NEW or IMPORTANT CHANGES FOR

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1 Yorktown Independent School District IMPORTANT BENEFIT INFORMATION Section 125 Plan Enrollment will be Wednesday, October 23, A new Benefit Election agreement must be signed by each employee for the plan year which begins December 1, 2013 and concludes November 30, Below is an overview of available benefits for YISD employees. Access to brochures and rates is available at Go to Forms tab, select N-Z, then Yorktown ISD. NEW or IMPORTANT CHANGES FOR Critical Illness Protection from AIG. New Benefit for Plan provides a lump sum benefit for Critical Illness. Employee can choose from $2,500 to $50,000 of coverage. Guarantee Issue -- Employees can enroll for up to $5,000 without health questions, regardless of health history. Plan pays 100% of Benefit Selected for Heart Attack, Stroke, Renal Failure, Invasive Cancer, or Major Organ Transplant Plan pays 25% of Benefit Selected for Coma, Coronary Bypass, In Situ Cancer, or Loss of Sight, Speech or Hearing Plan is Supplemental Coverage that pays direct to you, regardless of other insurance and is Cafeteria Plan Eligible. Dependent Coverage also available -- Spouse may apply for coverage up to 100% of employee s benefit. Children are covered for 25% of employee s benefit. Additional benefits include: $50 Annual Health Screening Benefit Experimental Cancer Treatment Benefit Cancer Radiation and Chemotherapy Benefit Disability or Income protection will now be provided by The Hartford. Benefits and premiums remain the same as last year. This change is made due to the prior company notice of a 22% increase in premiums. The Hartford offers the following benefits: Open Enrollment no health questions for new participants. Current disability participants are grandfathered with current benefits and may increase benefits without health questions. Disability insurance protects your lifestyle by providing a monthly benefit when you are unable to work due to a sickness or accident. If you rely on your income for housing, groceries, car payment, utilities, and out-of-pocket health care costs, then disability is one of the most important benefits you can have. Disability insurance assures that you continue to receive up to 66% of your income if your doctor says you are unable to work. You can have waiting (or elimination) periods with benefits starting the 1 st day of an accident or 8 th day of an illness. You can choose longer periods depending on your personal situation. If you choose a 30 day or shorter elimination period, benefits start the first day hospitalized. Guaranteed issue to $7500 monthly benefit if qualified. Dental and Vision Insurance will increase 5% for plan year. Dental and Vision insurance premiums will increase 5% effective December 1, ALL OTHER BENEFITS REMAIN THE SAME AS LAST YEAR Health Insurance from TRS Active Care is enrolled separately. Contact YISD business office. Voluntary Group Term Life from Companion Life -- You may choose up to $100,000 (not to exceed 3 times salary) guaranteed issue on yourself with option to add your spouse not to exceed 50% of employee coverage and $5,000 on all children for $1.08. No health questions for new employees. You must complete a Health Statement if did not enroll when first eligible or if you are increasing your life insurance benefit from prior year(s). New employees are guaranteed up to $100,000 not to exceed 3 times salary without a health statement. All others must complete the health statement. (Over, please)

2 Yorktown Independent School District IMPORTANT BENEFIT INFORMATION Section 125 Plan Enrollment will be Wednesday, October 23, A new Benefit Election agreement must be signed by each employee for the plan year which begins December 1, 2013 and concludes November 30, Cancer Insurance from American Public Life is a way of protecting your family from the high costs of out of pocket expenses associated with cancer. It pays directly to you and is not considered coinsurance. It includes coverage for items such as hospital room, ambulance, surgery, anesthesia, private nursing, various therapies, radiation and chemotherapy even things like travel and lodging and wellness testing ( Cover yourself, spouse and children; plus you may take it with you if you leave the district or retire. Dental Insurance from Ameritas offers a choice of Low Option or High Option plans. Both plans cover preventive and basic dental services. The High Option plan includes major services such as crowns, bridges, inlays, onlays and orthodontia for dependent children ages You may choose any dentist for services, there is no list of dentists from which you must select to receive benefits. Vision Insurance from Ameritas is vision coverage for exam and glasses or contacts. This is true vision insurance. Vision Service Plan (VSP) is the network which provides the most benefit for covered persons. Out of network benefits provide an option to use a non-network provider. Find a network provider at Heart Attack, Disease and Stroke Insurance from American Public Life provides several options for you to choose from including a lump sum benefit as well as coverage for heart transplant. Benefits are paid directly to you for heart attack, heart failure, or stroke. Heart transplant benefit is included. Cover yourself, spouse, and children; plus you can take it with you if you leave the district or retire. If you did not enroll when first eligible, you must answer health questions. Legal Plan from Legal Service Plans - Legal referral program with unlimited telephone access to legal services plus free will preparation, document review etc. is also available as a benefit plan. Permanent life insurance from Texas Life is permanent life insurance for you, your spouse, children or grandchildren. You can take it with you if you leave the district or retire and is guaranteed renewable to age 100 with the option to extend coverage to age 110. Representatives will be at the Elementary School campus from 8:15AM until 11:00AM and at the High School campus from 11:00 AM until 1:30PM on Wednesday, October 23, For questions you may contact the Business Office or call Calvin Crider ( criderins@aol.com). Web sites listed for provider lists and forms where needed.

3 Yorktown Independent School District Cafeteria Plan and Supplemental Benefits for Plan Year December 1, 2013 through November 30, 2014 Provided by Administrative Solutions and Crider Insurance Services, Inc. Third Party Administrators 6300 Ridglea Place Suite 315 Fort Worth, TX FAX:

4 Yorktown ISD Cafeteria Plan and Supplemental Benefits Table of Contents Page Benefit Summary 1 Cafeteria Plan Benefit Election Form 3 (Must complete and return to YISD Business Office or Benefits representative) Disability/Income Replacement Insurance 4 Benefits Enrollment form Outline of Benefits Critical Illness 19 Benefits Summary Enrollment form Dental Insurance Benefit Summary (Low Plan and High Plan options) 29 Vision Insurance Benefit Summary 35 Dental and/or Vision enrollment form 37 Cancer Insurance Plan Descriptions 38 Heart Disease, Heart Attack or Stroke Insurance 46 American Public Life Application for Cancer and/or Heart Insurance 53 Group Term Life 58 $10,000 Basic Term Life district paid must complete application Voluntary Group Term Life (optional) Basic and Voluntary Life application Health Statement (must be completed by employees increasing current coverage or who did not enroll during the first 31 days of employment) Permanent Life Insurance Texas Life 61

