La Grange ISD Benefits Guide

2022-2023 Employee Benefit Guide

LA GRANGE Independent School District

EFFECTIVE: 09/01/2022 - 08/31/2023 WWW.MYBENEFITSHUB.COM/LAGRANGEISD

ϮϬϮϮ KW E EZK>>D Ed /E&KZD d/KE dŚĞ ϮϬϮϮͲϮϬϮϯ ^ĞĐƚŝŽŶ ϭϮϱ ĂĨĞƚĞƌŝĂ WůĂŶ LJĞĂƌ ďĞŐŝŶƐ ϬϵͬϬϭͬϮϬϮϮ ĂŶĚ ĞŶĚƐ ϬϴͬϯϭͬϮϬϮϯ͘

ůů ďĞŶĞĨŝƚƐ ĞůĞĐƚĞĚ ĚƵƌŝŶŐ ƚŚĞ ĂŶŶƵĂů ŽƉĞŶ ĞŶƌŽůůŵĞŶƚ ǁŝůů ďĞ ĞĨĨĞĐƚŝǀĞ ϬϵͬϬϭͬϮϬϮϮ KƉĞŶ ŶƌŽůůŵĞŶƚƐ ĂƚĞƐ͗ :ƵůLJ ϭϭ ƚŽ ƵŐƵƐƚ ϭϴ >Ă 'ƌĂŶŐĞ /^ ŽĨĨĞƌƐ ĞůŝŐŝďůĞ ĞŵƉůŽLJĞĞƐ Ă ĐŽŵƉĞƚŝƚŝǀĞ ďĞŶĞĨŝƚƐ ƉĂĐŬĂŐĞ ƚŚĂƚ ŝŶĐůƵĚĞ ďŽƚŚ ĚŝƐƚƌŝĐƚ ƉĂŝĚ ĂŶĚ ǀŽůƵŶƚĂƌLJ ƉƌŽĚƵĐƚƐ͘ tĞ ŚĂǀĞ ǁŽƌŬĞĚ ĐůŽƐĞůLJ ǁŝƚŚ h^ ŵƉůŽLJĞĞ ĞŶĞĨŝƚƐ ^ĞƌǀŝĐĞƐ 'ƌŽƵƉ ;h^ ^'Ϳ ƚŽ ƉƌŽǀŝĚĞ LJŽƵ ǁŝƚŚ Ă ǀĂƌŝĞƚLJ ŽĨ ďĞŶĞĨŝƚƐ ĂŶĚ ƌĞƐŽƵƌĐĞƐ ƚŽ ŚĞůƉ LJŽƵ ƌĞĂĐŚ LJŽƵƌ ŚĞĂůƚŚĐĂƌĞ ĂŶĚ ƌĞƚŝƌĞŵĞŶƚ ŶĞĞĚƐ͘ ĞƚĂŝůƐ ŽĨ Ăůů ĂǀĂŝůĂďůĞ ďĞŶĞĨŝƚƐ ĐĂŶ ďĞ ĨŽƵŶĚ ŽŶ ƚŚĞ ŵƉůŽLJĞĞ ĞŶĞĨŝƚ WŽƌƚĂů͘ ŚƚƚƉƐ͗ͬ​ͬǁǁǁ͘ŵLJďĞŶĞĨŝƚƐŚƵď͘ĐŽŵͬůĂŐƌĂŶŐĞŝƐĚ /Ĩ LJŽƵ ŚĂǀĞ ĂŶLJ ƋƵĞƐƚŝŽŶƐ͕ ĨĞĞů ĨƌĞĞ ƚŽ ƌĞĂĐŚ ŽƵƚ ƚŽ ^ŚĞƌƌLJ ^ŬŝĚŵŽƌĞ Ăƚ ϱϭϮͲϰϲϭͲϲϳϵϰ Žƌ LJŽƵƌ ĞŶĞĨŝƚƐ ĞƉĂƌƚŵĞŶƚ͘

/ŵƉŽƌƚĂŶƚ EŽƚĞ͗ ůŝŐŝďůĞ ĞŵƉůŽLJĞĞƐ ŵƵƐƚ ďĞ ĂĐƚŝǀĞůLJ Ăƚ ǁŽƌŬ ŽŶ ƚŚĞ ƉůĂŶ ĞĨĨĞĐƚŝǀĞ ĚĂƚĞ ĨŽƌ ŶĞǁ ďĞŶĞĨŝƚƐ ƚŽ ďĞ ĞĨĨĞĐƚŝǀĞ͊​͊

d > K& KEd Ed^ v v v v v v v v v v v v v v v v v v v v

ŶƌŽůůŵĞŶƚ & YΖ^ ŽŶƚĂĐƚ /ŶĨŽƌŵĂƚŝŽŶ ŶƌŽůůŵĞŶƚ /ŶƐƚƌƵĐƚŝŽŶƐ ĂƐŝĐ >ŝĨĞ DĞĚŝĐĂů ,^ ,ŽƐƉŝƚĂů /ŶĚĞŵŶŝƚLJ WůĂŶ ĞŶƚĂů sŝƐŝŽŶ ĂŶĐĞƌ ĐĐŝĚĞŶƚ /ĚĞŶƚŝƚLJ dŚĞĨƚ ŝƐĂďŝůŝƚLJ sŽůƵŶƚĂƌLJ 'ƌŽƵƉ >ŝĨĞ Θ /ŶĚŝǀŝĚƵĂů >ŝĨĞ &^ ĂŶĚ ĞƉĞŶĚĞŶƚ ĂƌĞ ƌŝƚŝĐĂů /ůůŶĞƐƐ D ^ dĞůĞŚĞĂůƚ

1

EZK>>D Ed & YΖ^ INTRODUCTION

MID-YEAR CHANGES

ProvidŝŶŐ great beneĮt choices to you and your family is just ŽŶĞ ŽĨ ƚŚĞ ŵĂŶLJ ǁĂLJƐ >'/^ ůŽŽŬƐ ĂŌĞƌ ƚŚĞ ŚĞĂůƚŚ ĂŶĚ ĮŶĂŶcial welfare of the people who make our district work so well. KƵƌ ŐŽĂů Ăƚ >'/^ ŝƐ ƚŽ ƉƌŽǀŝĚĞ LJŽƵ ǁŝƚŚ ĂŶ ĂƌƌĂLJ ŽĨ ďĞŶĞĮƚ ŽƉƟŽŶƐ ƚŚĂƚ ǁŝůů ŵĞĞƚ LJŽƵƌ ƉĞƌƐŽŶĂů ŶĞĞĚƐ ĂƐ ƉĂƌƚ ŽĨ LJŽƵƌ ƚŽƚĂů ĐŽŵƉĞŶƐĂƟŽŶ ĂŶĚ ƌĞǁĂƌĚƐ͘

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

HOW DO I ENROLL? Visit ǁǁǁ͘ŵLJďĞŶĞĮƚƐŚƵď͘ĐŽŵͬůĂŐƌĂŶŐĞŝƐĚ h^ ZE D ͗ ŶƚĞƌ ƚŚĞ ĮƌƐƚ ϲ ůĞƩĞƌƐ ŽĨ LJŽƵƌ ůĂƐƚ ŶĂŵĞ͕ ĨŽůůŽǁĞĚ ďLJ ƚŚĞ ĮƌƐƚ ůĞƩĞƌ ŽĨ LJŽƵƌ ĮƌƐƚ ŶĂŵĞ͕ ĂŶĚ ƚŚĞŶ ƚŚĞ last 4 digits of your SSN. (EX: John Sanderson SSN: dždždžͲdždžͲϭϮϯϰ h^ ZE D ͗ ƐĂŶĚĞƌũϭϮϯϰͿ W ^^tKZ ͗ Complete last name (excluding any special ĐŚĂƌĂĐƚĞƌƐ Žƌ ƐƉĂĐĞƐͿ ĨŽůůŽǁĞĚ ďLJ ƚŚĞ ůĂƐƚ ϰ ĚŝŐŝƚƐ ŽĨ LJŽƵƌ ^^E͘ ; dž͗ ƐĂŶĚĞƌƐŽŶϭϮϯϰͿ

zŽƵ ŵƵƐƚ ŶŽƟĨLJ ƚŚĞ >Ă 'ƌĂŶŐĞ /^ ĞŶĞĨŝƚ KĸĐĞ ŽĨ ƚŚĞ ƌĞƋƵĞƐƚĞĚ ĐŚĂŶŐĞ ǁŝƚŚŝŶ ϯϬ ĐĂůĞŶĚĂƌ ĚĂLJƐ ŽĨ ƚŚĞ ĐŚĂŶŐĞ ŝŶ ƐƚĂƚƵƐ͘ dŚĞƌĞ ĂƌĞ ŶŽ ĞdžĐĞƉƟŽŶƐ ƚŽ ƚŚŝƐ ƌƵůĞ͘

WHO IS ELIGIBLE? WHEN WILL I RECEIVE ID CARDS?

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

Everyone enrolled in Medical will receive a new Medical Card. ŶƌŽůůĞĚ ƉĂƌƟĐŝƉĂŶƚ ǁŝůů ƌĞĐĞŝǀĞ ĞŶƚĂů͕ sŝƐŝŽŶ͕ ,^ ĂŶĚ &^ ĐĂƌĚƐ ƉƌŝŽƌ ƚŽ ƚŚĞ ĞīĞĐtiǀĞ ĚĂƚĞ ŽĨ ƚŚĞ ŶĞǁ ĐŽǀĞƌĂŐĞ͘ &Žƌ ŵŽƐƚ ƉůĂŶƐ͕ LJŽƵ ĐĂŶ ůŽŐŝŶ ƚŽ ƚŚĞ ĐĂƌƌŝĞƌ ǁĞďƐŝƚĞ ĂŶĚ ƉƌŝŶƚ Ă ƚĞŵƉŽrary ID card or give your provider the insurance company’s phone number to call and verify your coverage if you do not have an ID card at the time of service.

