UNION GROVE ISD OVERVIEW GUIDE

Transcription

1 UNION GROVE ISD OVERVIEW GUIDE Plan Year: November 1, October 31, 2017 Information Provided By: First Financial Group of America 1200 Walnut Hill Lane Suite dallas@ffga.com

2 Overview Union Grove Independent School District and First Financial Group of America would like to take this opportunity to present to you the information for the upcoming plan year. This information has been created to bring forth a brief overview of your 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. Open Enrollment will be September 28th. All employees must review plan options and make any necessary changes to your supplementary elections under the Cafeteria Plan. This is the only time you can make changes to your supplemental insurance, unless there is a qualified family status change during the year. Your plan year is November 1 through October 31. Payroll deductions for your benefits will begin in October. This guide contains a summary of the benefits offered by your employer. 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. For detailed benefits information please visit:

3 Section 125 Cafeteria Plan First Financial Administrators, Inc. As a district employee, you are eligible to participate in a Section 125 Flexible Plan. Enrollment opportunities are limited to the plan year dates for your district. A Section 125 Flexible Plan allows you, the employee, to select from a list of available benefits that will meet your family s healthcare needs. Certain premiums are deducted from your gross earnings before federal withholding taxes are figured. The amount you elect to have deducted 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 year 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 spouse s employment You must notify your employer within 31 days of the qualifying event to make changes. Section 125 Plan Sample Paycheck The example below shows how a married employee claiming 1 exemption can reduce their taxable income

4 Flexible Spending Accounts (FSAs) Flexible Spending Accounts (FSAs) are tax-favored accounts that allow participants to set aside money pretax for eligible Medical and Dependent Care costs. 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-Rule: Money remaining in your FSA account(s) will not be returned to you at the end of the plan year. Any amount remaining after the end of the 2.5 month grace period will be forfeited. Because of the use-it-or-lose-it rule, it is important for you to carefully estimate your out-of-pocket health and dependent care expenses for the upcoming plan year. Your employer has chosen the 2.5 month grace period for your plan. This option gives you the opportunity to continue to incur eligible expenses if you have unused funds in your account on the plan year end date for an additional 2.5 months. If the money is not used during the 2.5 months it will be forfeited. Medical FSA Your Medical FSA may be used to reimburse you for expenses that you incur for treatment of yourself, spouse and dependent children during your plan year. 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 over -the counter medications eligible for reimbursement must be accompanied by a doctor s prescription. Maximum contribution amount for 2016/2017 plan year is $2,550 ($ per month). Reminder If you or your spouse participate in a Qualified High Deductible Health Plan and contribute to a Health Savings Account, you are not eligible to enroll in Medical Reimbursement. Dependent Care Reimbursement A Dependent Care FSA allows you to pay for daycare expenses for your qualified dependent/child with pretax dollars while you (and your spouse) are working, seeking employment, or attending school as a full- time student for at least 4 months during the year. Eligible dependents must be claimed as an exemption on your tax return. These dependents can include step-children, grandchildren, adopted children or foster children. Under IRS regulations, eligible dependents are further defined as: under age 13 and/or physically or mentally unable to care for themselves, such as a disabled spouse, disabled child, or elderly parents that live with you. The IRS allows employees to contribute up to $5,000 annually to a Dependent Care FSA.

5 Flex Benefits Card The Flex Benefits Card is available to all employees that participate in Medical Reimbursement FSA. The Benefits Flex Card gives you immediate access to your money at the point of purchase. Cards are available for participating employees, their spouse and eligible dependents that are at least 18 years old. The IRS requires validation of most transactions. You must submit receipts for validation of expenses when requested. If you fail to substantiate by providing a receipt to First Financial within 60 days of the purchase or date of service your card will be suspended until the necessary receipt or explanation of benefits from your insurance provider is received. FF Flex Mobile App The FF Flex Mobile App is available for Apple or Android TM devices on the App Store SM or the Google Play Store TM. With the FF Flex Mobile App you can: Submit Claims View Account Balance & History See Claim Status View Alerts Upload Receipts and Documentation Download & register your app today! FSA Store First Financial has partnered with the FSA Store to bring you an easy to use online store to better understand and manage your Flexible Spending Account (FSA). Shop at FSA Store for eligible items from bandages to vitamins and thousands of products in between, browse or search for eligible products and services using the FSA Eligibility List, and visit the FSA Learning Center to help find answers to questions you may have about your FSA.

6 Dental Insurance Oral care can be a significant financial expense. Having dental insurance can help cover the costs. Help keep your family's smiles healthy with dental insurance. In addition to regularly scheduled checkups, a range of procedures may be covered under some plan options, such as: Comprehensive Exams Thorough Cleanings X-Rays Fillings Tooth Extractions General Anesthesia Crowns Root Canals

7 FFGA Texas State School Plan UNION GROVE ISD Dental Highlight Sheet Plan 1: Dental Plan Summary Policy # Effective Date: 11/1/2016 Plan Benefit Type 1 100% Type 2 80% Type 3 50% Deductible $5/visit Type 1 $50 Calendar Year Type 2,3 No Family Maximum Maximum (per person) $1,000 per calendar year Allowance Ameritas U&C Dental Rewards Included Waiting Period Type 3 6 months Orthodontia Summary - Child Only Coverage Allowance U&C Plan Benefit 50% Lifetime Maximum (per person) $1,000 Waiting Period 6 months Sample Procedure Listing (Current Dental Terminology American Dental Association.) Type 1 Type 2 Type 3 Routine Exam (2 per benefit period) Bitewing X-rays (1 per benefit period) Full Mouth/Panoramic X-rays (1 in 5 years) Cleaning (2 per benefit period) Fluoride for Children 13 and under (1 per benefit period) Sealants (age 13 and under) Space Maintainers Restorative Amalgams Restorative Composites (anterior and posterior teeth) Simple Extractions Monthly Rates Employee Only (EE) $29.96 EE + Spouse $63.88 EE + Children $70.12 EE + Spouse & Children $ Onlays Crowns (1 in 8 years per tooth) Crown Repair Denture Repair Implants Endodontics (nonsurgical) Endodontics (surgical) Periodontics (nonsurgical) Periodontics (surgical) Prosthodontics (fixed bridge; removable complete/partial dentures) (1 in 8 years) Complex Extractions Anesthesia Ameritas Information We're Here to Help This plan was designed specifically for the associates of UNION GROVE 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 toll-free: For plan information any time, access our automated voice response system or go online to ameritas.com. 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 visit us at ameritas.com and sign into (or create) a secure member account where they can access and print an online-only Rx discount savings ID card.