5 SECTION 125 FLEXIBLE BENEFITS RENEWAL PLAN AGREEMENT YORKTOWN ISD EMPLOYER NAME: ADDRESS: CITY/STATE/ZIP: SS NO.: - - CAMPUS TELEPHONE: - - For plan year beginning I authorize these Additions, Changes and Drops to my current Deductions. I elect not to participate in the Section 125 Plan at this time. I elect to participate and make no changes at this time. ADDITIONS: BENEFIT PROVIDER BEFORE TAX AFTER TAX TOTAL CHANGES/DROPS: BENEFIT PROVIDER OLD AMOUNT NEW AMOUNT BEFORE/AFTER I Understand: Money cannot be shifted from one account to another. My employer may change my sheltered amount if it is necessary to do so to keep the plan in compliance with IRS guidelines or if there is a change in the cost of my insurance premiums during the plan year. If I shelter expenses under the plan I cannot later claim them for income tax purposes. An application must be completed for any insurance item covered under the Section 125 Plan. All eligible benefits will be sheltered unless otherwise indicated. If I do not use all of the money sheltered in the Cafeteria Plan by the end of the Plan Year, whatever portion I am unable to use by federal law cannot be returned to me or carried over to the next year. I cannot make changes to my elections during the plan year unless I have a change in family status or change in the employment of spouse. I hereby release my employer, its officers, agents, and employees, from any legal liability or obligation for any cause or reason in connection with this Plan, except for willful misconduct or gross negligence. Signature / / ASI-125FLEXREN2011

6 Yorktown Independent School District Long Term Disability Premium Option Employee Plan Summary Feature Description Class Description Maximum Monthly Benefit All Active Full Time Employees Monthly flat amount elected by the employee from $200 to $7,500 in $100 increments, not to exceed 66 2/3% of monthly earnings Minimum Monthly Benefit 25% Elimination Period Employee to elect from the following options 0/7, 14/14, 30/30, 60/60, 90/90, 180/180 Benefit Duration (Sickness) Benefit Duration (Injury) Definition of Disability Return to Work Incentive Integration Method Pre-Existing Condition Limitation Takeover Provision Mental Illness Limitation Substance Abuse Limitation Family Care Credit Workplace Modification Rehabilitation Participation Requirements Recommended Treatment Requirements Survivor Income Benefit Option Employer Participates in Worker's Compensation Employee Contribution Enrollment Type Participation Requirement Number of Eligible Employees ADEA I with Social Security Normal Retirement Age ADEA I with Social Security Normal Retirement Age 2 Years own occupation Included Direct with Family Social Security Offset Treatment Free/Lookback/Continuously Insured 3/3/12 months No Loss, No Gain 24 Month Outpatient 24 Month Outpatient Included Greater of $1000 of 2x the monthly benefit Included Included 3 Times last monthly Gross Benefit Yes Contributory Annual Open Enrollment 25% of Eligible Employees 75 Employee Rate Summary Long Term Disability See attached premium rate table Rate Guarantee: 3 Years Page 4

7 Yorktown Independent School District Annual Earnings Sickness / Accident Elimination Period in Days Monthly Earnings Monthly Benefit 0 / 7 14 / / / / / 180 $3,600 $300 $200 $6.56 $5.66 $4.66 $3.34 $2.88 $2.34 $5,400 $450 $300 $9.84 $8.49 $6.99 $5.01 $4.32 $3.51 $7,200 $600 $400 $13.12 $11.32 $9.32 $6.68 $5.76 $4.68 $9,000 $750 $500 $16.40 $14.15 $11.65 $8.35 $7.20 $5.85 $10,800 $900 $600 $19.68 $16.98 $13.98 $10.02 $8.64 $7.02 $12,600 $1,050 $700 $22.96 $19.81 $16.31 $11.69 $10.08 $8.19 $14,400 $1,200 $800 $26.24 $22.64 $18.64 $13.36 $11.52 $9.36 $16,200 $1,350 $900 $29.52 $25.47 $20.97 $15.03 $12.96 $10.53 $18,000 $1,500 $1,000 $32.80 $28.30 $23.30 $16.70 $14.40 $11.70 $19,800 $1,650 $1,100 $36.08 $31.13 $25.63 $18.37 $15.84 $12.87 $21,600 $1,800 $1,200 $39.36 $33.96 $27.96 $20.04 $17.28 $14.04 $23,400 $1,950 $1,300 $42.64 $36.79 $30.29 $21.71 $18.72 $15.21 $25,200 $2,100 $1,400 $45.92 $39.62 $32.62 $23.38 $20.16 $16.38 $27,000 $2,250 $1,500 $49.20 $42.45 $34.95 $25.05 $21.60 $17.55 $28,800 $2,400 $1,600 $52.48 $45.28 $37.28 $26.72 $23.04 $18.72 $30,600 $2,550 $1,700 $55.76 $48.11 $39.61 $28.39 $24.48 $19.89 $32,400 $2,700 $1,800 $59.04 $50.94 $41.94 $30.06 $25.92 $21.06 $34,200 $2,850 $1,900 $62.32 $53.77 $44.27 $31.73 $27.36 $22.23 $36,000 $3,000 $2,000 $65.60 $56.60 $46.60 $33.40 $28.80 $23.40 $37,800 $3,150 $2,100 $68.88 $59.43 $48.93 $35.07 $30.24 $24.57 $39,600 $3,300 $2,200 $72.16 $62.26 $51.26 $36.74 $31.68 $25.74 $41,400 $3,450 $2,300 $75.44 $65.09 $53.59 $38.41 $33.12 $26.91 $43,200 $3,600 $2,400 $78.72 $67.92 $55.92 $40.08 $34.56 $28.08 $45,000 $3,750 $2,500 $82.00 $70.75 $58.25 $41.75 $36.00 $29.25 $46,800 $3,900 $2,600 $85.28 $73.58 $60.58 $43.42 $37.44 $30.42 $48,600 $4,050 $2,700 $88.56 $76.41 $62.91 $45.09 $38.88 $31.59 $50,400 $4,200 $2,800 $91.84 $79.24 $65.24 $46.76 $40.32 $32.76 $52,200 $4,350 $2,900 $95.12 $82.07 $67.57 $48.43 $41.76 $33.93 $54,000 $4,500 $3,000 $98.40 $84.90 $69.90 $50.10 $43.20 $35.10 $55,800 $4,650 $3,100 $ $87.73 $72.23 $51.77 $44.64 $36.27 $57,600 $4,800 $3,200 $ $90.56 $74.56 $53.44 $46.08 $37.44 $59,400 $4,950 $3,300 $ $93.39 $76.89 $55.11 $47.52 $38.61 $61,200 $5,100 $3,400 $ $96.22 $79.22 $56.78 $48.96 $39.78 $63,000 $5,250 $3,500 $ $99.05 $81.55 $58.45 $50.40 $40.95 $64,800 $5,400 $3,600 $ $ $83.88 $60.12 $51.84 $42.12 $66,600 $5,550 $3,700 $ $ $86.21 $61.79 $53.28 $43.29 $68,400 $5,700 $3,800 $ $ $88.54 $63.46 $54.72 $44.46 Page 5

