EDUCATION SERVICE CENTER REGION 19 BENEFIT GUIDE EFFECTIVE: 09/01/2017-8/31/2018

Transcription

1 EDUCATION SERVICE CENTER REGION 19 BENEFIT GUIDE EFFECTIVE: 09/01/2017-8/31/

2 Table of Contents Benefit Contact Information 3 How to Enroll Annual Enrollment 6 2. Eligibility Requirements 7 3. Benefit Updates 8 4. Section 125 Cafeteria Plan Guidelines 9 5. Helpful Definitions ACA Employee Responsibilities 11 TRS ActiveCare Aetna Medical APL-MEDlink Cigna Dental Superior Vision UNUM Long Term Disability APL Cancer UNUM Critical Illness The Hartford Term Life/AD&D Star FPP with Quality of Life Rider FLIP TO... PG. 4 HOW TO ENROLL PG. 8 SUMMARY PAGES PG. 12 YOUR BENEFITS 2

3 Benefit Contact Information Benefit Contact Information ESC REGION 19 VISION LIFE AND AD&D Financial Benefit Services (800) MEDICAL, TRS ACTIVECARE PHARMACY, MAIL ORDER AETNA (800) Caremark MEDICAL SUPPLEMENT MEDLINK American Public Life (800) DENTAL Cigna (800) Superior Vision (800) DISABILITY UNUM (800) CANCER American Public Life (800) CRITICAL ILLNESS UNUM (800) The Hartford (800) INDIVIDUAL LIFE 5 Star Life Insurance Company (800) COBRA CONTINUATION OF DENTAL, VISION & MEDLINK National Benefit Services (800) COBRA CONTINUATION OF MEDICAL TRS ACTIVE CARE AETNA/WELLSYSTEMS (844)

4 MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text FBS REG19 to and get access to everything you need to complete your benefits enrollment: Benefit Information Online Support Interactive Tools And more. Text FBS REG19 to OR SCAN PLAY VIDEO 4

5 How to Log In 1 region19 BENEFIT INFO 2 CLICK LOGIN INTERACTIVE TOOLS 3 ENTER USERNAME & PASSWORD All login credentials have been RESET to the default described below: Username: The first six (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number. ONLIINE SUPPORT If you have less than six (6) characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number. Default Password: The last Four (4) digits of your Social Security Number, followed by your four (4) digit birth year. 5

6 Annual Benefit Enrollment SUMMARY PAGES During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs. Changes, additions or drops may be made only during the annual enrollment period without a qualifying event. Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information. Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit. New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage. Q&A Where can I find forms? For benefit summaries and claim forms, go to the ESC Region 19 benefit website: Click on the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms section. How can I find a Network Provider? For benefit summaries and claim forms, go to the ESC Region 19 benefit website: Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section. When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company s phone number and they can call and verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year. Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at for assistance. 6

7 SUMMARY PAGES Employee Eligibility Requirements Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week. Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2017 benefits become effective on September 1, 2017, you must be actively-at-work on September 1, 2017 to be eligible for your new benefits. Dependent Eligibility Requirements Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within ESC Region 19 as both employees and dependents. PLAN CARRIER MAXIMUM AGE CONTINUATION Medical Aetna To age 26 COBRA Medical Supplement APL To age 26 COBRA Dental Cigna To age 26 COBRA Vision Superior Vision To age 26 COBRA Voluntary Life and AD&D TheHartford To age 26 Cancer APL To age 26 Critical Illness UNUM To age 26 Portable or Convertible Within 31 days of termination Portable if coverage in force at least 12 mos. Within 31 days of termination Portable Within 31 days of termination Individual Life 5Star Life Insurance Company Issuable to age 24, keep to 100 Portable to Age 100 If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician s statement confirming your dependent s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. 7

8 Annual Benefit Enrollment SUMMARY PAGES Benefit Updates: What s New: Benefit elections will become effective 9/01/2017 (elections requiring evidence of insurability, such as life Insurance, may have a later effective date, if approved). After annual enrollment closes, benefit changes can only be made if you experience a qualifying event and changes must be made within 31 days of event. Important! Aetna remains the carrier for TRS ActiveCare Medical Plans. All eligible employees, including active, contributing TRS members & employees regularly working 10 hours per week MUST either enroll for coverage or decline coverage in THEbenefitsHUB. ESC Region 19 is increasing the Employer Contribution towards medical to continue to fully fund employee only ActiveCare1HD and ActiveCare Select premium increases. Disability Insurance: Carrier Change to UNUM Disability You may receive coverage without answering any medical questions or providing evidence of insurability. UNUM will cover a pre-existing condition for a maximum of 90 days for current employees who enroll this year and New Hires who enroll during their new hire enrollment period. Future coverage may be subject to a 3/12 pre-existing condition exclusion (a disability is not covered if you have been treated or received medical advice for a condition 3 months prior to effective date and the disability occurs in the first 12 months of coverage). Dental by Cigna: Remember! Dental claims incurred in Mexico are not covered. Individual Life by 5Star: Guaranteed issue extended through this enrollment period. The Family Protection Plan is an individual term life policy that provides a specified death benefit to your beneficiary at the time of death. Guaranteed renewable to age 100, portable, and premiums do not increase. Available for employee, spouse, children and grandchildren. Quality of Life Rider included with eligible employee or spouse plan, pays up to 18 months of long term care whether at home or confined if unable to perform 2 of the 6 Activities of Daily Living. Voluntary Life by The Hartford: Voluntary Group Term Life is one of the most inexpensive ways to purchase life insurance. Existing participants may increase coverage 10k up to guaranteed issue amounts without medical questions or applications. Coverage is typically available to You, Your Spouse and Dependent Children. Age reductions begin at 70, all coverage cancels at retirement. EAP by Lifeworks Plan Ending! The Employee Assistance Plan will end on 8/31/17. Lifeworks will continue services thru 8/31/17. Enrollment Dates: 07/24/ /22/2017 Benefit Website: Call Center #: (866) Don t Forget! Login and complete your benefit enrollment from 07/24/ /21/2017 Enrollment assistance is available by calling Financial Benefit Services at (866) M - F 8am 5pm CST Update your profile information: home address, phone numbers, , beneficiaries REQUIRED: Provide correct dependent social security numbers 8

9 SUMMARY PAGES Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year. Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 31 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event. CHANGES IN STATUS (CIS): QUALIFYING EVENTS Marital Status Change in Number of Tax Dependents Change in Status of Employment Affecting Coverage Eligibility A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states). A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event. Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment. Gain/Loss of Dependents' Eligibility Status Judgment/Decree/Order An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements under an employer's plan may include change in age, student, marital, employment or tax dependent status. If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage. Eligibility for Government Programs Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. 9

10 Helpful Definitions SUMMARY PAGES Actively at Work You are performing your regular occupation for the employer on a full-time basis, either at one of the employer s usual places of business or at some location to which the employer s business requires you to travel. If you will not be actively at work beginning 9/1/2017 please notify your benefits administrator. Annual Enrollment The period during which existing employees are given the opportunity to enroll in or change their current elections. Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses. Calendar Year January 1st through December 31st In-Network Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider. Out of Pocket Maximum The most an eligible or insured person can pay in co-insurance for covered expenses. Plan Year September 1st through August 31st Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescriptions drugs or is under a health care provider s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services). Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service. Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or pre-existing condition exclusion provisions do apply, as applicable by carrier. 10

11 ACA Employee Responsibilities SUMMARY PAGES Mandatory Medical Enrollment After becoming eligible, you must elect or decline medical coverage offered through your employer. ACA 101 Medical Election Employee chooses to elect on the Medical Plans offered. Are you electing to enroll in the medical plan? YES RECEIVE C NO PENALTIES Play or Pay Rules If you elect a medical plan offered through your employer, you will receive the IRS Tax Form C. You will use this document to file your 1040 Tax Return. However, if you choose to decline medical coverage, you will be subject to the Individual Mandate Penalties, unless you have a minimum essential health plan & Beyond Penalty is $695 per adult and $ per child ( up to $2,085 for a family) OR 2.5% of family income, whichever is greater. NO Are you receiving medical coverage elsewhere? *See examples below NO PENALTIES ASSESSED YES RECEIVE C NO PENALTIES *Examples of other coverage: -Military -Medicare -Medicaid -Through a spouse -Marketplace exchange 11

