Employee Benefits Handbook

Transcription

1 Employee Benefits Handbook Plan Year Medical Expense Reimbursement Life Insurance Disability Insurance Cancer and Specified Disease Insurance Accident Insurance Dental Insurance

2 Table of Contents Topic Page Benefit Overview...1 Section 125 Plan Overview...2 Flexible Spending Account Details Benefit Summary Dental Insurance Vision Insurance Short Term Disability Long Term Disability Accident Insurance Medical Gap Insurance Critical Illness Insurance Cancer Insurance Term Life Insurance Permanent Life Insurance Group Life Insurance My Health MD...67 LegalShield...68 Important Phone Numbers...69

3 2016 Benefit Overview Marble Falls Independent School District and First Financial Group of America would like to take this opportunity to present to you the benefit information for the upcoming plan year. This information has been created to bring forth a brief overview of your benefit choices as well as offer you a reference guide when questions may arise regarding your insurance plans. Please take the time to look over the information contained in this booklet to familiarize yourself with the benefits that are provided to you as an employee with Marble Falls ISD. Representatives from First Financial will be at the district during the month of April to review plan options and make changes to your supplementary benefit elections under the Cafeteria Plan. The Plan Year for Marble Falls ISD is September 1, August 31, Payroll deductions for your benefits will begin in September. This guide contains a summary of the benefits offered by all ISD. If there is a conflict between the terms of this outline of benefits and the actual contracts, the terms of the contracts will prevail. For a more detailed explanation of benefits you may contact First Financial Administrators at or visit the website listed below. Your Benefits Website: Visit benefits.ffga.com/ all isd for detailed information. 1

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7 Available Benefits at a Glance Disability Income Insurance This insurance is designed to protect your ability to earn an income. This plan will provide you with income (70% of your gross monthly income) - should you become disabled as a result of a covered accident or illness. The plans have various waiting periods that you can select. There is a doctor bill benefit on the long term plan payable (if you are sick, miss a day of work, and go to a doctor) for out-of-pocket expenses up to $50 for illness and $150 for an accidental injury. There is also a short term disability option available. Cancer Insurance Cancer insurance is designed to be a supplemental insurance that pays for many of the costs not covered by your major medical. This plan pays in addition to other coverage you may have. There are several option riders available such as the option for family coverage, Critical Illness rider, and an ICU rider, giving you the flexibility for the best coverage to meet your needs. Accident Insurance Accident Insurance helps to cover the expenses for emergency room costs, follow-up treatments, medical imaging, hospital confinement, and many other expenses associated with accidental injuries. This plan can help with medical expenses and living costs when you get hurt unexpectedly. Dental Insurance Ameritas Dental Ameritas Dental is the provider for Marble Falls ISD. Preventative services are covered 100% with a $5.00 copayment. Orthodontia coverage is available for children after a six month waiting period. Vision Insurance - Eyemed Vision Eyemed Vision is the vision provider for Marble Falls ISD. There are two plans to choose from. Benefits for exam, contacts, or lenses and frames are available every 12 months.. My Health MD Access a Doctor 24 hours, 7 days a week. Employees can contact My Health MD and provide information to a medical assistant. A My Health MD Doctor will contact you for a consultation, create a treatment plan, and call in a prescription if necessary. Common conditions treated by My Health MD include: cold, pink eye, sinus infection, skin rashes, allergies, urinary tract infection, etc. 5

8 Available Benefits at a Glance cont.. Medical Gap Insurance - Metlife The medical gap plan is designed to help you cover your out of pockets expenses that can add up. Supplementing your major medical with medical gap insurance may help you pay for expenses such as deductibles, copayments, and co-insurance Critical Illness Insurance - Metlife Critical Illness provides a lump sum payment upon the first diagnosis of a covered condition. Benefit amount of $15,000 or $30,000. Coverage can be purchased for spouse and dependent children also. Flexible Spending Plans First Financial Administrators, Inc. Marble Falls ISD allows employees to set aside up to $2,550 per year for unreimbursed medical expenses and/or up to $5,000 per year for dependent day care expenses on a pre-tax basis. Federal regulations effective January 1, 2011, will exclude over-the-counter medications from being eligible expenses. Life Insurance Individual Life Insurance Texas Life Employees have the opportunity to purchase individual permanent life insurance through Texas Life. These policies are portable at the same price and coverage. Coverage can be purchased for dependents including spouses, children, and grandchildren. Coverage is guaranteed to age 121. Term Life Insurance Term life insurance is affordable life insurance that covers a specified period of time 10, 20, 30 years. Your coverage expires at the end of the term. Group Life Insurance Ft Dearborn Group life insurance gives employees the opportunity to purchase Group life insurance through Dearborn National at affordable group rates. You may purchase coverage for yourself, spouse, and dependent children. 6

