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PLAN YEAR: September 1, 2019 – August 31, 2020

Medina isd

What’s inside? EMPLOYEE BENEFITS CENTER

HOW TO ENROLL

S125 PLAN INFORMATION

FLEXIBLE SPENDING ACCOUNTS

AVAILABLE RESOURCES

BENEFITS AT A GLANCE

CONTACT INFORMATION

EMPLOYEE BENEFITs CENTER HTTP://BENEFITS.FFGA.COM/MEDINAISD

MARISSA WENNING, ACCOUNT MANAGER 2009 RR 620 N STE 123, AUSTIN TX 78734

OFFICE: 800-672-9666 | CELL: 210-380-0832

EMAIL: MARISSA.WENNING@FFGA.COM

This guide contains a summary of the benefits offered by your employer. If there is a conflict between the terms of this outline of benefits and the actual contracts, the terms of the contracts will prevail. For a more detailed explanation of benefits you may contact

your Account Manager or First Financial Administrators at 1-800-523-8422 or visit http://benefits.ffga.com.

Employee benefits center NEW employee benefits center - your guide to your benefits! We’ve created a custom site just for you! Find detailed information about current and upcoming benefits, voluntary product offerings and employer programs, Section 125 & Flex Information, important contact numbers and links, and downloadable forms and brochures.

http://benefits.ffga.com/medinaisd

How to Enroll Your First Financial Account Manager will be on site to assist you in enrolling in your benefits. To find out when your Account Manager will be at your location, view the schedule online or contact your site director. You also have the option to enroll online 24/7 through FFenroll during your enrollment period. To prepare for your enrollment, visit your Employee Benefits Center at http://benefits.ffga.com/medinaisd. Once you have reviewed available benefits for the upcoming plan year, visit FFenroll, https://ffga.benselect.com/enroll, to review currently enrolled benefits and dependent information.

ON SITE ENROLLMENT • What to have ready for your enrollment: • Social Security Numbers for all dependents • Any Status/Life Event or address changes • Questions about available benefits

ONLINE ENROLLMENT To enroll online, log in to FFenroll (https://ffga.benselect.com/enroll). For detailed information on how to enroll, visit the how to enroll tab on your Employee Benefits Center

Login and PIN Your login is your social security number (no dashes) and your PIN is the last four digits of your social security number and the last two digits of your birth year (678977) Once you login you will arrive at the Welcome Screen. Click “Next”, then: Verify your personal information Verify all dependent information (ssn/date of birth) **Very Important** View employment information

USEFUL INFORMATION TO KNOW • Write your PIN number down • Contact First Financial at 855‐523‐8422 with any technical questions • No changes will be permitted until annual enrollment, unless you have an IRS S125 qualified event

Section 125 Plan Information and rules

A Section 125 Plan provides a tax-saving way to pay for eligible medical or dependent care expenses. The

funds are automatically deducted from your paycheck on a pre-tax basis.

Here’s How It Works

A Section 125 Plan reduces your taxes and increases your spendable income by allowing you to deduct the

cost of eligible benefits from your earnings before tax. Plus, the plan is available to you at no cost, and you’re

already eligible. All you have to do is enroll.

Is It Right for Me? The savings you may experience with a Section 125 Plan are outlined below. By utilizing the Section 125

Plan, you would have $70 more every month to apply toward insurance benefits or other needs. That’s a

savings of $840 a year!

Flexible Spending Accounts

Medical FSA Medical Flexible Spending Accounts (FSA) allow you to set aside pre-tax payroll deductions each paycheck to pay for out of pocket medical, dental and vision expenses for you and your family. During open enrollment you will estimate the amount you think you will need during the year. This amount will be taken out of each paycheck. Your full annual election will be available to you at the beginning of the plan year. Your employer has chosen the $500 Roll-Over Option for your plan. This option allows you the opportunity to roll over $500 of unclaimed Medical FSA funds into the following plan year. Any amount in excess of $500 will be forfeited under the use-it-or-lose-it rule.

FSA Plan Year is: September 1, 2019 – August 31, 2020 FSA MAX: The maximum you can set aside each year is $2,700.

DEPENDENT CARE FSA With a Dependent Care Flexible Spending Account (FSA), you can set aside part of your pay on a pre-tax basis to pay for eligible dependent care expenses, such as:

• Day Care Centers • Before/After School Care • Mothers-Day-Out Program • Nursery Schools • Babysitters • Nanny • Au Pair • Day Camps

This account allows you to pay for day care expenses for your qualifying dependent/child with pre-tax dollars while you (and your spouse) are working, seeking employment, and/or attending school as a full time student (for at least five months of the year). Eligible dependents must be children under the age of 13 when care is provided or be an adult dependent incapable of self-care and be claimed as an exemption on your tax return. For full plan details, view the FSA Booklet available on the Employee Benefit Center.

Health Savings Account

Health Savings Account (HSA) through First Financial in conjunction with UMB HSAs were created to help control healthcare costs. They provide a savings vehicle that allows you to set aside money to pay for higher deductibles associated with lower monthly premium High Deductible Health Plans (HDHP). The money you save in monthly insurance premiums may be set aside for eligible medical expenses you incur in the future.

How it works: You choose the payroll deduction contributions up to the maximum allowed by the IRS. Your HSA balance rolls over from year-to-year earning interest along the way. The account is portable. Upon retirement or separation of service, you take the HSA with you because it’s your money and your account. When you want to access the funds, use your benefits card to pay your provider directly or simply request reimbursement or distribution on our online portal or mobile app. Be sure to keep receipts for all of your medical expenses, for which you received a reimbursement, for at least three years for tax-reporting purposes.

HSAs Offer a Triple Tax Advantage • The money you put in to the account is deducted from your paycheck before tax • The interest and earnings you make on the account grow tax free • Distributions for eligible medical expenses are tax free

What are the key advantages of an HSA? • No end-of-year forfeiture of funds • Portable account • Provides an excellent savings vehicle for healthcare expenses • No monthly account fees. • Free eStatements when you opt in for electronic delivery

Minimum Health Insurance Plan Deductible

Amounts for the Qualifying HDHP 2019 Individual Coverage $1,350 Family Coverage $2,700

Annual Maximum Contribution Levels 2019 Individual Coverage $3,500 Family Coverage $7,000

Maximums for HDHP Out-of-Pocket Expenses 2019 Individual Coverage $6,750 Family Coverage $13,500

BENEFITS CARD The Benefits Card is available to all employees that participate in Medical FSA, HSA and/or a Dependent Care FSA. The Benefits Card gives you immediate access to your money at the point of purchase. Cards are available for participating employees, their spouse and eligible dependents that are at least 18 years old. To request a card for your spouse or dependent, login to our secure portal at www.ffga.com.

The IRS requires validation of most transactions. You must submit receipts for validation of expenses when requested. If you fail to substantiate by providing a receipt to First Financial within 60 days of the purchase or date of service your card will be suspended until the necessary receipt or explanation of benefits from your insurance provider is received.

Online Portal Get account information from our easy-to-use online portal. View your Flex Account balance, find claim forms and view claim status and history. See your HSA account and investment balances in real time and request distributions. Visit www.ffga.com to set up your online account.

FF FLEX MOBILE APP With the FF Flex Mobile App you can submit claims, view account balance & history, see claim status, view alerts, upload receipts and documentation and more! The FF Flex Mobile App is available for Apple® or AndroidTM devices on the App StoreSM or the Google Play StoreTM.

FSa and hsa STORE First Financial has partnered with the FSA & HSA Store to bring you an easy to use online store to better understand and manage your FSA. For Flex, visit http://www.ffga.com/fsaextras and for HSA visit www.ffga.com/hsaextras for more details & special deals!

