availability, costs, benefits, riders 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 GHIP-00-1000.00, GHIP-1.2-1000. Coverage is underwritten by Life Insurance Company of North America, 1601 Chestnut St. Philadelphia, PA 19192

Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through op erating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Life Insurance Company of North America (“LINA”) (Philadelphia, PA); or (ii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna.

887511 © 2022 Cigna. Some content provided under license.

Dental Insurance

Low Option

The Lincoln

DentalConnect®PPO

Plan:

Covers many preventive, basic, and majordental care services

Features group coveragefor La Grange ISDemployees

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

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

Full-Time Employeesof La Grange ISD Benefits At-A-Glance

Contracting Dentists Non-Contracting Dentists

Deductible Individual: $50

Calendar (Annual)

Individual: $50

Family: $150

Waived for: Preventive

Family: $150

Waived for: Preventive

Deductibles are combined for basicand majorContracting Dentists’ services. Deductibles are combined for basicand majorNon-Contracting Dentists’services.

Annual Maximum $750 $750

Annual Maximums are combined for preventive, basic, and major services.

Waiting Period

This plan includes awaiting period if you do not enroll when it is first offered to you (known as a late entrant waiting period).

●12months for basic services

●12months for major services

Routine oral exams

Bitewing X-rays

Full-mouth or panoramic X-rays

Other dental X-rays (including periapical films)

Fluoride

Space maintainers for children

Sealants

(including emergency relief of dental pain)

Problem focused exams

Consultations

Injections of antibiotics and other therapeutic medications

Fillings

Simple extractions

Biopsy and examination of oral tissue (including brush biopsy)

Prefabricated stainless steel and resin crowns

Surgical extractions

Oral surgery

General anesthesia and I.V. s edation

Prosthetic repair and recementation services

Endodontics (including root canal treatment)

Non-surgical periodontal therapy

Periodontal surgery

Bridges

Full and partial dentures

Denture reline and rebase services

Crowns, inlays, onlays and related services

Implants & implant related services

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

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

…you pay a deductible (if applicable), then 60% of the remaining discounted fee for PPO members. This is known a s a PPO contracted fee.

… you pay a deductible (if applicable), then 60% of the maximum allowable charge (MAC) which is the maximum expense covered by the plan. You are responsible for the difference between the maximum allowable charge and the dentist’s billed charge.

With the Lincoln Dental Mobile App

Find a network dentist near you in minutes

Have an ID card on your phone

Customize the app to get details of your plan

Find out how much your plan covers for checkups and other services

Keep track of your claims

Lincoln DentalConnect® Online Health Center

Determine the average cost of a dental procedure

Have your questions answered by a licensed dentist

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

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

Covered Family Members

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

• Your spouse.

• Dependent children, up to age 26.

Benefit Exclusions

Like any coverage, this dental coverage doeshave some exclusions. The plan does not cover services started before coverage begins or after it ends. Benefits are limited to appropriate and necessary procedures listed in the summary plan description.Benefits are not payable for duplication of services. Covered expenses will not exceed the summary plan description’sallowances.

Plan benefits are not payable for a condition that is covered under Workers’ Compensation or a similar law; that occurs during the courseof employment or military service or involvement in an illegal occupation, felony, or riot; or that results from a self-inflicted injury. In certain situations, there may be more than one method of treating a dental condition. This summary plan description includes an alternative benefits provision that may reduce benefits to the lowestcost, generally effective, and necessary form of treatment. Certain conditions, such as age and frequency limitations, may impact your coverage. See the summary plan description for details. This plan includes continuation of coverage for employees with dental coverage from a previous employer. The member is required to complete the Continuity of Coverage form located on www.lfg.com. The form must be providedto us prior to the effective date to be eligible for continuation of coverage.

A complete list of benefit exclusions is included in the summary plan description.

This is not intended as a complete description of the coverage offered. Controlling provisions are provided in the summary plan description,and this summary does not modify coverage. A summary plan descriptionwill be made available to you that describes the benefits in greater detail. Refer to your summary plan descriptionfor your maximum benefit amounts.

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

The Lincoln National Life Insurance Company (Fort Wayne, IN), does not conduct business in New York, nor is it licensed to do so. In New York, business is conducted by Lincoln Life & Annuity Company of New York (Syracuse NY). Both are Lincoln Financial Group Companies.

Dental Rate

Here’s how little you pay with grouprates.

As aLa Grange ISDemployee, you can take advantage of this dental coveragefor less than $0.49a day. Plus, you can add loved ones to the plan for just a little more.

Your estimated cost is itemizedbelow.

The Lincoln National Life Insurance Company

Please see prior page for product information.

Full-Time Employeesof La Grange ISD

Benefits At-A-Glance

Dental Insurance

High Option

The Lincoln

DentalConnect®PPO

Plan:

Covers many preventive, basic, and majordental care services

Also covers orthodontic treatment for children

Features group coveragefor La Grange ISDemployees

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

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

Calendar (Annual)

Deductible

Contracting Dentists Non-Contracting Dentists

Individual: $50

Family: $150

Waived for: Preventive

Individual: $50

Family: $150

Waived for: Preventive

Deductibles are combined for basicand majorContracting Dentists’ services. Deductibles are combined for basicand majorNon-Contracting Dentists’services.

Annual Maximum $1,500 $1,500

Annual Maximums are combined for preventive, basic, and major services.

Lifetime Orthodontic Max $1,000 $1,000

Orthodontic Coverage is available for dependent children.

Waiting Period

This plan includes awaiting period if you do not enroll when it is first offered to you (known as a late entrant waiting period).

●12months for basic services

●12months for major services

●12months for orthodontic services

Routine oral exams

Bitewing X-rays

Full-mouth or panoramic X-rays

Other dental X-rays (including periapical films)

Routine

Fluoride

Space maintainers for children

Sealants Palliative

(including emergency relief of dental pain)

Problem focused exams

Consultations

Injections of antibiotics and other therapeutic medications

Fillings

Simple extractions

Surgical extractions

Oral surgery

Biopsy and examination of oral tissue (including brush biopsy)

General anesthesia and I.V. sedation

Periodontal maintenance procedures

Major Services

Prefabricated stainless steel and resin crowns

Prosthetic repair and recementation services

Endodontics (including root canal treatment)

Non-surgical periodontal therapy

Periodontal surgery

Bridges

Full and partial dentures

Denture reline and rebase services

Crowns, inlays, onlays and related serv ices

Harmful habit appliances

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

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

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

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

With the Lincoln Dental Mobile App

Find a network dentist near you in minutes

Have an ID card on your phone

Customize the app to get details of your plan

Find out how much your plan covers for checkups and other services

Keep track of your claims

Lincoln DentalConnect® Online Health Center

Determine the average cost of a dental procedure

Have your questions answered by a licensed dentist

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

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

Covered Family Members

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

• Your spouse.

• Dependent children, up to age 26.