8 Yorktown Independent School District $70,200 $5,850 $3,900 $ $ $90.87 $65.13 $56.16 $45.63 $72,000 $6,000 $4,000 $ $ $93.20 $66.80 $57.60 $46.80 $73,800 $6,150 $4,100 $ $ $95.53 $68.47 $59.04 $47.97 $75,600 $6,300 $4,200 $ $ $97.86 $70.14 $60.48 $49.14 $77,400 $6,450 $4,300 $ $ $ $71.81 $61.92 $50.31 $79,200 $6,600 $4,400 $ $ $ $73.48 $63.36 $51.48 $81,000 $6,750 $4,500 $ $ $ $75.15 $64.80 $52.65 $82,800 $6,900 $4,600 $ $ $ $76.82 $66.24 $53.82 $84,600 $7,050 $4,700 $ $ $ $78.49 $67.68 $54.99 $86,400 $7,200 $4,800 $ $ $ $80.16 $69.12 $56.16 $88,200 $7,350 $4,900 $ $ $ $81.83 $70.56 $57.33 $90,000 $7,500 $5,000 $ $ $ $83.50 $72.00 $58.50 $91,800 $7,650 $5,100 $ $ $ $85.17 $73.44 $59.67 $93,600 $7,800 $5,200 $ $ $ $86.84 $74.88 $60.84 $95,400 $7,950 $5,300 $ $ $ $88.51 $76.32 $62.01 $97,200 $8,100 $5,400 $ $ $ $90.18 $77.76 $63.18 $99,000 $8,250 $5,500 $ $ $ $91.85 $79.20 $64.35 $100,800 $8,400 $5,600 $ $ $ $93.52 $80.64 $65.52 $102,600 $8,550 $5,700 $ $ $ $95.19 $82.08 $66.69 $104,400 $8,700 $5,800 $ $ $ $96.86 $83.52 $67.86 $106,200 $8,850 $5,900 $ $ $ $98.53 $84.96 $69.03 $108,000 $9,000 $6,000 $ $ $ $ $86.40 $70.20 $109,800 $9,150 $6,100 $ $ $ $ $87.84 $71.37 $111,600 $9,300 $6,200 $ $ $ $ $89.28 $72.54 $113,400 $9,450 $6,300 $ $ $ $ $90.72 $73.71 $115,200 $9,600 $6,400 $ $ $ $ $92.16 $74.88 $117,000 $9,750 $6,500 $ $ $ $ $93.60 $76.05 $118,800 $9,900 $6,600 $ $ $ $ $95.04 $77.22 $120,600 $10,050 $6,700 $ $ $ $ $96.48 $78.39 $122,400 $10,200 $6,800 $ $ $ $ $97.92 $79.56 $124,200 $10,350 $6,900 $ $ $ $ $99.36 $80.73 $126,000 $10,500 $7,000 $ $ $ $ $ $81.90 $127,800 $10,650 $7,100 $ $ $ $ $ $83.07 $129,600 $10,800 $7,200 $ $ $ $ $ $84.24 $131,400 $10,950 $7,300 $ $ $ $ $ $85.41 $133,200 $11,100 $7,400 $ $ $ $ $ $86.58 $135,000 $11,250 $7,500 $ $ $ $ $ $87.75 Page 6

9 Yorktown Independent School District Long Term Disability Select Option Employee Plan Summary Feature Description Class Description Maximum Monthly Benefit All Active Full Time Employees Monthly flat amount elected by the employee from $200 to $7,500 in $100 increments, not to exceed 66 2/3% of monthly earnings Minimum Monthly Benefit 25% Elimination Period Employee to elect from the following options 0/7, 14/14, 30/30, 60/60, 90/90, 180/180 Benefit Duration (Sickness) Benefit Duration (Injury) Definition of Disability Return to Work Incentive Integration Method Pre-Existing Condition Limitation Takeover Provision Mental Illness Limitation Substance Abuse Limitation Family Care Credit Workplace Modification Rehabilitation Participation Requirements Recommended Treatment Requirements Survivor Income Benefit Option Employer Participates in Worker's Compensation Employee Contribution Enrollment Type Participation Requirement Number of Eligible Employees 5 Year Duration Maximum ADEA I with Social Security Normal Retirement Age 2 Years own occupation Included Direct with Family Social Security Offset Treatment Free/Lookback/Continuously Insured 3/3/12 months No Loss, No Gain 24 Month Outpatient 24 Month Outpatient Included Greater of $1000 of 2x the monthly benefit Included Included 3 Times last monthly Gross Benefit Yes Contributory Annual Open Enrollment 25% of Eligible Employees 75 Employee Rate Summary Long Term Disability See attached premium rate table Rate Guarantee: 3 Years Page 7

