WYLIE ISD BENEFIT GUIDE€¦ · UNUM Group #: 471659 (800) 858-6843 TRS-A TIVE ARE MEDI AL DENTAL A IDENT Aetna (800) 222-9205 eam Group #: TX00326-001/002/003 (800) 648-1179 Voya

WYLIE ISD

BENEFIT GUIDE

EFFECTIVE:

09/01/2018 - 8/31/2019

WWW.MYBENEFITSHUB.COM/WYLIEISD

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HOW TO ENROLL HOW TO ENROLL

PG. 4

BENEFIT UPDATES.

PG. 6

YOUR BENEFITS

PG. 12

FLIP TO...

Benefit Contact Information 3 How to Enroll 4-5 Annual Benefit Enrollment 6-11 1. Benefit Updates 6 2. Section 125 Cafeteria Plan Guidelines 7 3. Annual Enrollment 8 4. Eligibility Requirements 9 5. Helpful Definitions 10 6. Health Savings Account (HSA) vs. Flexible

Spending Account (FSA) 11

TRS-ActiveCare 12-15 Scott & White HMO 14-15 NBS Health Savings Account (HSA) 16-17 Special Insurance Services Medical Gap Insurance 18-19 MDLIVE Telehealth 20-21 Beam Dental 22-23 Avesis Vision 24-25 UNUM Educator Disability 26-33 APL Cancer 34-37 UNUM Life and AD&D 38-41 Voya Accident 42-45 NBS Flexible Spending Account (FSA) 46-49

Table of Contents

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Benefit Contact Information

WYLIE ISD BENEFITS TELEHEALTH LIFE AND AD&D

Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/wylieisd

MDLIVE (866) 365-1663 www.consultmdlive.com

UNUM Group #: 471659 (800) 858-6843 www.unum.com

TRS-ACTIVECARE MEDICAL DENTAL ACCIDENT

Aetna (800) 222-9205 www.trsactivecareaetna.com

Beam Group #: TX00326-001/002/003 (800) 648-1179 www.beam.dental

Voya Group #:70116-5 (877) 236-7564 www.voya.com

TRS HMO MEDICAL VISION FLEXIBLE SPENDING ACCOUNT

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

Avesis Group#:10771-1512 (800) 828-9341 www.avesis.com

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

HEALTH SAVINGS ACCOUNT DISABILITY

NBS (800) 274-0503 www.nbsbenefits.com

UNUM Group #:471660 (800) 583-6908 File a Claim 1-800-362-4462 www.unum.com

MEDICAL GAP INSURANCE CANCER

Special Insurance Services Group#: G4200OP122482 (800) 867-6811 http://www.specialinc.com/index.php

American Public Life Group #: 19449 (800) 256-8606 www.ampublic.com

Benefit Contact Information

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OR SCAN

Text “FBS WISD” 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 WISD” to

313131

PLAY VIDEO

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1 www.mybenefitshub.com/wylieisd

How to Log In

2 CLICK LOGIN

3 ENTER USERNAME & PASSWORD

All login credentials have been RESET to the default

described below:

Username:

The first six (6) characters of your last name, followed

by the first letter of your first name, followed by the

last four (4) digits of your Social Security Number.

If you have less than six (6) characters in your last

name, use your full last name, followed by the first

letter of your first name, followed by the last four (4)

digits of your Social Security Number.

Default Password:

Last Name* (lowercase, excluding punctuation)

followed by the last four (4) digits of your Social

Security Number.

BENEFIT INFO

INTERACTIVE TOOLS

ONLIINE SUPPORT

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TRS MEDICAL: All of the TRS medical plans will experience a rate increase effective 09/01/2018. ActiveCare 2 will no longer be available for new enrollees, however, current participants may elect to remain on the plan. The deductibles for ActiveCare 1 HD have increased as well as the out of pocket maximum. The deductibles for ActiveCare Select will remain the same for the upcoming plan year. As a reminder, ActiveCare 1 HD & ActiveCare 2 have In Network and Out of Network Deductibles. Copays for ActiveCare Select and ActiveCare 2 have increased. For more info on plan design changes for all TRS ActiveCare plans, please call 800-222-9205 or visit www.trsactivecareaetna.com. All ActiveCare enrollees should receive a new medical and prescription ID card this year.

SIS MEDICAL GAP INSURANCE: INCREASE! There will be a slight increase in rates for the group GAP policy; however no changes will be made to coverage.

FLEXIBLE SPENDING ACCOUNT: CHANGE! The 2018

maximum contribution has increased to $3,450. If you currently participate in a Healthcare or Dependent Care FSA, you MUST re-elect a new contribution amount every year to continue to participate. You can view account balance using the CHECK FSA link on the Benefit website or use the NBS smart phone app.

Login and complete your supplemental benefit enrollment from 07/18/2018 - 08/24/2018 Enrollment assistance is available by calling Financial Benefit Services at 866-914-5202 to

speak to an enrollment representative Monday—Thursday, 8 AM—5:30 PM, Friday 8 AM—3pm . Bilingual assistance is available.

Update your profile information: home address, phone numbers, email. IMPORTANT!! Due to the Affordable Care Act (ACA) reporting requirements, please add your

dependent’s social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator.

Benefit Updates - What’s New:

Annual Benefit Enrollment

SUMMARY PAGES

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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. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date 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 present proof of a qualifying event to your Benefit Office within 31 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

Section 125 Cafeteria Plan Guidelines

SUMMARY PAGES

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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/wylieisd.

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 website: www.mybenefitshub.com/wylieisd. 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

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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 2018 benefits become effective on September 1, 2018, you

must be actively-at-work on September 1, 2018 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 Wylie ISD 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

TRS Medical Aetna To Age 26

Dental Beam To Age 26

GAP Plan Special Insurance Services To Age 26 or married

Telehealth MDLIVE To Age 26

Accident Voya To Age 26 or Married

Vision Avesis To Age 26

Cancer American Public Life To Age 26

Voluntary Life/AD&D UNUM To Age 26

Health Savings Account (HSA) NBS To Age 26

Flexible Spending Account (FSA) NBS To Age 26

SUMMARY PAGES

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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 9/1/2018 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 the 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

orders to take drugs, or received medical care or services

(including diagnostic and/or consultation services).

Helpful Definitions SUMMARY PAGES

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Health Savings Account (HSA) (IRC Sec. 223)

Flexible Spending Account (FSA) (IRC Sec. 125)

Description

Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.

Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, tax-free. This also allows employees to pay for qualifying dependent care tax-free.

Employer Eligibility A qualified high deductible health plan. All employers

Contribution Source Employee and/or employer Employee and/or employer

Account Owner Individual Employer

Underlying Insurance Requirement

High deductible health plan None

Minimum Deductible $1,350 single (2018) $2,700 family (2018) N/A

Maximum Contribution $3,450 single (2018) $6,900 family (2018)

$2,650

Permissible Use Of Funds If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.

Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).

Cash-Outs of Unused Amounts (if no medical expenses)

Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65).

Not permitted

Year-to-year rollover of account balance?

Yes, will roll over to use for subsequent year’s health coverage.

No. Access to some funds can may be extended if your employer’s plan contains a 2 1/2 –month grace period or $500 rollover provision.

Does the account earn interest?

Yes No

Portable? Yes, portable year-to-year and between jobs.

