GUIDE TO YOUR 2021-2022 EMPLOYEE BENEFIT PLANS AND OPTIONS

WE BENEFITTOGETHER

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BENEFIT RESOURCESPlease visit the Schertz - Cibolo - Universal City ISD Benefits Hub for the latest information and benefit resources: //flimp.live/Schertz-Cibolo-Benefits-Hub

This Benefit Overview is only intended to highlight the major benefit provisions and should not viewed as being a complete representation of the plan details. Please refer to the plans Summary of Benefits and Coverage (SBC) for further details. Should this benefit overview differ from the SBC, the SBC will prevail.

WELCOME TO YOUR BENEFITS

Enroll by Phone:Contact the Schertz - Cibolo - Universal City ISD Benefits Call Center at 855-244-3990. Benefit counselors are available Monday- Friday, 8am-5pm CST.

Enroll Online:>>CLICK HERE<<www.enroll.thehartfordatwork.com

HOW TO ENROLL

You can enroll for your employee benefit plans at any of the following times:• As a new hire during your initial eligibility period. See page 3 for

details• Annual Enrollment period July 19th - August 12th with a annual

September 1st effective date.• Within 30 days of a qualified family status change. Additional details

can be found on page 3

WHEN TO ENROLL

Each year, Schertz - Cibolo - Universal City ISD strives to offer comprehensive benefit plans to our employees. In this employee benefits guide you will learn more about the benefits offered for the 2021-2022 plan year. Throughout this guide you will find interactive QR Codes that will take you deeper into your employee benefits plan documents and give you quick access to needed claims forms. To access, scan with a camera on your personal device or cell phone, or by clicking, if viewing electronically. This year’s Open Enrollment will run from JULY 19th - AUGUST 12th, 2021 . Your benefit elections and changes made during this period will become effective 9/1/2021-8/31/2022. Please review your open enrollment materials thoroughly before making your elections.

CLICK OR

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E m p l o y e e E l i g i b i l i t y The Group insurance coverage described in this guidebook is available to all full-time employees who work a minimum of 18.5 or more hours per week. The coverage effective date will begin on the 1st day of the month following your date of hire. All benefit elections must be made within 31 days from your date of hire. The insurance plan year is from September 1st through August 31st of each year. Once your enrollment window has closed, you may not make any changes to your elections unless you experience a qualified life event.

D e p e n d e n t E l i g i b i l i t y If you apply for coverage for yourself, you may also elect coverage for any of your eligible dependents. Eligible dependents include one or more of the following:• Your legal spouse• A child through age of 26• A child is defined as your natural child, legally adopted child, stepchild, and any child for whom you are the court-appointed guardian• A child of any age who is medically certified as disabled and dependent on the parent for support and maintenance

Q u a l i f y i n g l i f e e v e n t sIf you experience a Qualifying Life Event (QLE), such as getting married or having a baby, please contact the Benefits Department; proof of the QLE must be submitted within 31 days to change current benefit elections.

Q u a l i f y i n g L i f e E v e n t s I n c l u d e :• A change in the number of dependents (birth, adoption, death, guardianship)• A change in marital status (marriage, divorce, death, legal separation)• A dependent’s loss of eligibility (attainment of limiting age or change in student status)• A change in employee’s, spouse’s, or eligible dependents’ work hours• A termination or commencement of employment of employee’s spouse or eligible dependents with coverage• An entitlement to Medicare or Medicaid• Other events as the administrator determines to be permitted or any other applicable guidelines issued by the Internal Revenue Service

ELIGIBILITY

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CONTENTS

KEY TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5MEDICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6ACCIDENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9CRITICAL ILLNESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10CANCER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11DENTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12VISION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14HSA / FSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15TERM LIFE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16DISABILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17LEGAL PLAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18LEGAL NOTICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19CONTACTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

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DeductibleThe amount you pay for covered health care services before your insurance plan starts to pay. For example, with a $3,500 deductible you pay the first $3,500 of covered services yourself. After you pay your deductible you usually pay only a co-payment or coinsurance for covered services, your insurance company pays the rest.

Out-of-pocket maximum/limitThe maximum dollar amount you have to pay for covered services in a plan year. After you spend this amount on deductibles, co-payments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.The out-of-pocket limit doesn’t include:Your monthly premiumsAnything you spend for services your plan doesn’t coverOut-of-network care and servicesCosts above the allowed amount for a service that a provider may charge

CopaysCopays are the set dollar amount paid for a specific service, doctor’s office visit or medication and are typically collected at the time of service.

CoinsuranceThe percentage of costs of a covered health care service you pay (20%, for example) after you’ve paid your deductible.For example, let’s say the following amounts apply to your plan and you need a lot of treatment for a serious condition. Allowable costs are $12,000:Deductible: $3,000Coinsurance: 20%Out-of-pocket maximum: $6,850You will pay all of the first $3,000 (your deductible).You will pay 20% of the remaining $9,000, or $1,800 (your coinsurance).So your total out-of-pocket costs would be $4,800 — your $3,000 deductible plus your $1,800 coinsurance.If your total out-of-pocket costs reach $6,850, you’d pay only that amount, including your deductible and coinsurance. The insurance company would pay for all covered services for the rest of your plan year.

KEY TERMS

Access tele-health service to treat common medical conditions from anywhere.

• Colds and Flu• Allergies• Sore throats• Stomach aches• UTI’s

Know Where to GoV I R T U A L V I S I T S

The best option for preventive care, ongoing maintenance medications or if you are needing a referral for a specialist

• Immunizations• Injury• Preventative care• General health issues

D O C T O R ’ S

For non-life threatening illness after normal business hours. When your regular doctor is unavailable and you need care quickly.

• High Fever• Injury• Sudden illness• Dehydration• Cuts needing stitches

U R G E N T C A R E

Go to the emergency room for immediate treatment of serious injury or illness. If a situation feels life-threatening, call 911

• Chest pain or difficulty breathing

• Serious Injury• Seizure• Fever with rash• Concussion/confusion

EMERGENCY ROOM

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Benefits Nexus Plan Plan A Navigate HSA

Plan B Choice HSA

Plan D Choice Plus Premier

Designated Network Single/Family

PCP Required In-Network ONLY Single/Family In-Network Single/Family In-Network Single/Family

Coinsurance 80% 70% 70% 80%

Calendar Year Deductible $2,000/$4,000 $5,000/$10,000 $5,000/$10,000 $5,000/$10,000

Maximum out of Pocket $5,000/$10,000 $6,550/$13,100 $6,550/$13,100 $6,550/$13,100

In Network Single/Family Out-of-Network Out-of-Network Out-of-Network

Coinsurance 60% N/A N/A 50%

Calendar Year Deductible $2,000/$4,000 N/A N/A $15,000/$30,000

Maximum Out of Pocket $5,000/$10,000 N/A N/A $18,000/$36,000

Designated In-Network Benefits In-Network Benefits In-Network Benefits In-Network Benefits