10 Yorktown Independent School District Annual Earnings Sickness / Accident Elimination Period in Days Monthly Earnings Monthly Benefit 0 / 7 14 / / / / / 180 $3,600 $300 $200 $6.08 $4.96 $4.00 $2.86 $2.48 $2.00 $5,400 $450 $300 $9.12 $7.44 $6.00 $4.29 $3.72 $3.00 $7,200 $600 $400 $12.16 $9.92 $8.00 $5.72 $4.96 $4.00 $9,000 $750 $500 $15.20 $12.40 $10.00 $7.15 $6.20 $5.00 $10,800 $900 $600 $18.24 $14.88 $12.00 $8.58 $7.44 $6.00 $12,600 $1,050 $700 $21.28 $17.36 $14.00 $10.01 $8.68 $7.00 $14,400 $1,200 $800 $24.32 $19.84 $16.00 $11.44 $9.92 $8.00 $16,200 $1,350 $900 $27.36 $22.32 $18.00 $12.87 $11.16 $9.00 $18,000 $1,500 $1,000 $30.40 $24.80 $20.00 $14.30 $12.40 $10.00 $19,800 $1,650 $1,100 $33.44 $27.28 $22.00 $15.73 $13.64 $11.00 $21,600 $1,800 $1,200 $36.48 $29.76 $24.00 $17.16 $14.88 $12.00 $23,400 $1,950 $1,300 $39.52 $32.24 $26.00 $18.59 $16.12 $13.00 $25,200 $2,100 $1,400 $42.56 $34.72 $28.00 $20.02 $17.36 $14.00 $27,000 $2,250 $1,500 $45.60 $37.20 $30.00 $21.45 $18.60 $15.00 $28,800 $2,400 $1,600 $48.64 $39.68 $32.00 $22.88 $19.84 $16.00 $30,600 $2,550 $1,700 $51.68 $42.16 $34.00 $24.31 $21.08 $17.00 $32,400 $2,700 $1,800 $54.72 $44.64 $36.00 $25.74 $22.32 $18.00 $34,200 $2,850 $1,900 $57.76 $47.12 $38.00 $27.17 $23.56 $19.00 $36,000 $3,000 $2,000 $60.80 $49.60 $40.00 $28.60 $24.80 $20.00 $37,800 $3,150 $2,100 $63.84 $52.08 $42.00 $30.03 $26.04 $21.00 $39,600 $3,300 $2,200 $66.88 $54.56 $44.00 $31.46 $27.28 $22.00 $41,400 $3,450 $2,300 $69.92 $57.04 $46.00 $32.89 $28.52 $23.00 $43,200 $3,600 $2,400 $72.96 $59.52 $48.00 $34.32 $29.76 $24.00 $45,000 $3,750 $2,500 $76.00 $62.00 $50.00 $35.75 $31.00 $25.00 $46,800 $3,900 $2,600 $79.04 $64.48 $52.00 $37.18 $32.24 $26.00 $48,600 $4,050 $2,700 $82.08 $66.96 $54.00 $38.61 $33.48 $27.00 $50,400 $4,200 $2,800 $85.12 $69.44 $56.00 $40.04 $34.72 $28.00 $52,200 $4,350 $2,900 $88.16 $71.92 $58.00 $41.47 $35.96 $29.00 $54,000 $4,500 $3,000 $91.20 $74.40 $60.00 $42.90 $37.20 $30.00 $55,800 $4,650 $3,100 $94.24 $76.88 $62.00 $44.33 $38.44 $31.00 $57,600 $4,800 $3,200 $97.28 $79.36 $64.00 $45.76 $39.68 $32.00 $59,400 $4,950 $3,300 $ $81.84 $66.00 $47.19 $40.92 $33.00 $61,200 $5,100 $3,400 $ $84.32 $68.00 $48.62 $42.16 $34.00 $63,000 $5,250 $3,500 $ $86.80 $70.00 $50.05 $43.40 $35.00 $64,800 $5,400 $3,600 $ $89.28 $72.00 $51.48 $44.64 $36.00 $66,600 $5,550 $3,700 $ $91.76 $74.00 $52.91 $45.88 $37.00 $68,400 $5,700 $3,800 $ $94.24 $76.00 $54.34 $47.12 $38.00 Page 8

11 Yorktown Independent School District $70,200 $5,850 $3,900 $ $96.72 $78.00 $55.77 $48.36 $39.00 $72,000 $6,000 $4,000 $ $99.20 $80.00 $57.20 $49.60 $40.00 $73,800 $6,150 $4,100 $ $ $82.00 $58.63 $50.84 $41.00 $75,600 $6,300 $4,200 $ $ $84.00 $60.06 $52.08 $42.00 $77,400 $6,450 $4,300 $ $ $86.00 $61.49 $53.32 $43.00 $79,200 $6,600 $4,400 $ $ $88.00 $62.92 $54.56 $44.00 $81,000 $6,750 $4,500 $ $ $90.00 $64.35 $55.80 $45.00 $82,800 $6,900 $4,600 $ $ $92.00 $65.78 $57.04 $46.00 $84,600 $7,050 $4,700 $ $ $94.00 $67.21 $58.28 $47.00 $86,400 $7,200 $4,800 $ $ $96.00 $68.64 $59.52 $48.00 $88,200 $7,350 $4,900 $ $ $98.00 $70.07 $60.76 $49.00 $90,000 $7,500 $5,000 $ $ $ $71.50 $62.00 $50.00 $91,800 $7,650 $5,100 $ $ $ $72.93 $63.24 $51.00 $93,600 $7,800 $5,200 $ $ $ $74.36 $64.48 $52.00 $95,400 $7,950 $5,300 $ $ $ $75.79 $65.72 $53.00 $97,200 $8,100 $5,400 $ $ $ $77.22 $66.96 $54.00 $99,000 $8,250 $5,500 $ $ $ $78.65 $68.20 $55.00 $100,800 $8,400 $5,600 $ $ $ $80.08 $69.44 $56.00 $102,600 $8,550 $5,700 $ $ $ $81.51 $70.68 $57.00 $104,400 $8,700 $5,800 $ $ $ $82.94 $71.92 $58.00 $106,200 $8,850 $5,900 $ $ $ $84.37 $73.16 $59.00 $108,000 $9,000 $6,000 $ $ $ $85.80 $74.40 $60.00 $109,800 $9,150 $6,100 $ $ $ $87.23 $75.64 $61.00 $111,600 $9,300 $6,200 $ $ $ $88.66 $76.88 $62.00 $113,400 $9,450 $6,300 $ $ $ $90.09 $78.12 $63.00 $115,200 $9,600 $6,400 $ $ $ $91.52 $79.36 $64.00 $117,000 $9,750 $6,500 $ $ $ $92.95 $80.60 $65.00 $118,800 $9,900 $6,600 $ $ $ $94.38 $81.84 $66.00 $120,600 $10,050 $6,700 $ $ $ $95.81 $83.08 $67.00 $122,400 $10,200 $6,800 $ $ $ $97.24 $84.32 $68.00 $124,200 $10,350 $6,900 $ $ $ $98.67 $85.56 $69.00 $126,000 $10,500 $7,000 $ $ $ $ $86.80 $70.00 $127,800 $10,650 $7,100 $ $ $ $ $88.04 $71.00 $129,600 $10,800 $7,200 $ $ $ $ $89.28 $72.00 $131,400 $10,950 $7,300 $ $ $ $ $90.52 $73.00 $133,200 $11,100 $7,400 $ $ $ $ $91.76 $74.00 $135,000 $11,250 $7,500 $ $ $ $ $93.00 $75.00 Page 9

