2016 benefit guide birdville isd

EFFECTIVE:

09/01/2016 - 8/31/2017

BENEFIT GUIDE

www.mybenefitshub.com/birdvilleisd

BIRDVILLE 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. Health Savings Account (HSA) vs. Flexible

Spending Account (FSA) 11

TRS-ActiveCare and Scott & White HMO 12-15

APL MEDlink® Medical Supplement 16-19

Telehealth MDLIVE 20-21

Delta Dental DPO & DHMO 22-25

Superior Vision 26-27

Cigna Disability 28-31

APL Cancer 32-35

AUl a OneAmerica Company Life and AD&D 36-37

ID Watchdog ID Theft Protection 38-39

MetLaw Legal Services 40-41

Ceridian/LifeWorks Employee Assistance Program 42-43

NBS Flexible Spending Account 44-47

NBS Health Savings Account 48-49

Table of Contents

HOW TO ENROLL

PG. 4

BENEFIT UPDATES: WHAT’S NEW

PG. 6

YOUR BENEFITS PACKAGE

PG. 12

FLIP TO...

2

Benefit Contact Information

BIRDVILLE ISD BENEFIT ADMINISTRATORS

DENTAL EMPLOYER ASSISTANCE PROGRAM

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

Delta Dental (800) 521-2651 www.deltadentalins.com

Ceridian/LifeWorks (888) 456-1324 www.lifeworks.com

BIRDVILLE ISD BENEFITS OFFICE VISION IDENTITY THEFT Birdville ISD Benefits Office (817) 547-5782 www.schools.birdvilleschools.net/benefits

Superior Vision (800) 507-3800 www.superiorvision.com

ID Watchdog (800) 774-3772 www.idwatchdog.com

TRS ACTIVECARE MEDICAL DISABILITY HYATT METLAW Aetna (800) 222-9205 www.trsactivecareaetna.com

Cigna (800) 362-4462 www.mycigna.com

MetLife (800) 821-6400 www.metlife.com

TRS HMO MEDICAL CANCER FLEXIBLE SPENDING ACCOUNT Scott & White HMO (800) 321-7947 www.trs.swhp.org

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

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

MEDICAL SUPPLEMENT—MEDLINK ® LIFE AND AD&D HEALTH SAVINGS ACCOUNT (HSA) American Public Life (800) 256-8606 www.ampublic.com

AUL a OneAmerica Company (800) 537-6442 www.oneamerica.com

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

TELEHEALTH 403(B) /457 PLANS

MDLIVE (866) 365-1663 www.consultmdlive.com

JEM (800) 943-9179 www.jemtpa.com ISC GROUP, Inc. (800) 888-3520 www.iscgroup.com/home

Benefit Contact Information

3

!

How to Enroll

On Your Computer Access the Birdville ISD benefits

website 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/

birdvilleisd delivers important

benefit information with 24/7

access, as well as detailed plan

information, rates and product

videos.

TEXT

“birdvilleisd”

TO

313131

On Your Device Enrolling in your benefits just got

a lot easier! Text “birdvilleisd” 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/birdvilleisd 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

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/

birdvilleisd. 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/

birdvilleisd. 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.

If the insurance carrier provides ID cards, but there are no

changes to the plan, you typically will not receive a new ID

card each year.

SUMMARY PAGES

6

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 Birdville ISD as both

employees and dependents.

If your dependent is disabled, coverage may be able to 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

PLAN CARRIER MAXIMUM AGE

Medical Aetna To age 26

Telehealth MDLIVE To age 26

Dental High, Low & DHMO Delta Dental To age 26

Vision Superior Vision To age 26

MEDlink® American Public Life To age 26

Cancer American Public Life To age 26

Voluntary Life & AD&D OneAmerica To age 26

ID Theft Protection ID Watchdog To age 26

MetLaw MetLife To age 26

7

NEW: Long-Term Disability insurance by Cigna - Your current Disability plan will automatically change Cigna’s equivalent. You may change your election during open enrollment.

Don’t Forget!Social Security Numbers for your dependents are required regardless if they are enrolled in coverage or not. Please make sure you have these items on hand when going through your open enrollment.

Due to the Affordable Care Act (ACA), every employee is required to login and complete the enrollment process, even if you are declining benefits Login and complete your benefit enrollment from: 7/18/2016-8/22/2016.

Important Enrollment assistance is available by calling Financial Benefit Services at (469) 385-4685 to speak to a representative. Spanish speaking representatives are also available.

Annual Open Enrollment Benefit elections will become effective 9/1/2016 (elections requiring evidence of insurability, such as life Insurance, may have a later effective date, if approved). After annual enrollment closes, benefit changes can only be made if you experience a qualifying event (and changes must be made within 30 days of event).

YOU MUST RE-ELECT OR DECLINE YOUR MEDICAL PLAN

Annual Benefit Enrollment has been set for July and August by TRS. For additional Benefit Information: View the Benefits Open Enrollment power point. BISD home page- Departments-Benefits- 2016-2017 Benefits Enrollment.

Benefit Updates - What’s New:

SUMMARY PAGES

Annual Benefit Enrollment

8

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

9

SUMMARY PAGES

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

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

FOR HSA INFORMATION

FLIP TO… PG. 48

FOR FSA INFORMATION

FLIP TO… PG. 44

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.

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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

About this Benefit MEDlink® is designed to help supplement your Employer's major medical plan. This plan provides supplemental coverage to help offset out-of-pocket costs that you may experience due to deductibles, co-payments and coinsurance of your medical plan.

MEDlink®IV YOUR

BENEFITS

DID YOU KNOW?

33%

of total healthcare costs are paid

out-of-pocket.

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

Birdville ISD Benefits Website: www.mybenefitshub.com/birdvilleisd

AMERICAN PUBLIC LIFE

(03/16)16

APSB-22354(TX) MGM/FBS Birdville ISD

*Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with notice.The premium and amount of benefits vary dependent upon the Plan selected at time of application.

EligibilityYou are eligible to be covered under this Policy/Certificate if you are Actively At Work, qualify for coverage as defined in the Master Application, are covered under your Employer’s Medical Plan and are under age 70 (if you work for an employer employing less than 20 employees). Your Eligible Dependents, as defined in the Policy/Certificate, are eligible for coverage if they are covered under the Employer’s Medical Plan. You must apply for insurance during the Initial Enrollment period or on the date the person first becomes eligible for coverage. If you do not apply during the Initial Enrollment period or on the date you become eligible for coverage, you may be subject to additional underwriting by APL. Evidence of coverage under your Employer’s Medical Plan is required.

When Coverage BeginsCoverage will begin on the requested Certificate Effective Date or the Certificate Effective Date assigned by us, upon approval of your application, if our underwriting rules are met, the premium has been paid and all persons to be insured are covered under your Employer’s Medical Plan and you are Actively At Work on the Certificate Effective Date. If you are not Actively At Work on the Certificate Effective Date due to disability, Injury, Sickness, temporary layoff, leave of absence or Family and Medical Leave of Absence, coverage begins on the date you return to Actively At Work.

