2016 Benefit Guide Celina ISD

EFFECTIVE:

09/01/2016 - 8/31/2017

BENEFIT GUIDE

www.mybenefitshub.com/celinaisd

CELINA ISD

1

Benefit Contact Information 3

How to Enroll 4-5

Annual Benefit Enrollment 6-11

1. Benefit Updates 6

2. Section 125 Cafeteria Plan Guidelines 7

3. Annual Enrollment 8

4. Eligibility Requirements 9

5. Helpful Definitions 10 6. HSA vs FSA Comparison 11

TRS-ActiveCare and Scott & White HMO 12-15

HSA Bank Health Savings Account 16-19

MDLIVE Telehealth 20-21

OraQuest/First Continental Life (FCL) Dental 22-25

Superior Vision 26-27The Hartford Long Term Disability 28-31

APL Cancer 32-35

Loyal American Accident 36-39

Hartford Basic Life, Voluntary Life and AD&D 40-435Star Family Protection Plan Term Life Insurance with Quality of Life Rider 44-47

NBS Flexible Spending Account 48-51

Naturally Slim Weight Loss 52-53

Table of Contents

HOW TO ENROLL

PG. 4

YOUR BENEFIT UPDATES: WHAT’S NEW

PG. 6

YOUR MEDICAL BENEFITS

PG. 12

FLIP TO...

2

Benefit Contact Information

Benefit Contact Information

BENEFIT ADMINISTRATORS CELINA ISD BENFITS OFFICE TRS ACTIVECARE MEDICAL

Financial Benefit Services (800) 583-6908www.mybenefitshub.com/celinaisd

(469) 742-9100www.schools.celinaschools.net/benefits

Aetna (800) 222-9205www.trsactivecareaetna.com

HEALTH SAVINGS ACCOUNTS TELEHEALTH DENTAL

HSA Bank (800) 357-6246www.hsabank.com

MDLIVE(888) 365-1663www.consultmdlive.com

Group #: 1245-D OraQuest/First Continental Life PPO Dental (800) 660-6064Find a provider: (800) 752-1547www.dentemax.com

VISION DISABILITY CANCER

Group #:324700 Superior Vision (800) 507-3800www.superiorvision.com

Group #: 873302 The Hartford (800) 583-6908File a claim : (866) 278-2655www.thehartford.com

American Public Life (APL) (800) 256-8606www.ampublic.com

ACCIDENT LIFE AND AD&D FLEXIBLE SPENDING ACCOUNTS

Loyal American(800) 366-8354

The Hartford (469) 385-4685www.thehartford.com

National Benefit Services (800) 274-0503www.nbsbenefits.com

INDIVIDUAL LIFE WEIGHT LOSS

5Star Life Insurance Company (866) 863-9753www.5starlifeinsurance.com

Naturally Slim (800) 583-6908www.naturallyslim.com

3

http://www.aetna.com/

!

How to Enroll

On Your Computer Access THEbenefitsHUB from your

computer, tablet or smartphone!

Our online benefit enrollment

platform provides a simple and

easy to navigate process. Enroll

at your own pace, whether at

home or at work.

www.mybenefitshub.com/

celinaisd delivers important

benefit information with 24/7

access, as well as detailed plan

information, rates and product

videos.

TEXT

“celinaisd”

TO

313131

On Your Device Enrolling in your benefits just got

a lot easier! Text “celinaisd” to

313131 to receive everything you

need to complete your

enrollment.

Avoid typing long URLs and scan

directly to your benefits website,

to access plan information,

benefit guide, benefit videos, and

more!

SCAN: TRY ME

4

GO www.mybenefitshub.com/celinaisd 1

2

Login Steps

3

Go to:

Click Login

Enter Username & Password

OR SCAN

All login credentials have been RESET to the default

described below:

Username:

The first six (6) characters of your last name, followed

by the first letter of your first name, followed by the

last four (4) digits of your Social Security Number.

If you have six (6) or less characters in your last name,

use your full last name, followed by the first letter of

your first name, followed by the last four (4) digits of

your Social Security Number.

Default Password:

Last Name* (lowercase, excluding punctuation)

followed by the last four (4) digits of your Social

Security Number.

Sample Password

l incola1234

l incoln1234

If you have trouble

logging in, click on the

“Login Help Video”

for assistance.

Click on “Enrollment Instructions” for more information about how to enroll.

Sample Username

LOGIN

Open Enrollment Tip

For your User ID: If you have less than six (6) characters in your last

name, use your full last name, followed by the first letter of your first

name, followed by the last four (4) digits of your Social Security Number.

5

Due to the ACA, you MUST login towww.mybenefitshub.com/celinaisd in August 2016 &either waive or elect medical insurance by 8/22/16!

New Plan!: Celina ISD is adding an Individual Life Policythrough 5Star effective 9/1/16. If you currently have theTX Life Permanent plan, this will no longer be offered asa payroll deducted benefit. If you’re currently on the TXLife plan, you will receive instructions on how to directlypay your premium to the carrier.

New Plan!! Naturally Slim® is a proven soluƟon to helpyou lose weight and reduce Metabolic Syndrome (MetS)risk. MetS is a cluster of risk factors that predicts seriouscondiƟons such as diabetes, heart disease and stroke.Coverage is available for you and your spouse. You willenroll in this product using Naturally Slim’s link but it willbe a payroll deducted benefit through THEbenefitsHUB.

Benefit elections will become effective 9/1/2016(elections requiring evidence of insurability, such as lifeInsurance, may have a later effective date, ifapproved). After annual enrollment closes, benefitchanges can only be made if you experience a qualifyingevent (and changes must be made within 30 days ofevent).

If you currently participate in a Health Care orDependent Care FSA, you MUST re‐elect a newcontribution amount every year to continue toparticipate. The annual maximum for FSA will beincreasing for the 2016‐2017 plan year to $2,550.

Print & sign a copy of your “Consolidated EnrollmentForm” & send it to: Lana Brooks in Human Resources.

Social Security Numbers for your dependents are requiredregardless if they are enrolled in coverage or not. Pleasemake sure you have these items on hand when goingthrough your open enrollment.

Don’t Forget!

For questions about benefits or enrollment assistance, please call the FBS Call Center at469‐385‐4685. Bilingual assistance is available by calling this number.

Login & complete your benefit enrollment from 8/1/2016‐8/22/2016. Update your profile information: home address, phone numbers, email. Update dependent social security numbers and student status for college aged children.

Benefit Updates - What’s New:

SUMMARY PAGES

Annual Benefit Enrollment

6

SUMMARY PAGES

CHANGES IN STATUS (CIS):

QUALIFYING EVENTS

Marital Status A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).

Change in Number of Tax Dependents

A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.

Change in Status of Employment Affecting

Coverage Eligibility

Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.

Gain/Loss of Dependents' Eligibility Status

An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements under an employer's plan may include change in age, student, marital, employment or tax dependent status.

Judgment/Decree/Order

If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.

Eligibility for Government Programs

Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.

A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.

Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

Section 125 Cafeteria Plan Guidelines

7

Annual EnrollmentDuring your annual enrollment period, you have the opportunity

to review, change or continue benefit elections each year.

Changes are not permitted during the plan year (outside of

annual enrollment) unless a Section 125 qualifying event occurs.

Changes, additions or drops may be made only during the

annual enrollment period without a qualifying event.

Employees must review their personal information and verify

that dependents they wish to provide coverage for are

included in the dependent profile. Additionally, you must

notify your employer of any discrepancy in personal and/or

benefit information.

Employees must confirm on each benefit screen (medical,

dental, vision, etc.) that each dependent to be covered is

selected in order to be included in the coverage for that

particular benefit.

New Hire EnrollmentAll new hire enrollment elections must be completed in the

online enrollment system within the first 31 days of benefit

eligibility employment. Failure to complete elections during this

timeframe will result in the forfeiture of coverage.

Q&AWho do I contact with Questions?

For supplemental benefit questions, you can contact your

Benefits/HR department or you can call Financial Benefit Services

at 866-914-5202 for assistance.

Where can I find forms?

For benefit summaries and claim forms, go to your school district's benefit website: www.mybenefitshub.com/celinaisd.

Click on the benefit plan you need information on (i.e.,

Dental) and you can find the forms you need under the

Benefits and Forms section.

How can I find a Network Provider?

For benefit summaries and claim forms, go to your school district's benefit website: www.mybenefitshub.com/celinaisd.

Click on the benefit plan you need information on (i.e.,

Dental) and you can find provider search links under the

Quick Links section.

When will I receive ID cards?

If the insurance carrier provides ID cards, you can expect to

receive those 3-4 weeks after your effective date. For most

dental and vision plans, you can login to the carrier website

and print a temporary ID card or simply give your provider

the insurance company’s phone number and they can call

and verify your coverage if you do not have an ID card at that

time. If you do not receive your ID card, you can call the

carrier’s customer service number to request another card.

SUMMARY PAGES

8

PLAN CARRIER MAXIMUM AGE

AD&D The Hartford To age 25

Cancer American Public Life To age 26

Dental PPO OraQuest/First Continental Life To age 26

Medical Aetna To age 26

Individual Life 5 Star To age 24

Vision Superior Vision To age 26

Voluntary Life The Hartford To age 25

Employee Eligibility RequirementsSupplemental Benefits: Eligible employees must work 20 or more

regularly scheduled hours each work week.

Eligible employees must be actively at work on the plan effective

date for new benefits to be effective, meaning you are physically

capable of performing the functions of your job on the first day of

work concurrent with the plan effective date. For example, if

your 2016 benefits become effective on September 1, 2016, you

must be actively-at-work on September 1, 2016 to be eligible for

your new benefits.

Dependent Eligibility RequirementsDependent Eligibility: You can cover eligible dependent

children under a benefit that offers dependent coverage,

provided you participate in the same benefit, through the

maximum age listed below. Dependents cannot be double

covered by married spouses within Celina ISD or as both

employees and dependents.

If your dependent is disabled, coverage can continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage.

SUMMARY PAGES

9

Actively at Work You are performing your regular occupation for the employer

on a full-time basis, either at one of the employer’s usual

places of business or at some location to which the employer’s

business requires you to travel. If you will not be actively at

work beginning 9/1/2016 please notify your benefits

administrator.

Annual Enrollment The period during which existing employees are given the

opportunity to enroll in or change their current elections.

Annual Deductible The amount you pay each plan year before the plan begins to

pay covered expenses.

Calendar Year January 1st through December 31st.

Co-insurance After any applicable deductible, your share of the cost of a

covered health care service, calculated as a percentage (for

example, 20%) of the allowed amount for the service.

Guaranteed Coverage The amount of coverage you can elect without answering any

medical questions or taking a health exam. Guaranteed

coverage is only available during initial eligibility period.

Actively-at-work and/or pre-existing condition exclusion

provisions do apply, as applicable by carrier.

In-Network Doctors, hospitals, optometrists, dentists and other providers

who have contracted with the plan as a network provider.

Out of Pocket Maximum The most an eligible or insured person can pay in co-insurance

for covered expenses.

Plan Year September 1st through August 31st.

Pre-Existing Conditions Applies to any illness, injury or condition for which the

participant has been under the care of a health care provider,

taken prescriptions drugs or is under a health care provider’s

orders to take drugs, or received medical care or services

(including diagnostic and/or consultation services).

Helpful Definitions SUMMARY PAGES

10

SUMMARY PAGES HSA vs. FSA

Health Savings Account (HSA) (IRC Sec. 223)

Flexible Spending Account (FSA) (IRC Sec. 125)

Description

Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.

Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, tax-free. This also allows employees to pay for qualifying dependent care tax-free.

Employer Eligibility A qualified high deductible health plan. All employers

Contribution Source Employee and/or employer Employee and/or employer

Account Owner Individual Employer

Underlying Insurance Requirement

High deductible health plan None

Minimum Deductible $1,300 single (2016) $2,600 family (2016) N/A

Maximum Contribution $3,350 single (2016) $6,750 family (2016)

Varies per employer

Permissible Use Of Funds If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.

Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).

Cash-Outs of Unused Amounts (if no medical expenses)

Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65).

Not permitted

Year-to-year rollover of account balance?

Yes, will roll over to use for subsequent year’s health coverage.

No. Access to some funds can may be extended if your employer’s plan contains a 2 1/2 –month grace period or $500 rollover provision.

Does the account earn interest?

Yes No

Portable? Yes, portable year-to-year and between jobs.