Physician Visit $15 30% after deductible 30% after deductible $40 ($0 if <19)

Specialist Visit $50 30% after deductible 30% after deductible $60

Preventive Care / Immunization No Charge No Charge No Charge No Charge

Hospital Stay $500 + 20% after ded 30% after deductible 30% after deductible 20% after deductible

Outpatient Surgery $250 + 20% after ded 30% after deductible 30% after deductible 20% after deductible

Emergency Room Visit $300 copay; + 20% after deductible 30% after deductible 30% after deductible $250 + 20%

after deductible

Urgent Care $50 30% after deductible 30% after deductible $100

Diagnostic Test Covered In Full 30% after deductible 30% after deductible Covered in Full

Imaging (CT, PET, MRI) 20% after deductible 30% after deductible 30% after deductible 20% after deductible

Prescription Benefits

Retail - 30 Days $10/$45/$80 $10/$35/$60 after ded $10/$35/$60 after ded $10/$45/$80

Mail-order - 90 days 2.5X 2.5X after ded 2.5X after ded 2.5X

MEDICALSchertz - Cibolo - Universal City ISD will continue to offer four (4) medical plans by United Healthcare. United Healthcare offers several convenient and affordable options when you need care now. Knowing the right place to go can save you time, money, and unpleasant financial surprises. The chart below provides a plan compari-son overview illustrating the plan highlights. Click the QR Codes and Highlighted Text for more information.

Scan the QR Code below the corresponding medical plan to review the complete summary of benefits

CLICK OR SCAN

BY UNITED HEALTHCARE

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Benefits Nexus ACO Plan ANavigate HSA

Plan BChoice HSA

Plan DChoice Plus Premier

Monthly Rates Total Cost Employee Cost

Total Cost

Employee Cost

Total Cost

Employee Cost

Total Cost

Employee Cost

Employee Only $355.92 $45.92 $364.92 $54.92 $383.54 $73.54 $532.42 $222.42Employee +Spouse $774.12 $464.12 $793.70 $483.70 $834.18 $524.18 $1,158 $848Employee +Children $644.81 $334.81 $661.12 $351.12 $694.82 $384.82 $964.58 $654.58

Family $1,210.60 $900.60 $1,241.20 $931.20 $1,304.52 $994.52 $1,810.92 $1,500.92

MEDICAL

Once your health plan becomes active, you can choose to participate in the following programs. There’s no addi-tional cost to you — just the opportunity to get information and support.Find out more at myuhc.com.

Get rewarded for taking healthy steps.SimplyEngaged® is a personal health and wellness program supported with online tools available through myuhc.com and Rally. You’ll earn rewards* when you complete certain health and wellness activities. Available rewardable activities and programs may include Health Survey + Video, Coaching programs (including Wellness Coaching, Real Appeal and Quit for Life), Gym Check-in and Virtual Visits. •Visit myuhc.com > Health Resources to find and link to the Rally website to see your available programs •View Rewards on the Rally website to track your earned incentives

* There is a maximum associated with these rewards. Employees and covered spouses can earn rewards separately. Children may not participate in the reward program. Incentives can be earned only once every plan year.

Everything you need to help you lose weight and keep it off.Whether you want to lose a lot of weight or just a few extra pounds, try Real Appeal®,** a digital weight loss program focused on making small changes to help you live a healthier life. It includes: •A personalized transformation coach who will guide you by customizing steps to it your needs, personal preferences, medical history and goals •24/7 online support and a mobile app to help you stay on track and reach your goals •A success kit featuring program guides, exercise videos, a digital food scale and moreThe Real Appeal program is available at no additional cost to eligible members as part of your health plan.

**Access to Real Appeal not available in Hawaii.

Have a health plan question?We’re here to help you find information and resources. • Have questions about your benefits? • Need help resolving a claim? • Not sure where to go for care? • Have questions about a recent screening or test? • Can’t find a doctor?

Contact us for help with a personal touch. Call the member phone number listed on your ID card or sign in tomyuhc.com and click the Call or Chat button.

Download the UnitedHealthcare® app.The UnitedHealthcare app puts your health plan at your fingertips. Download it to:• Find nearby care options in your network• See your claim details and view progress toward your deductible• View and share your health plan ID card• Video chat with a doctor — without leaving the app

BY UNITED HEALTHCARE

**Click on Highlighted Text** for more infomoration

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VIRTUAL DOCTOR VISITS

A Virtual Visit lets you video chat with a doctor 24/7 from your computer or mobile device* for everyday con-ditions like the Flu, coughs, infections and more without an appointment. The doctor can provide a diagnosis

and, if appropriate, send a prescription** to your local pharmacy. It’s all part of your health benefits. Doctors can diagnose and treat a wide range of non-emergency medical conditions, including:

It’s easy to get started. Visit myuhc.com/virtualvisits to sign in to your account or set one up if you don’t have one. Complete a brief health profile and request a visit. You will pay your portion of the service costs according to your medical plan, and then you will enter a virtual waiting room. During your visit, you’ll be able to talk to a

doctor about your health concerns, symptoms and treatment options. *Data rates may apply.

**Certain prescriptions may not be available, and other restrictions may apply.

• Allergies• Bladder/Urinary Tract

Infections• Bronchitis• Eye Infections

• Headaches/Migranes• Rashes• Sore Throats• Stomach aches• Flu

CLICK OR SCAN

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ACCIDENT

Teatments following an injury Low Plan High PlanInitial Physician Offfce Visit Once per accident $125 $250

Accident Follow-Up Up to 3 visits per accident $75 $150Ambulance – Air Once per accident $600 $1,200

Ambulance – Ground Once per accident $200 $400Blood/Plasma/Platelets Once per accident $100 $200

Daily Hospital Confinement Up to 365 days per lifetime $100 $200Daily ICU Confinement Up to 30 days per accident $200 $400

Diagnostic Exam Once per accident $100 $200Emergency Dental Once per accident Up to $150 Up to $300Emergency Room Once per accident $125 $250

Hospital Admission Once per accident $500 $1,000Lodging Up to 30 nights per lifetime $75 $150

Medical Appliance Once per accident $60 $125Rehabilitation Facility Up to 15 days per lifetime $75 $150

Transportation Up to 3 trips per accident $250 $500Urgent Care Once per accident $125 $250

X-ray Once per accident $50 $100Abdominal/Thoracic Surgery Once per accident $750 $1,500

Arthroscopic Surgery Once per accident $200 $400Burn Once per accident Up to $7,500 Up to $15,000

Concussion Up to 3 per year $100 $200Dislocation Once per joint per lifetime $3750 Up to $7,500

Fracture Once per bone per accident Up to $3,000 Up to $6,000Laceration Once per accident Up to $300 Up to $600

Ruptured Disc Once per accident $400 $800Tendon/Ligament/Rotator Cuff Up to 2 per accident Up to $600 Up to $1,200

Accidental Death Within 90 days; SP @ %50 CH @ %25 $25,000 $50,000Common Carrier Death Within 90 days 3 times death benefit 3 times death benefit

