Llano ISD Employee Benefits Guide

2022-2023 Employee Benefits Guide

LLANO Independent School District

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

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 ϭϴ ƚŽ ƵŐƵƐƚ ϭϴ >ůĂŶŽ /^ ŽĨĨĞƌƐ ĞůŝŐŝďůĞ ĞŵƉůŽLJĞĞƐ Ă ĐŽŵƉĞƚŝƚŝǀĞ ďĞŶĞĨŝƚƐ ƉĂĐŬĂŐĞ ƚŚĂƚ ŝŶĐůƵĚĞ ďŽƚŚ ĚŝƐƚƌŝĐƚ ƉĂŝĚ ĂŶĚ ǀŽůƵŶƚĂƌLJ ƉƌŽĚƵĐƚƐ͘ tĞ ŚĂǀĞ ǁŽƌŬĞĚ ĐůŽƐĞůLJ ǁŝƚŚ dW ;^ŚĞƌƌLJ ^ŬŝĚŵŽƌĞͿ 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​ͬǁǁǁ͘ŵLJďĞŶĞĨŝƚƐŚƵď͘ĐŽŵͬůůĂŶŽŝƐĚ /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

ŶƌŽůůŵĞŶƚ & YΖ^ ŽŶƚĂĐƚ /ŶĨŽƌŵĂƚŝŽŶ ŶƌŽůůŵĞŶƚ /ŶƐƚƌƵĐƚŝŽŶƐ DĞĚŝĐĂů ,^ ŵƉůŽLJĞƌ WĂŝĚ 'ƌŽƵƉ >ŝĨĞ /ŶƐƵƌĂŶĐĞ sŽůƵŶƚĂƌLJ 'ƌŽƵƉ >ŝĨĞ /ŶƐƵƌĂŶĐĞ ,ŽƐƉŝƚĂů /ŶĚĞŵŶŝƚLJ WůĂŶ ĞŶƚĂů sŝƐŝŽŶ ŝƐĂďŝůŝƚLJ ĐĐŝĚĞŶƚ D ^ ĂŶĐĞƌ ƌŝƚŝĐĂů /ůůŶĞƐƐ dĞůĞŚĞĂůƚŚ >ĞŐĂů ^ĞƌǀŝĐĞƐ dĞdžĂƐ >ŝĨĞ &^ ĂŶĚ ĞƉĞŶĚĞŶƚ ĂƌĞ

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 ǁǁǁ͘ŵLJďĞŶĞĮƚƐŚƵď͘ĐŽŵͬůůĂŶŽŝƐĚ 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 >ůĂŶŽ /^ 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 ϮϬ ŚŽƵƌƐ ƉĞƌ ǁĞĞŬ ŝŶ Ă ƉĞƌŵĂŶĞŶƚ ƉŽƐŝƟŽŶ͘ • ůů ŽƚŚĞƌ ĞŵƉůŽLJĞĞƐ͕ ƚŽ ŝŶĐůƵĚĞ ƐƵďƐƟƚƵƚĞƐ͕ ǁŚŽ ǁŽƌŬ ůĞƐƐ ƚŚĂŶ ϮϬ 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

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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KEd d /E&KZD^d/KE Vendor

Phone Number

Website

USEBSG – Sherry Skidmore

512-461-6794

sskidmore@usebsg.com

Medical – TRS

866-355-5999

www.bcbstx.com/trsactivecare

Health Savings Account – ECCU

817-882-0800

www.eecu.org

Group Life – Unum

866-679-3054

www.unum.com

Hospital Indemnity – Hartford

800-523-2233

www.thehartford.com

Dental - Humana

800-448-6262

www.humana.com

Vision – Eyetopia

830-964-6444

www.eyetopia.com

Disability – Unum

866-679-3054

www.unum.com

Accident – APL

800-256-8606

www.ampublic.com

Medical Transportation – MASA

800-423-3226

www.masamts.com

Cancer – APL

800-256-8606

www.ampublic.com

Critical Illness – Cigna

800-244-6224

www.cigna.com

Telehealth – 1-800 MD

800-530-8666

www.1800md.com

Legal Services – Legal Shield

800-654-7757

www.legalshield.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 ǁǁǁ͘ŵLJďĞŶĞĨŝƚƐŚƵď͘ĐŽŵͬůůĂŶŽŝƐĚ͘

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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• 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

Premium: $1117.00 District Pays: $364.00 Employee Cost: $753.00

Premium: $735.00 District Pays: $364.00 Employee Cost: $371.00

Premium: $1058.00 District Pays: $364.00 Employee Cost: $694.00

Premium: $675.00 District Pays: $364.00 Employee Cost: $311.00

Premium: $1265.00 District Pays: $364.00 Employee Cost: $901.00

Premium: $1026 District Pays: $364.00 Employee Cost: $662.00

Premium: $654.00 District Pays: $364.00 Employee Cost: $290.00

Premium: $1228.00 District Pays: $364.00 Employee Cost: $864.00

Employee/Spouse

Employee/Child(ren)

Emloyee/Family

Premium: $1405.00 District Pays: $364.00 Employee Cost: $1041.00

Premium: $457.00 District Pays: $364.00 Employee Cost: $93.00

Premium: $376.00 District Pays: $364.00 Employee Cost: $12.00

Premium: $364.00 District Pays: $364.00 Employee Cost: $0.00

Employee Only

BCBS ActiveCare Primary+

BCBS ActiveCare HD

BCBS ActiveCare Primary

Catergory

Premium: $2841.00 District Pays: $364.00 Employee Cost: $2477.00

Premium: $1507.00 District Pays: $364.00 Employee Cost: $1143.00

Premium: $2402.00 District Pays: $364.00 Employee Cost: $2038.00

Premium: $1013.00 District Pays: $364.00 Employee Cost: $649.00

BCBS Active Care 2 (current enrollees only)

2022 - 2023 TRS Medical Rates Blue Essential West HMO

Premium: $1755.58 District Pays: $364.00 Employee Cost: $1391.58

Premium: $1083.58 District Pays: $364.00 Employee Cost: $719.58

Premium: $1672.26 District Pays: $364.00 Employee Cost: $1308.26

Premium: $689.60 District Pays: $364.00 Employee Cost: $325.60

Llano Independent School District

Premium: $1418.42 District Pays: $364.00 Employee Cost: $1054.42

Premium: $789.39 District Pays: $364.00 Employee Cost: $425.39

Premium: $1232.58 District Pays: $364.00 Employee Cost: $868.58

Premium: $491.55 District Pays: $364.00 Employee Cost: $127.55

Central and North Texas Baylor Scott & White HMO (Burnet County)

Health Savings Account – Fact Sheet

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

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

Benefits • Save money tax-free for healthcare expenses – contributions are not subject to federal income taxes and can be made by you, your employer or a third party1 • No monthly service fee – so you can save more • Competitive Dividends paid on your entire HSA balance, so you can earn more • Free EECU HSA Debit Mastercard® to conveniently pay for your qualified healthcare expenses. (HSA checks are also available upon request.2) • Free Online & Mobile Banking and Free Bill Pay & Mobile Deposit to manage your account from anywhere, at anytime • Comprehensive service and support – to assist you in optimizing your healthcare saving and spending • Federally insured by NCUA – to at least $250,000

Dividend Rates 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 2020

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.

Full Time Employees who regularly work 10 hours per week & Bus Drivers are eligible for insurance on their date of hire.

Llano Independent School District

Term Life with Accidental Death & Dismemberment (AD&D) Insurance How does it work?

Who can get Term Life coverage?

You keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more.

If If you you are are actively actively at at work work at at least least 10 10 hours hours per per week, week, you you can can receive coverage for: receive coverage for:

AD&D Insurance is also available, which can pay a benefit if you survive an accident but have certain serious injuries.

It can pay an additional amount if you die from a covered accident.

Why Choose Unum?

Your employer is offering you this coverage at no cost to you.

What else is included?

You: You:

You You can can receive receive a a benefit benefit amount amount of of $30,000. $30,000.

You You can can get get up up to to $30,000 $30,000 with with no no medical medical underwriting. underwriting.

Who can get Accidental Death & Dismemberment (AD&D) coverage?

You:

You can receive an AD&D benefit amount of $30,000.

No medical underwriting is required for AD&D coverage.

A “Living” Benefit If you are diagnosed with a terminal illness with less than 12 months to live, you can request 100% of your life insurance benefit (up to $250,000) while you are still living. This amount will be taken out of the death benefit and may be taxable.

Waiver of premium Your cost may be waived if you are totally disabled for a period of time.

Portability You may be able to keep coverage if you leave the company, retire or change the number of hours you work.

Employees or dependents who have a sickness or injury having a material effect on life expectancy at the time their group coverage ends are not eligible for portability.

Work-life balance Employee Assistance Program Get access to professional help for a range of personal and work-related issues, including counselor referrals, financial planning and legal support.

Worldwide emergency travel assistance One phone call gets you and your family immediate help anywhere in the world, as long as you’re traveling 100 or more miles from home. However, a spouse traveling on business for his or her employer is not covered.

EN-2046

FOR EMPLOYEES

(6-22)

Unum | Term Life Insurance

Actively at work Eligible employees must be actively at work to apply for coverage. Being actively at work means on the day the employee applies for coverage, the individual must be working at one of his/her company’s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the employee will be considered actively at work as of his/her last scheduled workday. Employees are not considered actively at work if they are on a leave of absence or lay off.

Employees must be U.S. citizens or legally authorized to work in the U.S. to receive coverage.

Employees must be actively employed in the United States with the Employer to receive coverage. Employees must be insured under the plan for spouses and dependents to be eligible for coverage.

Exclusions and limitations Life insurance benefits will not be paid for deaths that are caused by suicide occurring within 24 months after the effective date of coverage or the date that increases to existing coverage becomes effective. This exclusion standardly applies to all medically written amounts and contributory amounts that are funded by the employee including shared funding plans.

AD&D specific exclusions and limitations: Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from: ȏɄDisease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) ȏɄ6XLFLGH VHOI GHVWUXFWLRQ ZKLOH VDQH LQWHQWLRQDOO\ VHOI LQȵLFWHG LQMXU\ ZKLOH VDQH RU VHOI LQȵLFWHG LQMXU\ while insane ȏɄWar, declared or undeclared, or any act of war ȏɄActive participation in a riot ȏɄCommitting or attempting to commit a crime under state or federal law ȏɄThe voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your doctor. This exclusion does not apply to you if the chemical substance is ethanol. ȏɄIntoxication – “Being intoxicated” means your blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.

Delayed effective date of coverage (PSOR\HH bΖQVXUDQFH FRYHUDJH ZLOO EH GHOD\HG LI \RX DUH QRW LQ DFWLYH HPSOR\PHQW EHFDXVH RI DQ LQMXU\ sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

Age reduction Coverage amounts for Life and AD&D Insurance for you will reduce to 50% of the original amount when you reach age 70. Coverage may not be increased after a reduction.

Termination of coverage Your coverage under the policy ends on the earliest of: ȏɄThe date the policy or plan is cancelled ȏɄThe date you no longer are in an eligible group ȏɄThe date your eligible group is no longer covered ȏɄThe last day of the period for which you made any required contributions ȏɄThe last day you are actively employed (unless coverage is continued due to a covered layoff, leave of absence, injury or sickness), as described in the certificate of coverage Work-life balance Employee Assistance Program The Work-life balance Employee Assistance Program, provided by HealthAdvocate, is available with select unum insurance offerings, Terms and availability of service are subjet to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.

Worldwide emergency travel assistance Worldwide emergency travel assistance services, provided by Assist America, Inc., are available with select Unum insurance offerings. Terms and availability of service are subject to chance and prior notification requirements. Services are not valid after coverage terminates. Please contact your Unum representative for details.

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 limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative.

Life Planning Financial & Legal Resources services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.

Underwritten by: Unum Life Insurance Company of America, Portland, Maine © 2022 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

EN-2046

FOR EMPLOYEES

(6-22)

Unum | Term Life Insurance

Full Time Employees who regularly work 10 hours per week & Bus Drivers are eligible for insurance on their date of hire.

Llano Independent School District

Term Life and Accidental Death & Dismemberment (AD&D) Insurance How does it work?

Who can get Term Life coverage?

You choose the amount of coverage that’s right for you, and you keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more.

If you are actively at work at least 10 hours per week, you may apply for coverage for: You:

Choose in in $10,000 Choosefrom from$10,000 $10,000toto$500,000 $500,000 $10,000 increments, earnings. increments,up uptoto55times timesyour your earnings.

You can get up to $150,000. This is the amount You can getyou up to the of coverage can$150,000. qualify forThis withisno medical amount of coverage you can qualify for with underwriting.

Your spouse: Your spouse:

Get up to $250,000 of coverage in $5,000 increments.

Spouse coverage cannot exceed Get up to $250,000 of coverage in $5,000 100% of the coverage amount you purchase for increments. Spouse coverage cannot exceed yourself.

100%spouse of the can coverage you purchase Your get upamount to $50,000 with no medical underwriting, if eligible (see delayed for yourself. effective date).

AD&D Insurance is also available, which pays a benefit if you survive an accident but have certain serious injuries. It pays an additional amount if you die from a covered accident.

Why is this coverage so valuable?

If you buy a minimum of $10,000 of coverage now, you can increase your coverage in the future up to $150,000 to meet your growing needs. There would be no medical underwriting to qualify for coverage.

What else is included?

