BENEFIT REFERENCE GUIDE

Transcription

1 BENEFIT REFERENCE GUIDE Plan Year September 1, 2013 August 31, 2014 JR Cornejo, Sr. Account Mgr. (903) Scott Elgin, Sr. Account Executive (903)

2 TABLE OF CONTENTS TOPIC PAGE Customer Service Numbers and Websites... 1 Introduction... 2 Section 125 Cafeteria Plan... 3 Flexible Spending Account AFA Long-Term Disability... 5 Texas Life (Individual Life) Chartis Critical Illness Allstate Heart & Stroke AFA Cancer AFA Basic Accident & Enhanced Plan Lincoln Voluntary Term Life Ameritas Dental Ameritas Vision... 48

3 CENTER ISD 107 PR 605 P.O. Drawer 1689 Center, TX (936) First financial Administrators, Inc. Supplemental and Retirement Benefits P.O. Box Houston, TX JR Cornejo, Sr. Account Executive (903) Scott Elgin, Sr. Account Executive (903) Flexible Spending Accounts P.O. Box Houston, TX Fax Allstate Workplace Division Heart/Stroke American Fidelity Assurance Company Accident, Disability & Cancer Insurance Ameritas Dental/Vision Insurance Claim Forms Chartis/AIG Critical Illness Texas Life Insurance Company Permanent Life Insurance Metavante Debit Card Balances

4 2013 Benefit Overview Center Independent School District and First Financial Group of America would like to take this opportunity to present to you the benefit information for the upcoming plan year. This information has been created to bring forth a brief overview of your benefit choices as well as offer you a reference guide when questions may arise regarding your insurance plans. Please take the time to look over the information contained in this booklet to familiarize yourself with the benefits that are provided to you as an employee with Center ISD. Representatives from First Financial will be at the district during the month of March to review plan options and make changes to your supplementary benefit elections under the Cafeteria Plan. Education is Key! This guide contains a summary of the benefits offered by Center ISD. If there is a conflict between the terms of this outline of benefits and the actual contracts, the terms of the contracts will prevail. For a more detailed explanation of benefits you may contact First Financial Administrators at or visit the website listed below. Visit for detailed information.

5 SECTION 125 CAFETERIA PLAN As a district employee, you are eligible to participate in a Section 125 Flexible Benefit Plan. Enrollment opportunities are limited to the plan year dates for your district. A Section 125 Flexible Benefit Plan allows you, the employee, to select from a list of available benefits that will meet your family s healthcare needs. Certain benefit premiums are deducted from your gross earnings before federal withholding taxes are figured. The amount you elect to have deducted is pre-tax actually lowers your taxable income. By implementing this plan, your employer is helping you reduce your taxes and increase your take home pay. You cannot change your elections during the plan except for certain specified changes in family status. Those changes include: Marriage Divorce Death of a spouse/child Birth or adoption of a child Termination of a spouse s employment CENTER ISD SECTION 125 PLAN The example below shows how a married employee claiming 1 exemption can reduce their taxable income when they pay for their insurance coverage on a pre-tax basis. WITHOUT SECTION 125 WITH SECTION 125 Monthly Salary $3,000 Monthly Salary $3, Less TRS Less TRS Taxable Income 2, Less Ins./Flex Less Taxes Taxable Income 2, Less Ins./Flex Less Taxes TAKE HOME PAY $2, TAKE HOME PAY $2, You saved $72 per month in taxes by paying for your benefits on a pre-tax basis. This means more spendable income at the end of the month to use for additional benefits or to increase your take home pay.

6 FLEXIBLE SPENDING ACCOUNTS Flexible Spending Accounts are tax-favored accounts that allow participants to set aside money pretax for eligible Medical and Dependent Care costs. Flexible Spending Accounts (FSAs) allow an employee the opportunity to put some of his/her salary aside before taxes to pay for many common out-of-pocket expenses. Use-it-or-lose-it refers to an IRS requirement. If you do not spend all the money you have elected, it will be forfeited because it cannot be rolled over or refunded to you. Any money that you elect to set aside in a flexible spending account for a given Benefit Period may be used only for eligible expenses you incur for services received during that Benefit Period. So, it s very important that you plan carefully when deciding on how much to allot for your FSAs. The Benefit period for Center ISD is September 1, 2013 to August 31, Medical Reimbursement Your medical reimbursement account may be used to reimburse you for expenses that you incur for treatment of yourself, spouse and dependent children. Eligible medical expenses include deductibles and coinsurance amounts under a group health plan, charges that are in excess of the amount reimbursed under a group health plan and charges that are not covered under a group health plan such as certain corrective surgeries, vision care, dental care and hearing aids. Effective January 1, 2011, all OTC items eligible for reimbursement must be accompanied by a doctor s prescription and a reimbursement request (claim form). OTC claims may no longer be purchased using the FFA Benefits Debit Card. Maximum contribution amount for 2013 plan year is $2,400 ($200 per month). Reminder If you or your spouse participates in a High Deductible Health Savings Account you are not eligible to enroll in Medical Reimbursement. FFA Benefits Card The FFA benefits card is available for Medical Reimbursement Flexible Spending Accounts. This card may be used in lieu of cash for any out-of-pocket medical expenses only. It is a signature debit card and does not require a pin for use. Cards are good for three years from the issue date as long as you participate each consecutive plan year. Dependent Care Reimbursement This benefit allows you to pay for dependent care expenses with pre-tax dollars. The maximum amount for Dependent Care Reimbursement is $5,000 per plan year. Dependent daycare center expenses are eligible if the care is for your dependent under age 13 and for any other qualifying dependent (including adult dependents), who regularly spends at least 8 hours each day in your household. Child support payments and childcare payments qualifying as alimony are not qualified expenses for reimbursement.

7 American Fidelity Assurance Company s Long-Term Disability Income Insurance Plan Designed Specifically For: Texas Schools

8 Why Do You Need Disability Income Protection? Disability causes nearly 50% of all mortgage foreclosures each year 1. Disability 50% Death Other 48% 2% Are You Prepared If You Become Disabled? If your paycheck suddenly stopped today, what would you do? 70% of the working population live paycheck to paycheck 2. The consequence of suffering a disabling Injury or Sickness could be a financial concern. And with research showing 1 in 7 employees will be disabled for 5 years or more 2, American Fidelity s Disability Income Insurance may help you avoid becoming another statistic. Is Disability Insurance Right For You? A Disability Plan is designed to offer income protection when you are disabled and cannot work. Consider it Insurance on your Income! If you become disabled due to a covered Injury or Sickness, disability income insurance will pay you a monthly income based on your covered benefit amount, once you satisfy your elimination period. Plan benefits are paid directly to you and can be used however you d like. Protect Your Paycheck Today with American Fidelity s Disability Income Insurance! 1 Council for Disability Awareness, worker Disability Planning & Preparedness Study, Business Wire, Many Workers Would Rely on Credit or Family if Disabled or Ill; April 2009 If you reside in a state other than your employer s state of domicile, where required by law, policy provisions and benefits may vary.

9 Plan Highlights Benefits are paid directly to you, not to a doctor or your employer. Benefits are payable year-round. Convenient payroll deduction. Benefit payments may be directly deposited into your bank account. Benefits are paid due to a covered Injury or Sickness. Several benefit plan options are available. Optional Riders available including: Critical Illness Rider, Accident Only Spousal Rider, Hospital Indemnity Rider, Survivor Benefit Rider and COBRA Funding Rider. IMPORTANT Benefits include: Donor Benefit Worksite Accommodation Evaluation Social Security Filing Assistance Waiver Of Premium Portability Conversion Return To Work Benefit: Disabled While Working Family Care Benefit Physician Expense Benefit Hospital Confinement Benefit Accidental Death Benefit Choose The Plan That s Right For You benefits begin Plan II - On the 15th day of Disability due to a covered Injury or Sickness. Plan III - On the 31st day of Disability due to a covered Injury or Sickness. Plan IV - On the 61st day of Disability due to a covered Injury or Sickness. Plan V - On the 91st day of Disability due to a covered Injury or Sickness. Plan VI - On the 151st day of Disability due to a covered Injury or Sickness. benefits are payable Up to the period of time shown in the table below, based on your age as of the date Disability due to a covered Injury or Sickness begins. Age Maximum Benefit Period Less than age 60 To Social Security Normal Retirement Age (SSNRA)* months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater months, or to SSNRA*, whichever is greater Age 69 or older 12 months, or to SSNRA*, whichever is greater *Age at which you are entitled to unreduced Social Security benefits based on current Social Security Amendments.

