MCKINNEY ISD BENEFIT GUIDE...Unum Group #148506 (866) 679-3054 Unum Group #125328 (866) 679-3054 Unum ... included in the dependent profile. Additionally, you must notify your employer

MCKINNEY ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2019 - 8/31/2020

WWW.MYBENEFITSHUB.COM/MCKINNEYISD

1

Table of Contents

Benefit Contact Information 3

How to Enroll 4-5 Annual Benefit Enrollment 6-11 1. Section 125 Cafeteria Plan Guidelines 6 2. Annual Enrollment 7 3. Eligibility Requirements 8 4. Helpful Definitions 9 TRS-ActiveCare 10-13 Scott & White HMO 14-15

Delta Dental 16-17

Avesis Vision 18-19 Discovery Benefits FSA 20-21

UNUM Life and AD&D 22-23 UNUM Disability 24-29

UNUM Hospital Indemnity & Accident 30-31

UNUM Critical Illness 32-33

FLIP TO...

HOW TO ENROLL

PG. 4

SUMMARY PAGES

PG. 8

YOUR BENEFITS

PG. 14

Table of Contents

2

MCKINNEY ISD BENEFITS MCKINNEY ISD BENEFITS OFFICE

Financial Benefit Services (469) 385-4685 www.mybenefitshub.com/mckinneyisd

[email protected]

TRS ACTIVECARE MEDICAL TRS HMO MEDICAL HOSPITAL INDEMNITY Aetna (800) 222-9205 www.trsactivecareaetna.com

Scott & White HMO (800) 321-7947 www.trs.swhp.org

Unum Group #R0747188 (866) 679-3054 www.unum.com

DENTAL VISION FLEXIBLE SPENDING ACCOUNT Delta Dental Group #4370 (800) 521-2651 www.deltadental.com

Avesis High Group #10771-1205-01 Base Group #10771-1205 (800) 522-0258 www.avesis.com

Discovery Benefits 866-451-3399 [email protected] www.discoverybenefits.com

LIFE AND AD&D DISABILITY ACCIDENT Unum Group #148506 (866) 679-3054 www.unum.com

Unum Group #125328 (866) 679-3054 www.unum.com

Unum Group #R0747188 (866) 679-3054 www.unum.com

CRITICAL ILLNESS COBRA– MEDICAL COBRA- DENTAL/VISION/FLEX Unum Group #473073 (866) 679-3054 www.unum.com

BSWIFT 833.682.8972

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

Benefit Contact Information

3

OR SCAN

Text “FBS MCKINNEY”

to 313131 and get access to

everything you need to complete

your benefits enrollment:

• Benefit Information

• Online Support

• Interactive Tools And more.

Enrollment made simple through your smartphone or tablet.

MOBILE

ENROLLMENT

Text

“FBS MCKINNEY” to

313131

4

1 www.mybenefitshub.com/mckinneyisd

How to Log In

2 CLICK LOGIN

3 ENTER USERNAME & PASSWORD

BENEFIT INFO

INTERACTIVE TOOLS

ONLINE SUPPORT

Your login credentials will be the same as your McKinney ISD login. Username: Employee ID Password: district password If you do not know your username and password please contact the Help Desk at 469-302-4048 or Email [email protected]

5

CHANGES IN STATUS (CIS):

QUALIFYING EVENTS

Marital Status A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).

Change in Number of Tax Dependents

A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.

Change in Status of Employment Affecting

Coverage Eligibility

Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.

Gain/Loss of Dependents' Eligibility Status

An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements under an employer's plan may include change in age, student, marital, employment or tax dependent status.

Judgment/Decree/Order

If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.

Eligibility for Government Programs

Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.

A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Elections made during annual enrollment will become effective on the plan effective date or upon required underwriting approval and will remain in effect during the entire plan year.

Changes in benefit elections can occur only if you experience a qualifying event. You must submit a Family Status Change Form and proof of a qualifying event to your Benefit Office with 31 days of your qualifying event in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

Section 125 Cafeteria Plan Guidelines

SUMMARY PAGES

6

Annual Enrollment

During your annual enrollment period, you have the opportunity

to review, change or continue benefit elections each year.

Changes are not permitted during the plan year (outside of

annual enrollment) unless a Section 125 qualifying event occurs.

• Changes, additions or drops may be made only during the

annual enrollment period without a qualifying event.

• Employees must review their personal information and verify

that dependents they wish to provide coverage for are

included in the dependent profile. Additionally, you must

notify your employer of any discrepancy in personal and/or

benefit information.

• Employees must confirm on each benefit screen (medical,

dental, vision, etc.) that each dependent to be covered is

selected in order to be included in the coverage for that

particular benefit.

New Hire Enrollment

All new hire enrollment elections must be completed in the

online enrollment system within the first 31 days of benefit

eligibility employment. Failure to complete elections during this

time frame will result in the forfeiture of coverage.

Q&A

Who do I contact with Questions?

For supplemental benefit questions, you can contact your

Benefits/HR department or you can call Financial Benefit Services

at 866-914-5202 for assistance.

Where can I find forms?

For benefit summaries and claim forms, go to your school

district’s benefit website:

www.mybenefitshub.com/mckinneyisd. Click on the benefit

plan you need information on (i.e., Dental) and you can find

the forms you need under the Benefits and Forms section.

How can I find a Network Provider?

For benefit summaries and claim forms, go to your school

district’s benefit website:

www.mybenefitshub.com/mckinneyisd. Click on the benefit

plan you need information on (i.e., Dental) and you can find

provider search links under the Quick Links section.

When will I receive ID cards?

If the insurance carrier provides ID cards, you can expect to

receive those 3-4 weeks after your effective date. For most

dental and vision plans, you can login to the carrier website

and print a temporary ID card or simply give your provider the

insurance company’s phone number and they can call and

verify your coverage if you do not have an ID card at that

time. If you do not receive your ID card, you can call the

carrier’s customer service number to request another card.

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

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

card each year.

SUMMARY PAGES

7

Employee Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more

regularly scheduled hours each work week.

Eligible employees must be actively at work on the plan effective

date for new benefits to be effective, meaning you are physically

capable of performing the functions of your job on the first day of

work concurrent with the plan effective date. For example, if

your 2019 benefits become effective on September 1, 2019, you

must be actively-at-work on September 1, 2019 to be eligible for

your new benefits.

Dependent Eligibility Requirements

Dependent Eligibility: You can cover eligible dependent

children under a benefit that offers dependent coverage,

provided you participate in the same benefit, through the

maximum age listed below. Dependents cannot be double

covered by married spouses within the district or as both

employees and dependents.

If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage.

PLAN CARRIER MAXIMUM AGE

Medical TRS To 26

Dental Delta Dental To 26

Vision Avesis To 26

FSA Discovery Benefits To 26

Life and AD&D UNUM To 26

Accident UNUM Unmarried to 26

Hospital Indemnity UNUM Unmarried to 26

Critical Illness UNUM Unmarried to 26

SUMMARY PAGES

8

Actively at Work You are performing your regular occupation for the employer

on a full-time basis, either at one of the employer’s usual

places of business or at some location to which the employer’s

business requires you to travel. If you will not be actively at

work beginning 9/1/2019, please notify your benefits

administrator.