12 TRS AETNA Medical YOUR BENEFITS PACKAGE About this Benefit Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis. More than 70% of adults across the United States are already being diagnosed with a chronic disease. This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 12 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 19 Benefits Website:

13 ESC Region TRS Medical Rates TRS-ActiveCare Plan 1- HD TRS Monthly Premium ESC Region 19 Contribution TRS Employee Premium Employee Only $ $ $0.00 Employee & Spouse $ $ $ Employee & Child(ren) $ $ $ Employee & Family $1, $ $ TRS-ActiveCare Select- Exclusive Provider Organization TRS Monthly Premium ESC Region 19 Contribution TRS Employee Premium Employee Only $ $ $0.00 Employee & Spouse $1, $ $ Employee & Child(ren) $ $ $ Employee & Family $1, $ $1, TRS-ActiveCare 2 TRS Monthly Premium ESC Region 19 Contribution TRS Employee Premium Employee Only $ $ $ Employee & Spouse $1, $ $1, Employee & Child(ren) $1, $ $ Employee & Family $2, $ $1,

14 TRS-ActiveCare Plan Highlights Effective September 1, 2017 through August 31, 2018 In-Network Level of Benefits* Deductible (per plan year) In-Network Out-of-Network Out-of-Pocket Maximum (per plan year; medical and prescription drug deductibles, copays, and coinsurance count toward the out-of-pocket maximum) In-Network Out-of-Network Coinsurance In-Network Participant pays (after deductible) Out-of-Network Participant pays (after deductible) Office Visit Copay Participant pays Diagnostic Lab Participant pays Preventive Care See below for examples Teladoc Physician Services High-Tech Radiology (CT scan, MRI, nuclear medicine) Participant pays Inpatient Hospital (preauthorization required) (facility charges) Participant pays Emergency Room (true emergency use) Participant pays Outpatient Surgery Participant pays Bariatric Surgery Physician charges (only covered if performed at an IOQ facility) Participant pays Annual Vision Examination (one per plan year; performed by an ophthalmologist or optometrist using calibrated instruments) Participant pays Annual Hearing Examination Participant pays Preventive Care Routine physicals annually age 12 and over Mammograms 1 every year age 35 and over Smoking cessation counseling 8 visits per 12 months 14 Well-child care unlimited up to age 12 Colonoscopy 1 every 10 years age 50 and over Healthy diet/obesity counseling unlimited to Well - woman exam & pap smear annually age 18 and over Prostate cancer screening 1 per year age 50 and over Breastfeeding support 6 lactation counseling visits

15 Drug Deductible Short-Term Supply at a Retail Location Extended-Day Supply at Mail Order or Retail-Plus Pharmacy Location (60- to 90-day supply)**** Specialty Medications Short-Term Supply of a Maintenance Medication at Retail Location (up to a 31-day supply) What is a maintenance medication? Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes. When does the convenience fee apply? For example, if you are covered under TRS-ActiveCare Select, the first time you fill a 31-day supply of a generic maintenance drug at a retail pharmacy you will pay $20, then you will pay $35 each month that you fill a 31-day supply of that generic maintenance drug at a retail pharmacy. A 90-day supply of that same generic maintenance medication would cost $45, and you would save $225 over the year by filling a 90-day supply. Premium Information for ALEX You will need to enter the applicable amount YOUR ANNUAL COST from the table below into ALEX when prompted. To determine this cost, ask your Benefits Administrator for your monthly cost (this is the amount you will owe each month after your employer contributes to your coverage). Then multiply your monthly cost by 12 to get YOUR ANNUAL COST (use this amount for ALEX) Individual $351 $514 $714 +Spouse $991 $1,264 $1,694 +Children $671 $834 $1,062 +Family $1,316 $1,589 $2,004 A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. *Illustrates benefits when in-network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits under the ActiveCare Select or ActiveCare Select Whole Health Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for this balance bill amount, which maybe considerable. **For ActiveCare 1-HD, certain generic preventive drugs are covered at 100%. Participants do not have to meet the deductible ($2,500 - individual, $5,000 - family) and they pay nothing out of pocket for these drugs. The list of drugs is on the TRS-ActiveCare website. ***If a participant obtains a brand-name drug when a generic equivalent is available, they are responsible for the generic copay plus the cost difference between the brand-name drug and the generic drug. 15 ****Participants can fill 32-day to 90-day supply through mail order.

16 AMERICAN PUBLIC LIFE MEDlink YOUR BENEFITS PACKAGE PLAY VIDEO About this Benefit Medical supplement is designed to help supplement your Employer's major medical plan. This plan provides supplemental coverage to help offset outof-pocket costs that you may experience due to deductibles, co-payments and coinsurance of your medical plan. 33% of total healthcare costs are paid out-of-pocket. This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 16 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 19 Benefits Website:

17 MEDlink Limited Benefit Medical Expense Supplemental Insurance ESC Region 19 THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE 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. SUMMARY OF BENEFITS Base Policy Option 1 Option 2 In-Hospital Benefit - Maximum In-Hospital Benefit $1,500 per confinement $2,500 per confinement Outpatient Benefit up to $200 per treatment up to $200 per treatment Physician Outpatient Treatment Benefit $25 per treatment; $125 max per family per Calendar Year $25 per treatment; $125 max per family per Calendar Year Option 1 Total Monthly Premiums by Plan* Issue Ages Issue Ages Issue Ages Employee Only $21.50 $32.00 $49.00 Employee + Spouse $39.50 $59.00 $88.00 Employee + Child(ren) $36.50 $47.00 $64.00 Family Coverage $54.50 $74.00 $ Option 2 Total Monthly Premiums by Plan* Hospital Emergency Room Issue Ages Issue Ages Issue Ages Employee Only $28.00 $44.50 $68.50 Employee + Spouse $51.50 $81.50 $ Employee + Child(ren) $45.50 $62.00 $86.00 Family Coverage $69.00 $99.00 $ Plans available to employees age 70 and over if You work for an employer employing 20 or more employees on a typical workday in the preceding Calendar Year. *Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with notice. APSB-22330(TX)-0116 MGM/FBS ESC Region 19 17