9 FFGA TEXAS STATE PLAN MARBLE FALLS INDEPENDENT SCHOOL DISTRICT Dental Highlight Sheet Plan 1: Dental Plan Summary Policy # Effective Date: 9/1/2016 Plan Benefit Type 1 100% Type 2 80% Type 3 50% Deductible $5/visit Type 1 $50 Calendar Year Type 2,3 No Family Maximum Maximum (per person) $1,000 per calendar year Allowance Ameritas U&C Dental Rewards Included Waiting Period Type 3 6 months Orthodontia Summary - Child Only Coverage Allowance U&C Plan Benefit 50% Lifetime Maximum (per person) $1,000 Waiting Period 6 months Sample Procedure Listing (Current Dental Terminology American Dental Association.) Type 1 Type 2 Type 3 Routine Exam (2 per benefit period) Bitewing X-rays (1 per benefit period) Full Mouth/Panoramic X-rays (1 in 5 years) Cleaning (2 per benefit period) Fluoride for Children 13 and under (1 per benefit period) Sealants (age 13 and under) Space Maintainers Restorative Amalgams Restorative Composites Simple Extractions Monthly Rates Employee Only (EE) $29.96 EE + 1 Dependent $61.28 EE + 2 or more Dependents $ Onlays Crowns (1 in 8 years per tooth) Crown Repair Endodontics (nonsurgical) Endodontics (surgical) Periodontics (nonsurgical) Periodontics (surgical) Denture Repair Implants Prosthodontics (fixed bridge; removable complete/partial dentures) (1 in 8 years) Complex Extractions Anesthesia Ameritas Information We're Here to Help This plan was designed specifically for the associates of MARBLE FALLS INDEPENDENT SCHOOL DISTRICT. At Ameritas Group, we do more than provide coverage - we make sure there's always a friendly voice to explain your benefits, listen to your concerns, and answer your questions. Our customer relations associates will be pleased to assist you 7 a.m. to midnight (Central Time) Monday through Thursday, and 7 a.m. to 6:30 p.m. on Friday. You can speak to them by calling toll-free: For plan information any time, access our automated voice response system or go online to ameritas.com. 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 ameritas.com and sign into (or create) a secure member account where they can access and print an online-only Rx discount savings ID card. 7

10 FFGA TEXAS STATE PLAN MARBLE FALLS INDEPENDENT SCHOOL DISTRICT Dental Highlight Sheet Eyewear Savings Ameritas plan members may receive up to 15% off eyewear frames and lenses purchased at any Walmart Vision Center nationwide. Members may also bring in their current vision prescription from any vision care provider and purchase eyewear at Walmart. This savings arrangement is not insurance: it is available to members at no additional cost to their plan premium. To receive the eyewear savings identification card, Ameritas plan members can visit ameritas.com and sign-in (or create) a secure member account. Members must present the Ameritas Eyewear Savings Card at time of purchase to receive the discount. Dental Rewards This dental plan includes a valuable feature that allows qualifying plan members to carryover part of their unused annual maximum. A member earns dental rewards by submitting at least one claim for dental expenses incurred during the benefit year, while staying at or under the threshold amount for benefits received for that year. Employees and their covered dependents may accumulate rewards up to the stated maximum carryover amount, and then use those rewards for any covered dental procedures subject to applicable coinsurance and plan provisions. If a plan member doesn't submit a dental claim during a benefit year, all accumulated rewards are lost. But he or she can begin earning rewards again the very next year. Benefit Threshold $500 Dental benefits received for the year cannot exceed this amount Annual Carryover Amount $250 Dental Rewards amount is added to the following year's maximum Maximum Carryover $1,000 Maximum possible accumulation for Dental Rewards Dental Network Information To find a provider, visit ameritas.com and select FIND A PROVIDER, then DENTAL. Enter your criteria to search by location or for a specific dentist or practice. California Residents: When prompted to select your network, choose the Ameritas Network found on your ID Card or contact Customer Connections at Pretreatment While we don't require a pretreatment authorization form for any procedure, we recommend them for any dental work you consider expensive. As a smart consumer, it's best for you to know your share of the cost up front. Simply ask your dentist to submit the information for a pretreatment estimate to our customer relations department. We'll inform both you and your dentist of the exact amount your insurance will cover and the amount that you will be responsible for. That way, there won't be any surprises once the work has been completed. Open Enrollment If a member does not elect to participate when initially eligible, the member may elect to participate at the policyholder's next enrollment period. This enrollment period will be held each year and those who elect to participate in this policy at that time will have their insurance become effective on September 1. Late Entrant Provision We strongly encourage you to sign up for coverage when you are initially eligible. If you choose not to sign up during this initial enrollment period, you will become a late entrant. Late entrants will be eligible for only exams, cleanings, and fluoride applications for the first 12 months they are covered. 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. Dental Cost Estimator Ever wonder what a dental procedure usually costs? The answer can be found using the Ameritas group division s Dental Cost Estimator tool located in our Secure Member Account portal. Members can search by ZIP Code for a specific dental procedure and see fee range estimates for out-of-network general dentists in that area. Of course, we always suggest that members partner with their dentists, so they know what s involved in any recommended treatment plan. The estimator tool is powered by Go2Dental and uses FAIR Health data that is updated annually. Please note, cost estimates do not reflect discounted rates available through provider networks, and the estimator does not include orthodontic estimates at this time. In addition, when members are in their Secure Member Account, they can: Go paperless with electronic Explanation of Benefits statements and reduce the clutter in their mailboxes View their certificate of insurance and specific plan benefits information Access value-added extras like the Rx discount ID card Language Services We recognize the importance of communicating with our growing number of multilingual customers. That is why we offer a language assistance program that gives you access to: Spanish-speaking claims contact center representatives, telephone interpretation services in a wide range of languages, online dental network provider search in Spanish and a variety of Spanish documents such as enrollment forms, claim forms and certificates of insurance. 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. 8

