2016 Benefit Guide - Rusk ISD

EFFECTIVE:

09/01/2016 - 8/31/2017

BENEFIT GUIDE

www.mybenefitshub.com/ruskisd

RUSK ISD

1

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

Spending Account (FSA) 11

TRS-ActiveCare 12-15 HSA Bank Health Savings Account (HSA) 16-19 MDLIVE Telehealth 20-21 Cigna Dental 22-25 Superior Vision 26-27 UNUM Educator Select Disability 28-31 Philadelphia American Cancer 32-35 The Hartford Life and AD&D 36-39 NBS Flexible Spending Account (FSA) 40-43

Table of Contents

FLIP TO...

HOW TO ENROLL

PG. 4

BENEFIT UPDATE—WHAT’S NEW

PG. 6

YOUR BENEFITS PACKAGE

PG. 12

2

Benefit Contact Information

RUSK ISD BENEFITS DENTAL CANCER

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

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

Philadelphia American (800) 554-0092 www.neweralife.com

RUSK ISD BENEFITS OFFICE VISION LIFE AND AD&D

(903) 683-5592 www.ruskisd.net

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

The Hartford (800) 583-6908 www.thehartford.com

MEDICAL DISABILITY FLEXIBLE SPENDING ACCOUNT

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

UNUM (800) 858-6843 www.unum.com

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

TELEHEALTH

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

ruskisd delivers important

benefit information with 24/7

access, as well as detailed plan

information, rates and product

videos.

TEXT

“ruskisd”

TO

313131

On Your Device Enrolling in your benefits just got

a lot easier! Text “ruskisd” 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/ruskisd 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

Due to the Affordable Care Act (ACA), every employee is required to login & complete the enrollment process, even if you are declining benefits by 8/19/16!

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).

Dental rates are increasing. Cancer rates are increasing. If you have a

Grandfathered Cancer plan your rates are also increasing.

If you currently participate in a Health Care or Dependent Care FSA, you MUST re-elect a new contribution amount every year to continue to participate.

Flexible Spending Account Use-it or Roll-Over $500: You

are able to roll over HealthCare Reimbursement FSA funds up to $500 into the following plan year.

If you elect the HSA you are not eligible to participate in

the FSA and vice versa. The HSA Family annual contribution max is increasing. Social Security Numbers for your dependents are

required regardless if they are enrolled in coverage or not. Please make sure you have these items on hand when going through your open enrollment.

For questions about benefits or enrollment assistance, please call the FBS Call Center at 469-385-4685

Bilingual assistance is available by calling this number. Login & complete your benefit enrollment from 7/25/2016-8/19/2016. Changes made

after 8/20/15 must go through the payroll department. Update your profile information: home address, phone numbers, email.

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

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Annual Enrollment

During your annual enrollment period, you have the opportunity

to review, change or continue benefit elections each year.

Changes are not permitted during the plan year (outside of

annual enrollment) unless a Section 125 qualifying event occurs.

Changes, additions or drops may be made only during the

annual enrollment period without a qualifying event.

Employees must review their personal information and verify

that dependents they wish to provide coverage for are

included in the dependent profile. Additionally, you must

notify your employer of any discrepancy in personal and/or

benefit information.

Employees must confirm on each benefit screen (medical,

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

selected in order to be included in the coverage for that

particular benefit.

New Hire Enrollment

All new hire enrollment elections must be completed in the

online enrollment system within the first 31 days of benefit

eligibility employment. Failure to complete elections during this

timeframe will result in the forfeiture of coverage.

Q&A

Who do I contact with Questions?

For supplemental benefit questions, you can contact your

Benefits/HR department or you can call Financial Benefit Services

at 866-914-5202 for assistance.

Where can I find forms?

For benefit summaries and claim forms, go to your school

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

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

Dental) and you can find the forms you need under the

Benefits and Forms section.

How can I find a Network Provider?

For benefit summaries and claim forms, go to your school

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

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

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

Links section.

When will I receive ID cards?

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

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

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

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

insurance company’s phone number and they can call and

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

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

carrier’s customer service number to request another card.

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

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

card each year.

SUMMARY PAGES

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Employee Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more

regularly scheduled hours each work week.

Eligible employees must be actively at work on the plan effective

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

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

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

your 2016 benefits become effective on September 1, 2016, you

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

your new benefits.

Dependent Eligibility Requirements

Dependent Eligibility: You can cover eligible dependent

children under a benefit that offers dependent coverage,

provided you participate in the same benefit, through the

maximum age listed below. Dependents cannot be double

covered by married spouses within the Rusk 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.

SUMMARY PAGES

PLAN CARRIER MAXIMUM AGE

Medical Aetna To age 26

Dental Cigna To age 26

Vision Superior Vision To age 26

Cancer Philadelphia American To age 25

Voluntary Life The Hartford To age 26

Long Term Care UNUM To age 26

AD&D The Hartford To age 25

Telehealth MDLIVE To age 26

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

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

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

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

work beginning 9/1/2016 please notify your benefits

administrator.