WHO IS AN ELIGIBLE DEPENDENT? • zŽƵƌ ůĞŐĂů ƐƉŽƵƐĞ • ŚŝůĚƌĞŶ ƵŶĚĞƌ ƚŚĞ ĂŐĞ ŽĨ Ϯϲ͕ LJŽƵƌƐ KZ LJŽƵƌ ƐƉŽƵƐĞ͛Ɛ • Dependent children of any age who are disabled • Children under your legal guardianship

WHO DO I CONTACT WITH QUESTIONS? &Žƌ ƋƵĞƐƟŽŶƐ͕ LJŽƵ ĐĂŶ ĐŽŶƚĂĐƚ LJŽƵƌ dW

tŚĞŶ ĂĚĚŝŶŐ ĚĞƉĞŶĚĞŶƚƐ ĨŽƌ ƚŚĞ ĮƌƐƚ ƟŵĞ͕ ƉůĞĂƐĞ ƉƌŽǀŝĚĞ͕ ĚĂƚĞ ŽĨ ďŝƌƚŚ͕ ŐĞŶĚĞƌ ĂŶĚ ƐŽĐŝĂů ƐĞĐƵƌŝƚLJ ŶƵŵďĞƌ͘

^ŚĞƌƌLJ ^ŬŝĚŵŽƌĞ KĸĐĞ͗ ;ϱϭϮͿ ϰϲϭͲϲϳϵϰ Email: ƐƐŬŝĚŵŽƌĞ@ƵƐĞďƐŐ.ĐŽŵ

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

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/DWKZd Ed KEd d^ Vendor USEBSG – Rusty Freeman

Phone Number

Website

https://usebsg.com/

Medical – TRS

830-606-5100 866-355-5999

www.bcbstx.com/trsactivecare

Health Savings Account – ECCU

817-882-0800

www.eecu.org

Group Life – Lincoln Financial

800-423-2765

www.lincolnfinancial.com

Hospital Indemnity – Cigna

800-244-6224

www.cigna.com

Dental – Lincoln Financial

800-423-2765

www.lincolnfinancial.com

Vision – Humana

800-448-6262

www.humana.com

Disability – Hartford

800-523-2233

www.thehartford.com

Accident – MetLife

800-438-6888

www.metlife.com

Medical Transportation – MASA

800-423-3226

www.masamts.com

Cancer – APL

800-256-8606

www.ampublic.com

Critical Illness – Unum

866-679-3054

www.unum.com

Telehealth – 1-800 MD

800-530-8666

www.1800md.com

ID Theft – ID Watchdog

866-513-1518

www.idwatchdog.com

Individual Life – Texas Life

800-283-9233

www.texaslife.com

FSA and Dependent Care – NBS

800-274-0503

www.nbsbenefits.com

ŶƌŽůůŵĞŶƚ /ŶƐƚƌƵĐƚŝŽŶƐ ĨŽƌ d, ďĞŶĞĨŝƚƐ,h Site Access͗ To access your employer online enrollment site, d, ďĞŶĞĨŝƚƐ,h , you can ůŽŐŝŶ ƚŽ ƚŚĞ ĨŽůůŽǁŝŶŐ ǁebsite ǁǁǁ͘ŵLJďĞŶĞĨŝƚƐŚƵď͘ĐŽŵͬůĂŐƌĂŶŐĞŝƐĚ͘

hƐĞƌŶĂŵĞ͗ dŚĞ ĨŝƌƐƚ Ɛŝdž ;ϲͿ ĐŚĂƌĂĐƚĞƌƐ ŽĨ LJŽƵƌ ůĂƐƚ ŶĂŵĞ͕ ĨŽůůŽǁĞĚ ďLJ ƚŚĞ ĨŝƌƐƚ ůĞƚƚĞƌ ŽĨ LJŽƵƌ ĨŝƌƐƚ ŶĂŵĞ͕ ĨŽůůŽǁĞĚ ďLJ ƚŚĞ ůĂƐƚ ĨŽƵƌ ;ϰͿ ĚŝŐŝƚƐ ŽĨ LJŽƵƌ ^^E͗ džĂŵƉůĞ͗ mployee Eame Ͳ Robert Smith, SS# 123-45-6789

User Name: smithƌ6789

Default Password͗ ŽŵƉůĞƚĞ >ĂƐƚ EĂŵĞ ; džĐůƵĚŝŶŐ WƵŶĐƚƵĂƚŝŽŶͿ ĨŽůůŽǁ ďLJ ƚŚĞ ůĂƐƚ ĨŽƵƌ ;ϰͿ ĚŝŐŝƚƐ ĨŽƌ LJŽƵƌ ^^E Password ZĞƐĞƚ͗ ŵƉůŽLJĞĞƐ ǁŝůů ƉƌŽŵƉƚĞĚ ƚŽ ƵƉĚĂƚĞ ƚŚĞ password once you enter the site.

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La Grange ISD provides this valuable benefit at no cost to you.

Full-Time Employees

Term Life and AD&D Insurance Safeguard the most important people in your life.

Think about what your loved ones may face after you’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 accident.

AT A GLANCE: • A cash benefit of $10,000 to your loved ones in the event of your death, plus a matching cash benefit if you die in an accident • 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 access to 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 converted.

Benefit Reduction: Coverage amounts begin to reduce at age 65 and 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 difference between this summary and the contract, the contract will govern.

LifeKeys® services are provided by ComPsych® Corporation, Chicago, IL. ComPsych®, EstateGuidance® and GuidanceResources® are registered trademarks of ComPsych® Corporation. TravelConnect® services are provided by On Call International, Salem, NH. ComPsych® and On Call International are not Lincoln Financial Group® companies. Coverage is subject to actual contract language. Each independent company is solely responsible 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 apply. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations. Limitations and exclusions apply.

Benefits Overview | The Lincoln National Life Insurance Company GP-ERPD-FLI001-TX - ©2022 Lincoln National Corporation - LCN-1821793-061517-Q1.0

• Specialty drug insurance means you’re covered, no matter what life throws at you.

• TRS’s Texas-sized purchasing power enables access to broad networks without county boundaries.

Things to Know

*Available for all plans.

See the benefits guide for more details.

• And much more!

• Mental health benefits

• TRS Virtual Health

• OviaTM pregnancy support

• Nutrition programs

• Weight loss programs

• One-on-one health coaches

• 24/7 customer service

• $0 preventive care

Being healthy is easy with:

Wellness Benefits at No Extra Cost*

Ask your Benefits Administrator for your district’s specific premiums.

Your Premium

Your District and State Contributions

Total Monthly Premium

How to Calculate Your Monthly Premium

$1,228

Employee and Family

Integrated with medical

Your Premium

$1,200/$3,600

In-Network Coverage Only

$

$

$

$

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

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

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

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

Specialty

Insulin Out-of-Pocket Costs

You pay 50% after deductible

You pay 50% after deductible

Non-preferred Brand

You pay 25% after deductible

$15/$45 copay

$200 brand deductible

$12 per medical consultation

$0 per medical consultation

You pay 20% after deductible

$50 copay

$70 copay

$30 copay

Yes

Statewide Network

$6,900/$13,800

You pay 20% after deductible

$1,405

$735

$1,117

$457

Total Premium

You pay 30% after deductible

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

TRS-ActiveCare Primary+ • Lower deductible than the HD and Primary plans • Copays for many services and drugs • Higher premium • Statewide network • PCP referrals required to see specialists • Not compatible with a Health Savings Account (HSA) • No out-of-network coverage

Preferred Brand

Generics (30-Day Supply/90-Day Supply)

Drug Deductible

TRS Virtual Health-Teladoc®

Prescription Drugs

$0 per medical consultation $12 per medical consultation

TRS Virtual Health-RediMD (TM)

$50 copay

$70 copay

$30 copay

You pay 30% after deductible

Urgent Care

Specialist

Primary Care

Emergency Care

Immediate Care

Doctor Visits

Yes

$8,150/$16,300 Statewide Network

Network PCP Required

Your Premium

You pay 30% after deductible

$2,500/$5,000

Individual/Family Maximum Out of Pocket

Coinsurance

$

$

$

$

In-Network Coverage Only

$654

Type of Coverage

$1,026

Employee and Spouse Employee and Children

Individual/Family Deductible

Plan Features

$364

Total Premium Employee Only

Monthly Premiums

Plan Summary

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

TRS-ActiveCare Primary

$

$

$

$

$20,250/$40,500

You pay 50% after deductible

$5,500/$11,000

Out-of-Network

Your Premium

You pay 50% after deductible

You pay 50% after deductible

You pay 50% after deductible

You pay 25% after deductible

You pay 20% after deductible

You pay 50% after deductible

You pay 25% after deductible

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

Integrated with medical

$42 per medical consultation

$30 per medical consultation

You pay 30% after deductible

You pay 30% after deductible

You pay 30% after deductible

You pay 30% after deductible

No

Nationwide Network

$7,050/$14,100

You pay 30% after deductible

$3,000/$6,000

In-Network

$1,265

$675

$1,058

$376

Total Premium

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

TRS-ActiveCare HD

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

2022-23 TRS-ActiveCare Plan Highlights Sept. 1, 2022 – Aug. 31, 2023

No

You pay 40% after deductible

You pay 40% after deductible

You pay 40% after deductible

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

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

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

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

$20/$45 copay

$200 brand deductible

$12 per medical consultation

$0 per medical consultation

You pay a $250 copay plus 20% after deductible

$50 copay

$70 copay

$30 copay

$23,700/$47,400

$7,900/$15,800

Nationwide Network

You pay 40% after deductible

You pay 20% after deductible

$2,000/$6,000

$

$2,841

Out-of-Network

$

$1,507

In-Network

$

$2,402

Your Premium

$1,000/$3,000

$

$1,013

Total Premium

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

TRS-ActiveCare 2

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

Compare Prices for Common Medical Services

REMEMBER: Benefit

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.

