LLANO ISD 24-25 BENEFITS GUIDE

LLANO INDEPENDENT SCHOOL DISTRICT

2024-2025

BENEFITS GUIDE Rusty Freeman & Associates LLC 245 LandaStreet New Braunfels, TX 78130 Phone: (830) 606-5100 www.usebsg.com 1

Llano Independent School District

District Contact Lisa Reed LLANO HR COORDINATOR Office: (325) 247-4747 Email: lreed@llanoisd.org

U. S. Employee Benefit Services Contacts Monica Muniz

Randi Freeman

Account Manager

Account Manager Office: (830) 606-5100

Email: mmuniz@usebsg.com

Rmfreeman@usebsg.com 1

Table of Content

Page

Medical – TRS Activecare

5-10

Health Savings Account – EECU

11-12

Group Life – Unum

13-14

Voluntary Life – Unum

15-17

Hospital Indemnity – The Hartford

18-20

Dental – Humana

21-24

Vision – Eyetopia

25-26

Disability – Unum

27-28

Accident – American Public Life (APL)

29-34

Medical Transportation – MASA

35

Cancer – American Public Life (APL)

36-44

Telemedicine – 1800MD

45-46

Legal Services – Legal Shield

47-52

Texas Life - Permanent Life

53-56

Flexible Spending Account - NBS

57-58

Retirement Plans – The Omni Group

59

Benefit Contacts Benefit

Phone

Website

TRS ACTIVECARE – MEDICAL

1-866-355-5999WWW.BCBSTX.COM/TRSACTIVECARE

EECU – HEALTH SAVINGS ACCOUNT

1-817-882-0800 WWW.EECU.ORG

UNUM – GROUP & VOLUNTARY LIFE

1-866-679-3054 WWW.UNUM.COM

THE HARTFORD – HOSPITAL INDEMNITY HUMANA – DENTAL

1-800-523-2233 WWW.THEHARTFORD.COM 1-800-448-6262 WWW.HUMANA.COM

EYETOPIA – VISION UNUM – DISABILITY

1-830-964-6444 WWW.EYETOPIA.COM 1-866-679-3054 WWW.UNUM.COM

AMERICAN PUBLIC – ACCIDENT & CANCER

1-800-256-8606 WWW.AMPUBLIC.COM

MASA – MEDICAL TRANSPORT

1-954-334-8261 WWW.MASAMTS.COM

1800MD – TELEMEDICINE

1-800-423-2765 WWW.1800MD.COM

LEGAL SHIELD – LEGAL SERVICES

1-800-654-7757 WWW.LEGALSHIELD.COM

TEXAS LIFE – PERMANENT LIFE

1-800-283-9233 WWW.TEXASLIFE.COM

NBS – FLEXIBLE SPENDING ACCOUNT

1800-274-0503 WWW.NBSBENEFITS.COM

THE OMNI GROUP – RETIREMENT PLAN

1-877-544-6664 WWW.OMNI403b.com

2

EZK>>D Ed & YΖ^ INTRODUCTION 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

HOW DO I ENROLL? Visit ǁǁǁ͘ŵLJďĞŶĞĮƚƐŚƵď͘ĐŽŵͬůůĂŶŽŝƐĚ 1. Select "Log In" on the top right-hand corner.

2. Fill in your last name, date of birth, and the last four digits of your social security number, then click "Log In." 3. On the following page, enter the authentication code you'll receive this via text.

4. After entering the code, you'll be logged in.

Proceed to review and sign off on acknowledgements, confirm your demographic information, and then make your elections for the new plan year.

• 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.

MID-YEAR CHANGES 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 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

WHEN WILL I RECEIVE ID CARDS? 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 tŚĞŶ ĂĚĚŝŶŐ ĚĞƉĞŶĚĞŶƚƐ ĨŽƌ ƚŚĞ ĮƌƐƚ ƟŵĞ͕ ƉůĞĂƐĞ ƉƌŽǀŝĚĞ͕ ĚĂƚĞ ŽĨ ďŝƌƚŚ͕ ŐĞŶĚĞƌ ĂŶĚ ƐŽĐŝĂů ƐĞĐƵƌŝƚLJ ŶƵŵďĞƌ͘

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.

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

USEBSG KĸĐĞ͗ (830)606-5100

@ 3

Login Process 5P BDDFTT ZPVS FOSPMMNFOU TJUF 5)&CFOFGJUT)6# ZPV DBO MPHJO UP UIF GPMMPXJOH XFCTJUF XXX NZCFOFGJUTIVC DPN Llanoisd

On the login page, you will enter your Last Name, Date of Birth, and Last Four (4) of Social Security Number.

THEbenefitsHUB checks behind the scenes to confirm employment status.

Once confirmed, the Additional Security Verification page will list the contact options from your profile.

Select either Text, Email, Call, or Ask Admin options to get a code to complete the final verification step.

Enter the code that you receive and click Verify.

You can now complete your benefits enrollment!

4

Llano Independent School District 2024-2025 TRS-ActiveCare Rates - Region 13 TRS-ActiveCare Primary+

TRS-ActiveCare HD

TRS-ActiveCare 2

Employee Only

Premium: $445 District Pay: $445.00 Employee Cost: $0.00

Premium: $522.00 District Pay: $445.00 Employee Cost: $77.00

Premium: $460.00 District Pay: $445.00 Employee Cost: $15.00

Premium: $1,013.00 District Pay: $445.00 Employee Cost: $568.00

Employee and Spouse

Premium: $1,202.00 District Pay: $445.00 Employee Cost: $757.00

Premium: $1,358.00 District Pay: $445.00 Employee Cost: $913.00

Premium: $1,242.00 District Pay: $445.00 Employee Cost: $797.00

Premium: $2,402.00 District Pay: $445.00 Employee Cost: $1,957.00

Premium: $757.00 Employee and Child(ren) District Pay: $445.00 Employee Cost: $312.00

Premium: $888.00 District Pay: $445.00 Employee Cost: $443.00

Premium: $782.00 District Pay: $445.00 Employee Cost: $337.00

Premium: $1,507.00 District Pay: $445.00 Employee Cost: $1,062.00

Premium: $1,723.00 District Pay: $445.00 Employee Cost: $1278.00

Premium: $1,564.00 District Pay: $445.00 Employee Cost: $1,119.00

Premium: $2,841.00 District Pay: $445.00 Employee Cost: $2,396.00

Tier

Employee and Family

TRS-ActiveCare Primary

Premium: $1,513.00 District Pay: $445.00 Employee Cost: $1,068.00

5

BCBSTX West Texas HMO Monthly Premiums Coverage Tier

2024 Plan Year Premiums Per Month

Employee Only

Premium: $1011.20 District Pay: $445.00 Employee Cost: $566.20

Employee & Spouse

Premium: $2,462.32 District Pay: $445.00 Employee Cost: $2,017.32

Employee & Child(ren)

Premium: $1,593.00 District Pay: $445.00 Employee Cost: $1,148.00

Employee & Family

Premium: $2,614.90 District Pay: $445.00 Employee Cost: $2,169.99

6

TRS-ActiveCare has more doctors and hospitals than the hill country has hills.

TRS-ActiveCare Plan Highlights 2024-25 Learn the Terms.

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

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

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

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

•O ut-of-Pocket Maximum: The maximum amount you pay each year for medical costs. After reaching the out-of-pocket 7 maximum, the plan pays 100% of allowable charges for covered services.

765394.0424

2024-25 TRS-ActiveCare Plan Highlights Sept. 1, 2024 – Aug. 31, 2025 How to Calculate Your Monthly Premium

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

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

Total Monthly Premium Your Employer Contribution

TRS-ActiveCare Primary+

Plan Summary

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

Being healthy is easy with: • $0 preventive care • 24/7 customer service • One-on-one health coaches

TRS-ActiveCare HD

• Lower deductible than the HD and Primary plans • Copays for many services and drugs • Higher premium • Statewide network • Primary Care Provider referrals required to see specialists • Not compatible with a Health Savings Account • No out-of-network coverage

TRS-ActiveCare 2

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

• 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 Primary Care Providers or referrals

Total Premium

Employer Contribution

Your Premium

Total Premium

Employer Contribution

Your Premium

Total Premium

Employer Contribution

Your Premium

Total Premium

Employer Contribution

Your Premium

Employee Only

$445

$445

$0

$522

$445

$77

$460

$445

$368

$1,013

$445

$568

Employee and Spouse

$1,202

$445

$757

$1,358

$445

$913

$1,242

$445

$2,402

$445

$1,957

$757

$445

$312

$888

$445

$443

$797

Employee and Children

$782

$445

$337

$1,507

$445

$1,059

$445

$1,278

$1,564

$445

$1,119

$2,841

$445

$2,396

Monthly Premiums

Wellness Benefits at No Extra Cost*

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

Employee and Family

$1,513

$445

$1,068

$1,723

Plan Features Type of Coverage Individual/Family Deductible Coinsurance Individual/Family Maximum Out of Pocket

In-Network Coverage Only

In-Network

Out-of-Network

In-Network

$2,500/$5,000

$1,200/$2,400

$3,200/$6,400

$6,400/$12,800

$1,000/$3,000

Out-of-Network $2,000/$6,000 You pay 40% after deductible $23,700/$47,400

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

$8,050/$16,100

$6,900/$13,800

$8,050/$16,100

$20,250/$40,500

$7,900/$15,800

Statewide Network

Statewide Network

Nationwide Network

Nationwide Network

PCP Required

Yes

Yes

No

No

Primary Care

$30 copay

$15 copay

You pay 30% after deductible

You pay 50% after deductible

$30 copay

You pay 40% after deductible

Specialist

$70 copay

$70 copay

You pay 30% after deductible

You pay 50% after deductible

$70 copay

You pay 40% after deductible

Urgent Care

$50 copay

$50 copay

You pay 30% after deductible

You pay 50% after deductible

$50 copay

You pay 40% after deductible

Network

• Weight loss programs

In-Network Coverage Only

• Nutrition programs • OviaTM pregnancy support

Doctor Visits

• TRS Virtual Health • Mental health benefits • And much more! * Available for all plans.

See the benefits guide for more details.

Immediate Care Emergency Care

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay a $250 copay plus 20% after deductible

TRS Virtual Health‑RediMDTM

$0 per medical consultation

$0 per medical consultation

$30 per medical consultation

$0 per medical consultation

TRS Virtual Health‑Teladoc

$12 per medical consultation

$12 per medical consultation

$42 per medical consultation

$12 per medical consultation

Integrated with medical

$200 deductible per participant (brand drugs only)

Integrated with medical

$200 brand deductible

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

$15/$45 copay

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

$20/$45 copay

®

Primary Plans & Mental Health • Both Primary and Primary+ offer $0 virtual mental health visits with any in-network provider.

