Employee Benefit Guid EFFECTIVE 0 /01/ /31/201.

Transcription

1 Employee Benefit Guid EFFECTIVE 0 /01/ /31/201

2 Table of Contents 1 Contact Information 2 Online Benefit Enrollment 3-6 Employee Guide to Enroll in Benefits 7-8 Summary of Benefits 9-14 Cigna Dental 15 Superior Vision Cigna Short-Term Disability Cigna Long-Term Disability American Public Life Cancer American Public Life Accident American Public Life MEDLink Cigna Basic/Voluntary Life & AD&D Texas Life Permanent Life ID Watchdog ID Theft Protection 44 MDLIVE Telehealth NBS Flexible Spending Accounts HSA Bank Health Savings Accounts Benefit Contact Information Refer to this list when you need to contact one of your benefit providers. For general information, please contact your Benefits Department, Financial Benefit Services, or log on to Program Vendor Phone Number Website/ ESC Region 20 BC Benefits Financial Benefit Services (800) Dental Cigna (800) Group # Vision Superior Vision (800) Group #28888 Short-Term Disability Cigna (800) Group #VDT File A Claim (800) Long-Term Disability Cigna (800) Group #VDT File A Claim (800) Cancer American Public Life (800) Group #13309 Accident American Public Life (800) Group #13309 MEDLink American Public Life (800) Group #15304 Life and AD&D Cigna (800) Life Group #FLX AD&D Group #OK Permanent Life Texas Life (800) Identity Theft Protection ID Watchdog (800) Telehealth MDLIVE (888) Flexible Spending Accounts National Benefit Services (800) Health Savings Accounts HSA Bank (800) Page 1

3 Online Benefit Enrollment For benefit information and to enroll go to: 1 If you have trouble logging in, click on the Login Help Video for assistance. 2 Passwords All passwords have been RESET to the default described below: 3 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. Default Password: Last Name* (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number. Example) George Washington Username: washing1234 Password: washington1234 Enrollment Instructions Example) John Smith Username: smithj4321 Password: smith4321 Click on Enrollment Instructions for more information about how to enroll. Page 2

4 9/01/2014-8/31/2015 Annual Benefit Enrollment ESC 20 BC Enrollment is from 8/1/2014 through 8/31/2014 Benefit Updates - What s New: Benefit elections will become effective 9/1/2014 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. Changes must be made within 30 days of event. If you currently participate in a Health Care or Dependent Care Flexible Spending Account, you MUST re-elect a new contribution amount every year to continue to participate. Texas Life Permanent Life Insurance is now available. This plan is a whole life policy and provides a level benefit to age 121. Don t Forget! TRS Medical coverage is now enrolled in THEbenefitsHUB. Aetna is the new provider for TRS ActiveCare. Three plans are available: ActiveCare 1-HD, ActiveCare Select, and ActiveCare 2. ActiveCare 3 is no longer available. Employees are now able to enroll in a Health Savings Account (HSA) through HSABank. Health Savings Accounts are only available to employees enrolled in the high deductible health plan offered by your district. Teleheath by MDLIVE is now available. MDLIVE gives you access to telephone consultations with a licensed physician for evaluation, diagnosis, and prescription medication, as appropriate, for minor illnesses. Employees and dependents do not have to enroll in a TRS medical plan to enroll in this benefit. Login and complete your benefit enrollment from 8/1/2014 8/31/2014. ENROLLMENT ASSISTANCE: Call Financial Benefit Services at to speak to a representative. Employees have access to licensed insurance agents Monday-Friday during the month of August. Bilingual agents are also available for assistance in Spanish. Update your profile information: home address, phone numbers, . Update dependent social security numbers and student status for college aged children. ESC Region 20 Benefits Cooperative HUB: Benefit Information access / Online Enrollment Access / FBS Contact Information Page 3

5 Section 125 Cafeteria Plan Guidelines 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 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. Changes In Status (CIS): Marital Status Change in Number of Tax Dependents Qualifying Events A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states). 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 Change in employment status of the employee, or a spouse or dependent of the Employment Affecting employee, that affects the individual's eligibility under an employer's plan includes Coverage Eligibility commencement or termination of employment. Gain/Loss of An event that causes an employee's dependent to satisfy or cease to satisfy coverage Dependents' Eligibility requirements under an employer's plan may include change in age, student, marital, Status employment or tax dependent status. Judgment/Decree/ Order Eligibility for Government Programs 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. Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Page 4

6 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 2014 benefits become effective on September 1, 2014, you must be actively-at-work on September 1, 2014 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, up to the maximum age listed below. Plan Carrier Maximum Age Dental Cigna 26 Vision Block Vision 26 Cancer American Public Life 25 Accident Loyal American 21 (25 if Full-Time Student) Voluntary Life Unum 26 ID Theft Protection ID Watchdog 26 Telehealth MD Live 26 MEDlink American Public Life 26 Permanent Life Texas Life 22 If your dependent is disabled, coverage can continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician s statement confirming your dependent s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. Page 5

7 Annual Enrollment During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year 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 30 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 for assistance. Where can I find forms? For benefit summaries and claim forms, go to your school district s benefit website: 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: 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. Page 6

8 Benefit Summary Dental Insurance by Cigna Dental Insurance by CIGNA: Three plans are offered through the ESC-20 Benefits Cooperative: High Option PPO, Low Option PPO, and DHMO. High Option PPO - This plan has a $50 deductible for individuals and a $150 deductible for families. Class I expenses are covered 100%, Class II services are covered 80%, and Class III and Orthodontia (to age 19) are covered 50%. Low Option PPO - This plan has a $50 deductible for individuals and a $150 deductible for families. Class I expenses are covered 100%, Class II services are covered 60%, and Class III are covered 40%. DHMO - This plan requires the selection of a primary care dentist. No benefits are payable if you visit a dentist that is not your primary care dentist or one that is out-of-network. This plan offers benefits through a network of dentists and charges co-pays for services. Vision Insurance by Superior Vision Members pay a co-pay for in-network benefits. A member must file for allowable reimbursement with Superior Vision for Out-of-network vision services. The in-network exam co-pay is $10.00 and the Materials co-pay is $ Exams and lenses (within plan allowance) are covered in-network with a co-pay, once every 12 months. Frames in-network are paid up to $125 every 24 months. Short-Term Disability Insurance by Cigna There are 14 and 30 day elimination period options. Coverage can be selected up to 60% of weekly earnings to a maximum of $1,385 per week. All new or increases in coverage are subject to pre-existing condition exclusions. Long-Term Disability Insurance by Cigna Designed to provide a monthly income to an individual that is disabled due to an accident or illness. There are 90 and 180 day elimination periods available. Coverage can be selected up to 60% of you monthly income up to $6,000 per month. All new or increases in coverage are subject to pre-existing condition exclusions. Cancer Insurance by American Public Life Cancer insurance is designed to be a supplement and pays for many costs not covered by your medical insurance. There are 4 plan options. All plans reimburse up to $50 per calendar year for Diagnostic Testing. There is an optional Intensive Care Rider available. All new or increases in coverage are subject to a 12-month pre-existing condition exclusion. Accident Insurance by American Public Life Plan pays benefit amounts for covered medical expenses as a result of an accident, directly to you! Coverage is available for ages and is portable, you can choose to keep your benefit even if you leave the district or retire. This is only an outline of benefits. If the terms of this benefit summary differ from your policy, the policy will govern. Page 7

9 Benefit Summary MEDLink Insurance by American Public Life This supplemental coverage helps offset out-of-pocket costs you experience due to deductible and coinsurance of your employer s medical plan. The available plan options are based on enrollment in your employer s medical plans. Basic & Voluntary Term Life with AD&D Insurance by Cigna Voluntary term life insurance is available for employees up to the lesser of 7 times salary or $500,000. New hires can elect up to 7 times salary or $200,000 under guarantee issue without having to provide medical history. Coverage for spouses can be up to 100% of the employee election, guarantee issue up to $50,000. There is a flat $10,000 amount available for children. All increases in coverage or new elections are subject to evidence of insurability. Permanent Life Insurance by Texas Life This plan provides a level benefit to age 121. Individual policies can be purchased on the employee, their spouse, children and grandchildren. Identity Theft Protection by IDWatchdog Provides monthly reporting alerts to you and full resolution services are included should your identity ever be compromised while utilizing ID Watchdog s services. ID Watchdog Identity specialists will work on your behalf to resolve issues. Telehealth by MDLIVE This plan allows employees and their household members to call in to a licensed network doctor for non-emergencies such as answers to medical questions and diagnosis for common conditions. Healthcare & Dependent Care FSA by National Benefit Services Tax-sheltered flexible spending accounts allow an individual to set aside dollars to pay for future health care and dependent care expenses. Eligible expenses must be incurred within the plan year and contributions are use it or lose it. The healthcare reimbursement maximum is $2,500/plan year. The dependent care reimbursement maximum is $5,000 if filing married or $2,500 if filing single per plan year. It s Important to Save Your Receipts! The IRS requires the Flex Card only be used for eligible expenses. Most of the time, we can verify the eligibility of the expense automatically. Yet, there are instances when you ll receive a letter asking you to furnish an itemized receipt to verify the expense. Health Savings Accounts by HSA Bank An HSA is a tax free savings account available to employees enrolled in a high deductible health insurance plan. Deposited funds are tax deductible and are used to pay for medical expenses. The annual contribution maximum for 2014 is $3,300 for individual and $6,550 for family. For individuals who are between the ages of 55 and 65, there is an additional catch-up provision of $1,000 that can be contributed annually. This plan is only available for those who are participating in the Active Care 1-HD medical plan. You may not enroll in the MEDlink plan if you participate in the HSA. Depending on your district, you may or may not be able to participate in the FSA plan if you participate in HSA. Current participants of participating districts must complete a transfer form. This is only an outline of benefits. If the terms of this benefit summary differ from your policy, the policy will govern. Page 8