Annual Enrollment The period during which existing employees are given the

opportunity to enroll in or change their current elections.

Annual Deductible The amount you pay each plan year before the plan begins to

pay covered expenses.

Calendar Year January 1st through December 31st

Co-insurance After any applicable deductible, your share of the cost of a

covered health care service, calculated as a percentage (for

example, 20%) of the allowed amount for the service.

Guaranteed Coverage The amount of coverage you can elect without answering any

medical questions or taking a health exam. Guaranteed

coverage is only available during initial eligibility period.

Actively-at-work and/or pre-existing condition exclusion

provisions do apply, as applicable by carrier.

In-Network Doctors, hospitals, optometrists, dentists and other providers

who have contracted with the plan as a network provider.

Out-of-Pocket Maximum The most an eligible or insured person can pay in co-insurance

for covered expenses.

Plan Year September 1st through August 31st

Pre-Existing Conditions Applies to any illness, injury or condition for which the

participant has been under the care of a health care provider,

taken prescriptions drugs or is under a health care provider’s

order to take drugs, or received medical care or services

(including diagnostic and/or consultation services).

SUMMARY PAGES Helpful Definitions

9

Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis.

More than 70% of adults across the United States are already being diagnosed with

a chronic disease.

About this Benefit

YOUR BENEFITS PACKAGE Medical

AETNA

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the

McKinney ISD Benefits Website: www.mybenefitshub.com/mckinneyisd

10

2019-2020 TRS-ActiveCare Plans Employee Premium

The 19-20 MISD Monthly Contribution is $306 per month for active members in TRS.

19-20 Active Employee Monthly Premium

19-20 Active Employee "Per Paycheck" Premium

19-20 Sub/Temp Employee Monthly Premium

Medical Plan

Active Care 1 - HD

Employee Only $72.00 $36.00 $378.00

Employee/Spouse $760.00 $380.00 $1,066.00

Employee/Child(ren) $416.00 $208.00 $722.00

Employee/Family $1,109.00 $554.50 $1,415.00

Active Care Select

Employee Only $250.00 $125.00 $556.00

Employee/Spouse $1,061.00 $530.50 $1,367.00


Employee/Family $1,412.00 $706.00 $1,718.00

Scott and White Plan (HMO)

Employee Only $272.36 $136.18 $578.36

Employee/Spouse $1,047.40 $523.70 $1,353.40


Employee/Family $1,203.56 $601.78 $1,509.56

Active Care 2 Grandfathered plan / No new enrollees for 18-19

Employee Only $546.00 $273.00 $852.00

Employee/Spouse $1,714.00 $857.00 $2,020.00

Employee/Child(ren) $961.00 $480.50 $1,267.00

Employee/Family $2,083.00 $1,041.50 $2,389.00

*Note: The IRS allows changes, other than at open enrollment, if the change is necessary because of a Family Status Change. Any changes to your benefits must be made within 31 days of the Family Status Change. Verification of Status Change will be required. District Monthly Contribution applies to all employees greater than 50% (greater than half-time) all plan year. For all active Employees using payroll deductions. All Medical Insurance premiums will default to Pre-Tax status unless a Post- Tax Request Form is returned to the Benefits Office. MISD Benefits Office cautions employees considering the selection of TRS Active Care Select or Scott & White Plan (HMO) options for the following reasons: Extremely limited Physician choices available (specifically Specialists), Plan is defined as an In-Network Only Plan that provides NO coverage for out of network physicians.

11

2019 – 20 TRS-ActiveCare Plan Highlights Effective Sept. 1, 2019 through Aug. 31, 2020 | In-Network Level of Benefits1

TRS-ActiveCare 1-HD TRS-ActiveCare Select or TRS-ActiveCare Select Whole Health

ActiveCare 2

Deductible (per plan year) In-Network

Out-of-Network

Out-of-Pocket Maximum (per plan year; medical and prescription drug deductibles, copays, and coinsurance count toward the out-of-pocket maximum)

In-Network Out-of-Network

Coinsurance In-Network Participant pays (after deductible)

Out-of-Network Participant pays (after deductible)

Office Visit Copay Participant pays

Diagnostic Lab Participant pays

Preventive Care See below for examples

Teladoc® Physician Services

High-Tech Radiology (CT scan, MRI, nuclear medicine) Participant pays

Inpatient Hospital Facility Charges Only (preauthorization required)

In-Network

Out-of-Network

Urgent Care

Freestanding Emergency Room Participant pays

$500 copay per visit plus 20% after deductible



Emergency Room (true emergency use) Participant pays

Outpatient Surgery Participant pays

Bariatric Surgery (only covered if performed at an 10Q facility) Physician charges; Participant pays

Annual Vision Examination (one per plan year; performed by an ophthalmologist or optometrist)Participant pays

Annual Hearing Examination Participant pays

Preventive Care Some examples of preventive care frequency and services:

Note: Covered services under this benefit must be billed by the provider as “preventive care.” Non-network preventive care is not paid at 100%. If you receive preventive services from a non-network pro-vider, you will be responsible for any applicable deductible and coinsurance under the TRS-ActiveCare 1-HD and TRS-ActiveCare 2. There is no coverage for non-network services under the TRS-ActiveCare Select plan or TRS-ActiveCare Select Whole Health. For more information, please view the Benefits Booklet at www.trsactivecareaetna.com. TRS-ActiveCare is administered by Aetna Life Insurance Company. Aetna provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug benefits are administered by Caremark

• Routine physicals – annually age 12 and over

• Mammograms – 1 every year age 35 and over

• Smoking cessation counseling – 8 visits per 12 months

• Well-child care – unlimited up to age 12

• Colonoscopy – one every 10 years age 50 and over

• Healthy diet/obesity counseling – unlimited to age 22; age 22 and over – 26 visits per 12 months

• Well woman exam & pap smear – annually age 18 and over

• Prostate cancer screening – one per year age 50 and over

• Breastfeeding support – six lactation counseling visits per 12 months

12

http://www.trsactivecareaetna.com/

2019 – 20 TRS-ActiveCare Plan Highlights

Drug Deductible

Short-Term Supply at a Retail Location

20% coinsurance after deductible, except for certain generic preventive drugs that are covered at 100%.2

$15 copay $20 copay

25% coinsurance after deductible3 25% coinsurance (min. $404; max. $80)3 25% coinsurance (min. $404; max. $80)3

50% coinsurance after deductible3 50% coinsurance3 50% coinsurance (min. $1004; max. $200)3

Extended-Day Supply at Mail Order or Retail-Plus Pharmacy Location (60- to 90-day supply)5

20% coinsurance after deductible $45 copay $45 copay 25% coinsurance after deductible3 25% coinsurance (min. $1054; max. $210)3 25% coinsurance (min. $1054; max. $210)3

50% coinsurance after deductible3 50% coinsurance3 50% coinsurance (min. $2154; max. $430)3

Specialty Medications (up to a 31-day supply)

Specialty Medications 20% coinsurance after deductible 20% coinsurance 20% coinsurance (min. $2004 , max $900)

Short-Term Supply of a Maintenance Medication at Retail Location up to a 31-day supply The second time a participant fills a short-term supply of a maintenance medication at a retail pharmacy, they will be charged the coinsurance and copays in the rows below. Participants can save more over the plan year by filling a larger day supply of a maintenance medication through mail order or at a Retail-Plus location.