TRS-ActiveCare Primary

TRS-ActiveCare Primary+

In-Network Only

In-Network Only

Office/Indpendent Lab: You pay $0

Office/Indpendent Lab: You pay $0

TRS-ActiveCare HD In-Network

In-Network

Out-of-Network

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

Diagnostic Labs*

Out-of-Network

TRS-ActiveCare 2

You pay 40% after deductible

You pay 50% after deductible

Outpatient: You pay 30% after deductible

Outpatient: You pay 20% after deductible

High-Tech Radiology

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

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

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

Outpatient Costs

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

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

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

Inpatient Hospital Costs

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

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

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

You pay 40% after deductible ($500 facility per day maximum)

Freestanding Emergency Room

You pay $500 copay + 30% after deductible

You pay $500 copay + 20% after deductible

You pay $500 copay + 30% after deductible

You pay $500 copay + 50% after deductible

You pay $500 copay + 20% after deductible

You pay $500 copay + 40% after deductible

Facility: You pay 30% after deductible

Facility: You pay 20% after deductible

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

Professional Services: Professional Services: You pay $5,000 You pay $5,000 copay + 20% after copay + 30% after deductible deductible

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

Bariatric Surgery

Outpatient: You pay 20% after deductible

Not Covered

Not Covered

Not Covered

Only covered if rendered at a BDC+ facility

Only covered if rendered at a BDC+ facility

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

You pay $70 copay

You pay $70 copay

You pay 30% after deductible

You pay 50% after deductible

You pay $70 copay

You pay 40% after deductible

Annual Hearing Exam (one per plan year)

$30 PCP copay $70 specialist copay

$30 PCP copay $70 specialist copay

You pay 30% after deductible

You pay 50% after deductible

$30 PCP copay $70 specialist copay

You pay 40% after deductible

Only covered if rendered at a BDC+ facility

*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 Revised 05/03/22

2022-23 Health Maintenance Organization (HMO) Plans and Premiums for Select Regions of the State

REMEMBER:

Remember that when you choose an HMO, you’re choosing a regional network.

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.

Total Monthly Premiums

Central and North Texas Baylor Scott & White Health Plan

Blue Essentials - South Texas HMO

Brought to you by TRS-ActiveCare

Brought to you by TRS-ActiveCare

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

Total Premium

Your Premium

Total Premium

Your Premium

Blue Essentials - West Texas HMO Brought to you by TRS-ActiveCare 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 Total Premium

Your Premium

Employee Only

$491.55

$

N/A

$

$689.60

$

Employee and Spouse

$1,232.58

$

N/A

$

$1,672.26

$

Employee and Children

$789.39

$

N/A

$

$1,083.58

$

Employee and Family

$1,418.42

$

N/A

$

$1,755.58

$

Plan Features Type of Coverage

In-Network Coverage Only

N/A

In-Network Coverage Only

$1,900/$4,750

N/A

$950/$2,850

You pay 20% after deductible

N/A

You pay 25% after deductible

$8,000/$15,000

N/A

$7,450/$14,900

Primary Care

$15 copay

N/A

$20 copay

Specialist

$70 copay

N/A

$70 copay

Individual/Family Deductible Coinsurance Individual/Family Maximum Out of Pocket

Doctor Visits

Immediate Care Urgent Care

$45 copay

N/A

$50 copay

$500 copay after deductible

N/A

$500 copay before deductible + 25% after deductible

Drug Deductible

$200 (excl. generics)

N/A

$150

Days Supply

30-day supply/90-day supply

N/A

30-Day Supply/90-Day Supply $5/$12.50 copay; $0 for certain generics

Emergency Care

Prescription Drugs

$12/$30 copay

N/A

Preferred Brand

Generics

You pay 30% after deductible

N/A

You pay 30% after deductible

Non-preferred Brand

You pay 50% after deductible

N/A

You pay 50% after deductible

You pay 25%/35% after deductible (perferred/non-preferred)

N/A

You pay 15%/25% after deductible (preferred/non-preferred)

Specialty

www.trs.texas.gov Revised 05/03/22

BCBS ActiveCare HD

Premium: $376.00 District Pays: $344.00 Employee Cost: $32.00

Premium: $1058.00 District Pays: $344.00 Employee Cost: $714.00

Premium: $675.00 District Pays: $344.00 Employee Cost: $331.00

Premium: $1265.00 District Pays: $344.00 Employee Cost: $921.00

BCBS ActiveCare Primary

Premium: $364.00 District Pays: $344.00 Employee Cost: $20.00

Premium: $1026 District Pays: $344.00 Employee Cost: $682.00

Premium: $654.00 District Pays: $344.00 Employee Cost: $310.00

Premium: $1228.00 District Pays: $344.00 Employee Cost: $884.00

Catergory

Employee Only

Employee/Spouse

Employee/Child(ren)

Emloyee/Family

Premium: $1405.00 District Pays: $344.00 Employee Cost: $1061.00

Premium: $735.00 District Pays: $344.00 Employee Cost: $391.00

Premium: $1117.00 District Pays: $344.00 Employee Cost: $773.00

Premium: $457.00 District Pays: $344.00 Employee Cost: $113.00

BCBS ActiveCare Primary+

2022 - 2023 TRS Medical Rates

La Grange Independent School District

Premium: $2841.00 District Pays: $344.00 Employee Cost: $2497.00

Premium: $1507.00 District Pays: $344.00 Employee Cost: $1163.00

Premium: $2402.00 District Pays: $344.00 Employee Cost: $2058.00

Premium: $1013.00 District Pays: $344.00 Employee Cost: $669.00

BCBS Active Care 2 (current enrollees only)

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

BALANCE3

INTEREST RATE

APY4

$0-$2,499.99

0.10%

0.10%

$2,500-$4,999.99

0.20%

0.20%

$5,000-$9,999.99

0.45%

0.45%

$10,000 or more

0.95%

0.95%

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.

EECU – June 2022

TCN3S3ZFQAYU-1656369029-314

Dividend Rates

EECU Mobile App Manage Your Health Savings Account Anywhere, Anytime

Download Our Free App Today Our free app gives you easy and secure on-the-go access to your EECU accounts. With our mobile banking app for iPhone and Android, you can: • Check Balances • View Transactions

Download our free App today!

• Pay Bills • Transfer Funds • Deposit Checks • Set & Receive Card Activity & Fraud Alerts

EECU Mobile Banking — Easy to Use, Convenient and Secure

Federally insured by NCUA. *EECU does not charge a fee for the use of EECU Mobile Banking. Your mobile service carrier or provider may impose a data usage or text message charge for use of, or interactions with Mobile Banking.

Offered by Life Insurance Company of North America

Employee-Paid

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 approved 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.

Hospitalization Benefits

Plan 1

Plan 2

Hospital Admission No Elimination Period. Limited to 1 day, 1 benefit(s) every 365 days.

Hospital Chronic Condition Admission No Elimination Period. Limited to 1 day, 1 benefit(s) every 90 days.

Hospital Stay No Elimination Period. Limited to 30 days.

Hospital Intensive Care Unit (ICU) Stay No Elimination Period. Limited to 30 days.

Hospital Observation Stay 24 hour Elimination Period. Limited to 72 hours.

Newborn Nursery Care Admission Limited to 1 day, 1 benefit per newborn child. This benefit is payable to the employee even if child coverage is not elected.

Newborn Nursery Care Stay* Limited to 30 days, 1 benefit per newborn child. This benefit is payable to the employee even if child coverage is not elected.

$1,000

$2,000

$50

$100

$100

$200

$100

$200

$500 per 24-hour period $500

$500 per 24-hour period $500

$100

$100

Plan 1

Plan 2

$50, limited to 1 per year.

$50, limited to 1 per year.

Additional Benefits Health Screening Test Benefit* Examples include (but are not limited to) mammography, and certain blood tests. Also includes COVID-19 Immunization. Virtual Care accepted.

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.

Employee’s Monthly Cost of Coverage: Tier

Plan 1

Plan 2

Employee Only $16.98 $31.08 Employee & Spouse $31.28 $59.56 Employee & Child(ren) $26.36 $49.52 Employee & Family $41.36 $77.92 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 operating 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.

Full-Time Employees of La Grange ISD Benefits At-A-Glance

Dental Insurance Contracting Dentists

Non-Contracting Dentists

Individual: $50 Family: $150 Waived for: Preventive

Individual: $50 Family: $150 Waived for: Preventive

Low Option

Calendar (Annual) Deductible

The Lincoln DentalConnect® PPO Plan:

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

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

Annual Maximum

$750

$750

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

Waiting Period

This plan includes a waiting period if you do not enroll when it is first offered to you (known as a late entrant waiting period). ●12 months for basic services

x Features group coverage for La Grange ISD employees

●12 months for major services

x Allows you to choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a contracting dentist x Does not make you and your loved ones wait six months between routine cleanings

The Lincoln National Life Insurance Company 1

Preventive Services Routine oral exams Bitewing X-rays Full-mouth or panoramic X-rays Other dental X-rays (including periapical films) Routine cleanings Fluoride treatments Space maintainers for children Sealants Palliative treatment (including emergency relief of dental pain) Basic Services Problem focused exams Consultations Injections of antibiotics and other therapeutic medications Fillings Simple extractions Biopsy and examination of oral tissue (including brush biopsy) Periodontal maintenance procedures Major Services Prefabricated stainless steel and resin crowns Surgical extractions Oral surgery General anesthesia and I.V. sedation Prosthetic repair and recementation services Endodontics (including root canal treatment) Non-surgical periodontal therapy Periodontal surgery Bridges Full and partial dentures Denture reline and rebase services Crowns, inlays, onlays and related services Implants & implant related services Contracting Dentists/Non-Contracting Dentists

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

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

Contracting Dentists

Non-Contracting Dentists

100% No Deductible

100% No Deductible

Contracting Dentists

Non-Contracting Dentists

60% After Deductible

60% After Deductible

Contracting Dentists

Non-Contracting Dentists

40% After Deductible

40% After Deductible

Contracting Dentists

Non-Contracting Dentists

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

Dental Coverage | At-A-Glance | Low Option DTL-ENRO-BRC001-TX

2

Benefit Exclusions

With the Lincoln Dental Mobile App

Like any coverage, this dental coverage does have some exclusions.

x Find a network dentist near you in minutes x Have an ID card on your phone x Customize the app to get details of your plan x Find out how much your plan covers for checkups and other services x Keep track of your claims

Lincoln DentalConnect® Online Health Center x Determine the average cost of a dental procedure x Have your questions answered by a licensed dentist x Learn all about dental health for children, from baby’s first tooth to dental emergencies x Evaluate your risk for oral cancer, periodontal disease and tooth decay

Covered Family Members

x 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’s allowances. x Plan benefits are not payable for a condition that is covered under Workers’ Compensation or a similar law; that occurs during the course of employment or military service or involvement in an illegal occupation, felony, or riot; or that results from a self-inflicted injury. x 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. x Certain conditions, such as age and frequency limitations, may impact your coverage. See the summary plan description for details. x 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 provided to 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.