12 Yorktown Independent School District Please note the following descriptions that further explain some of our benefits and features. The descriptions are based on our Standard Language. The benefits shown below are available in most states, however, please be aware that state variations may apply. General: Support: As Simple as 1, 2, 3 The Hartford offers three service options to help you administer your group benefits. We also offer online tools for your employees. Employer View Employer View is a secure, password-protected Web site where employers can quickly obtain plan information and transact business to help reduce administrative burden. We continually work to enhance the site's capabilities to make it more responsive to your needs. On Employer View, you are able to access such features as: Electronic billing Reports (available in either PDF or Excel) Medical underwriting status for evidence of insurability Claim status inquiry Booklets Administration kits with forms specific to your coverage(s) Additional Support from our Customer Solutions Center Questions or services that cannot be handled on the Web can be addressed by our Customer Solutions Center. Our skilled representatives, who are familiar with your case, are available Monday through Friday from 8 a.m. to 8 p.m. EST at and provide support to new and existing customers. Local Service Representatives If our Customer Solutions Center representatives can t assist you with your request, they ll be glad to put you in touch with a local service representative. The Hartford At Work for Your Employees TheHartfordAtWork.com, a secure, password-protected Web site, is a valuable resource that makes your job easier. This site is an informational resource for your employees that they can access at any time. The site offers employees the ability to: View claim and payment status. Check their medical underwriting status for evidence of insurability. File an STD claim in place of telephonic submission (if your plan offers this coverage). Start an LTD claim. Registered users can access forms specific to your plan's coverage(s). Obtain information on coverage overviews and frequently asked benefit questions. Enroll in direct deposit for their claim payments. Assess appropriate coverage levels and costs using an online calculator (based on industry averages). Page 13

13 Long Term Disability: Yorktown Independent School District Benefit Calculation The benefit calculation is based on the Monthly Income Loss, which is the difference of the employee s pre-disability earnings less the current monthly earnings. The Monthly Benefit will not be less than the Minimum Monthly Benefit, if one is applicable. This calculation takes into account any income that the employee may earn while still meeting the definition of disability, and eliminates the need for additional benefit calculation methods such as partial and residual. If an overpayment occurs, we may recover all or any portion of an overpayment by reducing or withholding future benefit payments, including the Minimum Monthly Benefit. First Day Hospital For those employees electing an elimination period of 30 days or less, if confined in a hospital for 24 hours or more due to a disability, the waiting period for benefits to commence will be waived, and benefits will be payable from the first day. Page 14

14 Yorktown Independent School District Benefit Duration Premium Option The Benefit Duration is the maximum time for which we pay benefits for disability resulting from sickness or injury. Depending on the schedule selected and the age at which disability occurs, the maximum duration may vary. The following schedule applies to disabilities resulting from either sickness or injury: Age Disabled Prior to Age 63 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 and over Benefits Payable To Normal Retirement Age or 48 months if greater To Normal Retirement Age or 42 months if greater 36 months 30 months 27 months 24 months 21 months 18 months Normal Retirement Age means the Social Security Normal Retirement Age as stated in the 1983 revision of the United States Social Security Act. It is determined by the date of birth as follows: Year of Birth Normal Retirement Age months months months months months 1943 thru months months months months months 1960 or after 67 Page 15

15 Yorktown Independent School District Benefit Duration Select Option The Benefit Duration is the maximum time for which we pay benefits for disability resulting from sickness or injury. Depending on the schedule selected and the age at which disability occurs, the maximum duration may vary. Schedule for disability caused by injury: Age Disabled Prior to Age 63 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 and over Benefits Payable To Normal Retirement Age or 48 months if greater To Normal Retirement Age or 42 months if greater 36 months 30 months 27 months 24 months 21 months 18 months Normal Retirement Age means the Social Security Normal Retirement Age as stated in the 1983 revision of the United States Social Security Act. It is determined by the date of birth as follows: Year of Birth Normal Retirement Age months months months months months 1943 thru months months months months months 1960 or after 67 Schedule for disability caused by sickness: Age Disabled Benefits Payable Prior to 65 5 Years Age 65 to 69 To Age 70, but not less than one year 69 and over 1 Year Page 16