No

HSA vs. FSA SUMMARY PAGES

FLIP TO FOR FSA INFORMATION

PG. 16 PG. 46 FLIP TO

FOR HSA INFORMATION

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2018 – 2019 TRS-ActiveCare Plan Highlights Effective September 1, 2018 through August 31, 2019 | In-Network Level of Benefits1

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 (preauthorization required)

(facility charges)

Participant pays

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 Physician charges (only covered if performed at an IOQ facility) Participant pays

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

Annual Hearing Examination Participant pays

Preventive Care

Routine physicals – annually age 12 and over • Well-child care – unlimited up to age 12 • Well woman exam & pap smear – annually age 18 and over Mammograms – 1 every year age 35 and over • Colonoscopy – 1 every 10 years age 50 and over • Prostate cancer screening –1 per year age 50 and over

Smoking cessation counseling – 8 visits per 12 months • Healthy diet/obesity counseling – unlimited to • Breastfeeding support – 6 lactation counseling visits

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http://www.trsactivecareaetna.com/

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 $20 for a 1- to 31-day supply

$20 for a 1- to 31-day supply

20% coinsurance after deductible $40 for a 1- to 31-day supply3 $40 for a 1- to 31-day supply3 50% coinsurance after deductible 50% coinsurance for a 1- to 31-day supply3 50% coinsurance for a 1- to 31-day supply

(Min. $654; Max. $130)3

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

20% coinsurance after deductible



20% coinsurance after deductible $105 for a 60- to 90-day supply3 $105 for a 60- to 90-day supply3

50% coinsurance after deductible 50% coinsurance for a 60- to 90-day supply3 50% coinsurance for a 60- to 90-day supply3

(min. $1804 , max $360)3

Specialty Medications (up to a 31-day supply)

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)

Tier 1 – Generic Tier 2 – Preferred Brand Tier 3 – Non-Preferred Brand

20% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible

$35 for a 1- to 31-day supply $60 for a 1- to 31-day supply 50% coinsurance for a 1- to 31-day supply3

$35 for a 1- to 31-day supply $60 for a 1- to 31-day supply

Full monthly premium*

Premium with min. state/district contribution**

Your Monthly Premium***







Individual $367 $142 $540 $315 $782 $557

+Spouse $1,035 $810 $1,327 $1,102 $1,855 $1,630

+Children $701 $476 $876 $651 $1,163 $938

+Family $1,374 $1,149 $1,668 $1,443 $2,194 $1,969

What is a maintenance medication? Maintenance drugs 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 $20, then you will pay $35 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 $225 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 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 ActiveCare Select or 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 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.

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2018-2019 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare

Fully Covered Health Care 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 $1,000 Individual/ $3,000 Family

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

$7,000 Individual/ $14,000 Family (includes combined Medical and RX copays, deductibles and

coinsurance)

Lifetime Paid Benefit Maximum None

Outpatient Services Copay

Primary Care1 $15 co-pay

(First Primary Care Visit for Illness $0 Copay2)

Specialty Care $70 co-pay

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 co-pay 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

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2018-2019 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare

Home Health Services Copay

Home Health Care Visit $70 co-pay

Worldwide Emergency Care Copay

Nurse Advice Line 1-877-505-7947

Online Services No Charge — go to http://trs.swhp.org

After Hours Primary Care Clinics $20 co-pay

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

Emergency Room6 $250 copay plus 20% of charges after deductible

Urgent Care Facility $50 copay per visit; deductible does not apply

Prescription Drugs (Group Value Formulary) 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 BSW Pharmacies Only, including Mail Order

(Up to a 90-day supply)

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 http://trs.swhp.org

Mail Order 1-817-388-3090

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 max 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 staff 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.

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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

Wylie ISD Benefits Website: www.mybenefitshub.com/wylieisd

PLAY VIDEO

A Health Savings Account is a tax-advantaged medical savings account available to employees who are enrolled in a high-deductible health plan. The funds contributed to the account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent.

About this Benefit

HSA (Health Savings Account)

YOUR BENEFITS PACKAGE

The interest earned in an HSA is tax free.

Money withdrawn for medical spending never falls under taxable income.

NBS

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HSA (Health Savings Account)

You can use your Health Savings Account (HSA) to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free.

What is an HSA? A tax-advantaged savings account that you use to pay for

eligible medical expenses as well as deductible, co-insurance, prescriptions, vision and dental care. Allows you to save while reducing your taxable income.

Unused funds that will roll over year to year. There’s no “use it or lose it” penalty.

Potential to build more savings through investing. If you maintain a minimum balance of $2,000, your additional funds may be invested in mutual funds yielding tax‐free earnings.

A way to accumulate additional retirement savings. After age 65, funds can be withdrawn for any purpose without penalty.

Using Funds Pre-paid Debit Card: You may use the card to pay merchants or service providers that accept Master Card credit cards, so there is no need to pay cash up front and wait for reimbursements.

2018 Annual HSA Contribution Limits Individual: $3,450 Family: $6,900 Catch-Up Contributions: Account holders over the age of 55 who have not yet enrolled in Medicare are eligible to make an additional $1,000 “catch‐up” contribution to their HSA. Will my HSA Funds be up fronted to me? Like a savings account, you can only withdrawal what you’ve contributed to the account. Funds are not up fronted. Are there any monthly fees? No, there are no monthly fees.

Participant Account Web Access www.nbsbenefits.com A Health Savings Account (HSA) works with a high deductible health plan (HDHP) and lets you set aside a portion of your paycheck ‐ before taxes– into an account to help you pay for medical expenses before you reach your deductible or that you aren’t covered by your plan. It can also help you pay for future medical expenses.

A Health Savings Account (HSA): Grows with you. If you maintain a balance of $2,000,

your additional funds may be invested in mutual funds yielding tax‐free earnings.

Helps you plan for the future. Until you turn 65, withdrawals used for eligible expenses are tax free. After you turn 65, or if you become disabled, your HSA account becomes similar to a regular IRA. Withdrawals you use for non-eligible expenses will be taxed at your regular income tax rate but won’t incur additional penalties.

For a list of sample expenses, please refer to the Wylie ISD benefit website at www.mybenefitshub.com/wylieisd

NBS Contact Information P.O. Box 6980 West Jordan, UT 84084 Phone‐800‐274‐0503 Fax‐800‐478‐1528 Email: [email protected]

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PLAY VIDEO

Medical supplement is designed to help supplement your Employer's major medical plan. This plan provides supplemental coverage to help offset out-of-pocket costs that you may experience due to deductibles, co-payments and coinsurance of your medical plan.

About this Benefit

Medical Gap Insurance YOUR BENEFITS PACKAGE

33%

of total healthcare costs are paid out-of-pocket.

SPECIAL INSURANCE SERVICES


Wylie ISD Benefits Website: www.mybenefitshub.com/wylieisd 18

Medical Gap Insurance

Basic Plan Benefits offered to employees of Wylie ISD

Hospital Confinement Benefit* - This benefit is designed to offset the cost you incur as an in-patient in the hospital when your

primary comprehensive major medical policy applies such expenses to your deductible or coinsurance maximum, up to the $1,500 plan year maximum per insured person.

Out-Patient Benefit* - This benefit offsets the cost you incur for out-patient treatment when your primary major medical policy

applies such expenses to your deductible or coinsurance maximum, up to the $1,500 benefit limit, and up to a maximum of three out-patient occurrences per family per calendar year. An “occurrence” is the treatment, or the series of treatments, for a specific injury or illness within a plan year. Expenses related to physician office visits are not included in this benefit. Covered expenses include:

Surgery in an Out-Patient Facility or a Physician’s Office

Emergency Room visits

Diagnostic testing, MRI’s, CT scans, Lab & X-ray at a diagnostic or hospital out-patient facility or at a Physician’s office if the cost is not included in the global office visit fee and is not part of wellness/preventive care

*For expenses to be eligible under this plan they must be medically necessary for the treatment of an injury or illness. Expenses not covered by your group major medical plan are not covered.

How to File a Claim When you enroll in the Benefit Connection plan, you will receive an ID card, along with specific instructions on how to file a claim. This form outlines the procedures you should follow to obtain a claim form, what you need to file a claim, and where you should send your claim. Simply stated, you will need to submit a completed claim form, itemized bills (NOT balance due statements), and EOB’s that correspond to the itemized bills. Claims may be filed at any time, but must be filed no longer than 12 months from the date of service in order to be eligible for coverage.

Under Age 40 Ages 40 - 49 Ages 50 & Above

Monthly Monthly Monthly

Employee Only $26.89 $35.41 $74.37

Employee & Spouse $49.44 $65.05 $136.65

Employee & Child(ren) $64.64 $69.58 $128.15

Employee & Family $86.57 $98.44 $188.80

This information sheet highlights the important features of the product. The policy has limitations and exclusions. The exact provisions governing the insurance are contained in the master policy issued to each group on form number GAPP-4200, policy series G4200. Your carrier representative can supply you with costs and complete details of coverage.