When you choose coverage for yourself, you can also provide coverage for: • Your spouse.

• Dependent children, up to age 26.

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 description will be made available to you that describes the benefits in greater detail.

Refer to your summary plan description for 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 description language. 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.

©2020 Lincoln National Corporation LCN-2012491-013118 R 1.0 – Group ID: 1056395

Dental Coverage | At-A-Glance | Low Option DTL-ENRO-BRC001-TX

3

Dental Rate Here’s how little you pay with grouprates.

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

Your estimated cost is itemized below.

Coverage

Monthly Rate

Employee only

$14.76

Employee & spouse

$28.70

Employee & child/children

$36.00

Employee & family

$54.07

The Lincoln National Life Insurance Company Please see prior page for product information.

Dental Coverage | Rate Calculation | Low Option DTL-ENRO-BRC001-TX

4

Full-Time Employees of La Grange ISD Benefits At-A-Glance

Dental Insurance Contracting Dentists

Non-Contracting Dentists

Individual: $50 Family: $150 Waived for: Preventive

Individual: $50 Family: $150 Waived for: Preventive

High Option

Calendar (Annual) Deductible

The Lincoln DentalConnect® PPO Plan:

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

x Covers many preventive, basic, and major dental care services x Also covers orthodontic treatment for children

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 a waiting period if you do not enroll when it is first offered to you (known as a late entrant waiting period). ●12 months for basic services

x Features group coverage for La Grange ISD employees x Allows you to choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a contracting dentist

●12 months for major services ●12 months for orthodontic services

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

The Lincoln National Life Insurance Company 1

Contracting Dentists

Non-Contracting Dentists

100% No Deductible

100% No Deductible

Contracting Dentists

Non-Contracting Dentists

80% After Deductible

80% After Deductible

Contracting Dentists

Non-Contracting Dentists

50% After Deductible

50% After Deductible

Orthodontics

Contracting Dentists

Non-Contracting Dentists

Orthodontic exams X-rays Extractions Study models Appliances

50%

Contracting Dentists/Non-Contracting Dentists

Contracting Dentists

Non-Contracting Dentists

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

… you pay a deductible (if applicable), then 50% of the usual and customary fee, which is the maximum expense covered by the plan.

You are responsible for the difference between the usual and customary fee and the dentist’s billed charge.

Preventive Services Routine oral exams Bitewing X-rays Full-mouth or panoramic X-rays Other dental X-rays (including periapical films) Routine cleanings Fluoride treatments Space maintainers for children Sealants Palliative treatment (including emergency relief of dental pain) Basic Services 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 services 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…

Dental Coverage | At-A-Glance | High Option DTL-ENRO-BRC001-TX

2

50%

Benefit Exclusions

With the Lincoln Dental Mobile App

Like any coverage, this dental coverage does have some exclusions.

x Find a network dentist near you in minutes x Have an ID card on your phone x Customize the app to get details of your plan x Find out how much your plan covers for checkups and other services x Keep track of your claims

Lincoln DentalConnect® Online Health Center x Determine the average cost of a dental procedure x Have your questions answered by a licensed dentist x Learn all about dental health for children, from baby’s first tooth to dental emergencies x 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.

x 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’s usual and customary allowances. x Plan benefits are not payable for a condition that is covered under Workers’ Compensation or a similar law; that occurs during the course of employment or military service or involvement in an illegal occupation, felony, or riot; or that results from a self-inflicted injury. x 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’s lifetime orthodontia maximum. Plan benefits are not payable if the orthodontic appliance was installed after the age of 19. x 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. x Certain conditions, such as age and frequency limitations, may impact your coverage. See the summary plan description for details. x 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 provided to 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 description will be made available to you that describes the benefits in greater detail.

Refer to your summary plan description for 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 description language. 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.

©2020 Lincoln National Corporation LCN-2012491-013118 R 1.0 – Group ID: 1056395

Dental Coverage | At-A-Glance | High Option DTL-ENRO-BRC001-TX

3

Dental Rate Here’s how little you pay with grouprates.

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

Your estimated cost is itemized below.

Coverage

Monthly Rate

Employee only

$32.60

Employee & spouse

$64.84

Employee & child/children

$86.63

Employee & family

$129.43

The Lincoln National Life Insurance Company Please see prior page for product information.

Dental Coverage | Rate Calculation | High Option DTL-ENRO-BRC001-TX

4

TEXAS

Humana Vision 130 La Grange ISD If you use an IN-NETWORK provider (Member cost)

Vision care services

If you use an OUT-OF-NETWORK provider (Reimbursement)

Exam with dilation as necessary

$10

Up to $30

• Retinal imaging 1

Up to $39

Not covered

• Standard contact lens fit and follow-up • Premium contact lens fit and follow-up

Up to $40 10% off retail

Not covered Not covered

Frames 3

$130 allowance 20% off balance over $130

$65 allowance

$15 $15 $15 $15

Up to $25 Up to $40 Up to $60 Up to $100

$15 $15 $15 $40 $40 $45 Premium anti-reflective coatings as follows: $57 $68 80% of charge $15 Premium progressives as follows: $110 $120 $135 $90 copay, 80% of charge less $120 allowance $75 20% off retail

Not covered Not covered Not covered Not covered Not covered Not covered Premium anti-reflective coatings as follows: Not covered Not covered Not covered Up to $40 Premium progressives as follows: Not covered Not covered Not covered Not covered

$130 allowance, 15% off balance over $130 $130 allowance $0

$104 allowance

Contact lens exam options 2

Standard plastic lenses 4 • Single vision • Bifocal • Trifocal • Lenticular

Covered lens options 4 • UV coating • Tint (solid and gradient) • Standard scratch-resistance • Standard polycarbonate - adults • Standard polycarbonate - children <19 • Standard anti-reflective coating • Premium anti-reflective coating x – Tier 1 – Tier 2 – Tier 3 • Standard progressive (add-on to bifocal) • Premium progressive – Tier 1 – Tier 2 – Tier 3 – Tier 4 x • Photochromatic / plastic transitions • Polarized

Not covered Not covered

Contact lenses 5 (applies to materials only) • Conventional x • Disposable • Medically necessary

Page 1 of 5

$104 allowance $200 allowance

1-800-233-4013 | Humana.com

SGB0018A

Humana Vision 130

TEXAS If you use an IN-NETWORK provider (Member cost)

Vision care services

If you use an OUT-OF-NETWORK provider (Reimbursement)

Frequency • Examination • Lenses or contact lenses • Frame

Once every 12 months Once every 12 months Once every 12 months

Once every 12 months Once every 12 months Once every 12 months

$0

Up to $77

$0

Up to $50

$0

Up to $15

$0

Up to $15

$0

Up to $33

Diabetic Eye Care: care and testing for diabetic members • Examination - Up to (2) services per year • Retinal Imaging - Up to (2) services per year • Extended Ophthalmoscopy - Up to (2) services per year • Gonioscopy - Up to (2) services per year • Scanning Laser - Up to (2) services per year

Optional benefits • 12-month Frame Benefit

Benefit replaces the 24-month frequency of the base plan.

XDONOTDELETE

1. Member costs may exceed $39 with certain providers. Members may contact their participating provider to determine what costs or discounts are available.

2. Standard contact lens exam fit and follow up costs and premium contact lens exam discounts up to 10% may vary by participating provider. Members may contact their participating provider to determine what costs or discounts are available.

3. Discounts may be available on all frames except when prohibited by the manufacturer.

4. Lens option costs may vary by provider. Members may contact their participating provider to determine if listed costs are available.

5. Plan covers contact lenses or lenses for frames, but not both.

DONOTDELETE

Monthly rates* (12 deductions per year) Employee

$6.68

Employee + spouse

$13.38

Employee + child(ren)

$12.70

Family

$19.96

* This is not a substitute for a quote. Rates must be approved by Humana Vision underwriting.

Page 2 of 5

1-800-233-4013 | Humana.com

SGB0018A

Humana Vision 130

TEXAS

Additional plan discounts • Member may receive a 20% discount on items not covered by the plan at network Providers. Members may contact their participating provider to determine what costs or discounts are available. Discount does not apply to EyeMed Provider's professional services, or contact lenses. Plan discounts cannot be combined with any other discounts or promotional offers. Services or materials provided by any other group benefit plan providing vision care may not be covered. Certain brand name Vision Materials may not be eligible for a discount if the manufacturer imposes a no-discount practice. Frame, Lens, & Lens Option discounts apply only when purchasing a complete pair of eyeglasses. If purchased separately, members receive 20% off the retail price.

• Members may also receive 15% off retail price or 5% off promotional price for LASIK or PRK from the US Laser Network, owned and operated by LCA Vision. Since LASIK or PRK vision correction is an elective procedure, performed by specialty trained providers, this discount may not always be available from a provider in your immediate location.

Questions?