8 FFGA Texas State School Plan UNION GROVE 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 ameritas.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 Dental Network Information To find a provider, visit ameritas.com and select FIND A PROVIDER, then DENTAL. Enter your criteria to search by location or for a specific dentist or practice. California Residents: When prompted to select your network, choose the Ameritas Network found on your ID Card or contact Customer Connections at 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. Open Enrollment If a member does not elect to participate when initially eligible, the member may elect to participate at the policyholder's next enrollment period. This enrollment period will be held each year and those who elect to participate in this policy at that time will have their insurance become effective on November 1. 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. Dental Cost Estimator Ever wonder what a dental procedure usually costs? The answer can be found using the Ameritas group division s Dental Cost Estimator tool located in our Secure Member Account portal. Members can search by ZIP Code for a specific dental procedure and see fee range estimates for out-of-network general dentists in that area. Of course, we always suggest that members partner with their dentists, so they know what s involved in any recommended treatment plan. The estimator tool is powered by Go2Dental and uses FAIR Health data that is updated annually. Please note, cost estimates do not reflect discounted rates available through provider networks, and the estimator does not include orthodontic estimates at this time. In addition, when members are in their Secure Member Account, they can: Go paperless with electronic Explanation of Benefits statements and reduce the clutter in their mailboxes View their certificate of insurance and specific plan benefits information Access value-added extras like the Rx discount ID card Language Services We recognize the importance of communicating with our growing number of multilingual customers. That is why we offer a language assistance program that gives you access to: Spanish-speaking claims contact center representatives, telephone interpretation services in a wide range of languages, online dental network provider search in Spanish and a variety of Spanish documents such as enrollment forms, claim forms and certificates of insurance. 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.

9 Vision Insurance Vision insurance is a way to help cover expenses incurred for eye care services from eye care professionals such as optometrists and ophthalmologists. Regular eye exams can offer more than just measuring your eye sight! They can identify serious eye diseases early, allowing time for treatment. Most people don't realize that eye exams can also reveal the early signs of serious illnesses like diabetes, heart disease and high blood pressure. Having vision insurance can help you pay for: Eye exams Eyeglasses Contact lenses Eye surgeries Vision correction *VSP is the network provider for this plan

10 UNION GROVE ISD Eye Care Highlight Sheet Plan 1: Focus Plan Summary Policy # Effective Date: 11/1/2016 VSP Choice Network + Affiliates 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 $45 Lenses (per pair) Single Vision Covered in full Up to $30 Bifocal Covered in full Up to $50 Trifocal Covered in full Up to $65 Lenticular Covered in full Up to $100 Progressive See lens options NA Contacts Fit & Follow Up Exams Member cost up to $60 No benefit Elective Up to $150 Up to $120 Medically Necessary Covered in full Up to $210 Frames $150** Up to $75 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. **The Costco allowance will be the wholesale equivalent. Lens Options (member cost)* VSP Choice Network + Affiliates Out of Network (Other than Costco) Progressive Lenses Up to provider s contracted fee for Lined Up to Lined Bifocal allowance. Bifocal Lenses. The patient is responsible for the difference between the base lens and the Progressive Lens charge. Std. Polycarbonate Covered in full for dependent children No benefit $33 adults Solid Plastic Dye $15 No benefit (except Pink I & II) Plastic Gradient Dye $17 No benefit Photochromatic Lenses $31-$82 No benefit (Glass & Plastic) Scratch Resistant Coating $17-$33 No benefit Anti-Reflective Coating $43-$85 No benefit Ultraviolet Coating $16 No benefit *Lens Option member costs vary by prescription, option chosen and retail locations. Monthly Rates Employee Only (EE) $12.32 EE + Spouse $24.28 EE + Children $23.56 EE + Spouse & Children $35.52 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 visit us at ameritas.com and sign into (or create) a secure member account where they can access and print an online-only Rx discount savings ID card. 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.

11 UNION GROVE ISD Eye Care Highlight Sheet Additional Focus Choice Network Features Contact Lenses Elective 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 are chosen in lieu of glasses. For plans without a separate contact fitting & evaluation (which includes follow up contact lens exams), the cost of the fitting and evaluation is deducted from the allowance. Additional Glasses Frame Discount Laser VisionCare Low Vision 20% off additional complete pairs of prescription glasses and/or prescription sunglasses.* VSP offers 20% off any amount above the retail allowance.* VSP offers an average discount of 15% off or 5% off a promotional offer for LASIK Custom 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). Based on applicable laws, reduced costs may vary by doctor location. Retail Chain Affiliate Providers Available With Focus Plans Effective January 1, 2012, retail chain affiliate providers, which include Costco Optical and Visionworks, give members added convenience and additional retail choices. Costco Optical has 400 locations across the country, while Visionworks manages nearly 400 optical stores in 37 states and DC, including well-known stores such as EyeMasters, Visionworks, Dr. Bizer s VisionWorld, Eye DRx, and Hour Eyes, to name a few. Members enjoy a covered-in-full benefit experience with equivalent frame benefit at any of these retail chain locations. 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: ameritas.com View plan benefit information at: vsp.com Worldwide Support When our members travel abroad, they ll have peace of mind knowing that should a dental or vision need arise, help is just a phone call away. Through AXA Assistance, Ameritas offers its dental and vision plan members 24-hour access to dental or vision provider referrals when traveling outside the U.S. Immediately after a call is made to AXA, an assistance coordinator assesses the situation, provides credible provider referrals and can even assist with making the appointment. Within 48 hours following the appointment, the coordinator calls the member to find out if additional assistance is needed. If all is well, the case is closed. Then, the plan member may submit a claim to Ameritas for reimbursement consideration based on applicable plan benefits. Contact AXA Assistance USA toll free by calling , or call collect from anywhere in the world by dialing Language Services We recognize the importance of communicating with our growing number of multilingual customers. That is why we offer a language assistance program that gives you access to: Spanish-speaking claims contact center representatives, telephone interpretation services in a wide range of languages, online dental network provider search in Spanish and a variety of Spanish documents such as enrollment forms, claim forms and certificates of insurance. 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.

12 Accident Insurance Whether you are a weekend warrior with an active lifestyle or the stay-at-home type, accidents can happen anytime, anywhere, without warning. Being prepared for the unexpected can make all the difference. American Fidelity Assurance Company s Limited Benefit Accident Only Insurance plan is designed to help cover some of the expenses that can result from a covered accident, and benefit payments are made directly to you. HOW THE PLAN WORKS This plan provides 24-hour coverage for accidents that occur both on and off the job. With more than 25 available benefits, this plan pays for a wide range of benefits and can help offset the financial cost of medical expenses. FEATURES Four Coverage Options Choose the coverage that best fits your lifestyle and financial needs. Wellness Benefit The plan pays an annual Wellness Benefit for one Covered Person to receive their routine physical exam, including immunizations and preventive testing. Accidental Death and Dismemberment Benefit The plan pays a benefit when an Accidental Death or Dismemberment occurs within 90 days of a covered accident. Employer Paid: Employer pays $14.60 toward premiums for employees Marketed by: First Financial Capital Corporation Underwritten by: American Fidelity Assurance Company Limitations, exclusions, and waiting periods may apply. Not all products and benefits may be available in all states. This product is inappropriate for people who are eligible for Medicaid coverage. SB

13 Limited Benefit ACCIDENT ONLY Insurance Plan Underwritten by American Fidelity Assurance Company Wellness Benefit Benefits Paid Directly to You Excellent Customer Service Learn More»» Marketed by: First Financial Capital Corporation P.O. Box Houston, TX Local (281) Toll Free (800) 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.

