Benefits Guide 245 Landa Street New Braunfels, Texas Phone: (830) Fax (830)

Transcription

1 Celebrate Innovate Redefine Possible Benefits Guide 245 Landa Street New Braunfels, Texas Phone: (830) Fax (830)

2 OPEN ENROLLMENT INSURANCE BENEFITS FOR THE PLAN YEAR The Section 125 Cafeteria Plan year will begin on 09/01/2015 and end on 08/31/2016. All changes that are made during Open Enrollment will go in effect 09/01/2015. All deduction changes will be reflected in your September paycheck. Please refer to the chart below for specific plan effective dates and the pay periods in which we will begin deducting: INSURANCE DEDUCTION EFFECTIVE DATE PAYROLL DEDUCTION BEGINS TRS Health Insurance September 1 September Standard Disability September 1 September Texas Life Insurance September 1 September Lincoln Financial Term Life September 1 September Central United Cancer September 1 September Aflac-Critical Illness September 1 September Aflac - Accident September 1 September Lincoln Dental September 1 September Ameritas Vision September 1 September TASC- Medical Reimbursement September 1 September TASC-Child Care Reimbursement September 1 September Please note that if you will be new to the Standard disability and/or the Central United Cancer plans effective 09/01/2015, pre-existing conditions and waiting periods will apply. Standard Disability- the pre-existing condition exclusion will not cover any disability that begins in the first 12 months after your effective date of coverage that is caused by, contributed to by, or resulting from a consultation, care or services including diagnostic measures, or took prescribed drugs or medicines within 180 days just prior to your effective date of coverage. However, the plan will pay full benefits for up to 90 days if you are out due to a pre existing condition. After 90 days, benefits will only continue if the pre existing condition does not apply. Central United Cancer- The policy and riders contain a 30 day waiting period that begins on the effective date. No benefits are payable for any covered person who has cancer or a specified disease diagnosed before coverage has been in force 30 days from the effective date. Please check your September 2015 paycheck(s) to make sure that the correct benefits are being deducted. If you do find a discrepancy in your paycheck, please contact Stefanie Cisneros immediately at (512) or by at stefanie.cisneros@lockhart.txed.net so that the correction can be made. You may also contact Ms. Cisneros if you should have any additional questions.

3 CONTACT INFORMATION Please contact U.S. Employee Benefits Services Group if you have any questions regarding your supplemental benefits at For questions regarding TRS, please contact the district or TRS directly. TABLE OF CONTENTS INROLL INSTRUCTIONS page 4 Phone: U.S.Employee Benefits Services Group Web Site: LONG TERM CARE-Genworth...page 5 Phone: Web Site: DISABILITY- THE STANDARD...page(s) 6-14 Phone: Web Site: INDIVIDUAL LIFE-TEXAS LIFE INSURANCE...page(s) Phone: Web Site: GROUP LIFE LINCOLN FINANCIAL GROUP..page (s) Phone: Web Site: CANCER- CENTRAL UNITED LIFE INSURANCE...page(s) Phone: Web Site: CRITICAL ILLNESS & ACCIDENT INSURANCE- AFLAC.page(s) Phone: Web Site:

4 CONTACT INFORMATION DENTAL-LINCOLN FINANCIAL...page(s) Phone: Web Site: VISION-AMERITAS GROUP...page(s) Phone: Web Site: SECTION 125 PLAN-TASC...page(s) Phone: Fax: Web Site: 403B- THE OMNI GROUP..... page 51 Phone: Web Site: DISTRICT CONTACT: Stefanie Cisneros Employee Benefits Office: (512) Fax: (512) *This benefit booklet highlights certain features from the different policies and riders but is not the insurance contract. Please refer to the group master application or your policy for a full disclosure of benefits.

5 BENEFIT ENROLLMENT INSTRUCTIONS You will sign up for all benefits through our online enrollment system, In-Roll at We encourage all employees to make arrangements to either visit a representative or go online to verify your personal information and benefit election. Verify all information for yourself and all dependents. Only the dependents listed in In-Roll will be eligible for benefits. Under each benefit section, you must accept or waive the coverage for yourself and each dependent listed. Always print a confirmation sheet once you have completed your enrollment to keep for your records. USERNAME AND SECURE PASSWORD: User Name- Your user name will be the first initial of the legal first name on record with your employer, followed by your entire last name, followed by the last 4 digits of your SS#. (Ex: employee name- Robert Smith, SS# User Name will be: rsmith6789) Default Password- Your default password for the initial log in will be lockhartisd All Passwords have been reset to the Default Password for the open enrollment. Be sure to change your password to something that is easy to remember, yet secure, as you will be the only one with access to it. Once you have successfully changed your password you will be directed to a Welcome Page. WELCOME PAGE: CONFIRMATION STATEMENT: Once you have completed your enrollment, you will see a Confirmation Statement. This page shows you the benefit selections made, the cost of these benefits, and dependents entered into the system. Click the Print and Save button at the bottom of this page to create a printable version of this document. Once the printable version appears, click file/print to print a copy for your records. Note: If you have a valid address in the system, you can also request to have a copy of your Confirmation Statement ed to you. If the option to a statement does not appear, return to the Verify Information screen and make sure you have a valid address entered in InRoll. After this document prints, click the Exit link at the top of the page to close your enrollment site. InRoll Online Benefit Enrollment Assistance: (830) gapadilla@usebsg.com Please read the information and instructions included on the Welcome Page, about your benefits and how to enroll in your benefits. 4

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7 Educator Options Voluntary Long Term Disability Coverage Highlights Texas Lockhart Independent School District Voluntary Long Term Disability Insurance Standard Insurance Company has developed this document to provide you with information about the optional insurance coverage you may select through the Lockhart Independent School District. Written in non-technical language, this is not intended as a complete description of the coverage. If you have additional questions, please check with your human resources representative. Employer Plan Effective Date The group policy effective date is September 1, Eligibility To become insured, you must be: A regular, full-time employee of the Lockhart Independent School District, excluding temporary or seasonal employees, full-time members of the armed forces, leased employees or independent contractors Actively at work at least 15 hours each week A citizen or resident of the United States or Canada Employee Coverage Effective Date Please contact your human resources representative for more information regarding the following requirements that must be satisfied for your insurance to become effective. You must satisfy: Eligibility requirements An eligibility waiting period of the first day of the month coinciding with or next following your date of hire An evidence of insurability requirement, if applicable An active work requirement. This means that if you are not actively at work on the day before the scheduled effective date of insurance, your insurance will not become effective until the day after you complete one day of active work as an eligible employee. Benefit Amount You may select a monthly benefit amount in $100 increments from $300 to $8,000; based on the tables and guidelines presented in the Rates section of these Coverage Highlights. The monthly benefit amount must not exceed 66 2/3 percent of your monthly earnings. Plan Maximum Monthly Benefit: 66 2/3 percent of predisability earnings Plan Minimum Monthly Benefit: 10 percent of your LTD benefit before reduction by deductible income SI (4/15) 6

8 Standard Insurance Company Educator Options Voluntary Long Term Disability Coverage Highlights Texas Lockhart Independent School District Benefit Waiting Period and Maximum Benefit Period The benefit waiting period is the period of time that you must be continuously disabled before benefits become payable. Benefits are not payable during the benefit waiting period. The maximum benefit period is the period for which benefits are payable. The benefit waiting period and maximum benefit period associated with your plan options are shown below: Option Accidental Injury Other Disability Maximum Benefit Period 1 7 days 7 days To SSNRA for Sickness and Accident 2 14 days 14 days To SSNRA for Sickness and Accident 3 30 days 30 days To SSNRA for Sickness and Accident 4 60 days 60 days To SSNRA for Sickness and Accident 5 90 days 90 days To SSNRA for Sickness and Accident Options 1-5: Maximum Benefit Period of To SSNRA for Sickness and Accident If you become disabled before age 62, LTD benefits may continue during disability until you reach age 65 or to the Social Security Normal Retirement Age (SSNRA) or 3 years 6 months, whichever is longer. If you become disabled at age 62 or older, the benefit duration is determined by your age when disability begins: Age Maximum Benefit Period 62 To SSNRA, or 3 years 6 months, whichever is longer 63 To SSNRA, or 3 years, whichever is longer 64 To SSNRA, or 2 years 6 months, whichever is longer 65 2 years 66 1 year 9 months 67 1 year 6 months 68 1 year 3 months year First Day Hospital Benefit With this benefit, if an insured employee is admitted as a hospital inpatient for at least four hours during the Benefit Waiting Period, the Benefit Waiting Period will be satisfied. Benefits become payable on the date of hospitalization; the maximum benefit period also begins on that date. This feature is included only on LTD plans with Benefit Waiting Periods of 30 days or less. Preexisting Condition Exclusion A general description of the preexisting condition exclusion is included in the Group Voluntary Long Term Disability Insurance for Educators and Administrators brochure. If you have questions, please check with your human resources representative. Preexisting Condition Period: The 180-day period just before your insurance becomes effective Exclusion Period: 12 months SI (4/15) 7

9 Standard Insurance Company Educator Options Voluntary Long Term Disability Coverage Highlights Texas Lockhart Independent School District Preexisting Condition Waiver If your insurance has been in force for 12 months or more, for the first 30 days of disability after the benefit waiting period, the Preexisting Condition provision will not be applied to an increase in your benefit amount. After 30 days of benefits, the Preexisting Condition provision will apply to increases of more than $300. The Preexisting Condition Provision applies immediately if you: Decrease your Benefit Waiting Period by more than one level; or Increase your Maximum Benefit Period If a disability is deemed to be a Preexisting Condition, benefits are payable under your prior elections, if any. If your insurance has been in force for less than 12 months and your disability is found to be a Preexisting Condition, you may be eligible for up to 30 days of benefits if you are disabled and meet all applicable policy provisions. Own Occupation Period For the plan s definition of disability, as described in your brochure, the own occupation period is the first 12 months for which LTD benefits are paid. Any Occupation Period The any occupation period begins at the end of the own occupation period and continues until the end of the maximum benefit period. Other LTD Features Employee Assistance Program (EAP) This program offers support, guidance and resources that can help an employee resolve personal issues and meet life s challenges. Family Care Expense Adjustment Disabled employees faced with the added expense of family care when returning to work may receive combined income from LTD benefits and work earnings in excess of 100 percent of indexed predisability earnings during the first 12 months immediately after a disabled employee s return to work. Special Dismemberment Provision If an employee suffers a lost as a result of an accident, the employee will be considered disabled for the applicable Minimum Benefit Period and can extend beyond the end of the Maximum Benefit Period Reasonable Accommodation Expense Benefit Subject to The Standard s prior approval, this benefit allows us to pay up to $25,000 of an employer s expenses toward work-site modifications that result in a disabled employee s return to work. Survivor Benefit A Survivor Benefit may also be payable. This benefit can help to address a family s financial need in the event of the employee s death. Return to Work (RTW) Incentive The Standard s RTW Incentive is one of the most comprehensive in the employee benefits history. For the first 12 months after returning to work, the employee s LTD benefit will not be reduced by work earnings until work earnings plus the LTD benefit exceed 100 percent of predisability earnings. After that period, only 50 percent of work earnings are deducted. Rehabilitation Plan Provision Subject to The Standard s prior approval, rehabilitation incentives may include training and education expense, family (child and elder) care expenses, and job-related and job search expenses. SI (4/15) 8

10 Standard Insurance Company Educator Options Voluntary Long Term Disability Coverage Highlights Texas Lockhart Independent School District When Benefits End LTD benefits end automatically on the earliest of: The date you are no longer disabled The date your maximum benefit period ends The date you die The date benefits become payable under any other LTD plan under which you become insured through employment during a period of temporary recovery The date you fail to provide proof of continued disability and entitlement to benefits Rates Employees can select a monthly LTD benefit ranging from a minimum of $300 to a maximum amount based on how much they earn. Referencing the appropriate attached charts, follow these steps to find the monthly cost for your desired level of monthly LTD benefit and benefit waiting period: 1. Find the maximum LTD benefit by locating the amount of your earnings in either the Annual Earnings or Monthly Earnings column. The LTD benefit amount shown associated with these earnings is the maximum amount you can receive. If your earnings fall between two amounts, you must select the lower amount. 2. Select the desired monthly LTD benefit between the minimum of $300 and the determined maximum amount, making sure not to exceed the maximum for your earnings. 3. In the same row, select the desired benefit waiting period to see the monthly cost for that selection. If you have questions regarding how to determine your monthly LTD benefit, the benefit waiting period, or the premium payment of your desired benefit, please contact your human resources representative. Group Insurance Certificate If you become insured, you will receive a group insurance certificate containing a detailed description of the insurance coverage. The information presented above is controlled by the group policy and does not modify it in any way. The controlling provisions are in the group policy issued by Standard Insurance Company. SI (4/15) 9

