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1 Douglas County School System Benefits Enrollment Guide (Non-Medical Benefits) January 1, 2016 December 31, 2016

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3 Table of Contents 2 Table of Contents State Health Open Enrollment & Important Information 3 Benefit Enrollment 4 How To Enroll 5 State Health Benefits 6-9 Dental Benefits 10 Vision Benefits 11 Basic & Voluntary Life Insurance Short Term Disability 14 Long Term Disability 15 Voluntary Cancer & Specific Disease 16 Flexible Spending Account (FSA) 17 Disclosure Notice 18 ShawHankins Call Center 19 Notes 20 Contacts Back Cover This guide is designed to provide you with an overview of the benefits options we offer. The actual benefits available to you and the descriptions of these benefits are governed by the relevant Summary Plan Document (SPD) and our contracts. For more detailed plan information for all lines of coverage listed in guide please call ShawHankins. ShawHankins and Douglas County School System reserves the right to modify, change, revise, amend or terminate these benefit plans at any time.

4 State Health Open Enrollment & Important Information Regarding Voluntary Benefits 3 State For information on the Health Open Enrollment and instructions regarding enrolling for your State Health please visit the website at DO NOT WAIT UNTIL THE LAST MINUTE to go online to make your elections for 2016 as Web traffic may be heavy and exceptions will not be allowed if you were unable to complete your 2016 election. REMINDER: The enrollment for State Health will close at 11:59PM EST. Important Information Regarding Your Dental, Vision, Disability and Life Benefits If you are currently enrolled in benefits and do not wish to make a change, your current benefits, excluding the FSA (Flexible Spending Account), will roll-over into the new plan year. If you are currently enrolled in the FSA or are newly eligible for the FSA and would like to enroll, you are required to go online and make your election for the new plan year - the FSA will NOT rollover. Dental: The Dental will be changing to MetLife effective 1/1/2016. During the initial enrollment the late entrant will be waived for this year only. Subsequent years the Dental waiting period will apply for the entrants. Dental Waiting Period: If you are not a new hire and you and/or your dependents are not currently covered under the Dental plans there will be a waiting period applied to your coverage. The Waiting Period states for the first 12 months of coverage Major services will not be covered and Ortho services will not be covered for 18 months. Therefore, if you are electing coverage for yourself and/or your dependents and are not a newly eligible employee it is highly recommended you elect the Low Plan vs. one of the other Plans for the first 12 months of coverage as the waiting period will be applied to both plans regardless. Vision: There will be no changes to the Vision Plan. Short Term Disability (STD), Long Term Disability (LTD): Please note if you did not enroll in STD and/or LTD when you were initially eligible and you decide to enroll during this annual enrollment period you will be required to complete a Personal Health Application (PHA) which will be subject for approval by a Hartford medical underwriter before coverage will be issued. Please note the Pre- Existing Condition Exclusions as listed in your Enrollment Booklet and online under LTD. The cost of current coverage may change based on your salary as of 01/01/2016. Voluntary Life: If you currently have coverage, you may increase coverage on you and your spouse up to an additional $40,000 not to exceed the guaranteed issue without being required to complete a Personal Health Application (PHA). If you increase/elect coverage over $40,000, a PHA will be required. If you did not previously elect coverage for you and/or your spouse, a PHA will be required. You cannot purchase additional Life and AD&D insurance for your spouse and child(ren) without purchasing Life and AD&D insurance for yourself. The amount of Spouse/Child coverage may not exceed 100% of your optional life amount. The cost of your current coverage may change based on age as of 01/01/2016. Basic Paid Life and AD&D: Douglas County Schools will continue to provide $50,000 of Life and AD&D to all full-time benefit eligible Employees. Flexible Spending Accounts (Healthcare Reimbursement and Dependent Day Care): Your Flexible Spending Accounts (Healthcare Reimbursement and Dependent Day Care) benefits will remain the same. You are required to go online and make your election for the new plan year - the FSA will NOT roll-over.