Prescription Drugs Drug Deductible Generics (31-Day Supply/90-Day Supply) Preferred (Max does not apply if brand is selected and generic is available)

You pay 30% after deductible

You pay 25% after deductible ($100 max)/ You pay 25% after deductible ($265 max)

You pay 25% after deductible

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

Non-preferred

You pay 50% after deductible

You pay 50% after deductible

You pay 50% after deductible

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

Specialty (31-Day Max)

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

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

You pay 20% after deductible

Insulin Out-of-Pocket Costs

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

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

You pay 25% after deductible

$0 if SaveOnSP eligible; You pay 30% after deductible ($200 min/$900 max)/ No 90-day supply of specialty medications $25 copay for 31-day supply; $75 for 61-90 day8supply

Compare Prices for Common Medical Services

REMEMBER: Benefit

Call a Personal Health Guide 24/7 to help you find the best price for a medical service.

Reach them at 1-866-355-5999.

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 50% after deductible

You pay 40% 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 copay per incident)

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

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

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

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

$15 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

Bariatric Surgery

Outpatient: You pay 20% after deductible

Not Covered

Not Covered

Not Covered

Only covered if rendered at a BDC+ facility

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

www.trs.texas.gov Revised 04/30/24

9

2024-25 Health Maintenance Organization Plans and Premiums for Select Regions of the State

REMEMBER:

When you choose an HMO, you’re choosing a regional network.

TRS contracts with HMOs in certain regions to bring participants in those areas additional options.

HMOs set their own rates and premiums. They’re fully insured products who pay their own claims.

Total Monthly Premiums

Blue Essentials - South Texas HMOSM

Blue Essentials - West Texas HMOSM

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: Cameron, Hildalgo, Starr, Willacy

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

Total Premium

Employer Contribution

Your Premium

Total Premium

Employer Contribution

Your Premium

Employee Only

-

-

-

$1,011.20

-

-

Employee and Spouse

-

-

-

$2,462.32

-

-

Employee and Children

-

-

-

$1,593.00

-

-

Employee and Family

-

-

-

$2,614.90

-

-

Plan Features Type of Coverage

N/A

In-Network Coverage Only

Individual/Family Deductible

N/A

$950/$2,850

Coinsurance

N/A

You pay 25% after deductible

Individual/Family Maximum Out of Pocket

N/A

$7,450/$14,900

Primary Care

N/A

$20 copay

Specialist

N/A

$70 copay

Doctor Visits

Immediate Care Urgent Care

N/A

$50 copay

Emergency Care

N/A

$500 copay before deductible + 25% after deductible

Drug Deductible

N/A

$150

Days Supply

N/A

30-Day Supply/90-Day Supply

Prescription Drugs

Generics

N/A

$5/$12.50 copay; $0 for certain generics

Preferred Brand

N/A

You pay 30% after deductible

Non-preferred Brand

N/A

You pay 50% after deductible

Specialty

N/A

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

www.trs.texas.gov Revised 04/30/24

10

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.

11

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

Health Savings Account (HSA) Limits (Pre-tax contributions per calendar year) Single coverage $4,150 Family Coverage: $8,300 Catch up contributions; $1,000

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.

12

Llano Independent School District

All Full-Time Employees Policy 916098

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 20 20 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 can can receive receive a a benefit benefit amount amount of of $30,000.

You $30,000.

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

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13 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: • Disease 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) • Suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane • War, declared or undeclared, or any act of war • Active participation in a riot • Committing or attempting to commit a crime under state or federal law • The 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.

• Intoxication – “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 Employee: Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

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: • The date the policy or plan is cancelled • The date you no longer are in an eligible group • The date your eligible group is no longer covered • The last day of the period for which you made any required contributions • The 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

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14 Unum | Term Life Insurance

Llano Independent School District

All Full-Time Employees Policy 916099

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 20 hours per week, you may apply for coverage for: You:

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 previously purchased coverage, you can increase it up to $150,000 to meet your growing needs — with no medical underwriting.

Your spouse: Your spouse:

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:

Choose in in $1,000 Choosefrom from$10,000 $10,000toto$500,000 $500,000 $1,000 increments, earnings. increments,up uptoto55times timesyour your earnings.

If you previously purchased coverage, you can If you previously purchased you can increase it up to $150,000 withcoverage, no medical increase it upIftoyou $150,000 with no medical underwriting. previously declined coverage, you may have to answer some health underwriting.

If you previously declined questions.

coverage, you may have to answer some health questions.

Get up to $250,000 of coverage in $1,000

increments. Spouse coverage cannot exceed Get up $250,000 coverage $1,000 for 100% ofto the coverageofamount youinpurchase yourself. increments. Spouse coverage cannot exceed If you previously purchased coverage for your 100% of the coverage amount you purchase spouse, they can increase their coverage up to for yourself. $50,000 with no medical underwriting, if eligible (see delayed effective date). If coverage you previously If you previously purchased for your declined spouse coverage, some health spouse, they can increase their coverage up questions may be required.

to $50,000 with no medical underwriting, if eligible (see delayed effectiveindate).

If you Get up to $10,000 of coverage $1,000 increments if eligible spouse (see delayed effective date). previously declined coverage, some One policy covers all of your children until their health questions may be required.

26th birthday.

The maximum benefit for children live birth to 6 Get up to $10,000 of coverage in $1,000 months is $1,000.

increments if eligible (see delayed effective date). One policy covers all of your children Who can getuntil Accidental & Dismemberment their 26thDeath birthday.

(AD&D) coverage?

The maximum benefit for children live birth to 6 months is $1,000.

You:

Get up to $500,000 of AD&D coverage for yourself in $1,000 increments to a maximum of 5 times your earnings.

Your spouse:

Get up to $250,000 of AD&D coverage for your spouse in $1,000 increments, if eligible (see delayed effective date).

Your children:

Get up to $10,000 of coverage for your children in $1,000 increments if eligible (see delayed effective date).

No medical underwriting is required for AD&D coverage.

EN-1976

FOR EMPLOYEES

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15 Unum | Term Life Insurance

How much coverage can I get?

Calculate your costs 1. Enter the coverage amount you want.

2. Divide by the amount shown.

1

2

Employee

$______,000

÷ $1,000 = $________

X $______

= $_______

Spouse

$______,000

÷ $1,000 = $________

X $______

= $_______

Child

$______,000

÷ $1,000 = $________

X $______

= $_______

3. Multiply by the rate.

Use the rate table (at right) to find the rate based on age.

3

4

Total cost

Employee monthly rate

(Choose the age you will be when your coverage becomes effective on 09/01/2024. To determine your spouse rate, choose the age the spouse will be when coverage becomes effective on 09/01/2024.)

Age

Spouse monthly rate

monthly rate

Per $1,000 of coverage

Per $1,000 of coverage

$0.100 per $1,000 of coverage

Cost

Cost

$0.060 $0.070 $0.090 $0.110 $0.160 $0.260 $0.420 $0.680 $0.850 $1.470 $1.470 $1.470

$0.060 $0.070 $0.090 $0.110 $0.160 $0.260 $0.420 $0.680 $0.850 $1.470 $1.470 $1.470

15-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

4. Enter your cost.

1. Enter the AD&D coverage amount you want.

Child

AD&D

2. Divide by the amount shown.

3. Multiply by the rate.

Use the AD&D rate table (at right) to find the rate.

1

2

3

4

Employee

$______,000

÷ $1,000 = $________

X $0.020

= $_______

Spouse

$______,000

÷ $1,000 = $________

X $0.020

= $_______

Child

$______,000

÷ $1,000 = $________

X $0.040

= $_______

Total cost

4. Enter your cost.

AD&D monthly rates Coverage amount

Rate

Employee

per $1,000 of coverage

$0.020

Spouse

per $1,000 of coverage

$0.020

Child

per $1,000 of coverage

$0.040

Billed amount may vary slightly.

If you apply for coverage above the guaranteed issue amount, you may be subject to medical underwriting which may affect your ability to get the larger coverage amount. In order to purchase coverage for your dependents, you must buy coverage for yourself. Coverage amounts cannot exceed 100% of your coverage amounts.

EN-1976

FOR EMPLOYEES

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16 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: • Disease 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) • Suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane • War, declared or undeclared, or any act of war • Active participation in a riot • Committing or attempting to commit a crime under state or federal law • The 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.

• Intoxication – ‘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: • The date the policy or plan is cancelled • The date you no longer are in an eligible group • The date your eligible group is no longer covered • The last day of the period for which you made any required contributions • The 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: • The date your coverage under a plan ends • The date your dependent ceases to be an eligible dependent • For a spouse, the date of a divorce or annulment • For 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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17 Unum | Term Life Insurance

GROUP VOLUNTARY HOSPITAL INDEMNITY INSURANCE BENEFIT HIGHLIGHTS Llano Independent School District

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

Hospital Indemnity (HI) insurance pays a cash benefit if you or an insured dependent (spouse or child) are confined in a hospital for a covered illness or injury. It also provides additional daily benefits for related services. Even with the best primary health insurance plan, out-of-pocket costs from a hospital stay can add up.

The benefits are paid in lump sum amounts to you, and can help offset expenses that primary health insurance doesn’t cover (like deductibles, co-insurance amounts or copays), or benefits can be used for any non-medical expenses (like housing costs, groceries, car expenses, etc.).

To learn more about Hospital Indemnity insurance, visit thehartford.com/employee-benefits/employees

COVERAGE INFORMATION

You have a choice of three hospital indemnity plans, which allows you the flexibility to enroll for the coverage that best meets your needs.

Benefit amounts are based on the plan in effect for you or an insured dependent at the time the covered event occurs. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s).

