morehouse parish school board...voluntary benefits guide for 2018-19 plan year morehouse parish...

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Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from your full time date of hire to sign up for insurance benefits. Please contact us at 318-281-0000 as soon as possible once you are hired! If you wait past 30 days you will have to wait until open enrollment in April & May of the next year! Thanks! presented by Thomas & Farr Agency, LLC 348 Holt Street Bastrop, LA 71220 318-281-0000

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Page 1: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Voluntary Benefits Guide for 2018-19 Plan Year

Morehouse Parish School Board

Attention: To All New HiresPlease note that you only have 30 days from

your full time date of hire to sign up for insurance benefits. Please contact us at

318-281-0000 as soon as possible once you arehired! If you wait past 30 days you will haveto wait until open enrollment in April & May

of the next year! Thanks!

presented by Thomas & Farr Agency, LLC348 Holt Street

Bastrop, LA 71220318-281-0000

Page 2: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

2018-19 Open Enrollment Schedule

For Voluntary Benefits

For All Full Time Employees

Monday, April 16th Pine Grove

Tuesday, April 17th Bastrop High School

Wednesday, April 18th Bastrop High School

Thursday, April 19th Morehouse Jr. High

Friday, April 20th Morehouse Jr. High

Monday, April 23rd Delta

Tuesday, April 24th H.V. Adams

Thursday, April 26th Student Service Center

Friday, April 27th Morehouse Magnet

Tuesday, May 1st Central Office–Transportation

Wednesday, May 2nd Central Office Personnel

Friday, May 4th Make Up Day

@Student Service Center

The only change in benefits/rates this year is an increase on

Guardian Voluntary Life premiums; however, all other products

and rates stayed the same!

Page 3: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

2018-2019 Voluntary Benefits

Offered by Thomas & Farr Agency, LLC318-281-0000

Guardian Life Insurance Company of America Dental

Vision

Group Term Life

UNUM Life Insurance Company Disability

Assurity Life Insurance Company Cancer

Colonial Life Insurance Company Individual Universal, Term, and Guarantee Issue Whole LifeHospital Confinement

Critical Illness

Accident

Juvenile Life

Werntz & Associates Shreveport LA

(318) 797-2554

Cafeteria Plan Administrator

Flexible Spending Account (FSA)

Page 4: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Group Number: 00499943

About Your Benefits:

Taking care of your teeth can be expensive. That’s why the right dental insurance is so important — it not only pays for preventivecare that can keep you and your family healthy, but it also helps pay for more extensive, costly and often unexpected expenses —such as fillings, crowns and root canals. Plus, you save money and have the assurance that you are getting the right care when you useone of our contracted dentists. Guardian has been providing outstanding dental plans to millions of Americans for more than 50years. When you enroll with Guardian, you have access to one of the nation’s largest dental networks offering significant discounts soyou know there’s always high-quality, affordable dental care close by. From preventive checkups and cleanings, to comprehensiveoral care treatments, we have you covered.

With your PPO plan, you can visit any dentist; but you pay less out-of-pocket when you choose a PPO dentist. Out-of-networkbenefits are based on a percentile of the prevailing fee data for the dentist's zip code.

Benefit information illustrated within this material reflects the plan covered by Guardian as of 03/30/2018MOREHOUSE PARISH SCHOOL BOARD ALL ELIGIBLE EMPLOYEES Benefit SummaryThe Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004

Dental Benefit Summary

MOREHOUSE PARISH SCHOOL BOARD

Your Dental Plan PPO

Your Network is DentalGuard Preferred

Your Monthly premium $29.22

You and spouse $72.78You and child(ren) $77.18

You, spouse and child(ren) $108.06

Calendar year deductible In-Network Out-of-Network

Individual $50 $50

Family limit 3 per family

Waived for Preventive Preventive

Charges covered for you (co-insurance) In-Network Out-of-Network

Preventive Care 100% 100%

Basic Care 100% 80%

Major Care 60% 50%

Orthodontia 50% 50%

Annual Maximum Benefit $1250 $1250

Maximum Rollover Yes

Rollover Threshold $600

Rollover Amount $300

Rollover In-network Amount $450

Rollover Account Limit $1250

Lifetime Orthodontia Maximum $1200

Dependent Age Limits 26

Page 5: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

A Sample of Services Covered by Your Plan:

MOREHOUSE PARISH SCHOOL BOARD ALL ELIGIBLE EMPLOYEES Benefit Summary The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004

PPO

Plan pays (on average)

In-network Out-of-network

Preventive Care Cleaning (prophylaxis) 100% 100%

Frequency: Once Every 6 Months

Fluoride Treatments 100% 100%

Limits: Under Age 19

Oral Exams 100% 100%

Sealants (per tooth) 100% 100%

X-rays 100% 100%

Basic Care Anesthesia* 100% 80%

Fillings‡ 100% 80%

Simple Extractions 100% 80%

Surgical Extractions 100% 80%

Major Care Bridges and Dentures 60% 50%

Dental Implants 60% 50%

Inlays, Onlays, Veneers** 60% 50%

Perio Surgery 60% 50%

Periodontal Maintenance 60% 50%

Frequency: Once Every 6 Months

(Standard)

Repair & Maintenance ofCrowns, Bridges & Dentures 60% 50%

Root Canal 60% 50%

Scaling & Root Planing (per quadrant) 60% 50%

Single Crowns 60% 50%

Orthodontia Orthodontia 50% 50%

Limits: Child(ren)

This is only a partial list of dental services. Your certificate of benefits will show exactly what is covered and excluded. **For PPO andor Indemnity members, Crowns, Inlays, Onlays and Labial Veneers are covered only when needed because of decay or injury or otherpathology when the tooth cannot be restored with amalgam or composite filing material. When Orthodontia coverage is for"Child(ren)" only, the orthodontic appliance must be placed prior to the age limit set by your plan; If full-time status is required byyour plan in order to remain insured after a certain age; then orthodontic maintenance may continue as long as full-time student statusis maintained. If Orthodontia coverage is for "Adults and Child(ren)" this limitation does not apply. The total number of cleanings andperiodontal maintenance procedures are combined in a 12 month period. *General Anesthesia – restrictions apply. ‡For PPO and orIndemnity members, Fillings – restrictions may apply to composite fillings.

This document is a summary of the major features of the referenced insurance coverage.  It is intended for illustrativepurposes only and does not constitute a contract. The insurance plan documents, including the policy and certificate,comprise the contract for coverage. The full plan description, including the benefits and all terms, limitations and exclusionsthat apply will be contained in your insurance certificate. The plan documents are the final arbiter of coverage.  Coverageterms may vary by state and actual sold plan. The premium amounts reflected in this summary are an approximation; ifthere is a discrepancy between this amount and the premium actually billed, the latter prevails.

Manage Your Benefits:

Go to www.GuardianAnytime.com to access secure informationabout your Guardian benefits including access to an image of yourID Card. Your on-line account will be set up within 30 days afteryour plan effective date..

Find A Dentist:

Visit www.GuardianAnytime.comClick on “Find A Provider”; You will need to know your plan, whichcan be found on the first page of your dental benefit summary.

Need Assistance?

Call the Guardian Helpline (888) 600-1600, weekdays,8:00 AM to 8:30 PM, EST. Refer to your member ID (socialsecurity number) and your plan number: 00499943

Please call the Guardian Helpline if you need to useyour benefits within 30 days of plan effective date.Please note, self-serve options over the phone oronline at Guardian Anytime are not available until thecase is fully implemented, please wait to speak to alive agent when calling the Guardian Helpline.