19

75%

of all doctor, urgent care, and ER visits could be handled safely and effectively via

telehealth.



PLAY VIDEO

Telehealth provides 24/7/365 access to board-certified doctors via telephone consultations that can diagnose, recommend treatment and prescribe medication. Whether you are at home, traveling or at work, Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.

About this Benefit

Telehealth YOUR BENEFITS PACKAGE

MDLIVE

20

Telehealth

When should I use MDLIVE? If you’re considering the ER or urgent care for a

non-emergency medical issue

Your primary care physician is not available

At home, traveling, or at work

24/7/365, even holidays!

What can be treated? Allergies

Asthma

Bronchitis

Cold and Flu

Ear Infections

Joint Aches and Pain

Respiratory Infection

Sinus Problems

And More!

Pediatric Care related to: Cold & Flu

Constipation

Ear Infection

Fever

Nausea & Vomiting

Pink Eye

And More!

Who are our doctors? MDLIVE has the nation’s largest network of telehealth doctors. On average, our doctors have 15 years of experience practicing medicine and are licensed in the state where patients are located. Their specialties include primary care, pediatrics, emergency medicine and family medicine. Our doctors are committed to providing convenient, quality care and are always ready to take your call.

Are children eligible? Yes. MDLIVE has local pediatricians on-call 24/7/365. Please note, a parent or guardian must be present during any interactions involving minors. We ask parents to establish a child record under their account. Parents must be present on each call for children 18 or younger.

How much does it cost? $10.00 Covers you, your spouse, and children up to age 26, with unlimited phone consultations.

Download the App Doctor visits are easier and more convenient with the MDLIVE App. Be prepared. Download today. www.mdlive.com/getapp

Access to a doctor anywhere: at home, at work, or on the go

Choose doctors from one of the nation's largest telehealth networks

Available 24/7 by video or phone

Private, secure and confidential visits

Connect instantly with MDLIVE Assist

Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit www.mdlive.com/terms-of-use/ 010113

Call us at (888) 365-1663 or visit us at www.consultmdlive.com

Scan with your smartphone to get the app.

21

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.



PLAY VIDEO

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.

About this Benefit

Dental YOUR BENEFITS PACKAGE

BEAM

22

Dental

Monthly Premiums

Plus High Plan Monthly Premium

Medium Plan Monthly Premium

Low Plan Monthly Premium

Employee $38.12 $27.17 $18.31

Employee + Spouse $82.46 $58.28 $36.63

Employee + Child(ren) $75.82 $52.32 $32.89

Family $133.00 $91.93 $61.97

Plan coverage In network (PPO Fee)

Out of network (90th Percentile)

In network (PPO Fee)


In network (PPO Fee)


Diagnostic & Preventive Diagnostic and preventive, exams, cleanings, fluoride, space maintainers, x-rays, and sealants Emergency palliative treatment, to temporary relieve pain (High & Medium Plan)

100% 100% 100% 100% 100% 100%

Basic Services Minor restorative, fillings Prosthetic Maintenance, relines and repairs to bridges, implants, and dentures Oral surgery, extractions and dental surgery Emergency palliative treatment, to temporarily relieve pain

80% 80% 70% 70% 50% 50%

Major Services Major restorative, crowns, inlays, and onlays Prosthodontics, dentures Prosthetics, bridges Implants Periodontics, to treat gum disease Endodontics, root canals

50% 50% 40% 40% 25% 25%

Orthodontics Orthodontics, braces with dependent age limit of 26

50% 50% NC NC 50% 50%

Plan max

Maximum Payment Annual maximum applies to diagnostic & preventive, basic services and major services. Lifetime maximum applies to orthodontic services.

If at least one Covered Service is paid in a plan year and the total benefit paid does not exceed $500 in that plan year, $350 will be added to the next year rollover maximum. This amount will accumulate to the next period, but will not exceed $1,000.

If at least one Covered Service is paid in a plan year and the total benefit paid does not exceed $500 in that plan year, $350 will be added to the next year rollover maximum. This amount will accumulate to the next period, but will not exceed $1,000.

If at least one Covered Service is paid in a plan year and the total benefit paid does not exceed $250 in that plan year, $175 will be added to the next year rollover maximum. This amount will accumulate to the next period, but will not exceed $500.

Annual max $1,200/yr $1,000/yr $700/yr

Lifetime max $1,000/lifetime $1,000/lifetime

Plan max The deductible is waived for diagnostic & preventive and orthodontic services.

Individual $50/yr $50/yr $50/yr

Family $150/yr $150/yr $150/yr

23

75%

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

correction.



PLAY VIDEO

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

Vision YOUR BENEFITS PACKAGE

AVESIS VISION

24

Vision

Using Out-of-Network Providers Members who elect to use an out-of-network provider must pay the provider in full at the time of service and submit a claim to Avēsis for reimbursement. Reimbursement levels are in accordance with the out-of-network reimbursement schedule previously listed. Out-of-network benefits are subject to the same eligibility, availability, frequency of benefits, and limitation and exclusion provisions of the plan, and are in lieu of services provided by a participating Avēsis provider. Out-of-network claim forms can be obtained by contacting Avēsis’ Customer Service Center or your group administrator, or by visiting www.avesis.com.

Limitations and Exclusions Some provisions, benefits, exclusions or limitations listed herein may vary depending on your state of residence.

Limitations: This plan is designed to cover eye examinations and corrective eyewear. It is also designed to cover visual needs rather than cosmetic options. Should the member select options that are not covered under the plan, as shown in the schedule of benefits, the member will pay a discounted fee to the participating Avesis provider. Benefits are payable only for services received while the group and individual member’s coverage is in force.

Exclusions: There are no benefits under the plan for professional services or materials connected with and arising from: 1. Orthoptics or vision training; 2. Subnormal vision aids and any supplemental testing,

aniseikonic lenses;

3. Plano (non-prescription) lenses, sunglasses; 4. Two pair of glasses in lieu of bifocal lenses; 5. Any medical or surgical treatment of eye or supporting

structures; 6. Replacement of lost or broken lenses, contact lenses or

frames, except when the member is normally eligible for services;

7. Any eye examination or corrective eyewear required by an employer as a condition of employment and safety eyewear;

8. Services or materials provided as a result of Workers’ Compensation Law, or similar legislation, required by any governmental agency whether Federal, State, or subdivision thereof.

9. Services or materials provided by any other group benefit plan providing vision care.

Refractive Surgery Vision Benefit Exclusions: Benefits are not payable for any of the following: 1. Routine vision examinations or corrective vision materials,

including corrective eyeglasses, fittings, lenses, frames, or contact lenses; or

2. Medical or surgical procedures, services, or treatments: a. not specifically covered under this Rider; b. provided free of charge in the absence of

insurance c. payable under any Workers’ Compensation law or

similar statutory authority d. payable under governmental plan or program,

whether Federal, state, or subdivisions thereof.

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

Eye Examination Covered in full after $10 Up to $45.00

Materials: $15 copayment (Materials copay applies to frame or spectacle lenses, if applicable.)

Frame Allowance* Members receive a $65 wholesale allowance Up to $175 retail value†

Up to $65.00

Standard Spectacle Lenses Single Vision Covered in full after materials copay Up to $40.00 Bifocal Covered in full after materials copay Up to $60.00 Trifocal Covered in full after materials copay Up to $80.00 Lenticular Covered in full after materials copay Up to $80.00 Standard Progressives Covered up to $50, plus 20% off retail up to $60.00

Other Lens Options‡ Level 1 Lens Option Package Youth Polycarbonate (Up to Age 19)

Covered in full

up to $10.00

Contact Lenses§

(in lieu of frame and spectacle lenses) Elective $150 allowance $130.00

Medically Necessary Covered in full $250.00

Refractive Laser Surgery Provider discount up to 25% One-time/lifetime allowance of $150

$150.00

Frequency Eye Examination Once every 12 Months Once every 12 Months

Lenses or contact lenses Once every 12 Months Once every 12 Months

Frame Once every 12 Months Once every 12 Months

Employee Paid Rates Per Month

Employee $7.15

Employee + Spouse $12.52

Employee + Child(ren) $13.83 Employee + Family $19.60

‡ Discounts are not insured benefits

§ Prior authorization is required for medically necessary contacts.