• Shop at FSA Store for eligible items from bandages to wheel chairs and thousands of products inbetween

• Browse or search for eligible products and services using the FSA Eligibility List• Visit the FSA Learning Center to help find answers to questions you may have about your FSA

FSA and hsa RESOURCES

Visit http://benefits.ffga.com/medinaisd for rates and benefit information.

Medical- TRS ActiveCare Aetna is the plan administrator for the TRS-ActiveCare plans.

First Financial Group of America enrolls this product for your district however any product questions or concerns need to be directed to Aetna or your district benefit administrator.

Aetna offers:

• A variety of plan and network options to suit your individual needs

• A Health Concierge available by phone for answers and guidance on care and benefits

• Online services and mobile apps for easy access to health information and tools, wherever you travel.

To get the best view of Aetna resources and plan information, visit www.trsactivecareaetna.com. Please learn about your Aetna medical plan and take advantage of all it offers for your health and well-being.

Dental - ameritas Oral care can be a significant financial expense. Having dental insurance can help cover the costs. Help keep your family's smiles healthy with dental insurance.

Vision - superior Vision insurance is a way to help cover expenses incurred for eye care services from eye care professionals such as optometrists and ophthalmologists. Regular eye exams can offer more than just measuring your eye sight! They can identify serious eye diseases early, allowing time for treatment. Most people don't realize that eye exams can also reveal the early signs of serious illnesses like diabetes, heart disease and high blood pressure.

Disability – American fidelityDisability insurance pays a cash benefit and is designed to help protect you if you can’t work due to a covered injury or sickness. It pays a monthly benefit amount based on a percentage of your gross income, so you may continue to pay for everyday living expenses.

Benefits at a Glance

CANCER INSURANCE - aflac If cancer touches someone in your family, this plan may help ease the impact on your finances. Benefit payments are made directly to you, allowing you to pay for expenses like copayments, hospital stays, and house and car payments. For more information please contact Finley Financial at 830/896-4400

Accident Insurance - aflac Accidents are inevitable. Even though you can’t always prepare for unforeseen events, you can plan ahead. Accident Insurance is designed to help cover some of the expenses that can result from a covered accident, and benefit payments are made directly to you. For more information contact Finley Financial at 830/896-4400

Critical Illness Insurance – American fidelityIf you experience an event such as a heart attack or stroke, Critical Illness Insurance may help. It pays a lump sum amount to help with expenses that may not be covered by major medical insurance – house payments, everyday expenses, lost income, and more.

Permanent, Portable Life Insurance - TEXAS LIFE Ensuring your family is financially covered in the event of a loss is an important way of showing them you care about their needs. Life Insurance can help. Portable, Individual Life Insurance policies may help your family in the event of your death. The application process is simple. You only have to answer three health questions, and there are no medical exams required.

GROUP LIFE - dearborn Group life insurance allows you to purchase affordable life insurance on yourself, spouse and dependent children. This is term insurance, available as long as you are employed by district. Employees enrolling in the coverage after the first 31 days of their employment will be subject to insurability and must complete a health questionnaire prior to coverage being issued.

Term Life Insurance – American fidelityLife insurance is an important purchase to make. It is impossible for life insurance to emotionally compensate for a loss, but it may help ease the financial obligations left to your loved ones such as your mortgage, college tuition, other debts, and daily living expenses. Term Life Insurance offers protection during your peak earning years when you have financial responsibilities such as paying a mortgage or supporting your family.

Medical transport - masa With MASA you will have zero out of pocket expenses for any emergent air or ground transport from ANYWHERE in the U.S regardless of who transports you. MASA provides emergency transportation solutions and covers your out of pocket medical transport cost when your insurance falls short. For more information please contact Finley Financial at 830/896-4400

Enhanced Disability Income Plan

Coverage Options · Benefits Paid Directly to You · Excellent Customer Service · Learn More » »

LONG-TERM DISABILITYIncome Insurance

First Financial Capital Corporation P.O. Box 670329 • Houston, TX 77267-0329

Local (281) 847-8422 | Toll Free (800) 523-8422 www.ffga.com

Marketed by:

Underwritten by: American Fidelity Assurance Company

Underwritten and administered by:

Find the plan that’s best for you! 1. Locate your current salary and review the monthly benefit offered based on your income.2. Review Elimination Period and Premium columns to choose the one that best fits your needs.3. See your First Financial Representative to enroll in your plan!

SALARY BENEFIT ELIMINATION PERIOD/MONTHLY PREMIUM

Annual Salary Monthly Salary*

Monthly Disability Benefit**

Accidental Death

Benefit

14 day Elimination

Period

30 day Elimination

Period

60 day Elimination

Period

90 day Elimination

Period

150 day Elimination

Period

$3,432.00 - $5,147.99 $286.00 - $428.99 $200.00 $20,000.00 $7.28 $5.80 $4.92 $4.16 $3.12

$5,148.00 - $6,863.99 $429.00 - $571.99 $300.00 $20,000.00 $10.92 $8.70 $7.38 $6.24 $4.68

$6,864.00 - $8,579.99 $572.00 - $714.99 $400.00 $20,000.00 $14.56 $11.60 $9.84 $8.32 $6.24

$8,580.00 - $10,295.99 $715.00 - $857.99 $500.00 $20,000.00 $18.20 $14.50 $12.30 $10.40 $7.80

$10,296.00 - $11,999.99 $858.00 - $999.99 $600.00 $20,000.00 $21.84 $17.40 $14.76 $12.48 $9.36

$12,000.00 - $13,715.99 $1,000.00 - $1,142.99 $700.00 $20,000.00 $25.48 $20.30 $17.22 $14.56 $10.92

$13,716.00 - $15,431.99 $1,143.00 - $1,285.99 $800.00 $20,000.00 $29.12 $23.20 $19.68 $16.64 $12.48

$15,432.00 - $17,147.99 $1,286.00 - $1,428.99 $900.00 $20,000.00 $32.76 $26.10 $22.14 $18.72 $14.04

$17,148.00 - $18,863.99 $1,429.00 - $1,571.99 $1,000.00 $20,000.00 $36.40 $29.00 $24.60 $20.80 $15.60

$18,864.00 - $20,579.99 $1,572.00 - $1,714.99 $1,100.00 $20,000.00 $40.04 $31.90 $27.06 $22.88 $17.16

$20,580.00 - $22,295.99 $1,715.00 - $1,857.99 $1,200.00 $20,000.00 $43.68 $34.80 $29.52 $24.96 $18.72

$22,296.00 - $23,999.99 $1,858.00 - $1,999.99 $1,300.00 $20,000.00 $47.32 $37.70 $31.98 $27.04 $20.28

$24,000.00 - $25,715.99 $2,000.00 - $2,142.99 $1,400.00 $20,000.00 $50.96 $40.60 $34.44 $29.12 $21.84

$25,716.00 - $27,431.99 $2,143.00 - $2,285.99 $1,500.00 $20,000.00 $54.60 $43.50 $36.90 $31.20 $23.40

$27,432.00 - $29,147.99 $2,286.00 - $2,428.99 $1,600.00 $20,000.00 $58.24 $46.40 $39.36 $33.28 $24.96

$29,148.00 - $30,863.99 $2,429.00 - $2,571.99 $1,700.00 $20,000.00 $61.88 $49.30 $41.82 $35.36 $26.52

$30,864.00 - $32,579.99 $2,572.00 - $2,714.99 $1,800.00 $20,000.00 $65.52 $52.20 $44.28 $37.44 $28.08

$32,580.00 - $34,295.99 $2,715.00 - $2,857.99 $1,900.00 $20,000.00 $69.16 $55.10 $46.74 $39.52 $29.64

$34,296.00 - $35,999.99 $2,858.00 - $2,999.99 $2,000.00 $20,000.00 $72.80 $58.00 $49.20 $41.60 $31.20