10 Plan Features Hospital confinement benefit The Hospital Confinement Benefit will be paid each day you are confined as a patient in a Hospital due to an Injury or Sickness, for up to 60 days. The amount payable is 1 times the Disability Benefit which will be pro-rated on a daily basis. This benefit will not be reduced by Deductible Sources of Income. The Hospital confinement must be at least 18 continuous hours in duration. This benefit will begin after your satisfaction of the elimination period. return to work incentive benefit: Disabled While Working We will provide a Disability Payment if you are Disabled and your monthly Disability Earnings, if any, are less than 20% of your Monthly Compensation due to the same Disability. If you are Disabled and your Disability Earnings are greater than 20% of your Monthly Compensation due to the same Disability, we will figure your payment as follows: During the first 24 months of payments while Disabled and Working: Your Disability Payment will not be reduced as long as the Disability Earnings plus the gross Disability Benefit does not exceed 80% of your Monthly Compensation. If the Disability Earnings plus the gross Disability Benefit exceeds 80% of your Monthly Compensation, the Disability Payment will be reduced by the amount exceeding 80% of your Monthly Compensation. After 24 months of payments, while Disabled and Working, you will receive payments based on the percentage of Monthly Compensation you are losing due to Lost Earnings based on your Disability. We will stop payments and your claim will end, if at any time you are no longer Disabled or if your Disability Earnings exceed 80% of your Monthly Compensation. The Elimination Period cannot be satisfied with days you are Disabled and Working. Family Care Benefit If you are Disabled and Working, qualify to receive a Disability Payment from us, and have one or more eligible family members, you may be eligible to receive a Family Care Benefit. This may include payment for the care of an eligible family member by a licensed childcare provider or licensed caregiver who is not related to you by blood or marriage. We will provide a Family Care Benefit for expenses incurred of up to 25% of your monthly Disability Benefit provided the total of your Disability Earnings, the gross Disability Benefit, and the Family Care Benefit do not exceed 100% of your Monthly Compensation. Payment of the Family Care Benefit will end on the earlier of the following: the date you no longer incur Family Member expenses; or the date you no longer qualify as Disabled and Working; or the date Disabled and Working benefits have been paid for a total of 24 months. ACCIDENTAL DEATH BENEFIT A lump sum of $20, will be paid if you die as the direct result of an Injury and death occurs within 90 days after the Injury. The benefit will be increased 1% for each full month that your Certificate was continuously in force just prior to death. The total increase shall not be more than 60% of the benefit amount. Physician expense benefit Injury - $ per Injury Sickness - $50.00 If you need personal treatment by a Physician due to an Injury or Sickness, we will pay the amount shown above provided no other claim has been paid under the Policy. This benefit will be paid for Sickness only if the treatment is received during one full day of Disability during which you missed one full day of work. To be eligible for more than one payment for the same or related condition due to Sickness, you must have returned to Active Employment for at least 14 consecutive scheduled workdays. You are not required to miss one full day of work in order to receive the Injury benefit.

11 Donor benefit If you are Disabled as a result of being an organ or tissue donor, we will pay your benefit as any other Sickness under the terms of the plan. worksite accommodation If worksite modifications may assist your return to work, we will evaluate your claim for appropriate action. Direct deposit disability benefits In the event you choose the direct deposit option on an approved claim, we will deposit your benefits directly into your bank account at no additional cost. This can accelerate access to your benefits by several days. We also have a toll-free fax that allows you instant transmission of your claim forms to our Benefits Department. Social security filing assistance If we determine you are a likely candidate for Social Security Disability benefits, we can assist you with the application and appeal process. Waiver of premium No premium payments are required while you are receiving payments under the plan after Disability Payments have been received under the plan for 180 consecutive days. We will require proof on an annual basis that you remain Disabled during this time. Successive Disabilities Disabilities which result from the same or related causes will be considered one period of Disability unless the Disabilities are separated by your return to Active Employment or any other gainful occupation for at least 3 consecutive months. Special Conditions Limited Benefit The Special Conditions Limited Benefit provides a benefit up to 2 years, due to Special Conditions if you are disabled and under the regular and appropriate care of your physician. Benefits will be paid for only one disability when more than one disability exists at the same time or a disability results from two or more causes. Special Conditions means: Chronic Fatigue Syndrome; Fibromyalgia; Any disease, disorder, accident or injury of the neck or back not resulting in hemiplegia, paraplegia or quadriplegia; Environmental allergic illness including, but not limited to sick building syndrome and multiple chemical sensitivity; and Self-reported symptoms. Self-reported symptoms are symptoms that the insured tells their physician that are not verifiable using tests, procedures or clinical examinations. Examples include: headaches, pain, fatigue, stiffness, soreness, ringing in ears, dizziness, numbness, or loss of energy. Portability Conversion The Conversion Plan will be a separate group plan with a 30 day elimination period and 2 year benefit period. Certain other qualifications may apply. A brochure is available for this plan upon request after termination. Disability Insurance Needs Worksheet Use this worksheet to get a general estimate of how much Disability Income Protection insurance you need. However, you should consult with a financial advisor before buying any insurance products. Monthly Income Your Income Total Monthly Income Monthly Expenses Mortgage/Rent Car Payment Utilities Loan/Credit Card Payments Insurance (Home, Auto, Health, Life, etc.) Food/Clothing Child Care/Education Other Expenses Total Monthly Expenses Are You Covered? $ $ $ $ $ $ $ $ $ $ $

12 Important Policy Provisions Eligibility All permanent employees in subscribing group working 20 hours or more per week. Proof of good health may be required by us in order to be eligible for disability coverage. We will rely on answers given on your application to determine if coverage can be issued. Regardless of your health at the time of application, if coverage is approved and issued, claims incurred while coverage is in force will be subject to all terms of the Policy including any Pre-Existing Condition limitation. When coverage begins Certificates will become effective on the requested effective date following the date we approve the application, providing you are on Active Employment and premium has been paid. IF you ARE DISABLED DUE TO A COVERED DISABILITY AND NOT WORKING Your Disability Payment will be the Disability Benefit described in the Benefit Schedule less any Deductible Sources of Income you receive or are entitled to receive. Offsets with Other Sources of Income Deductible Sources of Income include: Other group disability income. Governmental or other retirement system, whether due to Disability, normal retirement or voluntary election of retirement benefits. United States Social Security Act or similar plan or act, including any amounts due your dependent(s) on account of your Disability. State Disability. Unemployment compensation. Sick leave or other salary or wage continuance plans provided by the Employer which extend beyond 60 (Plans II, III, and IV), 90 (Plan V), or 150 (Plan VI) calendar days from the Date of Disability. We reserve the right to estimate these Deductible Sources of Income that you may receive as defined in your Certificate. MINIMUM DISABILITY BENEFIT The minimum Monthly Disability Benefit is 10% of the Monthly Disability Benefit or $100.00, whichever is greater. INCREASE OF INCOME DUE TO COST OF LIVING ADJUSTMENTs The Disability Payment will not be reduced due to a cost of living increase if the increase from a Deductible Source of Income takes effect after the onset of Disability and while benefits are payable under the Policy. MENTAL ILLNESS LIMITED BENEFIT If you are Disabled due to a mental illness, regardless of the cause, Disability Payments will be provided for up to 2 years, not to exceed the Maximum Disability Period. ALCOHOLISM AND DRUG ADDICTION LIMITED BENEFIT If you are disabled due to alcoholism or drug addiction, a limited benefit of up to 15 days for each Disability will be paid. Benefits will not be paid beyond the Maximum Benefit Period. If drug addiction is sustained at the hands of, or while under the regular and appropriate care of a physician in the course of treatment for Injury or Sickness, it will be covered the same as any other Sickness. Pre-existing condition limitation A limited benefit up to 1 month s Disability Benefit will be payable for Disability caused by or resulting from a Pre-Existing Condition. This provision will not apply if you have: gone treatment-free; incurred no expense; taken no medication; and received no diagnosis or advice from a Physician for 12 consecutive months for such condition(s). This limitation will not apply to a Disability resulting from a Pre- Existing Condition that begins after you have been continuously covered under the Policy for 24 months. Any increase in benefits will be subject to this Pre-Existing Condition limitation. A new Pre-Existing Condition period must be satisfied with respect to any increase applied for and approved by us. EXCLUSIONS The Policy does not cover any loss, fatal or non-fatal, resulting from: Intentionally self-inflicted injury while sane or insane. An act of war, declared or undeclared. Injury sustained or Sickness contracted while in the service of the armed forces of any country. Committing a felony. Penal incarceration. We will not pay benefits for Disability or any other loss during any period for which you are incarcerated in a penal or correctional institution for a period of 30 consecutive days or longer. Injury or Sickness arising out of and in the course of any occupation for wage or profit or for which you are entitled to Workers Compensation*. *The term entitled to Workers Compensation shall also include Workers Compensation claim settlements that occur via compromise and release. Further, no benefits will be paid under this Policy for any period during which you are entitled to Workers Compensation benefits. Leave of Absence Your coverage may be continued for up to 1 year during a Leave of Absence approved in writing by your Employer.