Total Monthly Premiums by Plan*

Employee Employee & Spouse Employee & Child Employee & Family

Ages 18-54 $30.68 $70.55 $52.15 $92.03

Ages 55+ $46.01 $105.83 $78.22 $138.04

ENHANCED PLAN SUMMARY OF BENEFITS*

Base Policy Option 1

Maximum In-Hospital Benefits $2,500 per Covered Person per Confinement

In-Hospital Ambulance Benefit Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation where a Covered Person is Confined as an Inpatient. Limited to one trip per day.

In-Hospital Deductible $0 per Covered Person per Confinement

Outpatient Benefit Rider

Maximum Outpatient Benefits $500 per Covered Person per Occurrence for Covered Outpatient Services

Outpatient Ambulance Benefit Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation where a Covered Person resides less than 18 hours. Limited to one trip per day.

Outpatient Deductible $0 per Covered Person Per Occurrence

Covered Outpatient ServicesHospital Emergency Room Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Urgent Care Facility Maximum of three Urgent Care visits per Covered Person per Calendar Year. Maximum of six Urgent Care visits per Calendar Year for all Covered Persons combined. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Outpatient Surgery Outpatient Surgery in Hospital Outpatient Facility or Freestanding Outpatient Surgery Center. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Diagnostic Testing Diagnostic Testing in a Hospital Outpatient Facility or MRI Facility. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Outpatient Treatment for a Serious Mental Illness in a Hospital Outpatient Facility

Maximum of 60 days of treatment per Covered Person per Calendar Year. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Important Policy Provisions

MEDlink® IV EnhancedLimited Benefit Group Medical Expense Supplemental InsuranceBirdville ISDTHE 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.

17

No benefits will be payable for expenses incurred during any period the Covered Person does not have coverage under your Employer’s Medical Plan, except as provided in the Absence of the Insured’s Employer’s Medical Plan provision, described in the Policy.

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

Pre-Existing Condition LimitationNo benefits are payable during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date for any loss resulting from a Pre-Existing Condition. The Pre-Existing Condition Limitation will apply only if the Covered Person is subject to a Pre-Existing Condition Limitation under the Employer’s Medical Plan. Therefore, any Pre-Existing Condition Limitation applied to the Major Medical plan would, in effect, limit coverage under this plan.

ExclusionsNo benefits are payable for any loss resulting from or caused, whether directly or indirectly, by:

s war or any act of war, whether declared or undeclared, oractive service in the armed forces; (This exclusion includes Accidentsustained or Sickness contracted while in the service of anymilitary, naval or air force of any country engaged in war. Ifcoverage is suspended for any Covered Person during a periodof military service, APL will refund the pro-rata portion of anypremium paid for any such Covered Person upon receipt of yourwritten request)

s an intentionally self-inflicted Injury or Sickness;s suicide or attempted suicide, while sane or insane;s rest care or rehabilitative care and treatment;s outpatient routine newborn care;s voluntary abortion except, with respect to you or your covered

Eligible Dependent spouse:s where you or your Dependent spouse’s life would be

endangered if the fetus were carried to term; ors where medical complications have arisen from abortion;

s pregnancy of an Eligible Dependent child;s participating in a riot, insurrection, rebellion, civil commotion,

civil disobedience or unlawful assembly; (This does not includea loss which occurs while acting in a lawful manner within thescope of authority.)

s committing, or attempting to commit, an illegal act that isdefined as a felony; (Felony is as defined by the law of thejurisdiction in which the act takes place.)

s participation in a contest of speed in power driven vehicles,parachuting or hang gliding;

s air travel, except:s as a fare-paying passenger on a commercial airline on a

regularly scheduled route; ors as a passenger for transportation only and not as a pilot or

crew member;s being intoxicated or under the influence of any narcotic unless

administered by a Physician or taken according to the Physician’sinstructions; (Intoxication means that which is determined anddefined by the laws and jurisdiction of the geographical area inwhich the event that caused the loss occurred.)

s alcoholism or drug addiction;s sex changes;s experimental treatment, drugs or surgery;s Accident or Sickness arising out of, and in the course of, any

occupation for compensation, wage or profit; (This does notapply to those sole proprietors or partners not covered byWorkers’ Compensation.)

s dental or vision services, including treatment, surgery,extractions or x-rays, unless:

s resulting from an Accident occurring while the CoveredPerson’s coverage is in force and if performed within 12months of the date of such Accident; ors due to congenital disease or anomaly of a covered newborn

child.s routine examinations, such as health exams, periodic check-ups

or routine physicals, except when part of Inpatient routinenewborn care;

s elective cosmetic surgery;s drugs (prescription and non-prescription for use outside of a

covered facility as defined in this Policy/Certificate or anyattached rider);

s sterilization and reversal of sterilization;s an expense that does not meet the definition of Covered Charges;s an expense or service that exceeds any of the Maximum

Benefits, as shown in the Schedule of Benefits; ors any expense for which benefits are not payable under your Other

Medical Plan.

Premium ChangesThe premium rates may be changed by APL at the first anniversary date of this Policy or any premium due date thereafter. No such increase in rates will be made unless 60 days prior notice is given to the Policyholder. Premiums will not increase during the initial 12 months of coverage.

Optionally RenewableThis Policy is renewable at the option of APL. The Policyholder or APL may terminate this Policy on any premium due date after the first anniversary following the Policy Effective Date, subject to 60 days written notice.

Termination of CertificateYour insurance coverage under this Certificate and any attached riders will end on the earliest of these dates:s the date the Policy terminates;s the end of the grace period if the premium remains unpaid;s the date you no longer qualify as an Insured;s the date you attain age 70 (if you work for an employer employing

less than 20 employees);s the date your coverage under your Employer’s Medical Plan ends; ors the date of your death.

Termination of CoverageYour insurance coverage under this Certificate and any attached riders for a Covered Person will end as follows:s the date the Policy terminates;s the date the Certificate terminates;s the end of the Certificate Month in which APL receives a

written request from you to terminate the Covered Person’scoverage;

s the date a Covered Person no longer qualifies as an Insured orEligible Dependent; or

s the date of the Covered Person’s death.

APL may end the coverage of any Covered Person who submits a fraudulent claim.

Cobra Continuation of CoverageThis plan may be continued in accordance with the Consolidated Omnibus Reconciliation Act of 1986.

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

Limitations & Exclusions

APSB-22354(TX) MGM/FBS Birdville ISD

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

18

MEDlink® IV

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

DID YOU KNOW?

75%

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

telehealth.

MDLIVE YOUR BENEFITS PACKAGE


Birdville ISD Benefits Website: www.mybenefitshub.com/birdvilleisd 20

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

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?

Dental PPO & DHMO DELTA




Dental PPO—High & Low Options

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

** Fees are based on DPO Contracted Fees for DPO dentists, DPO contracted fees for Premier Dentists and DPO contracted fees for non-Delta Dental dentists.

*** Fees are based on DPO contracted fees for DPO Dentists, Delta Dental Premier contracted fees for Premier dentists and the 90th percentile for non-Delta Dental dentists.

