2016 benefit guide alamo heights isd

EFFECTIVE:

09/01/2016 - 8/31/2017

BENEFIT GUIDE

www.mybenefitshub.com/alamoheightsisd

ALAMO HEIGHTS ISD

1

Benefit Contact Information 3 How to Enroll 4-5Annual Benefit Enrollment 6-11

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

Spending Account (FSA) 11

MDLIVE Telehealth 12-13Cigna Dental and Humana DHMO 14-19Superior Vision 20-21The Hartford Disability 22-27Humana Cancer 28-31Humana Accident 32-35Aflac Critical Illness 36-39NBS Flexible Spending Account (FSA) 40-43HSA Bank Health Spending Account (HSA) 44-47AUL a OneAmerica Company Life and AD&D 48-51

Table of Contents

HOW TO ENROLL

PG. 4

BENEFIT UPDATES: WHAT’S NEW

PG. 6

YOUR BENEFITS PACKAGE

PG. 12

FLIP TO...

2

Benefit Contact Information

ALAMO HEIGHTS BENEFITS VISION CRITICAL ILLNESS

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

Superior Vision (800) 507-3800 www.superiorvision.com

Aflac (800) 992-3522 www.aflac.com

TELEHEALTH DISABILITY VOLUNTARY GROUP LIFE

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

The Hartford (800) 303-9744 File a claim: (866) 278-2655 www.thehartford.com

AUL a OneAmerica Company (800) 553-5318 www.oneamerica.com

DENTAL PPO CANCER FLEXIBLE SPENDING ACCOUNT

Cigna (800) 244-6224 www.cigna.com

Humana (800) 448-6262 www.humana.com

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

DENTAL DHMO ACCIDENT HEALTH SAVINGS ACCOUNT



HSA Bank (800) 357-6246 www.hsabank.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/

alamoheightsisd delivers

important benefit information

with 24/7 access, as well as

detailed plan information, rates

and product videos.

TEXT

“ahisd”

TO

313131

On Your Device Enrolling in your benefits just got

a lot easier! Text “ahisd” 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/alamoheightsisd 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.

5

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 30 days of event).

For information on new health insurance premiums and

plan changes, please contact your benefit administrator or go to www.trsactivecareaetna.com.

Reminder, If you currently participate in a Healthcare or

Dependent Care FSA, you MUST re-elect a new contribution amount every year to continue to participate.

Effective 9/1/2016, Dental Premiums will increase for Cigna PPO Plans and Humana DHMO plan. See benefit guide for the new rates.

All dependents should be added in the system with social

security numbers regardless if you are enrolling coverage for those dependents.

Login and complete your benefit enrollment from 7/18/2016—8/22/2016. Enrollment assistance is available by calling Financial Benefit Services at (800) 583-6908

to speak to a representative. Update your profile information: home address, phone numbers, email. Update dependent social security numbers and student status for college aged children.

Benefit Updates - What’s New:

Annual Benefit Enrollment

SUMMARY PAGES

Don’t Forget!

6

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

SUMMARY PAGES

7

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 school

district’s benefit website: www.mybenefitshub.com/

alamoheightsisd. Click on the benefit plan you need

information on (i.e., Dental) and you can find the forms you

need under the Benefits and Forms section.

How can I find a Network Provider?

For benefit summaries and claim forms, go to your school

district’s website: www.mybenefitshub.com/alamoheightsisd.

Click on the benefit plan you need information on (i.e.,

Dental) and you can find provider search links under the Quick

Links section.

When will I receive ID cards?

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

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

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

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

insurance company’s phone number and they can call and

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

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

carrier’s customer service number to request another card.

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

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

card each year.

SUMMARY PAGES

8

Employee Eligibility Requirements

Supplemental Benefits: Eligible employees must work 30 or more

regularly scheduled hours each work week.

Eligible employees must be actively at work on the plan effective

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

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

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

your 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 Alamo Heights ISD or as

both employees and dependents.

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

PLAN CARRIER MAXIMUM AGE

Dental (PPO/MAC) Cigna 25

Dental (DHMO) Humana 25

Telehealth MDLIVE 25

Vision Superior Vision 25

Cancer Humana 25

Accident Humana 25

Voluntary Life and AD&D AUL a OneAmerica Company 25

Critical Illness Aflac 25

SUMMARY PAGES

9

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

10

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. 44

FOR FSA INFORMATION

FLIP TO… PG. 40

HSA vs. FSA SUMMARY PAGES

11

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

DID YOU KNOW?

75%

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

telehealth.

MDLIVE YOUR BENEFITS PACKAGE

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

Alamo Heights ISD Benefits Website: www.mybenefitshub.com/alamoheightsisd 12

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.

13

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

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 CIGNA HUMANA

Discount Dental


Alamo Heights ISD Benefits Website: www.mybenefitshub.com/alamoheightsisd


14

Cigna Dental - Base Plan

Missing Tooth Limitation – The amount payable is 50% of the amount otherwise payable until insured for 12 months; thereafter, considered a Class III expense. Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed. * Subject to annual deductible Dental Oral Health Integration Program (OHIP) - All dental customers = Clinical research shows an association between oral health and overall health. The Cigna Dental Oral Health Integration Program (OHIP)® is designed to provide enhanced dental coverage for customers with certain eligible medical conditions. Eligible conditions for the program include cardiovascular disease, cerebrovascular disease (stroke), diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation. The program provides:

100% coverage for certain dental procedures guidance on behavioral issues related to oral health discounts on prescription and non-prescription dental products

For more information and to see the complete list of eligible conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24.

Benefits Cigna Dental PPO

In-Network Out-of-Network

Network Total Cigna DPPO Plan Year Maximum (Class I, II, and III expenses)

$1,000 $1,000

Annual Deductible Individual Family

$50 per person $150 per family


Reimbursement Levels** Based on Reduced Contracted Fees

Maximum Allowable Charge (In-network fee

level)

Plan Pays You Pay Plan Pays You Pay

Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Full Mouth X-rays Bitewing X-rays Panoramic X-ray Periapical X-rays Fluoride Application Sealants Emergency Care to Relieve Pain

100% No Charge 100% No Charge

Class II - Basic Restorative Care No Waiting Period Fillings Oral Surgery – Simple Extractions Oral Surgery – All Except Simple Extractions Anesthetics Surgical Extractions of Impacted Teeth Repairs to Bridges, Crowns and Inlays Space Maintainers Denture Adjustments and Repairs Brush Biopsies

80%* 20%* 80%* 20%*

Class III - Major Restorative Care No Waiting Period Crowns Dentures Bridges Denture Adjustments Inlays / Onlays Periodontal Scaling and Root Planing Osseous Surgery

50%* 50%* 50%* 50%*

Class IV - Orthodontia 12 Month Waiting Period Lifetime Maximum

50% $1,000

Dependent children to

age 19

50%

50% $1,000


age 19

50%

Monthly PPO Premiums

Tier Rate

EE Only $25.51

EE + 1 Dep $53.18

EE + 2 or more Dep $81.99

15

Cigna Dental - Buy-Up Plan

Missing Tooth Limitation – The amount payable is 50% of the amount otherwise payable until insured for 12 months; thereafter, considered a Class III expense. Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed. * Subject to annual deductible Dental Oral Health Integration Program (OHIP) - All dental customers = Clinical research shows an association between oral health and overall health. The Cigna Dental Oral Health Integration Program (OHIP)® is designed to provide enhanced dental coverage for customers with certain eligible medical conditions. Eligible conditions for the program include cardiovascular disease, cerebrovascular disease (stroke), diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation. The program provides:

100% coverage for certain dental procedures guidance on behavioral issues related to oral health discounts on prescription and non-prescription dental products

For more information and to see the complete list of eligible conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24.

