C-6 School District. A National District of Character Twelve Years of Distinction in Performance

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1 C-6 School District Achievement Character Excellence A National District of Character Twelve Years of Distinction in Performance What s Inside Benefits Overview 2014 This brochure provides an overview of your benefit options. If you have any questions after you enroll, please call the carriers directly or log on to their Web sites. See the table below for each carrier s contact information: Benefit Contact Telephone Web Address Medical United HealthCare Insurance Company Medical Customer Service Dental Delta Dental of Missouri Basic Life and AD&D (employer paid) Metropolitan Life Insurance Company Claims questions Conversion questions Telemedicine Ameridoc Voluntary Vision Superior Vision Voluntary Term Life/AD&D Eligibility Responsibility Honesty Unum You are eligible for Fox C-6 School District benefits on the first day of the month following employment if you are a benefit eligible employee. Dependent Eligibility You may enroll your eligible dependents in the same plans you choose for yourself. Eligible dependents include your legal spouse and your children up to age 26. How and When to Enroll You can enroll for coverage within 31 days of your eligibility date or during the annual Open Enrollment period. If you do not enroll for coverage within 31 days of your eligibility date, you will not receive health coverage during the plan year unless you experience a qualified change in family status, such as marriage, divorce, birth of a child, or loss of other health coverage. Service If you experience a qualifying event, you must enroll within 31 days after the event. Integrity Learning Respect If you are enrolling during the Open Enrollment period, any changes you make will go into effect on October 1, 2014.

2 Medical See the table below for a comparison of medical plan features: Medical Plans at a Glance Calendar Year Deductible Pocket Maximum Lifetime Maximum Office Visit Primary Care Specialist Preventive Care (As required by ACA) Emergency Room Urgent Care Center Convenience Care Clinic Outpatient Hospital Services Inpatient Hospital Services Outpatient Mental Health Inpatient Mental Health Eye Exam (one per calendar year) Choice Plus Buy-Up Plan Choice Plus Base Plan Choice Plus HSA Plan In- $300 individual $600 family $1,800 individual $3,600 family $600 individual $1,200 family $3,600 individual $7,200 family In- $1,500 individual $3,000 family $4,000 individual $8,000 family $3,000 individual $6,000 family $8,000 individual $16,000 family In- $2,400 individual $4,800 family $6,000 individual $12,000 family $4,800 individual $9,600 family $12,000 individual $24,000 family Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited $20 copay $30 copay No copay (100%) $150 copay; $150 copay; $20 copay $30 copay No copay (100%) $300 copay; 100% $300 copay; ; ; $25 copay $75 copay $20 copay $20 copay 90% 90% $30 copay $30 copay 90% $20 copay $20 copay

3 Medical Plans at a Glance Prescription Drugs: Retail (up to a 31-day supply) Tier 1 Tier 2 Tier 3 Prescription Drugs: Mail Order (up to a 90-day supply) Tier 1 Tier 2 Tier 3 Choice Plus Buy-Up Plan Choice Plus Base Plan Choice Plus HSA Plan In- $10 $30 $50 $25 $75 $125 n/a In- $15 $35 $60 $37.50 $87.50 $ n/a In- For a detailed summary of plan features, please refer to the Summary Plan Description located on the School District s intranet. Dental Delta Dental offers employees a choice of two plan options - the Delta Dental Traditional option, and the Delta Dental In- Only option. Employees can choose either plan at Open Enrollment. Please see the table below for a comparison of dental plan features: Dental Plans at a Glance Delta Dental Traditional Plan Delta Dental In- Only Plan In- (In- Only) Annual Deductible (waived for Preventive Services) $50 individual $150 family $50 individual $150 family Calendar Year Maximum $1,250 $1,250 Preventive Services (e.g., X-rays, cleanings, exams) 100% 100% 100% Basic Services (e.g., fillings, extraction) 85% Major Services (e.g., dentures, crowns, bridges) 60% 60% Orthodontic Services Adult Child $1,250 $1,250 n/a