Annual Enrollment The period during which existing employees are given the

opportunity to enroll in or change their current elections.

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

pay covered expenses.

Calendar Year January 1st through December 31st

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

covered health care service, calculated as a percentage (for

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

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

medical questions or taking a health exam. Guaranteed

coverage is only available during initial eligibility period.

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

provisions do apply, as applicable by carrier.

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

who have contracted with the plan as a network provider.

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

for covered expenses.

Plan Year September 1st through August 31st

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

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

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

orders to take drugs, or received medical care or services

(including diagnostic and/or consultation services).

Helpful Definitions SUMMARY PAGES

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HSA vs. FSA

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

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

Description

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

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

Employer Eligibility A qualified high deductible health plan. All employers

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

Account Owner Individual Employer

Underlying Insurance Requirement

High deductible health plan None

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

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

Varies per employer

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

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

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

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

Not permitted

Year-to-year rollover of account balance?

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

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

Does the account earn interest?

Yes No

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

No

FOR HSA INFORMATION

FLIP TO… PG. 16

FOR FSA INFORMATION

FLIP TO… PG. 40

SUMMARY PAGES

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

About this Benefit

Medical

DID YOU KNOW?

AETNA

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

a chronic disease.


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

Rusk ISD Benefits Website: www.mybenefitshub.com/ruskisd 12

Medical Rates

Plan Type TRS-ActiveCare

2016-17 Premium

State and District Contribution

Employee Deduction for

2016-17

Employee Deduction for

2015-16

Employee Deduction

Increase for 2016-17

Plan 1-HD

Employee Only $341 $225 $116 $116 $0

Employee and Spouse $914 $225 $689 $689 $0

Employee and Child(ren) $615 $225 $390 $390 $0

Employee and Family $1,231 $225 $1,006 $1,006 $0

Select Plan

Employee Only $484 $225 $259 $248 $11

Employee and Spouse $1,147 $225 $922 $897 $25

Employee and Child(ren) $779 $225 $554 $537 $17


Plan 2

Employee Only $645 $225 $420 $389 $31

Employee and Spouse $1,552 $225 $1,327 $1,253 $74

Employee and Child(ren) $1,042 $225 $817 $767 $50


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

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

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

Accountable Care Network; Seton Health Alliance)

ActiveCare 2

Deductible (per plan year)

$2,500 employee only $5,000 family

$1,200 individual $3,600 family


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

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



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

80% 20%

80% 20%

80% 20%

Office Visit Copay Participant pays

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

$30 copay for primary $50 copay for specialist

Diagnostic Lab Participant pays

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

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

Preventive Care See next page for a list of services

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

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

Plan pays 100% Plan pays 100%

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

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

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

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

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

Emergency Room (true emergency use) Participant pays

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

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

Outpatient Surgery Participant pays

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

$150 copay per visit plus 20% after deductible

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

$5,000 copay plus 20% after deductible

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

Prescription Drugs Drug deductible (per plan year)

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

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

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

20% after deductible

$20 $40** 50% coinsurance**

$20 $40** $65**

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

20% after deductible

$35 $60** 50% coinsurance**

$35 $60** $90**

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

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

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

Specialty Drugs Participant pays

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

A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. *Illustrates benefits when in-network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits under the ActiveCare Select or ActiveCare Select Whole Health Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for this balance bill amount, which maybe considerable. **If the patient obtains a brand-name drug when a generic equivalent is available, the patient will be responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug.

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TRS-ActiveCare Plans—Preventive Care

Preventive Care Services

Network Benefits When Using In-Network Providers

(Provider must bill services as “preventive care”)

ActiveCare 1-HD ActiveCare Select or ActiveCare Select

Whole Health (Baptist Health System and

HealthTexas Medical Group; Baylor Scott & White Quality Alliance;

Memorial Hermann Accountable Care Network; Seton Health

Alliance)

ActiveCare 2 Network

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

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

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

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

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

Plan pays 100% (deductible waived; no copay required) Some examples of preventive care frequency and services: Routine physicals – annually age

12 and over Well-child care – unlimited up to

age 12 Well woman exam & pap smear

– annually age 18 and over Mammograms – 1 every year age

35 and over Colonoscopy – 1 every 10 years

age 50 and over Prostate cancer screening – 1 per

year age 50 and over Smoking cessation counseling – 8

visits per 12 months Healthy diet/obesity counseling –

unlimited to age 22; age 22 and over-26 visits per 12 months

Breastfeeding support – 6 lactation counseling visits per 12 months

Plan pays 100% (deductible waived; no copay required) Some examples of preventive care frequency and services: Routine physicals –

annually age 12 and over Well-child care – unlimited

up to age 12 Well woman exam & pap

smear – annually age 18 and over

Mammograms – 1 every year age 35 and over

Colonoscopy – 1 every 10 years age 50 and over

Prostate cancer screening –1 per year age 50 and over

Smoking cessation counseling –8 visits per 12 months

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

Breastfeeding support –6 lactation counseling visits per 12 months

Plan pays 100% (deductible waived) Some examples of preventive care frequency and services: Routine physicals – annually

age 12 and over Well-child care – unlimited

up to age 12 Well woman exam & pap

smear – annually age 18 and over

Mammograms – 1 every year age 35 and over

Colonoscopy – 1 every 10 years age 50 and over

Prostate cancer screening – 1 per year age 50 and over

Smoking cessation counseling – 8 visits per 12 months

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

Breastfeeding support – 6 lactation counseling visits per 12 months

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

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

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

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

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

$60 copay for specialist $50 copay for specialist

Annual Hearing Examination Participant pays

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



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

TRS-ActiveCare is administered by Aetna Life Insurance Company. Aetna provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug benefits are administered by Caremark. 15