PLAN INFORMATION

PLAN 1

PLAN 2

PLAN 3

Coverage Type

On and off-job (24 hour)

On and off-job (24 hour)

On and off-job (24 hour)

Covered Events

Illness and injury

Illness and injury

Illness and injury

HSA Compatible

Yes

Yes

Yes

PLAN 1

PLAN 2

PLAN 3

$500 $100 $1,000 $200

$1,000 $150 $2,000 $300

$2,000 $ 20 0 $4,000 $ 40 0

PLAN 1

PLAN 2

PLAN 3

$50

$50

$ 50

BENEFITS HOSPITAL CARE2 First Day Hospital Confinement Daily Hospital Confinement (Day 2+) First Day ICU Confinement Daily ICU Confinement (Day 2+)

Up to 1 day per year Up to 30 days per year Up to 1 day per year Up to 20 days per year

FAMILY CARE Health Screening

Up to 1 day per year

FEATURES

PLAN 1

PLAN 2

PLAN 3

Ability Assist® EAP3 – 24/7/365 access to help for financial, legal or emotional issues

Included

Included

Included

HealthChampion

Included

Included

Included

SM4

– Administrative & clinical support following serious illness or injury

PREMIUMS

The amounts shown are monthly amounts (12 payments/deductions per year).5

COVERAGE TIER

PLAN 1

PLAN 2

PLAN 3

Employee Only

$10.08 ($0.33 per day)

$17.25 ($0.57 per day)

$29.73 ($0.98 per day)

Employee & Spouse/Partner

$19.52 ($0.64 per day)

$33.32 ($1.10 per day)

$57.25 ($1.88 per day)

Employee & Child(ren)

$18.04 ($0.59 per day)

$30.91 ($1.02 per day)

$53.14 ($1.75 per day)

Employee & Family

$28.80 ($0.95 per day)

$49.24 ($1.62 per day)

$84.54 ($2.78 per day)

ASKED & ANSWERED

IS THIS COVERAGE HSA COMPATIBLE? If you (or any dependent(s)) currently participate in a Health Saving Account (HSA) or if you plan to do so in the future, you should be aware that the IRS limits the types of supplemental insurance you may have in addition to a HSA, while still maintaining the tax-exempt status of the HSA.

LLANO INDEPENDENT SCHOOL DISTRICT HOSPITAL INDEMNITY BHS_PUBLICATION DATE: 5/3/2022

0 013 752 1

18

This plan design was designed to be compatible with Health Savings Accounts (HSAs). However, if you have or plan to open an HSA, please consult your tax and legal advisors to determine which supplemental benefits may be purchased by employees with an HSA. WHO IS ELIGIBLE? You are eligible for this insurance if you are an active full-time employee who works at least 20 hours per week on a regularly scheduled basis Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26.

CAN I INSURE MY DOMESTIC OR CIVIL UNION PARTNER? Yes. Any reference to “spouse” in this document includes your domestic partner, civil union partner or equivalent, as recognized and allowed by applicable law.

AM I GUARANTEED COVERAGE? This insurance is guaranteed issue coverage – it is available without having to provide information about your or your family’s health. All you have to do is elect the coverage to become insured.

HOW MUCH DOES IT COST AND HOW DO I PAY FOR THIS INSURANCE? Premiums are provided above. You have a choice of plan options. You may elect insurance for you only, or for you and your dependent(s), by choosing the applicable coverage tier.

Premiums will be automatically paid through payroll deduction, as authorized by you during the enrollment process. This ensures you don’t have to worry about writing a check or missing a payment.

WHEN CAN I ENROLL? You may enroll during any scheduled enrollment period.

WHEN DOES THIS INSURANCE BEGIN? Insurance will become effective in accordance with the terms of the certificate (usually the first day of the month following the date you elect coverage).

You must be actively at work with your employer on the day your coverage takes effect. Your spouse and child(ren) must be performing normal activities and not be confined (at home or in a hospital/care facility), unless already insured with the prior carrier.

WHEN DOES THIS INSURANCE END? This insurance will end when you or your dependents no longer satisfy the applicable eligibility conditions, premium is unpaid, you are no longer actively working, you leave your employer, or the coverage is no longer offered.

CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO LONGER A MEMBER OF THIS GROUP? Yes, you can take this coverage with you. Your spouse/partner may also continue insurance in certain circumstances.

1“Kaiser Family Foundation, November 2019. Adjusted expenses per inpatient day include expenses incurred for both inpatient and outpatient care; inpatient days are adjusted higher to reflect an estimate of the volume

of outpatient services: https://www.kff.org/health-costs/state-indicator/expenses-per-inpatient-day, viewed as of 4/16/2021.

2For Hospital Care benefits, when an insured is eligible for more than one benefit in a single day, only the highest benefit will be paid.

3AbilityAssist® services are offered through The Hartford by ComPsych®. ComPsych is not affiliated with The Hartford and is not a provider of insurance services. The Hartford is not responsible and assumes no liability

for the goods and services provided by ComPsych and reserves the right to discontinue any of these services at any time. Services may not be available in all states. Visit https://www.thehartford.com/employeebenefits/value-added-services for more information.

4HealthChampionSM services are provided through The Hartford by ComPsych®. ComPsych is not affiliated with The Hartford and is not a provider of insurance services. The Hartford is not responsible and assumes no liability for the goods and services provided by ComPsych and reserves the right to discontinue these services at any time. Services may not be available in all states. Visit https://www.thehartford.com/employeebenefits/value-added-services for more information. HealthChampionSM specialists are only available during business hours. Inquiries outside of this timeframe can either request a call-back the next day or schedule an appointment.

5Rates and/or benefits may be changed on a class basis.

The Buck’s Got Your Back ®

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

Hospital does not include: convalescent homes, or convalescent, rest or nursing facilities; facilities affording primarily custodial, educational or rehabilitory care; or facilities primarily for care of the aged/elderly, persons with substance abuse issues/disorders or mental/nervous disorders. Confinement means the assignment to a bed in a medical facility for a period of at least 20 consecutive hours. Required hours may vary by state. The Hartford compensates both internal and external producers, as well as others, for the sale and service of our products. For additional information regarding Hartford’s compensation practices, please review our website http://thehartford.com/group-benefits-producer-compensation. Hospital Indemnity Form Series includes GBD-2800, GBD-2900, or state equivalent.

5962h NS 08/21

LLANO INDEPENDENT SCHOOL DISTRICT HOSPITAL INDEMNITY BHS_PUBLICATION DATE: 5/3/2022

00 137 52 1

19

LIMITATIONS & EXCLUSIONS This insurance coverage includes certain limitations and exclusions. The certificate details all provisions, limitations, and exclusions for this insurance coverage. A copy of the certificate can be obtained from your employer.

GROUP HOSPITAL INDEMNITY INSURANCE LIMITATIONS AND EXCLUSIONS

The benefits payable are based on the insurance in effect on the date of the covered event, subject to the definitions, limitations, exclusions and other provisions of the policy.

You and your dependent(s) must be citizens or legal residents of the United States, its territories and protectorates.

Other Hospital Indemnity Policy Limitation (Over-insurance Limitation): If an employee is insured under any other hospital indemnity policy underwritten by The Hartford, any claim for benefit is only payable under the one policy elected by the employee (or beneficiary or estate, in the event of death). We will return the amount of premium paid for any other policy that is declined by the employee retroactive to the later of: • the last date any benefit was paid for any covered person under the other policy • the effective date of insurance for the employee under the other policy Exclusions. This insurance does not provide benefits for any loss that results from or is caused by: • Suicide or attempted suicide, whether sane or insane, or intentional self-infliction • Voluntary intoxication (as defined by the law of the jurisdiction in which the illness or injury occurred) or while under the influence of any narcotic, drug or controlled substance, unless administered by or taken according to the instruction of a physician or medical professional • Voluntary intoxication through use of poison, gas or fumes, whether by ingestion, injection, inhalation or absorption • Voluntary commission of or attempt to commit a felony, voluntary participation in illegal activities (except for misdemeanor violations), voluntary participation in a riot, or voluntary engagement in an illegal occupation • Incarceration or imprisonment following conviction for a crime • Travel in or descent from any vehicle or device for aviation or aerial navigation, except as a fare-paying passenger in a commercial aircraft (other than a charter airline) on a regularly scheduled passenger flight or while traveling on business of the policyholder • Ride in or on any motor vehicle or aircraft engaged in acrobatic tricks/stunts (for motor vehicles), acrobatic/stunt flying (for aircraft), endurance tests, off-road activities (for motor vehicles), or racing • Participation in any organized sport in a professional or semi-professional capacity • Participation in abseiling, base jumping, Bossaball, bouldering, bungee jumping, cave diving, cliff jumping, free climbing, freediving, freerunning, hang gliding, ice climbing, Jai Alai, jet powered flight, kite surfing, kiteboarding, luging, missed climbing, mountain biking, mountain boarding, mountain climbing, mountaineering, parachuting, paragliding, parakiting, paramotoring, parasailing, Parkour, proximity flying, rock climbing, sail gliding, sandboarding, scuba diving, sepak takraw, slacklining, ski jumping, skydiving, sky surfing, speed flying, speed riding, train surfing, tricking, wingsuit flying, or other similar extreme sports or high risk activities • Travel or activity outside the United States or Canada • Active duty service or training in the military (naval force, air force or National Guard/Reserves or equivalent) for service/training extending beyond 31 days of any state, country or international organization, unless specifically allowed by a provision of the certificate • Involvement in any declared or undeclared war or act of war (not including acts of terrorism), while serving in the military or an auxiliary unit attached to the military, or working in an area of war whether voluntarily or as required by an employer This insurance also does not provide benefits, unless required by law, for: • Elective abortion or complications thereof • Artificial insemination, in vitro fertilization, test tube fertilization • Sterilization, tubal ligation or vasectomy, and reversal thereof • Aroma therapeutic, herbal therapeutic, or homeopathic services • Any mental and nervous disorder, unless specifically allowed by a provision of the certificate • Substance abuse, unless specifically allowed by a provision of the certificate • Medical mishap or negligence on the part of any physician, medical professional, or therapist, including malpractice; • Treatment, supplies or services provided by, through or, behalf of any government agency or program; unless payment is required by a covered person • Custodial care, unless specifically allowed by a benefit provision in the certificate or any rider attached to the policy (if applicable) • Elective or cosmetic surgery or procedures, except for reconstructive surgery: - Incidental to or following surgery for disease, infection or trauma of the involved body part - Due to congenital anomaly or disease of a dependent child which has resulted in a functional defect • Dental care or treatment, except for: - Treatment due to an Injury to sound natural teeth within 12 months of an accident - Treatment necessary due to congenital disease or anomaly

Exclusions will vary by the jurisdiction/state in which the policy is issued.

NOTICES THIS IS A HOSPITAL CONFINEMENT INDEMNITY POLICY. THE POLICY PROVIDES LIMITED BENEFITS. This limited benefit plan (1) does not constitute major medical coverage, and (2) does not satisfy the individual mandate of the Affordable Care Act (ACA) because the coverage does not meet the requirements of minimum essential coverage.

In New York: This policy provides limited benefits health insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services.