14 Accident Only Insurance Life Provides the Accidents, First Financial Offers a Solution! Whether you re a weekend warrior with an active lifestyle or just a busy family, accidents can happen to you anytime, anywhere without warning. First Financial is pleased to offer American Fidelity Assurance Company s (AFA) Limited Benefit Accident Only Insurance. Accident Only Insurance can offer a solution to help you and your family prepare for those rising medical costs if you have to receive medical treatment for an Accidental injury. Think It Couldn t Happen to You? Consider this... Know The Facts: Total costs of accidental injuries averaged $19,216 per injury in National Safety Council, Injury Facts, 2012 Edition, p $19,216 How Would You Cover Your Out-of-Pocket Costs? Just going for a walk around the block or heading to your driveway could lead to a twisted knee and torn meniscus, one of the more common claims submitted under this plan. EMERGENCY ACCIDENT - Hypothetical Example 1 Twisted knee in the parking lot resulting in a torn meniscus and treatment is received within 72 hours. ENHANCED PLAN BENEFITS Accident Emergency Treatment $200 Accident Follow-Up Treatment (4 visits) $200 Physical Therapy (8 treatments) $200 Medical Imaging $200 X-Ray $100 Appliances $100 Surgical Facility $250 Torn Knee Cartilage Repair $500 Anesthesia $200 Total $1,950 Paid Directly To You! 1 Hypothetical example of a covered accident based on policy AO-03 and rider AMDI-258.

15 Marketed by: First Financial Group of America Solutions For Life s Accidents... The Accident Only Plan is the insurance policy that provides payments direct to you protecting you and your family from some of the expenses brought about by injuries suffered in an Accident, regardless of any additional coverage you may have. It s guaranteed renewable for as long as you pay your premiums. Accident Only Insurance Features:»» No medical questions.»» Benefits paid directly to you, to be used however you see fit.»» Benefits regardless of other coverage.»» Coverage for you and each covered family member 24 hours a day, 7 days a week.» Available conveniently through your employer with payroll deduction.»» Policy is guaranteed renewable at the option of the primary insured for life as long as premiums are paid as required. Any additional insureds must meet eligibility as outlined in the policy. The company has the right to change premium rates by class. Currently participating in, or possibly moving to a High Deductible Health Plan? Health Savings Account (HSA) and qualified High Deductible Health Plan enrollments have quadrupled in the past six years and are on the rise 2. The Choice is Yours: Be prepared with either of American Fidelity s two plan options (Basic and Enhanced) that provide the benefit amounts you require. Plus, American Fidelity supplies the coverage you need with four choices of coverage including individual, individual and spouse, individual and child(ren), and family. Ready To Learn More? Contact your First Financial Account Representative for more details or to schedule an one-on-one appointment. First Financial Group of America N. Freeway, Suite 900 Houston, TX Local: (281) / Toll Free: (800) AHIP: January 2012 Census Shows 13.5 Million People covered by HSA/High-Deductible Health Plans, May 2012, p.3.

16 Schedule of Benefits3 Emergency Accident Benefits Basic Enhanced Emergency Accident Treatment Emergency Accident Treatment $150 $200 Emergency Accident Follow-up Treatment (up to four visits) $50 $50 Accident Injury Benefits Benefit amounts for the following Benefits are the same for Basic and Enhanced Plans for all Persons: Primary, Spouse, and Child(ren). Basic / Enhanced Injury Treatment Fractures Benefit (Depending on open or closed reduction, bone involved, or chip fracture). $25 to $3,000 Lacerations Benefit Not requiring sutures Sutured lacerations up to two inches Sutured lacerations totaling two to six inches Sutured lacerations totaling over six inches $25 $100 $200 $400 Appliances Benefit (crutches, leg braces, etc.) $100 Torn Knee Cartilage or Ruptured Disc Benefit $500 Eye Injury Benefit Injury with surgical repair, for one or both eyes. Removal of foreign body by a Physician, for one or both eyes. Dislocations Benefit Depending on open or closed reduction, with or without anesthesia and joint involved. No other amount will be paid under this benefit. $250 $50 $25 to $3,000 Concussion Benefit $200 2nd & 3rd Degree Burns(Skin grafts are 25% of benefit) $100 to $10,000 Internal Injuries Benefit Resulting in open abdominal or thoracic surgery $1,000 Paralysis Benefit: Paraplegia / Quadriplegia $5,000 / $10,000 Tendons, Ligaments and Rotator Cuff Benefit One Tendon, Ligament or Rotator Cuff More than One Tendon, Ligament or Rotator Cuff $500 $750 Blood, Plasma and Platelets $250 Exploratory Surgery without Surgical Repair $250 Physical Therapy (per treatment up to eight treatments) $25 Prosthesis $500 Emergency Dental Work Broken teeth repaired with crown Extraction of broken teeth (regardless of number) Refer to Plan Benefit Highlights for complete Benefit Descriptions and limits on the Accident Only Insurance Plan. $150 $50

17 A Highlight of Benefits Available Under The Plan Wellness Benefit Basic Enhanced Wellness Annual Routine Physical Exam (Requires a 12-month waiting period before use and one exam per policy per calendar year.) $50 $75 Accidental Death & Dismemberment Benefit Accidental Death & Dismemberment Basic Primary Spouse Child Common Carrier $50,000 $50,000 $25,000 Other Accident $15,000 $15,000 $7,500 Dismemberment $1,000 to $15,000 $1,000 to $15,000 $500 to $7,500 Enhanced Primary Spouse Child Common Carrier $100,000 $100,000 $50,000 Other Accident $30,000 $30,000 $15,000 Dismemberment $1,500 to $30,000 $1,500 to $30,000 $750 to $15,000 Additional Accident Benefits Basic Enhanced Non-Emergency Accident Treatment Non-Emergency Accident Treatment $75 $100 Non-Emergency Follow-up Treatment (up to two visits) $50 $50 Hospital Confinement Hospital Admission $500 $1,000 Intensive Care Unit (up to 15 days) $300 $600 Hospital Confinement (up to 365 days) $100 $200 Medical Imaging MRI, CT, CAT, PET, US $200 $200 X-Rays $50 $100 Ambulance Ground $300 $300 Air $1,500 $1,500 Treatment Outpatient Hospital or Ambulatory Surgical Center $150 $250 Anesthesia $150 $200 Transportation Benefits Transportation (Patient Only) (per round trip for up to three round trips per calendar year) Family Member Lodging and Meals (per day per Accident; up to 30 days per confinement) $300 $300 $100 $100