Page 6: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

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0�>�0$"��B"H�%5�-�0�$'�&:�&��:H��:�&#��"�(%�(�)*%�+��--.(/,501��2%*�5//-��%0�:;�'<=$��'�063�)�+�>�&:6!?�6'@1'���''�@���!��:#>�&:6!?�6'@1'���''�@#>�&:6!?�6'@�1'���''�@�"!!�6&��=�>�&:6!?�6'@�1'���''�@#A�'�:B�33�&;�6!:9#>�&:6!?�6'@�1'���''�@B�&&��:"���8:�&7�&�;�86:��&:���C��P�����NL������� ����������BI"���R�R"���H�>>�%�/���M�:�&��H@��&'��#��"�(%��*)*%�+�55-.,,�*0�:;�'<=$��'�063�)�+�>�&:6!?�6'@1'���''�@�B�&&��:#>�&:6!?�6'@1'���''�@#>�&:6!?�6'@�1'���''�@�"!!�6&��=�>�&:6!?�6'@�1'���''�@#A�'�:B�33�&;�6!:9"���8:�&7�&�;�86:��&:���C��P�LD����EL����� ��������>�0$"��R��$%5�5�"'<6&�6��H@R��:���&'��#��"�(%�/%)*%�+�*/5.,5��01��2%,/(/(%(-�����&���0�34�'�2*,��0�:;�'<=$��'�063�)�+�>�&:6!?�6'@1'���''�@���!��:#>�&:6!?�6'@1'���''�@#>�&:6!?�6'@�1'���''�@�"!!�6&��=�>�&:6!?�6'@�1'���''�@#A�'�:B�33�&;�6!:9#>�&:6!?�6'@�1'���''�@B�&&��:"���8:�&7�&�;�86:��&:���C��P�LD����EL����� ��������>"G�>�RI�$�%5�5�"'<6&�6��H@R��:���&'��#��"�(%�/%)*%�+�*/5.,5��01��2%,/(/(%(-�����&���0�34�'�2*,��0�:;�'<=$��'�063�)�+�>�&:6!?�6'@1'���''�@�B�&&��:#>�&:6!?�6'@1'���''�@#>�&:6!?�6'@�1'���''�@�"!!�6&��=�>�&:6!?�6'@�1'���''�@#A�'�:B�33�&;�6!:9"���8:�&7�&�;�86:��&:���C��PL�LD���NLK���� ��������1�"BI�$H���>�0$"����,�A�'�M:9��" ���&'��#��"�(%��%)*%�+�*�-.,���01��2%55/�%��,�����&���0�34�'�25*(%0�:;�'<=$��'�063�)�+�>�&:6!?�6'@1'���''�@���!��:#>�&:6!?�6'@1'���''�@#>�&:6!?�6'@�1'���''�@�"!!�6&��=�>�&:6!?�6'@�1'���''�@#A�'�:B�33�&;�6!:9#>�&:6!?�6'@�1'���''�@B�&&��:"���8:�&7�&�;�86:��&:���C��PL�LD���NLK���� ������������C�R��I�$�,%,�H�����: 6<�?'� �#��"�(%�5*)*%�+�,��.,�--01��2%55/�%��,�����&���0�34�'�25*(%0�:;�'<=$��'�063�)�+�>�&:6!?�6'@1'���''�@�B�&&��:#>�&:6!?�6'@1'���''�@#>�&:6!?�6'@�1'���''�@�"!!�6&��=�>�&:6!?�6'@�1'���''�@#A�'�:B�33�&;�6!:9"���8:�&7�&�;�86:��&:���C��PL�LD���NLK���� ������������C�R��I�$�(5//�I�79;6M��A6'3�' �!!�#��"�(%�,%)*%�+�*5�./-%�01��2%55/�%��,�����&���0�34�'�25*(%0�:;�'<=$��'�063�)�+�>�&:6!?�6'@1'���''�@�B�&&��:#>�&:6!?�6'@1'���''�@#>�&:6!?�6'@�1'���''�@�"!!�6&��=�>�&:6!?�6'@�1'���''�@#A�'�:B�33�&;�6!:9"���8:�&7�&�;�86:��&:���C�� PL�LD���NLK���� ��������1�"BI�$H���>�0$"�(���0�$'�&:�&��:H��:�&#��"�(%�(�)*%�+��--./,,�01��2%55/�%��,�����&���0�34�'�25*(%0�:;�'<=$��'�063�)�+�>�&:6!?�6'@1'���''�@���!��:#>�&:6!?�6'@1'���''�@#>�&:6!?�6'@�1'���''�@�"!!�6&��=�>�&:6!?�6'@�1'���''�@#A�'�:B�33�&;�6!:9#>�&:6!?�6'@�1'���''�@B�&&��:"���8:�&7�&�;�86:��&:���C��PLL�N���QF��� �������� J$�1"$��0$���>�B"��B$H�0B��,�0�W���9��:$6!!�!69#��"�(%���)*%�+�*-�./�//01��2%5�/%/�*������&���0�34�'�2,�,/0�:;�'<=$��'�063�)�+�>�&:6!?�6'@1'���''�@�B�&&��:#>�&:6!?�6'@1'���''�@#>�&:6!?�6'@�1'���''�@�"!!�6&��=�>�&:6!?�6'@�1'���''�@#A�'�:B�33�&;�6!:9"���8:�&7�&�;�86:��&:���C��PL�QF��L�QF��� ��������"��� 0�R��� 0���������� �!!��" �#�$��%����&'��#��"�(%��%)*%�+�,-�.,%/�01��2%*(5�55-*�����&���0�34�'�25��(�6&7�67����86&��90�:;�'<=$��'�063�)�+�>�&:6!?�6'@1'���''�@�B�&&��:#>�&:6!?�6'@1'���''�@#>�&:6!?�6'@�1'���''�@�"!!�6&��=�>�&:6!?�6'@�1'���''�@#A�'�:B�33�&;�6!:9"���8:�&7�&�;�86:��&:���C��X�����K�������LX�V�D���� ��������H"BI���Y"BI"HC���������� �!!��" �#�$��%����&'��#��"�(%��%)*%�+�,-�.,%/�01��2%�*%-,55*/����&���0�34�'�255--�6&7�67����86&��90�:;�'<=$��'�063�)�+�>�&:6!?�6'@1'���''�@�B�&&��:#>�&:6!?�6'@1'���''�@#>�&:6!?�6'@�1'���''�@�"!!�6&��=�>�&:6!?�6'@�1'���''�@#A�'�:B�33�&;�6!:9"���8:�&7�&�;�86:��&:���C��Q�����U�QFN�D���LF�PLL�N��� ��������� ������������������ �!!��" �#�$��%����&'��#��"�(%��%)*%�+�,-�.,%/�01��2%%%,%/%**-����&���0�34�'�2-(-��6&7�67����86&��90�:;�'<=$��'�063�)�+�>�&:6!?�6'@1'���''�@���!��:#>�&:6!?�6'@1'���''�@#>�&:6!?�6'@�1'���''�@�"!!�6&��=�>�&:6!?�6'@�1'���''�@#A�'�:B�33�&;�6!:9#>�&:6!?�6'@�1'���''�@B�&&��:"���8:�&7�&�;�86:��&:���C��NL������EL�U�������� ��������>"G�>�����"J>���������� �!!��" �#�$��%����&'��#��"�(%��%)*%�+�,-�.,%/�01��2%,�((/5��/����&���0�34�'�2,5*(�6&7�67����86&��90�:;�'<=$��'�063�)�+�>�&:6!?�6'@1'���''�@���!��:#>�&:6!?�6'@1'���''�@#>�&:6!?�6'@�1'���''�@�"!!�6&��=�>�&:6!?�6'@�1'���''�@#A�'�:B�33�&;�6!:9#>�&:6!?�6'@�1'���''�@B�&&��:"���8:�&7�&�;�86:��&:���C��Q�D�Q�QFDL�DZ[\]U_]aTZbZ ZaNZcdZ�ZefgZhijklljmnijoknp 5

Page 11: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

��������������� ����������������������������������� !�"###�$%&'()*��+(,-��!�../0%1&%�-����2.3#.45.67�5668333#� ��9.25#32":/2����1'���;<=�&�9>>5/��)?%&@A���&��B<�4'7���1)BCD;B&E &���&&�E��CC�B1��-��1)BCD;B&E &���&&�E-��1)BCD;B&E� &���&&�E��CC�B1��A���1)BCD;B&E� &���&&�E-$�&')�%<<%1?�BC)*-��1)BCD;B&E� &���&&�E!C�)�-��1)BCD;B&E� &���&&�E��C��)-��1)BCD;B&E� &���&&�E��%11��)����,)�1F�1�?�,B)��1)'��G�'HI����H��JI��������������������!�!��� ����� �363#��%;�'K�CC���K�-��!�.##0%1&%�-����2.3#.45.67�>"#8>.:6� ��9.63.>5"/26����1'���;<=�&�9/"5.�B1F;BF����,B1�'*��)?%&@A���&��B<�4'7���1)BCD;B&E &���&&�E���C��)-��1)BCD;B&E &���&&�E-��1)BCD;B&E� &���&&�E��CC�B1��A���1)BCD;B&E� &���&&�E-$�&')�%<<%1?�BC)*-��1)BCD;B&E� &���&&�E�%11��)����,)�1F�1�?�,B)��1)'��G�'H������J������I�HI����JI���I���L�������������M�����0��!�363#��%;�'K�CC���K�-��!�.##0%1&%�-����2.3#.45.67�>"#8>.:6� ��9./":"355>6�B1F;BF����,B1�'*��)?%&@A���&��B<�4'7���1)BCD;B&E &���&&�E���C��)-��1)BCD;B&E &���&&�E-��1)BCD;B&E� &���&&�E��CC�B1��A���1)BCD;B&E� &���&&�E-$�&')�%<<%1?�BC)*-��1)BCD;B&E� &���&&�E�%11��)����,)�1F�1�?�,B)��1)'��G�'NO��P��Q����������������M�����0��!�363#��%;�'K�CC���K�-��!�.##0%1&%�-����2.3#.45.67�>"#8>.:6� ��9.2##:#//2>����1'���;<=�&�9"3"3�B1F;BF����,B1�'*��)?%&@A���&��B<�4'7���1)BCD;B&E &���&&�E���C��)-��1)BCD;B&E &���&&�E-��1)BCD;B&E� &���&&�E��CC�B1��A���1)BCD;B&E� &���&&�E-$�&')�%<<%1?�BC)*-��1)BCD;B&E� &���&&�E�%11��)����,)�1F�1�?�,B)��1)'��G�'������������������������M�����0��!�363#��%;�'K�CC���K�-��!�.##0%1&%�-����2.3#.45.67�>"#8>.:6� ��9."66:"35"3����1'���;<=�&�9/./3�B1F;BF����,B1�'*��)?%&@A���&��B<�4'7���1)BCD;B&E &���&&�E���C��)-��1)BCD;B&E &���&&�E-��1)BCD;B&E� &���&&�E��CC�B1��A���1)BCD;B&E� &���&&�E-$�&')�%<<%1?�BC)*-��1)BCD;B&E� &���&&�E�%11��)����,)�1F�1�?�,B)��1)'��G�'��QQ��NOI���������������R�������DD�� !��������!������G56#:�S*�)�'�$�&&(��ES�')�0%1&%�-����2.3:.45.67�5:/8/3#>� ��9.//:"5:25#��)?%&@A���&��B<�4'7���1)BCD;B&E &���&&�E� C;'-��1)BCD;B&E &���&&�E-��1)BCD;B&E� &���&&�E��CC�B1��A���1)BCD;B&E� &���&&�E-$�&')�%<<%1?�BC)*����,)�1F�1�?�,B)��1)'��G�' ��QQ��NOI���������������R�������DD�5.3�D&B<<%1)��)0%1&%�-����2.3#.45.67�5668>6>#� ��9.//:"5:25#��)?%&@A���&��B<�4'7���1)BCD;B&E &���&&�E� C;'-��1)BCD;B&E &���&&�E-��1)BCD;B&E� &���&&�E��CC�B1��A���1)BCD;B&E� &���&&�E-$�&')�%<<%1?�BC)*����,)�1F�1�?�,B)��1)'��G�'TUVWXQYWZ[�HZT\TZZT[T] TZ��TZ_aTb�cdeffdghcdiehj 2

Page 12: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Dental Maximum Rollover

Save Your Unused Claims Dollars For When You Need Them Most

Guardian will roll over a portion of your unused annual maximum into your personal Maximum Rollover Account (MRA). If you reach your Plan Annual Maximum in future years, you can use money from your MRA. To qualify for an MRA, you must have a paid claim (not just a visit) and must not have exceeded the paid claims threshold during the benefit year. Your MRA may not exceed the MRA limit. You can view your annual MRA statement detailing your account and those of your dependents on www.GuardianAnytime.com.

Please note that actual maximum limitations and thresholds vary by plan. Your plan may vary from the one used below as an example to illustrate how the Maximum Rollover functions.

Plan Annual Maximum*

Threshold Maximum Rollover Amount In-Network Only Rollover

Amount Maximum Rollover

Account Limit

$1250 $600 $300 $450 $1250

Maximum claims reimbursement

Claims amount that determines rollover

eligibility

Additional dollars added to Plan Annual Maximum for

future years

Additional dollars added to Plan Annual Maximum for

future years if only in-network providers were used during the

benefit year

Plan Annual Maximum plus Maximum Rollover cannot exceed $2,500 in

total

* If a plan has a different annual maximum for PPO benefits vs. non-PPO benefits, ($1500 PPO/$1000 non-PPO for example) the non-PPO maximum determines the MaximumRollover plan.

Here’s how the benefits work:

YEAR ONE: Jane starts with a $1,250 Plan Annual Maximum. She submits $150 in dental claims. Since she did not reach the $600 Threshold, she receives a $300 rollover that will be applied to Year Two.

YEAR TWO: Jane now has an increased Plan Annual Maximum of $1,550. This year, she submits $50 in claims and receives an additional $300 rollover added to her Plan Annual Maximum.

YEAR THREE: Jane now has an increased Plan Annual Maximum of $1,850. This year, she submits $1,550 in claims. All claims are paid due to the amount accumulated in her Maximum Rollover Account.

YEAR FOUR: Jane’s Plan Annual Maximum is $1,550 ($1,250 Plan Annual Maximum + $300 remaining in her Maximum Rollover Account).

For Overview of your Dental Benefits, please see About Your Benefit Section of this Enrollment Booklet.

NOTES: You and your insured dependents maintain separate MRAs based on your own claim activity. Each MRA may not exceed the MRA limit.

