Contact Information. 1. Website:

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2 ContactInformation 1.Website: 2.TollFree: Table of Contents Section 125 Plan Information PG 4-6 Online Enrollment Instructions PG 7-8 Flexible Spending Accounts PG OnlineEnrollmentInstructions p78 ProviderName:FinancialBenefitServices ProviderPhoneNumber: / ProviderWebAddress: TRSMedicalPlanInformation p910 ProviderName:BlueCrossBlueShield ProviderPhoneNumber: ProviderWebAddress: CignaDentalPlanInformation p1112 ProviderName:Cigna PPOProviderPhoneNumber: ProviderWebAddress: PolicyNumber: *MUSTWORK20HOURSORMOREPERWORKWEEKTOBEELIGIBLE* BlockVisionPlanInformation p1314 ProviderName:BlockVision ProviderPhoneNumber: ProviderWebAddress: GroupNumber: *MUSTWORK20HOURSORMOREPERWORKWEEKTOBEELIGIBLE*

3 ContactInformation 1.Website: 2.TollFree: AetnaDisabilityPlanInformation p1520 ProviderName:Aetna ProviderPhoneNumber: ProviderWebAddress: ClaimsPhoneNumber: GroupNumber: *MUSTWORK20HOURSORMOREPERWORKWEEKTOBEELIGIBLE* AetnaLifePlanInformation p2124 ProviderName:Aetna ProviderPhoneNumber: ProviderWebAddress: GroupNumber: *MUSTWORK20HOURSORMOREPERWORKWEEKTOBEELIGIBLE* LoyalAmericanCancerPlanInformation p2531 ProviderName:LoyalAmerican ProviderPhoneNumber: ProviderWebAddress: GroupNumber:1441 *MUSTWORK20HOURSORMOREPERWORKWEEKTOBEELIGIBLE* FlexSpendingAccounts(FSA) p3238 ProviderName:NationalBenefitServices ProviderPhoneNumber: /Fax ProviderWebAddress: *MUSTWORK20HOURSORMOREPERWORKWEEKTOBEELIGIBLE*

4 ContactInformation 1.Website: 2.TollFree: COBRAPlanInformation ProviderName:NationalBenefitServices(NBS) ProviderPhoneNumber: /Fax ProviderWebAddress: 403bPlanInformation ProviderName:NationalBenefitServices(NBS) ProviderPhoneNumber: /Fax ProviderWebAddress:

5 Section125PlanInformation INTRODUCTION In this booklet you will find an overview of the Section 125 Cafeteria plan, along with the voluntary plans available through Financial Benefit Services. WHATISACAFETERIAPLAN? It allows you to deduct certain premium amounts for benefits from your gross earnings before federal withholding taxes are figured. It is a way for you to pay for certain benefits while lowering your taxable income. Please see the following sample paycheck which illustrates the benefit of participating in Section 125. WHATBENEFITSAREAVAILABLE? A summary of available benefits follows. Please read all information carefully and always refer to the brochure on a particular coverage for more detailed information. HOWDOIENROLL? An open enrollment period will take place at approximately the same time each year at which time you may make changes to your benefits or add new benefits. CHANGESTOBENEFITS Mid-year changes in benefit elections can occur only if you experience a family status change, as detailed in this benefit guide. You must present proof of a family status change to your Benefit Office within 30 days of your family status change and meet with Benefit Office staff to complete and sign the necessary paperwork in order to make any benefit election changes.

6 Section125PlanInformation SECTION125PLAN The example below shows how a married employee claiming 1 exemption saves taxes when she pays for her insurance coverage on a pre-tax basis. WITHSECTION125 Monthly Salary $2,000 Less TRS Less Insurance Taxable Income $1,622 Less Taxes TAKE HOME PAY $1,436 ====== WITHOUTSECTION125 Monthly Salary $2,000 Less TRS Taxable Income $1,872 Less Taxes Less Insurance TAKE HOME PAY $1,394 ====== SAVINGS You save $42 per month in taxes by paying for your benefits on a pre-tax basis. This means more spendable income at the end of the month to use for additional benefits or to increase your take home pay.

7 Section125PlanInformation SPECIALRULESREGARDINGSECTION125CAFETERIAPLAN All benefit elections will remain in effect and cannot be revoked or changed during this plan year unless you have one of the following changes in family status: Marriage Divorce Birth Adoption Death Termination or change in employee or spouse s employment (full-time to part-time / part-time to full-time status). Change in eligibility status of a dependent (attains maximum eligibility age) Loss or curtailment in health coverage of employee or spouse due to change in spouse s employment and upon meeting a required eligibility period. New Hires must enroll in benefit elections within 30 days from their date of hire. After 30 days, an employee will not be allowed to enroll in benefits until the next open enrollment period without a family status change. TOLLFREEHELPLINEAVAILABLE In an effort to give you a faster response to questions concerning your benefits, there is a toll-free number to call. If you have a question concerning how your benefits work, how to file a claim, or if you need other policy information, call Financial Benefit Services, LLC at (469) / (800)

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10 PLAN HIGHLIGHTS Effective September 1, 2011 through August 31, 2012 Network Level of Benefits* Deductible (per plan year) Out-of-Pocket Maximum (per plan year; does not include deductible/copays) Coinsurance Plan pays (up to allowable amount) Participant pays (after deductible) Office Visit Copay Participant pays Preventive Care See reverse side for a list of covered services High-tech Radiology (CT scan, MRI, nuclear medicine) Participant pays Inpatient Hospital (facility charges) Participant pays Emergency Room Participant pays Outpatient Surgery Participant pays Prescription Drugs Drug Deductible (per plan year) Retail Short-Term (up to a 30-day supply) Retail Maintenance (after second fill; up to a 30-day supply) Mail Order (up to a 90-day supply) ActiveCare 1-HD ActiveCare 1 ActiveCare 2 ActiveCare 3 $2,400 employee-only $2,400 employee and spouse, employee and child(ren), employee and family $3,000 employee-only $5,000 employee and spouse, employee and child(ren), employee and family 80% 20% 20% after deductible $1,200 per individual $3,000 per family $2,000 per individual $6,000 per family 80% 20% 20% after deductible $750 per individual $2,250 per family $2,000 per individual $6,000 per family 80% 20% $30 for primary $50 for specialist $300 per individual $900 per family $1,000 per individual 80% 20% $20 for primary $30 for specialist Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% 20% after deductible 20% after deductible $100 copay, plus 20% after deductible 20% after deductible 20% after deductible $150 copay per day, plus 20% after deductible ($750 maximum copay per admission; $2,250 maximum copay per plan year) 20% after deductible 20% after deductible $150 copay plus 20% after deductible (copay waived if admitted) 20% after deductible 20% after deductible $150 copay per visit plus 20% after deductible Subject to plan year deductible Participant pays 20% after deductible Participant pays 20% after deductible Participant pays 20% after deductible Subject to plan year deductible Participant pays 20% after deductible Participant pays 20% after deductible Participant pays 20% after deductible $100 copay, plus 20% after deductible $150 copay per day, plus 20% after deductible ($750 maximum copay per admission; $2,250 maximum copay per plan year) $150 copay plus 20% after deductible (copay waived if admitted) $150 copay per visit plus 20% after deductible $100 per person $75 per person Participant pays $15 $35** $60** Participant pays $20 $45** $75** Participant pays $15 $35** $60** Participant pays $20 $45** $75** Participant pays Participant pays $ 45 $ 45 $105** $105** $180** $180** $200 per fill $200 per fill Specialty Drugs Participant pays 20% Participant pays 20% after deductible after deductible Monthly Premium Cost Semi-Monthly Rates: $0.00 $15.00 $69.50 $ Employee Only $287 $325 $ 434 $ 584 $ $ $ $ Employee and Spouse $703 $741 $ 987 $1,328 Employee and Child(ren) $76.50 $448 $ $519 $ $ 690 $ $ 931 Employee and Family*** $ $920 $ $817 $ $1,085 $ $1,461 * ** If the patient obtains a brand-name drug when a generic equivalent is available, the patient will be responsible for the generic copayment plus the cost difference between the brand-name drug and the ***

11 List of Covered Preventive Care Services Effective September 1, 2011, Plans Pay 100% When Using Network Providers* Children and Adolescents Newborns for eyes Immunizations Childhood health screenings throughout development management counseling Adolescent health screenings transmitted infections (STIs) General health screenings screenings Health Counseling Doctors are encouraged to counsel patients about these health issues and refer them to appropriate resources as needed: infections (STIs) disease Immunizations Adults Women Pregnant Women Men screening Cancer screenings occult blood testing, sigmoidoscopy or colonoscopy Note: If you receive preventive services during an office visit, you will be required to pay any applicable coinsurance or copayment if the doctor does not bill or code separately for the service and the primary.

