Keller Independent School District s Benefit Plan Year is from January 1, 2019 to December 31, 2019

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1 KELLER INDEPENDENT SCHOOL DISTRICT 2019 Benefits Guide The cmmunity f Keller ISD will educate ur students t achieve their highest standards f perfrmance by engaging them in exceptinal pprtunities. Keller Independent Schl District s Benefit Plan Year is frm January 1, 2019 t December 31, 2019 Keller ISD Medical Plans United Healthcare Member Line: ; Grup # Visit fr detailed infrmatin n cvered/nn-cvered items, prescriptins, benefits, as well as t check n claims, and ut f pcket maximums. All Summary Plan Dcuments and ther benefit infrmatin can be fund n THEbenefitsHUB at r n KClud under the Human Resurces icn. Benefit Plan Updates: UnitedHealthcare Nexus Narrw Netwrk (utilizing Tier 1 dctrs) Tailred Prescriptin Drug Netwrk (Target/CVS remved) Changes t Deductibles n all plans Imaging will change t Deductible/Cinsurance n the Essential Plan District will ffer three medical plans: High Deductible, Majr Medical and the Essential Plan District will ffer fur tiers: Emplyee Only, Emplyee + Spuse, Emplyee + Child(ren) and Emplyee + Family High Deductible Plan 2018 Incentive 2018 Mnthly 2019 Incentive 2019 Mnthly Emplyee Only $31.36 $91.36 $42.78 $ Emplyee + Spuse $ $ $ $ Emplyee + Child(ren) $ $ $ $ Emplyee + Family $ $ $1, $1, Highlights f the 2019 High Deductible Plan: Yu will pay the full amunt f all charges until yu have met yur deductible. $3,000 Individual Deductible/$6,000 Family Deductible Ttal Out f Pcket Limit: $6,650 Individual/$13,300 Family 80/20 Cinsurance - nce yu have met the $3,000/$6,000 deductible, the plan pays 80% f In- Netwrk charges and yu pay 20% if yu utilize a Tier 1 dctr/facility; therwise yu pay 60/40 cinsurance when utilizing an in-netwrk dctr/facility Medical Pharmacy/Prescriptin Emergency Rm Visit and/r Urgent Care Center In-Netwrk Benefits Only 100% Wellness Benefit - every cvered member receives rutine wellness and ther preventive care services 100% Lab Benefit preventative lab wrk dne at a participating In-Netwrk lab facility is paid at 100% (nt all lab wrk is cnsidered preventative, therefre yu will be respnsible fr thse fees) If yu g t the KISD Emplyee Health and Wellness Center yu will be assessed a $25.00 fee fr an acute visit. Yu will nt have t pay a fee fr wellness r caching ffice visits. Yu can partner this plan with a Health Savings Accunt (HSA)

2 Majr Medical Plan 2018 Incentive 2018 Mnthly 2019 Incentive 2019 Mnthly Emplyee Only $ $ $ $ Emplyee + Spuse $ $ $ $ Emplyee + Child(ren) $ $ $ $ Emplyee + Family $ $ $1, $1, Highlights f the 2019 Majr Medical Plan: $4,000 Individual Deductible/$8,000 Family Deductible Ttal Out f Pcket Limit: $7,350 Individual/$14,700 Family 70/30 Cinsurance - nce yu have met the $4,000/$8,000 deductible, the plan pays 70% f In- Netwrk charges and yu pay 30% if yu utilize a Tier 1 dctr/facility; therwise yu pay 50/50 cinsurance when utilizing an in-netwrk dctr/facility Primary Care Physician Cpays are $25/$45 and Specialist Cpays are $45/$65 In-Netwrk Benefits Only $ Prescriptin Deductible - per cvered member, per year (deductible des nt apply t generic r mail rder) Emergency Rm Deductible/Cinsurance - per visit Urgent Care Center $ Cpay - per visit (ex: Care Nw) 100% Wellness Benefit - every cvered member receives rutine wellness and ther preventive care services 100% Lab Benefit preventative lab wrk dne at a participating In-Netwrk lab facility is paid at 100% (nt all lab wrk is cnsidered preventative, therefre yu will be respnsible fr thse fees) If yu g t the KISD Emplyee Health and Wellness Center yu will nt be assessed a fee fr an acute, wellness r caching ffice visit. Yu can partner this plan with a Flexible Spending Accunt (FSA). Essential Plan 2018 Incentive 2018 Mnthly 2019 Incentive 2019 Mnthly Emplyee Only $ $ $ $ Emplyee + Spuse $ $ $1, $1, Emplyee + Child(ren) $ $ $ $ Emplyee + Family $1, $1, $1, $1, Highlights f the 2019 Essential Plan: $2,000 Individual Deductible/$4,000 Family Deductible Ttal Out f Pcket Limit: $7,350 Individual/$14,700 Family 70/30 Cinsurance - nce yu have met the $2,000/$4,000 deductible, the plan pays 70% f In- Netwrk charges and yu pay 30% if yu utilize a Tier 1 dctr/facility; therwise yu pay 50/50 cinsurance when utilizing an in-netwrk dctr/facility Primary Care Physician Cpays $25/$45 and Specialist Cpays $45/$65 In-Netwrk Benefits Only $150 Prescriptin Deductible - per cvered member, per year (deductible des nt apply t generic r mail rder) Emergency Rm - Deductible/Cinsurance - per visit Urgent Care Center $ Cpay - per visit (ex: Care Nw) 100% Wellness Benefit - every cvered member receives rutine wellness and ther preventive care services 100% Lab Benefit preventative lab wrk dne at a participating In-Netwrk lab facility is paid at 100% (nt all lab wrk is cnsidered preventative, therefre yu will be respnsible fr thse fees) If yu g t the KISD Emplyee Health and Wellness Center yu will nt be assessed a fee fr an acute, wellness r caching ffice visit. Yu can partner this plan with a Flexible Spending Accunt (FSA).