Benefit Exclusions

Like any coverage, this dental coverage doeshave some exclusions. The plan does not cover services started before coverage begins or after it ends. Benefits are limited to appropriate and necessary procedures listed in the summary plan description.Benefits are not payable for duplication of services. Covered expenses will not exceed the summary plan description’susual and customary allowances. Plan benefits are not payable for a condition that is covered under Workers’ Compensation or a similar law; that occurs during the courseof employment or military service or involvement in an illegal occupation, felony, or riot; or that results from a self-inflicted injury. The plan does not cover an orthodontia treatment plan started before coverage begins unless the member was receiving orthodontia benefits from the employer’s previous group dental summary plan description. In this case, Lincoln Financial will continue orthodontia benefits until the combined benefit paid by both policies is equal to this summary plan description’slifetime orthodontia maximum. Plan benefits are not payable if the orthodontic appliance was installed after the age of 19. In certain situations, there may be more than one method of treating a dental condition. This summary plan description includes an alternative benefits provision that may reduce benefits to the lowestcost, generally effective, and necessary form of treatment. Certain conditions, such as age and frequency limitations, may impact your coverage. See the summary plan description for details. This plan includes continuation of coverage for employees with dental coverage from a previous employer. The member is required to complete the Continuity of Coverage form located on www.lfg.com. The form must be providedto us prior to the effective date to be eligible for continuation of coverage.

A complete list of benefit exclusions is included in the summary plan description.

This is not intended as a complete description of the coverage offered. Controlling provisions are provided in the summary plan description,and this summary does not modify coverage. A summary plan descriptionwill be made available to you that describes the benefits in greater detail. Refer to your summary plan descriptionfor your maximum benefit amounts.

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

The Lincoln National Life Insurance Company (Fort Wayne, IN), does not conduct business in New York, nor is it licensed to do so. In New York, business is conducted by Lincoln Life & Annuity Company of New York (Syracuse NY). Both are Lincoln Financial Group Companies.

Dental Rate

Here’s how little you pay with grouprates.

As aLa Grange ISDemployee, you can take advantage of this dental coveragefor less than $1.09a day. Plus, you can add loved ones to the plan for just a little more.

Your estimated cost is itemizedbelow.

The Lincoln National Life Insurance Company

Please see prior page for product information.

Coveredlensoptions 4

• UVcoating

• Tint(solidandgradient)

• Standardscratch-resistance

• Standardpolycarbonate-adults

• Standardpolycarbonate-children<19

• Standardanti-reflectivecoating

• Premiumanti-reflectivecoating

• Standardprogressive(add-ontobifocal)

• Premiumprogressive –Tier1 –Tier2 –Tier3

• Photochromatic/plastictransitions •

Optionalbenefits

• 12-monthFrameBenefitBenefitreplacesthe24-monthfrequencyofthebaseplan.

XDONOTDELETE

1. Membercostsmayexceed$39withcertainproviders.Membersmaycontacttheirparticipatingproviderto determinewhatcostsordiscountsareavailable.

2. Standardcontactlensexamfitandfollowupcostsandpremiumcontactlensexamdiscountsupto10%may varybyparticipatingprovider.Membersmaycontacttheirparticipatingprovidertodeterminewhatcostsor discountsareavailable.

3. Discountsmaybeavailableonallframesexceptwhenprohibitedbythemanufacturer.

4. Lensoptioncostsmayvarybyprovider.Membersmaycontacttheirparticipatingprovidertodetermineiflisted costsareavailable.

5. DONOTDELETEPlancoverscontactlensesorlensesforframes,butnotboth.

$12.70

$19.96

*Thisisnotasubstituteforaquote.RatesmustbeapprovedbyHumanaVisionunderwriting.

Additionalplandiscounts

• Membermayreceivea20%discountonitemsnotcoveredbytheplanatnetworkProviders.Membersmaycontact theirparticipatingprovidertodeterminewhatcostsordiscountsareavailable.DiscountdoesnotapplytoEyeMed Provider'sprofessionalservices,orcontactlenses.Plandiscountscannotbecombinedwithanyotherdiscountsor promotionaloffers.Servicesormaterialsprovidedbyanyothergroupbenefitplanprovidingvisioncaremaynotbe covered.CertainbrandnameVisionMaterialsmaynotbeeligibleforadiscountifthemanufacturerimposesa no-discountpractice.Frame,Lens,&LensOptiondiscountsapplyonlywhenpurchasingacompletepairof eyeglasses.Ifpurchasedseparately,membersreceive20%offtheretailprice.

• Membersmayalsoreceive15%offretailpriceor5%offpromotionalpriceforLASIKorPRKfromtheUSLaser Network,ownedandoperatedbyLCAVision.SinceLASIKorPRKvisioncorrectionisanelectiveprocedure, performedbyspecialtytrainedproviders,thisdiscountmaynotalwaysbeavailablefromaproviderinyour immediatelocation.

LimitationsandExclusions:

Inadditiontothelimitationsandexclusionslistedin your"VisionBenefits"section,thispolicydoesnot providebenefitsforthefollowing:

1.Anyexpensesincurredwhileyouqualifyforany worker'scompensationoroccupationaldiseaseact orlaw,whetherornotyouappliedforcoverage.

2.Services:

• Thatarefreeorthatyouwouldnotberequiredto payforifyoudidnothavethisinsurance,unless chargesarereceivedfromandreimbursableto theU.S.governmentoranyofitsagenciesas requiredbylaw;

• Furnishedby,orpayableunder,anyplanorlaw throughanygovernmentoranypolitical subdivision(thisdoesnotincludeMedicareor Medicaid);or

• FurnishedbyanyU.S.government-ownedor operatedhospital/institution/agencyforany serviceconnectedwithsicknessorbodilyinjury.

3.Anylosscausedorcontributedby:

• Waroranyactofwar,whetherdeclaredornot;

• Anyactofinternationalarmedconflict;or

• Anyconflictinvolvingarmedforcesofany internationalauthority.

4.Anyexpensearisingfromthecompletionofforms.

5.Yourfailuretokeepanappointment.

6.Anyhospital,surgicalortreatmentfacility,orfor servicesofananesthesiologistoranesthetist.

7.Prescriptiondrugsorpre-medications,whether dispensedorprescribed.

8.AnyservicenotspecificallylistedintheScheduleof Benefits.

9.Anyservicethatwedetermine:

• Isnotavisualnecessity;

• Doesnotofferafavorableprognosis;

• Doesnothaveuniformprofessionalendorsement; or

• Isdeemedtobeexperimentalorinvestigational innature.

10.Orthopticorvisiontraining.

11.Subnormalvisionaidsandassociatedtesting.

12.Aniseikoniclenses.

13.Anyserviceweconsidercosmetic.

14.Anyexpenseincurredbeforeyoureffectivedateor afterthedateyourcoverageunderthispolicy terminates.

15.Servicesprovidedbysomeonewhoordinarilylivesin yourhomeorwhoisafamilymember.

16.Charges exceeding the reimbursement limit for the service.

17.Treatmentresultingfromanyintentionallyself-inflicted injuryorbodilyillness.

18.Planolenses.

19.Medicalorsurgicaltreatmentofeye,eyes,or supportingstructures.

20.Replacementoflensesorframesfurnishedunderthis planwhicharelostorbroken,unlessotherwise availableundertheplan.

21.AnyexaminationormaterialrequiredbyanEmployer asaconditionofemployment.

22.Non-prescriptionsunglasses.

23.Twopairofglassesinlieuofbifocals.

24.Servicesormaterialsprovidedbyanyothergroup benefitplansprovidingvisioncare.

25.Certainnamebrandswhenmanufacturerimposes nodiscount.

26.Correctivevisiontreatmentofanexperimentalnature.

27.Solutionsand/orcleaningproductsforglassesor contactlenses.

28.Pathologicaltreatment.

29.Non-prescriptionitems.

30.Costsassociatedwithsecuringmaterials.

31.Pre-andPost-operativeservices.

32.Orthokeratology.

33.Routinemaintenanceofmaterials.