10 Education Service Center Region 20 - High Cigna Dental Choice Benefit Summary Effective 09/01/2013 This is a summary of benefits for your dental plan. All deductibles, plan maximums, and service specific maximums (dollar and occurrence) cross accumulate between in and out of network. Cigna Radius Network Cigna Dental Choice Benefits In-Network Out-of-Network Calendar Year Maximum (Class I, II, and III Expenses) $1500, Class I Applies $1500, Class I Applies Calendar Year Deductible Per Individual $50 $50 Per Family $150 $150 Class I Expenses - Preventive & Diagnostic Care Oral Exams 100%, No Deductible 100%, No Deductible Cleanings Routine X-Rays Fluoride Application Sealants Space Maintainers (limited to non-orthodontic treatment) Non-Routine X-Rays Emergency Care to Relieve Pain Class II Expenses - Basic Restorative Care Fillings 80%, After Deductible 80%, After Deductible Oral Surgery - Simple Extractions Oral Surgery - All Except Simple Extraction Surgical Extraction of Impacted Teeth Anesthetics Class III Expenses - Major Restorative Care Major Periodontics 50%, After Deductible 50%, After Deductible Minor Periodontics Root Canal Therapy / Endodontics Relines, Rebases, and Adjustments Repairs - Bridges, Crowns, and Inlays Repairs - Dentures Crowns / Inlays / Onlays Dentures Bridges Class IV Expenses - Orthodontia Coverage for Eligible Children Only 50%, No Ortho Deductible 50%, No Ortho Deductible Lifetime Maximum $1,000 $1,000 Missing Tooth Provision The amount payable is 50% of the amount otherwise payable until insured for a specified time period; thereafter, considered a Class III expense. Late Entrant Limit Standard None Pretreatment Review Out-of-Network Reimbursement Available on a voluntary basis when extensive work in excess of $200 is proposed. 90th Percentile Student/Dependent Age 26/26 Page 9

11 Cigna Dental Choice / Indemnity Exclusions and Limitations: Procedure Exclusions & Limitations Exams Two per Calendar year Prophylaxis (cleanings) Two per Calendar year Fluoride 1 per calendar year for people under 19 X-Rays (routine) Bitewings: 2 per calendar year X-Rays (non-routine) Full mouth: 1 every 3 calendar years. Panorex: 1 every 3 calendar years 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 Prosthesis Over Implants 1 per every 5 years if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth colored material on molar crowns or bridges. 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 tooth. One treatment per tooth every three years up to age 14 Space Maintainers Limited to non-orthodontic treatment 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 e that will be included as Covered Expenses. 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 * 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. 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 Cigna HealthCare. Cigna is a registered service mark, and the "Tree of Life" logo is a service mark, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its opera All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut Genera Company, Cigna Health and Life Insurance Company, Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Prepared by Underwriting. Cigna Radius Network (P0003 / NS002 DNSP) Page 10

12 Education Service Center Region 20 - Low Cigna Dental Choice Benefit Summary Effective 09/01/2013 This is a summary of benefits for your dental plan. All deductibles, plan maximums, and service specific maximums (dollar and occurrence) cross accumulate between in and out of network. Cigna Radius Network Cigna Dental Choice Benefits In-Network Out-of-Network Calendar Year Maximum (Class I, II, and III Expenses) $750, Class I Applies $750, Class I Applies Calendar Year Deductible Per Individual $50 $50 Per Family $150 $150 Class I Expenses - Preventive & Diagnostic Care Oral Exams 100%, No Deductible 100%, No Deductible Cleanings Routine X-Rays Fluoride Application Sealants Space Maintainers (limited to non-orthodontic treatment) Non-Routine X-Rays Emergency Care to Relieve Pain Class II Expenses - Basic Restorative Care Fillings 60%, After Deductible 60%, After Deductible Oral Surgery - Simple Extractions Class III Expenses - Major Restorative Care Oral Surgery - All Except Simple Extraction 40%, After Deductible 40%, After Deductible Surgical Extraction of Impacted Teeth Anesthetics Major Periodontics Minor Periodontics Root Canal Therapy / Endodontics Relines, Rebases, and Adjustments Repairs - Bridges, Crowns, and Inlays Repairs - Dentures Crowns / Inlays / Onlays Dentures Bridges Class IV Expenses - Orthodontia Not Covered Not Covered Missing Tooth Provision The amount payable is 50% of the amount otherwise payable until insured for a specified time period; thereafter, considered a Class III expense. Late Entrant Limit Standard None Pretreatment Review Out-of-Network Reimbursement Available on a voluntary basis when extensive work in excess of $200 is proposed. 90th Percentile Student/Dependent Age 26/26 Page 11

13 Cigna Dental Choice / Indemnity Exclusions and Limitations: Procedure Exclusions & Limitations Exams Two per Calendar year Prophylaxis (cleanings) Two per Calendar year Fluoride 1 per calendar year for people under 19 X-Rays (routine) Bitewings: 2 per calendar year X-Rays (non-routine) Full mouth: 1 every 3 calendar years. Panorex: 1 every 3 calendar years 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 Prosthesis Over Implants 1 per every 5 years if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth colored material on molar crowns or bridges. 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 tooth. One treatment per tooth every three years up to age 14 Space Maintainers Limited to non-orthodontic treatment 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 e that will be included as Covered Expenses. 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 * 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. 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 Cigna HealthCare. Cigna is a registered service mark, and the "Tree of Life" logo is a service mark, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its opera All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut Genera Company, Cigna Health and Life Insurance Company, Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Prepared by Underwriting. Cigna Radius Network (P0003 / NS002 DNSP) Page 12

14 Cigna Dental Care DHMO 1 Affordable, Easy-to-Use Dental Coverage G1-V8 Under your plan, you have coverage for hundreds of dental procedures. This overview shows you a small sampling of covered services and what you will pay compared to your cost without coverage. See savings below! Review your plan materials to understand how your plan works. For questions on the plan before enrollment, or to ask for a full list of covered services and exclusions and limitations, call Cigna24 ( ) and select the Enrollment Information prompt. Regular dental visits may do more than brighten your smile. Receiving regular dental care often catches minor problems before they become major and more expensive to treat. And there s a link between gum disease and other conditions, such as pre-term birth, heart disease, stroke, diabetes and other health issues. So taking good care of your teeth and gums may help you live a healthier life. Get the most value from your plan Take advantage of your plan s preventive care services most are covered at low cost or no cost to you. Your plan also covers many other dental services that can help you achieve and maintain a healthy mouth. What You ll Pay 2 Sampling of Procedures Cost With Cigna Estimated Cost Without Dental Care Dental Coverage Adult cleaning (Two per calendar year each at $0. $0 $66-$125 each Additional two cleanings available at $45 each) Child cleaning (Two per calendar year each at $0. $0 $49-$93 each Additional two cleanings available at $30 each) Periodic oral evaluation $0 $94-$178 Comprehensive oral evaluation $0 $37-$69 Topical fluoride $0 $57-$108 X-rays - (bitewings) 2 films $0 $26-$49 X-rays - panoramic film $0 $30-$58 Sealant - per tooth $16 $39-$74 Amalgam filling (silver colored) - 2 surfaces $28 $110-$208 Composite filling (tooth-colored) - 1 surface $33 $111-$211 Molar root canal (excluding final restoration) $595 $800-$1,514 Comprehensive orthodontics - child (up to 19th birthday) banding $515 $991-$1,874 Periodontal (gum) scaling & root planing - 1 quadrant $135 $167-$316 Periodontal (gum) maintenance $93 $102-$193 Removal/extraction of erupted tooth $64 $112-$211 Removal/extraction of impacted tooth $300 $349-$660 Crown porcelain fused to high noble metal $450 $797-$1,509 Implant crown porcelain fused to high noble metal crown $780 $1,025-$1,939 1 DHMO is used to refer to product designs that may differ by state of residence of enrollee, including but not limited to prepaid plans, managed care plans, and plans with open access features. 2 Costs listed for the Cigna Dental Care plan do not vary. Estimated costs without dental coverage may vary based on location and dentists' actual charges. These estimated costs are based on charges submitted to Cigna in 2010 and are intended to reflect national average charges as of January 2013 assuming an annual cost increase of three percent. Estimates have been adjusted to reflect the 2010 Cigna DHMO geographical membership distribution. DFO Standard 08 Page a

15 know what s important to you Key Plan Features There is a $5 office visit fee associated with your plan. No deductibles you don t have to reach a certain level of out-of-pocket expenses before your insurance kicks in. No dollar maximums you don t have to worry about your coverage running out after your covered expenses reach a certain dollar amount. Easy to understand plan the fees you pay your dentist are clearly listed on your Patient Charge Schedule (PCS). There are no claim forms to file and no waiting periods for coverage. The network general dentist you choose will manage your overall dental care. Covered family members can choose their own network general dentists near home, work or school. You don t need a referral for children under seven to visit a network pediatric dentist. And you don t need a referral to see a network orthodontist. There s no age limit on sealants, which help prevent tooth decay. Your plan covers procedures to detect oral cancer in its early stages. 24/7 access to the Dental Information Line this line will be staffed by trained health care professionals who can answer questions about dental treatment and clinical symptoms. Finding a network dentist is easy. There are several ways to choose your network general dentist: Find a dentist at Cigna.com. Our online dental directory is updated weekly. Call Cigna24 ( ) to speak to a Customer Service representative. Our representatives can send you a customized dental directory listing via . make sure you read this important information What s covered You can save money on a wide range of services, including: Preventive care cleanings, fluoride, sealants, bitewing X-rays, full mouth X-rays, and more Basic care tooth-colored fillings (called resin or composite) and silver-colored fillings (called amalgam) Major services crowns, bridges, and dentures (including those placed over implants), root canals, oral surgery, extractions, treatment for periodontal (gum) disease, and more. Specialty care at the same fee as general care, with an approved referral Orthodontic care braces for children and adults General anesthesia when medically necessary Teeth whitening using take home bleaching trays and gel Age and frequency limitations may apply to some covered services. Review the rest of your enrollment materials for more details What s not covered* Your dental plan covers services that can help you maintain a healthy mouth and treat or manage dental conditions. But no plan covers everything. Here are some examples of services not covered: Services provided by a non-network dentist without prior approval from Cigna Dental (except emergencies) 3 Replacement of fixed or removable bridges, dentures and orthodontic retainers that are lost, stolen, or damaged due to patient abuse, misuse or neglect Cosmetic dentistry unless specifically listed on your PCS Dental implant surgery or services associated with placement, repair removal, or restoration of a dental implant *This is not a complete list. For a complete list of services not covered, refer to the rest of your enrollment materials or call Cigna24 ( ) if you have questions or need more information. 3 Minnesota and Oklahoma residents: See the enclosed brochure for information on your out of network coverage. The term DHMO is used to refer to product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans, managed care plans, and plans with open access features. Cigna is a registered service mark and the Tree of Life logo, GO YOU and Cigna Dental are 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 2011 Health Cigna and Life Insurance Company ( CHLIC ), Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. ( CDHI ) and its subsidiaries. Cigna DHMO plans are provided 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.; 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 DHMO plans are underwritten by CGLIC, CHLIC, or Cigna HealthCare of Connecticut, Inc., and administered by CDHI. Page 14