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 your school district’s benefits website at www.mybenefitshub.com/ruskisd

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

17

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

18

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

19

About this Benefit

Telehealth MDLIVE


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.

DID YOU KNOW?

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

telehealth.

75%



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.

21

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

About this Benefit

Dental

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?

CIGNA YOUR BENEFITS PACKAGE



Dental PPO

Monthly PPO Premiums

Tier Rate

EE Only $30.15

EE + Spouse $60.29

EE + Child(ren) $66.48

Family Coverage $91.31

Benefits Cigna Dental Choice

In-Network Out-of-Network

Network Cigna Choice - Radius Cigna Savings - Radius Calendar Year Maximum (Class I, II and III expenses)

$1,200 $1,200

Annual Deductible Individual Family

$50 per person $150 per family

$50 per person $150 per family

Reimbursement Levels** Based on Reduced Contracted Fees

90th percentile of Reasonable and Customary Allowances

Plan Pays You Pay Plan Pays You Pay

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

100% No Charge 100% No Charge

Class II - Basic Restorative Care Fillings Emergency Care to Relieve Pain Brush Biopsies Oral Surgery – Simple Extractions Space Maintainers Minor Periodontal

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

Class III - Major Restorative Care Crowns Root Canal Therapy/Endodontics Major Periodontal Scaling Osseous Surgery Surgical Extractions of Impacted Teeth Oral Surgery - all except simple extractions Anesthetics Denture Repairs Denture Relines, Rebases and Adjustments Repairs to Bridges, Crowns and Inlays Dentures Bridges Inlays/Onlays Prosthesis Over Implant

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

Class IV - Orthodontia Lifetime Maximum

50% $1,000

Dependent children to age 19

50%

50% $1,000

Dependent children to age 19

50%

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. **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to Reasonable and Customary Allowances but the dentist may balance bill up to their usual fees.

23

Dental PPO

Benefit Exclusions Services performed primarily for cosmetic reasons

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

Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and third molars

Bite registrations; precision or semi-precision attachments; splinting

A surgical implant of any type

Instruction for plaque control, oral hygiene and diet

Dental services that do not meet common dental standards

Services that are deemed to be medical services

Services and supplies received from a hospital

Charges which the person is not legally required to pay

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

Experimental or investigational procedures and treatments

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

Charges in excess of the reasonable and customary allowances

To the extent that payment is unlawful where the person resides when the expenses are incurred;

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);

For charges which would not have been made if the person had no insurance;

For charges for unnecessary care, treatment or surgery;

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.

24

Dental PPO

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 Various limits per Plan year depending on specific test 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 Minor Perio (non-surgical) Various limitations depending on the service Perio Surgery Various limitations depending on the service Crowns and Inlays Replacement every 5 years Bridges 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 Repairs - Bridges Reviewed if more than once Repairs - Dentures Reviewed if more than once Sealants Limited to posterior teeth. One treatment per tooth every three years 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 Alternate Benefit When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses 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 Con necticut 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. BSD48011 ©2014 Cigna

25

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 24 months

Lenses 12 months

Contact Lenses 12 months

(Based on date of service)

Benefits In-Network Out-of-Network

Exam Covered in full Up to $35 retail

Frames $150 retail allowance Up to $70 retail

Contact Lenses1 $175 retail allowance Up to $80 retail

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

Lasik Vision Correction $200 allowance2 (in or out of network)

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

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 $7.80

EE + Family $19.66

Co-Pays Exam $10

Materials $25

27

About this Benefit

Disability

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.

UNUM

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




Policy # 147245 Please read carefully the following description of your Unum Educator Select Income Protection Plan insurance.

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

Guarantee Issue Current Employees: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may enroll on or before the enrollment deadline. After the initial enrollment period, you can apply only during an annual enrollment period. Newly Hired Employees: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may apply for coverage within 60 days after your eligibility date. If you do not apply within 60 days after your eligibility date, you can apply only during an annual enrollment period. Benefits are subject to the pre-existing condition exclusion referenced later in this document. Please see your Plan Administrator for your eligibility date.

Benefit Amount You may purchase a monthly benefit in $100 units, starting at a minimum of $200, up to 66 2/3% of your monthly earnings rounded to the nearest $100, but not to exceed a monthly maximum benefit of $7,500. Please see your Plan Administrator for the definition of monthly earnings. The total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 100% of your monthly earnings unless the excess amount is payable as a Cost of Living Adjustment. However, if you are participating in Unum’s Rehabilitation and Return to Work Assistance program, the total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 110% of your monthly earnings (unless the excess amount is payable as a Cost of Living Adjustment).