12 CIGNA Dental Benefit Summary Humble ISD Semi-Monthly Receiving regular dental Rates: care can not only catch minor problems before they become major and expensive to treat - it may even help improve your overall health. Gum disease is increasingly being linked to complications for pre-term birth, heart disease, stroke, diabetes, osteoporosis and other Employee health issues. That's Only: why this dental $15.00 plan includes CIGNA Dental WellnessPlus SM features. Employee When you andorchild(ren):$29.50 your family members receive any Employee preventive care and in one Spouse: plan year, the $30.00 annual dollar maximum will increase in the following Employee plan year. and When Family: you or your family $44.00 members remain enrolled in the plan and continue to receive preventive care, the annual dollar maximum will increase in the following plan year, until it reaches the level specified below. Please refer to your plan materials for additional information on this plan feature. Benefits CIGNA Dental PPO In-Network Out-of-Network Network CIGNA DPPO -Core Core Calendar Year Maximum # # Annual Deductible Reimbursement Levels ** Plan Pays You Pay Plan Pays You Pay Class I - Preventive & Diagnostic Care Class II - Basic Restorative Care Class III - Major Restorative Care Class IV - Orthodontia Important Notes

13 CIGNA Dental PPO Exclusions and Limitations Procedure Exclusions and Limitations Benefit Exclusions: This benefit summary highlights some of the benefits available under the proposed plan. A complete description regarding the terms of coverage, exclusions andlimitations, 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 Dental refers to the following operating subsidiaries of CIGNA Corporation: Connecticut General Life Insurance Company, and CIGNA Dental Health, Inc., and its operating subsidiaries and affiliates. The CIGNA Dental Care plan is provided 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., 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, the CIGNA Dental Care plan is underwritten by Connecticut General Life Insurance Company or CIGNA HealthCare of Connecticut, Inc. and administered by CIGNA Dental Health, Inc. The term DHMO is used to refer to product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans, managed care plans, and plans with open access features.the CIGNA Dental PPO is underwritten and/or administered by Connecticut General Life Insurance Company with network management services provided by CIGNA Dental Health, Inc. For Arizona/Louisiana residents the dental PPO plan is known as CG Dental PPO. In Texas, CIGNA Dental's network-based indemnity plan is known as CIGNA Dental Choice. The CIGNA Traditional plan is underwritten or administered by Connecticut General Life Insurance Company. In Arizona and Louisiana, the CIGNA Traditional plan is referred to as CG Traditional.

14 Platinum $130 VISION PLAN with Lasik $10 Exam/$25 Eyewear Copayments Full Service Illustration Service / Material Participating Provider Non-Participating Provider Vision Examination: Frame: Lenses: (Clear, Standard, Glass or Plastic includes scratch resistant and polycarbonate lenses) Contact Lenses:** Laser Vision Correction: Laser Vision Correction in lieu of Frequency: Rates: WE FOCUS ON YOU SO YOU CAN FOCUS ON LIFE FOR MORE INFORMATION PLEASE CONTACT US TOLL-FREE AT (866) OR VISIT OUR WEBSITE AT

15 What plan options are available? How do I enroll in this plan? How do I use this plan? Am I able to obtain eyeglasses and contact lenses in the same year? What is the difference between an Optometrist and Ophthalmologist? How will the Block Vision provider determine what I am eligible to receive? If I wear disposable contact lenses, must I use my entire benefit at one time? What type of eyeglass lenses am I eligible for? What if I have other questions?

16 Benefit Summary Highlights for Humble Independent School District Underwritten by Aetna Life Insurance Company Long Term Disability Insurance Eligibility: Purpose: All active full time employees working 20 hours per week or more. Long Term Disability insurance provides income replacement benefits for you and your family in the event you are unable to work due to an accident or sickness. Maximizing Income Protection Long Term Disability (LTD) Insurance can offer an affordable way for educators and administrators to protect their lifestyles and the people who depend upon them. Employees can choose from a selection of LTD features they feel best match their financial needs. Employees can choose their Monthly Benefit Amount in $100 increments, from $200 to $7,500 (not to exceed 66 2/3% of monthly earnings). Employees can choose from among six accident/sickness Benefit Waiting Periods. A benefit waiting period is the period of time in which an employee must be continuously disabled. Accident Sickness 0 Days 7 Days 14 Days 14 Days 30 Days 30 Days 60 Days 60 Days 90 Days 90 Days 180 Days 180 Days Maximum Benefit Period: Option A: To age 65 for both Accident and Illness Option B: Accident and Sickness for 2 Years Own Occupation Period: 24 Months Any Occupation Period: To Age 65 Limitations & Exclusions: Benefits for Mental/Nervous/Substance Abuse are limited to 2 years. There is a 3/12 pre-existing conditions clause. This is a look back period to see if you were treatment-free for a 3-month period prior to the effective date of your coverage. If you weren t treatment-free, the pre-existing condition is excluded from coverage if you re disabled within 12-months of first becoming insured.

17 Plan Features Maximum Benefit This benefit allows employees to protect their income at higher maxes up to 66 2/3% of their income. Definition of Disability Covers total and partial disability. 1 st Day Hospital Benefit This feature waives the waiting period if an insured is hospitalized. This benefit is included in the 0/7, 14/14, and 30/30 waiting periods. 12 Month Return-to-Work Incentive This benefit gives an employee the opportunity to returnto-work part time earning some income plus receive LTD benefits allowing them to receive up to 100% income replacement during the first 12 months. Deductible Income No offset for Summer Earnings during the first 12 months of Disability. Approved Rehabilitation Program This benefit allows Aetna to pay for an employer s expenses toward work site modifications that result in a disabled employee s return-to-work. Survivor Benefit Pays a lump sum equal to 3 times the non-integrated LTD benefit. Waiver of Premium Payment of premium will be waived for LTD coverage while benefits are payable. Rehabilitation Plan Benefit Will pay for some or all of the expenses incurred by a disabled employee in connection with approved training and education, family care, and job-related and job search expenses. Minimum Benefit 25% of gross maximum Monthly Benefit. Cost: The cost for this benefit is paid by the Employee. The information above highlights some of the features of the Group Policy, but it is not intended to be a detailed description of coverage. If you become insured, you will receive a Certificate of Coverage that will contain more detailed information about the controlling terms and provisions of coverage.

18 LTD Coverage for Educators and Administrators Humble Independent School District Option A: Maximum Benefit to Age 65 Annual Earnings Monthly Earnings Monthly Disability Benefit Accident/Sickness Benefit Waiting Period Cost Per Month , $7.66 $6.12 $5.04 $3.46 $3.00 $2.32 5, $11.49 $9.18 $7.56 $5.19 $4.50 $3.48 7, $15.32 $12.24 $10.08 $6.92 $6.00 $4.64 9, $19.15 $15.30 $12.60 $8.65 $7.50 $ , $22.98 $18.36 $15.12 $10.38 $9.00 $ ,600 1, $26.81 $21.42 $17.64 $12.11 $10.50 $ ,400 1, $30.64 $24.48 $20.16 $13.84 $12.00 $ ,200 1, $34.47 $27.54 $22.68 $15.57 $13.50 $ ,000 1,500 1,000 $38.30 $30.60 $25.20 $17.30 $15.00 $ ,800 1,650 1,100 $42.13 $33.66 $27.72 $19.03 $16.50 $ ,600 1,800 1,200 $45.96 $36.72 $30.24 $20.76 $18.00 $ ,400 1,950 1,300 $49.79 $39.78 $32.76 $22.49 $19.50 $ ,200 2,100 1,400 $53.62 $42.84 $35.28 $24.22 $21.00 $ ,000 2,250 1,500 $57.45 $45.90 $37.80 $25.95 $22.50 $ ,800 2,400 1,600 $61.28 $48.96 $40.32 $27.68 $24.00 $ ,600 2,550 1,700 $65.11 $52.02 $42.84 $29.41 $25.50 $ ,400 2,700 1,800 $68.94 $55.08 $45.36 $31.14 $27.00 $ ,200 2,850 1,900 $72.77 $58.14 $47.88 $32.87 $28.50 $ ,000 3,000 2,000 $76.60 $61.20 $50.40 $34.60 $30.00 $ ,800 3,150 2,100 $80.43 $64.26 $52.92 $36.33 $31.50 $ ,600 3,300 2,200 $84.26 $67.32 $55.44 $38.06 $33.00 $ ,400 3,450 2,300 $88.09 $70.38 $57.96 $39.79 $34.50 $ ,200 3,600 2,400 $91.92 $73.44 $60.48 $41.52 $36.00 $ ,000 3,750 2,500 $95.75 $76.50 $63.00 $43.25 $37.50 $ ,800 3,900 2,600 $99.58 $79.56 $65.52 $44.98 $39.00 $ ,600 4,050 2,700 $ $82.62 $68.04 $46.71 $40.50 $ ,400 4,200 2,800 $ $85.68 $70.56 $48.44 $42.00 $ ,200 4,350 2,900 $ $88.74 $73.08 $50.17 $43.50 $ ,000 4,500 3,000 $ $91.80 $75.60 $51.90 $45.00 $ ,800 4,650 3,100 $ $94.86 $78.12 $53.63 $46.50 $ ,600 4,800 3,200 $ $97.92 $80.64 $55.36 $48.00 $ ,400 4,950 3,300 $ $ $83.16 $57.09 $49.50 $ ,200 5,100 3,400 $ $ $85.68 $58.82 $51.00 $ ,000 5,250 3,500 $ $ $88.20 $60.55 $52.50 $ ,800 5,400 3,600 $ $ $90.72 $62.28 $54.00 $ ,600 5,550 3,700 $ $ $93.24 $64.01 $55.50 $ ,400 5,700 3,800 $ $ $95.76 $65.74 $57.00 $44.08 First Day hospital is included in the 0-7, 14-14, and only. All amounts expressed in dollars.