No

FLIP TO… PG. 16 FOR HSA INFORMATION FOR FSA INFORMATION

FLIP TO… PG. 48

11

2016-2017 TRS-ActiveCare Plan Highlights Effective September 1, 2016 through August 31, 2017 | In-Network Level of Benefits*

Type of Service ActiveCare 1-HD ActiveCare Select or ActiveCare Select Whole Health

(Baptist Health System and HealthTexas Medical Group; Baylor Scott & White Quality Alliance; Memorial Hermann

Accountable Care Network; Seton Health Alliance)

ActiveCare 2

Deductible (per plan year)

$2,500 employee only $5,000 family

$1,200 individual $3,600 family


Out-of-Pocket Maximum (per plan year; does include medical deductible/ any medical copays/coinsurance/any prescription drug deductible and applicable copays/coinsurance)

$6,550 individual $13,100 family (the individual out-of-pocket maximum only includes covered expenses incurred by that individual)



Coinsurance Plan pays (up to allowable amount) Participant pays (after deductible)

80% 20%

80% 20%

80% 20%

Office Visit Copay Participant pays

20% after deductible $30 copay for primary $60 copay for specialist

$30 copay for primary $50 copay for specialist

Diagnostic Lab Participant pays

20% after deductible Plan pays 100% (deductible waived) if performed at a Quest facility; 20% after deductible at other facility

Plan pays 100% (deductible waived) if performed at a Quest facility; 20% after deductible at other facility

Preventive Care See next page for a list of services

Plan pays 100% Plan pays 100% Plan pays 100%

Teladoc® Physician Services $40 consultation fee (applies to deductible and out-of-pocket maximum)

Plan pays 100% Plan pays 100%

High-Tech Radiology (CT scan, MRI, nuclear medicine) Participant pays

20% after deductible $100 copay plus 20% after deductible $100 copay plus 20% after deductible

Inpatient Hospital (preauthorization required) (facility charges) Participant pays

20% after deductible $150 copay per day plus 20% after deductible ($750 maximum copay per admission)

$150 copay per day plus 20% after deductible($750 maximum copay per admission; $2,250 maximum copay per plan year)

Emergency Room (true emergency use) Participant pays

20% after deductible $150 copay plus 20% after deductible (copay waived if admitted)

$150 copay plus 20% after deductible (copay waived if admitted)

Outpatient Surgery Participant pays

20% after deductible $150 copay per visit plus 20% after deductible

$150 copay per visit plus 20% after deductible

Bariatric Surgery Physician charges (only covered if performed at an IOQ facility) Participant pays

$5,000 copay plus 20% after deductible

Not covered $5,000 copay (does not apply to out-of-pocket maximum) plus 20% after deductible

Prescription Drugs Drug deductible (per plan year)

Subject to plan year deductible $0 for generic drugs $200 per person for brand-name drugs

$0 for generic drugs $200 per person for brand-name drugs

Retail Short-Term (up to a 31-day supply) Participant pays • Generic copay • Brand copay (preferred list) • Brand copay (non-preferred list)

20% after deductible

$20 $40** 50% coinsurance**

$20 $40** $65**

Retail Maintenance (after first fill; up to a 31-day supply) Participant pays • Generic copay • Brand copay (preferred list) • Brand copay (non-preferred list)


$35 $60** 50% coinsurance**

$35 $60** $90**

Mail Order and Retail-Plus (up to a 90-day supply) Participant pays • Generic copay • Brand copay (preferred list) • Brand copay (non-preferred list)


$45 $105*** 50% coinsurance

$45 $105*** $180***

Specialty Drugs Participant pays

20% after deductible 20% coinsurance per fill $200 per fill (up to 31-day supply) $450 per fill (32- to 90-day supply)

A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. *Illustrates benefits when in-network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits under the ActiveCare Select or ActiveCare Select Whole Health Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for this balance bill amount, which maybe considerable. **If the patient obtains a brand-name drug when a generic equivalent is available, the patient will be responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug.

12

TRS-ActiveCare Plans—Preventive Care

Preventive Care Services

Network Benefits When Using In-Network Providers

(Provider must bill services as “preventive care”)

ActiveCare 1-HD ActiveCare Select or ActiveCare Select

Whole Health (Baptist Health System and

HealthTexas Medical Group; Baylor Scott & White Quality Alliance;

Memorial Hermann Accountable Care Network; Seton Health

Alliance)

ActiveCare 2 Network

Evidence−based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force (USPSTF) www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations

Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) with respect to the individual involved.

Evidence−informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) for infants, children and adolescents. Additional preventive care and screenings for women, not described above, as provided for in comprehensive guidelines supported by the HRSA www.hhs.gov/healthcare/facts-and-features/fact-sheets/preventive-services-covered-under-aca/#CoveredPreventive ServicesforAdults

For purposes of this benefit, the current recommendations of the USPSTF regarding breast cancer screening and mammography and prevention will be considered the most current (other than those issued in or around November 2009).

The preventive care services described above may change as USPSTF, CDC and HRSA guidelines are modified.

Plan pays 100% (deductible waived; no copay required)

Some examples of preventive care frequency and services: Routine physicals – annually age

12 and over Well-child care – unlimited up to

age 12 Well woman exam & pap smear

– annually age 18 and over Mammograms – 1 every year age

35 and over Colonoscopy – 1 every 10 years

age 50 and over Prostate cancer screening – 1 per

year age 50 and over Smoking cessation counseling – 8

visits per 12 months Healthy diet/obesity counseling –

unlimited to age 22; age 22 and over-26 visits per 12 months

Breastfeeding support – 6 lactation counseling visits per 12 months

Plan pays 100% (deductible waived; no copay required)

Some examples of preventive care frequency and services: Routine physicals –

annually age 12 and over Well-child care – unlimited

up to age 12 Well woman exam & pap

smear – annually age 18 and over

Mammograms – 1 everyyear age 35 and over

Colonoscopy – 1 every 10 years age 50 and over

Prostate cancer screening –1 per year age 50 and over

Smoking cessationcounseling –8 visits per 12 months

Healthy diet/obesitycounseling – unlimited to age 22; age 22 and over-26 visits per 12 months

Breastfeeding support –6 lactation counseling visitsper 12 months

Plan pays 100% (deductible waived)

Some examples of preventive care frequency and services: Routine physicals – annually

age 12 and over Well-child care – unlimited

up to age 12 Well woman exam & pap

smear – annually age 18 andover

Mammograms – 1 every year age 35 and over

Colonoscopy – 1 every 10 years age 50 and over

Prostate cancer screening – 1 per year age 50 and over

Smoking cessationcounseling – 8 visits per 12 months

Healthy diet/obesitycounseling – unlimited to age 22; age 22 and over-26 visits per 12 months

Breastfeeding support – 6 lactation counseling visits per 12 months

(Examples of covered services included are: Routine annual physicals (one per year); immunizations; well-child care; breastfeeding support, services and supplies; cancer screening mammograms; bone density test; screening for prostate cancer and colorectal cancer (including routine colonoscopies); smoking cessation counseling services and healthy diet counseling; and obesity screening/counseling.

Examples of covered services for women with reproductive capacity are: Female sterilization procedures and specified FDA-approved contraception methods with a written prescription by a health care practitioner, including cervical caps, diaphragms, implantable contraceptives, intra-uterine devices, injectables, transdermal contraceptives and vaginal contraceptive devices. Prescription contraceptives for women are covered under the pharmacy benefits administered by Caremark.

To determine if a specific contraceptive drug or device is included in this benefit, contact Customer Service at 1-800-222-9205. The list may change as FDA guidelines are modified.

Annual Vision Examination (one per plan year; performed by an opthalmologist or optometrist using calibrated instruments) Participant pays

After deductible, plan pays 80%; participant pays 20%

$60 copay for specialist $50 copay for specialist

Annual Hearing Examination Participant pays

After deductible, plan pays 80%; participant pays 20%



Note: Covered services under this benefit must be billed by the provider as “preventive care.” If you receive preventive services from a non-network provider, you will be responsible for any applicable deductible and coinsurance under the ActiveCare 1-HD and ActiveCare 2. Non-network preventive care is not paid at 100%. There is no coverage for non-network services under the ActiveCare Select plan or ActiveCare Select Whole Health.

TRS-ActiveCare is administered by Aetna Life Insurance Company. Aetna provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug benefits are administered by Caremark.

13

2016-2017 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare

Fully Covered Health Care Services Copay

Preventive Services No Charge

Standard Lab and X-ray No Charge

Disease Management and Complex Case Management No Charge

Well Child Care Annual Exams No Charge

Immunizations (age appropriate) No Charge

Plan Provisions Copay

Annual Deductible $1,000 Individual/ $3,000 Family

Annual out-of-pocket maximum (including medical and prescription co-pays and coinsurance)

$5,000 Individual/ $10,000 Family (includes combined Medical and RX copays, deductibles and

coinsurance)

Lifetime Paid Benefit Maximum None

Outpatient Services Copay

Primary Care1 $20 co-pay

(First Primary Care Visit for Illness $0 Copay2)

Specialty Care $50 co-pay

Other Outpatient Services 20% after deductible3

Diagnostic/Radiology Procedures 20% after deductible

Eye Exam (one annually) No Charge

Allergy Serum & Injections 20% after deductible

Outpatient Surgery $150 co-pay and 20% of charges after deductible

Maternity Care Copay

Prenatal Care No Charge

Inpatient Delivery $150 per day4 and 20% of charges after deductible

Inpatient Services Copay

Overnight hospital stay: includes all medical services including semi-private room or intensive care

$150 per day4 and 20% of charges after deductible

Diagnostic & Therapeutic Services Copay

Physical and Speech Therapy $50 copay

Manipulative Therapy5 20% without office visit $40 plus 20% with office visit

Equipment and Supplies Copay

Preferred Diabetic Supplies and Equipment $3 copay; no deductible

Non-Preferred Diabetic Supplies and Equipment 30% after Rx deductible

Durable Medical Equipment/ Prosthetics 20% after deductible

14

2016-2017 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare

Home Health Services Copay

Home Health Care Visit $50 co-pay

Worldwide Emergency Care Copay

Nurse Advice Line 1-877-505-7947

Online Services No Charge — go to www.trs.swhp.org

After Hours Primary Care Clinics $20 co-pay

Ambulance and Helicopter $40 copay and 20% of charges after deductible

Emergency Room6 $150 copay and 20% of charges after deductible

Urgent Care Facility $55 copay

Prescription Drugs Copay

Annual Benefit Maximum Unlimited

Rx Deductible Does not apply to preferred generic drugs

$100

Ask an SWHP Pharmacy representative how to save money on your prescriptions.

Retail Quantity (Up to a 30-day supply)

Maintenance Quantity BSWH Pharmacies Only (Up to a 90-day supply)

Preferred Generic7 $3 copay $6 copay

Preferred Brand 30% after Rx deductible 30% after Rx deductible

Non-preferred 50% after Rx deductible 50% after Rx deductible

Non-formulary Greater of $50 or 50% after deductible Not available

Mail Order 1-800-707-3477

1Including all services billed with office visit 2Does not apply to wellness or preventive visits 3Includes other services, treatments, or procedures received at time of office visit 4$750 maximum copay per admission and 20% after deductible 55 visits max per month, 35 max visit per year 6Copay waived if admitted within 24 hours 7If a brand name drug is dispensed when a generic is available, 50% copay applies

Specialty Medications (Up to a 30-day supply)

Copay

20% after Rx deductible

15

A Health Savings Account is a tax-advantaged medical savings account available to employees who are enrolled in a high-deductible health plan. The funds contributed to the account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent.

About this Benefit

HSA (Health Savings Account)

YOUR BENEFITS PACKAGE

The interest earned in an HSA is tax free.

DID YOU KNOW?

Money withdrawn for medical spending never falls under taxable income.

HSA BANK

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the

Celina ISD Benefits Website: www.mybenefitshub.com/celinaisd 16

HSA Bank has teamed up with your employer to create an affordable health coverage option that helps you save on healthcare expenses. This plan is only available for those who are participating in the Active Care 1-HD medical plan. If you choose to elect the HSA plan you are still eligible to enroll in the Limited Flexible Spending plan offered by the district. Medicare, Medicaid, and Tricare participants are not eligible to participate in an HSA.

You can use your Health Savings Account (HSA) to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free.

What is an HSA? A tax-advantaged savings account that you use to pay for

eligible medical expenses as well as deductible, co-insurance,prescriptions, vision and dental care. Allows you to savewhile reducing your taxable income.