5 Benefits Enrollment 4 BEFORE YOU ENROLL - THINGS TO KNOW You are REQUIRED to provide the below information/documentation for all dependents/beneficiaries: Date of Birth Social Security Number Please Note: Eligible Dependents are classified as your legal spouse who resides in the United States and/or your biological children/stepchildren/legal dependent children. HOW TO ENROLL Go to At this time, make sure to disable your pop up blocker. At the enrollment website enter your Username and Password. Username is first letter of first name, last name, and last 4 digits of your Social Security number (ex. jdoe4567). Password is the last 4 digits of your Social Security number ( ex. 4567). You will then be prompted to create a permanent password. **DO NOT CLICK ON FIRST TIME USER Annual Enrollment Period: Begins October 19, 2015 and ends at midnight on November 6, You may go online or contact the ShawHankins Service Center to elect or decline coverage for the new plan year by the deadline noted. Please contact ShawHankins at to speak with a Benefit Consultant if you need assistance with your annual enrollment. Qualifying Events (refer to your 2016 Summary Plan Description - Special Enrollment Rights): Once your new plan year elections become effective (January 1 st of each year ), you will not be able to change your elections until the next annual enrollment period unless you experience an eligible qualifying event. Examples of qualifying events include: a change in marital status; a change in the number of dependents due to birth, adoption, placement for adoption or death of a dependent; a change in employment status for myself or my spouse; loss or gain of coverage through my spouse; a change in dependents eligibility. You must enroll within 30 days from the effective date of a qualifying event. Please contact ShawHankins at to speak with a Benefit Consultant regarding enrollment due to a Qualifying Event. You ll receive a confirmation from both the SHBP and the bswift websites. Always print your confirmation page from both SHBP and bswift or save both documents to your computer. Please monitor your initial paychecks after employment and each year in December and January after Open Enrollment to make sure the deductions you expect are included. If not, contact the Human Resources Department immediately. We can correct most problems that are found immediately but not the ones that are noticed months later.

6 How to Enroll 5 NOTE: You must add any Dependents you wish to cover to the system at this year s annual enrollment. To Begin: 1) From the Home Page click on the Enroll Now link, to begin the election process. 2) On the Personal & Family Page, verify your information is accurate and Add all eligible dependents you wish to cover under any benefits. 3) To make a plan selection, select the button beside the newly elected plan. If you are covering dependents, make sure to Select them by checking off next to their name under Select who to cover with this plan. Then press Next at the bottom of the screen. 4) Once you have reviewed and completed your enrollment, click on I Agree and I am finished with my enrollment, then click on Save My Enrollment. 5) You will now be taken to the final confirmation page to either print or . Note: The enrollment images within this guide are for illustrative purposes only.

7 6 State Health Benefit Plan 2016 Plan Options Basic information on the health care options available to employees is given here. Please refer to the SHBP Decision Guide at If you have not registered to use the site, click Register Here to start, and use the registration code SHBP-GA. As a result of the 2016 State Health Benefit Plan (SHBP) Plan Options, members will experience a number of positive enhancements. The 2016 Plan Options listed below are designed to provide members with a choice of Plan Options that best meet their needs. BlueCross BlueShield of Georgia- BCBSGA Health Reimbursement Arrangement (HRA) without co-payments Gold Silver Bronze Statewide Health Maintenance Organization (HMO) UnitedHealthcare- UHC High Deductible Health Plan (HDHP) Statewide Health Maintenance Organization (HMO) Kaiser Permanente- KP The KP Regional HMO (Metro Atlanta Service Area only) offers medical, wellness and pharmacy benefits. You must live or work in one of the below 27 counties within the Metro Atlanta Service Area to be eligible to enroll in KP: Barrow Bartow Butts Carroll Cherokee Clayton Cobb Coweta DeKalb Douglas Fayette Forsyth Fulton Gwinnett Haralson Heard Henry Lamar Meriwether Newton Paulding Pickens Pike Rockdale Spalding Walton The TRICARE Supplement will continue to be available for those members enrolled in TRICARE. PeachCare for Kids will continue to be available for those members enrolled in PeachCare for Kids.