19 LTD Coverage for Educators and Administrators Humble Independent School District Option A: Maximum Benefit to Age 65 Annual Earnings Monthly Earnings Monthly Disability Benefit Accident/Sickness Benefit Waiting Period Cost Per Month ,200 5,850 3,900 $ $ $98.28 $67.47 $58.50 $ ,000 6,000 4,000 $ $ $ $69.20 $60.00 $ ,800 6,150 4,100 $ $ $ $70.93 $61.50 $ ,600 6,300 4,200 $ $ $ $72.66 $63.00 $ ,400 6,450 4,300 $ $ $ $74.39 $64.50 $ ,200 6,600 4,400 $ $ $ $76.12 $66.00 $ ,000 6,750 4,500 $ $ $ $77.85 $67.50 $ ,800 6,900 4,600 $ $ $ $79.58 $69.00 $ ,600 7,050 4,700 $ $ $ $81.31 $70.50 $ ,400 7,200 4,800 $ $ $ $83.04 $72.00 $ ,200 7,350 4,900 $ $ $ $84.77 $73.50 $ ,000 7,500 5,000 $ $ $ $86.50 $75.00 $ ,800 7,650 5,100 $ $ $ $88.23 $76.50 $ ,600 7,800 5,200 $ $ $ $89.96 $78.00 $ ,400 7,950 5,300 $ $ $ $91.69 $79.50 $ ,200 8,100 5,400 $ $ $ $93.42 $81.00 $ ,000 8,250 5,500 $ $ $ $95.15 $82.50 $ ,800 8,400 5,600 $ $ $ $96.88 $84.00 $ ,600 8,550 5,700 $ $ $ $98.61 $85.50 $ ,400 8,700 5,800 $ $ $ $ $87.00 $ ,200 8,850 5,900 $ $ $ $ $88.50 $ ,000 9,000 6,000 $ $ $ $ $90.00 $ ,800 9,150 6,100 $ $ $ $ $91.50 $ ,600 9,300 6,200 $ $ $ $ $93.00 $ ,400 9,450 6,300 $ $ $ $ $94.50 $ ,200 9,600 6,400 $ $ $ $ $96.00 $ ,000 9,750 6,500 $ $ $ $ $97.50 $ ,800 9,900 6,600 $ $ $ $ $99.00 $ ,600 10,050 6,700 $ $ $ $ $ $ ,400 10,200 6,800 $ $ $ $ $ $ ,200 10,350 6,900 $ $ $ $ $ $ ,000 10,500 7,000 $ $ $ $ $ $ ,800 10,650 7,100 $ $ $ $ $ $ ,600 10,800 7,200 $ $ $ $ $ $ ,400 10,950 7,300 $ $ $ $ $ $ ,200 11,100 7,400 $ $ $ $ $ $ ,000 11,250 7,500 $ $ $ $ $ $87.00 First Day hospital is included in the 0-7, 14-14, and only. All amounts expressed in dollars.

20 LTD Coverage for Educators and Administrators Humble Independent School District Option B: Maximum Benefit 2 Years Annual Earnings Monthly Earnings Monthly Disability Benefit Accident/Sickness Benefit Waiting Period Cost Per Month , $6.10 $4.68 $3.48 $1.78 $1.54 $1.20 5, $9.15 $7.02 $5.22 $2.67 $2.31 $1.80 7, $12.20 $9.36 $6.96 $3.56 $3.08 $2.40 9, $15.25 $11.70 $8.70 $4.45 $3.85 $ , $18.30 $14.04 $10.44 $5.34 $4.62 $ ,600 1, $21.35 $16.38 $12.18 $6.23 $5.39 $ ,400 1, $24.40 $18.72 $13.92 $7.12 $6.16 $ ,200 1, $27.45 $21.06 $15.66 $8.01 $6.93 $ ,000 1,500 1,000 $30.50 $23.40 $17.40 $8.90 $7.70 $ ,800 1,650 1,100 $33.55 $25.74 $19.14 $9.79 $8.47 $ ,600 1,800 1,200 $36.60 $28.08 $20.88 $10.68 $9.24 $ ,400 1,950 1,300 $39.65 $30.42 $22.62 $11.57 $10.01 $ ,200 2,100 1,400 $42.70 $32.76 $24.36 $12.46 $10.78 $ ,000 2,250 1,500 $45.75 $35.10 $26.10 $13.35 $11.55 $ ,800 2,400 1,600 $48.80 $37.44 $27.84 $14.24 $12.32 $ ,600 2,550 1,700 $51.85 $39.78 $29.58 $15.13 $13.09 $ ,400 2,700 1,800 $54.90 $42.12 $31.32 $16.02 $13.86 $ ,200 2,850 1,900 $57.95 $44.46 $33.06 $16.91 $14.63 $ ,000 3,000 2,000 $61.00 $46.80 $34.80 $17.80 $15.40 $ ,800 3,150 2,100 $64.05 $49.14 $36.54 $18.69 $16.17 $ ,600 3,300 2,200 $67.10 $51.48 $38.28 $19.58 $16.94 $ ,400 3,450 2,300 $70.15 $53.82 $40.02 $20.47 $17.71 $ ,200 3,600 2,400 $73.20 $56.16 $41.76 $21.36 $18.48 $ ,000 3,750 2,500 $76.25 $58.50 $43.50 $22.25 $19.25 $ ,800 3,900 2,600 $79.30 $60.84 $45.24 $23.14 $20.02 $ ,600 4,050 2,700 $82.35 $63.18 $46.98 $24.03 $20.79 $ ,400 4,200 2,800 $85.40 $65.52 $48.72 $24.92 $21.56 $ ,200 4,350 2,900 $88.45 $67.86 $50.46 $25.81 $22.33 $ ,000 4,500 3,000 $91.50 $70.20 $52.20 $26.70 $23.10 $ ,800 4,650 3,100 $94.55 $72.54 $53.94 $27.59 $23.87 $ ,600 4,800 3,200 $97.60 $74.88 $55.68 $28.48 $24.64 $ ,400 4,950 3,300 $ $77.22 $57.42 $29.37 $25.41 $ ,200 5,100 3,400 $ $79.56 $59.16 $30.26 $26.18 $ ,000 5,250 3,500 $ $81.90 $60.90 $31.15 $26.95 $ ,800 5,400 3,600 $ $84.24 $62.64 $32.04 $27.72 $ ,600 5,550 3,700 $ $86.58 $64.38 $32.93 $28.49 $ ,400 5,700 3,800 $ $88.92 $66.12 $33.82 $29.26 $22.80 First Day hospital is included in the 0-7, 14-14, and only. All amounts expressed in dollars.

