2016 benefit guide aubrey isd

EFFECTIVE:

09/01/2016 - 8/31/2017

BENEFIT GUIDE

www.mybenefitshub.com/aubreyisd

AUBREY ISD

1

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. HSA vs FSA Comparison 11 TRS-ActiveCare Aetna 12-15 TRS Aetna and Scott & White Rate Sheet 16-17 HSA Bank Health Savings Account 18-21 NBS Flexible Spending Account 22-25 Cigna Dental 26-28 QCD Discount Dental 29 Superior Vision 30-31 Unum Disability 32-35 Loyal American Cancer 36-39 Loyal American Accident 40-43 AUL a OneAmerica Company Term Life 44-47 Axis Global AD&D 48-49 Texas Life Permanent Life 50-51 MDLIVE Telehealth 52-53

Table of Contents

HOW TO ENROLL

PG. 4

YOUR BENEFIT UPDATES: WHAT’S NEW

PG. 6

YOUR MEDICAL BENEFITS

PG. 12

FLIP TO...

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Benefit Contact Information

BENEFIT ADMINISTRATORS VISION HEALTH SAVINGS ACCOUNTS (HSA’S) Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/aubreyisd

Superior Vision (866) 265-0517 www.superiorvision.com

HSA Bank

(800) 357-6246 www.hsabank.com

AUBREY ISD ADMINISTRATOR DISABILITY FLEXIBLE SPENDING ACCOUNTS (FSA’S) Betty Henderson (940) 668-0063 [email protected]

Unum (800) 583-6908 www.unum.com Unum Claims (800) 858-6843

National Benefit Services (800) 274-0503 opt 4 www.nbsbenefits.com

TRS ACTIVECARE MEDICAL CANCER COBRA (Dental, Vision & Medical FSA Card)

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

Loyal American (800) 366.8354 www.loyalamerican.com

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

TRS HMO MEDICAL VOLUNTARY LIFE COBRA (Medical) Scott and White (800) 321-7947 www.trs.swhp.org

AUL a OneAmerica Company (800) 537-6442 www.oneamerica.com

WellSystems (844) 752-5146

PPO DENTAL AD&D TELEHEALTH Dental Select (800) 999-9789 www.dentalselect.com

Axis Global (800) 583-6908 www.axisaccidentalhealth.com

MDlive (888) 365-1663 www.consultmdlive.com

DISCOUNT DENTAL PERMANENT LIFE QCD (800) 229-0304 www.qcdofamerica.com

Texas Life (800) 283-9233 www.texaslife.com

Benefit Contact Information

3

!

How to Enroll

On Your Computer Access THEbenefitsHUB from your

computer, tablet or smartphone!

Our online benefit enrollment

platform provides a simple and

easy to navigate process. Enroll

at your own pace, whether at

home or at work.

www.mybenefitshub.com/

aubreyisd delivers important

benefit information with 24/7

access, as well as detailed plan

information, rates and product

videos.

TEXT

“aubreyisd”

TO

313131

On Your Device Enrolling in your benefits just got

a lot easier! Text “aubreyisd” to

313131 to receive everything you

need to complete your

enrollment.

Avoid typing long URLs and scan

directly to your benefits website,

to access plan information,

benefit guide, benefit videos, and

more!

SCAN: TRY ME

4

GO www.mybenefitshub.com/aubreyisd 1

2

Login Steps

3

Go to:

Click Login

Enter Username & Password

OR SCAN

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 six (6) or less 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.

Sample Password

l incola1234

l incoln1234

If you have trouble

logging in, click on the

“Login Help Video”

for assistance.

Click on “Enrollment Instructions” for more information about how to enroll.

Sample Username

LOGIN

Open Enrollment Tip

For your User ID: 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.

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Financial Benefit Services (FBS) is the Third Party Administrator for Aubrey ISD. FBS will conduct the annual enrollment and provide benefit support for Aubrey ISD employees.

The Benefit elections will become effective 9/1/2016.

Elections requiring evidence of insurability, such as Life Insurance, may have a later effective date, if approved. After annual enrollment closes, benefit changes can only be made if you experience a qualifying event (and changes must be made within 31 days of event).

UPDATE! Aetna remains the carrier for Medical Plans:

ActiveCare 1 HD,ActiveCare 2 and ActiveCare Select. All eligible employees, including active, contributing TRS members and employees regularly working 10 hours per week MUST either enroll for coverage or decline coverage in the Benefits HUB per ACA Mandates. For comprehensive TRS medical information, visit the website, www.trsactivecareaetna.com.

A Health Savings Account with HSA Bank is a tax-free

savings account available to those employees enrolled in ActiveCare 1 HD. These funds can be used to pay for medical, dental or vision expenses. The HSA annual contribution maximum is $3,350 for individuals and $6,750 for your family. For individuals who are between 55-65, there is an additional catch-up provision of $1,000 that can be contributed annually.

If you currently participate in a Health Care or Dependent Care FSA, you MUST re-elect a new contribution amount every year to continue to participate. This benefit does not roll over. The 2016 FSA contribution limit is $2,550. If you are electing this benefit for the first time, you will receive your debit card by the end of September. You can manually submit claims prior to receiving your cards.

Don’t Forget!

Login and complete your benefit enrollment on 07/25/2016 - 08/22/2016

On-site enrollment assistance will be available on August 17th.

Add dependents to the system—please bring dependent Social Security numbers and date of birth.

Benefit Updates - What’s New:

SUMMARY PAGES

Annual Benefit Enrollment

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SUMMARY PAGES

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 30 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

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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

timeframe 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 benefit

website:

www.mybenefitshub.com/aubreyisd. 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 the Aubrey ISD

benefit website: www.mybenefitshub.com/aubreyisd. 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.

SUMMARY PAGES

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PLAN CARRIER MAXIMUM AGE

Accident Loyal American 25

Cancer Loyal American 19 (25 if Full-Time Student)

Dental Dental Select 25

Discount Dental QCD 26

Flexible Spending Accounts National Benefit Services 26 (benefits terminate at the end of the plan year following the birthday)

Health Savings Accounts HSA Bank 26 (benefits terminate at the end of the plan year following the birthday)

Individual Life Texas Life 25

Medical Aetna 26

Vision Superior Vision 26

Voluntary Life Dearborn National 26

Employee Eligibility Requirements

Medical and Supplemental Benefits: Eligible employees must

work 10 or more regularly scheduled hours each week for TRS

Medical Plans. Employees must work 20 regularly scheduled

hours each week for all supplemental benefits..

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 2016 benefits become effective on September 1, 2016, you

must be actively-at-work on September 1, 2016 to be eligible for

your new benefits.

Dependent Eligibility Requirements

Dependent Eligibility: You can cover eligible dependent

children under a benefit that offers dependent coverage,

provided you participate in the same benefit, through the

maximum age listed below. Dependents cannot be double

covered by married spouses within the Aubrey ISD or as both

employees and dependents.

If your dependent is disabled, coverage can 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.

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 9/1/2016 please notify your benefits

administrator.

Annual Enrollment The period during which existing employees are given the

opportunity to enroll in or change their current elections.

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

pay covered expenses.

Calendar Year January 1st through December 31st

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

covered health care service, calculated as a percentage (for

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

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

medical questions or taking a health exam. Guaranteed

coverage is only available during initial eligibility period.

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

provisions do apply, as applicable by carrier.

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

who have contracted with the plan as a network provider.

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

for covered expenses.

Plan Year September 1st through August 31st

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

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

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

orders to take drugs, or received medical care or services

(including diagnostic and/or consultation services).

Helpful Definitions SUMMARY PAGES

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SUMMARY PAGES HSA vs. FSA

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 $1,300 single (2016) $2,600 family (2016) N/A

Maximum Contribution $3,350 single (2016) $6,750 family (2016)

Varies per employer

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

FOR HSA INFORMATION

FLIP TO… PG. 18

FOR FSA INFORMATION

FLIP TO… PG. 22

11

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

About this Benefit

Medical

YOUR BENEFITS PACKAGE

DID YOU KNOW?

TRS Aetna

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

a chronic disease.