Coma Once per accident Up to $7,500 Up to $15,000Dismemberment Once per accident Up to $25,000 Up to $50,000

Prosthesis Up to 2 per accident Up to $750 Up to $1,500

FeaturesAbility Assist® EAP –24/7/365 access to help for financial, legal or emotional issues Included IncludedHealthChampion –Administrative & clinical support following serious illness or injury Included Included

Low Plan High PlanEmployee Only $6.05 ($0.20 per day) $11.65 ($0.38 per day)

Employee + Spouse $9.55($0.31 per day) $18.39 ($0.60 per day)

Employee + Child(ren) $9.89 ($0.33 per day) $19.21 ($0.63 per day)

Family $15.66 ($0.51 per day) $30.36 ($1.00 per day)

BY THE HARTFORDYou do everything you can to keep your family safe but accidents do happen. It’s comforting to know you have help to manage the medical costs associated with accidental injuries on and off the job. The Hartford Accident insurance pays you directly a scheduled benefit amount upon diagnosis of covered accident injuries and treatments. Both plans offer a $50 wellness benefit payable to you each year. Below are the plan highlights:

MOREINFO

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MOREINFO

CRITICAL ILLNESS

Monthly Premium AmountBenefit Amount Age 18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69

$10,000

Employee Only $2.93 $3.95 $5.59 $8.37 $13.18 $19.62 $27.86 $38.98 $54.10 $71.00Employee+Spouse $5.83 $7.86 $11.18 $16.83 $26.77 $40.20 $57.39 $80.58 $111.82 $146.46Employee + Child(ren) $5.36 $6.42 $8.08 $10.87 $15.65 $22.06 $30.27 $41.35 $56.41 $73.25

Family $8.89 $11.05 $14.42 $20.07 $29.93 $43.25 $60.35 $83.43 $114.52 $149.03

$20,000

Employee Only $4.86 $6.84 $10.08 $15.56 $25.08 $37.86 $54.24 $76.35 $106.42 $140.06Employee + Spouse $9.68 $13.64 $20.18 $31.34 $50.99 $77.60 $111.76 $157.87 $219.99 $288.93Employee + Child(ren) $8.85 $10.92 $14.21 $19.71 $29.17 $41.89 $58.20 $80.23 $110.19 $143.70

Family $14.80 $19.01 $25.65 $36.82 $56.29 $82.70 $116.68 $162.57 $224.41 $293.07

$30,000

Employee Only $6.79 $9.73 $14.56 $22.76 $36.98 $56.10 $80.61 $113.71 $158.74 $209.12Employee + Spouse $13.53 $19.41 $29.18 $45.85 $75.21 $115.01 $166.14 $235.16 $328.16 $431.41Employee + Child(ren) $12.35 $15.43 $20.33 $28.54 $42.69 $61.71 $86.13 $119.11 $163.96 $214.15

Family $20.71 $26.97 $36.88 $53.56 $82.66 $122.16 $173.02 $241.71 $334.29 $437.12

Coverage InformationEmployee Coverage Amount $10,000 / $20,000 / $30,000

Spouse Coverage Amount 100% of your coverage amountChild(ren) Coverage Amount 50% of your coverage amount

Covered Illnesses Benefit AmountsCancer ConditionsBenign Brain Tumor*; Invasive Cancer* 100% of coverage amountNon-invasive Cancer 25% of coverage amountVascular Conditions

Heart Attack*; Heart Transplant*; Stroke* 100% of coverage amount

Aneurysm; Angioplasty/Stent; Coronary Artery Bypass Graft 25% of coverage amountOther Specified ConditionsComa*; End Stage Renal Failure; Loss of Hearing; Loss of Speech; Loss of Vision; Major Organ Transplant*; Paralysis 100% of coverage amount

Bone Marrow Transplant 25% of coverage amountNeurological ConditionsAdvanced Multiple Sclerosis; Advanced Parkinson’s; Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s) 100% of coverage amount

Child Conditions

Cerebral Palsy; Congenital Heart Disease; Cystic Fibrosis; Muscular Dystrophy; Spina Bifida 100% of coverage amount

Additional Benefits Benefit AmountsRecurrence – Pays a benefit for a subsequent diagnosis of conditions marked with an asterisk (*) 100% of your coverage amount

Health Screening Benefit $50 one timeAbility Assist® EAP– 24/7/365 access to help for financial, legal or emotional issuesHealthChampionSM – Administrative and clinical support following serious illness or injury

BY THE HARTFORD

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MOREINFO

CANCERBY METLIFE

Employee’s age as of the last plan anniversary Employee Only Employee + Spouse Employee + Child(ren) Family

Rate per $1,000 Benefit Amount< 25 $0.34 $0.68 $0.55 $0.89

25-29 $0.38 $0.74 $0.59 $0.9530-34 $0.43 $0.84 $0.65 $1.0535-39 $0.52 $0.96 $0.73 $1.1840-44 $0.65 $1.20 $0.87 $1.4145-49 $0.85 $1.56 $1.06 $1.7850-54 $1.12 $2.15 $1.33 $2.3755-59 $1.43 $2.91 $1.64 $3.1260-64 $1.87 $3.95 $2.08 $4.1665-69 $2.57 $5.60 $2.78 $5.8170-74 $3.11 $6.88 $3.32 $7.0975+ $3.61 $8.10 $3.82 $8.31

Cancer Insurance BenefitsEligible Individual Benefit Amount Requirements

Employee $15,000 or $30,000 Coverage is guaranteed provided you are actively at work.

Spouse 100% of the Employees Initial BenefitCoverage is guaranteed provided the employee is actively at work and the spouse/domestic partner is not subject to a medical restric-

tion as set forth on the enrollment form and in the Certificate.

Dependent Child(ren) 50% of the Employees Initial BenefitCoverage is guaranteed provided the employee is actively at work and the dependent is not subject to a medical restriction as set forth

on the enrollment form and in the Certificate.

Covered Condition Initial Benefit Recurrence Benefit

Invasive Cancer 100% of the Benefit Amount payable no more than 1 time per Covered Person per Occurrence of each Separate and Unrelated Invasive Cancer

100% of the Initial Benefit Amount payable no more than 1 time per Covered Person

Non-Invasive Cancer25% of the Benefit Amount payable no more than 1 time per Covered Person per Occurrence of each Separate and Unrelated Non-Invasive

Cancer

100% of the Initial Benefit Amount payable no more than 1 time per Covered Person

Skin Cancer 5% of the Benefit Amount, but not less than $250; payable no more than 1 time per Covered Person None

Supplemental BenefitsBenefit Benefit Amount Benefit Maximum

Health Screening Benefits $50 for $15,000 Coverage Amount$100 for $30,000 Coverage Amount

We will pay the Health Screening Benefit 1 time per covered person per Calendar year.

