Palestine ISD 2023-2024 Benefit Guide

Palestine Independent School District

TableofContents

Enrollment Instructions for THEbenefitsHUB

Site Access: To access your employer online enrollment site, THEbenefitsHUB, you can login to the following website

www.mybenefitshub.com/palestineisd

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

Medical Transport - MASA Provides Emergency Transportation for ground, emergency air, and non-emergency hospital to hospital transportation anywhere in the US/Canada.

Employee Assistance Program - Employee Assistant Program that provides support, guidance, and resources. A helping hand when you need it. *Palestine ISD provides this benefit to all eligible employees at no cost.

TeleMedicine - 1.800MD, provides access to physicians for non-emergency treatment/prescriptions. For questions, please contact 1.800MD directly at 1-800-530-8666

Gap Plan - A low cost program designed to help you pay for covered out-of-pocket expenses you may incur while you are either confined in a hospital or being treated as an outpatient for an injury or illness.

Critical Illness UNUM - no Evidence of Insurability required, guaranteed issue. ** Includes $50 wellness benefit.

Standard Disability - Plan includes long term disability coverage. Plan is designed to protect up to 66 2/3% of your gross PISD income.

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

UNUM Group Life - Group term life that ends when you terminate employment with PISD. Coverage is also available for spouses and dependent children.

Colonial Life Cancer - Pays benefits for internal cancer diagnosis. ** Includes $50 wellness benefit.

BEAM Dental - Coverage for preventative, basic, major, and orthodontia services.

** All employee that enroll will receive a Beam toothbrush kit and perks throughout the year for regular use.

Superior Vision - Plan includes coverage for eye exams, materials (such as frames and lenses). This plan has a list of defined network providers. For more information, including a list of providers, visit www.superiorvision.com.

Wellfleet Accident - Pays benefits for off-the-job accidents and related treatments. Includes a physical/wellness exam reimbursement. ** Includes a $200 health screening Benefit per year, per covered member.

NBS Flexible Spending - Make sure to spend/claim the money in your current reimbursement account by 8/31/2023 Visit fsa.nbsbenefits.com to check account balances or request information.

HSA Bank - Participants in the TRS-ActiveCare HD health plan are eligible to contribute to a health savings account.

ENROLLMENT FAQ

INTRODUCTION

Providing great benefit choices to you and your family is just one of the many ways PISD looks after the health and financial welfare of the people who make our district work so well. Our goal at PISD is to provide you with an array of benefit options that will meet your personal needs as part of your total compensation and rewards.

HOW DO I ENROLL?

Visit www.mybenefitshub.com/palestineisd

USERNAME: Enter the first 6 letters of your last name, followed by the first letter of your first name, and then the last 4 digits of your SSN. (EX: John Sanderson SSN: xxxxx-1234

USERNAME: sanderj1234)

PASSWORD: Complete last name (excluding any special characters or spaces) followed by the last 4 digits of your SSN. (Ex: sanderson1234)

WHO IS ELIGIBLE?

You are eligible to enroll in the PISD Benefits Program if you are a regular employee working at least 15 hours per week in a permanent position. All other employees, to include substitutes, who work less than 15 hours per week, are eligible to enroll in medical insurance at full cost.

WHO IS AN ELIGIBLE DEPENDENT?

Your legal spouse

Children under the age of 26, yours OR your spouse’s Dependent children of any age who are disabled

Children under your legal guardianship

When adding dependents for the first time, please provide date of birth, gender and social security number.

NEW HIRE ENROLLMENT

Online benefit enrollment must be completed within 30 days of your active at work date. Elected benefits will take effect on the 1st of the following month.

MID-YEAR CHANGES

The benefits you choose will remain in effect throughout the plan year (from September 1 - August 31). You may only add or cancel coverage during the year if you have a qualifying change in the family or employment status that causes you to gain or lose eligibility for benefits. Qualifying changes may include:

A change in your legal marital status

A change in your number of dependents as a result of birth, adoption, legal custody, or if your dependent child satisfies or ceases to satisfy eligibility requirements for coverage, or the death of a dependent child or spouse

A change in employment status for you or your spouse loss or gain of eligibility for other insurance (including CHIP & Medicaid)

You must notify the Palestine ISD payroll office of the requested change within 30 calendar days of the change in status. There are no exceptions to this rule.

WHEN WILL I RECEIVE ID CARDS?

Everyone enrolled in Medical will receive a new Medical Card. Enrolled participants will receive HSA and FSA cards prior to the effective date of the new coverage. For most plans, you can login to the carrier website and print a temporary 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 DO I CONTACT WITH QUESTIONS?

For questions, you can contact your PISD Benefits Department

Gemma Funai

Office: 903-731-8048

Email: Gfunai@palestineschools.org

Marlene Freeman

Office: 830-606-5100

Email: Mfreeman@usebsg.com

Covering Dependents?

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

Making Changes During the Year

Choose your benefits carefully. Several of the employee benefits plan contributions are made on a pre-tax basis and per IRS regulations, contribution amounts cannot be changed unless you experience a qualified life event. Qualifying life events include:

Marriage, divorce, legal separation; Death of spouse or dependent;

Birth or adoption of a child;

Changes in employment for spouse or dependents; Coverage changes;

You must submit your benefit change requests and include required documentation within 30 days of the event. Also note that per the IRS, only changes consistent with the life event are allowed.

New Employees

New employees must enroll within 30 days of their start date. If employees fail to enroll within 30 days, all benefits will be waived. Except for health insurance, plans will be effective on the first of the month following the date of start. Health Insurance can be effective the date of start or the first month following date of start. Please be aware that if you choose date of start as effective date for health insurance, you will be charged for the entire month.

Very Important

Please carefully review your paycheck(s) to ensure all deductions are correct. If you find a discrepancy in your paycheck, please contact Gemma Funai immediately at 903-731-8048. Discrepancies must be identified within the first 30 days from the effective date of the policy to be considered.

Benefit Related Documents

For contact information, claim forms, benefits guides, and more, please visit palestineschools.org.

2023-24 TRS-ActiveCare Plan Highlights

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

*Available for all plans. See the benefits guide for more details.

HOW IT WORKS

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,  treatment and a prescription, when necessary, through the convenience of a telephone and digital communications.

*Subjecttostateregulations.

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.

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.

The Ultimate Peace of Mind for Employees and Their Families

The Harrison’s Story

• Jim and his family were at a local festival when his daughter, Sara, suddenly began experiencing horrible abdominal and back pain, after a fall from earlier in the day.

• His wife, Heather, called 911 and Sara was transported to a local hospital, when it was decided that she needed to be flown to another hospital.

• Upon arrival, Sara underwent multiple procedures and her condition was stabilized.

• After further testing, it was discovered that Sara needed additional specialized treatment at another hospital requiring transport on a non-emergent basis.

And then, the Bills came!

Any Ground. Any Air. Anywhere.TM

No matter how comprehensive your local in-network coverage may be, you still have significant exposure to out-of-network emergency transportation. Moreover, when you and your family travel outside your area, there is an 80% chance of being picked up by an out-of-network provider.

A MASA Membership prepares you for the unexpected. ONLY MASA MTS provides you with:

• Coverage ANYWHERE in all 50 states and Canada whether at home or away

• Coverage for BOTH emergent ground ambulance and air ambulance transport REGARDLESS of the provider

• Non-emergent transport services, which are frequently covered inadequately by your insurance, if at all

For more information, please contact your local MASA MTS representative or visit www.masamts.com

Based on a true story. Names were changed to protect identities in compliance with HIPAA.