Cases on either a calendar year or policy year accumulation basis qualify for the Maximum Rollover feature. For calendar year cases with an effective date in October, November or December, the Maximum Rollover feature starts as of the first full benefit year. For example, if a plan starts in November of 2013, the claim activity in 2014 will be used and applied to MRAs for use in 2015.

Under either benefit year set up (calendar year or policy year), Maximum Rollover for new entrants joining with 3 months or less remaining in the benefit year, will not begin until the start of the next full benefit year. Maximum Rollover is deferred for members who have coverage of Major services deferred. For these members, Maximum Rollover starts when coverage of Major services starts, or the start of the next benefit year if 3 months or less remain until the next benefit year. (Actual eligibility timeframe may vary. See your Plan Details for the most accurate information.)

Guardian's Dental Insurance is underwritten and issued by The Guardian Life Insurance Company of America or its subsidiaries, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. Plan documents are the final arbiter of coverage.

Policy Form #GP-1-DG2000, et al.

Page 13: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

About Your Benefits:

Eye care is a vital component of a healthy lifestyle. With vision insurance, having regular exams and purchasing contacts or glasses issimple and affordable. The coverage is inexpensive, yet the benefits can be significant! Guardian provides rich, flexible plans thatallow you to safeguard your health while saving you money. Review your plan options and see why vision insurance may be a greatbenefit for you.

Vision Benefit Summary

Visit any doctor with your Full Feature plan, but save by visiting any of the 50,000+ locations in the nation's largest visionnetwork.

Group Number: 00499943

MOREHOUSE PARISH SCHOOL BOARD

Benefit information illustrated within this material reflects the plan covered by Guardian as of 03/30/2018MOREHOUSE PARISH SCHOOL BOARD ALL ELIGIBLE EMPLOYEES Benefit SummaryThe Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004

Your Vision Plan Full Feature

Your Network is VSP Network Signature Plan

Your Monthly premium $ 10.94

You and spouse $ 18.64

You and child(ren) $ 18.98

You, spouse and child(ren) $ 29.90

Copay

Exams Copay $ 10

Materials Copay (waived for elective contact lenses) $ 25

Sample of Covered Services You pay (after copay if applicable):

In-network Out-of-network

Eye Exams $0 Amount over $50

Single Vision Lenses $0 Amount over $48

Lined Bifocal Lenses $0 Amount over $67

Lined Trifocal Lenses $0 Amount over $86

Lenticular Lenses $0 Amount over $126

Frames 80% of amount over $130¹ Amount over $48

Contact Lenses (Elective) Amount over $130 Amount over $120

Contact Lenses (Medically Necessary) $0 Amount over $210

Cosmetic Extras Avg. 30% off retail price No discounts

Glasses (Additional pair of frames and lenses) 20% off retail price^ No discounts

Laser Correction Surgery Discount Up to 15% off the usual charge or 5%

off promotional price

No discounts

Service Frequencies

Exams Every calendar year

Lenses (for glasses or contact lenses)‡‡ Every calendar year

Frames Every two calendar years

Network discounts (glasses and contact lens professional service) Limitless within 12 months of exam.

Dependent Age Limits 26

Visit www.GuardianAnytime.com and click on “Find a Provider”

Page 14: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

MOREHOUSE PARISH SCHOOL BOARD ALL ELIGIBLE EMPLOYEES Benefit Summary TheGuardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004

VSP

• ‡‡Benefit includes coverage for glasses or contact lenses, not both.

• ^ For the discount to apply your purchase must be made within 12 months of the eye exam. In addition Full-Feature plans offer 30% off additional prescription glassesand nonprescription sunglasses, including lens options, if purchased on the same day as the eye exam from the same VSP doctor who provided the exam.

• Charges for an initial purchase can be used toward the material allowance. Any unused balance remaining after the initial purchase cannot be banked for future use. The only exception would be if a member purchases contact lenses from an out of network provider, members can use the balance towards additional contact lenses withinthe same benefit period.• 1Extra $20 on select brandsThis document is a summary of the major features of the referenced insurance coverage.  It is intended for illustrative purposes only and does not constitute acontract. The insurance plan documents, including the policy and certificate, comprise the contract for coverage. The full plan description, including thebenefits and all terms, limitations and exclusions that apply will be contained in your insurance certificate. The plan documents are the final arbiter ofcoverage.  Coverage terms may vary by state and actual sold plan. The premium amounts reflected in this summary are an approximation; if there is adiscrepancy between this amount and the premium actually billed, the latter prevails.

Manage Your Benefits:

Go to www.GuardianAnytime.com to access secure

information about your Guardian benefits including access to

an image of your ID Card. Your on-line account will be set up

within 30 days after your plan effective date.

Need Assistance?

Call the Guardian Helpline (888) 600-1600, weekdays, 8:00 AM

to 8:30 PM, EST. Refer to your member ID (social security

number) and your plan number: 00499943.

Please call the Guardian Helpline if you need to use

your benefits within 30 days of plan effective date.

Please note, self-serve options over the phone or online

at Guardian Anytime are not available until the case is

fully implemented, please wait to speak to a live agent

when calling the Guardian Helpline.

EXCLUSIONS AND LIMITATIONS

Important Information: This policy provides vision care limited benefits health

insurance only. It does not provide basic hospital, basic medical or major

medical insurance as defined by the New York State Insurance Department.

Coverage is limited to those charges that are necessary for a routine vision

examination. Co-pays apply. The plan does not pay for: orthoptics or vision

training and any associated supplemental testing; medical or surgical treatment

of the eye; and eye examination or corrective eyewear required by an

employer as a condition of employment; replacement of lenses and frames

that are furnished under this plan, which are lost or broken (except at normal

intervals when services are otherwise available or a warranty exists). The plan

limits benefits for blended lenses, oversized lenses, photochromic lenses,

tinted lenses, progressive multifocal lenses, coated or laminated lenses, a

frame that exceeds plan allowance, cosmetic lenses; U-V protected lenses and

optional cosmetic processes.

The services, exclusions and limitations listed above do not constitute a

contract and are a summary only. The Guardian plan documents are the final

arbiter of coverage. Contract #GP-1-VSN-96-VIS et al.

Laser Correction Surgery:

On average, 15% off the usual charge or 5% off promotional price for vision

laser surgery. Members’ out-of-pocket costs are limited to $1,800 per eye for

LASIK and $1,500 per eye for PRK.

Laser surgery is not an insured benefit. The surgery is available at a discounted

fee. The covered person must pay the entire discounted fee. In addition, the

laser surgery discount may not be available in all states.

Page 15: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Apt,Richard K MD1310 N 19th StMonroe, LA 71201(318) 388-2020English

Cagnolatti,Dale OD1812 Roselawn AveMonroe, LA 71201(318) 387-9626English

Cooksey,John C MD1310 N 19th StMonroe, LA 71201(318) 388-2020English

Eaton,Jim N OD1801 Auburn AveMonroe, LA 71201(318) 812-1600English

Eaton,Jim N OD138 Christian DrRayville, LA 71269(318) 728-4081English

Eaton,Jim N OD1804 N 7th StWest Monroe, LA 71291(318) 325-2610English

Elahi,Mercy A OD303 McMillan RdWest Monroe, LA 71291(318) 387-7257English, Spanish, Urdu

Floyd,Jennifer A OD303 N Trenton StRuston, LA 71270(318) 202-5845English

Gandy,Jimmy S OD107 Maxwell StRayville, LA 71269(318) 728-2299English

Gandy,Jimmy S OD311 Lake StLake Providence, LA 71254(318) 559-2464English

Gandy,Stacy G OD107 Maxwell StRayville, LA 71269(318) 728-2299English

Gandy,Stacy G OD311 Lake StLake Providence, LA 71254(318) 559-2464English

Gilcrease,Edward G OD1010 S Vienna StRuston, LA 71270(318) 255-9433English

Gordon,William D OD3000 Forsythe AveMonroe, LA 71201(318) 807-2020English

Haik,Raymond E MD1801 Auburn AveMonroe, LA 71201(318) 812-1600English

Haik,Raymond E MD138 Christian DrRayville, LA 71269(318) 728-4081English

Haik,Raymond E MD1804 N 7th StWest Monroe, LA 71291(318) 325-2610English

Haynes,Michael J OD2808 Forsythe AveMonroe, LA 71201(318) 323-4994English

Humble,Joseph E MD1801 Auburn AveMonroe, LA 71201(318) 812-1600English

Humble,Joseph E MD138 Christian DrRayville, LA 71269(318) 728-4081English

Humble,Joseph E MD1804 N 7th StWest Monroe, LA 71291(318) 325-2610English

Lamar,James A OD3000 Forsythe AveMonroe, LA 71201(318) 807-2020English

Legg,Melinda S OD303 McMillan RdWest Monroe, LA 71291(318) 387-7257English

Marionneaux Jr W OD6609 Main StWinnsboro, LA 71295(318) 435-5145English

Moss,Joseph C OD2209 Forsythe AveMonroe, LA 71201(318) 387-5657English

Parker,Thomas G MD1801 Auburn AveMonroe, LA 71201(318) 812-1600English

Parker,Thomas G MD138 Christian DrRayville, LA 71269(318) 728-4081English

Parker,Thomas G MD1804 N 7th StWest Monroe, LA 71291(318) 325-2610English

Pierce,Robert H OD1801 Auburn AveMonroe, LA 71201(318) 812-1600English

Pierce,Robert H OD1804 N 7th StWest Monroe, LA 71291(318) 325-2610English

Pierce,Robert H OD116 Killgore Rd,#1Ruston, LA 71270(318) 251-3626English

Read,William J MD2600 Tower Dr,#111Monroe, LA 71201(318) 387-3881English

Robinson,Mark S OD1655 US-65Lake Village, AR 71653(870) 265-2274English

Russell,Richard R OD210 S Odom StBastrop, LA 71220(318) 281-2200English

Scogin,Jonathan E OD1801 Auburn AveMonroe, LA 71201(318) 812-1600English

Scogin,Jonathan E OD138 Christian DrRayville, LA 71269(318) 728-4081English

Scogin,Jonathan E OD1804 N 7th StWest Monroe, LA 71291(318) 325-2610English

Smith,Jeffrey K OD1602 Main StCrossett, AR 71635(870) 364-8996English

Ware,Garey E OD404 S Washington StBastrop, LA 71220(318) 281-6682English

Yeager,Dwayne OD3805 Cypress StWest Monroe, LA 71291(318) 325-3937English

VSP Choice NetworkMember Services 1-800-877-7195 2

Page 16: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

WillPrep Services

Special bonus for participants in voluntary life plan

Your employer has worked with Guardian to make WillPrep Services available to eligible members with Voluntary Lifeplans. Keeping an up-to-date will is essential to ensuring that your assets are distributed as you intended, no matter thesize of your estate. You may be avoiding creating a will because you believe you can’t afford the time or legal expense.Now you can with WillPrep Services.