34.Refittingorchangeinlensdesignafterinitialfitting, unlessspecificallyallowedelsewhereinthecertificate. 35.Artisticallypaintedlenses.

HumanaVisionproductsinsuredbyHumanaInsurance Company,HumanaHealthBenefitPlanofLouisiana,The DentalConcern,Inc.orHumanaInsuranceCompanyof NewYork.InArizona,groupvisionplansinsuredby HumanaInsuranceCompany.InNewMexico,groupvision plansinsuredbyHumanaInsuranceCompany.

Thisisnotacompletedisclosureoftheplanqualifications andlimitations.Specificlimitationsandexclusionsas containedintheRegulatoryandTechnicalInformation Guidewillbeprovidedbytheagent.Pleasereviewthis informationbeforeapplyingforcoverage.

NOTICE:Youractualexpensesforcoveredservicesmay exceedthestatedcostorreimbursementamountbecause actualproviderchargesmaynotbeusedtodetermine insurerandmemberpaymentobligations.

Accident Insurance

Benefits that may help cover costs such as those not covered by your medical plan.

Accident Insurance Benefits

With MetLife, you’ll have a plan that provide payments in addition to any other insurance payments you may receive 1. Here are just some of the covered events/services 2

Covered Benefits – All benefits must relate to injuries sustained in an accident.

ADF# AI664.14

Face or Nose (except mandible or maxilla)

Skull Fracture - depressed (except bones of face or nose)

Skull Fracture - non depressed (except bones of face or nose)

Lower Jaw, Mandible (except alveolar process)

Upper Jaw, Maxilla (except alveolar process)

Arm between Elbow and Shoulder (humerus)

Shoulder Blade (scapula), Collarbone (clavicle, sternum)

Forearm (radius and/or ulna), Hand, Wrist (except fingers)

Body of (excluding vertebral processes)

Process

(includes ilium, ischium, pubis, acetabulum except co ccyx)

If more than one bone is fractured, the amount we will pay for all fractures combined will be no more than 2 times the highest Fracture Benefit.

(except alveolar process)

If more than one bone is fractured, the amount we will pay for all fractures combined will be no more than 2 times the highest Fracture Benefit.

Accident Insurance

(radius and/or ulna), Hand, Wrist (except fingers)

ilium, ischium, pubis, acetabulum except coccyx)

If more than one joint is dislocated, the amount we will pay for all dislocations combined will be no more than 2 times the highest Dislocation Benefit.

If more than one joint is dislocated, the amount we will pay for all dislocations combined will be no more than 2 times the highest Dislocation Benefit.

Accident Insurance

Accident Insurance

Accident Insurance

Accident Insurance

Notes Regarding Certain Benefits:

Accidental Death Benefits Category: The benefit amount will be reduced by the amount of any Accidental Dismemberment/Functional Loss/Paralysis Benefits and Modification Benefit paid for Injuries sustained by the Covered Person in the same Accident for which the Accidental Death Benefit is being paid.

Accidental Death Common Carrier Benefit: “Common Carrier” : refers to airplanes, trains, buses, trolleys, subways and boats. Certain conditions apply. See your Disclosure Statement or Outline of Coverage/Disclosure Document for specific details.

Lodging Benefit: The lodging benefit is not available in all states. It provides a benefit for a companion accompanying a covered insured while hospitalized, provided that lodging is at least 50 miles from the insured’s primary residence.

Please contact MetLife for detailed definitions and state variations of covered benefits.

Organized Sports Activity Injury Benefit Rider

Accident Insurance

This coverage includes an Organized Sports Activity Benefit Rider. The rider increases the amount payable under the Certificate for certain benefits by 25% for injuries resulting from an accident that occurred while participating as a player in an organized s ports activity. The rider sets forth terms, conditions and limitations, including the covered persons to whom the rider applies.

Benefit Payment Example

Kathy’s daughter, Molly, was riding her bike to school. On her way there she fell to the ground, was knocked unconscious, and was taken to the local emergency room (ER) by ambulance for treatment. The ER doctor diagnosed a concussion and a broken tooth. He ordered a CT s can to check for facial fractures too, since Molly’s face was very swollen. Mol ly was released to her primary care physician for follow-up treatment, and her dentist repaired her broken tooth with a crown. Depending on her health insurance, Kathy’s out-of-pocket costs could run into hundreds of dollars to cover expenses like insurance co-payments and deductibles. MetLife Group Accident Insurance payments can be used to help cover these unexpected costs.

Benefit amount is based on a sample MetLife plan design. Actual plan design and benefits may vary.

Questions & Answers

Q. Who is eligible to enroll for this accident coverage?

A. You are eligible to enroll yourself and your eligible family members!4 You need to enroll during your Enrollment Period and to be actively at work for your coverage to be effective.

Q. How do I pay for my accident coverage?

A. Premiums will be paid through payroll deduction, so you don’t have to worry about writing a check or missing a payment.

Q. What happens if my employment status changes? Can I take my coverage with me?

A. Yes, you can take your coverage with you. 5 You will need to continue to pay your premiums to keep your coverage in force. Your coverage will only end if you stop paying your premium or if your employer offers you similar coverage with a different insurance carrier.

Q. Who do I call for assistance?

A. Contact a MetLife Customer Service Representative at Monday through Friday from 8:00 a.m. to 8:00 p.m., EST.

1 Covered services/treatments must be the result of a covered accident or sickness as defined in the group policy/certificate. S ee your Disclosure Statement or Outline of Coverage/Disclosure Document for full details.

2 Availability of benefits varies by state. See your Disclosure Statement or Outline of Coverage/Disclosure Document for state variations.

3 Benefits and amounts are based on sample MetLife plan design. Plan design and plan benefits may vary.

4 Coverage is guaranteed provided (1) the employee is actively at work and (2) dependents to be covered are not subject to medical restrictions as set forth on the enrollment form and in the Certificate. Some states require the insured to have medical coverage. Children may be covered to age 26. There are benefit reductions that may begin at age 65.

[5 Eligibility for portability through the Continuation of Insurance with Premium Payment provision may be subject to certain eligibility requirements and limitations. For more information, contact your MetLife representative.]

Document for full details.

Because There’s Only One You.

Your identity is important — it’s what makes you, you. You’ve spent a lifetime building your name and financial reputation. Let us help you better protect it. And, we’ll even go one step further and help you better protect the identities of your family.

Easy & Affordable Identity Protection

With ID Watchdog ®, you have an easy and affordable way to help better protect and monitor the identities of you and your family. You’ll be alerted to potentially suspicious activity and enjoy the peace of mind that comes with the support of dedicated resolution specialists. And, a customer care team that’s available any time, every day.

WHY CHOOSE ID WATCHDOG

With our online and in-app feature, lock your Equifax® credit report2 — and your child’s Equifax credit report — to help provide additional protection against unauthorized access to your credit.

ID Watchdog Is Here for You

More for Families

Our family plan helps you better protect your loved ones, with each adult getting their own account with all plan features. And, we offer more features that help protect minors than any other provider.

ID Watchdog is everywhere you can’t be — monitoring credit reports, social media, transaction records, public records and more — to help you better protect your identity. And don’t worry, we’re always here for you. In fact, our U.S.-based customer care team is available 24/7/365 at 866.513.1518.

A Leader in Detection & Prevention for 3 years running

12019 Identity Fraud Study, Javelin Research, March 2019

Dedicated Resolution Specialists

If you become a victim, you don’t have to face it alone. One of our certified resolution specialists will fully manage the case for you until your identity is restored.