Unused funds that will roll over year to year. There’s no “useit or lose it” penalty.

A way to accumulate additional retirement savings. After age65, funds can be withdrawn for any purpose withoutpenalty.

Using Funds Debit Card

You may use the card to pay merchants or service providersthat accept VISA credit cards, so there is no need to pay cashup front and wait for reimbursements.

You can make a withdrawal at any time. Reimbursements forqualified medical expenses are tax free. If you are disabled orreach age 65, you can receive non-medical distributionswithout penalty, but you must report the distributions astaxable income. You may also use your funds for a spouse ortax dependent not covered by your HDHP.

2016 Annual HSA Contribution Limits Individual: $3,350 Family: $6,750 Catch-Up Contributions: Accountholders who meet the qualifications noted below are eligible to make an HSA catch-up contribution of an additional $1,000.

Health Savings accountholder

Age 55 or older (regardless of when in the year anaccountholder turns 55)

Not enrolled in Medicare (if an accountholder enrolls in

Medicare mid-year, catch-up contributions should be prorated) Authorized Signers who are 55 or older must have their own HSA in order to make the catch-up contribution

Monthly Fee: Your account will be charged a monthly fee of $1.75, waived with an average daily balance at or above $3,000.

Examples of Qualified Medical Expenses Surgery

Braces

Contact lenses

Dentures

Eyeglasses

Vaccines

For a list of sample expenses, please refer to the Celina ISD website at www.mybenefitshub.com/celinaisd

HSA Bank Contact Information 605 N. 8th Street, Ste 320 Sheboygan, WI 53081 Phone: 800-357-6246 www.hsabank.com

HSA (Health Savings Account)

17

A Health Savings Account (HSA) is an individually-owned, tax-advantaged account that you can use to pay for current or future IRS-qualified medical expenses. With an HSA, you’ll have the potential to build more savings for healthcare expenses or additional retirement savings through self-directed investment options1.

How an HSA works: You can contribute to your HSA via payroll deduction,

online banking transfer, or by sending a personal check toHSA Bank. Your employer or third parties, such as aspouse or parent, may contribute to your account as well.

You can pay for qualified medical expenses with your HSABank Debit Card directly to your medical provider or payout-of-pocket. You can either choose to reimburseyourself or keep the funds in your HSA to grow yoursavings.

Unused funds will roll over year to year. After age 65,funds can be withdrawn for any purpose without penalty(subject to ordinary income taxes).

Check balances and account information via HSA Bank’sInternet Banking 24/7.

Are you eligible for an HSA? If you have a qualified High Deductible Health Plan (HDHP) - either through your employer, through your spouse, or one you’ve purchased on your own - chances are you can open an HSA. Additionally:

You cannot be covered by any other non-HSA-compatiblehealth plan, including Medicare Parts A and B.

You cannot be covered by TriCare.

You cannot have accessed your VA medical benefits in thepast 90 days (to contribute to an HSA).

You cannot be claimed as a dependent on anotherperson’s tax return (unless it’s your spouse).

You must be covered by the qualified HDHP on the firstday of the month.

When you open an account, HSA Bank will request certain information to verify your identity and to process your application.

What are the annual IRS contribution limits? Contributions made by all parties to an HSA cannot exceed the annual HSA limit set by the Internal Revenue Service (IRS). Anyone can contribute to your HSA, but only the accountholder and employer can receive tax deductions on those contributions. Combined annual contributions for the accountholder, employer, and third parties (i.e., parent, spouse, or anyone else) must not exceed these limits2.

2016 Annual HSA Contribution Limits Individual = $3,350 Family = $6,750

Catch-up Contributions Accountholders who meet these qualifications are eligible to make an HSA catch-up contribution of $1,000: Health Savings accountholder; age 55 or older (regardless of when in the year an accountholder turns 55); not enrolled in Medicare (if an accountholder enrolls in Medicare mid-year, catch-up contributions should be prorated). Authorized signers who are 55 or older must have their own HSA in order to make the catch-up contribution.

According to IRS guidelines, each year you have until the tax filing deadline to contribute to your HSA (typically April 15 of the following year). Online contributions must be submitted by 2:00 p.m., Central Time, the business day before the tax filingdeadline. Wire contributions must be received by noon, CentralTime, on the tax filing deadline, and contribution forms withchecks must be received by the tax filing deadline.

How can you benefit from tax savings? An HSA provides triple tax savings3. Here’s how:

Contributions to your HSA can be made with pre-tax dollarsand any after-tax contributions that you make to your HSAare tax deductible.

HSA funds earn interest and investment earnings are taxfree.

When used for IRS-qualified medical expenses, distributionsare free from tax.

IRS-Qualified Medical Expenses You can use your HSA to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse, or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free.

HSA funds can be used to reimburse yourself for past medical expenses if the expense was incurred after your HSA was established. While you do not need to submit any receipts to HSA Bank, you must save your bills and receipts for tax purposes.

How the HSA Plan Works

18

How the HSA Plan Works

Examples of IRS-Qualified Medical Expenses4:

For assistance, please contact the Client Assistance Center 800-357-6246Monday – Friday, 7 a.m. – 9 p.m., and Saturday, 9 a.m. - 1 p.m., CTwww.hsabank.com | 605 N. 8th Street, Ste. 320, Sheboygan, WI 53081

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 funds contributed in excess of these limits are subject to penalty and tax unless the excess and earnings are withdrawn prior to the due date, including any extensions for filing Federal Tax returns. Accountholders should consult with a qualified tax advisor in connection with excess contribution removal. The Internal Revenue Service requires HSA Bank to report withdrawals that are considered refunds of excess contributions. In order for the withdrawal to be accurately reported, accountholders may not withdraw the excess directly. Instead, an excess contribution refund must be requested from HSA Bank and an Excess Contribution Removal Form completed. 3 Federal Tax savings are available no matter where you live and HSAs are taxable in AL, CA, and NJ. HSA Bank does not provide tax advice. Consult your tax professional for tax‐related questions. 4 This list is not comprehensive. It is provided to you with the understanding that HSA Bank is not engaged in rendering tax advice. The information provided is not intended to be used to avoid Federal tax penalties. For more detailed information, please refer to IRS Publication 502 titled, “Medical and Dental Expenses”. Publications can be ordered directly from the IRS by calling 1-800-TAXFORM. If tax advice is required, you should seek the services of a professional. 5 Insurance premiums only qualify as an IRS-qualified medical expense: while continuing coverage under COBRA; for qualified long-term care coverage; coverage while receiving unemployment compensation; for any healthcare coverage for those over age 65 including Medicare (except Medicare supplemental coverage).

Acupuncture Alcoholism treatment Ambulance services Annual physical examination Artificial limb or prosthesis Birth control pills (by prescription) Chiropractor Childbirth/delivery Convalescent home (for medical treatment only) Crutches Doctor’s fees Dental treatments

(including x-rays, braces, dentures, fillings, oral surgery) Dermatologist Diagnostic services Disabled dependent care Drug addiction therapy Fertility enhancement

(including in-vitro fertilization) Guide dog

(or other service animal)

Gynecologist Hearing aids and batteries Hospital bills Insurance premiums5

Laboratory fees Lactation expenses Lodging (away from home for outpatient care) Nursing home Nursing services Obstetrician Osteopath Oxygen Pregnancy test kit Podiatrist Prescription drugs and medicines (over-the-counter drugs are not IRS- qualified medical expenses unless prescribed by a doctor) Prenatal care & postnatal treatments Psychiatrist Psychologist Smoking cessation programs

Special education tutoring Surgery Telephone or TV equipment to assist the hearing or vision impaired Therapy or counseling Medical transportation expenses Transplants Vaccines Vasectomy Vision care

(including eyeglasses, contact lenses, lasik surgery) Weight loss programs

(for a specific disease diagnosed by a physician – such as obesity, hypertension, or heart disease)

Wheelchairs X-rays

19

Telehealth provides 24/7/365 access to board-certified doctors via telephone consultations that can diagnose, recommend treatment and prescribe medication. Whether you are at home, traveling or at work, Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.

About this Benefit

Telehealth YOUR BENEFITS PACKAGE

DID YOU KNOW?

75%

of all doctor, urgent care, and ER visits could be handled safely and effectively via

telehealth.

MDLIVE



Telehealth

When should I use MDLIVE? If you’re considering the ER or urgent care for a

non-emergency medical issue

Your primary care physician is not available

At home, traveling, or at work

24/7/365, even holidays!

What can be treated? Allergies

Asthma

Bronchitis

Cold and Flu

Ear Infections

Joint Aches and Pain

Respiratory Infection

Sinus Problems

And More!

Pediatric Care related to: Cold & Flu

Constipation

Ear Infection

Fever

Nausea & Vomiting

Pink Eye

And More!

Who are our doctors? MDLIVE has the nation’s largest network of telehealth doctors. On average, our doctors have 15 years of experience practicing medicine and are licensed in the state where patients are located. Their specialties include primary care, pediatrics, emergency medicine and family medicine. Our doctors are committed to providing convenient, quality care and are always ready to take your call.

Are children eligible? Yes. MDLIVE has local pediatricians on-call 24/7/365. Please note, a parent or guardian must be present during any interactions involving minors. We ask parents to establish a child record under their account. Parents must be present on each call for children 18 or younger.

How much does it cost? $0 Covers you, your spouse, and children up to age 26, with unlimited phone consultations.

Download the App Doctor visits are easier and more convenient with the MDLIVE App. Be prepared. Download today. www.mdlive.com/getapp

Access to a doctor anywhere:at home, at work, or on the go

Choose doctors from one of the nation's largesttelehealth networks

Available 24/7 by video or phone

Private, secure and confidential visits

Connect instantly with MDLIVE Assist

Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit www.mdlive.com/pages/terms.html 010113

Call us at (888) 365-1663 or visit us at www.consultmdlive.com

Scan with your smartphone to get the app.

21

Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, treatment and dental disease.

About this Benefit

Dental YOUR BENEFITS PACKAGE

Good dental care may improve your overall health.

Also Women with gum disease may be at greater risk of giving birth to a preterm or low birth weight baby.

DID YOU KNOW?

ORAQUEST / FCL DENTAL



Passive PPO Dental Plan (100/80/50)

Annual Benefit Per Person: $1,500

Percentage of Covered Benefits Per Policy Year

Type I Type II Type III*

During the 1st Year 100% 80% 0%

2nd Year and Thereafter 100% 80% 50%

12-month waiting period (unless replacing prior coverage as described under “Takeover Benefit”)(Use Network Offices for Additional Savings)

Dentist List at Dentemax.com

Calendar Year Deductible, Per Person: $50/$150 This deductible applies to Type II and III services – Unmarried Dependent Children Covered to Age 26

Rates for: Celina ISD Effective Date September 1, 2016

EE Only $33.34

EE + Spouse $65.92

EE + Child(ren) $74.08

EE+ Family $113.94

Payment is based upon allowable charges in the area in which service is rendered. Services provided at a non-contracting provider are paid at the 90th percentile.

TYPE I (PREVENTIVE SERVICES) Including:

No waiting period

Routine Exams

Prophylaxis (cleanings-one per 6 months)

Emergency exams for dental pain (minor procedures)

Fluoride treatments for dependent children under age

19 (one per 12 months)

Bitewing X-rays (once per 6 months)

TYPE II (BASIC SERVICES) Including:

No waiting period

Periapical X-rays

Full mouth or panorex X-rays (one per 36 months)

Simple restorative services (fillings)

Simple extractions

Palliative treatment for dental pain, local anesthesia

Sealants for children ages 6-15 (one per tooth)

TYPE III (MAJOR SERVICES) Including:

12 month waiting period (new enrollees)

Major restorative services (crowns and inlays)

Prosthetics (bridges, dentures)

Replacement of prosthodontics, dentures, crowns and

inlays

Denture relines

Endodontics/root canal therapy

Periodontics

Space maintainers

Complex Oral Surgery

General anesthesia (for services dentally necessary)

ORTHODONTIC SERVICES - (12 MONTH WAIT) 50% coverage

$1,000 lifetime maximum benefit

Children under 19 only

23


Limitations and Exclusions Covered Expenses Will not Include and No Benefits Will be Payable:

1. For major services in the first 12 months that theInsured is covered, except as may be provided inthe Takeover Benefits provision.

2. For any treatment which is for cosmetic purposesor to correct congenital malformations, except formedically necessary care and treatment ofcongenital cleft lip and palate.