3 Additinal Benefits fr Emplyees wh elect ne f ur three Medical Plans: KISD Emplyee Health and Wellness Center - Emplyees are eligible t g the KISD Emplyee Health and Wellness Center fr acute and/r caching visits. If yu elect the Essential r Majr Medical Plan there is n cst; if yu elect the High Deductible Plan there will be a $25.00 fee per visit fr acute care visits. The address t the Wellness Center is 5308 N. Tarrant Parkway Frt Wrth, TX Phne number fr the Wellness Center is Marathn Health Website: my.marathn-health.cm Virtual Visits Lg int myuhc.cm and chse frm prvider sites where yu can register fr a virtual visit; payments are $50.00 a visit. Premium Incentive Plan Cmplete 3 activities fr the 2019 Premium Incentive Plan between September 1, 2018 thrugh August 31, 2019: Health Risk Assessment, Bimetric Screening and an Annual Wellness Exam; Emplyee nly will receive a $60.00 incentive mnthly fr an annual savings f $ fr the Benefit Plan Year in In additin, fr the 2019 Incentive, emplyees must have Three in the Green. This wuld require emplyees t have 3 ut f 5 metrics in range in rder t be eligible fr the Premium Incentive. The five areas that will be assessed are Chlesterl, LDL, HDL, Waist Circumference and Bld Pressure. Anyne that des nt meet that criteria will need t have a Health Caching Visit at the KISD Emplyee Health and Wellness Center by August 31, 2019 t receive the Premium Incentive Dental Insurance: Cigna Lw Plan Mnthly s High Plan Mnthly s DHMO s Emplyee Only $28.44 $35.78 $17.44 Emplyee + Spuse $55.53 $69.85 $34.02 Emplyee + Child(ren) $67.93 $85.42 $41.69 Emplyee + Family $89.96 $ $55.12 Highlights f the Dental Insurance Lw and High Plans (PPO): Cleanings 2 included per year, per cvered member (cvered at 100% n the High Plan and 90% n the Lw Plan) Child Orthdntia - ONLY cvered n the High Plan with a 50% benefit up t Lifetime Max f $1000 Deductible - $50 per individual; $150 per family; in r ut f netwrk n bth plans Highlights f the DHMO Dental Insurance Plan: N dllar Maximums N claim frms r waiting perids fr cverage t begin Services based n a fee schedule; mst fees are cvered with cpays Orthdntic cverage fr children and adults with n dllar maximum Must use a Cigna In-Netwrk DHMO Prvider nly; N ut f netwrk benefits 2019 Visin Insurance: Superir Visin Mnthly Plan s Emplyee Only $9.96 Emplyee + Spuse $19.30 Emplyee + Family $28.37 Highlights f the Visin Insurance Plan: Visin Exam every 12 mnths Either glasses r cntact lenses every 12 mnths (up t a $130 allwance) Frames every 12 mnths Prgressive lenses are cvered in full at lined trifcal level UV, plycarbnate and tint anti-reflective cating are all cvered in full Discunts fr anything yu chse t purchase in additin t the glasses r cntacts every 12 mnths

4 2019 Dental & Visin Discunt Plan: QCD f America Mnthly s Emplyee Only FREE Emplyee + One Dependent $10.00 Emplyee + Family $14.00 Highlights f QCD f America Discunt Dental and Visin Plan: This is nt an insurance plan; it nly prvides discunted fees. Participating netwrk f dentists Discunts n all dental services Includes a discunt visin plan thrugh Davis 2019 Accidental Insurance: Vya Accidental Mnthly s Emplyee Only $2.85 Emplyee + Spuse $5.00 Emplyee + Child $6.41 Emplyee + Family $8.56 Highlights f the Accidental Insurance Plan: Fr each cvered individual a set reimbursement is paid fr each accident ccurrence. This des nt apply t wrk related injuries. Accident cverage cvers child accidental injuries while participating in rganized sprts True Annual Open Enrllment withut medical questin requirement up t guarantee issue amunt 2019 In-Hspital Indemnity Insurance Vya Insurance pays lump sum benefit amunts based n the number f days spent in a hspital, critical care unit, r rehabilitatin facility. Yu can use this benefit fr any purpse yu like and the cverage is prtable. Cverage is available fr yu, yur spuse and/r children Critical Illness Insurance: Vya Attained Age EE Tbacc EE Nn-Tbacc <25 $0.74 $ $0.78 $ $0.92 $ $1.19 $ $1.73 $ $2.59 $ $3.71 $ $5.05 $ $7.07 $3.65 Highlights f the Critical Insurance Plan: Mnthly s per $1,000; 100% benefit fr recurrence Cancer is included in this plicy Emplyees can btain $20,000 f guaranteed Critical Illness cverage with n medical questins required Vya s Critical Illness plicy des include a wellness benefit f $50.00 annually