18 Plan Benefit Highlights A Covered Person (thereafter referred to as Person ) under American Fidelity s Limited Benefit Accident Only Policy can expect the following benefits when a Covered Accident (thereafter referred to as Accident ) happens. All benefits are paid once per Person per Accident unless otherwise specified. All benefits are only paid as a result of Injuries received in an Accident that occurs while coverage is in force. All treatment, procedures, and medical equipment must be diagnosed, recommended and treated by a Physician. These references are not intended to change or modify any definitions in the AO-03 policy series. Accident Emergency Treatment Benefit Payable for receiving emergency treatment in a Physician s office or emergency room within 72 hours, including physician fees and emergency services. Accident Follow-up Treatment Benefit Payable for necessary follow-up treatment of Injuries in addition to the emergency treatment administered within 72 hours for up to four treatments. Not payable for a visit in which a Physical Therapy Benefit or Non-Emergency Follow-Up Benefit is paid. Accidental Death and Dismemberment Benefit The applicable benefits apply when an Accidental Death or Dismemberment occurs within 90 days of an Accident. In the event that Accidental Death and Dismemberment result from the same Accident, only the Accidental Death Benefit will be paid. Ambulance Benefit If air and ground transportation is required for the same Accident, only the highest benefit will be paid. Anesthesia Benefit Pays the amount shown in the Schedule of Benefits for the services of an anesthesiologist for a surgery performed due to an Accident. Hospital Confinement is not required to receive this benefit. We will only pay one Anesthesia Benefit per Person in a 24-hour period even if more than one surgical procedure is performed. This benefit is not payable for local anesthesia. Appliances Benefit Payable for one of the following: crutches, leg braces, back braces, walkers, or wheel chairs. Not payable for Prosthetic Devices. Blood, Plasma and Platelets Benefit Payable for blood, plasma and platelets. This benefit does not provide benefits for immunoglobulins. Burns Benefit Payable for burns when treated by a Physician within 72 hours. Concussion Benefit Payable for a Person who sustains a concussion and is diagnosed by a Physician within 72 hours using any type of medical imaging. Dislocations Benefit Amount payable varies by the joint involved, type of treatment, and type of anesthesia. If a Person receives more than one Dislocation in an Accident, we will pay for all Dislocations up to two times the amount shown in the Schedule of Benefits for the Dislocation involved that has the highest benefit amount. No other amount will be paid under this benefit. Benefits are payable only for the first dislocation of a joint which occurs while this policy is in force. Emergency Dental Work Benefit Payable for repair to natural teeth when treated by a Physician or dentist. Initial dental treatment must be received within 72 hours. Exploratory Surgery Benefit Payable when an exploratory surgical operation without surgical repair is performed. Eye Injury Benefit Payable for one or both eyes requiring treatment. Family Member Lodging and Meals Benefit Payable for lodging and meals for a family member to be near a Person who is Confined in a non-local Hospital. The Hospital must be at least 50 miles one way from the Person s residence or site of the Accident. Fractures Benefit Varies based on the bone involved, type of fracture and type of treatment. If the Person fractures more than one bone, payment is made for all fractures up to two times the amount for the bone involved that has the highest benefit amount. Hospital Admission Benefit Pays per admission for confinement to a Hospital. This benefit does not pay for outpatient treatment, emergency room treatment, or a stay of less than 18 hours in an observation unit. Hospital Confinement Benefit Payable for a one-time Hospital Admission Benefit due to accidental Injuries (does not include emergency room and outpatient treatment). You will also receive a daily benefit for a Hospital Confinement that is longer than 18 hours for up to 365 days and an additional daily benefit for Confinement in an Intensive Care Unit up to 15 days. Intensive Care Unit Benefit Payable for each day of confinement in an Intensive Care Unit, as defined in the policy, up to 15 days. This benefit is paid in addition to the Hospital Confinement Benefit amount. Internal Injuries Benefit Payable for an open abdominal or thoracic surgery performed within 72 hours. Lacerations Benefit This benefit varies based on the severity of the laceration. Medical Imaging Benefit Payable for a Magnetic Resonance Imaging (MRI), a Computed Tomography (CT) scan, a Computed Axial Tomography (CAT) scan, a Positron Emission Tomography (PET) scan or an ultrasound.

19 Non-Emergency Accident Initial Treatment Benefit Payable for initial medical treatment when treatment is received more than 72 hours after the Accident. Initial medical treatment must: (1) be received in a Physician s office or emergency room; and (2) be the first treatment; and (3) occur within 30 days. Non-Emergency Accident Follow-up Treatment Benefit Payable only if the Non-Emergency Accident Initial Treatment Benefit is payable and later requires additional treatment: we will pay over and above the initial medical treatment administered. We will pay for up to two treatments. Not payable for the same visit that the Physical Therapy Benefit or the Accident Follow-Up Benefit is paid. Outpatient Hospital or Ambulatory Surgical Center Benefit When a surgical procedure is performed on an outpatient basis in a Hospital or at an Ambulatory Surgical Center, we will pay the indemnity amount shown in the Schedule of Benefits for the facility fee charged by such Hospital or Ambulatory Surgical Center. We will only pay one Outpatient Hospital or Ambulatory Surgical Center Benefit in a 24-hour period even if more than one surgical procedure is performed. This benefit will not be paid for surgery performed in a Hospital emergency room or in a Physician s office. Paralysis Benefit The duration of the Paralysis must be a minimum of 3 consecutive months. Paid once per lifetime per Person. Physical Therapy Benefit Payable for one treatment per day for up to eight treatments by a caregiver licensed in physical therapy. This benefit is not payable for the same visit that the Accident Follow-up Treatment Benefit or Non- Emergency Follow-Up Benefit. Prosthesis Benefit Payable for the use of a Prosthesis. This benefit is not payable for hearing aids; dental aids; eyeglasses; false teeth; or for cosmetic aids such as wigs. Tendons, Ligaments and Rotator Cuff Benefit Payable for the repair of one or more tendons, ligaments, or rotator cuffs. The tendons, ligaments, or rotator cuff must be repaired through surgery. Torn Knee Cartilage or Ruptured Disc Benefit Payable for surgical repair. Transportation Benefit Payable for the transportation when specialized treatment and Hospital Confinement in a non-local Hospital is required. A non-local Hospital must be at least 50 miles away, one way, using the most direct route, from the closer of the Person s residence or site of the Accident. Travel must be by scheduled bus, plane, train, or by car. Ambulance service does not qualify for this benefit. The treatment must be prescribed by a Physician and not be available locally. Wellness Benefit After coverage is in force for the waiting period shown, you can receive a benefit for an annual routine physical exam, including immunizations and preventive testing. Services must be supervised by a Physician and a charge must be incurred for the service. The benefit does not apply to dental or eye exams and is payable once per policy per calendar year. Limitations and Exclusions Base Policy No benefits will be provided for an Accident that is caused by or occurs as a result of: (1) intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; (2) participation in any form of flight aviation other than as a farepaying passenger in a fully licensed/passenger-carrying aircraft; (3) any act that was caused by war, declared or undeclared, or service in any of the armed forces; (4) participation in any activity or event while under the influence of any narcotic unless administered by a Physician or taken according to the Physician s instructions; (5) participation in, or attempting to participate in, a felony, riot or insurrection. (A felony is as defined by the law of the jurisdiction in which the activity takes place.) (6) participation in any sport for pay or profit; (7) participation in any contest of speed in a power driven vehicle for pay or profit; (8) participation in parachuting, bungee jumping, rappelling, mountain climbing or hang gliding. Benefits will not be provided for medical treatment for an Accident received outside the United States or its territories. Benefits will not be paid for services rendered by a member of the immediate family of a Person. An Accident is defined as a sudden, unexpected and unintended event, which results in bodily injury, which is independent of disease or bodily infirmity or any other cause. The policy will not pay benefits for injuries received prior to the Effective Date of coverage that are aggravated or re-injured by any event that occurs after the Effective Date. A hospital is not an institution, or part thereof, used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a rehabilitative facility; an extended-care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction. You cannot be singled out for a rate increase for any reason. The Insurer has the right to increase premium rates only if rates for all policies in this class change. This is a brief description of the coverage. For actual benefits, limitations, exclusions and other provisions, please refer to the policy, AO-03, and Accident Only Benefit Enhancement Rider, AMDI-258 Series. This coverage does NOT replace Workers Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage.