Check out Humana.com Call 1-866-995-9316 seven days a week: 8 a.m. to 6 p.m. Eastern Time Monday through Saturday and 11 a.m. to 8 p.m. Sunday.

Page 3 of 5

1-800-233-4013 | Humana.com

SGB0018A

Humana Vision 130

TEXAS

Limitations and Exclusions: In addition to the limitations and exclusions listed in your "Vision Benefits" section, this policy does not provide benefits for the following: 1. Any expenses incurred while you qualify for any worker's compensation or occupational disease act or law, whether or not you applied for coverage.

2. Services: • That are free or that you would not be required to pay for if you did not have this insurance, unless charges are received from and reimbursable to the U.S. government or any of its agencies as required by law; • Furnished by, or payable under, any plan or law through any government or any political subdivision (this does not include Medicare or Medicaid); or • Furnished by any U.S. government-owned or operated hospital/institution/agency for any service connected with sickness or bodily injury.

3. Any loss caused or contributed by: • War or any act of war, whether declared or not; • Any act of international armed conflict; or • Any conflict involving armed forces of any international authority.

4. Any expense arising from the completion of forms.

5. Your failure to keep an appointment.

6. Any hospital, surgical or treatment facility, or for services of an anesthesiologist or anesthetist.

7. Prescription drugs or pre-medications, whether dispensed or prescribed.

8. Any service not specifically listed in the Schedule of Benefits.

9. Any service that we determine: • Is not a visual necessity; • Does not offer a favorable prognosis; • Does not have uniform professional endorsement; or • Is deemed to be experimental or investigational in nature.

10. Orthoptic or vision training.

11. Subnormal vision aids and associated testing.

12. Aniseikonic lenses.

13. Any service we consider cosmetic.

14. Any expense incurred before your effective date or after the date your coverage under this policy terminates.

15. Services provided by someone who ordinarily lives in your home or who is a family member.

16. Charges exceeding the reimbursement limit for the service.

17. Treatment resulting from any intentionally self-inflicted injury or bodily illness.

18. Plano lenses.

19. Medical or surgical treatment of eye, eyes, or supporting structures.

20. Replacement of lenses or frames furnished under this plan which are lost or broken, unless otherwise available under the plan.

21. Any examination or material required by an Employer as a condition of employment.

22. Non-prescription sunglasses.

23. Two pair of glasses in lieu of bifocals.

24. Services or materials provided by any other group benefit plans providing vision care.

25. Certain name brands when manufacturer imposes no discount.

26. Corrective vision treatment of an experimental nature.

27. Solutions and/or cleaning products for glasses or contact lenses.

28. Pathological treatment.

29. Non-prescription items.

30. Costs associated with securing materials.

31. Pre- and Post-operative services.

32. Orthokeratology.

33. Routine maintenance of materials.

34. Refitting or change in lens design after initial fitting, unless specifically allowed elsewhere in the certificate.

35. Artistically painted lenses.

Humana Vision products insured by Humana Insurance Company, Humana Health Benefit Plan of Louisiana, The Dental Concern, Inc. or Humana Insurance Company of New York. In Arizona, group vision plans insured by Humana Insurance Company. In New Mexico, group vision plans insured by Humana Insurance Company.

This is not a complete disclosure of the plan qualifications and limitations. Specific limitations and exclusions as contained in the Regulatory and Technical Information Guide will be provided by the agent. Please review this information before applying for coverage.

NOTICE: Your actual expenses for covered services may exceed the stated cost or reimbursement amount because actual provider charges may not be used to determine insurer and member payment obligations.

Policy Number: TX-70148-019/15et.al.

Plan summary created on: 5/11/22 09:15

Page 4 of 5

1-800-233-4013 | Humana.com

SGB0018A

PLAN SUMMARY

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.

BENEFIT AMOUNTS BENEFIT

BENEFIT LIMITS

EMPLOYEE

SPOUSE

CHILD

$25,000

$12,500

$5,000

$75,000

$37,500

$15,000

ACCIDENTAL DEATH BENEFITS CATEGORY Basic Accidental Death

N/A

Accidental Death Common Carrier

ACCIDENTAL DISMEMBERMENT/FUNCTIONAL LOSS/PARALYSIS BENEFITS CATEGORY Basic Dismemberment/Functional Loss Benefit Loss of one finger or one toe

$750

$750

$750

Loss of one arm or one leg

$10,000

$10,000

$10,000

$10,000

$10,000

$10,000

$1,500

$1,500

$1,500

Loss of sight in one eye

$10,000

$10,000

$10,000

Loss of hearing in one ear

$10,000

$10,000

$10,000

$20,000

$20,000

$20,000

$20,000

$20,000

$20,000

$20,000

$20,000

$20,000

Loss of hearing in both ears

$20,000

$20,000

$20,000

Loss of ability to speak

$20,000

$20,000

$20,000

$10,000

$10,000

$10,000

$20,000

$20,000

$20,000

Loss of one hand or one foot

N/A

Loss of two or more fingers or toes

Catastrophic Dismemberment/Functional Loss Benefit Loss of both arms or both legs or one arm and one leg Loss of both hands or both feet or one hand and one foot Loss of sight in both eyes

N/A

Paralysis Benefit Two Limbs (paraplegia or hemiplegia) Four Limbs (quadriplegia)

N/A

BENEFIT AMOUNTS

ADF# AI664.14

Accident Insurance BENEFIT

BENEFIT LIMITS

ALL COVERED PERSONS

ACCIDENTAL INJURY BENEFITS CATEGORY Fracture Benefit (Closed) Face or Nose (except mandible or maxilla)

$1,000

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

$4,000

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

$2,000

Lower Jaw, Mandible (except alveolar process)

$750

Upper Jaw, Maxilla (except alveolar process)

$1,000

Upper Arm between Elbow and Shoulder (humerus)

$1,000

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

$750

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

$750 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.

Rib Finger, Toe Vertebrae, Body of (excluding vertebral processes)

$750 $100 $1,500

Vertebral Process

$500

Pelvis (includes ilium, ischium, pubis, acetabulum except coccyx)

$1,500

Hip, Thigh (femur)

$4,000

Coccyx

$500

Leg (tibia and/or fibula)

$1,500

Kneecap (patella)

$500

Ankle

$500

Foot (except toes)

$500

Chip Fracture

25% Fracture Benefit (Open)

Face or Nose (except mandible or maxilla)

$2,000

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

$8,000

Skull Fracture - non depressed (except bones of face or nose) Lower Jaw, Mandible (except alveolar process) Upper Jaw, Maxilla (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.

$4,000 $1,500 $2,000

Upper Arm between Elbow and Shoulder (humerus)

$2,000

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

$1,500

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 L0721015328[exp0722][All States] © 2021 MetLife Services and Solutions, LLC

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

$1,500

Rib

$1,500

Finger, Toe

$200

Vertebrae, Body of (excluding vertebral processes)

$3,000

Vertebral Process

$1,000

Pelvis (includes ilium, ischium, pubis, acetabulum except coccyx)

$3,000

Hip, Thigh (femur)

$8,000

Coccyx

$1,000

Leg (tibia and/or fibula)

$3,000

Kneecap (patella)

$1,000

Ankle

$1,000

Foot (except toes)

$1,000

Chip Fracture

25% Dislocation Benefit (Closed)

Lower Jaw

$750

Collarbone (sternoclavicular)

$1,000

Collarbone (acromioclavicular and separation)

$750

Shoulder (glenohumeral)

$750

Rib

$750

Elbow

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.

Wrist Bone or Bones of the Hand (other than fingers)

$750 $750 $750

Hip

$4,000

Knee (except patella)

$2,000

Ankle - Bone or bones of the Foot (other than toes)

$750

One Toe or Finger

$100

Partial Dislocation

25% Dislocation Benefit (Open)

Lower Jaw

$1,500

Collarbone (sternoclavicular)

$2,000

Collarbone (acromioclavicular and separation) Shoulder (glenohumeral) Rib

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.

$1,500 $1,500 $1,500

Elbow

$1,500

Wrist

$1,500

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 L0721015328[exp0722][All States] © 2021 MetLife Services and Solutions, LLC

Accident Insurance Bone or Bones of the Hand (other than fingers)

$1,500

Hip

$8,000

Knee (except patella)

$4,000

Ankle - Bone or bones of the Foot (other than toes)

$1,500

One Toe or Finger

$200

Partial Dislocation

25% Burn Benefit

2nd Degree w/ less than 10% of surface skin burnt

$75

2nd Degree 10-25% surface skin burnt

$150

2nd Degree 25-35% surface skin burnt

$500

2nd Degree 35% or more of surface skin burnt

1 time per accident; Unlimited time(s) per calendar year

3rd Degree w/ less than 10% of surface skin burnt

$1,000 $1,000

3rd Degree 10-25% surface skin burnt

$1,500

3rd Degree 25-35% surface skin burnt

$5,000

3rd Degree 35% or more of surface skin burnt

$10,000 Concussion Benefit

Concussion

1 time(s) per calendar year

$250

1 time(s) per accident; Unlimited time(s) per calendar year

$7,500

Coma Benefit Coma

Laceration Benefit Without repair by stiches

$50

Repaired by stiches but less than 2 inches long

1 time per accident; 3 time(s) per calendar year

Repaired by stiches and 2-6 inches long Repaired by stiches and over 6 inches long

$75 $200 $400

Broken Tooth Benefit

Crown

1 time(s) per accident; Unlimited time(s) per calendar year (applies to all procedures)

$200

Extraction

1 time(s) per accident; Unlimited time(s) per calendar year (applies to all procedures)

$100

Filling

1 time(s) per accident; Unlimited time(s) per calendar year (applies to all procedures)

$25

Eye Injury Benefit Eye Injury

1 time(s) per accident;

$300

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 L0721015328[exp0722][All States] © 2021 MetLife Services and Solutions, LLC

Accident Insurance Unlimited time(s) per calendar year

BENEFIT

BENEFIT LIMITS

BENEFIT AMOUNTS ALL COVERED PERSONS

MEDICAL TREATMENT AND SERVICES BENEFITS CATEGORY Ground Ambulance Benefit 1 time(s) per accident; Unlimited time(s) per calendar year

Ground Ambulance

$300

Air Ambulance Benefit 1 time(s) per accident; Unlimited time(s) per calendar year

Air Ambulance

$1,250

Emergency Care Benefit Emergency Room

1 time per accident (combined with Non-Emergency Initial Care Benefit).