EMERGENCY TRANSPORTATIONCOSTS

MASA MTS is hereto protect its members andtheir families from the shortcomings of health insurance coverageby providingthem with comprehensivefinancial protectionfor lifesaving emergencytransportationservices, both at home and away fromhome.

ManyAmericanemployers and employees believe that theirhealthinsurancepolicies covermost, if notallambulanceexpenses. Thetruth is, they DONOT!

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

HOW MASA ISDIFFERENT

Across the US therearethousands of ground ambulance providers and hundreds of air ambulance carriers. ONLYMASA offers comprehensive coverage since MASA is a PAYERand not aPROVIDER!

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

Members are covered ANYWHEREin all50 states andCanada!

Additionally, MASA provides a repatriation benefit: if amember is hospitalizedmore than 100 miles from home, MASA can arrangeand pay to have them transported to a hospital closer to their place of residence.

A MASA Membership prepares you for the unexpectedandgives you the peaceof mind to access vital emergency medical transportation no matter where you live, for a minimal monthlyfee.

• Onelow fee for the entire family

• NO deductibles

• NO healthquestions

• Easy claims process

For more information, pleasecontact Your Broker or MASA Representative

ACCIDENT INSURANCE for Palestine Independent School District

A personalized guide to understanding your plan

What is Accident Insurance?

This coverage pays benefits for injuries, such as cuts, broken bones, concussions and related expenses. Accident Insurance is supplemental coverage that can complement your health insurance and help cover your out-of-pocket expenses.

When you carry this coverage, if you have a covered accident, you are paid a total cash benefit that is based on the amount listed for each covered benefit and/or treatment. See the benefit schedule for additional details.

Use your benefits any way you like.

Use your benefit proceeds however you want. Whether it is toward your mortgage, medical bills or student loans, it is up to you.

Coverage highlights

• No health questions asked

• Affordable premiums

• Simplified claims-filing

How does the coverage work?

When you carry Accident Insurance and have a covered accident, simply file an Accident claim with our Claims Care Team online, or via mail or fax You’ll be paid a total cash benefit based on the amount listed for each covered benefit and/ or treatment.

Benefit snapshot: Luis’ goal

One night while playing a game with his local soccer league, Luis went for a goal that left him with a broken leg and concussion. Fortunately, he carried Accident Insurance. The benefits Luis received helped offset his medical bills and cover other expenses, like time away from work, while he recovered.

Ground ambulance:

Emergency room treatment:

Fracture (thigh, non-surgical):

Luis’ Accident policy paid these benefits*: $200 $200 $4,000

Concussion: $300

Total benefits paid: $4,700

*This example is for illustrative purposes only. Your plan details may vary. See your enrollment guide for more information around the benefits covered under your group’s plan.

What benefits are included in my coverage?

Due to Burns (% of applicable Burn benefit)

Blood tests for triglycerides

Annual exam for adults

Bone density screening

Breast MRI

Carotid ultrasound

Concussion baseline testing

How much does it cost?

Examples of Eligible Screening Events

Colonoscopy

Bone marrow testing

Chicken pox immunization

Fasting blood glucose test

Flu vaccination

Dermatological screening for skin cancer

Hepatitis B immunization

HPV immunization

Mammography

Pap smear

Pneumonia immunization

Genetic screening for medical diagnosis & treatment

Sports physicals

Stress test

Tetanus

Virtual colonoscopy

Well child visits

Serum cholesterol

HDL/LDL

See the rate chart below to calculate your coverage costs.

Exclusions & limitations

This is not a complete disclosure of plan qualifications and limitations. Benefits and riders may vary and may not be available in all states. In addition to any benefit-specific exclusion, benefits will not be paid for any loss which, directly or indirectly, in whole or in part, is caused by or results from any of the following, unless coverage is specifically provided for by name in the insurance certificate.

• An injury incurred while working for pay or profit;

• Intentionally self-inflicted injury, suicide, or any attempt or threat while sane or insane;

• Participating in war or any act of war whether declared or undeclared;

• Commission or attempt to commit a felony;

• Commission of or active participation in a riot, insurrection, or terrorist activity;

• Engaging in an illegal activity or occupation;

• Flight in, boarding, or alighting from an aircraft or any craft designed to fly above the earth’s surface, including any travel beyond the earth’s atmosphere except a fare-paying passenger on a regularly scheduled commercial or charter airline;

• Travel in or on any on-road and off-road motorized vehicle except a golf cart that does not require licensing as a motor vehicle;

• Practicing for or participating in any semi-professional or professional competitive athletic contest, including officiating or coaching, for which the covered person receives any compensation or remuneration;

• Sickness, except for any bacterial infection resulting from an accidental external cut or wound or accidental ingestion of contaminated food;

• Voluntary ingestion or inhalation of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a physician and taken in accordance with the prescribed dosage;

• Operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant including any prescribed drug for which the covered person has been provided a written warning against operating a vehicle while taking it. Under the influence of alcohol, for purposes of this exclusion, means intoxicated, as defined by the law of the State in which the covered accident occurred;

• Care that is not recommended and approved by a physician.

Questions?

Contact your plan administrator with questions about the offered Accident coverage.

This document is meant to highlight some, but not all the features Wellfleet coverage provides. It is not an insurance contract. Wellfleet Workplace benefits provide limited benefits and are not a substitute for mandated ACA healthcare coverage. Like most supplemental offerings, these benefits may have state-specific variations, and some product offerings and details may not be available in all states. Rates are subject to change. Wellfleet reserves the right to raise premium with proper notice, as noted in the policy. For complete details, see your certificate. Wellfleet is the marketing name used to refer to the insurance and administrative operations of Wellfleet Insurance Company, Wellfleet New York Insurance Company and Wellfleet Group, LLC. All insurance products are administered or managed by Wellfleet Group, LLC.

©2022 Wellfleet Group, LLC. All rights reserved.

Palestine Independent School District UNUM Critical Illness Plan Highlights

Policy Number 474777

Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness.

Who is eligible for this coverage?

What are the Critical Illness coverage amounts?

All employees in active employment in the United States working at least 15 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status).

The following coverage amounts are available.

For you: Select one of the following $10,000, $15,000 or $20,000

For your Spouse: 100% of employee coverage amount

For your Children: 50% of employee coverage amount Can I be denied coverage?

When is coverage effective?

Coverage is guarantee issue.

Please see your Plan Administrator for your effective date of coverage.

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.

Are wellness screenings covered?

*Please refer to the policy for complete definitions of covered conditions.

Covered Condition Benefit

The covered condition benefit is payable once per covered condition per insured.

Unum will pay a covered condition benefit for a different covered condition if: - the new covered condition is medically unrelated to the first covered condition; or

- the dates of diagnosis are separated by more than 180 days.

Reoccurring Condition Benefit

We will pay the reoccurring condition benefit for the diagnosis of the same covered condition if the covered condition benefit was previously paid and the new date of diagnosis is more than 180 days after the prior date of diagnosis.

The benefit amount for any reoccurring condition benefit is 100% of the percentage of coverage amount for that condition.