Elimination Period The Elimination Period is the length of time of continuous disability, due to sickness or injury, which must be satisfied before you are eligible to receive benefits. You may choose an Elimination Period (injury/sickness) of 0/7, 14/14, 30/30, 60/60, 90/90 or 180/180 days. If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.)

Benefit Duration Your duration of benefits is based on your age when the disability occurs. Plan: ADEA II/5 yR ADEA: Your duration of benefits is based on the following table: For disabilities due to injury: Age at Disability Maximum Duration of Benefits Less than age 60 To age 65, but not less than 5 years Age 60 through 64 5 years Age 65 through 69 To age 70, but not less than 1 year Age 70 and over 1 year For disabilities due to sickness: Age at Disability Maximum Duration of Benefits Less than age 60 5 years Age 60 through 68 To age 70, but not less than 1 year Age 69 and over 1 year

Next Steps How to Apply/Effective Date of Coverage Current employees: To apply for coverage, complete your enrollment form by the enrollment deadline. Your effective date of coverage is 9/1. Newly Hired Employees: To apply for coverage, complete your enrollment form within 60 days of your eligibility date. Please see your Plan Administrator for your effective date. If you do not enroll during the initial enrollment period, you may apply only during an annual enrollment.

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

Questions If you should have any questions about your coverage or how to enroll, please contact your Plan Administrator. This plan highlight is a summary provided to help you understand your insurance coverage from Unum. Some provisions may vary or not be available in all states. Please refer to your certificate booklet for your complete plan description. If the terms of this plan highlight summary or your certificate differ from your policy, the policy will govern. For complete details of coverage, please refer to policy form number C.FP-1, et al. Underwritten by: Unum Life Insurance Company of America 2211 Congress Street, Portland, Maine 04122, www.unum.com ©2007 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Disability

29

Disability

RUSK INDEPENDENT SCHOOL DISTRICT

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

Product: Educator Select Income Protection Plan

Plan A

Injury - ADEAII Duration of Benefits Sickness - 5YR Duration of Benefits

Elimination Period (Days)