A ‘Living’ Benefit — If you are diagnosed with a terminal illness with less than 12 months to live, you can request 100% of your life insurance benefit (up to $250,000) while you are still living. This amount will be taken out of the death benefit, and may be taxable. These benefit payments may adversely affect the recipient’s eligibility for Medicaid or other government benefits or entitlements, and may be taxable.

Recipients should consult their tax attorney or advisor before utilizing living benefit payments.

Waiver of premium — Your cost may be waived if you are totally disabled for a period of time.

Portability — You may be able to keep coverage if you leave the company, retire or change the number of hours you work.

Employees or dependents who have a sickness or injury having a material effect on life expectancy at the time their group coverage ends are not eligible for portability.

Your children: Your children:

no medical underwriting.

Your spouse can get up to $50,000 with no medical if eligible (see delayed Get up tounderwriting, $10,000 of coverage in $2,000 increments if eligible (see delayed effective date). effective date).

One policy covers all of your children until their 26th birthday.

Get up to $10,000 of coverage in $2,000 The maximum benefit (see for children birth to 6 increments if eligible delayedlive effective months is $1,000.

date). One policy covers all of your children until their 26th birthday.

Who can getThe Accidental Dismemberment maximumDeath benefit&for children live birth to (AD&D) coverage?

6 months is $1,000.

You:

Get up to $500,000 of AD&D coverage for yourself in $10,000 increments to a maximum of 5 times your earnings.

Your spouse:

Get up to $250,000 of AD&D coverage for your spouse in $5,000 increments, if eligible (see delayed effective date).

Your children:

Get up to $10,000 of coverage for your children in $2,000 increments if eligible (see delayed effective date).

No medical underwriting is required for AD&D coverage.

EN-1976

FOR EMPLOYEES

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Unum | Term Life Insurance

Exclusions and limitations Actively at work Eligible employees must be actively at work to apply for coverage. Being actively at work means on the day the employee applies for coverage, the individual must be working at one of his/her company’s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the employee will be considered actively at work as of his/her last scheduled workday. Employees are not considered actively at work if they are on a leave of absence or lay off.

An unmarried handicapped dependent child who becomes handicapped prior to the child’s attainment age of 26 may be eligible for benefits. Please see your plan administrator for details on eligibility.

Employees must be U.S. citizens or legally authorized to work in the U.S. to receive coverage. Employees must be actively employed in the United States with the Employer to receive coverage. Employees must be insured under the plan for spouses and dependents to be eligible for coverage.

Exclusions and limitations Life insurance benefits will not be paid for deaths caused by suicide occurring within 24 months after the effective date of coverage. The same applies for increased or additional benefits.

AD&D specific exclusions and limitations: Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from: ȏɄDisease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) ȏɄSuicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane ȏɄWar, declared or undeclared, or any act of war ȏɄActive participation in a riot ȏɄCommitting or attempting to commit a crime under state or federal law ȏɄThe voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol. ȏɄIntoxication – ‘Being intoxicated’ means your or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.

Delayed effective date of coverage Insurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

Delayed Effective Date: if your spouse or child has a serious injury, sickness, or disorder, or is confined, their coverage may not take effect. Payment of premium does not guarantee coverage. Please refer to your policy contract or see your plan administrator for an explanation of the delayed effective date provision that applies to your plan.

Age Reduction Coverage amounts for Life and AD&D Insurance for you and your dependents will reduce to 50% of the original amount when you reach age 70. Coverage may not be increased after a reduction.

Termination of coverage Your coverage and your dependents’ coverage under the policy ends on the earliest of: ȏɄThe date the policy or plan is cancelled ȏɄThe date you no longer are in an eligible group ȏɄThe date your eligible group is no longer covered ȏɄThe last day of the period for which you made any required contributions ȏɄThe last day you are actively employed (unless coverage is continued due to a covered layoff, leave of absence, injury or sickness), as described in the certificate of coverage In addition, coverage for any one dependent will end on the earliest of: ȏɄThe date your coverage under a plan ends ȏɄThe date your dependent ceases to be an eligible dependent ȏɄFor a spouse, the date of a divorce or annulment ȏɄFor dependents, the date of your death Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.

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 limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative.

Life Planning Financial & Legal Resources services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.

Unum complies with state civil union and domestic partner laws when applicable.

Underwritten by: Unum Life Insurance Company of America, Portland, Maine © 2022 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

EN-1976

FOR EMPLOYEES

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Unum | Term Life Insurance

UNUM CORPORATION LIFESTYLE LIFE/AD&D RATES Llano Independent School District Monthly Cost EMPLOYEE

LIFE Age Band 0-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$100,000

$130,000

$150,000

$0.60 $0.70 $0.90 $1.10 $1.60 $2.60 $4.20 $6.80 $8.50 $14.70 $14.70 $14.70

$1.20 $1.40 $1.80 $2.20 $3.20 $5.20 $8.40 $13.60 $17.00 $29.40 $29.40 $29.40

$1.80 $2.10 $2.70 $3.30 $4.80 $7.80 $12.60 $20.40 $25.50 $44.10 $44.10 $44.10

$2.40 $2.80 $3.60 $4.40 $6.40 $10.40 $16.80 $27.20 $34.00 $58.80 $58.80 $58.80

$3.00 $3.50 $4.50 $5.50 $8.00 $13.00 $21.00 $34.00 $42.50 $73.50 $73.50 $73.50

$3.60 $4.20 $5.40 $6.60 $9.60 $15.60 $25.20 $40.80 $51.00 $88.20 $88.20 $88.20

$6.00 $7.00 $9.00 $11.00 $16.00 $26.00 $42.00 $68.00 $85.00 $147.00 $147.00 $147.00

$7.80 $9.10 $11.70 $14.30 $20.80 $33.80 $54.60 $88.40 $110.50 $191.10 $191.10 $191.10

$9.00 $10.50 $13.50 $16.50 $24.00 $39.00 $63.00 $102.00 $127.50 $220.50 $220.50 $220.50

$0.20

$0.40

$0.60

$0.80

$1.00

$1.20

$2.00

$2.60

$3.00

AD&D

$150,000

IS THE MAXIMUM THAT MAY BE ISSUED WITHOUT ANSWERING HEALTH QUESTIONS

NOTE: FINAL RATES MAY VARY SLIGHTLY DUE TO ROUNDING. THESE GRIDS ARE PRICES OF FREQUENTLY SELECTED AMOUNTS. YOU MAY CHOOSE ANY INCREMENT OF $10,000 UP TO $500,000.(NOT TO EXCEED 5 TIMES YOUR ANNUAL SALARY) TO PURCHASE AN AMOUNT OTHER THAN THOSE LEVELS INDICATED ABOVE, SIMPLY COMPLETE THE FOLLOWING.

__________________ # of 10,000 units

X

* AGE = Age on Plan Anniversary

__________________________ Your age cost per 10,000 unit

=

_____________ Monthly Cost

UNUM CORPORATION LIFESTYLE LIFE/AD&D RATES Llano Independent School District Monthly Cost SPOUSE LIFE Age Band

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$50,000

$55,000

$60,000

0-24

$0.30

$0.60

$0.90

$1.20

$1.50

$1.80

$3.00

$3.30

$3.60

25-29

$0.35

$0.70

$1.05

$1.40

$1.75

$2.10

$3.50

$3.85

$4.20

30-34

$0.45

$0.90

$1.35

$1.80

$2.25

$2.70

$4.50

$4.95

$5.40

35-39

$0.55

$1.10

$1.65

$2.20

$2.75

$3.30

$5.50

$6.05

$6.60

40-44

$0.80

$1.60

$2.40

$3.20

$4.00

$4.80

$8.00

$8.80

$9.60

45-49

$1.30

$2.60

$3.90

$5.20

$6.50

$7.80

$13.00

$14.30

$15.60

50-54

$2.10

$4.20

$6.30

$8.40

$10.50

$12.60

$21.00

$23.10

$25.20

55-59

$3.40

$6.80

$10.20

$13.60

$17.00

$20.40

$34.00

$37.40

$40.80

60-64

$4.25

$8.50

$12.75

$17.00

$21.25

$25.50

$42.50

$46.75

$51.00

65-69

$7.35

$14.70

$22.05

$29.40

$36.75

$44.10

$73.50

$80.85

$88.20

70-74

$7.35

$14.70

$22.05

$29.40

$36.75

$44.10

$73.50

$80.85

$88.20

75+

$7.35

$14.70

$22.05

$29.40

$36.75

$44.10

$73.50

$80.85

$88.20

AD&D

$0.10

$0.20

$0.30

$0.40

$0.50

$0.60

$1.00

$1.10

$1.20

SPOUSE AMOUNT CANNOT EXCEED 100% OF EMPLOYEES AMOUNT and

$50,000

is the most that can be issued without answering health questions

CHILD(REN) $2,000

$4,000

$6,000

$8,000

$10,000

LIFE

$0.20

$0.40

$0.60

$0.80

$1.00

AD&D

$0.08

$0.16

$0.24

$0.32

$0.40

NOTE: FINAL RATES MAY VARY DUE TO ROUNDING. THESE GRIDS ARE PRICES OF FREQUENTLY SELECTED AMOUNTS. YOU MAY CHOOSE ANY INCREMENT OF $5,000 UP TO $500,000. TO PURCHASE AN AMOUNT OTHER THAN LEVELS INDICATED ABOVE, SIMPLY COMPLETE THE FOLLOWING.

___________________ # OF 5,000 UNITS

X

_______________________________

__________________

YOUR AGE COST PER 5,000 UNIT

Monthly Cost

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The average cost for a hospital stay is $2,607 per day1

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Humana Dental Traditional Plus

TEXAS

Llano ISD If you use an IN-NETWORK dentist

Calendar-year deductible (excludes orthodontia services)

If you use an OUT-OF-NETWORK dentist

Individual

Family

Individual

Family

$50

$150

$50

$150

Deductible applies to all services excluding preventive services.

Calendar-year annual maximum (excludes orthodontia services)

$1,000 + extended annual maximum (see section below)

Preventive services • Routine oral examinations (3 per year) • Bitewing x-rays (2 films under age 10, up to 4 films ages 10 and older) • Routine cleanings (3 per year) • Periodontal cleanings (4 per year) • Fluoride treatment (1 per year, through age 16) • Sealants (permanent molars, through age 16) • Space maintainers (primary teeth, through age 15) • Oral Cancer Screening (1 per year, ages 40 and older)

100% no deductible

100% no deductible

80% after deductible

80% after deductible

Basic services • Emergency care for pain relief • Amalgam fillings (1 per tooth every 2 years, composite for anterior/front teeth) • Composite fillings (1 per tooth every 2 years, molar teeth) • Oral surgery (tooth extractions including impacted teeth) • Stainless steel crowns • Harmful habit appliances for children (1 per lifetime, through age 14)

x

Major services • Crowns (1 per tooth every 5 years) • Inlays/onlays (1 per tooth every 5 years) • Bridges (1 per tooth every 5 years) • Dentures (1 per tooth ever 5 years) • Denture relines/rebases (1 every 3 years, following 6 months of denture use) • Denture repair and adjustments (following 6 months of denture use) • Implants (crowns, bridges, and dentures each limited to 1 per tooth every five years) • Periodontics (scaling/root planing and surgery 1 per quadrant every 3 years) • Endodontics (root canals 1 per tooth per lifetime and 1 re-treatment)

50% after deductible

x

50% after deductible

xs[pspace

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Humana Dental Traditional Plus

TEXAS

If you use an IN-NETWORK dentist

If you use an OUT-OF-NETWORK dentist

Extended Annual Max Additional coverage for preventive, basic, and major services after the calendar-year maximum is met (excludes orthodontia)

30%

30%

Orthodontia services

Child orthodontia - Covers children through age 18. Plan pays 50 percent (no deductible) of the covered orthodontia services, up to: $1,000 lifetime orthodontia maximum.

Non-participating dentists can bill you for charges above the amount covered by your Humana Dental plan. To ensure you do not receive additional charges, visit a participating PPO Network dentist. Members and their families benefit from negotiated discounts on covered services by choosing dentists in our network. If a member visits a participating network dentist, the member will not receive a bill for charges more than the negotiated fee for covered services. If a member sees an out-of-network dentist, coinsurance will apply to the usual and customary charge. Out-of-network dentists may bill you for charges above the amount covered by your dental plan.

Waiting periods Employer-sponsored funding: 5+ enrolled employees Enrollment type

Preventive

Basic

Major

Orthodontia

Initial enrollment, open enrollment and timely add-on

No

No

No

No

Late applicant 1, 2

No

12 months

12 months

12 months (24 months for 5-9 enrolled employees)

1 Late applicants not allowed with open enrollment option.

2 Waiting periods do not apply to endodontic or periodontic services unless a late applicant.

Monthly rates* (12 deductions per year) Employee:

$31.70

Employee + spouse:

$66.18

Employee + child(ren):

$72.54

Family:

$106.90

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

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Humana Dental Traditional Plus

TEXAS

Feel good about choosing a Humana Dental plan

Use your Humana Dental benefits

Make regular dental visits a priority

Find a dentist

Regular cleanings can help manage problems throughout the body such as heart disease, diabetes, and stroke.* Your Humana Dental Traditional Preferred plan focuses on prevention and early diagnosis, providing three routine cleanings, or four periodontal cleanings, along with three routine periodic exams per calendar year. * www.perio.org

With Humana Dental's Traditional Preferred plan, you can see any dentist. Members and their families benefit from negotiated discounts on covered services by choosing dentists in the Humana Dental Traditional Preferred Network. To find a dentist in Humana Dental's Traditional Preferred Network, log on to Humana.com or call 1-800-233-4013.