WillPrep Services offer support and guidance to help you properly prepare the documents necessary to preserve yourfamily’s financial security. WillPrep has a range of services including online planning documents, a resource library andaccess to professionals* to help with issues related to:

Advanced Health CareDirectives

Financial Power of Attorney Wills and Living Wills

Estate Taxes Guardianship andConservatorship

Resource Library

Executors & Probate Healthcare Power of Attorney Trusts

For more information about WillPrep Services, go to www.ibhwillprep.com; User name: WillPrep; Password: GLIC09or call 1-877-433-6789

*The Option of an attorney prepared will is available for a small fee.WillPrep Services are provided by Integrated Behavioral Health, Inc., and its contractors. The Guardian Life Insurance Company of America(Guardian) does not provide any part of WillPrep Services. Guardian is not responsible or liable for care or advice given by any provider or resourceunder the program. This information is for illustrative purposes only. It is not a contract. Only the Administration Agreement can provide the actualterms, services, limitations and exclusions. Guardian and IBH reserve the right to discontinue the WillPrep Services at any time without notice. Legalservices will not be provided in connection with or preparation for any action against Guardian, IBH, or your employer.

Page 17: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Life Benefit SummaryGroup Number: 00499943

MOREHOUSE PARISH SCHOOL BOARD

About Your Benefits:

Your family depends on you in many ways and you’ve worked hard to ensure their financial security. But if something happened to

you, will your family be protected? Will your loved ones be able to stay in their home, pay bills, and prepare for the future. Life

insurance provides a financial benefit that your family can depend on. And getting it at work is easier, more convenient and more

affordable than doing it on your own. If you have financial dependents- a spouse, children or aging parents, having life insurance is a

responsible and a smart decision. Enroll today to secure their future!

What Your Benefits Cover:

VOLUNTARY TERM LIFE

Employee Benefit $10,000 increments to a

maximum of $500,000. See Cost

Illustration page for details.

Accidental Death and Dismemberment Enhanced employee, spouse, and

child(ren) coverage. Maximum 1

times life amount.

Spouse‡ Benefit $5,000 increments to a maximum

of $250,000. See Cost Illustration

page for details.

Child Benefit Your dependent children age 14

days to 26 years.

You may elect one of the

following benefit options: $2,500,

$5,000, $7,500, $10,000. Subject

to state limits. See Cost

Illustration page for details.

Guarantee Issue: The ‘guarantee’ means you are not required to answer health questions to qualify for

coverage up to and including the specified amount, when you sign up for coverage during the initial

enrollment period.

We Guarantee Issue coverage up

to:

Employee $150,000.

Spouse $50,000.

Dependent children $10,000.

An Additional $100,000 per

employee, $25,000 for a spouse

can be obtained with a "No"

response to the Health question

(on your enrollment form).

Evidence of Insurability is required

if the elected amount exceeds the

Guarantee Issue plus Additional

amount.

Premiums Increase on plan anniversary after

you enter next five-year age

group

Page 18: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

VOLUNTARY TERM LIFE

Portability: Allows you to take your coverage with you if you terminate employment. Yes, with age and other

restrictions

Conversion: Allows you to continue your coverage after your group plan has terminated. Yes, with restrictions; see

certificate of benefits

Accelerated Life Benefit: A lump sum benefit is paid to you if you are diagnosed with a terminal

condition, as defined by the plan.

Yes

Waiver of Premiums: Premium will not need to be paid if you are totally disabled. For employees disabled prior to

age 60, with premiums waived

until age 65, if conditions met

Benefit Reductions: Benefits are reduced by a certain percentage as an employee ages. 35% at age 70, 50% at age 75, 70%

at age 80

Subject to coverage limits� Spouse coverage terminates at age 70.

Manage Your Benefits:

Go to www.GuardianAnytime.com to access secure information about

your Guardian benefits. Your on-line account will be set up within 30

days after your plan effective date.

Need Assistance?

Call the Guardian Helpline (888) 600-1600, weekdays, 8:00 AM to 8:30

PM, EST. Refer to your member ID (social security number) and your

plan number: 00499943

Page 19: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Voluntary Life Cost Illustration:

To determine the most appropriate level of coverage, as a rule of thumb, you should consider about 6 - 10 times your annual income,factoring in projected costs to help maintain your family’s current life style. To help you assess your needs, you can also go toGuardian Anytime and view a video: https://www.guardiananytime.com/gafd/wps/portal/fdhome/employees/products-coverage/life

Monthly premiums displayed. Cost of AD&D is included.

Policy Election Amount Policy Election Cost Per Age Bracket

Employee < 30 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69†

$10,000 $.90 $.90 $1.30 $2.00 $2.60 $4.00 $6.00 $9.30 $15.10

$20,000 $1.80 $1.80 $2.60 $4.00 $5.20 $8.00 $12.00 $18.60 $30.20

$30,000 $2.70 $2.70 $3.90 $6.00 $7.80 $12.00 $18.00 $27.90 $45.30

$40,000 $3.60 $3.60 $5.20 $8.00 $10.40 $16.00 $24.00 $37.20 $60.40

$50,000 $4.50 $4.50 $6.50 $10.00 $13.00 $20.00 $30.00 $46.50 $75.50

$60,000 $5.40 $5.40 $7.80 $12.00 $15.60 $24.00 $36.00 $55.80 $90.60

$70,000 $6.30 $6.30 $9.10 $14.00 $18.20 $28.00 $42.00 $65.10 $105.70

$80,000 $7.20 $7.20 $10.40 $16.00 $20.80 $32.00 $48.00 $74.40 $120.80

$90,000 $8.10 $8.10 $11.70 $18.00 $23.40 $36.00 $54.00 $83.70 $135.90

$100,000 $9.00 $9.00 $13.00 $20.00 $26.00 $40.00 $60.00 $93.00 $151.00

$110,000 $9.90 $9.90 $14.30 $22.00 $28.60 $44.00 $66.00 $102.30 $166.10

$120,000 $10.80 $10.80 $15.60 $24.00 $31.20 $48.00 $72.00 $111.60 $181.20

$130,000 $11.70 $11.70 $16.90 $26.00 $33.80 $52.00 $78.00 $120.90 $196.30

$140,000 $12.60 $12.60 $18.20 $28.00 $36.40 $56.00 $84.00 $130.20 $211.40

$150,000 $13.50 $13.50 $19.50 $30.00 $39.00 $60.00 $90.00 $139.50 $226.50

$160,000 $14.40 $14.40 $20.80 $32.00 $41.60 $64.00 $96.00 $148.80 $241.60

$170,000 $15.30 $15.30 $22.10 $34.00 $44.20 $68.00 $102.00 $158.10 $256.70

$180,000 $16.20 $16.20 $23.40 $36.00 $46.80 $72.00 $108.00 $167.40 $271.80

$190,000 $17.10 $17.10 $24.70 $38.00 $49.40 $76.00 $114.00 $176.70 $286.90

$200,000 $18.00 $18.00 $26.00 $40.00 $52.00 $80.00 $120.00 $186.00 $302.00

$210,000 $18.90 $18.90 $27.30 $42.00 $54.60 $84.00 $126.00 $195.30 $317.10

$220,000 $19.80 $19.80 $28.60 $44.00 $57.20 $88.00 $132.00 $204.60 $332.20

$230,000 $20.70 $20.70 $29.90 $46.00 $59.80 $92.00 $138.00 $213.90 $347.30

$240,000 $21.60 $21.60 $31.20 $48.00 $62.40 $96.00 $144.00 $223.20 $362.40

$250,000 $22.50 $22.50 $32.50 $50.00 $65.00 $100.00 $150.00 $232.50 $377.50

$260,000 $23.40 $23.40 $33.80 $52.00 $67.60 $104.00 $156.00 $241.80 $392.60

$270,000 $24.30 $24.30 $35.10 $54.00 $70.20 $108.00 $162.00 $251.10 $407.70

$280,000 $25.20 $25.20 $36.40 $56.00 $72.80 $112.00 $168.00 $260.40 $422.80

$290,000 $26.10 $26.10 $37.70 $58.00 $75.40 $116.00 $174.00 $269.70 $437.90

$300,000 $27.00 $27.00 $39.00 $60.00 $78.00 $120.00 $180.00 $279.00 $453.00

$310,000 $27.90 $27.90 $40.30 $62.00 $80.60 $124.00 $186.00 $288.30 $468.10

Page 20: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Voluntary Life Cost Illustration continued

< 30 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69†

$320,000 $28.80 $28.80 $41.60 $64.00 $83.20 $128.00 $192.00 $297.60 $483.20

$330,000 $29.70 $29.70 $42.90 $66.00 $85.80 $132.00 $198.00 $306.90 $498.30

$340,000 $30.60 $30.60 $44.20 $68.00 $88.40 $136.00 $204.00 $316.20 $513.40

$350,000 $31.50 $31.50 $45.50 $70.00 $91.00 $140.00 $210.00 $325.50 $528.50

$360,000 $32.40 $32.40 $46.80 $72.00 $93.60 $144.00 $216.00 $334.80 $543.60

$370,000 $33.30 $33.30 $48.10 $74.00 $96.20 $148.00 $222.00 $344.10 $558.70

$380,000 $34.20 $34.20 $49.40 $76.00 $98.80 $152.00 $228.00 $353.40 $573.80

$390,000 $35.10 $35.10 $50.70 $78.00 $101.40 $156.00 $234.00 $362.70 $588.90

$400,000 $36.00 $36.00 $52.00 $80.00 $104.00 $160.00 $240.00 $372.00 $604.00

$410,000 $36.90 $36.90 $53.30 $82.00 $106.60 $164.00 $246.00 $381.30 $619.10

$420,000 $37.80 $37.80 $54.60 $84.00 $109.20 $168.00 $252.00 $390.60 $634.20

$430,000 $38.70 $38.70 $55.90 $86.00 $111.80 $172.00 $258.00 $399.90 $649.30

$440,000 $39.60 $39.60 $57.20 $88.00 $114.40 $176.00 $264.00 $409.20 $664.40

$450,000 $40.50 $40.50 $58.50 $90.00 $117.00 $180.00 $270.00 $418.50 $679.50

$460,000 $41.40 $41.40 $59.80 $92.00 $119.60 $184.00 $276.00 $427.80 $694.60

$470,000 $42.30 $42.30 $61.10 $94.00 $122.20 $188.00 $282.00 $437.10 $709.70

$480,000 $43.20 $43.20 $62.40 $96.00 $124.80 $192.00 $288.00 $446.40 $724.80

$490,000 $44.10 $44.10 $63.70 $98.00 $127.40 $196.00 $294.00 $455.70 $739.90

$500,000 $45.00 $45.00 $65.00 $100.00 $130.00 $200.00 $300.00 $465.00 $755.00

Policy Election Amount

Spouse

$5,000 $.45 $.45 $.65 $1.00 $1.30 $2.00 $3.00 $4.65 $7.55

$10,000 $.90 $.90 $1.30 $2.00 $2.60 $4.00 $6.00 $9.30 $15.10

$15,000 $1.35 $1.35 $1.95 $3.00 $3.90 $6.00 $9.00 $13.95 $22.65

$20,000 $1.80 $1.80 $2.60 $4.00 $5.20 $8.00 $12.00 $18.60 $30.20

$25,000 $2.25 $2.25 $3.25 $5.00 $6.50 $10.00 $15.00 $23.25 $37.75

$30,000 $2.70 $2.70 $3.90 $6.00 $7.80 $12.00 $18.00 $27.90 $45.30

$35,000 $3.15 $3.15 $4.55 $7.00 $9.10 $14.00 $21.00 $32.55 $52.85

$40,000 $3.60 $3.60 $5.20 $8.00 $10.40 $16.00 $24.00 $37.20 $60.40

$45,000 $4.05 $4.05 $5.85 $9.00 $11.70 $18.00 $27.00 $41.85 $67.95

$50,000 $4.50 $4.50 $6.50 $10.00 $13.00 $20.00 $30.00 $46.50 $75.50

$55,000 $4.95 $4.95 $7.15 $11.00 $14.30 $22.00 $33.00 $51.15 $83.05

$60,000 $5.40 $5.40 $7.80 $12.00 $15.60 $24.00 $36.00 $55.80 $90.60

Page 21: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Voluntary Life Cost Illustration continued

