Palestine 2024 2025 Employee Benefit Guide by Riata245

Login Process

PalestineISD

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!

The 2024-2025 Section 125 Cafeteria Plan year begins 09/01/2024 and ends 08/31/2025 All benefits elected during the annual open enrollment will be effective 09/01/2024

Know Your Benefits!

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.

Delta Dental (NEW) - Coverage for preventative, basic, major, and orthodontia services.

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 8/31/2024

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

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

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

 Enter the code, then click VERIFY

YOU ARE NOW READY TO ENROLL IN YOUR BENEFITS.

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.

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?

•

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.

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?

MORE IMPORTANT INFORMATION

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.

MEMBER INFORMATION

Providing Fast And Convenient Care

For Your Medical Needs…

COMMONLY TREATED CONDITIONS

• Allergies

• Arthritic Pain

• Cold & Flu

• Tonsillitis

• Laryngitis

• Pharyngitis

• Skin Infections

• Gastroenteritis

• Ear Infection

• Pink Eye

• Insect Bites

• Minor Burns

• Respiratory Infections

• Sinusitis

• Sprains and Strains

• Urinary tract Infection

• Consulting for International and Domestic Travel

• AND MUCH MORE!

•Access to licensed, board-certified physicians

• Little or no time missed from work

•No crowded waiting rooms or appointment times

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.

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

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.

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

No matter how comprehensive your local in-network coverage may be, you still have

when

and

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

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. Luis’ Accident policy paid

*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.

Lower Jaw, Mandible (except Alveolar Process)

Vertebral Process

Forearm (Ulna and/or Radius)

Hand, Wrist (except Fingers)

Kneecap

Foot (except Toes)

$2,500.00

$1,600.00

$1,600.00 Ankle

Reduction

Closed/Non-Surgical Treatment

Knee (other than Kneecap)

$2,250.00 Shoulder

Kneecap

Ankle bone or bones of the foot

$2,250.00

$1,000.00

$1,000.00 Elbow

$1,000.00 Wrist

Bone or bones of the hand

$1,000.00

$1,000.00 Jawbone

Repair - up to 2 inches

Repair - over 2 inches, up to 6 inches $200.00

Repair - over 6 inches $400.00 Burns

2nd Degree Burns

At least 1%, but less than 20% of skin surface $100.00

20% or greater of skin surface $500.00

3rd Degree Burns

Less than 5% of skin surface $500.00

At least 5%, but less than 20% of skin surface

20% or greater of skin surface

Skin Graft

$5,000.00

$10,000.00

Examples of Eligible Screening Events

Blood tests for triglycerides Colonoscopy

Annual exam for adults

Hepatitis B immunization Sports physicals

Bone marrow testing HPV immunization Stress test

Bone density screening Chicken pox immunization Mammography Tetanus

Breast MRI

Fasting blood glucose test Pap smear

Carotid ultrasound Flu vaccination

Concussion baseline testing

Dermatological screening for skin cancer

Virtual colonoscopy

Pneumonia immunization Well child visits

Genetic screening for medical diagnosis & treatment

Serum cholesterol HDL/LDL

How much does it cost?

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?

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?

Progressive Diseases

for your Children

*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?

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.

Underwritten by Unum Insurance Company, Portland, Maine AE-1226 FOR EMPLOYEES

Zurich Specialty Health Supplemental GAP Medical

$1,000 per Injury or Sickness per Plan Year Maximum Per Family* 4 outpatient occurrences per Family per Plan Year

*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

• Eligibility

Doing business in the U.S. since 1912

Approximately 55,000 experienced professionals worldwide

Approximately 9,000 employees in North America

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

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

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

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

• 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.

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

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.

Keep smiling

DPO

Save with DPO

Visit a dentist in the DPO1 network to maximize your savings.2 These dentists have agreed to reduced fees, and you won’t get charged more than your expected share of the bill.3 Find a DPO dentist at deltadentalins.com.

Set up an online account

Get information about your plan, check benefits and eligibility information, find a network dentist and more. Sign up for an online account at deltadentalins.com

Check in without an ID card

You don’t need a Delta Dental ID card when you visit the dentist. Just provide your name, birth date and enrollee ID or Social Security number. If your family members are covered under your plan, they’ll need your information. Prefer to have an ID card? Simply log in to your account to view or print your card.

Coordinate dual coverage

If you’re covered under two plans, ask your dental office to include information about both plans with your claim — we’ll handle the rest.

Understand transition of care

Generally, multi-stage procedures are covered under your current plan only if treatment began after your plan’s effective date of coverage.4 Log in to your online account to find this date.

Get LASIK and hearing aid discounts

With access to QualSight and Amplifon Hearing Health Care5, you can receive significant savings on LASIK procedures and hearing aids. To take advantage of these discounts, call QualSight at 855-248-2020 and Amplifon at 888-779-1429.

1 In Texas, Delta Dental Insurance Company provides a dental provider organization (DPO) plan.

2 You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-DPO dentist. Network dentists are paid contracted fees.

3 You are responsible for any applicable deductibles, coinsurance, amounts over annual or lifetime maximums and charges for non-covered services. Out-of-network dentists may bill the difference between their usual fee and Delta Dental’s maximum contract allowance.

4 Applies only to procedures covered under your plan. If you began treatment prior to your effective date of coverage, you or your prior carrier is responsible for any costs. Group- and state-specific exceptions may apply. If you are currently undergoing active orthodontic treatment, you may be eligible to continue treatment under this plan. Review your Evidence of Coverage, Summary Plan Description or Group Dental Service Contract for specific details about your plan.