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

Aubrey ISD Benefits Website: www.mybenefitshub.com/aubreyisd 12

2016-2017 TRS-ActiveCare Plan Highlights Effective September 1, 2016 through August 31, 2017 | In-Network Level of Benefits*

Type of Service ActiveCare 1-HD ActiveCare Select or ActiveCare Select Whole Health

(Baptist Health System and HealthTexas Medical Group; Baylor Scott & White Quality Alliance; Memorial Hermann

Accountable Care Network; Seton Health Alliance)

ActiveCare 2

Deductible (per plan year)

$2,500 employee only $5,000 family

$1,200 individual $3,600 family


Out-of-Pocket Maximum (per plan year; does include medical deductible/ any medical copays/coinsurance/any prescription drug deductible and applicable copays/coinsurance)

$6,550 individual $13,100 family (the individual out-of-pocket maximum only includes covered expenses incurred by that individual)



Coinsurance Plan pays (up to allowable amount) Participant pays (after deductible)

80% 20%

80% 20%

80% 20%

Office Visit Copay Participant pays

20% after deductible $30 copay for primary $60 copay for specialist

$30 copay for primary $50 copay for specialist

Diagnostic Lab Participant pays

20% after deductible Plan pays 100% (deductible waived) if performed at a Quest facility; 20% after deductible at other facility

Plan pays 100% (deductible waived) if performed at a Quest facility; 20% after deductible at other facility

Preventive Care See next page for a list of services

Plan pays 100% Plan pays 100% Plan pays 100%

Teladoc® Physician Services $40 consultation fee (applies to deductible and out-of-pocket maximum)

Plan pays 100% Plan pays 100%

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

20% after deductible $100 copay plus 20% after deductible $100 copay plus 20% after deductible

Inpatient Hospital (preauthorization required) (facility charges) Participant pays

20% after deductible $150 copay per day plus 20% after deductible ($750 maximum copay per admission)

$150 copay per day plus 20% after deductible($750 maximum copay per admission; $2,250 maximum copay per plan year)

Emergency Room (true emergency use) Participant pays

20% after deductible $150 copay plus 20% after deductible (copay waived if admitted)

$150 copay plus 20% after deductible (copay waived if admitted)

Outpatient Surgery Participant pays

20% after deductible $150 copay per visit plus 20% after deductible

$150 copay per visit plus 20% after deductible

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

$5,000 copay plus 20% after deductible

Not covered $5,000 copay (does not apply to out-of-pocket maximum) plus 20% after deductible

Prescription Drugs Drug deductible (per plan year)

Subject to plan year deductible $0 for generic drugs $200 per person for brand-name drugs

$0 for generic drugs $200 per person for brand-name drugs

Retail Short-Term (up to a 31-day supply) Participant pays • Generic copay • Brand copay (preferred list) • Brand copay (non-preferred list)

20% after deductible

$20 $40** 50% coinsurance**

$20 $40** $65**

Retail Maintenance (after first fill; up to a 31-day supply) Participant pays • Generic copay • Brand copay (preferred list) • Brand copay (non-preferred list)

20% after deductible

$35 $60** 50% coinsurance**

$35 $60** $90**

Mail Order and Retail-Plus (up to a 90-day supply) Participant pays • Generic copay • Brand copay (preferred list) • Brand copay (non-preferred list)

20% after deductible $45 $105*** 50% coinsurance

$45 $105*** $180***

Specialty Drugs Participant pays

20% after deductible 20% coinsurance per fill $200 per fill (up to 31-day supply) $450 per fill (32- to 90-day supply)

A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. *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. **If the patient obtains a brand-name drug when a generic equivalent is available, the patient will be responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug.

13

TRS-ActiveCare Plans—Preventive Care

Preventive Care Services

Network Benefits When Using In-Network Providers

(Provider must bill services as “preventive care”)

ActiveCare 1-HD ActiveCare Select or ActiveCare Select

Whole Health (Baptist Health System and

HealthTexas Medical Group; Baylor Scott & White Quality Alliance;

Memorial Hermann Accountable Care Network; Seton Health

Alliance)

ActiveCare 2 Network

Evidence−based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force (USPSTF) www. uspreventiveservicestaskforce.org/Page/Name/uspstf-a-andb- recommendations.

Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) with respect to the individual involved.

Evidence−informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) for infants, children and adolescents. Additional preventive care and screenings for women, not described above, as provided for in comprehensive guidelines supported by the HRSA www.hhs.gov/healthcare/factsand- features/fact-sheets/preventive-services-covered-underaca/ index.html#CoveredPreventiveServicesforAdults.

For purposes of this benefit, the current recommendations of the USPSTF regarding breast cancer screening and mammography and prevention will be considered the most current (other than those issued in or around November 2009).

The preventive care services described above may change as USPSTF, CDC and HRSA guidelines are modified.

Plan pays 100% (deductible waived; no copay required) Some examples of preventive care frequency and services: 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 age 22; age 22 and over-26 visits per 12 months

Breastfeeding support – 6 lactation counseling visits per 12 months

Plan pays 100% (deductible waived; no copay required) Some examples of preventive care frequency and services: 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 age 22; age 22 and over-26 visits per 12 months

Breastfeeding support –6 lactation counseling visits per 12 months

Plan pays 100% (deductible waived) Some examples of preventive care frequency and services: 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 age 22; age 22 and over-26 visits per 12 months

Breastfeeding support – 6 lactation counseling visits per 12 months

(Examples of covered services included are: Routine annual physicals (one per year); immunizations; well-child care; breastfeeding support, services and supplies; cancer screening mammograms; bone density test; screening for prostate cancer and colorectal cancer (including routine colonoscopies); smoking cessation counseling services and healthy diet counseling; and obesity screening/counseling.

Examples of covered services for women with reproductive capacity are: Female sterilization procedures and specified FDA-approved contraception methods with a written prescription by a health care practitioner, including cervical caps, diaphragms, implantable contraceptives, intra-uterine devices, injectables, transdermal contraceptives and vaginal contraceptive devices. Prescription contraceptives for women are covered under the pharmacy benefits administered by Caremark.

To determine if a specific contraceptive drug or device is included in this benefit, contact Customer Service at 1-800-222-9205. The list may change as FDA guidelines are modified.

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

After deductible, plan pays 80%; participant pays 20%

$60 copay for specialist $50 copay for specialist

Annual Hearing Examination Participant pays

After deductible, plan pays 80%; participant pays 20%



Note: Covered services under this benefit must be billed by the provider as “preventive care.” If you receive preventive services from a non-network provider, you will be responsible for any applicable deductible and coinsurance under the ActiveCare 1-HD and ActiveCare 2. Non-network preventive care is not paid at 100%. There is no coverage for non-network services under the ActiveCare Select plan or ActiveCare Select Whole Health.

2016-2017 TRS-ActiveCare Plan Highlights Effective September 1, 2016 through August 31, 2017 | In-Network Level of Benefits*

TRS-ActiveCare is administered by Aetna Life Insurance Company. Aetna provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug benefits are administered by Caremark. 14

TRS-ActiveCare Plan 1- HD

TRS Monthly Premium

Aubrey ISD Contribution

2016-2017 TRS Employee Premium

Employee Only $341.00 $304.00 $37.00

Employee & Spouse $914.00 $304.00 $610.00

Employee & Child(ren) $615.00 $304.00 $311.00

Employee & Family $1,231.00 $304.00 $927.00

Deductible: Employee Only $2500 & Employee Family $5000 Max Out of Pocket: Employee Only $6550 & Employee Family $13,100

TRS-ActiveCare Select- Exclusive Provider

Organization

TRS Monthly Premium

Aubrey ISD Contribution

2016-2017 TRS Employee Premium

Employee Only $484.00 $304.00 $180.00

Employee & Spouse $1,147.00 $304.00 $843.00


Employee & Family $1,361.00 $304.00 $1,057.00

Deductible: Employee Only $1200 Ded & Employee Family $3600 Ded Max Out of Pocket: Employee Only $6850 & Employee Family $13,700

TRS-TRS-ActiveCare 2 TRS

Monthly Premium Aubrey ISD

Contribution 2016-2017 TRS

Employee Premium

Employee Only $645.00 $304.00 $341.00

Employee & Spouse $1,552.00 $304.00 $1,248.00

Employee & Child(ren) $1,042.00 $304.00 $738.00

Employee & Family $1,597.00 $304.00 $1,293.00

Deductible: Employee Only $1200 & Employee Family $3000 Max Out of Pocket: Employee Only $6850 & Employee Family $13,700

Scott and White HMO TRS

Monthly Premium Aubrey ISD

Contribution 2016-2017 TRS

Employee Premium

Employee Only $503.60 $304.00 $199.60

Employee & Spouse $1,135.62 $304.00 $831.62


Employee & Family $1,259.76 $304.00 $955.76

Deductible: Employee Only $1000 Ded & Employee Family $3000 Max Out of Pocket: Employee Only $5000 & Employee Family $10,000

Aubrey ISD 2016 - 2017 TRS Medical Rates

15

2016-2017 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)

$5,000 Individual/ $10,000 Family (includes combined Medical and RX copays, deductibles and

coinsurance)

Lifetime Paid Benefit Maximum None

Outpatient Services Copay

Primary Care1 $20 co-pay

(First Primary Care Visit for Illness $0 Copay2)

Specialty Care $50 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 $50 copay

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

Equipment and Supplies Copay

Preferred Diabetic Supplies and Equipment $3 copay; no deductible

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

Durable Medical Equipment/ Prosthetics 20% after deductible

16

2016-2017 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare

Home Health Services Copay

Home Health Care Visit $50 co-pay

Worldwide Emergency Care Copay

Nurse Advice Line 1-877-505-7947

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

After Hours Primary Care Clinics $20 co-pay

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

Emergency Room6 $150 copay and 20% of charges after deductible

Urgent Care Facility $55 copay

Prescription Drugs Copay

Annual Benefit Maximum Unlimited

Rx Deductible Does not apply to preferred generic drugs

$100

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

Retail Quantity (Up to a 30-day supply)

Maintenance Quantity BSWH Pharmacies Only (Up to a 90-day supply)

Preferred Generic7 $3 copay $6 copay

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

Non-preferred 50% after Rx deductible 50% after Rx deductible

Non-formulary Greater of $50 or 50% after deductible Not available

Mail Order 1-800-707-3477

1Including all services billed with office visit 2Does not apply to wellness or preventive visits 3Includes other services, treatments, or procedures received at time of office visit 4$750 maximum copay per admission and 20% after deductible 55 visits max per month, 35 max visit per year 6Copay waived if admitted within 24 hours 7If a brand name drug is dispensed when a generic is available, 50% copay applies

Specialty Medications (Up to a 30-day supply)

Copay

20% after Rx deductible

17

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)


The interest earned in an HSA is tax free.