Go to MyDentalIQ.com

Know what your plan covers

Take a health risk assessment that immediately rates your dental health knowledge. You'll receive a personalized action plan with health tips. You can print a copy of your scorecard to discuss with your dentist at your next visit.

The other side of this page gives you a summary of Humana Dental benefits. Your plan certificate describes your Humana Dental benefits, including limitations and exclusions. You can find it on MyHumana, your personal page at Humana.com or call 1-800-233-4013.

x

Tips to ensure a healthy mouth:

See your dentist

• Use a soft-bristled toothbrush • Choose toothpaste with fluoride • Brush for at least two minutes twice a day • Floss daily • Watch for signs of periodontal disease such as red, swollen, or tender gums • Visit a dentist regularly for exams and cleanings

Your Humana Dental identification card contains all the information your dentist needs to submit your claims.

Be sure to share it with the office staff when you arrive for your appointment. If you don't have your card, you can print proof of coverage at Humana.com.

Did you know that 74 percent of adult Americans believe an unattractive smile could hurt a person's chances for career success?* Humana Dental helps you feel good about your dental health so you can smile confidently. * American Academy of Cosmetic Dentistry

Learn what your plan paid After Humana Dental processes your dental claim, you will receive an explanation of benefits or claims receipt. It provides detailed information on covered dental services, amounts paid, plus any amount you may owe your dentist. You can also check the status of your claim on MyHumana at Humana.com or by calling 1-800-233-4013.

Humana group dental plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, Humana Health Benefit Plan of Louisiana, The Dental Concern, Inc., Humana Medical Plan of Utah, CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc. or DentiCare, Inc. (d/b/a CompBenefits). In Arizona, group dental plans insured by Humana Insurance Company. In New Mexico, group dental plans insured by Humana Insurance Company.

This is not a complete disclosure of plan qualifications and limitations. Your agents will provide you with specific limitations and exclusions as contained in the Regulatory and Technical Information Guide. Please review this information before applying for coverage. The amount of benefits provided depends upon the plan selected.

Premiums will vary according to the selection made.

Policy Number: TX-70090-HC 1/14 Plan summary created on: 5/10/22 10:23

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Educator Select Income Protection Plan Insurance Highlights

Llano Independent School District Policy # 882484 Please read carefully the following description of your Unum Educator Select Income Protection Plan insurance.

Your Plan Eligibility

You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. The date you are eligible for coverage is the later of: the plan effective date; or the day after you complete the waiting period.

Guarantee Issue

Current Employees: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may enroll on or before the enrollment deadline. After the initial enrollment period, you can apply only during an annual enrollment period.

New Hires: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may apply for coverage within 60 days after your eligibility date. If you do not apply within 60 days after your eligibility date, you can apply only during an annual enrollment period.

Benefits are subject to the pre-existing condition exclusion referenced later in this document.

Please see your Plan Administrator for your eligibility date.

Benefit Amount

You may purchase a monthly benefit in $100 units, starting at a minimum of $200, up to 66 2/3% of your monthly earnings rounded to the nearest $100, but not to exceed a monthly maximum benefit of $8,000. Please see your Plan Administrator for the definition of monthly earnings.

The total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 100% of your monthly earnings unless the excess amount is payable as a Cost of Living Adjustment.

However, if you are participating in Unum’s Rehabilitation and Return to Work Assistance program, the total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 110% of your monthly earnings (unless the excess amount is payable as a Cost of Living Adjustment).

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Elimination Period

The Elimination Period is the length of time of continuous disability, due to sickness or injury, which must be satisfied before you are eligible to receive benefits.

You may choose an Elimination Period (injury/sickness) of 0/7, 7/7, 14/14, 30/30, 60/60 or 180/180 days.

If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 14 days or less.)

Benefit Duration

Your duration of benefits is based on your age when the disability occurs.

Plan: SS ADEA: Your duration of benefits is based on the following table: Age at Disability Less than Age 62 Age 62 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 or older

Maximum Duration of Benefits To Social Security Normal Retirement Age 60 months 48 months 42 months 36 months 30 months 24 months 18 months 12 months

Year of Birth 1937 or before 1938 1939 1940 1941 1942 1943-1954 1955 1956 1957 1958 1959 1960 and after

Social Security Normal Retirement Age 65 years 65 years 2 months 65 years 4 months 65 years 6 months 65 years 8 months 65 years 10 months 66 years 66 years 2 months 66 years 4 months 66 years 6 months 66 years 8 months 66 years 10 months 67 years

OR For disabilities due to a pre-existing condition, Unum will send you a payment each week up to the maximum period of payment. Your maximum period of payment is 4 weeks during the continuous period of disability.

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Federal Income Taxation

You may wonder if your disability benefit amount will be taxed. It depends on how your premium — the price of your coverage — is paid.

If your premium is paid with: x x x

Pre-Tax Dollars,* your benefit amount will be taxed Post-Tax Dollars,** your benefit amount will not be taxed Both Pre-Tax and Post-Tax Dollars, a portion of your benefit amount will be taxed

The disability benefit amounts you receive will be reported annually on a W-2. It will show any taxable and non-taxable portions separately. *Pre-Tax Dollars are dollars paid by your employer toward premium that are not reported as earnings on your annual W-2. They are also dollars you pay toward premium through a cafeteria plan. **Post-Tax Dollars are dollars paid through payroll deductions after taxes and withholdings have been subtracted from your earnings. They are also dollars paid by your employer toward premium that are reported as earnings on your annual W-2 and taxed accordingly.

Additional Benefits Work/Life Balance Employee Assistance Program1

Work-life balance is a comprehensive resource providing access to professional assistance for a wide range of personal and work-related issues. The service is available to you and your family members twentyfour hours a day, 365 days a year, and provides resources to help employees find solutions to everyday issues such as financing a car or selecting child care, as well as more serious problems such as alcohol or drug addiction, divorce, or relationship problems.

Services include: toll-free phone access to master’s-level consultants, up to three face-to-face sessions to help with more serious issues; and online resources. There is no additional charge for utilizing the program.

Participation is confidential and strictly voluntary, and employees do not have to have filed a disability claim or be receiving benefits to use the program.

However, if you become disabled and are receiving benefits, Unum's On Claim Support can provide additional resources including: coaching on how to communicate effectively with medical personnel, conducting consumer research for medical equipment and supplies, assessing emotional needs and locating counseling resources.

Return to Work/ Work Incentive Benefit

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Unum supports efforts that enable a disabled employee to remain on the job or return to work as soon as possible. If you are disabled but working part time with monthly disability earnings of 20% or more of your indexed monthly earnings, during the first 12 months, the monthly benefit will not be reduced by any earnings until the gross disability payment plus your disability earnings, exceeds 100% of your indexed monthly earnings. The monthly benefit will then be reduced by that amount.

Rehabilitation and Return to Work Assistance

Unum has a vocational Rehabilitation and Return to Work Assistance program available to assist you in returning to work. We will make the final determination of your eligibility for participation in the program, and will provide you with a written Rehabilitation and Return to Work Assistance plan developed specifically for you. This program may include, but is not limited to the following benefits: x coordination with your Employer to assist your return to work; x adaptive equipment or job accommodations to allow you to work; x vocational evaluation to determine how your disability may impact your employment options; x job placement services; x resume preparation; x job seeking skills training; or x education and retraining expenses for a new occupation.

If you are participating in a Rehabilitation and Return to Work Assistance program, we will also pay an additional disability benefit of 10% of your gross disability payment to a maximum of $1,000 per month. In addition, we will make monthly payments to you for 3 months following the date your disability ends, if we determine you are no longer disabled while: x you are participating in a Rehabilitation and Return to Work Assistance program; and x you are not able to find employment.

Worksite Modification

If a worksite modification will enable you to remain at work or return to work, a designated Unum professional will assist in identifying what’s needed. A written agreement must be signed by you, your employer and Unum, and we will reimburse your employer for the greater of $1,000 or the equivalent of two months of your disability benefit.

Waiver of Premium

After you have received disability payments under the plan for 90 consecutive days, from that point forward you will not be required to pay premiums as long as you are receiving disability benefits.

Survivor Benefit

Unum will pay your eligible survivor a lump sum benefit equal to 3 months of your gross disability payment.

This benefit will be paid if, on the date of your death, your disability had continued for 180 or more consecutive days, and you were receiving or were entitled to receive payments under the plan. If you have no eligible survivors, payment will be made to your estate, unless there is none. In that case, no payment will be made. However, we will first apply the survivor benefit to any overpayment which may exist on your claim.

You may receive your survivor benefit prior to your death if you are receiving monthly payments and your physician certifies in writing that you have been diagnosed as terminally ill and your life expectancy has been reduced to less than 12 months. This benefit is only payable once and if you elect to receive this benefit, no survivor benefit will be payable to your eligible survivor upon your death. (Note this “Accelerated Survivor Benefit” is not available in Connecticut.)

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Dependent Care Expense Benefit

If you are disabled and participating in Unum’s Rehabilitation and Return to Work Assistance program, Unum will pay a Dependent Care Expense Benefit when you are disabled and you provide satisfactory proof that you: x are incurring expenses to provide care for a child under the age of 15; x and/or start incurring expenses to provide care for a child age 15 or older or a family member who needs personal care assistance.

The payment will be $350 per month per dependent, to a maximum of $1,000 per month for all dependent care expenses combined.

Worldwide Emergency Travel Assistance Services2

Whether your travel is for business or pleasure, our worldwide emergency travel assistance program is there to help you when an unexpected emergency occurs. With one phone call anytime of the day or night, you, your spouse and dependent children can get immediate assistance anywhere in the world3. Emergency travel assistance is available to you when you travel to any foreign country, including neighboring Canada or Mexico. It is also available anywhere in the United States for those traveling more than 100 miles from home. Your spouse and dependent children do not have to be traveling with you to be eligible. However, spouses traveling on business for their employer are not covered by this program.

Other Important Provisions Pre-existing Condition Exclusion

Benefits will not be paid for disabilities caused by, contributed to by, or resulting from a pre-existing condition. You have a pre-existing condition if: x

4 Week Pre-Existing Condition Benefit

Continuity of Coverage

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you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and the disability begins in the first 12 months after your effective date of coverage.

For disabilities due to a pre-existing condition, Unum will send you a payment each week up to the maximum period of payment. Your maximum period of payment is 4 weeks during the continuous period of disability.

If you are actively at work at the time you convert to Unum’s plan and become disabled due to a pre-existing condition, benefits may be payable if you were: x in active employment and insured under the plan on its effective date; and x insured by the prior plan at the time of change.

To receive a payment, you must satisfy the pre-existing condition under the Unum policy or the prior carrier’s policy. If you satisfy Unum’s pre-existing condition provision, payments will be determined by the Unum policy.

If you only satisfy the pre-existing condition provision for the prior carrier’s policy, the claim will be administered according to the Unum policy.

However,

x x x

Definition of Disability

the payments will be the lesser of the benefit payable under the terms of the prior plan or the benefit under the Unum plan; the elimination period will be the shorter of the elimination period under the prior plan or the elimination period under the Unum plan; and benefits will end on the earlier of the end of the maximum period of payment under the Unum plan or the date benefits would have ended under the prior plan.

You are disabled when Unum determines that: x

you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury;

x

you have a 20% or more loss in indexed monthly earnings due to the same sickness or injury; and

x

during the elimination period you are unable to perform any of the material and substantial duties of your regular occupation.

After benefits have been paid for 24 months, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.

You must be under the regular care of a physician in order to be considered disabled.

Gainful Occupation

Gainful occupation means an occupation that is or can be expected to provide you with an income within 12 months of your return to work, that exceeds 80% of your indexed monthly earnings if you are working or 60% of your indexed monthly earnings if you are not working.

Benefit Integration

Your disability benefit will be reduced by deductible sources of income and any earnings you have while disabled. Your gross disability payment will be reduced immediately by such items as disability income or other amounts you receive or are entitled to receive from workers compensation or similar occupational benefit laws, sabbatical or assault leave plans and the amount of earnings you receive from an extended sick leave plan as described in Louisiana Revised Statutes or any other act or law with similar intent.

After you have received monthly disability payments for 6 months, your gross disability payment will be reduced by such items as additional deductible sources of income you receive or are entitled to receive under: state compulsory benefit laws; automobile liability insurance; legal judgments and settlements; certain retirement plans; salary continuation or sick leave plans; other group or association disability programs or insurance; and amounts you or your family receive or are entitled to receive from Social Security or similar governmental programs.

Regardless of deductible sources of income, an employee who qualifies for disability benefits is guaranteed to receive a minimum benefit amount of the greater of $100 or 10% of the gross disability payment.

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Mental Illness/Self-Reported Symptoms

The lifetime cumulative maximum benefit period for all disabilities due to mental illness and disabilities based primarily on self-reported symptoms is 24 months. Only 24 months of benefits will be paid for any combination of such disabilities even if the disabilities are not continuous and/or are not related. Payments would continue beyond 24 months only if you are confined to a hospital or institution as a result of the disability.

Instances When Benefits Would Not Be Paid

Benefits will not be paid for disabilities caused by, contributed to by, or resulting from: x intentionally self-inflicted injuries; x active participation in a riot; x commission of a crime for which you have been convicted; x loss of professional license, occupational license or certification; x pre-existing conditions (see definition).