16 Benefits Vision Plan Benefits for ESC-20 Benefit Cooperative Co-Pays Services/Frequency Exam $10 Exam 12 months Materials 1 $25 Frame Contact Lens Fitting $25 Contact Lens Fitting 12 months (standard & specialty) Lenses 12 months In-Network Contact Lenses 12 months (Based on date of service) Out-of-Network Exam (Ophthalmologist) Covered in full Up to $42 retail Exam (Optometrist) Covered in full Up to $37 retail Frames $125 retail allowance Up to $68 retail Contact Lens Fitting (standard 2 ) Covered in full Not covered Contact Lens Fitting (specialty 2 ) $50 retail allowance Not covered Lenses (standard) per pair Single Vision Covered in full Up to $32 retail Bifocal Covered in full Up to $46 retail Trifocal Covered in full Up to $61 retail Progressive lens upgrade See description 3 Up to $61 retail Contact Lenses 4 $120 retail allowance Up to $100 retail Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1 Materials co-pay applies to lenses and frames only, not contact lenses 2 See your benefits materials for definitions of standard and specialty contact lens fittings 3 Covered to provider s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 4 Contact lenses are in lieu of eyeglass lenses and frames benefit Discount Features Look for providers in the Provider Directory who accept discounts, as some do not; please verify their services and discounts (range from 10%-40%) prior to service as they vary. Discounts on Covered Materials Frames: Lens options: Progressives: 20% off amount over allowance 20% off retail 20% off amount over retail lined trifocal lens, including lens options The following options have out-of-pocket maximums 5 on standard (not premium, brand, or progressive) lenses. Maximum Member Out-of-Pocket Single Vision Bifocal & Trifocal Scratch coat $13 $13 Ultraviolet coat $15 $15 Tints, solid or gradients $25 $25 Anti-reflective coat $50 $50 Polycarbonate $40 20% off retail High index 1.6 $55 20% off retail Photochromics $80 20% off retail Discounts on Non-Covered Exam and Materials Exams, frames, and prescription lenses: 30% off retail Lens options, contacts, other prescription materials: 20% off retail Disposable contact lenses: 10% off retail. Customer Service Refractive Surgery Superior Vision has a nationwide network of refractive surgeons and leading LASIK networks who offer members a discount. These discounts range from 5%-50%, and are the best possible discounts available to Superior Vision. 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. 5 Discounts and maximums may vary by lens type. Please check with your provider. Superior Vision Services, Inc. P.O. Box 967 Rancho Cordova, CA The Superior Vision Plan is underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with The Guardian Life Insurance Company of America, AKA The Guardian or Guardian Life NVIGRP 5-07 Page BSv2/TX

17 Voluntary Short-term Disability Insurance Overview Prepared for the employees of ESC-20 Benefits Cooperative Voluntary Short-term Disability Insurance Coverage paid by you Eligibility All active, full-time U.S. Employees of the Employer regularly working a minimum of hours per week. Forty-two percent of Americans live paycheckto-paycheck. CareerBuilder, 2011 Survey Weekly Benefit This plan pays a benefit of up to 60% of your weekly covered earnings to a maximum of $1,385 per week. Your benefit amount will be reduced by any amounts payable to you by any of the sources listed under the Effects of Other Income Benefits section. Definition of Disability Disability means that, solely because of a covered injury or sickness, you are unable to perform the material duties of your regular occupation and you are unable to earn 80% or more of your covered earnings from working in your regular occupation. We will require proof of earnings and continued disability. Covered Earnings Employee s annual wages or salary, excluding extra compensation, bonus, commission, and overtime. 60 percent of Americans do not have a rainy day fund to cover three months of unanticipated financial emergencies. FINRA Foundation State-by-state Financial Capability Survey, 2011 Elimination Period Option 1- You must be disabled for 30 days from either accident or sickness. This time period ends automatically on the date you are admitted as an inpatient to a hospital if that occurs before the 30 days are completed. Option 2- You must be disabled for 14 days from either accident or sickness. This time period ends automatically on the date you are admitted as an inpatient to a hospital if that occurs before the 14 days are completed. Cost The cost of this insurance program is paid by you. The cost of this coverage per $100 of monthly Benefit is: Option 1 Option 2 Under age 30: $0.26 Under age 30: $0.34 Age 30 34: $0.26 Age 30 34: $0.34 Age 35 39: $0.26 Age 35 39: $0.34 Age 40 44: $0.38 Age 40 44: $0.51 Age 45 49: $0.51 Age 45 49: $0.69 Age 50 54: $0.76 Age 50 54: $0.76 Age 55 59: $1.01 Age 55 59: $1.01 Age 60+: $1.17 Age 60+: $1.17 Costs are subject to change. 02/2013 Page 16

18 Effects of Other Income Benefits The disability benefit provided by this plan is a total benefit; that is, it will be reduced by any disability benefits payable on behalf of you or your dependents, or a qualified third party on behalf of you or your dependents, whether or not you are actually receiving them. Your disability benefits will not be reduced by any Social Security disability benefits you are not receiving as long as you cooperate fully in efforts to obtain them and agree to repay any overpayment when and if you do receive them. Other income sources that may reduce your benefits under this plan include: - Any Social Security disability or retirement benefits you or any third party receive (or are assumed to receive) on your own behalf; or which your dependents receive (or are assumed to receive) because of your entitlement to such benefits. - Benefits payable by a Canadian and/or Quebec provincial pension plan. - Amounts payable under the Railroad Retirement Act. - Amounts payable under any local, state, provincial or federal government disability or retirement plan or law as it pertains to the employer. - Employer-paid portion of company retirement plan benefits. - Amounts payable by company sponsored sick leave or salary continuation plan. - Amounts payable by any franchise or group insurance or similar plan. - Benefits payable under work-loss provisions of any mandatory no fault auto insurance. - Any amounts paid on account of loss of earnings or earning capacity through settlement, judgment, arbitration or otherwise, where a third party may be liable, regardless of whether liability is determined. - Income sources that WILL NOT reduce your benefits under this plan are: - Benefits paid by personal, individual disability income policies. - Individual deferred compensation agreements. - Employee savings plans, including thrift plans, stock options or stock bonuses. - Individual retirement funds, such as IRA or 401(k) plans. - Profit-sharing, investment or other retirement or savings plans maintained in addition to an employer-sponsored pension plan. Additional Plan Details Earnings While Disabled Benefits will be reduced for any week that benefits plus income from employment exceeds 100% of weekly covered earnings. Benefit Duration Option 1- Once you qualify for benefits under this plan, you continue to receive them until the end of the 9 or 22 benefit period, or until you no longer qualify for benefits, whichever occurs first. Option 2- Once you qualify for benefits under this plan, you continue to receive them until the end of the 11 or 24 benefit period, or until you no longer qualify for benefits, whichever occurs first. Pre-existing Conditions Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, received medical treatment, care or services (including diagnostic measures,) or for which a reasonable person would have consulted a physician during the 3 months just prior to the most recent effective date of insurance. Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after you have been in active service for a time of 3 consecutive months when you received no medical treatment, care, or services after you have been under this plan for at least 12 months after your most recent effective date of insurance. Termination of Disability Benefits Your benefits will terminate on the earliest of any of the following dates: the date the insurance company determines you are no longer disabled; the date you earn from any occupation more than the percentage of indexed earnings as 02/2013 Page 17

19 defined in your definition of disability; the date the maximum benefit period ends; the date you cease to get appropriate care; the date you die; the date you refuse to participate without good cause in all required phases of the rehabilitation plan; the date you fail to cooperate with us in the administration of the claim. Benefits may be resumed if you begin to cooperate in the rehabilitation plan within 30 days of the date benefits terminated. Exclusions This plan does not pay benefits for a disability which results, directly or indirectly, from any of the following: Suicide, attempted suicide, or whenever you injure yourself on purpose; war or any act of war, whether or not declared; active participation in a riot; commission of a felony; cosmetic surgery or medically unnecessary surgical procedures; an injury or sickness for which you are entitled to benefits from Workers Compensation or occupational disease law; an injury or sickness that is work-related; the revocation, restriction or non-renewal of your license, permit or certification necessary for you to perform the duties of your occupation, unless solely due to injury or sickness otherwise covered by the policy. In addition, we will not pay disability benefits for any period of disability during which you are incarcerated in a penal or corrections institution for any reason. Plan Termination Coverage terminates if the group policy is terminated, if you cease to be in active service, if you are no longer a member of an eligible class of employees, the day after the last date for which premium has been paid by you or the employer, or the date you become eligible for a plan of benefits intended to replace this coverage. If you are disabled and receiving benefits under this plan, your benefits and coverage will continue until the expiration of your benefit period, or until you no longer qualify for benefits under the plan, whichever comes first. When Coverage Takes Effect Your coverage takes effect on the later of the program s effective date, the date you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. If you have to submit evidence of good health, your coverage takes effect on the date we agree, in writing, to cover you. If you re not actively at work on the date your coverage would otherwise take effect, you ll be covered on the date you return to work. This information is a brief description of the important features of the plan. It is not a contract. Terms and conditions of insurance are set forth in Group Policy No. VDT Please refer to your Certificate of Insurance or Summary Plan Description for more detailed information. Coverage is underwritten by Life Insurance Company of North America, a Cigna company. Cigna and the Tree of Life logo are registered service marks of Cigna Intellectual Property, Inc. Cigna /2013 Page 18

20 Voluntary Long-term Disability Insurance Overview Prepared for the employees of ESC-20 Benefits Cooperative Voluntary Long-term Disability Insurance Coverage paid by you Eligibility All active, full-time U.S. Employees of the Employer regularly working a minimum of 30 hours per week. Forty-two percent of Americans live paycheckto-paycheck. CareerBuilder, 2011 Survey Monthly Benefit This plan pays a benefit of up to 60% of your monthly covered earnings to a maximum of $6,000 per month. Your benefit amount will be reduced by any amounts payable to you by any of the sources listed under the Effects of Other Income Benefits section. Definition of Disability Disability means that, solely because of a covered injury or sickness, you are unable to perform the material duties of your regular occupation and you are unable to earn 80% or more of your indexed earnings from working in your regular occupation. After benefits have been payable for 24 months, you are considered disabled if solely due to your injury or sickness, you are unable to perform the material duties of any occupation for which you are (or may reasonably become) qualified by education, training or experience, and you are unable to earn 60% or more of your indexed earnings. We will require proof of earnings and continued disability. Covered Earnings Employee s annual wages or salary, excluding extra compensation, bonus, commission, and overtime. 60 percent of Americans do n ot have a rainy day fund to cover three months of unanticipated financial emergencies. FINRA Foundation State-by-state Financial Capability Survey, 2011 Elimination Period Option 1- You must be disabled for 90 days before benefits may be payable. Option 2- You must be disabled for 180 days before benefits may be payable. Benefit Duration Once you qualify for benefits under this plan, you continue to receive them until the end of the benefit period shown below, or until you no longer qualify for benefits, whichever occurs first. Your benefit period begins on the first day after you complete your elimination period. And, should you remain disabled, your benefits continue according to the following schedule, depending on your age at the time you become disabled. Age at Disability Duration of Payments (months) Age 62 or younger To age 65 or the date the 42 nd monthly benefit is payable, if later Page 19