$36,000.00 - $37,715.99 $3,000.00 - $3,142.99 $2,100.00 $20,000.00 $76.44 $60.90 $51.66 $43.68 $32.76

$37,716.00 - $39,431.99 $3,143.00 - $3,285.99 $2,200.00 $20,000.00 $80.08 $63.80 $54.12 $45.76 $34.32

$39,432.00 - $41,147.99 $3,286.00 - $3,428.99 $2,300.00 $20,000.00 $83.72 $66.70 $56.58 $47.84 $35.88

$41,148.00 - $42,863.99 $3,429.00 - $3,571.99 $2,400.00 $20,000.00 $87.36 $69.60 $59.04 $49.92 $37.44

$42,864.00 - $44,579.99 $3,572.00 - $3,714.99 $2,500.00 $20,000.00 $91.00 $72.50 $61.50 $52.00 $39.00

$44,580.00 - $46,295.99 $3,715.00 - $3,857.99 $2,600.00 $20,000.00 $94.64 $75.40 $63.96 $54.08 $40.56

$46,296.00 - $47,999.99 $3,858.00 - $3,999.99 $2,700.00 $20,000.00 $98.28 $78.30 $66.42 $56.16 $42.12

$48,000.00 - $49,715.99 $4,000.00 - $4,142.99 $2,800.00 $20,000.00 $101.92 $81.20 $68.88 $58.24 $43.68

$49,716.00 - $51,431.99 $4,143.00 - $4,285.99 $2,900.00 $20,000.00 $105.56 $84.10 $71.34 $60.32 $45.24

$51,432.00 - $53,147.99 $4,286.00 - $4,428.99 $3,000.00 $20,000.00 $109.20 $87.00 $73.80 $62.40 $46.80

$53,148.00 - $54,863.99 $4,429.00 - $4,571.99 $3,100.00 $20,000.00 $112.84 $89.90 $76.26 $64.48 $48.36

$54,864.00 - $56,579.99 $4,572.00 - $4,714.99 $3,200.00 $20,000.00 $116.48 $92.80 $78.72 $66.56 $49.92

$56,580.00 - $58,295.99 $4,715.00 - $4,857.99 $3,300.00 $20,000.00 $120.12 $95.70 $81.18 $68.64 $51.48

$58,296.00 - $59,999.99 $4,858.00 - $4,999.99 $3,400.00 $20,000.00 $123.76 $98.60 $83.64 $70.72 $53.04

$60,000.00 - $61,715.99 $5,000.00 - $5,142.99 $3,500.00 $20,000.00 $127.40 $101.50 $86.10 $72.80 $54.60

$61,716.00 - $63,431.99 $5,143.00 - $5,285.99 $3,600.00 $20,000.00 $131.04 $104.40 $88.56 $74.88 $56.16

$63,432.00 - $65,147.99 $5,286.00 - $5,428.99 $3,700.00 $20,000.00 $134.68 $107.30 $91.02 $76.96 $57.72

$65,148.00 - $66,863.99 $5,429.00 - $5,571.99 $3,800.00 $20,000.00 $138.32 $110.20 $93.48 $79.04 $59.28

$66,864.00 - $68,579.99 $5,572.00 - $5,714.99 $3,900.00 $20,000.00 $141.96 $113.10 $95.94 $81.12 $60.84

$68,580.00 - $70,295.99 $5,715.00 - $5,857.99 $4,000.00 $20,000.00 $145.60 $116.00 $98.40 $83.20 $62.40

* Higher benefit amounts available up to a maximum Monthly Disability Benefit of $7,500. Ask your First Financial Representative for details.** Not to exceed 70% of your covered monthly compensation.

ACCIDENTAL DEATH BENEFITA lump sum of $20,000.00 will be paid if you die as the direct result of an Injury and death occurs within 90 days after the Injury.

The benefit will be increased 1% for each full month that your Certificate was continuously in force just prior to death. The total increase shall not be more than 60% of the benefit amount.

DIRECT DEPOSIT DISABILITY BENEFITSIn the event you choose the direct deposit option on an approved claim, we will deposit your benefits directly into your bank account at no additional cost. This can accelerate access to your benefits by several days. We also have a toll-free fax that allows you instant transmission of your claim forms to our Benefits Department.

DONOR BENEFITIf you are Disabled as a result of being an organ or tissue donor, we will pay your benefit as any other Sickness under the terms of the plan.

FAMILY CARE BENEFITIf you are Disabled and Working, qualify to receive a Disability Payment from us, and have one or more eligible family members, you may be eligible to receive a Family Care Benefit. This may include payment for the care of an eligible family member by a licensed childcare provider or licensed caregiver who is not related to you by blood or marriage. We will provide a Family Care Benefit for expenses incurred of up to 25% of your monthly Disability Benefit provided the total of your Disability Earnings, the gross Disability Benefit, and the Family Care Benefit do not exceed 100% of your Monthly Compensation. Payment of the Family Care Benefit will end on the earlier of the following: the date you no longer incur Family Member expenses; or the date you no longer qualify as Disabled and Working; or the date Disabled and Working benefits have been paid for a total of 24 months.

HOSPITAL CONFINEMENT BENEFITThe Hospital Confinement Benefit will not begin until the elimination period has been satisfied and will pay up to 60 days. The Hospital Confinement Benefit will be paid each day the insured is confined as a patient in a Hospital due to an Injury or Sickness. The amount payable is one times the Disability Benefit which will be pro-rated on a daily basis. This benefit is not reduced by Deductible Sources of Income. The Hospital Confinement must be at least 18 hours of continuous duration.

PHYSICIAN EXPENSE BENEFIT

» Injury - $150.00 per Injury

» Sickness - $50.00

If you need personal treatment by a Physician due to an Injury or Sickness, we will pay the amount shown above provided no other claim has been paid under the Policy. This benefit will be paid for Sickness only if the treatment is received during one full day of Disability during which you missed one full day of work. To be eligible for more than one payment for

the same or related condition due to Sickness, you must have returned to Active Employment for at least 14 consecutive scheduled workdays. You are not required to miss one full day of work in order to receive the Injury benefit.

PORTABILITY CONVERSIONThe Conversion Plan will be a separate group plan with a 30 day elimination period and 2 year benefit period. Certain other qualifications may apply. A brochure is available for this plan upon request after termination.

RETURN TO WORK INCENTIVE BENEFIT: DISABLED WHILE WORKINGWe will provide a Disability Payment if you are Disabled and your monthly Disability Earnings, if any, are less than 20% of your Monthly Compensation due to the same Disability.

If you are Disabled and your Disability Earnings are greater than 20% of your Monthly Compensation due to the same Disability, we will figure your payment as follows:

During the first 24 months of payments while Disabled and Working:

» Your Disability Payment will not be reduced as long as the Disability Earnings plus the gross Disability Benefit does not exceed 80% of your Monthly Compensation.

» If the Disability Earnings plus the gross Disability Benefit exceeds 80% of your Monthly Compensation, the Disability Payment will be reduced by the amount exceeding 80% of your Monthly Compensation.

After 24 months of payments, while Disabled and Working, you will receive payments based on the percentage of Monthly Compensation you are losing due to Lost Earnings based on your Disability.

We will stop payments and your claim will end, if at any time you are no longer Disabled or if your Disability Earnings exceed 80% of your Monthly Compensation. The Elimination Period cannot be satisfied with days you are Disabled and Working.

SOCIAL SECURITY FILING ASSISTANCEIf we determine you are a likely candidate for Social Security Disability benefits, we can assist you with the application and appeal process.