Tier 1 – Generic 20% coinsurance after deductible $30 copay $35 copay Tier 2 – Preferred Brand 25% coinsurance after deductible3 25% coinsurance (min. $604; max. $120)3 25% coinsurance (min. $604; max. $120)3

Tier 3 – Non-Preferred Brand 50% coinsurance after deductible3 50% coinsurance3 50% coinsurance (min. $1054; max. $210)3

Full monthly premium*

Premium with min. state/district contribution**

Your Monthly Premium***







Individual $378 $153 $556 $331 $852 $627

+Spouse $1,066 $841 $1,367 $1,142 $2,020 $1,795

+Children $722 $497 $902 $677 $1,267 $1,042

+Family $1,415 $1,190 $1,718 $1,493 $2,389 $2,164

What is a maintenance medication? Maintenance medications are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes.

When does the convenience fee apply? For example, if you are covered under TRS-ActiveCare Select, the first time you fill a 31-day supply of a generic maintenance drug at a retail pharmacy you will pay $15, then you will pay $30 each month that you fill a 31-day supply of that generic maintenance drug at a retail pharmacy. A 90-day supply of that same generic maintenance medication would cost $45, and you would save $180 over the year by filling a 90-day supply.

* If you are not eligible for the state/district subsidy, you will pay the full monthly premium. Please contact your Benefits Administrator for your monthly premium. ** The premium after state, $75 and district, $150 contribution is the maximum you may pay per month. Ask your Benefits Administrator for your monthly cost. (This is the amount you will owe each month after all available subsidies are applied to your premium.) *** Completed by your benefits administrator. The state/district contribution may be greater than $225.

A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. 1 Illustrates benefits when in-network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits under the TRS-ActiveCare Select or TRS-ActiveCare Select Whole Health Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for this balance bill amount, which maybe considerable. 2 For TRS-ActiveCare 1-HD, certain generic preventive drugs are covered at 100%. Participants do not have to meet the deductible ($2,750 – individual, $5,500 – family) and they pay nothing out of pocket for these drugs. Find the list of drugs at info.caremark.com/trsactivecare. 3 If a participant obtains a brand-name drug when a generic equivalent is available, they are responsible for the generic copay plus the cost difference between the brand-name drug and the generic drug. 4 If the cost of the drug is less than the minimum, you will pay the cost of the drug. 5 Participants can fill 32-day to 90-day supply through mail order.

Monthly Premiums

13

2019-2020 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare

Fully Covered Healthcare Services Copay

Preventive Services No Charge

Standard Lab and X-Ray No Charge

Disease Management and Complex Case Management No Charge

Well Child Care Annual Exams No Charge

Immunizations (age appropriate) No Charge

Plan Provisions Copay

Annual Deductible $950 Individual/ $2,850 Family

Annual out-of-pocket maximum (including medical and prescription copays and coinsurance)

$7,450 Individual/ $14,900 Family (includes combined Medical and RX copays, deductibles and

coinsurance)

Lifetime Paid Benefit Maximum None

Outpatient Services Copay

Primary Care1 $20 copay

(First Primary Care Visit for Illness - $0 Copay2) / $0 Copay for primary visit for dependents age 19 and under)

Specialty Care $70 copay

Other Outpatient Services 20% after deductible3

Diagnostic/Radiology Procedures 20% after deductible

Eye Exam (one annually) No Charge

Allergy Serum & Injections 20% after deductible

Outpatient Surgery $150 copay and 20% of charges after deductible

Maternity Care Copay

Prenatal Care No Charge

Inpatient Delivery $150 per day4 and 20% of charges after deductible

Inpatient Services Copay

Overnight hospital stay: includes all medical services including semi-private room or intensive care

$150 per day4 and 20% of charges after deductible

Diagnostic & Therapeutic Services Copay

Physical and Speech Therapy $70 copay

Manipulative Therapy5 20% without office visit $40 plus 20% with office visit

Equipment and Supplies Copay

Preferred Diabetic Supplies and Equipment $5/$12.50 copay; no deductible

Non-Preferred Diabetic Supplies and Equipment 30% after Rx deductible

Durable Medical Equipment/ Prosthetics 20% after deductible

14

2019-2020 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare

Home Health Services Copay

Home Healthcare Visit $70 copay

Worldwide Emergency Care Copay

Nurse Advice Line 1-877-505-7947

Online Services No Charge — go to trs.swhp.org

After-Hours Primary Care Clinics $20 copay

Ambulance and Helicopter $40 copay and 20% of charges after deductible

Emergency Room6 $500 copay after deductible

Urgent Care Facility $50 copay

Prescription Drugs Copay

Annual Benefit Maximum Unlimited

Rx Deductible Does not apply to preferred generic drugs

$150

Ask an SWHP Pharmacy representative how to save money on your prescriptions.

Retail Quantity (Up to a 30-day supply)

Maintenance Quantity (Up to a 90-day supply)

Available at BSW Pharmacies, in-network retail pharmacies

and mail order

Preferred Generic $5 copay $12.50 copay

Preferred Brand 30% after Rx deductible 30% after Rx deductible

Non-Preferred 50% after Rx deductible 50% after Rx deductible

Online Refills trs.swhp.org

Mail Order BSWH: 1-817-388-3090

OptumRx: 1-855-205-9182

1 Including all services billed with office visit 2 Does not apply to wellness or preventive visits 3 Includes other services, treatments, or procedures received at

time of office visit 4 $750 maximum copay per admission and 20% after deductible 5 35 maximum visit per year 6 Copay waived if admitted within 24 hours

Specialty Medications Copay

Tier 1: 15% after Rx deductible

(Up to a 30-day supply) Tier 2: 15% after Rx deductible

Tier 3: 25% after Rx deductible

The SWHP MOMS Program provides you with professional nurses who are notified of the delivery of your baby. These licensed professionals will contact you after you return home and help you with everything from the general well-being of both you and your baby, to breast/bottle feeding, to information on how to add your baby to your health plan.

15

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included

in the summary plan description located on the Frisco ISD Benefits Website: www.mybenefitshub.com/friscoisd

DELTA DENTAL

Dental

Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, treatment and dental disease.

YOUR BENEFITS PACKAGE

About this Benefit

Good dental care may improve your overall health.

Also Women with gum disease may be at greater risk of giving birth to a preterm or low birth weight baby.