Injury (Days) 0* 14* 30* 60 90 180

Sickness (Days) 7* 14* 30* 60 90 180

Annual Earnings

Monthly Earnings

Maximum Monthly Benefit

3600 300 200 8.04 6.36 5.32 3.62 3.14 2.42

5400 450 300 12.06 9.54 7.98 5.43 4.71 3.63

7200 600 400 16.08 12.72 10.64 7.24 6.28 4.84

9000 750 500 20.10 15.90 13.30 9.05 7.85 6.05

10800 900 600 24.12 19.08 15.96 10.86 9.42 7.26

12600 1050 700 28.14 22.26 18.62 12.67 10.99 8.47

14400 1200 800 32.16 25.44 21.28 14.48 12.56 9.68

16200 1350 900 36.18 28.62 23.94 16.29 14.13 10.89

18000 1500 1000 40.20 31.80 26.60 18.10 15.70 12.10

19800 1650 1100 44.22 34.98 29.26 19.91 17.27 13.31

21600 1800 1200 48.24 38.16 31.92 21.72 18.84 14.52

23400 1950 1300 52.26 41.34 34.58 23.53 20.41 15.73

25200 2100 1400 56.28 44.52 37.24 25.34 21.98 16.94

27000 2250 1500 60.30 47.70 39.90 27.15 23.55 18.15

28800 2400 1600 64.32 50.88 42.56 28.96 25.12 19.36

30600 2550 1700 68.34 54.06 45.22 30.77 26.69 20.57

32400 2700 1800 72.36 57.24 47.88 32.58 28.26 21.78

34200 2850 1900 76.38 60.42 50.54 34.39 29.83 22.99

36000 3000 2000 80.40 63.60 53.20 36.20 31.40 24.20

37800 3150 2100 84.42 66.78 55.86 38.01 32.97 25.41

39600 3300 2200 88.44 69.96 58.52 39.82 34.54 26.62

41400 3450 2300 92.46 73.14 61.18 41.63 36.11 27.83

43200 3600 2400 96.48 76.32 63.84 43.44 37.68 29.04

45000 3750 2500 100.50 79.50 66.50 45.25 39.25 30.25

46800 3900 2600 104.52 82.68 69.16 47.06 40.82 31.46

48600 4050 2700 108.54 85.86 71.82 48.87 42.39 32.67

50400 4200 2800 112.56 89.04 74.48 50.68 43.96 33.88

52200 4350 2900 116.58 92.22 77.14 52.49 45.53 35.09

54000 4500 3000 120.60 95.40 79.80 54.30 47.10 36.30

55800 4650 3100 124.62 98.58 82.46 56.11 48.67 37.51

57600 4800 3200 128.64 101.76 85.12 57.92 50.24 38.72

59400 4950 3300 132.66 104.94 87.78 59.73 51.81 39.93

61200 5100 3400 136.68 108.12 90.44 61.54 53.38 41.14

63000 5250 3500 140.70 111.30 93.10 63.35 54.95 42.35

64800 5400 3600 144.72 114.48 95.76 65.16 56.52 43.56

66600 5550 3700 148.74 117.66 98.42 66.97 58.09 44.77

68400 5700 3800 152.76 120.84 101.08 68.78 59.66 45.98

70200 5850 3900 156.78 124.02 103.74 70.59 61.23 47.19

72000 6000 4000 160.80 127.20 106.40 72.40 62.80 48.40

73800 6150 4100 164.82 130.38 109.06 74.21 64.37 49.61

75600 6300 4200 168.84 133.56 111.72 76.02 65.94 50.82

77400 6450 4300 172.86 136.74 114.38 77.83 67.51 52.03

30

Disability

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

RUSK INDEPENDENT SCHOOL DISTRICT

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

Product: Educator Select Income Protection Plan

Plan A

Injury - ADEAII Duration of Benefits Sickness - 5YR Duration of Benefits

Elimination Period (Days)

Injury (Days) 0* 14* 30* 60 90 180

Sickness (Days) 7* 14* 30* 60 90 180

Annual Earnings

Monthly Earnings

Maximum Monthly Benefit

79200 6600 4400 176.88 139.92 117.04 79.64 69.08 53.24

81000 6750 4500 180.90 143.10 119.70 81.45 70.65 54.45

82800 6900 4600 184.92 146.28 122.36 83.26 72.22 55.66

84600 7050 4700 188.94 149.46 125.02 85.07 73.79 56.87

86400 7200 4800 192.96 152.64 127.68 86.88 75.36 58.08

88200 7350 4900 196.98 155.82 130.34 88.69 76.93 59.29

90000 7500 5000 201.00 159.00 133.00 90.50 78.50 60.50

91800 7650 5100 205.02 162.18 135.66 92.31 80.07 61.71

93600 7800 5200 209.04 165.36 138.32 94.12 81.64 62.92

95400 7950 5300 213.06 168.54 140.98 95.93 83.21 64.13

97200 8100 5400 217.08 171.72 143.64 97.74 84.78 65.34

99000 8250 5500 221.10 174.90 146.30 99.55 86.35 66.55

100800 8400 5600 225.12 178.08 148.96 101.36 87.92 67.76

102600 8550 5700 229.14 181.26 151.62 103.17 89.49 68.97

104400 8700 5800 233.16 184.44 154.28 104.98 91.06 70.18

106200 8850 5900 237.18 187.62 156.94 106.79 92.63 71.39

108000 9000 6000 241.20 190.80 159.60 108.60 94.20 72.60

109800 9150 6100 245.22 193.98 162.26 110.41 95.77 73.81

111600 9300 6200 249.24 197.16 164.92 112.22 97.34 75.02

113400 9450 6300 253.26 200.34 167.58 114.03 98.91 76.23

115200 9600 6400 257.28 203.52 170.24 115.84 100.48 77.44

117000 9750 6500 261.30 206.70 172.90 117.65 102.05 78.65

118800 9900 6600 265.32 209.88 175.56 119.46 103.62 79.86

120600 10050 6700 269.34 213.06 178.22 121.27 105.19 81.07

122400 10200 6800 273.36 216.24 180.88 123.08 106.76 82.28

124200 10350 6900 277.38 219.42 183.54 124.89 108.33 83.49

126000 10500 7000 281.40 222.60 186.20 126.70 109.90 84.70

127800 10650 7100 285.42 225.78 188.86 128.51 111.47 85.91

129600 10800 7200 289.44 228.96 191.52 130.32 113.04 87.12

131400 10950 7300 293.46 232.14 194.18 132.13 114.61 88.33

133200 11100 7400 297.48 235.32 196.84 133.94 116.18 89.54

135000 11250 7500 301.50 238.50 199.50 135.75 117.75 90.75

31

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.

PHILADELPHIA AMERICAN YOUR BENEFITS PACKAGE



Cancer

A Cancer Expense Program A supplemental cancer insurance program designed to

protect your savings at the time when you need it the most.

This program helps to cover the costs associated with treating cancer that are not fully reimbursed by your present coverage.

It is a flexible benefit plan that offers you a variety of valuable coverage options.

Summary of Benefits: Cancer Screening Pays a scheduled amount up to $100 per calendar year for each insured person for any one or more of the following cancer screening tests that are performed more than 60 days after the policy effective date.

Mammography Screening

Pap Smear/Thin Prep Pap (test only)

CA125 (blood test for ovarian cancer)

PSA (blood test for prostate)

Hemocult stool specimen

CA 15-3 (blood test for breast cancer)

Flexible Sigmoidoscopy

CEA (blood test for colon cancer)

Colonoscopy

Chest X-ray

Thermography

Serum protein electrophoresis

Biopsy for Skin Cancer

Hospital Confinement: Pays the selected amount for each day of covered hospital confinement. Benefit options:

$150 per day

$250 per day

$350 per day

Experimental Treatment Benefits for experimental treatment are payable on the same basis as any other benefit under this policy.