SPECIAL CONDITIONS LIMITED BENEFITThe Special Conditions Limited Benefit provides a benefit up to 2 years, due to Special Conditions if you are disabled and under the regular and appropriate care of your physician. Special Conditions means: Chronic Fatigue Syndrome; Fibromyalgia; Any disease, disorder, accident or injury of the neck or back not resulting in hemiplegia, paraplegia or quadriplegia; Environmental allergic illness including, but not limited to sick building syndrome and multiple chemical sensitivity; and Self-reported symptoms. Self-reported symptoms are symptoms that the insured tells their physician that are not verifiable using tests, procedures or clinical examinations. Examples include: headaches, pain, fatigue, stiffness, soreness, ringing in ears, dizziness, numbness, or loss of energy.

Plan Features

SUCCESSIVE DISABILITIESDisabilities which result from the same or related causes will be considered one period of Disability unless the Disabilities are separated by your return to Active Employment or any other gainful occupation for at least 3 consecutive months.

WAIVER OF PREMIUMNo premium payments are required while you are receiving payments under the plan after Disability Payments have been received under the plan for 180 consecutive days. We will require proof on an annual basis that you remain Disabled during this time.

WORKSITE ACCOMMODATIONAs part of our claims evaluation process, if worksite modifications may assist your return to work, we will evaluate your claim for appropriate action.

Important Policy ProvisionsELIGIBILITYAll permanent employees in subscribing group working 20 hours or more per week. Proof of good health may be required by us in order to be eligible for disability coverage. We will rely on answers given on your application to determine if coverage can be issued. Regardless of your health at the time of application, if coverage is approved and issued, claims incurred while coverage is in force will be subject to all terms of the Policy including any Pre-Existing Condition limitation.

WHEN COVERAGE BEGINSCertificates will become effective on the requested effective date following the date we approve the application, providing you are on Active Employment and premium has been paid.

IF YOU ARE DISABLED DUE TO A COVERED DISABILITY AND NOT WORKINGYour Disability Payment will be the Disability Benefit described in the Benefit Schedule less any Deductible Sources of Income you receive or are entitled to receive. No Disability Payment will be provided for any period in which you are not under the regular and appropriate care of a physician.

OFFSETS WITH OTHER SOURCES OF INCOME Deductible Sources of Income include:

» Other group disability income.

» Governmental or other retirement system, whether due to Disability, normal retirement or voluntary election of retirement benefits.

» United States Social Security Act or similar plan or act, including any amounts due your dependent(s) on account of your Disability.

» State Disability.

» Unemployment compensation.

» Sick leave or other salary or wage continuance plans provided by the Employer which extend beyond 60 (14, 30, 60 day Elimination Periods), 90 (on 90 day Elimination Period) and 150 (on 150 day Elimination Period) calendar days from the Date of Disability.

We reserve the right to estimate these Deductible Sources of Income that you may receive as defined in your Certificate.

MINIMUM DISABILITY BENEFITThe minimum Monthly Disability Benefit is 10% of the Monthly Disability Benefit or $100.00, whichever is greater.

INCREASE OF INCOME DUE TO COST OF LIVING ADJUSTMENTSThe Disability Payment will not be reduced due to a cost of living increase if the increase from a Deductible Source of Income takes effect after the onset of Disability and while benefits are payable under the Policy.

MENTAL ILLNESS LIMITED BENEFITIf you are Disabled due to a mental illness, regardless of the cause, Disability Payments will be provided for up to 2 years, not to exceed the Maximum Disability Period.

ALCOHOLISM AND DRUG ADDICTION LIMITED BENEFIT If you are disabled due to alcoholism or drug addiction, a limited benefit of up to 15 days for each Disability will be paid. Benefits will not be paid beyond the Maximum Benefit Period. If drug addiction is sustained at the hands of, or while under the regular and appropriate care of a physician in the course of treatment for Injury or Sickness, it will be covered the same as any other Sickness.

PRE-EXISTING CONDITION LIMITATIONA limited benefit up to 1 month’s Disability Benefit will be payable for Disability caused by or resulting from a Pre-Existing Condition. This provision will not apply if you have:

» gone treatment-free;

» incurred no expense;

» taken no medication; and

» received no diagnosis or advice from a Physician,

for 12 consecutive months for such condition(s).

This limitation will not apply to a Disability resulting from a Pre-Existing Condition that begins after you have been continuously covered under the Policy for 24 months.

Any increase in benefits will be subject to this Pre-Existing Condition limitation. A new Pre-Existing Condition period must be satisfied with respect to any increase applied for and approved by us.

EXCLUSIONSThe Policy does not cover any loss, fatal or non-fatal, resulting from:

» Intentionally self-inflicted injury while sane or insane.

» An act of war, declared or undeclared.

» Injury sustained or Sickness contracted while in the service of the armed forces of any country.

» Committing a felony.

» Penal incarceration. We will not pay benefits for Disability or any other loss during any period for which you are incarcerated in a penal or correctional institution for a period of 30 consecutive days or longer.

» Injury or Sickness arising out of and in the course of any occupation for wage or profit or for which you are entitled to Workers’ Compensation*.

*The term “entitled to Workers’ Compensation” shall also include Workers’ Compensation claim settlements that occur via compromise and release. Further, no benefits will be paid under this Policy for any period during which you are entitled to Workers’ Compensation benefits.

LEAVE OF ABSENCEYour coverage may be continued for up to 1 year during a Leave of Absence approved in writing by your Employer.

TERMINATION OF INSURANCEYour insurance coverage will end on the earliest of these dates:

» the date you do not meet the Eligibility requirements as defined in the Eligibility paragraph in this brochure;

» the date you retire;

» the date you cease to be on Active Employment, except as provided for under the Leave of Absence provision;

» the end of the last period for which premium has been paid;

» the date the Policy is discontinued; or

» the date your employment terminates.If:

» your coverage ends as a result of your termination of Active Employment;

» such termination is caused by an Injury or Sickness for which Disability Benefits would be payable; and

» Disability is established prior to the termination of Active Employment,

then:

Disability Benefits will be paid as if such termination had not occurred.

Termination of the Policy will have no affect on Disability Payments which began before termination. We may end your coverage if you submit a fraudulent claim. Your coverage can be terminated or premiums may be increased on any premium due date with 31 days advance notice.

DEFINITIONSACTIVE EMPLOYMENT: Means you are doing in the usual manner all of the regular duties of your employment on a full-time basis on a scheduled work day and these duties are being done at one of the places of business where you normally do such duties or at some location to which your employment sends you. You will be said to be on Active Employment on a day which is not a scheduled work day only if you are not Disabled and would be able to perform in the usual manner all the regular duties of your employment if it were a scheduled work day.

DISABILITY: Disability or Disabled for the first 12 months of Disability means that you are unable to perform the material and substantial duties of your Regular Occupation. After that, Disability means you are unable to perform the material and substantial duties of any Gainful Occupation for wage or profit for which you are reasonably qualified by training, education, or experience.

DISABILITY EARNINGS: Means the gross monthly earnings you receive while Disabled and Working.

DISABILITY PAYMENT: Means your Disability Benefit minus Deductible Sources of Income.

ELIGIBLE FAMILY MEMBERS: With regards to the Family Care Benefit, this means your child (natural, step, or adopted) living in your household and under age 13; or your family member who is:

» living in your household;

» dependent upon you for support; and

» in need of supervision or assistance due to physical or mental incapacity.

HOSPITAL: The term “Hospital” shall not include an institution used by you as:

» a place for rehabilitation;

» a place for rest or for the aged;

» a nursing or convalescent home;

» a long-term nursing unit or geriatrics ward; or

» as an extended care facility for the care of convalescent, rehabilitative, or ambulatory patients.