Low Plan High Plan

Benefits and Covered Services* Delta Dental

DPO Dentists ** Non-Delta Dental DPO dentists**

Delta Dental DPO Dentists ***

Non-Delta Dental DPO dentists***

Diagnostic & Preventive Services (Exams, cleanings, x-rays & Sealants)

100% 100% 100% 100%

Basic Services (Fillings and simple tooth extractions)

50% 50% 80% 80%

Endodontics (root canals) 50% 50% 50% 50%

Other Oral Surgery 50% 50% 50% 50%

Major Services (Crowns, inlays, onlays, and cast restorations)

50% 50% 50% 50%

Prosthodontics (Bridges, denturs and implants) 50% 50% 50% 50%

Deductible In-Network Out-of Network In-Network Out-of Network

Individual $50.00 $50.00 $50.00 $50.00

Family $150.00 $150.00 $150.00 $150.00

Annual Max Benefit In-Network Out-of Network In-Network Out-of Network

Per Person Each Calendar Year $1,250 $1,250 $1,250 $1,250

Orthodontics– Dependent Children to age 26 In-Network Out-of Network In-Network Out-of Network

Orthodontic– Dependent Children to age 26 50% 50% 50% 50%

Orthodontic Maximums $1,000 Lifetime $1,000 Lifetime

Monthly Premiums by Plan

Tier Low Plan High Plan

EE Only $25.55 $36.12

EE + Spouse $50.66 $70.47

EE + Child(ren) $57.14 $80.75

EE + Family $82.23 $116.23

Network: Delta Dental PPO or Delta Dental Premiere

Birdville ISD offers 2 PPO options listed below. YOU DON’T NEED AN ID CARD TO VISIT A PPO DENTIST! Just register for Online Services to print an ID Card or pull it up on your smartphone at the dentist’s office.

In Texas, Delta Dental Insurance Company offers a Dental Provider Organization (DPO) plan.

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Dental PPO— High & Low Options

Low & High PPO Dental Plan

Preventive How Many/How Often:

Prophylaxis (cleanings) Two in a calendar year

Oral Examinations Two in a calendar year

Topical Fluoride Applications One fluoride treatment per calendar year for children up to age 19

X-rays Full mouth X-rays: one set per 5 years To age 18 - two in a calendar year and over age 18 - one in a

calendar year

Sealants 1st permanent molars to age 9 and 2nd permanent molars to age 16

Basic Restorative How Many/How Often:

Fillings Replacement: once every 24 months.

Crown, Denture, & Bridge Repair Once in 24 months.

General Anesthesia When dentally necessary in connection with oral surgery, ex-tractions or other covered dental services.

Major Restorative How Many/How Often:

Implants One in 5 years

Bridges One in 5 years

Dentures and Partials One in 5 years

Crowns/Inlays/Onlays Replacement One in 5 years

Orthodontia How Many/How Often:

Your Children, up to age 26, are covered while Dental Insur-ance is in effect

24

Dental DHMO

DHMO Plan Name: DeltaCare USA A DHMO plan provides dental benefits through a network of participating primary and specialty care dentists. Participants pay co-pay amounts for covered services and must see an in-network Delta dentist to receive those services. All covered services must be provided by the mem-ber’s Primary Care Dentist. Specialty care dentists require a referral and approval. Please refer to the schedule of benefits for full plan details. If terms of this summary and the schedule of benefits differs, the schedule of benefits governs.

Code Service Copayment

DIAGNOSTIC TREATMENT

D0120 Periodic Oral Evaluation $0.00

D0150 Comprehensive Oral Evaluation - New or Established Patient $0.00

D0180 Comprehensive Periodontal Evaluation - new or established patient $0.00

D0274 Bitewings - Four Radiographic images - limited to 1 series every 6 months

$0.00

D0330 Panoramic Radiographic Image $0.00

PREVENTIVE SERVICES

D1110 Prophylaxis - Adult $5.00

D1120 Prophylaxis - Child $5.00

D1351 Sealant-per tooth-through age 15 $15.00

RESTORATIVE SERVICES

D2140 Amalgam - One Surface, Primary or Permanent $8.00

D2330 Resin-Based Composite-One Surface, Anterior $22.00

D2391 Resin-Based Composite - One Surface, Posterior $65.00

CROWNS

D2750 Crown Porcelain Fused to High Noble Metal $395.00

D2751 Crown Porcelain Fused to Predominantly Base Metal $295.00

ENDODONTICS D3220 Therapeutic Pulpotomy $45.00

D3330 Root Canal - Molar $365.00

PERIODONTICS D4260 Osseous Surgery (Inc Flap Entry) - Four or More Contiguous Teeth or

Bounded Teeth Spaces - Per Quadrant $385.00

D4341 Periodontal Scaling & Root Planning - Four or More Contiguous Teeth - Per Quadrant

$60.00

D4910 Periodontal Maintenance $45.00

PROSTHODONTICS D5110 Complete Denture - Maxillary $365.00

D5120 Complete Denture - Mandibular $365.00

D5211 Partial Denture - Resin Base - Maxillary $325.00

D5212 Partial Denture - Resin Base - Mandibular $325.00

CROWNS/FIXED BRIDGES D6211 Pontic - Cast Predominantly Base Metal $295.00

D6750 Porcelain Crown Fused to High Noble Metal $395.00

ORAL SURGERY D7140 Extraction, Erupted Tooth, or Exposed Root (Elevation and/or For- ceps

Removal $14.00

D7210 Surgical Removal of Erupted Tooth $55.00

D7220 Removal of Impacted Tooth - Soft Tissue $70.00

D7240 Removal of Impacted Tooth - Completely Bony $120.00

ORTHODONTICS D8070 Comprehensive Orthodontic Treatment of Transitional Dentition (Full

Treatment Case up to 24 Months) $1,900.00

D8080 Comprehensive Orthodontic Treatment of Adolescent Dentition (Full Treatment Case up to 24 Months)

$1,900.00

D8090 Comprehensive Orthodontic Treatment of Adult Dentition (Full Treatment Case up to 24 Months)

$2,100.0

ADJUNCTIVE GENERAL SERVICE D9110 Palliative (Emergency) Treatment of Dental Pain - Minor Procedure $20.00

D9310 Consultation $25.00

DHMO Monthly Premiums

Tier Low Plan

EE Only $11.66

EE + Spouse $22.15

EE + Child(ren) $23.31

EE + Family $36.12

For a detailed list of services and fees please visit www.mybenefitshub.com/birdvilleisd

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

75%

DID YOU KNOW?

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

correction.

SUPERIOR VISION YOUR BENEFITS PACKAGE



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

1Materials co-pay applies to lenses and frames only, not contact lenses ₂See your benefits materials for definitions of standard and specialty contact lens fittings ₃Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 4Contact lenses are in lieu of eyeglass lenses and frames benefit

Vision

Vision Plan Benefits

Benefits In-Network Out-of-Network

Exam (ophthalmologist) Covered in full Up to $42 retail

Exam (optometrist) Covered in full Up to $37 retail

Frames $125 retail allowance Up to $68 retail

Contact Lens fitting (standard₂)

Covered in full Not Covered

Contact Lens fitting (specialty₂)

$50 retail allowance Not Covered

Contact Lenses $120 retail allowance Up to $100 retail

Lenses (standard) per pair

Single Vision Covered in full Up to $32 retail

Bifocal Covered in full Up to $46 retail

Trifocal Covered in full Up to $61 retail

Progressive See description₃ Up to $61 retail

CO-PAYS

Exam $10

Materials₁ $25

Contact Lens Fitting (standard & specialty)

$25

SERVICES/FREQUENCY

Exam 12

months

Frame 12

months

Contact Lens Fitting 12

months

Lenses 12

months

Contact Lenses 12

months

Monthly Premiums

EE Only $9.23

EE + SP $18.28

EE+ Child(ren) $17.93

EE + Family $27.24

Vision Plan Name: Members pay a co-pay for in-network benefits. Out-of-network vision services are reimbursed up to a certain dollar amount for covered ex-penses. The in-network exam co-pay is $10.00 and the materials co-pay is $25.00.Exams, lenses and frames (within plan allowance) are cov-ered in-network with a co-pay, once every 12 months.