11 Marble Falls ISD Low Plan Vision Care In-Network Out-of-Network Services Member Cost Reimbursement More, for less % Complete pair of prescription eyeglasses 20 % Non-prescription sunglasses 20 % OFF Remaining balance beyond plan coverage These discounts are for in-network providers only Hello, Neighbor OFF OFF You re on the INSIGHT Network For a complete list of providers near you, use our Provider Locator on and choose the INSIGHT network or call Exam With Dilation as Necessary $10 Copay Up to $40 Contact Lens Fit and Follow-Up (Contact lens fit and two follow up visits are available once a comprehensive eye exam has been completed) Standard Contact Lens Fit & Follow-Up Up to $55 N/A Premium Contact Lens Fit & Follow-Up 10% off retail N/A Retinal Imaging Up to $39 N/A Frames $0 Copay; $150 allowance; 80% of charge over $150 Up to $105 Standard Plastic Lenses Single Vision $20 Copay Up to $30 Bifocal $20 Copay Up to $50 Trifocal $20 Copay Up to $70 Standard Progressive Lens $20 Copay Up to $80 Premium Progressive Lens $40 Copay - $65 Copay Tier 1 $40 Copay Up to $80 Tier 2 $50 Copay Up to $80 Tier 3 $65 Copay Up to $80 Tier 4 $20 Copay, 80% of charge less $120 Allowance Up to $80 Lenticular $20 Copay Up to $70 Lens Options (paid by the member and added to the base price of the lens) UV Treatment $15 N/A Tint (Solid and Gradient) $15 N/A Standard Plastic Scratch Coating $15 N/A Standard Polycarbonate $40 N/A Standard Polycarbonate - Kids under 19 $0 Up to $32 Standard Anti-Reflective Coating $45 N/A Premium Anti-Reflective Coating $57 -$68 N/A Tier 1 $57 N/A Tier 2 $68 N/A Tier 3 80% of charge N/A Photochromic/Transitions $75 N/A Polarized 20% off retail price N/A Other Add-Ons and Services 20% off retail price N/A Contact Lenses Conventional $0 Copay; $150 allowance; 15% off retail price over $150 Up to $150 Disposable $0 Copay; $150 allowance; plus balance over $150 Up to $150 Medically Necessary $0 copay, Paid in Full Up to $210 Laser Vision Correction Lasik or PRK from U.S. Laser Network 15% off the retail price or 5% off the promotional price N/A Frequency Examination Once every 12 months Lenses or Contact Lenses Once every 12 months Frame Once every 12 months Premiums - monthly Subscriber $8.63 Subscriber + Spouse $16.40 Subscriber + Children $17.26 Subscriber + Family $25.38 For Lasik providers, call LASER6 or visit eyemedlasik.com. Premium progressives and premium anti-reflective designations are subject to annual review by EyeMed s Medical Director and are subject to change based on market conditions. Fixed pricing is reflective of brands at the listed product level. All providers are not required to carry all brands at all levels. 9

12 What s in it for me? Options. It s simple really. We love our members that s why we are dedicated to helping you see clearly and we ve built a network that gives you lots of choices and flexibility. You can choose from independent doctors and retail providers to find the one that best fits your needs and schedule. No matter which one you choose, our plan is designed to be easy to use and to save you money. Welcome to EyeMed. eyemed.com Benefits Snapshot With Us Out-of-Network Reimbursement Exam with dilation as necessary (Once every 12 months) Frames (Once every 12 months) Single Vision Lenses (Once every 12 months) $10 Copay Up to $40 $0 Copay; $150 allowance; 80% of charge over $150 Up to $105 $20 Copay Up to $30 Or Contacts (Once every 12 months) $0 Copay; $150 allowance; plus balance over $150 Up to $150 And now it s time for the breakdown... Here s an example of what you might pay for a pair of glasses vs. what you d pay without vision coverage. So, let s say you get an eye exam and choose a frame that costs $163 with single vision lenses that have UV and scratch protection. Now let s see the difference... With Us Without Insurance** Exam $10 Copay Exam $106 82% SAVINGS with us Frame $163 Frame $163 -$150 allowance $13 -$2.60 (20% discount off balance) $10.40 Lens $20 Copay Lens $78 $15 UV treatment add-on $23 UV treatment add-on +$15 Scratch coating add-on +$25 Scratch coating add-on $50 $126 Total $70.40 Total $395 Benefits are not provided from services or materials arising from: 1) Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; 2) Medical and/or surgical treatment of the eye, eyes or supporting structures; 3) Any eye or Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; Safety eyewear; 4) Services provided as a result of any Workers Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; 5) Plano (non-prescription) lenses and/or contact lenses; 6) Non-prescription sunglasses; 7) Two pair of glasses in lieu of bifocals; 8) Services or materials provided by any other group benefit plan providing vision care 9) Services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of such order. 10) Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available. Benefits may not be combined with any discount, promotional offering, or other group benefit plans. Standard/Premium Progressive lens not covered-fund as a Bifocal lens. Standard Progressive lens covered-fund Premium Progressive as a Standard. Premium progressives and premium anti-reflective designations are subject to annual review by EyeMed s Medical Director and are subject to change based on market conditions. Fixed pricing is reflective of brands at the listed product level. All providers are not required to carry all brands at all levels. Underwritten by Fidelity Security Life Insurance Company of Kansas City, Missouri, except in New York. This is a snapshot of your benefits. The Certificate of Insurance is on file with your employer. Benefit allowance provides no remaining balance for future use within the same benefit year. **Based on industry averages. 10