11 Standard Insurance Company Educator Options Voluntary Long Term Disability Coverage Highlights Texas Lockhart Independent School District Option 1 (7 days for Accidental Injury / 7 days for Other Disability): If your gross annual salary is at least: You are eligible for a maximum monthly benefit of: Monthly Premium If your gross annual salary is at least: You are eligible for a maximum monthly benefit of: Monthly Premium $5,400 $300 $10.77 $75,600 $4,200 $ $7,200 $400 $14.36 $77,400 $4,300 $ $9,000 $500 $17.95 $79,200 $4,400 $ $10,800 $600 $21.54 $81,000 $4,500 $ $12,600 $700 $25.13 $82,800 $4,600 $ $14,400 $800 $28.72 $84,600 $4,700 $ $16,200 $900 $32.31 $86,400 $4,800 $ $18,000 $1,000 $35.90 $88,200 $4,900 $ $19,800 $1,100 $39.49 $90,000 $5,000 $ $21,600 $1,200 $43.08 $91,800 $5,100 $ $23,400 $1,300 $46.67 $93,600 $5,200 $ $25,200 $1,400 $50.26 $95,400 $5,300 $ $27,000 $1,500 $53.85 $97,200 $5,400 $ $28,800 $1,600 $57.44 $99,000 $5,500 $ $30,600 $1,700 $61.03 $100,800 $5,600 $ $32,400 $1,800 $64.62 $102,600 $5,700 $ $34,200 $1,900 $68.21 $104,400 $5,800 $ $36,000 $2,000 $71.80 $106,200 $5,900 $ $37,800 $2,100 $75.39 $108,000 $6,000 $ $39,600 $2,200 $78.98 $109,800 $6,100 $ $41,400 $2,300 $82.57 $111,600 $6,200 $ $43,200 $2,400 $86.16 $114,400 $6,300 $ $45,000 $2,500 $89.75 $115,200 $6,400 $ $46,800 $2,600 $93.34 $117,000 $6,500 $ $48,600 $2,700 $96.93 $118,800 $6,600 $ $50,400 $2,800 $ $120,600 $6,700 $ $52,200 $2,900 $ $122,400 $6,800 $ $54,000 $3,000 $ $124,200 $6,900 $ $55,800 $3,100 $ $126,000 $7,000 $ $57,600 $3,200 $ $127,800 $7,100 $ $59,400 $3,300 $ $129,600 $7,200 $ $61,200 $3,400 $ $131,400 $7,300 $ $63,000 $3,500 $ $133,200 $7,400 $ $64,800 $3,600 $ $135,000 $7,500 $ $66,600 $3,700 $ $136,800 $7,600 $ $68,400 $3,800 $ $138,600 $7,700 $ $70,200 $3,900 $ $140,400 $7,800 $ $72,000 $4,000 $ $142,200 $7,900 $ $73,800 $4,100 $ $144,000 $8,000 $ SI (4/15) 10

12 Standard Insurance Company Educator Options Voluntary Long Term Disability Coverage Highlights Texas Lockhart Independent School District Option 2 (14 days for Accidental Injury / 14 days for Other Disability): If your gross annual salary is at least: You are eligible for a maximum monthly benefit of: Monthly Premium If your gross annual salary is at least: You are eligible for a maximum monthly benefit of: Monthly Premium $5,400 $300 $8.82 $75,600 $4,200 $ $7,200 $400 $11.76 $77,400 $4,300 $ $9,000 $500 $14.70 $79,200 $4,400 $ $10,800 $600 $17.64 $81,000 $4,500 $ $12,600 $700 $20.58 $82,800 $4,600 $ $14,400 $800 $23.52 $84,600 $4,700 $ $16,200 $900 $26.46 $86,400 $4,800 $ $18,000 $1,000 $29.40 $88,200 $4,900 $ $19,800 $1,100 $32.34 $90,000 $5,000 $ $21,600 $1,200 $35.28 $91,800 $5,100 $ $23,400 $1,300 $38.22 $93,600 $5,200 $ $25,200 $1,400 $41.16 $95,400 $5,300 $ $27,000 $1,500 $44.10 $97,200 $5,400 $ $28,800 $1,600 $47.04 $99,000 $5,500 $ $30,600 $1,700 $49.98 $100,800 $5,600 $ $32,400 $1,800 $52.92 $102,600 $5,700 $ $34,200 $1,900 $55.86 $104,400 $5,800 $ $36,000 $2,000 $58.80 $106,200 $5,900 $ $37,800 $2,100 $61.74 $108,000 $6,000 $ $39,600 $2,200 $64.68 $109,800 $6,100 $ $41,400 $2,300 $67.62 $111,600 $6,200 $ $43,200 $2,400 $70.56 $114,400 $6,300 $ $45,000 $2,500 $73.50 $115,200 $6,400 $ $46,800 $2,600 $76.44 $117,000 $6,500 $ $48,600 $2,700 $79.38 $118,800 $6,600 $ $50,400 $2,800 $82.32 $120,600 $6,700 $ $52,200 $2,900 $85.26 $122,400 $6,800 $ $54,000 $3,000 $88.20 $124,200 $6,900 $ $55,800 $3,100 $91.14 $126,000 $7,000 $ $57,600 $3,200 $94.08 $127,800 $7,100 $ $59,400 $3,300 $97.02 $129,600 $7,200 $ $61,200 $3,400 $99.96 $131,400 $7,300 $ $63,000 $3,500 $ $133,200 $7,400 $ $64,800 $3,600 $ $135,000 $7,500 $ $66,600 $3,700 $ $136,800 $7,600 $ $68,400 $3,800 $ $138,600 $7,700 $ $70,200 $3,900 $ $140,400 $7,800 $ $72,000 $4,000 $ $142,200 $7,900 $ $73,800 $4,100 $ $144,000 $8,000 $ SI (4/15) 11

13 Standard Insurance Company Educator Options Voluntary Long Term Disability Coverage Highlights Texas Lockhart Independent School District Option 3 (30 days for Accidental Injury / 30 days for Other Disability): If your gross annual salary is at least: You are eligible for a maximum monthly benefit of: Monthly Premium If your gross annual salary is at least: You are eligible for a maximum monthly benefit of: Monthly Premium $5,400 $300 $7.08 $75,600 $4,200 $99.12 $7,200 $400 $9.44 $77,400 $4,300 $ $9,000 $500 $11.80 $79,200 $4,400 $ $10,800 $600 $14.16 $81,000 $4,500 $ $12,600 $700 $16.52 $82,800 $4,600 $ $14,400 $800 $18.88 $84,600 $4,700 $ $16,200 $900 $21.24 $86,400 $4,800 $ $18,000 $1,000 $23.60 $88,200 $4,900 $ $19,800 $1,100 $25.96 $90,000 $5,000 $ $21,600 $1,200 $28.32 $91,800 $5,100 $ $23,400 $1,300 $30.68 $93,600 $5,200 $ $25,200 $1,400 $33.04 $95,400 $5,300 $ $27,000 $1,500 $35.40 $97,200 $5,400 $ $28,800 $1,600 $37.76 $99,000 $5,500 $ $30,600 $1,700 $40.12 $100,800 $5,600 $ $32,400 $1,800 $42.48 $102,600 $5,700 $ $34,200 $1,900 $44.84 $104,400 $5,800 $ $36,000 $2,000 $47.20 $106,200 $5,900 $ $37,800 $2,100 $49.56 $108,000 $6,000 $ $39,600 $2,200 $51.92 $109,800 $6,100 $ $41,400 $2,300 $54.28 $111,600 $6,200 $ $43,200 $2,400 $56.64 $114,400 $6,300 $ $45,000 $2,500 $59.00 $115,200 $6,400 $ $46,800 $2,600 $61.36 $117,000 $6,500 $ $48,600 $2,700 $63.72 $118,800 $6,600 $ $50,400 $2,800 $66.08 $120,600 $6,700 $ $52,200 $2,900 $68.44 $122,400 $6,800 $ $54,000 $3,000 $70.80 $124,200 $6,900 $ $55,800 $3,100 $73.16 $126,000 $7,000 $ $57,600 $3,200 $75.52 $127,800 $7,100 $ $59,400 $3,300 $77.88 $129,600 $7,200 $ $61,200 $3,400 $80.24 $131,400 $7,300 $ $63,000 $3,500 $82.60 $133,200 $7,400 $ $64,800 $3,600 $84.96 $135,000 $7,500 $ $66,600 $3,700 $87.32 $136,800 $7,600 $ $68,400 $3,800 $89.68 $138,600 $7,700 $ $70,200 $3,900 $92.04 $140,400 $7,800 $ $72,000 $4,000 $94.40 $142,200 $7,900 $ $73,800 $4,100 $96.76 $144,000 $8,000 $ SI (4/15) 12

14 Standard Insurance Company Educator Options Voluntary Long Term Disability Coverage Highlights Texas Lockhart Independent School District Option 4 (60 days for Accidental Injury / 60 days for Other Disability): If your gross annual salary is at least: You are eligible for a maximum monthly benefit of: Monthly Premium If your gross annual salary is at least: You are eligible for a maximum monthly benefit of: Monthly Premium $5,400 $300 $6.00 $75,600 $4,200 $84.00 $7,200 $400 $8.00 $77,400 $4,300 $86.00 $9,000 $500 $10.00 $79,200 $4,400 $88.00 $10,800 $600 $12.00 $81,000 $4,500 $90.00 $12,600 $700 $14.00 $82,800 $4,600 $92.00 $14,400 $800 $16.00 $84,600 $4,700 $94.00 $16,200 $900 $18.00 $86,400 $4,800 $96.00 $18,000 $1,000 $20.00 $88,200 $4,900 $98.00 $19,800 $1,100 $22.00 $90,000 $5,000 $ $21,600 $1,200 $24.00 $91,800 $5,100 $ $23,400 $1,300 $26.00 $93,600 $5,200 $ $25,200 $1,400 $28.00 $95,400 $5,300 $ $27,000 $1,500 $30.00 $97,200 $5,400 $ $28,800 $1,600 $32.00 $99,000 $5,500 $ $30,600 $1,700 $34.00 $100,800 $5,600 $ $32,400 $1,800 $36.00 $102,600 $5,700 $ $34,200 $1,900 $38.00 $104,400 $5,800 $ $36,000 $2,000 $40.00 $106,200 $5,900 $ $37,800 $2,100 $42.00 $108,000 $6,000 $ $39,600 $2,200 $44.00 $109,800 $6,100 $ $41,400 $2,300 $46.00 $111,600 $6,200 $ $43,200 $2,400 $48.00 $114,400 $6,300 $ $45,000 $2,500 $50.00 $115,200 $6,400 $ $46,800 $2,600 $52.00 $117,000 $6,500 $ $48,600 $2,700 $54.00 $118,800 $6,600 $ $50,400 $2,800 $56.00 $120,600 $6,700 $ $52,200 $2,900 $58.00 $122,400 $6,800 $ $54,000 $3,000 $60.00 $124,200 $6,900 $ $55,800 $3,100 $62.00 $126,000 $7,000 $ $57,600 $3,200 $64.00 $127,800 $7,100 $ $59,400 $3,300 $66.00 $129,600 $7,200 $ $61,200 $3,400 $68.00 $131,400 $7,300 $ $63,000 $3,500 $70.00 $133,200 $7,400 $ $64,800 $3,600 $72.00 $135,000 $7,500 $ $66,600 $3,700 $74.00 $136,800 $7,600 $ $68,400 $3,800 $76.00 $138,600 $7,700 $ $70,200 $3,900 $78.00 $140,400 $7,800 $ $72,000 $4,000 $80.00 $142,200 $7,900 $ $73,800 $4,100 $82.00 $144,000 $8,000 $ SI (4/15) 13