Benefits Cigna Dental PPO In-Network Out-of-Network Network Total Cigna DPPO Plan Year Maximum (Class I, II, and III expenses)

$1,250 $1,250

Annual Deductible Individual Family



Reimbursement Levels** Based on Reduced Contracted Fees

80th percentile of Reasonable & Customary

Allowances

Plan Pays You Pay Plan Pays You Pay

Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Full Mouth X-rays Bitewing X-rays Panoramic X-ray Periapical X-rays Fluoride Application Sealants Space Maintainers Emergency Care to Relieve Pain

100% No Charge 100% No Charge

Class II - Basic Restorative Care No Waiting Period Fillings Root Canal Therapy / Endodontics Denture Adjustments and Repairs Oral Surgery – Simple Extractions Oral Surgery – All Except Simple Extractions Anesthetics Surgical Extractions of Impacted Teeth Brush Biopsies

80%* 20%* 80%* 20%*

Class III - Major Restorative Care No Waiting Period Crowns Dentures Osseous Surgery Bridges Inlays / Onlays Repairs to Bridges, Crowns and Inlays Prosthesis Over Implant Periodontal Scaling and Root Planing

50%* 50%* 50%* 50%*

Class IV - Orthodontia 12 Month Waiting Period Lifetime Maximum

50% $1,000


age 19

50%

50% $1,000


age 19

50%

Monthly PPO Premiums

Tier Rate

EE Only $35.85

EE + 1 Dep $76.04

EE + 2 or more Dep $115.14

16

Cigna Dental - Base and Buy-Up Plans

Procedure Exclusions and Limitations Late Entrants Limit 50% coverage on Class III and IV for 12 months Exams Two per Plan year Prophylaxis (Cleanings) Two per Plan year Fluoride 1 per Plan year for people under 19 Histopathologic Exams Allowed for tooth and/or gingival related biopsies only X-Rays (routine) Bitewings: 2 per Plan year X-Rays (non-routine) Full mouth: 1 every 36 consecutive months., Panorex: 1 every 36 consecutive months Model Payable only when in conjunction with Ortho workup Periodontial Treatment Various limitations depending on the service Bridges, Crowns and Inlays Replacement every 5 years Dentures and Partials Replacement every 5 years Relines, Rebases Covered if more than 6 months after installation Adjustments Covered if more than 6 months after installation Bridge and Denture Repairs Reviewed if more than once Sealants Limited to posterior tooth. One treatment per tooth every 36 consecutive months up to age 14 Space Maintainers Limited to non-Orthodontic treatment Prosthesis Over Implant 1 per 60 consecutive months if unserviceable and cannot be repaired. Benefits are based on the amount payable for nonprecious metals. No porcelain or white/tooth colored material on molar crowns or bridges

Benefit Exclusions Listed below are the services or expenses which are NOT covered under your Dental Plan and which are your responsibility at the dentist's Usual Fees. There is no coverage for: Services performed primarily for cosmetic reasons; veneers of porcelain or acrylic materials on crowns or pontics on or replacing the

upper and lower first, second and third molars. Instruction for plaque control, oral hygiene and diet; experimental or investigational procedures and treatments; dental services that do

not meet common dental standards. Replacement of a lost or stolen appliance; replacement of a bridge or denture within five years following the date of its original

installation; replacement of a bridge or denture which can be made useable according to accepted dental standards. Procedures, appliances or restorations, other than full dentures, whose main purpose is to change vertical dimension, diagnose or treat

conditions of TMJ, stabilize periodontally involved teeth, or restore occlusion. Surgical implant of any type; bite registrations; precision or semi-precision attachments; splinting; services that are deemed to be

medical services; services and supplies received from a hospital. For charges which would not have been made if the person had no insurance; for charges for unnecessary care, treatment or surgery. Charges which the person is not legally required to pay; charges in excess of the reasonable and customary allowances; charges made

by a hospital which performs services for the U.S. Government if the charges are directly related to a condition connected to a military service.

Procedures performed by a dentist who is a member of the covered person’s family (covered person’s family is limited to a spouse, siblings, parents, children, grandparents, and the spouse’s siblings and parents); to the extent that payment is unlawful where the person resides when the expenses are incurred; any injury resulting from, or in the course of, any employment for wage or profit; any sickness covered under any workers’ compensation or similar law.

To the extent that you or any of your dependents is in any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid; to the extent that benefits are paid or payable for those expenses under the mandatory part of any auto insurance policy written to comply with a “no-fault” insurance law or an uninsured motorist insurance law. Cigna HealthCare will take into account any adjustment option chosen under such part by you or any one of your dependents.

In addition, these benefits will be reduced so that the total payment will not be more than 100% of the charge made for the Dental Service if benefits are provided for that service under this plan and any medical expense plan or prepaid treatment program sponsored or made available by your Employer.

This benefit summary highlights some of the benefits available under the proposed plan. A complete description regarding the terms of coverage, exclusions and limitations, including legislated benefits, will be provided in your insurance certificate or plan description. Benefits are insured and/or administered by Connecticut General Life Insurance Company. "Cigna HealthCare" refers to various operating subsidiaries of Cigna Corporation. Products and services are provided by these subsidiaries and not by Cigna Corporation. These subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. DPPO insurance coverage is set forth on the following policy form numbers: AR: HP-POL77; CA: HP-POL57; CO: HP-POL78; CT: HP-POL58; DE: HP-POL79; FL: HP-POL60; ID: HPPOL82; IL: HP-POL62; KS: HP-POL84; LA: HP-POL86: MA: HP-POL 63; MI: HP-POL88; MO: HP- POL65; MS: HP-POL90; NC: HP-POL96; NE: HP-POL92; NH: HP-POL94; NM: HP-POL95; NV: HP-POL93; NY: HP-POL67; OH: HP-POL98; OK: HP-POL99; OR: HP-POL68; PA: HP-POL100; RI: HP-POL101; SC: HP-POL102; SD: HP-POL103; TN: HP-POL69; TX: HP-POL70; UT: HP-POL104; VA: HP-POL72; VT: HP-POL71; WA: POL-07/08; WI: HP-POL107; WV: HP-POL106; and WY: HP-POL108. “Cigna,” the “Tree of Life” logo and “Cigna Dental Care” are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Cigna Dental PPO plans are underwritten or administered by CGLIC or CHLIC, with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Arizona and Louisiana, the insured Dental PPO plan offered by CGLIC is known as the “CG Dental PPO”. In Texas, the insured dental product offered by CGLIC and CHLIC is referred to as the Cigna Dental Choice Plan, and this plan utilizes the national Cigna Dental PPO network. Cigna Dental Care (DHMO) plans are underwritten or administered by Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska), Cigna Dental Health of Kentucky, Inc. (Kentucky and Illinois), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. In other states, Cigna Dental Care plans are underwritten by CGLIC, CHLIC, or Cigna HealthCare of Connecticut, Inc. and administered by Cigna Dental Health, Inc. BSD58334 © 2015 Cigna

17

Humana Dental DHMO

Use your HumanaDental benefits The HumanaDental HD Series dental plan has you covered for any circumstance. Whether you simply need quality routine dental care or unexpected dental treatment, you know what to expect with HumanaDental.

No waiting periods

No claims to file

No annual maximums

Know what your plan covers After you enroll in a plan and receive your ID card, you can manage your plan information on your personal home page on www.HumanaDental.com.

You have the freedom to select any participating general dentist as your primary care dentist. To select a dental provider from our network, simply visit www.HumanaDental.com. Once there, you can also check your benefits, email us and get a new or temporary ID card. If you prefer, contact us at 1-800-342-5209.

Life without claim forms! With the HumanaDental DHMO plan you pay your dentist directly, when applicable.

Your primary dentist will provide all of your routine dental care and you will pay any copayment or discounted charges at the time of service.

If you need a specialty dentist, you may receive up to a 25 percent discount by using certain participating specialty dentists from our network. Visit www.HumanaDental.com to find a participating specialist.

Good health starts with a healthy mouth Make dental visits a priority One of the first lines of defense in overall health is dental care. Regular dental cleanings can help manage problems throughout the body, such as heart disease, diabetes, and stroke. In fact, a healthy mouth can add 6.4 years to RealAge® life expectancy.1 The HumanaDental DHMO plan enables you to take better care of your teeth, and you’ll pay less for your dental care doing so. 1Dr. Michael Roizen, RealAge.com

Questions? Check out www.HumanaDental.com Call 1-800-233-4013, Monday through Friday, 8 AM to 6 PM (TDD: 1-800-325-2025) For exclusions and limitations, please review the Specialty Benefits Regulatory and Technical Information Guide available at www.Disclosure.Humana.com.

Check your dental IQ anytime Log on to www.MyDentalIQ.com and take the dental risk assessment that could help trim your total healthcare costs over time. Find out how you can improve your oral and overall health. The dental health risk assessment at www.MyDentalIQ.com takes minutes to complete, and immediately delivers a scorecard with health tips tailored to you.

Monthly DHMO Premiums

Tier Rate

EE Only $13.99

EE + 1 $27.70

Family Coverage $49.27

18

Humana Dental DHMO

19

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

75%

DID YOU KNOW?