20 Accident Only Insurance Premiums Monthly Premiums Basic Enhanced Individual $19.90 $26.10 Individual & Spouse $28.30 $34.90 Individual & Child(ren) $31.50 $41.00 Family $39.90 $ The premium and amount of benefits provided vary based upon the plan selected. Plan Options»» Individual Plan The Insured, age 18 through 64, at the date of policy issue, is the only Person.»» Individual and Lawful Spouse Plan Covers you and your Lawful Spouse (ages 18 to 64 at Policy Issue).»» Individual and Child(ren) Plan Covers you (ages 18 to 64 at Policy Issue) and each Eligible Child, as defined in the policy, under the age of 21 or 25 if attending school full-time.»» Family Plan Covers you, your Lawful Spouse (ages 18 to 64 at Policy Issue) and each Eligible Child, as defined in the policy, under the age of 21 or 25 if attending school full-time. Underwritten and administered by: 2000 N. Classen Boulevard Oklahoma City, Oklahoma SB-25787(TX)-0113 AO-03 Series and AMDI-258 Series

21 Long Term Disability If your paycheck suddenly stopped today, could you afford to pay for your mortgage, car payments, food, and other monthly expenses? How could you maintain your current lifestyle? American Fidelity Assurance Company knows one of the most important assets a person possesses is their ability to earn an income. Our Disability Income Insurance is a cost-effective solution designed to help protect you if you become disabled and cannot work due to a covered injury or sickness. HOW THE PLAN WORKS Multiple Elimination Periods Based on your individual need, you can select from multiple elimination periods. Waiver of Premium Benefit Premiums are not required while you are disabled based on the length of your disability. Return to Work Benefit This allows you to return to work, on a part-time basis, and still receive a portion of the benefit. Accidental Death Benefit Your beneficiary will receive a lump sum payment if you die within the period stated in your policy as a result of an accidental injury. *Premiums are Salary specific; see Dusty Gallagher for premiums.

22 Educator Disability Trust Plan Benefits What is Disability Insurance? Disability insurance can help replace a portion of your income if you are unable to work for an extended period of time due to a sickness or accidental injury. It helps provide day to day peace of mind that comes from knowing that, during the time you would be recovering from a significant event in your life. The plan is being made available to you through your employer and with the convenience of payroll deduction. Why do I Need Disability Insurance? While most people insure their lives and other material assets like homes and automobiles, many overlook the need to protect one of their most valuable assets their ability to work and earn a living. When Disability strikes, your ability to earn an income becomes interrupted, however, your monthly bills continue. Would you be adequately prepared to cover present and future financial obligations if you were to fall sick or become disabled and not able to work? Consider the following. 62% of employees are extremely concerned about the ability to pay bills during a sudden income loss Chances out of 1,000 of an employed individual becoming disabled for 90 days or more before age % at age 30 45% at age 35 43% at age 40 40% at age 45 36% at age 50 Over 51 million Americans are classified as disabled, representing 18% of the population. Eligibility Requirements: All active full-time employees working at least 20 hours per week are eligible to participate. How is Disability Defined Under the Plan? Generally, you are considered disabled and eligible for disability benefits if, due to sickness, pregnancy or accidental injury, you are receiving appropriate care and treatment and are complying with the requirements of treatment and you are unable to earn more than 80% of your predisability earnings at your own occupation for any employer in your local economy. Following the Own Occupation period, you are considered disabled if, due to sickness, pregnancy or accidental injury, you are receiving appropriate care and treatment and you are unable to earn 80% of your predisability earnings at any gainful occupation for which you are reasonably qualified taking into account your training, education and experience. For a complete description of this and other requirements that must be met, refer to the Certificate of Insurance Plan Description provided by your Employer. What is the Benefit Amount? The benefit amount is 60% of your predisability earnings up to $1,750 per week.

23 Educator Disability Trust Plan Benefits When do benefits begin and how long do they continue? Benefits begin after the end of the elimination period. The elimination period begins in the day you become disabled and is the length of time you must wait, while disabled, before you are eligible to receive a benefit. The elimination period is as follows: Option 1: 7 Days Sickness (includes pregnancy) / 7 Days Injury (1 st Day Hospitalization) Option 2: 14 Days Sickness (includes pregnancy) / 14 Days Injury (1 st Day Hospitalization) Option 3: 30 Days Sickness (includes pregnancy) / 30 Days Injury Option 4: 90 Days Sickness (includes pregnancy) / 90 Days Injury Benefits continue for as long as you are disabled up to Social Security Normal Retirement Age (SSNRA). Answers to Some Important Questions: Q. Are my benefits taxable? A. Your benefit in the event of a disability would be tax free. Q. Can I return to work part-time and still receive benefits? A. Yes, you may receive up to 100% if your predisability earnings for the first 24 months. With the Rehabilitation Incentive you can get a 10% increase in your monthly benefit if you participate in a Rehabilitation Program while you are disabled. The Family Care Incentive will provide reimbursement up to $100 per week for eligible expenses, such as child care, following the 4 th week of return to work. Q. Are there any other Incentives included? A. Yes, such as the following: Employee Assistance Program (EAP) Provides up to 3 counseling sessions with a licenses clinician per incident, per individual, per calendar year. Moving Expense Benefit Provides reimbursement for your move to a different address you make as part of an approved rehabilitation program Organ Donor Benefit 10% increase in the Weekly Benefit if Disability is a result of an Organ Transplant Procedure. Q. Are there any exclusions for pre-existing conditions? A. Yes. For the first 12 months your plan may not cover a sickness or accidental injury that arose in the 3 months prior to your participation in the plan. Thereafter provided you remain disabled, the sickness or accidental injury may be covered. A complete description of the pre-existing condition exclusion is included in the Certificate of Insurance/Summary Plan Description provided by your Employer. Q. Are there any other limitations or exclusions to my coverage? A. Yes. No payment will be made for any disability caused or contributed by: War, insurrection, or rebellion; Active participation in a riot; Intentionally self-inflicted injury or attempted suicide; Commission of a felony.