13 Marble Falls ISD High Plan Vision Care In-Network Out-of-Network Services Member Cost Reimbursement More, for less % Complete pair of prescription eyeglasses 20 % Non-prescription sunglasses 20 % OFF Remaining balance beyond plan coverage These discounts are for in-network providers only Hello, Neighbor OFF OFF You re on the INSIGHT Network For a complete list of providers near you, use our Provider Locator on and choose the INSIGHT network or call Exam With Dilation as Necessary $0 Copay Up to $40 Contact Lens Fit and Follow-Up (Contact lens fit and two follow up visits are available once a comprehensive eye exam has been completed) Standard Contact Lens Fit & Follow-Up Up to $55 N/A Premium Contact Lens Fit & Follow-Up 10% off retail N/A Retinal Imaging Up to $39 N/A Frames $0 Copay; $175 allowance; 80% of charge over $175 Up to $ Standard Plastic Lenses Single Vision $0 Copay Up to $30 Bifocal $0 Copay Up to $50 Trifocal $0 Copay Up to $70 Standard Progressive Lens $50 Copay Up to $56 Premium Progressive Lens $70 Copay - $95 Copay Tier 1 $70 Copay Up to $56 Tier 2 $80 Copay Up to $56 Tier 3 $95 Copay Up to $56 Tier 4 $50 Copay, 80% of charge less $120 Allowance Up to $56 Lenticular $0 Copay Up to $70 Lens Options (paid by the member and added to the base price of the lens) UV Treatment $0 Up to $12 Tint (Solid and Gradient) $0 Up to $12 Standard Plastic Scratch Coating $0 Up to $12 Standard Polycarbonate $0 Up to $32 Standard Polycarbonate - Kids under 19 $0 Up to $32 Standard Anti-Reflective Coating $45 N/A Premium Anti-Reflective Coating $57 -$68 N/A Tier 1 $57 N/A Tier 2 $68 N/A Tier 3 80% of charge N/A Photochromic/Transitions $75 N/A Polarized 20% off retail price N/A Other Add-Ons and Services 20% off retail price N/A Contact Lenses Conventional $0 Copay; $250 allowance; 15% off retail price over $250 Up to $250 Disposable $0 Copay; $250 allowance; plus balance over $250 Up to $250 Medically Necessary $0 copay, Paid in Full Up to $210 Laser Vision Correction Lasik or PRK from U.S. Laser Network 15% off the retail price or 5% off the promotional price N/A Frequency Examination Once every 12 months Lenses or Contact Lenses Once every 12 months Frame Once every 12 months Premiums - monthly Subscriber $12.97 Subscriber + Spouse $24.64 Subscriber + Children $25.93 Subscriber + Family $38.12 For Lasik providers, call LASER6 or visit eyemedlasik.com. Premium progressives and premium anti-reflective designations are subject to annual review by EyeMed s Medical Director and are subject to change based on market conditions. Fixed pricing is reflective of brands at the listed product level. All providers are not required to carry all brands at all levels. 11

14 What s in it for me? Options. It s simple really. We love our members that s why we are dedicated to helping you see clearly and we ve built a network that gives you lots of choices and flexibility. You can choose from independent doctors and retail providers to find the one that best fits your needs and schedule. No matter which one you choose, our plan is designed to be easy to use and to save you money. Welcome to EyeMed. eyemed.com Benefits Snapshot With Us Out-of-Network Reimbursement Exam with dilation as necessary (Once every 12 months) Frames (Once every 12 months) Single Vision Lenses (Once every 12 months) $0 Copay Up to $40 $0 Copay; $175 allowance; 80% of charge over $175 Up to $ $0 Copay Up to $30 Or Contacts (Once every 12 months) $0 Copay; $250 allowance; plus balance over $250 Up to $250 And now it s time for the breakdown... Here s an example of what you might pay for a pair of glasses vs. what you d pay without vision coverage. So, let s say you get an eye exam and choose a frame that costs $163 with single vision lenses that have UV and scratch protection. Now let s see the difference... With Us Without Insurance** Exam $0 Copay Exam $ % SAVINGS with us Frame $163 Frame $163 -$175 allowance $0 -$0.00 (20% discount off balance) $0.00 Lens $0 Copay Lens $78 $0 UV treatment add-on $23 UV treatment add-on +$0 Scratch coating add-on +$25 Scratch coating add-on $0 $126 Total $0.00 Total $395 Benefits are not provided from services or materials arising from: 1) Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; 2) Medical and/or surgical treatment of the eye, eyes or supporting structures; 3) Any eye or Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; Safety eyewear; 4) Services provided as a result of any Workers Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; 5) Plano (non-prescription) lenses and/or contact lenses; 6) Non-prescription sunglasses; 7) Two pair of glasses in lieu of bifocals; 8) Services or materials provided by any other group benefit plan providing vision care 9) Services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of such order. 10) Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available. Benefits may not be combined with any discount, promotional offering, or other group benefit plans. Standard/Premium Progressive lens not covered-fund as a Bifocal lens. Standard Progressive lens covered-fund Premium Progressive as a Standard. Premium progressives and premium anti-reflective designations are subject to annual review by EyeMed s Medical Director and are subject to change based on market conditions. Fixed pricing is reflective of brands at the listed product level. All providers are not required to carry all brands at all levels. Underwritten by Fidelity Security Life Insurance Company of Kansas City, Missouri, except in New York. This is a snapshot of your benefits. The Certificate of Insurance is on file with your employer. Benefit allowance provides no remaining balance for future use within the same benefit year. **Based on industry averages. 12