15 Standard Insurance Company Educator Options Voluntary Long Term Disability Coverage Highlights Texas Lockhart Independent School District Option 5 (90 days for Accidental Injury / 90 days for Other Disability): If your gross annual salary is at least: You are eligible for a maximum monthly benefit of: Monthly Premium If your gross annual salary is at least: You are eligible for a maximum monthly benefit of: Monthly Premium $5,400 $300 $5.04 $75,600 $4,200 $70.56 $7,200 $400 $6.72 $77,400 $4,300 $72.24 $9,000 $500 $8.40 $79,200 $4,400 $73.92 $10,800 $600 $10.08 $81,000 $4,500 $75.60 $12,600 $700 $11.76 $82,800 $4,600 $77.28 $14,400 $800 $13.44 $84,600 $4,700 $78.96 $16,200 $900 $15.12 $86,400 $4,800 $80.64 $18,000 $1,000 $16.80 $88,200 $4,900 $82.32 $19,800 $1,100 $18.48 $90,000 $5,000 $84.00 $21,600 $1,200 $20.16 $91,800 $5,100 $85.68 $23,400 $1,300 $21.84 $93,600 $5,200 $87.36 $25,200 $1,400 $23.52 $95,400 $5,300 $89.04 $27,000 $1,500 $25.20 $97,200 $5,400 $90.72 $28,800 $1,600 $26.88 $99,000 $5,500 $92.40 $30,600 $1,700 $28.56 $100,800 $5,600 $94.08 $32,400 $1,800 $30.24 $102,600 $5,700 $95.76 $34,200 $1,900 $31.92 $104,400 $5,800 $97.44 $36,000 $2,000 $33.60 $106,200 $5,900 $99.12 $37,800 $2,100 $35.28 $108,000 $6,000 $ $39,600 $2,200 $36.96 $109,800 $6,100 $ $41,400 $2,300 $38.64 $111,600 $6,200 $ $43,200 $2,400 $40.32 $114,400 $6,300 $ $45,000 $2,500 $42.00 $115,200 $6,400 $ $46,800 $2,600 $43.68 $117,000 $6,500 $ $48,600 $2,700 $45.36 $118,800 $6,600 $ $50,400 $2,800 $47.04 $120,600 $6,700 $ $52,200 $2,900 $48.72 $122,400 $6,800 $ $54,000 $3,000 $50.40 $124,200 $6,900 $ $55,800 $3,100 $52.08 $126,000 $7,000 $ $57,600 $3,200 $53.76 $127,800 $7,100 $ $59,400 $3,300 $55.44 $129,600 $7,200 $ $61,200 $3,400 $57.12 $131,400 $7,300 $ $63,000 $3,500 $58.80 $133,200 $7,400 $ $64,800 $3,600 $60.48 $135,000 $7,500 $ $66,600 $3,700 $62.16 $136,800 $7,600 $ $68,400 $3,800 $63.84 $138,600 $7,700 $ $70,200 $3,900 $65.52 $140,400 $7,800 $ $72,000 $4,000 $67.20 $142,200 $7,900 $ $73,800 $4,100 $68.88 $144,000 $8,000 $ SI (4/15) 14

16 Underwritten By purelife-plus Flexible Premium Life Insurance toage121 Portable, Permanent Individual Life Insurance for the Employee and Family Policy Form: PRFNG-NI-10 Product Highlights Permanent Life Insurance toage121 For the eligible employees of LOCKHART ISD Minimal Cash Value Premiums Dedicated Primarily to Purchase Life Insurance Level Premium Guarantees Coverage for a Significant Period of Time Unique Limited Right to Partial Refund of Premium if Future Premium Required to Continue Coverage Increases No Surrender Charges Apply Accelerated Death Benefit Due to Terminal Illness Included Convenient Premium Payments Through Payroll Deduction Portable When You Leave Employment Application for Life Insurance Express Issue Monthly Pay foruseonlyin Alaska, Colorado, Hawaii, Iowa, Kentucky, Nebraska, Texas and Utah Form: 10M014-rpltic EXP-A-M-1LO R

17 Issue Age monthly premiums PureLife-plus Standard Risk Table Premiums Non-Tobacco Express Issue Monthly Premiums for Life Insurance Face Amounts Shown GUARANTEED PERIOD Age to Which Coverage is Guaranteed at (ALB) $10,000 $15,000 $25,000 $40,000 $50,000 $75,000 $100,000 $125,000 $150,000 Table Premium 15D PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After the Guaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under Permanent Coverage. Form: 10M014-rpltic EXP-A-M-1LO R

18 Issue Age monthly premiums PureLife-plus Standard Risk Table Premiums Tobacco Express Issue Monthly Premiums for Life Insurance Face Amounts Shown GUARANTEED PERIOD Age to Which Coverage is Guaranteed at (ALB) $10,000 $15,000 $25,000 $40,000 $50,000 $75,000 $100,000 $125,000 $150,000 Table Premium 15D PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After the Guaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under Permanent Coverage. Form: 10M014-rpltic EXP-A-M-1LO R

19 Group Life Insurance Employer Paid Life and AD&D SUMMARY OF BENEFITS Sponsored by: Lockhart ISD All Active Full-time Employees Life Benefit Employee Amount $10,000 Guarantee Issue $10,000 AD&D Benefit Employee Amount $10,000 Guarantee Issue $10,000 Benefit Reduction Benefits will reduce: Additional Benefits See Definitions page for: Eligibility Employee Benefits will terminate upon retirement. Employee Accelerated Death Benefit Conversion Continuation of Coverage Seat Belt, Airbag, and Common Carrier Employee All full-time active employees working 30 or more hours per week in an eligible class are eligible for coverage on the policy effective date. A delayed effective date will apply if the employee is not actively at work. ROGGIVAN LCKHRTISD LCTKW636US /05/27 18

20 Voluntary Life Insurance SUMMARY OF BENEFITS Sponsored by: Lockhart ISD All Active Full-time Employees Life Benefit Employee Spouse Dependent Amount Choice of $10,000 increments Not to exceed 5 times your salary. Choice of $5,000 increments Employee must elect coverage for spouse to be eligible. Not to exceed 50% of employee elected amount. $500 Child: Day 14 to 6 months Choice of $1,000 increments up to $10,000 Child: 6 months to age 26 (if unmarried, regardless of student status) Employee must elect coverage for dependents to be eligible Minimum Amount $20,000 $10,000 $500 Maximum Amount $500,000 $150,000 $10,000 Guarantee Issue for Newly Eligible Employees at Open Enrollment September 01, 2014 $150,000 $50,000 $10,000 Guarantee Issue for Current Eligible Employees at Annual Enrollment You or your spouse may elect or increase insurance coverage up to 2 increments on a guaranteed acceptance basis during your company's defined annual open enrollment period, provided that you or your spouse have not been previously declined or withdrawn coverage. Benefit Reduction Employee Spouse Benefits will reduce: Coverage will terminate upon retirement. Benefits will terminate upon retirement. Additional Benefits See Definition: Accelerated Death Benefit Conversion Portability Eligibility Employee Spouse and Dependents All full-time active employees working 30 or more hours per week in an eligible class are eligible for coverage on the policy effective date. A delayed effective date will apply if the employee is not actively at work. Cannot be in a period of limited activity on the day coverage takes effect. ROGGIVAN LCKHRTISD LCTKW636US /07/01 19

21 Lockhart ISD Employee Monthly Premium Voluntary Life Premium for sample benefit amounts Employee and Spouse premiums are calculated separately. Spouse premiums will be calculated based on the Employee s age. Refer to Program Specifications for your maximum benefit amounts. AGE Monthly Rate per $1,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 < 25 $0.063 $1.26 $1.89 $2.52 $3.15 $3.78 $4.41 $5.04 $5.67 $ $0.063 $1.26 $1.89 $2.52 $3.15 $3.78 $4.41 $5.04 $5.67 $ $0.063 $1.26 $1.89 $2.52 $3.15 $3.78 $4.41 $5.04 $5.67 $ $0.090 $1.80 $2.70 $3.60 $4.50 $5.40 $6.30 $7.20 $8.10 $ $0.144 $2.88 $4.32 $5.76 $7.20 $8.64 $10.08 $11.52 $12.96 $ $0.225 $4.50 $6.75 $9.00 $11.25 $13.50 $15.75 $18.00 $20.25 $ $0.342 $6.84 $10.26 $13.68 $17.10 $20.52 $23.94 $27.36 $30.78 $ $0.549 $10.98 $16.47 $21.96 $27.45 $32.94 $38.43 $43.92 $49.41 $ $0.819 $16.38 $24.57 $32.76 $40.95 $49.14 $57.33 $65.52 $73.71 $ $1.260 $25.20 $37.80 $50.40 $63.00 $75.60 $88.20 $ $ $ This is an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency. Example: Use this formula to calculate premium for benefit amounts over $100,000. Age Monthly Rate Per $1,000 X Benefit In $1,000 s = Monthly Cost Example: 33 $0.063 X 150 = $9.45 X = Dependent Children Rate = $1.80 Monthly per $10,000 Premium covers all dependent children regardless of the number of children. ROGGIVAN LCKHRTISD LCTKW636US /07/01 20

22 Lockhart ISD Spouse Monthly Premium Voluntary Life Premium for sample benefit amounts Employee and Spouse premiums are calculated separately. Spouse premiums will be calculated based on the Employee s age. Refer to Program Specifications for your maximum benefit amounts. AGE Monthly Rate per $1,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 <25 $0.114 $1.14 $1.71 $2.28 $2.85 $3.42 $3.99 $4.56 $5.13 $ $0.114 $1.14 $1.71 $2.28 $2.85 $3.42 $3.99 $4.56 $5.13 $ $0.114 $1.14 $1.71 $2.28 $2.85 $3.42 $3.99 $4.56 $5.13 $ $0.114 $1.14 $1.71 $2.28 $2.85 $3.42 $3.99 $4.56 $5.13 $ $0.193 $1.93 $2.90 $3.86 $4.83 $5.79 $6.76 $7.72 $8.69 $ $0.250 $2.50 $3.75 $5.00 $6.25 $7.50 $8.75 $10.00 $11.25 $ $0.387 $3.87 $5.81 $7.74 $9.68 $11.61 $13.55 $15.48 $17.42 $ $0.603 $6.03 $9.05 $12.06 $15.08 $18.09 $21.11 $24.12 $27.14 $ $0.899 $8.99 $13.49 $17.98 $22.48 $26.97 $31.47 $35.96 $40.46 $ $1.412 $14.12 $21.18 $28.24 $35.30 $42.36 $49.42 $56.48 $63.54 $70.60 This is an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency. Example: Use this formula to calculate premium for benefit amounts over $50,000. Age Monthly Rate Per $1,000 X Benefit In $1,000 s = Monthly Cost Example: 33 $0.114 X 75 = $8.55 X = Dependent Children Rate = $1.80 Monthly per $10,000 Premium covers all dependent children regardless of the number of children. ROGGIVAN LCKHRTISD LCTKW636US /07/01 21

23 Definitions Accelerated Death Benefit Conversion Guarantee Issue Limited Activity Portability Term Life Exclusion: Suicide Additional Benefits LifeKeys SM TravelConnect SM Accelerated Death Benefit provides an option to withdraw a percentage of your life insurance coverage when diagnosed as terminally ill (as defined in the policy.) The death benefit will be reduced by the amount withdrawn. To qualify, you have satisfied the Active Work rule and have been covered under this policy for the required amount of time as defined under this policy for the required amount of time as defined by the policy. Check with your tax advisor or attorney before exercising this option. If you terminate your employment or become ineligible for this coverage, you have the option to convert all or part of the amount of coverage in force to an individual life policy on the date of termination without Evidence of Insurability. Conversion election must be made within 31 days of your date of termination. For timely entrants enrolled within 31 days of becoming eligible, the Guarantee Issue amount is available without any Evidence of Insurability requirement. Evidence of Insurability will be required for any amounts above this, for late enrollees or increase in insurance, and it will be provided at your own expense. A period when a spouse or dependent is confined in a health care facility; or, whether confined or not, is unable to perform the regular and usual activities of a healthy person of the same age and sex. If coverage has been in force for at least 12 months, you may continue coverage for a specified period of time after your employment by paying the required premium. Portability is available if you cease employment for a reason other than total disability or retirement at Social Security Normal Retirement Age. A written application must be made within 31 days of your termination. Coverage provided to the designated beneficiary upon the death of the insured. Coverage is provided for the time period that you are eligible and premium is paid. There is no cash value associated with this product. Benefits will not be paid if the death results from suicide within 2 years after coverage is effective. May apply if employee contributes toward the premium. Online will & testament preparation service, identity theft resources and beneficiary assistance support for all employees and eligible dependents covered under the Group Term Life and/or AD&D policy. Travel assistance services for employees and eligible dependents traveling more than 100 miles from home. For assistance or additional information Contact Lincoln Financial Group at (800) or log on to NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern Lincoln National Corporation Group Insurance products are issued by The Lincoln National Life Insurance Company (Ft. Wayne, IN), which is not licensed and does not solicit business in New York. In New York, group insurance products are issued by Lincoln Life & Annuity Company of New York (Syracuse, NY). Both are Lincoln Financial Group companies. Product availability and/or features may vary by state. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Each affiliate is solely responsible for its own financial and contractual obligations. ROGGIVAN LCKHRTISD LCTKW636US /07/01 22