16 Yorktown Independent School District Family Care Benefit This benefit is available to help a claimant with family care expenses while he or she is participating in a rehabilitation program. The allowable expenses are treated as a deduction from earnings for purposes of calculating the monthly benefit payable. The maximum monthly family care credit allowed for each qualifying child or family member is $350 during the first 12 Months of the rehabilitation program and $175 thereafter, not to exceed $2500 in a calendar year. The benefit is built into the coverage at no additional cost, and is designed to decrease as the employee's earnings increase. Job Offered but Refused In determining benefits payable, the amount of potential income from a job offered by the employer, or another employer, will be considered as earned income, even if the offer is refused. This encourages claimants to utilize return-to-work opportunities. Pre-existing Condition Limitation This limitation applies to conditions for which an employee receives medical services within 3 months of the effective date of coverage. No benefits are payable for a disability resulting from such a condition until the employee has been covered for 3 consecutive months with no medical care for the condition, or until the employee has been covered for 12 consecutive months. In addition, the amount of a benefit increase, which results from a change in benefit options, a change of class or a change in the Plan, will not be paid for any Disability that is due to, contributed to by, or results from a Pre- Existing condition. Note: This limitation does not include prudent person language, which is difficult to administer and can be unfair. Recommended Treatment Requirement Benefit payments will terminate if the claimant refuses to receive recommended treatment that is generally acknowledged by physicians to cure, correct or limit the disabling condition. This language also encourages claimants to participate in programs and treatments that can help them return to work and achieve independence. (This is not applicable in New Jersey.) Rehabilitation Participation Requirement Benefit payments will terminate if the claimant: refuses to participate in a rehabilitation program (not applicable in CA or NJ); refuses to cooperate with or try modifications made to the work site or job process, or adaptive equipment or devices designed to accommodate the claimant s identified medical limitations and enable the claimant to perform the essential duties of his/her or any occupation. A qualified physician must also agree that specific modifications or adaptive equipment accommodates the claimant s medical limitations. This language encourages claimants to take advantage of the programs and resources offered to them whenever appropriate to help them return to active, productive, independent lives. Page 17

17 Yorktown Independent School District Return to Work This incentive allows employees who return to work while disabled to receive up to 100% of predisability earnings for the first 12 months after they return to work. This encourages employees to return to full-time work as soon as possible. Survivor Income Benefit If an employee dies while receiving disability benefits, a benefit will be paid to the spouse or child(ren) of the employee. This is a way of providing eligible survivors with valuable financial help when the loss of the insured family member occurs. Workplace Modification Workplace Modification provides reimbursement to the employer for the expense of reasonable modifications made to a workplace to accommodate an employee s disability and return him/her to active full-time employment. Most accommodations cost less than $500, but this benefit will pay up to one month of the employee s maximum benefit if necessary to help get the employee back to work. No Self-Reported or Subjective Illness Limitations The Hartford LTD contracts do not contain contract wording to limit self-reported or subjective illnesses. We believe in handling claims for these conditions the same way we handle all claims by focusing on functionality instead of the diagnosis. We also do not include "prudent person" wording in our definition of what constitutes a pre-existing condition, as this is a highly subjective measurement. FICA Match Service The Hartford will match and pay a Long Term Disability policyholder s share of FICA taxes on benefits paid to disabled employees. We will also prepare all necessary Long Term Disability W 2 forms at year end. Page 18

18 Yorktown Independent School District Additional Services: Ability Assist The Hartford s Ability Assist provides employees and their dependents unlimited, 24/7 telephone access to a toll-free helpline staffed by Master s level counselors. Ability Assist is included as a part of the group Long Term Disability (LTD) insurance program. ComPsych counselors will help employees develop an assistance plan and provide referrals to a professional network of providers. They may also refer employees to support services, such as community-based help resources, not-forprofit self-help groups, and daycare for children and elderly parents. If needed, the employee and his or her dependents may use up to three face-to-face sessions per issue per year for emotional issues and unlimited telephone access for financial, legal and work-life services. Ability Assist services are provided through ComPsych, a leading provider of employee assistance and work/life services. The Hartford s Ability Assist program is included as a part of your group Long Term Disability (LTD) insurance program. Your employees and their dependents have access to Ability Assist services as soon as their LTD coverage is effective, as well as after they ve been approved for an LTD claim and are receiving LTD benefits. Should a covered employee become disabled under the LTD program, Ability Assist services will continue to provide the support disabled employees and their dependents need. LTD claimants and their immediate family members receive confidential services to assist them with the unique emotional, financial and legal issues that may result from a disability. A disabled employee will receive information about accessing Ability Assist with his or her LTD benefit check. ComPsych counselors will be available for unlimited phone contact. Three face-to-face sessions per issue per year for emotional issues or equivalent professional time are available to disabled employees and immediate family members. They also have unlimited telephone access for financial and legal services. Financial and legal advisors will provide assistance with financial planning and legal matters such as tax filing questions, serious debt issues, guardianship or power of attorney. Enhanced Ability Assist Option The services outlined above are available to employees and their dependents not covered by The Hartford s long-term disability program for an additional fee of $0.84 per employee per month. Ability Assist disclosures:ability Assist services are offered through The Hartford, however, all services are provided by ComPsych. Neither ComPsych nor Hartford is responsible or liable for care or advice rendered by any referral resources. All benefits are subject to the terms and conditions of the policy. Page 19

19 Yorktown Independent School District Travel Assistance and ID Theft Protection & Assistance Services When an employee is traveling, unexpected emergencies can occur. The Hartford has arranged through Europ Assistance USA, a 24-Hour toll-free emergency services line that helps employees, their spouses and dependents access emergency assistance worldwide, when traveling 100 miles or more from home for 90 days or less. These services are provided as part of our Group Benefits portfolio. Employees receive three kinds of travel services: 1. Emergency Medical Assistance 2. Emergency Personal Services 3. Pre-Trip Information Sometimes travel emergencies can be complicated by a lost or stolen wallet or medical information compromised by identity theft. Our travel assistance program is enhanced to include services for ID theft protection and assistance. The identity theft program provides education to prevent or avoid ID theft and resolution assistance if an employee suffers the unfortunate experience of having his or her identity stolen. Caseworkers are available 24/7 to employees, their spouse and dependents. They don't need to be traveling to use this service. Services include: Prevention through education and identity theft resolution kit Detection through credit bureau notification and fraud alert Resolution with credit information review, affidavit and card replacement assistance This is a general description of the program. A more detailed explanation of the travel assistance and ID theft program, including exclusions and limitations, is available through your sales contact with The Hartford. Page 20

20 AIG Benefit Solutions PROOF Benefits Brochure Group Critical Illness Insurance Be prepared if a critical illness arises For the employees of Yorktown ISD Policies issued by: American General Life Insurance Company