The Policy may provide payment of several benefits as a result of claims from a single hospitalization or covered incident. Payment of one benefit under the Policy does not constitute acceptance of liability for all claims made under the Policy nor does it prohibit Us from further investigation of subsequent claims.

Please note: For residents of CA, GA, NJ and NY, since this is a limited benefit health product, persons without comprehensive health benefits from an individual or group health insurance policy or an HMO, or an employer plan providing essential health benefits are not eligible for this insurance. For residents of CT, ID, ME, NH, and WV, a person covered by any Title XIX program (Medicaid or any similar name) is not eligible for this insurance.

5962h NS 05/21. Hospital Income Plan Form Series includes GBD-2800, GBD-2900, or state equivalent.

The Buck’s Got Your Back ®

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including underwriting company Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. All benefits are subject to the

LLANO INDEPENDENT SCHOOL DISTRICT LIMITATIONS & EXCLUSIONS_PUBLICATION DATE: 5/3/2022

00 137 52 1

20

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) x

50% after deductible

50% after deductible

xs[pspace

21

1-800-233-4013 | Humana.com

SGB0018A

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.

22

1-800-233-4013 | Humana.com

SGB0018A

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: • 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 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

See your dentist 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.

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

23

1-800-233-4013 | Humana.com

SGB0018A

24

Eyetopia 120/145 Standard Llano ISD Summary of Benefits Eyetopia Benefits Eyetopia provides two vision benefits each eligibility period. You may have the opportunity to maximize your Eyetopia benefits by coordinating benefits with your Health Insurance coverage.

BENEFIT ONE 2 (choose either one of the following 2 options every 12 months): 1. Refractive Exam. One routine Vision Exam.

2. Coverage towards a medical eye exam copay or other services or materials. 2

Co-pay1 $10.00 None

Allowance N/A $45.00

BENEFIT TWO (choose only 1 of the following Vision Correction Options): Eyetopia provides you with 3 options for correcting your vision every 12 months.3 Allowance Co-pay1 1. Prescription Lenses 4 $20.00 N/A CR-39 plastic single vision, bifocal, trifocal lenses.

N/A $20.00  CR-39 plastic Progressive (no-line multi-focal) lenses that retail for up to $199. $200.00 $20.00  CR-39 plastic Progressive (no-line multi-focal) lenses that retail for more than $199.

N/A $25.00  Polycarbonate material upgrade None Covered  Polycarbonate material upgrade for child dependents (under age 26) None Covered  Basic Coating (Ultraviolet Protection & Scratch Resistant Coating) None Covered  Mid-Level Anti-Reflective Coatings that retail up to $99.  Premium Anti-Reflective Coatings that retail for $100 or more copay not to exceed: N/A $130.00  Premium blue light blocking lenses or premium blue light blocking anti-reflective coating.

N/A $105.00  Tint (Solid or Gradient) N/A $12.00  Photochromic or Polarized Lenses N/A $90.00  Medically necessary spectacles for Aniseikonia or Amblyopia.5 $400.00 None $20.00  Anti-Fatigue lenses.

Covered $120 None ♦ Frame: The member may select any frame on display and is responsible for any amount exceeding the allowance.

2. Contact Lens Option: In lieu of spectacles. Allowance to be applied toward prescription contact lenses. ♦ This allowance can be applied toward the contact lens fitting fee and all other charges including follow-up visits and contact lenses.6 ♦ Medically necessary contact lenses - $145.00 evaluation allowance and $400.00 contact lens allowance.7 3. Refractive Surgery Option. 8 In lieu of spectacles or contact lenses. A $350.00 per eye allowance with contracted surgeons or a $75.00 per eye allowance with non-contracted surgeons toward the fees for refractive surgery care for the following procedures: LASIK, PRK, ICL or RLE. The member pays any amount exceeding the per eye allowance.

$145.00

$20.00

$545.00

None

$350/eye $75/eye

None

1 The co-pay must be paid to the Participating Provider at the time of service.

2 When Health Insurance Carriers offer a comprehensive medical eye exam it creates an overlap in benefits for Eyetopia Members. If this occurs, the Member may

choose another option under Benefit One as described, no co-pay is required to exercise these other options.

3 If your prescription has changed at least ½ diopter or your eye doctor recommends a change of lenses, you may select one of three vision correction options

every 12 months.

4

Special Lens Materials and Non-covered Items: Ultra-light, premium PALs, rush service, service agreements, other special lens materials, oversize, other extras and any items not specifically mentioned above may be substituted provided the Member pays any amount exceeding the price of the covered benefit and the Participating Provider’s usual and customary fees for the upgrade at the time of service.

5

The Shaw Lens coverage includes a premium anti-reflective coating and an upgraded lens material.

6 If the contact lens evaluation, fitting or dispensing service is performed and the Member decides to use their benefit toward an alternative vision correction

option, the Member must pay the cost of the contact lens evaluation, fitting or dispensing service before another vision correction benefit option can be used.

7

Total maximum benefit allowance is $545.00. The Participating Provider must pre-authorize medical necessity.

8 Non-covered Items and Exclusions – Facility fees, surgical procedures, medications and enhancements or treatments related to medical procedures.

3

Rates

4.

Included Services and/or Eye Wear. Only those professional vision care services and/or vision correction options specifically referenced herein are included in the Eyetopia.

Employee Only: $0 Employee + 1: $7 Employee + Fam: $14

In-Network coverage is available through Participating Providers. Out of network services are not covered.

For more information please contact customer service at (830) 964-6444 or toll free 800-662-8264 Support@Eyetopia.org or www.Eyetopia.org

25

Llano ISD

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26

Llano Independent School District

Educator Select Disability Insurance How does it work?

This coverage provides a monthly benefit if you have a covered illness or injury and you can’t work for a few months — or even longer.

You’re generally considered disabled if you’re unable to do important parts of your job — and your income suffers as a result.

Why is this coverage so valuable?

You can use the money however you choose. It can help you pay for your rent or mortgage, groceries, out-of-pocket medical expenses and more.

What else is included?

Survivor Benefit If you die while you’ve been disabled and receiving benefits for at least 180 days, your family could get a benefit equal to 3 months of your gross disability payment.

Waiver of premium If you’re disabled and receiving benefit payments for 90 consecutive days , Unum waives your cost until you return to work.

How much coverage can I get?

You are eligible for coverage if you are an active employee in the United States working a minimum of 20 hours per week.

.

You*

Choose from $200 to $8,000 a month, in $100 increments not to exceed 662/3 of your monthly salary.

Educator Select Disability Insurance can replace part of your income if a disability keeps you out of work for a long period of time

Return to Work/Work Incentive Benefit Unum supports efforts that enable remain a disabled on theemployee job or return to to work soon as possible.

If youas 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.

Elimination period (EP) The elimination period is the number of days that must pass after a covered accident or illness before you can begin to receive benefits.

You may choose from the following elimination periods (injury/illness): 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.)

The monthly benefit may be reduced or offset by other sources of income. *See the Legal Disclosures for more information.

Benefit duration (BD) This is the maximum length of time you can receive benefits while you’re disabled. You can receive benefits up to the Social Security (SS) normal retirement age.

Benefits will be paid for one month for disabilities caused by, contributed to by, or resulting from a pre-existing condition. See the disclosure section to learn more.

CE-1680650

FOR EMPLOYEES

(6-23)

27

Other Included Benefits Rehabilitation & 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: •coordination with your Employer to assist your return to work; •adaptive equipment or job accommodations to allow you to work; • vocational evaluation to determine how your disability may impact your employment options; • job placement services; • resume preparation; • job seeking skills training; or • 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: • you are participating in a Rehabilitation and Return to Work Assistance program; and • you are not able to find employment. *If you return to work in your usual occupation as a result of a modification made by your Employer, Unum will reimburse you or your Employer for up to $1,000.

The worksite modification benefit will be paid if Unum agrees to the modification in writing prior to its implementation. This benefit is available to you on a one time only basis.

Dependent Care Expense Benefit If you are disabled and participating in Unum 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: •are incurring expenses to provide care for a child under the age of 15; •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.

Pre-existing conditions You have a pre-existing condition if: • You received medical treatment, consultation, care or services including diagnostic measures for the condition, or took prescribed drugs or medicines for it 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.

Exclusions and limitations Active employee You are considered in active employment, if on the day you apply for coverage, you are being paid regularly by your employer for the required minimum hours each week and you are performing the material and substantial duties of your regular occupation.

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.

Benefit duration (BD) The duration of your benefit payments is based on your age when your disability occurs. Your Long Term Disability benefits are payable while you continue to meet the definition of disability. Please refer to your plan document for the duration of benefits under this policy.

CE-1680650

FOR EMPLOYEES (6-23)

Definition of disability You are considered disabled when Unum determines that: •You are limited from performing the material and substantial duties of your regular occupation due to sickness or injury; •You have a 20% or more loss of indexed monthly earnings due to the same sickness or injury; and •during the elimination period you are unable to perform any of the material and substantial duties of your regular occupation.

After 24 months, you are considered disabled when Unum determines that due to the same sickness orinjury, 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.

The loss of a professional or occupational license or certification does not, in itself, constitute disability.

“Substantial and material acts” means the important tasks, functions and operations that are generally required by employers from those engaged in your usual occupation and that cannot be reasonably omitted or modified.

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.

Deductible sources of income Your disability benefit may be reduced by deductible sources of income and any earnings you have while you are disabled, including such items as group disability benefits or other amounts you receive or are entitled to receive: • Workers’ compensation or similar occupational benefit laws, including a temporary disability benefit under a workers’ compensation law • State compulsory benefit laws • Automobile liability insurance policy • No fault motor vehicle plan • Third-party settlements • Other group insurance plans • A group plan sponsored by your employer • Governmental retirement system • Salary continuation or sick leave plans, if applicable • Retirement payments • 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 10% or $200 of the gross disability payment.

Exclusions and limitations Benefits will not be paid for disabilities caused by, contributed to by, or resulting from: • Intentionally self-inflicted injuries; • Active participation in a riot; • War, declared or undeclared or any act of war; • Commission of or attempt to commit a felony; • Loss of professional license, occupational license or certification; or • Pre-existing conditions (See the disclosure section to learn more).

• War, declared or undeclared; • Any period of incarceration while disabled The loss of a professional or occupational license does not, in itself, constitute disability.

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

The lifetime cumulative maximum benefit for all disabilities due to mental illness 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 can continue beyond 24 months only if you are confined to a hospital or institution as a result of the disability.