8 SHBP - HRA Benefit Summary 7 BCBSGa Gold HRA Option In-Network Out-of- Network BCBSGa Silver HRA Option In-Network Out-of- Network BCBSGa Bronze HRA Option In-Network Covered Services You Pay You Pay You Pay Out-of- Network Deductible You $1,500 $3,000 $2,000 $4,000 $2,500 $5,000 You + Spouse $2,250 $4,500 $3,000 $6,000 $3,750 $7,500 You + Child(ren) $2,250 $4,500 $3,000 $6,000 $3,750 $7,500 You + Family $3,000 $6,000 $4,000 $8,000 $5,000 $10,000 HRA credits will reduce You Pay amounts Out-of-Pocket Maximum You $4,000 $8,000 $5,000 $10,000 $6,000 $12,000 You + Spouse $6,000 $12,000 $7,500 $15,000 $9,000 $18,000 You + Child(ren) $6,000 $12,000 $7,500 $15,000 $9,000 $18,000 You + Family $8,000 $16,000 $10,000 $20,000 $12,000 $24,000 HRA credits will reduce You Pay amounts HRA The Plan Pays The Plan Pays The Plan Pays You $400 $200 $100 You + Spouse $600 $300 $150 You + Child(ren) $600 $300 $150 You + Family $800 $400 $200 Physicians' Services The Plan Pays The Plan Pays The Plan Pays Primary Care Physician or Specialist Office or Clinic Visits (illness or injury) 85% coverage coverage 80% 75% Maternity Care (nonroutine, prenatal, delivery & postpartum) 85% coverage coverage 80% 75% Primary Care Physician or Specialist Office or Clinic Visits (Wellness/preventive, prenatal care coded as preventive) 100% coverage not Not Covered 100% not Not covered 100% not Not Covered Physician Services Furnished in a Hospital 85% coverage coverage 80% 75% Telemedicine/Virtual Visit 85% coverage not coverage not 80% not not 75% not not

9 SHBP - HMO & HDHP Benefit Summary 8 Covered Services Deductible BCBSGA /UnitedHealthcare Statewide HMO In-Network only UnitedHealthcare HDHP In-Network Out-of- Network KP Regional HMO In-Network only You Pay You Pay You Pay You $1,300 $3,500 $7,000 N/A You + Spouse $1,950 $7,000 $14,000 N/A You + Child(ren) $1,950 $7,000 $14,000 N/A You + Family $2,600 $7,000 $14,000 N/A Out-of-Pocket Maximum You $4,000 $6,450 $12,900 $6,350 You + Spouse $6,500 $12,900 $25,800 $12,700 You + Child(ren) $6,500 $12,900 $25,800 $12,700 You + Family $9,000 $12,900 $25,800 $12,700 HRA The Plan Pays The Plan Pays The Plan Pays You You + Spouse You + Child(ren) You + Family Physicians' Services N/A The Plan Pays N/A The Plan Pays N/A The Plan Pays Primary Care Physician or Specialist Office or Clinic Visits (illness or injury) Maternity Care (nonroutine, prenatal, delivery & postpartum) Primary Care Physician or Specialist Office or Clinic Visits (Wellness/preventive) Physician Services Furnished in a Hospital Telemedicine/Virtual Visit HRA Pharmacy 100% coverage after $35 PCP copay $45 SPC copay 100% coverage after $35 PCP copay $45 SPC copay 100% not, innetwork only 100% 100% coverage after $35 PCP copay In-Network Tier 1 Coinsurance $20 Tier 2 Coinsurance Preferred Brand Tier 3 Coinsurance Non- Preferred Brand Out-of- Network 70% 70% 100% not 70% 70% coverage 50% 50% Not covered 50% 50% overage You Pay Out-of- In-Network Network 100% after $35 PCP copay $45 SPC copay 100% after $35 PCP copay $45 SPC copay 100% coverage 100% coverage 100% coverage after $35 PCP copay $45 SPC copay In-Network $20 $50 70% after $50 is met* $90 $80 Participating 90-day Tier 1 - $50 Tier 1 - $50 70% after Voluntary Mail Order or Tier 2 - $125 Tier 2 - $125 is met* Retail 90-day Network Tier 3 - $225 Tier 3 - $200 Note: Amounts you pay for Rx go toward the out-of-pocket maximum. *For HDHP out-of-network, pharmacy expenses are paid at 70% of the contracted rate. Out-of- Network Note: If you request a Brand-name Prescription Drug Product in place of the chemically equivalent Prescription Drug Product (Generic equivalent), you will pay the applicable Generic copayment or coinsurance in addition to the difference between the Brand and Generic Drug costs.