24 Cancer Care Plus Cancer and Dread Disease Insurance CP4000 9/04 G

25 Select your Benefit Package* according to plan A, B or C for: - Cancer First Occurrence - Hospital Confinement - Radiation/Chemotherapy - Surgery, In or Out of Hospital - Cancer Screening Tests - Dread Disease Treatment - Optional Riders Available for Critical Care and Intensive Care * See the Benefit Package Inserts for additional plan details. This information is considered incomplete without the plan insert. IN-HOSPITAL BENEFITS We will pay the following monetary benefits when a Covered Person is treated for Cancer or a covered Dread Disease. Prescribed Drugs and Medicines when Confined in Hospital Physician s Attendance Private Duty Nursing Service Ambulance Government or Charity Hospital Extended Benefits Adult Companion Transportation and Lodging Transportation for Non-Local Treatment Which Requires Hospital Confinement Transportation and Lodging for Non-Local Treatment Which Does Not Require Hospital Confinement Transportation and Lodging for Bone Marrow Donors Actual charges to a maximum of 20% of the Daily Hospital Confinement Benefit. Except in MO and MD, this benefit is not payable for Confinement in a government or charity Hospital. We will pay a Physician s Attendance benefit of $50 per day if the regular physician of the Covered Person makes a visit to the Covered Person in the Hospital. We will pay $150 per day while confined in a hospital and a Private Duty Nursing Service is retained. We will pay $250 per trip to transfer a Covered Person to or from a hospital for confinement as an inpatient. Maximum of three trips per year. (In NC, benefits shall include transportation from one medical facility to another.) We will pay $200 per day of confinement. We will pay $200 per day of treatment if a Covered Person receives outpatient Teleradiotherapy, Radio-Active Isotopes Therapy, Chemotherapy, Chemotherapy Enhancer Drug, Anti-Nausea, and Immunotherapy. This benefit is in lieu of all other benefits provided in the Policy, except for transportation and lodging benefits. In MO, government hospital benefits will be paid as any other benefit. We will pay $1,000 per day, beginning on the 71st day of one Period of Confinement in a hospital for treatment of Cancer or a Dread Disease. This benefit is payable in lieu of all other benefits payable for the same time period. TRANSPORTATION BENEFITS Pays actual charges for lodging and meal expenses to a maximum of $50 per day; actual charges for one round trip coach fare on a common carrier or a personal automobile allowance of $0.50 per mile, measured from the visiting Adult Companion s residence to the nearest (in NE, nearest does not apply) Hospital in which the Hospitalized person is Confined and is in excess of 50 miles one (in NE, each) way. We will not pay the personal automobile allowance in excess of 700 miles round trip. Maximum $2,500 per confinement. Pays actual charges for round trip coach fare on a common carrier to the nearest hospital or $0.50 per mile for personal vehicle, in excess of 50 miles one (in NE, each) way, not to exceed 700 miles per trip. The benefit will be paid if the attending Physician prescribes a treatment for Cancer or Dread Disease not available locally and requires Hospital Confinement Pays actual charges for round trip coach fare on a common carrier to the facility that provides the prescribed treatment or $0.50 per mile for personal automobile expenses in excess of 50 miles one (in NE, each) way, to a maximum of $1,500 per calendar year. Actual charges to a maximum of $50 per day for lodging and meal expenses. The benefit will be paid if the attending Physician prescribes a treatment for Cancer or Dread Disease not available locally and does not require Hospital Confinement. l Pays actual charges to a maximum of $2,500 for medical expenses directly relating to the services to the donor during the transplant; l Pays actual charges for round trip coach fare on a common carrier or a personal automobile allowance of $0.50 per mile in excess of 50 miles one (in NE, each)-way to the city where the transplant is performed not to exceed 700 miles round trip; l Pays actual charges to a maximum of $75 per day for lodging and meal expenses incurred by a bone marrow donor. 24

26 Anesthesia Additional Surgical Opinions Artificial Limb and Prosthesis Experimental Treatment ADDITIONAL BENEFITS Pays 25% of the amount payable under the Surgical Benefit. For skin Cancer operations, We will pay only $50 for each skin Cancer operation. We will pay $200 if a Covered Person obtains a second surgical opinion. If the second surgical opinion differs from the first, we will pay $200 for a third surgical opinion. Pays actual charges to a maximum of $1,500 per prosthetic device or artificial limb. Benefits will be paid for only two of the same type of device or artificial limb. If a Breast Reconstruction and Breast Prosthesis benefit is payable, the Artificial Limb and Prosthesis benefit is not payable. Pays actual charges to a lifetime maximum of $10,000. Experimental Treatment must be received in the U.S. If the Experimental Treatment benefit is payable, no other benefit associated with the treatment, service, or procedure underlying the Experimental Treatment is payable. Physical, Occupational or Speech Therapy We will pay $50 for each 60-minute session to a lifetime maximum of $1,500. Extended Care Facility Bone Marrow Transplant for Cancer Outpatient Positive Diagnosis Test Outpatient Surgery Benefit Skin Cancer Hospice Care Blood and Blood Plasma Breast Reconstruction and Breast Prosthesis Home Health Care Services Hairpiece Benefit Rental or Purchase of Durable Medical Equipment Professional Mental Health Consultation Tutor We will pay $100 for each day of confinement to a maximum of 70 days. Such confinement must be at the recommendation of the attending Physician and begin within 14 days of a covered Hospital Confinement. Pays actual charges incurred by a Covered Person for bone marrow transplants or other forms of stem cell rescue and all related services and supplies. This benefit is limited to a lifetime maximum of $10,000. Certain limitations and exceptions apply - please see Policy for details. We will pay $250 if a Covered Person has an outpatient diagnostic test that leads to a positive diagnosis within 90 days of such test. Pays for outpatient surgery in a Hospital or Ambulatory Surgical Center 150% of the maximum amount for such surgery shown in the Surgical Benefits Schedule; and $375 per operation for drugs, medicines and laboratory tests for the Covered Person. We will pay $150 for removal of skin Cancer when the diagnosis is made by a Physician other than a pathologist to a maximum of $600 per calendar year. If diagnosed by pathologist, pays according to Surgical Benefits Schedule. We will pay $100 per day for care provided by a Hospice if the Covered Person has been diagnosed as terminally ill due to Cancer or Dread Disease. This benefit is payable for confinement in a Hospice care center, and is limited to a lifetime maximum of 180 days or, if in the Covered Person s home, limited to a lifetime maximum of 30 days. Pays actual charges incurred by a Covered Person for blood, blood plasma and platelets inserted into a Covered Person to a maximum of $5,000 per calendar year. Pays actual charges incurred for reconstructive surgery, including an external breast or an internal breast prosthesis and the surgeon s fee for implantation following a mastectomy. We will pay: l $60 per day for services provided at home not to exceed a maximum of 180 days per calendar year; l l $150 per day for private duty nursing at home not to exceed a maximum of 15 days per calendar year; $50 per day for Physician s visits at home not to exceed 15 days per calendar year. Except in NE, this benefit is in lieu of other benefits provided in this Policy. We will pay a one-time benefit of $100 for a hairpiece when hair loss is the result of Cancer treatment. Pays actual charges incurred by a Covered Person to a maximum of $1,000 per calendar year for the rental or purchase of: a respirator or similar mechanical device, brace, crutches, hospital bed or a wheelchair. We will pay $50 per session if a Covered Person is receiving treatment for Cancer or a Dread Disease for which benefits are payable under this Policy. This benefit is limited to a lifetime maximum benefit of $250. A Tutor benefit of $25 per 60-minute session will be paid for an Insured Child under age 19 who is receiving treatment for a covered Cancer or Dread Disease for which benefits are payable under this Policy. Limited to a lifetime maximum of 50 sessions. WAIVER OF PREMIUM If the Named Insured becomes Totally Disabled for 60 days as a result of a Positive Diagnosis of Cancer or a Dread Disease while this Policy is in force, We will waive the premiums that fall due while he or she is Totally Disabled. The Total Disability must begin before the policy anniversary following that person s attainment of age 60. To be eligible for this benefit, premiums must continue to be paid for 60 days after the commencement of Total Disability. Upon approval of this benefit, waiver of premiums will begin on the premium due date next following 60 days of continuous Total Disability. This provision does not apply to Total Disability of the Insured Spouse or Insured Child(ren). 25

27 OPTIONAL RIDERS THESE RIDERS ARE OPTIONAL AND HAVE AN ADDITIONAL COST. Intensive Care Unit Rider (Form Number ICUR 4000, including state variations) Benefits Reduce to 1/2 at age 70. Benefit for Intensive Care Unit If a Covered Person is confined in an Intensive Care Unit of a Hospital, we will pay the ICU Daily Benefit Amount of $600 for each day of such confinement, not to exceed 30 days during any one period of confinement. In MN, options for benefit amounts per day will be in units of $100 to a maximum of $1,000. Benefit for Step-Down Unit If a Covered Person is confined in a Step-Down Unit of a Hospital, we will pay $300 for each day of such confinement, not to exceed 30 days during any one period of confinement. Critical Care Benefit Rider (Form Number CCBR 4000, including state variations) To a maximum of a $2,500 Benefit for Heart Disease A Heart Disease benefit will be paid for the actual charges incurred by a Covered Person for the following due to Heart Disease: 1. pacemaker insertion; 2. angioplasty; and 3. heart catheterization. This benefit is limited to a lifetime maximum of $2,500. To a maximum of a $5,000 Benefit for Heart Attack/Stroke A Heart Attack/Stroke benefit will be paid for the actual charges incurred by a Covered Person to a lifetime maximum of $5,000 for a Heart Attack or Stroke. The following limitations apply to both Intensive Care Unit and Critical Care Benefit Riders LIMITATIONS Pre-Existing Conditions These Riders do not provide benefits for loss or losses due to Pre-Existing Conditions that are incurred during the 12 months (in NM, 6 months) immediately prior to the Rider Date. In addition, a loss caused by a Pre-Existing Condition will not be covered if: 1. (except in MD) the Pre-Existing Condition was revealed in the application; or 2. we have specifically excluded the Pre-Existing Condition by name or specific description. However, a claim for a Pre-Existing Condition incurred after 2 years (in NM, 6 months; in CA, 12 months) from the date these Riders become effective will be covered, unless that condition is excluded by name or specific description effective on the date of loss. The benefits as specified in these Riders are payable in addition to all other indemnities set forth in the Policy and/or attached Riders, if any. 26

28 THIS IS A LIMITED BENEFIT CANCER AND DREAD DISEASE INSURANCE POLICY. ELIGIBILITY You and your covered spouse must be ages 18 through 69 to apply for coverage. Unmarried, dependent children under the age of 21 (in NM and TX, age 25 regardless of student status) may be covered. Unmarried children under the age of 25 may also be covered if enrolled as a full-time student in an accredited college or university, or marriage, whichever occurs first. When the child reaches the limiting age, the child may convert to an individual policy without evidence of insurability, subject to the Conversion provision in the base policy. LIMITATION 30-Day Waiting Period If a Covered Person has a Positive Diagnosis for Cancer or a Dread Disease during the first thirty days after the Effective Date of this Policy, coverage for such Cancer or Dread Disease will only apply to loss commencing after two years (in NH, six months; in NC, twelve months) from the Effective Date of this Policy; or, at Your option, You may elect to void this Policy from the beginning and receive a full refund of premium. In AZ and MO, we will pay a reduced benefit of $40 for loss covered by or resulting from such Positive Diagnosis during the first two years from the Effective Date of this Policy; in MN, we will pay a reduced benefit of $40 for loss covered by or resulting from any Cancer or Dread Disease during the first two years from the Effective Date of this Policy. EXCLUSIONS Subject to the Time Limit on Certain Defenses provision, We will not pay benefits for: 1. anything caused by or resulting from Injury; 2. anything other than Cancer or a Dread Disease; 3. any sickness, illness, bodily infirmity or incapacity that has been caused, complicated, worsened, or affected by Cancer or a Dread Disease or as a result of Cancer or a Dread Disease treatment including side effects from Cancer or a Dread Disease treatment except as specifically covered; 4. anything due to Cancer or a Dread Disease for which a Positive Diagnosis was made, or treatment was received, (in NE, five years; in NC, twelve months) prior to the Effective Date. In NC, a Pre-Existing Condition for Insured Persons age 65 or older shall include only conditions excluded by rider. In MT, any Cancer or Dread Disease during the first twelve months following the Effective Date due to Cancer or a Dread Disease for which a Positive Diagnosis was made, or treatment was received, 3 years prior to the Effective Date will not be covered; 5. anything for which no charge was incurred by the Covered Person (except as expressly provided herein); 6. (except in WI) any treatment, procedure, or service which is not grounded in current, generally accepted medical practices, except as specifically provided in the Experimental Treatment benefit or Bone Marrow Transplant benefit (benefits for Experimental Treatment are limited to a lifetime maximum of $10,000 and benefits for Bone Marrow Transplants are limited to a lifetime maximum of $10,000); 7. any care and/or treatment received outside the U.S. or its territories unless the Covered Person has traveled outside the United States and/or its territories and treatment is received due to an Emergency Situation; 8. (except in MO) any care, confinement and/or treatment in a government or charity hospital except as specifically provided in the Government or Charity Hospital benefit; 9. (except in AZ, MN, MO and MT) any Cancer or Dread Disease during the first two years (in NH, six months; in NC, twelve months) following the Effective Date in connection with a loss that was incurred during the Waiting Period; 10. planning, clinical treatment planning, clinical treatment management, medical radiation physics, dosimetry, blocks, molds, treatment devices, special services, and similar services ancillary or related to Teleradiotherapy or Radio-Active Isotopes Therapy; 11. side-effect medications or treatments, supplies, saline or similar fluids, administration charges, and other services or treatments ancillary or related to Chemotherapy (except as expressly provided in the Chemotherapy Enhancer Drug benefit and Anti-Nausea benefit provisions); or 12. side-effect medications or treatments, supplies, saline or similar fluids, administration charges, and other services or treatments ancillary or related to Chemotherapy Enhancer Drug, Anti-Nausea medication, or Immunotherapy. In MD, we will not pay any benefits otherwise covered under this Policy that are in connection with or resulting from a Prohibited Referral. We will reimburse you for the actual charges for the services provided. Actual charges are the amounts paid by you or on your behalf and accepted by the provider for the services provided. Policy Form Numbers CP /04, (including state variations) CP 4000 LA 4/04, CP 4000 MT 4/04 and CP 4000 TX 4/04 10 DAY RIGHT TO EXAMINE POLICY - You have ten (10) days to examine the policy and have your premiums refunded. This is only a brochure which provides a brief description of the important features of your policy. Only the actual policy provisions will control; therefore, it is important that you READ YOUR POLICY CAREFULLY. 27 Underwritten by: Central United Life Insurance Company Northwest Freeway, Houston, TX 77092