Transportation Benefit $0.50 per mile We will pay the Transportaion Benefit for a covered person up to $1,500 round trip; $5,000 per calendar year

Second Opinion Benefit$500 per evaluation or consultation

An additional $250 if the Evaluation Center is located more than 100 miles from the Covered Person’s Primary Residence

We will pay the Second Opinion Benefit for 5 second opinion(s) per Covered Person per lifetime

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High Plan Low Plan

Coverage Type In-Network1 % of Negotiated Fee2

Out-of-Network1 R&C 80th Percentile4

In-Network1 % of Negotiated Fee2

Out-of-Network1,3 % of Schedule Amount

Type A: Preventive (cleanings, exams, X-rays)

100% 100% 80% 80%

Type B: Basic Restorative (fillings, extractions)

80% 80% 80% 80%

Type C: Major Restorative (bridges, dentures)

50% 50% 50% 50%

Type D: Orthodontia 50% 50% 50% 50%Deductible†

Individual $50 $50 $50 $50Family $150 $150 $150 $150

Annual Maximum BenefitPer Person $1,200 $1,200 $1,000 $1,000

Orthodontia Lifetime MaximumPer Person5 $1,000 $1,000 $1,000 $1,000

Child(ren)’s eligibility for dental coverage is from birth up to age 26.

DENTALRegular dental visits can do more than keep your smile attractive, they can tell dentist a lot about your overall health including whether or not you may be developing a disease like diabetes. Through MetLife coverage you have the choice between two dental options both of which provide you and your dependents with access to a national network of dental providers.

1 “In-Network Benefits” refers to benefits provided under this plan for covered dental services that are provided by a participating dentist. “Out-of- Network Benefits” refers to benefits provided under this plan for covered dental services that are not provided by a participating dentist.² Negotiated fees refer to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copay-ments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change.³ Reimbursement for out-of-network services is based on the lesser of the dentist’s actual fee or the Maximum Allowable Charge (MAC). The out-of network Maximum Allowable Charge is a scheduled amount determined by MetLife.⁴ R&C fee refers to the Reasonable and Customary charge, which is based on the lowest of (1) the dentist’s actual charge, (2) the dentist’s usual charge for the same or similar services, or (3) the charge of most dentists in the same geographic area for the same or simlar services as deter-mined by MetLife.† Applies to Type A, B and C Services Applies only to Type B & C Services.5 Orthodontia excluded for adults. Available for dependent children up to age 19.

High Plan - 100/80/50

• $50 deductible, waived on preventive care• $1,200 annual maximum• Composite fillings and periodontics/ endodontics

including basic services

Employee Only $33.75Employee + 1 $63.66

Family $91.40

Low Plan - 80/80/50

• $50 deductible, waived on preventive care• $1,000 annual maximum• Composite fillings and periodontics/ endodontics

including basic services

Employee Only $25.81Employee + 1 $48.64

Family $69.85

BY METLIFE

13S C U C .T X E D . N E T

Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. Please contact MetLife or your plan administrator for complete details.

Dental

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166L1019519177[exp1220][All States][DC,GU,MP,PR,VI] © 2019 MetLife Services and Solutions, LLC.

Dental information available through the MetLife Mobile AppViewing your dental plan just got easier with the MetLife Mobile App.1

1. To use the MetLife mobile app, employees can choose to register at metlife.com/mybenefits from a computer ordirectly through the app. Certain features of MetLife US Mobile App are not available for some MetLife Dental Plans.

You can:

• Find a dentist

• Get estimates for most procedures enhanced to display personalized, plan specific costs and additional information such as percent covered, applicable deductible, Plan Maximum and Frequency Limits– Both in-network and out-of-network estimates available

• View your plan summary with quick links to important information on deductibles and Plan Maximums as wellas Covered Services

• View detailed coverage information for your dental policy such as benefit sharing percentage, applicable deductibles, Plan Maximum and Frequency Limits

• View your claims

• Track your brushing and flossing

• Access and save ID card to photo library or mobile app

It’s easy! Search “MetLife” at iTunes App Store or Google Play to download the MetLife US Mobile App, or scan the QR codes. Search our network of thousands of dentists and specialists to find a provider near you.

Or log-in to MyBenefits to access your plan information.1

It’s available 24 hours a day, seven days a week.

DENTALBY METLIFE

14 I S S U E 2 0 2 1

VISIONHealthy eyes and clear vision are an important part of your overall health and quality of life. Through Metlife, you have access to a national network of doctors and retail providers to help you care for your eyes. Eye exams, eyeglasses, and contacts are available to you at the cost of applicable co-pays.

BY METLIFE

Low Plan High Plan Employee Only $6.81 $10.50Employee + 1 $12.81 $19.73

Family $18.22 $28.24

Low Plan High PlanIn-Network Out-of-Network In-Network Out-of-Network

Eye Exam $10 copay $45 allowance $10 copay $45 allowanceStandard Plastic Lenses

Single Vision Lenses $15 copay $30 allowance $10 copay $30 allowanceBifocal Lenses $15 copay $50 allowance $10 copay $50 allowanceTrifocal Lenses $15 copay $65 allowance $10 copay $65 allowance

Lenticular Lenses $15 copay $100 allowance $10 copay $100 allowanceProgressive Up to $55 copay2 $50 allowance Up to $55 copay2 $50 allowance

Contact Lenses Elective

Medically Necessary$115 allowance Covered in full

$90 allowance $210 allowance

$150 allowance1 Covered in full

$105 allowance1 $210 allowance

Frames Up to $115 allowance $55 allowance $150 allowance1 $70 allowance1Frequencies 12/12/24 12/12/24 12/12/12 12/12/12

Supplemental Rider Benefit InformationIn-Network Out-of-Network

Second Paid Glasses/Contacts1 (High plan only) This benefit gives you additional eyewear coverage. You can get: • Two pairs of prescription eyeglasses, or • One pair of prescription eyeglasses and an allowance toward contact lenses, or • Double your contact lens allowance *Benefit provides for two (2) complete orders for eyewear. Eyewear purchases must be separate; allowances cannot be combined for a single eyewear purchase.

Service intervals are the same asshown at left for In-Network Coverage.Benefits payable are the same as theprimary plan benefits up to the Out-of-

Network exam and materialsallowances stated above.

2All lens options are available at participating private practice provider offices, and “not-to-exceed” copays and pricing are subject to change without notice. Please check with your provider for details and copays applicable to your lens choice. At this time, all lens options and “not-to-exceed” copays and pricing are not available at Costco, Walmart and Sam’s Club. Please contact your local Costco, Walmart and Sam’s Club to confirm the availability of lens options and pricing prior to receiving services.

CLICK OR

SCAN

15S C U C .T X E D . N E T

HSA / FSA

HSA TAX ADVANTAGES:Pre-tax or tax-deductible contributionsTax-free interest and investment earningsTax-free distributions when used for qualified expenses

WHAT IS AN HSA?A Health Savings account “HSA” is like a 401(k) for healthcare. It’s yours for life, regardlessof your employment or health plan. And unlike a flexible spending account (FSA), there’s no “use it or lose it” rule.With more tax advantages than any other savings vehicle, an HSA is one of the most efficient ways to manage healthcare costs. You can choose to put your money to work, or build a healthcare safety net. And after age 65, you can even use it for non-medical expenses just like a regular 401(k).