LOST EARNINGS: Means the percentage of Monthly Compensation you are losing due to your Disability while Disabled and Working. This is computed as follows:

» subtract your Disability Earnings from your Monthly Compensation;

» divide this answer by your Monthly Compensation. This will be your percentage of lost earnings. Multiply your Disability payment by your percentage of lost earnings.

MONTHLY COMPENSATION: Means for contracted employees, one-twelfth (1/12) of your contract salary through your Employer; or for non-contracted employees, one-twelfth (1/12) of your annual salary through your Employer, in effect on the date Disability began. It excludes any additional compensation including but not limited to, overtime pay, weekend or summer work compensation, bus or other allowances, bonuses or district-funded fringe benefits. If you become Disabled while on an approved leave of absence, we will use your gross Monthly Compensation from your Employer in effect just prior to the date your absence began.

Marketed by: First Financial Group of AmericaPRE-EXISTING CONDITION: The term “Pre-Existing Condition” means a disease, Injury, Sickness, physical condition or mental illness for which you:

» had treatment;

» incurred expense;

» took medication;

» received care or services including diagnostic testing or related measures; or

» received a diagnosis or advice from a Physician,

during the 12-month period immediately before your Effective Date of coverage. The term Pre-Existing Condition will also include conditions which are related to such disease, Injury, Sickness, physical condition, or mental illness.

ELIMINATION PERIODPeriod of time you must be disabled before benefit payments begin.

BENEFITS BEGIN Benefits begin on the following days, upon satisfying any required elimination period.

14 Day Elimination Period: Benefits begin on the 15th day of Disability due to a covered Injury or Sickness. 30 Day Elimination Period: Benefits begin on the 31st day of Disability due to a covered Injury or Sickness. 60 Day Elimination Period: Benefits begin on the 61st day of Disability due to a covered Injury or Sickness. 90 Day Elimination Period: Benefits begin on the 91st day of Disability due to a covered Injury or Sickness. 150 Day Elimination Period: Benefits begin on the 151st day of Disability due to a covered Injury or Sickness.

BENEFITS ARE PAYABLE

Up to the period of time shown in the table below, based on your age as of the date Disability due to a covered Injury or Sickness begins.

If you reside in a state other than your employer’s state of domicile, where required by law, policy provisions and benefits may vary.

Age Maximum Benefit Period Less than age 60 To Social Security Normal Retirement Age (SSNRA)*

60 60 months, or to SSNRA*, whichever is greater

61 48 months, or to SSNRA*, whichever is greater

62 42 months, or to SSNRA*, whichever is greater

63 36 months, or to SSNRA*, whichever is greater

64 30 months, or to SSNRA*, whichever is greater

65 24 months, or to SSNRA*, whichever is greater

66 21 months, or to SSNRA*, whichever is greater

67 18 months, or to SSNRA*, whichever is greater

68 15 months, or to SSNRA*, whichever is greater

Age 69 or older 12 months, or to SSNRA*, whichever is greater

*Age at which you are entitled to unreduced Social Security benefits based on current Social Security Amendments.

Disability Income Insurance Can Help! Ask Your First Financial Account

Representative For More Details.

This brochure highlights important features of the policy. Please refer to your certificate for complete details.

Group Critical Illness InsuranceLimited Benefit Group Critical Illness

This brochure highlights important features of the policy. Please refer to your certificate for complete details.

E M P L O Y E R B E N E F I T S O L U T I O N S F O R E D U C A T I O N

Group Critical Illness / Limited Benefit Group Critical Illness

Group Critical Illness Insurance

How It WorksIf you are diagnosed with a covered Critical Illness, such as a heart attack or stroke, this plan is designed to pay a lump sum benefit amount to help cover expenses. In addition, certain specified Critical Illnesses that reoccur will allow for an additional benefit.

American Fidelity’s Critical Illness Insurance features:

• Benefits paid directly to you, to be used however you see fit.

• No required medical exams as part of the application process.

• Guaranteed Issue benefit amounts may be available for first time eligible employees and spouse.

• Extends coverage to dependent children at no additional cost.

• Compatible with a Health Savings Account.

Coverage is available for you and your lawful spouse at determined benefit amounts and for your eligible child(ren), as defined in the policy, at 25% of the employees benefit amount.

HEALTH SCREENING BENEFIT(per calendar year per

Covered Employee and Covered Spouse)

$100

WELLNESS SCREENING BENEFIT

This benefit covers several qualified tests, including, but not limited to,

• Electrocardiogram (EKG) • Blood Glucose Testing

Surviving a critical illness, such as a heart attack or stroke, is becoming increasingly common with new medical technology. However, with advances in technology to treat these diseases, the cost of treatment rises more and more every year. Although many medical plans provide coverage for hospital stays and medical expenses arising from a critical illness, there are still out-of-pocket expenses that can affect anyone’s finances.

Co-pays, transportation expenses, and lost income should be the last thing you or your family worries about if a critical illness were to occur. American Fidelity Assurance Company’s Limited Benefit Group Critical Illness Insurance can help cover your out-of-pocket medical expenses and allow your family to focus on recovery.

Critical Illness insurance is here for you.

• Stress Test

• Echocardiogram

If you reside in a state other than your employer’s state of domicile, where required by law, policy provisions and benefits may vary.

17% of total healthcare costs are paid out-of-pocket.1

About every 40 seconds, an American will suffer a heart attack.2 American Fidelity’s Group Critical Illness Insurance can help with the rising cost of treatment for a covered Critical Illness such as heart attack or stroke.

12017 Milliman Medical Index; May 2017, p.9.2 American Heart Association: Heart Disease and Stroke Statistics 2017 At-a-Glance, p.2 September 2017.

Group Critical Illness Insurance

Critical Illness BenefitsPays once per Covered Person for each Critical Illness shown below.

Benefit Percentage Recurrent Diagnosis Benefit

Heart Attack Benefit Pays full lump sum benefit amount. 100% 50%

Coronary Artery Bypass Surgery Pays 25% of benefit amount. Payment will reduce the Heart Attack Benefit.

25% -Stroke Benefit (Permanent damage due to a Stroke)Pays full lump sum benefit amount. 100% 50%

Paralysis Benefit (Permanent due to a Covered Accident)Pays full lump sum benefit amount. 100% -Major Organ Failure BenefitPays full lump sum benefit amount. 100% 50%

End Stage Renal Failure BenefitPays full lump sum benefit amount. 100% -

Wellness Screening BenefitPays $100 when a Covered Employee or Covered Spouse receives a covered Health Screening Test. This benefit covers several qualified tests, including, but not limited to: Blood test for triglycerides, Doppler ultrasound, Echocardiogram, Electrocardiogram (EKG), Fasting blood glucose test, Serum cholesterol test to determine HDL and LDL levels, Exercise or Pharmacologic stress test, and Neuroimaging studies. This policy pays for one test per Covered Employee and one test per Covered Spouse per Calendar Year regardless of the number of tests received during the Calendar Year. This benefit is available without a diagnosis of a Critical Illness. This benefit does not reduce the Critical Illness lump sum benefit amount.

Critical Illness BenefitPays once per Covered Person for each Critical Illness. Each Critical Illness must be separated by at least 90 days following the first Critical Illness Occurrence Date.

Heart AttackPays following a Heart Attack due to Coronary Artery Disease. Any previous amounts paid for a Coronary Artery Bypass Surgery will be deducted from the amount payable under this benefit.

A Heart Attack is not congestive heart failure, atherosclerotic heart disease, angina, cardiac arrest, or any other disease or injury involving the cardiovascular system.

Coronary Artery Bypass SurgeryPays following open heart surgery performed by a Physician to correct Coronary Artery Disease with bypass grafts. Coronary Artery Bypass Surgery does not include balloon angioplasty, laser angioplasty, stenting, valve replacement surgery, or procedures other than Coronary Artery Bypass Surgery.