See

(Features and pricing tables on reverse.)

2Locking your Equifax credit report will prevent access to it by certain third parties. Locking your Equifax credit report will not prevent access to your credit report at any other credit reporting agency. Entities that may still have access to your Equifax credit report include: companies like ID Watchdog, which provide you with access to your credit report or credit score, or monitor your credit report as part of a subscription or similar service; companies that provide you with a copy of your credit report or credit score, upon your request; federal, state and local government agencies and courts in certain circumstances; companies using the information in connection with the underwriting of insurance, or for employment, tenant or background screening purposes; companies that have a current account or relationship with you, and collection agencies acting on behalf of those whom you owe; companies that authenticate a consumer’s identity for purposes other than granting credit, or for investigating or preventing actual or potential fraud; and companies that wish to make pre-approved offers of credit or insurance to you. To opt out of such pre-approved offers, visit www.optoutprescreen.com

our unique features and pricing and take a step to help better protect your identity today.

Credit Lock

1 in 18 consumers were victims of identity theft in 2018.1

The Powerful Features You Want — All at an Affordable Price

•Credit Report & VantageScore® Credit Score

1 Bureau Monthly

•Credit Score Tracker

1 Bureau Monthly

• Credit Report Monitoring | 1 Bureau

•Dark Web Monitoring1

•High-Risk Transactions Monitoring2

•Subprime Loan Monitoring2

•Public Records Monitoring

•USPS Change of Address Monitoring

•Identity Profile Report

•Credit Report Lock3 | 1 Bureau

•Child Credit Lock4 | 1 Bureau

•Financial Accounts Monitoring

•Social Network Alerts

•Registered Sex Offender Reporting

•Customizable Alert Options

•Breach Alert Emails

•Mobile App

•National Provider ID Alerts

Helps better protect children1 Bureau = Equifax®

What You Need to Know

•Identity Theft Resolution Specialists (Resolution for Pre-existing Conditions)

•24/7/365 U.S.-based Customer Care Center

•Up to $1M Identity Theft Insurance5

•Lost Wallet Vault & Assistance

•Deceased Family Member Fraud Remediation

•Fraud Alert & Credit Freeze Assistance

The credit scores provided are based on the VantageScore 3.0 model. Any one-bureau VantageScore uses Equifax data. Third parties use many different types of credit scores and are likely to use a different type of credit score to assess your creditworthiness.

Take steps to help better

1 child <18)

1Dark Web Monitoring scans thousands of internet sites where consumers’ personal information is suspected of being bought and sold, and is constantly adding new sites to those it searches. However, the internet addresses of these suspected internet trading sites are not published and frequently change, so there is no guarantee that ID Watchdog is able to locate and search every possible internet site where consumers’ personal information is at risk of being traded.

2The monitored network does not cover all businesses or transactions.

3Locking your Equifax credit report will prevent access to it by certain third parties. Locking your Equifax credit report will not prevent access to your credit report at any other credit reporting agency. Entities that may still have access to your Equifax credit report include: companies like ID Watchdog, which provide you with access to your credit report or credit score, or monitor your credit report as part of a subscription or similar service; companies that provide you with a copy of your credit report or credit score, upon your request; federal, state, and local government agencies and courts in certain circumstances; companies using the information in connection with the underwriting of insurance, or for employment, tenant or background screening purposes; companies that have a current account or relationship with you, and collection agencies acting on behalf of those whom you owe; companies that authenticate a consumer’s identity for purposes other than granting credit, or for investigating or preventing actual or potential fraud; and companies that wish to make pre-approved offers of credit or insurance to you. To opt out of such pre-approved offers, visit www.optoutprescreen.com.

4Locking your child’s Equifax credit report helps prevent access to it by lenders and creditors. It will not prevent access to your child’s credit report at any other credit reporting agency.

5The Identity Theft Insurance is underwritten and administered by American Bankers Insurance Company of Florida, an Assurant company. Please refer to the actual policies for terms, conditions, and exclusions of coverage. Coverage may not be available in all jurisdictions. Review the Summary of Benefits (www.idwatchdog.com/ terms/insurance).

BENEFIT HIGHLIGHTS FOR:

La Grange Independent School District

EDUCATOR DISABILITY INSURANCE OVERVIEW

What is Educator Disability Income Insurance?

Educator Disability insurance combines the features of a short-term and long-term disability plan into one policy. The coverage pays you a portion of your earnings if you cannot work because of a disabling illness or injury. The plan gives you the flexibility to choose a level of coverage to suit your need.

You have the opportunity to purchase Disability Insurance through your employer. This highlight sheet is an overview of your Disability Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail.

Why do I need Disability Insurance Coverage?

More than half of all personal bankruptcies and mortgage foreclosures are a consequence of disability 1

1 Facts from LIMRA, 2016 Disability Insurance Awareness Month

The average worker faces a 1 in 3 chance of suffering a job loss lasting 90 days or more due to a disability 2

2Facts from LIMRA, 2016 Disability Insurance Awareness Month

Only 50% of American adults indicate they have enough savings to cover three months of living expenses in the event they’re not earning any income 3

3Federal Reserve, Report on the Economic Well-Being of U.S. Households in 2018

ELIGIBILITY AND ENROLLMENT

Eligibility You are eligible if you are an active employee who works at least 18.75 hours per week on a regularly scheduled basis.

Enrollment You can enroll in coverage within 31 days of your date of hire or during your annual enrollment period.

Effective Date Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.

Actively at Work You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session.

FEATURES OF THE PLAN

Benefit Amount You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $7,500 that cannot exceed 66 2/3% of your current monthly earnings. Earnings are defined in The Hartford’s contract with your employer.

Elimination Period

You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a Disability benefit payment. The elimination period that you select consists of two numbers. The first number shows the number of days you must be disabled by an accident before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin.

For those employees electing an elimination period of 30 days or less, if you are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization.

Maximum Benefit Duration Benefit Duration is the maximum time for which we pay benefits for disability resulting from sickness or injury. Depending on the schedule selected and the age at which disability occurs, the maximum duration may vary. Please see the applicable schedules below based on your election of the Premium benefit option.

Premium Option: For the Premium benefit option – the table below applies to disabilities resulting from sickness or injury

Prior to 60 To age 65

Age 60-64 60 months

Age 65-67 To age 70

Age 68 and over 24 months

Mental Illness, Alcoholism and Substance Abuse, SelfReported or Subjective Illness:

Duration

You can receive benefit payments for Long-Term Disabilities resulting from mental illness, alcoholism and substance abuse or self-reported or subjective illness for a total of 24 months for all disability periods during your lifetime.

Any period of time that you are confined in a hospital or other facility licensed to provide medical care for mental illness, alcoholism and substance abuse does not count toward the 24 month lifetime limit.

Partial Disability Partial Disability is covered provided you have at least a 20% loss of earnings and duties of your job.

Other Important Benefits Survivor Benefit - If you die while receiving disability benefits, a benefit will be paid to your spouse or child under age 26, equal to three times your last monthly gross benefit.

The Hartford's Ability Assist service is included as a part of your group Long Term Disability (LTD) insurance program. You have access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD benefits. Once you are covered you are eligible for services to provide assistance with child/elder care, substance abuse, family relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist them with the unique emotional, financial and legal issues that may result from a disability. Ability Assist services are provided through ComPsych®, a leading provider of employee assistance and work/life services.