5 2019 Flexible Spending Accunts (FSA): Natinal Benefit Services (NBS) Tax-sheltered flexible spending accunts allw an individual t set aside dllars t pay fr future health care and dependent care expenses. Mnthly fee: $2.85 Health Care Cntributins are use-it-r-lse-it; Gain selected amunt all up frnt fr the year beginning in January Healthcare reimbursement maximum: $2,400/plan year Dependent Care Reimbursement maximum: $5,000 (married) r $2,500 (single) per year An FSA accunt can nly be partnered with the Essential r Majr Medical Plan 2019 Health Savings Accunt (HSA): UnitedHealthcare Optum Tax-sheltered Health Savings Accunts and yu can nly use it with the High Deductible Medical Plan Mnthly fee: $2.75 Health Care Cntributins accumulate mnth by mnth and can rll frm ne year t anther Healthcare reimbursement maximum: $7,000 fr family and $3,500 fr individual per plan year Emplyees cannt participate in the FSA if they have an HSA accunt An HSA accunt can nly be partnered with the High Deductible Plan 2019 Disability Insurance - The Hartfrd A disability plan will pay yu, based n what yu elect, while yu are ff wrk due t a disability. These payments are in additin t pay yu may r may nt receive thrugh the District. Chices are as fllws: Plan A: Premium Plan Plan B: Select Plan Plan A Injury 0/Sickness 3 Plan B Injury 0/Sickness 3 Plan A Injury 14/Sickness 14 Plan B Injury 14/Sickness 14 Plan A Injury 30/Sickness 30 Plan B Injury 30/Sickness 30 Plan A Injury 60/Sickness 60 Plan B Injury 60/Sickness 60 Plan A Injury 90/Sickness 90 Plan B Injury 90/Sickness 90 Plan A Injury 180/Sickness 180 Plan B Injury 180/Sickness 180 Plan A is ur premium plan and the payment perid prir t age 63 is t nrmal retirement age, fr disabilities resulting frm sickness r injury. Plan B is ur select plan and the payment perid prir t age 63 is t nrmal retirement age, fr disabilities resulting frm injury and prir t age 65 is 5 years, fr disabilities resulting frm sickness. If yu chse an eliminatin perid f 0/3, 14/14 r 30/30 and if yu are cnfined t the hspital fr mre than 24 hurs yur eliminatin perid is waived. Sick Leave Bank T becme a member, a ne-time dnatin f 2 sick days are required, unless the Sick Leave Bank ges belw a certain level. Once the dnatin has been made, the membership will cntinue the duratin f the emplyment. Yu can enrll in the Sick Leave Bank during yur Annual Open Enrllment. The purpse f the Sick Leave Bank is t prvide additinal sick leave days t members f the bank in the event f the emplyee r the emplyee's spuse, parent, sn, r daughter experience a catastrphic illness r injury. T request days frm the bank, an emplyee must have exhausted all paid leave, vacatin and must have been absent at least 5 wrkdays withut pay. Sick leave days frm the bank must be apprved by the District's Sick Leave Bank Cmmittee. Leave shall nt be granted fr a pre-existing cnditin.

6 2019 The Keller Pinte (Wrkut Facility) The address is 405 Rufe Snw Dr. Keller, TX T qualify as a Resident (RES), yur hme must be lcated within the City f Keller and yur prperty taxes must be paid t the City f Keller, therwise yu are cnsidered a Nn-Resident (Nn-Res). Sign up thrugh Keller Payrll Deductin the $60.00 enrllment fee is waived. Keller Pinte s Emplyee w/ Aerbics (RES) $33.15 Emplyee w/ Aerbics (Nn-Res) $42.23 Emplyee with Aerbics (RES) $39.97 Emplyee with Aerbics (Nn-Res) $49.05 Emplyee + Family w/ Aerbics (RES) $52.23 Emplyee + Family w/ Aerbics (Nn-Res) $66.30 Emplyee + Family with Aerbics (RES) $59.05 Emplyee + Family with Aerbics (Nn-Res) $73.12 Senir Emplyee with Aerbics (RES) $29.52 Senir Emplyee with Aerbics (Nn-Res) $35.88 Senir Emplyee + Spuse with Aerbics (RES) $59.04 Senir Emplyee + Spuse with Aerbics (Nn-Res) $73.11 Senir Emplyee + Senir Spuse with Aerbics (RES) $59.03 Senir Emplyee + Senir Spuse with Aerbics (Nn-Res) $71.76