Chemotherapy, Radiation Treatment, Hormone Therapy, Immunotherapy and Related Services Benefit: This benefit pays for charges incurred, as defined in the rider, up to the benefit amount selected. See the Outline of Coverage for a description of the available options.

Surgical Benefit Pays a scheduled amount for surgical procedures. The maximum amount payable is $10,000 per calendar year per insured person. The maximum amount payable for surgical procedures related to skin cancer is $500 per calendar year per insured person.

Outpatient Surgery Facility Benefit Pays two times the selected daily hospital confinement benefit for covered outpatient surgery in a hospital or free-standing surgical facility. This benefit is not payable for skin cancer.

Second Surgical Opinion Pays up to $250 for the charges incurred for a second surgical opinion.

Home Health Care Services Pays up to $100 per day for charges incurred for services provided at home, not to exceed a maximum of 60 days per calendar year.

Hospice Care Pays up to $100 per day for charges incurred for care provided by a hospice. This benefit is payable for a lifetime maximum of 120 days.

Artificial Limb After amputation, pays up to a lifetime maximum of $2,500 per insured person for an artificial limb and the procedure to affix or implant it.

Additional Benefits Ambulance

Anesthesia

Blood and Blood Plasma

Bone Marrow Donors

Breast Prosthesis/Breast Reconstruction

Durable Medical Equipment

Extended Care Facility

Government or Charity Hospital

Hairpiece

Physical or Speech Therapy

Transportation and Lodging for Insured and Adult Companion

Waiver of Premium

33

Cancer

Specified Disease Benefit Rider 8311N Available for additional premium Benefits for treatment of 24 specified diseases are subject to a lifetime maximum of $50,000 for each insured person. (Maximums vary in Texas) Hospital Confinement Pays $250 per day for each day of covered hospital confinement. Radiation Treatment, Chemotherapy, Hormone Therapy and Immunotherapy Benefit for the Treatment of Specified Disease Pays 50 percent of the charges incurred, as defined in the rider, up to a maximum of $1,200 per calendar month per insured person for covered treatment of a specified disease.

Oral or self-administered chemotherapy, hormone therapy and immunotherapy drugs are limited to 50 percent up to a maximum of $300 for each filled prescription.

Internal Cancer First Occurrence Benefit Rider 8288N Available for additional premium Pays the first time an insured person has been diagnosed as having internal cancer. Benefit Options:

$2,500

$5,000

Hospital Intensive Care Confinement Benefit Rider 8290N Available for additional premium Pays for each day beginning with the first day of confinement in an Intensive Care Unit (ICU) of a hospital as the result of any sickness or any accident. Benefit Options:

$300 per day

$600 per day Pays $150 for each day of confinement in a sub-acute ICU, if confinement immediately follows an ICU confinement. Pays $150 per day for confinement in a regular hospital room if the confinement was immediately preceded by an ICU confinement, or by sub-acute intensive care confinement which was immediately preceded by an ICU confinement. The number of days paid will not exceed the number of covered days of hospital ICU confinement. Total benefits for any one period of confinement are limited to 30 days.

Ambulance Benefit Pays the ambulance charges incurred per trip to transfer an insured person to the hospital for an ICU confinement. This ambulance benefit is limited to $5,000 per calendar year per insured person. All ICU benefits under this rider reduce 50 percent after an insured person is age 70 or older.

34

Cancer

INDIVIDUAL

Non‐Tobacco Rates Tobacco Rates

Issue Age

$150 Daily $250 Daily $350 Daily Issue Age

$150 Daily $250 Daily $350 Daily

Base Policy with 8306N and 8311N $2500 First Occurrent Rider 8288N

18‐49 $18.65 $20.27 $22.50 18‐49 $20.51 $22.30 $24.75

50‐64 $36.34 $39.51 $43.87 50‐64 $39.99 $43.48 $48.27

Base Policy with 8306N and 8311N $2500 First Occurrent Rider 8288N/$600 ICU Rider 8209N

18‐49 $23.16 $24.78 $27.01 18‐49 $25.47 $27.26 $29.71

50‐64 $45.14 $48.31 $52.67 50‐64 $49.67 $53.16 $57.95

SINGLE-PARENT FAMILY


Issue Age




18‐49 $23.45 $25.48 $28.33 18‐49 $25.80 $28.03 $31.16

50‐64 $45.73 $49.69 $55.24 50‐64 $50.31 $54.67 $60.76


18‐49 $29.47 $31.50 $34.35 18‐49 $32.42 $34.65 $37.78

50‐64 $57.46 $61.42 $66.97 50‐64 $63.21 $67.57 $73.66

FAMILY


Issue Age




18‐49 $31.67 $34.31 $37.96 18‐49 $34.83 $37.74 $41.76

50‐64 $61.77 $66.91 $74.04 50‐64 $80.60 $86.26 $94.10


18‐49 $40.31 $42.95 $46.60 18‐49 $44.34 $47.25 $51.27

50‐64 $78.63 $83.77 $90.90 50‐64 $99.15 $104.81 $112.65

35

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

THE HARTFORD YOUR BENEFITS PACKAGE



Voluntary Group Term Life and AD&D

Benefit Highlights Rusk ISD

What is Voluntary Life Insurance?