18 MEDlink Limited Benefit Medical Expense Supplemental Insurance Limitations Eligibility This policy will be issued to those persons who meet American Public Life Insurance Company s insurability requirements. Evidence of insurability acceptable to us may be required. If our underwriting rules are met, you are on active service, you are covered under your Employer s Medical Plan and premium has been paid, your insurance will take effect on the requested Effective Date or the Effective Date assigned by us upon approval of your written application, whichever is later. Covered Charges mean those charges that are incurred by a Covered Person because of an Accident or Sickness; are for necessary treatment, services and medical supplies and recommended by a Physician; are not more than any dollar limit set forth in the Schedule; are incurred while insured under the Policy, subject to any Extension of Benefits; and are not excluded under the Policy. A Hospital is not any institution used as a place for rehabilitation; a place for rest, or for the aged; a nursing or convalescent home; a long term nursing unit or geriatrics ward; or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients. In-Hospital Benefit Benefits payable are limited to any out-of-pocket deductible amount; any out-of-pocket co-payment or coinsurance amounts the Covered Person actually incurs after the Employer s Medical Plan has paid; any out-of-pocket amount the Covered Person actually incurs for surgery performed by a Physician after the Employer s Medical Plan has paid; and the Maximum In-Hospital Benefit shown in the Policy Schedule. The Covered Person must be an Inpatient and covered by your Employer s Medical Plan when the Covered Charges are incurred. Outpatient Benefits Treatment is for the same or related conditions, unless separated by a period of 90 consecutive days. After 90 consecutive days, a new Outpatient Benefit will be payable. The Covered Person must be covered by your Employer s Medical Plan when the Covered Charges are incurred. Physician Outpatient Treatment Benefit Benefit maximum of $125 per family per Calendar Year. The Covered Person must be covered by your Employer s Medical Plan when the Covered Charges are incurred. The Covered Person must not be an Inpatient when the Covered Charges are incurred. Premiums The premium rates may be changed by Us. If the rates are changed, We will give You at least 31 days advance written notice. If a change in benefits increases Our liability, premium rates may be changed on the date Our liability is increased. This plan may be continued in accordance with the Consolidated Omnibus Reconciliation Act of Exclusions We will pay no benefits for any expenses incurred during any period the Covered Person does not have coverage under your Employer s Medical Plan, except as provided in the Absence of your Employer s Medical Plan provision or which result from: (a) suicide or any attempt, thereof, while sane or insane; (b) any intentionally self-inflicted injury or Sickness; (c) rest care or rehabilitative care and treatment; (d) outpatient routine newborn care; (e) voluntary abortion except, with respect to You or Your covered Dependent spouse: (1) where Your or Your Dependent spouse s life would be endangered if the fetus were carried to term; or (2) where medical complications have arisen from abortion; (f) pregnancy of a Dependent child; (g) participation in a riot, civil commotion, civil disobedience, or unlawful assembly. This does not include a loss which occurs while acting in a lawful manner within the scope of authority; (h) commission of a felony; (i) (j) (k) (l) participation in a contest of speed in power driven vehicles, parachuting, or hang gliding; air travel, except: (1) as a fare-paying passenger on a commercial airline on a regularly scheduled route; or (2) as a passenger for transportation only and not as a pilot or crew member; intoxication; (Whether or not a person is intoxicated is determined and defined by the laws and jurisdiction of the geographical area in which the loss occurred.) alcoholism or drug use, unless such drugs were taken on the advice of a Physician and taken as prescribed; (m) sex changes; (n) experimental treatment, drugs, or surgery; (o) an act of war, whether declared or undeclared, or while performing police duty as a member of any military or naval organization; (This exclusion includes Accident sustained or Sickness contracted while in the service of any military, naval, or air force of any country engaged in war. We will refund the pro rata unearned premium for any such period the Covered Person is not covered.) (p) Accident or Sickness arising out of and in the course of any occupation for compensation, wage or profit; (This does not apply to those sole proprietors or partners not covered by Workers Compensation.) (q) mental illness or functional or organic nervous disorders, regardless of the cause; (r) dental or vision services, including treatment, surgery, extractions, or x-rays, unless: (1) resulting from an Accident occurring while the Covered Person s coverage is in force and if performed within 12 months of the date of such Accident; or (2) due to congenital disease or anomaly of a covered newborn child. (s) routine examinations, such as health exams, periodic check-ups, or routine physicals, except when part of Inpatient routine newborn care; (t) any expense for which benefits are not payable under the Covered Person s Employer s Medical Plan; or (u) air or ground ambulance. APSB-22330(TX) MGM/FBS ESC Region 19

19 MEDlink Limited Benefit Medical Expense Supplemental Insurance Termination of Coverage Your Insurance coverage will end on the earliest of these dates: the date You no longer qualify as an Insured; the end of the last period for which premium has been paid; the date the Policy is discontinued; the date You retire; if You work for an employer employing less than 20 employees on a typical work day in the preceding Calendar Year, the date You attain age 70; the date You cease to be on Active Service; the date Your coverage under Another Medical Plan ends; or the date You cease employment with the employer through whom You originally became insured under the Policy. Insurance coverage on a Dependent will end on the earliest of these dates: the date Your coverage terminates; the end of the last period for which premium has been paid; the date the Dependent no longer meets the definition of Dependent; the date the Dependent s coverage under Another Medical Plan ends; or the date the Policy is modified so as to exclude Dependent coverage. We may end the coverage of any Covered Person who submits a fraudulent claim. We may end the coverage of a Subscribing Unit if fewer persons are insured than the Policyholder s application requires Lakeland Drive Flowood, MS ampublic.com Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the policy and riders. This coverage does not replace Workers Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. Policy Form MEDlink Series Texas Limited Benefit Medical Expense Supplemental Insurance (10/14) ESC Region 19 APSB-22330(TX)-0116 MGM/FBS ESC Region 19 19

20 CIGNA Dental YOUR BENEFITS PACKAGE PLAY VIDEO About this Benefit Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, treatment and dental disease. Good dental care may improve your overall health. Also Women with gum disease may be at greater risk of giving birth to a preterm or low birth weight baby. This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 20 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 19 Benefits Website:

21 Dental PPO - Low Plan Benefits Cigna Dental PPO Network Total Cigna DPPO Network Out-of-Network Plan Year Maximum (Class I, II, and III, IX expenses) $1,000 $1,000 Annual Deductible $50 per person $50 per person Individual $150 per family $150 per family Family Reimbursement Levels** Based on Maximum Allowable Based on Charge (In- Contracted Fees network fee level) Plan Pays You Pay** Plan Pays You Pay** Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Bitewing X-rays Full Mouth X-rays Panoramic X-ray Emergency Care to Relieve Pain Fluoride Application Sealants Space Maintainers Class II - Basic Restorative Care Fillings Brush Biopsies Anesthetics Denture Repairs Denture Relines, Rebases and Adjustments Repairs to Bridges, Crowns and Inlays Oral Surgery Simple Extractions Class III - Major Restorative Care Crowns Root Canal Therapy/Endodontics Osseous Surgery Periodontal Scaling and Root Planning Surgical Extractions of Impacted Teeth Oral Surgery except simple extractions Dentures Bridges Inlays/Onlays Prosthesis Over Implant Class IV - Orthodontia Lifetime Maximum $1,000 No Deductible Class IX - Implants Annual Maximum 80% 20% 80% 20% 50%* 50%* 50%* 50%* 50%* 50%* 50%* 50%* 50% Covered for Children & Adults** 50% Subject to plan deductible Subject to plan annual maximum** 50% Covered for Children & Adults** 50% Subject to plan deductible Subject to plan annual maximum** 50% Covered for Children & Adults** 50% Subject to plan deductible Subject to plan annual maximum** 50% Covered for Children & Adults** 50% Subject to plan deductible Subject to plan annual maximum** Monthly PPO Premiums Tier Rate EE Only $17.24 EE + Spouse EE + Child (ren) Family Coverage $34.49 $41.31 $58.78 **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to the Contracted Fee Schedule but the dentist may balance bill up to their usual fees. Missing Tooth Limitation The amount payable is 50% of the amount otherwise payable until insured for 12 months; thereafter, considered a Class III expense. Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed. * Subject to annual deductible Dental Oral Health Integration Program (OHIP) - All dental customers - Clinical research shows an association between oral health and overall health. The Cigna Dental Oral Health Integration Program (OHIP) is designed to provide enhanced dental coverage for customers with certain eligible medical conditions. Eligible conditions for the program include cardiovascular disease, cerebrovascular disease (stroke), diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation. The program provides: 100% coverage for certain dental procedures guidance on behavioral issues related to oral health discounts on prescription and non-prescription dental products For more information and to see the complete list of eligible conditions, go to or call customer service 24/7 at CIGNA24. **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to the Contracted Fee Schedule but the dentist may balance bill up to their usual fees. 21