Stroke (Permanent Damage Due To A Stroke) Pays following permanent neurological damage to the brain due to a Stroke which results from an acute or sub-acute interruption of blood flow to brain tissue as defined in the policy. Permanent Damage due to a Stroke does not include Transient Ischemic Attacks (TIA).

Paralysis (Permanent Due To A Covered Accident)Injuries to the spinal cord due to a Covered Accident, which result in the loss of use of two or more limbs. Paralysis must be diagnosed as permanent, total, and irreversible.

Major Organ FailurePays following the date the Covered Person is placed on the United Network for Organ Sharing (UNOS) list for a transplant of the heart, liver, lung, or entire pancreas.

End Stage Renal Failure Pays following the Occurrence Date of End Stage Renal Failure resulting in irreversible failure of both kidneys to function and which requires regular dialysis or renal transplantation to sustain life.

Schedule of BenefitsKnowing everyone’s financial situation is different, American Fidelity offers multiple lump sum benefit amounts. Depending on the plan selected by your employer, the following Benefit Amounts may be available. The Employee Benefit Amounts can range from $10,000 to $30,000 in $5,000 increments. If elected, Spousal Benefit Amounts will be 50% of the Employee Benefit Amount.

Plan Benefit Highlights

SB-32278(FF)-0518

9000 Cameron Parkway Oklahoma City, Oklahoma 73114 800-654-8489americanfidelity.com

CG925 Series AFES

Plan Benefit Highlights, continued

Effective DateCertificates will become effective on the requested effective date following the date we approve the application, providing you are on Active Employment and premium has been paid.

EligibilityAll permanent employees in the subscribing group working 20 hours or more per week.

Recurrent Diagnosis BenefitUpon a second Occurrence of certain specified Critical Illnesses, this benefit pays 50% of the amount previously paid under the policy. Covered Critical Illness events include Heart Attack, Permanent Damage Due To a Stroke, and Major Organ Failure. The second Occurrence Date must be separated by at least 180 days following the first Occurrence Date of that same Critical Illness. Once a Recurrent Diagnosis Benefit has been paid for a Critical Illness, no further benefits for that same Critical Illness will be payable.

Portability Upon becoming no longer eligible for coverage, you will have 30 days to request continuation of coverage. Providing you pay premiums when due, you may continue your coverage provided in this certificate upon leaving employment until the earliest of these dates: a) your 75th birthday, b) 10 years from the portability effective date, c) the date the policy is terminated, or d) the date you fail to pay the required premium. You must have been continuously covered for 12 consecutive months prior to the date your coverage under the Policy ends.

Limitations and ExclusionsPre-Existing Condition LimitationNo Critical Illness Benefit will be payable for a Critical Illness which is caused by or resulting from a Pre-Existing Condition when the Critical Illness Occurrence Date occurs before a Covered Person has been continuously covered under the Policy for 12 consecutive months. Pre-Existing Condition means a disease, Accident, Sickness, physical condition or mental illness for which a Covered Person has experienced any of the following: (a) treatment; (b) incurred expense; (c) took medication; (d) received care or services including diagnostic testing or related measures; or (e) received a diagnosis or advice from a Physician, during the 12-month period immediately before the Covered Person’s Effective Date of coverage. The term Pre-Existing Condition will also include conditions which are related to such disease, Accident, Sickness, physical condition or mental illness.

A Heart Attack is an acute Myocardial Infarction due to Coronary Artery Disease resulting in death of a portion of the heart muscle. Diagnosis must be supported by onset of new symptoms and any of the following: EKG changes, elevation of biochemical markers, or imaging studies, consistent with an acute myocardial infarction. In the event of death, an autopsy, medical examiner’s confirmation or death certificate identifying Heart Attack will be acceptable.

Heart attack does not include congestive heart failure, atherosclerotic heart disease, angina, cardiac arrest, or any other disease or injury involving the cardiovascular system.

ExclusionsWe will not pay benefits for any Critical Illness resulting from or caused, whether directly or indirectly, by: (a) An intentionally self-inflicted Accident or Sickness. (b) Suicide or attempted suicide, while sane or insane. (c) Participating in a riot, insurrection, rebellion, civil commotion, civil disobedience, or unlawful assembly. This does not include a loss which occurs while acting in a lawful manner within the scope of authority. (d) Being intoxicated or under the influence of any narcotic unless administered by a Physician or taken according to the Physician’s instructions. Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the event that caused the Critical Illness occurred. (e) Committing, or attempting to commit a felony. (f ) Being incarcerated in any type of penal institution. (g) Alcoholism or drug addiction. (h) A diagnosis received outside the United States, or its territories, that cannot be confirmed by a Physician licensed and practicing in the United States.

Your coverage may be continued for up to 1 year during a leave of absence approved in writing by your employer. Coverage will continue as long as the group policy remains in force, the premiums are paid and you remain eligible for the coverage under the policy. Your coverage will end when you no longer qualify as an insured, you retire, you are not on active employment, or your employment terminates. Your coverage can be terminated or premiums may be increased on any premium due date with 31 days advance notice.This product is only offered on an after-tax basis. This product is inappropriate for people who are eligible for Medicaid coverage.

View and print your policies or file a claim at americanfidelity.comAmerican Fidelity’s Online Service Center provides you

convenient, secure access to manage your account.

Group Critical Illness / Limited Benefit Group Critical Illness

G925 Series AFES

E M P L O Y E R B E N E F I T S O L U T I O N S F O R E D U C A T I O NSB-32279(FF)(RATE INSERT)-0518

Marketed by American Fidelity Assurance Company

Extends coverage to dependent children at no additional cost.

This insert must be used in conjunction with SB-32278(FF) and any state specific deviations thereof.

9000 Cameron Parkway • Oklahoma City, Oklahoma 73114800-654-8489 • americanfidelity.com

EMPLOYEE MONTHLY RATES $10,000 $15,000 $20,000 $25,000 $30,000

Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco

18-29 $4.76 $6.76 $5.82 $8.84 $6.90 $10.92 $7.98 $13.02 $9.06 $15.1030-39 $6.72 $9.90 $8.80 $13.54 $10.86 $17.18 $12.92 $20.82 $15.00 $24.4640-49 $11.18 $16.90 $15.46 $24.06 $19.74 $31.18 $24.04 $38.34 $28.32 $45.5050-59 $17.56 $27.04 $25.04 $39.24 $32.52 $51.46 $40.00 $63.68 $47.46 $75.90

60 & Over $27.88 $43.44 $40.54 $63.88 $53.18 $84.28 $65.84 $104.70 $78.48 $125.14

AGE

SPOUSE MONTHLY RATES $5,000 $7,500 $10,000 $12,500 $15,000

AGE Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco

18-29 $3.38 $4.92 $3.76 $6.08 $4.16 $7.26 $4.56 $8.42 $4.94 $9.5830-39 $4.56 $7.00 $5.54 $9.22 $6.54 $11.42 $7.50 $13.62 $8.48 $15.8240-49 $7.24 $11.68 $9.56 $16.22 $11.86 $20.76 $14.18 $25.30 $16.50 $29.8250-59 $11.10 $18.42 $15.36 $26.34 $19.60 $34.26 $23.86 $42.16 $28.10 $50.0860-69 $17.36 $29.34 $24.72 $42.72 $32.10 $56.08 $39.48 $69.44 $46.84 $82.80

Group Critical Illness InsuranceLimited Benefit Group Critical Illness

Limited Benefit Group Critical Illness/ Rate Insert

FFGA STATE PLAN

Medina ISD Dental Highlight Sheet

Plan 1: Dental Plan Summary Effective Date: 9/1/2019

Plan Benefit Type 1 100% Type 2 80% Type 3 50%

Deductible $5/visit Type 1 $50 Calendar Year Type 2,3

No Family Maximum Maximum (per person) $1,000 per calendar year Allowance Ameritas U&C Dental Rewards® Included Waiting Period Type 3 – 6 months