Unum will not cover a disability due to war, declared or undeclared, or any act of war.

Unum will not pay a benefit for any period of disability during which you are incarcerated.

Termination of Coverage

Your coverage under the policy ends on the earliest of the following: x The date the policy or plan is cancelled; x The date you no longer are in an eligible group; x The date your eligible group is no longer covered; x The last day of the period for which you made any required contributions; x The later of the last day you are in active employment except as provided under the covered layoff or leave of absence provision; or if applicable, the last day of your contract with your Employer but not beyond the end of your Employer’s current school contract year.

Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan.

Next Steps How to Apply/ Effective Date of Coverage

Current employees: To apply for coverage, complete your enrollment form by the enrollment deadline.

New Hires: To apply for coverage, complete your enrollment form within 60 days of your eligibility date. Please see your Plan Administrator for your effective date.

If you do not enroll during the initial enrollment period, you may apply only during an annual enrollment.

Delayed Effective Date of Coverage

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If you are absent from work due to injury, sickness, temporary layoff or leave of absence, your coverage will not take effect until you return to active employment. Please contact your Plan Administrator after you return to active employment for when your coverage will begin.

Questions

If you should have any questions about your coverage or how to enroll, please contact your Plan Administrator.

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 limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form( C.FP-1 et.al. or contact your Unum representative.

1,2

The work-life balance employee assistance program, provided by HealthAdvocate, is available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.

Worldwide emergency travel assistance services, provided by Assist America, Inc., are available with select Unum insurance offerings. Terms and availability of service are subject to change and prior notification requirements. Services are not valid after coverage terminates. Please contact your Unum representative for details. All emergency travel assistance must be arranged by Assist America, which pays for all services it provides. Medical expenses such as prescriptions or physician, lab or medical facility fees are paid by the employee or the employee’s health insurance.

Underwritten by: Unum Life Insurance Company of America 2211 Congress Street, Portland, Maine 04122, www.unum.com ©2022 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

CE-540703-1 (4-22)

LLANO INDEPENDENT SCHOOL DISTRICT Costs Effective as of September 1, 2022 Costs below are based on a Monthly payroll deduction (Employer billing mode is based on 12 Payments per year) Plan A SS ADEA Duration of Benefits

Product: Educator Select Income Protection Plan Injury (Days) Sickness (Days) Annual Earnings

Monthly Earnings

Maximum Monthly Benefit

3600 5400 7200 9000 10800 12600 14400 16200 18000 19800 21600 23400 25200 27000 28800 30600 32400 34200 36000 37800 39600 41400 43200 45000 46800 48600 50400 52200 54000 55800 57600 59400 61200 63000 64800 66600 68400 70200 72000 73800 75600 77400 79200 81000 82800 84600 86400 88200 90000 91800 93600

300 450 600 750 900 1050 1200 1350 1500 1650 1800 1950 2100 2250 2400 2550 2700 2850 3000 3150 3300 3450 3600 3750 3900 4050 4200 4350 4500 4650 4800 4950 5100 5250 5400 5550 5700 5850 6000 6150 6300 6450 6600 6750 6900 7050 7200 7350 7500 7650 7800

200 300 400 500 600 700 800 900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300 2400 2500 2600 2700 2800 2900 3000 3100 3200 3300 3400 3500 3600 3700 3800 3900 4000 4100 4200 4300 4400 4500 4600 4700 4800 4900 5000 5100 5200

0* 7*

7* 7*

7.26 10.89 14.52 18.15 21.78 25.41 29.04 32.67 36.30 39.93 43.56 47.19 50.82 54.45 58.08 61.71 65.34 68.97 72.60 76.23 79.86 83.49 87.12 90.75 94.38 98.01 101.64 105.27 108.90 112.53 116.16 119.79 123.42 127.05 130.68 134.31 137.94 141.57 145.20 148.83 152.46 156.09 159.72 163.35 166.98 170.61 174.24 177.87 181.50 185.13 188.76

7.16 10.74 14.32 17.90 21.48 25.06 28.64 32.22 35.80 39.38 42.96 46.54 50.12 53.70 57.28 60.86 64.44 68.02 71.60 75.18 78.76 82.34 85.92 89.50 93.08 96.66 100.24 103.82 107.40 110.98 114.56 118.14 121.72 125.30 128.88 132.46 136.04 139.62 143.20 146.78 150.36 153.94 157.52 161.10 164.68 168.26 171.84 175.42 179.00 182.58 186.16

Elimination Period (Days) 14* 30 14* 30

6.12 9.18 12.24 15.30 18.36 21.42 24.48 27.54 30.60 33.66 36.72 39.78 42.84 45.90 48.96 52.02 55.08 58.14 61.20 64.26 67.32 70.38 73.44 76.50 79.56 82.62 85.68 88.74 91.80 94.86 97.92 100.98 104.04 107.10 110.16 113.22 116.28 119.34 122.40 125.46 128.52 131.58 134.64 137.70 140.76 143.82 146.88 149.94 153.00 156.06 159.12

3.82 5.73 7.64 9.55 11.46 13.37 15.28 17.19 19.10 21.01 22.92 24.83 26.74 28.65 30.56 32.47 34.38 36.29 38.20 40.11 42.02 43.93 45.84 47.75 49.66 51.57 53.48 55.39 57.30 59.21 61.12 63.03 64.94 66.85 68.76 70.67 72.58 74.49 76.40 78.31 80.22 82.13 84.04 85.95 87.86 89.77 91.68 93.59 95.50 97.41 99.32

60 60

180 180

3.42 5.13 6.84 8.55 10.26 11.97 13.68 15.39 17.10 18.81 20.52 22.23 23.94 25.65 27.36 29.07 30.78 32.49 34.20 35.91 37.62 39.33 41.04 42.75 44.46 46.17 47.88 49.59 51.30 53.01 54.72 56.43 58.14 59.85 61.56 63.27 64.98 66.69 68.40 70.11 71.82 73.53 75.24 76.95 78.66 80.37 82.08 83.79 85.50 87.21 88.92

1.36 2.04 2.72 3.40 4.08 4.76 5.44 6.12 6.80 7.48 8.16 8.84 9.52 10.20 10.88 11.56 12.24 12.92 13.60 14.28 14.96 15.64 16.32 17.00 17.68 18.36 19.04 19.72 20.40 21.08 21.76 22.44 23.12 23.80 24.48 25.16 25.84 26.52 27.20 27.88 28.56 29.24 29.92 30.60 31.28 31.96 32.64 33.32 34.00 34.68 35.36 REF #: 5797682

* If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement.

Find your Annual/Monthly Earnings above to determine your Maximum Monthly Benefit. If your Annual/Monthly Earnings are not shown, use the next lower Annual/Monthly Earnings and corresponding Maximum Monthly Benefit. Or, you may refer to the Plan Highlights to calculate your Maximum Monthly Benefit based on your earnings.

LLANO INDEPENDENT SCHOOL DISTRICT Costs Effective as of September 1, 2022 Costs below are based on a Monthly payroll deduction (Employer billing mode is based on 12 Payments per year) Plan A SS ADEA Duration of Benefits

Product: Educator Select Income Protection Plan Injury (Days) Sickness (Days) Annual Earnings

Monthly Earnings

Maximum Monthly Benefit

95400 97200 99000 100800 102600 104400 106200 108000 109800 111600 113400 115200 117000 118800 120600 122400 124200 126000 127800 129600 131400 133200 135000 136800 138600 140400 142200 144000

7950 8100 8250 8400 8550 8700 8850 9000 9150 9300 9450 9600 9750 9900 10050 10200 10350 10500 10650 10800 10950 11100 11250 11400 11550 11700 11850 12000

5300 5400 5500 5600 5700 5800 5900 6000 6100 6200 6300 6400 6500 6600 6700 6800 6900 7000 7100 7200 7300 7400 7500 7600 7700 7800 7900 8000

0* 7*

7* 7*

192.39 196.02 199.65 203.28 206.91 210.54 214.17 217.80 221.43 225.06 228.69 232.32 235.95 239.58 243.21 246.84 250.47 254.10 257.73 261.36 264.99 268.62 272.25 275.88 279.51 283.14 286.77 290.40

189.74 193.32 196.90 200.48 204.06 207.64 211.22 214.80 218.38 221.96 225.54 229.12 232.70 236.28 239.86 243.44 247.02 250.60 254.18 257.76 261.34 264.92 268.50 272.08 275.66 279.24 282.82 286.40

Elimination Period (Days) 14* 30 14* 30

162.18 165.24 168.30 171.36 174.42 177.48 180.54 183.60 186.66 189.72 192.78 195.84 198.90 201.96 205.02 208.08 211.14 214.20 217.26 220.32 223.38 226.44 229.50 232.56 235.62 238.68 241.74 244.80

101.23 103.14 105.05 106.96 108.87 110.78 112.69 114.60 116.51 118.42 120.33 122.24 124.15 126.06 127.97 129.88 131.79 133.70 135.61 137.52 139.43 141.34 143.25 145.16 147.07 148.98 150.89 152.80

60 60

180 180

90.63 92.34 94.05 95.76 97.47 99.18 100.89 102.60 104.31 106.02 107.73 109.44 111.15 112.86 114.57 116.28 117.99 119.70 121.41 123.12 124.83 126.54 128.25 129.96 131.67 133.38 135.09 136.80

36.04 36.72 37.40 38.08 38.76 39.44 40.12 40.80 41.48 42.16 42.84 43.52 44.20 44.88 45.56 46.24 46.92 47.60 48.28 48.96 49.64 50.32 51.00 51.68 52.36 53.04 53.72 54.40 REF #: 5797682

* If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement.

Find your Annual/Monthly Earnings above to determine your Maximum Monthly Benefit. If your Annual/Monthly Earnings are not shown, use the next lower Annual/Monthly Earnings and corresponding Maximum Monthly Benefit. Or, you may refer to the Plan Highlights to calculate your Maximum Monthly Benefit based on your earnings.

Group Accident Insurance Limited Benefit Policy

Are you covered?

Accident Insurance can provide protection to help with the high cost of a covered accidental injury. From a simple physician’s office visit, to x-rays, ambulance transportation or an intensive care admission due to an accidental injury — unexpected expenses can add up.

How it works

Key features

C CHOOSE the benefit options that best protect you and your family from a covered accident. y

Benefit funds are paid directly to you for expenses incurred as the result of a covered accident You decide how to use the benefit funds—for medical and non-medical expenses

RECEIVE treatment for a covered accident.

Multiple coverage options for your whole family

FILE your claim online or mail it in. You'll receive a cash benefit to use however you wish.

Cost-effective premiums with convenient payroll deduction

THE INSURANCE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. YOU SHOULD CONSULT YOUR EMPLOYER TO DETERMINE WHETHER YOUR EMPLOYER IS A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM.

Summary of Benefits for Llano ISD Plan 1 Insured Benefit

Plan 2 Insured Benefit

Type of Coverage

24-Hour

24-Hour

Spouse Coverage

Spouse benefit amounts are 100% of the insured’s benefit amount, unless otherwise stated.

Spouse benefit amounts are 100% of the insured’s benefit amount, unless otherwise stated.

Dependent Child(ren) Coverage

Dependent child(ren) benefit amounts are 100% of the insured’s benefit amount, unless otherwise stated.

Dependent child(ren) benefit amounts are 100% of the insured’s benefit amount, unless otherwise stated.

Continuation Coverage Based on defined qualifying events defined in your certificate

Coverage will be continued for 12 months following the date the insured ceased active employment.

Coverage will be continued for 12 months following the date the insured ceased active employment.

Portability Coverage

Included, age 79 or younger

Included, age 79 or younger

Plan 1 Insured Benefit

Plan 2 Insured Benefit

Post-Accident Time Frame Requirement Unless otherwise defined, confinement, stay, treatment, therapy, diagnosis, surgery, paralysis, dismemberment, death or prescription of covered items must occur within the defined number of days after a covered accident.

365 days

365 days

$500/5 days

$500/5 days

Hospital Benefits Hospital Admission Pays only once per day, even if the confinement or observation long stay is the result of more than one injury.

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Group Accident Insurance Hospital Confinement Pays once per day

$100/365 days

$200/365 days

ICU Admission Pays only once per day, even if the confinement is the result of more than one injury.

$100/30 days

$200/365 days

ICU Confinement Pays once per day

$100/30 days

$200/30 days

Observation Room Treatment Pays once per day

$50/ 5 days

$100/5 days

Emergency Room Treatment Pays once per day

$50/$10 days

$150/10 days

Urgent Care Treatment Pays once per day

$50/$10 days

$150/10 days

Physician’s Office Treatment Pays once per day

$25/10 days

$75/10 days

X-ray

$100/5 days

$200/5 days

Major Diagnostic Exam

$100/5 days

$200/5 days

Initial Treatment Benefits

Diagnostic Benefits

Therapy Benefits Inpatient Rehabilitation

$50/60 days

$100/60 days

Physical Therapy

$15/20 days

$25/20 days

Extended Treatment

$15/20 days Benefits includes Chiropractic Therapy, Acupuncture Therapy

$25/20 days Benefits includes Chiropractic Therapy, Acupuncture Therapy

Coma Must continue for at least 30 days before a benefit is payable. Pays once per covered accident.