22 Dental PPO - High Plan Benefits Network Plan Year Maximum (Class I, II, and III expenses) Annual Deductible Individual Family Reimbursement Levels** Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Bitewing X-rays Full Mouth X-rays Panoramic X-ray Emergency Care to Relieve Pain Fluoride Application Sealants Space Maintainers Class II - Basic Restorative Care Fillings Brush Biopsies Anesthetics Denture Repairs Denture Relines, Rebases and Adjustments Repairs to Bridges, Crowns and Inlays Oral Surgery Simple Extractions Only Class III - Major Restorative Care Crowns Root Canal Therapy/Endodontics Osseous Surgery Periodontal Scaling and Root Planning Surgical Extractions of Impacted Teeth Dentures and Bridges Inlays and Onlays Prosthesis Over Implant Class IV - Orthodontia Lifetime Maximum $1,000 No Deductible Class IX - Implants Deductible Annual Maximum Cigna Dental Choice In-Network Out-of-Network Total Cigna DPPO See Non-Network Reimbursement $1,000 $1,000 $50 per person $150 per family $50 per person $150 per family Based on Maximum Allowable Based on Reduced Charge (In- Contracted Fees network fee level) Plan Pays You Pay** Plan Pays You Pay** 100% No Charge 100% No Charge 80%* 20%* 80%* 20%* 50%* 50%* 50%* 50%* 50% Covered for Children & Adults** 50% Subject to plan deductible Subject to plan annual maximum** 50% Covered for Children & Adults** 50% Subject to plan deductible Subject to plan annual maximum** 50% Covered for Children & Adults** 50% Subject to plan deductible Subject to plan annual maximum** 50% Covered for Children & Adults** 50% Subject to plan deductible Subject to plan annual maximum** Monthly PPO Premiums Tier Rate EE Only $25.12 EE + Spouse $50.24 EE + Child (ren) Family Coverage $60.18 $85.62 **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to the Contracted Fee Schedule but the dentist may balance bill up to their usual fees. Missing Tooth Limitation The amount payable is 50% of the amount otherwise payable until insured for 12 months; thereafter, considered a Class III expense. Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed. * Subject to annual deductible Dental Oral Health Integration Program (OHIP) - All dental customers - Clinical research shows an association between oral health and overall health. The Cigna Dental Oral Health Integration Program (OHIP) is designed to provide enhanced dental coverage for customers with certain eligible medical conditions. Eligible conditions for the program include cardiovascular disease, cerebrovascular disease (stroke), diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation. The program provides: 100% coverage for certain dental procedures guidance on behavioral issues related to oral health discounts on prescription and non-prescription dental products For more information and to see the complete list of eligible conditions, go to call customer service 24/7 at CIGNA24. **For services provided 22 by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to the Contracted Fee Schedule but the dentist may balance bill up to their usual fees.

23 Dental PPO - High and Low Plans Procedure Exclusions and Limitations Late Entrants Limit 50% coverage on Class III and IV for 12 months Exams Two per Plan year Prophylaxis (Cleanings) Two per Plan year Fluoride 1 per Plan year for people under 19 X-Rays (routine) Bitewings: 2 per Plan year X-Rays (non-routine) Full mouth: 1 every 36 consecutive months., Panorex: 1 every 36 consecutive months Model Payable only when in conjunction with Ortho workup Minor Perio (non-surgical) Various limitations depending on the service Perio Surgery Various limitations depending on the service Crowns and Inlays Replacement every 5 years Bridges Replacement every 5 years Dentures and Partials Replacement every 5 years Relines, Rebases Covered if more than 6 months after installation Adjustments Covered if more than 6 months after installation Repairs - Bridges Reviewed if more than once Repairs - Dentures Reviewed if more than once Sealants Limited to posterior tooth. One treatment per tooth every three years up to age 14 Space Maintainers Limited to non-orthodontic treatment Prosthesis Over Implant 1 per 60 consecutive months if unserviceable and cannot be repaired. Benefits are based on the amount payable for nonprecious metals. No porcelain or white/tooth colored material on molar crowns or bridges Alternate Benefit When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses Dental Service on which payment will be based and the expenses that will be included as Covered Expenses Benefit Exclusions Services performed primarily for cosmetic reasons Replacement of a lost or stolen appliance Replacement of a bridge or denture within five years following the date of its original installation Replacement of a bridge or denture which can be made useable according to accepted dental standards Procedures, appliances or restorations, other than full dentures, whose main purpose is to change vertical dimension, diagnose or treat conditions of TMJ, stabilize periodontally involved teeth, or restore occlusion Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and third molars Bite registrations; precision or semi-precision attachments; splinting A surgical implant of any type Instruction for plaque control, oral hygiene and diet Dental services that do not meet common dental standards Services that are deemed to be medical services Services and supplies received from a hospital Charges which the person is not legally required to pay Charges made by a hospital which performs services for the U.S. Government if the charges are directly related to a condition connected to a military service Experimental or investigational procedures and treatments Any injury resulting from, or in the course of, any employment for wage or profit Any sickness covered under any workers compensation or similar law Charges in excess of the reasonable and customary allowances To the extent that payment is unlawful where the person resides when the expenses are incurred; Procedures performed by a Dentist who is a member of the covered person s family (covered person s family is limited to a spouse, siblings, parents, children, grandparents, and the spouse s siblings and parents); For charges which would not have been made if the person had no insurance; For charges for unnecessary care, treatment or surgery; To the extent that you or any of your Dependents is in any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid; To the extent that benefits are paid or payable for those expenses under the mandatory part of any auto insurance policy written to comply with a no-fault insurance law or an uninsured motorist insurance law. Cigna HealthCare will take into account any adjustment option chosen under such part by you or any one of your Dependents. In addition, these benefits will be reduced so that the total payment will not be more than 100% of the charge made for the Dental Service if benefits are provided for that service under this plan and any medical expense plan or prepaid treatment program sponsored or made available by your Employer. This benefit summary highlights some of the benefits available under the proposed plan. A complete description regarding the terms of coverage, exclusions and limitations, including legislated benefits, will be provided in your insurance certificate or plan description. Benefits are insured and/or administered by Connecticut General Life Insurance Company. "Cigna HealthCare" refers to various operating subsidiaries of Cigna Corporation. Products and services are provided by these subsidiaries and not by Cigna Corporation. These subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. DPPO insurance coverage is set forth on the following policy form numbers: AR: HP-POL77; CA: HP-POL57; CO: HP-POL78; CT: HP-POL58; DE: HP-POL79; FL: HP-POL60; ID: HP-POL82; IL: HP-POL62; KS: HP-POL84; LA: HP-POL86: MA: HP-POL 63; MI: HP-POL88; MO: HP- POL65; MS: HP-POL90; NC: HP-POL96; NE: HP- POL92; NH: HP-POL94; NM: HP-POL95; NV: HP-POL93; NY: HP-POL67; OH: HP-POL98; OK: HP-POL99; OR: HP-POL68; PA: HP-POL100; RI: HP-POL101; SC: HP-POL102; SD: HP-POL103; TN: HP-POL69; TX: HP-POL70; UT: HP-POL104; VA: HP-POL72; VT: HP-POL71; WA: POL-07/08; WI: HP-POL107; WV: HP-POL106; and WY: HP-POL108. Cigna, the Tree of Life logo and Cigna Dental Care are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Cigna Dental PPO plans are underwritten or administered by CGLIC or CHLIC, with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Arizona and Louisiana, the insured Dental PPO plan offered by CGLIC is known as the CG Dental PPO. In Texas, the insured dental product offered by CGLIC and CHLIC is referred to as the Cigna Dental Choice Plan, and this plan utilizes the national Cigna Dental PPO network. Cigna Dental Care (DHMO) plans are underwritten or administered by Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska), Cigna Dental Health of Kentucky, Inc. (Kentucky and Illinois), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. In other states, Cigna Dental Care plans are underwritten by CGLIC, CHLIC, or Cigna HealthCare of Connecticut, Inc. and administered by Cigna Dental Health, Inc. 23

24 SUPERIOR VISION Vision YOUR BENEFITS PACKAGE PLAY VIDEO About this Benefit Vision insurance provides coverage for routine eye examinations and may cover all or part of the costs associated with contact lenses, eyeglasses and vision correction, depending on the plan. 75% of U.S. residents between age 25 and 64 require some sort of vision correction. This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 24 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 19 Benefits Website:

25 Vision - Superior Select Southwest Network Benefits In-Network Out-of-Network Covered in full Up to $35 retail Frames $130 retail allowance Up to $70 retail Contact Lenses2 $130 retail allowance Up to $80 retail Covered in full Up to $150 retail Exam Medically Necessary Contact Lenses Lasik Vision Correction3 $200 allowance Lenses (standard) per pair Single Vision Covered in full Up to $25 retail Bifocal Covered in full Up to $40 retail Trifocal Covered in full Up to $45 retail See description1 Up to $45 retail Progressive Monthly Premiums Emp. Only $6.28 Emp. + Spouse $11.00 Emp. + Child(ren) $13.20 Emp. + Family $16.35 Co-Pays Exam $10 Materials₁ $10 Services/Frequency Exam 12 months Frame 12 months Lenses 12 months Contact Lenses 12 months (Based on date of service) Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1Covered to provider s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 2 Contact lenses and related professional services (fitting, evaluation and followup) are covered in lieu of eyeglass lenses and frames benefit 3 Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limitations Discount Features Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens extras such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart s Always Low Prices policy. The National LASIK Network of laser vision correction providers, featuring LasikPlus, offers members special program pricing on services. The program pricing should be verified prior to service. 25