< 30 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69†

$65,000 $5.85 $5.85 $8.45 $13.00 $16.90 $26.00 $39.00 $60.45 $98.15

$70,000 $6.30 $6.30 $9.10 $14.00 $18.20 $28.00 $42.00 $65.10 $105.70

$75,000 $6.75 $6.75 $9.75 $15.00 $19.50 $30.00 $45.00 $69.75 $113.25

$80,000 $7.20 $7.20 $10.40 $16.00 $20.80 $32.00 $48.00 $74.40 $120.80

$85,000 $7.65 $7.65 $11.05 $17.00 $22.10 $34.00 $51.00 $79.05 $128.35

$90,000 $8.10 $8.10 $11.70 $18.00 $23.40 $36.00 $54.00 $83.70 $135.90

$95,000 $8.55 $8.55 $12.35 $19.00 $24.70 $38.00 $57.00 $88.35 $143.45

$100,000 $9.00 $9.00 $13.00 $20.00 $26.00 $40.00 $60.00 $93.00 $151.00

$105,000 $9.45 $9.45 $13.65 $21.00 $27.30 $42.00 $63.00 $97.65 $158.55

$110,000 $9.90 $9.90 $14.30 $22.00 $28.60 $44.00 $66.00 $102.30 $166.10

$115,000 $10.35 $10.35 $14.95 $23.00 $29.90 $46.00 $69.00 $106.95 $173.65

$120,000 $10.80 $10.80 $15.60 $24.00 $31.20 $48.00 $72.00 $111.60 $181.20

$125,000 $11.25 $11.25 $16.25 $25.00 $32.50 $50.00 $75.00 $116.25 $188.75

$130,000 $11.70 $11.70 $16.90 $26.00 $33.80 $52.00 $78.00 $120.90 $196.30

$135,000 $12.15 $12.15 $17.55 $27.00 $35.10 $54.00 $81.00 $125.55 $203.85

$140,000 $12.60 $12.60 $18.20 $28.00 $36.40 $56.00 $84.00 $130.20 $211.40

$145,000 $13.05 $13.05 $18.85 $29.00 $37.70 $58.00 $87.00 $134.85 $218.95

$150,000 $13.50 $13.50 $19.50 $30.00 $39.00 $60.00 $90.00 $139.50 $226.50

$155,000 $13.95 $13.95 $20.15 $31.00 $40.30 $62.00 $93.00 $144.15 $234.05

$160,000 $14.40 $14.40 $20.80 $32.00 $41.60 $64.00 $96.00 $148.80 $241.60

$165,000 $14.85 $14.85 $21.45 $33.00 $42.90 $66.00 $99.00 $153.45 $249.15

$170,000 $15.30 $15.30 $22.10 $34.00 $44.20 $68.00 $102.00 $158.10 $256.70

$175,000 $15.75 $15.75 $22.75 $35.00 $45.50 $70.00 $105.00 $162.75 $264.25

$180,000 $16.20 $16.20 $23.40 $36.00 $46.80 $72.00 $108.00 $167.40 $271.80

$185,000 $16.65 $16.65 $24.05 $37.00 $48.10 $74.00 $111.00 $172.05 $279.35

$190,000 $17.10 $17.10 $24.70 $38.00 $49.40 $76.00 $114.00 $176.70 $286.90

$195,000 $17.55 $17.55 $25.35 $39.00 $50.70 $78.00 $117.00 $181.35 $294.45

$200,000 $18.00 $18.00 $26.00 $40.00 $52.00 $80.00 $120.00 $186.00 $302.00

$205,000 $18.45 $18.45 $26.65 $41.00 $53.30 $82.00 $123.00 $190.65 $309.55

$210,000 $18.90 $18.90 $27.30 $42.00 $54.60 $84.00 $126.00 $195.30 $317.10

$215,000 $19.35 $19.35 $27.95 $43.00 $55.90 $86.00 $129.00 $199.95 $324.65

$220,000 $19.80 $19.80 $28.60 $44.00 $57.20 $88.00 $132.00 $204.60 $332.20

Page 22: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Voluntary Life Cost Illustration continued

< 30 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69†

$225,000 $20.25 $20.25 $29.25 $45.00 $58.50 $90.00 $135.00 $209.25 $339.75

$230,000 $20.70 $20.70 $29.90 $46.00 $59.80 $92.00 $138.00 $213.90 $347.30

$235,000 $21.15 $21.15 $30.55 $47.00 $61.10 $94.00 $141.00 $218.55 $354.85

$240,000 $21.60 $21.60 $31.20 $48.00 $62.40 $96.00 $144.00 $223.20 $362.40

$245,000 $22.05 $22.05 $31.85 $49.00 $63.70 $98.00 $147.00 $227.85 $369.95

$250,000 $22.50 $22.50 $32.50 $50.00 $65.00 $100.00 $150.00 $232.50 $377.50

Policy Election Amount

Child(ren)

$2,500 $0.50 $0.50 $0.50 $0.50 $0.50 $0.50 $0.50 $0.50 $0.50

$5,000 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00

$7,500 $1.50 $1.50 $1.50 $1.50 $1.50 $1.50 $1.50 $1.50 $1.50

$10,000 $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $2.00

Refer to Guarantee Issue row on page above for Voluntary Life GI+AA amounts.

Premiums for Voluntary Life Increase in five-year increments

‡Spouse coverage premium is based on Employee age. Coverage for the spouse terminates at spouse’s age 70.

†Benefit reductions apply.

Manage Your Benefits:

Go to www.GuardianAnytime.com to access secure information about

your Guardian benefits. Your on-line account will be set up within 30

days after your plan effective date.

Need Assistance?

Call the Guardian Helpline (888) 600-1600, weekdays, 8:00 AM to 8:30 PM,

EST. Refer to your member ID (social security number) and your plan

number: 00499943

LIMITATIONS AND EXCLUSIONS:

A SUMMARYOF PLANLIMITATIONSANDEXCLUSIONS FORLIFEANDAD&DCOVERAGE:

You must be working full-time on the effective date of your coverage; otherwise, yourcoverage becomes effective after you have completed a specific waiting period. Employeesmust be legally working in the United States in order to be eligible for coverage.Underwriting must approve coverage for employees on temporary assignment: (a)exceeding one year; or (b) in an area under travel warning by the US Department of State.Subject to state specific variations. Evidence of Insurability is required on all late enrollees.This coverage will not be effective until approved by a Guardian underwriter. This proposalis hedged subject to satisfactory financial evaluation. Please refer to certificate of coverage forfull plan description.

Dependent life insurance will not take effect if a dependent, other than a newborn, isconfined to the hospital or other health care facility or is unable to perform the normalactivities of someone of like age and sex.

Accelerated Life Benefit is not paid to an employee under the following circumstances: onewho is required by law to use the benefit to pay creditors; is required by court order to paythe benefit to another person; is required by a government agency to use the payment toreceive a government benefit; or loses his or her group coverage before an acceleratedbenefit is paid.

We pay no benefits if the insured’s death is due to suicide within two years from theinsured’s original effective date. This two year limitation also applies to any increase inbenefit. This exclusion may vary according to state law. Late entrants and benefit increasesrequire underwriting approval.

GP-1-R-EOPT-96

Guarantee Issue/Conditional Issue amounts may vary based on age and case size. See yourPlan Administrator for details. Late entrants and benefit increases require underwritingapproval.

For AD&D: We pay no benefits for any loss caused: by willful self-injury; sickness, diseaseor medical treatment; by participating in a civil disorder or committing a felony; Travelingon any type of aircraft while having duties er on that aircraft; by declared or undeclared actof war or armed aggression; while a member of any armed force (May vary by state); whiledriving a motor vehicle without a current, valid driver’s license; by legal intoxication; or byvoluntarily using a non-prescription controlled substance. Contract #GP-1-R-ADCL1-00 etal. We won't pay more than 100% of the Insurance amount for all losses due to the sameaccident, except as stated. The loss must occur within a specified period of time of theaccident. Please see contract for specific definition; definition of loss may vary depending onthe benefit payable.

This document is a summary of the major features of the referenced insurance coverage.  It is intended for illustrative purposes only and does not constitute acontract. The insurance plan documents, including the policy and certificate, comprise the contract for coverage. The full plan description, including thebenefits and all terms, limitations and exclusions that apply will be contained in your insurance certificate. The plan documents are the final arbiter ofcoverage.  Coverage terms may vary by state and actual sold plan. The premium amounts reflected in this summary are an approximation; if there is adiscrepancy between this amount and the premium actually billed, the latter prevails.

Page 23: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

UNUM DISABILITY INSURANCE

ALL EMPLOYEES PLEASE NOTE:If any employee currently has 90 days of Louisiana Extended Sick Leave left and you have purchased or are planning to purchase the Unum Disablilty Policy, please understand that this policy will not pay but a minimum of 10% of the benefit amount you buy or $100 per month, whichever is greater, until which time your Louisiana Extended Leave Policy is exhausted. At that time it will pick up the full amount of the benefit you chose as long as you have no other deductible income and continue to pay until you If you fall in this category, you may want to consider changing your eligibility period to 90 days to save on premium. Thanks.

Page 24: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Educator Select Income Protection Plan Insurance Highlights

EB-975

Morehouse Parish School Board Policy # 701578

Please read carefully the following description of your Unum Educator Select Income Protection Plan

insurance.

Your Plan

Eligibility You are eligible for disability coverage if you are an active employee in the

United States working a minimum of 20 hours per week. The date you are

eligible for coverage is the later of: the plan effective date; or the day after

you complete the waiting period.

Guarantee Issue Coverage is available to you without answering any medical questions or

providing evidence of insurability. You may apply for coverage within 60

days after your eligibility date. If you do not apply within 60 days after

your eligibility date, you can apply only during an annual enrollment

period.

Benefits are subject to the pre-existing condition exclusion

referenced later in this document.

Please see your Plan Administrator for your eligibility date.

Benefit Amount You may purchase a monthly benefit in $100 units, starting at a minimum

of $200, up to 66 2/3% of your monthly earnings rounded to the nearest

$100, but not to exceed a monthly maximum benefit of $6,000. Please see

your Plan Administrator for the definition of monthly earnings.