5 Vision corrective services and Amplifon’s hearing health care services are not insured benefits. Delta Dental makes the vision corrective services program and hearing health care services program available to you to provide access to the preferred pricing for LASIK surgery and for hearing

and other hearing health services.

Benefit Highlights: DPO from Delta Dental

For eligibility details, refer to the plan's Evidence/Certificate of

employer).

*Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist’s submitted fees.

** Reimbursement is based on DPO contracted fees for DPO dentists, Premier contracted

This benefit information is not intended or designed to replace or serve as the plan’s Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company’s benefits representative.

Vision Plan Benefits for Palestine ISD

Benefits through Superior Select Southwest Network

to $70 retail Lenses (standard) per pair Single Vision Covered in full

to $25 retail Bifocal Covered in full

in full

to $40 retail

to $45 retail

to $20 retail

to $15 retail Polycarbonate Covered in full

Scratch resistant coating Covered in full

Lenses

to $150 retail Lasik Vision Correction $200 allowance3

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.

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 AD&D Insurance Plan Highlights 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

Do my life insurance benefits decrease with age?

Coverage amounts will reduce according to the following schedule:

Insurance amount reduces to:

of original amount

of the original amount

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

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?

How do I apply?

When is coverage effective?

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.

Please see your plan administrator.

Please see your plan administrator for your effective date.

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?

Rates

Do my life insurance benefits decrease with age?

Child Life monthly rate is $1.00 for $10,000. One life premium covers all children.

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:

amount reduces to:

Coverage may not be increased after a reduction. 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?

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.

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.

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)

Life Insurance Highlights

For the employee

Flexible Premium Life Insurance to Age 121 Policy Form PRFNG-NI-10

For the eligible employees of Palestine ISD

Voluntary permanent life insurance can be an ideal complement to the group term and optional term 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, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually cost more and decline in death benefit.

The policy, 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.

• 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.2 Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time.3

• Refund of Premium. Unique in the marketplace, purelife-plus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy 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)

You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, children and grandchildren by answering just 3 questions: 4

During the last six months, has the proposed insured:

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

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

c. 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 therapy, dialysis treatment, or treatment for alcohol or drug abuse?

Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details.

1 Voluntary Whole and Universal Life Products, Eastbridge Consulting Group, December 2015

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

3After the guaranteed period, premiums may go down, stay the same, or go up.

4Texas Life complies with all state laws regarding marriages, domestic and civil union partnerships, and legally recognized familial relationships. Accordingly, we will treat each party to a civil union or domestic partnership that is recognized and valid under applicable state law as a spouse. Coverage not available on children and grandchildren in Washington.

See the purelife-plus brochure for details.

PureLife-plusispermanentlifeinsurancetoAttainedAge121thatcan neverbecancelledaslongasyoupaythenecessarypremiums.Afterthe GuaranteedPeriod,thepremiumscanbelower,thesame,orhigherthanthe TablePremium.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 SINGLE PLAN

$8,300 $4,150 2024

Catch-up contributions

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

Triple tax savings

• 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 HSA contributions

3 Federal tax savings are available regardless of your state. State tax laws may

PLAN Visit www.hsabank.com orcallthe numberonthebackofyourdebit cardformoreinformation.

Earnings from interest and investments are tax-free.

Distributions are tax free when used for qualified medical expenses.

FLEXIBLE BENEFITS PLAN

Congratulations! Palestine 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.

GENERAL PLAN INFORMATION

Plan Year:…………… September 1st through August 31st

Maximum Health FSA Limit…… .…Current IRSlimit …See Code Section 125(i)(2) or current enrollment information

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

Carryover

If you have unused contributions in your Health Flexible Spending Account following the Plan run-out period, you may roll forward a limited dollar amount into the following plan year.

Health FSA Carryover…….Up to $640 following the Plan run-out Amounts exceeding $640 will be forfeited

Grace Period

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.

Dependent Care (DCAP) ...…...75 days

Deadlines to Incur Expenses on Elected Funds

Health FSA

..……….....August 31 Plan Year End

DCAP…………… November 14 following Plan Year End

Deadlines to File for Reimbursement Run-out Period:………………………………… 90 days

HealthFSA andDCAP… November 29 following plan year end

Mid-Year Terminations

FSA 30 days following termination date

DCAP……………………....… 30 days following termination date

Orthodontic Reimbursement……….as paidper service contract or in full at time of banding Upfront payment……………….…………..… …allowed

AM I ELIGIBLE TO PARTICIPATE

If you work 15 hours or more each week for the company, you will be eligible to join the Plan once you have satisfied the conditions for coverage under our group medical plan

You will enter the Plan on the first day of the month following the day in which you meet the above eligibility requirements.

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.

WHAT TYPE OF BENEFITS ARE AVAILABLE

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

NBS Welfare Benefit Service Center

(801) 532-4000 or 800-274-0503

Fax: 800-478-1528

service@nbsbenefits.com Palestine Independent School District Flexible Benefits Plan

Flexible Benefits Plan Highlights

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.

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

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

Palestine ISD

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

•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 - Horace Mann Life Ins. Co.

•ROTH - National Life Group (LSW)

•ROTH - PlanMember Services Corp.

•Vanguard Fiduciary Trust Co.

•Voya Financial (North.)

•Voya Financial (Reliastar)

•Voya Financial (VRIAC)

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.

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