The following Covered Conditions are eligible for a reoccurring condition benefit:

Benign Brain Tumor Heart Attack (Myocardial Infarction)

Coma

Invasive Cancer (includes all Breast Cancer)

Coronary Artery Disease (Major) Major Organ Failure Requiring Transplant

Coronary Artery Disease (Minor) Non-Invasive Cancer

End Stage Renal (Kidney) Failure Stroke

Each insured is eligible to receive one Be Well Benefit per calendar year.

Be Well Benefit

For you, your spouse and your children: $50

If the employee’s Critical Illness Coverage Amount is: The Be Well Benefit Amount for you, your spouse and your children is:

Be Well Screenings include tests for the following: cholesterol and diabetes, cancer and cardiovascular function. They also include imaging studies, immunizations and annual examinations by a Physician. See certificate for details.

Do my critical illness insurance benefits decrease with age?

Are there any exclusions or limitations?

Option 3

Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date.

Spouse rate is based on your Spouse’s insurance age, which is their age immediately prior to and including the anniversary/effective date.

Critical Illness benefits do not decrease due to age.

We will not pay benefits for a claim that is caused by, contributed to by, or occurs as a result of any of the following:

- committing or attempting to commit a felony;

- being engaged in an illegal occupation or activity;

- injuring oneself intentionally or attempting or committing suicide, whether sane or not;

- active participation in a riot, insurrection, or terrorist activity. This does not include civil commotion or disorder, injury as an innocent bystander, or Injury for self-defense;

- participating in war or any act of war, whether declared or undeclared;

- combat or training for combat while serving in the armed forces of any nation or authority, including the National Guard, or similar government organizations;

- voluntary use of or treatment for voluntary use of any prescription or nonprescription drug, alcohol, poison, fume, or other chemical substance unless taken as prescribed or directed by the Insured’s Physician;

- being intoxicated; and

- a Date of Diagnosis that occurs while an Insured is legally incarcerated in a penal or correctional institution.

Additionally, no benefits will be paid for a Date of Diagnosis that occurs prior to the coverage effective date.

Is the coverage portable (can I keep it if I leave my employer)?

Pre-existing Conditions

We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following:

- a pre-existing condition; or

- complications arising from treatment or surgery for, or medications taken for, a pre-existing condition.

An insured has a pre-existing condition if, within the 3 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which:

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

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

- symptoms existed.

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

The pre-existing condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date any initial coverage or increases in coverage become effective.

If your employment with your employer ends or you are no longer in an eligible group you can apply for ported coverage and pay the first premium within 31 days to continue coverage for yourself, your spouse and your children.

If your spouse’s coverage ends as a result of your death, divorce or annulment, your spouse may elect to continue spouse and children coverage, as long as premium is paid as required.

When does my coverage end?

If you choose to cancel coverage, it will end on the first of the month following the date you provide notification to your employer.

Otherwise, coverage ends on the earliest of:

- the date the policy is cancelled by your employer;

- the date you no longer are in an eligible group;

- the date your eligible group is no longer covered;

- the date of your death

- the last day of the period any required contributions are made;

- the last day you are in active employment

If you choose to cancel your Spouse’s coverage, it will end on the first of the month following the date you provide notification to your employer.

Otherwise, your spouse’s coverage will end on the earliest of:

- the date your coverage ends;

- the date your spouse is no longer eligible for coverage;

- the date your spouse no longer meets the definition of a spouse;

- the date of your spouse’s death; or

- the date of divorce or annulment.

Your children’s coverage will end on the earliest of:

- the date your coverage ends;

- the date your children are no longer eligible for coverage; or

- the date your children no longer meet the definition of children.

The limited benefits provided are a supplement to major medical coverage and are not a substitute for major medical coverage or other minimal essential coverage as required by federal law. Lack of minimal essential coverage may result in an additional tax payment being due.

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 GCIP16-1 et al or contact your Unum representative.

© 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Underwritten by Unum Insurance Company, Portland, Maine

AE-1226 FOR EMPLOYEES

Zurich Specialty Health Supplemental

GAP Medical

*This maximum applies to the entire family unit, regardless of the number of covered persons within the family unit. An “occurrence” is the treatment, or series of treatments, for a specific sickness or injury. All expenses related to the treatment of the same or related sickness or injury will accrue toward the out-patient maximum for one occurrence, regardless of whether such treatment is received in more than one calendar year period. If, however, a Covered Person is treatment-free, at any time, for at least 30 consecutive days, they may qualify for an additional outpatient maximum benefit if the family maximum per calendar year has not been met.

Monthly Rates*

Employees and dependents enrolled in the company sponsored Major Medical Plan may enroll for coverage in the Zurich Supplemental GAP Medical Plan.

Serving customers for almost 150 years

Zurich Insurance Group

Founded in Switzerland in 1872, we are one of the world’s most experienced global insurers

Providing a wide range of property and casualty, and life insurance products and services in more than 215 countries and territories

Strong investor proposition; resilient business model, clear strategy, and responsible and impactful business

Doing business in the U.S. since 1912

Approximately 55,000 experienced professionals worldwide

Approximately 9,000 employees in North America

North America contributed approximately $1.43 billion toward Zurich’s $4.2 billion in operating profit in 2020

Insurance a broad range of Middle Market customers as well as more than 95 percent of the Fortune 500

Providing multinational solutions in the U.S. for almost 50 years

Zurich North America is one of the largest providers of insurance solutions and services to businesses and individuals.

To learn more, visit www.zurichna.com

• Eligibility

• Employees enrolled in the company’s sponsored Major Medical Plan are eligible for Gap medical coverage. Employee’s dependents are also eligible for coverage.

• Eligibility waiting period

• Same as Major Medical Plan.

• Inpatient Expense Benefit – Benefits will be paid if a covered person is confined to a hospital as a direct result of an injury sustained in an accident or sickness. Benefits are limited to out-of-pocket expenses incurred by the covered person, including the deductible and coinsurance amounts the covered person is required to pay under the Major Medical Plan.

• Outpatient Expense Benefit – Benefits will be paid for outpatient treatment of an injury sustained in an accident or sickness. Benefits are limited to out-of-pocket expenses incurred by the covered person, including the deductible and coinsurance amounts the covered person is required to pay under the Major Medical Plan.

• Combined Inpatient and Outpatient Expense Benefit –Benefits will be paid if a covered person is confined to a hospital or receives outpatient treatment as a direct result of an injury sustained in an accident or sickness. Benefits are limited to out-of-pocket expenses incurred by the covered person, including the deductible and coinsurance amounts the covered person is required to pay under the Major Medical Plan. All benefits are subject to the Policy Deductible and the Supplemental Medical Coinsurance percentage for the Plan Year shown on the following pages:

• Policy Deductible – Benefits will be payable after the Covered Person has met the “Per Covered Person” Policy Deductible or after the “Per Family” Policy Deductible has been met, whichever occurs first.

• Supplemental Medical Co-insurance – The maximum percentage that will be paid under this Policy for covered expenses incurred by a covered person.

• Plan Year – A consecutive 12-month period during which a covered person’s coverage under the policy is in force.