26 UNUM Disability YOUR BENEFITS PACKAGE PLAY VIDEO About this Benefit Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time. Just over 1 in 4 of today's 20 year -olds will become disabled before they retire months is the duration of the average disability claim. This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 26 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 19 Benefits Website:

27 Long Term Disability Please read carefully the following description of your Unum Educator Select Income Protection Plan insurance. Eligibility You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. Coverage Your effective date of coverage is 9/1/2017. If you become eligible after this. You may receive coverage without answering any medical questions or providing evidence of insurability if you apply for coverage within 31 days after your eligibility date. If you apply more than 31 days after your eligibility date, your coverage will be subject to a 3/12 preexisting condition exclusion. Please see your plan administrator for your eligibility date. Insurance will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. Your coverage under the policy ends on the earliest of the following: The date the policy or plan is cancelled; The date you no longer are in an eligible group; The date your eligible group is no longer covered; The last day of the period for which you made any required contributions; The last day you are in active employment except as provided under the covered layoff or leave of absence provision. Please see your plan administrator for further information on these provisions. Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan. Benefit Amount You can elect to purchase a benefit of 40%, 50% or 60% of your monthly earnings. Your total monthly benefit (including all benefits provided under this plan) will not exceed 100% of your monthly earnings, unless the excess amount is payable as a Cost of Living Adjustment. Worldwide emergency travel assistance is included with this long term disability plan. Emergency travel assistance is available to you, your spouse* and your dependent children when you travel to any foreign country, including Canada or Mexico. It is also available anywhere in the United States when you travel just 100 or more miles from home. * A spouse traveling on business for his or her employer is not covered by the program. Our work-life balance employee assistance program (EAP) provides professional advice for a wide range of personal and work-related issues. The service is available to you and your family members 24 hours a day, 365 days a year. It provides resources to help you find solutions to everyday issues such as financing a car or selecting child care as well as more serious problems, such as alcohol or drug addiction, divorce or relationship problems. There is no additional charge for using the program, and you do not have to have filed a disability claim or be receiving benefits to use the program. Elimination Period The elimination period is the length of time you must be continuously disabled before you can receive benefits. Elimination Period Options: Option 1: 14 days/14 days first day hospital Option 2: 30 days/30 days first day hospital Option 3: 90 days/90 days Option 3: 180 days/180 days During your elimination period, you will be considered disabled if you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury, you are under the regular care of a physician and you are unable to perform any of the material and substantial duties of your regular occupation due to the same sickness or injury. If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.) Benefit Duration Your duration of benefits is based on your age when the disability occurs. Plan: SS ADEA: Your duration of benefits is based on the following table: Age at Disability Less than age 60 Age 60 Age 61 Age 62 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 or older Maximum Duration of Benefits To age 65, but not less than 5 years 60 months 48 months 42 months 36 months 30 months 24 months 21 months 18 months 15 months 12 months Delayed Effective Date of Coverage Insurance will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. 27

28 Long Term Disability 14 Day with First Day Hospital Rates are $100 of covered payroll Age-Band 40% Plan 50% Plan 60% Plan < Day with First Day Hospital Rates are $100 of covered payroll Age-Band 40% Plan 50% Plan 60% Plan <

29 Long Term Disability 90 Day Rates are $100 of covered payroll Age-Band 40% Plan 50% Plan 60% Plan < Day Rates are $100 of covered payroll Age-Band 40% Plan 50% Plan 60% Plan <

30 AMERICAN PUBLIC LIFE Cancer YOUR BENEFITS PACKAGE PLAY VIDEO About this Benefit Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment. Breast Cancer is the most commonly diagnosed cancer in women. If caught early, prostate cancer is one of the most treatable malignancies. This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 30 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 19 Benefits Website:

31 GC13 Limited Benefit Group Cancer Indemnity Insurance ESC Region 19 THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE 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. SUMMARY OF BENEFITS Benefits Option 1 Option 2 Radiation Therapy/Chemotherapy/Immunotherapy Benefit Maximum per 12-month period $15,000 $20,000 Hormone Therapy - Maximum of 12 treatments per Calendar Year $50 per treatment $50 per treatment Experimental Treatment Benefit Paid in the same manner and under the same maximums as any other benefit Waiver of Premium Waive Premium Waive Premium Internal Cancer First Occurrence Benefit Lump Sum Benefit Maximum 1 per Covered Person per lifetime Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime Heart Attack/Stroke First Occurrence Benefit Lump Sum Benefit Maximum 1 per Covered Person per lifetime Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime $5,000 $10,000 $7,500 $15,000 $5,000 $10,000 $7,500 $15,000 Monthly Premium* Option 1 Option 2 Individual $13.66 $23.00 Individual & Spouse $29.48 $ Parent Family $15.70 $ Parent Family $31.52 $53.48 *The premium and amount of benefits vary dependent upon the option selected at time of application. All benefits are per covered person, per calendar year unless otherwise stated. APSB-22331(TX) MGM/FBS ESC Region 19 31

32 GC13 Limited Benefit Group Cancer Indemnity Insurance Eligibility You and your Eligible Dependents are eligible to be insured under the Certificate if you and your Eligible Dependents meet APL s underwriting rules and you are Actively at Work and qualify for coverage as defined in the Master Application. Limitations & Exclusions No benefits will be paid for care or treatment received outside the territorial limits of the United States, treatment by any program engaged in research that does not meet the definition of Experimental Treatment or losses or medical expenses incurred prior to the Covered Person s Effective Date regardless of when Cancer was diagnosed. Only Loss for Cancer The Policy/Certificate pays only for loss resulting from definitive Cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The Policy/Certificate also covers other conditions or diseases directly caused by Cancer or the treatment of Cancer. The Policy/Certificate does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of Cancer, even though after contracting Cancer it may have been complicated, aggravated or affected by Cancer or the treatment of Cancer. Pre-Existing Condition Exclusion No benefits are payable for any loss incurred during the Pre-Existing Condition Exclusion Period following the Covered Person s Effective Date as the result of a Pre-Existing Condition. Pre-Existing Conditions specifically named or described as excluded in any part of the Policy/Certificate are never covered. If any change to coverage after the Certificate Effective Date results in an increase or addition to coverage, the Time Limit on Certain Defenses and Pre-Existing Condition Limitation for such increase will be based on the effective date of such increase. Waiting Period The Policy/Certificate contains a Waiting Period during which no benefits will be paid. If any Covered Person has a Specified Disease diagnosed before the end of the Waiting Period immediately following the Covered Person s Effective Date, coverage for that person will apply only to loss that is incurred after one year from the Covered Person s Effective Date. If any Covered Person is diagnosed as having a Specified Disease during the Waiting Period immediately following the Covered Person s Effective Date, the Insured may elect to void the Certificate from the beginning and receive a full refund of premium. If the Policy/Certificate replaced Specified Disease Cancer coverage from another company that terminated within 30 days of the Certificate Effective Date, the Waiting Period will be waived for those Covered Persons that were covered under the prior coverage. However, the Pre-Existing Condition Limitation will still apply. Termination of Certificate Insurance coverage under the Certificate and any attached riders will end on the earliest of any of the following dates: the date the Policy terminates; the end of the grace period if the premium remains unpaid; the date insurance has ceased on all persons covered under this Certificate; the end of the Certificate Month in which the Policyholder requests to terminate this coverage; the date you no longer qualify as an Insured; or the date of your death. Termination of Coverage Insurance coverage for a Covered Person under the Certificate and any attached riders for a Covered Person will end as follows: the date the Policy terminates; the date the Certificate terminates; the end of the grace period if the premium remains unpaid; the end of the Certificate Month in which the Policyholder requests to terminate the coverage for an Eligible Dependent; the date a Covered Person no longer qualifies as an Insured or Eligible Dependent; or the date of the Covered Person s death. 32 APSB-22331(TX) MGM/FBS ESC Region 19 Optionally Renewable The policy is optionally renewable. The Policyholder has the right to terminate the policy on any premium due date after the first Anniversary following the Policy Effective Date. APL must give at least 60 days written notice prior to cancellation. Portability (Voluntary Plans Only) When the Insured no longer meets the definition of Insured, he or she will have the option to continue this coverage, including any attached riders. No Evidence of Insurability will be required. Portability must meet all of the following conditions: the Certificate has been continuously in force for the last 12 months; APL receives a request and payment of the first premium for the portability coverage no later than 30 days after the date the Insured no longer qualifies as an eligible Insured. All future premiums due will be billed directly to the Insured. The Insured is responsible for payment of all premiums for the portability coverage; the Policy, under which this Certificate was issued, continues to be in force on the date the Insured ceases to qualify for coverage. The benefits, terms and conditions of the portability coverage will be the same as those elected under the Certificate immediately prior to the date the Insured exercised portability. Portability coverage may include any Eligible Dependents who were covered under the Certificate at the time the Insured ceased to qualify as an eligible Insured. No new Eligible Dependents may be added to the portability coverage except as provided in the Newborn and Adopted Children provision. No increases in coverage will be allowed while the Insured is exercising his or her rights under this rider. If the Policy is no longer in force, then portability coverage is not available. Heart Attack/Stroke First Occurrence Benefit Rider Pays a lump sum amount when a Covered Person receives a first diagnosis of Heart Attack/Stroke and the Date of Diagnosis occurs after the Waiting Period. The Heart Attack/Stroke lump sum benefit amount will reduce by 50% at age 70. Exclusions & Limitations We will not pay benefits for any loss caused by or resulting from any of the following: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces; military service for any country at war. If coverage is suspended for any Covered Person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the Policyholder s written request; participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a Physician or taken according to the Physician s instructions; or participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place). Pre-Existing Condition Exclusion No benefits are payable for any loss incurred during the Pre-Existing Condition Exclusion Period following the Covered Person s Effective Date of this rider as the result of a Pre-Existing Condition. Waiting Period This rider contains a Waiting Period during which no benefits will be paid. If any Heart Attack or Stroke is diagnosed before the end of the Waiting Period immediately following the Covered Person s Effective Date of this rider, coverage will apply only to loss that is incurred after one year from the Covered Person s Effective Date.