29 PLAN - A CancerCare Plus Cancer and Dread Disease Insurance Policy BENEFIT PACKAGE FIRST OCCURRENCE BENEFIT RIDER HOSPITAL CONFINEMENT RADIATION CHEMOTHERAPY AND OTHER TREATMENTS SURGICAL BENEFIT DESCRIPTION We will pay a one-time monetary benefit when a Covered Person is diagnosed for the first time as having Cancer (other than skin cancer) as defined in the policy. Not available for ages 65 and above. For Cancer and Dread Disease, we will pay a monetary benefit for each day of Hospital Confinement, to a maximum of 70 days per Confinement. For Cancer and Dread Disease, we will pay monetary benefits for Teleradiotherapy, Radio-Active Isotopes T h e r a p y, Chemotherapy, Chemotherapy Enhancer Drug, Anti-Nausea and Immunotherapy treatments, as defined in the policy. For Cancer and Dread Disease, we will pay monetary benefits for covered surgeries in or out of the hospital based on a percentage of the maximum amount, according to the schedule shown in the policy. AMOUNT $1,000 $100 per day Actual Charges To a maximum of $2,500 per month* Maximum per Surgery $2,500 Policy Form Numbers CP /04 (including state variations), CP 4000 LA 4/04, CP 4000 OK 4/04, C P 4000 TX 4/04 and First Occurrence Benefit Rider Form Numbers FOB97 (including state variations) or FOBR02 * We will pay monetary benefits representing the actual charges for the covered services provided. Actual Charges means the amount(s) actually paid by or on behalf of the Covered Person and accepted by the provider as full payment for the covered services provided. If this Policy is the Covered Person s only form of insurance coverage, the amount the Covered Person is required to pay the provider for the covered services is the Actual Charge. CANCER SCREENING BENEFIT We will pay $50 per calendar year for each insured person who has one of the following cancer screening tests performed: Mammography Screening Flexible Sigmoidoscopy 7. Colonoscopy 8. CEA (blood test for colon Cancer) 3. Pap Smear (test only) 9. CA125 (blood test for ovarian Cancer) Thermography Chest X-Ray 10. PSA (blood test for prostate Cancer) 11. Serum Protein Electrophoresis 6. Hemoccult Stool Specimen The following defines the list of Dread Diseases covered under the Policy: Addison s Disease Muscular Dystrophy Tay-Sachs Disease Amyotrophic Lateral Sclerosis Myasthenia Gravis Tetanus Diphtheria Niemann-Pick Disease Toxic Epidermal Necrolysis Encephalitis Osteomyelitis Toxic Shock Syndrome Epilepsy Poliomyelitis Tuberculosis Legionnaire s Disease Reye s Syndrome Tularemia Lupus Erythematosus Rheumatic Fever Typhoid Fever Meningitis Rocky Mountain Spotted Fever Whipple s Disease Multiple Sclerosis Sickle-Cell Anemia Whooping Cough Additional Benefits and Exclusions apply, please refer to main CancerCare Plus brochure for a description of the important features of the policy. This information is considered incomplete without the main brochure. CP /04 28 Underwritten by: Central United Life Insurance Company Northwest Freeway, Houston, TX Insert A-0406

30 PLAN - B CancerCare Plus Cancer and Dread Disease Insurance Policy BENEFIT PACKAGE FIRST OCCURRENCE BENEFIT RIDER HOSPITAL CONFINEMENT RADIATION CHEMOTHERAPY AND OTHER TREATMENTS SURGICAL BENEFIT DESCRIPTION We will pay a one-time monetary benefit when a Covered Person is diagnosed for the first time as having Cancer (other than skin cancer) as defined in the policy. Not available for ages 65 and above. For Cancer and Dread Disease, we will pay a monetary benefit for each day of Hospital Confinement, to a maximum of 70 days per Confinement. For Cancer and Dread Disease, we will pay monetary benefits for Teleradiotherapy, Radio-Active Isotopes T h e r a p y, Chemotherapy, Chemotherapy Enhancer Drugs, Anti-Nausea and Immunotherapy treatments, as defined in the policy. For Cancer and Dread Disease, we will pay monetary benefits for covered surgeries in or out of the hospital based on a percentage of the maximum amount, according to the schedule shown in the policy. AMOUNT $2,500 $150 per day Actual Charges To a maximum of $5,000 per month* Maximum per Surgery $3,000 Policy Form Numbers CP /04 (including state variations), CP 4000 LA 4/04, CP 4000 OK 4/04, CP 4000 TX 4/04 and First Occurrence Benefit Rider Form Numbers FOB97 (including state variations) or FOBR02 * We will pay monetary benefits representing the actual charges for the covered services provided. Actual Charges means the amount(s) actually paid by or on behalf of the Covered Person and accepted by the provider as full payment for the covered services provided. If this Policy is the Covered Person s only form of insurance coverage, the amount the Covered Person is required to pay the provider for the covered services is the Actual Charge. CANCER SCREENING BENEFIT We will pay the amount you choose: $50 or $100 per calendar year for each insured person who has one of the following cancer screening tests performed: 1. Mammography Screening 7. Colonoscopy 2. Flexible Sigmoidoscopy 8. CEA (blood test for colon Cancer) Pap Smear (test only) Thermography 9. CA125 (blood test for ovarian Cancer) 10. PSA (blood test for prostate Cancer) 5. Chest X-Ray 11. Serum Protein Electrophoresis 6. Hemoccult Stool Specimen The following defines the list of Dread Diseases covered under the Policy: Addison s Disease Muscular Dystrophy Tay-Sachs Disease Amyotrophic Lateral Sclerosis Myasthenia Gravis Tetanus Diphtheria Niemann-Pick Disease Toxic Epidermal Necrolysis Encephalitis Osteomyelitis Toxic Shock Syndrome Epilepsy Poliomyelitis Tuberculosis Legionnaire s Disease Reye s Syndrome Tularemia Lupus Erythematosus Rheumatic Fever Typhoid Fever Meningitis Rocky Mountain Spotted Fever Whipple s Disease Multiple Sclerosis Sickle-Cell Anemia Whooping Cough Additional Benefits and Exclusions apply, please refer to main CancerCare Plus brochure for a description of the important features of the policy. This information is considered incomplete without the main brochure. CP /06 29 Underwritten by: Central United Life Insurance Company Northwest Freeway, Houston, TX Insert B

31 30

32 GROUP CRITICAL ILLNESS Policy Series CAI2800 This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions. CI G You can win the battle against a critical illness, but can you handle the added costs? A group critical illness plan helps prepare you for the added costs of battling a specific critical illness. The good news is that many people with a critical illness survive these lifethreatening battles. Unfortunately, as the recovery process begins, people become aware of the medical bills that have piled up. Your recovery doesn t have to be spoiled by medical bills. With this plan, our goal is to help you and your family cope with and recover from the financial stress of surviving a critical illness. C O V E R A G E W O R K S H E E T Employee Benefit: Spouse Benefit: Child Benefit: (25 percent of the primary insured amount) $ $ $ Total Deduction: $ This work sheet is for illustration purposes only. It does not imply coverage. 31

33 B E N E F I T S This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions. COVERED CRITICAL ILLNESSES: 1 CANCER (Internal or Invasive) 100% HEART ATTACK (Myocardial Infarction) 100% STROKE (Apoplexy or Cerebral Vascular Accident) 100% MAJOR ORGAN TRANSPLANT 100% FIRST-OCCURRENCE BENEFIT After the waiting period, a lump sum benefit is payable upon initial diagnosis of a covered critical illness. Employee benefit amounts available from $5,000 to $50,000. Spouse coverage is also available in benefit amounts up to $25,000. If you are deemed ineligible due to a previous medical condition, you still retain the ability to purchase Spouse coverage. ADDITIONAL OCCURRENCE BENEFIT If an insured collects full benefits for a critical illness under the plan and later has one of the remaining covered critical illnesses, then we will pay the full benefit amount for each additional illness. Occurrences must be separated by at least six months. $50 HEALTH SCREENING BENEFIT (Employee and Spouse only) After the waiting period, an insured may receive a maximum of $50 for any one covered health screening test per calendar year. We will pay this benefit regardless of the results of the test. Payment of this benefit will not reduce the critical illness benefit payable under your certificate. There is no limit to the number of years the insured can receive the health screening benefit; it will be paid as long as the certificate remains in force. This benefit is payable for the covered Employee and Spouse. This benefit is not paid for Dependent Children. C OV ERED HE A LT H SCREENING T ESTS INCLUDE: Mammography Colonoscopy Pap smear Breast ultrasound Chest X-ray PSA (blood test for prostate cancer) Stress test on a bicycle or treadmill Bone marrow testing CA 15-3 (blood test for breast cancer) RENAL FAILURE (End-Stage) 100% CARCINOMA IN SITU 2 25% CORONARY ARTERY BYPASS SURGERY 2 25% RE-OCCURRENCE BENEFIT If an insured collects full benefits for a covered condition and is later diagnosed with the same condition, we will pay the full benefit again. The two dates of diagnosis must be separated by at least 12 months, or for cancer, 12 months treatment free. Cancer that has spread (metastasized) even though there is a new tumor, will not be considered an additional occurrence unless the Insured has gone treatment free for 12 months. CHILD COVERAGE AT NO ADDITIONAL COST Each Dependent Child is covered at 25 percent of the primary insured amount at no additional charge. OVER 1.4 FA C T MILLION The number of new cancer cases that were expected to be diagnosed in Cancer Facts & Figures 2009, American Cancer Society. CA 125 (blood test for ovarian cancer) CEA (blood test for colon cancer) Flexible sigmoidoscopy Hemocult stool analysis Serum protein electrophoresis (blood test for myeloma) Thermography Fasting blood glucose test Serum cholesterol test to determine level of HDL and LDL 1 All covered conditions are subject to the definitions found in your certificate. 2 If a benefit is paid for Carcinoma in Situ, the Internal Cancer benefit will be reduced by 25 percent. If a benefit is paid for Coronary Artery Bypass Surgery, the Heart Attack benefit will be reduced by 25 percent. WHAT IS NOT COVERED, LIMITATIONS AND EXCLUSIONS, AND TERMS YOU NEED TO KNOW If this coverage will replace any existing individual policy, please be aware that it may be in your best interest to maintain your individual guaranteed-renewable policy. IF DIAGNOSIS OCCURS AFTER THE AGE OF 70, HALF OF THE BENEFIT IS PAYABLE. The plan contains a 30-day waiting period. This means that no benefits are payable for any insured who has been diagnosed before your coverage has been in force 30 days from the effective date. If an insured is first diagnosed during the waiting period, benefits for treatment of that critical illness will apply only to loss starting after 12 months from the Effective Date or the Employee can elect to void the coverage and receive a full refund of premium. The applicable benefit amount will be paid if: the date of diagnosis is after the waiting period; the date of diagnosis occurs while the certificate is in force; and the cause of the illness is not excluded by name or specific description. EXCLUSIONS Benefits will not be paid for loss due to: Intentionally self-inflicted injury or action; 32