27

About this Benefit

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.

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.



Birdville ISD Benefits Website: www.mybenefitshub.com/birdvilleisd

Disability CIGNA

28

Long Term Disability

Important Definitions and Features Definition of Disability “Disability” or “Disabled” means that, solely because of a covered injury or sickness, you are unable to perform the material duties of your regular occupation and you are unable to earn 80% or more of your indexed earnings from working in your regular occupation. After benefits have been payable for 24 months, you are considered disabled if solely due to your injury or sickness, you are unable to perform the material duties of any occupation for which you are (or may reasonably become) qualified by education, training or experience, and you are unable to earn 80% or more of your indexed earnings. We will require proof of earnings and continued disability.

Covered Earnings “Covered Earnings” means your wages or salary, not including bonuses, commissions, and other extra compensation.

When Benefits Begin You must be continuously Disabled for your elected benefit waiting period before benefits will be payable for a covered Disability.

Long Term Disability (LTD) Insurance Coverage

Eligibility If you are an active employee who works at least 20 hours per week, you are eligible on the first of the month following 30 days actively at work.

Eligibility Waiting Period

No waiting period.

Monthly Benefit Benefit Amount

Flat dollar benefit in $100 increments between $200 and $7,500 that cannot exceed 66.67% of your current monthly earnings. Your benefit amount will be reduced by any amounts payable to you by any of the sources listed under the “Effects of Other income Benefits” section.

Maximum $7,500 per month

Elimination Period

Select from Six Options: Accident/Sickness 0 days/7 days* 14 days/14 days* 30 days/30 days* 60 days/60 days 90 days/90 days 180 days/180 days *If because of your disability, you are hospital confined an inpatient, benefits begin on the first day ofinpatient confinement

Maximum Benefit Duration

Age at Disability

Under 60 60 -64 65-6970 and

over

Duration of Payments (Accident and Sickness)

To age 65, but not less than 5 years

5 years To age 70,

but not less than 1 year

1 year

Monthly Rates by Type of Plan (Per $100 Benefit)

Duration Acc Sick

Normal Retirement Age Normal Retirement Age

EP (Days) Acc Sick

0 7

14 14

30 30

60 60

90 90

180 180

$4.31 $3.44 $2.84 $1.95 $1.68 $1.29 All Ages

Monthly Rates by Type of Plan (Per $100 Benefit)

Duration Acc Sick

Normal Retirement Age Normal Retirement Age

EP (Days)

Acc Sick

0 7

14 14

30 30

60 60

90 90

180 180

$3.85 $3.04 $2.54 $1.73 $1.50 $1.17 All Ages

29


Termination of Disability Benefits Your benefits will terminate when your Disability ceases, when your benefit duration period is exceeded, or on the following events: (1) the date you earn from any occupation more than 80% of your Covered Earnings, or the date you fail to cooperate with us in a rehabilitation plan, or transitional work arrangement, or the administration of the claim.

Effects of Other Income Benefits This plan is structured to prevent your total benefits and post-disability earnings from equaling or exceeding pre-disability earnings. Therefore, we reduce this plan’s benefits by Other Income Benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Disability benefits maybe reduced by amounts received through Social Security disability benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Your disability benefits will not be reduced by any Social Security disability benefits you are not receiving as long as you cooperate fully in efforts to obtain them and agree to repay any overpayment when and if you do receive them. Disability benefits will also be reduced by amounts received through other government programs, sick leave, employer’s sabbatical leave, employer’s assault leave plan, employer funded retirement benefits, workers’ compensation, franchise/group insurance, auto no-fault, and damages for wage loss. For details, see your outline of coverage, policy certificate, or your employer’s summary plan description. Note: Some of the Other Income Benefits, as defined in the group policy, will not be considered until after disability benefits are payable for 6 months.

Additional Plan Details & FeaturesEarnings While Disabled During the first 24 months that benefits are payable, benefits will be reduced if benefits plus income from employment exceeds 100% of pre-disability Covered Earnings. After that, benefits will be reduced by 50% of earnings from employment.

Pre-existing Condition Waiver The Insurance Company will waive the Pre-Existing Condition Limitation for the first month of Disability even if the Employee has a Pre-Existing Condition. The Disability Benefits as shown in the Schedule of Benefits will continue beyond 1 month only if the Pre-Existing Condition Limitation does not apply.

Pre-existing Condition Limitation

Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, received medical treatment, care or services (including diagnostic measures,) during the 3 months just prior to the most recent effective date of insurance. Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after you have been insured under this plan for at least 12 months after your most recent effective date of insurance.

Limited Benefit Period Disabilities caused by or contributed to by any one or more of the following conditions are subject to a lifetime limit of 24 months for outpatient treatment: Anxiety-disorders, delusional (paranoid) or depressive disorders, eating disorders, mental illness, somatoform disorders (including psychosomatic illnesses) ,alcoholism, drug addiction or abuse. Benefits are payable during periods of hospital confinement for these conditions for hospitalizations lasting more than 14 consecutive days that occur before the 24-month lifetime outpatient limit is exhausted.

Exclusions This plan does not pay benefits for a Disability which results, directly or indirectly, from any of the following:

Suicide, attempted suicide, or intentionally self-inflictedinjury while sane or insane;

war or any act of war, whether or not declared;

active participation in a riot;

commission of a felony;

the revocation, restriction or non-renewal of anEmployee’s license, permit or certification necessary toperform the duties of his or her occupation unless duesolely to Injury or Sickness otherwise covered by thePolicy;

any cosmetic surgery or surgical procedure that is notMedically Necessary;

an Injury or Sickness for which the Employee is entitled tobenefits from Workers’ Compensation or occupationaldisease law;

an Injury or Sickness that is work related.

In addition, the plan does not pay disability benefits any period of Disability during which you are incarcerated in a penal or corrections institution.

30


Plan Termination Coverage terminates if the group policy is terminated, if you cease to be in active service, if you are no longer a member of an eligible class of employees, the day after the last date for which premium has been paid by you or the employer, or the date you become eligible for a plan of benefits intended to replace this coverage.

If you are disabled and receiving benefits under this plan, your benefits and coverage will continue until the expiration of your benefit period, or until you no longer qualify for benefits under the plan, whichever comes first.

When Coverage Takes Effect Your coverage takes effect on the later of the policy’s effective date, the date you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. If you’re not actively at work on the date your coverage would otherwise take effect, your coverage will take effect on the date you return to work. If you have to submit evidence of good health, your coverage takes effect on the date we agree, in writing, to cover you.