3. To replace any prosthetic appliance, crown, inlay oronlay restoration, or fixed bridge within five yearsof the date of the last placement of these items,unless required because of an accidental bodilyinjury sustained while the Insured is covered.Replacement is not covered if the item can berepaired.

4. For initial placement of any prosthetic appliance orfixed bridge unless such placement is neededbecause of the extraction of natural teeth duringthe same period of continuous coverage. But theextraction of a third molar (wisdom tooth) will notqualify the item for payment. Any such appliance orfixed bridge must include the replacement of theextracted tooth or teeth. Coverage does not includethe part of the cost that applies specifically toreplacement of teeth extracted prior to the periodof coverage.

5. For addition of teeth to an existing prostheticappliance or fixed bridge unless for replacement ofnatural teeth extracted during the same period ofcontinuous coverage.

6. For any expense incurred or procedure begunbefore the Insured’s current period of continuouscoverage.

7. For any expense incurred or procedure begun afterthe Insured’s insurance under this sectionterminates, except for a prosthetic appliance, fixedbridge, crown, or inlay or onlay restoration forwhich both (a) the procedure begins beforeinsurance ends and (b) the item’s final placement iswithin 90 days after insurance ends.

8. To duplicate appliances or replace lost or stolenappliances.

9. For appliances, restorations or procedures to:a. alter vertical dimension;b. restore or maintain occlusion;c. splint or replace tooth structure lost as a

result of abrasion or attrition; ord. treat jaw fractures or disturbances of the

temporomandibular joint.10. For education or training in, and supplies used for,

dietary or nutritional counseling, personal oral hygiene or dental plaque control.

11. For broken appointments or the completion ofclaim forms.

12. For orthodontia service or for any servicesassociated with orthodontic therapy when thisoptional coverage is not elected and the premium isnot paid.

13. For sealants which are:j. not applied to a permanent molar;k. applied before age 6 or after attaining age

16; orl. reapplied to a molar within three years

from the date of a previous sealantapplication.

14. For subgingival curettage or root planing (procedurenumbers 4220 and 4341) unless the presence ofperiodontal disease is confirmed by both x-rays and pocketdepth summaries of each tooth involved.

15. Because of an Insured’s injury arising out of, or in thecourse of, work for wage or profit.

16. For an Insured’s sickness, injury or condition for which he orshe is eligible for benefits under any Workers CompensationAct or similar laws.

17. For charges for which the Insured is not liable or whichwould not have been made had no insurance been in force.

18. For services which are not recommended by a dentist, notrequired for necessary care and treatment, or do not have areasonably favorable prognosis.

19. Because of war or any act of war, declared or not, or whileon fulltime active duty in the armed forces of any country.

20. To an Insured if payment is not legal where the Insured isliving when expenses are incurred.

21. For any services related to: equilibration, bite registration orbite analysis.

22. For crowns for the purpose of periodontal splinting.23. For charges for: any implants; overdentures; precision or

semiprecision attachments and associated endodontictreatment; other customized attachments; or specializedprosthodontic techniques or characterizations.

24. For charges for myofunctional therapy, orthognathicsurgery or athletic mouthguards.

25. For procedures for which benefits are payable under theemployer’s medical expense benefits plan for employeesand their dependents.

26. Services or supplies provided by a family member or amember of the Insured’s household.

Note: This is a general outline of covered benefits and does not include all the benefits, limitations and exclusions of the policy. See your certificate for details.

Predetermination of Benefits: As a service to protect the Insured, First Continental Life & Accident Insurance Co. will provide predetermination of benefits for recommended treatment plans

24


that exceed $300. This predetermination of benefits explains which of the recommended procedures will be covered and at what amount. This benefit helps Insured's better understand their coverage. The Insured should submit the treatment plan to First Continental Life & Accident Insurance Co. for

TAKEOVER BENEFITS

Takeover means that you are given credit for waiting periods for like coverage's accumulated under your existing plan. No credit is given for deductibles satisfied under your existing plan. 1. In order to provide Takeover Benefits your employer’s

current dental plan must have been in effect continuouslyfor at least 12 months prior to the effective date of thisplan.

2. All employees insured on the effective date with continu‐ous coverage from the prior group dental contract areeligible for Takeover Benefits. Waiting periods will be re‐duced by the amount of time insured under the prior plan.

3. A minimum of five (5) enrolled members are needed foran employer to be eligible for Takeover Benefits.

4. Takeover Benefits must be requested and are subject tothe approval of First Continental Life & Accident InsuranceCo.

Submission of Claims: First Continental Life & Accident Insurance Co. ATTN: Claims Department 101 Parklane Blvd, Suite 301 Sugar Land, TX. 77478 Verification of Claims: 281-313-7170 (local)1-877-493-6282 (toll free)

25

Vision insurance provides coverage for routine eye examinations and may cover all or part of the costs associated with contact lenses, eyeglasses and vision correction, depending on the plan.

About this Benefit

Vision YOUR BENEFITS PACKAGE

75%

DID YOU KNOW?

of U.S. residents between age 25 and 64 require some sort of vision

correction.

SUPERIOR VISION



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

1 Covered 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

Vision

Discount FeaturesNon-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.

Co-Pays

Exam $10

Materials $10

Services/Frequency

Exam 12 months

Frame 12 months

Lenses 12 months

Contact Lenses 12 months

Benefits In-Network Out-of-Network

Exam Covered in full Up to $35 retail

Frames $125 retail allowance Up to $70 retail

Contact Lenses2 $150 retail allowance Up to $80 retail

Medically Necessary Contact Lenses Covered in full Up to $150 retail

Lenses (standard) per pair

Single Vision Covered in full Up to $25 retail

Bifocal Covered in full Up to $40 retail

Trifocal Covered in full Up to $45 retail

Progressive See description1 Up to $45 retail

Lenticular Covered in full Up to $80 retail

Monthly Premiums

EE Only $8.86

EE + Spouse $15.09

EE + Family $22.15

SuperiorVision.com Customer Service 800.507.3800

27

About this Benefit

Disability YOUR BENEFITS PACKAGE

Just over 1 in 4 of today's 20 year-olds will become disabled before

they retire.

DID YOU KNOW?

34.6 months is the duration of the

average disability claim.

THE HARTFORD

Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.



Disability is designed to provide a monthly income to an individual that is disabled due to an accident or illness. There are different plans available with benefits becoming available from the 1st day of disability to as late as the 180th day. For specific details on how benefits are paid, refer to carrier brochure. Your disability coverage amount and premium can be accessed during your enrollment.

Pre-existing Conditions Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have not received treatment for the disabling condition within 3 months, while insured under this policy, before the disability begins, or You have been insured under this policy for 12 months before your disability begins. You may also be covered if you have already satisfied the pre-existing condition requirement of your previous insurer. If your disability is a result of a pre-existing condition we will pay benefits for a maximum of 4 weeks.

Benefit Reductions Your benefit payments may be reduced by other income you receive or are eligible to receive due to your disability, such as: Social Security Disability Insurance (please see

www.mybenefitshub.com/celinaisd for exceptions) Workers' Compensation Other employer-based Insurance coverage you may have Unemployment benefits Settlements or judgments for income loss Retirement benefits that your employer fully or partially

pays for (such as a pension plan.)

Your benefit payments will not be reduced by certain kinds of other income, such as: Retirement benefits if you were already receiving them

before you became disabled Retirement benefits that are funded by your after-tax

contributions Your personal savings, investment, IRAs or Keoghs Profit-sharing Most personal disability policies Social Security increases

Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.

Exclusions You cannot receive Disability benefit payments for disabilities that are caused or contributed to by: War or act of war (declared or not) Military service for any country engaged in war or other

armed conflict The commission of, or attempt to commit a felony An intentionally self-inflicted injury

Any case where your being engaged in an illegaloccupation was a contributing cause to your disability

You must be under the regular care of a physician toreceive benefits

Mental Illness, Alcoholism and Substance Abuse You can receive benefit payments for Long-Term

Disabilities resulting from mental illness, alcoholism andsubstance abuse for a total of 24 months for all disabilityperiods during your lifetime.

Any period of time that you are confined in a hospital orother facility licensed to provide medical care for mentalillness, alcoholism and substance abuse does not counttoward the 24 month lifetime limit.

What other benefits are included in my disability coverage? Workplace Modification provides for reasonable

modifications made to a workplace to accommodate yourdisability and allow you to return to active full-timeemployment.

Survivor Benefit - If you die while receiving disabilitybenefits, a benefit will be paid to your spouse or in equalshares to your surviving children under the age of 25,equal to three times the last monthly gross benefit.

Travel Assistance Program – Available 24/7, this programprovides assistance to employees and their dependentswho travel 100 miles from their home for 90 days or less.Services include pre-trip information, emergency medicalassistance and emergency personal services.

The Hartford's Ability Assist service is included as a partof your group Long Term Disability (LTD) insuranceprogram. You have access to Ability Assist services bothprior to a disability and after you’ve been approved foran LTD claim and are receiving LTD benefits. Once youare covered you are eligible for services to provideassistance with child/elder care, substance abuse,family relationships and more. In addition, LTDclaimants and their immediate family members receiveconfidential services to assist them with the uniqueemotional, financial and legal issues that may resultfrom a disability. Ability Assist services are providedthrough ComPsych®, a leading provider of employeeassistance and work/life services.

Waiver of Premium – Once your disability claim isapproved and you have satisfied your eliminationperiod, your coverage premiums will be waived.

Identity Theft Protection – An array of identity fraudsupport services to help victims restore their identity.Benefits include 24/7 access to an 800 number; directcontact with a certified caseworker who follows thecase until it’s resolved; and a personalized fraudresolution kit with instructions and resources for IDtheft victims.

Long Term Disability

29


For the Premium benefit option – the table below applies to disabilities resulting from injury or sickness:

Age Disabled Benefits Payable

Prior to Age 63 To Normal Retirement Age or 48 months if greater

Age 63 To Normal Retirement Age or 42 months if greater

Age 64 36 months

Age 65 30 months

Age 66 27 months

Age 67 24 months

Age 68 21 months

Age 69 and older 18 months

MONTHLY PREMIUMS

Accident / Sickness Elimination Period in Days

Annual Earnings Monthly Earnings Monthly Benefit 0 / 7 14 / 14 30 / 30 60 / 60 90 / 90 180 / 180

$3,600 $300 $200 $7.92 $7.16 $6.46 $5.24 $3.92 $2.98

$5,400 $450 $300 $11.88 $10.74 $9.69 $7.86 $5.88 $4.47

$7,200 $600 $400 $15.84 $14.32 $12.92 $10.48 $7.84 $5.96

$9,000 $750 $500 $19.80 $17.90 $16.15 $13.10 $9.80 $7.45

$10,800 $900 $600 $23.76 $21.48 $19.38 $15.72 $11.76 $8.94

$12,600 $1,050 $700 $27.72 $25.06 $22.61 $18.34 $13.72 $10.43

$14,400 $1,200 $800 $31.68 $28.64 $25.84 $20.96 $15.68 $11.92

$16,200 $1,350 $900 $35.64 $32.22 $29.07 $23.58 $17.64 $13.41

$18,000 $1,500 $1,000 $39.60 $35.80 $32.30 $26.20 $19.60 $14.90

$19,800 $1,650 $1,100 $43.56 $39.38 $35.53 $28.82 $21.56 $16.39

$21,600 $1,800 $1,200 $47.52 $42.96 $38.76 $31.44 $23.52 $17.88

$23,400 $1,950 $1,300 $51.48 $46.54 $41.99 $34.06 $25.48 $19.37

$25,200 $2,100 $1,400 $55.44 $50.12 $45.22 $36.68 $27.44 $20.86

$27,000 $2,250 $1,500 $59.40 $53.70 $48.45 $39.30 $29.40 $22.35

$28,800 $2,400 $1,600 $63.36 $57.28 $51.68 $41.92 $31.36 $23.84

$30,600 $2,550 $1,700 $67.32 $60.86 $54.91 $44.54 $33.32 $25.33

$32,400 $2,700 $1,800 $71.28 $64.44 $58.14 $47.16 $35.28 $26.82

$34,200 $2,850 $1,900 $75.24 $68.02 $61.37 $49.78 $37.24 $28.31

$36,000 $3,000 $2,000 $79.20 $71.60 $64.60 $52.40 $39.20 $29.80

$37,800 $3,150 $2,100 $83.16 $75.18 $67.83 $55.02 $41.16 $31.29

$39,600 $3,300 $2,200 $87.12 $78.76 $71.06 $57.64 $43.12 $32.78

$41,400 $3,450 $2,300 $91.08 $82.34 $74.29 $60.26 $45.08 $34.27

$43,200 $3,600 $2,400 $95.04 $85.92 $77.52 $62.88 $47.04 $35.76

$45,000 $3,750 $2,500 $99.00 $89.50 $80.75 $65.50 $49.00 $37.25

$46,800 $3,900 $2,600 $102.96 $93.08 $83.98 $68.12 $50.96 $38.74

$48,600 $4,050 $2,700 $106.92 $96.66 $87.21 $70.74 $52.92 $40.23

$50,400 $4,200 $2,800 $110.88 $100.24 $90.44 $73.36 $54.88 $41.72

$52,200 $4,350 $2,900 $114.84 $103.82 $93.67 $75.98 $56.84 $43.21

$54,000 $4,500 $3,000 $118.80 $107.40 $96.90 $78.60 $58.80 $44.70

$55,800 $4,650 $3,100 $122.76 $110.98 $100.13 $81.22 $60.76 $46.19

$57,600 $4,800 $3,200 $126.72 $114.56 $103.36 $83.84 $62.72 $47.68

$59,400 $4,950 $3,300 $130.68 $118.14 $106.59 $86.46 $64.68 $49.17

30


MONTHLY PREMIUMS

Accident / Sickness Elimination Period in Days

Annual Earnings Monthly Earnings Monthly Benefit 0 / 7 14 / 14 30 / 30 60 / 60 90 / 90 180 / 180