4 Life and Accidental Death and Dismemberment Insurance Fox C-6 School District provides you with employee life and accidental death and dismemberment (AD&D) insurance at no cost to you. You automatically receive life and AD&D coverage in the amount of $40,000. Optional Life Insurance You can purchase additional life insurance for yourself in a multiple of $10,000 up to a benefit maximum of $500,000 or five times your basic annual earnings, whichever is less.* You can purchase additional life insurance for your spouse and/or children. Spouse: Up to 100% of employee amount in increments of $5,000. Not to exceed $500,000. Child(ren): Up to 100% of employee coverage amount in increments of $2,000. Not to exceed $10,000. Voluntary Accidental Death and Dismemberment Insurance You can purchase additional life insurance for yourself and your eligible dependents in the amounts shown below:* Employee: Multiple of $10,000 up to 5 times your basic annual earnings or $500,000, whichever is less Spouse: Up to 100% of employee amount in increments of $5,000. Not to exceed $500,000. Child(ren): Up to 100% of employee coverage amount in increments of $2,000. Not to exceed $10,000. Please note: Evidence of Insurability may be required prior to approval of Optional Life Insurance. *If you are enrolling due to a qualifying event, you must enroll within 31 days of the event. This communication highlights some of your Fox C-6 School District benefit plans. Your actual rights and benefits are governed by the official plan documents. If any discrepancy exists between this communication and the official plan documents, the plan documents will prevail. Fox C-6 School District reserves the right to change any benefit plan without notice. Benefits are not a guarantee of employment Communication Partners, Inc.

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6 C-6 School District A National District of Character Twelve Years of Distinction in Performance FOX C-6 SCHOOL DISTRICT HEALTH INSURANCE MONTHLY RATES Effective MEDICAL INSURANCE RATES Buy-Up Plan Base Plan HSA Plan Employee Only $ $ $ Employee/Spouse $ $ $ Employee/(1) Child $ $ $ Employee/Children $ $ $ Employee/Spouse/(1) Child $ $ $ Family $1, $ $ The District is contributing 100% of the monthly subsidized Base Plan Employee Only rate ($ Full Board Paid) toward the cost of Medical Insurance for 12-Month Employees, Certified Staff, Teacher Assistants, Secretaries, and Nurses. EMPLOYEE CONTRIBUTIONS (FULL BOARD PAID EMPLOYEES) Buy-Up Plan Base Plan *HSA Plan Employee Only $ $0.00 ($57.00) Employee/Spouse $ $ $ Employee/(1) Child $ $ $ Employee/Children $ $ $ Employee/Spouse/(1) Child $ $ $ Family $ $ $ *Employees selecting the HSA plan and enrolling in Employee Only coverage will have $57.00 to use for deposit into a Health Savings Account (HSA). The District is contributing $ Partial Board-Paid amount toward the cost of the Medical Insurance for all full time employees in Character Kids Club, Transportation, Food Service, and Aides. EMPLOYEE CONTRIBUTIONS (PARTIAL BOARD PAID EMPLOYEES) Buy-Up Plan Base Plan *HSA Plan Employee Only $ $ $46.12 Employee/Spouse $ $ $ Employee/(1) Child $ $ $ Employee/Children $ $ $ Employee/Spouse/(1) Child $ $ $ Family $ $ $ DENTAL INSURANCE RATES Delta Dental Traditional Plan Delta Dental In- Only Plan Employee $30.86 $26.68 Employee/Spouse $61.64 $53.26 Employee/Children $85.40 $73.80 Family $94.84 $81.96 Employees can choose either plan at Open Enrollment. Effective October 1, 2014, the District pays $26.68 toward the cost of dental coverage for all full time staff. PLEASE CONTACT RHONDA MIJANGOS AT FOR ADDITIONAL INSURANCE INFORMATION