Termination of coverage Your coverage under the policy ends on the earliest of the following: • The date the policy or plan is cancelled • The date you no longer are in an eligible group • The date your eligible group is no longer covered • The last day of the period for which you made any required contributions • The last day you are in active employment except as provided under the covered layoff or leave of absence provision.

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

Unum’s LTD contracts standardly include a provision called the Social Security Claimant Advocacy Program.

With this feature, claimants can receive expert advice and assistance from us regarding their Social Security Disability claim during the application and appeal process. Social Security advocacy services are provided by GENEX Services, LLC or Brown & Brown Absence Services Group. Referral to one of our advocacy partners is determined by Unum.

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.

Underwritten by: Unum Life Insurance Company of America, Portland, Maine © 2023 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

28

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

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



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



Multiple coverage options for your whole family



Cost-effective premiums with convenient payroll deduction

RECEIVE treatment for a covered accident.

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

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

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 or for inpatient rehabilitation, if applicable to the plan, within the defined number of days after the date of discharge from the hospital

365 days

365 days

$500/5 days

$1,000/5 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.

29 APSB-22591(TXd)-0622

Group Accident Insurance Plan 1 Insured Benefit

Plan 2 Insured Benefit

Hospital Confinement Pays once per day

$100/365 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

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

Fracture (open reduction) - based on bone involved

$225 to $3,000

$450 to $6,000

Fracture (closed reduction) percentage

50% of open reduction benefit amount

50% of open reduction benefit amount

Chip fracture percentage1

25% of open reduction benefit amount

25% of open reduction benefit amount

$25 to $200/5 days

$50 to $400/5 days

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

Initial Treatment Benefits

Diagnostic Benefits

Therapy Benefits

Coma and Paralysis Benefits

Accidental Death Benefits

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

Fracture Benefits 1

Laceration Benefits Based on length of laceration Inpatient Surgery Benefits

30 APSB-22591(TXd)-0622

Group Accident Insurance Plan 1 Insured Benefit

Plan 2 Insured Benefit

Outpatient Surgery Benefits 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)

$1,250/5 days

$2,500/5 days

Brain Injury Benefits

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

$500 to $10,000

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

Auto & Home Modification

$500/5 times

$1,000/5 times

Blood/Plasma/Platelets

$300/5 days

$400/5 days

Ambulance Benefits

Emergency Dental & Vision Treatment Benefits

Appliance and Prosthesis Benefits

Other Benefits

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 days per month, up to 12 days per plan year

$5/3 days per month, up to 12 days 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.

31 APSB-22591(TXd)-0622

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

$26.45

$48.04

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

32 APSB-22591(TXd)-0622

Group Accident Insurance 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.

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

33 APSB-22591(TXd)-0622

Group Accident Insurance 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) 34 APSB-22591(TXd)-0622

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.

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35

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.

RECEIVE treatment for a covered benefit.

FILE your claim online or mail it in.



Radiation Therapy, Chemotherapy, Immunotherapy



Experimental Treatments



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

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/Pre-Existing Condition Exclusion Period

12 months/12 months

12 months/12 months

Cancer Plan Benefits

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

Mastectomy Confinement

$50 per day of hospital confinement

$50 per day of hospital confinement

Surgery

$25 per surgery

$25 per surgery

Prosthesis surgical or non-surgical; 1 device per site, per lifetime

$25

$25

Ovarian/Cervical Cancer Screening 1 test per calendar year

$10

$10

Prosthesis and Orthotic Device surgical or non-surgical

$25

$25

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

Optional Benefit Riders

36 APSB-22585(TXd)-1022

Group Cancer Insurance Plan 1 Insured Benefit

Plan 2 Insured Benefit

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

Stem Cell Transplant Maximum per lifetime

$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

US Government, Charity Hospital or HMO

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

$200 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

37 APSB-22585(TXd)-1022

Group Cancer Insurance Plan 1 Insured Benefit

Plan 2 Insured Benefit

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

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

38 APSB-22585(TXd)-1022

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.

39 APSB-22585(TXd)-1022

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; your natural child, adopted child or stepchild who is under 26 years of age; a child 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 Plan 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.

Mastectomy Confinement Payable following a mastectomy or lymph node dissection for the treatment of breast cancer.

Surgery Payable when a mastectomy is performed on a covered person for a covered diagnosed cancer and surgery is performed in the hospital.

Reconstructive surgery to the non-diseased breast must occur within a specified amount of time from the reconstructive surgery of the diseased breast, as determined to be appropriate by the covered person’s physician.

Prosthesis Payable for mastectomy related prosthesis and treatment of physical complications, including lymphedemas, at all stages of mastectomy.

Ovarian/Cervical Cancer Screening A charge must be incurred for the screening test. Payable without a diagnosis of cancer, but not payable for any test other than for the detection of ovarian and cervical cancer. Each of these tests are only payable annually, and second follow-up screening tests from an abnormal result are not covered under this benefit.

Prosthesis and Orthotic Device Benefit and Related Services Covered benefits are limited to the most appropriate model of prosthetic device or orthotic device that adequately meets the medical needs of the covered person as determined by the covered person’s treating physician. The prosthesis benefit will include repair or replacement of a prosthetic device or orthotic device, unless the repair or replacement is necessitated by misuse by the covered person. Prosthetic related supplies such as special bras or ostomy pouches and supplies are not covered. Benefits for prosthesis in relation to a mastectomy will only be payable under the mastectomy prosthesis benefit. Benefits for a hair prosthesis is 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 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.

40 APSB-22585(TXd)-1022

Group Cancer Insurance 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.

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.

41 APSB-22585(TXd)-1022

Group Cancer Insurance 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.

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.

42 APSB-22585(TXd)-1022

Group Cancer Insurance 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.

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 internal cancer received outside the territorial limits of the United States or 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.

43 APSB-22585(TXd)-1022

Group Cancer Insurance 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 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 | (10/22)

44 APSB-22585(TXd)-1022

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

COMMONLY TREATED CONDITIONS • Allergies

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• Access to licensed, board-certified physicians • Little or no time missed from work • No crowded waiting rooms or appointment times

HOW IT WORKS Activate your account online at www.1800MD.com or by calling member services at 1.800.530.8666. Once activated, you will need to setup your member profile and complete your electronic health record. Health and pharmacy information must be completed before requesting a consultation.

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Activate

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Receive Care

Login to your account online or call member services at 1.800.530.8666 to request a consult anytime 24/7.

Receive diagnosis and treatment. 1.800MD provides quality care and peace of mind wherever you are.

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What is 1.800MD? 1.800MD is a national telehealth company specializing in convenient, quality medical care. With board-certified physicians in all 50 states*, those in need can obtain diagnosis, ecessary, through the convenience of a telephone treatment and a prescription, when n and digital communications. *Subject to state regulations.

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

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

Can I get a consultation after hours or on weekends?

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

CONVENIENCE

Talk to a doctor any time, day or night, on the weekend or when traveling away from home. No inconvenience or hassle of traveling to the doctor’s office, urgent care or ER and waiting to be seen.

SAVES MONEY

1.800MD reduces unnecessary doctor’s office and emergency room visits. Up to 70 percent of all urgent care and emergency room visits are unneeded, costly and can be handled with a 1.800MD telephone or video consultation.

QUALITY CARE

With an average of 15 years of internal medicine, family practice or pediatrics experience, you can rest assured each physician is properly licensed in your state, board-certified and verified by the National Physician Data Base and the American Medical Association.

CONTINUITY OF CARE

Real-time access to medical records, and the ability to send them to your primary care physi-cian or other providers.

BENEFITS TO YOU

WELLNESS AND PREVENTATIVE HEALTH TOOLS

The 1.800MD member portal contains information and tools to help you make informed health care decisions.

E-PRESCRIPTIONS

If a 1.800MD physician recommends medication as part of your treatment plan, the prescription will be digitally sent to the local pharmacy of your choice.

www.1800md.com

CALL 1.800.530.8666 l.800MD does not replace the primary care physician. l.800MD does not guarantee that a prescription will be written. l.800MD operates subject to State regulations and may not be available in certain States. l.800MD does not prescribe DEA controlled substances, 46 non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. l.800MD physicians reserve the right to deny care for potential misuse of services.

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Mark Seguin - TBG Inc. Solutions Inc. Mark Seguin - TBG Solutions MyLegalShieldUSA.com Mark@MyLegalShieldUSA.com / 903.539.68212 Mark@MyLegalShieldUSA.com text/call 903.539.6821

47

LEGAL PLAN VÚËæ æ¬Ä¤ æ© ½ ¤ ½ Ú¬¤©æÞ Ë£ ì½½¬ËÄÞ Ë£ DËÚæ© Ã Ú¬ ÄÞDz = ¤ ½]©¬ ½ ¬Þ æ© ½ Ú¤ Þæ ½ ¤ ½ ×½ Ä ×ÚËõ¬ ÚǷ s¬æ© ƫƬ ü ÚÞ Ë£ û× Ú¬ Ä ¬Ä êÞæËÃ Ú ÄæÚ¬ ½ ¤ ½ ×½ ÄÞDz ö ©Ë½ ËêÚ ½ öü ÚÞ Ä Ã×½Ëü Þ æË ©¬¤© Þ ÚõÞæ Ä Ú ÞǷ s ȣõ Ú ×½ æ© æÚ ¬æ¬ËÄ ½ ×ÚËõ¬ Ú Ä æöËÚº ××ÚË ©Dz ö¬æ© ÃË ÚĬā Þ Úõ¬ Ä æöËÚº æ© æ ×½ Þ æ© × Úæ¬ ¬× ÄæȣÞ Ä Þ ĈÚÞæ Ä ×ÚËõ¬ Þ ©¬¤©ȗæ ©Dz ©¬¤©ȗæËê © Þ Úõ¬ û× Ú¬ Ä Ƿ

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Document Preparation

Advice c˽½ȗ£Ú שËÄ ËÄÞê½æ æ¬ËÄÞ ö¬æ© üËêÚ Provider Law Firm for any personal legal à ææ ÚDz õ Ä ËÄ ×Ú ȗ û¬Þæ¬Ä¤ ËÄ ¬æ¬ËÄÞ

Standard Will Preparation • Will preparation and annual reviews and updates for covered members • Other documents available: Living Will, + ½æ© Ú VËö Ú Ë£ ææËÚÄ ü Ä %¬Ä Ä ¬ ½ VËö Ú Ë£ ææËÚÄ ü

Letters and Phone Calls on Your Behalf õ ¬½ ½ æ æ© ¬Þ Ú æ¬ËÄ Ë£ üËêÚ Provider Lawyer

Residential Loan Document Assistance Mortgage documents (as required of the borrower by the lending institution) prepared by your Provider Law Firm for the purchase of your primary residence

Contract and Document Review ËÄæÚ æǽ Ë êà Äæ Ú õ¬ ö ê× æË ƨƬ pages each 24/7 Emergency Assistance £æ Úȗ©ËêÚÞ ½ ¤ ½ ËÄÞê½æ æ¬ËÄ £ËÚ Ëõ Ú ½ ¤ ½ à ڤ Ä ¬ ÞǷ ]× ¬Ĉ coverage depends on plan, such as: if you’re arrested or detained, if you’re seriously injured, if you’re served with a warrant, or if the state tries to take your child(ren).