General exclusions and limitations

This coverage does not cover any loss, treatment, or services resulting from any of the following:

1. Suicide or any attempt at suicide

2. Intentionally self-inflicted Injury or Sickness, while sane or insane

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

4. Full-time active duty in the armed forces of any country or international authority

5. Any Injury or Sickness for which the Covered Person is entitled to benefits pursuant to any workers’ compensation law or other similar legislation

6. The Covered Person’s commission of or attempt to commit a felony, assault, sexual assault, riot or insurrection or any Injury resulting from the Covered Person’s provocation of an attack against them

7. Travel or flight in or on (including getting in or out of, or on or off of) any vehicle used for aerial navigation, if the Covered Person is

a. Riding as a passenger in any aircraft not intended or licensed for the transportation of passengers

b. Performing, learning to perform or instructing others to perform as a pilot or crew member of any aircraft

c. Riding as a passenger in an aircraft owned, leased or operated by the Policyholder or the Covered Person

8. Skydiving, parasailing, parachuting, hang-gliding, bungee-jumping and participation in a contest of speed in power driven vehicles

9. Dental or vision services, including treatment, surgery, extractions, or x-rays, unless: (a) resulting from an Accident occurring while the Covered Person’s coverage is in force and if performed within 12 months of the date of such Accident; or (b) due to congenital disease or anomaly of a covered newborn child

10. Treatment or services for Injury and Sickness provided outside of the United States

11. Rest care or rehabilitative care and treatment (this does not include rehabilitation for treatment of physical disability)

12. Voluntary abortion except, with respect to the Covered Person: (a) where the Insured or the Insured’s Dependent’s life would be endangered if the fetus were carried to term; or (b) where medical complications have arisen from abortion

13. Elective cosmetic surgery (except newborn circumcision)

14. Sterilization and reversal of sterilization

15. Any expense which is not Medically Necessary

16. Prescription drugs

17. Any loss for which the Covered Person is not required to pay a Health Benefit Plan Deductible, co-payment and/or Health Benefit Plan Coinsurance under the Covered Person’s Health Benefit Plan; and

18. Any expense or benefit that is excluded under the Covered Person’s Health Benefit Plan

Health Benefit Plan Limitation

If a Covered Person does not have a Health Benefit Plan on the Covered Person’s Effective Date under this coverage, the Company’s sole obligation will then be to refund all premiums paid for that Covered Person.

Nearly everyone has experienced or knows somebody who has experienced a cancer diagnosis in their family. The good news is that cancer screenings and cancer-fighting technologies have gotten a lot better in recent years. However, with advanced technology come high costs. Major medical health insurance is a great start, but even with this essential safety net, cancer sufferers can still be hit with unexpected medical and non-medical expenses.

Cancer coverage from Colonial Life offers the protection you need to concentrate on what is most important — your care.

Features of Colonial Life’s Cancer Insurance:

1. Pays benefits to help with the cost of cancer screening and cancertreatment.

2. Provides benefits to help pay for the indirect costs associated with cancer, such as:

l Loss of wages or salary

l Deductibles and coinsurance

l Travel expenses to and from treatment centers

l Lodging and meals

l Child care

3. Pays regardless of any other insurance you have with other insurance companies.

4. Provides a cancer screening benefit that you can use even if you are never diagnosed with cancer.

5. Benefits paid directly to you unless you specify otherwise.

6. Flexible coverage options for employees and theirfamilies.

This is a brief description of some available benefits.

We will pay benefits if one of the following routine cancer screening tests is performed or if cancer is diagnosed while your coverage is in force.

Cancer Screening Benefit Tests

This benefit is payable once per calendar year per covered person.

l Pap Smear

l ThinPrep Pap Test1

l CA125 (Blood test for ovarian cancer)

l Mammography

l Breast Ultrasound

l CA15-3(Bloodtestforbreastcancer)

l PSA(Bloodtest for prostate cancer)

l Chest X-ray

l Biopsy of Skin Lesion

l Colonoscopy

l Virtual Colonoscopy

l Hemoccult Stool Analysis

l Flexible Sigmoidoscopy

l CEA (Blood test for colon cancer)

l Bone Marrow Aspiration/Biopsy

l Thermography

l Serum Protein Electrophoresis (Blood test for Myeloma)

To file a claim for a covered cancer screening/wellness test, it is not necessary to complete a claim form. Call our toll-free Customer Service number, 1.800.325.4368, with the medical information

Inpatient Benefits

l Hospital andHospitalIntensiveCare Unit Confinement

l Ambulance

l Private Full-Time Nursing Services

l Attending Physician

Treatment Benefits (In-or Outpatient)

l Radiation/Chemotherapy

l Antinausea Medication

l Blood/Plasma/Platelets/Immunoglobulins

l Experimental Treatment

l HairProsthesis/ExternalBreast/VoiceBoxProsthesis

l Supportive/Protective Care Drugs and Colony

Stimulating Factors

l Bone Marrow Stem Cell Transplant

l Peripheral Stem Cell Transplant

Surgery Benefits

l Surgery Procedures (including skin cancer)

l Anesthesia (including skin cancer)

l Second Medical Opinion

l Reconstructive Surgery

l Prosthesis/ArtificialLimb

l Outpatient Surgical Center

Transportation/Lodging Benefits

l Transportation

l Transportation for Companion

l Lodging

Extended Care Benefits

l Skilled Nursing Care Facility

l Hospice

l Home Health Care Service

Waiver of Premium

THIS IS A CANCER ONLY POLICY.

This policy has exclusions and limitations. For cost and complete details of the coverage, see your Colonial Life benefits counselor. Coverage may vary by state and may not be available in all states. Applicable to policy form GCAN-MP and certificate form GCAN-C (including state abbreviations where used, for example GCAN-C-TX.)

1ThinPrep is a registered trademark of Cytyc Corporation.

Educator Options Voluntary Long Term Disability Coverage Highlights – Texas Palestine Independent School District

Voluntary Long Term Disability Insurance

Standard Insurance Company has developed this document to provide you with information about the optional insurance coverage you may select through Palestine Independent School District. Written in non-technical language, this is not intended as a complete description of the coverage. If you have additional questions, please check with your human resources representative.

Employer Plan Effective Date

The group policy effective date is October 1, 2013.

Eligibility

To become insured, you must be:

• A regular employee of Palestine Independent School District, excluding temporary or seasonal employees, fulltime members of the armed forces, leased employees or independent contractors

• Actively at work at least 15 hours each week

• A citizen or resident of the United States or Canada

Employee Coverage Effective Date

Please contact your human resources representative for more information regarding the following requirements that must be satisfied for your insurance to become effective. You must satisfy:

• Eligibility requirements

• An evidence of insurability requirement, if applicable

• An active work requirement. This means that if you are not actively at work on the day before the scheduled effective date of insurance, your insurance will not become effective until the day after you complete one full day of active work as an eligible employee.

Benefit Amount

You may select a monthly benefit amount in $100 increments from $200 to $8,000; based on the tables and guidelines presented in the Rates section of these Coverage Highlights. The monthly benefit amount must not exceed 66 2/3 percent of your monthly earnings.

Benefits are payable for non-occupational disabilities only. Occupational disabilities are not covered.

Plan Maximum Monthly Benefit: 66 2/3 percent of predisability earnings

Plan Minimum Monthly Benefit: 10 percent of your LTD benefit before reduction by deductible income

Benefit Waiting Period and Maximum Benefit Period

The benefit waiting period is the period of time that you must be continuously disabled before benefits become payable. Benefits are not payable during the benefit waiting period. The maximum benefit period is the period for which benefits are payable. The benefit waiting period and maximum benefit period associated with your plan options are shown below:

Options 1-6: Maximum Benefit Period To Age 65 for Sickness and Accident

If you become disabled before age 62, LTD benefits may continue during disability until you reach age 65. If you become disabled at age 62 or older, the benefit duration is determined by your age when disability begins:

First Day Hospital Benefit

With this benefit, if an insured employee is hospital confined for at least four hours, is admitted as an inpatient and is charged room and board during the benefit waiting period, the benefit waiting period will be satisfied. Benefits become payable on the date of hospitalization; the maximum benefit period also begins on that date. This feature is included only on LTD plans with benefit waiting periods of 30 days or less.