The total benefit payable to you on a monthly basis (including all benefits

provided under this plan) will not exceed 100% of your monthly earnings

unless the excess amount is payable as a Cost of Living Adjustment.

However, if you are participating in Unum’s Rehabilitation and Return to

Work Assistance program, the total benefit payable to you on a monthly

basis (including all benefits provided under this plan) will not exceed 110%

of your monthly earnings (unless the excess amount is payable as a Cost of

Living Adjustment.

Elimination Period The Elimination Period is the length of time of continuous disability, due to

sickness or injury, which must be satisfied before you are eligible to receive

benefits.

You may choose an Elimination Period (injury/sickness) of 0/7, 14/14,

30/30, 60/60, 90/90 or 180/180 days.

If, because of your disability, you are hospital confined as an inpatient,

benefits begin on the first day of inpatient confinement. Inpatient means

that you are confined to a hospital room due to your sickness or injury

for 23 or more consecutive hours. (Applies to Elimination Periods of

0/7 and 14/14 only.)

Benefit Duration Your duration of benefits is based on your age when the disability occurs.

Page 25: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Plan: ADEA I: Your duration of benefits is based on the following table:

Age at Disability Maximum Duration of Benefits

Less than age 60 To age 65, but not less than 5 years

Age 60 60 months

Age 61 48 months

Age 62 42 months

Age 63 36 months

Age 64 30 months

Age 65 24 months

Age 66 21 months

Age 67 18 months

Age 68 15 months

Age 69 and over 12 months

Federal Income Taxation You may wonder if your disability benefit amount will be taxed. It depends

on how your premium — the price of your coverage — is paid.

If your premium is paid with:

• Pre-Tax Dollars,* your benefit amount will be taxed

• Post-Tax Dollars,** your benefit amount will not be taxed

• Both Pre-Tax and Post-Tax Dollars, a portion of your benefit

amount will be taxed

The disability benefit amounts you receive will be reported annually on a

W-2. It will show any taxable and non-taxable portions separately.

*Pre-Tax Dollars are dollars paid by your employer toward premium that are not reported

as earnings on your annual W-2. They are also dollars you pay toward premium through a

cafeteria plan.

**Post-Tax Dollars are dollars paid through payroll deductions after taxes and

withholdings have been subtracted from your earnings. They are also dollars paid by your

employer toward premium that are reported as earnings on your annual W-2 and taxed

accordingly.

Additional Benefits

Work/Life Balance Employee Assistance

Program1

Work-life balance is a comprehensive resource providing access to

professional assistance for a wide range of personal and work-related

issues. The service is available to you and your family members twenty-

four hours a day, 365 days a year, and provides resources to help employees

find solutions to everyday issues such as financing a car or selecting child

care, as well as more serious problems such as alcohol or drug addiction,

divorce, or relationship problems.

Services include: toll-free phone access to master’s-level consultants, up to

three face-to-face sessions to help with more serious issues; and online

resources. There is no additional charge for utilizing the program.

Participation is confidential and strictly voluntary, and employees do not

have to have filed a disability claim or be receiving benefits to use the

program.

However, if you become disabled and are receiving benefits, Unum's On

Claim Support can provide additional resources including: coaching on how

to communicate effectively with medical personnel, conducting consumer

Page 26: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

research for medical equipment and supplies, assessing emotional needs

and locating counseling resources.

Return to Work/ Work Incentive Benefit

Unum supports efforts that enable a disabled employee to remain on the job

or return to work as soon as possible. If you are disabled but working part

time with monthly disability earnings of 20% or more of your indexed

monthly earnings, during the first 12 months, the monthly benefit will not be

reduced by any earnings until the gross disability payment plus your

disability earnings, exceeds 100% of your indexed monthly earnings. The

monthly benefit will then be reduced by that amount.

Rehabilitation and Return to Work Assistance

Unum has a vocational Rehabilitation and Return to Work Assistance

program available to assist you in returning to work. We will make the

final determination of your eligibility for participation in the program, and

will provide you with a written Rehabilitation and Return to Work

Assistance plan developed specifically for you. This program may include,

but is not limited to the following benefits:

• coordination with your Employer to assist your return to work;

• adaptive equipment or job accommodations to allow you to work;

• vocational evaluation to determine how your disability may impact

your employment options;

• job placement services;

• resume preparation;

• job seeking skills training; or

• education and retraining expenses for a new occupation.

If you are participating in a Rehabilitation and Return to Work Assistance

program, we will also pay an additional disability benefit of 10% of your

gross disability payment to a maximum of $1,000 per month. In addition,

we will make monthly payments to you for 3 months following the date

your disability ends, if we determine you are no longer disabled while:

• you are participating in a Rehabilitation and Return to Work Assistance

program; and

• you are not able to find employment.

(This benefit is not allowed in New Jersey.)

Worksite Modification If a worksite modification will enable you to remain at work or return to

work, a designated Unum professional will assist in identifying what’s

needed. A written agreement must be signed by you, your employer and

Unum, and we will reimburse your employer for the greater of $1,000 or

the equivalent of two months of your disability benefit.

Waiver of Premium After you have received disability payments under the plan for 90

consecutive days, from that point forward you will not be required to pay

premiums as long as you are receiving disability benefits.

Page 27: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Survivor Benefit Unum will pay your eligible survivor a lump sum benefit equal to 3 months

of your gross disability payment.

This benefit will be paid if, on the date of your death, your disability

had continued for 180 or more consecutive days, and you were

receiving or were entitled to receive payments under the plan. If you

have no eligible survivors, payment will be made to your estate, unless

there is none. In that case, no payment will be made. However, we will

first apply the survivor benefit to any overpayment which may exist on

your claim.

You may receive your survivor benefit prior to your death if you are

receiving monthly payments and your physician certifies in writing that you

have been diagnosed as terminally ill and your life expectancy has been

reduced to less than 12 months. This benefit is only payable once and if

you elect to receive this benefit, no survivor benefit will be payable to your

eligible survivor upon your death. (Note this “Accelerated Survivor

Benefit” is not available in Connecticut.)

Dependent Care Expense Benefit

If you are disabled and participating in Unum’s Rehabilitation and Return

to Work Assistance program, Unum will pay a Dependent Care Expense

Benefit when you are disabled and you provide satisfactory proof that you:

• are incurring expenses to provide care for a child under the age of 15;

• and/or start incurring expenses to provide care for a child age 15 or

older or a family member who needs personal care assistance.

The payment will be $350 per month per dependent, to a maximum of

$1,000 per month for all dependent care expenses combined.

Worldwide Emergency Travel

Assistance Services2

Whether your travel is for business or pleasure, our worldwide

emergency travel assistance program is there to help you when an

unexpected emergency occurs. With one phone call anytime of the

day or night, you, your spouse and dependent children can get

immediate assistance anywhere in the world3. Emergency travel

assistance is available to you when you travel to any foreign

country, including neighboring Canada or Mexico. It is also

available anywhere in the United States for those traveling more

than 100 miles from home. Your spouse and dependent children do

not have to be traveling with you to be eligible. However, spouses

traveling on business for their employer are not covered by this

program.

Other Important Provisions

Pre-existing Condition Exclusion

Benefits will not be paid for disabilities caused by, contributed to by, or

resulting from a pre-existing condition. You have a pre-existing condition if:

• you received medical treatment, consultation, care or services

including diagnostic measures, or took prescribed drugs or

medicines in the 3 months just prior to your effective date of

coverage; andthe disability begins in the first 12 months after your

effective date of coverage.

Definition of Disability You are disabled when Unum determines that:

• you are limited from performing the material and substantial duties of

your regular occupation due to your sickness or injury;

Page 28: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

• you have a 20% or more loss in indexed monthly earnings due to the

same sickness or injury; and

• during the elimination period you are unable to perform any of the

material and substantial duties of your regular occupation.

After benefits have been paid for 24 months, you are disabled when Unum

determines that due to the same sickness or injury, you are unable to

perform the duties of any gainful occupation for which you are reasonably

fitted by education, training or experience.

You must be under the regular care of a physician in order to be considered

disabled.

Gainful Occupation Gainful occupation means an occupation that is or can be expected to

provide you with an income within 12 months of your return to work, that

exceeds 80% of your indexed monthly earnings if you are working or 60%

of your indexed monthly earnings if you are not working.

Benefit Integration Your disability benefit will be reduced by deductible sources of income

and any earnings you have while disabled. Your gross disability payment

will be reduced immediately by such items as disability income or other

amounts you receive or are entitled to receive from workers compensation

or similar occupational benefit laws, sabbatical or assault leave plans and

the amount of earnings you receive from an extended sick leave plan as

described in Louisiana Revised Statutes or any other act or law with similar

intent.

After you have received monthly disability payments for 12 months, your

gross disability payment will be reduced by such items as additional

deductible sources of income you receive or are entitled to receive under:

state compulsory benefit laws; automobile liability insurance; legal

judgments and settlements; certain retirement plans; salary continuation or

sick leave plans; other group or association disability programs or

insurance; and amounts you or your family receive or are entitled to receive

from Social Security or similar governmental programs.

Regardless of deductible sources of income, an employee who qualifies for

disability benefits is guaranteed to receive a minimum benefit amount of the

greater of $100 or 10% of the gross disability payment.

Mental Illness/Self-Reported Symptoms

The lifetime cumulative maximum benefit period for all disabilities due to

mental illness and disabilities based primarily on self-reported symptoms is

24 months. Only 24 months of benefits will be paid for any combination of

such disabilities even if the disabilities are not continuous and/or are not

related. Payments would continue beyond 24 months only if you are

confined to a hospital or institution as a result of the disability.

Instances When Benefits Would Not Be Paid

Benefits will not be paid for disabilities caused by, contributed to by, or

resulting from:

• intentionally self-inflicted injuries;

• active participation in a riot;

• commission of a crime for which you have been convicted;

• loss of professional license, occupational license or certification;

• pre-existing conditions (see definition).

Unum will not cover a disability due to war, declared or undeclared, or any

act of war.

Page 29: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Unum will not pay a benefit for any period of disability during which you

are incarcerated.

Termination of Coverage Your coverage under the policy ends on the earliest of the following:

• The date the policy or plan is cancelled;

• The date you no longer are in an eligible group;

• The date your eligible group is no longer covered;

• The last day of the period for which you made any required

contributions;

• The later of the last day you are in active employment except as

provided under the covered layoff or leave of absence provision; or

if applicable, the last day of your contract with your Employer but

not beyond the end of your Employer’s current school contract

year.

Unum will provide coverage for a payable claim which occurs while you are

covered under the policy or plan.

Next Steps

How to Apply/ Effective Date of Coverage

To apply for coverage, complete your enrollment form within 60 days of

your eligibility date. Please see your Plan Administrator for your effective

date.

If you do not enroll during the initial enrollment period, you may apply

only during an annual enrollment.

Delayed Effective Date of Coverage

If you are absent from work due to injury, sickness, temporary layoff or

leave of absence, your coverage will not take effect until you return to

active employment. Please contact your Plan Administrator after you return

to active employment for when your coverage will begin.

Questions If you should have any questions about your coverage or how to enroll,

please contact your Plan Administrator.