21 Why Critical Illness Insurance? Even with excellent medical insurance, just one critical illness can be a tremendous financial burden. Being diagnosed with a critical illness can generate costs that may or may not be covered by traditional health plans. Non-medical-related expenses and out-of-pocket costs such as co-pays, deductibles, loss of income and experimental drug treatments are frequently not covered by health insurance. A critical illness insurance policy can help you cover these costs, leaving your family savings intact. How Does Group Critical Illness Insurance Work? Upon diagnosis of a covered critical illness, Group Critical Illness insurance delivers a benefit directly to you to use as you see fit: What Can Group Critical Illness Insurance Offer Me? Added Security Delivers a lump sum on first diagnosis. Continues to pay if you have more than one critical illness. Covers a broad range of conditions, including heart attack, stroke and kidney failure. Provides annual health screening benefit for all insureds. Lets you cover your spouse up to 100 percent of your own coverage. Provides coverage for your children at no additional cost. Financial Advantages Benefits paid as a lump sum directly to you. No restrictions on how your benefit is used. Convenience and Flexibility Premiums paid through payroll deduction no checks to write. If you leave your place of employment, you may be able to continue your coverage while the group policy is in effect. Tim s Story 1 When Tim suffered a heart attack, his health insurance covered most medical costs. However, his co-pays, deductibles and outside expenses added up to a large amount. Furthermore, his disability insurance only covered part of his income. Fortunately, Tim was also covered by a group critical illness policy, which delivered a lump-sum cash benefit directly to him upon initial diagnosis.

22 Group Critical Illness Benefit Summary No one expects a critical illness to strike, which is why diagnosis can be much more than an emotional shock. The cost of treatment is often substantial. With a quality critical illness policy, the proceeds can be used to absorb non-covered medical expenses, shortfalls in disability benefits, or any number of other financial issues associated with life changes following a critical illness diagnosis. The following benefits are payable under Group Critical Illness (Plan C). All benefits are paid directly to you. See the certificate for details regarding benefit descriptions, limitations and exclusions. Features and Benefits Issue ages You and your spouse: Your dependent child: Under age 19; to 23 if a full-time student (state variation applies) Employee benefit amount Dependent spouse benefit amount Dependent child benefit amount Additional diagnosis benefit Recurrence benefit Benefit reduction Waiting period Covered conditions and benefits 2 Heart attack 100% Stroke 100% Invasive cancer 100% Renal failure 100% Major organ transplant 100% Coronary artery bypass 3 25% Coma 25% Loss of sight, speech or hearing 25% In situ cancer 25% Cancer death benefit $5,000 Health screening $2,500 $50,000 in increments of $5,000 after initial $5,000 benefit amount Up to 100% of employee amount (employee must apply for coverage to be eligible) 25% of the employee amount (employee must apply for coverage to be eligible); no additional cost An additional benefit will be paid upon the diagnosis of a subsequent medically unrelated condition for which benefits have not been previously paid; there is no time period that must separate the two conditions. If an insured receives the full benefit for a covered condition and is later diagnosed with the same condition, the full benefit will be paid again, as long as the two dates of diagnosis are at least 12 months apart (applies only to the following critical illnesses: stroke, renal failure, invasive cancer and heart attack). At age 70, the benefit reduces to 50% of the face amount. 30 days from the effective date of coverage for the first diagnosis of a critical illness $50 (one test per calendar year) Treatment-Related Benefits for Cancer for Which a Critical Illness Benefit Is Payable Antinausea medication Actual charges up to $100 per month (no lifetime maximum) Blood and plasma Inpatient: $2,000 lifetime limit Outpatient: $300 lifetime limit Experimental treatment Actual charges up to $300 per day; not payable on the same day that radiation or chemotherapy benefit is payable (no lifetime maximum) Radiation and chemotherapy Actual charges up to $1,000 per month

23 Enroll Today! Enroll in Group Critical Illness insurance today. Your premium will be conveniently taken through payroll deduction. For more information, please contact: Pre-existing Conditions and Limitations (state variations may apply) Benefits under this policy are not payable in connection with a pre-existing condition during the initial 12 consecutive months the insured person has been enrolled for coverage under this policy. A critical illness resulting from a pre-existing condition commencing thereafter will be covered unless otherwise excluded from the policy. A pre-existing condition generally means an injury or sickness for which you incurred charges; received medical treatment, consultation, care or services, including diagnostic measures; took prescribed drugs or medicines; or had symptoms for which an ordinarily prudent person would have consulted a physician during the 12 months immediately preceding the coverage effective date under this policy. Exclusions (state variations may apply) This policy does not cover any loss caused in whole or in part by, or resulting in whole or in part from, the following: The insured person s suicide or intentional self-inflicted injury or sickness, while sane or insane. The insured person s being under the influence of an excitant, depressant, hallucinogen, narcotic, or other drug or intoxicant, including those taken as prescribed by a physician. The insured person s commission of or attempt to commit an assault or felony. The insured person s engaging in an illegal activity or occupation. The insured person s voluntary participation in a riot. Any illness, loss or condition specifically excluded from the definition of any critical illness. War, declared or not; however, this does not include loss due to terrorism. Balloon angioplasty, laser relief of an obstruction, and/or other intra-arterial procedures. 1. Not an actual case; presented for illustrative purposes only. 2. Benefit payable as percentage of face amount. Partial benefits for coma, coronary artery bypass, or loss of sight, hearing or speech do not reduce any of the other critical illness benefits. 3. Heart and Stroke Statistics, 2012 Update, American Heart Association. Policies issued by: American General Life Insurance Company Houston, Texas Policy form number: GCI AIG Benefit Solutions is the marketing name for the domestic benefits i division of of American International Group, Inc. Inc. Yorktown <<COMPANY ISD is a separate NAME> and is a separate unrelated and entity. unrelated entity.> The underwriting risks, ffinancial i and contractual obligations, and support functions associated with products issued by by American General Life Life Insurance Company are are its its responsibility. American General Life Insurance Company does not solicit business in in the the state of of New York. Not all policies are available in all states. This is a summary only of products and services offered. Actual offerings may vary by group size and are subject to to state insurance law, and the benefits/provisions i as as described may may vary vary due to such law. All products are subject to the terms, conditions, limitations and and exclusions of of the the policy. Please see see policy and certificate icate for details. Comprehensive medical coverage may be required in some states in in order to to apply for or or maintain this this coverage. If If applicable, applicable, any any rates rates shown shown are are based based on on the the information information provided provided at at the the time time of of quoting quoting and and are are subject subject to to adjustment adjustment in in the the event event such such information information changes. changes. Group Group Critical Critical Illness Illness is is the the marketing marketing name name for for the the Group Group Critical Critical Illness Illness Insurance Insurance Policy. Policy All rights reserved All rights reserved. AIGB100206DOD R08/13 AIGB106269DOD R08/13 <The logo for <COMPANY NAME> is not a registered trademark of American International Group, Inc. All other marks are owned by American International Group, Inc.>