Preexisting Condition Exclusion

A general description of the preexisting condition exclusion is included in the Group Voluntary Long Term Disability Insurance for Educators and Administrators brochure. If you have questions, please check with your human resources representative.

Preexisting Condition Period: The 90-day period just before your insurance becomes effective Exclusion Period: 12 months

Preexisting Condition Waiver

If your insurance has been in force for 12 months or more, for the first 90 days of disability after the benefit waiting period, the Preexisting Condition provision will not be applied to an increase in your benefit amount. After 90 days of benefits, the Preexisting Condition provision will apply to increases of more than $300. The Preexisting Condition Provision applies immediately if you:

• Decrease your Benefit Waiting Period by more than one level; or

• Increase your Maximum Benefit Period

If your insurance has been in force for less than 12 months and your disability is found to be a Preexisting Condition, you may be eligible for up to 90 days of benefits if you are disabled and meet all applicable policy provisions. If the Benefit Waiting Period you elect under this policy is less than the Benefit Waiting Period you were insured for under the Prior Plan, your benefits will begin on the later of these two plans.

If a disability is deemed to be a Preexisting Condition, benefits are payable under your prior elections, if any.

Own Occupation Period

For the plan’s definition of disability, as described in your brochure, the own occupation period is the first 24 months for which LTD benefits are paid.

Any Occupation Period

The any occupation period begins at the end of the own occupation period and continues until the end of the maximum benefit period.

Other LTD Features

• Employee Assistance Program (EAP) – This program offers support, guidance and resources that can help an employee resolve personal issues and meet life’s challenges.

• Family Care Expense Adjustment – Disabled employees faced with the added expense of family care when returning to work may receive combined income from LTD benefits and work earnings in excess of 100 percent of indexed predisability earnings during the first 12 months immediately after a disabled employee’s return to work.

• Special Dismemberment Provision – If an employee suffers a lost as a result of an accident, the employee will be considered disabled for the applicable Minimum Benefit Period and can extend beyond the end of the Maximum Benefit Period

• Reasonable Accommodation Expense Benefit – Subject to The Standard’s prior approval, this benefit allows us to pay up to $25,000 of an employer’s expenses toward work-site modifications that result in a disabled employee’s return to work.

• Survivor Benefit – A Survivor Benefit may also be payable. This benefit can help to address a family’s financial need in the event of the employee’s death.

• Return to Work (RTW) Incentive – The Standard’s RTW Incentive is one of the most comprehensive in the employee benefits history. For the first 12 months after returning to work, the employee’s LTD benefit will not be reduced by work earnings until work earnings plus the LTD benefit exceed 100 percent of predisability earnings. After that period, only 50 percent of work earnings are deducted.

• Rehabilitation Plan Provision – Subject to The Standard’s prior approval, rehabilitation incentives may include training and education expense, family (child and elder) care expenses, and job-related and job search expenses.

When Benefits End

LTD benefits end automatically on the earliest of:

• The date you are no longer disabled

• The date your maximum benefit period ends

• The date you die

• The date benefits become payable under any other LTD plan under which you become insured through employment during a period of temporary recovery

• The date you fail to provide proof of continued disability and entitlement to benefits

Rates

Employees can select a monthly LTD benefit ranging from a minimum of $200 to a maximum amount based on how much they earn. Referencing the appropriate attached charts, follow these steps to find the monthly cost for your desired level of monthly LTD benefit and benefit waiting period:

1.Find the maximum LTD benefit by locating the amount of your earnings in either the Annual Earnings or Monthly Earnings column. The LTD benefit amount shown associated with these earnings is the maximum amount you can receive. If your earnings fall between two amounts, you must select the lower amount.

2. Select the desired monthly LTD benefit between the minimum of $200 and the determined maximum amount, making sure not to exceed the maximum for your earnings.

3. In the same row, select the desired benefit waiting period to see the monthly cost for that selection. If you have questions regarding how to determine your monthly LTD benefit, the benefit waiting period, or the premium payment of your desired benefit, please contact your human resources representative.

Group Insurance Certificate

If you become insured, you will receive a group insurance certificate containing a detailed description of the insurance coverage. The information presented above is controlled by the group policy and does not modify it in any way. The controlling provisions are in the group policy issued by Standard Insurance Company.

PLAN: SmartPremium 100/80/50/50-1250-1000

POLICY EFFECTIVE DATE: 2022-09-01

POLICY LENGTH: 24 months

MINIMUM EMPLOYER CONTRIBUTIONS: 0.0% for employee and 0.0% for dependent(s).

EMPLOYEE $30.44 monthly

EMPLOYEE + SPOUSE $65.38 monthly

EMPLOYEE + CHILDREN $70.64 monthly

FAMILY $108.72 monthly

WHY BEAM

Beam is the future of group dental insurance, for employers large and small. We’re pairing innovative tech with personal service to deliver an insurance experience unlike any other.

90th Percentile UCR OON

Nationwide network (Over 400,000 access points) Digital implementation and admin

Beam Perks included

BEAM PERKS

Plans ship with the Beam Brush included.

Beam Brush Smart, electric toothbrush.

Beam Paste

High-quality, custom formulated toothpaste.

Free shipping Delivered to your door, right when you need it.

PLAN COVERAGE

PREVENTIVE & DIAGNOSTIC

Diagnostic and preventive: exams, cleanings, fluoride, space maintainers, x-rays, and sealants

BASIC

Minor restorative: fillings

Emergency palliative treatment: to temporarily relieve pain

Oral surgery: extractions and dental surgery

Prosthetic maintenance: relines and repairs to bridges and dentures

MAJOR

Endodontics: root canals

Periodontics: to treat gum disease

Implants: endosteal in lieu of a 2 or 3 unit bridge

Major restorative: crowns, inlays, and onlays

Prosthetics: bridges

Prosthodontics: dentures

ORTHODONTIA

100% 100%

80% 80%

50% 50%

Child Orthodontics: braces with age limit of 19 50% 50%

PLAN MAXES

Annual maximum applies to diagnostic & preventive, basic services, and major services. Lifetime maximum applies to orthodontic services.

Annual max based on Calendar Year ANNUAL MAX

PLAN DEDUCTIBLE

The deductible is waived for diagnostic & preventive services. INDIVIDUAL

CLAIMS INFORMATION

Beam Dental PPO Standard coverages, as of August 1, 2019

SMART PREMIUM

HOW LOWERING YOUR PREMIUM WORKS

Using the Beam Brush earns you a Beam score. The better your group’s Beam score, the bigger potential drop in your premium at your renewal.*

Brush better, get a lower premium—pretty simple. Don’t worry, your rates will not increase based on your group Beam score alone. Just get rewarded for good brushing by your group.

*Premium reduction occurs at renewal (plan year or calendar year) and is based on Beam score aggregate of your group, prior year claims data analysis, and changes in dentist reimbursement contracts. The reduction stated above nor any reduction in premiums is guaranteed. Premium rates can be increased based on the factors previously stated, if determined in the underwriting process. Increases in premium will not occur based on group aggregate Beam score alone.