15 AMERICAN FIDELITY ASSURANCE COMPANY S Short-Term Disability Income Insurance 13 Plan Designed Specifically For: Marble Falls Independent School District

16 Why Do You Need Disability Income Protection? Disability causes nearly 50% of all mortgage foreclosures 1. Disability nearly causes 50% Are You Prepared If You Become Disabled? If your paycheck suddenly stopped today, what would you do? 68% of Americans are now living paycheck to paycheck 2. The consequence of suffering a disabling Injury or Sickness could be a financial concern. And with research showing about 1 in 4 working Americans will become disabled for at least 90 days 3, American Fidelity s Disability Income Insurance may help you avoid becoming another statistic. Is Disability Insurance Right For You? A Disability Plan is designed to offer income protection when you are disabled and cannot work. Consider it Insurance on your Income! If you become disabled due to a covered Injury or Sickness, disability income insurance will pay you a monthly income based on your covered benefit amount, once you satisfy your elimination period. Plan benefits are paid directly to you and can be used however you d like. Help Protect Your Paycheck Today with American Fidelity s Disability Income Insurance! 1 Preparing for Disability. Council for Disability Awareness. Web. 10 Oct Reuters. More than two-thirds in U.S. live paycheck to paycheck: survey, September 19, Council for Disability Awareness: Disability Statistics, July

17 Plan Highlights Benefits are paid directly to you, not to a doctor or your employer. Benefits are payable year-round. Convenient payroll deduction. Benefit payments may be directly deposited into your bank account. Benefits are paid due to a covered Injury or Sickness. Several benefit plan options are available. Optional Riders available including: Critical Illness Rider, Accident Only Spousal Rider, Hospital Indemnity Rider, Survivor Benefit Rider and COBRA Funding Rider. IMPORTANT BENEFITS INCLUDE: Donor Benefit Return To Work Benefit: Disabled While Working Social Security Filing Assistance Family Care Benefit Waiver Of Premium Choose The Plan That s Right For You BENEFITS BEGIN Plan I - On the 1st day of Disability due to a covered Injury and on the 4th day of Disability due to a covered Sickness. Plan II - On the 15th day of Disability due to a covered Injury or Sickness. Plan III - On the 31st day of Disability due to a covered Injury or Sickness. Plan IV - On the 61st day of Disability due to a covered Injury or Sickness. Plan V - On the 91st day of Disability due to a covered Injury or Sickness. BENEFITS ARE PAYABLE Up to the period of time shown in the table below, based on your age as of the date of Disability due to a covered Injury or Sickness begins. For Injury: For Sickness: Age Under 65 Maximum Benefit Period 5 years 65 through 68 To age or older 1 year Age Under 68 Maximum Benefit Period 2 years Age 68 To age or older 1 year 15

18 Plan Features RETURN TO WORK INCENTIVE BENEFIT: DISABLED WHILE WORKING We will provide a Disability Payment if you are Disabled and your monthly Disability Earnings, if any, are less than 20% of your Monthly Compensation due to the same Disability. If you are Disabled and your Disability Earnings are greater than 20% of your Monthly Compensation due to the same Disability, we will figure your payment as follows: During the first 24 months of payments while Disabled and Working: Your Disability Payment will not be reduced as long as the Disability Earnings plus the gross Disability Benefit does not exceed 80% of your Monthly Compensation. If the Disability Earnings plus the gross Disability Benefit exceeds 80% of your Monthly Compensation, the Disability Payment will be reduced by the amount exceeding 80% of your Monthly Compensation. After 24 months of payments, while Disabled and Working, you will receive payments based on the percentage of Monthly Compensation you are losing due to Lost Earnings based on your Disability. We will stop payments and your claim will end, if at any time you are no longer Disabled or if your Disability Earnings exceed 80% of your Monthly Compensation. The Elimination Period cannot be satisfied with days you are Disabled and Working. FAMILY CARE BENEFIT If you are Disabled and Working, qualify to receive a Disability Payment from us, and have one or more eligible family members, you may be eligible to receive a Family Care Benefit. This may include payment for the care of an eligible family member by a licensed childcare provider or licensed caregiver who is not related to you by blood or marriage. We will provide a Family Care Benefit for expenses incurred of up to 25% of your monthly Disability Benefit provided the total of your Disability Earnings, the gross Disability Benefit, and the Family Care Benefit do not exceed 100% of your Monthly Compensation. Payment of the Family Care Benefit will end on the earlier of the following: the date you no longer incur Family Member expenses; or the date you no longer qualify as Disabled and Working; or the date Disabled and Working benefits have been paid for a total of 24 months. DONOR BENEFIT If you are Disabled as a result of being an organ or tissue donor, we will pay your benefit as any other Sickness under the terms of the plan. WORKSITE ACCOMMODATION As part of our claims evaluation process, if worksite modifications may assist your return to work, we will evaluate your claim for appropriate action. DIRECT DEPOSIT DISABILITY BENEFITS In the event you choose the direct deposit option on an approved claim, we will deposit your benefits directly into your bank account at no additional cost. This can accelerate access to your benefits by several days. We also have a toll-free fax that allows you instant transmission of your claim forms to our Benefits Department. SOCIAL SECURITY FILING ASSISTANCE If we determine you are a likely candidate for Social Security Disability benefits, we can assist you with the application and appeal process. WAIVER OF PREMIUM No premium payments are required while you are receiving payments under the plan after Disability Payments have been received under the plan for 60 consecutive days. We will require proof on an annual basis that you remain Disabled during this time. SUCCESSIVE DISABILITIES Disabilities which result from the same or related causes will be considered one period of Disability unless the Disabilities are separated by your return to Active Employment or any other gainful occupation for at least 3 consecutive months.. 16