“Am I eligible for an HSA?” You may be eligible for an HSA if your health plan meets the IRS criteria for a high-deductible health plan (HDHP). In 2021, this means your minimum deductible is $1,400 for individuals or $2,800 for families. And your maximum out-of-pocket is $7,000 for individuals or $14,000 for families.

“How much can I contribute to an HSA?” The IRS sets annual contribution limits for HSAs. I n 2021, individuals may contribute up to $3,600, and fami-lies may contribute up to $7,200. If you are 55 or older, you may contribute an additional $1,000. These limits are subject to change from year to year.

“What can I spend HSA funds on?” You can use your HSA for a wide range of qualified expenses, such as doctor’s visits, prescription drugs, imaging, lab work, medical equipment, contacts lenses, dental work, physical therapy… the list goes on! Refer to IRS Publication 502 for comprehensive guide-lines.Have more questions about HSAs? Check out livelyme.com/hsa-guide.

IS AN FSA RIGHT FOR ME?An FSA is a great way to pay for expenses with pre-tax dollars.A Healthcare FSA could save you money if you or your dependents:• Have out-of-pocket expenses like co-pays, coinsurance, or deduct-ibles for health, prescription, dental or vision plans• Have a health condition that requires the purchase of prescription medications on an ongoing basis• Wear glasses or contact lenses or are planning LASIK surgery• Need orthodontia care such as braces, or have dental expenses not covered by your insurance.• Email alerts and convenient portal and mobile home page messagesGet one-click answers to benefits questions

WITH AN FSA YOU CAN:An FSA is a great way to pay for expenses with pre-tax dollars.• Enjoy significant tax savings with pre-tax contributions and tax-free reimbursements for qualified plan expenses• Quickly and easily access funds using debit card at point of sale, or request to have funds directly deposited to your bank account via online or mobile app• Reduce filing hassles and paperwork by using your debit card• Enjoy secure access to accounts using a convenient Consumer Portal available 24/7/365• Manage your FSA “on the go” with an easy-to-use mobile app• File claims easily online (when required) and let the system deter-mine approval based on eligibility and availability of funds• Stay up to date on balances and action required with automated email alert and convenient portal and mobile home page messages• Get one-click answers to benefits questions• Use it or Roll It Over. And now up to $500 of your unused healthcareFlexible Spending Account balance can be carried over into the nextplan year instead of you “losing it” - making enrollment in an FSA muchless risky. This gives you more flexibility to spend your FSA money when you need it. You can use it for necessary out-of-pocket healthcare expenses rather than feeling pressured to engage in last minute and potentially unnecessary spending at the end of the year.

FSA: BY CPI

HSA: BY LIVELY

16 I S S U E 2 0 2 1

Basic Life/AD&D Insurance Employee OnlySchertz Cibolo Universal City ISD provides a $25,000 life insurance policy for you. Be sure to up-date your beneficiary during Open Enrollment.

Supplemental Life & AD&D Insurance, Employee, Spouse, DependentsIf you want extra, you can buy it. Remember, whatever you buy for yourself, you can also buy half that amount for your spouse and up to $10,000 for dependent children.

Coverage AmountEmployee Benefit 10,000 increments to a maximum of the lesser of

2.00 times pay or $150,000Spouse Benefit $5,000 increments to a maximum of $50,000

Coverage not to exceed 50% of employee’s Supplemental Life/AD&D benefit

Child BenefitCoverage Amounts of $5,000 or $10,000 for each child.

Coverage not to exceed 50% of employee’s Supplemental Life/AD&D benefit Coverage Limited to $500 live birth to 6 months

Eligibility: All eligible full-time employee who are actively at work and working a minimum of 17.5 hours per week. Portability: Option to continue term insurance under a different policy when coverage terminates. Minimums, maximums, and other conditions apply.Reduction Schedule: (Employee/Spouse) Reduces to 65% at Age 70, 50% at Age 75Actively at work: If you are not actively at work when coverage is scheduled to become effective, you coverage does not take effect until you complete your first day at work.

TERM LIFEBY UNITED HEALTHCARE

Benefits PayableLoss Occurrence Period 365 days

Seat Belt Benefit 50.0% to $50,000Seat Belt & Air Bag Benefit 50.0% to $50,000

Loss of Life 100%Quadriplegia 100%Paraplegia 75%Hemiplegia 50%Uniplegia 25%

Loss of one hand 50%Loss of one foot 50%

Loss of sight of one eye 50%Loss of both hands or both feet 100%

Loss of sight of both eyes 100%Loss of one hand and sight of one eye 100%Loss of one foot and sight of one eye 100%

Loss of thumb and index finger of same hand 25%Loss of speech 50%Loss of hearing 50%

Evidence of Insurability

(EOI)

Please refer to your benefits summary for rates

BenefitsSummary

17S C U C .T X E D . N E T

Long Term Disability Insurance can replace part of your income if a disability keeps you out of work for a extended period of time. This coverage can pay you a monthly benefit if you have a covered illness or injury to help cover your monthly expenses.

DISABILITYBY UNUM

Enter your annual earnings and calculate your monthly maximum benefit available

$ ÷ 12 = $ x 66.67% = $

Enter your Your monthly (Max % of Max monthly benefit available (if the amount annuall earnings earnings income covered) exceeds the plan max $7,500, enter $7,500.)

Choose your monthly benefit amount and calculate your per paycheck cost

$ ÷ 100 = $ x $ = $ x 12 = $ ÷ =

Your monthly benefit amount ($200 – $7,500 in $100 increments)

Your monthlycost

Your Number of Costannual paychecks per

cost per year payheck

Your Ratebased on

elimination period

$

Caclculate your cost• Follow the instructions onthe worksheet at right todetermine your cost perpaycheck.• For step 2:Enter the monthly benefitamount you wouldwant if disabled. Thisamount needs to be in$100 increments from$200 to the maximummonthly benefit available(calculated in step 1).

Elimination Period (days)

Injury (days) 7* 14* 30 60Sickness (days) 7* 14* 30 60

Employee Age Band Monthly Rate per Increment of $100

15-29 $2.68 $1.63 $1.26 $1.01

30-34 $3.36 $2.06 $1.62 $1.22

35-39 $3.95 $2.49 $2.07 $1.56

40-44 $4.52 $2.91 $2.52 $1.9645-49 $4.83 $3.13 $2.78 $2.27

50-54 $5.20 $3.32 $3.02 $2.63

55-59 $5.82 $3.75 $3.53 $3.2960+ $7.50 $4.83 $4.69 $4.46

*If because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement

How does it work?This coverage can pay a monthly benefit if you have a covered illness or injury and you can’t work for a few months — or even longer.You’re generally considered disabled if you’re unable to do important parts of your job — and your income suffers as a result.Why is this coverage so valuable?You can use the money however you choose.It can help you pay for your rent or mortgage, groceries, out-of-pocket medical expenses and more.