ADDITIONAL DETAILS

SEE ANY DENTIST

Our PPO plans allow you to see any licensed dentist. Savings in plan cost and member out of pocket expenses may be obtained by utilizing participating network dentists.

Beam has partnered with leading regional and national PPO network partners through Dental Benefit Providers, Careington PPO Dental, and DenteMax Plus Network to provide you with the most choices possible.

Note: The information contained in this proposal is not intended to be contractually binding without a written agreement executed by both parties memorializing the terms and conditions of dental benefit underwriting and/or administration anticipated to be provided by Beam and its partners. We and our partners reserve the right to withdraw this proposal at any time.

RATING REQUIREMENTS

Minimum employer contributions: 0.0% for employee and 0.0% for dependent(s).

Minimum employee enrollment: 20% of eligible employees

Maximum number of subgroups: 10

Rates are valid for 90 days after 06/03/22

This proposal is based on information provided with the proposal request. If accepted, final rates and benefits will be based on verification of the information provided with the rate request.

Once eligible, Certificate Holders and their Eligible Dependents must enroll for coverage under this policy within 30 days from the date upon which such Certificate Holder or Eligible Dependents become eligible for Benefits.

A Certificate Holder properly enrolls for coverage by completing all enrollment forms required by Beam and NGL and submitting such forms to the Policyholder.

If the Certificate Holder or Eligible Dependent is not properly enrolled for coverage within 30 days from the date upon which he/she becomes eligible for Benefits, then such Certificate Holder or Eligible Dependent must wait until the next Open Enrollment Period to enroll.

COVERAGE RULES

CODE PROCEDURE

COVERED UNDERFREQUENCY

D0120, D0150, D9310 Periodic oral exam, Comprehensive oral exam, Consultation Diagnostic Limit of three per 12 months

D0140 Limited oral exam Diagnostic Two per 12 months

D0210 Radiographs-FMX Diagnostic One per 60 months

D0220 Radiographs-periapical (first) Diagnostic Not covered if inclusive of a procedure with x-rays.

D0230 Radiographs-periapical (each additional)Diagnostic Not covered if inclusive of a procedure with x-rays.

D0270-D0274Radiographs-bitewings Diagnostic Every 6 months

D0330 Radiographs-panoramic

D1110 Prophylaxis

D1206, D1208Fluoride

D1351, D1352Sealants, Resins

D2140-D2161Fillings

D2330-D2394Fillings

D2740, D2750 ...Crowns (N,X,A)

D2950 Core Build-up (X)

Diagnostic One per 60 months

Preventive Two per benefit period

Preventive One per 12 months

Preventive One per 36 months, per tooth

Minor RestorativeOne per 24 months, per tooth

Minor RestorativeOne per 24 months, per tooth

Major One per 60 months, paid on seat date; seat date required

Major One per 60 months

D4341-D4342Periodontal scaling and root planing (N, P, X)PeriodonticsOne per 24 months, per quadrant

D4910 Periodontal maintenance (H) Periodontics Two per year unless pregnant (3) or diabetes (4)

D6010 Endosteal Implants (N,M,X2)

Major One per lifetime

Not covered: D0350, D0364, D0470, D1330, D2962, D3110, D3120, D8093, D9230, D9248

NOTES

Limited to 3 oral evaluation procedures, in any combination (D0120, D0150, D9310) per 12 month period

Can do treatment on same day; no shared freq with D0120; shared freq with D0170

Shared freq with D0330; not reimbursed within 6 months of Bitewing Radiographs

Bitewings and 7 or more periapicals will be reimbursed as FMX. Not covered on same day as D0210, D0330 or if considered a part of billed procedures

Bitewings and 7 or more periapicals will be reimbursed as FMX. Not covered on same day as D0210, D0330 or if considered a part of billed procedures

Can perform 6 months after D0210

Shared freq with D0210

Three per 12 months if pregnant 2nd/3rd trimester, four per 12 months if diabetic (N, V); not covered within 3 months of D4910

Covered under age 16

Covered under age 16, 1st & 2nd permanent molars

Multiple restorations on one surface are payable as one surface. Multiple surfaces on a single tooth will not be paid as separate restorations.

Multiple restorations on one surface are payable as one surface. Multiple surfaces on a single tooth will not be paid as separate restorations. Posterior composites covered.

See * note below for details

See * note below for details

Can perform all 4 quads in one day

After peridontal treatment; can be alternated with D1110 for one per three months

In lieu of a single tooth replacement when a 2 or 3 unit bridge has been approved for coverage when adjacent teeth are not in need of crowns on their own merit; if there are no additional teeth missing throughout the arch. Alternate benefit of a partial denture will be considered if criteria is not met.

*Exclusions include, but are not limited to: correction of attrition, abrasion, erosion, or abfraction; for teeth that are not broken down by extensive decay or accidental injury; to restore teeth with microfractures fracture lines, undermined cusps, or existing large restorations without overt pathology.

FREQUENTLY ASKED QUESTIONS

Continuation of service? Covered starting on patient's effective date

Continuation of benefits? Earlier effective date is primary

Frequency of ortho payments? Monthly – submit claims for on-going treatment

Are prior extractions covered? Yes – no missing tooth clause

N = Narrative of medical necessity

P = Perio charting

X = Labeled & dated, pre-op x-rays

X2 = Labeled & dated, pre-op and post op x-rays

Timely Filing limit? 12 months from date of service unless otherwise specified by state law. Please refer to your CertificateH = Periodontal history

Is pre-authorization mandatory? No – but estimates recommended for $300+ services

A = date of prior insertion of existing crown

M = panoramic x-ray or FMX (if available), all missing teeth

V = Verification from physician (if pregnant requires due date)

DISCLAIMER: Depending on the coverage you selected, your benefits may differ from those outlined above. Please review your Certificate of Insurance for full benefit descriptions and limitations. If there are any discrepancies between this summary and the plan documents, the plan documents will prevail.

Vision Plan Benefits for Palestine ISD

Co-Pays Monthly Premiums Services/Frequency

Benefits through Superior Select Southwest Network

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements

1Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay

2 Contact lenses and related professional services (fitting, evaluation and follow-up) are covered in lieu of eyeglass lenses and frames benefit

3 Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limitations

Discount Features

Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.

The Plan discount features are not insurance.

All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan.

Discounts are subject to change without notice.

Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions

Learn more about your annual Be Well Benefit

Your Unum plan pays a Be Well Benefit for one Be Well screening each year.

With Unum’s Be Well Benefit, you and other covered family members can receive a valuable incentive for important tests and screenings. Many of these tests are routinely performed, so it’s easy to take advantage of this benefit.

Your Critical Illness Be Well benefit is $50.

Be Well screenings

• Annual exams by a physician including sports physicals and well-child visits

• Cancer screenings including pap smear, colonoscopy

• Cardiovascular function screenings

• Cholesterol and diabetes screenings

• Imaging studies, including chest X-ray, mammography

• Immunizations including HPV, MMR, tetanus, influenza

It’s easy to file a claim.

You can receive a benefit for tests that are performed after your initial coverage date. Follow these simple steps:

File your claim by mail or over the phone. Simply call 1-800-635-5597 to learn more.

You will need to provide the following:

•First and last names of the employee and claimant (the employee might not be the claimant)

•Employee’s Social Security number or policy number

• Name and date of the test

•Name of physician and the facility where the test was performed.

Each year, you can earn a valuable incentive just for taking care of your health. And so can each of your covered family members.