Travel Assistance Program – Available 24/7, this program provides assistance to employees and their dependents who travel 100 miles from their home for 90 days or less. Services include pre-trip information, emergency medical assistance and emergency personal services.

Identity Theft Protection – An array of identity fraud support services to help victims restore their identity. Benefits include 24/7 access to an 800 number; direct contact with a certified caseworker who follows the case until it’s resolved; and a personalized fraud resolution kit with instructions and resources for ID theft victims.

Workplace Modification provides for reasonable modifications made to a workplace to accommodate your disability and allow you to return to active full-time employment.

PROVISIONS OF THE PLAN

Definition of Disability Disability is defined as The Hartford’s contract with your employer. Typically, disability means that you cannot perform one or more of the essential duties of your occupation due to injury, sickness, pregnancy or other medical conditions covered by the insurance, and as a result, your current monthly earnings are 80% or less of your pre-disability earnings.

One you have been disabled for 24 months, you must be prevented from performing one or more essential duties of any occupation, and as a result, your monthly earnings are 66 2/3% or less of your pre-disability earnings.

Pre-Existing Condition Limitation

Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have been insured under this policy for 12 months before your disability begins.

If your disability is a result of a pre-existing condition, we will pay benefits for a maximum of 1 month.

Continuity of Coverage

If you were insured under your district’s prior plan and not receiving benefits the day before this policy is effective, there will not be a loss in coverage and you will get credit for your prior carrier’s coverage.

Recurrent Disability What happens if I Recover but become Disabled again?

Periods of Recovery during the Elimination Period will not interrupt the Elimination Period, if the number of days You return to work as an Active Employee are less than one-half (1/2) the number of days of Your Elimination Period. Any day within such period of Recovery, will not count toward the Elimination Period.

Benefit Integration

Your benefit may be reduced by other income you receive or are eligible to receive due to your disability, such as:

• Social Security Disability Insurance

• State Teacher Retirement Disability Plans

• Workers’ Compensation

• Other employer-based disability insurance coverage you may have

• Unemployment benefits

• Retirement benefits that your employer fully or partially pays for (such as a pension plan)

Your plan includes a minimum benefit the greater of 10% of your elected benefit or $100.

General Exclusions

You cannot receive Disability benefit payments for disabilities that are caused or contributed to by:

• War or act of war (declared or not)

• Military service for any country engaged in war or other armed conflict

• The commission of, or attempt to commit a felony

• An intentionally self-inflicted injury

• Any case where Your being engaged in an illegal occupation was a contributing cause to your disability

• You must be under the regular care of a physician to receive benefits

Termination Provisions

Your coverage under the plan will end if:

• The group plan ends or is discontinued

• You voluntarily stop your coverage

• You are no longer eligible for coverage

• You do not make the required premium payment

• Your active employment stops, except as stated in the continuation provision in the policy

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including underwriting company Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. All benefits are subject to the terms and conditions of the policy. Policies underwritten by the underwriting company listed above detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued. This Benefit Highlights Sheet explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this Benefit Highlights Sheet and the policy, the terms of the policy apply. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the policyholder. Benefits are subject to state availability. © 2020 The Hartford.

La Grange Independent School District

Voluntary TermLife Insurance

The Lincoln Term Life Insurance Plan:

• Provides a cash benefit to your loved ones in the event of your death

• Features group rates for La Grange ISDemployees

• 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 medicalassistance when you’re on a trip 100+ miles from home

Full-Time Employeesof La Grange ISD

Benefits At-A-Glance

Employee

Newly hired employeeguaranteed coverage amount $200,000

Continuing employeeguaranteed coverage annual increase amount

Choice of $10,000 or $20,000

Maximum coverage amount 5times your annual salary ($500,000 maximumin increments of $10,000)

Minimum coverage amount $10,000

Spouse

Newly hired employeeguaranteed coverage amount $50,000

Continuing employeeguaranteed coverage annual increase amount Choice of $10,000 or $20,000

Maximum coverage amount 100%of the employee coverage amount ($500,000maximumin increments of $10,000)

Minimum coverage amount $10,000

Dependent Children

6 months to age 26guaranteed coverage amount $10,000

Age 1 day to 6 monthsguaranteed coverage amount $1,000

What your benefits cover

Employee Coverage

Guaranteed Life Insurance Coverage Amount

• Newly Hired Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $200,000 without providing evidence of insurability.

Annual Limited Enrollment: If you are a continuing employ ee, you can increase your coverage amount by $10,000 or $20,000 without providing evidence of insurability . If you submitted evidence of insurability in the past and were declined for medical reasons, 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.

You can increase this amount by up to $20,000 during the next limited open enrollment period.

Maximum Life Insurance Coverage Amount

• You can choose a coverage amount up to 5 times your annual salary ($500,000 maximum) with evidence of insurability. See the Evidence of Insurability page for details.

• Your coverage amount will reduce by 50% when you reach age 70.

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

Guaranteed Life Insurance Coverage Amount

Newly Hired Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to 100% of your coverage amount ($50,000 maximum) 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 $10,000 or $20,000 without providing evidence of insurability. If y ou submitted evidence of insurability in the past and were declined for medical reasons, 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.

You can increase this amount by up to $20,000 during the next limited open enrollment period.

Maximum Life Insurance Coverage Amount

You can choose a coverage amount up to 100% of your coverage amount ($500,000 maximum) for your spouse with evidence of insurability.

Dependent Children Coverage - You can secure term life insurance for your dependent children when you choose coverage for yourself.

Guaranteed Life Insurance Coverage Options: $10,000

Additional Plan Benefits

Benefit Exclusions

Like any insurance, this term life insurance policy does have exclusions. A suicide exclusion may apply. A complete list of benefit exclusions is included in the policy. State variations apply.

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

LifeKeys® services are provided by ComPsych® Corporation, Chicago, IL. TravelConnect® travel assistance services are provided by On Call International, Salem NH. On Call International must coordinate and provide all arrangements in order for eligible services to b e covered. ComPsych® and On Call International are not Lincoln Financial Group companies and Lincoln Financial Group does not administerthese Services. Each independent company is solely responsible for its own obligations. Coverage is subject to contractlanguage that contains s pecific terms, conditions, and limitations.

Insurance products (policy series GL1101) 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. ©2019 LincolnNationalCorporation LCN-2016746-020518 R 1.0 –Group ID: 1056395

MonthlyVoluntary Life Insurance Premium

Here’s how little you pay with grouprates.

The Lincoln National Life Insurance Company

Please see prior page for product information.

Voluntary Life Insurance At-A-Glance

Dependent Children MonthlyPremium for

Group Rates for Your Dependent Children

One affordable monthlypremium covers all of youreligible dependent children.

Note: You must be an active La Grange ISDemployeeto select coverage for a spouseand/or dependent children. To be eligible for coverage, a spouse or dependent child cannot be confined to a health care facility or unable to perform the typical activities of a healthy person of the same age and gender.

Please see prior page for product information.

Voluntary AD&D Insurance

The Lincoln AD&D Insurance Plan:

• Provides a cash benefit to your loved ones if you die in an accident

• Provides a cash benefit to you if you suffer a covered loss in an accident

• Features group rates for La Grange ISDemployees

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

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

Full-Time Employeesof La Grange ISD

Benefits At-A-Glance

EmployeeOnly

This coverage provides a cash benefit to the beneficiary/beneficiaries you name if you die in an accident, or to you if you suffer a covered loss in an accident, such as losing a limb or your eyesight

Maximum coverage amount

Minimum coverage amount

Up to 5times your annual salary ($500,000 maximum) in $10,000increments

$10,000

Your employeeAD&D coverage amount will reduce by 50% when you reach age 70. Benefits end when you retire.