Payable within 96 hours after the accident.

Physician’s Office Urgent Care

$150 $75 $75

Non-Emergency Initial Care Benefit 1 time per accident (combined with Emergency Care Benefit)

Non-Emergency Initial Care

$75

Medical Testing Benefit Medical Testing (X-rays, MRI/MR, Ultrasound, NCV, CT/CAT, EEG)

2 time(s) per accident; Unlimited time(s) per calendar year

$150

Physician Follow-Up Benefit Physician Follow-Up Visit

2 time(s) per accident; 6 time(s) per calendar year

$75

1 time(s) per accident; 2 time(s) per calendar year

$300

Transportation Benefit Transportation

Therapy Services Benefit Acupuncture

$35

Chiropractic Therapy

$35

Cognitive Behavioral Therapy

$35

Occupational Therapy Physical Therapy

10 time(s) per accident; Unlimited time(s) per calendar year

$35 $35

Respiratory therapy

$35

Speech Therapy

$35

Vocational Therapy

$35

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 L0721015328[exp0722][All States] © 2021 MetLife Services and Solutions, LLC

Accident Insurance Pain Benefit 1 time(s) per accident; Unlimited time(s) per calendar year

Pain Management (for Epidural Anesthesia)

$75

Prosthetic Device Benefit One Device Only

1 time(s) per accident; Unlimited time(s) per calendar year

More than One Device

$750 $1,500

Medical Appliance Benefit Brace

$75

Cane

$75

Crutches

$75

Walker - expected use < 1yr

$150

Walker - expected use >=1 yr

$300

Walking Boot

$75

Wheel chair or motorized scooter - expected use < 1yr

$200

Wheel chair or motorized scooter - expected use >=1yr

$750

Other medical device used for Mobility

$75

Medical Appliance Benefit Limit (for all appliances combined per accident)

$750

Modification Benefit 1 time(s) per accident; Unlimited time(s) per calendar year

Modification

$1,000

Blood/ Plasma/ Platelets Benefit 1 time(s) per accident; Unlimited time(s) per calendar year

Blood/Plasma/Platelets

$400

Surgery Benefits Surgical Repair – Cranial

$1,500

Surgical Repair – Hernia

$150

Surgical Repair – Ruptured Disc

$750

Surgical Repair – Skin Graft (% of Burn Benefit )

50% 1 time(s) per accident; Unlimited time(s) per calendar year

Surgical Repair – Torn Cartilage in Knee

$750

Surgical Repair – Torn tendon/ligament/rotator cuff - one

$750

Surgical Repair – Torn tendon/ligament/rotator cuff - two or more

$1,500

Surgical Repair – Thoracic Cavity or Abdominal Pelvic Cavity

$1,500

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 L0721015328[exp0722][All States] © 2021 MetLife Services and Solutions, LLC

Accident Insurance Exploratory Surgery (for any Surgery Benefit procedure)

$150

Other Outpatient Surgery Benefit 1 time(s) per accident; Unlimited time(s) per calendar year

Other Outpatient Surgery Benefit

BENEFIT

BENEFIT LIMITS

$300

BENEFIT AMOUNTS ALL COVERED PERSONS

ACCIDENT – HOSPITAL BENEFITS CATEGORY Hospital Admission Benefit Admission ICU Supplemental Admission (paid in addition to Admission)

1 time per accident; Unlimited times per calendar year

$1,000 $1,000

Hospital Confinement Benefit Confinement ICU Supplemental Confinement (paid in addition to Confinement)

15 days per accident. Payable after the first day of admission.

ICU Supplemental Confinement will pay an additional benefit for 15 of those days.

$200 $200

Inpatient Rehabilitation Benefit 15 days per accident; 30 days per calendar year

Inpatient Rehabilitation

BENEFIT

BENEFIT LIMITS

$150

BENEFIT AMOUNTS ALL COVERED PERSONS

OTHER BENEFITS CATEGORY Lodging Benefit

15 day(s) per calendar year

$100

Notes Regarding Certain Benefits: x

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.

x

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.

x

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

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 L0721015328[exp0722][All States] © 2021 MetLife Services and Solutions, LLC

Accident Insurance This coverage includes an Organized Sports Activity Benefit Rider. The rider increases the amount payable under the Certific ate for certain benefits by 25% for injuries resulting from an accident th at occurred while participating as a player in an organized sports 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 scan 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 insuranc e co-payments and deductibles.

MetLife Group Accident Insurance payments can be used to help cover these unexpected costs.

Covered Event 3

Benefit Amount

Ambulance (ground )

$300

Emergency Care

$150

Physician Follow-Up ($75 x 2)

$150

Medical Testing

$150

Concussion

$250

Broken Tooth (repaired by crown)

$200

Benefits paid by MetLife Group Accident Insurance

$1,200

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. See 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 cove red 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.

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 L0721015328[exp0722][All States] © 2021 MetLife Services and Solutions, LLC

IDENTITY THEFT PROTECTION

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.

1 in 18 consumers were victims of identity theft in 2018.1

WHY CHOOSE ID WATCHDOG

Credit Lock 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.

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 Here for You 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.

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

(Features and pricing tables on reverse.)

A Leader in Detection & Prevention for 3 years running

1

2019 Identity Fraud Study, Javelin Research, March 2019 Locking 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

2

IDENTITY THEFT PROTECTION ID WATCHDOG®

The Powerful Features You Want — All at an Affordable Price

1B

PLAN FEATURES

Monitor & Detect

Manage & Alert

Support & Restore

• Credit Report & VantageScore® Credit Score 1 Bureau Monthly

• Credit Report Lock3 | 1 Bureau

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

• Child Credit Lock4 | 1 Bureau • Financial Accounts Monitoring

• Credit Score Tracker 1 Bureau Monthly • Credit Report Monitoring | 1 Bureau • Dark Web Monitoring1 • High-Risk Transactions Monitoring2

• Social Network Alerts

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

• Registered Sex Offender Reporting

• Up to $1M Identity Theft Insurance5

• Customizable Alert Options

• Lost Wallet Vault & Assistance

• Breach Alert Emails

• Deceased Family Member Fraud Remediation

• Subprime Loan Monitoring2

• Mobile App

• Public Records Monitoring

• National Provider ID Alerts

• Fraud Alert & Credit Freeze Assistance

• USPS Change of Address Monitoring • Identity Profile Report Helps better protect children

1 Bureau = Equifax®

What You Need to Know 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.

SPECIAL EMPLOYEE PRICING

PER MONTH

Employee

$ɒȜǒŇ

Take steps to help better protect your identity.

(Includes 1 child <18)

Employee + Family

$ǵŗȜǒŇ

1

Enroll in this valuable benefit today.

Dark 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.

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

3 Locking 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.

4 Locking 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.

5 The 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).

© 2019 ID Watchdog. Other product and company names are property of their respective owners. EE79376CG0819

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 disability1 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 disability2 2

Facts 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 income3 3

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

ELIGIBILITY AND ENROLLMENT

1

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.

Age Disabled Prior to 60 Age 60-64 Age 65-67 Age 68 and over

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

Partial Disability

2

Maximum Benefit Duration To age 65 60 months To age 70 24 months

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 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

3

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: • • • • • •

Termination Provisions

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

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.