Auto

Motor Vehicle Services ǰ DËÄȗ Ú¬Ã¬Ä ½ ÃËõ¬Ä¤ æÚ Ć õ¬Ë½ æ¬ËÄ assistance ǰ CËæËÚ õ ©¬ ½ ȗÚ ½ æ Ú¬Ã¬Ä ½ © Ú¤ assistance for manslaughter, involuntary manslaughter, negligent homicide or vehicular homicide • Up to 2.5 hours of help with driver’s license reinstatement and property damage collection assistance of ȯƬDzƧƧƧ ËÚ ½ ÞÞ × Ú ½ ¬Ã ǰ õ ¬½ ½ ËĽü ¬£ Ã Ã Ú © Þ õ ½driver’s license and is driving a noncommercial motor vehicle

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Uncontested Name Change Assistance* Uncontested name change prepared by Provider Law Firm Uncontested Adoption Representation* Representation by your Provider Law Firm for uncontested adoption proceedings

IRS

IRS Audit Legal Services • One hour of consultation, advice or ÞÞ¬Þæ Ä ö© Ä üËê Ú ÄËæ¬Ĉ Ë£ Ä audit by the IRS ǰ Ä ¬æ¬ËÄ ½ ƩǷƬ ©ËêÚÞ ¬£ Þ ææ½ Ã Äæ ¬Þ ÄËæ ©¬ õ ö¬æ©¬Ä ƪƧ üÞ • If your case goes to trial, you’ll receive 46.5 hours of your Provider Law Firm’s services ǰ Ëõ Ú ¤ £ËÚ æ©¬Þ Þ Úõ¬ ¤¬ÄÞ ö¬æ© æ© æ û Ú æêÚÄ ê ×Ú¬½ ƨƬ Ë£ æ© ü Ú you enroll

Uncontested Separation/Divorce Representation* Representation by your Provider Law Firm for uncontested legal separation, uncontested civil annulment and uncontested divorce proceedings ÞÞ¬Þæ Ä ¬£ üËê ËÚ üËêÚ Þ×ËêÞ Ú named defendant or respondent in a Ëõ Ú ¬õ¬½ æ¬ËÄ Ĉ½ ¬Ä ËêÚæ

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Trial Defense Services ÞÞ¬Þæ Ä ¬£ üËê ËÚ üËêÚ Þ×ËêÞ Ú named defendant in a covered civil action Ĉ½ ¬Ä ËêÚæ YEAR

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25% Preferred Member Discount You may continue to use your Provider Law Firm for legal situations that extend beyond plan coverage. The additional Þ Úõ¬ Þ Ú ƩƬɅ Ëą æ© ½ ö ĈÚÃȣÞ standard hourly rates. Your Provider Law Firm will let you know when the 25% discount applies, and go over these fees

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Your Plan Cover: Family Plan: • The member • The member’s spouse/ domestic partner ǰ D õ Úȗà ÚÚ¬ × Ä Äæ children under age 26 living at home • Dependent children under age ƨƯ £ËÚ ö©ËÃ æ© Ã Ã Ú ¬Þ legal guardian • Never married, dependent, ©¬½ Ú Ä ö©Ë Ú £ê½½ȗæ¬Ã college students up to age 26 • Physically or mentally disabled children living at home

ǭc© Þ Þ Úõ¬ Þ Ú õ ¬½ ½ ưƧ ËÄÞ êæ¬õ üÞ £ÚËÃ æ© ą æ¬õ date of your membership. For detailed information about the legal services provided by the LegalShield contract, go to http://www.legalshield.com/info/legalplan.

Business issues are not included; however, plans providing those services are available.

]× ¬Ĉ û ½êÞ¬ËÄÞ ××½ü. See plan contract for complete terms, coverage, amounts, conditions and exclusions.

Access LegalShield on the go!

Access LegalShield on the go!

c© = ¤ ½]©¬ ½ ×× ×êæÞ üËêÚ ½ ö ĈÚà ¬Ä æ© × ½Ã Ë£ üËêÚ © Ä Ƿ c × æË ½½ üËêÚ ½ ö ĈÚà directly, access free legal forms, and send ¬Ä£Ë ¬Ú æ½ü æË üËêÚ ½ ö ĈÚà ö¬æ© £ æêÚ Þ like Prepare Your Will and Snap (for speeding tickets). The LegalShield app makes it easy to access legal guidance you can trust.

Download the free app from the App Store or Google Play.

Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc., registered in the U.S. and other countries. Android is a trademark of Google Inc.

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48 SHEET_LS_1995D 051018

©2018 LegalShield®, Ada, OK

Identity Consultation Services

As a member, you have unlimited access to identity consultation services provided by our licensed private investigators. The investigator will advise you on best practices for identity Ã Ä ¤ à Äæ æ ¬½ËÚ æË üËêÚ Þ× ¬Ĉ Þ¬æê æ¬ËÄǷ Consultative services include: Privacy and Security Best Practice • Consult on best practices for the use and protection of your Social Security number and Personally Identifying Information (PII).

• Provide consultation on current trends, scams and schemes related to identity theft and fraud issues.

• ¬Þ êÞÞ Þæ ×Ú æ¬ Þ £ËÚ ĈÄ Ä ¬ ½ æÚ ÄÞ æ¬ËÄÞDz online activities and consumer privacy.

• Provide the knowledge to help protect your identity and to inform you of your rights under federal and state laws.

• Help interpret and analyze your credit report and æ º Þæ ×Þ æË Ú ê ×Ú ȗ ××ÚËõ Ú ¬æ Ëą ÚÞǷ • Consult on public record inquiries, background searches or credit freeze issues.

Event-Driven Consultation Support • Lost/stolen wallet assistance • Data Exposure/Data Breach • Safeguards ½ ÚæÞ Ä DËæ¬Ĉ æ¬ËÄÞ • Monthly identity theft updates to help educate and protect • æ Ú © ÄËæ¬Ĉ æ¬ËÄÞ Consultation services are limited to the solutions, best practices, legislation and established industry and organizational procedures in place in the gĬæ ]æ æ Þ Ä Ä Þ æ ÚÃ¬Ä Ä Ĉ ¬ ½ or productive by our licensed private investigators.

Privacy Monitoring

Black Market Website Surveillance (Internet Monitoring) Monitors global black-market websites, Internet Relay Chat (IRC), chat rooms, peer-to-peer sharing networks and social feeds or your PII, looking for matches of name, date of birth, Social Security number, email addresses (up to 10), phone numbers (up to 10), driver’s license number, passport number and medical ID numbers (up to 10). Ú ÞÞ © Ĥ r Ú¬Ĉ æ¬ËÄ Keeps track of a personal mailing address and sends an alert when a change of address has been requested through the United States Postal Service.

Social Media Monitoring Monitors multiple social media accounts and content feeds for privacy and reputational risks.

You will be alerted to privacy risks like the exposure of PII, including street address, date of birth or Social Security number, as well as reputational risks like foul language, drug and alcohol references, or discriminatory terms.

Security Monitoring

Black Market Website Surveillance (Internet Monitoring) Monitors global black market websites, Internet Relay Chat (IRC), chat rooms, peer-to-peer sharing networks and social feeds for PII, looking for matches of Social Security number, credit card numbers (up to 10) and bank account numbers (up to 10).

Court Records Monitoring Detects criminal activity that may be associated with your personal information, sending an alert when signs of potential criminal identity theft are recognized.

Credit Monitoring NEW! High Risk Account Monitoring.

New! As a member, you have access to continuous credit monitoring through TransUnion. Monitoring can be accessed immediately via the member’s service portal dashboard on myidshield.com or through the free IDShield mobile app. Credit activity will be reported promptly to the member õ¬ Ä Ã ¬½ ½ Úæ Ä ÃË ¬½ ×êÞ© ÄËæ¬Ĉ æ¬ËÄ Credit Inquiry Alerts NEW! Instant Hard Inquiry Alerts.

New! C à ÚÞ ö¬½½ ÄËæ¬Ĉ õ¬ à ¬½ ö© Ä Ú ¬æËÚ Ú Ùê ÞæÞ æ© ¬Ú cÚ ÄÞgĬËÄ Ú ¬æ Ĉ½ £ËÚ æ© purposes of opening a new credit account. Alerts may also be triggered when a creditor requests a Ú ¬æ Ĉ½ £ËÚ © Ĥ Þ æ© æ öËê½ Ú Þê½æ ¬Ä Ä ö ĈÄ Ä ¬ ½ Ë ½¬¤ æ¬ËÄDz Þê © Þ Ä ö ½½ שËÄ account, a lease for a new apartment or even an application for a new mortgage. Inquiry alerts can be helpful in determining when an identity thief is opening a new account without your authorization.

Monthly Credit Score Tracker You’ll receive a monthly credit score report from TransUnion that plots your score month-by-month on a graph, giving you the ability to see how your credit scores have changed over time, along with score factors that provide insight into what events may have caused your credit score to change.

Payday Loan Monitoring Alerts you when your personal information is associated with short-term, payday or similar cash-advance loans.

Password Manager IDShield Vault allows you to manage and generate passwords. With a browser plugin installed, . ]©¬ ½ r ê½æ ö¬½½ ½ÞË êæËĈ½½ ºÄËöÄ × ÞÞöËÚ Þ when browsing on the web and sync across devices to provide secure auto backup.

Employee Family Plan Coverage

Minor Identity Protection (Formerly Safeguard for Minors - Family Plan only) Allows parents/guardians of up to 10 dependents under the age of 18 to monitor for potentially fraudulent activity associated with their child’s SSN. Unauthorized names, aliases and addresses that become associated with a minor’s name and date of birth may be detected. The service monitors public records in all 50 States including: real estate data, new mover information, property and recorder of deed registration, county assessor/record data, internet job site providers, state occupational license data providers, voter information, public records/ court proceedings, bankruptcies, liens and judgements. Parents/ Guardians are provided a baseline scan, with Þê Þ Ùê Äæ ½ ÚæÞ Ä ÄËæ¬Ĉ æ¬ËÄÞ æ© Ú £æ ÚǷ Dependent Identity Theft Protection (Ages 18 to 26 - Family Plans only) If you have dependents between the ages of 1826, that either live at your home or are a full-time student and have never been married, they are still eligible for protection. Dependents who fall under this category will receive unlimited consultation and complete restoration by our licensed private investigators. Note that monitoring is not available for dependents in this category.