DID YOU KNOW?

Money withdrawn for medical spending never falls under taxable income.

HSA BANK



HSA Bank has teamed up with your employer to create an affordable health coverage option that helps you save on healthcare expenses. This plan is only available for those who are participating in the Active Care 1-HD medical plan. You may not enroll in the MEDlink® plan if you participate in the HSA. Depending on your district, you may or may not be able to participate in the FSA plan if you participate in HSA. Medicare, Medicaid, and Tricare participants are not eligible to participate in an HSA. 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.

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

Using Funds Debit Card

You may use the card to pay merchants or service providers that accept VISA credit cards, so there is no need to pay cash up front and wait for reimbursements.

You can make a withdrawal at any time. Reimbursements for qualified medical expenses are tax free. If you are disabled or reach age 65, you can receive non-medical distributions without penalty, but you must report the distributions as taxable income. You may also use your funds for a spouse or tax dependent not covered by your HDHP.

2016 Annual HSA Contribution Limits Individual: $3,350 Family: $6,750 Catch-Up Contributions: Accountholders who meet the qualifications noted below are eligible to make an HSA catch-up contribution of an additional $1,000.

Health Savings accountholder

Age 55 or older (regardless of when in the year an accountholder turns 55)

Not enrolled in Medicare (if an accountholder enrolls in Medicare mid-year, catch contributions should be prorated)

Authorized Signers who are 55 or older must have their own HSA in order to make the catch-up contribution Monthly Fee: Your account will be charged a monthly fee of $1.75, waived with an average daily balance at or above $3,000.

Examples of Qualified Medical Expenses Surgery

Braces

Contact lenses

Dentures

Eyeglasses

Vaccines For a list of sample expenses, please refer to the Aubrey ISD website at www.mybenefitshub.com/aubreyisd

HSA Bank Contact Information 605 N. 8th Street, Ste 320 Sheboygan, WI 53081 Phone: 800-357-6246 www.hsabank.com

HSA (Health Savings Account)

19

A Health Savings Account (HSA) is an individually-owned, tax-advantaged account that you can use to pay for current or future IRS-qualified medical expenses. With an HSA, you’ll have the potential to build more savings for healthcare expenses or additional retirement savings through self-directed investment options1.

How an HSA works: You can contribute to your HSA via payroll deduction,

online banking transfer, or by sending a personal check to HSA Bank. Your employer or third parties, such as a spouse or parent, may contribute to your account as well.

You can pay for qualified medical expenses with your HSA Bank Debit Card directly to your medical provider or pay out-of-pocket. You can either choose to reimburse yourself or keep the funds in your HSA to grow your savings.

Unused funds will roll over year to year. After age 65, funds can be withdrawn for any purpose without penalty (subject to ordinary income taxes).

Check balances and account information via HSA Bank’s Internet Banking 24/7.

Are you eligible for an HSA? If you have a qualified High Deductible Health Plan (HDHP) - either through your employer, through your spouse, or one you’ve purchased on your own - chances are you can open an HSA. Additionally:

You cannot be covered by any other non-HSA-compatible health plan, including Medicare Parts A and B.

You cannot be covered by TriCare.

You cannot have accessed your VA medical benefits in the past 90 days (to contribute to an HSA).

You cannot be claimed as a dependent on another person’s tax return (unless it’s your spouse).

You must be covered by the qualified HDHP on the first day of the month.

When you open an account, HSA Bank will request certain information to verify your identity and to process your application.

What are the annual IRS contribution limits? Contributions made by all parties to an HSA cannot exceed the annual HSA limit set by the Internal Revenue Service (IRS). Anyone can contribute to your HSA, but only the accountholder and employer can receive tax deductions on those contributions. Combined annual contributions for the accountholder, employer, and third parties (i.e., parent, spouse, or anyone else) must not exceed these limits2.

2016 Annual HSA Contribution Limits Individual = $3,350 Family = $6,750

Catch-up Contributions Accountholders who meet these qualifications are eligible to make an HSA catch-up contribution of $1,000: Health Savings accountholder; age 55 or older (regardless of when in the year an accountholder turns 55); not enrolled in Medicare (if an accountholder enrolls in Medicare mid-year, catch-up contributions should be prorated). Authorized signers who are 55 or older must have their own HSA in order to make the catch-up contribution. According to IRS guidelines, each year you have until the tax filing deadline to contribute to your HSA (typically April 15 of the following year). Online contributions must be submitted by 2:00 p.m., Central Time, the business day before the tax filing deadline. Wire contributions must be received by noon, Central Time, on the tax filing deadline, and contribution forms with checks must be received by the tax filing deadline.

How can you benefit from tax savings? An HSA provides triple tax savings3. Here’s how:

Contributions to your HSA can be made with pre-tax dollars and any after-tax contributions that you make to your HSA are tax deductible.

HSA funds earn interest and investment earnings are tax free.

When used for IRS-qualified medical expenses, distributions are free from tax.

IRS-Qualified Medical Expenses You can use your 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. HSA funds can be used to reimburse yourself for past medical expenses if the expense was incurred after your HSA was established. While you do not need to submit any receipts to HSA Bank, you must save your bills and receipts for tax purposes.

How the HSA Plan Works

20

How the HSA Plan Works

Examples of IRS-Qualified Medical Expenses4:

For assistance, please contact the Client Assistance Center 800-357-6246 Monday – Friday, 7 a.m. – 9 p.m., and Saturday, 9 a.m. - 1 p.m., CT www.hsabank.com | 605 N. 8th Street, Ste. 320, Sheboygan, WI 53081 1 Investment accounts are not FDIC insured, may lose value and are not a deposit or other obligation of, or guarantee by the bank. Investment losses which are replaced are subject to the annual contribution limits of the HSA. 2 HSA funds contributed in excess of these limits are subject to penalty and tax unless the excess and earnings are withdrawn prior to the due date, including any extensions for filing Federal Tax returns. Accountholders should consult with a qualified tax advisor in connection with excess contribution removal. The Internal Revenue Service requires HSA Bank to report withdrawals that are considered refunds of excess contributions. In order for the withdrawal to be accurately reported, accountholders may not withdraw the excess directly. Instead, an excess contribution refund must be requested from HSA Bank and an Excess Contribution Removal Form completed. 3 Federal Tax savings are available no matter where you live and HSAs are taxable in AL, CA, and NJ. HSA Bank does not provide tax advice. Consult your tax professional for tax‐related questions. 4 This list is not comprehensive. It is provided to you with the understanding that HSA Bank is not engaged in rendering tax advice. The information provided is not intended to be used to avoid Federal tax penalties. For more detailed information, please refer to IRS Publication 502 titled, “Medical and Dental Expenses”. Publications can be ordered directly from the IRS by calling 1-800-TAXFORM. If tax advice is required, you should seek the services of a professional. 5 Insurance premiums only qualify as an IRS-qualified medical expense: while continuing coverage under COBRA; for qualified long-term care coverage; coverage while receiving unemployment compensation; for any healthcare coverage for those over age 65 including Medicare (except Medicare supplemental coverage).

Acupuncture Alcoholism treatment Ambulance services Annual physical examination Artificial limb or prosthesis Birth control pills (by prescription) Chiropractor Childbirth/delivery Convalescent home (for medical treatment only) Crutches Doctor’s fees Dental treatments (including x-rays, braces, dentures, fillings, oral surgery) Dermatologist Diagnostic services Disabled dependent care Drug addiction therapy Fertility enhancement (including in-vitro fertilization) Guide dog (or other service animal)

Gynecologist Hearing aids and batteries Hospital bills Insurance premiums5

Laboratory fees Lactation expenses Lodging (away from home for outpatient care) Nursing home Nursing services Obstetrician Osteopath Oxygen Pregnancy test kit Podiatrist Prescription drugs and medicines (over-the-counter drugs are not IRS- qualified medical expenses unless prescribed by a doctor) Prenatal care & postnatal treatments Psychiatrist Psychologist Smoking cessation programs

Special education tutoring Surgery Telephone or TV equipment to assist the hearing or vision impaired Therapy or counseling Medical transportation expenses Transplants Vaccines Vasectomy Vision care (including eyeglasses, contact lenses, lasik surgery) Weight loss programs (for a specific disease diagnosed by a physician – such as obesity, hypertension, or heart disease) Wheelchairs X-rays

21

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

FSA (Flexible Spending Account)


NBS



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.