$61,200 $5,100 $3,400 $134.64 $121.72 $109.82 $89.08 $66.64 $50.66

$63,000 $5,250 $3,500 $138.60 $125.30 $113.05 $91.70 $68.60 $52.15

$64,800 $5,400 $3,600 $142.56 $128.88 $116.28 $94.32 $70.56 $53.64

$66,600 $5,550 $3,700 $146.52 $132.46 $119.51 $96.94 $72.52 $55.13

$68,400 $5,700 $3,800 $150.48 $136.04 $122.74 $99.56 $74.48 $56.62

$70,200 $5,850 $3,900 $154.44 $139.62 $125.97 $102.18 $76.44 $58.11

$72,000 $6,000 $4,000 $158.40 $143.20 $129.20 $104.80 $78.40 $59.60

$73,800 $6,150 $4,100 $162.36 $146.78 $132.43 $107.42 $80.36 $61.09

$75,600 $6,300 $4,200 $166.32 $150.36 $135.66 $110.04 $82.32 $62.58

$77,400 $6,450 $4,300 $170.28 $153.94 $138.89 $112.66 $84.28 $64.07

$79,200 $6,600 $4,400 $174.24 $157.52 $142.12 $115.28 $86.24 $65.56

$81,000 $6,750 $4,500 $178.20 $161.10 $145.35 $117.90 $88.20 $67.05

$82,800 $6,900 $4,600 $182.16 $164.68 $148.58 $120.52 $90.16 $68.54

$84,600 $7,050 $4,700 $186.12 $168.26 $151.81 $123.14 $92.12 $70.03

$86,400 $7,200 $4,800 $190.08 $171.84 $155.04 $125.76 $94.08 $71.52

$88,200 $7,350 $4,900 $194.04 $175.42 $158.27 $128.38 $96.04 $73.01

$90,000 $7,500 $5,000 $198.00 $179.00 $161.50 $131.00 $98.00 $74.50

$91,800 $7,650 $5,100 $201.96 $182.58 $164.73 $133.62 $99.96 $75.99

$93,600 $7,800 $5,200 $205.92 $186.16 $167.96 $136.24 $101.92 $77.48

$95,400 $7,950 $5,300 $209.88 $189.74 $171.19 $138.86 $103.88 $78.97

$97,200 $8,100 $5,400 $213.84 $193.32 $174.42 $141.48 $105.84 $80.46

$99,000 $8,250 $5,500 $217.80 $196.90 $177.65 $144.10 $107.80 $81.95

$100,800 $8,400 $5,600 $221.76 $200.48 $180.88 $146.72 $109.76 $83.44

$102,600 $8,550 $5,700 $225.72 $204.06 $184.11 $149.34 $111.72 $84.93

$104,400 $8,700 $5,800 $229.68 $207.64 $187.34 $151.96 $113.68 $86.42

$106,200 $8,850 $5,900 $233.64 $211.22 $190.57 $154.58 $115.64 $87.91

$108,000 $9,000 $6,000 $237.60 $214.80 $193.80 $157.20 $117.60 $89.40

$109,800 $9,150 $6,100 $241.56 $218.38 $197.03 $159.82 $119.56 $90.89

$111,600 $9,300 $6,200 $245.52 $221.96 $200.26 $162.44 $121.52 $92.38

$113,400 $9,450 $6,300 $249.48 $225.54 $203.49 $165.06 $123.48 $93.87

$115,200 $9,600 $6,400 $253.44 $229.12 $206.72 $167.68 $125.44 $95.36

$117,000 $9,750 $6,500 $257.40 $232.70 $209.95 $170.30 $127.40 $96.85

$118,800 $9,900 $6,600 $261.36 $236.28 $213.18 $172.92 $129.36 $98.34

$120,600 $10,050 $6,700 $265.32 $239.86 $216.41 $175.54 $131.32 $99.83

$122,400 $10,200 $6,800 $269.28 $243.44 $219.64 $178.16 $133.28 $101.32

$124,200 $10,350 $6,900 $273.24 $247.02 $222.87 $180.78 $135.24 $102.81

$126,000 $10,500 $7,000 $277.20 $250.60 $226.10 $183.40 $137.20 $104.30

$127,800 $10,650 $7,100 $281.16 $254.18 $229.33 $186.02 $139.16 $105.79

$129,600 $10,800 $7,200 $285.12 $257.76 $232.56 $188.64 $141.12 $107.28

$131,400 $10,950 $7,300 $289.08 $261.34 $235.79 $191.26 $143.08 $108.77

$133,200 $11,100 $7,400 $293.04 $264.92 $239.02 $193.88 $145.04 $110.26

$135,000 $11,250 $7,500 $297.00 $268.50 $242.25 $196.50 $147.00 $111.75

31

Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.

About this Benefit

Cancer YOUR

BENEFITS

Breast Cancer is

the most commonly

diagnosed cancer

in women.

DID YOU KNOW?

If caught early,

prostate cancer is one

of the most treatable

malignancies.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan

details on covered expenses, limitations and exclusions are included in the summary plan description located on the

Celina ISD Benefits Website: www.mybenefitshub.com/celinaisd

AMERICAN PUBLIC LIFE

(0316)32

GC13 Limited Benefit Group Cancer Indemnity InsuranceCelina ISD

THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

SUMMARY OF BENEFITS

Benefits Option 1 Option 2

Radiation Therapy/Chemotherapy/Immunotherapy Benefit Maximum per 12-month period

$15,000 $20,000

Hormone Therapy - Maximum of 12 treatments per Calendar Year $50 per treatment $50 per treatment

Experimental Treatment Benefit Paid in the same manner and under the same maximums as any other benefit

Waiver of Premium Waive Premium Waive Premium

Internal Cancer First Occurrence Benefit

Lump Sum Benefit Maximum 1 per Covered Person per lifetime

$5,000 $10,000

Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime

$7,500 $15,000

Heart Attack/Stroke First Occurrence Benefit

Lump Sum Benefit Maximum 1 per Covered Person per lifetime

$5,000 $10,000

Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime

$7,500 $15,000

Monthly Premium* Option 1 Option 2

Individual $13.66 $23.00

Individual & Spouse $29.48 $49.94

1 Parent Family $15.70 $26.50

2 Parent Family $31.52 $53.48

*The premium and amount of benefits vary dependent upon the option selected at time of application. All benefits are per covered person, per calendar year unless otherwise stated.

APSB-22331(TX) MGM/FBS Celina ISD33

EligibilityYou and your Eligible Dependents are eligible to be insured under the Certificate if you and your Eligible Dependents meet APL’s underwriting rules and you are Actively at Work and qualify for coverage as defined in the Master Application.

Limitations & ExclusionsNo benefits will be paid for care or treatment received outside the territorial limits of the United States, treatment by any program engaged in research that does not meet the definition of Experimental Treatment or losses or medical expenses incurred prior to the Covered Person’s Effective Date regardless of when Cancer was diagnosed.

Only Loss for CancerThe Policy/Certificate pays only for loss resulting from definitive Cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The Policy/Certificate also covers other conditions or diseases directly caused by Cancer or the treatment of Cancer. The Policy/Certificate does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of Cancer, even though after contracting Cancer it may have been complicated, aggravated or affected by Cancer or the treatment of Cancer.

Pre-Existing Condition ExclusionNo benefits are payable for any loss incurred during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date as the result of a Pre-Existing Condition. Pre-Existing Conditions specifically named or described as excluded in any part of the Policy/Certificate are never covered. If any change to coverage after the Certificate Effective Date results in an increase or addition to coverage, the Time Limit on Certain Defenses and Pre-Existing Condition Limitation for such increase will be based on the effective date of such increase.

Waiting PeriodThe Policy/Certificate contains a Waiting Period during which no benefits will be paid. If any Covered Person has a Specified Disease diagnosed before the end of the Waiting Period immediately following the Covered Person’s Effective Date, coverage for that person will apply only to loss that is incurred after one year from the Covered Person’s Effective Date. If any Covered Person is diagnosed as having a Specified Disease during the Waiting Period immediately following the Covered Person’s Effective Date, the Insured may elect to void the Certificate from the beginning and receive a full refund of premium.

If the Policy/Certificate replaced Specified Disease Cancer coverage from another company that terminated within 30 days of the Certificate Effective Date, the Waiting Period will be waived for those Covered Persons that were covered under the prior coverage. However, the Pre-Existing Condition Limitation will still apply.

Termination of CertificateInsurance coverage under the Certificate and any attached riders will end on the earliest of any of the following dates: the date the Policy terminates; the end of the grace period if the premium remains unpaid; the date insurance has ceased on all persons covered under this Certificate; the end of the Certificate Month in which the Policyholder requests to terminate this coverage; the date you no longer qualify as an Insured; or the date of your death.

Termination of CoverageInsurance coverage for a Covered Person under the Certificate and any attached riders for a Covered Person will end as follows: the date the Policy terminates; the date the Certificate terminates; the end of the grace period if the premium remains unpaid; the end of the Certificate Month in which the Policyholder requests to terminate the coverage for an Eligible Dependent; the date a Covered Person no longer qualifies as an Insured or Eligible Dependent; or the date of the Covered Person’s death.

GC13 Limited Benefit Group Cancer Indemnity Insurance

Optionally RenewableThe policy is optionally renewable. The Policyholder has the right to terminate the policy on any premium due date after the first Anniversary following the Policy Effective Date. APL must give at least 60 days written notice prior to cancellation.

Portability (Voluntary Plans Only)When the Insured no longer meets the definition of Insured, he or she will have the option to continue this coverage, including any attached riders. No Evidence of Insurability will be required. Portability must meet all of the following conditions: the Certificate has been continuously in force for the last 12 months; APL receives a request and payment of the first premium for the portability coverage no later than 30 days after the date the Insured no longer qualifies as an eligible Insured. All future premiums due will be billed directly to the Insured. The Insured is responsible for payment of all premiums for the portability coverage; the Policy, under which this Certificate was issued, continues to be in force on the date the Insured ceases to qualify for coverage.

The benefits, terms and conditions of the portability coverage will be the same as those elected under the Certificate immediately prior to the date the Insured exercised portability. Portability coverage may include any Eligible Dependents who were covered under the Certificate at the time the Insured ceased to qualify as an eligible Insured. No new Eligible Dependents may be added to the portability coverage except as provided in the Newborn and Adopted Children provision. No increases in coverage will be allowed while the Insured is exercising his or her rights under this rider. If the Policy is no longer in force, then portability coverage is not available.

Heart Attack/Stroke First Occurrence Benefit RiderPays a lump sum amount when a Covered Person receives a first diagnosis of Heart Attack/Stroke and the Date of Diagnosis occurs after the Waiting Period. The Heart Attack/Stroke lump sum benefit amount will reduce by 50% at age 70.