13 Termination of insurance Your insurance coverage will end on the earliest of these dates: the date you do not meet the Eligibility requirements as defined in the Eligibility paragraph in this brochure; the date you retire; the date you cease to be on Active Employment, except as provided for under the Leave of Absence provision; the end of the last period for which premium has been paid; the date the Policy is discontinued; or the date your employment terminates. If: your coverage ends as a result of your termination of Active Employment; such termination is caused by an Injury or Sickness for which Disability Benefits would be payable; and Disability is established prior to the termination of Active Employment, then: Disability Benefits will be paid as if such termination had not occurred. Termination of the Policy will have no affect on Disability Payments which began before termination. We may end your coverage if you submit a fraudulent claim. Definitions ACTIVE EMPLOYMENT: Means 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 Employment on a day which is not a scheduled work day only if you are not Disabled and would be able to perform in the usual manner all the regular duties of your employment if it were a scheduled work day. Disability: Disability or Disabled for the first 12 months of Disability means that you are unable to perform the material and substantial duties of your Regular Occupation. After that, Disability means you are unable to perform the material and substantial duties of any Gainful Occupation for wage or profit for which you are reasonably qualified by training, education, or experience. Disability Earnings: Means the gross monthly earnings you receive while Disabled and Working. Disability PAYMENT: Means your Disability Benefit minus Deductible Sources of Income. ELIGIBLE FAMILY MEMBERS: With regards to the Family Care Benefit, this means your child (natural, step, or adopted) living in your household and under age 13; or your family member who is: living in your household; dependent upon you for support; and in need of supervision or assistance due to physical or mental incapacity. Hospital: The term Hospital shall not include an institution used by you 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 as an extended care facility for the care of convalescent, rehabilitative, or ambulatory patients. LOST EARNINGS: Means the percentage of Monthly Compensation you are losing due to your Disability while Disabled and Working. This is computed as follows: subtract your Disability Earnings from your Monthly Compensation; divide this answer by your Monthly Compensation. This will be your percentage of lost earnings. multiply your Disability payment by your percentage of lost earnings. MONTHLY COMPENSATION: Means for contracted employees, one-twelfth (1/12) of your contract salary through your Employer; or for non-contracted employees, one-twelfth (1/12) of your annual salary through your Employer, in effect on the date Disability began. It excludes any additional compensation including but not limited to, overtime pay, weekend or summer work compensation, bus or other allowances, bonuses or district-funded fringe benefits. If you become Disabled while on an approved leave of absence, we will use your gross Monthly Compensation from your Employer in effect just prior to the date your absence began. Pre-existing Condition: The term Pre-Existing Condition means a disease, Injury, Sickness, physical condition or mental illness for which you: had treatment; incurred expense; took medication; received care or services including diagnostic testing or related measures; or received a diagnosis or advice from a Physician, during the 12-month period immediately before your Effective Date of coverage. The term Pre-Existing Condition will also include conditions which are related to such disease, Injury, Sickness, physical condition, or mental illness.

14 Critical Illness Rider Consider The Facts The cost of a two-year disability can equal one to two times an individual s or family s annual household income. AHIP and LIFE: The Impact of Disability prepared by Milliman, Inc; May CRITICAL illness rider Benefit Amount Monthly Premium $10, $9.80 $15, $13.18 $20, $16.56 $25, $19.94 We will pay a one-time lump sum benefit amount based on diagnosis of the following conditions: Heart Attack, Stroke, Kidney Failure, Paralysis, or Major Organ Failure. In the case of Heart Attack, a physician must make the diagnosis and treatment must occur within 72 hours of the onset of symptoms. Accident Only Spousal Rider Consider The Facts On average, one out of every 11 Americans suffered a disabling injury in National Safety Council, Injury Facts, 2009 Edition, p. 2 Total costs of accidental injuries averaged $26,023 per injury in National Safety Council, Injury Facts, 2009 Edition, p. 4 Monthly Indemnity Amount Accident Only Spousal rider Annual Salary Monthly Premium $ up to $10, $4.00 $1, $10, $20, $8.00 $1, $20, $30, $12.00 $2, $30, and over. $16.00 We will pay a monthly indemnity amount to you for your spouse who is disabled as a result of a non-occupational accident. Benefits will begin on the 31st consecutive day after the Injury and will continue for up to 2 years. Coverage under this Rider will begin on the later of the requested Effective Date or the date we approve the written application, provided that your spouse has no other group disability income coverage in force; is less than age 70; is engaged in Full Time Employment on the date this Rider becomes effective; and is able to perform the material and Critical Illness Rider Limitations In addition to the Exclusions listed in the Base Plan to which this Rider is attached, no benefits will be paid for any loss caused by or resulting from: (a) a Critical Illness when the Date of Diagnosis occurs during the Waiting Period; (b) a Critical Illness diagnosed outside of the United States; or (c) a Sickness or Injury not specifically defined in this Rider. No Critical Illness Benefit will be payable for a Critical Illness which is caused by or resulting from a Pre-Existing Condition when the Critical Illness Date of Diagnosis occurs before you have been continuously covered under this Rider for 12 consecutive months. Following 12 consecutive months this exclusion does not apply. Pre-Existing Condition means a disease, Injury, Sickness, physical condition or mental illness for which you have experienced any of the following: (a) treatment; (b) incurred expense; (c) took medication; (d) received care or services including diagnostic testing or related measures; or (e) received a diagnosis or advise from a Physician, during the 12-month period immediately before the Effective Date of this Rider. The term Pre-Existing Condition will also include conditions which are related to such disease, Injury, Sickness, physical condition or mental illness. Benefits reduce by 50% at age 70. No benefits will be paid for a Critical Illness when the Date of Diagnosis occurs during the Critical Illness Waiting Period. The waiting period is 30 days from the Effective Date of this Rider. substantial duties of his or her occupation on the date this Rider becomes effective, and; your coverage under the Policy is in force and you are on Active Employment; and the required premium has been paid. FULL TIME EMPLOYMENT (or Full Time) means your Spouse is employed an average of 25 or more hours per week for pay or benefits. Full Time Employment does not include any hours your Spouse is working while self-employed. Accident Only Spousal Rider Limitations This Rider does not provide benefits for your Spouse for any Disability, fatal or non-fatal, which results from any of the following: (a) Intentionally self-inflicted Injury while sane or insane; (b) An act of war, declared or undeclared; (c) Injury sustained or contracted while in the service of the armed forces of any country; (d) Committing a felony; (e) Penal incarceration. We will not pay benefits during any period for which your Spouse is incarcerated in a penal or correctional institution or for any Injury that occurs while your Spouse is incarcerated in a penal or correctional institution; (f) Injury arising out of and in the course of any occupation for wage or profit or for which your Spouse is entitled to Workers Compensation. The term entitled to Workers Compensation shall also include Workers Compensation claim settlements which occur via compromise and release. Further, no benefits will be paid under this Policy for any period during which your Spouse is entitled to Workers Compensation benefits; (g) Participation in any sport for wage or profit; (h) Participation in any contest of speed in a power driven vehicle for wage or profit. Spouse means the person you are lawfully married to who is less than age 70. No benefits are payable for your Spouse under this Rider for a Disability from an Injury that occurred outside of the United States or its territories. No benefit will be provided for any period in which your Spouse is not under the Regular and Appropriate Care of a Physician. No benefits will be paid for any Injury to your Spouse which is caused by or resulting from spousal abuse.

15 Hospital Indemnity Rider Consider The Facts The average charge for a hospital stay is $26,100. HCUP Facts and Figures, 2007: Statistics on Hospital-based Care in the United States; Agency for Healthcare Research and Quality, % of total healthcare costs are paid out-of-pocket. Kaiser Family Foundation: Trends in Health Care Costs and Spending; March 2009 The average length of a hospital stay is 4.6 days. HCUP Facts and Figures, 2007: Statistics on Hospital-based Care in the United States; Agency for Healthcare Research and Quality, We will pay a daily benefit amount for an Inpatient Hospital confinement up to a maximum of 90 days. Inpatient means you are admitted as a resident patient to a Hospital for at least 18 continuous hours and are being charged for room and board facilities. Survivor Benefit Rider If you have been Disabled and not working for at least 90 days; and die while receiving Disability Benefits, a Survivor Benefit will be paid to your beneficiary or estate. Hospital Indemnity rider Daily Benefit Amount Monthly Premium $ $6.00 $ $9.00 Hospital Indemnity Rider Limitations The Hospital Confinement Benefit will not be payable for an Injury or Sickness incurred in the first 12 months of coverage if the Injury or Sickness is caused by or resulting from a Pre-Existing Condition as defined in the Policy. In addition to the Exclusions listed in the Policy, no benefits will be payable under this Rider for any Hospital Confinement that is caused by or resulting from Mental Illness or Drug or Alcohol Abuse. Benefits are reduced by 50% at age 70. Successive Hospital stays will be considered as one confinement if they are separated by less than 90 days of confinement to a Hospital. Survivor Benefit rider Monthly Benefit Amount Monthly Premium $2, $6.80 The Survivor Benefit will be paid monthly up to 1 year or until the Maximum Disability Period is exhausted, whichever occurs first. COBRA Funding Rider Consider The Facts Currently, the average long-term disability absence lasts 2.5 years. Council for Disability Awareness, Worker Disability Planning & Preparedness Study, 2008 Half of bankruptcies are caused by unexpected illnesses, injuries, and medical bills. Business Wire: Many Workers Would Rely on Credit or Family if Disabled or Ill; April 2009 Many people suffering from a serious sickness or injury lose their job and their employer-provided medical insurance. Council for Disability Awareness, Worker Disability Planning & Preparedness Study, 2008 In order to receive benefits under this Rider, you must: be receiving benefits under your Disability base plan; elect medical Cobra coverage; and be paying medical Cobra premiums. This Benefit will pay up to the end of the disability benefit period or to the end of your medical COBRA benefit period, whichever occurs first. COBRA FUNDING rider Monthly Benefit Amount Monthly Premium $ $4.50 COBRA Funding Rider Limitations Proof of election of medical COBRA continuation must be provided to us. Proof of continued medical COBRA participation will be required before benefits are paid under this Rider.