Employee& Family

As an alternative, you can secure AD&D insurance for yourself, your spouse, and dependent children by selecting family coverage. The amount of AD&D insurance for family members is equal to a percentage of your AD&D coverage amount. The payout percentage isbased on family structure—who makes up your immediate family —when a loss occurs.

Spouse coverage percentage

Child(ren) coverage percentage

50% of the employeecoverage amount when the family is made up of only the spouseand the employee

15% of the employeecoverage amount when the family is made up of only dependent children and the employee.

Spouse & Child(ren) coverage percentage

Spouse: 40% of the employeecoverage amount when the family is made up of dependent children, the spouse, and the employee.

Child(ren): 10% of the employeecoverage amount when the family is made up of dependent children, the spouse, and the employee.

The spouseAD&D coverage amount will reduce by 50% when you reach age 70. Benefits end when you retire.

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

Benefit Exclusions

Like any insurance, this AD&D insurance policy does have exclusions. Benefits will not be paid if death results from suicide, or death/dismemberment occurs while:

Intentionally inflicting or attempting to inflict injury to one’s self

Participating in a war, act of war, or riot

Serving on full-time active duty in the armed forces of any state or country (this does not include duty of 30 days or less training in the Reserves or National Guard)

Flying on any non-commercial airplane or aircraft, such as a hot air balloon or glider (see the contract for details and exceptions)

Flying on a commercial airline or aircraft as a pilot or crewmember

Committing or attempting to commit a felony

Deliberately inhaling gas (such as carbon monoxide) or using drugs other than those taken as prescribed by a licensed physician

Driving while intoxicated, impaired, or under the influence of drugs

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

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

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

LifeKeys® services are provided by ComPsych® Corporation, Chicago, IL. TravelConnect® travel assistance services are provided by On Call International, Salem NH. On Call International must coordinate and provideall arrangements in order for eligible services to be covered. ComPsych® and On Call International are not Lincoln Financial Group companies and Lincoln Financial Group does not administerthese Services. Each independent company is solely responsible for its own obligations. Coverage is subject to contract language that contains specific terms, conditions, and limitations.

Insurance products (policy series GL1101) 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. ©2020 LincolnNationalCorporation -LCN-2016756-020518-07–R1.0 –Group ID: 1056395

Voluntary Accidental Death & DismembermentInsurance Here’s how

little you pay with grouprates.

MonthlyPremium Calculation for You

The estimated monthlypremium for AD&D insurance is determined by multiplying the desired amount of coverage (in increments of $10,000) by the premium rate. See table at right for select coverage amounts.

$____________ X 0.0000250 = $

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

MonthlyPremium Calculation for You & Your Family

The estimated monthlypremium for AD&D insurance is determined by multiplying the desired amount of employeecoverage (in increments of $10,000) by the family premium rate. See table at right for select premium amounts.

$____________ X 0.0000400 = $

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

The Lincoln National Life Insurance Company

Please see prior page for product information.

life insurance highlights

Voluntary permanent life insurance can be an ideal complement to the group term and optional term life insurance your employer might provide. This voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term life insurance may be portable if you change jobs, but even if you can keep them after you retire, they usually cost more and decline in death benefit.

The contract, purelife-plus, is underwritten by Texas Life Insurance Company, and it has the following features:

• HighDeathBenefit. With one of the highest death benefits available at the worksite,1 purelife-plus gives your loved ones peace of mind, knowing there will be life insurance in force when you die.

• RefundofPremium. Unique in the marketplace, purelife-plus offers you a refund of 10 years’ premium, should you surrender the contract if the premium you pay when you buy the contract ever increases. (Conditions apply.)

• AcceleratedDeathBenefitDuetoTerminalIllnessRider. Should you be diagnosed as terminally ill with the expectation of death within 12 months, you will have the option to receive 92% of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.) (Form ICC07-ULABR-07 or Form Series ULABR-07)

AdditionalFeatures

• MinimalCashValue. Designed to provide a high death benefit at a reasonable premium, purelife-plus provides peace of mind for you and your beneficiaries while freeing investment dollars to be directed toward such tax-favored retirement plans as 403(b), 457 and 401(k).

• LongGuarantees. Enjoy the assurance of a contract that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time (after the guaranteed period, premiums may go down, stay the same, or go up). 2

You may apply for this permanent coverage, not only for yourself, but also for your spouse, children and grandchildren.3

QUICK QUESTIONS 3

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?

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?

PureLife-plus is a Flexible Premium Adjustable Life Insurance to Age 121. As with most life insurance products, Texas Life contracts and riders contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative or see the Purelife-plus brochure for costs and complete details. Contract Form ICC18-PRFNG-NI-18, Form Series PRFNG-NI-18 or PRFNG-NI -20-OHIO.

1 Voluntary Whole and Universal Life Products, Eastbridge Consulting Group, December 2018

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

Flexible Spending Plans

Flexible Spending Plans

What Can I Save with an FSA?

NBS Mobile App

Mobile app features

Sample Expenses

Medical Expenses

•Acupuncture

•Addiction programs

•Adoption (medical expenses for baby birth)

•Alternative healer fees

•Ambulance

•Body scans

•Breast pumps

•Care for mentally handicapped

•Chiropractor

•Copayments

•Crutches

•Diabetes (insulin, glucose monitor)

•Eye patches

Dental Expenses

•

•Dentures

•Fertility treatment

•First aid (e.g., bandages, gauze)

•Hearing aids & batteries

•Hypnosis (for treatment of illness)

•Incontinence products (e.g., Depends, Serene)

•Joint support bandages and hosiery

•Lab fees

•Menstrual Products*

•Monitoring device (blood pressure, cholesterol)

•Non-prescription medicines or drugs (vitamins/supplements without a prescription are not eligible)*

•Physical exams

•Pregnancy tests

•Prescription medicines or drugs

•Psychiatrist/psychologist (for mental illness)

•Physical therapy

•Speech therapy

•Vaccinations

•

•Weight loss program fees (if prescribed by physician)

•Wheelchair

Vision Expenses

•Braille - books & magazines

•Eyeglasses

*After January 1, 2020

•Copayments

•Deductible

•Dental work

•Orthodontia expenses

•

•Bridges, crown, etc.

•Contact lenses

•Contact lens solutions

•Eye exams

Items that generally do not qualify for reimbursement

•Personal hygiene (e.g., deodorant, soap, body powder, sanitary products. Does not include menstrual products)

•Addiction products**

•Cosmetic surgery**

•Cosmetics (e.g., makeup, lipstick, cotton swabs, cotton balls, baby oil)

•Counseling (e.g., marriage/family)

•Dental care - routine (e.g., toothpaste, rinses, teeth whitening/bleaching)**

•Exercise equipment**

•Haircare (e.g., hair color, shampoo, conditioner, brushes, hair loss products)

•

•Homeopathic supplement or herbs**

•Household or domestic help

•Laser hair removal

•Massage therapy**

•Laser surgery

•

•Guide dog and upkeep/ other animal aid

•Nutritional and dietary supplements (e.g., bars, milkshakes, power drinks, Pedialyte)**

•Skin care (e.g., moisturizing lotion, lip balm)

•Sleep aids (e.g., snoring strips)**

•Vitamins**

•Weight reduction aids (e.g., Slimfast, appetite suppressant)**

**Portions of these expenses may be eligible for reimbursement if they are recommended by a licensed medical

Critical Illness Insurance

canpaymoneydirectlytoyouwhenyou’rediagnosedwithcertainseriousillnesses.