21 LTD Coverage for Educators and Administrators Humble Independent School District Option B: Maximum Benefit 2 Years Annual Earnings Monthly Earnings Monthly Disability Benefit Accident/Sickness Benefit Waiting Period Cost Per Month ,200 5,850 3,900 $ $91.26 $67.86 $34.71 $30.03 $ ,000 6,000 4,000 $ $93.60 $69.60 $35.60 $30.80 $ ,800 6,150 4,100 $ $95.94 $71.34 $36.49 $31.57 $ ,600 6,300 4,200 $ $98.28 $73.08 $37.38 $32.34 $ ,400 6,450 4,300 $ $ $74.82 $38.27 $33.11 $ ,200 6,600 4,400 $ $ $76.56 $39.16 $33.88 $ ,000 6,750 4,500 $ $ $78.30 $40.05 $34.65 $ ,800 6,900 4,600 $ $ $80.04 $40.94 $35.42 $ ,600 7,050 4,700 $ $ $81.78 $41.83 $36.19 $ ,400 7,200 4,800 $ $ $83.52 $42.72 $36.96 $ ,200 7,350 4,900 $ $ $85.26 $43.61 $37.73 $ ,000 7,500 5,000 $ $ $87.00 $44.50 $38.50 $ ,800 7,650 5,100 $ $ $88.74 $45.39 $39.27 $ ,600 7,800 5,200 $ $ $90.48 $46.28 $40.04 $ ,400 7,950 5,300 $ $ $92.22 $47.17 $40.81 $ ,200 8,100 5,400 $ $ $93.96 $48.06 $41.58 $ ,000 8,250 5,500 $ $ $95.70 $48.95 $42.35 $ ,800 8,400 5,600 $ $ $97.44 $49.84 $43.12 $ ,600 8,550 5,700 $ $ $99.18 $50.73 $43.89 $ ,400 8,700 5,800 $ $ $ $51.62 $44.66 $ ,200 8,850 5,900 $ $ $ $52.51 $45.43 $ ,000 9,000 6,000 $ $ $ $53.40 $46.20 $ ,800 9,150 6,100 $ $ $ $54.29 $46.97 $ ,600 9,300 6,200 $ $ $ $55.18 $47.74 $ ,400 9,450 6,300 $ $ $ $56.07 $48.51 $ ,200 9,600 6,400 $ $ $ $56.96 $49.28 $ ,000 9,750 6,500 $ $ $ $57.85 $50.05 $ ,800 9,900 6,600 $ $ $ $58.74 $50.82 $ ,600 10,050 6,700 $ $ $ $59.63 $51.59 $ ,400 10,200 6,800 $ $ $ $60.52 $52.36 $ ,200 10,350 6,900 $ $ $ $61.41 $53.13 $ ,000 10,500 7,000 $ $ $ $62.30 $53.90 $ ,800 10,650 7,100 $ $ $ $63.19 $54.67 $ ,600 10,800 7,200 $ $ $ $64.08 $55.44 $ ,400 10,950 7,300 $ $ $ $64.97 $56.21 $ ,200 11,100 7,400 $ $ $ $65.86 $56.98 $ ,000 11,250 7,500 $ $ $ $66.75 $57.75 $45.00 First Day hospital is included in the 0-7, 14-14, and only. All amounts expressed in dollars.

22 Benefit Summary Highlight for Humble Independent School District Group Voluntary Term Life Insurance Coverage Election Options Employee Benefit: Choice of 1-5 times basic annual earnings to a maximum of $750,000 Guarantee Issue: The lesser of 5 times salary or $200,000 Spouse Benefit: 50% of EE Benefit up to $375,000 Guarantee Issue: $30,000 Child(ren) Benefit: $5,000 or $10,000 (not to exceed 50% of employees amount) Guarantee Issue: $10,000 ** Evidence of Insurability required for all late entrants and amounts over the Guarantee Issue** Benefit Highlights Accelerated Benefit: If you become terminally ill with a life expectancy of 12 months or less, you may receive 75% of your life benefit before you die. Waiver of Premium: Your life insurance will be continued to age 65 and premiums will be Waived if you are totally disabled before the age of 60. Benefit Reductions: 35% at age 65 50% at age 70 Portability: You may continue you Life Insurance at group rates if your employment terminates.

23 How to Determine Your Cost Employee & Spouse: Cost is based on your age and the amount of coverage you elect. Employee and Spouse coverage cost is a factor of your age and elected amount. o Monthly Cost = Rate x Benefit / 1,000 o Premium adjustments due to changes in age will be made annually. EMPLOYEE & SPOUSE YOUR AGE MONTHLY RATE per $1,000 COVERAGE Less than 24 years $ $ $ $ $ $ $ $ $ $ $2.060 Child(ren) coverage cost is $0.40 per month for $5,000 of coverage or $0.80 per month for $10,000 of coverage.

24 HUMBLE INDEPENDENT SCHOOL DISTRICT Employee & Spouse Monthly Cost Calculations Rate: Election < $10,000 $0.40 $0.60 $0.70 $0.80 $1.40 $2.30 $3.30 $5.90 $11.80 $20.60 $20,000 $0.80 $1.20 $1.40 $1.60 $2.80 $4.60 $6.60 $11.80 $23.60 $41.20 $30,000 $1.20 $1.80 $2.10 $2.40 $4.20 $6.90 $9.90 $17.70 $35.40 $61.80 $40,000 $1.60 $2.40 $2.80 $3.20 $5.60 $9.20 $13.20 $23.60 $47.20 $82.40 $50,000 $2.00 $3.00 $3.50 $4.00 $7.00 $11.50 $16.50 $29.50 $59.00 $ $60,000 $2.40 $3.60 $4.20 $4.80 $8.40 $13.80 $19.80 $35.40 $70.80 $ $70,000 $2.80 $4.20 $4.90 $5.60 $9.80 $16.10 $23.10 $41.30 $82.60 $ $80,000 $3.20 $4.80 $5.60 $6.40 $11.20 $18.40 $26.40 $47.20 $94.40 $ $90,000 $3.60 $5.40 $6.30 $7.20 $12.60 $20.70 $29.70 $53.10 $ $ $100,000 $4.00 $6.00 $7.00 $8.00 $14.00 $23.00 $33.00 $59.00 $ $ $110,000 $4.40 $6.60 $7.70 $8.80 $15.40 $25.30 $36.30 $64.90 $ $ $120,000 $4.80 $7.20 $8.40 $9.60 $16.80 $27.60 $39.60 $70.80 $ $ $130,000 $5.20 $7.80 $9.10 $10.40 $18.20 $29.90 $42.90 $76.70 $ $ $140,000 $5.60 $8.40 $9.80 $11.20 $19.60 $32.20 $46.20 $82.60 $ $ $150,000 $6.00 $9.00 $10.50 $12.00 $21.00 $34.50 $49.50 $88.50 $ $ $160,000 $6.40 $9.60 $11.20 $12.80 $22.40 $36.80 $52.80 $94.40 $ $ $170,000 $6.80 $10.20 $11.90 $13.60 $23.80 $39.10 $56.10 $ $ $ $180,000 $7.20 $10.80 $12.60 $14.40 $25.20 $41.40 $59.40 $ $ $ $190,000 $7.60 $11.40 $13.30 $15.20 $26.60 $43.70 $62.70 $ $ $ $200,000 $8.00 $12.00 $14.00 $16.00 $28.00 $46.00 $66.00 $ $ $ $210,000 $8.40 $12.60 $14.70 $16.80 $29.40 $48.30 $69.30 $ $ $ $220,000 $8.80 $13.20 $15.40 $17.60 $30.80 $50.60 $72.60 $ $ $ $230,000 $9.20 $13.80 $16.10 $18.40 $32.20 $52.90 $75.90 $ $ $ $240,000 $9.60 $14.40 $16.80 $19.20 $33.60 $55.20 $79.20 $ $ $ $250,000 $10.00 $15.00 $17.50 $20.00 $35.00 $57.50 $82.50 $ $ $ $260,000 $10.40 $15.60 $18.20 $20.80 $36.40 $59.80 $85.80 $ $ $ $270,000 $10.80 $16.20 $18.90 $21.60 $37.80 $62.10 $89.10 $ $ $ $280,000 $11.20 $16.80 $19.60 $22.40 $39.20 $64.40 $92.40 $ $ $ $290,000 $11.60 $17.40 $20.30 $23.20 $40.60 $66.70 $95.70 $ $ $ $300,000 $12.00 $18.00 $21.00 $24.00 $42.00 $69.00 $99.00 $ $ $ $310,000 $12.40 $18.60 $21.70 $24.80 $43.40 $71.30 $ $ $ $ $320,000 $12.80 $19.20 $22.40 $25.60 $44.80 $73.60 $ $ $ $ $330,000 $13.20 $19.80 $23.10 $26.40 $46.20 $75.90 $ $ $ $ $340,000 $13.60 $20.40 $23.80 $27.20 $47.60 $78.20 $ $ $ $ $350,000 $14.00 $21.00 $24.50 $28.00 $49.00 $80.50 $ $ $ $ $360,000 $14.40 $21.60 $25.20 $28.80 $50.40 $82.80 $ $ $ $ $370,000 $14.80 $22.20 $25.90 $29.60 $51.80 $85.10 $ $ $ $ $380,000 $15.20 $22.80 $26.60 $30.40 $53.20 $87.40 $ $ $ $ $390,000 $15.60 $23.40 $27.30 $31.20 $54.60 $89.70 $ $ $ $ $400,000 $16.00 $24.00 $28.00 $32.00 $56.00 $92.00 $ $ $ $ $410,000 $16.40 $24.60 $28.70 $32.80 $57.40 $94.30 $ $ $ $ $420,000 $16.80 $25.20 $29.40 $33.60 $58.80 $96.60 $ $ $ $ $430,000 $17.20 $25.80 $30.10 $34.40 $60.20 $98.90 $ $ $ $ $440,000 $17.60 $26.40 $30.80 $35.20 $61.60 $ $ $ $ $906.40