16 Benefit Schedule Several benefit options are available to you. You may participate in the Plan under any one of the benefit levels outlined below, provided the Monthly Disability Benefit level selected does not exceed 70% of your Monthly Compensation. Monthly Salary Monthly Disability Benefit Accidental Death Benefit Plan II (15th) Plan III (31st) Plan IV (61st) Plan V (91st) Plan VI (151st) $ $ $ $20, $7.28 $5.80 $4.92 $4.16 $3.12 $ $ $ $20, $10.92 $8.70 $7.38 $6.24 $4.68 $ $ $ $20, $14.56 $11.60 $9.84 $8.32 $6.24 $ $ $ $20, $18.20 $14.50 $12.30 $10.40 $7.80 $ $ $ $20, $21.84 $17.40 $14.76 $12.48 $9.36 $1, $1, $ $20, $25.48 $20.30 $17.22 $14.56 $10.92 $1, $1, $ $20, $29.12 $23.20 $19.68 $16.64 $12.48 $1, $1, $ $20, $32.76 $26.10 $22.14 $18.72 $14.04 $1, $1, $1, $20, $36.40 $29.00 $24.60 $20.80 $15.60 $1, $1, $1, $20, $40.04 $31.90 $27.06 $22.88 $17.16 $1, $1, $1, $20, $43.68 $34.80 $29.52 $24.96 $18.72 $1, $1, $1, $20, $47.32 $37.70 $31.98 $27.04 $20.28 $2, $2, $1, $20, $50.96 $40.60 $34.44 $29.12 $21.84 $2, $2, $1, $20, $54.60 $43.50 $36.90 $31.20 $23.40 $2, $2, $1, $20, $58.24 $46.40 $39.36 $33.28 $24.96 $2, $2, $1, $20, $61.88 $49.30 $41.82 $35.36 $26.52 $2, $2, $1, $20, $65.52 $52.20 $44.28 $37.44 $28.08 $2, $2, $1, $20, $69.16 $55.10 $46.74 $39.52 $29.64 $2, $2, $2, $20, $72.80 $58.00 $49.20 $41.60 $31.20 $3, $3, $2, $20, $76.44 $60.90 $51.66 $43.68 $32.76 $3, $3, $2, $20, $80.08 $63.80 $54.12 $45.76 $34.32 $3, $3, $2, $20, $83.72 $66.70 $56.58 $47.84 $35.88 $3, $3, $2, $20, $87.36 $69.60 $59.04 $49.92 $37.44 $3, $3, $2, $20, $91.00 $72.50 $61.50 $52.00 $39.00 $3, $3, $2, $20, $94.64 $75.40 $63.96 $54.08 $40.56 $3, $3, $2, $20, $98.28 $78.30 $66.42 $56.16 $42.12 $4, $4, $2, $20, $ $81.20 $68.88 $58.24 $43.68 $4, $4, $2, $20, $ $84.10 $71.34 $60.32 $45.24 $4, $4, $3, $20, $ $87.00 $73.80 $62.40 $46.80 $4, $4, $3, $20, $ $89.90 $76.26 $64.48 $48.36 $4, $4, $3, $20, $ $92.80 $78.72 $66.56 $49.92 $4, $4, $3, $20, $ $95.70 $81.18 $68.64 $51.48 $4, $4, $3, $20, $ $98.60 $83.64 $70.72 $53.04 $5, $5, $3, $20, $ $ $86.10 $72.80 $54.60 $5, $5, $3, $20, $ $ $88.56 $74.88 $56.16 $5, $5, $3, $20, $ $ $91.02 $76.96 $57.72 $5, $5, $3, $20, $ $ $93.48 $79.04 $59.28

17 Benefit Schedule (con t) Several benefit options are available to you. You may participate in the Plan under any one of the benefit levels outlined below, provided the Monthly Disability Benefit level selected does not exceed 70% of your Monthly Compensation. Monthly Salary Monthly Disability Benefit Accidental Death Benefit Plan II (15th) Plan III (31st) Plan IV (61st) Plan V (91st) Plan VI (151st) $5, $5, $3, $20, $ $ $95.94 $81.12 $60.84 $5, $5, $4, $20, $ $ $98.40 $83.20 $62.40 $5, $5, $4, $20, $ $ $ $85.28 $63.96 $6, $6, $4, $20, $ $ $ $87.36 $65.52 $6, $6, $4, $20, $ $ $ $89.44 $67.08 $6, $6, $4, $20, $ $ $ $91.52 $68.64 $6, $6, $4, $20, $ $ $ $93.60 $70.20 $6, $6, $4, $20, $ $ $ $95.68 $71.76 $6, $6, $4, $20, $ $ $ $97.76 $73.32 $6, $6, $4, $20, $ $ $ $99.84 $74.88 $7, $7, $4, $20, $ $ $ $ $76.44 $7, $7, $5, $20, $ $ $ $ $78.00 $7, $7, $5, $20, $ $ $ $ $79.56 $7, $7, $5, $20, $ $ $ $ $81.12 $7, $7, $5, $20, $ $ $ $ $82.68 $7, $7, $5, $20, $ $ $ $ $84.24 $7, $7, $5, $20, $ $ $ $ $85.80 $8, $8, $5, $20, $ $ $ $ $87.36 $8, $8, $5, $20, $ $ $ $ $88.92 $8, $8, $5, $20, $ $ $ $ $90.48 $8, $8, $5, $20, $ $ $ $ $92.04 $8, $8, $6, $20, $ $ $ $ $93.60 $8, $8, $6, $20, $ $ $ $ $95.16 $8, $8, $6, $20, $ $ $ $ $96.72 $9, $9, $6, $20, $ $ $ $ $98.28 $9, $9, $6, $20, $ $ $ $ $99.84 $9, $9, $6, $20, $ $ $ $ $ $9, $9, $6, $20, $ $ $ $ $ $9, $9, $6, $20, $ $ $ $ $ $9, $9, $6, $20, $ $ $ $ $ $9, $9, $6, $20, $ $ $ $ $ $10, $10, $7, $20, $ $ $ $ $ $10, $10, $7, $20, $ $ $ $ $ $10, $10, $7, $20, $ $ $ $ $ $10, $10, $7, $20, $ $ $ $ $ $10, $10, $7, $20, $ $ $ $ $ $10, $10, $7, $20, $ $ $ $ $117.00

18 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) Not for use in WA.

19 monthly premiums PureLife-plus Standard Risk Table Premiums Non-Tobacco Express Issue Monthly Premiums for Life Insurance Face Amounts Shown Includes Added Cost for Non-Tobacco GUARANTEED PERIOD Age to Which Issue Accidental Death Benefit (Ages 17-59) Coverage is Age Guaranteed at (ALB) $10,000 $25,000 $40,000 $50,000 $75,000 $100,000 $125,000 $150,000 $200,000 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-K-M-1AD R

20 monthly premiums PureLife-plus Standard Risk Table Premiums Tobacco Express Issue Monthly Premiums for Life Insurance Face Amounts Shown Includes Added Cost for Tobacco GUARANTEED PERIOD Age to Which Issue Accidental Death Benefit (Ages 17-59) Coverage is Age Guaranteed at (ALB) $10,000 $25,000 $40,000 $50,000 $75,000 $100,000 $125,000 $150,000 $200,000 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-K-M-1AD R

21 Critical Illness Insurance Affordable Coverage for Times of Greatest Need Why You Should Consider Critical Illness Insurance Millions of Americans survive critical illnesses each year. For example, nearly 60% of those who had heart attacks in 2001 survived 1. But many people are not prepared for the costs of recovery, which may involve a long hospital stay and an extended period of recuperation. Consider these facts: the costs of a stroke, including inpatient care, rehabilitation and follow-up care, can add up to $140, And a heart bypass operation can cost more than $60, Critical Illness Insurance can help ease the financial impact of critical illness for survivors and their families. A Complement to Core Benefits Now your employer is offering you the opportunity to purchase Critical Illness Insurance underwritten by a subsidiary Chartis, Inc. This simple, affordable Critical Illness Insurance pays cash benefits you can spend as your wish for you and your family to help cover the costs of recovering from a critical illness. The coverage can be a valuable supplement to medical, disability, long-term care and life insurance. What the Plan Covers Your plan covers a variety of critical illnesses: Heart attack Kidney failure Coma Stroke Major organ transplant Paralysis Bypass surgery Severe burns How It Works Cash to Use as Your Choose- Cash benefits are paid directly to you or your family, unless you direct otherwise, in addition to any other coverages you may have. And you can use the money for reimbursed medical expenses, alternative treatments, travel, home modifications, home help, rehabilitation, or any other purpose. Simple Enrollment- Most programs require you to complete only a simple questionnaire. Family Coverage Available- You can also insure your spouse and unmarried, dependent children up to the age of 25. Portable and Guaranteed Renewable- Your policy is guaranteed renewable for your lifetime 3 and you can keep your benefits even if you change jobs. Affordability and Tax Savings- You buy this affordable coverage with pretax payroll deductions. 4 Timely, Responsive Claims Service- All claims are handled by seasoned professionals with the expertise to swiftly evaluate claims and the sensitivity to respond compassionately to crisis situations. 1 Heart Attack and Angina Statistics, 2004 Update, American Heart Association 2 Heart Disease and Stroke Statistics, 2004 Update, American Heart Association 13 Subject to the insurer s right to change premiums by class upon any renewal date 14 Chartis does not provide tax advice. Consult your tax advisor or attorney for details.