Identity Restoration

Our Licensed Private Investigators perform the bulk of the restoration work required to restore a member’s identity to pre-theft status.

IDShield Service Guarantee We don’t give up until your identity is restored.

Note: Purchase of IDShield requires member to have a valid email address.

The following are excluded from the services: LEGAL REMEDY - Any stolen identity event where the victim is unable or unwilling to prosecute the person ö©Ë êÞ æ© õ¬ æ¬Ã æË Þêą Ú æ© £Ú ê ËÚ ¬æÞ ËÄÞ Ùê Ä ÞǷ DISHONEST ACTS - Any dishonest, criminal, malicious or fraudulent acts, if the member(s) ö©Ë Þêą Ú æ© £Ú ê × ÚÞËÄ ½½ü × Úæ¬ ¬× æ ¬ÄDz ¬Ú æ ËÚ © ºÄËö½ ¤ Ë£ Þê © æÞǷ FINANCIAL LOSS - Membership services do not cover any ĈÄ Ä ¬ ½ ½ËÞÞ Þ ææÚ¬ êæ æË æ© Þæ˽ Ä ¬ Äæ¬æü õ ÄæDz ¬Ä ½ê ¬Ä¤ êæ ÄËæ ½¬Ã¬æ æËDz ÃËÄ ü Þæ˽ Ä £ÚËà ö ½½ æ ËÚ Ëæ© Ú ÃËÄ æ Úü ½ËÞÞ ÞDz êÄ êæ©ËÚ¬ā purchases of retail goods or services online, by phone, by mail or direct. BUSINESS - A covered stolen identity event does not include business losses, including but not limited to the theft or unauthorized or illegal use of the victim’s business name, DBA or any other method of identifying the victim’s business activity. DORMANCY OR INACTIVITY - If the victim cannot or does not provide the items required to open a case, or having initiated restoration, if the victim fails to respond to or cooperate in activity facilitated for the purpose of ID restoration. INCURABLE – Because of the nature of the activity associated with identity theft, some issues cannot be resolved. For example, if a fraudulent act results in the victim’s name being improperly placed on a ¤Ëõ ÚÄà Äæ ¤ Ä üȣÞ Ú ÞæÚ¬ æ ½¬Þæ ȅ Ƿ¤ǷDz ȠÄË ĉüȡ ½¬ÞæȆ . ]©¬ ½ ÄÄËæ ×ÚËÃ¬Þ Ú ÃËõ ½ Ë£ æ© õ¬ æ¬ÃȣÞ Ä Ã Ƿ = ¤ ½ Þ Úõ¬ Þ Ú ÄËæ ×ÚËõ¬ êÄ Ú . æ© £æ restoration services. IDShield plan members should consult their individual plans to determine availability of legal services.

Marketed by: Pre-Paid Legal Services, Inc. dba LegalShield® and subsidiaries; Pre-Paid Legal CasualtySM, Inc.; Pre-Paid Legal Access, Inc.; In FL: LS, Inc.; In VA: Legal Service Plans of Virginia, Inc.; and PPL Legal Care of Canada Corporation 49 SHEET.IDSB2B (11.29.18)_AH ©2017 LegalShield®, Ada, OK

Save with these incredible MEMBERPERKS Your LegalShield and IDShield memberships are simply amazing. And in addition to the privileges that are already yours, we have added these MEMBERPERKS with hundreds of merchants and thousands of discounts.

Members can access savings at both national and local companies on everyday purchases such as tickets, electronics, apparel, travel and more. Members have the opportunity to save, on average, over $2,000 per year.

MEMBERPERKS can save you enough to pay for your membership for years to come!

RECEIVE EXCLUSIVE DISCOUNTS

Access your members-only discounts in categories such as: APPAREL

HOME SERVICES

AUTOMOTIVE

INSURANCE & PROTECTION SERVICES

BOOKS, MOVIES & MUSIC OFFICE & BUSINESS CELL PHONES ELECTRONICS FINANCE FLOWERS & GIFTS FOOD

REAL ESTATE & MOVING SERVICES SPORTS & OUTDOORS TICKETS & ENTERTAINMENT

WHAT MEMBERS ARE SAYING: “MEMBERPerks pays for my membership!”

— Martha S. “I saved 20% at Advance Auto and I also saved 30% on movie tickets on date night with my wife. This membership is it!”

— Andre E. Ƞ. Ã Ú ¬õ¬Ä¤ ƯɅ Ëą Ãü r Ú¬āËÄ cell phone monthly charge!”

— Paulette M.

TRAVEL

HEALTH & WELLNESS

Enjoy preferred member pricing on some of your favorite brands and services.

AND MANY MORE!

Getting Started

To sign up, simply login at legalshield.com, click on the Resources tab, then click on MEMBERPERKS. If you don’t already have an account, follow the simple on-screen instructions to make an account with your personal or work email and LegalShield membership number. x½­ï­ £­×­ɮõï ë­ ·Ýë T­¸ Ðr½À­Ðª ת F0r½À­Ðª Ö­Ö£­ëïĦ ÐÐ Ýɫ­ëï Ýë éëÝÖÝõÀÝ×ï ë­ ïù£Ê­¤õ õÝ ¤½ ׸­ ąÀõ½Ýùõ ×ÝõÀ¤­Ħ50 SHEET_MEMBERPerks_051818

Create Your Account Legal protection is just a tap away.

Follow these steps to create your LegalShield account.

1. ACTIVATE your account by visiting accounts.legalshield.com/activate. (Tip: Your membership number can be found in the email welcoming you as a LegalShield Member.)

2. DOWNLOAD the mobile app.

3. SIGN IN by selecting “I am a member” and use the email and password you just created in step 1.

If you have questions about setting up your account or forgot your member number, please call LegalShield Member Services at 1-800-654-7757.

LegalShield Member Services is available 7 a.m.-7 p.m. CT, Monday-Friday.

Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc., registered in the U.S. and other countries. Google Play and the Google Play logo are trademarks of Google Inc. The LegalShield apps are available for download at no cost. Some services require an active LegalShield Membership to be accessed.

US_NT_LS_FS_EN_CreateAccountActivation_v1_080621

51

Identity Theft and Privacy Protection Guarding your personal information is as EASY as 1-2-3!

Follow these steps to create your IDShield account.

1.

Create an Account with LegalShield Create your account at accounts.legalshield.com using your member number. If you already have a LegalShield account, simply sign-in.

2.

Add Your Information to be Monitored Select “Credit and Dark Web” from your IDShield Member Portal and create your identity protection account. Once you create your account you can add the personal information you want to monitor, including your social media accounts.

From the IDShield Member Portal you can also access your password manager, VPN Proxy One and anti-malware protection services provided by Trend Micro™. To download these services you will be asked to create a separate account with Trend Micro.

3.

Download the IDShield Mobile App After you create your identity protection account, download the IDShield mobile app and sign-in using your created login credentials.

If you have questions about setting up your account or forgot your member number, please call IDShield Member Services at 1-888-494-8519.

IDShield Member Services is available 7 a.m.-7 p.m. CT, Monday-Friday.

Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc., registered in the U.S. and other countries. Google Play and the Google Play logo are trademarks of Google Inc. The LegalShield apps are available for download at no cost. Some services require an active LegalShield Membership to be accessed.

US_NT_ID_FS_EN_CreateAccountActivation_v1_080621

52

life insurance highlights For the employee

purelife-plus

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

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

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

•

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

•

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

21M066-C R0222 2009 (exp0523)

53

Additional Features •

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

•

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

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

3

QUICK QUESTIONS

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

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

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

2

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

3

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

PureLife-plus is a Flexible Premium Adjustable Life Insurance to Age 121. As with most life insurance products, Texas Life contracts and riders contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative or see the Purelife-plus brochure for costs and complete details. Contract Form ICC18-PRFNG-NI-18, Form Series PRFNG-NI-18 or PRFNG-NI-20-OHIO. Voluntary Whole and Universal Life Products, Eastbridge Consulting Group, December 2018 Guarantees are subject to product terms, limitations, exclusions, and the insurer’s claims paying ability and financial strength 3 Coverage not available on children in WA or on grandchildren in WA or MD. In MD, children must reside with the applicant to be eligible for coverage.

1

2

54

21M066-C R0222 2009 (exp0523)

monthly p r e m i u m s PureLife-plus — Standard Risk Table Premiums — Non-Tobacco — Express Issue GUARANTEED

Monthly Premiums for Life Insurance Face Amounts Shown

PERIOD

Age

9.25 9.95 10.75 11.45 12.15 12.85 13.65 14.35 15.05 15.95 16.95 18.15 19.45 20.45 21.45 22.55 23.55 24.75 25.85 27.05 28.55 29.85 31.45 33.05 34.75 36.65 38.75 41.05 43.55 46.05 48.65

$15,000

10.05 10.35 10.80 11.25 12.00 12.75 13.80 15.00 16.05 17.10 18.15 19.35 20.40 21.45 22.80 24.30 26.10 28.05 29.55 31.05 32.70 34.20 36.00 37.65 39.45 41.70 43.65 46.05 48.45 51.00 53.85

$25,000 9.25 9.50 9.75 10.00 10.25 10.25 10.50 10.75 11.00 11.50 11.75 12.00 12.25 13.00 13.50 14.25 15.25 15.75 16.50 17.25 18.50 19.75 21.50 23.50 25.25 27.00 28.75 30.75 32.50 34.25 36.50 39.00 42.00 45.25 47.75 50.25 53.00 55.50 58.50 61.25 64.25 68.00 71.25 75.25 79.25 83.50 88.25

Coverage is Guaranteed at

$40,000

$50,000

$75,000

$100,000

$125,000

$150,000

15.05 15.45 15.85 16.25 17.05 17.45 17.85 18.25 19.45 20.25 21.45 23.05 23.85 25.05 26.25 28.25 30.25 33.05 36.25 39.05 41.85 44.65 47.85 50.65 53.45 57.05 61.05 65.85 71.05 75.05 79.05 83.45 87.45 92.25 96.65 101.45 107.45 112.65 119.05 125.45 132.25 139.85