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

correction.

SUPERIOR VISION YOUR BENEFITS PACKAGE



Vision

Services/Frequency

Exam 12 months

Frame 12 months

Lenses 12 months

Contact Lenses 12 months

(Based on date of service)

Co-Pays

Exam $10

Materials $25

Benefits In-Network Out-of-Network

Exam Covered in full Up to $35 retail

Frames $150 retail allowance Up to $70 retail

Contact Lenses1 $150 retail allowance Up to $80 retail

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

Lasik Vision Correction $200 allowance2

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 description3 Up to $45 retail

Lenticular Covered in full Up to $80 retail

Polycarbonate Covered in full Up to $20 retail

UV coating Covered in full Up to $20 retail

Scratch coating Covered in full Up to $25 retail

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

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. 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 duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions

SuperiorVision.com Customer Service 800.507.3800

Monthly Premiums

EE only $9.25

EE + 1 dependent $15.75

EE + Family $20.10

21

Disability THE HARTFORD

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

About this Benefit

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.




Disability is designed to provide a monthly income to an individual that is disabled due to an accident or illness. There are different plans available with benefits becoming available from the 1st day of disability to as late as the 180th day. For specific details on how benefits are paid, refer to carrier brochure. Your disability coverage amount and premium can be accessed during your enrollment.

Pre-existing Conditions Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have not received treatment for the disabling condition within 3 months, while insured under this policy, before the disability begins, or You have been insured under this policy for 12 months before your disability begins. You may also be covered if you have already satisfied the pre-existing condition requirement of your previous insurer. If your disability is a result of a pre-existing condition we will pay benefits for a maximum of 4 weeks.

Benefit Reductions Your benefit payments may be reduced by other income you receive or are eligible to receive due to your disability, such as: Social Security Disability Insurance (please see

www.mybenefitshub.com/alamoheightsisd for exceptions)

Workers' Compensation Other employer-based Insurance coverage you may have Unemployment benefits Settlements or judgments for income loss Retirement benefits that your employer fully or partially

pays for (such as a pension plan.) Your benefit payments will not be reduced by certain kinds of other income, such as: Retirement benefits if you were already receiving them

before you became disabled Retirement benefits that are funded by your after-tax

contributions Your personal savings, investment, IRAs or Keoghs Profit-sharing Most personal disability policies Social Security increases

Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.

Exclusions You cannot receive Disability benefit payments for disabilities that are caused or contributed to by: War or act of war (declared or not) Military service for any country engaged in war or other

armed conflict The commission of, or attempt to commit a felony An intentionally self-inflicted injury

Any case where your being engaged in an illegal occupation was a contributing cause to your disability

You must be under the regular care of a physician to receive benefits

Mental Illness, Alcoholism and Substance Abuse You can receive benefit payments for Long-Term

Disabilities resulting from mental illness, alcoholism and substance abuse for a total of 24 months for all disability periods during your lifetime.

Any period of time that you are confined in a hospital or other facility licensed to provide medical care for mental illness, alcoholism and substance abuse does not count toward the 24 month lifetime limit.

What other benefits are included in my disability coverage? Workplace Modification provides for reasonable

modifications made to a workplace to accommodate your disability and allow you to return to active full-time employment.

Survivor Benefit - If you die while receiving disability benefits, a benefit will be paid to your spouse or in equal shares to your surviving children under the age of 25, equal to three times the last monthly gross benefit.

Travel Assistance Program – Available 24/7, this program provides assistance to employees and their dependents who travel 100 miles from their home for 90 days or less. Services include pre-trip information, emergency medical assistance and emergency personal services.

The Hartford's Ability Assist service is included as a part of your group Long Term Disability (LTD) insurance program. You have access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD benefits. Once you are covered you are eligible for services to provide assistance with child/elder care, substance abuse, family relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist them with the unique emotional, financial and legal issues that may result from a disability. Ability Assist services are provided through ComPsych®, a leading provider of employee assistance and work/life services.

Waiver of Premium – Once your disability claim is approved and you have satisfied your elimination period, your coverage premiums will be waived.

Identity Theft Protection – An array of identity fraud support services to help victims restore their identity. Benefits include 24/7 access to an 800 number; direct contact with a certified caseworker who follows the case until it’s resolved; and a personalized fraud resolution kit with instructions and resources for ID theft victims.

Long Term Disability

23


Premium Option: For the Premium benefit option – the table below applies to disabilities resulting from injury or sickness:

Age Disabled Benefits Payable

Prior to Age 63 To Normal Retirement Age or 48 months if greater

Age 63 To Normal Retirement Age or 42 months if greater

Age 64 36 months

Age 65 30 months

Age 66 27 months

Age 67 24 months

Age 68 21 months

Age 69 and older 18 months

MONTHLY PREMIUMS Accident / Sickness Elimination Period in Days

Annual Earnings Monthly Earnings Monthly Benefit 0 / 3 14 / 14 30 / 30 60 / 60 90 / 90 $3,600 $300 $200 $8.16 $6.24 $5.48 $2.98 $2.24 $5,400 $450 $300 $12.24 $9.36 $8.22 $4.47 $3.36 $7,200 $600 $400 $16.32 $12.48 $10.96 $5.96 $4.48 $9,000 $750 $500 $20.40 $15.60 $13.70 $7.45 $5.60

$10,800 $900 $600 $24.48 $18.72 $16.44 $8.94 $6.72 $12,600 $1,050 $700 $28.56 $21.84 $19.18 $10.43 $7.84 $14,400 $1,200 $800 $32.64 $24.96 $21.92 $11.92 $8.96 $16,200 $1,350 $900 $36.72 $28.08 $24.66 $13.41 $10.08 $18,000 $1,500 $1,000 $40.80 $31.20 $27.40 $14.90 $11.20 $19,800 $1,650 $1,100 $44.88 $34.32 $30.14 $16.39 $12.32 $21,600 $1,800 $1,200 $48.96 $37.44 $32.88 $17.88 $13.44 $23,400 $1,950 $1,300 $53.04 $40.56 $35.62 $19.37 $14.56 $25,200 $2,100 $1,400 $57.12 $43.68 $38.36 $20.86 $15.68 $27,000 $2,250 $1,500 $61.20 $46.80 $41.10 $22.35 $16.80 $28,800 $2,400 $1,600 $65.28 $49.92 $43.84 $23.84 $17.92 $30,600 $2,550 $1,700 $69.36 $53.04 $46.58 $25.33 $19.04 $32,400 $2,700 $1,800 $73.44 $56.16 $49.32 $26.82 $20.16 $34,200 $2,850 $1,900 $77.52 $59.28 $52.06 $28.31 $21.28 $36,000 $3,000 $2,000 $81.60 $62.40 $54.80 $29.80 $22.40 $37,800 $3,150 $2,100 $85.68 $65.52 $57.54 $31.29 $23.52 $39,600 $3,300 $2,200 $89.76 $68.64 $60.28 $32.78 $24.64 $41,400 $3,450 $2,300 $93.84 $71.76 $63.02 $34.27 $25.76 $43,200 $3,600 $2,400 $97.92 $74.88 $65.76 $35.76 $26.88 $45,000 $3,750 $2,500 $102.00 $78.00 $68.50 $37.25 $28.00 $46,800 $3,900 $2,600 $106.08 $81.12 $71.24 $38.74 $29.12 $48,600 $4,050 $2,700 $110.16 $84.24 $73.98 $40.23 $30.24 $50,400 $4,200 $2,800 $114.24 $87.36 $76.72 $41.72 $31.36 $52,200 $4,350 $2,900 $118.32 $90.48 $79.46 $43.21 $32.48 $54,000 $4,500 $3,000 $122.40 $93.60 $82.20 $44.70 $33.60 $55,800 $4,650 $3,100 $126.48 $96.72 $84.94 $46.19 $34.72 $57,600 $4,800 $3,200 $130.56 $99.84 $87.68 $47.68 $35.84