What else is included?Work-life balance EAPGet access to professional help for a range of personal andwork-related issues, including counselor referrals, financialplanning and legal support.Worldwide emergency travel assistanceOne phone call gets you and your family immediate helpanywhere in the world, as long as you’re traveling 100 ormore miles from home. However, a spouse traveling onbusiness for his or her employer is not covered.Survivor benefitIf you die while you’ve been disabled and receiving benefitsfor at least 180 days, your family could get a benefit equal to3 months of your gross disability payment.Waiver of premiumIf you’re disabled and receiving benefit payments, Unumwaives your cost until you return to work.

Disability Claim Form

Round this amount Down to Nearest $1000

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LEGAL PLANBY METLIFE

Helping you navigate life’s planned and unplanned events.For a monthly fee, you get legal assistance for some of the most frequently needed personal legal matters —with no waiting periods, no deduct-ibles and no claim forms, when using a Network Attorney for a covered matter. And, for non-covered matters that are not otherwise excluded, this benefit provides four hours of Network Attorney time and services per year.²

To learn more, visitinfo.legalplans.comand enter access codeforlaw4 or call800.821.6400Monday – Friday8:00 am – 8:00 pm(EST/EDT).

1 You will be responsible to pay the difference, if any, between the plan’s payment and the out-of-network attorney’s charge for services.2 No more than a combined maximum total of four hours of attorney time and service are provided for the member, spouse and qualified dependents, annually.³ These benefits provide the Participant with access to LifeStages Identity Management Services provided by CyberScout, LLC. CyberScout is not a corporate affiliate of MetLife Legal Plans.⁴Does not cover DUI.

Money Matters• Debt Collection Defense • Identity Management Services3 • Identity Theft Defense

• Negotiations with Creditors • Personal Bankruptcy • Promissory Notes

• Tax Audit Representation • Tax Collection Defense

Home & Real Estate

• Boundary & Title Disputes • Deeds • Eviction Defense • Foreclosure

• Home Equity Loans • Mortgages • Property Tax Assessments • Refinancing of Home

• Sale or Purchase of Home • Security Deposit Assistance • Tenant Negotiations • Zoning Applications

Estate Planning

• Codicils • Complex Wills • Healthcare Proxies • Living Wills

• Powers of Attorney (Healthcare, Financial, Childcare, Immigration)

• Revocable & Irrevocable Trusts • Simple Wills

Family & Personal

• Adoption • Affidavits • Conservatorship • Demand Letters • Garnishment Defense • Guardianship • Immigration Assistance

• Juvenile Court Defense, Including Criminal Matters • Name Change • Parental Responsibility Matters • Personal Property Protection

• Prenuptial Agreement • Protection from Domestic Violence • Review of ANY Personal Legal Document • School Hearings

Civil Lawsuits • Administrative Hearings • Civil Litigation Defense

• Disputes Over Consumer Goods & Services • Incompetency Defense

• Pet Liabilities • Small Claims Assistance

Elder-Care Issues

Consultation & Document Review for your parents: • Deeds • Leases

• Medicaid • Medicare • Notes • Nursing Home Agreements

• Powers of Attorney • Prescription Plans • Wills

Vehicle & Driving

• Defense of Traffic Tickets4 • Driving Privileges Restoration • License Suspension Due to DUI • Repossession

E-Services • Attorney Locator • Financial Planning

• Insurance Resources • Law Firm E-Panel • Self-Help Legal Documents

Group legal plans provided by MetLife Legal Plans, Inc., Cleveland, Ohio. In certain states, group legal plans are provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and affiliates, Warwick, RI. No service, including consultations, will be provided for: 1) employment-related matters, including company or statutory benefits; 2) matters involving the employer, MetLife, its affiliates, or plan attorneys; 3) matters in which there is a conflict of interest between the employee and spouse/civil union partner or depen-dents, in which case services are excluded for the spouse/civil union partner and dependents; 4) appeals and class actions; 5) farm and business matters, including rental issues when the participant is the landlord; 6) patent, trademark, and copyright matters; 7) costs and fines; 8) frivolous or unethical matters; 9) matters for which an attorney-client relationship exists prior to the participant becoming eligible for plan benefits. For all other personal legal matters, an advice and consultation benefit is provided. Additional representation is also included for certain matters. Please see your plan description for details. MetLife® is a registered trademark of Metropolitan Life Insurance Company, New York, NY. [ML4]

Monthly RateFamily $18.00

19S C U C .T X E D . N E T

LEGAL NOTICESThis notice packet includes all notices required under federal law for the Schertz-Cibolo-Universal City ISD Employee Benefit Plan (the “Plan”). These notices are provided annually and it is important that you read them carefully to understand your rights under the Plan.

Women’s Health & Cancer Rights ActIf you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (“WHCRA”). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner deter-mined in consultation with the attending physician and the patient, for:• All states of reconstruction of the breast on which the mastectomy was performed;• Surgery and reconstruction of the other breast to produce a symmetrical appearance;• Prostheses; and• Treatment of physical complications of the mastectomy, including lymphedema.These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under the plan. If you would like more information on WHCRA benefits, contact Human Resources.

Newborns’ and Mothers’ Health Protection Act DisclosureGroup health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or theinsurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

ACA DISCLAIMERThis offer of coverage may disqualify you from receiving government subsidies for an Exchange plan even if you choose not to en-roll. To be subsidy eligible you would have to establish that this offer is unaffordable foryou, meaning that the required contribution for employee only coverage under our base plan exceeds 9.78% of your modified adjusted household income.

Michelle’s LawMichelle’s Law requires group health plans to provide continued coverage for a dependent child covered under the plan if the child loses eligibility under the Schertz-Cibolo-Universal City ISD Welfare Benefits Plan because of the loss of student status resulting from a medi-cally necessary leave of absence from a postsecondary educational institution. If your child is covered under the Schertz-Cibolo-Universal City ISD Welfare Benefits Plan, but will lose eligibility because of a loss of student status caused by a medically necessary leave of asence, your child may be able to continue coverage under our plan for up to one year during the medically necessary leave of absence. This coverage continuation may be available if on the day before the medically necessary leave of absence begins your child is covered under the Schertz-Cibolo-Universal City ISD Welfare Benefits Plan and was enrolled as a student at a post-secondary educational institution.

A “medically necessary leave of absence” means a leave of absence from a post-secondary educational institution (or change in enroll-ment status in that institution) that: (1) begins while the child is suffering from a serious illness or injury, (2) is medically necessary, and (3) causes the child to lose student status as defined under our plan.

The coverage continuation is available for up to one year after the first day of the medically necessary leave of absence and is the same coverage your child would have had if your child had continued to be a covered student and not needed to take a medical leave of absence. Coverage continuation may end before the end of one year if your child would otherwise lose eligibility under the plan – for example, by reaching age 26.

If your child is eligible for this coverage continuation and loses coverage under the plan at the end of the continuation period, COBRA continuation may be available at the end of the Michelle’s Law coverage continuation period.