Rehabilitation Requirement To be eligible for Disability benefits under this plan, you may be required to participate in a rehabilitation plan at the sole discretion and expense of the insurance company or company administering benefits under this plan. If you fail to fully cooperate with the rehabilitation plan, no Disability benefits will be paid, and coverage will end. For details, see your Certificate of Insurance.

Terms and conditions of coverage for Long-Term Disability insurance are set forth in Group Policy No. SLH100006. This is not intended as a complete description of the insurance coverage offered. This is not a contract. Complete coverage details, including premiums, are contained in the Policy Certificate. If there are any differences between this summary and the group policy, the information in the group policy takes precedence. Product availability and/or features may vary by state. Please keep this material as a reference. Insurance coverage is issued on group policy form number: Policy Form TL-004700. Coverage is underwritten by Life Insurance Company of North America, 1601 Chestnut St. Philadelphia, PA 19192. “Cigna” and the “Tree of Life” logo are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, including Life Insurance Company of North America and Cigna Life Insurance Company of New York, and not by Cigna Corporation.

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 PACKAGE

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.

AMERICAN PUBLIC LIFE



GC3 Limited Benefit Group Cancer Indemnity InsuranceBirdville 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 Level 1 Base Plan Level 2 Base Plan

Radiation Therapy/Chemotherapy/ Immunotherapy Benefit

$1,000 per calendar month of treatment $1,500 per calendar month of treatment

Hormone Therapy Benefit $50 per treatment, up to 12 per calendar year $50 per treatment, up to 12 per calendar year

Surgical Schedule Benefit $3,200 max per operation; $30 per surgical unit $4,800 max per operation; $45 per surgical unit

Anesthesia Benefit 25% of the amount paid for covered surgery 25% of the amount paid for covered surgery

Hospital Confinement Benefit $200 per day 1-90 days; $200 per day, 91+ days in lieu of other benefits

$300 per day 1-90 days; $300 per day, 91+ days in lieu of other benefits

US Government/Charity Hospital/HMO $200 per day in lieu of most other benefits $300 per day in lieu of most other benefits

Outpatient Hospital or Ambulatory Surgical Center Benefit

$400 per day of surgery $600 per day of surgery

Drugs & Medicine Benefit - Inpatient $150 per confinement $150 per confinement

Drugs & Medicine Benefit - Outpatient $50 per prescription, up to $100 per calendar month $50 per prescription, up to $150 per cal month

Transportation & Outpatient Lodging Benefit

$0.50 per mile per round trip $100 per day, up to 100 days per calendar year


Family Member Transportation & Lodging Benefit



Blood, Plasma & Platelets Benefit $200 per day, up to $10,000 per calendar year $250 per day, up to $12,500 per calendar year

Bone Marrow/Stem Cell Transplant Autologous - $1,000 per calendar year Non-Autologous - $3,000 per calendar year

Autologous - $1,500 per calendar year Non-Autologous - $4,500 per calendar year

Experimental Treatment Benefit Pays as any non-experimental benefit Pays as any non-experimental benefit

Attending Physician Benefit $40 per day of confinement $50 per day of confinement

Surgical Prosthesis Benefit $2,000 per device (includes surgical fee); max 1 device per site, 2 lifetime max

$3,000 per device (includes surgical fee); max 1 device per site, 2 lifetime max

Hair Prosthesis Benefit $50 per hair prosthetic, 2 lifetime max $50 per hair prosthetic, 2 lifetime max

Dread Disease Benefit $200 per day, 1-90 days of hospital confinement $300 per day, 1-90 days of hospital confinement

Hospice Care Benefit $75 per day, $13,500 lifetime max $100 per day, $18,000 lifetime max

Inpatient Special Nursing Services $150 per day of confinement $150 per day of confinement

Ambulance Ground Benefit $200 per ground trip $200 per ground trip

Ambulance Air Benefit $2,000 per air trip; up to 2 trips per hospital confinement (any combination of ground/air)

$2,000 per air trip; up to 2 trips per hospital confinement (any combination of ground/air)

Extended Care Benefit $200 per day $300 per day

Home Health Care Benefit $200 per day $300 per day

Second & Third Surgical Opinions $300 per diagnosis; additional $300 if third opinion required

$300 per diagnosis; additional $300 if third opinion required

Waiver of Premium Premium waived after 90 days of primary insured continuous total disability due to cancer

Premium waived after 90 days of primary insured continuous total disability due to cancer

Physical/Speech Therapy Benefit $25 per visit, up to 4 visits per calendar month, $1,000 lifetime max

$25 per visit, up to 4 visits per calendar month, $1,000 lifetime max

Riders

Diagnostic Testing Benefit Rider $50; 1 person, per calendar year $50; 1 person, per calendar year

Critical Illness Rider: Heart/Stroke $2,500 lump sum benefit $2,500 lump sum benefit

Optional Benefit Rider

Intensive Care Unit Rider Up to $800 max of 30 days per ICU confinement; $100 ambulance per ICU admission

Up to $800 max of 30 days per ICU confinement; $100 ambulance per ICU admission

APSB-22356(TX) MGM/FBS Birdville ISD-0315

Monthly Premium** Level 1 Level 1 + ICU Rider Level 2 Level 2 + ICU Rider

Individual $22.00 $26.40 $29.90 $34.30

One Parent $30.30 $36.30 $40.90 $46.90

Two Parent $38.50 $47.70 $51.90 $61.10

*Premium and amount of benefits provided vary dependent upon the level selected at time of application.**Total premium includes the policy and riders of the option selected.

33

EligibilityThis policy/certificate will be issued only to those persons who meet American Public Life Insurance Company’s insurability requirements. The policy/certificate and the Internal Cancer coverage under the Critical Illness Rider will not be issued to anyone who has been diagnosed or treated for Cancer in the previous ten years. The Heart Attack or Stroke coverage under the Critical Illness Rider will not be issued to anyone who has been diagnosed or treated for any heart or stroke related conditions. The Hospital Intensive Care Unit Rider will not cover heart conditions for a period of two years following the Effective Date of coverage for anyone who has been diagnosed or treated for any heart related condition prior to the 30th day following the Covered Person’s Effective Date of coverage.

If You are working either under contract to or as a Full-Time Employee for the Policyholder, or You are a member in or employed by the association, You are eligible for insurance provided You qualify for coverage as defined in the Master Application. You must apply for insurance within thirty (30) days of the Policy Effective Date or the date that You become eligible for coverage. If You do not apply within thirty (30) days of the Policy Effective Date or the date You become eligible for coverage, You may be subject to additional underwriting by Us.

Base PolicyAll diagnosis of cancer must be positively diagnosed by a legally licensed doctor of medicine certified by the American Board of Pathology or American Board of Osteopathic Pathology. This 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. This policy/certificate also covers other conditions or diseases directly caused by cancer or the treatment of cancer.