24



Annual Earnings Monthly Earnings Monthly Benefit 0 / 3 14 / 14 30 / 30 60 / 60 90 / 90 $59,400 $4,950 $3,300 $134.64 $102.96 $90.42 $49.17 $36.96 $61,200 $5,100 $3,400 $138.72 $106.08 $93.16 $50.66 $38.08 $63,000 $5,250 $3,500 $142.80 $109.20 $95.90 $52.15 $39.20 $64,800 $5,400 $3,600 $146.88 $112.32 $98.64 $53.64 $40.32 $66,600 $5,550 $3,700 $150.96 $115.44 $101.38 $55.13 $41.44 $68,400 $5,700 $3,800 $155.04 $118.56 $104.12 $56.62 $42.56 $70,200 $5,850 $3,900 $159.12 $121.68 $106.86 $58.11 $43.68 $72,000 $6,000 $4,000 $163.20 $124.80 $109.60 $59.60 $44.80 $73,800 $6,150 $4,100 $167.28 $127.92 $112.34 $61.09 $45.92 $75,600 $6,300 $4,200 $171.36 $131.04 $115.08 $62.58 $47.04 $77,400 $6,450 $4,300 $175.44 $134.16 $117.82 $64.07 $48.16 $79,200 $6,600 $4,400 $179.52 $137.28 $120.56 $65.56 $49.28 $81,000 $6,750 $4,500 $183.60 $140.40 $123.30 $67.05 $50.40 $82,800 $6,900 $4,600 $187.68 $143.52 $126.04 $68.54 $51.52 $84,600 $7,050 $4,700 $191.76 $146.64 $128.78 $70.03 $52.64 $86,400 $7,200 $4,800 $195.84 $149.76 $131.52 $71.52 $53.76 $88,200 $7,350 $4,900 $199.92 $152.88 $134.26 $73.01 $54.88 $90,000 $7,500 $5,000 $204.00 $156.00 $137.00 $74.50 $56.00 $91,800 $7,650 $5,100 $208.08 $159.12 $139.74 $75.99 $57.12 $93,600 $7,800 $5,200 $212.16 $162.24 $142.48 $77.48 $58.24 $95,400 $7,950 $5,300 $216.24 $165.36 $145.22 $78.97 $59.36 $97,200 $8,100 $5,400 $220.32 $168.48 $147.96 $80.46 $60.48 $99,000 $8,250 $5,500 $224.40 $171.60 $150.70 $81.95 $61.60

$100,800 $8,400 $5,600 $228.48 $174.72 $153.44 $83.44 $62.72 $102,600 $8,550 $5,700 $232.56 $177.84 $156.18 $84.93 $63.84 $104,400 $8,700 $5,800 $236.64 $180.96 $158.92 $86.42 $64.96 $106,200 $8,850 $5,900 $240.72 $184.08 $161.66 $87.91 $66.08 $108,000 $9,000 $6,000 $244.80 $187.20 $164.40 $89.40 $67.20 $109,800 $9,150 $6,100 $248.88 $190.32 $167.14 $90.89 $68.32 $111,600 $9,300 $6,200 $252.96 $193.44 $169.88 $92.38 $69.44 $113,400 $9,450 $6,300 $257.04 $196.56 $172.62 $93.87 $70.56 $115,200 $9,600 $6,400 $261.12 $199.68 $175.36 $95.36 $71.68 $117,000 $9,750 $6,500 $265.20 $202.80 $178.10 $96.85 $72.80 $118,800 $9,900 $6,600 $269.28 $205.92 $180.84 $98.34 $73.92 $120,600 $10,050 $6,700 $273.36 $209.04 $183.58 $99.83 $75.04 $122,400 $10,200 $6,800 $277.44 $212.16 $186.32 $101.32 $76.16 $124,200 $10,350 $6,900 $281.52 $215.28 $189.06 $102.81 $77.28 $126,000 $10,500 $7,000 $285.60 $218.40 $191.80 $104.30 $78.40 $127,800 $10,650 $7,100 $289.68 $221.52 $194.54 $105.79 $79.52 $129,600 $10,800 $7,200 $293.76 $224.64 $197.28 $107.28 $80.64 $131,400 $10,950 $7,300 $297.84 $227.76 $200.02 $108.77 $81.76 $133,200 $11,100 $7,400 $301.92 $230.88 $202.76 $110.26 $82.88 $135,000 $11,250 $7,500 $306.00 $234.00 $205.50 $111.75 $84.00

25


Select Option: For the Select benefit option – see the tables below for the applicable benefit duration based on whether your disability is a result of injury or sickness.

Schedule for disability caused by injury:

Schedule for disability caused by sickness:

Age Disabled Benefits Payable Prior to Age 63 To Normal Retirement Age or 48 months if greater Age 63 To Normal Retirement Age or 42 months if greater Age 64 36 months Age 65 30 months Age 66 27 months Age 67 24 months Age 68 21 months Age 69 and older 18 months

Age Disabled Benefits Payable Prior to Age 65 3 Years Age 65 to 69 To Age 70, but not less than one year Age 69 and older 1 Year


Annual Earnings Monthly Earnings Monthly Benefit 0 / 3 14 / 14 30 / 30 60 / 60 90 / 90 $3,600 $300 $200 $7.90 $6.00 $5.24 $2.42 $1.84 $5,400 $450 $300 $11.85 $9.00 $7.86 $3.63 $2.76 $7,200 $600 $400 $15.80 $12.00 $10.48 $4.84 $3.68 $9,000 $750 $500 $19.75 $15.00 $13.10 $6.05 $4.60

$10,800 $900 $600 $23.70 $18.00 $15.72 $7.26 $5.52 $12,600 $1,050 $700 $27.65 $21.00 $18.34 $8.47 $6.44 $14,400 $1,200 $800 $31.60 $24.00 $20.96 $9.68 $7.36 $16,200 $1,350 $900 $35.55 $27.00 $23.58 $10.89 $8.28 $18,000 $1,500 $1,000 $39.50 $30.00 $26.20 $12.10 $9.20 $19,800 $1,650 $1,100 $43.45 $33.00 $28.82 $13.31 $10.12 $21,600 $1,800 $1,200 $47.40 $36.00 $31.44 $14.52 $11.04 $23,400 $1,950 $1,300 $51.35 $39.00 $34.06 $15.73 $11.96 $25,200 $2,100 $1,400 $55.30 $42.00 $36.68 $16.94 $12.88 $27,000 $2,250 $1,500 $59.25 $45.00 $39.30 $18.15 $13.80 $28,800 $2,400 $1,600 $63.20 $48.00 $41.92 $19.36 $14.72 $30,600 $2,550 $1,700 $67.15 $51.00 $44.54 $20.57 $15.64 $32,400 $2,700 $1,800 $71.10 $54.00 $47.16 $21.78 $16.56 $34,200 $2,850 $1,900 $75.05 $57.00 $49.78 $22.99 $17.48 $36,000 $3,000 $2,000 $79.00 $60.00 $52.40 $24.20 $18.40 $37,800 $3,150 $2,100 $82.95 $63.00 $55.02 $25.41 $19.32 $39,600 $3,300 $2,200 $86.90 $66.00 $57.64 $26.62 $20.24 $41,400 $3,450 $2,300 $90.85 $69.00 $60.26 $27.83 $21.16 $43,200 $3,600 $2,400 $94.80 $72.00 $62.88 $29.04 $22.08 $45,000 $3,750 $2,500 $98.75 $75.00 $65.50 $30.25 $23.00 $46,800 $3,900 $2,600 $102.70 $78.00 $68.12 $31.46 $23.92 $48,600 $4,050 $2,700 $106.65 $81.00 $70.74 $32.67 $24.84 $50,400 $4,200 $2,800 $110.60 $84.00 $73.36 $33.88 $25.76 $52,200 $4,350 $2,900 $114.55 $87.00 $75.98 $35.09 $26.68 $54,000 $4,500 $3,000 $118.50 $90.00 $78.60 $36.30 $27.60