For more information, please contact your HR representative.

Unum will pay Be Well benefits for all eligible policies according to policy terms. THESE POLICIES OFFER LIMITED BENEFITS

The policies or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benefits payable. See the actual policy or your Unum representative for specific provisions and details of availability.

Who is eligible for this coverage?

What is the coverage amount?

Is it portable (can I keep it if I leave my employer)?

When is coverage effective?*

What does my AD&D insurance pay for?

Palestine Independent School District UNUM Life and

Do my life insurance benefits decrease with age?

Insurance Plan Highlights

AD&D

Policy Number 474775

All actively employed employees working at least 15 hours each week for your employer in the U.S.

Your employer is providing you with $10,000 of term life insurance. You will also receive $10,000 of Accidental Death and Dismemberment insurance

If you retire, reduce your hours or leave your employer, you can continue coverage at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy.

Please see your plan administrator for your effective date.

The full benefit amount is paid for loss of:

- Life

- Both hands or both feet or sight of both eyes

- One hand and one foot

- One hand and the sight of one eye

- Speech and hearing

Coverage amounts will reduce according to the following schedule:

amount reduces to:

Coverage may not be increased after a reduction.

*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.

The policy provisions may vary or not be available in all states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage, 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

© 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

EN-1771 (6-18) FOR EMPLOYEES

Who is eligible for this coverage?

What are the Life coverage amounts?

Palestine Independent School District

UNUM Voluntary Life and AD&D Insurance Plan Highlights Policy Number 474776

All actively employed employees working at least 15 hours each week for your employer in the U.S. and their eligible spouses and children to 26.

Employee: up to 5 times salary in increments of $10,000; not to exceed $500,000. Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $250,000

Child: $10,000. The maximum death benefit for a child between the ages of live birth and six months is $1,000.

What are the AD&D coverage amounts?

Employee: up to 5 times salary in increments of $10,000; not to exceed $500,000. Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $250,000.

Note: In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself.

Can I be denied coverage?

Current employees: If you and your eligible dependents are enrolled in the plan and wish to increase your life insurance coverage, you may apply on or before the enrollment deadline for any amount of additional coverage up to $150,000 for yourself and any amount of additional coverage up to $50,000 for your spouse. Any life insurance coverage over the guaranteed amount(s) will be subject to answers to health questions.

If you and your eligible dependents are not currently enrolled in the plan, you may apply for coverage on or before the enrollment deadline and will be required to answer health questions for any amount of coverage.

New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense.

How do I apply? Please see your plan administrator.

When is coverage effective?

Please see your plan administrator for your effective date.

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.

For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness, or disorder, your dependent spouse and children: are confined in a hospital or similar institution; or are confined at home under the care of a physician for a sickness or injury. Exception: Infants are insured from live birth.

How much does the coverage cost?

Do my life insurance benefits decrease with age?

Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date.

Spouse rate is based on employee’s insurance age.

Coverage amounts will reduce according to the following schedule:

Is the coverage portable (can I keep it if I leave my employer)?

Are there any life insurance exclusions or limitations?

Will my premiums be waived if I’m disabled?

What does my AD&D insurance pay for?

Coverage may not be increased after a reduction.

If you retire, reduce your hours or leave your employer, you can continue coverage for yourself your spouse and your dependent children at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy.

Life insurance benefits will not be paid for deaths caused by suicide within the first 24 months after the date your coverage becomes effective. If you increase or add coverage, these enhancements will not be paid for deaths caused by suicide within the first 24 months after you make these changes.

If you become disabled (as defined by your plan) and are no longer able to work, your life premium payments will be waived until your disability period ends.

The full benefit amount is paid for loss of:

• life;

• both hands or both feet or sight of both eyes;

• one hand and one foot;

• one hand or one foot and the sight of one eye;

• speech and hearing.

Other losses may be covered as well. Please contact your plan administrator.

Are there any AD&D exclusions or 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 you 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.

When does my coverage end?

You and your dependents’ coverage under the Summary of Benefits 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 in active employment unless continued due to a covered layoff or leave of absence or due to an 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 dependent coverage, 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.

© 2017 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Underwritten by Unum Life Insurance Company of America, Portland, Maine

EN-1773 (8-17) FOR EMPLOYEES

Find clarity and comfort during trying times

Life planning financial & legal resources

When a loved one is terminally ill, or passes away, you may need help with the personal, financial and legal decisions that need to be made. Support is always available when you are protected by Unum Group Life Insurance.

When a loved one is terminally ill, or passes away, you may need help with the personal, financial and legal decisions that need to be made. Support is always available when you are protected by Unum Group Life Insurance.

LIFE PLANNING FINANCIAL & LEGAL RESOURCES WILL BE THERE

With Unum group life coverage, you have automatic access to Life Planning Financial & Legal Resources. This service is provided at no extra cost for employees, spouses and beneficiaries who need help during a terminal illness, or after the loss of a covered employee.

CARING CONSULTANTS CAN PROVIDE THE ASSISTANCE YOU NEED

When a life claim is submitted and approved, a speciallytrained consultant will reach out to the employee or beneficiary to provide support. Each consultant holds a Master’s degree in the mental health field, and is highly skilled at assisting those who need help dealing with the emotional challenges of a terminal illness or the loss of a loved one.

Life Planning consultants are also able to provide financial and legal support regarding estate settlement, Social Security, cash flow, taxes and investment planning. They can help you develop a customized financial plan to preserve your quality of life, protect resources and build future security.

These consultants are available to assist you in your time of need, and their services are designed to coordinate with the efforts of a family attorney, accountant, or broker. Their services are strictly confidential, and they do not work on commission and will not try to sell any product or service.

YOU MAY HAVE QUESTIONS LIKE THESE:

• There’s so much paperwork. Where do I begin?

• Do I need to pay outstanding bills?

• How should I manage retirement accounts?

• How should I invest the insurance money?

• What do I do with the will?

• Do I need to file probate?

Answers to these questions and more are available at no charge as part of your life insurance coverage from Unum.

ASSISTANCE IS ONLY A CALL OR CLICK AWAY

Whenever you need support, a Master’s level consultant can be reached by phone 24 hours a day, 365 days of the year.

To speak to a counselor or for more information:

• Call 1-800-854-1446 (multi-lingual)

• Visit members.healthadvocate.com (Enter Unum - Life Planning)

PureLife-plusispermanentlifeinsurancetoAttainedAge121that canneverbecancelledaslongasyoupaythenecessarypremiums.Afterthe GuaranteedPeriod,thepremiumscanbelower,thesame,orhigherthantheTablePremium.Seethebrochureunder”PermanentCoverage”.

Health Savings Accounts

Maximize your savings

A Health Savings Account, or HSA, is a tax-advantaged savings account you can use for healthcare expenses. Along with saving you money on taxes, HSAs can help you grow your nest egg for retirement.

How an HSA works:

• Contribute to your HSA by payroll deduction, online banking transfer or personal check.

• Pay for qualified medical expenses for yourself, your spouse and your dependents. Both current and past expenses are covered if they’re from after you opened your HSA.

• Use your HSA Bank Health Benefits Debit Card to pay directly, or pay out of pocket for reimbursement or to grow your HSA funds.

• Roll over any unused funds year to year. It’s your money — for life.

• Invest your HSA funds and potentially grow your savings.¹

What’s covered?