If you have any questions concerning this notice or your child’s right to continued coverage under Michelle’slaw, please contact Human Resources.

20 I S S U E 2 0 2 1

LEGAL NOTICESHIPAA Notice of Privacy Practices Reminder

Schertz-Cibolo-Universal City ISD Welfare Benefits PlanProtecting Your Health Information Privacy RightsSchertz-Cibolo-Universal City ISD is committed to the privacy of your health information. The administrators of the Schertz-Cibo-lo-Universal City ISD Welfare Benefits Plan (the “Plan”) use strict privacy standards to protect your health information from unautho-rized use or disclosure.The Plan’s policies protecting your privacy rights and your rights under the law are described in the Plan’s Notice of Privacy Practic-es. You may receive a copy of the Notice of Privacy Practices by contacting Human Resources.

Notice of Your HIPAA Special Enrollment RightsOur records show that you are eligible to participate in the Schertz-Cibolo-Universal City ISD’s Health and Welfare Plan (to actually participate, you must complete an enrollment form and pay part of the premium through payroll deduction).A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under its “special enrollment provision” if you acquire a new dependent, or if you decline coverage under this plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons.Loss of Other Coverage (Excluding Medicaid or a State Children’s Health Insurance Program). If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).Loss of Coverage for Medicaid or a State Children’s Health Insurance Program. If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state children’s health insurance program is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must equest enrollment within 60 days after your or your dependents’ coverage ends under Medicaid or a state children’s health insurance program.New Dependent by Marriage, Birth, Adoption, or Placement for Adoption. If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your new dependents. However, you must request enrollment within 30 days of the marriage or 60 days of the birth, adoption, or placement for adoption.Eligibility for Medicaid or a State Children’s Health Insurance Program. If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program with respect to cov-erage under this plan, you may be able to enroll yourself and your dependents in this plan. However, you must request enrollment within 60 days after your or your dependents’ determination of eligibility for such assistance. To request special enrollment or to obtain more information about the plan’s special enrollment provisions, contact Human Resources.

HIPAA Special Enrollment RightsLoss of Other Coverage – If you are declining enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect, you may be able to enroll yourself or your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage). However, you must request enrollment within 30 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).In addition, this special enrollment opportunity will not be available when other coverage ends unless youprovide a written state-ment now explaining the reason that you are declining coverage for yourself or your dependent(s). Failing to accurately complete and return this form for each person for whom you are decliningcoverage will eliminate this special enrollment opportunity for the person(s) for whom a statement is not completed, even if other coverage is currently in effect and is later lost. In addition, unless you indicate in the statement that you are declining coverage be-cause other coverage is in effect, you will not have this special enrollment opportunity for the person(s) covered by the statement. (See the paragraph on the next pade (21), however, regarding enrollment in the event of marriage, birth, adoption or placement for adoption.)

21S C U C .T X E D . N E T

LEGAL NOTICESNew dependent as result of marriage, birth, adoption or placement for adoption – if you have a newdependent as result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourselfand your dependents. To be eligible for this special enrollment opportunity you must request enrollment within30 days after the marriage, birth, adoption, or placement for adoption.Effective April 1, 2009 special enrollment rights also exist in the following circumstances:• If you or your dependents experience a loss of eligibility for Medicaid or your State Children’s Health Insurance Program (SCHIP)

coverage; or• If you or your dependents become eligible for premium assistance under an optional state Medicaid or SCHIP program that

would pay the employee’s portion of the health insurance premium.To be eligible for the two above listed special enrollment opportunities, you must request coverage within 60 days after the date the employee or dependent becomes eligible for premium assistance under Medicaid or CHIP or the date your dependent’s Medicaid or state-sponsored CHIP coverage ends.

Important Notice From Schertz-Cibolo-Universal City ISD About Your Prescription DrugCoverage And MedicarePlease read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug-coverage with Schertz-Cibolo-Universal City ISD and about your options under Medicare’s prescription drug coverage. This informa-tion can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.There are two important things you need to know about your current coverage and Medicare’sprescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. Schertz-Cibolo-Universal City ISD has determined that the prescription drug coverage offered by the Schertz-Cibolo-Univer-sal City ISD’s Health Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When Can You Join a Medicare Drug Plan?You can join a Medicare drug plan when you first become eligible for Medicare and each year from October15 to December 7. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you willalso be eligible for a two- (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens to Your Current Coverage if You Decide to Join a Medicare Drug Plan?If you decide to join a Medicare drug plan, your current Schertz-Cibolo-Universal City ISD coverage may be affected. If you do decide to join a Medicare drug plan and drop your current Schertz-Cibolo-Universal City ISD coverage, be aware that you and your dependents may not be able to get this coverage back.

When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan?You should also know that if you drop or lose your current coverage with Schertz-Cibolo-Universal City ISD and don’t join a Medi-care drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premi-um may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that cov-erage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

22 I S S U E 2 0 2 1

LEGAL NOTICESFor More Information about This Notice or Your Current Prescription Drug Coverage:Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Schertz-Cibolo-Universal City ISD changes. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage:More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.• Visit www.medicare.gov.• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook

for their telephone number) for personalized help.• Call 800.MEDICARE (800.633.4227). TTY users should call 877.486.2048.If you have limited income and resources, extra help paying for Medicare prescription drug coverage isavailable. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 800.772.1213 (TTY 800.325.0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore,whether or not you are required to pay a higher premium (a penalty).

Name of Entity/Sender: Schertz-Cibolo-Universal City ISDContact: Jackie PortelaAddress: 1060 Elbel Rd. Schertz, Texas 78154Email/Phone Number: 210.945.6216

Pre-Tax Contributions:In most cases, Schertz-Cibolo-Universal City ISD employees’ contributions for health coverage are deducted from their paychecks on a pre-tax basis meaning before federal income taxes, state income taxes (in most cases), and FICA taxes are calculated. Internal Revenue Code (I.R.C) Section 152 defines what dependent contributions are eligible for pre-tax deductions. The IRS does not allow employees’ contributions fordependent health coverage to be deducted on a pre-tax basis unless the dependent(s) meet the defi-nition of a tax dependent under I.R.C. Section 152. If they do not meet the definition of a tax dependent, they may be either ineligi-ble for the Plan, or in some cases, the IRS taxes the additional fair market value of these benefits and treats it as Imputed Income. Contributions for medical, dental and vision coverage for eligible dependents that do not meet the definition of a tax dependent will be made on a post-tax basis and the Imputed Income will be included on your paycheck and IRS Form W-2.Summary of Benefits and CoverageSummary of Benefits Coverage for the Schertz-Cibolo-Universal City ISD PPO Plan and HDHP Plan is available at scuc.txed.net. You may also request a paper copy by contacting Human Resources.Notice Regarding Wellness ProgramSchertz-Cibolo-Universal City ISD’s Right You is a voluntary wellness program available to all employees. The program is admin-istered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Ac-countability Act, as applicable, among others. If you choose to participate in the wellness program you may be asked to complete a voluntary health risk assessment or “HRA” that asks a series of questions about your health-related activities and behaviors andwhether you have or had certain medical conditions (e.g., cancer, diabetes, or heart disease). You will also be asked to complete a biometric screening, which may include a blood test. You are not required to complete the HRA or to participate in the blood test or other medical examinations. However, employees who choose to participate in the wellness program may be eligible to receive anincentive. Although you are not required to complete the HRA or participate in the biometric screening, only employees who do so will receive the incentive.