19 Disability Insurance Needs Worksheet Use this worksheet to get a general estimate of how much Disability Income Protection insurance you need. However, you should consult with a financial advisor before buying any insurance products. Monthly Income Your Income Total Monthly Income Monthly Expenses Mortgage/Rent Car Payment Utilities Loan/Credit Card Payments Insurance (Home, Auto, Health, Life, etc.) Food/Clothing Child Care/Education Other Expenses Total Monthly Expenses Are You Covered? $ $ $ $ $ $ $ $ $ $ $ 17

20 Important Policy Provisions ELIGIBILITY All permanent employees in covered group working 20 hours or more per week. Proof of good health may be required by us in order to be eligible for disability coverage. We will rely on answers given on your application to determine if coverage can be issued. Regardless of your health at the time of application, if coverage is approved and issued, claims incurred while coverage is in force will be subject to all terms of the Policy including any Pre-Existing Condition limitation. WHEN COVERAGE BEGINS Certificates will become effective on the requested effective date following the date we approve the application, providing you are on Active Employment and premium has been paid. IF YOU ARE DISABLED DUE TO A COVERED DISABILITY AND NOT WORKING Your Disability Payment will be the Disability Benefit less any Deductible Sources of Income you receive or are entitled to receive. No Disability Payment will be provided for any period in which you are not under the regular and appropriate care of a physician. OFFSETS WITH OTHER SOURCES OF INCOME Deductible Sources of Income include: Other group disability income. Governmental or other retirement system, whether due to Disability, normal retirement or voluntary election of retirement benefits. United States Social Security Act or similar plan or act, including any amounts due your dependent(s) on account of your Disability. State Disability. Unemployment compensation. Workers compensation law, occupational disease law or any similar act or law. Sick leave or other salary or wage continuance plans provided by the Employer which extend beyond 60 (Plans I, II, III, and IV) or 90 (Plan V) calendar days from the Date of Disability. We reserve the right to estimate these Deductible Sources of Income that you may receive as defined in your Certificate. MINIMUM DISABILITY BENEFIT The minimum Monthly Disability Benefit is 10% of the Monthly Disability Benefit or $100.00, whichever is greater. INCREASE OF INCOME DUE TO COST OF LIVING ADJUSTMENTS The Disability Payment will not be reduced due to a cost of living increase if the increase from a Deductible Source of Income takes effect after the onset of Disability and while benefits are payable under the Policy. MENTAL ILLNESS LIMITED BENEFIT If you are Disabled due to a mental illness, regardless of the cause, Disability Payments will be provided for up to 1 year, not to exceed the Maximum Disability Period. ALCOHOLISM AND DRUG ADDICTION LIMITED BENEFIT If you are disabled due to alcoholism or drug addiction, a limited benefit of up to 30 days for each Disability will be paid. Benefits will not be paid beyond the Maximum Benefit Period. If drug addiction is sustained at the hands of, or while under the regular and appropriate care of a physician in the course of treatment for Injury or Sickness, it will be covered the same as any other Sickness. PRE-EXISTING CONDITION LIMITATION No Disability Benefit will be payable if Disability is caused by or resulting from a Pre-Existing Condition and begins before you have been continuously covered under the Policy for 24 months. This provision will not apply if you have: gone treatment-free; incurred no expense; taken no medication; and received no diagnosis or advice from a Physician for 12 consecutive months for such condition(s). This limitation will not apply to a Disability resulting from a Pre- Existing Condition that begins after you have been continuously covered under the Policy for 24 months. Any increase in benefits will be subject to this Pre-Existing Condition limitation. A new Pre-Existing Condition period must be satisfied with respect to any increase applied for and approved by us. EXCLUSIONS The Policy does not cover any loss, fatal or non-fatal, resulting from: Intentionally self-inflicted injury while sane or insane. An act of war, declared or undeclared. Injury sustained or Sickness contracted while in the service of the armed forces of any country. Committing a felony. Penal incarceration. We will not pay benefits for Disability or any other loss during any period for which you are incarcerated in a penal or correctional institution for a period of 30 consecutive days or longer. LEAVE OF ABSENCE Your coverage may be continued for up to 1 year during a Leave of Absence approved in writing by your Employer. TERMINATION OF INSURANCE Your insurance coverage will end on the earliest of these dates: the date you do not meet the Eligibility requirements as defined in the Eligibility paragraph in this brochure; the date you retire; the date you cease to be on Active Employment, except as provided for under the Leave of Absence provision; the end of the last period for which premium has been paid; the date the Policy is discontinued; or the date your employment terminates. 18