Current plan participants: KEEP YOUR CARDS! NBS debit cards are good for 3 years. If you throw away your cards, there is a $5.00 fee to replace them.

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: $2,550

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 claim FAQs

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

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

23

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/aubreyisd

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/aubreyisd 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!

24

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.

25

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

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.

DID YOU KNOW?

DENTAL SELECT


Aubrey ISD Benefits Website: www.mybenefitshub.com/aubreyisd

QCD

Discount Dental

26

Dental Select

Indemnity Classic Plan - Max Plan

Platinum Network

PREVENTIVE Contracted Dentist Non-Contracted Dentist

Routine exams, cleanings (2 per year), topical fluoride, x-rays

100% 100% of R&C

BASIC

Composite fillings, extractions, oral

surgery, sealants, space maintainers

80% 80% of R&C No Waiting Period

MAJOR

Crowns, bridges, dentures, endodontics, periodontics

50% 50% of R&C

12 Month Waiting Period

ORTHODONTICS

Children under 19

Waiting Period

Lifetime Maximum

50% 50%

12 Month Waiting Period

$1000.00

20% Discount No Discount

MAXIMUM BENEFIT

$1000.00

DEDUCTIBLE

$50.00

$150.00

$50.00 $150.00

SPECIALISTS

Endodontists, Oral Surgeons, Pediatric, Periodontists, Prosthodontists

Contracted Specialist payment:

1) You receive a 20% discount off the Specialist fee

2) Plan pays according to the Reasonable and Customary fees

3) Member pays the difference between plan payment and discounted Specialist fee

Non-contracted Specialist payment:

Paid the same as non-contracted dentists

Employee Employee + 1 Employee + Family

$36.68 $68.69 $115.00

Applies to Preventative, Basic and

Major Services

Benefit Period is:

Per Calendar

Year

Per Benefit Period

Per Person

Family Maximum

Applies to Basic and

Major Services

27

Dental Select Notes

Network Access General Dentists Dental Select participating general dentists accept the Platinum or Gold fee schedule as payment in full.

Specialists (Include Pediatric, Endodontist, Prosthodontist, Oral Surgeon, Periodontist, Orthodontist*) Coinsurance Plans *Contracted Orthodontist: The member may receive a discount of up to 20% off of the contracted Orthodontist’s fee. Contracted Specialists: The plan will pay based on a contracted fee schedule. Contracted specialist providers accept the fee schedule as payment in full with no balance billing. Non-Contracted Specialists:

MAC- No discount - including Orthodontists. The plan will pay from our contracted fee schedule. The Member is responsible for the difference between the plan’s payment and the Specialist’s fee. UCR- No discount - including Orthodontists. The plan will pay based on Reasonable & Customary fees. The Member is responsible for the difference between the plan’s payment and the Specialist’s fee.

Co-Pay Plans - See Schedule of co-payments for member responsibility

Minnesota Dental Select participating general dentists utilize the Premier network. Services rendered will be reimbursed according to the Premier network fee schedule as payment in full.

Plan Notes UCR CONTRACTED: General Dentists & Specialists: All payments made by the plan are based on the Platinum contracted fee schedule. NON-CONTRACTED: Dental Select will allow up to the reasonable and customary charge for the dental procedures and services after the required deductible amount, as shown. Charges above the plan payment are the member's responsibility. DISCOUNT: Discount only; no benefit will be paid.

Max Rewards™ For every consecutive year on the plan, each member will receive increased maximums by the schedule outlined below. The annual maximum benefit of each member will never exceed $2,000. Year 2 - $100 Year 3 - $200 Year 4 - $300 Year 5 - $400 This summary of benefits is current as of 09/01/2016. To verify up to date benefits, please contact Dental Select Member Services (1-800-999-9789) or refer to your current Certificate of Insurance.

28

QCD Discount Dental

MONTHLY

Employee Only No Charge

Employee and One Dependent $8.00

Employee and Entire Household $12.00

No Claim Forms, Deductibles or Coverage Maximums Immediate Coverage for all Pre-Existing Conditions

Orthodontics (Braces) for Children and Adults

SAMPLE DENTAL PROCEDURE FEE PAID WITH QCD OF AMERICA

NATIONAL AVERAGE DENTAL FEES2

SAVINGS WITH QCD OF AMERICA

Oral Exam $ 9 $35 74%

Full Mouth X-ray $28 $77 64%

Teeth Cleaning $24 $54 56%

Amalgam (1Surface) $28 $79 65%

Simple Extraction $36 $80 55%

Root Canal (1Canal) $185 $387 55%

Porcelain w/ Metal Crown $350 $652 46%

Complete Upper or Lower Denture $400 $770 48%

1 A fee of $8.00 is charged per appointment for infection control costs. There will be an additional charge for all lab fees less a 20% discount. 2 The schedule represents a sample of highly utilized dental procedures. The average costs are estimated from data gathered by the U.S. Bureau of Labor

Statistics, the American Dental Association, and the American Chamber of Commerce Research Association.

After you sign and turn in your enrollment form, QCD will send you a membership card.

Please select any dentist within the QCD Affiliated Dentist Team and make an appointment.

Please be sure to identify yourself as a QCD member and the reduced fee schedule will apply to all charges.

Please call the QCD Member Services Department at 972.726.0444 or 1.800.229.0304 for assistance.

Information may be obtained from the website at www.qcdofamerica.com

29

http://www.qcdofamerica.com/

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

75%

DID YOU KNOW?

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

correction.

SUPERIOR VISION



Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements. Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 2 Contact lenses and related professional services (fitting, evaluation and follow-up) are covered in lieu of eyeglass lenses and frames benefit 3 Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limitations

Vision

Discount Features

Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy

Co-Pays

Exam $10

Materials₁ $25

Services/Frequency

Exam 12 months

Frame 12 months

Lenses 12 months

Contact Lenses 12 months

Benefits In-Network Out-of-Network

Exam (ophthalmologist) Covered in full Up to $35 retail

Frames $125 retail allowance Up to $70 retail

Contact Lenses2 $150 retail allowance Up to $80 retail

Medically Necessary Contact Lenses Covered in full Up to $150 retail

Lasik Vision Correction $200 allowance3

Lenses (standard) per pair

Single Vision Covered in full Up to $25 retail

Bifocal Covered in full Up to $40 retail

Trifocal Covered in full Up to $45 retail

Progressive See description 1 Up to $45 retail

Lenticular Covered in full Up to $80 retail

Monthly Premiums

EE Only $7.83

EE + spouse $13.27

EE + child(ren) $14.05

EE + family $21.01

(Based on date of service)

The Plan discount features are not insurance.

All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan.

Discounts are subject to change without notice.

Disclaimer: All final determinations of benefits, administrative du-ties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources depart-ment if you have any questions

31

About this Benefit

Long Term Disability YOUR BENEFITS PACKAGE

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

they retire.

DID YOU KNOW?

34.6 months is the duration of the

average disability claim.


Aubrey ISD Benefits Website: www.mybenefitshub.com/aubreyisd

UNUM

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.

32

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 18.75 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 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.

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 $7,500. Please see your Plan Administrator for the definition of monthly earnings.

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, 90/90 or 180/180 days. If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.)

Benefit Duration Your duration of benefits is based on your age when the disability occurs. Plan: ADEA II: Your duration of benefits is based on the following table: Age at Disability Maximum Duration of Benefits Less than age 60 To age 65, but not less than 5 years Age 60 through 64 5 years Age 65 through 69 To age 70, but not less than 1 year Age 70 and over 1 year

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. 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. 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.