24 Educator Disability Plan - Monthly Premium Rate Sheet First 90 days After 90 days Option 1 Option 2 Option 3 Option 4 Annual Salary Weekly Benefit Monthly Benefit (8th day) (15th day) (31st day) (91st day) $4, $46.15 $ $6.95 $6.75 $4.01 $1.93 $5, $57.69 $ $8.68 $8.43 $5.02 $2.42 $6, $69.23 $ $10.42 $10.12 $6.02 $2.90 $7, $80.77 $ $12.15 $11.81 $7.03 $3.38 $8, $92.31 $ $13.89 $13.49 $8.03 $3.87 $9, $ $ $15.63 $15.18 $9.03 $4.35 $10, $ $ $17.36 $16.87 $10.04 $4.83 $11, $ $ $19.10 $18.55 $11.04 $5.32 $12, $ $ $20.84 $20.24 $12.04 $5.80 $13, $ $ $22.57 $21.93 $13.05 $6.28 $14, $ $ $24.31 $23.62 $14.05 $6.77 $15, $ $ $26.05 $25.30 $15.06 $7.25 $16, $ $ $27.78 $26.99 $16.06 $7.73 $17, $ $ $29.52 $28.68 $17.06 $8.22 $18, $ $ $31.26 $30.36 $18.07 $8.70 $19, $ $ $32.99 $32.05 $19.07 $9.18 $20, $ $1, $34.73 $33.74 $20.07 $9.67 $21, $ $1, $36.46 $35.42 $21.08 $10.15 $22, $ $1, $38.20 $37.11 $22.08 $10.63 $23, $ $1, $39.94 $38.80 $23.09 $11.12 $24, $ $1, $41.67 $40.48 $24.09 $11.60 $25, $ $1, $43.41 $42.17 $25.09 $12.08 $26, $ $1, $45.15 $43.86 $26.10 $12.57 $27, $ $1, $46.88 $45.54 $27.10 $13.05 $28, $ $1, $48.62 $47.23 $28.10 $13.53 $29, $ $1, $50.36 $48.92 $29.11 $14.02 $30, $ $1, $52.09 $50.60 $30.11 $14.50 $31, $ $1, $53.83 $52.29 $31.12 $14.98 $32, $ $1, $55.57 $53.98 $32.12 $15.47 $33, $ $1, $57.30 $55.66 $33.12 $15.95 $34, $ $1, $59.04 $57.35 $34.13 $16.43 $35, $ $1, $60.77 $59.04 $35.13 $16.92 $36, $ $1, $62.51 $60.72 $36.13 $17.40 $37, $ $1, $64.25 $62.41 $37.14 $17.88 $38, $ $1, $65.98 $64.10 $38.14 $18.37 $39, $ $1, $67.72 $65.79 $39.15 $18.85 $40, $ $2, $69.46 $67.47 $40.15 $19.33 $41, $ $2, $71.19 $69.16 $41.15 $19.82 $42, $ $2, $72.93 $70.85 $42.16 $20.30 $43, $ $2, $74.67 $72.53 $43.16 $20.78 $44, $ $2, $76.40 $74.22 $44.16 $21.27 $45, $ $2, $78.14 $75.91 $45.17 $21.75 $46, $ $2, $79.87 $77.59 $46.17 $22.23 $47, $ $2, $81.61 $79.28 $47.17 $22.72 $48, $ $2, $83.35 $80.97 $48.18 $23.20 $49, $ $2, $85.08 $82.65 $49.18 $23.68 $50, $ $2, $86.82 $84.34 $50.19 $24.17 $51, $ $2, $88.56 $86.03 $51.19 $24.65 $52, $ $2, $90.29 $87.71 $52.19 $25.13 $53, $ $2, $92.03 $89.40 $53.20 $25.62 $54, $ $2, $93.77 $91.09 $54.20 $26.10 $55, $ $2, $95.50 $92.77 $55.20 $26.58 $56, $ $2, $97.24 $94.46 $56.21 $27.07 $57, $ $2, $98.98 $96.15 $57.21 $27.55 $58, $ $2, $ $97.83 $58.22 $28.03 $59, $ $2, $ $99.52 $59.22 $28.52 $60, $ $3, $ $ $60.22 $29.00 $61, $ $3, $ $ $61.23 $29.48 $62, $ $3, $ $ $62.23 $29.97 $63, $ $3, $ $ $63.23 $30.45

25 Educator Disability Plan - Monthly Premium Rate Sheet First 90 days After 90 days Option 1 Option 2 Option 3 Option 4 Annual Salary Weekly Benefit Monthly Benefit (8th day) (15th day) (31st day) (91st day) $64, $ $3, $ $ $64.24 $30.93 $65, $ $3, $ $ $65.24 $31.42 $66, $ $3, $ $ $66.25 $31.90 $67, $ $3, $ $ $67.25 $32.38

26 Educator Disability Plan - Monthly Premium Rate Sheet First 90 days After 90 days Option 1 Option 2 Option 3 Option 4 Annual Salary Weekly Benefit Monthly Benefit (8th day) (15th day) (31st day) (91st day) $68, $ $3, $ $ $68.25 $32.87 $69, $ $3, $ $ $69.26 $33.35 $70, $ $3, $ $ $70.26 $33.83 $71, $ $3, $ $ $71.26 $34.32 $72, $ $3, $ $ $72.27 $34.80 $73, $ $3, $ $ $73.27 $35.28 $74, $ $3, $ $ $74.28 $35.77 $75, $ $3, $ $ $75.28 $36.25 $76, $ $3, $ $ $76.28 $36.73 $77, $ $3, $ $ $77.29 $37.22 $78, $ $3, $ $ $78.29 $37.70 $79, $ $3, $ $ $79.29 $38.18 $80, $ $4, $ $ $80.30 $38.67 $81, $ $4, $ $ $81.30 $39.15 $82, $ $4, $ $ $82.30 $39.63 $83, $ $4, $ $ $83.31 $40.12 $84, $ $4, $ $ $84.31 $40.60 $85, $ $4, $ $ $85.32 $41.08 $86, $ $4, $ $ $86.32 $41.57 $87, $1, $4, $ $ $87.32 $42.05 $88, $1, $4, $ $ $88.33 $42.53 $89, $1, $4, $ $ $89.33 $43.02 $90, $1, $4, $ $ $90.33 $43.50 $91, $1, $4, $ $ $91.34 $43.98 $92, $1, $4, $ $ $92.34 $44.47 $93, $1, $4, $ $ $93.35 $44.95 $94, $1, $4, $ $ $94.35 $45.43 $95, $1, $4, $ $ $95.35 $45.92 $96, $1, $4, $ $ $96.36 $46.40 $97, $1, $4, $ $ $97.36 $46.88 $98, $1, $4, $ $ $98.36 $47.37 $99, $1, $4, $ $ $99.37 $47.85 $100, $1, $5, $ $ $ $48.33 $101, $1, $5, $ $ $ $48.82 $102, $1, $5, $ $ $ $49.30 $103, $1, $5, $ $ $ $49.78 $104, $1, $5, $ $ $ $50.27 $105, $1, $5, $ $ $ $50.75 $106, $1, $5, $ $ $ $51.23 $107, $1, $5, $ $ $ $51.72 $108, $1, $5, $ $ $ $52.20 $109, $1, $5, $ $ $ $52.68 $110, $1, $5, $ $ $ $53.17 $111, $1, $5, $ $ $ $53.65 $112, $1, $5, $ $ $ $54.13 $113, $1, $5, $ $ $ $54.62 $114, $1, $5, $ $ $ $55.10 $115, $1, $5, $ $ $ $55.58 $116, $1, $5, $ $ $ $56.07

27 Critical Illness Insurance Critical illness insurance offers you financial protection when you need it the most with cash benefits paid directly to you. Since benefits are provided in a lump sum at the time a covered diagnosis occurs, there is flexibility in how you use your benefits. Whether for medical expenses, or the cost of daily living, the decision is yours to use the benefits in a way that best fits your needs so you can focus on your recovery. Supplementing your major medical with critical illness insurance helps you pay for your care so you can focus on getting well. Critical illness insurance may cover: Invasive Cancer Severe burns Coma Paralysis Heart attack Permanent damage from a stroke Bypass surgery Kidney failure Major organ transplant Employer Paid: Employer pays for $10,000 worth of benefit for all employees. *See premiums below for additional coverage

28

29

30 Permanent, Portable Life Insurance 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 it after you retire, usually costs more and declines in death benefit. You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, and minor children and grandchildren. 1,2 Please see Purelife-plus brochure for additional information and rates. 1. Policies not available for children and grandchildren in Washington. 2. Texas Life complies with all state laws regarding marriages, domestic and civil union partnerships, and legally recognized familial relationships.