21 Termination of Disability Benefits Your benefits will terminate on the earliest of any of the following dates: the date the insurance company determines you are no longer disabled; the date you earn from any occupation more than the percentage of indexed earnings as defined in your definition of disability; the date the maximum benefit period ends; the date you cease to get appropriate care; the date you die; the date you refuse to participate without good cause in all required phases of the rehabilitation plan; the date you fail to cooperate with us in the administration of the claim. Benefits may be resumed if you begin to cooperate in the rehabilitation plan within 30 days of the date benefits terminated. Cost The cost of this insurance program is paid by you. The cost per $100 of monthly covered earnings are shown below. Costs are subject to change. Option 1 Option 2 Under age 30: $0.126 Under age 30: $0.081 Age 30 34: $0.180 Age 30 34: $0.117 Age 35 39: $0.270 Age 35 39: $0.171 Age 40 44: $0.432 Age 40 44: $0.342 Age 45 49: $0.612 Age 45 49: $0.450 Age 50 54: $0.900 Age 50 54: $0.666 Age 55 59: $1.206 Age 55 59: $0.882 Age 60+: $1.431 Age 60+: $1.035 Costs are subject to change. Effects of Other Income Benefits The disability benefit provided by this plan is a total benefit; that is, it will be reduced by any disability benefits payable on behalf of you or your dependents, or a qualified third party on behalf of you or your dependents, whether or not you are actually receiving them. Other income sources that may reduce your benefits under this plan include: - Any Social Security disability or retirement benefits you or any third party receive (or are assumed to receive) on your own behalf; or which your dependents receive (or are assumed to receive) because of your entitlement to such benefits. - Benefits payable by a Canadian and/or Quebec provincial pension plan. - Amounts payable under the Railroad Retirement Act. - Amounts payable under local, state, provincial or federal government disability or retirement plan or law as it pertains to the employer. - Employer-paid portion of company retirement plan benefits. - Amounts payable by company sponsored sick leave salary continuation plan. - Amounts payable by any franchise or group insurance or similar plan. - Benefits payable under work-loss provisions of any mandatory no fault auto insurance. - Any amounts paid on account of loss of earnings or earning capacity through settlement, judgment, arbitration or otherwise, where a third party may be liable, regardless of whether liability is determined. - Amounts payable under any workers compensation (including temporary or permanent disability benefits), occupational disease, and unemployment compensation. This includes damages, compromises or settlements paid in place of such benefits, whether or not liability is admitted. Income sources that WILL NOT reduce your benefits under this plan are: - Benefits paid by personal, individual disability income policies. - Individual deferred compensation agreements. - Employee savings plans, including thrift plans, stock options or stock bonuses. - Individual retirement funds, such as IRA or 401(k) plans. Page 20

22 - Profit-sharing, investment or other retirement or savings plans maintained in addition to an employersponsored pension plan. Additional Plan Details Earnings While Disabled During the first 24 months that benefits are payable, benefits will be reduced if benefits plus income from employment exceeds 100% of predisability covered earnings. After that, benefits will be reduced by 50% of earnings from employment. Pre-existing Conditions Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, received medical treatment, care or services (including diagnostic measures,) or for which a reasonable person would have consulted a physician during the 3 months just prior to the most recent effective date of insurance. Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after you have been in active service for a time of 3 consecutive months when you received no medical treatment, care, or services after you have been under this plan for at least 12 months after your most recent effective date of insurance. Limited Benefit Period Disabilities caused by or contributed to by any one or more of the following conditions are subject to a lifetime limit of 24 months: Anxiety-disorders, delusional (paranoid) or depressive disorders, eating disorders, mental illness, somatoform disorders (including psychosomatic illnesses). Benefits are payable during periods of hospital confinement for these conditions for hospitalizations lasting more than 14 consecutive days that occur before the 24-month lifetime limit is exhausted. Once the 24-month benefits are exhausted, the plan pays no further benefits. Disabilities caused by or contributed to by any one or more of the following conditions are subject to a lifetime limit of 24 months: Alcoholism, drug addiction or abuse. Benefits are payable during periods of hospital confinement for these conditions for hospitalizations lasting more than 14 consecutive days that occur before the 24-month lifetime limit is exhausted. Once the 24-month benefits are exhausted, the plan pays no further benefits. Exclusions This plan does not pay benefits for a disability which results, directly or indirectly, from any of the following: Suicide, attempted suicide, or whenever you injure yourself on purpose; war or any act of war, whether or not declared; active participation in a riot; commission of a felony; the revocation, restriction or non-renewal of your license, permit or certification necessary for you to perform the duties of your occupation, unless solely due to injury or sickness otherwise covered by the policy. In addition, we will not pay disability benefits for any period of disability during which you are incarcerated in a penal or corrections institution for any reason. Plan Termination Coverage terminates if the group policy is terminated, if you cease to be in active service, if you are no longer a member of an eligible class of employees, the day after the last date for which premium has been paid by you or the employer, or the date you become eligible for a plan of benefits intended to replace this coverage. If you are disabled and receiving benefits under this plan, your benefits and coverage will continue until the expiration of your benefit period, or until you no longer qualify for benefits under the plan, whichever comes first. When Coverage Takes Effect Your coverage takes effect on the later of the program s effective date, the date you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. If you have to submit evidence of good health, your coverage takes effect on the date we agree, in writing, to cover you. 02/2013 Page 21

23 If you re not actively at work on the date your coverage would otherwise take effect, you ll be covered on the date you return to work. Family Survivor Benefit If you die while receiving disability benefits, we will pay a survivor benefit based on 100% of the total of your last month s benefit plus the amount of any disability earnings by which this benefit had been reduced for that month. This plan pays a single lump sum equal to 3 months of benefits. We pay this benefit directly to your lawful spouse, or to your children in equal shares, if there is no lawful spouse. If you have no lawful spouse or children, we pay this benefit to your estate. This information is a brief description of the important features of the plan. It is not a contract. Terms and conditions of insurance are set forth in Group Policy No. VDT Please refer to your Certificate of Insurance or Summary Plan Description for more detailed information. Coverage is underwritten by Life Insurance Company of North America, a Cigna company. Cigna and the Tree of Life logo are registered service marks of Cigna Intellectual Property, Inc. Cigna 2013 Page 22

24 Voluntary Short-term Disability & Long-term Disability Insurance Contribution Worksheet ESC-20 Benefits Cooperative This worksheet allows you to approximate your monthly and annual contributions for Voluntary Short-term Disability and Long-term Disability. Voluntary Short-term Disability Insurance Coverage paid by you Short Term Contribution: STD Example A. Annual Earnings B. Monthly Earnings (A. divided 12) C. Monthly Earnings/100 D. Rate per $100 Based on your age E. Estimated Monthly Cost Contribution (C X D) F. Estimated Annual Contribution (E X 12) A. Annual Earnings $30,000 B. Monthly Earnings $2,500 (A. divided 12) C. Monthly Earnings/100 $25.00 D. Rate per $100 $0.34 E. Estimated Monthly Cost $8.50 Contribution (C X D) F. Estimated Annual $ Contribution (E X 12) Voluntary Long-term Disability Insurance Coverage paid by you Long Term Contribution: LTD Example A. Annual Earnings B. Monthly Earnings (A. divided 12) C. Monthly Earnings/100 D. Rate per $100 Based on your age E. Estimated Monthly Cost Contribution (C X D) F. Estimated Annual Contribution (E X 12) A. Annual Earnings $30,000 B. Monthly Earnings $2,500 (A. divided 12) C. Monthly Earnings/100 $25.00 D. Rate per $100 $0.27 E. Estimated Monthly Cost $6.75 Contribution (C X D) F. Estimated Annual $81.00 Contribution (E X 12) Page 23

25 Cigna Disability Rates Short Term Disability 30 Day 14 Day 0-29 $0.26 $ $0.26 $ $0.26 $ $0.38 $ $0.51 $ $0.76 $ $1.01 $ $1.17 $1.17 Long-Term Disability 90 Day 180 Day 0-29 $0.126 $ $0.180 $ $0.270 $ $0.432 $ $0.612 $ $0.900 $ $1.206 $ $1.431 $1.035 Page 24

26 American Public Life Group Cancer (APL GC AP GC-3 5/1/06)- E.S.C. 20 Benefit Co-Op - w/continuation Rider This coverage is offered on a guarantee issue basis. However, no benefits are payable for any loss during the first year of a Covered Person s coverage as the result of a Pre-Existing Specified Disease. A Pre-Existing Specified Disease is defined as one for which, within twelve (12) months prior to the Covered Person s effective date of coverage, medical advice, consultation, or treatment, including prescribed medications, was recommended or received from a member of the medical profession, or for which symptoms manifested ins such a manner as would cause an ordinarily prudent person to seek diagnosis, medical advice or treatment. Benefit Low Option Base Plan High Option Base Plan Radiation/Chemotherapy/Immunotherapy Hormone Therapy Surgical Schedule Anesthesia Reconstructive Surgery Skin Cancer Hospital Confinement Government/Charity Hospital/HMO Ambulatory Surgical Facility Drugs and Medicine - Inpatient Drugs and Medicine - Outpatient Transportation and Lodging Patient Transportation Family Transportation Patient Lodging Family Lodging $500/month of treatment $50/treatment; 12/year $1,600 Schedule; $15/unit 25% of schedule Included in schedule Included in schedule $100/day 1-90; $100/day 91+ in lieu of other benefits $100/day in lieu of other benefits $200/day $150/confinement $50/script; $50/month $.40/mile up to 1,000 miles $.40/mile up to 1,000 miles $50/day up to 50 days/cal year (out) $50/day up to 50 days/cal year (in) $1500/month of treatment $50/treatment; 12/year $4,800 Schedule; $45/unit 25% of schedule Included in schedule Included in schedule $300/day 1-90; $300/day 91+ in lieu of other benefits $300/day in lieu of other benefits $600/day $150/confinement $50/script; $150/month $.40/mile up to 1,000 miles $.40/mile up to 1,000 miles $50/day up to 50 days/cal year (out) $50/day up to 50 days/cal year (in) Blood and Plasma $150/day; $7,500/cal year (50 days) $250/day; $12,500/cal year (50 days) Bone Marrow/Stem Cell Transplant autologous non-autologous for other type cancer Experimental Treatment Attending Physician Prosthesis - Surgical Prosthesis - hairpiece Dread Disease Hospice Care Private Nursing Ambulance - Ground Ambulance - Air Extended Care Home Health Care Second & Third Surgical Opinion Waiver of Premium Physical Therapy $500/cal year $1,500/cal year Same as non-experimental $30/day of confinement $1,000/device; lifetime max 2 $50/hairpiece; lifetime max 2 $100/day up to 90 days $50/day; $9,000 lifetime max $150/day of confinement $200/trip; 2/confinement $2,000/air; 2/confinement $100/day up to confinement days $100/day up to confinement days $300/diagnosis 90 day elimination period $25/visit; 4/month; $1,000 life $1500/cal year $4,500/cal year Same as non-experimental $50/day of confinement $3,000/device; lifetime max 2 $50/hairpiece; lifetime max 2 $300/day up to 90 days $100/day; $18,000 lifetime max $150/day of confinement $200/trip; 2/confinement $2,000/air; 2/confinement $300/day up to confinement days $300/day up to confinement days $300/diagnosis 90 day elimination period $25/visit; 4/month; $1,000 life Diagnostic Testing Benefit $50; 1per person, per year (30 day waiting period) $50; 1per person, per year (30 day waiting period) Critical Illness Rider: Internal Cancer & Heart Attack/Stroke Optional Benefit $2500 Lump Sum Benefit; 30 day WP, no survival period; Payable once for internal cancer and once for heart attack or stroke $2500 Lump Sum Benefit; 30 day WP, no survival period - Payable once for internal cancer and once for heart attack or stroke ICU Rider $600 - up to a maximum of 30 days per confinement $600 - up to a maximum of 30 days per confinement Monthly Premiums Individual Single Parent Family Family Individual Single Parent Family Family Plan Opt 1 - Low Option Base Only $14.80 $20.60 $26.40 Plan Opt 2 - Low Option Base Plan + Intensive Care Rider $17.80 $24.80 $32.70 Plan Opt 3 - High Option Base Plan Only $29.40 $40.40 $51.50 Plan Opt 4 - High Option Base Plan + Intensive Care Rider $32.40 $44.60 $57.80 Page 25