You can use your HSA funds to pay for any IRS-qualified medical expenses, like doctor visits, hospital fees, prescriptions, dental exams, vision appointments, over-the-counter medications and more. Visit hsabank.com/QME for a full list.

Am I eligible for an HSA?

You’re most likely eligible to open an HSA if:

• You have a qualified high-deductible health plan (HDHP).

• You’re not covered by any other non-HSA-compatible health plan, like Medicare Parts A and B.

• You’re not covered by TriCare.

• No one (other than your spouse) claims you as a dependent on their tax return.

How much can I contribute?

The IRS limits how much you can contribute to your HSA every year. This includes contributions from your employer, spouse, parents and anyone else.2 Maximum contribution limit

Catch-up contributions

You may be eligible to make a $1,000 HSA catch-up contribution if you’re:

• Over 55.

• An HSA accountholder.

• Not enrolled in Medicare (if you enroll mid-year, annual contributions are prorated).

A huge way that HSAs can benefit you is they let you save on taxes in three ways.

1 You don’t pay federal taxes on contributions to your HSA.3

2 Earnings from interest and investments are tax-free.

3

Distributions are tax free when used for qualified medical expenses.

¹ Investment accounts are not FDIC insured, may lose value and are not a deposit or other obligation of, or guarantee by the bank. Investment losses which are replaced are subject to the annual contribution limits of the HSA.

2 HSA contributions in excess of IRS limits are subject to penalty and tax unless the excess and earnings are withdrawn prior to the tax filing deadline as explained in IRS Publication 969.

3 Federal tax savings are available regardless of your state. State tax laws may vary. Consult a tax professional for more information.

Flexible Spending Account (FSA)

Partial List of Eligible Expenses:

Medical/Dental/Vision Copays and Deductibles

Prescription Drugs

Physical Therapy

Chiropractor

First-Aid Supplies

Two Types of FSAs

To take advantage of a health FSA, start by choosing an annual election amount. This amount will be available on day one of your plan year for eligible medical expenses.

Payroll deductions will then be made throughout the plan year to fund your account.

A dependent care FSA works differently than a health FSA. Money only becomes available as it is contributed and can only be used for dependent care expenses.

Both are pre-tax benefits your employer offers through a cafeteria plan. Choose one or both — whichever is right for you.

What is a Cafeteria Plan?

A cafeteria plan enables you to save money on group insurance, healthcare expenses, and dependent care expenses. Your contributions are deducted from your paycheck by your employer before taxes are withheld. These deductions lower your taxable income which can save you up to 35% on income taxes!

How to Spend

Spending is easy

Our convenient NBS Smart Card allows you to avoid out-of-pocket expenses, cumbersome claim forms and reimbursement delays. You may also utilize the “pay a provider” option on our web portal.

Lab Fees

Psychiatrist/Psychologist

Vaccinations

Dental Work/Orthodontia

Eye Exams

Laser Eye Surgery

Eyeglasses, Contact Lenses, Lens Solution

Prescribed OTC Medication

Account access is easy

Get account information from our easy-to-use online portal and mobile app. See your account balance, contributions and account history in real time.

Life’s not always flexible, but your money can be.

Enrollment Consideration

After the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying “change of status” (e.g. marriage, divorce, employment change, dependent change).

Be conservative in the total amount you elect to avoid forfeiting money at the end of the plan year.

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Get $10 off using code NBS1819.

Shop FSA Store at fsastore.com/nbs

What is a Dependent Care Assistance Program (DCAP)?

The Dependent Care Assistance Program (DCAP) allows you to use tax-free dollars to pay for child day care or elder day care expenses that you incur because you and your spouse are both gainfully employed.

To participate, determine the annual amount that you want to deduct from your paycheck before taxes. The maximum amount you can elect depends on your federal tax filing status ($5,000 if you are married and filing a joint return or if you are a single parent, $2,500 if you are married but filing separately)

Your annual amount will be divided by the number of pay periods in the plan year and that amount will be deducted from each paycheck.

Who is an eligible dependent?

You can use the DCAP for expenses incurred for:

•Your qualifying child who is age twelve or younger for whom you claim a dependency exemption on your income tax return.

•Your qualifying relative (e.g. a child over twelve, your parent, a spouse’s parent) who is physically or mentally incapable of caring for himself or herself and has the same principal place of abode as you for more than half of the year.

•Your spouse who is physically or mentally incapable of caring for himself or herself and has the same principal place of abode as you for more than half of the year.

Special Rule for Parents Who Are Divorced, Separated, or Living Apart

Only the custodial parent can claim expenses from the DCAP. The custodial parent is generally the parent with whom the child resides for the greater number of nights during the calendar year. Additionally, the custodial parent cannot be reimbursed from the DCAP for child-care expenses while the child lives with the non-custodial parent because such expenses are not incurred to enable the custodial parent to be gainfully employed.

What are eligible expenses for the DCAP?

The expenses which are eligible for reimbursement must have been incurred during the plan year and in connection with you and your spouse to remain gainfully employed.

Examples of eligible expenses:

•Before and After School and/or Extended Day Programs

•Daycare in your home or elsewhere so long as the dependent regularly spends at least 8 hours a day in your home.

•Base cost of day camps or similar programs.

Examples of ineligible expenses:

•Schooling for a child in kindergarten or above

•Babysitter while you go to the movies or out to eat

•Cost of overnight camps

What does it mean to be “gainfully employed”?

This means that you are working and earning an income (i.e. not doing volunteer work). You are not considered gainfully employed during paid vacation time or sick days. Gainful employment is determined on a daily basis.

If you are married, then your spouse would also need to be gainfully employed for your day care expenses to be eligible for reimbursement.

You are also considered gainfully employed if you are unemployed but actively looking for work, you are self-employed, you are physically or mentally not capable of self-care, or you are a full-time student (must attend for the number of hours that the school considers full-time, must have been a student for some part of each of 5 calendar months during the year, cannot be attending school only at night, does not include on-the-job training courses or correspondence schools).

What are some other important IRS regulations?

•You cannot be reimbursed for dependent care expenses that were paid to (1) one of your dependents, (2) your spouse, or (3) one of your children who is under the age of nineteen.

•In the event that you use a day care center that cares for more than six children, the center must be licensed.

• You must provide the day care provider’s Social Security Number/Tax Identification Number (EIN) on form 2441 when you file your taxes.

What are some other important IRS regulations?

The IRS allows you to take a tax credit for your dependent care expenses. The tax credit may provide you with a greater benefit than the DCAP if you are in a lower tax bracket. To determine whether the tax credit or the DCAP is best for you, you will need to review your individual tax circumstances. You cannot use the same expenses for both the tax credit and the DCAP, however, you may be able to coordinate the federal dependent care tax credit with participation in the DCAP for expenses not reimbursed through DCAP. For more information, please call 1(800) 274-0503

•American Fund/Capital Guardian

•Corebridge Financial (formerly AIG/VALIC)

•Equitable (formerly AXA)

•Horace Mann Life Ins. Co.

•Industrial Alliance - (Sec.Ben.)

•Invesco OppenheimerFunds

•Jefferson National Life

•National Life Group (LSW)

•PlanMember Services Corp.

•Putnam Investments

•ROTH - Equitable (formerly AXA)

•ROTH - National Life Group (LSW)

•ROTH - PlanMember Services Corp.

•Vanguard Fiduciary Trust Co.

•Voya Financial (North.)

•Voya Financial (Reliastar)

•Voya Financial (VRIAC)