33


AUBREY INDEPENDENT SCHOOL DISTRICT Costs below are based on a Monthly payroll deduction (Employer billing mode is based on 12 Payments per year)

Product: Educator Select Income Protection Plan

Plan A

ADEA II Duration of Benefits

Elimination Period (Days)

Injury (Days) 14* 30* 60 90 180

Sickness (Days) 14* 30* 60 90 180

Annual Earnings

Monthly Earnings

Maximum Monthly Benefit

3600 300 200 5.88 5.08 4.08 2.30 1.62 5400 450 300 8.82 7.62 6.12 3.45 2.43 7200 600 400 11.76 10.16 8.16 4.60 3.24 9000 750 500 14.70 12.70 10.20 5.75 4.05

10800 900 600 17.64 15.24 12.24 6.90 4.86 12600 1050 700 20.58 17.78 14.28 8.05 5.67 14400 1200 800 23.52 20.32 16.32 9.20 6.48 16200 1350 900 26.46 22.86 18.36 10.35 7.29 18000 1500 1000 29.40 25.40 20.40 11.50 8.10 19800 1650 1100 32.34 27.94 22.44 12.65 8.91 21600 1800 1200 35.28 30.48 24.48 13.80 9.72 23400 1950 1300 38.22 33.02 26.52 14.95 10.53 25200 2100 1400 41.16 35.56 28.56 16.10 11.34 27000 2250 1500 44.10 38.10 30.60 17.25 12.15 28800 2400 1600 47.04 40.64 32.64 18.40 12.96 30600 2550 1700 49.98 43.18 34.68 19.55 13.77 32400 2700 1800 52.92 45.72 36.72 20.70 14.58 34200 2850 1900 55.86 48.26 38.76 21.85 15.39 36000 3000 2000 58.80 50.80 40.80 23.00 16.20 37800 3150 2100 61.74 53.34 42.84 24.15 17.01 39600 3300 2200 64.68 55.88 44.88 25.30 17.82 41400 3450 2300 67.62 58.42 46.92 26.45 18.63 43200 3600 2400 70.56 60.96 48.96 27.60 19.44 45000 3750 2500 73.50 63.50 51.00 28.75 20.25 46800 3900 2600 76.44 66.04 53.04 29.90 21.06 48600 4050 2700 79.38 68.58 55.08 31.05 21.87 50400 4200 2800 82.32 71.12 57.12 32.20 22.68 52200 4350 2900 85.26 73.66 59.16 33.35 23.49 54000 4500 3000 88.20 76.20 61.20 34.50 24.30 55800 4650 3100 91.14 78.74 63.24 35.65 25.11 57600 4800 3200 94.08 81.28 65.28 36.80 25.92 59400 4950 3300 97.02 83.82 67.32 37.95 26.73 61200 5100 3400 99.96 86.36 69.36 39.10 27.54 63000 5250 3500 102.90 88.90 71.40 40.25 28.35 64800 5400 3600 105.84 91.44 73.44 41.40 29.16 66600 5550 3700 108.78 93.98 75.48 42.55 29.97 68400 5700 3800 111.72 96.52 77.52 43.70 30.78 70200 5850 3900 114.66 99.06 79.56 44.85 31.59 72000 6000 4000 117.60 101.60 81.60 46.00 32.40 73800 6150 4100 120.54 104.14 83.64 47.15 33.21 75600 6300 4200 123.48 106.68 85.68 48.30 34.02 77400 6450 4300 126.42 109.22 87.72 49.45 34.83 79200 6600 4400 129.36 111.76 89.76 50.60 35.64 81000 6750 4500 132.30 114.30 91.80 51.75 36.45 82800 6900 4600 135.24 116.84 93.84 52.90 37.26 84600 7050 4700 138.18 119.38 95.88 54.05 38.07 86400 7200 4800 141.12 121.92 97.92 55.20 38.88 88200 7350 4900 144.06 124.46 99.96 56.35 39.69 90000 7500 5000 147.00 127.00 102.00 57.50 40.50 91800 7650 5100 149.94 129.54 104.04 58.65 41.31 93600 7800 5200 152.88 132.08 106.08 59.80 42.12

34


* 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 Monthly Benefit based on your earnings.

AUBREY INDEPENDENT SCHOOL DISTRICT Costs below are based on a Monthly payroll deduction (Employer billing mode is based on 12 Payments per year)

Product: Educator Select Income Protection Plan

Plan A

ADEA II Duration of Benefits

Elimination Period (Days)

Injury (Days) 14* 30* 60 90 180

Sickness (Days) 14* 30* 60 90 180

Annual Earnings

Monthly Earnings Maximum Monthly Benefit

95400 7950 5300 155.82 134.62 108.12 60.95 42.93

97200 8100 5400 158.76 137.16 110.16 62.10 43.74

99000 8250 5500 161.70 139.70 112.20 63.25 44.55

100800 8400 5600 164.64 142.24 114.24 64.40 45.36

102600 8550 5700 167.58 144.78 116.28 65.55 46.17

104400 8700 5800 170.52 147.32 118.32 66.70 46.98

106200 8850 5900 173.46 149.86 120.36 67.85 47.79

108000 9000 6000 176.40 152.40 122.40 69.00 48.60

109800 9150 6100 179.34 154.94 124.44 70.15 49.41

111600 9300 6200 182.28 157.48 126.48 71.30 50.22

113400 9450 6300 185.22 160.02 128.52 72.45 51.03

115200 9600 6400 188.16 162.56 130.56 73.60 51.84

117000 9750 6500 191.10 165.10 132.60 74.75 52.65

118800 9900 6600 194.04 167.64 134.64 75.90 53.46

120600 10050 6700 196.98 170.18 136.68 77.05 54.27

122400 10200 6800 199.92 172.72 138.72 78.20 55.08

124200 10350 6900 202.86 175.26 140.76 79.35 55.89

126000 10500 7000 205.80 177.80 142.80 80.50 56.70

127800 10650 7100 208.74 180.34 144.84 81.65 57.51

129600 10800 7200 211.68 182.88 146.88 82.80 58.32

131400 10950 7300 214.62 185.42 148.92 83.95 59.13

133200 11100 7400 217.56 187.96 150.96 85.10 59.94

135000 11250 7500 220.50 190.50 153.00 86.25 60.75

136800 11400 7600 223.44 193.04 155.04 87.40 61.56

138600 11550 7700 226.38 195.58 157.08 88.55 62.37

140400 11700 7800 229.32 198.12 159.12 89.70 63.18

142200 11850 7900 232.26 200.66 161.16 90.85 63.99

144000 12000 8000 235.20 203.20 163.20 92.00 64.80

35

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

Breast Cancer is the most commonly diagnosed cancer in women.

DID YOU KNOW?

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

LOYAL AMERICAN



Cancer

ADDITIONAL BENEFIT AMOUNTS PLAN A

Maximum PLAN B

Maximum ANNUAL CANCER SCREENING BENEFIT RIDER (form LG-6041) A. Basic Benefit We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule, once per calendar year per Insured Person for screening tests performed to determine whether Cancer exists in an Insured Person. Covered annual Cancer screening tests include but are not limited to: mammogram, pap smear, breast ultrasound, ThinPrep, biopsy, chest x-ray, thermography, colonoscopy, flexible sigmoidoscopy, hemocult stool specimen, PSA (blood test for prostate cancer), CEA (blood tests for colon cancer), CA125 (blood test for ovarian cancer), CA15-3 (blood test for breast cancer), serum protein electrophesis (blood test for myeloma).

B. Additional Benefit We will pay the expense incurred, but not to exceed two times the maximum benefit amount per calendar year as shown on the Certificate Schedule, for one additional invasive diagnostic procedure required as the result of an abnormal cancer screening test for which benefits are payable under the Basic Benefit above for an Insured Person. This additional benefit is payable regardless of the results of the additional diagnostic procedure. However, the amount payable will be reduced dollar for dollar for any amount payable under the Positive Diagnosis Benefit contained in the base Certificate.

$50 Per Calendar

Year

$100 Per Calendar

Year

$50 Per Calendar

Year

$100 Per Calendar

Year

FIRST OCCURRENCE BENEFIT RIDER (form LG-6043) If an Insured Person receives a positive diagnosis of Internal Cancer, We will pay the First Occurrence benefit amount shown on the Certificate Schedule. If the Insured Person receiving the positive diagnosis of Internal Cancer is a child under the age of 21, we will pay one and one-half times the First Occurrence benefit amount shown on the Certificate Schedule.

$2,000 Once per Lifetime $3,000

Once per Lifetime

$500 Once per Lifetime

$750 Once per Lifetime

DAILT RADIATION, CHEMOTHERAPY, IMMUNOTHERAPY and EXPERIMENTAL TREATMENT BENEFIT RIDER (form LG-6046) We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule for each day that an Insured Person receives one or more of the following treatments for Cancer: (1) Chemotherapy (including Hormonal Therapy) or Immunotherapy; (2) Self-injected Chemotherapy or Immunotherapy drugs, limited to the maximum daily benefit amount per treatment; (3) Chemotherapy or Immunotherapy drugs dispensed by a pump or implant, limited to the maximum daily benefit amount for the initial prescription and an equal amount for each refill; (4) Oral Chemotherapy or Immunotherapy, limited to the maximum daily benefit amount per prescription; (5) Radiation Treatment. Benefits payable for interstitial or intracavitary applications of Radiation Treatments are payable on the day of insertion only and not for each day the Radiation Treatment remains in the body; or (6) Experimental Treatment. The benefit amount shown on the Certificate Schedule is the maximum daily benefit available per Insured Person regardless of the number or types of Cancer treatments received on the same day.