21 If: your coverage ends as a result of your termination of Active Employment; such termination is caused by an Injury or Sickness for which Disability Benefits would be payable; and Disability is established prior to the termination of Active Employment, then: Disability Benefits will be paid as if such termination had not occurred. Termination of the Policy will have no affect on Disability Payments which began before termination. We may end your coverage if you submit a fraudulent claim. Your coverage can be terminated or premiums may be increased on any premium due date with 31 days advance notice. DEFINITIONS ACTIVE EMPLOYMENT: Means you are doing in the usual manner all of the regular duties of your employment on a full-time basis on a scheduled work day and these duties are being done at one of the places of business where you normally do such duties or at some location to which your employment sends you. You will be said to be on Active Employment on a day which is not a scheduled work day only if you are not Disabled and would be able to perform in the usual manner all the regular duties of your employment if it were a scheduled work day. DISABILITY: Disability or Disabled for the first 12 months of Disability means that you are unable to perform the material and substantial duties of your Regular Occupation. After that, Disability means you are unable to perform the material and substantial duties of any Gainful Occupation for wage or profit for which you are reasonably qualified by training, education, or experience. DISABILITY EARNINGS: Means the gross monthly earnings you receive while Disabled and Working. DISABILITY PAYMENT: Means your Disability Benefit minus Deductible Sources of Income. ELIGIBLE FAMILY MEMBERS: With regards to the Family Care Benefit, this means your child (natural, step, or adopted) living in your household and under age 13; or your family member who is: living in your household; dependent upon you for support; and in need of supervision or assistance due to physical or mental incapacity. HOSPITAL: The term Hospital shall not include an institution used by you as: a place for rehabilitation; a place for rest or for the aged; a nursing or convalescent home; a long-term nursing unit or geriatrics ward; or an extended care facility for the care of convalescent, rehabilitative, or ambulatory patients. LOST EARNINGS: Means the percentage of Monthly Compensation you are losing due to your Disability while Disabled and Working. This is computed as follows: subtract your Disability Earnings from your Monthly Compensation; divide this answer by your Monthly Compensation. This will be your percentage of lost earnings. multiply your Disability payment by your percentage of lost earnings. MONTHLY COMPENSATION: Means for contracted employees, one-twelfth (1/12) of your contract salary through your Employer; or for non-contracted employees, one-twelfth (1/12) of your annual salary through your Employer, in effect on the date Disability began. It excludes any additional compensation including but not limited to, overtime pay, weekend or summer work compensation, bus or other allowances, bonuses or district-funded fringe benefits. If you become Disabled while on an approved leave of absence, we will use your gross Monthly Compensation from your Employer in effect just prior to the date your absence began. PRE-EXISTING CONDITION: The term Pre-Existing Condition means a disease, Injury, Sickness, physical condition or mental illness for which you: had treatment; incurred expense; took medication; received care or services including diagnostic testing or related measures; or received a diagnosis or advice from a Physician, during the 12-month period immediately before your Effective Date of coverage. The term Pre-Existing Condition will also include conditions which are related to such disease, Injury, Sickness, physical condition, or mental illness. 19