$5,000

$10,000

Paralysis Must continue for at least 60 days before a benefit is payable

Quadriplegia - $5,000 Paraplegia - $2,500

Quadriplegia - $10,000 Paraplegia - $5,000

Accidental Death

Insured - $25,000 Spouse - $25,000 Dependent Child(ren) - $25,000

Insured - $50,000 Spouse - $50,000 Dependent Child(ren) - $50,000

Common Carrier Accidental Death

Insured - $50,000 Spouse - $50,000 Dependent Child(ren) - $50,000

Insured - $100,000 Spouse - $100,000 Dependent Child(ren) - $100,000

$500 to $10,000

$1,250 to $25,000

Dislocation (open reduction) - based on joint involved

$225 to $3,000

$450 to $6,000

Dislocation (closed reduction) percentage1

50% of open reduction benefit amount

50% of open reduction benefit amount

Partial dislocation percentage1

25% of open reduction benefit amount

25% of open reduction benefit amount

$225 to $3,000

$450 to $6,000

50% of open reduction benefit amount

50% of open reduction benefit amount

25% of open reduction benefit amount

25% of open reduction benefit amount

$25 to $200/5 day

$50 to $400/5 day

Coma and Paralysis Benefits

Accidental Death Benefits

Dismemberment Benefits Dismemberment - Single, Double, Finger/Toe Dislocation Benefits

Fracture Benefits Fracture (open reduction) - based on bone involved Fracture (closed reduction) percentage Chip fracture percentage1

1

Laceration Benefits Based on length of laceration Inpatient Surgery Benefits

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Group Accident Insurance Pays once per covered accident based on type of surgery

$375

$750

General Anesthesia1

25% of inpatient surgery benefit amount

25% of inpatient surgery benefit amount

Tendon/ligament/rotator cuff/torn knee cartilage based on type of surgery

$200/5 days

$400/5 days

Other miscellaneous surgery for repair

$200/5 days

$400/5 days

Exploratory Surgery

$200/2 days

$400/2 days

Concussion

$200/5 days

$400/5 days

Severe Traumatic Brain Injury (TBI)

$1,200/5 days

$2,500/5 days

Outpatient Surgery Benefits

Brain Injury Benefits

Severe Burn Benefits 2nd degree & 3rd degree Burns $5,000 to $250 Pays once per covered accident based on degree and size of burn

$1,000 to $500

Skin Graft

1% of severe burn benefit amount

1% of severe burn benefit amount

Lodging and Travel Benefits Transportation for treatment for the injured covered person by train, bus, coach or plane must be at least 100 miles from the covered person’s primary residence. Not payable if ambulance benefit is payable.

Non-Local Transportation

$200/up to 3 round trips

$400/up to 3 round trips

Family Lodging

$100/30 nights

$200/30 nights

Air Ambulance

$600/5 days

$900/5 days

Ground or Water Ambulance

$200/5 days

$300/5 days

Emergency dental extraction of a broken sound, natural tooth

$50

$50

Emergency repair of a broken sound, natural tooth with a crown

$100

$200

Eye surgery or removal of a foreign object

$200

$300

Wheelchair, motorized scooter, walker, walking boot, any other medical device used for mobility, including a brace, cane and crutches - based on type of appliance

$50/5 days

$100/5 days

Prosthesis Pays once per covered accident, per plan year based on number of devices

$500

$1,500

$500/5 times

$1,000/5 times

Ambulance Benefits

Emergency Dental & Vision Treatment Benefits

Appliance and Prosthesis Benefits

Other Benefits Auto & Home Modification Blood/Plasma/Platelets

$300/5 days

$400/5 days

Epidural/Pain Management

$50/5 days

$100/5 days

Organized Sports Benefit Booster1

20%

20%

Post-Traumatic Stress Disorder (PTSD)

$100

$200

Prescription Drugs Pays once per day

$5/3 day(s) per month, up to 12 day(s) per plan year

$5/3 day(s) per month, up to 12 day(s) per plan year

$50/1 per covered person, up to 4 per family. Additional screening tests included

$50/1 per covered person, up to 4 per family. Additional screening tests included

Accident Screening Benefit Accident Screening1

1

Spouse and/or dependent child(ren) benefit amount and/or percentage is the same as the insured’s benefit amount and/or percentage.

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Group Accident Insurance Premiums Monthly Premium* Age 18+

Plan 1

Plan 2

Employee Only

$8.79

$16.01

Employee + Spouse

$14.29

$25.12

Employee + Child(ren)

$19.43

$35.61

Family

$26.24

$48.04

*The premium and amount of benefits vary dependent upon Plan selected at time of application.

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Group Accident Insurance

Refer to the Summary of Benefits for details specific to each plan.

Benefits are only paid as a result of injuries received in a covered accident that occurs while coverage is in force for a covered person. Payable once per covered accident, up to the defined number of days per plan year for each covered person, unless stated otherwise. All diagnosis, treatment, therapy and/or confinement, as a result of death or injuries, must begin/occur within the defined number of days after a covered accident.

A covered person means you and any dependent currently covered under the policy and the certificate. If dependent coverage is applicable to your plan, a dependent means your spouse, or your grandchild if claimed as a dependent on your federal tax return as of the date the grandchild’s application for coverage is submitted to APL, a child for whom the insured must provide medical or dental support regardless of whether the child resides with you, or your natural child, or legally adopted child, including where you are a party to a suit in which you seek to adopt the child, or stepchild who is under 26 years of age. Dependent also includes any minor under your charge, care, and control who has been placed in your home for adoption and is under 26 years of age.

A hospital is not an institution, or part thereof, used as: a place for rehabilitation, a place for rest or for the aged, a nursing or convalescent home, a long-term nursing unit or geriatrics ward or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients.

Hospital Benefits Hospital Admission – Not payable for treatment in an emergency room, urgent care facility or rehabilitation unit, for an observation unit short stay or for treatment as an outpatient.

Hospital Confinement - Not payable for any day for which a hospital admission benefit is payable, for treatment in an emergency room, urgent care facility or rehabilitation unit, for an observation unit short stay or for treatment as an outpatient.

ICU Confinement – Not payable for any day for which an ICU admission benefit is payable, for treatment in an emergency room, urgent care facility, rehabilitation unit or observation unit or for treatment as an outpatient. This benefit is payable in addition to the Hospital Confinement Benefit.

Initial Treatment Benefits Observation Room Treatment (Short Stay) – Not payable for any day for which a hospital admission, hospital confinement, ICU admission or ICU confinement benefit is payable, if applicable to your plan.

Emergency Room Treatment – Treatment must occur within the defined number of days after the covered accident occurs. Payable once per covered accident, up to the defined number of days per plan year for each covered person. Payable only once per day.

Urgent Care Treatment – Benefit will not be paid for routine health examinations and immunizations, physical therapy, chiropractic care or other therapy services.

Physician’s Office Treatment – Benefit will not be paid for immunizations, routine health examinations, physical therapy, chiropractic care, other therapy services or treatment received through telemedicine.

Diagnostic Benefits X-ray – Does not include a major diagnostic exam or lab test.

Major Diagnostic Exam – Major diagnostic exams include those defined in your certificate.

Therapy Benefits Inpatient Rehabilitation – Not payable for any day for which a hospital admission, hospital confinement, ICU admission or ICU confinement benefit is payable, if applicable to your plan.

Physical Therapy – Physical therapy must begin within the defined number of days and be rendered within 365 days after the covered accident occurs. Payable up to the defined number of days per plan year for each covered person. Physical therapy must follow initial treatment in a hospital, emergency room or other medical facility for a covered accident for this benefit to be payable.

Extended Treatment – Treatment must begin within the defined number of days and be rendered within 365 days after the covered accident occurs. This benefit is payable up to the defined number of days per plan year for each covered person.

Coma and Paralysis Benefits Coma – Must be diagnosed by a physician as having commenced within the defined number of days after the covered accident occurs.

Paralysis – Must begin within the defined number of days after the covered accident occurs and be determined by a physician as expected to be permanent. Only one paralysis benefit amount, the highest amount, is payable per covered accident.

Accidental Death Benefits Accidental Death – If the covered accident that causes the covered person’s loss of life occurs while the covered person is on or occupying a common carrier, the common carrier accidental death benefit will be paid in lieu of the accidental death benefit, if applicable to your plan.

Dismemberment Benefits Single, Double and/or Finger/Toe Dismemberment – If the covered person later dies as a result of the same covered accident, APL will pay the applicable death benefit less any amounts paid under this benefit, if applicable to your plan.

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Group Accident Insurance Dislocation Benefits - If multiple dislocations or partial dislocations, if applicable to your plan, are suffered as the result of one covered accident, APL will not pay more than two times the greatest dislocation benefit payable for an individual joint per covered accident for each covered person. No more than one dislocation benefit per joint per covered accident will be paid for each covered person.

Fracture Benefits - If multiple fractures or chip fractures, if applicable to your plan, are suffered as the result of one covered accident, APL will not pay more than two times the greatest fracture benefit payable for an individual bone per covered accident for each covered person. No more than one fracture benefit per bone per covered accident will be paid for each covered person.

Laceration Benefits – Treatment for the laceration must occur within 14 days after the covered accident occurs. Benefits are payable when laceration is repaired with stitches by a physician as a result of a covered accident. Payable up to the defined number of days per plan year for each covered person. Payable only once per covered accident for each covered person, even if treatment is received for more than one laceration.

Inpatient Surgery Benefits Inpatient Surgery Benefits – Surgery must be performed by a physician within the defined number of days after the covered accident occurs.

General Anesthesia – Inpatient surgery benefit must be payable and general anesthesia must be received during inpatient surgery for this benefit to be payable.

Outpatient Surgery Benefits Outpatient Surgery Benefits - Surgery must be performed by a physician within the defined number of days after the covered accident occurs.

Exploratory Surgery - Exploratory arthroscopic surgery must be performed by a physician within the defined number of days after the covered accident occurs.

Brain Injury Benefits - Concussion must be diagnosed by a physician. A severe traumatic brain injury (TBI) must be diagnosed by a neurologist, if applicable to your plan. If both a concussion and a severe traumatic brain injury (TBI) occur in the same covered accident, only the highest benefit will be payable, if applicable to your plan.

Severe Burn Benefits Severe Burn Benefits – No benefits will be paid if the degree and percentage of the body surface burned is not shown as a covered benefit.

Skin Graft – Severe burns benefit must be payable and skin graft treatment undergone for this benefit to be payable.

Lodging and Travel Benefits Non-Local Transportation – Treatment in a hospital must be advised by a physician because treatment for an injury is not available locally.

Payable only once per round trip for up to the defined number of round trip(s) per plan year for each covered person. This benefit is not payable on any day that an ambulance benefit is payable.

Family Lodging – Expense must be incurred for lodging by an adult family member accompanying a covered person who is confined away from the family member’s primary residence for treatment as the result of a covered accident. Payable up to the defined number of nights per plan year for each covered person. Payable only once per night, even if more than one family member accompanies the covered person; if the adult family member is providing care for the covered person or is acting as an advocate on the behalf of the covered person; and while the covered person is receiving treatment in a hospital that is advised by a physician because treatment for an injury is not available locally.

Proof of the expense incurred for lodging, evidenced by a receipt, invoice or another appropriate document, must be submitted with the claim.

Mileage is measured as the geographic distance from the family member’s primary residence to the facility at which the confinement occurs.

Ambulance Benefits – Ambulance transportation, to or from a hospital or between medical facilities, must occur within 168 hours after the covered accident.

Emergency Dental & Vision Treatment Benefits – Emergency dental work or vision work must occur within the defined number of days after the covered accident. Payable once per plan year for each covered person and only once per covered accident even if multiple teeth or eyes are affected. If more than one type of procedure is performed on the same day, only the highest emergency dental and vision treatment benefit will be payable.

Appliance and Prosthesis Benefits Appliance – Medical appliance must be prescribed within the defined number of days after the covered accident occurs. Payable the defined number of days per plan year for each covered person. If more than one type of medical appliance is prescribed on the same day, only the highest appliance benefit will be payable.

Prosthesis – Prosthetic device, artificial limb or artificial eye must be prescribed by a physician and received within the defined number of days after the covered accident occurs.

Other Benefits Auto & Home Modification – Residence and/or vehicle modification must occur within 365 days after the covered accident occurs.

Blood/Plasma/Platelets - Payable up to the defined number of days per plan year for each covered person. Transfusion of blood, plasma or platelets must be received during a surgery for which an inpatient surgery or outpatient surgery benefit is payable.

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Group Accident Insurance Epidural/Pain Management – Epidural injection, for treatment of an injury, must occur within the defined number of days after the covered accident occurs.

Organized Sports Benefit Booster – Pays an additional percentage only if a covered person suffers an injury for which a benefit is payable under the certificate and the injury occurred while the covered person was participating in an organized sport.

Post-Traumatic Stress Disorder (PTSD) – Must be under the active care of a physician or mental health professional for the treatment of PTSD. Prescription Drugs – Drug must be prescribed by a physician or medical professional within 365 days after a covered accident occurs. Benefit will not be paid for any drug that is received or prescription that is filled while a covered person is confined in any medical facility.

Accident Screening Benefit – Service must be rendered by a physician while the covered person is not an inpatient in a hospital and while the covered person is covered under the policy. Covered tests are defined in your certificate.