No benefits are payable for any covered person for any loss incurred during the first year of this policy/certificate as a result of a Pre-Existing Condition. A Pre-Existing Condition is a specified disease for which, within 12 months prior to the covered person’s effective date of coverage, medical advice, consultation or treatment, including prescribed medications, was recommended by or received from a member of the medical profession, or for which symptoms manifested in such a manner as would cause an ordinarily prudent person to seek diagnosis, medical advice or treatment. Pre-Existing Conditions specifically named or described as excluded in any part of this contract are never covered. This policy/certificate contains a 30-day waiting period during which no benefits will be paid under this policy/certificate. If any covered person has a specified disease diagnosed before the end of the 30-day 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 effective date of such person’s coverage. If any covered person is diagnosed as having a specified disease during the 30-day period immediately following the effective date, you may elect to void the policy/certificate from the beginning and receive a full refund of premium. All benefits payable only up to the maximum amount listed in the schedule of benefits in the policy/certificate.

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

Diagnostic Testing Benefit RiderWe will pay the indemnity amount for one generally medically recognized internal cancer screening test per covered person per calendar year. Screening test include, but limited to: mammogram; breast ultrasound; breast thermography; breast cancer blood test (CA15-3); colon cancer blood test (CEA); prostate-specific antigen blood test (PSA); flexible sigmoidoscopy; colonoscopy; virtual colonoscopy; ovarian cancer blood test (CA-125); pap smear (lab test required); chest x-ray; hemocult stool specimen; serum protein electrophoresis (blood test for myeloma); thin prep pap test. Screening tests payable under this benefit will only be paid under this benefit. Benefits will only be paid for tests performed after the 30-day period following the covered person’s effective date of coverage.

Critical Illness RiderBenefits will only be paid for a covered critical illness as shown on the policy/certificate schedule page in the policy. No benefits will be provided for any loss caused by or resulting from: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; or alcoholism or drug addiction; or any act of war, declared or undeclared , or any act related to war; or military service for any country at war; or a pre-existing condition; or a covered critical illness when the date of diagnosis occurs during the waiting period; or 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 as defined by the law of the jurisdiction in which the activity takes place). Internal cancer does not include: other conditions that may be considered pre-cancerous or having malignant potential such as: acquired immune deficiency syndrome (AIDS); or actinic keratosis; or myelodysplastic and non-malignant myeloproliferative disorders; or aplastic anemia; or atypia; or non-malignant monoclonal gamopathy; or Leukoplakia; or Hyperplasia; or Carcinold; or Polycythemia; or carcinoma in situ or any skin cancer other than invasive malignant melanoma into the dermis or deeper. For a pre-existing condition no benefits are payable. Pre-Existing Condition, as used in this rider means any sickness or condition for which prior to the Effective Date of coverage, medical advice, consultation or treatment, including prescribed medications, was recommended by or received from a member of the medical profession, or for which symptoms manifested in such a manner as would cause an ordinarily prudent person to seek diagnosis, medical advice or treatment.

Hospital Intensive Care Unit RiderNo benefits will be provided during the first two years of this rider for hospital intensive care unit confinement caused by any heart condition when any heart condition was diagnosed or treated prior to the 30th day following the covered person’s effective date of this rider. The heart condition causing the confinement need not be the same condition diagnosed or treated prior to the effective date. No benefits will be provided if the loss results from: attempted suicide, whether sane or insane; or intentional self-injury; or alcoholism or drug addiction; or any act of war, declared or undeclared, or any act related to war; or military service for a country at war. No benefits will be paid for confinements in units such as surgical recovery rooms, progressive care, burn units, intermediate care, private monitored rooms, observation units, telemetry units or psychiatric units not involving intensive medical care; or other facilities which do not meet the standards for intensive care unit as defined in the rider. For a newborn child born within the ten-month period following the effective date of this rider, no benefits will be provided for hospital intensive care unit confinement that begins within the first 30 days following the birth of such child.


GC3 Limited Benefit Group Cancer Indemnity Insurance

34

Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the policy/certificate/riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GC-3 Series | Texas | Limited Benefit Group Cancer Indemnity Insurance Policy | (11/14) | Birdville ISD

Conditionally RenewableThis policy/certificate is conditionally renewable. This means that We have the right to terminate your policy/certificate on any premium due date after the first Policyholder’s Anniversary Date. We must give the Policyholder at least 60 days written notice prior to cancellation. We cannot cancel Your coverage because of a change in Your age or health. We can change Your premiums if We change premiums for all similar Certificates issued to the Policyholder. We must give the Policyholder at least 60 days written notice before We change Your premiums.

Continuation RiderContinuation Coverage is continued when the Insured (You) cease employment with the employer through whom You originally became insured under the Policy. You will have the option to continue this Certificate (including any Riders, if applicable) by paying the premiums directly to Us at Our home office. Premiums must be paid within thirty-one (31) days after employment with your employer terminates. Premium rates required under this Continuation provision will be the same rates as those charged under the Employer’s Policy as if You had continued employment. We will bill You for these premiums after You notify Us to continue this coverage. Coverage will continue until the earlier of: (1) the Policy under which You originally became insured ends; or (2) You stop paying premiums under this option (subject to the terms of the Grace Period).

ConversionIf the Employer’s Policy is terminated, this Certificate will terminate. Upon termination of the Employer’s Policy, the employee (You) will be entitled to convert to an individual policy of insurance issued by Us without evidence of insurability provided the required premiums have been paid on your behalf and You notified Us in writing within thirty-one (31) days of the Employer’s Policy termination. Premiums for the individual policy of insurance will be figured from the premium rate table in effect on the date of conversion.

Subject to the terms of this provision, a covered child who ceases to be eligible may convert to an individual policy of insurance and a covered spouse who ceases to be eligible for coverage because of divorce or annulment may convert to an individual policy.

Terms of this provision include: (1) Application for the individual policy and payment of the first premium must be made within 60 days after coverage ceases under the Policy/Certificate. Premiums will be figured from the premium rate table in effect on the date of conversion. (2) The individual policy will be issued without proof of insurability. It will provide benefits that most nearly approximates those of the Policy/Certificate. (3) The individual policy will take effect the day after coverage ceasesunder the Policy/Certificate. However, no benefits will be payable underthe individual policy for any loss for which benefits are payable under thePolicy/Certificate. (4) The Pre-Existing Condition Limitation and Time Limiton Certain Defenses provisions for the individual policy will be figuredfrom the Covered Person’s Effective Date of coverage under the Policy/Certificate. (5) Any benefit maximums will be figured from the EffectiveDate of the Policy/Certificate.

This rider is subject to all the provisions of the Policy and Certificate to which it is attached that are not in conflict with this rider.

Termination of CoverageYour Insurance coverage will end on the earliest of these dates: (a) the date You no longer qualify as an Insured; (b) the last day of the period for which a premium has been paid, subject to the Grace Period; (c) the date the Policy terminates (See Conversion provision); (d) the date You retire; (e) the date You cease employment, or terminate Your contract with the employer through whom You originally became insured under the Policy (See Conversion provision); or (f) the date We receive Your written request for termination. Termination of Dependent(s) Insurance coverage on Your Dependent(s) will end on the earliest of these dates: (a) the date the coverage under the Certificate terminates; (b) the date the Dependent no longer meets the definition of Dependent, as defined in the Policy/Certificate (See Conversion provision); (c) the date We receive Your written request for termination.

Termination of Rider Coverage This rider terminates: (a) when Your coverage terminates under the Policy/Certificate to which this Rider is attached; or, (b) when any premium for this rider is not paid before the end of the Grace Period; or, (c) when You give Us a written request to do so. Coverage on a Dependent terminates under this rider when such person ceases to meet the definition of Dependent, as defined in the Policy.