16

Dental DPO - High Option

Employee PPO Premiums

Tier Monthly Per Paycheck

EE Only $42.32 $21.16

EE + 1 Dep $74.89 $37.45

EE + 2 or more Deps $96.61 $48.31

Eligibility Primary enrollee, spouse and eligible dependent children to age 26

Deductibles $50 per person / $150 per family each plan year

Deductibles waived for Diagnostic &

Preventive (D & P) and Orthodontics? Yes

Maximums $1,500 per person each plan year

D & P counts toward maximum? Yes Waiting Period(s) Basic Benefits Major Benefits Prosthodontics Orthodontics

None None None None

Benefits and Covered Services* Delta Dental DPO dentists** Non-Delta Dental DPO dentists**

Diagnostic & Preventive Services (D&P) 100%

100%

Exams, cleanings, x-rays and sealants Basic Services 80% 80%

Fillings and denture repair/reline/rebase Endodontics (root canals) 80% 80%

Covered Under Basic Services Periodontics (gum treatment) 80% 80%

Covered Under Basic Services Oral Surgery 80% 80%

Covered Under Basic Services Major Services

50%

50% Crowns, inlays, onlays and cast

restorations Prosthodontics 50% 50%

Bridges, dentures and implants Orthodontic Benefits 50% 50%

Dependent children Orthodontic Maximums $1,500 Lifetime $1,500 Lifetime

* Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan.

Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist’s submitted fees.

** Reimbursement is based on DPO contracted fees for DPO dentists, Premier contracted fees for Premier dentists and program allowance for

non-Delta Dental dentists. Out-of-network dentists may bill the difference between their usual fee and Delta Dental’s contracted rate - a

process known as “balance billing”.

1130 Sanctuary Parkway, Suite 600 800-521-2651 P.O. Box 1809

Alpharetta, GA 30009 Alpharetta, GA 30023-1809

This benefit information is not intended or designed to replace or serve as the plan’s Evidence of Coverage or Summary Plan Description. If

you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company’s benefits repre-

sentative.

17

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included

in the summary plan description located on the Frisco ISD Benefits Website: www.mybenefitshub.com/friscoisd

Vision AVESIS

Vision insurance provides coverage for routine eye examinations and may cover all or part of the costs associated with contact lenses, eyeglasses and vision correction, depending on the plan.


About this Benefit

75%

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

correction.



18

Vision

HIGH OPTION LOW OPTION

Vision Care Services In-Network Member Cost Out-of-Network Reimbursement

In-Network Member Cost Out-of-Network Reimbursement

Vision Examination (Includes Refraction)

Covered in full after $10 copay

Up to $35 Covered in full after $10 copay

Covered in full after $10 copay

Contact Lens Fit and Follow-up Standard Contact Lens Fitting Custom Contact Lens Fitting

out-of-pocket maximum: Up to $50 Up to $75

N/A out-of-pocket maximum: Up to $50 Up to $75

N/A

Materials* $ 20 copay (Materials copay applies to frame or spectacle lenses, if

applicable.)

$ 20 copay (Materials copay applies to frame or spectacle lenses, if

applicable.)

$ 20 copay (Materials copay applies to frame or spectacle lenses, if

applicable.)

Frame Allowance (Up to 20% discount above frame allowance.)

$150 allowance Up to $45 $150 allowance Up to $45

Standard Spectacle Lenses

Single Vision Covered in full after copay Up to $25 Covered in full after copay Up to $25

Bifocal Covered in full after copay Up to $40 Covered in full after copay Up to $40

Trifocal Covered in full after copay Up to $50 Covered in full after copay Up to $50

Lenticular Covered in full after copay Up to $80 Covered in full after copay Up to $80

Preferred Pricing Options Level 7 Option Package Polycarbonate (Single Vision/Multi-Focal)

Covered in full

Up to $10

$40/$44 (Covered in full up to age 19)

$40/$44 (Covered in full up to age 19)

Standard Scratch-Resistant Coating

Covered in full Up to $5 $17 N/A

Ultra-Violet Screening Covered in full Up to $6 $15 N/A

Solid or Gradient Tint Covered in full Up to $4 $17 N/A

Standard Anti-Reflective Coating

Covered in full Up to $24 $45 N/A

Level 1 Progressives Covered in full Up to $40 $75 Up to $40 Level 2 Progressives Covered in full Up to $48 $110 Up to $40

All Other Progressives $140 allowance + 20% discount

Up to $48 $50 allowance + 20% discount

Up to $40

Transitions® (Single Vision/Multi-Focal)

$70/$80 N/A $70/$80 N/A

Polarized $75 N/A $75 N/A

PGX/PBX $40 N/A $40 N/A

Other Lens Options Up to 20% discount N/A Up to 20% discount N/A

Contact Lenses† (in lieu of frame and spectacle lenses)

Elective $150 allowance Up to $128 $150 allowance Up to $128

Medically Necessary Covered in full Up to $250 Covered in full Up to $250

Refractive Laser Surgery Onetime/lifetime $150 allowance

Provider discount up to 25%

Onetime/lifetime $150 allowance


Provider discount up to 25%


Benefit Frequency (All Plans)

Eye Examination Once every 12 months

Lenses or Contact Lenses Once every 12 months Frame Once every 12 months

HIGH OPTION LOW OPTION

Employee Paid Rates Monthly Per Pay Check Monthly Per Pay Check

Employee $8.90 $4.45 $5.90 $2.95

Employee + Spouse $15.80 $7.90 $10.30 $5.15

Employee + Child(ren) $18.34 $9.17 $12.14 $6.07

Employee + Family $23.26 $11.63 $15.05 $7.53

19

About this Benefit

FSA (Flexible Spending Account)


DISCOVERY BENEFITS

A Cafeteria Plan is designed to take advantage of Section 125 of the Internal Revenue Code. It allows you to pay certain qualified expenses on a pre-tax basis, thereby reducing your taxable income. You can set aside a pre-established amount of money per plan year in a Healthcare Flexible Spending Account (FSA). Funds allocated to a healthcare FSA must be used during the plan year or are forfeited.



20

An FSA That Simplifies Savings • One online account, one mobile app, and one debit card for

all your benefits

• Averages debit card auto-substantiation rate of more than 85%

• Easy documentation uploading using mobile app

• Thousands of eligible expense for purchase at the FSA store

A Flexible Spending Account (FSA) allows you to budget and save for qualified medical expenses incurred over the course of your plan year. Dollars invested in an FSA are tax-free, and the entire election amount is available on the first day of the plan year. That makes an FSA a great tool for saving money, especially when big expenses are anticipated.

Types of FSAs Medical FSA Pair a traditional health plan with a Medical FSA, which covers eligible medical, dental and vision expenses. Dependent Care Account (DCA) A DCA allows you to put money aside for dependent care for children up to age 13, a disabled dependent of any age or a disabled spouse. You may receive reimbursement up to the current balance in your account at the time the request is made. To be eligible for a DCA, you and your spouse (if applicable) must work, be looking for work or be full- time students.

Medical FSA Annual Contribution Max: $2,700 effective 9/1/2019

Dependent Care Annual Max: $5,000

Eligible Expenses Common eligible expenses for a Medical FSA are prescriptions, hearing aids, orthopedic goods, doctor visits and dentist visits, while a Limited FSA is limited to dental and vision expenses. A DCA covers expenses such as work-related daycare and elderly care costs. To find out which specific expenses are eligible, view our searchable eligibility list at www.DiscoveryBenefits.com/eligibleexpenses.