25

Disability YOUR BENEFITS PACKAGE

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.

UNUM



PLAY VIDEO

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.

About this Benefit

26

Long Term Disability

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. After the initial enrollment period, you can apply only during an annual 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. Please see your Plan Administrator for your eligibility date.

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 0/7, 14/14, 30/30, 60/60, or 90/90 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 I: Your duration of benefits is based on the following table: Age at Disability Maximum Duration of Benefits Age 60 60 months Age 61 48 months Age 62 42 months Age 63 36 months Age 64 30 months Age 65 24 months Age 66 21 months Age 67 18 months Age 68 15 months Age 69 and over 12 months OR:

Plan B: 5 YR ADEA: Your duration of benefits is based on the following table: Age at Disability Maximum Duration of Benefits Less than age 65 5 years Age 65 through 68 To age 70, but not less than 1 year Age 69 and over 1 year

Federal Income Taxation You may wonder if your disability benefit amount will be taxed. It depends on how your premium — the price of your coverage — is paid. If your premium is paid with:

Pre-Tax Dollars,* your benefit amount will be taxed

Post-Tax Dollars,** your benefit amount will not be taxed

Both Pre-Tax and Post-Tax Dollars, a portion of your benefit amount will be taxed

The disability benefit amounts you receive will be reported annually on a W-2. It will show any taxable and non-taxable portions separately.

27


Additional Benefits Work/Life Balance Employee Assistance Program1 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; 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 Unum 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.)

28


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.

Worldwide Emergency Travel Assistance Services2 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 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

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.

29


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 the greater of $100 or 10% 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.

Next Steps How to Apply/Effective Date of Coverage Current Employees: To apply for coverage, complete your enrollment form by the enrollment deadline. Your effective date of coverage is 9/01/2018. New Hires: To apply for coverage, complete your enrollment form within 60 days of your eligibility date. Please see your Plan Administrator for your effective date. If you do not enroll during the initial enrollment period, you may apply only during an annual enrollment.

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.

Questions If you should have any questions about your coverage or how to enroll, please contact your Plan Administrator.

This plan highlight is a summary provided to help you understand your insurance coverage from Unum. Some provisions may vary or not be available in all states. Please refer to your certificate booklet for your complete plan description. If the terms of this plan highlight summary or your certificate differ from your policy, the policy will govern. For complete details of coverage, please refer to policy form number C.FP-1, et al. 1,2 Work-life balance employee assistance program and On-Claim Support services are provided by Ceridian Corporation. Worldwide emergency travel assistance services are provided by Assist America, Inc. Services are available with selected Unum insurance offerings. Exclusions, limitations and prior notice requirements may apply, and service features, terms and eligibility criteria are subject to change. The services are not valid after termination of coverage and may be withdrawn at any time. Please contact your Unum representative for full details. 3 All Worldwide emergency travel assistance must be arranged by Assist America, which pays for all services it provides. Medical expenses such as prescriptions or physician, lab or medical facility fees are paid by the employee or the employee’s health insurance.

Underwritten by: Unum Life Insurance Company of America 2211 Congress Street, Portland, Maine 04122, www.unum.com ©2007 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

30


WYLIE INDEPENDENT SCHOOL DISTRICT Costs Effective as of September 1, 2018

Product: Educator Select Income Protection Plan

Plan A Plan B

ADEA II Duration of Benefits 5 YR ADEA Duration of Benefits Elimination Period (Days) Elimination Period (Days)

Injury (Days) 0* 14* 30* 60 90 0* 14* 30* 60 90

Sickness (Days) 7* 14* 30* 60 90 7* 14* 30* 60 90

Annual Earnings

Monthly Earnings

Maximum Monthly Benefit

3600 300 200 7.38 6.30 5.56 4.66 2.72 6.66 5.60 4.80 3.78 2.10

5400 450 300 11.07 9.45 8.34 6.99 4.08 9.99 8.40 7.20 5.67 3.15

7200 600 400 14.76 12.60 11.12 9.32 5.44 13.32 11.20 9.60 7.56 4.20

9000 750 500 18.45 15.75 13.90 11.65 6.80 16.65 14.00 12.00 9.45 5.25

10800 900 600 22.14 18.90 16.68 13.98 8.16 19.98 16.80 14.40 11.34 6.30

12600 1050 700 25.83 22.05 19.46 16.31 9.52 23.31 19.60 16.80 13.23 7.35

14400 1200 800 29.52 25.20 22.24 18.64 10.88 26.64 22.40 19.20 15.12 8.40

16200 1350 900 33.21 28.35 25.02 20.97 12.24 29.97 25.20 21.60 17.01 9.45

18000 1500 1000 36.90 31.50 27.80 23.30 13.60 33.30 28.00 24.00 18.90 10.50

19800 1650 1100 40.59 34.65 30.58 25.63 14.96 36.63 30.80 26.40 20.79 11.55

21600 1800 1200 44.28 37.80 33.36 27.96 16.32 39.96 33.60 28.80 22.68 12.60

23400 1950 1300 47.97 40.95 36.14 30.29 17.68 43.29 36.40 31.20 24.57 13.65

25200 2100 1400 51.66 44.10 38.92 32.62 19.04 46.62 39.20 33.60 26.46 14.70

27000 2250 1500 55.35 47.25 41.70 34.95 20.40 49.95 42.00 36.00 28.35 15.75

28800 2400 1600 59.04 50.40 44.48 37.28 21.76 53.28 44.80 38.40 30.24 16.80

30600 2550 1700 62.73 53.55 47.26 39.61 23.12 56.61 47.60 40.80 32.13 17.85

32400 2700 1800 66.42 56.70 50.04 41.94 24.48 59.94 50.40 43.20 34.02 18.90

34200 2850 1900 70.11 59.85 52.82 44.27 25.84 63.27 53.20 45.60 35.91 19.95

36000 3000 2000 73.80 63.00 55.60 46.60 27.20 66.60 56.00 48.00 37.80 21.00

37800 3150 2100 77.49 66.15 58.38 48.93 28.56 69.93 58.80 50.40 39.69 22.05

39600 3300 2200 81.18 69.30 61.16 51.26 29.92 73.26 61.60 52.80 41.58 23.10

41400 3450 2300 84.87 72.45 63.94 53.59 31.28 76.59 64.40 55.20 43.47 24.15

43200 3600 2400 88.56 75.60 66.72 55.92 32.64 79.92 67.20 57.60 45.36 25.20

45000 3750 2500 92.25 78.75 69.50 58.25 34.00 83.25 70.00 60.00 47.25 26.25

46800 3900 2600 95.94 81.90 72.28 60.58 35.36 86.58 72.80 62.40 49.14 27.30

48600 4050 2700 99.63 85.05 75.06 62.91 36.72 89.91 75.60 64.80 51.03 28.35

50400 4200 2800 103.32 88.20 77.84 65.24 38.08 93.24 78.40 67.20 52.92 29.40 31




Plan A Plan B


Injury (Days) 0* 14* 30* 60 90 0* 14* 30* 60 90

Sickness (Days) 7* 14* 30* 60 90 7* 14* 30* 60 90

Annual Earnings

Monthly Earnings


52200 4350 2900 107.01 91.35 80.62 67.57 39.44 96.57 81.20 69.60 54.81 30.45

54000 4500 3000 110.70 94.50 83.40 69.90 40.80 99.90 84.00 72.00 56.70 31.50

55800 4650 3100 114.39 97.65 86.18 72.23 42.16 103.23 86.80 74.40 58.59 32.55

57600 4800 3200 118.08 100.80 88.96 74.56 43.52 106.56 89.60 76.80 60.48 33.60

59400 4950 3300 121.77 103.95 91.74 76.89 44.88 109.89 92.40 79.20 62.37 34.65

61200 5100 3400 125.46 107.10 94.52 79.22 46.24 113.22 95.20 81.60 64.26 35.70

63000 5250 3500 129.15 110.25 97.30 81.55 47.60 116.55 98.00 84.00 66.15 36.75

64800 5400 3600 132.84 113.40 100.08 83.88 48.96 119.88 100.80 86.40 68.04 37.80

66600 5550 3700 136.53 116.55 102.86 86.21 50.32 123.21 103.60 88.80 69.93 38.85

68400 5700 3800 140.22 119.70 105.64 88.54 51.68 126.54 106.40 91.20 71.82 39.90

70200 5850 3900 143.91 122.85 108.42 90.87 53.04 129.87 109.20 93.60 73.71 40.95

72000 6000 4000 147.60 126.00 111.20 93.20 54.40 133.20 112.00 96.00 75.60 42.00

73800 6150 4100 151.29 129.15 113.98 95.53 55.76 136.53 114.80 98.40 77.49 43.05

75600 6300 4200 154.98 132.30 116.76 97.86 57.12 139.86 117.60 100.80 79.38 44.10