22 The Benefits for You The comprehensive range of benefits available to you and your covered family members include: First Occurrence Benefit- A one-time $5,000 upon a diagnosis of a covered critical illness Recurrence Benefit-$2,500 if a covered illness recurs Angioplasty Benefit- $1,000 for an angioplasty procedure Angioplasty Recurrence Benefit- $500 for a subsequent angioplasty Hospital Confinement Benefit- $300 a day for a covered critical illness Continuing Care Benefit- $100 a day, up to 60 days, for rehabilitation therapy, physical therapy, speech therapy, occupational therapy, home health care, dialysis, hospice and nursing home care Ambulance Benefit- $100 for ground ambulance and $1,000 for air ambulance Transportation Benefit-Up to $1,500 per round-trip for commercial travel or $.50 per mile for private automobile travel to a medical facility 100 miles of more from a covered person s home Lodging Benefit- Up to $60 a day for lodging (maximum 15 days for Occurrence of a covered illness) for one adult family member when a covered person receives medical treatment at a facility 100 miles or more away from home Waiver of Premium Benefit- If you are unable to perform your job duties or two or more activities for daily living for 90 continuous days, premiums will be waived Continuation of Coverage Benefit- If you leave your employer after six months of payroll deductions, premiums will be waived for up to two months First-Occurence Building Benefit- This rider increases the first-occurence building benefit by $500 per year for up to 20 years, after the policy has been in force for 12 months. Individual One-Parent Family Two-Parent Family Issue Age Monthly Issue Age Monthly Issue Age Monthly $ $ $ $15.30 $36-45 $ $ $ $ $ $ $ $72.55 *Rate includes First Occurrence Building Benefit Rider Enrolling is Easy Enrolling is simple. In a matter of minutes, you can complete an application and payroll deductions will be automatically set up by your computer This document provides only a brief description of the coverages available. The Policy contain reductions, limitations, exclusions and termination provisions. Full details of the coverage are contained in each Policy. If there are any conflicts between this document and each Policy, the Policy shall govern. Insurance is underwritten by National Union Fire Insurance Company of Pittsburgh, Pa., with its principal place of business in New York, NY. 2000, Chartis All rights reserved /05 TX,LA,NM,VA

23 BE WELL. BE SMART. BE PROTECTED. Allstate at Work heart/stroke insurance HeartCare Plus and HeartCare Direct No one likes to think about getting heart disease. But 61,800,000 Americans have one or more types of cardiovascular disease according to current estimates. 1 While you may not be able to prevent the disease, you can help protect yourself from its costs. The American Heart Association estimates the total direct and indirect costs of Cardiovascular Diseases and Stroke in 2002 in the United States to be $329.2 billion. 1 You can protect yourself and your family from these costs. HeartCare Plus and HeartCare Direct insurance covers a portion of the costs for ambulance, surgery and physicians. HeartCare Plus and HeartCare Direct insurance helps you: Manage the high expenses of treatment Preserve your savings Protect your family from financial hardship Concentrate on getting well 1American Heart Association Heart Stroke Statistical Update. 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 NOTIFICATIONS THAT MUST BE FILED AND POSTED (HEART CARE PLUS ONLY). D-7803 (2/03)

24 EXPLANATION OF BENEFITS 1/2 UNIT 1 UNIT Second Surgical Opinion Amount shown for a second opinion obtained after a positive diagnosis that results in the physician recommending surgery for a covered illness. Ambulance Amount shown for transfer by ambulance to a hospital or emergency room for the treatment of a covered condition. Non-Air Ambulance Air Ambulance Cardiac Catheterization Amount shown for a cardiac catheterization procedure. Blood, Plasma and Platelets Amount shown for the administration of blood, plasma or platelets during a covered hospital confinement, subject to a maximum of 1 payment per continuous hospital confinement. Non-Local Transportation Amount shown for a covered hospital confinement which is obtained more than 100 miles from the covered person s home because the prescribed treatment cannot be obtained locally. This is subject to a maximum of 1 payment per continuous hospital confinement Surgery and Anesthesia 1. Surgery. Amount shown in the surgical schedule for a surgery performed in a hospital or ambulatory surgical center. For a surgical procedure not listed in the surgical schedule, we pay $17 per unit of coverage ($8.50 per half unit) multiplied by the 1964 California Relative Value Schedule (C.R.V.S.) unit value for the procedure, subject to maximum of amount shown. If no 1964 C.R.V.S. unit value exists for the procedure, then the payment amount will be based upon relative difficulty and payment amounts for other procedures, up to maximum amount shown. Two or more surgical or invasive procedures done at the same time and through a common incision or entry point are considered one operation and benefit is paid for the one with the largest total benefit. 2. Anesthesia. Additional percentage shown of the amount paid for surgery benefit described in 1 above for anesthesia received during the surgery. 3. Ambulatory Surgical Center. Amount shown when surgery benefit described in 1 above is paid for a surgery performed at an ambulatory surgical center.these benefits do not pay for surgeries covered by other benefits in the policy. Family Member Lodging and Transportation 1. Lodging. Amount shown per day when the Non-Local Transportation benefit is paid and a family member stays in a motel, hotel, or any other accommodation acceptable to us, in order to be near the covered person, subject to a maximum of 60 days per continuous hospital confinement. 2.Transportation. Amount shown when the Non-Local Transportation benefit is paid and a family member travels more than 100 miles from their home to be near the covered person for a portion of their continuous hospital confinement. This is subject to a maximum of 1 payment per continuous hospital confinement. $50 $100 $100 $200 $200 $400 $250 $500 $100 $200 $100 $200 $2,500 $5,000 maximum maximum 25% 25% $125 $250 $25 $50 each day each day $100 $200 Renewability The policy will remain in effect when renewal premiums are paid as they are due or during the grace period. Renewal premiums will be at the premium rates in effect on the renewal date.we can change the premium rates on premiums becoming due after the first premium. However, we can only change the rate on this policy by making the rate change for all such policies in a class. Once the policy has been issued, we cannot place any restrictive riders on it or cancel or refuse to renew your policy if you maintain it continuously in force. If we do change rates on all like policies in your class, we will mail you a notice of this change. Notice will be mailed at least 31 days prior to such change. It will be mailed to your address as shown on our records. No change in premiums is effective unless this notice is mailed. Termination of Insurance If the insured s spouse is a covered person, the spouse s coverage ends upon valid decree of divorce. If your child is a covered person, the child s coverage ends on the policy anniversary next following the date the child is no longer eligible, which is either when the child marries or reaches age 25. Coverage does not terminate on an unmarried child who: 1. is incapable of self-sustaining employment by reason of mental retardation or physical handicap; 2. is chiefly dependent upon you for support and maintenance. Dependent coverage continues as long as this policy remains in force and the dependent child remains in such condition. Exclusions and Limitations The policy provides benefits only for Heart Attack, Heart Disease or Stroke.This policy does not cover any other disease or sickness or incapacity other than Heart Attack, Heart Disease or Stroke even though such disease, sickness or incapacity may be caused, complicated or otherwise affected by Heart Attack, Heart Disease or Stroke. If a covered confinement is due to more than one covered condition, benefits will be payable as though the confinement were due to one condition. If a confinement due to a covered disease is also due to a condition that is not covered, benefits will be payable only for the part of confinement attributable to the covered condition. Pre-Existing Condition Limitation A pre-existing condition is the existence of: symptoms which would cause an ordinarily prudent person to seek diagnosis, care or treatment within a 1 year period preceding the effective date of coverage of the insured person or a condition for which medical advice or treatment was recommended by or received from a physician within a 1 year period preceding the effective date of the coverage of the insured person. If a covered person has a pre-existing condition as defined, we do not pay benefits for such conditions under this policy or any riders attached to this policy during the 12 month period beginning on the date that person became a covered person. If the loss is not due to a pre-existing condition, then the pre-existing condition limitation does not apply. All losses are subject to the Incontestability provision. Exclusions and limitations to the policy also apply to the riders. This brochure highlights some features of the policy, but is not the insurance contract. Only the actual policy provisions control. The policy itself sets forth, in detail, the rights and obligations of both the insured and the insurance company.

25 BE WELL. BE SMART. BE PROTECTED. why it makes sense It s probably crossed your mind that you or your family may need treatment for heart disease or stroke. And you may have thought about the ways it would affect your life and your loved ones. But have you considered how cardiovascular diseases could impact your financial security. Medical insurance often stops short of considering these costs essential but some of these costs may be covered with Allstate Workplace Division s HeartCare Plus and HeartCare Direct Insurance. HeartCare Plus and HeartCare Direct Insurance Might Be Right For You If: There are cardiovascular diseases in your family s history You don t have much money set aside for an unexpected cardiovascular illness You want to help keep your family financially secure You want coverage you can take with you if you leave your job What You Get HeartCare Plus Policy and HeartCare Direct Pays you benefits that can be used for non-medical expenses that health insurance might not cover Benefits are paid as you go and cover the costs of specific treatments and expenses (up to the maximum allowed) as they happen Supplemental coverage, it works in addition to other insurance you may have, such as medical and disability income Guaranteed renewable for life, subject to change in premiums by class Coverage for yourself or your entire family HeartCare Plus Policy Only Pays in addition to your Workers Compensation Premiums can be made using pre-tax dollars under Section 125 Plan is portable. It s a benefit that you can keep if you change jobs or retire by paying premiums directly to Allstate Workplace Division. Optional Riders for HeartCare Plus and HeartCare Direct Optional riders which can be added to your base policy are: an optional intensive care benefit which pays benefits for an intensive care confinement due to any covered accident or disease, and a cancer initial diagnosis benefit, which pays a one-time benefit when a covered person is positively diagnosed with cancer (other than skin cancer). Exclusions and Limitations apply. how it works EXPLANATION OF BENEFITS Hospital Confinement Amount shown per day for each day a covered person is admitted and confined as an inpatient in a hospital due to a Heart Attack, Heart Disease or Stroke. Physician s Attendance Amount shown per day for the services of a physician during a covered hospital confinement. Payable only for the number of days the hospital confinement benefit is payable. Inpatient Drugs and Medicine Amount shown per day for drugs or medicine required during a covered hospital confinement. Payable only for the number of days the hospital confinement benefit is payable. Private Duty Nursing Amount shown per day for private nursing care and attendance by a nurse during a covered hospital confinement, subject to a maximum of 60 days per continuous hospital confinement. Must be required and authorized by attending physician. Physiotherapy Amount shown per day for physiotherapy performed by a licensed physical therapist during a covered hospital confinement, subject to a maximum of 60 days per continuous hospital confinement. Oxygen Amount shown for the use of oxygen equipment during a covered hospital confinement, subject to a maximum of 1 payment per continuous hospital confinement. Cardiograms Amount shown for an electrocardiogram, echocardiogram, phonocardiogram or vectorcardiogram required during a covered hospital confinement, subject to a maximum of 1 payment per continuous hospital confinement. Cerebral or Carotid Angiogram Amount shown for a cerebral or carotid angiogram required during a covered hospital confinement, subject to a maximum of 1 payment per continuous hospital confinement. Coronary Angioplasty Amount shown for a coronary angioplasty procedure, regardless of the number of blood vessels repaired during the procedure. Pacemaker Insertion Amount shown for the initial insertion of a permanent pacemaker. Thromboendarterectomy Amount shown for a thromboendarterectomy operation. Coronary Artery Bypass Graft Operation Amount shown for a coronary artery bypass graft operation, regardless of the number of grafts performed during the operation. Heart Transplant Amount shown for the implantation of a natural human heart. This benefit is only payable once per covered person. 1/2 UNIT 1 UNIT $100 $200 each day each day $12.50 $25 each day each day $12.50 $25 each day each day $50 $100 each day each day $25 $50 each day each day $100 $200 $50 $100 $75 $150 $375 $750 $500 $1,000 $1,250 $2,500 $1,250 $2,500 $50,000 $100,000