25 HUMBLE INDEPENDENT SCHOOL DISTRICT Employee & Spouse Monthly Cost Calculations Rate: Election < $460,000 $18.40 $27.60 $32.20 $36.80 $64.40 $ $ $ $ $ $470,000 $18.80 $28.20 $32.90 $37.60 $65.80 $ $ $ $ $ $480,000 $19.20 $28.80 $33.60 $38.40 $67.20 $ $ $ $ $ $490,000 $19.60 $29.40 $34.30 $39.20 $68.60 $ $ $ $ $1, $500,000 $20.00 $30.00 $35.00 $40.00 $70.00 $ $ $ $ $1, $510,000 $20.40 $30.60 $35.70 $40.80 $71.40 $ $ $ $ $1, $520,000 $20.80 $31.20 $36.40 $41.60 $72.80 $ $ $ $ $1, $530,000 $21.20 $31.80 $37.10 $42.40 $74.20 $ $ $ $ $1, $540,000 $21.60 $32.40 $37.80 $43.20 $75.60 $ $ $ $ $1, $550,000 $22.00 $33.00 $38.50 $44.00 $77.00 $ $ $ $ $1, $560,000 $22.40 $33.60 $39.20 $44.80 $78.40 $ $ $ $ $1, $570,000 $22.80 $34.20 $39.90 $45.60 $79.80 $ $ $ $ $1, $580,000 $23.20 $34.80 $40.60 $46.40 $81.20 $ $ $ $ $1, $590,000 $23.60 $35.40 $41.30 $47.20 $82.60 $ $ $ $ $1, $600,000 $24.00 $36.00 $42.00 $48.00 $84.00 $ $ $ $ $1, $610,000 $24.40 $36.60 $42.70 $48.80 $85.40 $ $ $ $ $1, $620,000 $24.80 $37.20 $43.40 $49.60 $86.80 $ $ $ $ $1, $630,000 $25.20 $37.80 $44.10 $50.40 $88.20 $ $ $ $ $1, $640,000 $25.60 $38.40 $44.80 $51.20 $89.60 $ $ $ $ $1, $650,000 $26.00 $39.00 $45.50 $52.00 $91.00 $ $ $ $ $1, $660,000 $26.40 $39.60 $46.20 $52.80 $92.40 $ $ $ $ $1, $670,000 $26.80 $40.20 $46.90 $53.60 $93.80 $ $ $ $ $1, $680,000 $27.20 $40.80 $47.60 $54.40 $95.20 $ $ $ $ $1, $690,000 $27.60 $41.40 $48.30 $55.20 $96.60 $ $ $ $ $1, $700,000 $28.00 $42.00 $49.00 $56.00 $98.00 $ $ $ $ $1, $710,000 $28.40 $42.60 $49.70 $56.80 $99.40 $ $ $ $ $1, $720,000 $28.80 $43.20 $50.40 $57.60 $ $ $ $ $ $1, $730,000 $29.20 $43.80 $51.10 $58.40 $ $ $ $ $ $1, $740,000 $29.60 $44.40 $51.80 $59.20 $ $ $ $ $ $1, $750,000 $30.00 $45.00 $52.50 $60.00 $ $ $ $ $ $1,545.00

26 A New Dimension in Supplemental Cancer Insurance Administrative Office: P.O. Box 1604 Duncan, OK Toll Free: National Marketing Office - Worksite: P.O. Box Kansas City, MO Toll Free: A Promise In an era where many financial services companies are concerned with bottom- line results at the expense of customer service and loyalty, we come from the old school. We take great pride in providing the finest services to our employer groups, policyholders, business associates, agents - to everyone with whom we come in contact. The following is not an exhaustive list of terms and conditions but only serves as a depiction of benefits and exclusions. Interested parties should consult the contract for a complete listing of terms and conditions. LG-6040-AD (08/10)

27 BASE POLICY BENEFITS BENEFIT PROVISIONS. We will pay the benefits described in the Certificate for the treatment of an Insured Person s Cancer, provided he or she is covered under an issued Certificate which remains in force. Payment will be made in accordance with all applicable policy provisions. Benefits are payable for a positive diagnosis that begins after the Effective Date. The positive diagnosis must be for Cancer as defined in the policy. 1. POSITIVE DIAGNOSIS BENEFIT. We will pay the Actual Charge but not to exceed $300 per Calendar Year for one test that confirms the Positive Diagnosis of Cancer in an Insured Person. This benefit is not payable for multiple diagnoses of the same Cancer or for Cancer that metastasizes or for recurrence of the same Cancer. 2. NATIONAL CANCER INSTITUTE DESIGNATED COMPREHENSIVE CANCER TREATMENT CENTER EVALUATION/CONSULTATION BENEFIT We will pay the Actual Charge, but not to exceed a lifetime maximum of $750, if an Insured Person is diagnosed with Internal Cancer and seeks evaluation or consultation from a National Cancer Institute designated Comprehensive Cancer Treatment Center. If the Comprehensive Cancer Treatment Center is located more than 30 miles from the Insured Person s place of residence, We will also pay the transportation and lodging expenses incurred but not to exceed a lifetime maximum of $350. This benefit is not payable on the same day a Second or Third Surgical Opinion Benefit is payable and is in lieu of the Non-Local Transportation and Lodging Expense Benefits of the Policy. This benefit is payable one time during the lifetime of the Insured Person. 3. SECOND AND THIRD SURGICAL OPINION EXPENSE BENEFIT We will pay the Actual Charge for a written second surgical opinion concerning the recommendation of Cancer surgery and if the second surgical opinion is in conflict with that of the Physician originally recommending the surgery and the Insured Person desires a third opinion, We will the Actual Charge for a written third surgical opinion. The Physician providing the second or third surgical opinion cannot be associated with the Physician who originally recommended the surgery. This benefit is not payable the same day the National Cancer Institute Evaluation/Consulting Benefit is payable. 4. MEDICAL IMAGING, TREATMENT PLANNING AND MONITORING EXPENSE BENEFIT We will pay the Actual Charge, but not to exceed $1,000 per Calendar Year, for laboratory tests, diagnostic X-rays, medical images, when used in Cancer treatment plannings related to Radiation Treatment, Chemotherapy or Immunotherapy. 5. ANTI-NAUSEA MEDICATION EXPENSE BENEFIT We will pay the Actual Charge for anti-nausea medication, but not to exceed $150 per calendar month, when an Insured Person is prescribed such medication as the result of Radiation Treatment, Chemotherapy or Immunotherapy treatments for Cancer. 6. COLONY STIMULATING FACTOR OR IMMUNOGLOBULIN EXPENSE BENEFIT We will pay the Actual Charge but not to exceed $1,000 per Calendar Month for Colony Stimulating Factor Drugs or Immunoglobulins prescribed by a Physician or Oncologist during an Insured Person s Cancer treatment regimen for which benefits are payable under the Radiation, Chemotherapy and Immunotherapy Benefit of this Policy or rider attached to it. 7. OUTPATIENT HOSPITAL OR AMBULATORY SURGICAL CENTER EXPENSE BENEFIT We will pay the Actual Charge from an Ambulatory Surgical Center or Outpatient department of a Hospital for the use of its facilities for the performance of a surgical procedure covered under this Policy but not to exceed $350 per day. 8. PROSTHESIS EXPENSE BENEFIT (A.) Surgically Implanted Breast Prosthesis We will pay the Actual Charge for a surgically implanted prosthetic device required and prescribed to restore normal body contour lost as the direct result of an Insured Person s breast removal for the treatment of Cancer. The Surgically Implanted Breast Prosthesis Benefit does not include coverage for breast reconstruction surgery which may be covered under the Surgical Schedule within the Surgical and Anesthesia Benefits Rider. (B.) Non-Surgically Implanted Prosthesis We will pay the Actual Charge incurred not to exceed $2,000 per amputation for an artificial limb or other non-surgically implanted prosthetic device that is prescribed and required to restore normal body function lost as the direct result of an Insured Person s amputation for the treatment of Cancer. We will pay a lifetime maximum of $2,000 per amputation. The cost of replacement of a prosthetic device is not covered. Hairpieces or wigs are not covered under this benefit. 9. NON-LOCAL TRANSPORTATION EXPENSE BENEFIT We will pay the Actual Charge, but not to exceed the coach fare on a Common Carrier for the Insured Person and one adult companion s travel to a Hospital, Radiation Therapy Treatment Center, Chemotherapy Treatment Center, Oncology Clinic or any other specialized treatment center where the Insured Person receives treatment for Cancer. This benefit is payable only if the treatment is not available Locally but is available Non-Locally. The adult companion may include the live donor of bone marrow or stem cells used in a bone marrow or stem cell transplant for the Insured Person. At the option of the Insured Person, We will pay a single private vehicle mileage allowance of $.50 per mile for Non-Local transportation in lieu of the common carrier coach fare.