10 State Health Benefit Plan 9 Basic information on the health care options available to employees is given here. Please refer to the SHBP Decision Guide at If you have not registered to use the site, click Register Here to start, and use the registration code SHBP-GA.c State Health Benefit Plan Monthly Premiums for Active Employees January 1 December 31, 2016 Employee Employee + Children Employee + Spouse Family BCBS Gold $ $ $ $ BCBS Silver $ $ $ $ BCBS Bronze $66.28 $ $ $ BCBS HMO $ $ $ $ UHC HMO $ $ $ $ UHC HDHP $57.46 $ $ $ Kaiser HMO $ $ $ $ Tricare Supplement $60.50 $ $ $ NOTES: An additional $80 will be added to the monthly premium shown above when you or any of your covered dependents use tobacco products. Premiums are deducted in advance. Special note about calling BlueCross BlueShield, UHC or Kaiser: If you contact your insurance carrier about a coverage or eligibility question and they ask you to contact your employer, they are intending for you to contact SHBP directly. The Benefits Office does not have access to the information necessary to answer these questions. SHBP s telephone number is

11 Dental Benefits 10 In 2016, Dental Benefits will be changing from Delta Dental to MetLife. Douglas County School System offers the choice between three dental plans through as summarized below. Benefit: Low Plan Medium Plan High Plan Annual Deductible: (3 family Maximum) $50 per individual / $150 per family $50 per individual / $150 per family $50 per individual / $150 per family Class I: Diagnostic & Preventative Services 100% ( waived) 100% ( waived) 100% ( waived) Class II: Basic Benefits / Restorative Benefits / Denture Repairs 50% ( applies) 80% ( applies) 80% ( applies) Class III: Crowns & Cast Restorations / Prosthodontic Benefits Not Covered 50% ( applies) 50% ( applies) Maximum Benefit: $1,250 per calendar year $3,000 per calendar year $5,000 per calendar year Orthodontia Not covered 50% Lifetime maximum: $750 50% Lifetime maximum: $750 The Dental will be changing to MetLife effective 1/1/2016. During the initial enrollment the late entrant will be waived for this year only. Subsequent years the Dental waiting period will apply for the entrants. Waiting Period - There are no Waiting Periods for Current enrollees, new hires, or qualifying events enrolled within 30 days of the event. - Waiting Periods (12 months for Major, 18 months for Ortho) will apply to all who are not new hires who declined coverage when initially eligible but who now want coverage 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. Dental Costs Per Month Tier of Coverage Low Plan Medium Plan High Plan Employee Only $22.94 $26.47 $35.37 Family $66.23 $71.18 $95.38 Locate a Provider: For a complete list of providers near you, use our Provider Locator on or call

12 11 Vision Benefits Douglas County School System offers the vision plan through Ameritas EyeMed as summarized below. Benefit In-Network Out-of-Network Frequency Vision Exam $10 Copay Up to $30 Contact Lens Fit & Follow-up Standard: Up to $40 Premium: 10% off retail price N/A N/A Once every 12 months Contact Lenses* Allowance Max Amount Conventional Disposables $0 Copay; $130 allowance; 15% off retail price over $130 $0 Copay; $130 allowance; plus balance over $130 Up to $104 Up to $104 Once every 12 months Medically Necessary Standard Plastic Lenses $0 Copay; Paid-in-Full Copayment Up to $200 Max Amount Single Vision Bifocal Trifocal Lenticular $25 $25 $25 20% Discount Up to $25 Up to $40 Up to $55 N/A Once every 12 months Frames $0 Copay; $130 allowance; 80% of charge over $130 Up to $65 maximum amount Once every 24 months Lasik Surgery 15% off the retail price or 5% off the promotional price N/A 1 per Lifetime Please note: This plan covers either contact lenses or lenses for your glasses once every 12 months. Vision Costs Per Month Tier of Coverage Employee Cost Employee Only $ 4.81 Family $12.27 Locate a Provider: For a complete list of providers near you, use our Provider Locator on or call