26 D-7876 BE WELL. BE SMART. BE PROTECTED. heartcare plus premiums for texas When you buy heartcare plus insurance, you decide which coverage you want. You can choose the one that s right for your budget and your coverage needs. The units of coverage you select will determine your benefit amounts and your corresponding premium. Plan A - HeartCare Plus Policy (HSP2) INDIVIDUAL FAMILY (if covered) Weekly Weekly INDIVIDUAL FAMILY (if covered) Weekly Weekly INDIVIDUAL FAMILY (if covered) Monthly Monthly INDIVIDUAL FAMILY (if covered) Monthly Monthly 1/2 unit 1/2 unit $2.08 $ unit 1 unit $4.15 $8.00 1/2 unit 1/2 unit $8.98 $ unit 1 unit $17.96 $34.64 Issue Ages Name: The HeartCare Plus Policy You Have Selected Total Premium Individual Family Premium: 1/2 unit 1 unit Weekly Monthly This premium insert is incomplete without brochure D-7803, which describes the benefits, exclusions and limitations of the heartcare plus insurance policy.this is not an application for coverage. Please see your agent for details. Benefits are subject to all of the terms, conditions and provisions of the policy. All terms defined and used in the policy apply unless otherwise provided.this insert highlights some features of the policy, but is not the insurance contract. Only the actual policy provisions control. The policy itself sets forth, in detail, the rights and obligations of both the insured and the insurance company. HeartCare Plus Insurance Policy provided by form HSP2, or state variations thereof. Underwritten by American Heritage Life Insurance Company. Allstate Workplace Division is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a wholly owned subsidiary of The Allstate Corporation American Heritage Life Insurance Company allstate.com

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42 FOR GROUP BENEFITS EduBenefit Protect the ones you love with EduBenefit Optional group Term Life insurance Help secure their future You can help make sure your loved ones can continue to pay the mortgage, make car payments, fund a child s education, and much more with this valuable offering of Term Life and Accidental Death & Dismemberment (AD&D) insurance. All employees regularly working 10 hours or more per week and all bus drivers will have the option to purchase Term Life and AD&D insurance at competitive group rates from The Lincoln National Life Insurance Company, a Lincoln Financial Group company. Here are some program highlights: $100,000 Guarantee Issue for employees under age 65, and $50,000 Guarantee Issue for a spouse when the employee is under age 60. You can purchase optional life insurance in increments of $20,000, $40,000, $60,000, $80,000, $100,000, or additional increments of $10,000 up to a maximum of $500,000 (not to exceed five times your annual salary). Premiums are conveniently deducted from your paycheck. Optional dependent (spouse and children) life coverage is also available. Children can be covered for $10,000 of life insurance. Continuation of Coverage (portability) You can take your coverage with you if you leave the District. Accelerated Life Benefit You can collect up to 75% of your death benefit (to a maximum of $250,000) if you become terminally ill with a life expectancy of 12 months or less. AD&D equals the life insurance benefit or a percentage thereof for dismemberment. AD&D benefits are not payable for any loss resulting from any of the following contributory causes: intentional self-inflicted injury; a disease or the medical treatment of it; participation in a riot or while committing a felony; military service; war or any act of war; use of drugs, except when prescribed by a doctor; voluntary inhalation of gas; travel in any aircraft, except as a fare-paying passenger on a regularly scheduled flight; or driving while intoxicated. We are pleased to be adding this improved life insurance benefit to your current benefit package. GI-TXPLN-FLI001 Products issued by: The Lincoln National Life Insurance Company Page 1 of 2

43 Employee coverage Eligibility Amount of life and AD&D insurance Guarantee Issue Reduction All active employees working for the district at least 10 hours per week on a regular basis and all bus drivers. $20,000, $40,000, $60,000, $80,000 or $100,000, or increments of $10,000 up to a maximum of $500,000 (not to exceed five times your annual salary). Evidence of insurability is needed with an election amount above $100,000 Guarantee Issue. AD&D equals the life insurance benefit or a percentage of that benefit for dismemberment. Employees under age 65: $100,000 Employees ages 65 69: $30,000 No Guarantee Issue for employees age 70 and over. Coverage reduces 50% of the original amount at age 70. All coverage terminates at retirement; however, an insured can convert his or her group policy to an individual policy without providing evidence of insurability. Spouse coverage Eligibility Employee under age 70. Amount of life and AD&D insurance Guarantee Issue $10,000, $20,000, $30,000, $40,000 or $50,000 (not to exceed 50% of the employee s approved amount). Evidence of insurability is needed with an election amount above $50,000 Guarantee Issue. AD&D equals the life insurance benefit or a percentage of that benefit for dismemberment. Spouses of employees under age 60: $50,000 Spouses of employees ages 60 69: $10,000 No coverage available for spouses of employees age 70 and over. Reduction Will terminate when the employee attains age 70. Dependent children Eligibility Guarantee Issue Amount of life insurance Employees must purchase the minimum amount ($10,000) of optional life insurance on themselves in order to purchase child coverage. $10,000 (dependent child(ren) included) Available for unmarried dependent child(ren) ages 14 days to 19 years (up to 25 if a full-time student, higher state limits may apply) $10, Lincoln National Corporation BP 5/11 Z01 Order code: GI-TXPLN-FLI001 Important notes Insurance will be delayed for an employee if he/she is not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise be effective. Insurance will also be delayed for spouse or dependent child(ren) if confined to home or hospital and not performing normal daily activities. Guarantee Issue amounts are only available during a designated Term Life open enrollment period or your first 31 days of employment. A suicide exclusion will apply to any medically underwritten amount or increased amount of insurance during the first two years of coverage. EduBenefit and the EduBenefit swirl design are registered trademarks of Crenshaw Whitley & Associates, LLC, All Rights Reserved. Group insurance products are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), a Lincoln Financial Group company. This flier is not intended as a complete description of Lincoln Financial Group insurance coverage. The controlling provisions are provided in the policy, and this flier does not modify those provisions or the insurance in any way. State-specific restrictions, requirements, and approvals are not addressed in this brochure. Available in Texas only. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations. THIS IS NOT A CONTRACT. Page 2 of 2