77400 6450 4300 158.67 135.45 119.54 100.19 58.48 143.19 120.40 103.20 81.27 45.15

79200 6600 4400 162.36 138.60 122.32 102.52 59.84 146.52 123.20 105.60 83.16 46.20

81000 6750 4500 166.05 141.75 125.10 104.85 61.20 149.85 126.00 108.00 85.05 47.25

82800 6900 4600 169.74 144.90 127.88 107.18 62.56 153.18 128.80 110.40 86.94 48.30

84600 7050 4700 173.43 148.05 130.66 109.51 63.92 156.51 131.60 112.80 88.83 49.35

86400 7200 4800 177.12 151.20 133.44 111.84 65.28 159.84 134.40 115.20 90.72 50.40

88200 7350 4900 180.81 154.35 136.22 114.17 66.64 163.17 137.20 117.60 92.61 51.45

90000 7500 5000 184.50 157.50 139.00 116.50 68.00 166.50 140.00 120.00 94.50 52.50

91800 7650 5100 188.19 160.65 141.78 118.83 69.36 169.83 142.80 122.40 96.39 53.55

93600 7800 5200 191.88 163.80 144.56 121.16 70.72 173.16 145.60 124.80 98.28 54.60

95400 7950 5300 195.57 166.95 147.34 123.49 72.08 176.49 148.40 127.20 100.17 55.65

97200 8100 5400 199.26 170.10 150.12 125.82 73.44 179.82 151.20 129.60 102.06 56.70

99000 8250 5500 202.95 173.25 152.90 128.15 74.80 183.15 154.00 132.00 103.95 57.75

100800 8400 5600 206.64 176.40 155.68 130.48 76.16 186.48 156.80 134.40 105.84 58.80

32




Plan A Plan B


Injury (Days) 0* 14* 30* 60 90 0* 14* 30* 60 90

Sickness (Days) 7* 14* 30* 60 90 7* 14* 30* 60 90

Annual Earnings

Monthly Earnings


102600 8550 5700 210.33 179.55 158.46 132.81 77.52 189.81 159.60 136.80 107.73 59.85

104400 8700 5800 214.02 182.70 161.24 135.14 78.88 193.14 162.40 139.20 109.62 60.90

106200 8850 5900 217.71 185.85 164.02 137.47 80.24 196.47 165.20 141.60 111.51 61.95

108000 9000 6000 221.40 189.00 166.80 139.80 81.60 199.80 168.00 144.00 113.40 63.00

109800 9150 6100 225.09 192.15 169.58 142.13 82.96 203.13 170.80 146.40 115.29 64.05

111600 9300 6200 228.78 195.30 172.36 144.46 84.32 206.46 173.60 148.80 117.18 65.10

113400 9450 6300 232.47 198.45 175.14 146.79 85.68 209.79 176.40 151.20 119.07 66.15

115200 9600 6400 236.16 201.60 177.92 149.12 87.04 213.12 179.20 153.60 120.96 67.20

117000 9750 6500 239.85 204.75 180.70 151.45 88.40 216.45 182.00 156.00 122.85 68.25

118800 9900 6600 243.54 207.90 183.48 153.78 89.76 219.78 184.80 158.40 124.74 69.30

120600 10050 6700 247.23 211.05 186.26 156.11 91.12 223.11 187.60 160.80 126.63 70.35

122400 10200 6800 250.92 214.20 189.04 158.44 92.48 226.44 190.40 163.20 128.52 71.40

124200 10350 6900 254.61 217.35 191.82 160.77 93.84 229.77 193.20 165.60 130.41 72.45

126000 10500 7000 258.30 220.50 194.60 163.10 95.20 233.10 196.00 168.00 132.30 73.50

127800 10650 7100 261.99 223.65 197.38 165.43 96.56 236.43 198.80 170.40 134.19 74.55

129600 10800 7200 265.68 226.80 200.16 167.76 97.92 239.76 201.60 172.80 136.08 75.60

131400 10950 7300 269.37 229.95 202.94 170.09 99.28 243.09 204.40 175.20 137.97 76.65

133200 11100 7400 273.06 233.10 205.72 172.42 100.64 246.42 207.20 177.60 139.86 77.70

135000 11250 7500 276.75 236.25 208.50 174.75 102.00 249.75 210.00 180.00 141.75 78.75

136800 11400 7600 280.44 239.40 211.28 177.08 103.36 253.08 212.80 182.40 143.64 79.80

138600 11550 7700 284.13 242.55 214.06 179.41 104.72 256.41 215.60 184.80 145.53 80.85

140400 11700 7800 287.82 245.70 216.84 181.74 106.08 259.74 218.40 187.20 147.42 81.90

142200 11850 7900 291.51 248.85 219.62 184.07 107.44 263.07 221.20 189.60 149.31 82.95

144000 12000 8000 295.20 252.00 222.40 186.40 108.80 266.40 224.00 192.00 151.20 84.00

* If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Find your Annual/Monthly Earnings above to determine your Maximum Monthly Benefit. If your Annual/Monthly Earnings are not shown, use the next lower Annual/Monthly Earnings and corresponding Maximum Monthly Benefit. Or, you may refer to the Plan Highlights to calculate your Maximum Month-ly Benefit based on your earnings. 33

Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.

About this Benefit

Cancer YOUR BENEFITS PACKAGE

AMERICAN PUBLIC LIFE



Breast Cancer is the most commonly diagnosed cancer in women.

If caught early, prostate cancer is one of the most treatable malignancies.

PLAY VIDEO

34

APSB-22339(TX)-0615 MGM/FBS Wylie ISD

SUMMARY OF BENEFITS Plan 1 Plan 2Cancer Treatment Policy Benefits Level 2 Level 3

Radiation Therapy, Chemotherapy, Immunotherapy - Maximum per 12-month period $10,000 $15,000

Hormone Therapy - Maximum of 12 treatments per calendar year $50 per treatment $50 per treatment

Experimental Treatment paid in same manner and under the same maximums as any other benefit

GC14 Limited Benefit Group Cancer Indemnity InsuranceWylie ISDTHE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON- SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

Internal Cancer First Occurrence Rider Benefits Level 2 Level 4

Lump Sum Benefit - Maximum 1 per Covered Person per lifetime $5,000 $10,000

Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime $7,500 $15,000

Heart Attack/Stroke First Occurrence Rider Benefits Level 4

Lump Sum Benefit - Maximum 1 per Covered Person per lifetime Not Available $10,000

Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime Not Available $15,000

TOTAL MONTHLY PREMIUMS BY PLAN**

Issue Ages Individual Individual & Spouse 1 Parent Family 2 Parent Family

Plan 1 Plan 2 Plan 1 Plan 2 Plan 1 Plan 2 Plan 1 Plan 2

18 + $10.48 $21.14 $22.40 $46.30 $12.04 $24.24 $23.94 $49.42

**Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with notice.The premium and amount of benefits vary dependent upon the Plan selected at time of application.

Benefits are only payable following a diagnosis of cancer for a loss incurred for the treatment of cancer while covered under the policy. A charge must be incurred for benefits to be payable. When coverage terminates for loss incurred after the coverage termination date, our obligation to pay benefits also terminates for a specified disease that manifested itself while the person was covered under the policy. All benefits are subject to the benefit maximums.