Substantiation The IRS requires FSA participants to provide documentation (e.g. an Explanation of Benefits) to show that an expense is FSA-eligible. You can easily upload documentation to a claim by logging in to your online account or taking a photo of your documentation with your phone’s camera and uploading it through the Discovery Benefits mobile app.

Using Funds For easy access to your FSA funds, you can swipe your Discovery Benefits debit card and avoid out-of-pocket costs. If you use your card at a provider with an Inventory Information Approval System (IIAS), the expense will automatically be approved at the point of sale. If the card is swiped at a merchant that meets the IRS’ 90% rule, you may need to provide documentation to show the expense is eligible. FSA funds are use-it-or-lose-it. You must use your funds before the end of the plan year or you will lose them. There is not a grace period to use your FSA balance after the end of the plan year but you do have 90 days from the end of the plan year to submit any claims for reimbursement on any incurred charges.

Resources Eligible Expense List www.DiscoveryBenefits.com/eligibleexpenses FSA Calculator www.DiscoveryBenefits.com/fsacalculator Mobile App Video www.DiscoveryBenefits.com/mobileappvideo FSA 101 Video www.DiscoveryBenefits.com/fsa101 FSA Store www.DiscoveryBenefits.com/fsastore

FSA (Flexible Spending Account)

Benefits Participant Services 6 a.m. to 9 p.m. CST M-F Toll-Free: 866-451-3399

Toll-Free Fax: 866-451-3245 [email protected]

Live chat available at: www.DiscoveryBenefits.com/contact

21

Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family.

Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family.

About this Benefit



Life and AD&D UNUM


Experts recommend at least

your gross annual income in coverage when purchasing life insurance.

x 10

22

Life and AD&D

Eligibility

All actively employed employees working at least 20 hours each week for your employer in the U.S. and their eligible spouses and children to age 26.

Coverage Amounts

Your Term Life coverage options are: Employee: Up to 5 times salary in increments of $10,000. Not to exceed $500,000. Spouse: Up to 100% of employee amount in increments of

$5,000. Not to exceed $500,000. Child: Up to 100% of employee coverage amount in increments

of $2,000, not to exceed $10,000.

The maximum death benefit for a child between the ages of live birth and 6 months is $1,000.

Your AD&D coverage options are: Employee: Up to 5 times salary in increments of $10,000. Not to

exceed $500,000. Spouse: Up to 100% of employee amount in increments of

$5,000. Not to exceed $500,000. Child: Up to 100% of employee coverage amount in increments

of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $1,000.

Note: You may purchase AD&D coverage for yourself regardless of whether you purchase term life coverage. In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself.

AD&D Benefit Schedule: The full benefit amount is paid for loss of:

• Life

• Both hands or both feet or sight of both eyes

• One hand and one foot

• One hand or foot and the sight of one eye

• Speech and hearing Other losses may be covered as well. Please see your Plan Administrator.

Coverage amount(s) will reduce according to the following schedule: Age: Insurance Amount Reduces to: 70 65% of original amount 75 50% of original amount Coverage may not be increased after reduction

Guarantee Issue

Current Employees: If you and your eligible dependents are enrolled in the plan and wish to increase your life insurance coverage, you may apply on or before the enrollment deadline for any amount of additional coverage up to the plan max for yourself and any amount of additional coverage up to $50,000 for your spouse. Any life insurance coverage over the guaranteed amount(s) will be subject to answers to health questions.

If you and your eligible dependents are not currently enrolled in the plan, you may apply for coverage on or before the enrollment deadline and will be required to answer health questions for any amount of coverage.

New Employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense.

Additional Benefits Portability/Conversion If you retire, reduce your hours or leave your employer, you can continue coverage for yourself your spouse and your dependent children at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy.

Waiver of Premium If you become disabled (as defined by your plan) and are no longer able to work, your premium payments will be waived during the period of disability.

Monthly Premium

Term Life

Age band Employee rate

per $1,000

Spouse rate

per $1,000

<25 0.019 0.019

25-29 0.019 0.019

30-34 0.028 0.028

35-39 0.048 0.048

40-44 0.057 0.057

45-49 0.085 0.085

50-54 0.143 0.143

55-59 0.247 0.247

60-64 0.323 0.323

65-69 0.599 0.599

70-74 0.960 0.960

75+ 0.960 0.960

Child life monthly rate is $0.26 per $1,000. One life premium covers all children.

AD&D (You must purchase life coverage to purchase AD&D coverage)

AD&D cost Monthly Cost

Employee Per $1,000 $0.02

Spouse Per $1,000 $0.02

Child Per $1,000 $0.02

23

Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.



Disability UNUM


Just over 1 in 4 of today's 20 year-olds will become disabled before

they retire.

34.6 months is the duration of the

average disability claim.

About this Benefit

24

Long Term Disability

Policy # 125328 Please read carefully the following description of your Unum Educator Select Income Protection Plan insurance.

Eligibility You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. The date you are eligible for coverage is the later of: the plan effective date; or the day after you complete the waiting period.

Guarantee Issue Current Employees: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may enroll on or before the enrollment deadline during an annual open enrollment period.

New Hires: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may apply for coverage within 60 days after your eligibility date. If you do not apply within 60 days after your eligibility date, you can apply only during an annual enrollment period.

Benefits are subject to the pre-existing condition exclusion referenced later in this document.

Benefit Amount You may purchase a monthly benefit in $100 units, starting at a minimum of $200, up to 66 2/3% of your monthly earnings rounded to the nearest $100, but not to exceed a monthly maximum benefit of $8,000. Please see your Plan Administrator for the definition of monthly earnings.

The total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 100% of your monthly earnings unless the excess amount is payable as a Cost of Living Adjustment. However, if you are participating in Unum’s Rehabilitation and Return to Work Assistance program, the total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 110% of your monthly earnings (unless the excess amount is payable as a Cost of Living Adjustment).

Elimination Period The Elimination Period is the length of time of continuous disability, due to sickness or injury, which must be satisfied before you are eligible to receive benefits. You may choose an Elimination Period (injury/sickness) of 14/14, 30/30, 60/60, 90/90 or 180/180 days. If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.)

Benefit Duration Your duration of benefits is based on your age when the disability occurs.

Plan: ADEA II: Your duration of benefits is based on the following table:

Age at Disability Maximum Duration of Benefits Less than age 60 To age 65, but not less than 5 years Age 60 through 64 5 years Age 65 through 69 To age 70, but not less than 1 year Age 70 and over 1 year

Federal Income Taxation

The taxability of benefits depends on how premium was taxed during the plan year in which you become disabled. If you paid 100% of the premium for the plan year with post-tax dollars, your benefits will not be taxed. If premium for the plan year is paid with pre-tax dollars, your benefits will be taxed. If premium for the plan year is paid partially with post-tax dollars and partially with pre-tax dollars, or if you and your Employer share in the cost, then a portion of your benefits will be taxed.