33 GC13 Limited Benefit Group Cancer Indemnity Insurance Termination This rider will terminate and coverage will end for all Covered Persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the Policy or Certificate to which this rider is attached terminates; the end of the Certificate Month in which we receive a request from the Policyholder to terminate this rider; the date of your death; or the date the lump sum benefit amount for Heart Attack or Stroke has been paid for all Covered Persons under this rider. Coverage on an Eligible Dependent terminates under this rider when such person ceases to meet the definition of Eligible Dependent. Internal Cancer First Occurrence Benefit Rider Pays a lump sum benefit amount when a Covered Person receives a first diagnosis of a covered Internal Cancer and the Date of Diagnosis occurs after the Waiting Period. The Internal Cancer lump sum benefit amount will reduce by 50% at age 70. Exclusions & Limitations We will not pay benefits for a diagnosis of Internal Cancer received outside the territorial limits of the United States or a metastasis to a new site of any Cancer diagnosed prior to the Covered Person s Effective Date, as this is not considered a first diagnosis of an Internal Cancer. Pre-Existing Condition Exclusion No benefits are payable for any loss incurred during the Pre-Existing Condition Exclusion Period following the Covered Person s Effective Date of this rider as the result of a Pre-Existing Condition. Waiting Period This rider contains a Waiting Period during which no benefits will be paid. If any Internal Cancer is diagnosed before the end of the Waiting Period immediately following the Covered Person s Effective Date of this rider, coverage will apply only to loss that is incurred after one year from the Covered Person s Effective Date of this Rider. Termination This rider will terminate and coverage will end for all Covered Persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the Policy or Certificate to which this rider is attached terminates; the end of the Certificate Month in which we receive a request from the Policyholder to terminate this rider; the date of your death; or the date the lump sum benefit amount for Internal Cancer has been paid for all Covered Persons under this rider. Coverage on an Eligible Dependent terminates under this rider when such person ceases to meet the definition of Eligible Dependent. Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete benefits and other provisions, please refer to your policy/certificate/rider(s). This coverage does not replace Workers Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. This product contains Limitations and Exclusions This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines Policy Form GC13APL Limited Benefit Group Cancer Indemnity Insurance Series Texas (10/14) ESC Region APSB-22331(TX) MGM/FBS ESC Region Lakeland Drive Flowood, MS ampublic.com

34 UNUM Critical Illness YOUR BENEFITS PACKAGE PLAY VIDEO About this Benefit Critical illness insurance is designed to supplement your medical and disability coverage easing the financial impacts by covering some of your additional expenses. It provides a benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. $16,500 Is the aggregate cost of a hospital stay for a heart attack. This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 34 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 19 Benefits Website:

35 Critical Illness Coverage Amounts Employee - $10,000 to $30,000 in increments of $5,000 Spouse - $5,000 to $15,000 in increments of $5,000 Child 25% of Employee Coverage Amount Guarantee Issue Employee $30,000 Spouse - $15,000 Pre-Existing Condition 12/12 exclusion Benefit Waiting Period 30 days Wellness Benefit $50 per insured per calendar year Recurrence Benefit Included 50% of the coverage amount for an additional payout for a subsequent occurrence of benign brain tumor, coma, heart attack or stroke. Premium Paid by the Employee Rate Information Wellness benefit premium is in addition to the base premium. Portability Included Without Cancer Monthly Rates per $1,000 Issue Ages Non-Tobacco Tobacco < Wellness Benefit - Additional Monthly Cost per $50 Employee and Children $1.60 Spouse $1.60 This plan highlight is a summary provided to help you understand your insurance coverage from Unum. Details may differ from state to state. Please refer to your certificate booklet for your complete plan description. If the terms of this plan highlight summary or your certificate differ from your policy, the policy will govern. 35

36 THE HARTFORD Voluntary Group term Life YOUR BENEFITS PACKAGE PLAY VIDEO About this Benefit Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy. Experts recommend at least x 10 your gross annual income in coverage when purchasing life insurance. This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 36 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 19 Benefits Website:

37 Basic Group Term Life and AD&D Benefit Highlights - ESC Region 19 Am I eligible? When can I enroll? When is it effective? You are eligible if you are an active full time employee who works at least 20 hours per week on a regularly scheduled basis. As an eligible Employee, you are automatically covered by Basic Life and AD&D Insurance. If you have not already done so, you must designate a beneficiary as described below. Coverage goes into effect subject to the terms and conditions of the policy. You must be Actively at Work with your employer on the date your coverage takes effect. What is Basic Life and AD&D? Your employer provides, at no cost to you, Basic Life and AD&D Insurance in an amount equal to $25,000 Does my coverage reduce as I get older? What is a beneficiary? AD&D Coverage Can I keep my Life coverage if I leave my employer? What is the Living Benefits Option? Your benefits will be reduced by 35% on the Policy Anniversary Date following the date you attain age 70 and by 50% at age 75. All coverage cancels at retirement. Your beneficiary is the person (or persons) or legal entity (entities) who receives a benefit payment if you die while you are covered by the policy. You must select your beneficiary when you complete your enrollment application; your selection is legally binding. AD&D provides benefits due to certain injuries or death from an accident. The covered injuries or death can occur up to 365 days after that accident. The Insurance pays: 100% of the amount of coverage you purchase in the event of accidental loss of life, two limbs, the sight of both eyes, one limb and the sight of one eye, or speech and hearing in both ears or quadriplegia. 75% for paraplegia or triplegia (paralysis of three limbs). One-half (50%) for accidental loss of one limb, sight of one eye, or speech or hearing in both ears or hemiplegia. One-quarter (25%) for accidental loss of thumb and index finger of the same hand or uniplegia. Your total benefit for all losses due to the same accident will not be more than 100% of the amount of coverage provided to you Yes, subject to the contract, you have the option of: Converting your group Life coverage to your own individual policy (policies). If you leave your employer, Portability is an option that allows you to continue your Life Insurance coverage. To be eligible, you must terminate your employment prior to Social Security Normal Retirement Age. This option allows you to continue all or a portion of your Life Insurance under a separate Portability term policy. Portability is subject to a minimum of $5,000 and a maximum of $250,000 and does not include coverage for your dependents. To elect Portability, you must apply and pay the premium within 31 days of the termination of your Life Insurance. Evidence of Insurability will not be required. If you are diagnosed as terminally ill with a 12 month life expectancy, you may be eligible to receive payment of a portion of your Life Insurance. The remaining amount of your Life Insurance would be paid to your beneficiary when you die. Important Details As is standard with most term life insurance, this insurance coverage includes certain limitations and exclusions: the amount of your coverage may be reduced when you reach certain ages. AD&D Insurance does not cover losses caused by or contributed by: Sickness; disease; or any treatment for either; Any infection, except certain ones caused by an accidental cut or wound; Intentionally self-inflicted injury, suicide or suicide attempt; War or act of war, whether declared or not; Injury sustained while in the armed forces of any country or international authority; Taking prescription or illegal drugs unless prescribed for or administered by a licensed physician; Injury sustained while committing or attempting to commit a felony; The injured person s intoxication. Other exclusions may apply depending upon your coverage. Once a group policy is issued to your employer, a certificate of Insurance will be available to explain your coverage in detail. 37