Cancer Treatment BenefitsEligibilityYou and your eligible dependents are eligible to be insured under this certificate if you and your eligible dependents meet our underwriting rules and you are actively at work with the policyholder and qualify for coverage as defined in the master application.

Limitations and ExclusionsNo benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date regardless of when specified disease was diagnosed.

Only Loss for Cancer The policy pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The policy also covers other conditions or diseases directly caused by cancer or the treatment of cancer. The policy does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer.

Pre-Existing Condition ExclusionNo benefits are payable for any loss incurred during the pre-existing condition exclusion period, following the covered person’s effective date as the result of a pre-existing condition. Pre-existing conditions specifically named or described as excluded in any part of the policy are never covered. If any change to coverage after the certificate effective date results in an increase or addition to coverage, the time limit on certain defenses and pre-existing condition exclusion for such increase will be based on the effective date of such increase.

Waiting PeriodThe policy and any attached riders contain a waiting period during which no benefits will be paid. If any covered person has a specified disease diagnosed before the end of the waiting period immediately following the covered person’s effective date, coverage for that person will apply only to loss that is incurred after one year from the covered person’s effective date. If any covered person is diagnosed as having a specified disease during the waiting period immediately following the covered person’s effective date, you may elect to void the certificate from the beginning and receive a full refund of premium.

If the policy replaced group specified disease cancer coverage from any company that terminated within 30 days of the certificate effective date, the waiting period will be waived for those covered persons that were covered under the prior coverage. However, the pre-existing condition exclusion provision will still apply.

Termination of CertificateInsurance coverage under the certificate and any attached riders will end on the earliest of these dates: the date the policy terminates; the end of the grace period if the premium remains unpaid; the date insurance has ceased on all persons covered under this certificate; the end of the certificate month in which the policyholder requests to terminate this coverage; the date you no longer qualify as an insured; or the date of your death.

Termination of CoverageInsurance coverage for a covered person under the certificate and any attached riders for a covered person will end as follows: the date the policy terminates; the date the certificate terminates; the end of the grace period if the premium remains unpaid; the end of the certificate month in which the policyholder requests to terminate the coverage for an eligible dependent; the date a covered person no longer qualifies as an insured or eligible dependent; or the date of the covered person’s death.

We may end the coverage of any Covered Person who submits a fraudulent claim.

35

Internal Cancer First Occurrence Benefits Pays a lump sum benefit amount when a covered person receives a first diagnosis of internal cancer and the date of diagnosis occurs after the waiting period. Only one benefit per covered person, per lifetime is payable under this benefit and the lump sum benefit amount will reduce by 50% at age 70.

Limitations and ExclusionsWe will not pay benefits for a diagnosis of internal cancer received outside the territorial limits of the United States or a metastasis to a new site of any cancer diagnosed prior to the covered person’s effective date, as this is not considered a first diagnosis of an internal cancer.

Pre-Existing Condition ExclusionNo benefits are payable for any loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as the result of a pre-existing condition.

Waiting PeriodThis rider contains a 30-day waiting period during which no benefits will be paid. If any internal cancer is diagnosed before the end of the waiting period immediately following the covered person’s effective date of this rider, coverage will apply only to loss that is incurred after one year from the covered person’s effective date of this rider.

TerminationThis rider will terminate and coverage will end for all covered persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the policy or certificate to which this rider is attached terminates; the end of the certificate month in which we receive a request from the policyholder to terminate this rider; the date of covered person’s death or the date the lump sum benefit amount for internal cancer has been paid for all covered persons under this rider. Coverage on an eligible dependent terminates under this rider when such person ceases to meet the definition of eligible dependent.

Heart Attack/Stroke First Occurrence BenefitsPays a lump sum benefit amount when a covered person receives a first diagnosis of heart attack or stroke and the date of diagnosis occurs after the waiting period. Only one benefit per covered person per lifetime is payable under this benefit and the lump sum benefit amount will reduce by 50% at age 70.

Limitations and ExclusionsWe will not pay benefits for any loss caused by or resulting from any of the following: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces, or military service for any country at war [(if coverage is suspended for any covered person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the policyholder’s written request)]; participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions; or participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place).

Pre-Existing Condition ExclusionNo benefits are payable for any loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as the result of a Pre-Existing Condition.

Waiting PeriodThis rider contains a 30-day waiting period during which no benefits will be paid. If any heart attack or stroke is diagnosed before the end of the waiting period immediately following the covered person’s effective date of this rider, coverage will apply only to loss that is incurred after one year from the covered person’s effective date.

TerminationThis rider will terminate and coverage will end for all covered persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the policy or certificate to which this rider is attached terminates; the end of the certificate month in which we receive a request from the policyholder to terminate this rider; the date of a covered person’s death or the date the lump sum benefit amount for heart attack or stroke has been paid for all covered persons under this rider. Coverage on an eligible dependent terminates under this rider when such person ceases to meet the definition of eligible dependent, as defined in the policy.

Optionally RenewableThis policy/riders are optionally renewable. The policyholder or we have the right to terminate the policy/riders on any premium due date after the first anniversary following the policy/riders effective date. We must give at least 60 days written notice to the policyholder prior to cancellation.

Portability (Voluntary Plans Only)When you no longer meet the definition of Insured, you will have the option to continue this coverage, including any attached riders. No Evidence of Insurability will be required. Portability must meet all of the following conditions: the certificate has been continuously in force for the last 12 months; we receive a request and payment of the first premium for the portability coverage no later than 30 days after the date you no longer qualify as an eligible insured; and the policy, under which this certificate was issued, continues to be in force on the date you cease to qualify for coverage. All future premiums due will be billed directly to you. You are responsible for payment of all premiums for the portability coverage.

The benefits, terms and condition of the portability coverage will be the same as those elected under the certificate immediately prior to the date you exercised portability. Portability coverage may include any eligible dependents who were covered under the certificate at the time you ceased to qualify as an eligible insured. No new eligible dependents may be added to the portability coverage except as provided in the New Born and Adopted Children provision. No increases in coverage will be allowed while you are exercising your rights under this rider. The premium for the portability coverage will be based on the premium tables used for such coverage at the time of the portability request.

Coverage under this rider will terminate in accordance with the provisions of the Termination of Coverage in the certificate. If the policy is no longer in force, then portability coverage is not available.

APSB-22339(TX)-0615 MGM/FBS Wylie ISD

GC14 Limited Benefit Group Cancer Indemnity Insurance

Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For detailed benefits, limitations, exclusions and other provisions, please refer to the policy/certificate/riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GC14 Series | TX | Limited Benefit Group Cancer Indemnity Insurance | (10/14) | MGM/FBS | Wylie ISD

2305 Lakeland Drive | Flowood, MS 39232ampublic.com | 800.256.8606

36

GC14 Limited Benefit Group Cancer Indemnity Insurance Wylie ISD

37

PLAY VIDEO

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. Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

About this Benefit

Life and AD&D YOUR BENEFITS PACKAGE

cause of accidental deaths in the US, followed by poisoning, falls,

drowning, and choking.

#1

Motor vehicle crashes are the

UNUM


Wylie ISD Benefits Website: www.mybenefitshub.com/wylieisd 38

Life and AD&D

Who is eligible for this coverage?

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

Basic Coverage Amounts Your employer is providing you with $15,000 of term life insurance. You will also receive $15,000 of Accidental Death and Dismemberment insurance.

What are the coverage amounts?

Employee: up to 7 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 $500.

What are the AD&D coverage amounts?

Employee: up to 7 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 $500. Note: You may purchase AD&D coverage for yourself regardless of whether you purchase term life coverage. In order to purchase AD&D coverage for your dependents, you must buy coverage for yourself.

Can I be denied coverage? If you and your eligible dependents enroll before the enrollment deadline, you may apply for any amount of coverage up to $250,000 for yourself and any amount of coverage up to $50,000 for your spouse, without answering any medical questions. If you want coverage over the amount you are guaranteed, you will need to provide answers to health questions. In addition, if you and your eligible dependents do not enroll during this enrollment period, you will have to wait for a future annual enrollment period to apply — and then you will need to answer health questions for the entire amount of coverage you apply for. 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.