Exclusions APL will not pay benefits for a claim that is caused by, contributed to by, or resulting from any of the following: voluntary intoxication (as defined by the law of the jurisdiction in which such intoxication occurred) or while under the influence of any narcotic, drug or controlled substance, unless administered by or taken according to the instructions of a physician or medical professional; voluntary intoxication through use of poison, gas or fumes, whether by ingestion, injection, inhalation or absorption; committing or attempting to commit a felony, or active participation in a riot, insurrection or terrorist activity; intentional self-harm or attempting or committing suicide, whether sane or not; war or any act of war, whether declared or undeclared, or any act related to war while serving in the military forces or any auxiliary unit thereto (the pro-rata portion of any premium paid for any such covered person will be refunded upon receipt of your written request); any injury that occurs while a covered person is engaged in an illegal occupation or activity, or legally incarcerated in a penal or correctional institution; cosmetic surgery or other elective procedure that is not medically necessary, except for reconstructive surgery incidental to or following surgery for trauma to the affected body part; diagnosis or treatment received outside the United States, its territories or Canada, except for emergency care received within seven days of an injury; treatment provided at a facility, office or other location owned or operated by a covered person or family member; treatment of mental or nervous disorder(s) that is not a direct result of trauma sustained by a covered accident; any bacterial infection (except pyogenic infections which shall occur with and through an accidental cut or wound); operating, learning to operate, serving as a crew member of any aircraft or hot air balloon, including those which are not motor-driven, unless flying as a fare paying passenger; travel or flight in any aircraft or hot air balloon, including those which are not motor-driven, if it is being used for testing or experimental purposes, used by or for any military authority, or used for travel beyond the earth’s atmosphere; participation in any organized sport in a professional or semi-professional capacity; riding or driving an air, land or water vehicle in any organized and scheduled race, speed or endurance contest; participation in base jumping, bungee jumping, cliff jumping, kite surfing, kiteboarding, luging, parachuting, paragliding, parakiting, parasailing, ski jumping, skydiving, spelunking, tricking or wingsuit flying; or an on the job injury, if applicable to your plan. Additionally, no benefits will be paid for an injury that occurs prior to a covered person being covered under the certificate.

Termination of Coverage Your coverage ends on the earliest of: the date you leave an eligible class under the certificate; any premium due date, if full payment for your coverage is not made within the grace period following the premium due date; the date the policy terminates and you have not elected coverage under the portability provision of the certificate; the last day of the month during which you attain the limiting age defined in your certificate. If dependent coverage is included in your plan, coverage for a dependent ends on the earliest of: your termination date; the last day of the month during which the dependent is no longer eligible for coverage due to a change to the policy; or the last day of the month during which a dependent no longer satisfies the definition of a dependent. Termination will not affect a claim that occurred while a covered person was covered by the policy.

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606 If the accident insurance premium is paid on a pre-tax basis, the benefit may be taxable. Please contact your tax or legal advisor regarding tax treatment of your policy benefits.

This is not intended to be a complete description of the insurance coverage offered. While benefit amounts stated in this summary are specific to your coverage, other items may summarize our standard product features and not the specific features of your coverage. Provisions are provided in the certificate and this summary does not modify those provisions or the insurance in any way. This is not a contract. A certificate 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 certificate, the certificate will govern.

Underwritten by American Public Life Insurance Company | This is a brief description of the coverage. This product contains limitations and exclusions. For complete benefits and other provisions, please refer to the policy/certificate. This is not a Medicare supplement policy. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association, union or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GAO21APL Series | Texas | Group Accident Insurance | Limited Benefit Group Accident Insurance (02/22)

APSB-22591(TXd)-0222

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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

3KRQH )D[

86 (PSOR\HH %HQHILWV 6HUYLFHV *URXS /DQGD 6WUHHW 1HZ %UDXQIHOV 7;

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

Group Cancer Insurance Limited Benefit Policy

How would cancer impact you and your family?

If you or a family member are diagnosed with cancer, APL’s Cancer Insurance may help cover the costs associated with the detection and treatment of cancer and help you be more financially prepared.

How it works

Key features

CHOOSE the benefit options that best protect you and your family.

Radiation Therapy, Chemotherapy, Immunotherapy Experimental Treatments

RECEIVE treatment for a covered benefit.

FILE your claim online or mail it in.

Surgical and Anesthesia Benefits

Prescriptions, Transportation Benefits and more

Plus, multiple plan options to cover you, your spouse or your child(ren) with convenient payroll deduction

THE INSURANCE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. YOU SHOULD CONSULT YOUR EMPLOYER TO DETERMINE WHETHER YOUR EMPLOYER IS A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM.

Summary of Benefits for Llano ISD Plan 1 Insured Benefit

Plan 2 Insured Benefit

Spouse Coverage

Available

Available

Dependent Child(ren) Coverage

Available

Available

Pre-Existing Condition Period/PreExisting Condition Exclusion Period

12 months/12 months

12 months/12 months

Cancer Treatment Benefit

Level 3

Level 4

Radiation Therapy, Chemotherapy, Immunotherapy Maximum per 12-month period

$15,000

$20,000

Hormone Therapy Maximum of 12 treatments per calendar year

$50 per treatment

$50 per treatment

Experimental Treatment

paid in same manner and under the same maximums as any other benefit

paid in same manner and under the same maximums as any other benefit

Cancer Screening Benefit Rider

Level 1

Level 3

Diagnostic Testing 1 test per calendar year

$50 per test

$75 per test

Follow-Up Diagnostic Testing 1 test per calendar year

$100 per test

$100 per test

Medical Imaging

$500 per test; 1 test(s) per calendar year

$500 per test; 2 test(s) per calendar year

Surgical Benefit Rider

Level 1

Level 3

Surgical Operation

$30 unit dollar amount; Max $3,000 per operation

$45 unit dollar amount; Max $4,500 per operation

Anesthesia

25% of amount paid for covered surgery

25% of amount paid for covered surgery

Bone Marrow Transplant Maximum per lifetime

$6,000

$9,000

Benefit Riders

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Group Cancer Insurance Plan 1 Insured Benefit Stem Cell Transplant Maximum per lifetime

Plan 2 Insured Benefit

$600

$900

Prosthesis Surgical implantation Non-surgical (not hair piece) 1 device per site, per lifetime

$1,000 per device $100 per device

$2,000 per device $200 per device

Patient Care Benefit Rider

Level 3

Level 4

Hospital Confinement

Insured or Spouse: $200 per day of hospital confinement, days 1-30; $400 per day of hospital confinement, days 31+ Eligible Dependent Child(ren): $400 per day of hospital confinement, days 1-30; $800 per day of hospital confinement, days 31+

Insured or Spouse: $300 per day of hospital confinement, days 1-30; $600 per day of hospital confinement, days 31+ Eligible Dependent Child(ren): $600 per day of hospital confinement, days 1-30; $1,200 per day of hospital confinement, days 31+

Outpatient Facility

$400 per day surgery is performed

$600 per day surgery is performed

Attending Physician

$40 per day of hospital confinement

$50 per day of hospital confinement

Dread Disease

$200 per day of hospital confinement, days 1-30; $400 per day of hospital confinement, days 31+

$300 per day of hospital confinement, days 1-30; $600 per day of hospital confinement, days 31+

Extended Care Facility

$200 per day

$300 per day

Donor

$200 per day

$300 per day

Home Health Care

$200 per day

$300 per day

Hospice Care

$200 per day; maximum of 365 days per lifetime

$300 per day; maximum of 365 days per lifetime

U.S. Government, Charity Hospital or HMO

$200 per day of hospital confinement, days 1-30; $400 per day of hospital confinement, days 31+

$300 per day of hospital confinement, days 1-30; $600 per day of hospital confinement, days 31+

Miscellaneous Benefit Rider

Level 2

Level 2

Cancer Treatment Center Evaluation or Consultation - 1 per lifetime

$750

$750

Evaluation or Consultation Travel and Lodging - 1 per lifetime

$350

$350

Second / Third Surgical Opinion Per diagnosis of cancer

$300 / $300

$300 / $300

Drugs and Medicine

$150 per inpatient confinement; $50 per outpatient prescription, maximum $150 per month

$150 per inpatient confinement; $50 per outpatient prescription, maximum $150 per month

Hair Piece (Wig) - 1 per lifetime

$150

$150

Transportation and Lodging Transportation - maximum 12 trips per calendar year for all modes of transportation combined Lodging - up to a maximum of 100 days per calendar year

actual coach fare or $0.75 per mile for travel by bus, plane or train; $0.75 per mile for travel by car; $100 per day for lodging

actual coach fare or $0.75 per mile for travel by bus, plane or train; $0.75 per mile for travel by car; $100 per day for lodging

Family Member Transportation and Lodging Transportation - maximum 12 trips per calendar year for all modes of transportation combined Lodging - up to a maximum of 100 days per calendar year

actual coach fare or $0.75 per mile for travel by bus, plane or train; $0.75 per mile for travel by car; $100 per day for lodging

actual coach fare or $0.75 per mile for travel by bus, plane or train; $0.75 per mile for travel by car; $100 per day for lodging

Blood, Plasma and Platelets

$300 per day

$300 per day

Ambulance Maximum of 2 trips per hospital confinement for all modes of transportation combined

Ground: $200 per trip Air: $2,000 per trip

Ground: $200 per trip Air: $2,000 per trip

Inpatient Special Nursing Services

$150 per day of hospital confinement

$150 per day of hospital confinement

Outpatient Special Nursing Services

$150 per day

$150 per day

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Group Cancer Insurance Plan 1 Insured Benefit

Plan 2 Insured Benefit

Medical Equipment Maximum of 1 benefit per calendar year

$150

$150

Physical, Occupational, Speech, Audio Therapy and Psychotherapy

$25 per visit; maximum of $1,000 per calendar year

$25 per visit; maximum of $1,000 per calendar year

Waiver of Premium

Included

Included

Internal Cancer First Occurrence Benefit Rider

Level 4

Level 4

Lump Sum Benefit Maximum 1 per lifetime

Insured or Spouse: $10,000 Eligible Dependent Child(ren): $15,000

Insured or Spouse: $10,000 Eligible Dependent Child(ren): $15,000

Intensive Care Unit Maximum of 45 days per confinement for any combination of intensive care unit or step down unit

$600 per day

$600 per day

Step Down Unit Maximum of 45 days per confinement for any combination of intensive care unit or step down unit

$300 per day

$300 per day

Increase in Coverage

Only available at annual renewal. Must be approved by APL and premium rates will be based upon the insured’s attained age. Subject to the Time Limit on Certain Defenses and Pre-Existing Condition provisions, as defined in the policy.

Only available at annual renewal. Must be approved by APL and premium rates will be based upon the insured’s attained age. Subject to the Time Limit on Certain Defenses and Pre-Existing Condition provisions, as defined in the policy.

Included

Included

Hospital Intensive Care Unit Benefit Rider

Additional Rider(s) Portability Amendment Rider

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Group Cancer Insurance Premiums Plan 1 - Monthly Premium* Age

Employee Only

Employee + Spouse

Employee + Child(ren) Employee + Family

18+

$31.68

$67.14

$39.96

$75.42

Plan 2 - Monthly Premium* Age

Employee Only

Employee + Spouse

Employee + Child(ren) Employee + Family

18+

$39.70

$83.76

$50.20

$94.24

*Total premium includes the Plan selected and any applicable rider premium. The premium and amount of benefits vary dependent upon the Plan selected at time of application.

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Group Cancer Insurance Refer to the Summary of Benefits for details specific to each plan.

Benefits are only payable following a diagnosis of cancer for a loss incurred for the treatment of cancer while covered under the policy. A charge must be incurred for benefits to be payable. All benefits are per covered person per calendar year, unless otherwise stated. When coverage terminates for loss incurred after the coverage termination date, APL’s obligation to pay benefits also terminates for a specified disease that manifested itself while the person was covered under the policy. All benefits are subject to the benefit maximums proposed.

A covered person means a person who is eligible for coverage under the certificate and for whom coverage is in force. An eligible dependent means your lawful spouse who lives with you; your natural child, adopted child or stepchild who is under 26 years of age; a child under your charge, care and control, if placed with you for adoption, who is under the age of 26 and/or for whom you are a party in a suit in which adoption of the child is sought; any child under the age of 26 for whom you provide medical support under an order issued under Chapter 154 of the Texas Family Code, or enforceable by a court in Texas; or grandchildren under the age of 26 if those grandchildren are the insured’s dependents for federal income tax purposes at the time application for coverage of the grandchild is made.

A hospital is not an institution, or part thereof, used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a rehabilitative facility; an extended-care facility; a skilled nursing facility or facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction.

Cancer Treatment Benefits Radiation Therapy, Chemotherapy or Immunotherapy - Benefits are payable for actual charges, the amount actually paid by or on behalf of the covered person and accepted by the provider for services provided, up to the maximum benefit amount per 12-month period. The 12-month period begins on the first day covered radiation therapy, chemotherapy or immunotherapy is received. Chemotherapy and immunotherapy coverage will be limited to drugs only. Benefits not covered are defined in your certificate.

Hormone Therapy - Must be prescribed by a physician. This benefit covers drugs and medicine only. This benefit does not cover associated administrative processes, anti-nausea drugs, pain medicine, administration of anti-nausea drugs or pain medicine, or any drugs or medicines covered under the radiation therapy, chemotherapy or immunotherapy benefit.

Experimental Treatment - Must be prescribed by a physician for treatment of cancer the same as any other non-experimental treatment covered under the policy and any attached riders.

Limitations and Exclusions No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date regardless of when specified disease was diagnosed. Loss must result from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The policy does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer.