How does it work?

If you’re diagnosed with an illness that is covered by this insurance, you can receive a lump sum benefit payment. You can use the money however you want.

Why is this coverage so valuable?

•Themoneycanhelpyoupayout-of-pocketmedical expenses,likeco-paysanddeductibles.

•Youcanusethiscoveragemorethanonce. Even after you receive a payout for one illness, you’re still covered for the remaining conditions and for the reoccurrence of any critical illness with the exception of skin cancer. The reoccurrence benefit pays 100% of your coverage amount. Diagnoses must be at least 180 days apart or the conditions can’t be related to each other.

What’s covered?

• Heart attack

• Stroke

• Major organ failure

Critical illnesses

• Coronary artery disease

Major(50%): Coronary artery bypass graft or valve replacement

• End-stage kidney failure

Minor(10%): Balloon angioplasty or stent placement

Cancer conditions

• Invasive cancer — all breast cancer is considered invasive

• Non-invasive cancer (25%)

• Skin cancer — $500

Progressive diseasesSupplemental conditions

• Amyotrophic Lateral Sclerosis (ALS)

• Dementia, including Alzheimer’s disease

• Multiple Sclerosis (MS)

• Parkinson’s disease

• Functional loss

• Loss of sight, hearing or speech

• Benign brain tumor

• Coma

• Permanent Paralysis

• Occupational HIV, Hepatitis B, C or D

• Infectious Diseases (25%)

Why should I buy coverage now?

•It’smoreaffordablewhenyoubuyitthroughyour employerandthepremiumsareconveniently deductedfromyourpaycheck.

•Coverageisportable.Youmaytakethecoveragewith youifyouleavethecompanyorretire.You’llbebilled athome.

Be Well Benefit

Every year, each family member who has Critical Illness coverage can also receive $50 for getting a covered Be Well Benefit screening test, such as:

• Annual exams by a physician include sports physicals, wellchild visits, dental and vision exams

• Screenings for cancer, including pap smear, colonoscopy

• Cardiovascular function screenings

Who can get coverage?

• Screenings for cholesterol and diabetes

• Imaging studies, including chest X-ray, mammography

• Immunizations including HPV, MMR, tetanus, influenza

You: Choose $10,000, $20,000 or $30,000 of coverage with no medical questions if you apply during this enrollment.

Your spouse: Spouses can only get 100% of the employee coverage amount as long as you have purchased coverage for yourself.

Your children: Children from live birth to age 26 are automatically covered at no extra cost. Their coverage amount is 50% of yours. They are covered for all the same illnesses plus these specific childhood conditions: cerebral palsy, cleft lip or palate, cystic fibrosis, Down syndrome and spina bifida. The diagnosis must occur after the child’s coverage effective date.

Active employment: You are considered in active employment if, on the day you apply for coverage, you are being paid regularly for the required minimum 18.75 hours each week and you are performing the material and substantial duties of your regular occupation. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. New employees have a 0 day waiting period to be eligible for coverage. Please contact your plan administrator to confirm your eligibility date.

If enrolling, and eligible for Medicare (age 65+; or disabled) the Guide to Health Insurance for People with Medicare is available at www.medicare.gov/media/9486. Please refer to the certificate for complete definitions about these covered conditions. Coverage may vary by state. See exclusions and limitations.

Critical Illness Insurance benefit and cost

Monthly

Well benefit: $50 EmployeeSpouse under25$3.86$3.86 25-29$4.76$4.76 30-34$5.96$5.96 35-39$7.96$7.96 40-44$10.46$10.46 45-49$13.56$13.56 50-54$16.96$16.96 55-59$22.66$22.66 60-64$31.46$31.46 65-69$45.26$45.26 70-74$70.36$70.36 75-79$103.76$103.76 80-84$151.36$151.36 85+$243.76$243.76 Monthly costs Age Employee coverage: $20,000 Spouse coverage: $20,000

Be Well

Your paycheck deduction will include the cost of coverage and the Be Well Benefit. Actual billed amounts may vary.

Pre-existing conditions

We will not pay benefits for a claim when the Covered Loss occurs in the first 12 months following an Insured’s Coverage Effective Date and the Covered Loss is caused by, contributed to by or occurs as the result of any of the following:

• a Pre-existing Condition; or

• complications arising from treatment or surgery for, or medications taken for, a Preexisting Condition.

An Insured has a Pre-existing Condition if, within the 12 months just prior to their Coverage Effective Date, they have an injury or sickness, whether diagnosed or not, for which:

• medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period;

• drugs or medications were taken, or prescribed to be taken during that period; or

• symptoms existed.

The Pre-existing Condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage Effective Date refers to the date any initial coverage or increases in coverage become effective.

Pre-existing Condition requirements are not applicable to children who are newly acquired after your Coverage Effective Date.

Continuity of coverage

We will provide coverage for an Insured if the Insured was covered by a similar prior policy on the day before the Policy Effective Date. Coverage is subject to payment of premium and all other terms of the certificate. If an employee is on a temporary Layoff or Leave of Absence on the Policy Effective Date of this certificate, we will consider your temporary Layoff or Leave of Absence to have started on that date and coverage will continue for the period provided temporary Layoff or Leave of Absence under Continuation of your Coverage During Extended Absences in the certificate. If you have not returned to Active Employment before any Insured’s Date of Diagnosis, any benefits payable will be limited to what would have been paid by the prior carrier.

If the Employer replaces a critical illness policy with this Policy, or the employee becomes insured due to a merger, acquisition or affiliation, and the prior carrier’s pre-existing condition requirement has been satisfied, the Pre-existing Condition requirement under this coverage will not apply. However, if the Unum certificate provides a higher level of coverage at the time it becomes effective, its Pre-existing Condition requirement will apply to any increase in coverage. If the prior carrier’s pre-existing condition requirement has not been satisfied, periods of coverage applicable to the prior carrier’s Pre-existing Condition will count towards satisfying the Pre-existing Condition requirement under this coverage.

Date of diagnosis must be after the coverage effective date.

Exclusions and limitations

We will not pay benefits for a claim that is caused by, contributed to by, or occurs as a result of any of the following: committing or attempting to commit a felony; being engaged in an illegal occupation or activity; injuring oneself intentionally or attempting or committing suicide, whether sane or not; active participation in a riot, insurrection, or terrorist activity. This does not include civil commotion or disorder, injury as an innocent bystander, or injury for self-defense; participating in war or any act of war, whether declared or undeclared; combat or training for combat while serving in the armed forces of any nation or authority, including the National Guard, or similar government organizations; voluntary use of or treatment for voluntary use of any prescription or nonprescription drug, alcohol, poison, fume, or other chemical substance unless taken as prescribed or directed by the Insured’s Physician; being intoxicated; and a Date of Diagnosis that occurs while an Insured is legally incarcerated in a penal or correctional institution.

Additionally, no benefits will be paid for a Date of Diagnosis that occurs prior to the Coverage Effective Date.

End of employee coverage

If you choose to cancel your coverage your coverage ends on the first of the month following the date you provide notification to your employer. Otherwise, your coverage ends on the earliest of the: date this policy is canceled by Unum or your employer; date you are no longer in an eligible group; date your eligible group is no longer covered; date of your death; last day of the period any required premium contributions are made; or last day you are in active employment.