27 LIMITATIONS AND EXCLUSIONS Only Loss For Cancer: This Policy pays only for loss resulting from definitive Cancer treatment including direct extension, metastatic spread, or recurrence. Proof must be submitted to support each claim. This Policy also covers other conditions or diseases directly caused by Cancer or the treatment of Cancer. Pre-Existing Condition Limitation: No benefits are payable for any loss incurred during the first year of the Covered Person s coverage under this Policy as the result of a Pre-Existing Specified Disease, as defined in this Certificate. Pre-Existing Conditions specifically named or described as excluded in any part of this contract are never covered. Pre-Existing Condition Limitation - Hospital Intensive Care Rider: No benefits will be provided during the first two years of this rider for hospital intensive care unit confinement caused by any heart condition when any heart condition was diagnosed or treated prior to the 30 th day following the covered person s effective date for this rider. Waiting Period: This Policy/Certificate contains a 30-day Waiting Period during which no benefits will be paid under this Policy/Certificate. If any Covered Person has a Specified Disease diagnosed before the end of the 30-day period immediately following the Covered Person s effective date, coverage for that person will apply only to loss that is incurred after one year from the effective date of such person s coverage. If any Covered Person is diagnosed as having a Specified Disease during the 30-day period immediately following the effective date, the Insured may elect to void the Certificate from the beginning and receive a full refund of premium. If this Policy replaced Specified Disease Cancer coverage from another company that terminated within 30 days of the effective date of the Certificate, the 30-day Waiting Period will be waived for those Covered Persons that were covered under the prior coverage. However, the Pre-Existing Condition Limitation paragraph will still apply. Continuation Rider: Coverage is continued when the Insured (You) cease employment with the employer through whom You originally became insured under the Policy. You will have the option to continue this certificates (including any Riders, if applicable) by paying the premiums directly to Us at Our home office. Premiums must be paid within thirty-one (31) days after employment with your employer terminates. Premium rates required under this Continuation provision will be the same rates as those charged under the Employer s Policy as if You had continued employment. We will bill You for these premiums after You notify Us to continue this coverage. Coverage will continue until the earlier of: (1) the Policy under which You originally became insured ends; or (2) You stop paying premiums under this option (subject to the terms of the Grace Period) Page 26

28 A3 - Accident Expense Policy For ESC 20 Benefits Cooperative Benefits Accidental Injury Benefit - We will pay the actual charges per accident (not to exceed maximum benefits for units selected) for physician s treatment, surgery, x-rays, reduction of fractures and dislocations or other emergency treatment expenses. In no case will the benefit exceed actual charges. There is a $50 deductible for emergency room expenses, per occurrence, regardless of the number of units. Expenses must commence within 60 days of the covered accident. Ambulance Benefit - We will pay the actual charges (not to exceed maximum benefits for units selected) for emergency transportation for covered treatment (ground or air). Such emergency transportation must occur within 21 calendar days of the covered accident. Hospital Confinement - We will pay the daily hospital benefit, based upon the number of units selected, when a covered insured is confined to a hospital due to accident or injury. This benefit begins the first day of confinement and pays up to 30 days per any one accident. Accidental Death Benefit - We will pay the benefit shown for accidental death which results within 90 days of the accident, based upon the number of units selected. Dismemberment - We will pay the following benefit, based upon the number of units selected, for dismemberment which results within 90 days of a covered accident (dismemberment benefits are subject to a $5,000 per unit cumulative maximum per accident). Single Finger or toe Multiple fingers or toes Single Hand, Arm, Foot or Leg Multiple Hands, Arms, Feet or Legs $500 $1,250 $75 $5,000 $250 $500 $2,500 $5,000 Loss of Sight Benefit - We will pay the benefit, based upon the number of units selected, shown for the loss of sight due to accidental injury. Loss of sight in one eye Loss of sight in both eyes $2,500 $5,000 Premiums: Individual Individual and Spouse Individual and Children Family (2 Parents and children) $10.80 $19.40 $21.20 $29.80 American Public Life Insurance Company P. O. Box 925! Jackson, MS or Page 27

29 DEFINITIONS INJURY or ACCIDENTAL INJURY or ACCIDENTAL BODILY INJURY means physical damage to an Insured Person, sustained on or after the Effective Date, and while this Policy is in force, which is the direct cause of the loss, independent of disease, bodily infirmity or any other cause. All injuries sustained in any one accident and all complications arising therefrom and recurrence and complication shall be deemed to be a single Injury. DISABILITY means Your inability, as a result of covered Accidental Injury, to perform the substantial and material duties of Your occupation and You are not gainfully employed. EXCLUSIONS AND LIMITATION Benefits otherwise provided by this policy will not be payable for services or expenses or any such loss resulting from or in connection with: 1. sickness, illness or bodily infirmity; except as covered by the Sickness Disability Rider; 2. suicide, attempted suicide or intentional self-inflicted injury, whether sane or insane; 3. dental care or treatment due to accidental injury to natural teeth; 4. war or any act of war (whether declared or undeclared) or participating in a riot or felony; 5. alcoholism or drug addiction; 6. travel or flight in or descent from any aircraft or device which can fly above the earth s surface in any capacity other than as a fare-paying passenger on a regularly scheduled airline; 7. injury originating prior to the effective date of the policy; 8. injury occurring while intoxicated (intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the loss or cause of loss is incurred); 9. voluntary inhalation of gas or fumes or taking of poison or asphyxiation; 10. voluntary ingestion or injection of any drug, narcotic or sedative, unless administered on the advice and taken in such doses as prescribed by a physician; 11. injury sustained or sickness which manifests itself while on full-time duty in the armed forces. Upon notice, the company will refund the proportion of unearned premium while in such forces; 12. injury incurred while engaged in an illegal occupation; 13. injury incurred while attempting to commit a felony or an assault; 14. mental or emotional disorders; 15. injury to a covered person while practicing for or being a part of organized or competitive rodeo, sky diving, hang gliding parachuting or scuba diving; 16. driving in any race or speed test or while testing an automobile or any vehicle on any racetrack or speedway; 17. charges incurred outside the U.S. if an insured traveled to the location for the purpose of receiving medical services, drugs or supplies; 18. hernia, carpal tunnel syndrome or any complication therefrom; 19. any bacterial infection (except pyogenic infections which shall occur with and through an accidental cut or wound). If you are entitled to benefits under this policy, as a result of sprained or lame back, or any intervertebral disk conditions, such benefits shall be payable for a maximum period of time, not exceeding in the aggregate three (3) months for any injury. These exclusions and limitations are not applicable for all states. Please refer to your policy or outline for applicable exclusions and limitations. Page 28

30 This coverage should be viewed as a supplement to other health insurance. This is not the insurance contract, and only the actual policy provisions will apply. It is therefore important that you read your policy carefully. All products are not available in all states. In West Virginia: 18, and 19 above are changed and read as follows: 18. hernia, within six (6) months after the Effective Date; 19. carpal tunnel syndrome or any complication therefrom; 20. any bacterial infection (except pyogenic infections which shall occur with and through an accidental cut or wound). In Idaho: Exclusions and Limitations 1. sickness, illness or bodily infirmity; 2. suicide, attempted suicide or intentional self-inflicted Injury, whether sane or insane; 3. dental care or treatment due to accidental Injury to natural teeth; 4. war or any act of war (whether declared or undeclared) or participating in a riot or felony; 5. alcoholism or drug addiction; 6. participation in any form of flight aviation other than as a fare-paying passenger in a licensed, passenger-carrying aircraft; 7. a Pre-existing Condition incurred within 12 months following the effective date of coverage; 8. Injury occurring while intoxicated or under the influence of any narcotic, unless administered on the advice and taken in such doses as prescribed by a Physician; 9. Injury sustained or sickness which first manifests itself while on full-time duty in the armed forces. Upon notice, We will refund the proportion of unearned premium while in such forces. 10. Injury incurred while engaging in an illegal occupation; 11. Injury incurred while attempting to commit a felony; 12. mental or emotional disorders; 13. Injury to a covered person while participating as a professional as a part of organized or competitive rodeo, sky diving, hang gliding, parachuting or scuba diving; 14. driving as a professional in any race or speed test or while testing an automobile or any vehicle on any racetrack or speedway; 15. charges incurred outside the U.S., if an Insured traveled to the location for the purpose of receiving medical services, drugs or supplies; American Public Life Insurance Company A member of the American Fidelity Group American Public Life Insurance Company P.O. Box 925 Jackson, Mississippi (Sales Department) This brochure does not constitute the full contract and is intended to provide basic information about American Public Life Insurance Company s Form A-3B Supplemental Accident product. For specific details, please consult an actual policy and its provisions. Page 29