Exclusions & LimitationsWe will not pay benefits for any loss caused by or resulting from any of the following: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces; military service for any country at war. If coverage is suspended for any Covered Person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the Policyholder’s written request; participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a Physician or taken according to the Physician’s instructions; or participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place).

Pre-Existing Condition ExclusionNo benefits are payable for any loss incurred during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date of this rider as the result of a Pre-Existing Condition.

Waiting PeriodThis rider contains a Waiting Period during which no benefits will be paid. If any Heart Attack or Stroke is diagnosed before the end of the Waiting Period immediately following the Covered Person’s Effective Date of this rider, coverage will apply only to loss that is incurred after one year from the Covered Person’s Effective Date.

APSB-22331(TX) MGM/FBS Celina ISD34

TerminationThis rider will terminate and coverage will end for all Covered Persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the Policy or Certificate to which this rider is attached terminates; the end of the Certificate Month in which we receive a request from the Policyholder to terminate this rider; the date of your death; or the date the lump sum benefit amount for Heart Attack or Stroke has been paid for all Covered Persons under this rider. Coverage on an Eligible Dependent terminates under this rider when such person ceases to meet the definition of Eligible Dependent.

Internal Cancer First Occurrence Benefit RiderPays a lump sum benefit amount when a Covered Person receives a first diagnosis of a covered Internal Cancer and the Date of Diagnosis occurs after the Waiting Period. The Internal Cancer lump sum benefit amount will reduce by 50% at age 70.

Exclusions & LimitationsWe will not pay benefits for a diagnosis of Internal Cancer received outside the territorial limits of the United States or a metastasis to a new site of any Cancer diagnosed prior to the Covered Person’s Effective Date, as this is not considered a first diagnosis of an Internal Cancer.

Pre-Existing Condition ExclusionNo benefits are payable for any loss incurred during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date of this rider as the result of a Pre-Existing Condition.

Waiting PeriodThis rider contains a Waiting Period during which no benefits will be paid. If any Internal Cancer is diagnosed before the end of the Waiting Period immediately following the Covered Person’s Effective Date of this rider, coverage will apply only to loss that is incurred after one year from the Covered Person’s Effective Date of this Rider.

TerminationThis rider will terminate and coverage will end for all Covered Persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the Policy or Certificate to which this rider is attached terminates; the end of the Certificate Month in which we receive a request from the Policyholder to terminate this rider; the date of your death; or the date the lump sum benefit amount for Internal Cancer has been paid for all Covered Persons under this rider. Coverage on an Eligible Dependent terminates under this rider when such person ceases to meet the definition of Eligible Dependent.

APSB-22331(TX) MGM/FBS Celina ISD

Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete benefits and other provisions, please refer to your policy/certificate/rider(s). This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This product contains Limitations and Exclusions | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines | Policy Form GC13APL | Limited Benefit Group Cancer Indemnity Insurance Series | Texas | (10/14) | Celina ISD

GC13 Limited Benefit Group Cancer Indemnity Insurance

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

35

Accident insurance is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or a not-so-serious, injury. Accident coverage is low cost protection available to you and your family without evidence of insurability.

About this Benefit

Accident YOUR BENEFITS PACKAGE

of disabling injuries suffered by American workers are not work related.

DID YOU KNOW?

36% of American workersreport they always or usually live paycheck to paycheck.

2/3

LOYAL AMERICAN



Accident

Plan A Monthly Premiums Available for Issue Ages 18-64

Individual $12.70

Single Parent $20.40

Insured + Spouse $19.50

Family $27.20

Plan pays benefit amounts for covered medical expenses as a result of an accident, directly to you! Coverage is available for ages 18-64 and is portable, you can choose to keep your benefit even if you leave the district or retire.

This policy does not pay for losses resulting from sickness, onlyaccident.

Always refer to your policy for detailed terms and conditions.

This policy is guaranteed renewable.

Summary of Benefits Plan A

Ambulance

Ground Ambulance Benefit: Loyal American will pay this benefit if you require transportation by a licensed professional ambulance company to or from a hospital or between medical facilities within 90 days for injuries sustained after a covered accident. Payable once per accident.

$150

Air Ambulance Benefit: Loyal American will pay this benefit if you require transportation by a license professional air ambulance company to or from a hospital or between medical facilities within 48 hours for injuries sustained after a covered accident. Payable once per accident.

$600

Indemnity Benefits

Emergency Room Treatment Benefit: Loyal American will pay this benefit if you received hospital emergency room treatment within 72 hours of injuries sustained in a covered accident and for which charges are submitted.

Insured/Spouse: $150

Child: $75

Accident Follow-Up Treatment Benefit: Loyal American will pay this benefit for three additional treatments of injuries sustained in a covered accident over and above emergency treatment administered during the first 72 hours following the accident. Treatment must begin within 30 days of the covered accident and must be within the 6 month period following the covered accident.

$50 per visit

Specific Sum Injuries Benefit: Loyal The specific indemnity amount as listed in the policy's Benefit Schedule will be paid according to the type of injury received in a covered accident. Loyal American will pay for dislocations (separated joint), burns, tendon (torn, ruptured, severed, ligaments, or rotator cuff), torn knee cartilage, eye injuries, lacerations, and fractures (broken bones).

Blood, Plasma, Platelets Benefit: Loyal American will pay this benefit if you require transfusion, administration, cross matching, typing and processing of blood, plasma or platelets when administered within 90 days for injuries sustained in a covered accident. Payable once per accident.

$100

Hospital Benefits

Initial Accident Hospitalization Benefit: Loyal American will pay this benefit if hospital confinement is required within six (6) months for injuries sustained in a covered accident. Payable once per accident. $500

Hospital Confinement Benefit: Loyal American will pay this benefit for a maximum of 180 days per confinement.* if you require confinement in a hospital or in a hospital intensive care unit– sub acute within six (6) months for injuries sustained in a covered accident.

$200 per day

Intensive Care

Hospital Intensive Care Unit Confinement Benefit: Loyal American will pay this benefit for a maximum of 15 days per confinement* if you are confined in a hospital intensive care unit within 30 days because of injuries received in a covered accident. *Confinements separated by less than 90 days will be considered as the same period of confinement.

$400 per day

37

Summary of Benefits Plan A Plan B

Physical Therapy

Physical Therapy Benefit: Loyal American will pay this benefit, not to exceed five treatments per accident, for services prescribed by a doctor and rendered by a licensed physical therapist. Physical therapy must be for injuries sustained in a covered accident and must start within 60 days after the accident. Treatment must be completed within 6 months after the accident.

$50 per treatment

$25 per treatment

Prostheses Benefit: Loyal American will pay this benefit if a doctor prescribes the use of a prosthetic device due to the loss of a hand, foot or sight of an eye in a covered accident. The prosthetic must be received within 1 year of the covered accident. This benefit is payable once per accident and is not payable for hearing aids, dental aids, false teeth or for cosmetic prosthesis (e.g. hair wigs). We will not pay for joint replacement (e.g. artificial hip or knee).

1 prosthetic device/artificial

limb: $100 More than 1:

$500

1 prosthetic device/artificial

limb: $50 More than 1:

$250

Appliance Benefit: Loyal American will pay this benefit if a doctor advises you to use a medical appliance as an aid to personal locomotion within 90 days as a result of injuries sustained in a covered accident. Benefits are payable for crutches, wheelchairs, braces, etc. Benefits are payable for crutches and wheelchairs once per accident.

$50 $25

Family Lodging & Transportation

Family Lodging Benefit: Loyal American will pay this benefit for a maximum of 30 days per accident, during the time you are confined in a hospital, for one motel/hotel room for a family member to accompany you if injuries sustained in a covered accident require hospital confinement, and if the hospital and motel/hotel are more than 100 miles from your residence.

$100 per day

$50 per day

Transportation Benefit: Loyal American will pay this benefit for a maximum of three trips per calendar year if you require special treatment and confinement in a hospital located more than 100 miles from your residence or site of the accident for injuries sustained in a covered accident.

$300 $150

Accidental Death

Accidental Death* Benefit: This policy will pay the following benefit for death if it is the result of injuries sustained in a covered accident. Death must occur within 90 days of a covered accident.

Common-Carrier: You must be a fare paying passenger on a common-carrier. Common-carrier vehicles are limited to commercial airplanes, trains, buses, trolleys, subways, ferries and boats that operate on a regular scheduled basis between predetermined points or cities. Taxies and privately chartered vehicles are not included.

Insured: $100,000 Spouse:

$50,000 Child: $15,000

Insured: $50,000 Spouse: $25,000

Child: $7,500

Other Accidents: Other Accidents are those not classified as common-carrier and are not specifically excluded in the limitations and exclusions section of the policy.


Child: $5,000


Child: $2,500

Dismemberment

Accidental Dismemberment* Benefit This policy will pay a percentage of the Accidental Death-Other Accidents Benefit for the selected plan.

Both arms and both legs 100% 100%

Two arms or legs 50% 50%

Sight of two eyes, hands, or feet 50% 50%

Sight of one eye, hand, foot, arm, or leg 20% 20%

One or more fingers and/or one or more toes 5% 5%

Accident

*Death or dismemberment must occur within 90 days of the accident. Only the highest single benefit will be paid for accidentaldismemberment.

38

Accident

This is a limited benefit policy. This policy does not pay for losses resulting from sickness. RENEWABILITY CONDITIONS: The policy is guaranteed renewable. Premium rates may be changed on a class basis. A class may be defined by age, sex, occupation, premium payment method, issue state,elimination period, benefit period, etc.

WHAT IS NOT COVERED BY THIS POLICY. We will not pay benefits for any injury as a result of you(r):

Operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft. Aircraft includes thosewhich are not motor-driven.

Engaging in hang gliding, bungee jumping, parachuting, sailgliding , parakiting, or hot-air ballooning.

Participating or attempting to participate in an illegal activity.

Riding in or driving any motor-driven vehicle in a race, stunt show, or speed test.

Intentionally causing a self-inflicted injury.

Having any sickness or declining process caused by a sickness, including physical or mental infirmity. We also will not paybenefits to diagnose or treat the sickness. Sickness means any disease or disorder that is not caused by an injury.

Practicing for or participating in any semi-professional or professional competitive athletic contest for which any type ofcompensation or remuneration is received.

Committing or trying to commit suicide, whether sane or insane.

Being in an accident which occurs more than 40 miles outside the territorial limits of the United States, Canada, Puerto Ri‐co,and Virgin Islands.

Involvement in any period of armed conflict, even if it is not declared.

This brochure contains a summary of the Accident Insurance Policy form L-6020. Coverage as described in the brochure is pro‐vided only through the issuance of a policy. The policy should be consulted for full terms and conditions of coverage.

39

Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family.

Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

About this Benefit

Life and AD&D YOUR BENEFITS PACKAGE

cause of accidental deaths in the US, followed by poisoning, falls,

drowning, and choking.

DID YOU KNOW?

#1

Motor vehicle crashes are the



THE HARTFORD

40

Voluntary Group Term Life and AD&D

Benefit Highlights Celina ISD

What is Supplemental Life Insurance?

Supplemental Life Insurance is coverage that you pay for. Supplemental Life Insurance pays your beneficiary (please see below) a benefit if you die while you are covered. This highlight sheet is an overview of your Supplemental Life Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail.

Am I eligible? You are eligible if you are an active full time employee who works at least 20 hours per week on a regularly scheduled basis.

When is it effective? Coverage goes into effect subject to the terms and conditions of the policy. You must be actively at work with your employer on the day your coverage takes effect.

How much Supplemental Life Insurance can I purchase?

You can purchase Supplemental Life Insurance in increments of $10,000. The maximum amount you can purchase cannot be more than the lesser of 7 times your annual Earnings or $500,000. Annual Earnings are as defined in The Hartford’s contract with your employer.

Am I guaranteed coverage?

If you enroll during your initial enrollment period or are newly eligible and elect an amount that exceeds the guaranteed issue amount of $150,000, you will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you enroll after your initial enrollment period, evidence of insurability will be required for all coverage amounts.

What is a beneficiary?

Your beneficiary is the person (or persons) or legal entity (entities) who receives a benefit payment if you die while you are covered by the policy. You must select your beneficiary when you complete your enrollment application; your selection is legally binding.

Are there other limitations to enrollment?

If you do not enroll within 31 days of your first day of eligibility, you will be considered a late entrant. Typically, late entrants may need to show evidence of insurability and may be responsible for the cost of physical exams or other associated costs if they are required.