However, as long as premium is paid as required, coverage will continue in accordance with the Continuation of your Coverage during Absences provision or if you elect to continue coverage for you, your Spouse, and Children under Portability of Critical Illness Insurance. Unum will provide coverage for a payable claim that occurs while you are covered under this certificate.

THIS INSURANCE PROVIDES LIMITED BENEFITS

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and imitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form GCIP16-1 or the Certificate Form GCIC16-1 or contact your Unum representative.

Underwritten by: Unum Insurance Company, Portland, Maine

DID YOU KNOW?

MILLION PEOPLE 25

are sent to the emergency room through ground or air ambulance every year * .

Insurance companies may not may not cover all air and ground ambulance expenses which can result in max in-network out-of-pocket** costs of:

$8,700 Individual $17,400 Family

Ground ambulance out-of-network transportation costs may be even costs may be even higher than in-network than in-network since the No Surprises Act does not apply to ground ambulance at this time.

EMERGENT PLUS MEMBERSHIP BENEFITS

A MASA MTS Membership provides the ultimate peace of mind at an a ordablerateforemergencygroundand air transportation assistance expenses within the continental United States, Alaska, Hawaii, and while traveling in Canada, regardless of whether the provider is in or out of your group healthcare bene tsnetwork.Afterthe group health plan pays its portion, MASA works with providers to make certain our Members have no out-ofpocket expenses~ for emergency ambulance transportation assistance and other related services.

Emergency Air Ambulance Coverage1

MASA MTS covers out-of-pocket expenses associated with emergency air transportation to a medical facility for serious medical emergencies deemed medically necessary for you or your dependent family member.

Emergency Ground Ambulance Coverage1

MASA MTS covers out-of-pocket expenses associated with emergency ground transportation to a medical facility for serious medical emergencies deemed medically necessary for you or your dependent family member.

Hospital to Hospital Ambulance Coverage1

MASA MTS covers out-of-pocket expenses that you or a dependent family member may incur for hospital transfers, due to a serious emergency, to the nearest and most appropriate medical facility when the current medical facility cannot provide the required level of specialized care by air ambulance to include medically equipped helicopter or xed-wingaircraft.

Repatriation to Hospital Near Home Coverage1

MASA MTS provides services and covers out-of-pocket expenses for the coordination of a Member’s nonemergency transportation by a medically equipped, air or ground ambulance in the event of hospitalization more than one hundred (100) miles from the Member’s home if the treating physician and MASA MTS’ Medical Director says it’s medically appropriate and possible to transfer the Member to a hospital nearer to home for continued care and recuperation.

Contact Your Representative, to learn more:

The information provided in this product information sheet is for informational purposes only. The bene ts listed and the descriptions thereof do not represent the full terms and conditions applicable for usage and may only be o ered in some memberships. Premiums and bene ts vary depending on the bene ts selected. Commercial air and Worldwide coverage are not available in all territories. For a complete list of bene ts, premiums, and full terms, conditions, and restrictions, please refer to the applicable member services agreement for your territory. MASA MTS products and services are not available in AK, NY, WA, ND, and NJ. MASA MTS utilizes third-party transportation service providers for all transportation services. MASA Global, MASA MTS and MASA TRS are registered service marks of MASA Holdings, Inc., a Delaware corporation. Void where prohibited by law.

~If a member has a high deductible health plan that is compatible with a health savings account, bene ts will become available under the MASA membership for expenses incurred for medical care (as de ned under Internal Revenue Code (“IRC”) section 213 (d)) once a member satis es the applicable statutory minimum deductible under IRC section 223(c) for high-deductible health plan coverage that is compatible with a health savings account.

COVERAGE TERRITORIES:

1. All coverage provided by this membership is limited to the continental United States, Alaska, Hawaii, and Canada, and must originate and conclude therein.

SOURCES:

*ACEP NOW 2014

** Patient Protection and A ordable Care Act; HHS Notice of Bene t and Payment Parameters for 2022 and Pharmacy Bene t Manager Standards. May 5, 2021.

FrequentlyAsked Questions

What is 1-800MD?

1-800MD is an industry-leading telehealth company backed by a national network of board-certified, credentialed physicians throughout the United States. 1.800MD physiciansdiagnose illnesses, recommend treatment plans and prescribe medications, when deemed appropriate, for its members over the telephone or via secure bi-directional video and email.

How does 1-800MD improve quality of care?

Immediate access to medical attention can often resolve problemsthat, if left untreated, could eventually result in hospitalization. 1-800MD provid es convenient, affordable access to healthcare at anytime and anywhere! 1-800MD provides 24/7/365 access to a physician without ever having to leave your home or office. Nowaiting for office visits! And, prescriptions,if needed and appropriate, are sent to the local pharmacy of your choice.

How does 1-800MD reduce health care costs?

1-800MD reduces unnecessary doctor’s office and emergency room visits and allow members alternatives to visiting their primary care physician for purely informational and other basic reasons. Data shows up to 70% of all doctor visits may be superfluous, costing billions of dollars and can be handled with a 1-800MD telephone or videoconsultation.

What about the doctors?

1-800MD uses a third-partycredentialing agency to ensure that only the best providers are servicing our clients. Thecredentialing process is comprehensive and includes license verification, reference checks, and background checks. In fact, the process is fully in accordance with the American Association of Preferred Provider Organization (AAPPO) standards and is the same criteria used by hospitals to grant privileges.

Is there a minimum age requirement?

No, there is not a minimum age to consult with a 1- 800MD physician. However, the physician’s ability to provide information or diagnose and treat is dependent on the nature of the symptoms and the patient’s ability to communicate his/her condition to the doctor.

I have a pre-existing condition. Will1-800MD still accept me?

Absolutely! 1-800MD is not insurance. Wedo not deny access to quality care because of pre-existing conditions.

FrequentlyAsked Questions

Can I get a consultation after hours or on weekends?

Yes. 1-800MD services are available 24/7/365 throughout the United States.The physician will call the patient on the number that was provided generally within one hour (guaranteed within two).

Are there any restrictions on how many times I can use 1-800MD?

No.As a member, you have access to unlimited telephone consults anywhere, anytime.Youonlyhave to pay the nominal consult fee for each instance.

Are

there any limitations as to what can be prescribed?

A 1-800MD physician has the ability (if medically appropriate) to prescribe a wide range of products.These include, but are not limited to, medications such as antibiotics and antihistamines. Our physicians do not prescribe medications regulated by the Drug EnforcementAgency or those that pose a potential for abuse or addiction. Also, 1-800MD physicians do not prescribe lifestyle drugs.

How are prescriptions filled?

If after consult with the physician, he/she determines that a prescription medication isindicated as part of your treatment,the doctor will electronically send the prescription to a local pharmacy of your choice.

Is Video Conferencing available?

Yes.The physician will schedule a convenient time, generally within 2 hours (guaranteed same day) to conduct the video consultation. Note, you must have a web camera and high-speed internet access to participate in a video consultation. Based on the presenting complaint or possibly state regulations, video consultations, when necessary, are suggested and initiated by the 1-800MD physician.

Are phone consultations allowed without an online Personal Medical History?

No. All active family members MUST complete a Personal Medical History form prior to receiving the first consultation.

The

Easily

Select

Manage

View

And

Our doctors are waiting to help within 1-2 hours of your request(wait time varies based on your chosen communication method).

Notes

Notes