Additional Benefits Work/Life Balance Employee Assistance Program: Work-life balance is a comprehensive resource providing access to professional assistance for a wide range of personal and work-related issues. The service is available to you and your family members twenty- four hours a day, 365 days a year, and provides resources to help employees find solutions to everyday issues such as financing a car or selecting child care, as well as more serious problems such as alcohol or drug addiction, divorce, or relationship problems.

Services include: toll-free phone access to master’s-level consultants, up to three face-to-face sessions to help with more serious issues; and online resources. There is no additional charge for utilizing the program. Participation is confidential and strictly voluntary, and employees do not have to have filed a disability claim or be receiving benefits to use the program.

However, if you become disabled and are receiving benefits, Unum's On Claim Support can provide additional resources including: coaching on how to communicate effectively with medical personnel, conducting consumer research for medical equipment and supplies, assessing emotional needs and locating counseling resources.

Return to Work/Work Incentive Benefit: Unum supports efforts that enable a disabled employee to remain on the job or return to work as soon as possible. If you are disabled but working part time with monthly disability earnings of 20% or more of your indexed monthly earnings, during the first 12 months, the monthly benefit will not be reduced by any earnings until the gross disability payment plus your disability earnings, exceeds 100% of your indexed monthly earnings. The monthly benefit will then be reduced by that amount.

Rehabilitation and Return to Work Assistance: Unum has a vocational Rehabilitation and Return to Work Assistance program available to assist you in returning to work. We will make the final determination of your eligibility for participation in the program, and will provide you with a written Rehabilitation and Return to Work Assistance plan developed specifically for you. This program may include, but is not limited to the following benefits:

• coordination with your Employer to assist your return to work;

• adaptive equipment or job accommodations to allow you to work;

• vocational evaluation to determine how your disability may impact your employment options;

• job placement services; 25

Disability

• resume preparation;

• job seeking skills training; or

• education and retraining expenses for a new occupation.

If you are participating in a Rehabilitation and Return to Work Assistance program, we will also pay an additional disability benefit of 10% of your gross disability payment to a maximum of $1,000 per month. In addition, we will make monthly payments to you for 3 months following the date your disability ends, if we determine you are no longer disabled while:

• you are participating in a Rehabilitation and Return to Work Assistance program; and

• you are not able to find employment. (This benefit is not allowed in New Jersey.)

Worksite Modification: If a worksite modification will enable you to remain at work or return to work, a designated Unum professional will assist in identifying what’s needed. A written agreement must be signed by you, your employer and Unum, and we will reimburse your employer for the greater of $1,000 or the equivalent of two months of your disability benefit.

Waiver of Premium: After you have received disability payments under the plan for 90 consecutive days, from that point forward you will not be required to pay premiums as long as you are receiving disability benefits.

Survivor Benefit: Unum will pay your eligible survivor a lump sum benefit equal to 3 months of your gross disability payment.

This benefit will be paid if, on the date of your death, your disability had continued for 180 or more consecutive days, and you were receiving or were entitled to receive payments under the plan. If you have no eligible survivors, payment will be made to your estate, unless there is none. In that case, no payment will be made. However, we will first apply the survivor benefit to any overpayment which may exist on your claim.

You may receive your survivor benefit prior to your death if you are receiving monthly payments and your physician certifies in writing that you have been diagnosed as terminally ill and your life expectancy has been reduced to less than 12 months. This benefit is only payable once and if you elect to receive this benefit, no survivor benefit will be payable to your eligible survivor upon your death. (Note this “Accelerated Survivor Benefit” is not available in Connecticut.)

Dependent Care Expense Benefit: If you are disabled and participating in Unum’s Rehabilitation and Return to Work Assistance program, Unum will pay a Dependent Care Expense Benefit when you are disabled and you provide satisfactory proof that you:

• are incurring expenses to provide care for a child under the age of 15;

• and/or start incurring expenses to provide care for a child age 15 or older or a family member who needs personal care assistance.

The payment will be $350 per month per dependent, to a maximum of $1,000 per month for all dependent care expenses combined.

Education Benefit: If you are disabled and receiving monthly disability benefits, you may receive an additional monthly Education Benefit of $200 for each child who is an eligible student. Benefits will be payable in between terms provided the eligible student is enrolled for the next scheduled term.

Eligible student means your unmarried dependent child(ren) who are:

• less than 25 years of age; and

• attending an accredited post-secondary school beyond the 12th grade level on a full-time basis.

Medical Treatment Benefit: A Medical Treatment Benefit will be paid when you receive treatment by a doctor as a result of a sickness or injury, provided no other benefits are payable under the plan as a result of the condition for which the treatment was rendered.

The Medical Treatment Benefit will be the doctor's actual charge for services rendered, up to a maximum benefit of $50 for sickness or $100 for injury. In addition, the charges must be for medically necessary care and treatment and in keeping with the extent of the sickness or injury. No benefit will be paid unless you are personally seen and treated by a doctor and the treatment is not for routine medical examinations or dental work.

Note: No more than one Medical Treatment Benefit will be paid for the same or related condition(s) unless the treatment dates are separated by at least 14 consecutive days. In addition, no more than one benefit will be paid for treatment during any 24 hour period and the benefit will not be paid more than 4 times per calendar year.

Worldwide Emergency Travel Assistance Services : Whether your travel is for business or pleasure, our worldwide emergency travel assistance program is there to help you when an unexpected emergency occurs. With one phone call anytime of the day or night, you, your spouse and dependent children can get immediate assistance anywhere in the world3. Emergency travel assistance is available to you when you travel to any foreign country, including neighboring Canada or Mexico. It is also available anywhere in the United States for those traveling more than 100 miles from home. Your spouse and dependent children do not have to be traveling with you to be eligible. However, spouses traveling on business for their employer are not covered by this program.

Other Important Provisions Pre-Existing Condition Exclusion : Benefits will not be paid for disabilities caused by, contributed to by, or resulting from a pre-existing condition. You have a pre-existing condition if: • you received medical treatment, consultation, care or services

including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and

• the disability begins in the first 12 months after your effective date of coverage.

Continuity of Coverage: If you are actively at work at the time you convert to Unum’s plan and become disabled due to a pre-existing condition, benefits may be payable if you were:

• in active employment and insured under the plan on its effective date; and

• insured by the prior plan at the time of change.

To receive a payment, you must satisfy the pre-existing condition under the Unum policy or the prior carrier’s policy. If you satisfy Unum’s pre-existing condition provision, payments will be determined by the Unum policy.

If you only satisfy the pre-existing condition provision for the prior carrier’s policy, the claim will be administered according to the Unum

26

Disability

policy. However,

• the payments will be the lesser of the benefit payable under the terms of the prior plan or the benefit under the Unum plan;

• the elimination period will be the shorter of the elimination period under the prior plan or the elimination period under the Unum plan; and

• benefits will end on the earlier of the end of the maximum period of payment under the Unum plan or the date benefits would have ended under the prior plan.