Orthodontia Summary - Child Only Coverage

Allowance U&C Plan Benefit 50% Lifetime Maximum (per person) $1,000 Waiting Period 6 months

Sample Procedure Listing (Current Dental Terminology © American Dental Association.) Type 1 Type 2 Type 3

⚫ Routine Exam(2 per benefit period)

⚫ Bitewing X-rays(1 per benefit period)

⚫ Full Mouth/Panoramic X-rays(1 in 5 years)

⚫ Cleaning(2 per benefit period)

⚫ Fluoride for Children 13 and under(1 per benefit period)

⚫ Sealants (age 13 and under)

⚫ Space Maintainers⚫ Restorative Amalgams⚫ Restorative Composites

(anterior and posterior teeth)⚫ Simple Extractions

⚫ Onlays⚫ Crowns

(1 in 8 years per tooth)⚫ Crown Repair⚫ Endodontics (nonsurgical)⚫ Endodontics (surgical)⚫ Periodontics (nonsurgical)⚫ Periodontics (surgical)⚫ Denture Repair⚫ Implants⚫ Prosthodontics (fixed bridge; removable

complete/partial dentures)(1 in 8 years)

⚫ Complex Extractions⚫ Anesthesia

Monthly Rates 3 Tier

Employee Only (EE) $32.68 EE + Spouse $68.24 EE + Children $74.80 EE + Spouse & Children $110.24

Ameritas Information We're Here to HelpThis plan was designed specifically for the associates of Medina ISD . At Ameritas Group, we do more than provide coverage - we make sure there's always a friendly voice to explain your benefits, listen to your concerns, and answer your questions. Our customer relations associates will be pleased to assist you 7 a.m. to midnight (Central Time) Monday through Thursday, and 7 a.m. to 6:30 p.m. on Friday. You can speak to them by calling toll-free: 800-487-5553. For plan information any time, access our automated voice response system or go online to ameritas.com.

FFGA STATE PLAN

Medina ISD Dental Highlight Sheet

Rx Savings Our valued plan members and their covered dependents (even their pets) can save on prescription medications through any Walmart or Sam's Club pharmacy across the nation. This Rx discount is offered at no additional cost, and it is not insurance. To receive the Walmart Rx discount, Ameritas plan members just need to visit us at ameritas.com and sign into (or create) a secure member account where they can access and print an online-only Rx discount savings ID card.

Eyewear Savings

Ameritas plan members may receive up to 15% off eyewear frames and lenses purchased at any Walmart Vision Center nationwide. Members may also bring in their current vision prescription from any vision care provider and purchase eyewear at Walmart. This savings arrangement is not insurance: it is available to members at no additional cost to their plan premium. To receive the eyewear savings identification card, Ameritas plan members can visit ameritas.com and sign-in (or create) a secure member account. Members must present the Ameritas Eyewear Savings Card at time of purchase to receive the discount. Dental Rewards®

This dental plan includes a valuable feature that allows qualifying plan members to carryover part of their unused annual maximum. A member earns dental rewards by submitting at least one claim for dental expenses incurred during the benefit year, while staying at or under the threshold amount for benefits received for that year. Employees and their covered dependents may accumulate rewards up to the stated maximum carryover amount, and then use those rewards for any covered dental procedures subject to applicable coinsurance and plan provisions. If a plan member doesn't submit a dental claim during a benefit year, all accumulated rewards are lost. But he or she can begin earning rewards again the very next year.

Benefit Threshold $500 Dental benefits received for the year cannot exceed this amount

Annual Carryover Amount $250 Dental Rewards amount is added to the following year's maximum

Maximum Carryover $1,000 Maximum possible accumulation for Dental Rewards

Dental Network Information

To find a provider, visit ameritas.com and select FIND A PROVIDER, then DENTAL. Enter your criteria to search by location or for a specific dentist or practice. California Residents: When prompted to select your network, choose the Ameritas Network found on your ID Card or contact Customer Connections at 800-487-5553. Pretreatment

While we don't require a pretreatment authorization form for any procedure, we recommend them for any dental work you consider expensive. As a smart consumer, it's best for you to know your share of the cost up front. Simply ask your dentist to submit the information for a pretreatment estimate to our customer relations department. We'll inform both you and your dentist of the exact amount your insurance will cover and the amount that you will be responsible for. That way, there won't be any surprises once the work has been completed. Open Enrollment

If a member does not elect to participate when initially eligible, the member may elect to participate at the policyholder's next enrollment period. This enrollment period will be held each year and those who elect to participate in this policy at that time will have their insurance become effective on September 1. Late Entrant Provision

We strongly encourage you to sign up for coverage when you are initially eligible. If you choose not to sign up during this initial enrollment period, you will become a late entrant. Late entrants will be eligible for only exams, cleanings, and fluoride applications for the first 12 months they are covered. Section 125

This plan is provided as part of the Policyholder's Section 125 Plan. Each employee has the option under the Section 125 Plan of participating or not participating in this plan. If an employee does not elect to participate when initially eligible, he/she may elect to participate at the Policyholder's next Annual Election Period. Language Services

We recognize the importance of communicating with our growing number of multilingual customers. That is why we offer a language assistance program that gives you access to: Spanish-speaking claims contact center representatives, telephone interpretation services in a wide range of languages, online dental network provider search in Spanish and a variety of Spanish documents such as enrollment forms, claim forms and certificates of insurance. This document is a highlight of plan benefits provided by Ameritas Life Insurance Corp. as selected by your employer. It is not a certificate of insurance and does not include exclusions and limitations. For exclusions and limitations, or a complete list of covered procedures, contact your benefits administrator.

Superior Vision of Texas P.O. Box 967 Rancho Cordova, CA 95741 (800) 507-3800 superiorvision.com 0519-BSv2/TX

superiorvision.com

(800) 507-3800

Vision plan benefits for Medina ISD

Copays Monthly premiums Services/frequency Exam1 $10 Emp. only $8.62 Exam 12 months Eyewear2 $25 Emp. + spouse $14.67 Frame 12 months Emp. + children $15.54 Lenses 12 months Emp. + family $23.30 Contact lenses 12 months

(Based on date of service) Benefits through Superior Select Southwest network

In-network Out-of-network Exam Covered in full Up to $35 retail Frames $125 retail allowance Up to $70 retail Lenses (standard) per pair Single vision Covered in full Up to $25 retail Bifocal Covered in full Up to $40 retail Trifocal Covered in full Up to $45 retail Progressive See description3 Up to $45 retail Contact lenses4 $150 retail allowance Up to $80 retail Medically necessary contact lenses Covered in full Up to $150 retail

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1 Eye exam copay is a single payment due to the provider at the time of service. 2 Eyewear copay applies to eyeglass lenses / frame and contact lenses. Eyewear copay is a single payment that applies to the entire purchase of eyeglasses (frame and lenses) 3Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 4 Contact lenses and related professional services (fitting, evaluation and follow-up) are covered in lieu of eyeglass lenses and frames benefit

Discount features Non-covered eyewear discount: members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy. The national LASIK network of laser vision correction providers offers members special program pricing on services. The program pricing should be verified prior to service.

.

The Plan discount features are not insurance.

All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan.

Discounts are subject to change without notice.

Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions.

Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. This voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually cost more and decline in death benefit.

The policy, purelife-plus, is underwritten by Texas Life Insurance Company, and it has the following features:

• HighDeathBenefit. With one of the highest death benefits available at the worksite,1 purelife-plus gives your loved ones peace of mind, knowing there will be significant life insurance in force should you die prematurely.