Spouse Supplemental Life Insurance

If you elect Supplemental Life Insurance for yourself, you may choose to purchase Spouse Supplemental Life Insurance in increments of $10,000, to a maximum of $250,000. Coverage cannot exceed 50% of the amount of your Employee voluntary/supplemental life insurance coverage. You may not elect coverage for your spouse if they are in active full-time military service or is already covered as an employee under this policy. If your spouse is confined in a hospital or elsewhere because of disability on the date his or her insurance would normally have become effective, coverage (or an increase in coverage) will be deferred until that dependent is no longer confined and has performed all the normal activities of a healthy person of the same age for at least 15 consecutive days. If you enroll during your initial enrollment period or are newly eligible and elect an amount that exceeds the guaranteed issue amount of $30,000, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you enroll after your initial enrollment period, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective.

41


Child(ren) Supplemental Life Insurance

If you elect Supplemental Life Insurance for yourself, you may choose to purchase Child(ren) Supplemental Life Insurance coverage in the amount(s) of $10,000 for each child – no medical information is required.

If your dependent child(ren) is confined in a hospital or elsewhere because ofdisability on the date his or her insurance would normally have become effective,coverage (or an increase in coverage) will be deferred until that dependent is nolonger confined and has performed all the normal activities of a healthy person ofthe same age for at least 15 consecutive days.

Does my coverage reduce as I get older?

Yes by 35% at 65, and 50% at 70. All coverage cancels at retirement.

Can I keep my life coverage if I leave my employer?

Yes, subject to the contract, you have the option of:

Converting you and your dependent(s)' group life coverage to your own individualpolicy (policies).

If you leave your employer, portability is an option that allows you to continueyour life insurance coverage. To be eligible, you must terminate your employmentprior to Social Security Normal Retirement Age.

What is the living benefits option? If you are diagnosed as terminally ill with a 12 month life expectancy, you may be eligible to receive payment of a portion of your life insurance. The remaining amount of your life insurance would be paid to your beneficiary when you die.

Do I still pay my life insurance premiums if I become disabled?

If you become totally disabled before age 60 and your disability lasts for at least 9 months, your life insurance premium may be waived. The premium for your dependent’s coverage will also be waived if you are disabled and approved for waiver of premium. Coverage for your dependents will end if the policy terminates.

Important DetailsAs is standard with most term life insurance, this insurance coverage includes certain limitations and exclusions:

the amount of your coverage may be reduced when you reach certain ages.

death by suicide (two years).Other exclusions may apply depending upon your coverage. Once a group policy is issued to your employer, a certificate of insur‐ance will be available to explain your coverage in detail.This benefit highlights sheet is an overview of the insurance being offered and is provided for illustrative purposes only and is not acontract. It in no way changes or affects the policy as actually issued. Only the insurance policy issued to the policyholder (youremployer) can fully describe all of the provisions, terms, conditions, limitations and exclusions of your insurance coverage. In theevent of any difference between the benefit highlights sheet and the insurance policy, the terms of the insurance policy apply.

42


$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $100,000

Age Band

0-24 $0.40 $0.80 $1.20 $1.60 $2.00 $2.40 $2.80 $3.20 $4.00

25-29 $0.40 $0.80 $1.20 $1.60 $2.00 $2.40 $2.80 $3.20 $4.00

30-34 $0.50 $1.00 $1.50 $2.00 $2.50 $3.00 $3.50 $4.00 $5.00

35-39 $0.70 $1.40 $2.10 $2.80 $3.50 $4.20 $4.90 $5.60 $7.00

40-44 $1.10 $2.20 $3.30 $4.40 $5.50 $6.60 $7.70 $8.80 $11.00

45-49 $1.80 $3.60 $5.40 $7.20 $9.00 $10.80 $12.60 $14.40 $18.00

50-54 $2.90 $5.80 $8.70 $11.60 $14.50 $17.40 $20.30 $23.20 $29.00

55-59 $4.60 $9.20 $13.80 $18.40 $23.00 $27.60 $32.20 $36.80 $46.00

60-64 $6.00 $12.00 $18.00 $24.00 $30.00 $36.00 $42.00 $48.00 $60.00

65-69 $9.70 $19.40 $29.10 $38.80 $48.50 $58.20 $67.90 $77.60 $97.00

70-74 $17.00 $34.00 $51.00 $68.00 $85.00 $102.00 $119.00 $136.00 $170.00

75+ $30.80 $61.60 $92.40 $123.20 $154.00 $184.80 $215.60 $246.40 $308.00

Employee Life Rates

Spouse Life Rates

Child Life Rates $10,000 $2.00 Per Child Unit

AD&D Rates

NOTE: FINAL RATES MAY VARY SLIGHTLY DUE TO ROUNDING.

THESE GRIDS ARE PRICES OF FREQUENTLY SELECTED AMOUNTS. YOU MAY CHOOSE ANY INCREMENT OF $10,000 UP TO $500,000 (NOT TO EXCEED 7 TIMES YOUR ANNUAL SALARY). FOR SPOUSE ANY INCREMENT OF $10,000 UP TO $250,000 (NOT TO EXCEED 50% OF EMPLOYEE LIFE AMOUNT) TO PURCHASE AN AMOUNT OTHER THAN THOSE LEVELS INDICATED ABOVE, SIMPLY ADD LEVELS TOGETHER.

$5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $50,000

Age Band

0-24 $0.40 $0.80 $1.20 $1.60 $2.00 $2.40 $2.80 $3.20 $4.00

25-29 $0.40 $0.80 $1.20 $1.60 $2.00 $2.40 $2.80 $3.20 $4.00

30-34 $0.50 $1.00 $1.50 $2.00 $2.50 $3.00 $3.50 $4.00 $5.00

35-39 $0.70 $1.40 $2.10 $2.80 $3.50 $4.20 $4.90 $5.60 $7.00

40-44 $1.10 $2.20 $3.30 $4.40 $5.50 $6.60 $7.70 $8.80 $11.00

45-49 $1.80 $3.60 $5.40 $7.20 $9.00 $10.80 $12.60 $14.40 $18.00

50-54 $2.90 $5.80 $8.70 $11.60 $14.50 $17.40 $20.30 $23.20 $29.00

55-59 $4.60 $9.20 $13.80 $18.40 $23.00 $27.60 $32.20 $36.80 $46.00

60-64 $6.00 $12.00 $18.00 $24.00 $30.00 $36.00 $42.00 $48.00 $60.00

65-69 $9.70 $19.40 $29.10 $38.80 $48.50 $58.20 $67.90 $77.60 $97.00

70-74 $17.00 $34.00 $51.00 $68.00 $85.00 $102.00 $119.00 $136.00 $170.00

75+ $30.80 $61.60 $92.40 $123.20 $154.00 $184.80 $215.60 $246.40 $308.00

Any amount over $150,000 will be medically underwritten. You must complete an Evidence of Insurability Form.

Any amount over $30,000 will be medically underwritten. You must complete an Evidence of Insurability Form.

$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $100,000

EMPLOYEE $0.30 $0.60 $0.90 $1.20 $1.50 $1.80 $2.10 $2.40 $3.00

FAMILY $0.60 $1.20 $1.80 $2.40 $3.00 $3.60 $4.20 $4.80 $6.00

43

Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.

About this Benefit

Individual Life YOUR BENEFITS PACKAGE

DID YOU KNOW?



5STAR

x 10

Experts recommend at least

your gross annual income in coverage when purchasing life insurance.

44

Individual Life with Terminal Illness and Quality of Life Rider

The Family Protection Plan: Individual Life Insurance with Terminal Illness Coverage to Age 100

With the Family Protection Plan (FPP), you can provide financial stability for your loved ones should something happen to you. You have peace of mind that you are covered up to age 100.* No matter what the future brings, you and your family will be protected.

If faced with a chronic medical condition that required continuous care, would you be able to protect yourself? Traditionally, expenses associated with treatment and care necessitated by a chronic injury or illness have accounted for 86% of all health care spending and can place strain on your assets when you need them most. To provide protection during this time of need, 5Star Life Insurance Company (5Star Life) is pleased to offer the Quality of Life Rider, which is included with your FPP life insurance coverage.

This rider accelerates a portion of the death benefit on a monthly basis - 4% - each month as scheduled by your employer at the group level, and payable directly to you on a tax favored basis. You can receive up to 75% of the current face amount of the life benefit, following a diagnosis of either a chronic illness or cognitive impairment that requires substantial assistance.

Benefits are paid for the following:

Permanent inability to perform at least two of the sixActivities of Daily Living (ADLs) without substantialassistance, or

A permanent severe cognitive impairment, such asdementia, Alzheimer’s disease and other forms of senilityrequiring substantial supervision.

For example, in case of chronic illness, you would receive $3,586 each month up to $67,241.25. The remainder death benefit of $22,413.75 would be made payable to your beneficiary.

* Life insurance product underwritten by 5Star Life Insurance Company (a Baton Rouge,Louisiana company). Product may not be available in all states or territories. Request FPP insurance from Dell Perot, Post Office Box 83043, Lincoln, Nebraska 68501, (866) 863-9753.

Affordability—With several options to choose from, select the coverage that best meets the needs of your family.

Terminal Illness—This plan pays the insured 30% (25% in Connecticut and Michigan) of the policy coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months.

Portability—You and your family continue coverage with no loss of benefits or increase in cost should you terminate employment after the first premium is paid. If this happens, we can simply bill you directly. Coverage can never be cancelled by the insurance company or your employer unless you stop paying premiums.

Family Protection—Individual policies can be purchased on the employee, their spouse, children and grandchildren.

Children & Grandchildren Plan—Policies can be purchased for children and grandchildren ages 15 days to age 24 .

Convenience—Premiums are taken care of simply and easily through payroll deductions.

Protection You Can Count On—Within 24 hours after receiving notice of an insured’s death, an emergency death benefit of the lesser of 50% of the coverage amount, or $10,000, will be mailed to the insured’s beneficiary, unless the death is within the two-year contestability period and/or under investigation. This product also contains no war or terrorism exclusions.