Definition of Disability: You are disabled when Unum determines that:

• you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury;

• you have a 20% or more loss in indexed monthly earnings due to the same sickness or injury; and

• during the elimination period you are unable to perform any of the material and substantial duties of your regular occupation.

After benefits have been paid for 24 months, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience. You must be under the regular care of a physician in order to be considered disabled.

Gainful Occupation: Gainful occupation means an occupation that is or can be expected to provide you with an income within 12 months of your return to work, that exceeds 80% of your indexed monthly earnings if you are working or 60% of your indexed monthly earnings if you are not working.

Benefit Integration: Your disability benefit will be reduced by deductible sources of income and any earnings you have while disabled. Your gross disability payment will be reduced immediately by such items as disability income or other amounts you receive or are entitled to receive from workers compensation or similar occupational benefit laws, sabbatical or assault leave plans and the amount of earnings you receive from an extended sick leave plan as described in Louisiana Revised Statutes or any other act or law with similar intent.

After you have received monthly disability payments for 12 months, your gross disability payment will be reduced by such items as additional deductible sources of income you receive or are entitled to receive under: state compulsory benefit laws; automobile liability insurance; legal judgments and settlements; certain retirement plans; salary continuation or sick leave plans; other group or association disability programs or insurance; and amounts you or your family receive or are entitled to receive from Social Security or similar governmental programs.

Regardless of deductible sources of income, an employee who qualifies for disability benefits is guaranteed to receive a minimum benefit amount of 25% of the gross disability payment.

Mental Illness/Self-Reported Symptoms: The lifetime cumulative maximum benefit period for all disabilities due to mental illness and disabilities based primarily on self-reported symptoms is 24 months. Only 24 months of benefits will be paid for any combination of such disabilities even if the disabilities are not continuous and/or are not related. Payments would continue beyond 24 months only if you are confined to a hospital or institution as a result of the disability.

Instances When Benefits Would Not Be Paid: Benefits will not be paid for disabilities caused by, contributed to by, or resulting from:

• intentionally self-inflicted injuries;

• active participation in a riot;

• commission of a crime for which you have been convicted;

• loss of professional license, occupational license or certification;

• pre-existing conditions (see definition).

Unum will not cover a disability due to war, declared or undeclared, or any act of war.

Unum will not pay a benefit for any period of disability during which you are incarcerated.

Termination of Coverage: Your coverage under the policy ends on the earliest of the following:

• The date the policy or plan is cancelled;

• The date you no longer are in an eligible group;

• The date your eligible group is no longer covered;

• The last day of the period for which you made any required contributions;

• The later of the last day you are in active employment except as provided under the covered layoff or leave of absence provision; or if applicable, the last day of your contract with your Employer but not beyond the end of your Employer’s current school contract year.

Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan.

Delayed Effective Date of Coverage: If you are absent from work due to injury, sickness, temporary layoff or leave of absence, your coverage will not take effect until you return to active employment. Please contact your Plan Administrator after you return to active employment for when your coverage will begin.

27


MONTHLY PREMIUMS Rates effective 9/1/2019

Accident / Sickness Elimination Period in Days

Annual Earnings Monthly Earnings Monthly Benefit 14 / 14 30 / 30 60 / 60 90 / 90 180 / 180

$7.88 $6.44 $4.32 $3.70 $2.78

$11.82 $9.66 $6.48 $5.55 $4.17

$15.76 $12.88 $8.64 $7.40 $5.56

$19.70 $16.10 $10.80 $9.25 $6.95

$23.64 $19.32 $12.96 $11.10 $8.34

$27.58 $22.54 $15.12 $12.95 $9.73

$31.52 $25.76 $17.28 $14.80 $11.12

$35.46 $28.98 $19.44 $16.65 $12.51

$39.40 $32.20 $21.60 $18.50 $13.90

$43.34 $35.42 $23.76 $20.35 $15.29

$47.28 $38.64 $25.92 $22.20 $16.68

$51.22 $41.86 $28.08 $24.05 $18.07

$55.16 $45.08 $30.24 $25.90 $19.46

$59.10 $48.30 $32.40 $27.75 $20.85

$63.04 $51.52 $34.56 $29.60 $22.24

$66.98 $54.74 $36.72 $31.45 $23.63

$70.92 $57.96 $38.88 $33.30 $25.02

$74.86 $61.18 $41.04 $35.15 $26.41

$78.80 $64.40 $43.20 $37.00 $27.80

$82.74 $67.62 $45.36 $38.85 $29.19

$86.68 $70.84 $47.52 $40.70 $30.58

$90.62 $74.06 $49.68 $42.55 $31.97

$94.56 $77.28 $51.84 $44.40 $33.36

$98.50 $80.50 $54.00 $46.25 $34.75

$102.44 $83.72 $56.16 $48.10 $36.14

$106.38 $86.94 $58.32 $49.95 $37.53

$110.32 $90.16 $60.48 $51.80 $38.92

$114.26 $93.38 $62.64 $53.65 $40.31

$118.20 $96.60 $64.80 $55.50 $41.70

$122.14 $99.82 $66.96 $57.35 $43.09

$126.08 $103.04 $69.12 $59.20 $44.48

$130.02 $106.26 $71.28 $61.05 $45.87

$133.96 $109.48 $73.44 $62.90 $47.26

$137.90 $112.70 $75.60 $64.75 $48.65

$141.84 $115.92 $77.76 $66.60 $50.04

$145.78 $119.14 $79.92 $68.45 $51.43

$149.72 $122.36 $82.08 $70.30 $52.82

28


MONTHLY PREMIUMS Rates effective 9/1/2019

Accident / Sickness Elimination Period in Days

Annual Earnings Monthly Earnings Monthly Benefit 14 / 14 30 / 30 60 / 60 90 / 90 180 / 180

$153.66 $125.58 $84.24 $72.15 $54.21

$157.60 $128.80 $86.40 $74.00 $55.60

$161.54 $132.02 $88.56 $75.85 $56.99

$165.48 $135.24 $90.72 $77.70 $58.38

$169.42 $138.46 $92.88 $79.55 $59.77

$173.36 $141.68 $95.04 $81.40 $61.16

$177.30 $144.90 $97.20 $83.25 $62.55

$181.24 $148.12 $99.36 $85.10 $63.94

$185.18 $151.34 $101.52 $86.95 $65.33

$189.12 $154.56 $103.68 $88.80 $66.72

$193.06 $157.78 $105.84 $90.65 $68.11

$197.00 $161.00 $108.00 $92.50 $69.50

$200.94 $164.22 $110.16 $94.35 $70.89

$204.88 $167.44 $112.32 $96.20 $72.28

208.82 170.66 114.48 98.05 73.67

212.76 173.88 116.64 99.90 75.06

216.70 177.10 118.80 101.75 76.45

220.64 180.32 120.96 103.60 77.84

224.58 183.54 123.12 105.45 79.23

228.52 186.76 125.28 107.30 80.62

232.46 189.98 127.44 109.15 82.01

236.40 193.20 129.60 111.00 83.40

240.34 196.42 131.76 112.85 84.79

244.28 199.64 133.92 114.70 86.18

248.22 202.86 136.08 116.55 87.57

252.16 206.08 138.24 118.40 88.96

256.10 209.30 140.40 120.25 90.35

260.04 212.52 142.56 122.10 91.74

263.98 215.74 144.72 123.95 93.13

267.92 218.96 146.88 125.80 94.52

271.86 222.18 149.04 127.65 95.91

275.80 225.40 151.20 129.50 97.30

279.74 228.62 153.36 131.35 98.69

283.68 231.84 155.52 133.20 100.08

287.62 235.06 157.68 135.05 101.47

291.56 238.28 159.84 136.90 102.86

295.50 241.50 162.00 138.75 104.25

29

Hospital Confinement Indemnity Insurance pays a daily benefit if you have a covered stay in a hospital*, critical care unit and rehabilitation facility. The benefit amount is determined based on the type of facility and the number of days you stay. Hospital Confinement Indemnity Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

About this Benefit


The median hospital costs per stay have steadily grown to over

$10,500 per day.