22 Critical Illness Rider CONSIDER THE FACTS One in eight workers will be disabled for five years or more during their working careers. Council for Disability Awareness: Disability Statistics, July CRITICAL ILLNESS RIDER Benefit Amount Monthly Premium $10, $9.80 $15, $13.18 $20, $16.56 $25, $19.94 We will pay a one-time lump sum benefit amount based on diagnosis of the following conditions: Heart Attack, Stroke, Kidney Failure, Paralysis, or Major Organ Failure. In the case of Heart Attack, a physician must make the diagnosis and treatment must occur within 72 hours of the onset of symptoms. CRITICAL ILLNESS RIDER LIMITATIONS In addition to the Exclusions listed in the Base Plan to which this Rider is attached, no benefits will be paid for any loss caused by or resulting from: (a) a Critical Illness when the Date of Diagnosis occurs during the Waiting Period; (b) a Critical Illness diagnosed outside of the United States; or (c) a Sickness or Injury not specifically defined in this Rider. No Critical Illness Benefit will be payable for a Critical Illness which is caused by or resulting from a Pre-Existing Condition when the Critical Illness Date of Diagnosis occurs before you have been continuously covered under this Rider for 12 consecutive months. Following 12 consecutive months this exclusion does not apply. Pre-Existing Condition means a disease, Injury, Sickness, physical condition or mental illness for which you have experienced any of the following: (a) treatment; (b) incurred expense; (c) took medication; (d) received care or services including diagnostic testing or related measures; or (e) received a diagnosis or advise from a Physician, during the 12-month period immediately before the Effective Date of this Rider. The term Pre-Existing Condition will also include conditions which are related to such disease, Injury, Sickness, physical condition or mental illness. Benefits reduce by 50% at age 70. No benefits will be paid for a Critical Illness when the Date of Diagnosis occurs during the Critical Illness Waiting Period. The waiting period is 30 days from the Effective Date of this Rider. Accident Only Spousal Rider CONSIDER THE FACTS On average, one out of every eight Americans sought medical attention for an injury in National Safety Council, Injury Facts, 2014 Edition, p.2. Total costs of accidental injuries averaged $20,657 per injury in National Safety Council, Injury Facts, 2014 Edition, p Monthly Indemnity Amount ACCIDENT ONLY SPOUSAL RIDER Annual Salary Monthly Premium $ up to $10, $4.00 $1, $10, $20, $8.00 $1, $20, $30, $12.00 $2, $30, and over. $16.00 We will pay a monthly indemnity amount to you for your spouse who is disabled as a result of a non-occupational accident. Benefits will begin on the 31st consecutive day after the Injury and will continue for up to 2 years. Coverage under this Rider will begin on the later of the requested Effective Date or the date we approve the written application, provided that your spouse has no other group disability income coverage in force; is less than age 70; is engaged in Full Time Employment on the date this Rider becomes effective; and is able to perform the material and 20 substantial duties of his or her occupation on the date this Rider becomes effective, and; your coverage under the Policy is in force and you are on Active Employment; and the required premium has been paid. FULL TIME EMPLOYMENT (or Full Time) means your Spouse is employed an average of 25 or more hours per week for pay or benefits. Full Time Employment does not include any hours your Spouse is working while self-employed. ACCIDENT ONLY SPOUSAL RIDER LIMITATIONS This Rider does not provide benefits for your Spouse for any Disability, fatal or non-fatal, which results from any of the following: (a) Intentionally self-inflicted Injury while sane or insane; (b) An act of war, declared or undeclared; (c) Injury sustained or contracted while in the service of the armed forces of any country; (d) Committing a felony; (e) Penal incarceration. We will not pay benefits during any period for which your Spouse is incarcerated in a penal or correctional institution or for any Injury that occurs while your Spouse is incarcerated in a penal or correctional institution; (f) Injury arising out of and in the course of any occupation for wage or profit or for which your Spouse is entitled to Workers Compensation. The term entitled to Workers Compensation shall also include Workers Compensation claim settlements which occur via compromise and release. Further, no benefits will be paid under this Policy for any period during which your Spouse is entitled to Workers Compensation benefits; (g) Participation in any sport for wage or profit; (h) Participation in any contest of speed in a power driven vehicle for wage or profit. Spouse means the person you are lawfully married to who is less than age 70. No benefits are payable for your Spouse under this Rider for a Disability from an Injury that occurred outside of the United States or its territories. No benefit will be provided for any period in which your Spouse is not under the Regular and Appropriate Care of a Physician. No benefits will be paid for any Injury to your Spouse which is caused by or resulting from spousal abuse.

23 Hospital Indemnity Rider CONSIDER THE FACTS The average charge for a hospital stay is $35,400. HCUP Statistical Brief #166. November % of total healthcare costs are paid out-of-pocket Milliman s Medical Index, May The average length of a hospital stay is over 4 days. HCUP Statistical Brief #166. November We will pay a daily benefit amount for an Inpatient Hospital confinement up to a maximum of 90 days. Inpatient means you are admitted as a resident patient to a Hospital for at least 18 continuous hours and are being charged for room and board facilities. HOSPITAL INDEMNITY RIDER Daily Benefit Amount Monthly Premium $ $6.00 $ $9.00 HOSPITAL INDEMNITY RIDER LIMITATIONS The Hospital Confinement Benefit will not be payable for an Injury or Sickness incurred in the first 12 months of coverage if the Injury or Sickness is caused by or resulting from a Pre-Existing Condition as defined in the Policy. In addition to the Exclusions listed in the Policy, no benefits will be payable under this Rider for any Hospital Confinement that is caused by or resulting from Mental Illness or Drug or Alcohol Abuse. Benefits are reduced by 50% at age 70. Successive Hospital stays will be considered as one confinement if they are separated by less than 90 days of confinement to a Hospital. Survivor Benefit Rider If you have been Disabled and not working for at least 90 days; and die while receiving Disability Benefits, a Survivor Benefit will be paid to your beneficiary or estate. SURVIVOR BENEFIT RIDER Monthly Benefit Amount Monthly Premium $2, $6.80 The Survivor Benefit will be paid monthly up to 1 year or until the Maximum Disability Period is exhausted, whichever occurs first. COBRA Funding Rider CONSIDER THE FACTS The average group long-term disability claim lasts almost 3 years. Council for Disability Awareness: Disability Statitics July 2013 Of all Americans who file bankruptcy this year, 60% will be due to medical bills. The Real Risk That You ll Have A Critical Illness. American Association for Critical Illness Insurance. n.d. Web. 4 Apr In order to receive benefits under this Rider, you must: be receiving benefits under your Disability base plan; elect medical Cobra coverage; and be paying medical Cobra premiums. This Benefit will pay up to the end of the disability benefit period or to the end of your medical COBRA benefit period, whichever occurs first. COBRA FUNDING RIDER Monthly Benefit Amount Monthly Premium $ $4.50 $ $9.00 COBRA FUNDING RIDER LIMITATIONS Proof of election of medical COBRA continuation must be provided to us. Proof of continued medical COBRA participation will be required before benefits are paid under this Rider. Your employment must have terminated for the benefit to be payable. 21