38 Voluntary Group Term Life and AD&D Benefit Highlights - ESC Region 19 When can I enroll? When is it effective? To be determined by your Employer Coverage goes into effect subject to the terms and conditions of the policy. You must be Actively at Work with your employer on the date your coverage takes effect. How much Supplemental Life and AD&D Insurance can I purchase? AD&D Coverage I already have Supplemental Life and AD&D Insurance coverage; do I have to do anything? Am I guaranteed coverage? Are there other limitations to enrollment? Spouse Supplemental Life and AD&D Insurance Child(ren) Supplemental Life and AD&D Insurance 38 You can purchase Supplemental Life and AD&D Insurance in increments of $10,000. The maximum amount you can purchase cannot be more than the lesser of 5 times your annual Earnings or $500,000. Annual Earnings are defined in The Hartford s contract with your employer. AD&D provides benefits due to certain injuries or death from an accident. The covered injuries or death can occur up to 365 days after that accident. The Insurance pays: 100% of the amount of coverage you purchase in the event of accidental loss of life, two limbs, the sight of both eyes, one limb and the sight of one eye, or speech and hearing in both ears or quadriplegia. 75% for paraplegia or triplegia (paralysis of three limbs). One-half (50%) for accidental loss of one limb, sight of one eye, or speech or hearing in both ears or hemiplegia. One-quarter (25%) for accidental loss of thumb and index finger of the same hand or uniplegia. Your total benefit for all losses due to the same accident will not be more than 100% of the amount of coverage you purchase. If you take no action, your coverage and coverage for your eligible dependents will automatically continue with The Hartford subject to the terms of the contract. The guaranteed issue amount is the amount of Insurance that you may elect without providing evidence of insurability. If you are currently participating in this coverage you may increase your current coverage by $10,000, not to exceed the lesser of 5 times your annual Earnings or $150,000, without providing evidence of insurability. Additional coverage amounts will require evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you are electing coverage for the first time, evidence of insurability that is satisfactory to The Hartford will be required before any coverage can become effective. If you do not enroll within 31 days of your first day of eligibility, you will be considered a late entrant. Typically, late entrants must show evidence of insurability and may be responsible for the cost of physical exams or other associated costs if they are required. This coverage, like most group benefit Insurance, requires that a certain percentage of eligible employees participate. If that group participation minimum is not met, the Insurance coverage that you have elected may not be in effect. If you elect Supplemental Life and AD&D Insurance for yourself, you may choose to purchase Spouse Supplemental Life and AD&D Insurance in increments of $5,000, to a maximum of $250,000. Coverage cannot exceed 50% of the amount of your Employee Supplemental Life Insurance coverage. You may not elect coverage for your Spouse if they are already covered as an Employee under this policy. If your Spouse is confined in a hospital or elsewhere because of disability on the date his or her Insurance would normally have become effective, coverage (or an increase in coverage) will be deferred until that dependent is no longer confined and has performed all the normal activities of a healthy person of the same age for at least 15 consecutive days. If you are currently participating in this coverage you may increase your current coverage in the amount of $5,000, not to exceed $25,000 without providing evidence of insurability. Additional coverage amounts will require your Spouse to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you are electing coverage for the first time, your Spouse will be required to provide evidence of insurability that is satisfactory to The Hartford before any coverage can become effective. If you elect Supplemental Life and AD&D Insurance for yourself, you may choose to purchase Child(ren) Supplemental Life and AD&D Insurance coverage in increments of $2,000, to a maximum of $10,000 for each Child no medical information is required. You may not elect coverage for your Child if your Child is an active member of the armed forces of any country or international authority. If your dependent Child is confined in a hospital or elsewhere because of disability on the date his or her Insurance would normally have become effective, coverage (or an increase in coverage) will be deferred until that dependent is no longer confined and has performed all the normal activities of a healthy person of the same age for at least 15 consecutive days. Children must be unmarried and are covered from Live Birth to 25 years old. Unmarried Children over age 25 may be covered if they are disabled and primarily dependent upon the Employee for financial support. Children from Live Birth to 6 months are limited to a reduced benefit of $1,000.

39 Voluntary Group Term Life and AD&D Does my coverage reduce as I get older? Can I keep my Life coverage if I leave my employer? What is the Living Benefits Option? Do I still pay my Life Insurance premiums if I become disabled? Your benefits will be reduced by 35% on the Policy Anniversary Date following the date you attain age 70 and by 50% at age 75. All coverage cancels at retirement. Yes, subject to the contract, you have the option of: Converting your group Life coverage to your own individual policy (policies). If you leave your employer, Portability is an option that allows you to continue your Life Insurance coverage. To be eligible, you must terminate your employment prior to Social Security Normal Retirement Age. This option allows you to continue all or a portion of your Life Insurance coverage under a separate Portability term policy. Portability is subject to a minimum of $5,000 and a maximum of $250,000 and includes coverage for your Spouse and Child(ren). To elect Portability, you must apply and pay the premium within 31 days of the termination of your Life Insurance. Evidence of Insurability will not be required. Dependent Spouse Portability is subject to a maximum of $50,000. Dependent Child Portability is subject to a maximum of $10,000. If you are diagnosed as terminally ill with a 12 month life expectancy, you may be eligible to receive payment of a portion of your Life Insurance. The remaining amount of your Life Insurance would be paid to your beneficiary when you die. If you become totally disabled before age 60 and your disability lasts for at least 9 months, your Life Insurance premium may be waived. The premium for your dependent's coverage will also be waived if you are disabled and approved for waiver of premium. Important Details As is standard with most term life insurance, this insurance coverage includes certain limitations and exclusions: Death by suicide (two years). Hartford Voluntary Life/AD&D Rates - ESC Region 19 EMPLOYEE Age Band 0-24 $0.65 $1.30 $1.95 $2.60 $3.25 $4.55 $6.50 $8.45 $ $0.65 $1.30 $1.95 $2.60 $3.25 $4.55 $6.50 $8.45 $ $0.75 $1.50 $2.25 $3.00 $3.75 $5.25 $7.50 $9.75 $ $0.85 $1.70 $2.55 $3.40 $4.25 $5.95 $8.50 $11.05 $ $1.25 $2.50 $3.75 $5.00 $6.25 $8.75 $12.50 $16.25 $ $2.05 $4.10 $6.15 $8.20 $10.25 $14.35 $20.50 $26.65 $ $3.35 $6.70 $10.05 $13.40 $16.75 $23.45 $33.50 $43.55 $ $4.75 $9.50 $14.25 $19.00 $23.75 $33.25 $47.50 $61.75 $ $5.75 $11.50 $17.25 $23.00 $28.75 $40.25 $57.50 $74.75 $ $10.45 $20.90 $31.35 $41.80 $52.25 $73.15 $ $ $ $17.75 $35.50 $53.25 $71.00 $88.75 $ $ $ $ $34.35 $68.70 $ $ $ $ $ $ $ SPOUSE Age Band 0-24 $0.42 $0.84 $1.26 $1.68 $2.10 $2.52 $4.20 $4.62 $ $0.31 $0.62 $0.93 $1.24 $1.55 $1.86 $3.10 $3.41 $ $0.36 $0.72 $1.08 $1.44 $1.80 $2.16 $3.60 $3.96 $ $0.44 $0.87 $1.31 $1.74 $2.18 $2.61 $4.35 $4.79 $ $0.56 $1.11 $1.67 $2.22 $2.78 $3.33 $5.55 $6.11 $ $0.85 $1.70 $2.55 $3.40 $4.25 $5.10 $8.50 $9.35 $ $1.32 $2.64 $3.96 $5.28 $6.60 $7.92 $13.20 $14.52 $ $1.88 $3.75 $5.63 $7.50 $9.38 $11.25 $18.75 $20.63 $ $2.91 $5.81 $8.72 $11.62 $14.53 $17.43 $29.05 $31.96 $ $5.43 $10.85 $16.28 $21.70 $27.13 $32.55 $54.25 $59.68 $ $9.64 $19.27 $28.91 $38.54 $48.18 $57.81 $96.35 $ $ $17.53 $35.05 $52.58 $70.10 $87.63 $ $ $ $ SPOUSE AMOUNT CANNOT EXCEED 50% OF EMPLOYEE AMOUNT Child(ren) $2,000 $4,000 $6,000 $8,000 $10,000 $0.40 $0.80 $1.20 $1.60 $2.00 NOTE: FINAL RATES MAY VARY SLIGHTLY DUE TO ROUNDING. Employee Maximum is Lesser of 5x Salary or $500,000 39