4

La Grange Independent School District Premium Option – Monthly Premium Cost

(based on 12 payments per year) Accident / Sickness Elimination Period in Days Annual Earnings Monthly Earnings Monthly Benefit 0/7 14 / 14 30 / 30 60 / 60 90 / 90 180 / 180 $3,600 $300 $200 $5.88 $4.96 $4.28 $3.44 $1.96 $1.36 $5,400 $450 $300 $8.82 $7.44 $6.42 $5.16 $2.94 $2.04 $7,200 $600 $400 $11.76 $9.92 $8.56 $6.88 $3.92 $2.72 $9,000 $750 $500 $14.70 $12.40 $10.70 $8.60 $4.90 $3.40 $10,800 $900 $600 $17.64 $14.88 $12.84 $10.32 $5.88 $4.08 $12,600 $1,050 $700 $20.58 $17.36 $14.98 $12.04 $6.86 $4.76 $14,400 $1,200 $800 $23.52 $19.84 $17.12 $13.76 $7.84 $5.44 $16,200 $1,350 $900 $26.46 $22.32 $19.26 $15.48 $8.82 $6.12 $18,000 $1,500 $1,000 $29.40 $24.80 $21.40 $17.20 $9.80 $6.80 $19,800 $1,650 $1,100 $32.34 $27.28 $23.54 $18.92 $10.78 $7.48 $21,600 $1,800 $1,200 $35.28 $29.76 $25.68 $20.64 $11.76 $8.16 $23,400 $1,950 $1,300 $38.22 $32.24 $27.82 $22.36 $12.74 $8.84 $25,200 $2,100 $1,400 $41.16 $34.72 $29.96 $24.08 $13.72 $9.52 $27,000 $2,250 $1,500 $44.10 $37.20 $32.10 $25.80 $14.70 $10.20 $28,800 $2,400 $1,600 $47.04 $39.68 $34.24 $27.52 $15.68 $10.88 $30,600 $2,550 $1,700 $49.98 $42.16 $36.38 $29.24 $16.66 $11.56 $32,400 $2,700 $1,800 $52.92 $44.64 $38.52 $30.96 $17.64 $12.24 $34,200 $2,850 $1,900 $55.86 $47.12 $40.66 $32.68 $18.62 $12.92 $36,000 $3,000 $2,000 $58.80 $49.60 $42.80 $34.40 $19.60 $13.60 $37,800 $3,150 $2,100 $61.74 $52.08 $44.94 $36.12 $20.58 $14.28 $39,600 $3,300 $2,200 $64.68 $54.56 $47.08 $37.84 $21.56 $14.96 $41,400 $3,450 $2,300 $67.62 $57.04 $49.22 $39.56 $22.54 $15.64 $43,200 $3,600 $2,400 $70.56 $59.52 $51.36 $41.28 $23.52 $16.32 $45,000 $3,750 $2,500 $73.50 $62.00 $53.50 $43.00 $24.50 $17.00 $46,800 $3,900 $2,600 $76.44 $64.48 $55.64 $44.72 $25.48 $17.68 $48,600 $4,050 $2,700 $79.38 $66.96 $57.78 $46.44 $26.46 $18.36 $50,400 $4,200 $2,800 $82.32 $69.44 $59.92 $48.16 $27.44 $19.04 $52,200 $4,350 $2,900 $85.26 $71.92 $62.06 $49.88 $28.42 $19.72 $54,000 $4,500 $3,000 $88.20 $74.40 $64.20 $51.60 $29.40 $20.40 $55,800 $4,650 $3,100 $91.14 $76.88 $66.34 $53.32 $30.38 $21.08 $57,600 $4,800 $3,200 $94.08 $79.36 $68.48 $55.04 $31.36 $21.76 $59,400 $4,950 $3,300 $97.02 $81.84 $70.62 $56.76 $32.34 $22.44 $61,200 $5,100 $3,400 $99.96 $84.32 $72.76 $58.48 $33.32 $23.12 $63,000 $5,250 $3,500 $102.90 $86.80 $74.90 $60.20 $34.30 $23.80 $64,800 $5,400 $3,600 $105.84 $89.28 $77.04 $61.92 $35.28 $24.48 $66,600 $5,550 $3,700 $108.78 $91.76 $79.18 $63.64 $36.26 $25.16 $68,400 $5,700 $3,800 $111.72 $94.24 $81.32 $65.36 $37.24 $25.84 $70,200 $5,850 $3,900 $114.66 $96.72 $83.46 $67.08 $38.22 $26.52 $72,000 $6,000 $4,000 $117.60 $99.20 $85.60 $68.80 $39.20 $27.20 $73,800 $6,150 $4,100 $120.54 $101.68 $87.74 $70.52 $40.18 $27.88 $75,600 $6,300 $4,200 $123.48 $104.16 $89.88 $72.24 $41.16 $28.56 $77,400 $6,450 $4,300 $126.42 $106.64 $92.02 $73.96 $42.14 $29.24 $79,200 $6,600 $4,400 $129.36 $109.12 $94.16 $75.68 $43.12 $29.92 $81,000 $6,750 $4,500 $132.30 $111.60 $96.30 $77.40 $44.10 $30.60 $82,800 $6,900 $4,600 $135.24 $114.08 $98.44 $79.12 $45.08 $31.28 $84,600 $7,050 $4,700 $138.18 $116.56 $100.58 $80.84 $46.06 $31.96 $86,400 $7,200 $4,800 $141.12 $119.04 $102.72 $82.56 $47.04 $32.64 $88,200 $7,350 $4,900 $144.06 $121.52 $104.86 $84.28 $48.02 $33.32 $90,000 $7,500 $5,000 $147.00 $124.00 $107.00 $86.00 $49.00 $34.00 $91,800 $7,650 $5,100 $149.94 $126.48 $109.14 $87.72 $49.98 $34.68 $93,600 $7,800 $5,200 $152.88 $128.96 $111.28 $89.44 $50.96 $35.36 $95,400 $7,950 $5,300 $155.82 $131.44 $113.42 $91.16 $51.94 $36.04 $97,200 $8,100 $5,400 $158.76 $133.92 $115.56 $92.88 $52.92 $36.72 $99,000 $8,250 $5,500 $161.70 $136.40 $117.70 $94.60 $53.90 $37.40 $100,800 $8,400 $5,600 $164.64 $138.88 $119.84 $96.32 $54.88 $38.08 $102,600 $8,550 $5,700 $167.58 $141.36 $121.98 $98.04 $55.86 $38.76 $104,400 $8,700 $5,800 $170.52 $143.84 $124.12 $99.76 $56.84 $39.44 $106,200 $8,850 $5,900 $173.46 $146.32 $126.26 $101.48 $57.82 $40.12 $108,000 $9,000 $6,000 $176.40 $148.80 $128.40 $103.20 $58.80 $40.80 $109,800 $9,150 $6,100 $179.34 $151.28 $130.54 $104.92 $59.78 $41.48 $111,600 $9,300 $6,200 $182.28 $153.76 $132.68 $106.64 $60.76 $42.16 $113,400 $9,450 $6,300 $185.22 $156.24 $134.82 $108.36 $61.74 $42.84 $115,200 $9,600 $6,400 $188.16 $158.72 $136.96 $110.08 $62.72 $43.52 $117,000 $9,750 $6,500 $191.10 $161.20 $139.10 $111.80 $63.70 $44.20 $118,800 $9,900 $6,600 $194.04 $163.68 $141.24 $113.52 $64.68 $44.88 $120,600 $10,050 $6,700 $196.98 $166.16 $143.38 $115.24 $65.66 $45.56 $122,400 $10,200 $6,800 $199.92 $168.64 $145.52 $116.96 $66.64 $46.24 $124,200 $10,350 $6,900 $202.86 $171.12 $147.66 $118.68 $67.62 $46.92 $126,000 $10,500 $7,000 $205.80 $173.60 $149.80 $120.40 $68.60 $47.60 $127,800 $10,650 $7,100 $208.74 $176.08 $151.94 $122.12 $69.58 $48.28 $129,600 $10,800 $7,200 $211.68 $178.56 $154.08 $123.84 $70.56 $48.96 $131,400 $10,950 $7,300 $214.62 $181.04 $156.22 $125.56 $71.54 $49.64 $133,200 $11,100 $7,400 $217.56 $183.52 $158.36 $127.28 $72.52 $50.32 $135,000 $11,250 $7,500 $220.50 $186.00 $160.50 $129.00 $73.50 $51.00 © 2022 by The Hartford. Classification: Company Confidential. No part of this document may be reproduced, published, or used without the permission of The Hartford.

Full-Time Employees of La Grange ISD Benefits At-A-Glance

Voluntary Term Life Insurance

The Lincoln Term Life Insurance Plan:

Employee Newly hired employee guaranteed coverage amount Continuing employee guaranteed coverage annual increase amount

loved ones in the event of your death • Features group rates for La Grange ISD employees

Minimum coverage amount

Spouse Newly hired employee guaranteed coverage amount Continuing employee guaranteed coverage annual increase amount

• Includes LifeKeys® services, which provide access to

Minimum coverage amount

counseling, financial, and legal

Dependent Children

support services

6 months to age 26 guaranteed coverage amount Age 1 day to 6 months guaranteed coverage amount

services, which give you and

$50,000 Choice of $10,000 or $20,000 100% of the employee coverage amount ($500,000 maximum in increments of $10,000) $10,000

Maximum coverage amount

• Also includes TravelConnect®

Choice of $10,000 or $20,000 5 times your annual salary ($500,000 maximum in increments of $10,000) $10,000

Maximum coverage amount

• Provides a cash benefit to your

$200,000

$10,000 $1,000

your family access to emergency medical assistance when you’re on a trip 100+ miles from home

The Lincoln National Life Insurance Company 1

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. x Annual Limited Enrollment: If you are a continuing employee, 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. x If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense.

x 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 x 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. x 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 you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability. x If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense.

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

Maximum Life Insurance Coverage Amount x

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

Voluntary Life Insurance Benefits At-A-Glance LFE-ENRO-BRC001-TX

2

Additional Plan Benefits Accelerated Death Benefit

Included

Premium Waiver

Included

Conversion

Included

Portability

Included

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 be covered.

ComPsych® and On Call International are not Lincoln Financial Group companies and Lincoln Financial Group does not administer these 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.

©2019 Lincoln National Corporation LCN-2016746-020518 R 1.0 – Group ID: 1056395

Voluntary Life Insurance Benefits At-A-Glance LFE-ENRO-BRC001-TX

3

Monthly Voluntary Life Insurance Premium Here’s how little you pay with group rates.

Employee |Monthly Premiums for Select Life Insurance Coverage Amounts Employee Age Range 0-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 Employee Age Range 70 -74 Employee Age Range 75 -79 Employee Age Range 80 -99

$10,000

$50,000

$100,000

$150,000

$200,000

$500,000

$0.50 $0.50 $0.70 $0.80 $1.00

$2.50 $2.50 $3.50 $4.00 $5.00

$5.00 $5.00 $7.00 $8.00 $10.00

$7.50 $7.50 $10.50 $12.00 $15.00

$10.00 $10.00 $14.00 $16.00 $20.00

$25.00 $25.00 $35.00 $40.00 $50.00

$1.40 $2.40 $3.90 $5.90 $8.26

$7.00 $12.00 $19.50 $29.50 $41.30

$14.00 $24.00 $39.00 $59.00 $82.60

$21.00 $36.00 $58.50 $88.50 $123.90

$28.00 $48.00 $78.00 $118.00 $165.20

$70.00 $120.00 $195.00 $295.00 $413.00

$5,000

$25,000

$50,000

$75,000

$100,000

$250,000

$5.15

$25.75

$51.50

$77.25

$103.00

$257.50

$5,000

$25,000

$50,000

$75,000

$100,000

$250,000

$7.35

$36.75

$73.50

$110.25

$147.00

$367.50

$5,000

$25,000

$50,000

$75,000

$100,000

$250,000

$7.35

$36.75

$73.50

$110.25

$147.00

$367.50

Spouse | Monthly Premiums for Select Life Insurance Coverage Amounts Employee Age Range 0-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69

$10,000

$20,000

$50,000

$100,000

$150,000

$250,000

$0.50 $0.50 $0.70 $0.80 $1.00 $1.40 $2.40 $3.90 $5.90 $8.26

$1.00 $1.00 $1.40 $1.60 $2.00 $2.80 $4.80 $7.80 $11.80 $16.52

$2.50 $2.50 $3.50 $4.00 $5.00 $7.00 $12.00 $19.50 $29.50 $41.30

$5.00 $5.00 $7.00 $8.00 $10.00 $14.00 $24.00 $39.00 $59.00 $82.60

$7.50 $7.50 $10.50 $12.00 $15.00 $21.00 $36.00 $58.50 $88.50 $123.90

$12.50 $12.50 $17.50 $20.00 $25.00 $35.00 $60.00 $97.50 $147.50 $206.50

Dependent Children Monthly Premium for Life Insurance Coverage The Lincoln National Life Insurance Company

Please see prior page for product information.