Pre-Existing Condition Exclusion No benefits are payable for any loss incurred during the defined pre-existing condition exclusion period following the covered person’s effective date of the certificate as the result of a pre-existing condition. Pre-existing conditions specifically named or described as excluded in any part of the policy are never covered.

Termination of Certificate Insurance coverage under the certificate and any attached riders will end on the earliest of these dates: the date the policy terminates; the end of the grace period if the premium remains unpaid; the date insurance has ceased on all persons covered under the certificate; the end of the certificate month in which the policyholder requests to terminate the coverage; the date you no longer qualify as an insured; or the date of your death.

Termination of Coverage Insurance coverage for a covered person under the certificate and any attached riders will end as follows: the date the policy terminates; the date the certificate terminates; the end of the grace period if the premium remains unpaid; the end of the certificate month in which the policyholder requests to terminate the coverage for an eligible dependent; the date a covered person no longer qualifies as an insured or eligible dependent; or the date of the covered person’s death. We may end the coverage of any covered person who submits a fraudulent claim.

Benefit Riders All riders are part of the policy/certificate to which it is attached and are subject to all the provisions of the policy/certificate that are not in conflict with the provisions of the rider. A charge must be incurred for benefits to be payable, with the exception of the Internal Cancer First Occurrence Benefit Rider and the Heart Attack/Stroke First Occurrence Benefit Rider, if applicable to the plan. No benefits are payable for loss incurred during the defined pre-existing condition exclusion period following the covered person’s effective date of the rider as a result of a pre-existing condition, with the exception of the Hospital Intensive Care Unit Rider, if applicable to the plan.

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Group Cancer Insurance Cancer Screening Benefit Rider Diagnostic Testing - Must be a screening test that is generally medically recognized to detect internal cancer. Not payable for any test payable under the medical imaging benefit.

Follow-Up Diagnostic Testing - An abnormal result from a covered screening test must be received for an invasive screening test to be payable.

For an invasive test involving an incision or surgery, this benefit will only be paid for a test that results in a negative diagnosis of cancer. For invasive tests that do not require an incision, this benefit will be paid regardless of the diagnosis.

Medical Imaging - CT, CAT, PET scan(s) or MRI must be requested by a physician and performed due to a diagnosis of cancer or treatment of cancer.

Limitations and Exclusions No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment, as defined in the policy; or losses or medical expenses incurred prior to the covered person’s effective date of the rider.

Surgical Benefit Rider Benefits are only payable for a loss incurred and treatment of a diagnosed cancer or skin cancer while covered under the rider.

Surgical Operation - Must be performed for a covered diagnosed cancer, skin cancer or for reconstructive surgery due to cancer. Pays the lesser of the surgical unit value assigned to the procedure multiplied by the unit dollar amount or the maximum per operation amount. Two or more surgical procedures performed through the same incision will be considered one operation and benefits will be limited to the most expensive procedure. Reconstructive surgery to the non-diseased breast to establish symmetry with a diseased breast must occur within 24 months of the reconstructive surgery of the diseased breast. Diagnostic surgeries that result in a negative diagnosis of cancer, surgeries required to implant a permanent prosthetic device or bone marrow transplant or stem cell transplant surgeries are not covered under this benefit.

Anesthesia - Payable at 25% of the paid surgical benefit amount. Anesthesiologist services must be for the result of a covered surgery. Services of an anesthesiologist for bone marrow or stem cell transplants, skin cancer or surgical prosthesis implantation are not covered under this benefit.

Bone Marrow and Stem Cell Transplant - Payable in lieu of the surgical and the anesthesia benefits. If a bone marrow transplant and a stem cell transplant are performed on the same day, only the bone marrow transplant benefit will be payable.

Prosthesis - Surgically implanted prosthetic device must be prescribed by a physician as a direct result of surgery for cancer. Artificial limbs will be paid under the surgical implantation portion of this benefit. Temporary prosthetic devices used as tissue expanders are covered under the surgical benefit. Prosthetic related supplies and hair prosthesis are not covered under this benefit.

Limitations and Exclusions No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed.

Patient Care Benefit Rider Benefits are only payable for a loss incurred and treatment of a diagnosed specified disease while covered under the rider.

Hospital Confinement - Must be confined to a hospital for the treatment of a covered cancer or the treatment of a condition or disease directly caused by cancer or the treatment of cancer. Outpatient treatment or a stay of less than 18 hours in an observation unit or an emergency room is not covered.

Outpatient Facility - Facility fee must be charged and surgical procedure performed on an outpatient basis in a hospital or ambulatory surgical center. Surgical procedures for skin cancer are not covered under this benefit.

Attending Physician - Services of a physician, other than a surgeon, must be required while confined in a hospital for the treatment of cancer.

Dread Disease - Must be confined in a hospital for treatment of a dread disease, as defined in the policy.

Extended Care Facility - Confinement in an extended care facility must be due to cancer, at the direction of a physician and begin within 14 days after a hospital confinement. Payable for up to the same number of days benefits were paid for the covered person’s preceding hospital confinement.

Donor - Expenses must be incurred for treatment of cancer on behalf of a covered person for a surgery due to organ transplant, bone marrow transplant or stem cell transplant. Blood donor expenses are not covered under this benefit. Donor may not be the same covered person for which expenses are incurred.

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Group Cancer Insurance Home Health Care - Care required due to cancer must be in lieu of hospital confinement, prescribed by a physician, provided by a nurse or by a home health nurse’s aide under the supervision of a registered nurse and must begin within 14 days after a covered hospital confinement.

Payable up to the same number of days benefits were paid for the covered person’s preceding hospital confinement. Caregiver may not be a member of your immediate family. Physical, speech, occupational or audio therapies or psychotherapy are not covered under this benefit. If the covered person qualifies for coverage under the hospice care benefit, the hospice care benefit will be paid in lieu of this benefit.

Hospice Care - Must be diagnosed by a physician as terminally ill, as defined in the policy, and require hospice care due to cancer. Care must be directed by a licensed hospice organization in the patient’s home or on an outpatient or short-term inpatient basis in a hospice facility.

U.S. Government Hospital / Charity Hospital / HMO - An itemized list of services must not be available due to confinement in a charity hospital, U.S. Government owned or operated hospital or coverage under a Health Maintenance Organization (HMO) or a Diagnostic Related Group (D.R.G.) where no charges are made to the covered person. If this option is elected, this benefit will be paid in lieu of any amounts payable under the rider, base policy, cancer screening benefit rider, surgical benefit rider and miscellaneous benefit rider (except for the transportation and lodging benefits), if applicable to the plan.

Limitations and Exclusions No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date of the rider regardless of when a specified disease was diagnosed. The rider only pays for loss for cancer or dread disease resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The rider also covers other conditions or diseases directly caused by cancer or the treatment of cancer. The rider does not cover any other disease, sickness or incapacity, which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer except for conditions specifically provided in the dread disease benefit.

Miscellaneous Benefit Rider Benefits are only payable for a loss incurred and treatment of a diagnosed cancer while covered under the rider.

Cancer Treatment Center Evaluation or Consultation - Treatment opinion must be obtained at a national cancer institute designated comprehensive cancer treatment center. If the comprehensive cancer treatment center is located more than 50 miles from the covered person’s place of residence, an evaluation or consultation travel or lodging benefit is also payable. This benefit is payable in lieu of the transportation and lodging benefit and family member transportation and lodging benefit listed in the rider.

Second/Third Surgical Opinion - Surgery must be recommended by an attending physician as treatment for a diagnosed cancer. Second and/ or third surgical opinion must be obtained from the consulting physician prior to surgery. Surgical opinions for reconstructive, skin cancer or prosthesis surgeries are not covered under this benefit.

Drugs and Medicine - Anti-nausea and pain medication must be prescribed by a physician and administered while receiving radiation therapy, chemotherapy, immunotherapy, a covered surgery, bone marrow transplant or stem cell transplant due to cancer. This benefit does not in include coverage for associated administrative charges or drugs or medicines covered under the radiation therapy, chemotherapy, immunotherapy or hormone therapy benefits.

Hair Piece (Wig) - Must be needed as a direct result of cancer or treatment of cancer.

Transportation and Lodging - Travel by a covered person to the hospital that provides radiation therapy, chemotherapy, immunotherapy, bone marrow transplant, stem cell transplant or surgery due to cancer must be by scheduled bus, plane, train or car and be within the United States or its territories. Hospital must be prescribed by a physician, be the nearest hospital which offers the specialized treatment and be at least 50 miles away from the covered person’s residence, using the most direct route. Proof of coach fare for bus, plane, train transportation must be provided or the per mile benefit will be paid. Travel by car will be paid at the stated rate per mile for up to 1,000 miles round trip. Benefits will be provided for only one mode of transportation per round trip. If treatment is received while confined in a hospital, benefits for transportation will be paid once per hospital confinement. Lodging for the covered person must be in a single room in a motel, hotel or other accommodation acceptable to APL. Benefit will only be paid on the days the covered person receives specialized treatment on an outpatient basis.

Family Member Transportation and Lodging - Travel must be for an adult family to be near a covered person who is receiving treatment in the hospital at least 50 miles away from the covered person’s residence, using the most direct route. If the family member travels by bus, plane or train, you will have the option to receive the coach fare benefits or the per mile benefit. Proof of coach fare for bus, plane, train transportation must be provided or the per mile benefit will be paid. Travel by car will be paid at the stated rate per mile for up to 1,000 miles round trip.

Benefits will be provided for only one mode of transportation per round trip. If the covered person receives treatment while confined in a hospital, benefits for travel and/or lodging will be paid once per hospital confinement. If the family member and the covered person who is receiving treatment travel in the same car or lodge in the same room, benefits for travel and lodging will only be paid under the transportation and lodging benefit.

Blood, Plasma and Platelets - This benefit does not include coverage for any laboratory processes or colony stimulating factors.

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Group Cancer Insurance Ambulance - Transportation must be by licensed air or ground ambulance to a hospital or from one medical facility to another. Must be admitted as an inpatient and confined in a hospital for at least 18 consecutive hours for the treatment of cancer. If both air and ground ambulance is required on the same day, only the highest benefit amount will be paid.

Inpatient Special Nursing Services - Full-time special nursing care for the treatment of cancer (other than that regularly furnished by a hospital), must be provided by a nurse and prescribed by a physician. Care must be for at least eight consecutive hours during a 24-hour period.

Outpatient Special Nursing Services - Outpatient full-time private duty nursing for the treatment of cancer at the covered person’s home must be provided by a nurse, prescribed by a physician and begin within 14 days following a hospital confinement for the treatment of cancer.

Care must be for at least eight consecutive hours during a 24-hour period. Payable for up to the same number of days of the covered person’s preceding hospital confinement. If both inpatient special nursing services and outpatient special nursing services occur within the same 24hour period, only the inpatient special nursing services benefit will be paid.

Medical Equipment - Rental or purchase of medical equipment, as listed in the rider, must be prescribed by a physician for the treatment of cancer. This benefit will not be paid while the covered person is confined in a hospital.

Physical, Occupational, Speech, Audio Therapy or Psychotherapy - Must be advised by a physician as a result of cancer or treatment of cancer and performed by a licensed caregiver. If two or more therapies occur on the same day, only one benefit will be paid.

Waiver of Premium You must remain disabled for 60 continuous days due to cancer and disability must occur while receiving treatment for such cancer. Proof of disability must be provided to APL. Proof includes, but is not limited to, a physician’s statement containing the date the cancer was diagnosed, the date disability due to cancer began, the expected date, if any, the disability will end and an employer’s statement with the last date of work and expected date of return, if known. Waiver of Premium will continue for as long as you remain disabled until the earliest of the following: the date you are no longer disabled; the date coverage ends according to the termination provisions in the certificate; or the date coverage ends according to the termination provisions in this rider. Proof of disability must be provided for each new period of disability.

Limitations and Exclusions No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date of the rider regardless of when a specified disease was diagnosed.

Internal Cancer First Occurrence Benefit Rider First diagnosis of internal cancer must be while the rider is in force. Internal cancer must be positively diagnosed by a legally licensed doctor of medicine certified by the American Board of Pathology or American Board of Osteopathic Pathology. Diagnosis must be made based on microscopic examination of fixed tissue or preparations from the hemic system (either during life or postmortem). Internal cancer does not include other conditions that may be considered pre-cancerous or having malignant potential as defined in your certificate. Benefits reduce 50% at age 70.

Limitations and Exclusions No benefits will be paid for a diagnosis of a metastasis to a new site of any cancer diagnosed prior to the covered person’s effective date, as this is not considered a first diagnosis of an internal cancer.

Hospital Intensive Care Unit Rider Benefits will not be paid for an ICU or step-down unit confinement that begins prior to the effective date of coverage. Refer to your certificate for confinement not covered under this benefit. Benefits reduce by 50% at age 70.

Limitations and Exclusions No benefits will be paid for any loss caused by or resulting from an intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war declared or undeclared, or any act related to war, or active service in the armed forces, or military service for any country at war; (If coverage is suspended for any covered person during a period of military service, APL will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the policyholder’s written request.); participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions; participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place); for a newborn child born within the 10-month period following the effective date for confinements that begin within the first 30 days following the birth of such child; or for confinements caused by any heart condition during the first two years following the effective date of coverage when any heart condition was diagnosed or treated prior to the end of the 30-day period following the covered person’s effective date. The heart condition causing the confinement need not be the same condition diagnosed or treated prior to the effective date.