This plan highlight is a summary provided to help you understand your insurance coverage from Unum.

Some provisions may vary or not be available in all states. Please refer to your certificate booklet for

your complete plan description. If the terms of this plan highlight summary or your certificate differ from

your policy, the policy will govern. For complete details of coverage, please refer to policy form number

C.FP-1, et al.

1,2 Work-life balance employee assistance program and On-Claim Support services are provided by Ceridian

Corporation. Worldwide emergency travel assistance services are provided by Assist America, Inc. Services are

available with selected Unum insurance offerings. Exclusions, limitations and prior notice requirements may apply,

and service features, terms and eligibility criteria are subject to change. The services are not valid after termination

of coverage and may be withdrawn at any time. Please contact your Unum representative for full details. 3 All Worldwide emergency travel assistance must be arranged by Assist America, which pays for all services it

provides. Medical expenses such as prescriptions or physician, lab or medical facility fees are paid by the employee

or the employee’s health insurance.

Underwritten by: Unum Life Insurance Company of America 2211 Congress Street, Portland, Maine 04122,

www.unum.com

©2007 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group

and its insuring subsidiaries.

Page 30: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Rate per increment of $100 $4.45 $3.65 $2.95 $2.64 $1.50 $1.06

Morehouse Parish School Board Educator Select Income Protection

2018-19 Insurance Rate Grid

Monthly

Annual Monthly Disability

Earnings Earnings Benefit 0-7 14-14 30-30 60-60 90-90 180-180

$3,600 $300 $200 8.90$ 7.30$ 5.90$ 5.28$ 3.00$ 2.12$

$5,400 $450 $300 13.35$ 10.95$ 8.85$ 7.92$ 4.50$ 3.18$

$7,200 $600 $400 17.80$ 14.60$ 11.80$ 10.56$ 6.00$ 4.24$

$9,000 $750 $500 22.25$ 18.25$ 14.75$ 13.20$ 7.50$ 5.30$

$10,800 $900 $600 26.70$ 21.90$ 17.70$ 15.84$ 9.00$ 6.36$

$12,600 $1,050 $700 31.15$ 25.55$ 20.65$ 18.48$ 10.50$ 7.42$

$14,400 $1,200 $800 35.60$ 29.20$ 23.60$ 21.12$ 12.00$ 8.48$

$16,200 $1,350 $900 40.05$ 32.85$ 26.55$ 23.76$ 13.50$ 9.54$

$18,000 $1,500 $1,000 44.50$ 36.50$ 29.50$ 26.40$ 15.00$ 10.60$

$19,800 $1,650 $1,100 48.95$ 40.15$ 32.45$ 29.04$ 16.50$ 11.66$

$21,600 $1,800 $1,200 53.40$ 43.80$ 35.40$ 31.68$ 18.00$ 12.72$

$23,400 $1,950 $1,300 57.85$ 47.45$ 38.35$ 34.32$ 19.50$ 13.78$

$25,200 $2,100 $1,400 62.30$ 51.10$ 41.30$ 36.96$ 21.00$ 14.84$

$27,000 $2,250 $1,500 66.75$ 54.75$ 44.25$ 39.60$ 22.50$ 15.90$

$28,800 $2,400 $1,600 71.20$ 58.40$ 47.20$ 42.24$ 24.00$ 16.96$

$30,600 $2,550 $1,700 75.65$ 62.05$ 50.15$ 44.88$ 25.50$ 18.02$

$32,400 $2,700 $1,800 80.10$ 65.70$ 53.10$ 47.52$ 27.00$ 19.08$

$34,200 $2,850 $1,900 84.55$ 69.35$ 56.05$ 50.16$ 28.50$ 20.14$

$36,000 $3,000 $2,000 89.00$ 73.00$ 59.00$ 52.80$ 30.00$ 21.20$

$37,800 $3,150 $2,100 93.45$ 76.65$ 61.95$ 55.44$ 31.50$ 22.26$

$39,600 $3,300 $2,200 97.90$ 80.30$ 64.90$ 58.08$ 33.00$ 23.32$

$41,400 $3,450 $2,300 102.35$ 83.95$ 67.85$ 60.72$ 34.50$ 24.38$

$43,200 $3,600 $2,400 106.80$ 87.60$ 70.80$ 63.36$ 36.00$ 25.44$

$45,000 $3,750 $2,500 111.25$ 91.25$ 73.75$ 66.00$ 37.50$ 26.50$

$46,800 $3,900 $2,600 115.70$ 94.90$ 76.70$ 68.64$ 39.00$ 27.56$

$48,600 $4,050 $2,700 120.15$ 98.55$ 79.65$ 71.28$ 40.50$ 28.62$

$50,400 $4,200 $2,800 124.60$ 102.20$ 82.60$ 73.92$ 42.00$ 29.68$

$52,200 $4,350 $2,900 129.05$ 105.85$ 85.55$ 76.56$ 43.50$ 30.74$

$54,000 $4,500 $3,000 133.50$ 109.50$ 88.50$ 79.20$ 45.00$ 31.80$

$55,800 $4,650 $3,100 137.95$ 113.15$ 91.45$ 81.84$ 46.50$ 32.86$

$57,600 $4,800 $3,200 142.40$ 116.80$ 94.40$ 84.48$ 48.00$ 33.92$

$59,400 $4,950 $3,300 146.85$ 120.45$ 97.35$ 87.12$ 49.50$ 34.98$

$61,200 $5,100 $3,400 151.30$ 124.10$ 100.30$ 89.76$ 51.00$ 36.04$

$63,000 $5,250 $3,500 155.75$ 127.75$ 103.25$ 92.40$ 52.50$ 37.10$

$64,800 $5,400 $3,600 160.20$ 131.40$ 106.20$ 95.04$ 54.00$ 38.16$

$66,600 $5,550 $3,700 164.65$ 135.05$ 109.15$ 97.68$ 55.50$ 39.22$

$68,400 $5,700 $3,800 169.10$ 138.70$ 112.10$ 100.32$ 57.00$ 40.28$

$70,200 $5,850 $3,900 173.55$ 142.35$ 115.05$ 102.96$ 58.50$ 41.34$

Accident/Sickness Benefit Waiting Period

Cost Per Month

Page 31: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Rate per increment of $100 $4.45 $3.65 $2.95 $2.64 $1.50 $1.06

Morehouse Parish School Board Educator Select Income Protection

2018-19 Insurance Rate Grid

Monthly

Annual Monthly Disability

Earnings Earnings Benefit 0-7 14-14 30-30 60-60 90-90 180-180

Accident/Sickness Benefit Waiting Period

Cost Per Month

$72,000 $6,000 $4,000 178.00$ 146.00$ 118.00$ 105.60$ 60.00$ 42.40$

$73,800 $6,150 $4,100 182.45$ 149.65$ 120.95$ 108.24$ 61.50$ 43.46$

$75,600 $6,300 $4,200 186.90$ 153.30$ 123.90$ 110.88$ 63.00$ 44.52$

$77,400 $6,450 $4,300 191.35$ 156.95$ 126.85$ 113.52$ 64.50$ 45.58$

$79,200 $6,600 $4,400 195.80$ 160.60$ 129.80$ 116.16$ 66.00$ 46.64$

$81,000 $6,750 $4,500 200.25$ 164.25$ 132.75$ 118.80$ 67.50$ 47.70$

$82,800 $6,900 $4,600 204.70$ 167.90$ 135.70$ 121.44$ 69.00$ 48.76$

$84,600 $7,050 $4,700 209.15$ 171.55$ 138.65$ 124.08$ 70.50$ 49.82$

$86,400 $7,200 $4,800 213.60$ 175.20$ 141.60$ 126.72$ 72.00$ 50.88$

$88,200 $7,350 $4,900 218.05$ 178.85$ 144.55$ 129.36$ 73.50$ 51.94$

$90,000 $7,500 $5,000 222.50$ 182.50$ 147.50$ 132.00$ 75.00$ 53.00$

$91,800 $7,650 $5,100 226.95$ 186.15$ 150.45$ 134.64$ 76.50$ 54.06$

$93,600 $7,800 $5,200 231.40$ 189.80$ 153.40$ 137.28$ 78.00$ 55.12$

$95,400 $7,950 $5,300 235.85$ 193.45$ 156.35$ 139.92$ 79.50$ 56.18$

$97,200 $8,100 $5,400 240.30$ 197.10$ 159.30$ 142.56$ 81.00$ 57.24$

$99,000 $8,250 $5,500 244.75$ 200.75$ 162.25$ 145.20$ 82.50$ 58.30$

$100,800 $8,400 $5,600 249.20$ 204.40$ 165.20$ 147.84$ 84.00$ 59.36$

$102,600 $8,550 $5,700 253.65$ 208.05$ 168.15$ 150.48$ 85.50$ 60.42$

$104,400 $8,700 $5,800 258.10$ 211.70$ 171.10$ 153.12$ 87.00$ 61.48$

$106,200 $8,850 $5,900 262.55$ 215.35$ 174.05$ 155.76$ 88.50$ 62.54$

$108,000 $9,000 $6,000 267.00$ 219.00$ 177.00$ 158.40$ 90.00$ 63.60$

$109,800 $9,150 $6,100 271.45$ 222.65$ 179.95$ 161.04$ 91.50$ 64.66$

$111,600 $9,300 $6,200 275.90$ 226.30$ 182.90$ 163.68$ 93.00$ 65.72$

$113,400 $9,450 $6,300 280.35$ 229.95$ 185.85$ 166.32$ 94.50$ 66.78$

$115,200 $9,600 $6,400 284.80$ 233.60$ 188.80$ 168.96$ 96.00$ 67.84$

$117,000 $9,750 $6,500 289.25$ 237.25$ 191.75$ 171.60$ 97.50$ 68.90$

$118,800 $9,900 $6,600 293.70$ 240.90$ 194.70$ 174.24$ 99.00$ 69.96$

$120,600 $10,050 $6,700 298.15$ 244.55$ 197.65$ 176.88$ 100.50$ 71.02$

$122,400 $10,200 $6,800 302.60$ 248.20$ 200.60$ 179.52$ 102.00$ 72.08$

$124,200 $10,350 $6,900 307.05$ 251.85$ 203.55$ 182.16$ 103.50$ 73.14$

$126,000 $10,500 $7,000 311.50$ 255.50$ 206.50$ 184.80$ 105.00$ 74.20$

$127,800 $10,650 $7,100 315.95$ 259.15$ 209.45$ 187.44$ 106.50$ 75.26$

$129,600 $10,800 $7,200 320.40$ 262.80$ 212.40$ 190.08$ 108.00$ 76.32$

$131,400 $10,950 $7,300 324.85$ 266.45$ 215.35$ 192.72$ 109.50$ 77.38$

$133,200 $11,100 $7,400 329.30$ 270.10$ 218.30$ 195.36$ 111.00$ 78.44$

$135,000 $11,250 $7,500 333.75$ 273.75$ 221.25$ 198.00$ 112.50$ 79.50$

Page 32: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

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CANCER EXPENSE PRO INDIVIDUAL - BENEFITS

(Form W H1220 (ROS-13)

The Assurity at Work Cancer Expense PRO individual policy pays specified benefits for the prevention, diagnosis, and medically necessary treatment of cancer. All benefits specified below are payable per insured person.