31 Limited Benefit Medical Expense Supplement Insurance MEDlink THIS IS NOT A POLICY OF WORKERS COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS COMPENSATION SYSTEM BY PURCHASING THIS POLICY, AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYER LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATION THAT MUST BE FILED AND POSTED. APSB-21399(TX)-0212 Page 30

32 Summary of Benefits by Plan * Benefit Description In-Hospital Benefit Maximum In-Hospital Benefit Outpatient Benefit Physician Outpatient Treatment Benefit Available Options $1,500 or $2,500 per confinement up to $200 per treatment $25 per treatment; $125 max per family per Calendar Year Facts to Consider n 33% of total healthcare costs are paid out-of-pocket. 1 n n 24% of American households reported having problems paying medical bills within the last year. 2 More than half of all Americans (53%) with health coverage have decreased their contributions to savings as a result of increased health care costs. 3 Policy Benefit Highlights In-Hospital Benefit Pays up to the maximum In-Hospital benefit for Covered Charges incurred when a Covered Person is confined in a Hospital as an Inpatient for at least 18 continuous hours. Other (or Another) Medical Plan means any basic major medical or comprehensive medical policy which includes managed care and through which a Covered Person has coverage. The term Other Medical Plan does not include CHAMPUS. Outpatient Benefits Pays a benefit for Covered Charges incurred by a Covered Person for treatment in a Hospital emergency room without the Covered Person subsequently being considered an Inpatient; surgery performed in a Hospital outpatient facility or a free-standing outpatient surgery center; or diagnostic testing performed in a Hospital outpatient facility or a magnetic resonance imaging (MRI) facility. Physician Outpatient Treatment Benefit Pays $25 per treatment per calendar year for Covered Charges incurred by a Covered Person in a Hospital Outpatient Clinic, Free- Standing Emergency Care Clinic, or a Physician s Office, as the result of treatment due to Sickness or emergency care for an injury due to an Accident. Limitations and Exclusions Eligibility This policy will be issued to those persons who meet American Public Life Insurance Company s insurability requirements. Evidence of insurability acceptable to us may be required. You are eligible to be insured under this Policy if You are on Active Service as an employee of the Policyholder, or as a member or employee of a member of the Policyholder; qualify as an eligible Insured; and meet the definition of Eligibility. Eligibility means all active full-time employees who are working 18 hours or more per week; covered under Another Medical Plan; and under age 70. (This age limit does not apply, if You work for an employer employing 20 or more employees on a typical workday in the preceding Calendar Year.) If our underwriting rules are met, You are on Active Service, You are covered under Another Medical Plan and premium has been paid, Your insurance will take effect on the requested Effective Date or the Effective Date assigned by Us upon approval of Your written application, whichever is later. If You are not on Active Service due to an Accident or Sickness when Your coverage is to take effect, it will take effect on the first day of the calendar month after the date You return to Active Service. Evidence of coverage under Another Medical Plan may be required. Active Service means that You are doing in the usual manner all of the regular duties of Your employment on a full-time basis on a scheduled work day; and these duties are being done at one of the places of business where You normally do such duties or at some location to which Your employment sends You. You will be said to be on Active Service on a day which is not a scheduled work day only if You would be able to perform in the usual manner all of the regular duties of Your employment if it were a scheduled work day. Accident means sudden, unexpected and unintended injury which is independent of any Sickness; over which the Covered Person has no control; and that takes place while the Covered Person's coverage is in force. Sickness means illness or disease which starts while the Covered Person's coverage is in force and is the direct cause of the loss. Base Policy No benefits are payable for the first twelve (12) months as a result of a Pre-Existing Condition. Pre-Existing Condition means a disease, Accident, Sickness, or physical condition for which the Covered Person had treatment; incurred expense; took medication; or received a diagnosis or advice from a Physician during that period of time immediately before the Effective Date of the Covered Person's coverage shown under "Pre-Existing Period" on the Schedule of Benefits. The term "Pre-Existing Condition" will also include conditions which are related to such disease, Accident, Sickness or physical condition. *The premiums and amount of benefits may vary dependent upon the Plan selected at time of application. 1 Kaiser Family Foundation: Trends in Health Care Costs and Spending; March Robert Wood Johnson Foundation: Health Priorities Survey: The Medical System and the Uninsured; June Employee Benefits Research Institute: "EBRI Issue Brief #331", July Page 31

33 Limitations and Exclusions continued Covered Charges means those charges that are incurred by a Covered Person because of an Accident or Sickness; are for necessary treatment, services and medical supplies and recommended by a Physician; are not more than any dollar limit set forth in the Schedule; are incurred while insured under the Policy, subject to any Extension of Benefits; and are not excluded under the Policy. A Hospital is not any institution used as a place for rehabilitation; a place for rest, or for the aged; a nursing or convalescent home; a long term nursing unit or geriatrics ward; or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients. In-Hospital Benefit Benefits payable are limited to any out-of-pocket deductible amount; any out-of-pocket co-payment or coinsurance amounts the Covered Person actually incurs after the Other Medical Plan has paid; any out-of-pocket amount the Covered Person actually incurs for surgery performed by a Physician after the Other Medical Plan has paid; and the Maximum In- Hospital Benefit shown in the Policy Schedule. The Covered Person must be an Inpatient and covered by Another Medical Plan when the Covered Charges are incurred. Outpatient Benefits Treatment is for the same or related conditions, unless separated by a period of 90 consecutive days. After 90 consecutive days, a new Outpatient Benefit will be payable. The Covered Person must be covered by Another Medical Plan when the Covered Charges are incurred. Physician Outpatient Treatment Benefit Benefit maximum of $125 per family per Calendar Year. The Covered Person must be covered by Another Medical Plan when the Covered Charges are incurred. The Covered Person must not be an Inpatient when the Covered Charges are incurred. Premiums The premium rates may be changed by Us. If the rates are changed, We will give You at least 31 days advance written notice. If a change in benefits increases Our liability, premium rates may be changed on the date Our liability is increased. This plan may be continued in accordance with the Consolidated Omnibus Reconciliation Act of Family Coverage You can take advantage of several options to extend coverage to your family: n Family Plan Employee and their spouse and any eligible Dependent* under age 26. n Single Parent Family Employee and any eligible Dependent* under age 26. We will pay no benefits for any expenses incurred during any period the Covered Person does not have coverage under Another Medical Plan, except as provided in the Absence of Other Medical Plan provision or which result from: (a) suicide or any attempt, thereof, while sane or insane; (b) any intentionally self-inflicted injury or Sickness; (c) rest care or rehabilitative care and treatment; (d) routine newborn care, including routine nursery charges; (e) voluntary abortion except, with respect to You or Your covered Dependent spouse: (1) where Your or Your Dependent spouse's life would be endangered if the fetus were carried to term; or (2) where medical complications have arisen from abortion; (f) pregnancy of a Dependent child; (g) participation in a riot, civil commotion, civil disobedience, or unlawful assembly. This does not include a loss which occurs while acting in a lawful manner within the scope of authority; (h) commission of a felony; (i) (j) (k) (l) (m) (n) (o) (p) (q) (r) (s) (t) (u) (v) participation in a contest of speed in power driven vehicles, parachuting, or hang gliding; air travel, except: (1) as a fare-paying passenger on a commercial airline on a regularly scheduled route; or (2) as a passenger for transportation only and not as a pilot or crew member; intoxication; (Whether or not a person is intoxicated is determined and defined by the laws and jurisdiction of the geographical area in which the loss occurred.) alcoholism or drug use, unless such drugs were taken on the advice of a Physician and taken as prescribed; sex changes; experimental treatment, drugs, or surgery; Pre-Existing Conditions, unless the Covered Person has satisfied the Pre-Existing Condition Exclusion Period shown on the Schedule; an act of war, whether declared or undeclared, or while performing police duty as a member of any military or naval organization; (This exclusion includes Accident sustained or Sickness contracted while in the service of any military, naval, or air force of any country engaged in war. We will refund the pro rata unearned premium for any such period the Covered Person is not covered.) Accident or Sickness arising out of and in the course of any occupation for compensation, wage or profit; (This does not apply to those sole proprietors or partners not covered by Workers' Compensation.) mental illness or functional or organic nervous disorders, regardless of the cause; dental or vision services, including treatment, surgery, extractions, or x-rays, unless: (1) resulting from an Accident occurring while the Covered Person's coverage is in force and if performed within 12 months of the date of such Accident; or (2) due to congenital disease or anomaly of a covered newborn child. routine examinations, such as health exams, periodic check-ups, or routine physicals; any expense for which benefits are not payable under the Covered Person's Other Medical Plan; or air or ground ambulance. Termination of Coverage Your Insurance coverage will end on the earliest of these dates: the date You no longer qualify as an Insured; the end of the last period for which premium has been paid; the date the Policy is discontinued; the date You retire; if You work for an employer employing less than 20 employees on a typical work day in the preceding Calendar Year, the date You attain age 70; the date You cease to be on Active Service; the date Your coverage under Another Medical Plan ends; or the date You cease employment with the employer through whom You originally became insured under the Policy. Insurance coverage on a Dependent will end on the earliest of these dates: the date Your coverage terminates; the end of the last period for which premium has been paid; the date the Dependent no longer meets the definition of Dependent; the date the Dependent's coverage under Another Medical Plan ends; or the date the Policy is modified so as to exclude Dependent coverage. We may end the coverage of any Covered Person who submits a fraudulent claim. We may end the coverage of a Subscribing Unit if fewer persons are insured than the Policyholder's application requires. *Please consult the policy for definition of eligible Dependent and full-time student eligibility. Page 32

34 Limited Benefit Medical Expense Supplement Insurance MEDlink Monthly Premiums Issue Ages $1,500 $2,500 Employee $21.50 $28.00 Employee & Spouse $39.50 $ Parent Family $36.50 $ Parent Family $54.50 $69.00 Issue Ages $1,500 $2,500 Employee $32.00 $44.50 Employee & Spouse $59.00 $ Parent Family $47.00 $ Parent Family $74.00 $99.00 Issue Ages $1,500 $2,500 Employee $49.00 $68.50 Employee & Spouse $88.00 $ Parent Family $64.00 $ Parent Family $ $ Plans available to employees age 70 and over if You work for an employer employing 20 or more employees on a typical workday in the preceding Calendar Year. Underwritten by: This is a brief description of the coverage. n For actual benefits and other provisions, please refer to the policy. This coverage does not replace Workers Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. n Policy Form MEDlink series n Texas n Limited Benefit Medical Expense Supplement Insurance n Employee Brochure. n (02/12) n Financial Benefit Services, LLC n WPX Page 33