44 FOR GROUP BENEFITS EduBenefit Special rates for educators Employee under age 25 Employee age Employee age Employee amount Employee rate Employee amount Employee rate Employee amount Employee rate $20,000 $1.60 $20,000 $1.80 $20,000 $2.20 $40,000 $3.20 $40,000 $3.60 $40,000 $4.40 $60,000 $4.80 $60,000 $5.40 $60,000 $6.60 $80,000 $6.40 $80,000 $7.20 $80,000 $8.80 $100,000 $8.00 $100,000 $9.00 $100,000 $11.00 $100,000+ per $10,000 $0.80 $100,000+ per $10,000 $0.90 $100,000+ per $10,000 $1.10 Spouse amount Spouse rate Spouse amount Spouse rate Spouse amount Spouse rate $10,000 $0.80 $10,000 $0.90 $10,000 $1.10 $20,000 $1.60 $20,000 $1.80 $20,000 $2.20 $30,000 $2.40 $30,000 $2.70 $30,000 $3.30 $40,000 $3.20 $40,000 $3.60 $40,000 $4.40 $50,000 $4.00 $50,000 $4.50 $50,000 $5.50 Employee age Employee age Employee age Employee amount Employee rate Employee amount Employee rate Employee amount Employee rate $20,000 $2.60 $20,000 $3.60 $20,000 $5.60 $40,000 $5.20 $40,000 $7.20 $40,000 $11.20 $60,000 $7.80 $60,000 $10.80 $60,000 $16.80 $80,000 $10.40 $80,000 $14.40 $80,000 $22.40 $100,000 $13.00 $100,000 $18.00 $100,000 $28.00 $100,000+ per $10,000 $1.30 $100,000+ per $10,000 $1.80 $100,000+ per $10,000 $2.80 Spouse amount Spouse rate Spouse amount Spouse rate Spouse amount Spouse rate $10,000 $1.30 $10,000 $1.80 $10,000 $2.80 $20,000 $2.60 $20,000 $3.60 $20,000 $5.60 $30,000 $3.90 $30,000 $5.40 $30,000 $8.40 $40,000 $5.20 $40,000 $7.20 $40,000 $11.20 $50,000 $6.50 $50,000 $9.00 $50,000 $14.00 Employee age Employee age Employee age Employee amount Employee rate Employee amount Employee rate Employee amount Employee rate $20,000 $8.80 $20,000 $14.00 $20,000 $17.40 $40,000 $17.60 $40,000 $28.00 $40,000 $34.80 $60,000 $26.40 $60,000 $42.00 $60,000 $52.20 $80,000 $35.20 $80,000 $56.00 $80,000 $69.60 $100,000 $44.00 $100,000 $70.00 $100,000 $87.00 $100,000+ per $10,000 $4.40 $100,000+ per $10,000 $7.00 $100,000+ per $10,000 $8.70 Spouse amount Spouse rate Spouse amount Spouse rate Spouse amount Spouse rate $10,000 $4.40 $10,000 $7.00 $10,000 $8.70 $20,000 $8.80 $20,000 $14.00 $20,000 $17.40 $30,000 $13.20 $30,000 $21.00 $30,000 $26.10 $40,000 $17.60 $40,000 $28.00 $40,000 $34.80 $50,000 $22.00 $50,000 $35.00 $50,000 $43.50 Continued on the back page. GI-TXRAT-FLI001 Products issued by: The Lincoln National Life Insurance Company Page 1 of 2

45 Continued from the front page. Employee age Rates per $10,000 of employee coverage Age Employee rate $ $ $36.40 Age Spouse rate ($5K) $ not available not available Child amount Child rate $10,000 $1.00 AD&D coverage is not available for children. Employee must purchase a minimum amount of Optional Life coverage in order to purchase child coverage. Employee Guarantee Issue is $100,000 for employees under age 65. Spouse Guarantee Issue is $50,000 for employees under age 60. Here s a hypothetical example of how much coverage an employee and spouse elected and how much it would cost. Coverage amount Monthly cost Employee John Smith, age 69 $10,000 $ % coverage on John s wife $5,000 $7.45 Total $ Lincoln National Corporation BP 4/11 Z01 Order code: GI-TXRAT-FLI001 EduBenefit and the EduBenefit swirl design are registered trademarks of Crenshaw Whitley & Associates, LLC, All Rights Reserved. Group insurance products are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), a Lincoln Financial Group company. This flier is not intended as a complete description of Lincoln Financial Group insurance coverage. The controlling provisions are provided in the policy, and this flier does not modify those provisions or the insurance in any way. State-specific restrictions, requirements, and approvals are not addressed in this flier. Available in Texas only. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations. THIS IS NOT A CONTRACT. Page 2 of 2

46 Center ISD Dental Highlight Sheet Low Dental Plan Summary Policy # Effective Date: 9/1/2013 Coinsurance Type 1 100% Type 2 80% Deductible $50/Calendar Year Type 2 Waived Type 1 3 Family Maximum Maximum (per person) $750 per calendar year Allowance 80th U&C Waiting Period None Sample Procedure Listing (Current Dental Terminology American Dental Association.) Type 1 Type 2 Routine Exam (1 in 6 months) Bitewing X-rays (1 in 12 months) Full Mouth/Panoramic X-rays (1 in 5 years) Periapical X-rays Cleaning (1 in 6 months) Fluoride for Children 13 and under (1 per benefit period) Sealants (age 13 and under) Restorative Amalgams Restorative Composites Denture Repair Simple Extractions Complex Extractions Anesthesia Monthly Rates Employee Only (EE) $23.72 EE + Spouse $52.60 EE + Children $50.44 EE + Spouse & Children $86.64 Ameritas Information We're Here to Help This plan was designed specifically for the associates of Center ISD. At Ameritas Group, we do more than provide coverage - we make sure there's always a friendly voice to explain your benefits, listen to your concerns, and answer your questions. Our customer relations associates will be pleased to assist you 7 a.m. to midnight (Central Time) Monday through Thursday, and 7 a.m. to 6:30 p.m. on Friday. You can speak to them by calling tollfree: For plan information any time, access our automated voice response system or go online to ameritasgroup.com/member. Contracted Provider Information Go online to ameritasgroup.com/member to find the contracted network providers who are most convenient for you. While using a contracted provider will almost always lower your out of pocket costs, every Ameritas Group plan gives you the freedom to visit any dentist you choose. Pretreatment While we don't require a pretreatment authorization form for any procedure, we recommend them for any dental work you consider expensive. As a smart consumer, it's best for you to know your share of the cost up front. Simply ask your dentist to submit the information for a pretreatment estimate to our customer relations department. We'll inform both you and your dentist of the exact amount your insurance will cover and the amount that you will be responsible for. That way, there won't be any surprises once the work has been completed.

47 Center ISD Dental Highlight Sheet Rx Savings Our valued plan members and their covered dependents (even their pets) can save on prescription medications through any Walmart or Sam's Club pharmacy across the nation. This Rx discount is offered at no additional cost, and it is not insurance. To receive the Walmart Rx discount, Ameritas plan members just need to show their original Ameritas ID card. The identifier is the Ameritas logo. It's that easy. Or members can visit us at ameritasgroup.com and sign into (or create) a secure member account where they can print off an onlineonly Rx discount savings ID card. Eyewear Savings Ameritas plan members may receive up to 15% off eyewear frames and lenses purchased at any Walmart Vision Center nationwide. Members may also bring in their current vision prescription from any vision care provider and purchase eyewear at Walmart. This savings arrangement is not insurance: it is available to members at no additional cost to their plan premium. To receive the eyewear savings identification card, Ameritas plan members can visit ameritasgroup.com and sign-in (or create) a secure member account. Members must present the Ameritas Eyewear Savings Card at time of purchase to receive the discount. Late Entrant Provision We strongly encourage you to sign up for coverage when you are initially eligible. If you choose not to sign up during this initial enrollment period, you will become a late entrant. Late entrants will be eligible for only exams, cleanings, and fluoride applications for the first 12 months they are covered. Section 125 This plan is provided as part of the Policyholder's Section 125 Plan. Each employee has the option under the Section 125 Plan of participating or not participating in this plan. If an employee does not elect to participate when initially eligible, he/she may elect to participate at the Policyholder's next Annual Election Period. This document is a highlight of plan benefits provided by Ameritas Life Insurance Corp. as selected by your employer. It is not a certificate of insurance and does not include exclusions and limitations. For exclusions and limitations, or a complete list of covered procedures, contact your benefits administrator.

48 Center ISD Dental Highlight Sheet High Dental Plan Summary Policy # Effective Date: 9/1/2013 Coinsurance Type 1 100% Type 2 80% Type 3 50% Deductible $50/Calendar Year Type 2 & 3 Waived Type 1 3 Family Maximum Maximum (per person) $1,000 per calendar year Allowance 80th U&C Waiting Period Type 3 12 months Orthodontia Summary - Child Only Coverage Allowance U&C Coinsurance 50% Lifetime Maximum (per person) $1,500 Waiting Period 12 months Sample Procedure Listing (Current Dental Terminology American Dental Association.) Type 1 Type 2 Type 3 Routine Exam (1 in 6 months) Bitewing X-rays (1 in 12 months) Full Mouth/Panoramic X-rays (1 in 5 years) Periapical X-rays Cleaning (1 in 6 months) Fluoride for Children 13 and under (1 per benefit period) Sealants (age 13 and under) Restorative Amalgams Restorative Composites Denture Repair Simple Extractions Complex Extractions Anesthesia Monthly Rates Employee Only (EE) $33.96 EE + Spouse $75.08 EE + Children $72.04 EE + Spouse & Children $ Onlays Crowns (1 in 10 years) Crown Repair Endodontics (nonsurgical) Endodontics (surgical) Periodontics (nonsurgical) Periodontics (surgical) Prosthodontics (fixed bridge; removable complete/partial dentures) (1 in 10 years) Ameritas Information We're Here to Help This plan was designed specifically for the associates of Center ISD. At Ameritas Group, we do more than provide coverage - we make sure there's always a friendly voice to explain your benefits, listen to your concerns, and answer your questions. Our customer relations associates will be pleased to assist you 7 a.m. to midnight (Central Time) Monday through Thursday, and 7 a.m. to 6:30 p.m. on Friday. You can speak to them by calling tollfree: For plan information any time, access our automated voice response system or go online to ameritasgroup.com/member. Rx Savings Our valued plan members and their covered dependents (even their pets) can save on prescription medications through any Walmart or Sam's Club pharmacy across the nation. This Rx discount is offered at no additional cost, and it is not insurance. To receive the Walmart Rx discount, Ameritas plan members just need to show their original Ameritas ID card. The identifier is the Ameritas logo. It's that easy. Or members can visit us at ameritasgroup.com and sign into (or create) a secure member account where they can print off an onlineonly Rx discount savings ID card.