31 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. 2 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.) (Form ICC07-ULABR-07 or ULABR-07) You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, minor children and grandchildren. 3 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 Guarantees are subject to product terms, exclusions and limitations and the insurer s claims-paying ability and financial strength. 3 Policies not available for children and grandchildren in Washington. See the purelife-plus brochure for details. 14M034-C 1025 (exp0316) purelife-plus is not available in NJ, NY or PA.

32 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 $50,000 $75,000 $100,000 $150,000 $200,000 $250,000 $300,000 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-AZrplt EXP-K-M-1AD R

33 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 $50,000 $75,000 $100,000 $150,000 $200,000 $250,000 $300,000 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-AZrplt EXP-K-M-1AD R

34 Group Life Insurance Group life insurance allows you to purchase affordable life insurance on yourself, spouse and dependent children. This is term insurance, available as long as you are an employee with the District. Low cost term life insurance Age Banded Plan New employees can apply for up to the guarantee issue amount without answering health questions No cash value accumulates Spouse and Dependent Child(ren) can also apply Employees enrolling in the coverage after the first 31 days of their employment will be subject to insurability and must complete a health questionnaire prior to coverage being issued. Employer Paid: Employer pays for $10,000 worth of benefit for all employees (age reduction if over 70). *See premiums below for additional coverage

35 BENEFIT PROGRAM SUMMARY For UNION GROVE ISD The death of a family provider can mean that a family will not only find itself facing the loss of a loved one, but also the loss of financial security. With our Group Term Life plan, an employee can achieve peace of mind by giving their family the security they can depend on. GROUP TERM LIFE / AD&D Eligibility All Eligible Active Full Time Employees and Bus Drivers Group Term Life/AD&D Benefit - Employee $10,000 Guarantee Issue Amount Employee $10,000 Age Reduction Schedule Waiver of Premium Definition of Disability Accelerated Death Benefit (ADB) Conversion Privilege Travel Resource Services Life and AD&D benefits reduce by 35% of the original amount at age 65, and an additional 25% of the original amount at age 70, and an additional 15% of the original amount at age 75. Benefits terminate at retirement. If an employee is unable to engage in any occupation as a result of injury or sickness for a minimum of 9 months, prior to age 60, premium will be waived for the employee s life insurance benefit until the employee is no longer disabled or reaches age 65, whichever occurs first. Diagnosed by a doctor to be completely unable, because of sickness or injury to engage in any occupation for wage or profit or any occupation for which they become qualified by education, training or experience. Upon the employee s request, this benefit pays a lump sum up to 75% of the employee s Life insurance, if diagnosed with a terminal illness and has a life expectancy of 12 months or less. Minimum: $7,500. Maximum: $250,000. The amount of group term life insurance otherwise payable upon the employee s death will be reduced by the ADB. Included. Helps travelers deal with the unexpected that may take place while traveling. Services include emergency medical assistance, financial, legal and communication assistance, and access to other critical services and resources available via the internet. Products and services marketed under the Dearborn National brand and the star logo are underwritten and/or provided by Dearborn National Life Insurance Company, (Downers Grove, IL) (formerly known as Fort Dearborn Life Insurance Company ) in all states (excluding New York), the District of Columbia, the United States Virgin Islands, the British Virgin Islands, Guam and Puerto Rico. Product features and availability vary by state and company, and are solely the responsibility of each affiliate. Refer to your certificate for complete details and limitations of coverage. (For internal use only: Policy number FDL ) This information is only a product highlight. Life benefits may be subject to medical underwriting. Coverage for a medically underwritten benefit is not effective until the date the insurer has approved the employee s application. The policy has exclusions, limitations, and reduction of benefits and/or terms under which the policy may be continued or discontinued. The policy may be cancelled by the insurer at any time. The insurer reserves the right to change premium rates, but not more than once in a 12-month period. For employee distribution..

36 GROUP ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) PROGRAM SUMMARY Group AD&D is an additional death benefit that pays in the event a covered employee dies or is dismembered in a covered accident. AD&D benefit is 24-hour coverage. AD&D Schedule of Loss* Loss of Life 100% Loss of Both Hands or Both Feet 100% Loss of One Hand and One Foot 100% Loss of Speech and Hearing 100% Loss of Sight of Both Eyes 100% Loss of One Hand and the Sight of One Eye 100% Loss of One Foot and the Sight of One Eye 100% Quadriplegia 100% Paraplegia 75% Hemiplegia 50% Loss of Sight of One Eye 50% Loss of One Hand or One Foot 50% Loss of Speech or Hearing 50% Loss of Thumb and Index Finger on Same Hand 25% Uniplegia 25% * Loss must occur within 365 days of the accident. AD&D Product Features Included: Seatbelt and Airbag Benefits Repatriation Benefit Education Benefit Principal Sum Exclusions Unless specifically covered in the policy, or required by state law, we will not pay any AD&D benefit for any loss that, directly or indirectly, results in any way from or is contributed to by: 1. disease of the mind or body, or any treatment thereof; 2. infections, except those from an accidental cut or wound; 3. suicide or attempted suicide; 4. intentionally self-inflicted injury; 5. war or act of war; 6. travel or flight in any aircraft while a member of the crew; 7. commission of, or participation in a felony; 8. under the influence of certain drugs, narcotics, or hallucinogen unless properly used as prescribed by a physician; or 9. intoxication as defined in the jurisdiction where the accident occurred; 10. participation in a riot. Products and services marketed under the Dearborn National brand and the star logo are underwritten and/or provided by Dearborn National Life Insurance Company, (Downers Grove, IL) (formerly known as Fort Dearborn Life Insurance Company ) in all states (excluding New York), the District of Columbia, the United States Virgin Islands, the British Virgin Islands, Guam and Puerto Rico. Product features and availability vary by state and company, and are solely the responsibility of each affiliate. Refer to your certificate for complete details and limitations of coverage. (For internal use only: Policy number FDL ) This information is only a product highlight. Life benefits may be subject to medical underwriting. Coverage for a medically underwritten benefit is not effective until the date the insurer has approved the employee s application. The policy has exclusions, limitations, and reduction of benefits and/or terms under which the policy may be continued or discontinued. The policy may be cancelled by the insurer at any time. The insurer reserves the right to change premium rates, but not more than once in a 12-month period. For employee distribution.