$9,600 $10,400 $10,700

2008 2012 2018



Group Accident & Hospital Indemnity

UNUM

30

Group Accident

Group Hospital Indemnity

Group Hospital Indemnity insurance is designed to help provide financial protection for covered individuals by paying a benefit due to a hospitalization and in some cases, for treatment received for an accident or sickness, even if that treatment occurs outside the hospital. Employee can use the benefit to meet the out-of-pocket expenses and extra bills that can occur. Indemnity lump sum benefits are paid directly to the employee based on the amount of coverage listed, regardless of the actual cost of treatment.

Hospital Admission $1,000 per insured per calendar year Wellness Included - $50 per insured per calendar year Portability Included Pre-Existing Condition Period 12/12 Exclusion Premium Paid by the Employee

Group Accident insurance is designed to help covered employees meet the out-of-pocket expenses and extra bills that can follow an accidental injury, whether minor or catastrophic. Indemnity lump sum benefits are paid directly to the employee based on the amount of coverage listed in the schedule of benefits. The accident base plan is guaranteed issue, so no health questions are required.

Plan Type On/Off Job Covered Conditions See Schedule of Benefits Wellness Benefit Included - $50 per insured per calendar year Premium Paid by the Employee

Monthly Premium (includes Wellness)

Employee Employee and Spouse Employee and Child Employee, Spouse and Child

$16.04 $26.30 $28.50 $38.76

Spouse issue ages are 17 through 64 years. Dependent Children issue ages are newborn up to their 26th birthday or to the maximum coverage age defined in the policy.

Monthly Premium (includes Wellness)

Age Band Employee Employee and Spouse Employee and Child Employee, Spouse and Child

17 - 49 $12.52 $24.99 $17.82 $30.29

50 - 59 $14.26 $29.14 $19.56 $34.44

60 - 64 $19.04 $39.19 $24.34 $44.49

65 + $27.42 $56.79 $32.72 $62.09

Note: Family Coverage Options assume Employee and Spouse are in the same Age Band. If Employee and Spouse are in different Age Bands, the final Monthly Premium amounts will be different. Spouse issue ages are 17 through 64 years. Dependent Children issue ages are newborn up to their 26th birthday or to the maximum coverage age defined in the policy. 31

Critical illness insurance is designed to supplement your medical and disability coverage easing the financial impacts by covering some of your additional expenses. It provides a benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke.

About this Benefit



YOUR BENEFITS PACKAGE Critical Illness

Is the aggregate cost of a hospital stay for a heart

attack.

$16,500

UNUM

32

Critical Illness

How can critical illness insurance help? Critical Illness insurance helps offset the financial effects of a catastrophic illness by paying a lump sum benefit when employees or their family members are diagnosed with a covered illness. The benefit is based on the amount of coverage inforce, the illness diagnosed and all other terms and provisions of the policy.

Benefit Overview

Critical illness insurance is designed to help employees offset the financial effects of a catastrophic illness with a lump sum benefit if an insured is diagnosed with a covered critical illness. The Critical Illness benefit is based on the amount of coverage in effect on the date of diagnosis of a critical illness or the date treatment is received according to the terms and provisions of the policy.

Coverage Amounts Employee - $10,000, $20,000, or $30,000 Spouse/Child - 100% of Employee Coverage Amount Guarantee Issue Employee - $30,000 Spouse /Child– 100% of Employee Coverage Amount Pre-Existing Condition 12/12 exclusion Benefit Waiting Period 0 days Portability Included Wellness Benefit $50, $75, or $100 per insured per calendar year (based on elected coverage amount) Recurrence Benefit 100% for select Covered Conditions more than 180 days after prior diagnosis (Marked with *)

Covered Conditions Critical Illnesses:

• Coronary Artery Disease (major) (50%)* • Coronary Artery Disease (minor) (10%)* • End Stage Renal (Kidney) Failure* • Heart Attack (Myocardial Infarction)* • Major Organ Failure Requiring Transplant* • Stroke*

Cancer:

• Invasive Cancer (including all Breast Cancer)* • Non-Invasive Cancer (25%)* • Skin Cancer ($500)

Supplemental Critical Illnesses:

• Benign Brain Tumor* • Coma* • Loss of Hearing • Infectious Disease (25%) • Loss of Sight • Loss of Speech • Occupational Human Immunodeficiency Virus (HIV) or

Hepatitis • Permanent Paralysis

Progressive Diseases:

• Amyotrophic Lateral Sclerosis (ALS) • Dementia (including Alzheimer's Disease) • Functional Loss • Multiple Sclerosis (MS) • Parkinson's Disease

Additional Critical Illnesses for your Children:

• Cerebral Palsy • Cleft Lip or Palate • Cystic Fibrosis • Down Syndrome • Spina Bifida Please refer to the policy for complete definitions of covered conditions *Covered Condition eligible for Recurrence Benefit

Employee/Spouse Cost

Employee Age $10,000 + $50 Be Well Benefit $20,000+ $75 Be Well Benefit $30,000+ $100 Be Well Benefit

<25 $3.52 $7.05 $10.57

25 - 29 $4.42 $8.85 $13.27

30 - 34 $5.62 $11.25 $16.87

35 - 39 $7.42 $14.85 $22.27

40 - 44 $9.72 $19.45 $29.17

45 - 49 $12.72 $25.45 $38.17

50 - 54 $16.02 $32.05 $48.07

55 - 59 $21.52 $43.05 $64.57

60 - 64 $29.72 $59.45 $89.17

65 - 69 $42.82 $85.65 $128.47

70 - 74 $66.72 $133.45 $200.17

75 - 79 $98.42 $196.85 $295.27

80 - 84 $143.62 $287.25 $430.87

85+ $231.42 $462.85 $694.27 33

NOTES

34

NOTES

35

WWW.MYBENEFITSHUB.COM/MCKINNEYISD

36

Documents

MCKINNEY ISD BENEFIT GUIDE...Unum Group #148506 (866) 679-3054 Unum Group #125328 (866) 679-3054 Unum ... included in the dependent profile. Additionally, you must notify your employer