$400 Per Day

$200 Per Day

SURGICAL BENEFIT RIDER (form LG-6048) Surgical Expense We will pay the Surgical Expense benefit for a surgical procedure for the treatment of an Insured Person’s Cancer (except Skin Cancer) according to the Surgical Schedule shown in this rider. However, in no event will the amount payable exceed the maximum Surgical Expense benefit shown on the Certificate Schedule, nor will it exceed the expense incurred.

$5,000

Procedure Maximum

$500

Procedure Maximum

Anesthesia Expense We will pay the anesthesia expense incurred, not to exceed 25% of the covered Surgical Expense benefit for the operation performed. This includes the services of an anesthesiologist or of an anesthetist under supervision of a physician for the purpose of administering anesthesia.

$1,250 Procedure Maximum

$125 Procedure Maximum

Breast Reconstruction With transverse rectus adominis myocutaneous flap (TRAM), single pedicle, including closure of donor site, with microvascular anastomosis (supercharging) is one of the surgical procedures listed in the Surgical Schedule. If this procedure is performed on an Insured Person as the result of a mastectomy for which We paid a Surgical Expense benefit for the treatment of Breast Cancer, We will pay the expense incurred not to exceed $900 per $1,000 of the Surgical Benefit issued.

Skin Cancer Surgery Expense We will pay the expense incurred, not to exceed the procedure amount listed in this rider ($125 to $750 depending on the procedure) when a surgical operation is performed on an Insured Person for treatment of a diagnosed Skin Cancer. This benefit is payable in lieu of any benefits for Surgical Expense and Anesthesia Expense which are not applicable to Skin Cancer.

$4,500

Procedure Maximum

Per Procedure

$450

Procedure Maximum

Per Procedure

DAILY HOSPITAL CONFINEMENT BENEFIT RIDER (form LG-6042) Confinements of 30 Days or Less We will pay the Daily Hospital Confinement benefit amount shown on the Certificate Schedule for each of the first 30 days in each period of hospital confinement during which an Insured Person is confined to a hospital, including a government or charity hospital, for the treatment of Cancer.

Confinements of 31 Days or More If an Insured Person is continuously confined to a hospital, including a government or charity hospital, for longer than 30 consecutive days for the treatment of Cancer, We will pay two times the Daily Hospital Confinement benefit amount shown on the Certificate Schedule. This benefit payment will begin on the 31st continuous day of such confinement and continue for each day of confinement until the Insured Person is discharged from the Hospital.

Benefits for an Insured Dependent Child under Age 21 The amount payable under this benefit will be double the Daily Hospital Confinement benefit shown on the Certificate Schedule if the Insured Person so confined is a dependent child under the age of 21.

$200

Per Day

$400 Per Day

$400/ $800

Per Day

$100

Per Day

$200 Per Day

$200/ $400

Per Day

37

Cancer

Additional Benefits Amounts SPECIFIED DISEASE BENEFIT RIDER (form LG-6052) If an Insured Person is first diagnosed with one or more covered Specified Diseases and is hospitalized for the definitive treatment of any covered Specified Disease, We will pay benefits according to the provisions of this rider.

Covers These 38 Specified Diseases

Addison’s Disease Lupus Erythematosus Rocky Mountain Spotted Fever

Amyotrophic Lateral Sclerosis Malaria Sickle Cell Anemia

Botulism Meningitis Tay-Sachs Disease

Bovine Spongiform Encephalopathy Multiple Sclerosis Tetanus

Budd-Chiari Syndrome Muscular Dystrophy Toxic Epidermal Necrolysis

Cystic Fibrosis Myasthenia Gravis Tuberculosis

Diptheria Neimann-Pick Disease Tularemia

Encephalitis Osteomyelitis Typhoid Fever

Epilepsy Poliomyelitis Undulant Fever

Hansen’s Disease Q Fever West Nile Virus

Histoplasmosis Rabies Whipple’s Disease

Legionnaire’s Disease Reye’s Syndrome Whooping Cough

Lyme Disease Rheumatic Fever

Benefits If an Insured Person is first diagnosed with one or more covered Specified Diseases and is hospitalized for the definitive treatment of any covered Specified Disease, We will pay benefits according to the provisions of this rider. An applicant may select 1, 2 or 3 units of coverage. Initial Hospitalization Benefit We will pay a benefit of $1,500 per unit of coverage selected when an Insured Person is confined to a hospital (for 12 or more hours, not applicable in SD) as a result of receiving treatment for a Specified Disease. This benefit is payable only once per period of confinement and once per calendar year for each Insured Person. Hospital Confinement Benefit We will pay a benefit of $300 per day per unit of coverage selected when an Insured Person is hospitalized during any continuous period of 30 days or less for the treatment of a covered Specified Disease. Benefits will double per day beginning with the 31st day of continuous confinement. If the hospital confinement follows a previously covered confinement, it will be deemed a continuation of the first confinement unless it is the result of an entirely different Specified Disease, or unless the confinements are separated by 30 days or more.

Monthly Rates Employee Single Parent Family

Base Plan A $20.41 $25.00 $34.46 Base Plan B $12.05 $15.46 $20.85

38

Cancer

OPTIONAL BENEFITS YOU MAY SELECT FOR ADDITIONAL PREMIUM

HOSPITAL INTENSIVE CARE UNIT BENEFIT RIDER (form LG-6047)* Intensive Care Unit Benefit We will pay the daily Hospital Intensive Care Unit Benefit shown on the Certificate Schedule for an Insured Person’s confinement in an ICU for sickness or injury.

$1000

Per Day

Double Intensive Care Unit Benefit We will pay double the daily Hospital Intensive Care Unit benefit amount shown on the Certificate Schedule for an Insured Person’s confinement in an ICU as a result of Cancer. We will also double this ICU benefit for only the initial ICU confinement resulting from an Insured Person’s travel related injury, provided that the ICU confinement begins within 24 hours of the accident causing the travel related injury. A travel related injury includes being struck by an automobile, bus, truck, van, motorcycle, train or airplane; or being involved in an accident where the Insured Person was the operator or passenger in or on such vehicle.

$2,000 Per Day

Step Down Unit Benefit We will pay one-half of the daily Hospital Intensive Care Unit benefit amount shown on the Certificate Schedule for an Insured Person’s confinement in a Step Down Unit for a sickness or injury.

$500

Per Day

*Additional Limitations and Exclusions for the Hospital Intensive Care Unit Benefit Rider If the rider is issued and coverage is in force, it will provide benefits if an Insured Person goes into a hospital Intensive Care Unit (including a Cardiac Intensive Care Unit or Neonatal Intensive Care Unit). Benefits start the first day of confinement in an ICU for sickness or injury. Any combination of benefits payable under this rider is limited to a maximum of 45 days per each period of confinement. ALL BENEFITS CONTAINED IN THIS HOSPITAL INTENSIVE CARE UNIT BENEFIT RIDER REDUCE BY ONE-HALF AT AGE 75. Benefits are not payable for any ICU or Step Down Unit confinement that results from intentional self-inflicted injury; or the Insured Person’s being intoxicated or under the influence of alcohol, drugs or any narcotics, unless administered on and according to the advice of a medical practitioner. THIS IS A LIMITED RIDER.

Monthly Rates Employee Single Parent Family

Base Plan A + ICU $25.06 $31.39 $43.26 Base Plan B + ICU $16.69 $21.85 $29.65

39

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

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

DID YOU KNOW?

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

2/3

LOYAL AMERICAN



Accident

Plan A Monthly Premiums Available for Issue Ages 18-64

Individual $12.70

Single Parent $20.40

Insured + Spouse $19.50

Family $27.20

Group #1575 Plan pays benefit amounts for covered medical expenses as a result of an accident, directly to you! Coverage is available for ages 18-64 and is portable, you can choose to keep your benefit even if you leave the district or retire.

This policy does not pay for losses resulting from sickness, only accident.

Always refer to your policy for detailed terms and conditions.

This policy is guaranteed renewable.

Summary of Benefits Plan A Plan B

Ambulance

Ground Ambulance Benefit: Loyal American will pay this benefit if you require transportation by a licensed professional ambulance company to or from a hospital or between medical facilities within 90 days for injuries sustained after a covered accident. Payable once per accident.

$150 $75

Air Ambulance Benefit: Loyal American will pay this benefit if you require transportation by a license professional air ambulance company to or from a hospital or between medical facilities within 48 hours for injuries sustained after a covered accident. Payable once per accident.

$600 $300

Indemnity Benefits

Emergency Room Treatment Benefit: Loyal American will pay this benefit if you received hospital emergency room treatment within 72 hours of injuries sustained in a covered accident and for which charges are submitted.