Voluntary Life Insurance is coverage that you pay for. Voluntary Life Insurance pays your beneficiary (please see below) a benefit if you die while you are covered. This highlight sheet is an overview of your Voluntary Life Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail.

Am I eligible? You are eligible if you are an active full time employee who works at least 20 hours per week on a regularly scheduled basis.

When is it effective? Coverage goes into effect subject to the terms and conditions of the policy. You must be actively at work with your employer on the day your coverage takes effect.

How much Voluntary Life Insurance can I purchase?

You can purchase Voluntary Life Insurance in increments of $10,000. The maximum amount you can purchase cannot be more than the lesser of 7 times your annual Earnings or $500,000. Annual Earnings are as defined in The Hartford’s contract with your employer.

Am I guaranteed coverage?

If you are newly eligible and elect an amount that exceeds the guaranteed issue amount of $150,000, you will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you were previously eligible and are electing coverage for the first time or electing to increase your current coverage, you will need to provide evidence of insurability that is satisfactory to The Hartford before coverage can become effective.

What is a beneficiary?

Your beneficiary is the person (or persons) or legal entity (entities) who receives a benefit payment if you die while you are covered by the policy. You must select your beneficiary when you complete your enrollment application; your selection is legally binding.

Are there other limitations to enrollment?

If you do not enroll within 31 days of your first day of eligibility, you will be considered a late entrant. Typically, late entrants may need to show evidence of insurability and may be responsible for the cost of physical exams or other associated costs if they are required. This coverage, like most group benefit insurance, requires that a certain percentage of eligible employees participate. If that group participation minimum is not met, the insurance coverage that you have elected may not be in effect.

Spouse Voluntary Life Insurance

If you elect Voluntary Life Insurance for yourself, you may choose to purchase Spouse Voluntary Life Insurance in increments of $5,000, to a maximum of $100,000. Coverage cannot exceed 50% of the amount of your Employee voluntary/supplemental life insurance coverage. You may not elect coverage for your spouse if they are in active full-time military service or is already covered as an employee under this policy. If your spouse is confined in a hospital or elsewhere because of disability on the date his or her insurance would normally have become effective, coverage (or an increase in coverage) will be deferred until that dependent is no longer confined and has performed all the normal activities of a healthy person of the same age for at least 15 consecutive days. If you are newly eligible and elect an amount that exceeds the guaranteed issue amount of $50,000, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you were previously eligible and are electing coverage for the first time or electing to increase your spouse's current coverage, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before coverage can become effective .

37


Child(ren) Voluntary Life Insurance

If you elect Voluntary Life Insurance for yourself, you may choose to purchase Child(ren) Voluntary Life Insurance coverage in the amount(s) of $10,000 for each child – no medical information is required.

If your dependent child(ren) is confined in a hospital or elsewhere because of disability on the date his or her insurance would normally have become effective, coverage (or an increase in coverage) will be deferred until that dependent is no longer confined and has performed all the normal activities of a healthy person of the same age for at least 15 consecutive days.

Does my coverage reduce as I get older? By 35% @ 70, 55% of Original @ 75, 70% of Original @ 80, 80% of Original @ 85, 85% of Original @ 90. All coverage cancels at retirement.

Can I keep my life coverage if I leave my employer?

Yes, subject to the contract, you have the option of:

Converting your group life coverage to your own individual policy (policies).

If you leave your employer, portability is an option that allows you to continue your life insurance coverage. To be eligible, you must terminate your employment prior to Social Security Normal Retirement Age. This option allows you to continue all or a portion of your life insurance coverage under a separate portability term policy. Portability is subject to a minimum of $5,000 and a maximum of $250,000 and does include coverage for your spouse and child(ren). To elect portability, you must apply and pay the premium within 31 days of the termination of your life insurance. Evidence of insurability will not be required.

Dependent spouse portability is subject to a maximum of $50,000. Dependent child(ren) portability is subject to a maximum of $10,000.

What is the living benefits option? If you are diagnosed as terminally ill with a 12 month life expectancy, you may be eligible to receive payment of a portion of your life insurance. The remaining amount of your life insurance would be paid to your beneficiary when you die.

Do I still pay my life insurance premiums if I become disabled?

If you become totally disabled before age 60 and your disability lasts for at least 9 months, your life insurance premium may be waived. The premium for your dependent’s coverage will also be waived if you are disabled and approved for waiver of premium. Coverage for your dependents will end if the policy terminates.

Important Details

As is standard with most term life insurance, this insurance coverage includes certain limitations and exclusions:

the amount of your coverage may be reduced when you reach certain ages.

death by suicide (two years). Other exclusions may apply depending upon your coverage. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail. This benefit highlights sheet is an overview of the insurance being offered and is provided for illustrative purposes only and is not a contract. It in no way changes or affects the policy as actually issued. Only the insurance policy issued to the policyholder (your employer) can fully describe all of the provisions, terms, conditions, limitations and exclusions of your insurance coverage. In the event of any difference between the benefit highlights sheet and the insurance policy, the terms of the insurance policy apply.