35 Basic & Voluntary Term Life, Basic & Voluntary Personal Accident Insurance Overview Prepared for the employees of ESC-20 Benefits Cooperative Basic Term Life Insurance Coverage paid by your employer What would happen to your family if you and your income were gone? - Could they maintain their standard of living? - Pay for college tuition? - Household bills? - What about monthly mortgage or rent? Three in 10 households carry no life insurance on anyone in the household. Household Trends in U.S. Life Insurance Ownership. LIMRA, 2010 Half of U.S. households now believe they are underinsured. Household Trends in U.S. Life Insurance Ownership. LIMRA, 2010 Employee - If you are an active, full-time employee and work at least hours per week for your employer, you are eligible for coverage on the first of the month after 30 days of active service. - Benefit Amount and Maximum based on the option chosen by your employer: - Option I: $5,000 - Option II: $10,000 - Option III: $20,000 - Option IV: $50,000 - Benefit Reduction Schedule Benefits will reduce to 65% at age 65, 50% at age 70, 25% at age 75 Voluntary Term Life Insurance Coverage paid by you Employee If you are an active, full-time employee and work at least hours per week for your employer, you are eligible for coverage on the first of the month after 30 days of active service - Benefit Amount 1 to 7 X Annual Compensation - Guaranteed Coverage Amount $200,000 - Maximum The lesser of 7 times Annual Compensation rounded to the next higher $10,000 or $500,000 - Benefit Reduction Schedule Providing you are still employed, your benefits will reduce to 65% at age 65, 50% at age 70, 25% at age 75. Your Spouse* terms at age 70 - is eligible provided that you apply for and are approved for coverage for yourself. - Benefit Amount Units of $10,000 - Guaranteed Coverage Amount - $50,000 - Maximum $500,000, not to exceed 100% of the employee s coverage amount Your Unmarried, Dependent Children Under age 26, as long as you apply for and are approved for coverage for yourself. - Benefit Amount $10,000 - Maximum $10,000 No one may be covered more than once under this plan. Guaranteed Coverage for Voluntary Term Life Insurance Coverage 01/2013 Page 34

36 Guaranteed Coverage Amount is the amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed Coverage is only available during Initial Enrollment and other times as approved. If you apply for coverage that is above the Guaranteed Coverage Amount, or if you are applying for coverage after 31 days after you become eligible, you must fill out a Medical Evidence of Insurability form. All dependent child benefits are guaranteed issue. Age Employee Cost Per $10,000 Spouse Cost Per $10,000 How Much Your Coverage will Cost per Month Age Employee Cost Per $10,000 Spouse Cost Per $10,000 <29 $0.50 $ $5.90 $ $0.70 $ $8.26 $ $0.80 $ $ $1.00 $ $ $1.40 $ $ $2.40 $ $3.90 $3.90 Benefit Voluntary Child per $10,000 of Coverage Elected Premium Cost $1.80 * Costs are subject to change Age Cost Calculation Example Monthly Cost per $10,000 Benefit Monthly Cost Example X 100,000 10,000 = $7.00 Yours X 10,000 = Other Coverage Features Accelerated Death Benefit Terminal Illness If you or your spouse is diagnosed by two unaffiliated physicians as terminally ill with a life expectancy of 12 months or less, the benefit for terminal illness provides for up to 75% of the Term Life Insurance coverage amount inforce or $250,000, whichever is less, to be paid to the insured. This benefit is payable only once in the insured's lifetime, and will reduce the life insurance death benefit. Continuation for Disability for Employees Age 60 or over If your active service ends due to disability, at age 60 or over, your coverage will continue while you are disabled. Benefits will remain in force until the earliest of: the date you are no longer disabled, the date the policy terminates, the date you are Disabled for 12 consecutive months, or the day after the last period for which premiums are paid. You are considered disabled if, because of injury or sickness, you are unable to perform all the material duties of your Regular Occupation, or you are receiving disability benefits under your Employer s plan. Extended Death Benefit The extended death benefit ensures that if you become disabled prior to age 60, and die before it is determined if you qualify for Waiver of Premium, we will pay the life insurance benefit if you remain disabled during that period. If you qualify for this benefit and have insured your spouse or children, their coverage is also extended. No additional premium payment is required for the extended coverage. Waiver of Premium If you are totally disabled prior to age 60 and can't work for at least 9 months, you won't need to pay premiums for your coverage while you are disabled, provided the insurance 01/2013 Page 35

37 company approves you for this benefit. You are considered totally disabled when you are completely unable to engage in any occupation for wage or profit because of injury or sickness. This benefit will remain in force until age 65, subject to proof of continuing disability each year. If you qualify and have insured your spouse or children, their premium is also waived. Conversion If group life insurance coverage is reduced or ends for any reason except nonpayment of premiums, you can convert to an individual policy. To convert, you must apply for the conversion policy and pay the first premium payment within 31 days after your group coverage ends. Family members may convert their coverage as well. Converted policies are subject to certain benefits and limits as outlined in the conversion brochure which may be requested as needed. Premiums may change at this time. Portability This plan allows you to continue all of your voluntary coverage if you leave your employer. Premiums may change at this time. Just pay your premiums directly to the insurance company. Coverage may be continued for you and your spouse until age 70. Coverage may also be continued for your children. Exclusions Voluntary life insurance will not be paid if loss of life is the result of suicide that occurs within the first two years of coverage. Personal Accident Insurance Coverage Basic Personal Accident Insurance Coverage paid by your employer Employee - If you are an active, full-time employee and work at least hours per week for your employer, you are eligible for coverage on the first of the month after 30 days of active service Benefit Amount and Maximum based on the option chosen by your employer: - Option I: $5,000 - Option II: $10,000 - Option III: $20,000 - Option IV: $50,000 - Benefit Reduction Schedule Benefits will reduce to 65% at age 65, 50% at age 70, 25% at age 75. Voluntary Personal Accident Insurance Coverage paid by you Employee - If you are an active, full-time employee and work at least hours per week for your employer, you are eligible for coverage on the first of the month after 30 days of active service - Benefit Amount Units of $10,000 - Maximum $500,000 - Benefit Reduction Schedule Providing you are still employed, your benefits will reduce to 65% at age 70, 45% at age 75, 30% at age 80, 15% at age 85+. Family Plan Benefit Based on Family members at time of accident: - 50% for spouse if no children - 50% for spouse if eligible children - 10% for children if eligible spouse - 10% for children if no spouse Spouse maximum principle sum: - $250,000 01/2013 Page 36

38 - Child maximum principle sum: - $50,000 No one may be covered more than once under this plan. You may need to request changes to your existing coverage if, in the future, you no longer have dependents who qualify for coverage. We will refund premium if you do not notify us of this and it is determined at the time of a claim that premium has been overpaid. How Much Your Coverage will Cost per Month The cost of the voluntary insurance is paid by you. Indicate your choice, or your decision not to elect coverage, on your enrollment form. The monthly cost per $1,000 of coverage is $0.025 for Employee, $0.04 for Family. Costs are subject to change. A Valuable Combination of Benefits To help survivors of severe accidents adjust to new living circumstances, we will pay benefits according to the chart below. If, within 365 days of a covered accident, bodily injuries result in: We will pay this % of the benefit amount: Loss of life 100% Total paralysis of upper and lower limbs, or Loss of any combination of two: hands, feet or eyesight, or 100% Loss of speech and hearing in both ears Total paralysis of both lower or upper limbs 75% Total paralysis of upper and lower limbs on one side of the body, or Loss of hand, foot or sight in one eye, or 50% Loss of speech or loss of hearing in both ears, or Severance and Reattachment of one hand or foot Total paralysis of one upper or lower limb, or Loss of all four fingers of the same hand, or 25% Loss of thumb and index finger of the same hand Loss of all toes of the same foot 20% Only one benefit (the largest) will be paid for losses from the same accident. Additional Benefits of Personal Accident Insurance For Wearing a Seatbelt & Protection by an Airbag Additional 10% benefit but not more than $25,000 if the covered person dies in an automobile accident while wearing a seatbelt or approved child restraint. We will increase the benefit by an additional 5% but not more than $5,000 if the insured person was also positioned in a seat protected by a properly-functioning and properly deployed Supplemental Restraint System (Airbag). For Comas 1% of full benefit amount, for up to 11 months, if you, your spouse, or your children are in a coma for 30 days or more as a result of a covered accident. If the covered person is still in a coma after 11 months, or dies, the full benefit amount will be paid. For Exposure & Disappearance Benefits are payable if you or an insured family member suffer a covered loss due to unavoidable exposure to the elements as a result of a covered accident. If your or an insured family member's body is not found within one year of the disappearance, wrecking or sinking of the conveyance 01/2013 Page 37

39 in which you or an insured family member were riding, on a trip otherwise covered, it will be presumed that you sustained loss of life as a result of a covered accident. For Furthering Education If you die in a covered accident, we will pay an extra benefit for each insured child under age 25 who enrolls in a school of higher learning within one year of your death. We will increase your benefit by 3% or $3,000, whichever is less, for each qualifying child, each year for 4 consecutive years as long as your child continues his/her education. If there is no qualifying child, we will pay an additional $1,000 to your beneficiary. For Child Care Expenses If you die as a result of a covered accident, we will pay a benefit for a surviving child under 13 who is enrolled in a licensed child care center at the time of the accident or within 90 days afterwards. This benefit is 3% of your benefit amount per year, but not more than $3,000 per year for 5 years or until the child turns 13, whichever occurs first, for each covered child For Training for Your Spouse If you die from a covered accident, your spouse will receive educational reimbursement if he or she enrolls, within 3 years of your death, in an accredited school to gain skills needed for employment. We will pay the actual cost of the education or training program to 3% of your benefit amount, not exceeding $5,000. What is Not Covered Self-inflicted injuries or suicide while sane or insane; commission or attempt to commit a felony or an assault; any act of war, declared or undeclared; any active participation in a riot, insurrection or terrorist act; bungee jumping; parachuting; skydiving; parasailing; hang-gliding; sickness, disease, physical or mental impairment, or surgical or medical treatment thereof, or bacterial or viral infection; voluntarily using any drug, narcotic, poison, gas or fumes except one prescribed by a licensed physician and taken as prescribed; while operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant including any prescribed drug for which the covered person has been provided a written warning against operating a vehicle while taking it; while the covered person is engaged in the activities of active duty service in the military, navy or air force of any country or international organization (this does not include Reserve or National Guard training, unless it extends beyond 31 days); traveling in an aircraft that is owned, leased or controlled by the sponsoring organization or any of its subsidiaries or affiliates; air travel, except as a passenger on a regularly scheduled commercial airline or in an aircraft being used by the Air Mobility Command or its foreign equivalent; being flown by the covered person or in which the covered person is a member of the crew. When Your Coverage Begins and Ends Coverage becomes effective on the later of the program s effective date, the date you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. Your coverage will not begin unless you are actively at work on the effective date. Dependent coverage will not begin for any dependent who on the effective date is hospital or home confined; receiving chemotherapy or radiation treatment; or disabled and under the care of a physician. Coverage will continue while you and your dependents remain eligible, the group policy is in force, and required premiums are paid. This information is a brief description of the important features of the plan. It is not a contract. Terms and conditions of coverafge are set forth in Group Policy No. FLX and Group Policy No. OK Please refer to your Certificate of Insurance or Summary Plan Description for more detailed information. Coverage is underwritten by Life Insurance Company of North America, a Cigna company. Cigna and the Tree of Life logo are registered service marks of Cigna Intellectual Property, Inc. Cigna /2013 Page 38