Insured/Spouse: $150

Child: $75

Insured/Spouse: $75

Child: $40

Accident Follow-Up Treatment Benefit: Loyal American will pay this benefit for three additional treatments of injuries sustained in a covered accident over and above emergency treatment administered during the first 72 hours following the accident. Treatment must begin within 30 days of the covered accident and must be within the 6 month period following the covered accident.

$50 per visit

$25 per visit

Blood, Plasma, Platelets Benefit: Loyal American will pay this benefit if you require transfusion, administration, cross matching, typing and processing of blood, plasma or platelets when administered within 90 days for injuries sustained in a covered accident. Payable once per accident.

$100 $50

Hospital Benefits

Initial Accident Hospitalization Benefit: Loyal American will pay this benefit if hospital confinement is required within six (6) months for injuries sustained in a covered accident. Payable once per accident.

$500 $250

Hospital Confinement Benefit: Loyal American will pay this benefit for a maximum of 180 days per confinement.* if you require confinement in a hospital or in a hospital intensive care unit– sub acute within six (6) months for injuries sustained in a covered accident.

$200 per day

$100 per day

Intensive Care

Hospital Intensive Care Unit Confinement Benefit: Loyal American will pay this benefit for a maximum of 15 days per confinement* if you are confined in a hospital intensive care unit within 30 days because of injuries received in a covered accident. *Confinements separated by less than 90 days will be considered as the same period of confinement.

$400 per day

$200 per day

Plan B Monthly Premiums Available for Issue Ages 18-64

Individual $9.00

Single Parent $14.20

Insured + Spouse $13.50

Family $18.70

41

Summary of Benefits Plan A Plan B

Physical Therapy

Physical Therapy Benefit: Loyal American will pay this benefit, not to exceed five treatments per accident, for services prescribed by a doctor and rendered by a licensed physical therapist. Physical therapy must be for injuries sustained in a covered accident and must start within 60 days after the accident. Treatment must be completed within 6 months after the accident.

$50 per treatment

$25 per treatment

Prostheses Benefit: Loyal American will pay this benefit if a doctor prescribes the use of a prosthetic device due to the loss of a hand, foot or sight of an eye in a covered accident. The prosthetic must be received within 1 year of the covered accident. This benefit is payable once per accident and is not payable for hearing aids, dental aids, false teeth or for cosmetic prosthesis (e.g. hair wigs). We will not pay for joint replacement (e.g. artificial hip or knee).

1 prosthetic device/artificial

limb: $100 More than 1:

$500

1 prosthetic device/artificial

limb: $50 More than 1:

$250

Appliance Benefit: Loyal American will pay this benefit if a doctor advises you to use a medical appliance as an aid to personal locomotion within 90 days as a result of injuries sustained in a covered accident. Benefits are payable for crutches, wheelchairs, braces, etc. Benefits are payable for crutches and wheelchairs once per accident.

$50 $25

Family Lodging & Transportation

Family Lodging Benefit: Loyal American will pay this benefit for a maximum of 30 days per accident, during the time you are confined in a hospital, for one motel/hotel room for a family member to accompany you if injuries sustained in a covered accident require hospital confinement, and if the hospital and motel/hotel are more than 100 miles from your residence.

$100 per day

$50 per day

Transportation Benefit: Loyal American will pay this benefit for a maximum of three trips per calendar year if you require special treatment and confinement in a hospital located more than 100 miles from your residence or site of the accident for injuries sustained in a covered accident.

$300 $150

Accidental Death

Accidental Death* Benefit: This policy will pay the following benefit for death if it is the result of injuries sustained in a covered accident. Death must occur within 90 days of a covered accident.

Common-Carrier: You must be a fare paying passenger on a common-carrier. Common-carrier vehicles are limited to commercial airplanes, trains, buses, trolleys, subways, ferries and boats that operate on a regular scheduled basis between predetermined points or cities. Taxies and privately chartered vehicles are not included.

Insured: $100,000 Spouse:

$50,000 Child: $15,000

Insured: $50,000 Spouse: $25,000

Child: $7,500

Other Accidents: Other Accidents are those not classified as common-carrier and are not specifically excluded in the limitations and exclusions section of the policy.


Child: $5,000


Child: $2,500

Dismemberment

Accidental Dismemberment* Benefit This policy will pay a percentage of the AccidentalDeath-Other Accidents Benefit for the selected plan.

Both arms and both legs 100% 100%

Two arms or legs 50% 50%

Sight of two eyes, hands, or feet 50% 50%

Sight of one eye, hand, foot, arm, or leg 20% 20%

One or more fingers and/or one or more toes 5% 5%

Accident

*Death or dismemberment must occur within 90 days of the accident. Only the highest single benefit will be paid for accidental dismemberment.

42

Accident

This is a limited benefit policy. This policy does not pay for losses resulting from sickness. RENEWABILITY CONDITIONS: The policy is guaranteed renewable. Premium rates may be changed on a class basis. A class may be defined by age, sex, occupation, premium payment method, issue state,elimination period, benefit period, etc. WHAT IS NOT COVERED BY THIS POLICY. We will not pay benefits for any injury as a result of you(r):

Operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft. Aircraft includes those which are not motor-driven.

Engaging in hang gliding, bungee jumping, parachuting, sailgliding , parakiting, or hot-air ballooning.

Participating or attempting to participate in an illegal activity.

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

Intentionally causing a self-inflicted injury.

Having any sickness or declining process caused by a sickness, including physical or mental infirmity. We also will not pay benefits to diagnose or treat the sickness. Sickness means any disease or disorder that is not caused by an injury.

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

Committing or trying to commit suicide, whether sane or insane.

Being in an accident which occurs more than 40 miles outside the territorial limits of the United States, Canada, Puerto Ri‐co,and Virgin Islands.

Involvement in any period of armed conflict, even if it is not declared. This brochure contains a summary of the Accident Insurance Policy form L-6020. Coverage as described in the brochure is pro‐vided only through the issuance of a policy. The policy should be consulted for full terms and conditions of coverage.

43

Life insurance provides a cash death benefit to your beneficiary upon your death. 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. If you are covered, you may apply for coverage on your spouse and eligible dependent children.

About this Benefit

Voluntary Life YOUR BENEFITS PACKAGE

x 10

Experts recommend at least

your gross annual income in coverage when purchasing life insurance.

DID YOU KNOW?

AUL A ONEAMERICA COMPANY



AUL's Group Voluntary Term Life Insurance Terms and Definitions

Eligible Employees: This benefit is available for employees who are actively at work on the effective date and working a minimum of 20 hours per week.

Flexible Choices: Since everyone's needs are different, this plan offers flexibility for you to choose a benefit amount that fits your needs and budget.

Guaranteed Issue Amounts: This is the most coverage you can purchase without having to answer any health questions. If you decline insurance coverage now and decide to enroll later, you will need to provide Evidence of Insurability

Evidence of Insurability: Enrolling timely means you have enrolled during the initial enroll‐ment period when benefits were first offered by AUL, or as a newly hired employee within 31 days following completion of any applicable waiting period.

Timely Enrollment: If you elect a benefit amount over the Guaranteed Issue Amount shown above for you or your eligible dependents, or you do not enroll timely, you will need to submit a Statement of Insurability form for review. Based on health history, you and / or your de‐pendents will be approved or declined for insurance coverage by AUL.

Guaranteed Increase in Benefit: If eligible, this benefit allows you to increase your coverage every year as your life insurance needs change. You may be able to increase your benefit amount by $10,000 every year until you reach the guaranteed issue amount, without providing Evidence of Insurability. NOTE: If Evidence of Insurability is applied for and denied, please

be aware Guaranteed Increase in Benefits will not be made avail‐able to you in the future.

Continuation of Coverage Options: Portability Should your coverage terminate for any reason, you may be eligi‐ble to take this term life insurance with you without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible. The Portability option is available until you reach age 70.

OR

Conversion Should your life insurance coverage, or a portion of it, cease for any reason, you may be eligible to convert your Group Term Cov‐erage to Individual Coverage without providing Evidence of Insur‐ability. You must apply within 31 days from the last day you are eligible. Accelerated Life Benefit: If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose. Waiver of Premium: If approved, this benefit waives your and your dependents' insur‐ance premium in case you become totally disabled and are una‐ble to collect a paycheck.

Voluntary Life

Under Age 60 Age 60-69 Age 70+

Employee Guaranteed Issue Amount

$100,000 $20,000 None

Spouse Guaranteed Issue Amount

$50,000

Child Guaranteed Issue Amount

$10,000

45

Voluntary Life

Monthly Payroll Deduction Illustration

About your benefit options:

You may select a minimum benefit of $10,000 up to a maximum amount of $500,000, in increments of $10,000.

Amounts requested above $100,000 for an Employee under age 60, above $20,000 for an Employee age 60-69, any amount for an Employee age 70+ and $50,000 for a Spouse, or any amount not requested timely will require Evidence of Insurability.

Employee must select coverage to select any Dependent coverage.