Guaranteed Renewable - This product and all riders are guaranteed renewable for life with no reduction in benefits.

Rates - Same rates for men and women and no increased cost for tobacco use.

BENEFITS

Cancer Prevention and Wellness

Cancer Screening Test Pays $100 per calendar year for specified cancer screening tests.

Cancer Diagnosis

NCI (National Cancer Institute) Consultation

Pays $500 per day for a consultation at a NCI (National Cancer Institute) designated cancer treatment center one day per lifetime.

Positive Diagnosis Test Pays $500 per day for the diagnostic test that leads to a positive diagnosis of cancer one day per lifetime.

Additional Surgical Opinions Pays $200 per day for a second surgical opinion. Pays an additional $200 per day for a third surgical opinion if the first two surgical opinions are conflicting .

Cancer Treatment

Radiation Treatment, Chemotherapy, Hormone Therapy or lmmunotherapy

Pays a $5,000 monthly benefit when an insured person receives covered treatment. This benefit is payable for a maximum of six months per calendar year.

Self-administered Chemotherapy, Hormone Therapy or lmmunotherapy

Pays $300 per calendar week up to $1,200 per month. After this benefit has been paid in 24 months, the benefit is payable for a maximum of $100 per calendar month.

Supportive Drugs and Services Pays $500 per calendar year for specified supportive drugs and services related to radiation treatment, chemotherapy, hormone therapy and immunotherapy.

Experimental Treatment Pays $5,000 per calendar year for experimental treatment.

Bone Marrow Transplant Pays $10,000 per day for a bone marrow or stem cell transplant. This benefit is payable for a maximum of one day per lifetime.

Surgery and Anesthesia Pays a daily surgical benefit of $100 - $5,000 according to the surgical schedule. Pays an anesthesia benefit equal to 25% of the surgical benefit per day.

Outpatient Surgery Pays $150 per day an outpatient surgery is performed in a hospital or ambulatory surgical center.

Skin Cancer (Non-Melanoma) Pays $100 per day for the removal of non-melanoma skin cancer for a maximum of two days per calendar year.

Blood and Plasma Pays $150 per day for the transfusion , administration , cross-matching, typing and processing of blood and blood plasma. This benefit is payable 30 days per calendar year.

Hospitalization

Hospital Confinement Pays $150 per day for the first 75 consecutive days and $300 per day thereafter for confinement in a hospital.

CANCER EXPENSE PRO PROVIDES LIMITED BENEFIT COVERAGE. This is a proposal, not a contract nor an offer to contract. Availability of this product, along with all benefits and premiums as presented, is subject to the approval of Assurity. All benefits, premiums, conditions, exclusions and limitations are governed only by the actual contract as approved by Assurity and not this proposal. Policy availability features and rates may vary by state.

Page 33: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

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CANCER EXPENSE PRO INDIVIDUAL - BENEFITS (continued)

Government/Charity Hospital Confinement

Pays $200 per day for the first 75 consecutive days and $400 per day thereafter for confinement in a government or charity hospital.

Private Duty Nursing Pays $100 per day for a maximum of 60 days per calendar year.

Physician's Attendance Pays $35 per day for in-hospital visits from the physician.

Transportation and Lodging Benefit

Ambulance Pays $200 per day for ground transportation provided by ambulance to or from a hospital.

Transportation

Transportation benefits are payable for each of the insured person and one adult companion when such insured must travel over 50 miles for covered treatment.

Pays $250 per person per day for coach fare on common carrier. This benefit is payable for a maximum of four days per calendar year for both, the insured person and an adult companion.

Pays $175 per calendar week payable for a maximum of four calendar weeks per calendar year, for personal automobile expenses associated with non-local treatment.

Lodging Pays $60 per day for the lodging of either an insured person or an adult companion at a hotel, motel or other accommodations acceptable to us.

Continuing Care

Prosthesis Pays $1,000 per day for a prosthetic device. This benefit is payable for a maximum of two days per calendar year and is not payable for a hairpiece or breast prosthesis.

Prosthesis - External Breast Pays $250 per day for an external breast prosthesis two days per lifetime.

Prosthesis - Internal Breast Pays $2,500 per day for an internal breast prosthesis. This benefit is payable for a maximum of one day per breast per lifetime.

Home Health Care Services Pays $100 per day for services received at home by a licensed home health care agency. This benefit is payable 60 days per calendar year.

Hospice Care Pays $100 per day for care provided by hospice following a terminal diagnosis. This benefit is payable for a maximum of 120 days per lifetime.

Reconstructive Surgery Benefit

Pays $3,000 per day for Breast Transverse Rectus Abdominis Myocutaneous (TRAM) flap or Deep Inferior Epigastric Perforator (DIEM) flap.

Pays $750 per day for breast reconstruction four times per lifetime.

Pays $300 per day for breast symmetry four times per lifetime.

Pays $750 per day for facial reconstruction two times per lifetime.

The reconstructive surgery benefit will not exceed $3,000 per day.

Hairpiece Benefit Pays $150 per day for a hairpiece one day per lifetime.

Durable Medical Equipment

Pays $200 for braces or crutches once per calendar year.

Pays $1,000 for a hospital bed, respirator or wheelchair once per calendar year.

Cancer First Occurrence Benefit Rider (Form R W1221 (ROS-13)) Pays a lump sum benefit of $2,500 per day the first time an insured person is diagnosed as having cancer.

Specified Disease Benefit Rider (Form R W1224) Pays a daily benefit of $150 for the first 75 consecutive days and $300 per day thereafter when an insured person is confined to a hospital for treatment of one of 48 different specified diseases including ALS (Lou Gehrig's), Meningitis, Multiple Sclerosis, Hepatitis (chronic B or C with liver failure), Cystic Fibrosis and Cerebral Palsy. This rider also provides $500 per calendar year for drugs and medicines used in the treatment of a specified disease.

Page 34: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

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CANCER EXPENSE PRO INDIVIDUAL – PREMIUMS

Base Plan Options: Hospital Confinement Benefit: $150 (Daily) Radiation I Chemo Benefit: $5,000/6 months (Monthly Max/Months per Year)

Rider(s): Cancer First Occurrence Benefit Rider: $2,500 Specified Disease Benefit Rider

MONTHLY RATES FOR INDIVIDUAL PLAN IN LOUISIANA

Coverage Issue Ages Base Plan 1st Occurrence Benefit Rider

Specified Disease Benefit Rider Total Premium

Employee 18-39 10.21 0.57 0.27 11.05

40-49 27.22 2.10 0.41 29 .73

50-59 45.43 3.80 0.43 49.66

60-64 68.27 5.94 0.58 74.79

65-69 81 .55 7.11 0.58 89.24

70+ 99.17 8.82 0.72 108.71

Employee/Spouse 18-39 17.63 1.12 0.55 19.30

40-49 50.87 3.98 0.81 55.66

50-59 88.74 7.32 0.87 96.93

60-64 137.04 11.61 1.21 149.86

65-69 164.43 13.50 1.21 179.14

70+ 200.72 16.75 1.50 218.97

Employee/Child 18-39 12.43 0.69 0.38 13.50

40-49 29.04 2.22 0.51 31 .77

50-59 47.30 3.98 0.51 51.79

60-64 70.93 6.26 0.65 77.84

65-69 83.68 7.40 0.61 91 .69

70+ 101.87 9.17 0.75 111.79

Family 18-39 19.70 1.24 0.66 21 .60

40-49 52.91 4.08 0.92 57.91

50-59 90 .33 7.40 0.96 98.69

60-64 137.97 11.66 1.26 150.89

65-69 164.43 13.50 1.21 179.14

70+ 200.72 16.75 1.50 218.97

Page 35: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

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Wellness Benefit Claims

NOTE (Assurity Direct Number): To file a wellness claim call 866-289-7337, choose option 0, and tell representative that you would like to file your wellness over the phone. Pays up to $100.00 per year.

Information Needed: Please have a copy of your bill when you call with: Physician's Name, address, phone number, date of service, and total amount charged.

Page 36: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Everyone’s benefit needs are different. That’s why it’s important to choose the benefits that are right for your personal situation. See below the products you would like to learn more about at your 1-to-1 session with a Colonial Life Benefits counselor during Open Enrollment. You will learn how these products can fit into your overall benefits package. These products are portable, which means when you retire or if you should leave employment, you can take them with you!

Accident Insurance – Helps Offset the unexpected medical expenses, such as

emergency room fees, deductibles and copayments, that can result from a fracture, dislocation or other covered accidental injury.

Critical Illness Insurance – Complements your major medical coverage by

providing a lump-sum benefit that you can use to pay the direct and indirect costs related to a covered critical illness, which can often be expensive and lengthy.

Hospital Confinement Indemnity Insurance – Provides a lump-sum benefit

for a covered hospital confinement and a covered outpatient surgery to help offset the gaps caused by copayments and deductibles that are not covered by most major medical plans.

Life Insurance – Enable you to tailor coverage for you and your families

individual needs and helps provide financial security for your family members. We offer term, universal life and whole life. Each full time employee can purchase a whole life policy that is guarantee issue, no health questions, up to $75,000. Also available are juvenille policies for children and grandchildren

Page 37: Morehouse Parish School Board...Voluntary Benefits Guide for 2018-19 Plan Year Morehouse Parish School Board Attention: To All New Hires Please note that you only have 30 days from

Open Enrollment for Voluntary Benefits

Voluntary Benefits open enrollment period for Full-Time Employees runs from April 1, 2018through May 15, 2018. Any changes or new benefits elected are effective July 1, 2018 (June payroll

deduction). You will need to verify personal information and make any necessary changes at this time.

No changes are allowed outside of the open enrollment period unless you have a qualified change in

status.

Qualified changes in status include, for example: marriage, divorce, legal separation, birth or adoption

of a child, change in child’s dependent status, death of spouse, child or other qualified dependent,

change in residence, commencement or termination of adoption proceedings, change in employment

status or change in coverage under another employer-sponsored plan.

COBRA Continuation Notice

This notice contains important information about your right to continue your Dental and/or Vision

coverage in the Morehouse Parish School Board Group Plan. Please read the information contained in

this notice very carefully.

Eligibility begins with a loss of your regular insurance coverage under certain qualifying events

(employment ends, divorce, etc). Each person covered under the Plan at time of termination or loss of

eligibility is entitled to elect COBRA continuation. Federal law allows 60 days from the date of your

notice to elect continuation coverage.

Employees: Termination of employment for reasons other than gross misconduct including retirement,

unless paid coverage becomes available at retirement or a reduction of hours which results in the loss of

insurance plan eligibility. If you are disabled at the time of termination and give notice of disability

before the end of 18 months, coverage will be extended to 29 months.

Dependents (including Spouse): If employee becomes eligible, dependents coverage lasts up to 18

months. If no longer a “dependent child”, coverage lasts up to 36 months. Dependent loss of coverage

due to employee death, coverage lasts up to 36 months. Spouse loss of coverage due to a divorce or

legal separation, coverage lasts up to 36 months.