49 Center ISD Dental Highlight Sheet Eyewear Savings Ameritas plan members may receive up to 15% off eyewear frames and lenses purchased at any Walmart Vision Center nationwide. Members may also bring in their current vision prescription from any vision care provider and purchase eyewear at Walmart. This savings arrangement is not insurance: it is available to members at no additional cost to their plan premium. To receive the eyewear savings identification card, Ameritas plan members can visit ameritasgroup.com and sign-in (or create) a secure member account. Members must present the Ameritas Eyewear Savings Card at time of purchase to receive the discount. Dental Rewards This dental plan includes a valuable feature that allows qualifying plan members to carryover part of their unused annual maximum. A member earns Dental Rewards by submitting at least one claim for dental expenses incurred during the benefit year, while staying at or under the threshold amount for benefits received for that year. Employees and their covered dependents may accumulate rewards up to the stated maximum carryover amount, and then use those rewards for any covered dental procedures subject to applicable coinsurance and plan provisions. If a plan member doesn't submit a dental claim during a benefit year, all accumulated rewards are lost. But he or she can begin earning rewards again the very next year. Benefit Threshold $500 Dental benefits received for the year cannot exceed this amount Annual Carryover Amount $250 Dental Rewards amount is added to the following year's maximum Maximum Carryover $1,000 Maximum possible accumulation for Dental Rewards Contracted Provider Information Go online to ameritasgroup.com/member to find the contracted network providers who are most convenient for you. While using a contracted provider will almost always lower your out of pocket costs, every Ameritas Group plan gives you the freedom to visit any dentist you choose. Pretreatment While we don't require a pretreatment authorization form for any procedure, we recommend them for any dental work you consider expensive. As a smart consumer, it's best for you to know your share of the cost up front. Simply ask your dentist to submit the information for a pretreatment estimate to our customer relations department. We'll inform both you and your dentist of the exact amount your insurance will cover and the amount that you will be responsible for. That way, there won't be any surprises once the work has been completed. Late Entrant Provision We strongly encourage you to sign up for coverage when you are initially eligible. If you choose not to sign up during this initial enrollment period, you will become a late entrant. Late entrants will be eligible for only exams, cleanings, and fluoride applications for the first 12 months they are covered. Section 125 This plan is provided as part of the Policyholder's Section 125 Plan. Each employee has the option under the Section 125 Plan of participating or not participating in this plan. If an employee does not elect to participate when initially eligible, he/she may elect to participate at the Policyholder's next Annual Election Period. This document is a highlight of plan benefits provided by Ameritas Life Insurance Corp. as selected by your employer. It is not a certificate of insurance and does not include exclusions and limitations. For exclusions and limitations, or a complete list of covered procedures, contact your benefits administrator.

50 Center ISD Eye Care Highlight Sheet Low Focus Plan Summary Effective Date: 9/1/2013 VSP Network Out of Network Deductibles $10 Exam $10 Exam $25 Eye Glass Lenses or Frames* $25 Eye Glass Lenses or Frames* Annual Eye Exam Covered in full Up to $52 Lenses (per pair) Single Vision Covered in full Up to $55 Bifocal Covered in full Up to $75 Trifocal Covered in full Up to $95 Lenticular Covered in full Up to $125 Progressive See lens options NA Contacts Fit & Follow Up Exams 15% discount No benefit See Additional Focus Features. Elective Up to $120 Up to $105 Medically Necessary Covered in full Up to $210 Frames $120 Up to $45 Frequencies (months) Exam/Lens/Frame 12/12/24 12/12/24 Based on date of service Based on date of service *Deductible applies to a complete pair of glasses or to frames, whichever is selected. Lens Options (member cost)* VSP Network Out of Network Progressive Lenses $60-$119 No benefit Std. Polycarbonate Covered in full for dependent children No benefit $25 - $35 adults High Luster Edge Polish $14 No benefit Solid Plastic Dye $13 No benefit (except Pink I & II) Plastic Gradient Dye $15 No benefit Photochromatic Lenses $27-$76 No benefit (Glass & Plastic) Scratch Resistant Coating $15-$29 No benefit Anti-Reflective Coating $39-$61 No benefit Ultraviolet Coating $15 No benefit Lasik or PRK Average discount of 15% off retail. See Additional Focus Features. No benefit *Lens Option member costs vary by prescription and option chosen. Monthly Rates Employee Only (EE) $9.48 EE + 1 Dependent $13.76 EE + 2 or more Dependents $24.64

51 Center ISD Eye Care Highlight Sheet Additional Focus Features Contact Lenses Elective Additional Glasses Laser VisionCare Low Vision Cost of the fitting and evaluation is deducted from the allowance and any amount left is deducted from the material allowance. Allowance can be applied to disposables, but the dollar amount must be used all at once (provider will order 3 or 6 month supply). Applies when contacts chosen in lieu of glasses. 20% discount off the retail price on additional pairs of prescription glasses (complete pair). VSP offers an average discount of 15% on LASIK and PRK. The maximum out-of-pocket per eye for members is $1,800 for LASIK and $2,300 for custom LASIK using Wavefront technology, and $1,500 for PRK. In order to receive the benefit, a VSP provider must coordinate the procedure. With prior authorization, 75% of approved amount (up to $1,000 is covered every two years). Eye Care Plan Member Service Focus eye care from Ameritas Group features the money-saving eye care network of VSP. Customer service is available to plan members through VSP's well-trained and helpful service representatives. Call or go online to locate the nearest VSP network provider, view plan benefit information and more. VSP Call Center: Service representative hours: 5 a.m. to 7 p.m. PST Monday through Friday, 6 a.m. to 2:30 p.m. PST Saturday Interactive Voice Response available 24/7 Locate a VSP provider at: ameritasgroup.com/member View plan benefit information at: vsp.com Section 125 This plan is provided as part of the Policyholder's Section 125 Plan. Each employee has the option under the Section 125 Plan of participating or not participating in this plan. If an employee does not elect to participate when initially eligible, he/she may elect to participate at the Policyholder's next Annual Election Period. This document is a highlight of plan benefits provided by Ameritas Life Insurance Corp. as selected by your employer. It is not a certificate of insurance and does not include exclusions and limitations. For exclusions and limitations, or a complete list of covered procedures, contact your benefits administrator.

52 Center ISD Eye Care Highlight Sheet High Focus Plan Summary Effective Date: 9/1/2013 VSP Network Out of Network Deductibles $10 Exam $10 Exam $25 Eye Glass Lenses or Frames* $25 Eye Glass Lenses or Frames* Annual Eye Exam Covered in full Up to $52 Lenses (per pair) Single Vision Covered in full Up to $55 Bifocal Covered in full Up to $75 Trifocal Covered in full Up to $95 Lenticular Covered in full Up to $125 Progressive See lens options NA Contacts Fit & Follow Up Exams 15% discount No benefit See Additional Focus Features. Elective Up to $120 Up to $105 Medically Necessary Covered in full Up to $210 Frames $120 Up to $45 Frequencies (months) Exam/Lens/Frame 12/12/12 12/12/12 Based on date of service Based on date of service *Deductible applies to a complete pair of glasses or to frames, whichever is selected. Lens Options (member cost)* VSP Network Out of Network Progressive Lenses $60-$119 No benefit Std. Polycarbonate Covered in full for dependent children No benefit $25 - $35 adults High Luster Edge Polish $14 No benefit Solid Plastic Dye $13 No benefit (except Pink I & II) Plastic Gradient Dye $15 No benefit Photochromatic Lenses $27-$76 No benefit (Glass & Plastic) Scratch Resistant Coating $15-$29 No benefit Anti-Reflective Coating $39-$61 No benefit Ultraviolet Coating $15 No benefit Lasik or PRK Average discount of 15% off retail. See Additional Focus Features. No benefit *Lens Option member costs vary by prescription and option chosen. Monthly Rates Employee Only (EE) $11.84 EE + 1 Dependent $17.16 EE + 2 or more Dependents $30.75

53 Center ISD Eye Care Highlight Sheet Additional Focus Features Contact Lenses Elective Additional Glasses Laser VisionCare Low Vision Cost of the fitting and evaluation is deducted from the allowance and any amount left is deducted from the material allowance. Allowance can be applied to disposables, but the dollar amount must be used all at once (provider will order 3 or 6 month supply). Applies when contacts chosen in lieu of glasses. 20% discount off the retail price on additional pairs of prescription glasses (complete pair). VSP offers an average discount of 15% on LASIK and PRK. The maximum out-of-pocket per eye for members is $1,800 for LASIK and $2,300 for custom LASIK using Wavefront technology, and $1,500 for PRK. In order to receive the benefit, a VSP provider must coordinate the procedure. With prior authorization, 75% of approved amount (up to $1,000 is covered every two years). Eye Care Plan Member Service Focus eye care from Ameritas Group features the money-saving eye care network of VSP. Customer service is available to plan members through VSP's well-trained and helpful service representatives. Call or go online to locate the nearest VSP network provider, view plan benefit information and more. VSP Call Center: Service representative hours: 5 a.m. to 7 p.m. PST Monday through Friday, 6 a.m. to 2:30 p.m. PST Saturday Interactive Voice Response available 24/7 Locate a VSP provider at: ameritasgroup.com/member View plan benefit information at: vsp.com Section 125 This plan is provided as part of the Policyholder's Section 125 Plan. Each employee has the option under the Section 125 Plan of participating or not participating in this plan. If an employee does not elect to participate when initially eligible, he/she may elect to participate at the Policyholder's next Annual Election Period. This document is a highlight of plan benefits provided by Ameritas Life Insurance Corp. as selected by your employer. It is not a certificate of insurance and does not include exclusions and limitations. For exclusions and limitations, or a complete list of covered procedures, contact your benefits administrator.