34 WHAT IS NOT COVERED, LIMITATIONS AND EXCLUSIONS, AND TERMS YOU NEED TO KNOW Suicide or attempted suicide while sane; Illegal activities or participation in an illegal occupation; War, whether declared or undeclared or military conflicts, participation in an insurrection or riot, civil commotion or state of belligerence; Substance abuse; or Pre-Existing Conditions (except as stated below). No benefits will be paid for loss which occurred prior to the Effective Date. No benefits will be paid for diagnosis made or treatment received outside of the United States. PRE- EXISTING CONDITION LIMITATION Pre-Existing Condition means a sickness or physical condition which, within the 12-month period prior to the Effective Date, resulted in the insured receiving medical advice or treatment. We will not pay benefits for any critical illness starting within 12 months of the Effective Date which is caused by, contributed to, or resulting from a Pre-Existing Condition. A claim for benefits for loss starting after 12 months from the Effective Date will not be reduced or denied on the grounds that it is caused by a Pre-Existing Condition. A critical illness will no longer be considered pre-existing at the end of 12 consecutive months starting and ending after the Effective Date. TERMS YOU NEED TO KNOW The Effective Date of your insurance will be the date shown in your Certificate Schedule. Employee means the insured as shown in the Certificate Schedule. Spouse means an Employee's legal wife or husband. Dependent Children means your natural children, step-children, foster children, legally adopted children or children placed for adoption, who are under age 26. Your natural Children born after the Effective Date of the Rider will be covered from the moment of live birth. No notice or additional premium is required. Coverage on Dependent Children will terminate on the child s 26th birthday. However, if any child is incapable of self-sustaining employment due to mental or physical handicap and is dependent on his parent(s) for support, the above age 26 shall not apply. Proof of such incapacity and dependency must be furnished to the Company within 31 days following such 26th birthday. Treatment means consultation, care, or services provided by a physician, including diagnostic measures and taking prescribed drugs and medicines. Major Organ Transplant means undergoing surgery as a recipient of a transplant of a human heart, lung, liver, kidney, or pancreas. Myocardial Infarction (Heart Attack) means the death of a portion of the heart muscle (myocardium) resulting from a blockage of one or more coronary arteries. Heart Attack does not include any other disease or injury involving the cardiovascular system. Cardiac arrest not caused by a Myocardial Infarction is not a Heart Attack. The diagnosis must include all of the following criteria: 1. New and serial eletrocardiographic (EKG) findings consistent with Myocardial Infarction; 2. Elevation of cardiac enzymes above generally accepted laboratory levels of normal [in case of creatine phosphokinase (CPK), a CPK-MB measurement must be used]; and 3. Confirmatory imaging studies such as thallium scans, MUGA scans, or stress echocardiograms. Stroke means apoplexy (due to rupture or acute occlusion of a cerebral artery), or a cerebral vascular accident or incident which begins on or after your Effective Date. We ve got you under our wing. aflacgroupinsurance.com The certificate to which this sales material pertains is written only in English; the certificate prevails if interpretation of this material varies. Stroke does not include transient ischemic attacks and attacks of vertebrobasilar ischemia. We will pay a benefit for Stroke that produces permanent clinical neurological sequela following an initial diagnosis made after any applicable Waiting Period. We must receive evidence of the permanent neurological damage provided from computed axial tomography (CAT scan) or magnetic resonance imaging (MRI). Stroke does not mean head injury, transient ischemic attack, or chronic cerebrovascular insufficiency. Cancer (Internal or Invasive) means a malignant tumor characterized by the uncontrolled growth and spread of malignant cells and the invasion of distant tissue. Cancer includes leukemia. Excluded are Cancers that are noninvasive, such as (1) Premalignant tumors or polyps; (2) Carcinoma in Situ; (3) Any skin cancers except melanomas; (4) Basal cell carcinoma and squamous cell carcinoma of the skin; and (5) Melanoma that is diagnosed as Clark s Level I or II or Breslow thickness less than.77 mm. Cancer is also defined as a disease which meets the diagnosis criteria of malignancy established by The American Board of Pathology after a study of the histocytologic architecture or pattern of the suspect tumor, tissue, or specimen. Carcinoma in Situ means Cancer that is in the natural or normal place, confined to the site of origin without having invaded neighboring tissue. Renal Failure (Kidney Failure) means the end-stage renal failure presenting as chronic, irreversible failure of both of your kidneys to function. The Kidney Failure must necessitate regular renal dialysis, hemodialysis or peritoneal dialysis (at least weekly); or which results in kidney transplantation. Renal failure is covered, provided it is not caused by a traumatic event, including surgical traumas. Coronary Artery Bypass Surgery means undergoing open heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass grafts, but excluding procedures such as but not limited to balloon angioplasty, laser relief, stents or other nonsurgical procedures. A doctor, physician, or pathologist does not include an insured or a family member. P ORTA B L E C OV ER AGE When coverage would otherwise terminate because the Employee ends employment with the employer, coverage may be continued. The Employee will continue the coverage that is in force on the date employment ends, including dependent coverage then in effect. The Employee will be allowed to continue the coverage until the earlier of the date the Employee fails to pay the required premium or the date the group master policy is terminated. Coverage may not be continued if the Employee fails to pay any required premium or the group master policy terminates. TERMINATION Coverage will terminate on the earliest of: (1) The date the master policy is terminated; (2) The 31st day after the premium due date if the required premium has not been paid; (3) The date the insured ceases to meet the definition of an Employee as defined in the master policy; or (4) The date the Employee is no longer a member of the class eligible. Coverage for an insured Spouse or Dependent Child will terminate the earliest of: (1) the date the Plan is terminated; (2) the date the Spouse or Dependent Child ceases to be a dependent; (3) the premium due date following the date we receive your written request to terminate coverage for your Spouse and/or all Dependent Children. Continental American Insurance Company (CAIC), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. Continental American Insurance Company 2801 Devine Street Columbia, South Carolina This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions. This brochure is subject to the terms, conditions, and limitations of Policy Form Series CAI

35 Lockhart Independent School District Rate sheet prepared by Web User on 2/20/2013 2:45:54 PM. Texas Payroll Premium rates are Monthly. Aflac Group coverage is underwritten by Continental American Insurance Company (CAIC) The rates shown on this insert page are for illustration purposes only; they do not imply coverage. For more information about policy/plan benefits and limitations, please refer to the accompanying product brochure for each insurance policy/plan listed below. CAIC GROUP CRITICAL ILLNESS Series UNI-TOBACCO for Employee Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $3.90 $6.05 $8.20 $10.35 $12.50 $14.65 $16.80 $18.95 $21.10 $ $5.75 $9.75 $13.75 $17.75 $21.75 $25.75 $29.75 $33.75 $37.75 $ $10.55 $19.35 $28.15 $36.95 $45.75 $54.55 $63.35 $72.15 $80.95 $ $17.35 $32.95 $48.55 $64.15 $79.75 $95.35 $ $ $ $ $26.75 $51.75 $76.75 $ $ $ $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series UNI-TOBACCO for Spouse Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $3.90 $4.98 $6.05 $7.13 $8.20 $9.28 $10.35 $11.43 $ $5.75 $7.75 $9.75 $11.75 $13.75 $15.75 $17.75 $19.75 $ $10.55 $14.95 $19.35 $23.75 $28.15 $32.55 $36.95 $41.35 $ $17.35 $25.15 $32.95 $40.75 $48.55 $56.35 $64.15 $71.95 $ $26.75 $39.25 $51.75 $64.25 $76.75 $89.25 $ $ $ Rates include cancer benefit. Rates include $50 Health Screening Benefit. 34

36 Lockhart Independent School District Rate sheet prepared by Web User on 2/20/2013 2:46:16 PM. Texas Payroll Premium rates are Monthly. Aflac Group coverage is underwritten by Continental American Insurance Company (CAIC) The rates shown on this insert page are for illustration purposes only; they do not imply coverage. For more information about policy/plan benefits and limitations, please refer to the accompanying product brochure for each insurance policy/plan listed below. CAIC GROUP CRITICAL ILLNESS Series UNI-TOBACCO for Employee Buy Up Rates Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45, $2.15 $4.30 $6.45 $8.60 $10.75 $12.90 $15.05 $17.20 $ $4.00 $8.00 $12.00 $16.00 $20.00 $24.00 $28.00 $32.00 $ $8.80 $17.60 $26.40 $35.20 $44.00 $52.80 $61.60 $70.40 $ $15.60 $31.20 $46.80 $62.40 $78.00 $93.60 $ $ $ $25.00 $50.00 $75.00 $ $ $ $ $ $ CAIC GROUP CRITICAL ILLNESS Series UNI-TOBACCO for Spouse Buy Up Rates Age $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20, $2.15 $3.23 $4.30 $5.38 $6.45 $7.53 $ $4.00 $6.00 $8.00 $10.00 $12.00 $14.00 $ $8.80 $13.20 $17.60 $22.00 $26.40 $30.80 $ $15.60 $23.40 $31.20 $39.00 $46.80 $54.60 $ $25.00 $37.50 $50.00 $62.50 $75.00 $87.50 $ Rates include cancer benefit. Maximum total benefit for Employees is $50,000 and for Spouses is $25,

37 GROUP ACCIDENT INSURANCE Policy Series CA7700-MP This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions. AC1 G Do you know how much a trip to the emergency room could cost you? An accident insurance plan provides benefits to help cover the costs associated with unexpected bills. You don t budget for accidents if you re like most people. When a Covered Accident occurs, the last thing on your mind is the charges that may be accumulating while you re at the emergency room, including: The ambulance ride Use of the emergency room Surgery and anesthesia Stitches Casts Wheelchairs Crutches Bandages You get the picture. These costs add up fast. You hope they never happen, but at some point you may take a trip to your local emergency room. If that time comes, wouldn t it be nice to have an insurance plan that pays benefits regardless of any other insurance you have? This group accident plan does just that. FEATURES 24-hour coverage No limit on the number of claims Pays regardless of any other insurance plans you may have Benefits available for your Spouse and/or Dependent Children Benefits for both inpatient and outpatient treatment of Covered Accidents Guaranteed issue (No underwriting is required to qualify for coverage.) Payroll deduction (Premiums are paid by convenient payroll deduction.) Portable coverage (You can continue coverage when you leave employment; see back of brochure for guidelines.) 33.2MILLION The number of people who in 2005 sought medical attention for an injury; 2.8 million people were hospitalized for injuries.* *Injury Facts 2008, National Safety Council. 36

38 H O S P I T A L B E N E F I T S E M P L O Y E E S P O U S E C H I L D HOSPITAL ADMISSION $1,000 $1,000 $1,000 We will pay this benefit when an insured is admitted to a hospital and confined as a resident bed patient because of injuries received in a Covered Accident (within six months of the date of the accident). We will pay this benefit once per calendar year, per Covered Accident. We will not pay this benefit for confinement to an observation unit, or for emergency room treatment or outpatient treatment. HOSPITAL CONFINEMENT (per day) $200 $200 $200 We will provide this benefit on the first day of hospital confinement for up to 365 days per Covered Accident when an insured is confined to a hospital due to a Covered Accident. Hospital confinement must begin within 90 days from the date of the accident. HOSPITAL INTENSIVE CARE (per day) $400 $400 $400 This benefit is paid up to 30 days per Covered Accident. Benefits are paid in addition to the Hospital Confinement Benefit. MEDICAL FEES (for each accident) $125 $125 $75 If an insured is injured in a Covered Accident and receives treatment within one year after the accident, we will pay up to the applicable amount for physician charges, emergency room services, supplies, and X-rays. The total amount payable will not exceed the maximum shown per accident. Initial treatment must be received within 60 days after the accident. PARALYSIS (lasting 90 days or more and diagnosed by a physician within 90 days) Quadriplegia $10,000 $10,000 $10,000 Paraplegia $5,000 $5,000 $5,000 A C C I D E N T A L - D E A T H A N D - D I S M E M B E R M E N T (within 90 days) E M P L O Y E E S P O U S E C H I L D ACCIDENTAL- DEATH $50,000 $10,000 $5,000 ACCIDENTAL COMMON-CARRIER DEATH (plane, train, boat, or ship) $100,000 $50,000 $15,000 SINGLE DISMEMBERMENT $6,250 $2,500 $1,250 DOUBLE DISMEMBERMENT $25,000 $10,000 $5,000 LOSS OF ONE OR MORE FINGERS OR TOES $1,250 $500 $250 PARTIAL AMPUTATION OF FINGERS OR TOES (including at least one joint) $100 $100 $100 If the Accidental Common-Carrier Death Benefit is paid, we will not pay the Accidental-Death Benefit. Accidental Injury means bodily injury caused solely by or as the result of a Covered Accident. Covered Accident means an accident that occurs on or after the Effective Date, while the certificate is in force, and that is not specifically excluded. This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions. 37