Benefit Rider(s) Termination of Coverage Rider(s) will terminate and coverage will end for all covered persons on the earliest of any of the following: the end of the grace period if the

APSB-22585(TX)-0222

Page 8 of 9

Group Cancer Insurance premium for the rider remains unpaid; the date the policy or certificate to which the rider is attached terminates; the end of the certificate month in which APL receives a request from the policyholder to terminate the rider; the date of your death; if applicable to the plan, the date the lump sum benefit amount for the internal cancer first occurrence benefit rider has been paid for all covered persons under the rider; and if applicable to the plan, the date of covered person’s death or the date the lump sum benefit amount for the heart attack/stroke benefit rider has been paid for all covered persons under the rider. Coverage for an eligible dependent terminates under the rider when such person ceases to meet the definition of eligible dependent.

Additional Riders Portability Rider You may elect portability coverage when coverage ends under the policy for reasons other than non-payment of premium. The requirements for election of portability, election of dependent portability and termination of portability will be defined in rider attached to your certificate.

When elected, APL will notify you of the amount of premium due, the frequency of the premium payments and the premium due dates.

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606

If the cancer insurance premium is paid on a pre-tax basis, the benefit may be taxable. Please contact your tax or legal advisor regarding tax treatment of your policy benefits.

Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. This product contains Limitations, Exclusions and Waiting Periods. For complete benefits and other provisions, please refer to your policy/certificate. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GC14APL Series | Texas | Limited Benefit Group Specified Disease Cancer Insurance | (02/22)

APSB-22585(TX)-0222

Page 9 of 9

Offered by Life Insurance Company of North America

Employee-Paid

CRITICAL ILLNESS INSURANCE Prepared for: Llano Independent School District

SUMMARY OF BENEFITS

Critical Illness insurance provides a cash benefit when a Covered Person is diagnosed with a covered critical illness or event after coverage is in effect. 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 20 hours per week and regularly residing in the United States and who are United States citizens or permanent resident aliens and their Spouse, Domestic Partner, or Civil Union Partner and Dependent Children who are United States citizens or permanent resident aliens and who are residing in the United States.

You will be eligible to elect coverage on the first of the month following Date of Hire.

Your Spouse/Domestic Partner: 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 will be paid regardless of the actual expenses incurred. The benefit descriptions are a summary only. There are terms, conditions, state variations, exclusions and limitations applicable to these benefits.

Please read all of the information in this Summary and your Certificate of Insurance for more information. All Covered Critical Illness Conditions must be due to disease or sickness.

Benefit Amount

Guaranteed Issue Amount

Employee $10,000, $20,000, $30,000 Spouse $5,000, $10,000, $15,000 Children $2,500, $5,000, $10,000 See “Guaranteed Issue” section below for more information.

Up to $30,000 Up to $15,000 All guaranteed issue

Covered Conditions

Benefit Amount

Cancer Conditions Skin Cancer*

$250 1x per lifetime

Covered Conditions Invasive Cancer Carcinoma in Situ Vascular Conditions Heart Attack Stroke Coronary Artery Disease Nervous System Conditions Advanced Alzheimer's Disease Amyotrophic Lateral Sclerosis (ALS) Parkinson's Disease Multiple Sclerosis Childhood Conditions* Cerebral Palsy Cystic Fibrosis Muscular Dystrophy Poliomyelitis

Initial Benefit Amount %

Recurrence % of Initial Benefit Amount

100% 25%

100% 25%

100% 100% 25%

100% 100% 25%

50% 100% 50% 100%

Not Available Not Available Not Available Not Available

100% 100% 100% 100%

Not Available 100% 100% Not Available

Covered Conditions

Initial Benefit Amount %

Recurrence % of Initial Benefit Amount

Other Specified Conditions Benign Brain Tumor 100% 100% Blindness 100% Not Available Coma 25% 25% End-Stage Renal (Kidney) Disease 100% 100% Major Organ Failure 100% 100% Paralysis 100% 100% For Childhood Conditions please refer to the beginning of the Available Coverage section above for details on how much coverage is available for covered children.

Wellness Treatment, Health Screening Test and Preventive Care Benefit* Examples includes (but are not limited to) routine gynecological exams, general health exams, mammography, and certain blood tests. The benefit amount shown will be paid regardless of the actual expenses incurred and is paid on a per day basis. Also includes COVID-19 Immunization, Tests, and Screenings.

Virtual Care accepted.

Benefits Initial Critical Illness Benefit

Recurrence Benefit Skin Cancer Benefit Maximum Lifetime Limit

Benefit Amount $50 1 per year

Benefit for a diagnosis made after the effective date of coverage for each Covered Condition shown above. The amount payable per Covered Condition is the Initial Benefit Amount multiplied by the applicable percentage shown. Each Covered Condition will be payable one time per Covered Person, subject to the Maximum Lifetime Limit. A 180 days separation period between the dates of diagnosis is required.* Benefit for the diagnosis of a subsequent and same Covered Condition for which an Initial Critical Illness Benefit has been paid, payable after a 12 month separation period from diagnosis of a previous Covered Condition, subject to the Maximum Lifetime Limit.

Pays benefit stated above.

The maximum benefit payable per Covered Person is the lesser of 5 times the elected Benefit Amount or $150,000. The following benefits are not subject to this limit: Skin Cancer

Portability Feature: You can continue 100% of coverage for all Covered Persons 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: Employee Age Band <25 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 to 74 75 to 79 80 to 84 85 to 89 90 to 94 95+

$10,000

$20,000

$30,000

$3.00 $3.49 $4.98 $7.28 $9.63 $12.99 $17.87 $23.78 $31.86 $40.80 $55.57 $74.90 $89.76 $124.10 $124.10 $124.10

$6.00 $6.98 $9.96 $14.56 $19.26 $25.98 $35.74 $47.56 $63.72 $81.60 $111.14 $149.80 $179.52 $248.20 $248.20 $248.20

$9.00 $10.47 $14.94 $21.84 $28.89 $38.97 $53.61 $71.34 $95.58 $122.40 $166.71 $224.70 $269.28 $372.30 $372.30 $372.30

Spouse Age Band <25 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 to 74 75 to 79 80 to 84 85 to 89 90 to 94 95+

$2,500 $1.23

$5,000

$10,000

$15,000

$1.73 $1.89 $2.30 $3.41 $4.50 $6.53 $10.23 $15.23 $19.98 $24.00 $33.65 $43.40 $56.17 $77.49 $77.49 $77.49

$3.45 $3.77 $4.60 $6.81 $9.00 $13.06 $20.45 $30.46 $39.96 $48.00 $67.30 $86.79 $112.33 $154.97 $154.97 $154.97

$5.18 $5.66 $6.90 $10.22 $13.50 $19.59 $30.68 $45.69 $59.94 $72.00 $100.95 $130.19 $168.50 $232.46 $232.46 $232.46

Children $5,000 $2.46

$10,000 $4.91

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

The policy’s rate structure is based on attained age, which means the premium can increase due to the increase in your age.

Important Policy Provisions and Definitions: Covered Person: An eligible person who is enrolled for coverage under the Policy.

Covered Loss: A loss that is specified in the Policy in the Schedule of Benefits section and suffered by the Covered Person within the applicable time period described in the Policy.

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 all 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.

When your coverage ends: Coverage ends on the earliest of the date you and your dependents 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 dependent, 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. Be sure to read the provisions in your Certificate about when coverage may continue.)

30 Day Right To Examine Certificate: If a Covered Person is not satisfied with the Certificate of Insurance 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.

Benefit Reductions, Common Exclusions and Limitations: Exclusions: In addition to any benefit-specific exclusions, benefits will not be paid for any Covered Loss that is caused directly or indirectly, in whole or in part by any of the following:• intentionally self-inflicted injury, suicide or any attempt thereat while sane or insane; • commission or attempt to commit a felony or an assault; • declared or undeclared war or act of war; • a Covered Loss that results from 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; • operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant (‘’Under the influence of alcohol’’, for purposes of this exclusion, means intoxicated, as defined by the law of the state in which the Covered Loss occurred)• a diagnosis not in accordance with generally accepted medical principles prevailing in the United States at the time of the diagnosis.

Specific Definitions, Benefit Exclusions and Limitations: The date of diagnosis must occur while coverage is in force and the condition definition must be satisfied. Only one Initial Benefit will be paid for each Covered Condition per person and benefits will be subject to separation periods and Maximum Lifetime Limits.

Skin Cancer, basal cell/squamous cell carcinoma or certain forms of melanoma.

Invasive Cancer, uncontrolled/abnormal growth or spread of invasive malignant cells. Excludes pre-malignant conditions or conditions with malignant potential, carcinoma in situ, basal cell carcinoma, squamous cell carcinoma of the skin, unless metastatic disease develops, melanoma that is diagnosed as Clark’s Level I or II or Breslow less than 0.75mm, or melanoma in situ, or prostate tumor that is classified as T-1a, b, or c, N-0, and M-0 on a TNM classification scale. Also excludes the recurrence or metastasis of an original Cancer that was diagnosed prior to the coverage effective date if the Insured has undergone treatment for such cancer within 12 months of being diagnosed with cancer while under this coverage.

Carcinoma in Situ, non-invasive malignant tumor. Excludes premalignant conditions or conditions with malignant potential, skin cancers, invasive cancer (basal/squamous cell carcinoma or melanoma/ melanoma in situ).

Heart Attack, includes the following that confirms permanent loss of heart muscle function: 1) EKG; 2) elevation of cardia enzyme.

Stroke, cerebrovascular event–for instance, cerebral hemorrhage–confirmed by neuroimaging studies and neurological deficits lasting 96 hours or more. Excludes transient ischemic attack (TIAs), brain injury related to trauma or infection, brain injury associated with hypoxia or anoxia, vascular disease affecting eye or optic nerve or ischemic disorders of the vestibular system.

Coronary Artery Disease, heart disease/angina requiring coronary artery bypass surgery, as prescribed by a Physician.

Excludes angioplasty (percutaneous coronary intervention) and stent implantation.

Advanced Alzheimer’s Disease, progressive degenerative disorder that attacks the brain’s nerve cells resulting in the inability to perform 3 or more of the Activities of Daily Living.

Amyotrophic Lateral Sclerosis (ALS aka Lou Gehrig’s Disease), motor neuron disease resulting in muscular weakness and atrophy.

Parkinson’s Disease, progressive, degenerative neurologic disease with indicated signs of the disease.

Multiple Sclerosis, disease involving damage to brain and spinal cord cells with signs of motor or sensory deficits confirmed by MRI. Cerebral Palsy, brain injury or abnormality occurring within 24 hours of birth resulting in developmental brain disorder.

Cystic Fibrosis, progressive disorder that affects exocrine glands.

Muscular Dystrophy, progressive disorder that interferes with formation of healthy muscles.

Poliomyelitis, acute, infectious disease caused by the poliovirus with indicated signs of the disease. Excludes nonparalytic polio or post-polio syndrome.

Benign Brain Tumor, non-cancerous abnormal cells in the brain.

Blindness, irreversible sight reduction in both eyes; Best corrected single eye visual acuity less than 20/200 (E-Chart) or 6/60 (Metric) or with visual field reduction (both eyes) to 20 degrees or less. May require loss be due to specific illness.

Coma, unconscious state lasting at least 96 continuous hours. Excludes any state of unconsciousness intentionally or medically induced from unconsciousness intentionally which the Covered Person is able to be aroused.

End-Stage Renal (Kidney) Disease, chronic, irreversible function of both kidneys. Requires hemo or peritoneal dialysis.

Major Organ Failure, includes: liver, lung, pancreas, kidney, heart or bone marrow. Happens when transplant is prescribed or recommended and placed on UNOS registry. If the Covered Person has a combination transplant (i.e. heart and lung), a single benefit amount will be payable. Recurrence Benefit not payable for same organ for which a benefit was previously paid.

Paralysis, complete, permanent loss of use of two or more limbs due to a disease. Excludes loss due to Stroke and Multiple Sclerosis.

Guaranteed Issue: If you are a new hire you are not required to provide proof of good health if you enroll during your employer's eligibility waiting period and you choose an amount of coverage up to and including the Guaranteed Issue Amount. If you apply for an amount of coverage greater than the Guaranteed Issue Amount, coverage in excess of the Guaranteed Issue Amount will not be issued until the insurance company approves acceptable proof of good health. Guaranteed Issue coverage may be available at other specified periods of time. Your employer will notify you when these periods of time are available.

Your Spouse must be age 18 or older to apply if evidence of insurability is required. *State Variations Spouse definition includes civil union partners in New Hampshire and Vermont. 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 ID, MN, NC, SC, SD, VT and WA. Wellness Treatment, Health Screening Test and Preventive Care Benefit is referred to as Health Screening Test and Preventive Care Benefit in WA. The Wellness Treatment and Preventive Care Benefit is not available

*State Variations to ID residents. Preventive Care Benefit may not be available to NC residents. 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 2.0/2.1 Terms and conditions of coverage for Critical Illness Insurance are set forth in Group Policy No. CI962329. 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. Insurance coverage is issued on group policy form number: Policy Form GCI-02-1000. 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.

905808 11/19 © 2022 Cigna. Some content provided under license.

MEMBER INFORMATION Providing Fast And Convenient Care For Your Medical Needs…

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life insurance you can keep!

purelife-plus

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

You own it

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

You pay for it through convenient payroll deductions

You can cover your spouse, children and grandchildren, too2

You can get a living benefit if you become terminally ill3

It’s Affordable

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

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

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

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

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

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

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

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