40 Life Insurance Highlights For the employee purelife-plus Flexible Premium Life Insurance to Age 121 Policy Form PRFNG-NI-10 Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. Designed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually costs more and declines in death benefit. The policy, purelife-plus, is underwritten by Texas Life Insurance Company, and it has these outstanding features: High Death Benefit. With one of the highest death benefits available at the worksite, 1 purelife-plus gives your loved ones peace of mind, knowing there will be significant life insurance in force should you die prematurely. Minimal Cash Value. Designed to provide high death benefit, purelife-plus does not compete with the cash accumulation in your employer-sponsored retirement plans. Long Guarantees. Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time (after the guaranteed period, premiums may go down, stay the same, or go up). Refund of Premium. Unique in the marketplace, purelife-plus offers you a refund of 10 years premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.) Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.) You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, minor children and grandchildren. Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details. 1 Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 2008 See the purelife-plus brochure for details. 10M055-C 1040 (Expires 0612) Page 39 Not for use in WA.

41 monthly premiums Issue Age PureLife-plus Standard Risk Table Premiums Non-Tobacco Express Issue Monthly Premiums for Life Insurance Face Amounts Shown Non-Tobacco Sample For Review GUARANTEED PERIOD Age to Which Coverage is Guaranteed at (ALB) $10,000 $15,000 $25,000 $40,000 $50,000 $75,000 $100,000 $125,000 $150,000 Table Premium 15D PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After the Guaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under Permanent Coverage. Form: 10M014-rpltic EXP-A-M-1LO R Page 40

42 monthly premiums Issue Age PureLife-plus Standard Risk Table Premiums Tobacco Express Issue Monthly Premiums for Life Insurance Face Amounts Shown Tobacco Sample For Review GUARANTEED PERIOD Age to Which Coverage is Guaranteed at (ALB) $10,000 $15,000 $25,000 $40,000 $50,000 $75,000 $100,000 $125,000 $150,000 Table Premium 15D PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After the Guaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under Permanent Coverage. Form: 10M014-rpltic EXP-A-M-1LO R Page 41

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45 24/7/365 on-demand access to affordable, quality healthcare. Anytime, Anywhere. MDLIVE offers 24/7/365 on-demand access to a national network of board-certified doctors and pediatricians that can diagnose, recommend treatment, and prescribe medication. Get the care you need, when you need it. How much does it cost? $10.00 Voluntary One Cost Covers Entire Family Unlimited Phone Consultations 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 providers? Our providers practice primary care, pediatrics, family and emergency medicine, and have incorporated MDLIVE into their practice to provide convenient access to quality care. Are children eligible? Yes. MDLIVE has local pediatricians on-call 24/7/365. However, a parent or guardian must be present during registration and any consultations involving minors. Visit us at mdlive.com/fbs 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 Page 44

46 Flexible Spending Accounts Maximize your benefits and give yourself a raise. Page 45

47 Flexible Spending Plans A Cafeteria Plan enables you to save money on group insurance, health-related expenses, and dependent-care expenses. Your contributions are deducted from your pay before taxes are withheld. Because you are taxed on a lower amount of pay, you pay less in taxes and you have more to spend. You may save as much as 35 percent on the cost of each benefit option! FSA Savings FSA Savings Comparison FSA No FSA Annual Taxable Income $24,000 $24,000 Out of Pocket Expenses Health Care Expenses $1,500 $0 Dependent Day Care Expenses $1,500 $0 Total Pre-Tax Contributions ($3,000) $0 Taxable Income After FSA $21,000 $24,000 Federal, State, & SS Taxes (30+%) ($6,300) ($7,200) Typical Savings After-Tax Income $14,700 $16,800 FICA 7.65% After-Tax Dollars spent on health/ dep care expenses $0 $3,000 State Tax* 7.10% Take-Home Pay $14,700 $13,800 Fed. Tax* 15.00% Increased Take-Home Pay $900 $0 30% Savings *Federal and State Tax savings may vary. A savings calculator can be found on our website: NBSbenefits.com to find out how much you could save. Partial List of Eligible Expenses: Medical/dental/vision co-pays and deductibles Prescription drugs Physical therapy Chiropractor First aid supplies Lab fees Psychiatrist/psychologist Vaccinations Dental work, including orthodontia Eye exams Laser eye surgery Eye glasses, contact lenses, lens solution Prescribed OTC Medications See the full list at Enrollment Options Health Care Expense Account Your health care expense account allows you to save money by paying out-of-pocket health-related expenses with pre-tax dollars. During your annual benefit enrollment, you must decide whether to participate in this account and how much to contribute. Dependent Care Account (Day Care Expenses) This optional plan allows you to use pre-tax dollars to pay for dependentcare expenses while you and your spouse (if married) are at work. During the annual benefit enrollment, you must decide whether to participate in this account and how much to contribute. The dependent care account is not pre-funded. You are eligible for reimbursement once you have incurred a claim and money has been deducted from your paycheck. Page 46

48 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 webclaim. 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 VISA 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 VISA 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) or toll free (888) For immediate access to your account information at any time, log on to our website 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 the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying change of status (marriage status, employment change, dependent change). Be conservative in the total amount you elect to avoid forfeiting money that may be left in your account at the end of the year. Your employer may allow a short grace period after the Plan year ends for you to submit qualified claims for any unused funds. NATIONAL BENEFIT SERVICES, LLC 8523 South Redwood Road West Jordan, UT Phone: Fax: Service@NBSbenefits.com NBSbenefits.com Page 47

49 Health Care Expense Account Sample Expenses Medical Expenses Dental Expenses Vision Expenses Acupuncture Addiction programs Adoption (medical expenses for baby birth) Alternative healer fees Ambulance Body scans Breast pumps Care for mentally handicapped Chiropractor Co-payments Crutches Diabetes (i.e. insulin, glucose monitor) Eye patches Fertility treatment First aid (i.e. bandages, gauze) Hearing aids & batteries Hypnosis (for treatment of illness) Incontinence products (ie Depends, Serene) Joint support bandages and hosiery Lab fees Monitoring device (blood pressure, cholesterol) Physical exams Pregnancy tests Prescription drugs Psychiatrist/Psychologist (for mental illness) Physical therapy Speech therapy Vaccinations Vaporizers or humidifiers Weight loss program fees (if prescribed by physician) Wheelchair Artificial teeth Co-payments Deductible Dental work Dentures Orthodontia expenses Preventative care at dentist office Bridges, crowns, etc. Braille books & magazines Contact lenses Contact lens solutions Eye exams Eye glasses Laser surgery Office fees Guide dog and its upkeep, other animal aid Items listed below generally do not qualify for reimbursement Personal Hygiene (i.e. deodorant, soap, body powder, shaving cream, sanitary products) Addiction products Allergy relief (oral meds, nasal spray) Antacids and heartburn relief Anti-itch and hydrocortisone creams Athlete s foot treatment Arthritis pain relieving creams Cold medicines (i.e. syrups, drops, tablets) Cosmetic surgery Cosmetics (i.e. makeup, lipstick, cotton swabs, cotton balls, baby oil) Counseling (i.e. marriage/family counseling) Dental care routine (i.e. toothpaste, toothbrushes, dental floss, anti-bacterial mouthwashes, fluoride rinses, breath strips, teeth whitening/bleaching, etc.) Exercise equipment Fever & pain reducers (i.e. Aspirin, Tylenol) Hair care (i.e. hair color, shampoo, conditioner, brushes, hair loss products) Health club or fitness program fees Homeopathic supplement or herbs Household or domestic help Laser hair removal Laxatives Massage therapy Motion sickness medication Nutritional and dietary supplements (i.e. bars, milkshakes, power drinks, Pedialyte) Skin care (i.e. sun block, moisturizing lotion, lip balm) Sleep aids (i.e. oral meds, snoring strips) Smoking cessation relief (i.e. patches, gum) Stomach & digestive relief (i.e. Pepto-Bismol, Imodium) Tooth and mouth pain relief (Orajel, Anbesol) Vitamins Wart removal medication Weight reduction aids (i.e. Slimfast, appetite suppressant These expenses may be eligible if they are prescribed by a physician (if medically necessary for a specific condition) For Additional Information, Visit Welfare-547 (1/12) 8523 S Redwood Rd, West Jordan, UT (800) Fax (801) Page 48

50 It s easy with HSA Bank. Start saving more on healthcare. HSA Bank has teamed up with your employer to create an affordable health coverage option that helps you save on healthcare expenses while protecting your health and finances. It combines a high-deductible health plan (HDHP) from your insurance provider with a tax-advantaged health savings account (HSA) from HSA Bank. Together, they offer you health, savings and tax advantages that a traditional health plan can t duplicate. What is an HDHP? An HDHP, or high-deductible health plan, is a major-medical health insurance plan that has a lower premium than traditional health plans. Your HDHP: Is a major-medical health plan that is HSA-compatible. That means it can be used with a health savings account from HSA Bank Has a higher annual deductible with lower monthly premiums, which means you ll have less taken out of your paycheck and more to add to your HSA Covers 100% of preventive care, including annual physicals, immunizations, well-woman and well-child exams, and more all without having to meet your deductible Provides coverage for health screenings, such as blood pressure, cholesterol, diabetes, vision, hearing and more What is an HSA? An HSA, or health savings account, is a unique tax-advantaged account that you can use to pay for current or future healthcare expenses. With an HSA, you ll have: A tax-advantaged savings account that you use to pay for eligible medical expenses as well as deductibles, co-insurance, prescriptions, vision and dental care Unused funds that will roll over year to year. There s no use or lose it penalty Potential to build more savings through investing. You can choose from a variety of HSA self-directed investment options with no minimum balance required Additional retirement savings. After age 65, funds can be withdrawn for any purpose without penalty 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. Page 49