39 M A J O R I N J U R I E S (diagnosis and treatment within 90 days) E M P L O Y E E S P O U S E // C H I L D FRACTURES (closed reduction): Hip/Thigh $4,500 $4,000 Vertebrae (except processes) $4,050 $3,600 Pelvis $3,600 $3,200 Skull (depressed) $3,375 $3,000 Leg $2,700 $2,400 Forearm/Hand/Wrist $2,250 $2,000 Foot/Ankle/Knee Cap $2,250 $2,000 Shoulder Blade/Collar Bone $1,800 $1,600 Lower Jaw (mandible) $1,800 $1,600 Skull (simple) $1,575 $1,400 Upper Arm/Upper Jaw $1,575 $1,400 Facial Bones (except teeth) $1,350 $1,200 Vertebral Processes $900 $800 Coccyx/Rib/Finger/Toe $360 $320 DISLOCATIONS (closed reduction): Hip $3,600 $2,700 Knee (not knee cap) $2,600 $1,950 Shoulder $2,000 $1,500 Foot/Ankle $1,600 $1,200 Hand $1,400 $1,050 Lower Jaw $1,200 $900 Wrist $1,000 $750 Elbow $800 $600 Finger/Toe $320 $240 Open reduction is paid at 150% of closed reduction. Multiple fractures and dislocations are paid at 150% of the benefit amount for open or closed reduction. Chip fractures are paid at 10% of the fracture benefit. Partial dislocations are paid at 25% of the dislocation benefit. S P E C I F I C I N J U R I E S E M P L O Y E E // S P O U S E //C H I L D RUPTURED DISC (treatment within 60 days; surgical repair within one year) Injury occurring during first certificate year $100 Injury occurring after first certificate year $400 TENDONS/LIGAMENTS (within 60 days; surgical repair within $400 (Single) 90 days). If the insured fractures a bone $600 (Multiple) or dislocates a joint, the amount paid will be based on the number (single or multiple) of tendons or ligaments repaired. We will only pay one benefit. TORN KNEE CARTILAGE (treatment within 60 days; surgical repair within one year) Injury occurring during first certificate year $100 Injury occurring after first certificate year $400 EYE INJURIES Treatment and surgical repair within 90 days $250 Removal of foreign body $50 CONCUSSION (a head injury resulting in electroencephalogram $200 abnormality) COMA ( lasting 30 days or more) $10,000 E M P L O Y E E // S P O U S E //C H I L D EMERGENCY DENTAL WORK ( per accident) Repaired with crown $150 Resulting in extraction $50 BURNS (treatment within 72 hours and based on percent of body surface burned): Second-Degree Burns Less than 10% $100 At least 10%, but less than 25% $200 At least 25%, but less than 35% $500 35% or more $1,000 Third-Degree Burns Less than 10% $500 At least 10%, but less than 25% $3,000 At least 25%, but less than 35% $7,000 35% or more $10,000 First-degree burns are not covered. LACERATIONS (treatment and repair within 72 hours): Under 2" long $50 2" to 6" long $200 Over 6" long $400 Lacerations not requiring stitches $25 Multiple Lacerations: We will pay for the largest single laceration requiring stitches. This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions. 38

40 A D D I T I O N A L B E N E F I T S E M P L O Y E E // S P O U S E //C H I L D AMBULANCE $100 AIR AMBULANCE $500 If an insured requires transportation to a hospital by a professional ambulance or air ambulance service within 90 days after a Covered Accident, we will pay the amount shown. BLOOD/ PLASMA $100 If the insured receives blood or plasma within 90 days following a Covered Accident, we will pay the amount shown. APPLIANCES $100 We will pay this benefit when an insured is advised by a physician to use a medical appliance due to injuries received in a Covered Accident. Benefits are payable for crutches, wheelchairs, leg braces, back braces, and walkers. INTERNAL INJURIES $1,000 (resulting in open abdominal or thoracic surgery) ACCIDENT FOLLOW- UP TREATMENT $25 We will pay this benefit for up to six treatments per Covered Accident, per insured for follow-up treatment. The insured must have received initial treatment within 72 hours of the accident, and the follow-up treatment must begin within 30 days of the Covered Accident or discharge from the hospital. This benefit is not payable for the same visit that the Physical Therapy Benefit is paid. EXPLORATORY SURGERY $250 [without repair (i.e., arthroscopy)] PROSTHESIS $500 If an insured requires the use of a prosthetic device due to injuries received in a Covered Accident, we will pay this benefit. Hearing aids, wigs, or dental aids, including but not limited to false teeth, are not covered. PHYSICAL THERAPY $25 We will pay this benefit for up to six treatments per Covered Accident, per insured for treatment from a physical therapist. The insured must have received initial treatment within 72 hours of the accident, and physical therapy must begin within 30 days of the Covered Accident or discharge from the hospital. Treatment must take place within six months after the accident. This benefit is not payable for the same visit that the Accident Follow-Up Treatment Benefit is paid. TRANSPORTATION If hospital treatment or diagnostic study is recommended by the insured s physician and is not available in the insured s city of residence, we will pay the amount shown. Transportation must begin within 90 days from the date of the Covered Accident. The distance to the hospital must be greater than 50 miles from your residence. $300 (train/plane) $150 (bus) FAMILY LODGING BENEFIT ( per night) $100 If an insured is required to travel more than 100 miles from his or her home for inpatient treatment of injuries received in a Covered Accident, we will pay this benefit for an immediate adult family member s lodging. Benefits are payable up to 30 days per accident and only while the insured is confined to the hospital. The treatment must be prescribed by the insured's local physician. This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions. 39

41 L I M I T A T I O N S A N D E X C L U S I O N S If this coverage will replace any existing individual policy, please be aware that it may be in your best interest to maintain your individual guaranteed-renewable policy. WE WILL NOT PAY BENEFITS FOR LOSS, INJURY, OR DEATH CONTRIBUTED TO, CAUSED BY, OR RESULTING FROM: Participating in war or any act of war, declared or not, or participating in the armed forces of or contracting with any country or international authority. We will return the prorated premium for any period not covered when you are in such service. Operating, learning to operate, serving as a crew member on, or jumping or falling from any aircraft, including those that are not motor-driven. Participating or attempting to participate in an illegal activity or working at an illegal job. Committing or attempting to commit suicide, while sane or insane. Injuring or attempting to injure yourself intentionally. Having any disease or bodily/mental illness or degenerative process. We also will not pay benefits for any related medical/surgical treatment or diagnostic procedures for such illness. Traveling more than 40 miles outside the territorial limits of the United States, Canada, Mexico, Puerto Rico, the Bahamas, the Virgin Islands, Bermuda, and Jamaica, except under the Accidental Common-Carrier Death Benefit. Riding in or driving any motor-driven vehicle in a race, stunt show, or speed test. Participating in any professional or semiprofessional organized sport. Being legally intoxicated or under the influence of any narcotic, unless taken under the direction of a physician. Driving any taxi, or intrastate or interstate long-distance vehicle for wage, compensation, or profit. Mountaineering using ropes and/or other equipment, parachuting, or hang gliding. Having cosmetic surgery or other elective procedures that are not medically necessary, or having dental treatment, except as a result of a covered accident. A doctor or physician does not include you or a member of your immediate family. A hospital is not a nursing home, an extended-care facility, a convalescent home, a rest home or a home for the aged, a place for alcoholics or drug addicts, or a mental institution. PRE-EXISTING CONDITION LIMITATION We will not pay benefits for a loss that is caused by, that is contributed to, or that results from a Pre-Existing Condition for 12 months after the Effective Date of your certificate and attached riders, as applicable. Pre-Existing Condition means within the 12-month period prior to the Effective Date of a certificate and attached riders, as applicable: (1) those conditions for which medical advice or treatment was received or recommended, or (2) the existence of symptoms that would cause an ordinarily prudent person to seek diagnosis, care, or treatment. A claim for benefits for loss starting after 12 months from the Effective Date of a certificate and attached riders will not be reduced or denied on the grounds that it is caused by a Pre-Existing Condition. Treatment means consultation, care, or services provided by a physician, including diagnostic measures, and taking prescribed drugs and medicines. A certificate may have been issued as a replacement for a certificate previously issued under the plan. If so, then the Pre-Existing Condition Limitation provision of the certificate applies only to any increase in benefits over the prior certificate. Any remaining period of the Pre-Existing Condition Limitation of the prior certificate will continue to apply to the prior level of benefits. We ve got you under our wing. aflacgroupinsurance.com The certificate to which this sales material pertains is written only in English; the policy prevails if interpretation of this material varies. You and Your refer to an employee as defined in the plan. Spouse means the person married to you on the Effective Date of the rider. The rider may only be issued to your Spouse if your Spouse is between ages 18 and 64, inclusive. Coverage on your Spouse terminates when your Spouse attains age 70. Dependent Children means your natural children, stepchildren, foster children, legally adopted children, or children placed for adoption, who are under age 26. Your natural Children born after the Effective Date of the rider will be covered from the moment of live birth. No notice or additional premium is required. Coverage on Dependent Children will terminate on the child's 26th birthday. However, if any child is incapable of self-sustaining employment due to mental retardation or physical handicap and is dependent on his or her parent(s) for support, the above age 26 limitation shall not apply. Proof of such incapacity and dependency must be furnished to the company within 31 days following such child s 26th birthday. P ORTA B L E C OV ER AGE When coverage would otherwise terminate because the employee ends employment with the employer, coverage may be continued. The employee will continue the coverage that is in force on the date employment ends, including dependent coverage then in effect. The employee will be allowed to continue the coverage until the earlier of the date the employee fails to pay the required premium or the date the group master policy is terminated. Coverage may not be continued if the employee fails to pay any required premium, the insured attains age 70, or the group master policy terminates. T ERMIN AT ION Insurance for an insured employee will terminate on the earliest of: (1) the date the master policy is terminated, (2) the 31st day after the premium due date if the required premium has not been paid, (3) the date the employee ceases to meet the definition of an employee as defined in the master policy, (4) the premium due date which falls on or first follows the employee s 70th birthday, or (5) the date the employee is no longer a member of the class eligible. Insurance for an insured Spouse or Dependent Child will terminate the earliest of: (1) the date the plan is terminated; (2) the date the Spouse or Dependent Child ceases to be a dependent; (3) the premium due date following the date we receive your written request to terminate coverage for your Spouse and/or all Dependent Children. EFFEC T I V E DAT E The Effective Date for an employee is as follows: (1) An employee's insurance will be effective on the date shown on the Certificate Schedule, provided the employee is then actively at work. (2) If an employee is not actively at work on the date coverage would otherwise become effective, the Effective Date of his or her coverage will be the date on which such employee is first thereafter actively at work. Continental American Insurance Company (CAIC), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. Continental American Insurance Company 2801 Devine Street Columbia, South Carolina This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions. This brochure is subject to the terms, conditions, and limitations of Policy Form Series CA7700-MP. 40

42 Lockhart Independent School District Rate sheet prepared by Web User on 2/20/2013 2:45:06 PM. Texas Payroll Premium rates are Monthly. Aflac Group coverage is underwritten by Continental American Insurance Company (CAIC) CAIC GROUP ACCIDENT ADVANTAGE - PLAN Series 7700 With High Option - 24 Hour Plan Without Wellness Benefit Coverage Premium Employee $16.12 Employee & Spouse $23.06 Employee & Child $30.68 Family $37.62 The rates shown on this insert page are for illustration purposes only; they do not imply coverage. For more information about policy/plan benefits and limitations, please refer to the accompanying product brochure for each insurance policy/plan listed below. 41