Why buy now? As long as you buy $10,000 of life coverage now, you can buy more coverage later - up to $250,000 - without answering any medical questions.

How do I apply? To apply for coverage, complete your enrollment form by the enrollment deadline. If you were hired after 9/1/2018, complete your enrollment form within 31 days of your eligibility date determined by your employer. If you apply for coverage after your effective date or if you choose coverage over the guaranteed issue amount, 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.

When is coverage effective?

Your coverage is effective 9/1/2018 or the date your application is approved by underwriting, if health questions were required. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness or disorder, your dependent spouse and children: are confined in a hospital or similar institution; are confined at home under the care of a physician for a sickness or injury; or your spouse has a life-threatening condition. Exception: Infants are insured from live birth.

39

Life and AD&D

How much does the coverage cost?

Term Life

Age band Employee rate per $10,000 Spouse rate per $5,000

<25 $0.50 $0.25

25-29 $0.50 $0.25

30-34 $0.60 $0.30

35-39 $0.80 $0.40

40-44 $1.10 $0.55

45-49 $1.90 $0.95

50-54 $3.20 $1.60

55-59 $5.10 $2.55

60-64 $7.80 $3.90

65-69 $14.10 $7.05

70-74 $25.40 $12.70

75+ $25.40 $12.70

Child Life/AD&D monthly rate is $0.24 per $2,000. One life premium covers all children.

AD&D rate chart Anniversary aging: Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date. Spouse aging: Spouse rate is based on employee’s insurance age. AD&D AD&D calculation worksheet

AD&D cost Monthly Cost

Employee Per $10,000 $0.20 Spouse Per $5,000 $0.10 Child Per $2,000 $0.04

Term Life calculation worksheet Coverage amount Increment Rate Monthly cost

Employee $10,000 Spouse $5,000 Children $2,000

Coverage amount Increment Rate Monthly cost Employee $10,000 $0.20 Spouse $5,000 $0.10 Children $2,000 $0.04

40

Life and AD&D

Is the coverage portable (can I keep it if I leave my employer)?

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.

Are there any life insurance exclusions or limitations?

Life insurance benefits will not be paid for deaths caused by suicide within the first 24 months after the date your coverage becomes effective. If you increase or add coverage, these enhancements will not be paid for deaths caused by suicide within the first 24 months after you make these changes.

Will my premiums be waived if I’m disabled?

If you become disabled (as defined by your plan) and are no longer able to work, your life premium payments will be waived until your disability period ends.

What does my AD&D insurance pay for?

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 one foot and the sight of one eye;

speech and hearing. Other losses may be covered as well. Please contact your plan administrator.

Are there any AD&D exclusions or limitations?

Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from:

disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM);

suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane;

war, declared or undeclared, or any act of war;

active participation in a riot;

committing or attempting to commit a crime under state or federal law;

the voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol;

intoxication – “being intoxicated” means you or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.

When does my coverage end?

You and your dependents’ coverage under the Summary of Benefits ends on the earliest of:

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 last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness, as described in the certificate of coverage.

In addition, coverage for any one dependent will end on the earliest of:

the date your coverage under a plan ends;

the date your dependent ceases to be an eligible dependent;

for a spouse, the date of a divorce or annulment;

for dependent coverage, the date of your death. Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative.

41

PLAY VIDEO

Accident insurance is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or a not-so-serious, injury. Accident coverage is low cost protection available to you and your family without evidence of insurability.

About this Benefit

Accident YOUR BENEFITS PACKAGE

VOYA



of disabling injuries suffered by American workers are not work related.

36% of American workers report they always or usually live paycheck to paycheck.

2/3

42

Accident

What accident benefits are available?

The following list is a summary of the benefits provided by Accident Insurance. You may be required to seek care for your injury within a set amount of time.

Note that there may be some variations by state. For a list of standard exclusions and limitations, go to the end of this document. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any benefits.

EVENT BENEFIT

Accident Hospital Care Surgery Open abdominal, thoracic $1,000

Surgery exploratory or without repair $140

Blood, plasma, platelets $500

Hospital admission $1,125 Hospital confinement Per day up to 365 $350

Critical care unit confinement per day, up to 15 days $525

Rehabilitation facility confinement per day for 90 days

$150

Coma Duration of 14 or more days $14,500

Transportation per trip, up to 3 per accident $650

Lodging Per day, up to 30 days $150

Family care per child, up to 45 days $20

Accident Care

Initial doctor visit $75

Urgent care facility treatment $200

Emergency room treatment $200

Ground ambulance $300

Air ambulance $1,250

Follow-up doctor treatment $75

Medical equipment $100 Physical or occupational therapy up to six per accident $40

Speech therapy up to 6 per accident $40

Prosthetic device (one) $625

Prosthetic device (two or more) $1,000

Major diagnostic exam $200

Outpatient surgery (one per accident) $200

X-ray $40 Common Injuries

Burns second degree, at least 36% of the body $1,125

Burns 3rd degree, at least 9 but less than 35 square inches of the body $6,000

Burns 3rd degree, 35 or more square inches of the body $12,500

Skin Grafts 25% of the burn benefit

Emergency dental work $300 crown, $75 extraction

Eye Injury removal of foreign object $80

Eye Injury surgery $275

Torn Knee Cartilage surgery with no repair or if cartilage is shaved $175

Torn Knee Cartilage surgical repair $650

Laceration1 treated no sutures $25

Laceration1 sutures up to 2” $50

Laceration1 sutures 2” – 6” $200

Laceration1 sutures over 6” $400

Ruptured Disk surgical repair $650

43

Accident

EVENT BENEFIT Tendon/Ligament/Rotator Cuff One, surgical repair $350

Tendon/Ligament/Rotator Cuff Two or more, surgical repair $675

Tendon/Ligament/Rotator Cuff Exploratory Arthroscopic Surgery with no repair $1,000

Concussion $175 Paralysis quadriplegia $13,500 Paralysis paraplegia $20,000

Dislocations Closed/open reduction2 Hip joint $3,200/$6,400 Knee $2,000/$4,000 Ankle or foot bone (s) Other than toes $1,200/$2,400

Shoulder $1,500/$3,000 Elbow $900/$1,800 Wrist $900/$1,800 Finger/toe $250/$500 Hand bone(s) Other than fingers $900/$1,800

Lower jaw $900/$1,800 Collarbone $900/$1,800 Partial dislocations 25% of the closed reduction amount

Fractures Closed/open reduction3 Hip $2,500/$5,000 Leg $1,800/$3,600 Ankle $1,500/$3,000 Kneecap $1,500/$3,000 Foot Excluding toes, heel $1,500/$3,000

Upper arm $1,750/$,3500 Forearm, Hand, Wrist Except fingers $1,500/$3,000

Finger, Toe $200/$400 Vertebral body $2,800/$5,600 Vertebral processes $1,200/$2,400 Pelvis Except coccyx $2,750/$5,500

Coccyx $300/$600 Bones of face Except nose $1,000/$2,000

Nose $500/$1,000 Upper jaw $1,250/$2,500 Lower jaw $1,200/$2,400 Collarbone $1,200/$2,400 Rib or ribs $350/$700 Skull – simple Except bones of face $1,250/$2,500

Skull – depressed Except bones of face $2,500/$5,000

Sternum $300/$600 Shoulder blade $1,500/$3,000

Chip fractures 25% of the closed reduction amount 1 Laceration benefits are a total of all lacerations per accident. 2 Closed Reduction of Dislocation = Non-surgical reduction of a completely separated joint. Open Reduction of Dislocation = Surgical reduction of a completely separated joint. 3 Closed Reduction of Fracture = Non-surgical. Open Reduction of Fracture = Surgical.

44

What does my Accident Insurance include? The benefits listed below are included with your Accident Insurance coverage. For a list of standard exclusions and limitations, please refer to the end of this document. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any benefits.

Sports Accident Benefit: If your accident occurs while participating in an organized sporting activity as defined in the certificate; the accident hospital care, accident care or common injuries benefit will be increased by 25%; to a maximum additional benefit of $1000.