Voluntary Life Insurance At-A-Glance LFE-ENRO-BRC001-TX

4

Coverage Amount $10,000

Monthly Premium $1.80

Group Rates for Your Dependent Children One affordable monthly premium covers all of your eligible dependent children.

Note: You must be an active La Grange ISD employee to select coverage for a spouse and/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.

The Lincoln National Life Insurance Company

Please see prior page for product information.

Voluntary Life Insurance At-A-Glance LFE-ENRO-BRC001-TX

5

Full-Time Employees of La Grange ISD Benefits At-A-Glance Employee Only

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 ISD employees • Includes LifeKeys® services, which provide access to

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

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

Minimum coverage amount

$10,000

Your employee AD&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 is based on family structure—who makes up your immediate family—when a loss occurs.

Spouse coverage percentage

50% of the employee coverage amount when the family is made up of only the spouse and the employee.

Child(ren) coverage percentage

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

counseling, financial, and legal support • Also includes TravelConnectSM services, which give you and your family access to emergency medical assistance

Spouse & Child(ren) coverage percentage

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

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

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

The spouse AD&D coverage amount will reduce by 50% when you reach age 70.

Benefits end when you retire.

The Lincoln National Life Insurance Company

1

Benefit Exclusions

Additional Plan Benefits Safe Driver Benefit

Included

Education Benefit

Included

Spouse Training Benefit

Included

Felonious Assault

Included

Child Care Benefit

Included

Coma Benefit

Included

Common Disaster Benefit

Included

Exposure Benefit

Included

Disappearance Benefit

Included

Common Carrier Benefit

Included

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: x Intentionally inflicting or attempting to inflict injury to one’s self x Participating in a war, act of war, or riot x 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) x Flying on any non-commercial airplane or aircraft, such as a hot air balloon or glider (see the contract for details and exceptions) x Flying on a commercial airline or aircraft as a pilot or crewmember x Committing or attempting to commit a felony x Deliberately inhaling gas (such as carbon monoxide) or using drugs other than those taken as prescribed by a licensed physician x Driving while intoxicated, impaired, or under the influence of drugs

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

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 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 be covered.

ComPsych® and On Call International are not Lincoln Financial Group companies and Lincoln Financial Group does not administer these 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 Lincoln National Corporation - LCN-2016756-020518-07 – R1.0 – Group ID: 1056395

Voluntary AD&D Insurance At-A-Glance LFE-ADD-BRC001-TX

2

Voluntary Accidental Death & Dismemberment Insurance Here’s how little you pay with group rates.

Monthly Premium Calculation for You The estimated monthly premium 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 coverage amount

premium rate

Coverage Amount $10,000 $100,000

Monthly Premium $0.25 $2.50

$250,000 $500,000

$6.25 $12.50

Coverage Amount

Monthly Premium

$10,000 $100,000 $250,000 $500,000

$0.40 $4.00 $10.00 $20.00

= $_______________ monthly premium

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

Monthly Premium Calculation for You & Your Family The estimated monthly premium for AD&D insurance is determined by multiplying the desired amount of employee coverage (in increments of $10,000) by the family premium rate. See table at right for select premium amounts.

$____________ X 0.0000400 coverage amount

premium rate

= $_______________ monthly premium

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

The Lincoln National Life Insurance Company Please see prior page for product information.

Voluntary AD&D Insurance At-A-Glance LFE-ADD-BRC001-TX

3

life insurance highlights For the employee

purelife-plus

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: •

High Death Benefit. 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.

•

Refund of Premium. 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.)

•

Accelerated Death Benefit Due to Terminal Illness Rider. 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)

21M066-C R0222 2009 (exp0523)

Additional Features •

Minimal Cash Value. 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).

•

Long Guarantees. 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

3

QUICK QUESTIONS

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

DURING THE LAST SIX MONTHS, HAS THE PROPOSED INSURED: 1

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

2

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

3

Been disabled or received tests, treatment or care of any kind in a hospital or nursing home or received chemotherapy, hormonal therapy for cancer, radiation, dialysis treatment, or treatment for alcohol or drug abuse?

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 Guarantees are subject to product terms, limitations, exclusions, and the insurer’s claims paying ability and financial strength 3 Coverage not available on children in WA or on grandchildren in WA or MD. In MD, children must reside with the applicant to be eligible for coverage.

2

21M066-C R0222 2009 (exp0523)

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Acupuncture

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First aid (e.g., bandages, gauze)

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Critical Illness Insurance can pay money directly to you when you’re diagnosed with certain serious illnesses.

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?

• The money can help you pay out-of-pocket medical expenses, like co-pays and deductibles.

• You can use this coverage more than once.

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?

Critical illnesses • Heart attack • Stroke • Major organ failure • End-stage kidney failure

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

Supplemental 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’s more affordable when you buy it through your

employer and the premiums are conveniently deducted from your paycheck.

• Coverage is portable. You may take the coverage with

you if you leave the company or retire. You’ll be billed at home.

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 • Screenings for cholesterol and include sports physicals, welldiabetes child visits, dental and vision • Imaging studies, including exams chest X-ray, mammography • Screenings for cancer, including • Immunizations including HPV, pap smear, colonoscopy MMR, tetanus, influenza • Cardiovascular function screenings

Who can get coverage?

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.

EN-2050

FOR EMPLOYEES

(9-21)

Page 1

Critical Illness Insurance benefit and cost Monthly costs Age under 25 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+

Employee coverage: $10,000 Spouse coverage: $10,000 Be Well benefit: $50 Employee Spouse $3.86 $3.86 $4.76 $4.76 $5.96 $5.96 $7.96 $7.96 $10.46 $10.46 $13.56 $13.56 $16.96 $16.96 $22.66 $22.66 $31.46 $31.46 $45.26 $45.26 $70.36 $70.36 $103.76 $103.76 $151.36 $151.36 $243.76 $243.76

Monthly costs Age under 25 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+

Employee coverage: $20,000 Spouse coverage: $20,000 Be Well benefit: $50 Employee Spouse $5.86 $5.86 $7.66 $7.66 $10.06 $10.06 $14.06 $14.06 $19.06 $19.06 $25.26 $25.26 $32.06 $32.06 $43.46 $43.46 $61.06 $61.06 $88.66 $88.66 $138.86 $138.86 $205.66 $205.66 $300.86 $300.86 $485.66 $485.66

Monthly costs Age under 25 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+

EN-2050

Employee coverage: $30,000 Spouse coverage: $30,000 Be Well benefit: $50 Employee Spouse $7.86 $7.86 $10.56 $10.56 $14.16 $14.16 $20.16 $20.16 $27.66 $27.66 $36.96 $36.96 $47.16 $47.16 $64.26 $64.26 $90.66 $90.66 $132.06 $132.06 $207.36 $207.36 $307.56 $307.56 $450.36 $450.36 $727.56 $727.56

FOR EMPLOYEES

(9-21)

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 © 2021 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Page 2

14/MONTH

$

DID YOU KNOW?

25PEOPLE

MILLION

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

Insurance companies 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 higher 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 beneȴtsnetwork.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 ȴxed-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: ZZZ XVHEVJ FRP MASAEP_CB_FLR_14_032422

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The information provided in this product information sheet is for informational purposes only. The beneȴts 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 beneȴts vary depending on the beneȴts selected. Commercial air and Worldwide coverage are not available in all territories. For a complete list of beneȴts, 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, beneȴts will become available under the MASA membership for expenses incurred for medical care (as deȴned under Internal Revenue Code (“IRC”) section 213 (d)) once a member satisȴes 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 Beneȴt and Payment Parameters for 2022 and Pharmacy Beneȴt Manager Standards. May 5, 2021.

1250 S. Pine Island Rd., Suite 500, Plantation, FL 33324 MASAEP_CB_FLR_14_032422

800-643-9023 I www.masamts.com

Frequently Asked 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 physicians diagnose 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 problems that, if left untreated, could eventually result in hospitalization. 1-800MD provides 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. No waiting 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 video consultation.

What about the doctors?

1-800MD uses a third-party credentialing agency to ensure that only the best providers are servicing our clients. The credentialing 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. Will 1-800MD still accept me?

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

1800md.com

800.530.8666

Frequently Asked 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. You only have 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 is indicated 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.

1800md.com

800.530.8666

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1.800MD 0RELOH App Telemedicine in the Palm of your Hands The new 1.800MD app gives quick and convenient access to our vast network of board-certified 1.800.530.8666 physicians.

Access your GLJLWLDO healthcare EHQHILW by downloading the PRELOH app today!

www.1800MD.com

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Easily request medical consultations

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Schedule doctor consultations when it’s most convenient for you

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Select your preferred pharmacy for easy prescription pick-up

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Manage and confirm dependents

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View past virtual consultation history

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And much more!

HOW IT WORKS – click here to view the app demonstration video

Activate your Account Using the Member and Group numbers given by your employer.

Enter your Health Info Including your personal health information and pharmacy info.

1800md.com

Request Consultations With the tap of a button!

Schedule an appointment if needed.

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

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