43 Group Dental Insurance SUMMARY OF BENEFITS Sponsored by: Lockhart ISD You may choose any dentist. However, using contracting dentists should lower your out-of-pocket expenses. You do not need a referral to see a specialist. A list of participating dentist may be accessed at By enrolling in the dental plan you and your enrolled family members will have access to Lincoln DentalConnect SM, our free on-line dental health information Web site. If you incur dental expenses and have satisfied the benefit waiting period(s), the plan pays the following percentage of allowable expenses in excess of the deductible up to the maximum benefit. Covered dental expenses include only those services listed in your certificate. Covered expenses outside the panel service area will not exceed the policy s usual and customary allowances. Preventive Basic Major Orthodontics Deductible - Routine Oral Exams - Bitewing X-rays - Full-mouth or Panoramic X-rays - Other Dental X-rays (including periapical films) - Routine Cleanings - Fluoride Treatments - Space Maintainers for children - Sealants - Problem Focused Exams - Consultations - Palliative Treatment (including emergency relief of dental pain) - Injections of antibiotics and other therapeutic medications - Fillings - Prefabricated Stainless Steel and Resin Crowns - Simple Extractions - Surgical Extractions - Oral Surgery - Biopsy and Examination of Oral Tissue (including brush biopsy) - General Anesthesia and I.V. Sedation - Prosthetic Repair and Recementation Services - Endodontics (including Root Canal Treatment) - Periodontal Maintenance procedures - Non-surgical Periodontal Therapy - Periodontal Surgery - Bridges - Full and Partial Dentures - Denture Reline and Rebase Services - Crowns, Inlays, Onlays and related services - Orthodontic Treatment- Including Orthodontic Exams, X-rays, Extractions, Study Models and Appliances Calendar year deductible. Waived for Preventive services Contracting Dentist Non-Contracting Dentist 100% 100% 80% 80% 50% 50% 50% 50% $50 Individual $150 Family $50 Individual $150 Family Maximum Calendar year maximum for Preventive, Basic and Major services $1100 $1100 Ortho Maximum Lifetime Ortho Maximum for family: $1000 $1000 MaxRewards SM A covered person may be eligible for a rollover of a portion of the previous year's unused Annual maximum for Preventive, Basic and Major services combined based on the following: Eligible Range (claim threshold) $1 - $600 Rollover Amount Rollover Amount with Preferred Provider $250 per calendar year $350 per calendar year Maximum Rollover Account Balance $1000 ROGGIVAN LCKHRTISD LCTGY261US /03/11 42

44 Your plan costs Employee Only $29.82 Monthly Employee and Spouse $57.58 Monthly Employee and Children $74.50 Monthly Family $ Monthly Dependent eligibility Children are covered for dental services up to age 26. Orthodontic Treatment is covered for children who have the orthodontic appliance initially installed prior to age 19 and adult spouses and employees. Benefit waiting period Basic services: None Major services: None Orthodontics: None Exclusions This is a summary of policy exclusions. The policy contains other, more specific, exclusions and limitations not fully explained in this benefit summary. The plan does not cover services started before coverage begins or after it ends. Services must be necessary and appropriate for the claimant s condition. Benefits are limited to services specifically shown on the list of procedures included in the policy, unless coverage for additional services is required by state law. Benefits are not payable for duplication of services or for treatment by a practitioner who lives with or is related to the employee or dependent. Benefits are not payable for placement of a prosthetic, unless it is needed to replace teeth extracted while covered. Installation, maintenance or removal of implants or any related expense is excluded. Policy does not cover the cost of athletic mouth guards, appliances to correct harmful habits or the replacement of lost or stolen dental appliances. Policy excludes services for treatment of TMJ or congenital malformations, except as required by law. Benefits are not payable for veneers, cosmetic procedures or medications administered outside the dentist s office, for prescription drugs, or for analgesia, sedation, hypnosis or acupuncture administered for the purposes of alleviating anxiety or apprehension. Nitrous oxide is not covered. Plan benefits are not payable for a condition for which the claimant is eligible for benefits under worker s compensation or a similar law; or for a condition attributed to employment or military service. Coverage is not available for dental conditions caused by an act of war, self-inflicted injury, involvement in an illegal occupation, attempt to commit a felony, or active participation in a riot. If benefits for orthodontia are included, the plan does not cover any treatment plan started before coverage begins or during the benefit waiting period unless the member was receiving orthodontia benefits from this employer s previous group dental policy. In that case, Lincoln Financial will continue orthodontia benefits until the combined benefit paid by the two policies is equal to this policy s lifetime orthodontia. Plan benefits are not payable if the orthodontic appliance was installed after the age of 19. Alternative benefits provision In certain situations there may be two or more methods of treating a dental condition. Your policy includes an alternative benefits provision that may reduce benefits to the lowest cost, generally effective and necessary form of treatment. For example, the policy covers amalgam fillings on posterior teeth even if tooth-colored fillings are used. Predetermination of benefits Allows you to find the amount covered prior to having a dental procedure. We recommend that you use this service when expenses are expected to exceed $300. Claim submission Submit a claim by mail to: Lincoln Financial Group Dental Claims Input Center P.O. Box Orlando, FL Submit a claim by fax to: (877) For assistance or additional information Contact Lincoln Financial Group at or log on to NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern Lincoln National CorporationGroup Insurance products are issued by The Lincoln National Life Insurance Company (Ft. Wayne, IN), which is not licensed and does not solicit business in New York. In New York, group insurance products are issued by Lincoln Life & Annuity Company of New York (Syracuse, NY). Both are Lincoln Financial Group companies. Product availability and/or features may vary by state. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Each affiliate is solely responsible for its own financial and contractual obligation. ROGGIVAN LCKHRTISD LCTGY261US /03/11 43

45 LOCKHART INDEPENDENT SCHOOL DISTRICT Eye Care Highlight Sheet Plan 1: EyeChoice Focus Plan Summary Effective Date: 9/1/2015 VSP Choice Network + Affiliates Out of Network Deductibles $10 Exam $10 Exam $25 Eye Glass Lenses or Frames* $25 Eye Glass Lenses or Frames* Annual Eye Exam Covered in full Up to $45 Lenses (per pair) Single Vision Covered in full Up to $30 Bifocal Covered in full Up to $50 Trifocal Covered in full Up to $65 Lenticular Covered in full Up to $100 Progressive See lens options NA Contacts Fit & Follow Up Exams 15% discount No benefit See Additional Focus Features. Elective Up to $130 Up to $105 Medically Necessary Covered in full Up to $210 Frames $130 Up to $70 Frequencies (months) Exam/Lens/Frame 12/12/24 12/12/24 Based on date of service Based on date of service *Deductible applies to a complete pair of glasses or to frames, whichever is selected. Lens Options (member cost)* VSP Choice Network + Affiliates Out of Network Progressive Lenses Up to provider s contracted fee for Lined Bifocal Up to Lined Bifocal allowance. Lenses. The patient is responsible for the difference between the base lens and the Progressive Lens charge. Std. Polycarbonate Covered in full for dependent children No benefit $33 adults Solid Plastic Dye $15 No benefit (except Pink I & II) Plastic Gradient Dye $17 No benefit Photochromatic Lenses $31-$82 No benefit (Glass & Plastic) Scratch Resistant Coating $17-$33 No benefit Anti-Reflective Coating $43-$85 No benefit Ultraviolet Coating $16 No benefit Lasik or PRK Average discount of 15% off retail. See Additional Focus Features. No benefit *Lens Option member costs vary by prescription and option chosen. Monthly Rates Employee Only (EE) $8.44 EE + 1 Dependent $16.88 EE + 2 or more Dependents $

46 LOCKHART INDEPENDENT SCHOOL DISTRICT Eye Care Highlight Sheet Additional Focus Choice Network Features Contact Lenses Elective Allowance includes fitting, exam and lenses. The cost of the fitting and evaluation is deducted from the contact allowance. Allowance can be applied to disposables, but the dollar amount must be used all at once (provider will order 3 or 6 month supply). Applies when contacts are chosen in lieu of glasses. Additional Glasses Frame Discount Laser VisionCare Low Vision 20% discount off the retail price on additional pairs of prescription glasses (complete pair). VSP offers a 20% discount off the remaining balance in excess of the frame allowance. VSP offers an average discount of 15% on LASIK and PRK. The maximum out-of-pocket per eye for members is $1,800 for LASIK and $2,300 for custom LASIK using Wavefront technology, and $1,500 for PRK. In order to receive the benefit, a VSP provider must coordinate the procedure. With prior authorization, 75% of approved amount (up to $1,000 is covered every two years). Rx Savings Our valued plan members and their covered dependents (even their pets) can save on prescription medications through any Walmart or Sam's Club pharmacy across the nation. This Rx discount is offered at no additional cost, and it is not insurance. To receive the Walmart Rx discount, Ameritas plan members just need to visit us at ameritasgroup.com and sign into (or create) a secure member account where they can access and print an online-only Rx discount savings ID card. Retail Chain Affiliate Providers Available With Focus Plans Effective January 1, 2012, retail chain affiliate providers, which include Costco Optical and Eye Care Centers of America TM (ECCA), give members added convenience and additional retail choices. Costco Optical has 400 locations across the country, while ECCA manages nearly 400 optical stores in 37 states and DC, including well-known stores such as EyeMasters, Visionworks, Dr. Bizer s VisionWorld, Eye DRx, and Hour Eyes, to name a few. Members enjoy a covered-in-full benefit experience with equivalent frame benefit at any of these retail chain locations. Eye Care Plan Member Service Focus eye care from Ameritas Group features the money-saving eye care network of VSP. Customer service is available to plan members through VSP's well-trained and helpful service representatives. Call or go online to locate the nearest VSP network provider, view plan benefit information and more. VSP Call Center: Service representative hours: 5 a.m. to 7 p.m. PST Monday through Friday, 6 a.m. to 2:30 p.m. PST Saturday Interactive Voice Response available 24/7 Locate a VSP provider at: ameritasgroup.com/member View plan benefit information at: vsp.com Section 125 This plan is provided as part of the Policyholder's Section 125 Plan. Each employee has the option under the Section 125 Plan of participating or not participating in this plan. If an employee does not elect to participate when initially eligible, he/she may elect to participate at the Policyholder's next Annual Election Period. This document is a highlight of plan benefits provided by Ameritas Life Insurance Corp. as selected by your employer. It is not a certificate of insurance and does not include exclusions and limitations. For exclusions and limitations, or a complete list of covered procedures, contact your benefits administrator. 45

47 The TASC Card MyBenefits. MyCash. MyWay Offering ease and convenience for your FlexSystem FSA! The TASC Card features two accounts on one card MyBenefits for employee benefits purchases and MyCash for cash reimbursements. Visit MyTASC ( and click TASC Card Management to view card information, request a dependent card, reissue a card (due to never received, damaged, lost/stolen, or name change), request a PIN, and view allowed benefits. MyBenefits. The TASC Card provides a convenient method to pay for eligible healthcare, dependent care, and/or transportation expenses as defined by your FlexSystem Plan. MyBenefits is funded through equal pre-tax payroll deductions based on your annual benefit election. Card purchases are limited to your Plan type, and also to merchants with an inventory information approval system (IIAS) in place to identify FSA-eligible purchases. Qualifying merchants may include doctors, dentists, vision care facilities, and day care centers. Simply swipe your card at the time you incur the eligible expense and the IIAS automatically approves the purchase of eligible items and deducts the amount from your MyBenefits account. MyCash. Reimbursements are fast and paperless! If you do not use your TASC Card to pay for an eligible expense, you may submit a request for reimbursement via MyTASC Mobile (visit for more information), online Request for Reimbursement Wizard in MyTASC, text message, fax, or mail. Your reimbursement will be deposited in your MyCash account. Access your MyCash funds in three ways: (1) swipe your TASC Card at any merchant that accepts major credit cards, (2) withdraw at an ATM using your TASC Card, or (3) transfer to a personal bank account from MyCash Manager. Spend your MyCash funds any way and anywhere you want! Visit the MyCash Manager within MyTASC ( to view account activity, request an ATM PIN, make and manage transfers, view and manage multiple bank accounts, and more. MyWay. Access to two accounts on one card makes the TASC Card more versatile than ever! Avoid embarrassing declines. MyCash funds can be used to pay for eligible expenses if no funds are available in your MyBenefits account. Combine general retail items with healthcare expenses in one transaction. The TASC Card is smart enough to know that eligible expenses are automatically deducted from your MyBenefits account while ineligible expenses are withdrawn from your MyCash account. Transfer MyCash funds via a quick, one-time, recurring, or automatic transfer from MyCash Manager within MyTASC. The TASC Card is available for the following FlexSystem Accounts (where applicable): FlexSystem Healthcare FSA FlexSystem Dependent Care FSA FlexSystem Transportation Account FSA Eligible Expenses FlexSystem FSA funds may only be used for eligible expenses under your healthcare FSA and/ or dependent care FSA. Some eligible expenses include: Medical care services Dental care services Vision care expenses Prescriptions Daycare tuition More detailed lists can be found at in IRS Publications 502 & 503. Please note insurance premiums are NOT eligible for reimbursement. Track Account Activity MyTASC ( MyCash Manager (within MyTASC) MyTASC Mobile App Keep your receipts! MyTASC Text Messaging (SMS) TASC 2302 International Lane Madison, WI Fax: FX