24 Solutions to Meet Your Benefit Needs Why Group Critical Illness Insurance? No one expects a critical illness to strike, which is why diagnosis can come as a financial and/or emotional shock. The costs of treatment are often substantial. That's why it's beneficial to seek a quality critical illness policy. The proceeds can be used to absorb non-covered medical expenses, shortfalls in disability benefits, or any number of other financial issues associated with life-changes following a covered critical illness. Think of it as a "living benefit". Group Critical Illness (Employee-Paid) Plan Features Three plan options Flexible coverage amounts up to $50,000 Lump-sum benefits payable to the employee: - First diagnosis payable upon the first diagnosis of a covered critical illness - Additional First Diagnosis an additional benefit will be paid upon the diagnosis of a subsequent medically unrelated condition for which benefits have not been previously paid; there is no time period that must separate the two critical illnesses. - Recurrence of a covered critical illness if benefits have been paid for Heart Attack, Invasive Cancer, Renal Failure or Stroke and subsequently, the insured experiences a recurrence of the same critical illness, the benefit will be paid again, provided the subsequent diagnosis occurs more than 12 months following the initial diagnosis Spouse coverage available up to 100 percent of employee amount Child coverage available at 25 percent of employee amount Health Savings Account (HSA) Compatible This plan is compliant for employers that offer a Health Savings Account to their employees alongside a High Deductible Health Plan 1 [ 1 Although the Company has attempted to ensure that the benefits included in this policy are HSA Compatible, Employers need to consult their own advisors as to whether the inclusion of these benefits into the Employer's offerings creates coverage that would make an employee ineligible to contribute to an HSA] WEEKLY RATES Option 1 (Class All employees) Plan C Non Tobacco Rates - Employee Issue Age $2,500 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $1.05 $1.29 $1.75 $2.22 $2.69 $3.15 $3.62 $4.09 $4.56 $5.03 $ $1.37 $1.83 $2.74 $3.66 $4.57 $5.48 $6.39 $7.31 $8.22 $9.13 $ $2.07 $2.97 $4.77 $6.57 $8.37 $10.17 $11.96 $13.76 $15.56 $17.36 $ $2.96 $4.41 $7.31 $10.21 $13.11 $16.01 $18.92 $21.82 $24.72 $27.62 $ $4.79 $7.12 $11.80 $16.47 $21.14 $25.82 $30.49 $35.16 $39.84 $44.51 $49.19 Quote ID: Industry classification: Elementary and Secondary Schools Page 3 of 9

25 Group Critical Illness (Employee-Paid) Continued Option 1 (Class All employees) Plan C Non Tobacco Rates - Spouse Issue Age $1,250 $2,500 $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $0.93 $1.05 $1.29 $1.52 $1.75 $1.99 $2.22 $2.46 $2.69 $2.92 $ $1.14 $1.37 $1.83 $2.28 $2.74 $3.20 $3.66 $4.11 $4.57 $5.02 $ $1.62 $2.07 $2.97 $3.87 $4.77 $5.67 $6.57 $7.47 $8.37 $9.27 $ $2.23 $2.96 $4.41 $5.86 $7.31 $8.76 $10.21 $11.66 $13.11 $14.56 $ $3.62 $4.79 $7.12 $9.46 $11.80 $14.13 $16.47 $18.81 $21.14 $23.48 $25.82 Option 1 (Class All employees) Plan C Non Tobacco Rates - Spouse Issue Age $27,500 $30,000 $32,500 $35,000 $37,500 $40,000 $42,500 $45,000 $47,500 $50, $3.39 $3.62 $3.86 $4.09 $4.32 $4.56 $4.79 $5.03 $5.26 $ $5.94 $6.39 $6.85 $7.31 $7.76 $8.22 $8.68 $9.13 $9.59 $ $11.07 $11.96 $12.86 $13.76 $14.66 $15.56 $16.46 $17.36 $18.26 $ $17.46 $18.92 $20.37 $21.82 $23.27 $24.72 $26.17 $27.62 $29.07 $ $28.16 $30.49 $32.83 $35.16 $37.50 $39.84 $42.18 $44.51 $46.85 $49.19 Option 1 (Class All employees) Plan C Tobacco Rates - Employee Issue Age $2,500 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $1.19 $1.57 $2.31 $3.06 $3.81 $4.56 $5.31 $6.06 $6.80 $7.55 $ $1.66 $2.41 $3.91 $5.40 $6.90 $8.39 $9.89 $11.38 $12.87 $14.37 $ $2.67 $4.16 $7.14 $10.12 $13.10 $16.08 $19.06 $22.04 $25.02 $28.00 $ $3.93 $6.35 $11.18 $16.02 $20.85 $25.68 $30.52 $35.35 $40.19 $45.02 $ $6.35 $10.24 $18.02 $25.80 $33.59 $41.37 $49.15 $56.93 $64.71 $72.49 $80.28 Option 1 (Class All employees) Plan C Tobacco Rates - Spouse Issue Age $1,250 $2,500 $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $1.00 $1.19 $1.57 $1.94 $2.31 $2.69 $3.06 $3.44 $3.81 $4.19 $ $1.29 $1.66 $2.41 $3.16 $3.91 $4.65 $5.40 $6.15 $6.90 $7.64 $ $1.92 $2.67 $4.16 $5.65 $7.14 $8.63 $10.12 $11.61 $13.10 $14.59 $ $2.72 $3.93 $6.35 $8.76 $11.18 $13.60 $16.02 $18.43 $20.85 $23.27 $ $4.41 $6.35 $10.24 $14.13 $18.02 $21.91 $25.80 $29.70 $33.59 $37.48 $41.37 Quote ID: Industry classification: Elementary and Secondary Schools Page 4 of 9