40 5STAR Individual Life YOUR BENEFITS PACKAGE PLAY VIDEO About this Benefit Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy. 1/3 of Americans would be financially impacted by the loss of the primary wage earner in just one month. This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 40 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 19 Benefits Website:

41 Individual Life The Family Protection Plan: Term Life Insurance with Terminal Illness Coverage to Age 100 Nearly 85% of Americans say most people need life insurance; unfortunately only 62% have coverage and a staggering 33% say they don t have enough life insurance, including one-fourth who already have life insurance coverage.** Nobody wants to be a statistic - especially during a period of grief. That s why 5Star Life Insurance Company developed its FPP policy - to ensure you and your loved ones are covered during a period of loss. Affordability - With several options to choose from, select the coverage that best meets the needs of your family. Terminal Illness - This plan pays the insured 30% (25% in Connecticut and Michigan) of the policy coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months. Portability - You and your family continue coverage with no loss of benefits or increase in cost should you terminate employment after the first premium is paid. If this happens, we can simply bill you directly. Coverage can never be cancelled by the insurance company or your employer unless you stop paying premiums. DID YOU KNOW? Protecting your financial well being is easier than you think. It s like trading in a daily latte for peace of mind. $4.30 per day to start your morning with a gourmet coffee OR $1.75 per day to enrich your employee benefits package It s less expensive than you think. Family Protection - Individual policies can be purchased on the employee, their spouse, children and grandchildren (ages 15 days to age 24). Quality of Life Benefit - Following a diagnosis of either a chronic illness or cognitive impairment, this rider accelerates a portion of the death benefit on a monthly basis 4%; up to 75% of your benefit, and payable directly to you on a tax favored basis for the following: Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or Permanent severe cognitive impairment, such as dementia, Alzheimer s disease and other forms of senility, requiring substantial supervision. Convenience - Premiums are taken care of simply and easily through payroll deductions. Protection You Can Count On - Within 24 hours after receiving notice of an insured s death, an emergency death benefit of the lesser of 50% of the coverage amount, or $10,000, will be mailed to the insured s beneficiary, unless the death is within the twoyear contestability period and/or under investigation. This product also contains no war or terrorism exclusions. * Life * Life insurance product underwritten by 5Star Life insurance Company (a Baton Rouge, Louisiana company) with an administrative office at 909 N. Washington Street, Alexandria, VA

42 Family Protection Plan - Terminal Illness Monthly Rates with Quality of Life Rider Defined Benefit Age on App. Date Employee Coverage Amounts Spouse Coverage Amounts $10,000 $25,000 $50,000 $75,000 $100,000 $10,000 $20,000 $30, $7.56 $12.40 $20.46 $28.52 $36.58 $7.56 $10.78 $ $7.58 $12.46 $20.58 $28.71 $36.83 $7.58 $10.83 $ $7.65 $12.63 $20.92 $29.21 $37.50 $7.65 $10.97 $ $7.74 $12.85 $21.38 $29.90 $38.42 $7.74 $11.15 $ $7.88 $13.21 $22.08 $30.96 $39.83 $7.88 $11.43 $ $8.07 $13.67 $23.00 $32.33 $41.67 $8.07 $11.80 $ $8.27 $14.17 $24.00 $33.83 $43.67 $8.27 $12.20 $ $8.49 $14.73 $25.13 $35.52 $45.92 $8.49 $12.65 $ $8.73 $15.31 $26.29 $37.27 $48.25 $8.73 $13.12 $ $9.00 $16.00 $27.67 $39.33 $51.00 $9.00 $13.67 $ $9.30 $16.75 $29.17 $41.58 $54.00 $9.30 $14.27 $ $9.64 $17.60 $30.88 $44.15 $57.42 $9.64 $14.95 $ $10.02 $18.54 $32.75 $46.96 $61.17 $10.02 $15.70 $ $10.41 $19.52 $34.71 $49.90 $65.08 $10.41 $16.48 $ $10.84 $20.60 $36.88 $53.15 $69.42 $10.84 $17.35 $ $11.31 $21.77 $39.21 $56.65 $74.08 $11.31 $18.28 $ $11.83 $23.08 $41.83 $60.58 $79.33 $11.83 $19.33 $ $12.41 $24.52 $44.71 $64.90 $85.08 $12.41 $20.48 $ $13.00 $26.00 $47.67 $69.33 $91.00 $13.00 $21.67 $ $13.63 $27.56 $50.79 $74.02 $97.25 $13.63 $22.92 $ $14.28 $29.19 $54.04 $78.90 $ $14.28 $24.22 $ $14.97 $30.92 $57.50 $84.08 $ $14.97 $25.60 $ $15.69 $32.73 $61.13 $89.52 $ $15.69 $27.05 $ $16.43 $34.56 $64.79 $95.02 $ $16.43 $28.52 $ $17.22 $36.54 $68.75 $ $ $17.22 $30.10 $ $18.08 $38.69 $73.04 $ $ $18.08 $31.82 $ $19.04 $41.10 $77.88 $ $ $19.04 $33.75 $ $20.16 $43.90 $83.46 $ $ $20.16 $35.98 $ $21.40 $47.00 $89.67 $ $ $21.40 $38.47 $ $22.79 $50.48 $96.63 $ $ $22.79 $41.25 $ $24.27 $54.17 $ $ $ $24.27 $44.20 $ $25.93 $58.33 $ $ $ $25.93 $47.53 $ $27.66 $62.65 $ $ $ $27.66 $50.98 $ $29.42 $67.04 $ $ $ $29.42 $54.50 $ $31.23 $71.56 $ $ $ $31.23 $58.12 $

43 Family Protection Plan - Terminal Illness Age on App. Date Employee Coverage Amounts Spouse Coverage Amounts $10,000 $25,000 $50,000 $75,000 $100,000 $10,000 $20,000 $30, $7.56 $12.40 $20.46 $28.52 $36.58 $7.56 $10.78 $ $33.12 $76.29 $ $ $ $33.12 $61.90 $ $35.08 $81.19 $ $ $ $35.08 $65.82 $ $37.13 $86.31 $ $ $ $37.13 $69.92 $ $39.31 $91.77 $ $ $ $39.31 $74.28 $ $41.68 $97.71 $ $ $ $41.68 $79.03 $ $44.33 $ $ $ $ $44.33 $84.33 $ * $44.93 $ $ $ $ $44.93 $85.52 $ * $48.25 $ $ $ $ $48.25 $92.17 $ * $52.03 $ $ $ $ $52.03 $99.73 $ * $56.33 $ $ $ $ $56.33 $ $ * $61.17 $ $ $ $ $61.17 $ $ *Quality of Life not available ages Quality of Life benefits not available for children. Child life coverage available only on children and grandchildren of employee (age on application date: 15 days to age 24 years). $4.98 monthly for $10,000 coverage and $9.97 monthly for $20,000 coverage. 43

44 44 REGION19