13 Voluntary Life Insurance 12 Term Life Insurance provides valuable financial protection for your family. Douglas County School System is pleased to offer $50,000 of Basic Life Insurance & AD&D to all employees. Voluntary Term Life/AD&D Insurance is also available to provide additional financial protection for your family. Douglas County School System is pleased to offer additional life Insurance coverage options as a solution. You are eligible to enroll in the Voluntary Term Life Insurance program underwritten by The Hartford. This enrollment period is an annual opportunity to increase coverage or elect life insurance if you do not already have coverage. Your premium will be based on the coverage amount you elect and your age. You will be able to elect coverage during the enrollment period. Premiums will be paid through the convenience of payroll deduction Benefit Employee Voluntary Life & AD&D Coverage You can purchase coverage in increments of $10,000 up to the lesser of $500,000 or 5 times salary. New Hires: You will have a guarantee issue amount of $250,000 or 5 times annual salary Late Entrants are Personal Health Application (PHA) Spouse Voluntary Life & AD&D You can purchase coverage in increments of $5,000 to a maximum of $250,000 not to exceed 100% of employee s coverage. New Hires: Spouse elections over $50,000 will require Evidence of Insurability. Late Entrants are Personal Health Application (PHA) Child(ren) Voluntary Life & AD&D You can purchase coverage of $1,000, $5,000 or $10,000 for eligible child(ren) not to exceed 100% of employee s coverage Child(ren) are covered up to age 26. * If you do not elect coverage when initially eligible and later elect coverage, you will be considered a late entrant. Late entrants will be required to complete a Personal Health Application (PHA) form that is satisfactory to the insurance carrier before the coverage can become effective. Additionally, coverage amounts elected over the Guarantee Issue amounts will require a PHA that is satisfactory to the insurance carrier before the excess can become effective.

14 13 Voluntary Life Insurance (con.) Important Terms to Understand The chart shows rates per $1,000. Personal Health Application (PHA): Personal Health Application is a request to verify good health and is often in the form of a questionnaire. This is required when you are requesting insurance that is over the guarantee issue amount or if you are enrolling after your initial enrollment. Guarantee Issue: Guarantee Issue is the amount of life insurance that you can elect without having to provide evidence of insurability. The guarantee issue period is 31 days from the date you first become eligible for the plan from your date of hire. If you choose not to enroll when you are first eligible and enroll at a later date, the entire amount of insurance will be evidence of insurability. Current Employees: Employees with current coverage will be able to increase coverage in increments of $40,000 up to Guarantee Issue amount without Evidence of Insurability Rate per $1,000 Age EE Rate Spouse Rate < Employee AD&D $.02 N/A Child Life Rate is $0.251 per $1000 (all covered children). Basic and Voluntary Life: Employees and Spouse coverage will reduce at age 65 to 65% of the original amount and at age 70 to 50% of the original amount. Age is based on age as of 1/1/2016. Steps to Calculate Voluntary Life Insurance Premium Per Paycheck Step 1: Amount of Voluntary Life Insurance Desired Amount Step 2: Divide amount of Voluntary Life Insurance in Step 1 by $1,000 Step 3: Rate from table based on age (spouse based on employee age) Step 4: Multiply Step 2 by Step 3 Monthly Premium

15 14 Short Term Disability Short Term Disability provided through The Hartford Douglas County School System provides you the option to elect Short Term Disability (STD) income benefits through convenient payroll deductions. Short Term Disability insurance provides you with a portion of your weekly income if you are unable to work or have a reduced income due to an illness or injury unrelated to your occupation. Benefits Voluntary Short Term Disability Percentage of Income Maximum Benefits $1415 Per week Benefits Begin After (Elimination Period) Maximum Benefit Duration 7 Days - Accident 7 Days Sickness 12 Weeks Elimination Period: The elimination period is the length of time of continuous disability which must be satisfied before you are eligible to receive benefits. Exclusions: Benefits will not be payable for any disability caused by: an intentionally self inflicted injury; an act of war (declared or undeclared); commission of a felony; sickness covered by workers compensation or other workers disability law; injury occurring out of or in the course of work for wage or profit. For a comprehensive list of exclusions, limitations, and any applicable benefit offsets, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for coverage and benefits You must be under the regular care of a physician in order to be considered disabled. Short Term Disability Premium Calculation Worksheet Steps to Calculate Short Term Disability Premium Per Paycheck Step 1: Divide your annual salary by 52 Step 2: Multiply weekly salary in step 1 by. If of weekly benefit amount exceeds $1000, then enter $1000 Step 3: Divide weekly benefit amount in step 2 by 10 Step 4: Multiply Step 3 by your rate (.50) Weekly Salary Weekly Benefit Amount Monthly Premium Your short term disability benefit is offset by sick leave not to exceed 100% of your pre-disability income.