26



Annual Earnings Monthly Earnings Monthly Benefit 0 / 3 14 / 14 30 / 30 60 / 60 90 / 90 $55,800 $4,650 $3,100 $122.45 $93.00 $81.22 $37.51 $28.52 $57,600 $4,800 $3,200 $126.40 $96.00 $83.84 $38.72 $29.44 $59,400 $4,950 $3,300 $130.35 $99.00 $86.46 $39.93 $30.36 $61,200 $5,100 $3,400 $134.30 $102.00 $89.08 $41.14 $31.28 $63,000 $5,250 $3,500 $138.25 $105.00 $91.70 $42.35 $32.20 $64,800 $5,400 $3,600 $142.20 $108.00 $94.32 $43.56 $33.12 $66,600 $5,550 $3,700 $146.15 $111.00 $96.94 $44.77 $34.04 $68,400 $5,700 $3,800 $150.10 $114.00 $99.56 $45.98 $34.96 $70,200 $5,850 $3,900 $154.05 $117.00 $102.18 $47.19 $35.88 $72,000 $6,000 $4,000 $158.00 $120.00 $104.80 $48.40 $36.80 $73,800 $6,150 $4,100 $161.95 $123.00 $107.42 $49.61 $37.72 $75,600 $6,300 $4,200 $165.90 $126.00 $110.04 $50.82 $38.64 $77,400 $6,450 $4,300 $169.85 $129.00 $112.66 $52.03 $39.56 $79,200 $6,600 $4,400 $173.80 $132.00 $115.28 $53.24 $40.48 $81,000 $6,750 $4,500 $177.75 $135.00 $117.90 $54.45 $41.40 $82,800 $6,900 $4,600 $181.70 $138.00 $120.52 $55.66 $42.32 $84,600 $7,050 $4,700 $185.65 $141.00 $123.14 $56.87 $43.24 $86,400 $7,200 $4,800 $189.60 $144.00 $125.76 $58.08 $44.16 $88,200 $7,350 $4,900 $193.55 $147.00 $128.38 $59.29 $45.08 $90,000 $7,500 $5,000 $197.50 $150.00 $131.00 $60.50 $46.00 $91,800 $7,650 $5,100 $201.45 $153.00 $133.62 $61.71 $46.92 $93,600 $7,800 $5,200 $205.40 $156.00 $136.24 $62.92 $47.84 $95,400 $7,950 $5,300 $209.35 $159.00 $138.86 $64.13 $48.76 $97,200 $8,100 $5,400 $213.30 $162.00 $141.48 $65.34 $49.68 $99,000 $8,250 $5,500 $217.25 $165.00 $144.10 $66.55 $50.60

$100,800 $8,400 $5,600 $221.20 $168.00 $146.72 $67.76 $51.52 $102,600 $8,550 $5,700 $225.15 $171.00 $149.34 $68.97 $52.44 $104,400 $8,700 $5,800 $229.10 $174.00 $151.96 $70.18 $53.36 $106,200 $8,850 $5,900 $233.05 $177.00 $154.58 $71.39 $54.28 $108,000 $9,000 $6,000 $237.00 $180.00 $157.20 $72.60 $55.20 $109,800 $9,150 $6,100 $240.95 $183.00 $159.82 $73.81 $56.12 $111,600 $9,300 $6,200 $244.90 $186.00 $162.44 $75.02 $57.04 $113,400 $9,450 $6,300 $248.85 $189.00 $165.06 $76.23 $57.96 $115,200 $9,600 $6,400 $252.80 $192.00 $167.68 $77.44 $58.88 $117,000 $9,750 $6,500 $256.75 $195.00 $170.30 $78.65 $59.80 $118,800 $9,900 $6,600 $260.70 $198.00 $172.92 $79.86 $60.72 $120,600 $10,050 $6,700 $264.65 $201.00 $175.54 $81.07 $61.64 $122,400 $10,200 $6,800 $268.60 $204.00 $178.16 $82.28 $62.56 $124,200 $10,350 $6,900 $272.55 $207.00 $180.78 $83.49 $63.48 $126,000 $10,500 $7,000 $276.50 $210.00 $183.40 $84.70 $64.40

$127,800 $10,650 $7,100 $280.45 $213.00 $186.02 $85.91 $65.32

$129,600 $10,800 $7,200 $284.40 $216.00 $188.64 $87.12 $66.24

$131,400 $10,950 $7,300 $288.35 $219.00 $191.26 $88.33 $67.16

$133,200 $11,100 $7,400 $292.30 $222.00 $193.88 $89.54 $68.08

$135,000 $11,250 $7,500 $296.25 $225.00 $196.50 $90.75 $69.00

27

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

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.

HUMANA YOUR BENEFITS PACKAGE



Cancer

Benefit Low High

Wellness Benefit. For Cancer screening tests such as mammogram, flexible sigmoidoscopy, pap smear, chest X-ray, hemocult stool specimen, or prostate screen. No Lifetime Maximum

Up to $50 per calendar year


Positive Diagnosis Test. Payable for a test that leads to positive diagnosis of Cancer or Specified Disease within 90 days. This benefit is not payable if the same Cancer or Specified Disease recurs.



First Diagnosis Benefit. One-time benefit payable when a Covered Person is first diagnosed with Cancer (other than Skin Cancer) or a Specified Disease. Must occur after the Certificate Effective Date.

$2,500 $2,500

Adult Companion Lodging and Transportation. Payable for one adult companion to stay with a Covered Person who is confined in a Hospital that is more than 60 miles and less than 700 miles from his or her home. Covered expenses include a single room in a motel or hotel up to 60 days per confinement; and the actual charge of round trip coach fare by a common carrier or a mileage allowance for the use of a personal vehicle. This benefit is not payable for lodging expense incurred more than 24 hours before the treatment nor for lodging expense incurred more than 24 hours following treatment. No Lifetime Maximum

Up to $75 per day for lodging.

50 cents per mile if a personal

vehicle is used.

Up to $75 per day for lodging.

50 cents per mile if a personal

vehicle is used.

Surgery. Covers actual surgeon’s fee for an operation up to the amount listed on the schedule. Benefits for surgery performed on an outpatient basis will be 150% of the schedule benefit amount, not to exceed the actual surgeon’s fees. No Lifetime Maximum

Up to $1,500 Up to $3,000

Bone Marrow and Stem Cell Transplant. We will pay Actual Charges per Covered Person for surgical and anesthetic charges associated with bone marrow transplant and/or peripheral stem cell transplant

Actual charges to a combined lifetime

maximum of $15,000

Actual charges to a combined lifetime

maximum of $15,000

Anesthesia. For services of an anesthesiologist during a Covered Person’s surgery. No Lifetime Maximum

Up to 25% of surgical benefit paid.

$100 maximum per Covered Person

Up to 25% of surgical benefit paid.

$100 maximum per Covered Person

Radiation, Radioactive Isotopes Therapy, Chemotherapy, or Immunotherapy. Covers treatment administered by a Radiologist, Chemotherapist or Oncologist on an inpatient or outpatient basis. No Lifetime Maximum

Actual charges up to $500 per day

Actual charges up to $1,000 per day

New or Experimental Treatment. We will pay the expenses incurred by a Covered Person for New or Experimental Treatment judged necessary by the attending Physician and received in the United States or in its territories. No Lifetime Maximum

Up to $7,500 per calendar year

Up to $7,500 per calendar year

Plan Features

Donor Benefits

Wellness Benefits

Many Benefits have no Lifetime Maximum

Covers Certain Lodging and Transportation

Portable (take it with You) In and Out of Hospital benefits

Pays regardless of other coverage

29

Cancer

Other Specified Diseases Covered

Meningitis (epidemic cerebrospinal) Scarlet Fever

Amyotrophic Lateral Sclerosis

Cystic Fibrosis Muscular Dystrophy Tay-Sachs Disease

Myasthenia Gravis Tetanus

Encephalitis Niemann-Pick Disease Toxic Epidermal Necrolysis

Osteomyelitis Tuberculosis

Hansen’s Disease Poliomyelitis Tularemia

Legionnaire’s Disease Rabies

Lupus Erythematosus Reye’s Syndrome

Lyme Disease Rheumatic Fever Whipple’s Disease

Malaria Rocky Mountain Spotted Fever

Payment of Benefits Benefits are payable for a Covered Person’s Positive Diagnosis of a Cancer or Specified Disease that begins after the Certificate Effective Date and while this Certificate has remained in force. See brochure for additional coverage, exclusions and limitations.

Termination of Coverage A Covered Person’s insurance under the Policy will automatically terminate on the earliest of the following dates: 1. the date that the Policy terminates. 2. the date of termination of any section or part of the

Policy with respect to insurance under such section or part.

3. the date the Policy is amended to terminate the eligibility of the Employee class.

4. any premium due date, if premium remains unpaid by the end of the grace period.

5. the premium due date coinciding with or next following the date the Covered Person ceases to be a member of an eligible class.

6. the date the Policyholder no longer meets participation requirements.

Covered Persons Covered Person means any of the following: a. the Named Insured; or b. any eligible Spouse or Child, as defined and as

indicated on the Certificate Schedule whose coverage has become effective;

c. any eligible Spouse or Child, as defined and added to this Certificate by endorsement after the Certificate Effective Date whose coverage has become effective; or

d. a newborn child (as described in the Eligibility Section).