GC3 Limited Benefit Group Cancer Indemnity Insurance

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

35

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

AUL A ONEAMERICA COMPANY



Life and AD&D

Supplemental Term LifeEmployee Coverage $10,000 increments to a maximum of the lesser of 7 times your basic annual earnings or $500,000. Dependent Coverage You must be enrolled in voluntary employee life benefits to be eligible for benefits on your dependent(s) Spouse - $5,000 increments to a maximum of the lesser of 100% of your Life Benefits or $250,000. Dependent Children - $10,000. *Child(ren)’s Eligibility: Dependent children ages from live birthto 26 years old are eligible for coverage

Guarantee Increase of Benefit : If eligible, this benefit allows you to increase your coverage every year as your life insurance needs change. You may increase your benefit amount by $10,000, and your spouse by $5,000 every year until you reach your maximum amount, without providing Evidence of Insurability.

For New Hires:

Your enrollment takes place within 31 days from the dateyou become eligible for benefits, and

You are enrolling for coverage equal to/less than 7 timesyour basic annual earnings or $250,000

If you do not meet all of the conditions stated above, you will need to provide additional medical information by completing a Statement of Health form.

For Annual Enrollment The enrollment takes place prior to the enrollment deadline, and Your spouse and child(ren) are enrolling for coverage only one increment more than their current coverage

For New Hires

The enrollment takes place within 31 days from the dateyou become eligible for benefits, and

You are enrolling your spouse for coverage equal to/lessthan $50,000.

If you do not meet all of the conditions stated above, you will need to provide additional medical information by completing a Statement of Health form.

Voluntary AD&DEmployee Coverage

Increments of $10,000The maximum amount of coverage you can receive is $500,000,not to exceed 10 times annual salaryDependent CoverageYou can choose to cover your dependent spouse and child(ren)with AD&D coverage under the Family Plan. Your dependentswill be eligible for the following coverage:Dependent Spouse and Child(ren):

Spouse — 50% of your coverage amount

Child(ren) — 10% of your coverage amount

What Is Not Covered? Accidental Death & Dismemberment insurance does not include payment for any loss which is caused by or contributed to by: physical or mental illness, diagnosis of or treatment of the illness; an infection, unless caused by an external wound accidentally sustained; suicide or attempted suicide; injuring oneself on purpose; the voluntary intake or use by any means of any drug, medication or sedative, unless taken as prescribed by a doctor or an over-the-counter drug taken as directed; voluntary intake of alcohol in combination with any drug, medication or sedative; war, whether declared or undeclared, or act of war, insurrection, rebellion or riot; committing or trying to commit a felony; any poison, fumes or gas, voluntarily taken, administered or absorbed; service in the armed forces of any country or international authority, except the United States National Guard; operating, learning to operate, or serving as a member of a crew of an aircraft; while in any aircraft for the purpose of descent from such aircraft while in flight (except for self preservation); or operating a vehicle or device while intoxicated as defined by the laws of the jurisdiction in which the accident occurs.

Age EE Cost per

$10,000 Spouse Cost per

$10,000 Under 25 $0.40 $0.20

25-29 $0.50 $0.25 30-34 $0.70 $0.35 35-39 $0.80 $0.40 40-44 $1.10 $0.55 45-49 $1.80 $0.90 50-54 $3.20 $1.60 55-59 $5.00 $2.50 60-64 $7.50 $3.75 65-69 $11.50 $5.75

70 & Over $18.50 $9.25 Cost for your Child

(ren)* $1.20

AD&D Supplemental Coverage

Monthly Cost per $10,000

Employee $0.21

Employee & Family $0.29

37

Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered.

About this Benefit

YOUR BENEFITS PACKAGE Identity Theft

ID WATCHDOG

An identity is stolen every

2 seconds,and takes over

300 hours to resolve, causing an

average loss of $9,650.

DID YOU KNOW?



Identity Theft

Identity theft can strike anyone, at any time. More than 11 million Americans were victimized by identity theft in 2011, including more than 500,000 children.

Identity theft devastates its victims financially. The average victim will lose $4,841, and spend an additional $1,400 in out-of-pocket expenses resolving their case.

Repairing the damage caused by identity theft is frustrating and time consuming. The average victim spends 330 hours repairing the damage from identity theft—the equivalent of working a full-time job for more than 2 months.

The impact of identity theft follows victims for years. 50% of identity theft victims experience trouble getting loans or credit cards as a result of identity theft. 12% of identity theft victims end up having warrants issued by law enforcement in their name for crimes committed by the identity thief.

Who’s Evaluating your Credit Report? Potential Creditors, Potential Employers, Insurance Companies, Current Creditors, Government Agencies

ID Watchdog Monthly Rates

Individual Plan $7.95

Family Plan $14.95

Basic & Advanced Identity Monitoring

Cyber Monitoring

Full-Service Identity Restoration

Non-Credit Loan Monitoring

Address Monitoring

Credit Report Monitoring

100% Resolution Guarantee

ID Watchdog Services

39

Having an affordable, qualified lawyer on your side can be an invaluable asset. Legal plans provide valuable benefits that cover the most common legal needs you may encounter - like creating a standard will, living will, healthcare power of attorney or buying a home. This plan also provides access to quality law firms for advice, consultation and representation.

About this Benefit

YOUR BENEFITS PACKAGE Legal Services

of American adults do not have a will or other estate

plan in place.

DID YOU KNOW?

55%

METLAW



Legal Services

Telephone & Office Consultations

MetLaw provides you with telephone and office consultations for an unlimited number of matters with the attorney of your choice. During the consultation, the attorney will review the law, discuss your rights and responsibilities, explore your options and recommend a course of action.

Legal Representation

Trials for covered matters are covered from beginning to end, regardless of length, when using a network attorney.

Estate Planning Documents Financial Matters Real Estate Matters Elder Law Matters

Simple Wills Complex Wills Revocable Trusts

Irrevocable Trusts Powers of Attorney (Healthcare, Financial, Childcare)

Healthcare Proxies

Living Wills Codicils

Personal Bankruptcy/Wage Earner Plan

Debt Collection Defense

Foreclosure Defense

Repossession Defense

Garnishment Defense

Identity Theft Defense

Tax Collection Defense

Negotiations with Creditors Tax

Audit Representation (Municipal, State, Federal)

Sale, Purchase or Refinancing of your Primary, Second or Vacation Home

Home

Equity Loans for your Primary, Second or Vacation Home

Tenant Negotiations (Tenant Only)

Eviction Defense

Security Deposit Assistance (Tenant Only)

Boundary or Title Disputes

Property Tax Assessments

Zoning Applications

Consultation and Document Review for Issues Related to your Parents:

Medicare

Medicaid

Prescription Plans

Nursing Home Agreements

Leases

Notes

Deeds

Wills

Powers of Attorney

Family Law Traffic Offenses* Document Preparation Immigration Assistance

Adoption

Guardianship

Conservatorship

Name Change

Prenuptial Agreement

Protection from Domestic Violence

Defense of Traffic Tickets (Excludes DUI)

Driving Privileges Restoration (Includes License Suspension due to DUI)

Affidavits

Deeds

Demand Letters

Mortgages

Notes

Review of Any Personal Legal Document

Advice and Consultation Review of Immigration Documents

Preparation of Affidavits

Preparation of Powers of Attorney

Juvenile Matters Personal Property Protection

Consumer Protection Defense of Civil Lawsuits Property Protection

Juvenile Court Defense (Including Criminal Matters)

Parental Responsibility Matters

Disputes over Consumer Goods and Services

Small Claims Assistance

Litigation Defense

Incompetency Defense

Administrative Hearings

School Hearings

Pet Liabilities

Consultation and Document Review for Personal Property Issues

Assistance for Disputes over Goods and Services

$16.50 Per Month & Covers Employee, Spouse and Dependents.