28 10. LODGING EXPENSE BENEFIT We will pay the Actual Charge not to exceed $75 per day for a room in a motel, hotel or other appropriate lodging facility (other than a private residence), when an Insured Person receives treatment for Cancer at a Non-Local Hospital, Radiation Therapy Treatment Center, Chemotherapy Treatment Center, Oncology Clinic or any other specialized treatment center. The room must be occupied by the Insured Person or an adult companion which may include the live donor of bone marrow or stem cells used in a bone marrow or stem cell transplant for the Insured Person. This benefit is not payable for lodging expense incurred more than 24 hours before the treatment nor for lodging expense incurred more than 24 hours following treatment. This benefit is limited to 100 days per Calendar Year. 11. INPATIENT BLOOD, PLASMA AND PLATELETS EXPENSE BENEFIT We will pay the Actual Charge not to exceed $300 per day for the procurement cost, administration, processing and cross matching of blood, plasma or platelets administered to an Insured Person in the treatment of Cancer while an Inpatient. 12. OUTPATIENT BLOOD, PLASMA AND PLATELETS EXPENSE BENEFIT We will pay the Actual Charge not to exceed $300 per day for the procurement cost, administration, processing and cross matching of blood, plasma or platelets administered to an Insured Person in the treatment of Cancer while an Outpatient. 13. BONE MARROW DONOR EXPENSE BENEFIT We will pay the Daily Hospital Confinement Benefit shown on the Certificate Schedule for each day a live donor, other than the Insured Person, is confined in a Hospital for the harvesting of bone marrow or stem cells used in a bone marrow or stem cell transplant for the treatment of an Insured Person s Cancer. 14. BONE MARROW OR STEM CELL TRANSPLANT EXPENSE BENEFIT We will pay the Actual Charge not to exceed a lifetime maximum of $15,000 for surgical and anesthesia procedures (including the harvesting and subsequent re-infusion of blood cells or peripheral stem cells) performed for a bone marrow transplant and/or a peripheral stem cell transplant for the treatment of an Insured Person s Cancer. This benefit will be paid in lieu of the Surgical Expense Benefit and the Anesthesia Expense Benefit which may be described in a rider attached to an issued Certificate. 15. AMBULANCE EXPENSE BENEFIT We will pay the Actual Charge for ambulance service if an Insured Persons is transported to a Hospital where he or she is admitted as an inpatient for the treatment of Cancer. The ambulance service must be provided by a licensed professional ambulance company or an ambulance owned by the Hospital. 16. INPATIENT OXYGEN EXPENSE BENEFIT We will pay the Actual Charge not to exceed $300 per Hospital confinement for oxygen prescribed by a Physician and received by an Insured Person while confined in a Hospital for the treatment of Cancer. 17. ATTENDING PHYSICIAN EXPENSE BENEFIT We will pay the Actual Charge not to exceed $40 per day for the professional services of a Physician or Oncologist rendered to an Insured Person while he or she is confined in a Hospital for the treatment of Cancer. This benefit is payable only if the Physician or Oncologist personally visits the Hospital room occupied by the Insured Person and the amount stated is the maximum amount that will be payable for each day of Hospital confinement regardless of the number of visits made by one or more Physicians or Oncologists. 18. INPATIENT PRIVATE DUTY NURSING EXPENSE BENEFIT We will pay the Actual Charge not to exceed $150 per day for the full time service of a Nurse that is required and ordered by a Physician when an Insured Person is confined in a Hospital for the treatment of Cancer. The Nurse must provide services other than those normally provided by the Hospital and the Nurse may not be an employee of the Hospital or an Immediate Family Member of the Insured Person. 19. OUTPATIENT PRIVATE DUTY NURSING EXPENSE BENEFIT We will pay the Actual Charge not to exceed $150 per day limited to the same number of days of the prior Hospital confinement for the full time service of a Nurse that is required and ordered by a Physician when an Insured Person is confined indoors at home as the result of Cancer. This benefit is not payable if the services of the Nurse are custodial in nature or to assist the Insured Person in the activities of daily living. This benefit is not payable when the Nurse is a member of the Insured Person s Immediate Family. Charges must begin following a period of Hospital confinement for which benefits are payable under this Certificate. 20. CONVALESCENT CARE FACILITY EXPENSE BENEFIT We will pay the Actual Charge not to exceed $100 per day for an Insured Person s confinement in a Convalescent Care Facility. The maximum number of days for which this benefit is payable will be the number of days in the last Period of Hospital Confinement that immediately preceded admission to a Convalescent Care Facility. The Convalescent Care Facility Confinement must: be due to Cancer ; begin within 14 days after the Insured Person has been discharged from a Hospital for the treatment of Cancer ; be authorized by a Physician as being medically necessary for the treatment of Cancer. 21. RENTAL OR PURCHASE OF MEDICAL EQUIPMENT EXPENSE BENEFIT We will pay the lesser of the Actual Charge not to exceed $1,500 per Calendar Year for either the rental or purchase of covered medical equipment designed for home use, required and ordered by the Insured Person s attending Physician as the direct result of the treatment of Cancer. Covered medical equipment includes wheel chair, oxygen equipment, respirator, braces, crutches or hospital bed.