Child (Children) means the Named Insured’s unmarried child, including a natural child from the moment of birth, stepchild, foster or legally adopted child, or child in the process of adoption (including a child while the Named Insured is a party to a proceeding in which the adoption of such child by the Named Insured is sought); a child for whom the Named Insured is required by a court order to provide medical support, and grandchildren who are dependent on the Named Insured for federal income tax purposes at the time of application, who is: a. not yet age 25; or b. not yet age 26 if a full time student at an accredited

school.

30

Cancer

Option To Add Additional Benefits Hospital Intensive Care Insurance Rider Form Number HIC-GP-ICR 6/09 In consideration of additional premium, this coverage will provide you with benefits if you go into a Hospital Intensive Care Unit (ICU).

Benefits Your benefits start the first day you go into ICU. The benefit is payable for up to 45 days per ICU stay. Hospital Intensive Care Confinement Benefit You may choose the benefit of $325 or $625 per day. It is reduced by one-half at age 75. Double Benefits We will double the daily benefits for each day you are in an ICU as a result of Cancer or a Specified Disease. We will also double the benefit for an injury that results from: being struck by an automobile, bus, truck, motorcycle, train, or airplane; or being involved in an accident in which the named insured was the operator or was a passenger in such vehicle. ICU confinement must occur within 48 hours of the accident.

Emergency Hospitalization and Subsequent Transfer to an ICU We will pay the benefit selected by you for the highest level of care in a hospital that does not have an ICU, if you are admitted on an emergency basis, and you are transferred within 48 hours to the ICU of another Hospital.

Step Down Unit We will pay a benefit equal to one half the chosen daily benefit for confinement in a Step Down Unit.

Exceptions and Other Limitations Except as provided in Step Down Unit and Emergency Hospitalization and Subsequent Transfer to an ICU, coverage does not provide benefits for: surgical recovery rooms; progressive care; intermediate care; private monitored rooms; observation units; telemetry units; or other facilities which do not meet the standards for a Hospital Intensive Care Unit. Benefits are not payable: if you go into an ICU before the Certificate Effective Date; if you go into an ICU for intentionally self-inflicted bodily injury or suicide attempts; if you go into an ICU due to being intoxicated or under the influence of alcohol, drugs or any narcotics, unless administered on the advice of a Physician and taken according to the Physician’s instructions. The term “intoxicated” refers to that condition as defined by law in the jurisdiction where the accident or cause of loss occurred. See the Medicare Supplement Buyer’s Guide available from the Company. This policy only covers cancer and the diseases specified above. Upon receipt of your policy, please review it and your application. If any information is incorrect, please contact us. P.O. Box 161690 | Austin, Texas 78716 | 1-800-845-7519

Group Cancer Rate—Monthly Rates

Underwritten by: Humana Insurance Company

Base Policy

Coverage Tier High Low

Individual $23.87 $18.38

Individual + Spouse $48.84 $37.60

Individual + Child(ren) $31.25 $24.43

Family $43.66 $56.23

Optional Intensive Care Rider

Coverage Tier $625 per day $325 per day

Individual $5.04 $2.62

Individual + Spouse $10.48 $5.45

Individual + Child(ren) $8.02 $4.17

Family $7.00 $13.46

Variable Benefit Elections Benefit High Low

Hospital Confinement $100 $100

Surgical $3,000 $1,500

Radiation/Chemotherapy

$1,000 per day $500 per day

First Diagnosis $2,500 $2,500

Colony Stimulating Factors

$1,500 per month $3,000 per month

Wellness $50 $50

31

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

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

HUMANA YOUR BENEFITS PACKAGE



Accident

Benefit Bronze 1 Unit

Silver 2 Units

Gold 3 Units

Accident Medical Expense Benefit We will pay the Actual Charge incurred up to $250 per unit if, as a result of Injury, a Covered Person requires medical or surgical treatment.

$250 $500 $750

Accident Hospital Indemnity Benefit We will pay for each day a Covered Person is Confined during one or more periods of Hospital Confinement if: a) the Confinement is due to Injury b) the first day of Confinement occurs within 90 days after the accident.

$100 $200 $300

Regular Ambulance / Air Ambulance Ambulance Service Benefit We will pay for regular ambulance service and for air Ambulance if as a result of an injury, a Covered Person requires ambulance service for transfer; a) to a Hospital; or b) from a Hospital

$100 / $200 $200 / $400 $300 / $600

Plan Features

On and off the job benefits

Pays regardless of other coverage

Portable (take it with You)

Benefits For: Accident Medical Expense Benefit

Accident Hospital Indemnity

Dislocations and Fractures

Accidental Death and Dismemberment

Accidental Death and Dismemberment Benefit

We will pay the following amount shown based on Your Selection of coverage:

For Loss of: Bronze (1 Unit)

Silver (2 Units)

Gold (3 Units)

Life $20,000 $40,000 $60,000

Both Hands or Both Feet or Sight of Both Eyes $20,000 $40,000 $60,000

Both Arms or Both Legs $20,000 $40,000 $60,000

One Hand or Arm and One Foot or Leg $20,000 $40,000 $60,000

Sight of One Eye $10,000 $20,000 $30,000

One Hand or One Arm $10,000 $20,000 $30,000

One Foot or One Leg $10,000 $20,000 $30,000

One or More Entire Toes $1,000 $2,000 $3,000

One or More Entire Fingers $800 $1,600 $2,400

Primary Insured Coverage 100%/Spouse Coverage 50%/ Child Coverage 25% Loss means with regard to: a) hands and feet--actual severance through or above wrist or ankle joints; b) sight, entire and irrecoverable loss thereof; c) toes and fingers--actual severance through or above the metacarpophalangeal joints. If loss is sustained by a Covered Person while riding as a fare-paying passenger on a scheduled Common Carrier, We will pay three times the amount payable under the Accidental Death and Dismemberment Benefit.

Monthly Rates

Coverage Tier Base Policy Silver Level

Base Policy Bronze Level

Base Policy Gold Level

Additional Benefit Rider

Individual $18.80 $9.40 $28.20 $3.29

Individual + Spouse $33.64 $16.82 $50.46 $6.57

Individual + Child(ren) $34.92 $17.46 $52.38 $7.36

Family $24.89 $49.78 $74.67 $10.64

33

Accident

Exclusions and Limitations No Benefits are payable when a Covered Person’s loss is caused or contributed to by:

suicide, while sane or insane, or attempted suicide;

intentionally self-inflicted Injury;

any act of war whether or not declared;

participation in a riot, or insurrection;

Injury sustained while on full-time active duty (other than for two (2) months or less training) in any military, naval or air force. When the Employee gives Us written notice, any unearned Premium will be refunded pro-rata for any period not covered by the Policy due to this exclusion;

Injury occurring prior to the Employee’s start date of insurance;

Injury while engaged in an illegal activity;

aviation, except flight in a regularly scheduled passenger aircraft;

being intoxicated as established by the laws of his or her state of residence;

the voluntary taking of any sedative, drug, alcohol, poison or inhalation of any gas unless taken as prescribed or administered by a physician;

participation in a felony;

dental care or treatment unless caused by Injury to natural teeth;

all Sicknesses including pregnancy, illness, mental illness or emotional disorders, bodily infirmity, rest cure, convalescent care or rehabilitation. Complications of Pregnancy that are the result of accidental Injury are covered;

Injury while sky diving, hang gliding, parachuting, bungee jumping, rock climbing, ballooning or scuba diving;

driving in any race or speed test or while testing an automobile or vehicle on any racetrack or speedway;

services received in an emergency room, unless required because of emergency treatment;

participating in or practicing for any semi-professional or professional competitive athletic contest in which any compensation is received;

hernia, carpal tunnel syndrome or any complication therefrom;

any bacterial infection (except pyogenic infections which shall occur with and through an accidental cut or wound).

No Benefits of the Policy will be paid for loss that takes place outside of the United States.

Pre-Existing Condition Limitation Pre-existing Condition means a condition which a Physician has treated or for which a Physician has advised treatment of the Covered Person within 12 months before the Covered Person’s Effective Date. It is also one which would cause a person to seek diagnosis or care within the same 12-month period. Losses that occur after the Pre-existing Condition provision has been satisfied will be covered for an Injury that occurred before the date the person becomes a Covered Person under the Policy unless the Injury has been specifically excluded by name or description within the Policy or Rider.