Example Weekly Pre-

mium Death Bene-

fit Accelerated

Benefit

Your age at issue: 35

$10.00 $89,655 4%

$3,586.20 a month

45

Family Protection Plan - Terminal Illness

Age on Eff. Date

Employee Coverage Amounts Spouse Coverage Amounts

$10,000 $25,000 $50,000 $75,000 $100,000 $10,000 $20,000 $30,000

18-25 $7.56 $12.40 $20.46 $28.52 $36.58 $7.56 $10.78 $14.01

26 $7.58 $12.46 $20.58 $28.71 $36.83 $7.58 $10.83 $14.08

27 $7.65 $12.63 $20.92 $29.21 $37.50 $7.65 $10.97 $14.28

28 $7.74 $12.85 $21.38 $29.90 $38.42 $7.74 $11.15 $14.56

29 $7.88 $13.21 $22.08 $30.96 $39.83 $7.88 $11.43 $14.98

30 $8.07 $13.67 $23.00 $32.33 $41.67 $8.07 $11.80 $15.53

31 $8.27 $14.17 $24.00 $33.83 $43.67 $8.27 $12.20 $16.13

32 $8.49 $14.73 $25.13 $35.52 $45.92 $8.49 $12.65 $16.81

33 $8.73 $15.31 $26.29 $37.27 $48.25 $8.73 $13.12 $17.51

34 $9.00 $16.00 $27.67 $39.33 $51.00 $9.00 $13.67 $18.33

35 $9.30 $16.75 $29.17 $41.58 $54.00 $9.30 $14.27 $19.23

36 $9.64 $17.60 $30.88 $44.15 $57.42 $9.64 $14.95 $20.26

37 $10.02 $18.54 $32.75 $46.96 $61.17 $10.02 $15.70 $21.38

38 $10.41 $19.52 $34.71 $49.90 $65.08 $10.41 $16.48 $22.56

39 $10.84 $20.60 $36.88 $53.15 $69.42 $10.84 $17.35 $23.86

40 $11.31 $21.77 $39.21 $56.65 $74.08 $11.31 $18.28 $25.26

41 $11.83 $23.08 $41.83 $60.58 $79.33 $11.83 $19.33 $26.83

42 $12.41 $24.52 $44.71 $64.90 $85.08 $12.41 $20.48 $28.56

43 $13.00 $26.00 $47.67 $69.33 $91.00 $13.00 $21.67 $30.33

44 $13.63 $27.56 $50.79 $74.02 $97.25 $13.63 $22.92 $32.21

45 $14.28 $29.19 $54.04 $78.90 $103.75 $14.28 $24.22 $34.16

46 $14.97 $30.92 $57.50 $84.08 $110.67 $14.97 $25.60 $36.23

47 $15.69 $32.73 $61.13 $89.52 $117.92 $15.69 $27.05 $38.41

48 $16.43 $34.56 $64.79 $95.02 $125.25 $16.43 $28.52 $40.61

49 $17.22 $36.54 $68.75 $100.96 $133.17 $17.22 $30.10 $42.98

50 $18.08 $38.69 $73.04 $107.40 $141.75 $18.08 $31.82 $45.56

51 $19.04 $41.10 $77.88 $114.65 $151.42 $19.04 $33.75 $48.46

52 $20.16 $43.90 $83.46 $123.02 $162.58 $20.16 $35.98 $51.81

53 $21.40 $47.00 $89.67 $132.33 $175.00 $21.40 $38.47 $55.53

54 $22.79 $50.48 $96.63 $142.77 $188.92 $22.79 $41.25 $59.71

55 $24.27 $54.17 $104.00 $153.83 $203.67 $24.27 $44.20 $64.13

56 $25.93 $58.33 $112.33 $166.33 $220.33 $25.93 $47.53 $69.13

57 $27.66 $62.65 $120.96 $179.27 $237.58 $27.66 $50.98 $74.31

58 $29.42 $67.04 $129.75 $192.46 $255.17 $29.42 $54.50 $79.58

59 $31.23 $71.56 $138.79 $206.02 $273.25 $31.23 $58.12 $85.01

60 $33.12 $76.29 $148.25 $220.21 $292.17 $33.12 $61.90 $90.68

61 $35.08 $81.19 $158.04 $234.90 $311.75 $35.08 $65.82 $96.56

62 $37.13 $86.31 $168.29 $250.27 $332.25 $37.13 $69.92 $102.71

63 $39.31 $91.77 $179.21 $266.65 $354.08 $39.31 $74.28 $109.26

64 $41.68 $97.71 $191.08 $284.46 $377.83 $41.68 $79.03 $116.38

65 $44.33 $104.33 $204.33 $304.33 $404.33 $44.33 $84.33 $124.33

66* $44.93 $105.81 $207.29 $308.77 $410.25 $44.93 $85.52 $126.11

67* $48.25 $114.13 $223.92 $333.71 $443.50 $48.25 $92.17 $136.08

68* $52.03 $123.58 $242.83 $362.08 $481.33 $52.03 $99.73 $147.43

69* $56.33 $134.31 $264.29 $394.27 $524.25 $56.33 $108.32 $160.31

70* $61.17 $146.42 $288.50 $430.58 $572.67 $61.17 $118.00 $174.83

46

Family Protection Plan - Terminal Illness

*Quality of Life not available ages 66 - 70. Quality of Life benefits not available for children.Child life coverage available only on children and grandchildren of employee (age on application date: 15 days to age 24).$4.98 monthly for $10,000 coverage and $9.97 monthly for $20,000 coverage.

47

A Cafeteria Plan is designed to take advantage of Section 125 of the Internal Revenue Code. It allows you to pay certain qualified expenses on a pre-tax basis, thereby reducing your taxable income. You can set aside a pre-established amount of money per plan year in a Healthcare Flexible Spending Account (FSA). Funds allocated to a healthcare FSA must be used during the plan year or are forfeited.

Limited FSA (HSA Compatible) The funds in the limited healthcare FSA can be used to pay for eligible dental or vision expenses like orthodontics, glasses and contacts.

About this Benefit

FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

NBS



FOR HSA VS. FSA COMPARISON

FLIP TO… PG. 11

48

NBS Flexcard You may use the card to pay merchants or service providers that accept MasterCard® credit cards, so there is no need to pay cash up front, then wait for reimbursement. If you are participating in the Dependent Care portion, the money isn’t loaded to the card. You must file web or paper claims or enroll in continual reimbursement.

Current plan participants: KEEP YOUR CARDS! NBS debit cards are good for 3 years. If you throw away your cards, there is a $5.00 fee to replace them.

New Plan Participants NBS will mail out your new benefit cards to the address listed in THEbenefitsHUB. They will be sent in unmarked envelopes so please watch for them as they should arrive within 21 business days of effective date. NBS debit cards are good for 3 years.

FSA Annual Contribution Max: $2,550

Dependent Care Annual Max: $5,000

Account Information: Participant Account Web Access: www.participant.nbsbenefits.com

Participants may call NBS and talk to a representative during regular business hours, Monday-Friday, 8 am to 7 pm Central Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to the NBS website: www.NBSbenefits.com

-Detailed claim history and processing status-Health Care and Dependent Care account balances-Claim forms, Direct Deposit form, worksheets, etc.-Online claims-FAQs

*Celina ISD offers a limited purpose Flexible Spending Accountplan which you may use to pay for eligible dental and visionexpenses only. The Limited FSA is only available if you choose toelect the Health Savings Account (HSA) plan.

For a list of sample expenses, please refer to the Celina ISD benefit website: www.mybenefitshub.com/celinaisd

NBS Contact Information:

8523 South Redwood Road West Jordan, UT 84088 Phone (800) 274‐0503 Fax (800) 478‐1528 Email: [email protected]

When Will I Receive My Flex Card?

Expect Flex Cards to be delivered to the address listed in THEbenefitsHUB near the end of September.

Don’t forget, Flex Cards Are Good For 3 Years!

FSA (Flexible Spending Account)

DID YOU KNOW?

FSAs use tax-free funds to help pay for your Health Care Expenses.

NBS Prepaid MasterCard® Debit Card

49

What is a Flexible Spending Account? A Flexible Spending Account allows you to save money by paying out-of-pocket health and/or dependent care related expenses with pre-tax dollars. Your contributions are deducted from your pay before taxes are withheld and your account is up fronted with an annual amount. Because you are taxed on a lower amount of pay, you pay less in taxes and you have more to spend.

How does a Flexible Spending Account Benefit Me? A Cafeteria plan enables you to save money on group insurance, health-related expenses, and dependent-care expenses. You may save as much as 35 percent on the cost of each benefit option! Eligible expenses must be incurred within the plan year and contributions are use-it-or- lose-it. Remember to retain all your receipts.

Health Care Expense Account Example Expenses:

Dependent Care Expense Account Example Expenses: Before and After School and/or Extended Day Programs

The actual care of the dependent in your home.

Preschool tuition.

The base costs for day camps or similar programs used ascare for a qualifying individual.

What Can I Use My Flexible Spending Account On? For a full list of eligible expenses, please refer to www.mybenefitshub.com/celinaisd

What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)? Eligible expenses must be incurred within the plan year +75 day grace period. Contributions are use-it-or- lose-it. Remember to retain all your receipts (including receipts for card swipes).

How Do I File A Claim? In most situations, you will be able to swipe your card however, in the event you lose your card or are waiting to receive one, you can visit www.mybenefitshub.com/celinaisd and complete the “Claim Form” to send to NBS or use the web or phone app to file online.

Hearing aids &batteries

Lab fees

Laser Surgery

Orthodontia Expenses

Physical exams

Pregnancy tests

Prescription drugs

Vaccinations

Vaporizers orhumidifiers

Acupuncture

Body scans

Breast pumps

Chiropractor

Co-payments

Deductible

Diabetes Maintenance

Eye Exam & Glasses

Fertility treatment

First aid

FSA Frequently Asked Questions

How To Receive Your Dependent Care Reimbursement Faster.

A Direct Deposit form is available on the Benefits Website which will help you get reimbursed quicker!

50

How the FSA Plan Works

You designate an annual election of pre-tax dollars to be deposited into your health and dependent-care spending accounts. Your total election is divided by the number of pay periods in the Plan year and deducted equally from each paycheck before taxes are calculated. By the end of the Plan year, your total election will be fully deposited.

However, you may make a claim for eligible health FSA expenses as soon as they are incurred during the Plan year. Eligible claims will be paid up to your total annual election even if you have not yet contributed that amount to your account.

Get Your Money 1. Complete and sign a claim form (available on our website) or an online claim.2. Attach documentation; such as an itemized bill or an Explanation of Benefits (EOB) statement from a health insurance provider.3. Fax or mail signed form and documentation to NBS.4. Receive your non-taxable reimbursement after your claim is processed either by check or direct deposit.

NBS Flexcard—FSA Pre-paid Benefit Card Your employer may sponsor the use of the NBS Flexcard, making access to your flex dollars easier than ever. 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.

Account Information Participants may call NBS and talk to a representative during our regular business hours, Monday–Friday, 7am to 6pm Mountain Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to our website:www.NBSbenefits.com

Information includes:

Detailed claim history and processing status

Health Care and Dependent Care account balances

Claim forms, worksheets, etc.

Online Claim Submission

Enrollment Considerations After the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying “change of status” (marriage status, employment change, dependent change). Be conservative in the total amount you elect to avoid forfeiting money that may be left in your account at the end of the year. Your employer may allow a short grace period after the Plan year ends for you to submit qualified claims for any unused funds.

51

Learn how to lose weight and improve your health while eating the foods you love. The Naturally Slim® program has the secret to lasting weight loss and it doesn’t include starving, counting calories or eating diet food. This program offers you the chance to learn how to eat to reduce your chances of getting a serious disease, like diabetes or heart disease, and increase your chance at living a longer, healthier life.

About this Benefit

Weight LossYOUR BENEFITS PACKAGE

DID YOU KNOW?

is the average weight loss per participant in

10 weeks.

NATURALLY SLIM

10.6 lbs



Naturally Slim® is a proven solution to help your employees lose weight and reduce their Metabolic Syndrome (MetS) risk. MetS is a cluster of risk factors that predicts serious conditions such as diabetes, heart disease and stroke. Naturally Slim has helped more than 650 employers reduce their health care spending and measurably improve the health of their employees.

The Problem The prevalence of obesity and the related MetS risk factors is growing at an alarming rate. MetS dramatically increases the chances of developing diabetes, heart disease, depression, stroke, cancer and a number of other serious medical conditions. Individuals with MetS average almost twice as much in medical costs per year as those without MetS. They also have a seven times higher likelihood of being a high-cost claimant.

Finally…there is a weight loss program with proven, lasting clinical results.

The Solution Naturally Slim is a mindful-eating program that helps your employees lose weight and reduce the risks associated with MetS. It starts with ten weeks of skill building focused on behavior modification, not dieting. After the first ten weeks, participants receive ongoing counseling and support for one full year to reinforce skills to ensure long-term, sustainable results. Naturally Slim is an online program, so it is easily deployed across large and geographically-dispersed employee groups. It is a turnkey solution, so it is simple to rollout. It has been successful in helping hundreds of companies reverse the incidence of MetS of their employees – by 50% on average.

What is Naturally Slim? Naturally Slim is a high-value, behavior modification program proven to deliver sustainable weight loss and reverse obesity, pre-diabetes, and MetS. Naturally Slim shares the latest research on mindful eating, focusing on how the learned behaviors of True Thin™ individuals, not dieting, are best for lasting weight loss and risk reduction.

Why Naturally Slim? More than 650 companies have implemented the Naturally Slim program to date with consistent results of dramatically improving obesity, pre-diabetes and MetS risk factors. The consistent results across a variety of industries prove that the program works for all types of organizations.

How is the program delivered? Naturally Slim is delivered via proprietary distance learning technology which makes it simple and scalable for your school district. The first ten weeks of the program are focused on building behavioral skills to promote weight loss. The remainder of the program focuses on reinforcing those skills and fostering long-term weight maintenance.

What’s included? 10 weeks of skill-building video instruction

(approximately 1 hour of instruction made up of 3 - 12minute segments.)

Online dashboard to watch videos, track weight lossprogress, log activity and more

A welcome kit and email reminders to encourageparticipant adherence

Online access to health coaches

One full year of video instruction and support whichincludes seven bi-weekly videos after the first ten weeksand monthly videos during the final six months.

Online community to interact with current participantsand alumni for inspiration and support

Integration with activity devices and wireless scales,such as FitBit® and Jawbone® devices

Employee Weight Loss Program

Monthly Premiums

EE Only $30

EE + Spouse $60

Spouse Only $30

53

NOTES

54

NOTES

55

www.mybenefitshub.com/celinaisd

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2016 Benefit Guide Celina ISD

Documents

Transcript of 2016 Benefit Guide Celina ISD