Dependent coverage cannot exceed 100% of the Voluntary Term Life amount selected by the Employee.

EMPLOYEE ONLY OPTIONS (based on Employee's age as of 09/01)

Life Options

0-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

$10,000 $.60 $.60 $.60 $.80 $.90 $1.00 $1.50 $2.30 $4.30 $6.60 $12.70 $20.60 $24.50

$20,000 $1.20 $1.20 $1.20 $1.60 $1.80 $2.00 $3.00 $4.60 $8.60 $13.20 $25.40 $41.20 $49.00

$30,000 $1.80 $1.80 $1.80 $2.40 $2.70 $3.00 $4.50 $6.90 $12.90 $19.80 $38.10 $61.80 $73.50

$40,000 $2.40 $2.40 $2.40 $3.20 $3.60 $4.00 $6.00 $9.20 $17.20 $26.40 $50.80 $82.40 $98.00

$50,000 $3.00 $3.00 $3.00 $4.00 $4.50 $5.00 $7.50 $11.50 $21.50 $33.00 $63.50 $103.00 $122.50

$60,000 $3.60 $3.60 $3.60 $4.80 $5.40 $6.00 $9.00 $13.80 $25.80 $39.60 $76.20 $123.60 $147.00

$70,000 $4.20 $4.20 $4.20 $5.60 $6.30 $7.00 $10.50 $16.10 $30.10 $46.20 $88.90 $144.20 $171.50

$80,000 $4.80 $4.80 $4.80 $6.40 $7.20 $8.00 $12.00 $18.40 $34.40 $52.80 $101.60 $164.80 $196.00

$90,000 $5.40 $5.40 $5.40 $7.20 $8.10 $9.00 $13.50 $20.70 $38.70 $59.40 $114.30 $185.40 $220.50

$100,000 $6.00 $6.00 $6.00 $8.00 $9.00 $10.00 $15.00 $23.00 $43.00 $66.00 $127.00 $206.00 $245.00

SPOUSE ONLY OPTIONS (based on Employee's Age as of 09/01

Life Options

0-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

$10,000 $.60 $.60 $.60 $.80 $.90 $1.00 $1.50 $2.30 $4.30 $6.60 $12.70 $20.60 $24.50

$20,000 $1.20 $1.20 $1.20 $1.60 $1.80 $2.00 $3.00 $4.60 $8.60 $13.20 $25.40 $41.20 $49.00

$30,000 $1.80 $1.80 $1.80 $2.40 $2.70 $3.00 $4.50 $6.90 $12.90 $19.80 $38.10 $61.80 $73.50

$40,000 $2.40 $2.40 $2.40 $3.20 $3.60 $4.00 $6.00 $9.20 $17.20 $26.40 $50.80 $82.40 $98.00

$50,000 $3.00 $3.00 $3.00 $4.00 $4.50 $5.00 $7.50 $11.50 $21.50 $33.00 $63.50 $103.00 $122.50

46

Voluntary Life

CHILD(REN) OPTIONS (Premium shown for Child(ren) reflects the cost for all eligible dependent children)

Child(ren) 6 months to age 26 Child(ren) live birth to 6 months Monthly Payroll Deduction Life

Amount

Option 1: $10,000 $1,000 $2.00

About Premiums: The premiums shown above may vary slightly due to rounding; actual premiums will be calculated by American United Life Insurance Company® (AUL), and may increase upon reaching certain age brackets, according to contract terms, and are subject to change.

47

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

AD&D YOUR BENEFITS PACKAGE

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

drowning, and choking.

DID YOU KNOW?

#1

Motor vehicle crashes are the

Axis Global



AD&D

Principal Sum: Employee - $10,000 to $500,000 in $10,000 increments. Amounts over $250,000 may not exceed 10 times Base Earnings. Spouse – 60% of the employee’s benefit without child coverage, 50% of the employee’s benefit with child coverage. Spouse Maximum Principal Sum: $300,000. Child – 10% of the employee’s benefit with spouse coverage,

15% of the employee’s benefit without spouse coverage. Child(ren) Maximum Principal Sum: $30,000.

Eligibility: All active full time Employees of the Employer working 20 plus hours per week who are domiciled in the United States, its territories and protectorates, excluding temporary, lease or seasonal employees.

Core Benefits Accidental Death & Dismemberment Schedule of Benefits

Loss of Life 100% of the Principal Sum Loss of or Loss of use of Two or more Hands or Feet 100% of the Principal Sum Loss of Sight Both Eyes 100% of the Principal Sum Loss of One Hand or One Foot and Sight in One Eye 100% of the Principal Sum Loss of Speech and Hearing (both ears) 100% of the Principal Sum

Coma 1% of the Principal Sum for the first 11 months, 100% in the 12th Month

Loss of or Loss of use of One Hand or Foot 50% of the Principal Sum Loss of Sight in One Eye 50% of the Principal Sum

Loss of Speech 50% of the Principal Sum Loss of Hearing (both ears) 50% of the Principal Sum Loss of Thumb and Index Finger of the Same Hand 25% of the Principal Sum Loss of all Four Fingers of the Same Hand 25% of the Principal Sum Loss of all the Toes of the Same Foot 20% of the Principal Sum Quadriplegia (total paralysis of both upper and lower limbs) 100% of the Principal Sum Paraplegia (total paralysis of both lower limbs) 75% of the Principal Sum Hemiplegia (total paralysis of upper and lower limbs on one side of body 50% of the Principal Sum Uniplegia (total paralysis of one upper or lower limb) 25% of the Principal Sum Exposure and Disappearance Benefit Included

Additional Benefits Travel Assistance Services – You and your family have access to travel assistance services for emergencies that occur while traveling almost anywhere in the world, at least 100 miles from home. Comprehensive services are available locally in over 200 countries and through 35 assistance centers open 24/7, these comprehensive services offer support to help travelers in an emergency. Refer to the travel assurance flyer provided by your employer which includes information on the services available, as well as a wallet card with important contact information Your coverage includes Additional Benefits beyond the Principal Sum that can be paid if an Accidental Death Benefit is payable under the Policy. Certain other conditions may apply.

Special Education Benefits Surviving Dependent Child

Your Dependent Child attending school could qualify for an additional 5% of the Principal Sum, up to a maximum of $5,000 per year for up to 4 years

Spouse Retraining Benefit

Your surviving Spouse attending school could qualify for an additional 5% of the Principal Sum, up to a maximum of $5,000.

Seatbelt and Airbag Benefits If you were traveling in a private passenger vehicle and

properly wearing a seatbelt, you could qualify for an

additional 10% of the Principal Sum, up to a maximum of $50,000

If you were traveling in a private passenger vehicle equipped with a properly functioning airbag, you could qualify for an additional 5% of the Principal Sum, up to a maximum of $10,000.

Bereavement & Trauma If bereavement and trauma counseling is needed due to a

covered loss, you could qualify for 10 - $100 sessions with a maximum benefit of $1,000

Home Alteration and Vehicle Modification Benefit If you suffer a covered loss and require home alteration and

vehicle modification, you could qualify for an additional 10% of the Principal Sum, up to a maximum of $10,000

Medical Evacuation and Repatriation Benefits If a covered accident occurs while traveling that results in

the need for your emergency medical evacuation or a repatriation of your remains, you could qualify for an additional benefit of 100% of the Usual and Customary charges for such an expense.

COBRA

Reimburses COBRA Insurance Continuation expenses if you die in a covered accident and are survived by a spouse or dependent child(ren). You could qualify for 3% of the Principal Sum, up to a maximum of $3,000 per policy year for a maximum of 3 years.

49

Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.

About this Benefit

Individual Life YOUR BENEFITS PACKAGE

DID YOU KNOW?

TEXAS LIFE

1/3 of Americans would be financially impacted by the loss of the primary wage earner in just one month.



Individual Life

Life Insurance Highlights

Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. Designed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually costs more and declines in death benefit. The policy, PureLife-plus, is underwritten by Texas Life Insurance Company, and it has these outstanding features:

High Death Benefit. With one of the highest death benefit available at the worksite,1 PureLife-plus gives your loved ones peace of mind, knowing there will be significant life insurance in force should you die prematurely.

Minimal Cash Value. Designed to provide high death benefit, PureLife-plus does not compete with the cash accumulation in your employer-sponsored retirement plans.

Long Guarantees. Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time (after the guaranteed period, premiums may go down, stay the same, or go up).

Refund of Premium. Unique in the marketplace, PureLife-plus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.)

Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.)

You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, minor children and grandchildren. Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details. 1Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 2008

DID YOU KNOW? Those with no life insurance think it’s 3 times more expensive than it actually is.

51

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

DID YOU KNOW?

75%

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

telehealth.

MDLIVE



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 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/pages/terms.html 010113

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

Scan with your smartphone to get the app.

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NOTES

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NOTES

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www.mybenefitshub.com/aubreyisd

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2016 benefit guide aubrey isd

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