Covered Persons Covered Person means: a) You; and b) each person named as Your Dependent in the Enrollment Form Child (Children) means a person who is primarily dependent upon and living with the Insured in a permanent parent-child relationship and a:

natural or adopted child of the Insured or Spouse;

Child placed with the Insured or Spouse for adoption;

Child legally placed with the Insured or Spouse as a foster Child; or

stepchild of the Insured. Child does not include a:

person not meeting the above Child definition;

Child living outside of the United States (unless living with an Insured); or

Child on active military duty for a period in excess of 30 days.

Termination of Coverage A Covered Person’s insurance under the Group Policy will automatically terminate on the earliest of the following dates: a. the date that the Group Policy terminates. b. the date the Group Policy is amended to terminate the

eligibility of the Employee class. c. the last day of the grace period, if premium remains

unpaid by the end of the grace period. d. the premium due date coinciding with or next following

the date the Employee ceases to be a member of an eligible class;

e. the date of death of the Employee f. the date of attainment of the Group Policy Age Limit as

shown in the Schedule of Benefits

34

Accident

Dependent Termination: A Dependent’s coverage will end: a. with respect to a covered Spouse, on the date he or she is

divorced from the Primary Covered Person; b. on the date the primary Covered Person dies; c. on the date the required premium for the Dependent’s

coverage is not paid; d. with respect to a covered Dependent, first of the month

following the date the Dependent is a member of an eligible Class; or

e. on the date the Primary Covered Person reaches the Policy Age Limit noted on the Insuring Information page.

Portability On the date the Policy terminates or the date the Named Insured ceases to be a member of an eligible class, Named Insureds and their covered dependents will be eligible to exercise the portability privilege. Portability coverage may continue beyond the termination date of the Policy, subject to the timely payment of premiums. Portability coverage will be effective on the day after insurance under the Policy terminates. The benefits, terms and conditions of the portability coverage will be the same as those provided under the Policy when the insurance terminated. The initial portability premium rate is the rate in effect under the Policy for active employees who have the same coverage. The premium rate for portability coverage may change for the class of Covered Persons on portability on any premium due date.

35

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

About this Benefit

Critical Illness

Is the aggregate cost of a hospital stay for a heart

attack.

DID YOU KNOW?

$16,500

AFLAC YOUR BENEFITS PACKAGE



Critical Illness

COVERED CRITICAL ILLNESSES

CANCER (Internal or Invasive) 100%

HEART ATTACK (Myocardial Infarction) 100%

STROKE (Apoplexy or Cerebral Vascular Accident) 100%

MAJOR ORGAN TRANSPLANT 100%

END-STAGE RENAL FAILURE 100%

CARCINOMA IN SITU (Payment of this benefit will reduce your benefit for cancer by 25%.) 25%

CORONARY ARTERY BYPASS SURGERY (Payment of this benefit will reduce your benefit for heart attack by 25%.)

25%

FIRST OCCURRENCE BENEFIT A lump sum benefit is payable upon initial diagnosis of a covered critical illness. Employee benefit amounts are available from $10,000 to $20,000. Spouse coverage is also available in benefit amounts up to $10,000, not to exceed one half of the employee’s amount. If you are deemed ineligible due to a previous medical condition, you still retain the ability to purchase spouse coverage.

ADDITIONAL OCCURRENCE BENEFIT If you collect full benefits for a critical illness under the plan and later are diagnosed with one of the remaining covered critical illnesses, then we will pay the full benefit amount for each additional illness. Occurrences must be separated by at least six months or for cancer at least six months treatment free.

REOCCURRENCE BENEFIT If you collect full benefits for a covered condition and are later diagnosed with the same condition, we will pay the full benefit again. The two dates of diagnosis must be separated by at least 12 months, or for cancer at least 12 months treatment-free. Cancer that has spread (metastasized), even though there is a new tumor, will not be considered an additional occurrence unless you have gone treatment-free for 12 months.

CHILD COVERAGE AT NO ADDITIONAL COST Each dependent child is covered at 25 percent of the primary insured’s benefit amount at no additional charge.

ADDITIONAL BENEFITS RIDER (This benefit is paid based on your selected benefit amount.)

PARALYSIS 100%

SEVERE BURNS 100%

COMA 100%

LOSS OF SPEECH / S IGHT / HEARING 100%

HEART EVENT RIDER (This benefit is paid based on your selected benefit amount.)

OPEN HEART SURGERIES (Category I: Coronary Artery Bypass Surgery (CABS)*, Mitral Valve Replacement or Repair, Aortic Valve Replacement or Repair, Surgical Treatment of Abdominal Aortic Aneurysm). *Payment of this benefit will still reduce the benefit payable for Heart Attack by 25%.

100%

INVASIVE HEART PROCEDURE (Category II: AngioJet Clot Busting, Balloon Angioplasty, Laser Angioplasty, Atherectomy, Stent Implantation, Cardiac Catheterization, Automatic Implantable (or Internal) Cardioverter Defibrillator, Pacemakers)

10%

*Benefits from the Heart Event Rider and certificate will not exceed 100% of the maximum applicable benefit. When you purchase the Heart Event Rider, the 25% CABS partial benefit in your certificate is increased to 100%. That means the CABS benefit in the Heart Event Rider, combined with the benefit in your certificate, equal 100% of the maximum benefit—not 125%. We will pay the indicated percentages of your maximum benefit if you are treated with one of the specified surgical procedures (Category I) or interventional procedures (Category II) shown; treatment is incurred while coverage is in force; treatment is recommended by a physician; and is not excluded by name or specific description. This benefit is paid based on your selected benefit amount. We will pay the indicated percentages of your maximum benefit if you are treated with one of the specified surgical procedures (Category I) or interventional procedures (Category II) shown; treatment is incurred while coverage is in force; treatment is recommended by a physician; and is not excluded by name or specific description. This benefit is paid based on your selected benefit amount.

37

Critical Illness

INDIVIDUAL ELIGIBILITY Issue Ages Employee: 18-69 Spouse: 18-69 Children under age 26 All full-time employees, working at least 20 hours or more weekly are eligible to apply. If an employee is eligible, their spouse is eligible for coverage and all children of the Insured who are less than twenty-six (26) years of age. Seasonal and temporary workers are not eligible to participate.

LIMITATIONS AND EXCLUSIONS If the coverage outlined in this summary will replace any existing coverage, please be aware that it may be in your best interest to maintain your individual guaranteed-renewable policy. The applicable benefit amount will be paid if: the date of diagnosis occurs while the certificate is in force; and the cause of the illness is not excluded by name or specific description.

EXCLUSIONS Benefits will not be paid for loss due to:

Intentionally self-inflicted injury or action;

Suicide or attempted suicide while sane or insane;

Illegal activities or participation in an illegal occupation;

War, whether declared or undeclared or military conflicts, participation in an insurrection or riot, civil commotion or state of belligerence;

Substance abuse; or

Pre-Existing Conditions (except as stated below). No benefits will be paid for loss which occurred prior to the effective date. No benefits will be paid for diagnosis made or treatment received outside of the United States.

PRE-EXISTING CONDITION LIMITATION Not applicable to cancer and/or carcinoma in situ. Pre-Existing Condition means a sickness or physical condition which, within the 12-month period prior to the effective date, resulted in you receiving medical advice or treatment. We will not pay benefits for any critical illness starting within 12 months of the effective date which is caused by, contributed to, or resulting from a pre-existing condition. A claim for benefits for loss starting after 12 months from the effective date will not be reduced or denied on the grounds that it is caused by a preexisting condition. A critical illness will no longer be considered pre-existing at the end of 12

consecutive months starting and ending after the effective date.

CONTINUATION PRIVILEGE When coverage would otherwise terminate because you end employment with the employer, coverage may be continued. You may continue the coverage that is in force on the date employment ends, including dependent coverage then in effect. You must apply to us in writing within 31 days after the date that the insurance would terminate. You may be allowed to continue the coverage until the earlier of the date you fail to pay the required premium or the date the group master policy is terminated. Coverage may not be continued if you fail to pay any required premium or the group master policy terminates.