38


$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $100,000

Age Band

0-24 $0.40 $0.80 $1.20 $1.60 $2.00 $2.40 $2.80 $3.20 $4.00

25-29 $0.40 $0.80 $1.20 $1.60 $2.00 $2.40 $2.80 $3.20 $4.00

30-34 $0.50 $1.00 $1.50 $2.00 $2.50 $3.00 $3.50 $4.00 $5.00

35-39 $0.70 $1.40 $2.10 $2.80 $3.50 $4.20 $4.90 $5.60 $7.00

40-44 $1.10 $2.20 $3.30 $4.40 $5.50 $6.60 $7.70 $8.80 $11.00

45-49 $1.80 $3.60 $5.40 $7.20 $9.00 $10.80 $12.60 $14.40 $18.00

50-54 $3.00 $6.00 $9.00 $12.00 $15.00 $18.00 $21.00 $24.00 $30.00

55-59 $4.70 $9.40 $14.10 $18.80 $23.50 $28.20 $32.90 $37.60 $47.00

60-64 $6.20 $12.40 $18.60 $24.80 $31.00 $37.20 $43.40 $49.60 $62.00

65-69 $9.90 $19.80 $29.70 $39.60 $49.50 $59.40 $69.30 $79.20 $99.00

70-74 $17.40 $34.80 $52.20 $69.60 $87.00 $104.40 $121.80 $139.20 $174.00

75+ $31.50 $63.00 $94.50 $126.00 $157.50 $189.00 $220.50 $252.00 $315.00

Employee Life Rates

Spouse Life Rates

Child Life Rates $10,000 $1.25 Per Child Unit

AD&D Rates

NOTE: FINAL RATES MAY VARY SLIGHTLY DUE TO ROUNDING. THESE GRIDS ARE PRICES OF FREQUENTLY SELECTED AMOUNTS. YOU MAY CHOOSE SEE YOUR PLAN ADMINISTRATOR FOR DETAILS OF COVERAGES. TO PURCHASE AN AMOUNT OTHER THAN THOSE LEVELS INDICATED ABOVE, SIMPLY ADD RATES TOGETHER FROM COLUMNS TO EQUAL AMOUNT ELECTED (I.E ELECTION $170,000, TAKE THE RATE FOR 100K IN YOUR AGE-BRACKET & YOUR AGE-BRACKET RATE FROM THE 70K COLUMN AND ADD TOGETHER, THAT WILL BE THE MONTHLY PREMIUM RATE)

$5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $50,000

Age Band

0-24 $0.30 $0.60 $0.90 $1.20 $1.50 $1.80 $2.10 $2.40 $3.00

25-29 $0.30 $0.60 $0.90 $1.20 $1.50 $1.80 $2.10 $2.40 $3.00

30-34 $0.35 $0.70 $1.05 $1.40 $1.75 $2.10 $2.45 $2.80 $3.50

35-39 $0.50 $1.00 $1.50 $2.00 $2.50 $3.00 $3.50 $4.00 $5.00

40-44 $0.75 $1.50 $2.25 $3.00 $3.75 $4.50 $5.25 $6.00 $7.50

45-49 $1.15 $2.30 $3.45 $4.60 $5.75 $6.90 $8.05 $9.20 $11.50

50-54 $1.85 $3.70 $5.55 $7.40 $9.25 $11.10 $12.95 $14.80 $18.50

55-59 $2.90 $5.80 $8.70 $11.60 $14.50 $17.40 $20.30 $23.20 $29.00

60-64 $3.85 $7.70 $11.55 $15.40 $19.25 $23.10 $26.95 $30.80 $38.50

65-69 $6.10 $12.20 $18.30 $24.40 $30.50 $36.60 $42.70 $48.80 $61.00

70-74 $10.70 $21.40 $32.10 $42.80 $53.50 $64.20 $74.90 $85.60 $107.00

75+ $19.35 $38.70 $58.05 $77.40 $96.75 $116.10 $135.45 $154.80 $193.50

$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $100,000

EMPLOYEE $0.25 $0.50 $0.75 $1.00 $1.25 $1.50 $1.75 $2.00 $2.50

FAMILY $0.40 $0.80 $1.20 $1.60 $2.00 $2.40 $2.80 $3.20 $4.00

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



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 claim FAQs

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

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-roll $500. 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/ruskisd

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-roll $500. Remember to retain all your receipts (including receipts for card swipes).

How Do I File A Claim? In most situations, you will be able to swipe your card however, in the event you lose your card or are waiting to receive one, you can visit www.mybenefitshub.com/ruskisd 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. If you choose to enroll in the HSA you are not eligible to enroll in the FSA.

43

NOTES

44

NOTES

45

www.mybenefitshub.com/ruskisd

46

Documents

2016 Benefit Guide - Rusk ISD