Provides you with telephone and office consultations for an unlimited number of matters with the network attorney of your choice.

41

An Employee Assistance Plan (EAP) is an employee benefit program offered to help employees manage personal and professional problems that might adversely impact their work performance, health, and well-being. Employee Assistance Plans generally include short-term counseling and referral services for employees and their household members. Your Employee Assistance Program benefit is provided to you by your employer.

About this Benefit

EAP (Employee Assistance Program)

DID YOU KNOW?

LifeWorks

38% of employees have missed life events because of bad work-life balance.




Employee Assistance Program

Employees and their families have anytime access to LifeWorks Integrated EAP and Work-life services in a variety of ways that fit their preferences and unique needs.

Telephone All calls are answered live by Ceridian employees who are

trained clinical consultants with master’s/doctorate degrees.

LifeWorks is a 24/7 operation, so there are no changes in ourservice delivery during non-business hours — youremployees will not be directed to leave messages.

A fully staffed bilingual clinical consultant team answers callsfrom service centers in St. Petersburg, FL; Minneapolis, MN;Blue Bell, PA; Toronto, Winnipeg and Montreal, Canada.

Mobile An app for mobile devices makes the LifeWorks.com site

accessible from anywhere at any time for iPhone, Androidand Blackberry users.

In-Person Employees and their families will have access to face-to-face

assessments and short- term, solution-focused counselingwith EAP clinicians.

Ceridian develops close relationships and carefully evaluatesthe national network of EAP providers who deliver in-personcounseling to your employees. This cohesive team includesconsultants that complete the initial screening assessmentand connect participants to the EAP provider and EAPaffiliate managers to ensure a high quality experience.Ceridian also employs a Clinical Supervisor within ProviderNetwork Services for case consultation and assistance to thelocal EAP affiliate.

Our North American network of 11,300 EAP providersincludes all 50 U.S. states, Puerto Rico, the Virgin Islands,Mexico, Canada and U.S. Territories.

Our entire network is composed of licensed mental healthprofessionals. Minimum qualifications include a license topractice independently in the state in which services areprovided along with five years post graduate experience andthree years providing EAP services.

Our counselors and providers possess strong EAP and work-life skills, and we aggressively recruit Certified EmployeeAssistance Professionals (CEAPs) whose focus is on helpingemployees quickly resolve issues that may interfere withtheir work.

Topic Description

Emotions and Stress Relationship issues, depression and anxiety – even an online “calm room

Parenting Parenting skills, adoption, talking with your teenager, help in finding child care

Midlife and Retirement Financial considerations, work and career in midlife, relationships with

adult children, growing as a couple

Addictive Behaviors Drug and alcohol abuse, eating disorders, gambling

Education Applying to college, understanding financial aid and scholarships, advocating in the schools

Caring of older adults Caregiver support, referrals to in-home and other services, and federally fund-

ed programs

Disability Special needs programs, advocacy and specific disabilities information

Everyday Issues Community resources and consumer information

Financial Issues Credit management, budget analysis, 401(k) plan questions, basic estate plan-ning, and questions about federal tax planning and preparation

Legal Issues On-staff attorneys provide information and referrals for family matters, real

estate, consumer credit and criminal matters. Also online program with forms,

guides and simple wills.

Work Special content for managers includes employee relations, interpersonal con-

flicts, performance issues, discrimination and workplace change. Also general

support for co-worker relationships and stress.

With LifeWorks Integrated EAP and Work-life services, employees and their families will have access to confidential assistance and support on a wide range of issues in the areas of life, health, family, work and money.

43

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.

Unlimited FSA (Non HSA Compatible) The funds in the unlimited healthcare FSA can be used to pay for eligible medical expenses like deductibles, co-payments, orthodontics, glasses and contacts.

About this Benefit

FSA (Flexible Spending Account)

NBS YOUR BENEFITS PACKAGE

FOR HSA VS. FSA COMPARISON

FLIP TO… PG. 11



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 need a replacement card please contact NBS directly at (800) 274-0503.

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

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

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

45

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/birdvilleisd

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/birdvilleisd 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!

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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 or rollover after the Plan year ends for you to submit qualified claims for any unused funds.

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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)


The interest earned in an HSA is tax free.

DID YOU KNOW?

Money withdrawn for medical spending never falls under taxable income.

NBS



HSA (Health Savings Account)

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.

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

Potential to build more savings through investing. If youmaintain a minimum balance of $2,000, your additionalfunds may be invested in mutual funds yielding tax-freeearnings.

Additional retirement savings. After you turn 65, or if youbecome disabled, your HSA account becomes similar to aregular IRA. Withdrawals you use for non-eligible expenseswill be taxed at your regular income tax rate but won’t incuradditional penalties.

Pre-Paid Debit Card You may use the card to pay merchants or service providers that accept Master Card credit cards, so there is no need to pay cash up front then wait for reimbursement.

2016 Annual HSA Contribution Limits Individual: $3,350 Family: $6,750 Catch-Up Contributions: Account holders over the age of 55 who have not yet enrolled in Medicare are eligible to make an additional $1,000 “catch-up” contribution to their HSA.

Will my HSA Funds be Up Fronted to Me? Like a savings account, you can only withdrawal what you’ve contributed to the account. Funds are not up fronted.

Are There Any Monthly Fees?There is a $2.00 administrative fee that will be deducted from your HSA account on a monthly basis.

Participant Account Web Access: www.nbsbenefits.com A Health Savings Account (HSA) works with a high deductible health plan (HDHP) and lets you set aside a portion of your paycheck - before taxes– into an account to help you pay for medical expenses before you reach your deductible or that you aren’t covered by your plan. It can also help you pay for future medical expenses. *If you enroll in HSA you are no eligible for MEDlink®insuranceor an FSA account.

A Health Savings Account (HSA):

Grows with you. If you maintain a balance of $2,000, youradditional funds may be invested in mutual funds yieldingtax-free earnings.

Helps you plan for the future. Until you turn 65, withdrawalsused for eligible expenses are tax free. After you turn 65, orif you become disabled, your HSA account becomes similarto a regular IRA. Withdrawals you use for non-eligibleexpenses will be taxed at your regular income tax rate butwon’t incur additional penalties.

For a list of sample expenses, please refer to www.mybenefitshub.com/birdvilleisd

NBS Contact Information P.O. Box 6980 West Jordan, UT 84084 Phone‐800‐274-0503 Fax‐800-478-1528 Email: [email protected]

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NOTES

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NOTES

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www.mybenefitshub.com/birdvilleisd

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