23S C U C .T X E D . N E T

LEGAL NOTICES

Additional incentives may be available for employees who participate in certain health-related activities or achieve certain health outcomes. If you are unable to participate in any of the health-related activities or achieve any of the health outcomes required to earn an incentive, you may be entitled to a reasonable accommodation or an alternative standard. You may request a reasonable accommodation or an alternative standard by contacting Human Resources.The information from your HRA and the results from your biometric screening will be used to provide you with information to help you understand your current health and potential risks, and may also be used to offer you services through the wellness program. You also are encouraged to share your results or concerns with your own doctor.

Protections from Disclosure of Medical InformationWe are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program and Schertz-Cibolo-Universal City ISD may use aggregate information it collects to design a program based on identified health risks in the workplace, Right You will never disclose any of your personal information either publicly or to the employer, ex-cept as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the well-ness program will not be provided to your supervisors or managers and may never be used to make decisions regarding youremployment. Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confiden-tiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who re-ceives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements. The only individual(s) who will receive your personally identifiable health information is (are) CareATC in order toprovide you with services under the wellness program. In addition, information will be maintained separate from your personnel records, information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you immediately. You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate. If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact Human Resources.Wellness Program – Notice of Alternative StandardYour health plan is committed to helping you achieve your best health. Rewards for participating in a wellnessprogram are available to all employees. If you think you might be unable to meet a standard for a rewardunder this wellness program, you might qualify for an opportunity to earn the same reward by different means.Contact Human Resources and we will work with you (and, if you wish, with your doctor) to find a wellnessprogram with the same reward that is right for you in light of your health status.

24 I S S U E 2 0 2 1

TEXAS – Medicaidhttp://gethipptexas.com 800.440.0493

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services

www.cms.hhs.gov877.267.2323, Menu Option 4, Ext. 61565

U.S. Department of LaborEmployee Benefits Security Administratio

www.dol.gov/agencies/ebsa866.444.EBSA (3272)

LEGAL NOTICES

Paperwork Reduction Act StatementAccording to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law,no person shall be subject to penalty for failing to comply with a collection of information if the collection ofinformation does not display a currently valid OMB control number. See 44 U.S.C. 3512.

The public reporting burden for this collection of information is estimated to average approximately seven minutes per respon-dent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Admin-istration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washing-ton, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.OMB Control Number 1210-0137 (expires 1/31/2023)

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.If you or your dependents are not currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eli-gible for either of these programs, contact your State Medicaid or CHIP office or dial 877.KIDS.NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” op-portunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 866.444.EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. To see if any other states have added a premium assistance program since January 31, 2020, or formore information on special enrollment rights, contact either:

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LEGAL NOTICESGeneral Notice of Cobra Continuation Coverage RightsUpon enrollment in our medical, dental and/or life coverage, we are required to send you (and your family) the General Notice of COBRA Continuation Coverage Rights. This notice explains continuation of your coverage and when it may become available to you and/or your fami-ly members under the federal COBRA law. It also provides you important information regarding your responsibilities if you were to experience a “qualifying event”. For instance, if your dependent child loses eligibility on the Company Name plan, you must notify Human Resources in writing within 60 days. If you fail to notify your employer, your dependent would lose their right to COBRA continuation. This document is important to read so you are aware of Company Name and your rights and responsibilities.

General Notice of Cobra Continuation Coverage Rights Notice of COBRA Continuation Coverage Rights (For Company Name Health Plan)You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. Whenyou become eligible for COBRA, you may also become eligible for other coverage options that may cost lessthan COBRA continuation coverage.The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health cover-age. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.What is COBRA continuation coverage?COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be of-fered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation cover-age [choose and enter appropriate information: must pay or aren’t required to pay] for COBRA continuation coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

»Your hours of employment are reduced, or»Your employment ends for any reason other than your gross misconduct.

If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

»Your spouse dies;»Your spouse’s hours of employment are reduced;»Your spouse’s employment ends for any reason other than his or her gross misconduct; .»Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or»You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:» The parent-employee dies;» The parent-employee’s hours of employment are reduced;» The parent-employee’s employment ends for any reason other than his or her gross misconduct;» The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);» The parents become divorced or legally separated; or» The child stops being eligible for coverage under the Plan as a “dependent child.”

When is COBRA continuation coverage available?The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:» The end of employment or reduction of hours of employment;» Death of the employee; or» The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).

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For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to: Human Resources.

How is COBRA continuation coverage provided?Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA con-tinuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employ-ment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.There are also ways in which this 18-month period of COBRA continuation coverage can be extended:Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA contin-uation coverage.Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes en-titled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.Are there other coverage options besides COBRA Continuation Coverage?Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.If you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts iden-tified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa.(Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.healthcare.gov. Keep your Plan informed of address changesTo protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator. You Must Give Notice of Some Qualifying Events For the other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibil-ity for coverage as a dependent child), you must notify the Plan Administrator within 31 days or less after the qualifying event occurs. You must provide this notice to Jackie Portela, Benefits Specialist at 210.945.6216 or jportela@scuc.txed.net.Plan contact informationTo obtain more information, contact Jackie Portela, Benefits Specialist at 210.945.6216 or jportela@scuc.txed.net.

LEGAL NOTICES

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Benefit Administrator Phone Website

Accident & Critical Illness The Hartford 866.547.4205 thehartford.com/employeebenefits

Cancer MetLife 1 800- GET-MET8 (1-800-438-6388 ) mybenefits.metlife.com

Dental MetLife 800.942.0854 metlife.com/mybenefits

Disability Unum 866.679.3054 unum.com

FSA CPI 255.215.2203 mycpiteam.com

HSA Lively 888.576.4837 Livelyme.comemail: support@livelyme.com

Legal MetLife 800.821.6400 members.legalplans.com

Medical UnitedHealthcare 844.269.5753 myuhc.com

Term Life UnitedHealthcare 888.299.2070 myuhc.com

Vision MetLife 1.855.MET.EYE1 (1.855.638.3931) metlife.com/mybenefits

District Contacts Phone Email

Employee Benfits Service Center 855-244-3990

Jackie PortelaBenefits Specialist

210-945-6216Fax: 210-945-6211 jportela@scuc.txed.net

Shannon BurnsDirector

of Human Resources210-945-6212 sburns@scuc.txed.net

Schertz-Cibolo-Universal City ISD 1060 Elbel Rd. Schertz, Texas 78154 210.945.6200

scuc.txed.net

CONTACTS

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