29 22. HOME HEALTH CARE EXPENSE BENEFIT We will pay benefits for the following Covered Charges when a Insured Person requires Home Health Care for the treatment of Cancer. 1. Home Health Care Visits - We will pay the Actual Charge for Home Health Care Visits not to exceed $75 for each day on which one or more such visits occur. We will not pay this benefit for more than 60 days in any Calendar Year. 2. Medicine and Supplies - We will pay the Actual Charge not to exceed $450 in any Calendar Year for drugs, medicine, and medical supplies provided by or on behalf of a Home Health Care Agency. 3. Services of a Nutritionist - We will pay the Actual Charge not to exceed a lifetime maximum of $300 for the services of a nutritionist to set up programs for special dietary needs. 23. HOSPICE CARE EXPENSE BENEFIT We will pay the Actual Charge for Hospice Care not to exceed $100 per day, when such care is required because of Cancer. This benefit is payable whether confinement is required in a Hospice Center or services are provided in the Insured Person s home by a Hospice Team. Eligibility for payments will be based on the following conditions being met:(1) the Insured Person has been given a prognosis as being Terminally Ill with an estimated life expectancy of 6 months or less; and (2) We have received a written summary of such prognosis from the attending Physician. We will not pay this benefit while the Insured Person is confined to a Hospital or Convalescent Care Facility. The lifetime maximum benefit is 365 days of Hospice Care 24. HAIRPIECE EXPENSE BENEFIT We will pay the Actual Charge not to exceed a lifetime maximum of $150 for the purchase of a wig or hairpiece that is required as the direct result of hair loss due to Cancer treatment. 25. PHYSICAL, SPEECH, AUDIO THERAPY AND PSYCHOTHERAPY EXPENSE BENEFIT We will pay the Actual Charge not to exceed $25 per therapy session for: 1. Physical therapy treatments given by a license Physical Therapist, or 2. Speech therapy given by a licensed Speech Pathologist/Therapist; or 3. Audio therapy given by a licensed Audiologist; or 4. Psychotherapy given by a licensed Psychologist. These sessions may be given at an institute of physical medicine and rehabilitation, a Hospital, or the Insured Person s home. These treatments must be given on an Outpatient basis unless the primary purpose of a Hospital confinement is for treatment of Cancer other than with physical, speech or audio therapy or psychotherapy. Benefits may not exceed $1,000 per Calendar Year. 26. WAIVER OF PREMIUM. We will waive the premiums starting on the first premium due date following a 60 day period of Total Disability of the Named Insured due to Cancer. The Named Insured must: (a) be receiving treatment for such Cancer for which benefits are payable under this Certificate; and (b) remain disabled for 60 consecutive days. We will waive premiums for as long as the Named Insured remains Totally Disabled. THIS IS A CANCER ONLY POLICY, which should be used to supplement your existing health care protection. RENEWABILITY. Coverage will terminate when the Group Master Policy terminates or when required premium remains unpaid after expiration of the Grace Period. PREMIUM RATES. We may change the premium rates for coverage only if we also change the rates for all other Certificates issued under the Group Master Policy. EXCLUSIONS AND LIMITATIONS. No benefits will be paid under the Certificate or any attached riders for: 1. any loss due to any disease or illness other than Cancer, or a listed covered Specified Disease; 2. care and treatment received outside the territorial limits of the United States; 3. treatment by any program engaged in research that does not meet the criteria for Experimental Treatment as defined; 4. treatment that has not been approved by a Physician as being medically necessary; or 5. losses or medical expenses incurred prior to the Certificate Effective Date of an Insured Person s coverage regardless of the Date of Positive Diagnosis. PRE-EXISTING CONDITIONS LIMITATION. Relative to any Insured Person, We will not pay benefits for expenses resulting from Pre-existing Conditions during the 12 months after coverage becomes effective. Pre-existing Condition means Cancer, or a listed Specified Disease if that optional rider is issued, which was diagnosed by a Physician or for which medical consultation, advice or treatment was recommended by or received from or sought from a Physician within 1 year prior to the effective date of coverage for each Insured Person. Insurance coverage is provided by form number series LG-6040 and associated riders. This advertisement highlights some features of the Certificate and riders, but is not the insurance contract. An issued Master Group Policy, Certificate and riders set forth, in detail, the rights and obligations of both the insured and the insurance company. Please read the policy, certificate and riders for detailed coverage information.

30 We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule, once per calendar year per Insured Person for screening tests performed to determine whether Cancer exists in an Insured Person. Covered annual Cancer screening tests include but are not limited to: mammogram, pap smear, breast ultrasound, ThinPrep, biopsy, chest x-ray, thermography, colonoscopy, flexible sigmoidoscopy, hemocult stool specimen, PSA (blood test for prostate cancer), CEA (blood tests for colon cancer), CA125 (blood test for ovarian cancer), CA15-3 (blood test for breast cancer), serum protein electrophesis (blood test for myeloma). We will pay the expense incurred, but not to exceed two times the maximum benefit amount per calendar year as shown on the Certificate Schedule, for one additional invasive diagnostic procedure required as the result of an abnormal cancer screening test for which benefits are payable under the Basic Benefit above for an Insured Person. This additional benefit is payable regardless of the results of the additional diagnostic procedure. However, the amount payable will be reduced dollar for dollar for any amount payable under the Positive Diagnosis Benefit contained in the base Certificate. If an Insured Person receives a positive diagnosis of Internal Cancer, We will pay the First Occurrence benefit amount shown on the Certificate Schedule. If the Insured Person receiving the positive diagnosis of Internal Cancer is a child under the age of 21, we will pay one and one-half times the First Occurrence benefit amount shown on the Certificate Schedule. We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule for each day that an Insured Person receives one or more of the following treatments for Cancer: (1) Chemotherapy (including Hormonal Therapy) or Immunotherapy; (2) Self-injected Chemotherapy or Immunotherapy drugs, limited to the maximum daily benefit amount per treatment; (3) Chemotherapy or Immunotherapy drugs dispensed by a pump or implant, limited to the maximum daily benefit amount for the initial prescription and an equal amount for each refill; (4) Oral Chemotherapy or Immunotherapy, limited to the maximum daily benefit amount per prescription; (5) Radiation Treatment. Benefits payable for interstitial or intracavitary applications of Radiation Treatments are payable on the day of insertion only and not for each day the Radiation Treatment remains in the body; or (6) Experimental Treatment. The benefit amount shown on the Certificate Schedule is the maximum daily benefit available per Insured Person regardless of the number or types of Cancer treatments received on the same day. $ We will pay the Surgical Expense benefit for a surgical procedure for the treatment of an Insured Person s Cancer (except Skin Cancer) according to the Surgical Schedule shown in this rider. However, in no event will the amount payable exceed the maximum Surgical Expense benefit shown on the Certificate Schedule, nor will it exceed the expense incurred. We will pay the anesthesia expense incurred, not to exceed 25% of the covered Surgical Expense benefit for the operation performed. This includes the services of an anesthesiologist or of an anesthetist under supervision of a physician for the purpose of administering anesthesia. with transverse rectus adominis myocutaneous flap (TRAM), single pedicle, including closure of donor site, with microvascular anastomosis (supercharging)is one of the surgical procedures listed in the Surgical Schedule. If this procedure is performed on an Insured Person as the result of a mastectomy for which We paid a Surgical Expense benefit for the treatment of Breast Cancer, We will pay the expense incurred not to exceed We will pay the expense incurred, not to exceed the procedure amount listed in this rider when a surgical operation is performed on an Insured Person for treatment of a diagnosed Skin Cancer. This benefit is payable in lieu of any benefits for Surgical Expense and Anesthesia Expense which are not applicable to Skin Cancer. We will pay the Daily Hospital Confinement benefit amount shown on the Certificate Schedule for each of the first 30 days in each period of hospital confinement during which an Insured Person is confined to a hospital, including a government or charity hospital, for the treatment of Cancer. If an Insured Person is continuously confined to a hospital, including a government or charity hospital, for longer than 30 consecutive days for the treatment of Cancer, We will pay two times the Daily Hospital Confinement benefit amount shown on the Certificate Schedule. This benefit payment will begin on the 31 st continuous day of such confinement and continue for each day of confinement until the Insured Person is discharged from the Hospital. The amount payable under this benefit will be shown on the Certificate Schedule if the Insured Person so confined is a dependent child under the age of 21. This page is an Insert to be used ONLY with Brochure Form LG If you do not have this Brochure, ask that your agent provide one for you. All exclusions, limitations, definitions and terms of renewability of the Group Limited Benefit Cancer Policy (form LG-6040) apply to these riders. THESE ARE LIMITED RIDERS HUMBLE ISD FOR GROUP PRESENTATION PURPOSES ONLY

31 NTS If an Insured Person is first diagnosed with one or more covered Specified Diseases and is hospitalized for the definitive treatment of any covered Specified Disease, We will pay benefits according to the provisions of this rider. If an Insured Person is first diagnosed with one or more covered Specified Diseases and is hospitalized for the definitive treatment of any covered Specified Disease, We will pay benefits according to the provisions of this rider. An applicant may We will pay a benefit of selected when an Insured Person is confined to a hospital (for 12 or more hours, not applicable in SD) as a result of receiving treatment for a Specified Disease. This benefit is payable only once per period of confinement and once per calendar year for each Insured Person. We will pay a benefit of selected when an Insured Person is hospitalized during any continuous period of 30 days or less for the treatment of a covered Specified Disease. Benefits will If the hospital confinement follows a previously covered confinement, it will be deemed a continuation of the first confinement unless it is the result of an entirely different Specified Disease, or unless the confinements are separated by 30 days or more. This page is an Insert to be used ONLY with Brochure Form LG If you do not have this Brochure, ask that your agent provide one for you. All exclusions, limitations, definitions and terms of renewability of the Group Limited Benefit Cancer Policy (form LG-6040) apply to these riders. THESE ARE LIMITED RIDERS HUMBLE ISD FOR GROUP PRESENTATION PURPOSES ONLY MONTHLY RATES EMPLOYEE SINGLE PARENT FAMILY BASE PLAN A $ $ $ BASE PLAN B $ $ $