16 Long Term Disability 15 Long Term Disability provided through The Hartford Douglas County School System provides you the opportunity to elect Long Term Disability (LTD) income benefits through convenient payroll deductions. Long Term Disability (LTD) insurance is another valuable benefit that protects your financial well-being in the event you are unable to work for more than 90 days. STD and LTD insurance, when combined, provide seamless protection against the financial consequences of a disability. Benefits Voluntary Long Term Disability Percentage of Income Maximum Benefits Benefits Begin After (Elimination Period) Maximum Benefit Duration Pre-Existing Condition Exclusion $5000 Per Month 90 Days- Accident 90 Days- Sickness Social Security Normal Retirement Age (SSNRA) 3/3/12 LIMITATIONS - Limited Benefit Period for Other Specific Conditions 24 months - Mental/Nervous Illness Limitation 24 month out patient - Pre Existing Condition Limitation 3/3/12 - Substance Abuse Limitation 24 months Please note pre existing limitations also apply to benefit increases Rate per $100 Age EE Rate < **Pre-Existing Condition: Your insurance limits the benefits you can receive for pre-existing conditions. In general, if you were diagnosed or received care for a condition before the effective date of your policy, you will be covered for a disability due to that condition only if - You have not received treatment for your condition 3 months before the effective date of your insurance, or - You have been insured under this coverage 12 months prior to your disability commencing, so you can receive benefits even if you re receiving treatment, or - You have already satisfied the pre-existing condition requirement of your previous insurer Long Term Disability Premium Calculation Worksheet Your long term disability benefit is offset by sick leave not to exceed 100% of your predisability income. Steps to Calculate Long Term Disability Premium Per Paycheck Step 1: Divide your annual salary by 12 (If your monthly salary exceeds $ , then use $ ) Step 2: Divide weekly benefit amount in step 2 by $100 Step 3: Multiply Step 3 by your rate Monthly Salary Monthly Premium

17 Voluntary Cancer & Specific Disease Coverage from Allstate Workplace 16 Voluntary cancer and specified disease coverage from Allstate Workplace Division is designed to help with the un-reimbursed medical and non-medical costs associated with the treatment of cancer. Some of these expenses not covered by health insurance may include, but are not limited to: co-payments, s, lost wages for the patient and the caregiver, long distance travel to specialty treatment center, and new or experimental treatment. Plan Highlights: - Benefits are paid directly to the insured unless assigned to the provider - Coverage is available through the convenience of payroll deduction - Plan qualifies for Section 125 pre-tax savings - Wellness claims can be submitted every year for annual cancer screenings - Employees may choose either Individual or Family coverage - Optional non-disease specific Intensive Care coverage may be added - Coverage is portable at the same rate - Guaranteed renewable for life, change of premiums by class Key Features: - $75 or $100 for cancer wellness claims - $2000 or $4000 for cancer Initial Diagnosis other than skin cancer - $200 or $300 per day for Cancer hospitalization - Up to $10,000 of $15,000 every 12 months for Radiation/Chemotherapy - Up to $10,000 every 12 months for new or experimental treatment - Coverage for Skin Cancer -Up to $3000 for inpatient or $4500 for outpatient surgeries A detailed plan brochure explaining your Allstate options is posted on your Bswift home page under My Benefits. This plan information is for information purposes only. Allstate Benefits CAN NOT be elected online you must meet with an Allstate Rep. For more information please call

18 Flexible Spending Account 17 Maximum Annual Election Employees can elect up to the annual maximum benefit set by the employer. Please see below the annual maximum benefit selected by Douglas County School System: HealthCare: $2500 Dependent Care: $5000 A waiting period applies to new hires therefore the Healthcare Flexible Spending Account and/or Dependent Day Care Account can only be elected during Open Enrollment.