37 BENEFIT PROGRAM SUMMARY For UNION GROVE ISD SUPPLEMENTAL GROUP TERM LIFE (100% Employee Paid) Dearborn National s Supplemental Group Term Life coverage is payroll deducted and sponsored by your employer at a conveniently cost effective rate. Most families depend upon each paycheck to pay expenses and plan for the future. In the unexpected event of death, life insurance provides immediate financial assistance for you and your family when it is most needed. Eligibility: All Eligible Active Full Time Employees and Bus Drivers EMPLOYEE COVERAGE Group Term Life Benefit Guarantee Issue Amount $150,000 Age Reduction Schedule SPOUSE COVERAGE Group Term Life Benefit Guarantee Issue Amount $50,000 Age Reduction Schedule CHILD(REN) COVERAGE Group Term Life Benefit Live birth to 6 months: $250 6 months to 26 years: $10,000 Waiver of Premium Accelerated Death Benefit (ADB) Portability Feature (Life coverage) Conversion Privilege (Life coverage) Exclusions Your choice of $10,000 increments, up to a maximum of $500,000 (not to exceed 5 times your annual salary), minimum of $10,000. Employees age 70 and older, a maximum benefit of $50,000. Life benefits reduce as follows: At age 65, benefits will reduce by 35% of the original amount; At age 70, benefits will reduce an additional 25% of the original amount; At age 75, benefits will reduce an additional 15% of the original amount; At age 80, benefits will reduce an additional 15% of the original amount. All benefits terminate at retirement. Choice of $5,000 increments, up to a maximum of $125,000 (not to exceed 50% of employee approved amount), minimum of $5,000. Employee must elect coverage for spouse to be eligible. Life benefits reduce by 35% at employee age 65. Benefits terminate at employee age 70 or retirement, whichever occurs first If an employee is unable to engage in any occupation as a result of injury or sickness for a minimum of 9 months, prior to age 60, premium will be waived for the employee s life insurance benefit until the employee is no longer disabled or reaches age 65, whichever occurs first. Upon the employee s request, this benefit pays a lump sum up to 75% of the employee s Life insurance, if diagnosed with a terminal illness and has a life expectancy of 12 months or less. Minimum: $7,500. Maximum: $250,000. The amount of group term life insurance otherwise payable upon the employee s death will be reduced by the ADB. Included. (Employee) Included. One-year suicide exclusion applies to Supplemental Group Term Life coverage. This information is only a product highlight. Life benefits may be subject to medical underwriting. Coverage for a medically underwritten benefit is not effective until the date the insurer has approved the employee s application. The policy has exclusions, limitations, and reduction of benefits and/or terms under which the policy may be continued or discontinued. The policy may be cancelled by the insurer at any time. The insurer reserves the right to change premium rates, but not more than once in a 12-month period. Products and services marketed under the Dearborn National brand and the star logo are underwritten and/or provided by Dearborn National Life Insurance Company, (Downers Grove, IL) in all states (excluding New York), the District of Columbia, the United States Virgin Islands, the British Virgin Islands, Guam and Puerto Rico. Product features and availability vary by state and company, and are solely the responsibility of each affiliate. Refer to your certificate for complete details and limitations of coverage. (For internal use only: Policy number FDL )

38 SUPPLEMENTAL GROUP LIFE PREMIUM RATE GRID UNION GROVE ISD Eligibility You are eligible to enroll if you work the minimum number of hours per week by your employer, and you have satisfied any waiting period. EMPLOYEE & SPOUSE Supplemental Life Monthly rates per $1,000 Supplemental Life Insurance Age Rates Employee Benefit: $10,000 to $500,000, in increments of $10,000, not to exceed Under 20 $ times annual salary $0.070 Employees age 70 and older: $50,000 maximum benefit $0.080 Spouse Benefit: $5,000 to $125,000, in increments of $5, $0.090 (not to exceed 50% of the employee benefit) $0.120 $0.180 Note: Spouse may not have coverage unless the employee has coverage $0.300 $0.510 Guarantee Issue $0.860 Employee $ 150, $1.250 $2.080 Spouse: $ 50, $4.090 $6.160 Child Coverage Live birth to 6 months: $250 6 months to age 26: $10,000 Employee: Life benefits reduce by 35% of the original amount at age 65, and an additional 25% of the original amount at age 70, and an additional 15% of the original amount at age 75, and an additional 15% of the original amount at age 80. Benefits terminate at retirement. Dependent Life (Children) Monthly Premium per Family Spouse: Life benefits reduce by 35% at employee age 65. Benefits terminate at $10,000 $1.00 employee age 70 or retirement, whichever occurs first. Supplemental Life Monthly Premium Cost (Based on 12 payroll deductions per year) ATTAINED AGE Benefit Amount < $10,000 $0.70 $0.70 $0.80 $0.90 $1.20 $1.80 $3.00 $5.10 $8.60 $12.50 $20.80 $40.90 $61.60 $20,000 $1.40 $1.40 $1.60 $1.80 $2.40 $3.60 $6.00 $10.20 $17.20 $25.00 $41.60 $81.80 $ $30,000 $2.10 $2.10 $2.40 $2.70 $3.60 $5.40 $9.00 $15.30 $25.80 $37.50 $62.40 $ $ $40,000 $2.80 $2.80 $3.20 $3.60 $4.80 $7.20 $12.00 $20.40 $34.40 $50.00 $83.20 $ $ $50,000 $3.50 $3.50 $4.00 $4.50 $6.00 $9.00 $15.00 $25.50 $43.00 $62.50 $ $ $ $60,000 $4.20 $4.20 $4.80 $5.40 $7.20 $10.80 $18.00 $30.60 $51.60 $75.00 $ $70,000 $4.90 $4.90 $5.60 $6.30 $8.40 $12.60 $21.00 $35.70 $60.20 $87.50 $ $80,000 $5.60 $5.60 $6.40 $7.20 $9.60 $14.40 $24.00 $40.80 $68.80 $ $ $90,000 $6.30 $6.30 $7.20 $8.10 $10.80 $16.20 $27.00 $45.90 $77.40 $ $ $100,000 $7.00 $7.00 $8.00 $9.00 $12.00 $18.00 $30.00 $51.00 $86.00 $ $ $110,000 $7.70 $7.70 $8.80 $9.90 $13.20 $19.80 $33.00 $56.10 $94.60 $ $ $120,000 $8.40 $8.40 $9.60 $10.80 $14.40 $21.60 $36.00 $61.20 $ $ $ $130,000 $9.10 $9.10 $10.40 $11.70 $15.60 $23.40 $39.00 $66.30 $ $ $ $140,000 $9.80 $9.80 $11.20 $12.60 $16.80 $25.20 $42.00 $71.40 $ $ $ $150,000 $10.50 $10.50 $12.00 $13.50 $18.00 $27.00 $45.00 $76.50 $ $ $ *Additional amounts up to $500,000, are available. Policy Provisions may vary by state. Refer to a certificate or enrollment brochure for details about coverage features and limitations. For internal use only: Policy number FDL Slife/blend-12 Products and services marketed under the Dearborn National brand and the star logo are underwritten and/or provided by Dearborn National Life Insurance Company (Downers Grove, IL) (formerly known as Fort Dearborn Life Insurance Company ) in all states (excluding New York), the District of Columbia, the United States Virgin Islands, the British Virgin Islands, Guam and Puerto Rico.

39 Retirement Plans Smart financial planning is important for your long term goals. Our investments offer you tax advantages and can be a great strategy for your child's education and your retirement. We offer tax deferred retirement plans that allow you to place a percentage of your salary into an employer sponsored plan that helps you save. Each has multiple investment options and the flexibility to start, stop and adjust your contributions. Visit and View Employer Retirement Plans for specific plan options available through your employer.