TERMINATION Coverage will terminate on the earliest of: (1) The date the master policy is terminated; (2) The 31st day after the premium due date if the required premium has not been paid; (3) The date the insured ceases to meet the definition of an employee as defined in the master policy; or (4) The date the employee is no longer a member of the class eligible. Coverage for an insured spouse or dependent child will terminate the earliest of: (1) the date the plan is terminated; (2) the date the spouse or dependent child ceases to be a dependent; (3) the premium due date following the date we receive your written request to terminate coverage for his or her spouse and/or all dependent children.

TERMS YOU NEED TO KNOW The Effective Date of your insurance will be the date shown on the certificate schedule. Employee means the insured as shown on the certificate schedule. Spouse means your legal wife or husband. Dependent Children means your natural children, step-children, foster children, adopted children or children placed for adoption, who are under age 26. Child(ren) also include grandchildren, who are unmarried and under age 26.

These dependents must also be: your dependents for federal income tax purposes; and/or dependents for whom you must provide medical support under an order issued under Chapter 154, Family Code (or enforceable by a court order in your state).

38

Critical Illness

Your natural children born after the effective date of the rider will be covered from the moment of birth. A child you adopt may be enrolled the date you become a party to a suit in which you seek to adopt the child or the date the adoption becomes final, at your option. If Employee or Employee/Spouse coverage is in force and you desire uninterrupted coverage for a newborn or adopted child, you must notify us within 31 days of the child’s birth or the date you become a party to a suit in which you seek to adopt the child or the date the adoption becomes final. Coverage for newborn or adopted children will be in effect through the 31st day following the date of such event. Upon notification, we will advise you of the additional premium due. If your children are covered under the rider, it is not necessary for you to notify us of the birth of a child or the date you become a party to a suit in which you seek to adopt the child or the date the adoption becomes final, and an additional premium payment will not be required. Coverage on dependent children will terminate on the child’s 26th birthday. However, if any child is incapable of self-sustaining employment due to mental or physical handicap and is dependent on his parent(s) for support, the above age 26 shall not apply. Proof of such incapacity and dependency must be furnished to us within 31 days following such 26th birthday.

Non Tobacco Employee Rates (Children covered at 25% of Employee amount at no charge)

Age Bracket $10,000 $20,000

18—29 $7.25 $12.75

30—39 $10.65 $19.55

40—49 $20.45 $39.15

50—59 $33.08 $64.42

60—69 $51.75 $101.75

Non Tobacco Spouse Rates (Limited to 50% of employee election)

Age Bracket $5,000 $10,000

18—29 $4.50 $7.25

30—39 $6.20 $10.65

40—49 $11.10 $20.45

50—59 $17.42 $33.08

60—69 $26.75 $51.75

Tobacco Employee Rates (Children covered at 25% of Employee amount at no charge)

Age Bracket $10,000 $20,000

18—29 $10.45 $19.15

30—39 $16.65 $31.55

40—49 $40.35 $78.95

50—59 $63.55 $125.35

60—69 $100.45 $199.15

Tobacco Spouse Rates (Limited to 50% of employee election)

Age Bracket $5,000 $10,000

18—29 $6.10 $10.45

30—39 $9.20 $16.65

40—49 $21.05 $40.35

50—59 $32.65 $63.55

60—69 $51.10 $100.45

39

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 YOUR BENEFITS PACKAGE

FOR HSA VS. FSA COMPARISON

FLIP TO… PG. 11



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 need a replacement card please contact NBS directly at (800) 274-0503.

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 claims

FAQs

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

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

41

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/alamoheightsisd

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). Please contact your benefits admin to determine if your district has the grace period or the $500 Roll-Over option. If your district does not have the roll-over, your plan contributions are use-it-or-lose-it.

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/alamoheightsisd 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!

42

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 or rollover after the Plan year ends for you to submit qualified claims for any unused funds.

43

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 YOUR BENEFITS PACKAGE



HSA (Health Savings Account)

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 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-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 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 Alamo Heights ISD website at www.mybenefitshub.com/alamoheightsisd

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

45

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

46

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

47

Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family. Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

About this Benefit

Life and AD&D

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

drowning, and choking.

DID YOU KNOW?

#1

Motor vehicle crashes are the

AUL A ONEAMERICA COMPANY YOUR BENEFITS PACKAGE



AUL's Group Voluntary Term Life and AD&D 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 30 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.

Accidental Death & Dismemberment (AD&D) If approved for this benefit, additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract. AD&D coverage is not included for dependents.

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.

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

Evidence of Insurability: 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 dependents will be approved or declined for insurance coverage by AUL.

Continuation of Coverage Options: Portability Should your coverage terminate for any reason, you may be eligible 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 Coverage to Individual Coverage without providing Evidence of Insurability. 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' insurance premium in case you become totally disabled and are unable to collect a paycheck. Reductions: Upon reaching certain ages, your original benefit amount will reduce to a percentage as shown in the following schedule.

This invitation to inquire allows eligible employees an opportunity to inquire further about AUL's group insurance and is limited to a brief description of any losses for which benefits are payable. The contract has exclusions, limitations reduction of benefits, and terms under which the contract may be continued in force or discontinued.

Life and AD&D

Age: 70 75

Reduces To: 65% 50%

Employee Guaranteed Issue Amount $150,000

Spouse Guaranteed Issue Amount $30,000

Child Guaranteed Issue Amount $10,000

49

Life and AD&D

Voluntary Term Life including matching AD&D Coverage Monthly Payroll Deduction Illustration

About your benefit options: You may select a minimum benefit of $10,000 up to a maximum amount of $150,000, in increments of $10,000, not to

exceed 5 times your annual base salary only, rounded to the next higher $10,000.

Amounts requested above $150,000 for an Employee, $30,000 for a Spouse, or any amount not requested timely will require Evidence of Insurability.

Employee must select coverage to select any Dependent coverage. AD&D coverage is not included for dependents.

Dependent coverage cannot exceed 50% of the Voluntary Term Life amount selected by the Employee.

A Spouse must be under age 70 to be eligible for benefits.

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

Life & AD&D 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 $2.10 $2.10 $2.10 $2.10 $2.10 $2.10 $2.10 $2.10 $2.10 $2.10 $6.30 $15.30 $15.30

$20,000 $4.20 $4.20 $4.20 $4.20 $4.20 $4.20 $4.20 $4.20 $4.20 $4.20 $12.60 $30.60 $30.60

$30,000 $6.30 $6.30 $6.30 $6.30 $6.30 $6.30 $6.30 $6.30 $6.30 $6.30 $18.90 $45.90 $45.90

$40,000 $8.40 $8.40 $8.40 $8.40 $8.40 $8.40 $8.40 $8.40 $8.40 $8.40 $25.20 $61.20 $61.20

$50,000 $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $31.50 $76.50 $76.50

$60,000 $12.60 $12.60 $12.60 $12.60 $12.60 $12.60 $12.60 $12.60 $12.60 $12.60 $37.80 $91.80 $91.80

$70,000 $14.70 $14.70 $14.70 $14.70 $14.70 $14.70 $14.70 $14.70 $14.70 $14.70 $44.10 $107.10 $107.10

$100,000 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $63.00 $153.00 $153.00

$125,000 $26.25 $26.25 $26.25 $26.25 $26.25 $26.25 $26.25 $26.25 $26.25 $26.25 $78.75 $191.25 $191.25

$150,000 $31.50 $31.50 $31.50 $31.50 $31.50 $31.50 $31.50 $31.50 $31.50 $31.50 $94.50 $229.50 $229.50

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

$5,000 $.90 $.90 $.90 $.90 $.90 $.90 $.90 $.90 $.90 $.90 $.90

$10,000 $1.80 $1.80 $1.80 $1.80 $1.80 $1.80 $1.80 $1.80 $1.80 $1.80 $1.80

$15,000 $2.70 $2.70 $2.70 $2.70 $2.70 $2.70 $2.70 $2.70 $2.70 $2.70 $2.70

$20,000 $3.60 $3.60 $3.60 $3.60 $3.60 $3.60 $3.60 $3.60 $3.60 $3.60 $3.60

$25,000 $4.50 $4.50 $4.50 $4.50 $4.50 $4.50 $4.50 $4.50 $4.50 $4.50 $4.50

$30,000 $5.40 $5.40 $5.40 $5.40 $5.40 $5.40 $5.40 $5.40 $5.40 $5.40 $5.40

50

Life and AD&D

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 $5,000 $1,000 $1.00

Option 2 $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.

51

NOTES

52

NOTES

53

www.mybenefitshub.com/alamoheightsisd

54

2016 benefit guide alamo heights isd

Documents