18.25 18.75 19.25 19.75 20.75 21.25 21.75 22.25 23.75 24.75 26.25 28.25 29.25 30.75 32.25 34.75 37.25 40.75 44.75 48.25 51.75 55.25 59.25 62.75 66.25 70.75 75.75 81.75 88.25 93.25 98.25 103.75 108.75 114.75 120.25 126.25 133.75 140.25 148.25 156.25 164.75 174.25

26.25 27.00 27.75 28.50 30.00 30.75 31.50 32.25 34.50 36.00 38.25 41.25 42.75 45.00 47.25 51.00 54.75 60.00 66.00 71.25 76.50 81.75 87.75 93.00 98.25 105.00 112.50 121.50 131.25 138.75 146.25 154.50 162.00 171.00 179.25 188.25 199.50 209.25 221.25 233.25 246.00 260.25

34.25 35.25 36.25 37.25 39.25 40.25 41.25 42.25 45.25 47.25 50.25 54.25 56.25 59.25 62.25 67.25 72.25 79.25 87.25 94.25 101.25 108.25 116.25 123.25 130.25 139.25

42.25 43.50 44.75 46.00 48.50 49.75 51.00 52.25 56.00 58.50 62.25 67.25 69.75 73.50 77.25 83.50 89.75 98.50 108.50 117.25 126.00 134.75 144.75 153.50 162.25 173.50

50.25 51.75 53.25 54.75 57.75 59.25 60.75 62.25 66.75 69.75 74.25 80.25 83.25 87.75 92.25 99.75 107.25 117.75 129.75 140.25 150.75 161.25 173.25 183.75 194.25 207.75

n-T o

$10,000

No

(ALB) 15D-1 2-4 5-8 9-10 11-16 17-20 21-22 23 24-25 26 27-28 29 30-31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70

bac co

Age to Which Issue

Table Premium 81 80 79 79 77 75 74 75 74 75 74 74 73 74 74 75 76 76 77 77 78 79 80 81 82 83 83 84 84 85 85 86 87 88 88 88 89 89 89 89 89 90 90 90 90 90 90 90 91 91 91 91

PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After the Guaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under ”Permanent Coverage”.

Form: 21M013-ICC EXP-A-M-1LO

55

monthly p r e m i u m s PureLife-plus — Standard Risk Table Premiums — Tobacco — Express Issue GUARANTEED

Monthly Premiums for Life Insurance Face Amounts Shown

PERIOD

Age to Which Issue

Coverage is

Age

Guaranteed at

14.15 15.05 16.15 17.55 18.25 19.25 20.05 21.05 21.95 23.25 24.35 25.45 27.05 28.45 29.75 31.15 32.75 34.35 36.05 37.75 39.55 41.85 44.05 46.25 48.45 50.85 53.45 56.25 59.15 62.25 65.55

$25,000

$40,000

$50,000

$75,000

$100,000

$125,000

$150,000

15.30 15.75 16.80 17.25 18.45 20.10 21.45 23.10 25.20 26.25 27.75 28.95 30.45 31.80 33.75 35.40 37.05 39.45 41.55 43.50 45.60 48.00 50.40 52.95 55.50 58.20 61.65 64.95 68.25 71.55 75.15

15.25 16.00 16.75 17.25 17.75 18.25 18.50 21.00 21.75 22.00 22.25 24.00 24.75 26.50 27.25 29.25 32.00 34.25 37.00 40.50 42.25 44.75 46.75 49.25 51.50 54.75 57.50 60.25 64.25 67.75 71.00 74.50 78.50 82.50 86.75 91.00 95.50 101.25 106.75 112.25 117.75 123.75

23.05 24.25 25.45 26.25 27.05 27.85 28.25 32.25 33.45 33.85 34.25 37.05 38.25 41.05 42.25 45.45 49.85 53.45 57.85 63.45 66.25 70.25 73.45 77.45 81.05 86.25 90.65 95.05 101.45 107.05 112.25 117.85 124.25 130.65 137.45 144.25 151.45 160.65 169.45 178.25 187.05 196.65

28.25 29.75 31.25 32.25 33.25 34.25 34.75 39.75 41.25 41.75 42.25 45.75 47.25 50.75 52.25 56.25 61.75 66.25 71.75 78.75 82.25 87.25 91.25 96.25 100.75 107.25 112.75 118.25 126.25 133.25 139.75 146.75 154.75 162.75 171.25 179.75 188.75 200.25 211.25 222.25 233.25 245.25

41.25 43.50 45.75 47.25 48.75 50.25 51.00 58.50 60.75 61.50 62.25 67.50 69.75 75.00 77.25 83.25 91.50 98.25 106.50 117.00 122.25 129.75 135.75 143.25 150.00 159.75 168.00 176.25 188.25 198.75 208.50 219.00 231.00 243.00 255.75 268.50 282.00 299.25 315.75 332.25 348.75 366.75

54.25 57.25 60.25 62.25 64.25 66.25 67.25 77.25 80.25 81.25 82.25 89.25 92.25 99.25 102.25 110.25 121.25 130.25 141.25 155.25 162.25 172.25 180.25 190.25 199.25 212.25

67.25 71.00 74.75 77.25 79.75 82.25 83.50 96.00 99.75 101.00 102.25 111.00 114.75 123.50 127.25 137.25 151.00 162.25 176.00 193.50 202.25 214.75 224.75 237.25 248.50 264.75

80.25 84.75 89.25 92.25 95.25 98.25 99.75 114.75 119.25 120.75 122.25 132.75 137.25 147.75 152.25 164.25 180.75 194.25 210.75 231.75 242.25 257.25 269.25 284.25 297.75 317.25

o

$15,000

acc

$10,000

Tob

(ALB) 15D-1 2-4 5-8 9-10 11-16 17-20 21-22 23 24-25 26 27-28 29 30-31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70

Table Premium 81 80 79 79 77 71 71 72 71 72 71 71 72 72 72 71 72 72 73 73 74 76 77 78 80 80 81 81 82 82 83 83 83 84 85 85 85 85 86 86 86 86 86 87 87 87 87 88 88 88 88 89

PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After the Guaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under ”Permanent Coverage”.

Form: 21M013-ICC EXP-A-M-1LO

56

FLEXIBLE BENEFITS PLAN Llano Independent School District Employer ID NBS766157

PLAN HIGHLIGHTS Login at: my.nbsbenefits.com

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

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

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

Grace Period

WHAT TYPE OF BENEFITS ARE AVAILABLE

GENERAL PLAN INFORMATION Plan Year:………………..…...September 1st through August 31st Maximum Health FSA Limit……….....…………..Current IRS limit …….…See Code Section 125(i)(2) or current enrollment information

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

Health FSA ……………...…………………….....………….60 days Dependent Care (DCAP)..………………………….....…...60 days Deadlines to Incur Expenses on Elected Funds Health FSA……………….....October 30 following Plan Year End DCAP………………………...October 30 following Plan Year End Deadlines to File for Reimbursement Run-out Period:…………………………………..……....…75 days Health FSA and DCAP..….November 14 following plan year end Mid-Year Terminations FSA ……………….…………...30 days following termination date DCAP……………..………....…30 days following termination date Orthodontic Reimbursement ……….as paid per service contract ………………………………………..…or in full at time of banding Upfront payment……………….…………..………………..allowed

AM I ELIGIBLE TO PARTICIPATE If you work for the company, you will be eligible to join the Plan following your date of employment.

You will enter the Plan on the day in which you meet the above eligibility requirements.

NBS Welfare Benefit Service Center (801) 532-4000 or 800-274-0503 Fax: 800-478-1528 service@nbsbenefits.com

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

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

Health Savings Account: A Health Savings Account is a portable benefit which allows participants insured by a Qualified High Deductible Insurance Plan to save for deductibles and other expenses not covered under the Plan. If you participate in this benefit you cannot participate in the Health Flexible Spending Account benefit.

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

Llano Independent School District Flexible Benefits Plan Plan Contact Person: Ryan Turner 1400 Oatman Street Llano, TX 78643 (325) 847-4747 rturner@llanoisd.net 57

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

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

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

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

HOW DO I RECEIVE REIMBURSEMENTS Participant Portal or Mobile App During the course of the Plan Year, you may submit requests for reimbursement of expenses you have incurred. Expenses are considered “incurred” when the service is performed, not necessarily when it is paid for. Claims may be submitted through your online account or the NBS Mobile App. In order to have the reimbursements made to you for qualifying Dependent Care expenses, you must provide a statement from the service provider including the name, address, date of service, the amount of expense and proof that the expense has been incurred. In most cases, the taxpayer identification number of the service provider will also be necessary.

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

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

Updated: 6/10/2024

NBS Welfare Benefit Service Center (801) 532-4000 or 800-274-0503 Fax: 800-478-1528 service@nbsbenefits.com

Llano Independent School District Flexible Benefits Plan Plan Contact Person: Ryan Turner 1400 Oatman Street Llano, TX 78643 (325) 847-4747 rturner@llanoisd.net 58

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

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

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

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

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

• American Fund/Capital Guardian • Americo Financial Life/Annuity • Equitable (formerly AXA) • Horace Mann Life Ins. Co. • National Life Group (LSW) • PlanMember Services Corp.

• ROTH - Equitable (formerly AXA) • ROTH - PlanMember Services Corp.

• ROTH - Vanguard Fiduciary Trust Co. • Security Benefit • Thrivent Financial for Lutherans • Vanguard Fiduciary Trust Co.

Future retirement savings value assuming 6% growth Monthly Contributions

5 Year

15 Years

20 Years

$50

$3,489

$14,541

$23,102

$200

$13,954

$58,164

$92,408

$500

$34,885

$145,409

$231,020

HOW CAN I PARTICIPATE? Prior to contributing you must open an account with an investment provider authorized in the Plan, a list of which is available on the right.

You may then complete a Salary Reduction Agreement (SRA) online at: www.omni403b.com/SRA If you are already contributing to your Employer’s Plan and you want to change your contribution amount or investment provider, simply complete and submit a new SRA. Once we are in receipt of the newly completed SRA, we will notify your employer to begin contributions.

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

15 Yr. Contribution Limits Combined Limit Maximum Service Age 49 Age 50 Age 49 Age 50 Employer Catch-up & below & above Contributions & below & above (if eligible) $23,000

$30,500

$3,000

$69,000

$69,000

$76,500

LOOKING FOR HELP? Click the link below for an investment professional to reach out to you.

Llano Independent School District Plan Detail Page

59