Accidental Death and Dismemberment (AD&D) coverage: If you are severely injured or die as a result of a covered accident, an AD&D benefit may be payable to you or your beneficiary.

Common carrier: If the death occurs as a result of a covered accident on a common carrier, a higher benefit will be payable. Common carrier means any commercial transportation that operates on a regularly scheduled basis between predetermined points or cities.

Exclusions and limitations

Exclusions for the Certificate, Spouse Accident Insurance, and Children’s Accident Insurance and AD&D are listed below. (These may vary by state.) Benefits are not payable for any loss caused in whole or directly by any of the following*:

Participation or attempt to participate in a felony or illegal activity.

An accident while the covered person is operating a motorized vehicle while intoxicated. Intoxication means the covered person’s blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the accident occurred.

Suicide, attempted suicide or any intentionally self-inflicted injury, while sane or insane.

War or any act of war, whether declared or undeclared, other than acts of terrorism.

Loss sustained while on active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.

Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor.

Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.

Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded. Performing these acts as part of your employment with the employer is not excluded.

Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar activities.

Practicing for, or participating in, any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received.

Any sickness or declining process caused by a sickness.

Work for pay, profit or gain. *See the certificate of insurance and riders for a complete list of available benefits, exclusions and limitations.

Accident

Monthly Rates (12 Pay Periods)

Employee Employee

and Spouse Employee

and Children Family

$9.82 $15.98 $18.92 $25.08

Accidental Death Benefits Benefit

Employee $85,000 Spouse $40,000 Children $20,000

Other Accident Employee $40,000 Spouse $15,000 Children $8,000

Accidental Dismemberment Benefits Benefit Loss of both hand or both feet or sight in both eyes $24,000 Loss of one hand or one foot AND the sight of one eye $18,000

Loss of one hand AND one foot $18,000 Loss of one hand OR one foot $10,000

Loss of Two or more fingers or toes $1,500 Loss of one finger or one toe $1,000

How much does Accident Insurance cost?

All employees pay the same rate, no matter their age. See the chart below for the premium amounts. Rates shown are guaranteed until September 2020.

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FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

NBS



PLAY VIDEO

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 unless your plan contains a $500 rollover or grace period provision.

Unlimited FSA (Non HSA Compatible) The funds in the unlimited healthcare FSA can be used to pay for eligible medical expenses like deductibles, co-payments, orthodontics, glasses and contacts.

About this Benefit

FOR HSA VS. FSA COMPARISON

FLIP TO… PG. 11

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NBS Flexcard You may use the card to pay merchants or service providers that accept MasterCard® credit cards, so there is no need to pay cash up front, then wait for reimbursement. If you are participating in the Dependent Care portion, the money isn’t loaded to the card. You must file web or paper claims or enroll in continual reimbursement.

New Plan Participants NBS will mail out your new benefit cards to the address listed in THEbenefitsHUB. They will be sent in unmarked envelopes so please watch for them as they should arrive within 21 business days of effective date. NBS debit cards are good for 3 years.

FSA Annual Contribution Max: $2,650

Dependent Care Annual Max: $5,000

Account Information: Participant Account Web Access: www.participant.nbsbenefits.com Participants may call NBS and talk to a representative during regular business hours, Monday-Friday, 8 am to 7 pm Central Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to the NBS website: www.NBSbenefits.com

Detailed claim history and processing status

Health Care and Dependent Care account balances

Claim forms, Direct Deposit form, worksheets, etc.

Online claims

FAQs

For a list of sample expenses, please refer to the Wylie ISD benefit website: www.mybenefitshub.com/wylieisd

NBS Contact Information:

8523 South Redwood Road West Jordan, UT 84088 Phone (800) 274‐0503 Fax (800) 478‐1528 Email: [email protected]

When Will I Receive My Flex Card? Expect Flex Cards to be delivered to the address listed in THEbenefitsHUB near the end of September. Don’t forget, Flex Cards Are Good For 3 Years!

FSA (Flexible Spending Account)

DID YOU KNOW? FSAs use tax-free funds to help pay for your Health Care Expenses.

NBS Prepaid MasterCard® Debit Card

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What is a Flexible Spending Account? A Flexible Spending Account allows you to save money by paying out-of-pocket health and/or dependent care related expenses with pre-tax dollars. Your contributions are deducted from your pay before taxes are withheld and your account is up fronted with an annual amount. Because you are taxed on a lower amount of pay, you pay less in taxes and you have more to spend.

How does a Flexible Spending Account Benefit Me? A Cafeteria plan enables you to save money on group insurance, health-related expenses, and dependent-care expenses. You may save as much as 35 percent on the cost of each benefit option! Eligible expenses must be incurred within the plan year and contributions are use-it-or-lose-it. Remember to retain all your receipts.

Health Care Expense Account Example Expenses:

Dependent Care Expense Account Example Expenses:

Before and After School and/or Extended Day Programs

The actual care of the dependent in your home.

Preschool tuition.

The base costs for day camps or similar programs used as care for a qualifying individual.

What Can I Use My Flexible Spending Account On? For a full list of eligible expenses, please refer to www.mybenefitshub.com/wylieisd

What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)? Eligible expenses must be incurred within the plan year +75 day grace period. Contributions are use-it-or-lose-it. Remember to retain all your receipts (including receipts for card swipes).

How Do I File A Claim? In most situations, you will be able to swipe your card however, in the event you lose your card or are waiting to receive one, you can visit www.mybenefitshub.com/wylieisd and complete the “Claim Form” to send to NBS or use the web or phone app to file online.

Hearing aids & batteries

Lab fees

Laser Surgery

Orthodontia Expenses

Physical exams

Pregnancy tests

Prescription drugs

Vaccinations

Vaporizers or humidifiers

Acupuncture

Body scans

Breast pumps

Chiropractor

Co-payments

Deductible

Diabetes Maintenance

Eye Exam & Glasses

Fertility treatment

First aid

FSA Frequently Asked Questions

How To Receive Your Dependent Care Reimbursement Faster.

A Direct Deposit form is available on the Benefits Website which will help you get reimbursed quicker!

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How the FSA Plan Works

You designate an annual election of pre-tax dollars to be deposited into your health and dependent-care spending accounts. Your total election is divided by the number of pay periods in the Plan Year and deducted equally from each paycheck before taxes are calculated. By the end of the Plan year, your total election will be fully deposited. However, you may make a claim for eligible health FSA expenses as soon as they are incurred during the Plan year. Eligible claims will be paid up to your total annual election even if you have not yet contributed that amount to your account.

Get Your Money 1. Complete and sign a claim form (available on our website) or an online claim. 2. Attach documentation; such as an itemized bill or an Explanation of Benefits (EOB) statement from a health insurance provider. 3. Fax or mail signed form and documentation to NBS. 4. Receive your non-taxable reimbursement after your claim is processed either by check or direct deposit.

NBS Flexcard—FSA Pre-paid Benefit Card Your employer may sponsor the use of the NBS Flexcard, making access to your flex dollars easier than ever. You may use the card to pay merchants or service providers that accept credit cards, so there is no need to pay cash up front then wait for reimbursement.

Account Information Participants may call NBS and talk to a representative during our regular business hours, Monday–Friday, 7am to 6pm Mountain Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to our website: www.NBSbenefits.com Information includes:

Detailed claim history and processing status

Health Care and Dependent Care account balances

Claim forms, worksheets, etc.

Online Claim Submission

Enrollment Considerations After the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying “change of status” (marriage status, employment change, dependent change). Be conservative in the total amount you elect to avoid forfeiting money that may be left in your account at the end of the year. Your employer may allow a short grace period after the Plan year ends for you to submit qualified claims for any unused funds.

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NOTES

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NOTES

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WWW.MYBENEFITSHUB.COM/WYLIEISD

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Documents

WYLIE ISD BENEFIT GUIDE€¦ · UNUM Group #: 471659 (800) 858-6843 TRS-A TIVE ARE MEDI AL DENTAL A IDENT Aetna (800) 222-9205 eam Group #: TX00326-001/002/003 (800) 648-1179 Voya