32 We will pay the daily Hospital Intensive Care Unit Benefit shown on the Certificate Schedule for an Insured Person s confinement in an ICU for sickness or injury. We will pay double the daily Hospital Intensive Care Unit benefit amount shown on the Certificate Schedule for an Insured Person s confinement in an ICU as a result of Cancer. We will also double this ICU benefit for only the initial ICU confinement resulting from an Insured Person s travel related injury, provided that the ICU confinement begins within 24 hours of the accident causing the travel related injury. A travel related injury includes being struck by an automobile, bus, truck, van, motorcycle, train or airplane; or being involved in an accident where the Insured Person was the operator or passenger in or on such vehicle. We will pay one-half of the daily Hospital Intensive Care Unit benefit amount shown on the Certificate Schedule for an Insured Person s confinement in a Step Down Unit for a sickness or injury. If the rider is issued and coverage is in force, it will provide benefits if an Insured Person goes into a hospital Intensive Care Unit (including a Cardiac Intensive Care Unit or Neonatal Intensive Care Unit). Benefits start the first day of confinement in an ICU for sickness or injury. Any combination of benefits payable under this rider is limited to a maximum of 45 days per each period of confinement. Benefits are not payable for any ICU or Step Down Unit confinement that results from intentional self-inflicted injury; or the Insured Person s being intoxicated or under the influence of alcohol, drugs or any narcotics, unless administered on and according to the advice of a medical practitioner. THIS IS A LIMITED RIDER. This page is an Insert to be used ONLY with Brochure Form LG If you do not have this Brochure, ask that your agent provide one for you. All exclusions, limitations, definitions and terms of renewability of the Group Limited Benefit Cancer Policy (form LG-6040) apply to these riders. THESE ARE LIMITED RIDERS HUMBLE ISD FOR GROUP PRESENTATION PURPOSES ONLY MONTHLY RATES EMPLOYEE SINGLE PARENT FAMILY BASE PLAN A + ICU $ $ $ BASE PLAN B + ICU $ $ $

33 Flexible Spending Accounts Maximize your benefits and give yourself a raise.

34 DearPlanParticipant, NationalBenefitServices,LLC(NBS)ispleasedtobeyournewCafeteriaPlan AdministratoreffectiveSeptember1,2011.Withthis change,youwillseethefollowing enhancementstoyourcafeteriaplanbenefit. Dailyclaimprocessing ChecksReimbursement&DirectDepositReimbursementissueddaily ContinualReimbursementoptionsavailableforDependentCare&Orthodontia AutosubstantiationonDebitCardTransactions ParticipantWebAccess&OnlineClaimSubmission CallcenteravailabletoansweraccountquestionsMF8am6pm 24HourVoiceResponseUnittoobtainbasicaccountinformation Thefollowinglistofitemswillbehelpfultoyouasaplanparticipantduringthetransition. ParticipantAccountWebAccess: Detailedaccountinformationandclaimhistory OnlineClaimsubmission Accesstodownloadableclaimforms,changeinstatus,anddetailedbenefitinformation NewNBSDebitCard: NBSwillbesendingoutinth yournewflexcards.Theywillbesentinunmarked envelopes,pleasewatchforthemastheywillarriveinthenextfewweeks. NBSContactInformation: 8523SouthRedwoodRoad WestJordan,UT84088 Phone Fax S.RedwoodRd.,WestJordan,UT84084(801) ,(800) www.NBSbenefits.com

35 Flexible Spending Plans A Cafeteria Plan enables you to save money on group insurance, health-related expenses, and dependent-care expenses. Your contributions are deducted from your pay before taxes are withheld. Because you are taxed on a lower amount of pay, you pay less in taxes and you have more to spend. You may save as much as 35 percent on the cost of each benefit option! FSA Savings FSA Savings Comparison FSA No FSA Annual Taxable Income $20,000 $20,000 Out of Pocket Expenses Health Care Expenses $500 $0 $500 $0 Total Pre-Tax Contributions ($1,000) $0 Taxable Income After FSA $19,000 $20,000 Federal, State, & SS Taxes (30+%) ($5,320) ($5,600) After-Tax Income $13,680 $14,400 care expenses $0 $1,000 Take-Home Pay $13,680 $13,400 Increased Take-Home Pay $280 $0 *Federal Tax saving may vary. A savings calculator can be found on our website: NBSbenefits.com to find out how much you could save. Partial List of Eligible Expenses: co-pays and deductibles orthodontia lenses, lens solution See the full list at Enrollment Options This account allows you to use pre-tax dollars to pay for group premium expenses sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Your health care expense account allows you to save money by paying annual benefit enrollment, you must decide whether to participate in this account and how much to contribute. This optional plan allows you to use pre-tax dollars to pay for dependent- the annual benefit enrollment, you must decide whether to participate in this account and how much to contribute.

36 How the FSA Plan Works You designate an annual election of pre-tax dollars to be deposited into your health and dependent-care spending accounts. Your total election is divided by the number of pay periods in the Plan year and deducted equally from each paycheck before taxes are calculated. By the end of the Plan year, your total election will be fully deposited. However, you may make a claim for eligible expenses as soon as they are incurred during the Plan year. Eligible claims will be paid up to your total annual election even if you have not yet contributed that amount to your account. Get Your Money 1. Complete and sign a claim form (available on our website) or an online webclaim. 2. Attach documentation; such as an itemized bill or an Explanation of Benefits (EOB) statement from a health insurance provider. 3. Fax or mail signed form and documentation to NBS. 4. Receive your non-taxable reimbursement after your claim is processed either by check or direct deposit. NBS Flexcard FSA Pre-paid VISA Your employer may sponsor the use of the NBS Flexcard, making access to your flex dollars easier than ever. You may use the card to pay merchants or service providers that accept VISA credit cards, so there is no need to pay cash up front then wait for reimbursement. Account Information Participants may call NBS and talk to a representative during our regular business hours, Monday Friday, 8am to 5pm Mountain Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) or toll free (888) For immediate access to your account information at any time, log on to our website NBSbenefits.com. Information includes: Enrollment Considerations After the the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying change of status (marriage status, employment change, dependent change). Be conservative in the total amount you elect to avoid forfeiting money that may be left in your account at the end of the year. Your employer may allow a short grace period after the Plan year ends for you to submit qualified claims for any unused funds. NATIONAL BENEFIT SERVICES, LLC 8523 South Redwood Road West Jordan, UT Phone: Fax: Service@NBSbenefits.com NBSbenefits.com

37 HealthCareExpenseWorksheet (Thisworksheetisforestimatingannualhealthcareexpensesonly.Toenroll,pleasecompleteanEnrollmentForm) Instructions MedicalCare 1.Enteryourannualcostforeachhealthcareoptionyouuse 2.AdduptheTotalAnnualHealthCareExpense 3.DetermineyouryearlyNumberofPayPeriods=Weekly/52,BiWeekly/26,SemiMonthly/24,Monthly/12 4.DividetheTotalAnnualExpensebythenumberofpayperiodstocalculatetheamountneededtobewithheldeverypayperiod InsuranceDeductibles $ Copays $ RoutineExams $ Prescriptions $ LabExpenses $ MedicalEquipment $ ChiropractorVisits $ PhysicalTherapy $ Other $ TotalAnnualMedicalCareExpense $ VisionCare EyeExams $ Glasses $ PrescriptionSunGlasses $ Contacts $ ContactLensSolutions $ InsuranceDeductibles/Copays $ TotalAnnualVisionCareExpense $ DentalCare Cleanings $ Xrays $ InsuranceDeductibles/Copays $ Fillings $ Crowns $ Other $ TotalAnnualDentalCareExpense $ Orthodontics Orthodontia $ Retainers $ TotalAnnualOrthodontiaCareExpense $ Totals TotalAnnualHealthCareExpense NumberofPayPeriods TotalPayPeriodDeduction $ = NationalBenefitServices,LLC P.O.Box6980,WestJordan,UT84084PH(801) TollFree(888) FAX:SaltLakeCityAreaFax:(801) TollFreeFax:(800) claims@nbsi.com(PDF,TIFForJPEGfilesonly) $

38 3DJH