19 Disclosure Notices 18 Unless otherwise noted, these Notices are available on the web at: A paper copy is also available, free of charge, by calling ShawHankins at NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS: If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards you or your dependents other coverage). However, you must request enrollment within 30 days after you or your dependents other coverage ends (or after the employer stops contribution toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself or your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. SECTION 125 PRE-TAX BENEFIT AUTHORIZATION NOTICE: Before-tax deductions will lower the amount of income reported to the federal government. This may result in slightly reduced Social Security benefits. If you do not enroll eligible dependents at this time, you may not enroll them until the next open enrollment period. You may not drop the coverage you elected until the next open enrollment period. You may only make a change or drop coverage elections before the next open enrollment period under the following circumstances: A change in marital status, or A change in the number of dependents due to birth, adoption, placement for adoption or death of a dependent, or A change in employment status for myself or my spouse, or Open enrollment elections for my spouse, or A change in dependents eligibility, or A change in residence or worksite. Any change being made must be appropriate and consistent with the event and must be made within 30 days of when the event occurred. All changes are approval by your Employer/Plan. NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION: This Notice describes how the Plan(s) may use and disclose your protected health information ("PHI ) and how you can get access to your information. The privacy of your protected health information that is created, received, used or disclosed by the Plan(s) is protected by the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). This Notice is available on the web at: A paper copy is also available, free of charge, by calling your Employer or ShawHankins at Please note the participant is responsible for providing a copy to their dependents covered under the group health plan." GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS: On April 7, 1986, a federal law was enacted (Public Law 99272, Title X) requiring that most employers sponsoring group health plans offer employees and their families the opportunity for a temporary extension of health coverage (called "continuation coverage") at group rates in certain instances where coverage under the plan would otherwise end. If you or your eligible dependents enroll in the group health benefits available through your Employer you may have access to COBRA continuation coverage under certain circumstances. Therefore, your plan makes available to you and your dependents the General Notice Of COBRA Continuation Coverage Rights. This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it. The full Notice is available on the web at: A paper copy is also available, free of charge, by calling your Employer or ShawHankins at Please note the participant is responsible for providing a copy to their spouse/dependents covered under the group health plan.

20 ShawHankins Call Center 19 The ShawHankins Call Center is here for you Order ID Cards We can contact the insurance carrier directly and have your replacement card in five to seven business days. Claim Resolution and Research We can help you understand your Explanation of Benefits (EOB) as well as contact the insurance carriers on your behalf. We can assist in appealing a denied claim or help you request a Prior Authorization (PA) from your dentist as may be required by your dental carrier. Locate In-Network Providers Staying in network saves everyone money. Our Call Center can help you locate in-network providers whether you are at home or away. Request Copies of Any Necessary Forms We can provide you with out-of-network claim forms, short and long term disability as well as life claims forms if the need should arise. Understanding Your Benefits We can assist you with questions regarding s, copayments and coinsurance. We can explain waiting periods, elimination periods and eligibility rules. Explain Section 125 Cafeteria Plans We can explain qualifying events regulated by the IRS as described in your Summary Plan Description (SPD). We help clarify the time frames and qualifying events allowed by your Plan. Annual Enrollment Information We can give you details about when open enrollment begins and ends and if your plan designs or payroll deductions are changing. Walk Through Enrollment with CSR The Call Center Representative can walk you through every step of the way of the enrollment process. Whether it s a paper enrollment form or an online enrollment portal, your Call Center Representative is available to help. Confirmation Statements We can provide copies of your online enrollment confirmation statement or a copy of your paper enrollment form at any time. The Call Center is available from 8:30 a.m. to 5:00 p.m. Eastern Time Monday through Friday to assist you. We have an after-hours voice mailbox and your call will be returned the next business day. Our Call Center is located in Cartersville, Georgia and is staffed with friendly, knowledgeable individuals ready to answer your questions!

21 Notes 20

22 Contacts Plan Administrator Website Phone Number Benefit/Enrollment Questions ShawHankins Dental MetLife Vision Ameritas (EyeMed) Basic & Voluntary Life The Hartford Short Term Disability The Hartford Long Term Disability The Hartford Flexible Spending TASC About this Guide This guide describes the benefit plans available to you as an eligible Employee of Douglas County School System. The details of these plans are contained in the official Plan Documents, including some insurance contracts. This guide is meant only to cover the major points of each plan. It does not contain all of the details that are included in your Summary Plan Descriptions (SPD) (as described by the Employee Retirement Income Security Act). If there is ever a question about one of these plans, or if there is a conflict between the information in this guide and the formal language of the Plan Documents, the formal wording in the Plan Documents will govern. Please note the benefits described in this guide may be changed at any time and do not represent a contractual obligation on the part of Douglas County School System.