• RefundofPremium. Unique in the marketplace, purelife-plus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.)

• AcceleratedDeathBenefitDuetoTerminalIllnessRider. Should you be diagnosed as terminally ill with the expectation of death within 12 months, you will have the option to receive 92% of the death benefit, minus a $150 ($100 in Florida) administrative fee in most states. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.) (Form ICC07-ULABR-07 or Form Series ULABR-07)

• Accelerated Death Benefit for Chronic Illness Rider. Included for employees at a small extra cost, this rider will be triggered by the loss of two activities of daily living2 or permanent cognitive impairment. It pays the insured 92% of the death benefit minus a small administrative fee, should the insured decide to exercise it. This valuable living benefit can help offset the cost of either in-home care or care in a resident facility. (Conditions apply.) (Form ICC15-ULABR-CI-15 or Form Series ULABR-CI-15)

(over)

Flexible Premium Life Insurance to Age 121Policy Form PRFNG-NI-10

Life Insurance HighlightsFor the employee

purelife-plus

16M005-C FF 1002 R0916 (exp0118) purelife-plus is not available in NJ, NY or PA.

See the purelife-plus brochure for details.

Accelerated Death Benefit for Chronic Illness Rider Form ICC15-ULABR-CI-15 or ULABR-CI-15Accidental Death Benefit Form ICC 07-ULCL-ADB-07 or Form Series ULCL-ADB-07

MONTHLY NON-TOBACCO PREMIUMSEmployee Only with Accidental Death and Chronic Illness Riders

Non

-Tob

acco

Employee monthly p r e m i u m s

PureLife-plus — Standard Risk Table Premiums — Non-Tobacco — Express IssueGUARANTEED

Monthly Premiums for Life Insurance Face Amounts Shown PERIOD

Includes Added Cost for Age to Which

Issue Accidental Death Benefit (Ages 17-59) Coverage is

Age and Accelerated Death Benefit for Chronic Illness (All Ages) Guaranteed at

(ALB) $10,000 $25,000 $50,000 $75,000 $100,000 $150,000 $200,000 $250,000 $300,000 Table Premium

15D-1 83

2-3 83

4-10 79

11-16 75

17-20 11.40 20.55 29.70 38.85 57.15 75.45 93.75 112.05 73

21-22 11.68 21.10 30.53 39.95 58.80 77.65 96.50 115.35 73

23-25 11.95 21.65 31.35 41.05 60.45 79.85 99.25 118.65 71

26 12.23 22.20 32.18 42.15 62.10 82.05 102.00 121.95 72

27 12.50 22.75 33.00 43.25 63.75 84.25 104.75 125.25 72

28 12.50 22.75 33.00 43.25 63.75 84.25 104.75 125.25 71

29 12.78 23.30 33.83 44.35 65.40 86.45 107.50 128.55 71

30-31 13.05 23.85 34.65 45.45 67.05 88.65 110.25 131.85 70

32 13.60 24.95 36.30 47.65 70.35 93.05 115.75 138.45 70

33 14.15 26.05 37.95 49.85 73.65 97.45 121.25 145.05 71

34 14.70 27.15 39.60 52.05 76.95 101.85 126.75 151.65 72

35 15.53 28.80 42.08 55.35 81.90 108.45 135.00 161.55 73

36 16.08 29.90 43.73 57.55 85.20 112.85 140.50 168.15 73

37 16.63 31.00 45.38 59.75 88.50 117.25 146.00 174.75 73

38 17.45 32.65 47.85 63.05 93.45 123.85 154.25 184.65 74

39 18.55 34.85 51.15 67.45 100.05 132.65 165.25 197.85 75

40 9.21 19.65 37.05 54.45 71.85 106.65 141.45 176.25 211.05 76

41 9.76 21.03 39.80 58.58 77.35 114.90 152.45 190.00 227.55 77

42 10.53 22.95 43.65 64.35 85.05 126.45 167.85 209.25 250.65 78

43 11.30 24.88 47.50 70.13 92.75 138.00 183.25 228.50 273.75 80

44 12.07 26.80 51.35 75.90 100.45 149.55 198.65 247.75 296.85 81

45 12.95 29.00 55.75 82.50 109.25 162.75 216.25 269.75 323.25 82

46 13.83 31.20 60.15 89.10 118.05 175.95 233.85 291.75 349.65 83

47 14.60 33.13 64.00 94.88 125.75 187.50 249.25 311.00 372.75 83

48 15.48 35.33 68.40 101.48 134.55 200.70 266.85 333.00 399.15 84

49 16.47 37.80 73.35 108.90 144.45 215.55 286.65 357.75 428.85 85

50 17.68 40.83 79.40 117.98 156.55 86

51 19.11 44.40 86.55 128.70 170.85 87

52 20.87 48.80 95.35 141.90 188.45 88

53 22.63 53.20 104.15 155.10 206.05 90

54 23.84 56.23 110.20 164.18 218.15 90

55 24.94 58.98 115.70 172.43 229.15 91

56 26.04 61.73 121.20 180.68 240.15 91

57 27.25 64.75 127.25 189.75 252.25 91

58 28.57 68.05 133.85 199.65 265.45 91

59 29.78 71.08 139.90 208.73 277.55 91

60 30.63 73.20 144.15 215.10 286.05 91

61 32.28 77.33 152.40 227.48 302.55 91

62 34.04 81.73 161.20 240.68 320.15 92

63 35.91 86.40 170.55 254.70 338.85 92

64 37.89 91.35 180.45 269.55 358.65 92

65 39.98 96.58 190.90 285.23 379.55 92

66 42.29 92

67 44.82 92

68 47.57 92

69 50.43 93

70 53.29 93

PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After the

Guaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under ”Permanent Coverage”.

Form: 18M049-ICC EXP-K-M-3AD

19M022-C-ADB-CI NT 1097 (exp0221) Policy Form ICC18-PRFNG-NI-18 or Form Series PRFNG-NI-18

PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After theGuaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under “Permanent Coverage”.

Non

-Tob

acco

Spouse/Child monthly p r e m i u m s

PureLife-plus — Standard Risk Table Premiums — Non-Tobacco — Express IssueGUARANTEED

M ont h l y Pr emi ums for L i fe I nsu r ance Face Amoun t s Show n PERI OD

Includes Added Cost for Age to Which

Issue Accidental Death Benefit (Ages 17-59) Coverage is

Age Guaranteed at

(ALB) $10,000 $25,000 $50,000 $75,000 $100,000 $150,000 $200,000 $250,000 $300,000 Table Premium15D-1 8.00 13.75 832-3 8.25 14.25 834-10 8.50 14.75 7911-16 8.75 15.25 7517-20 10.75 19.25 27.75 36.25 53.25 70.25 87.25 104.25 7321-22 11.00 19.75 28.50 37.25 54.75 72.25 89.75 107.25 7323-25 11.25 20.25 29.25 38.25 56.25 74.25 92.25 110.25 71

26 11.50 20.75 30.00 39.25 57.75 76.25 94.75 113.25 7227 11.75 21.25 30.75 40.25 59.25 78.25 97.25 116.25 7228 11.75 21.25 30.75 40.25 59.25 78.25 97.25 116.25 7129 12.00 21.75 31.50 41.25 60.75 80.25 99.75 119.25 71

30-31 12.25 22.25 32.25 42.25 62.25 82.25 102.25 122.25 7032 12.75 23.25 33.75 44.25 65.25 86.25 107.25 128.25 7033 13.25 24.25 35.25 46.25 68.25 90.25 112.25 134.25 7134 13.75 25.25 36.75 48.25 71.25 94.25 117.25 140.25 7235 14.50 26.75 39.00 51.25 75.75 100.25 124.75 149.25 7336 15.00 27.75 40.50 53.25 78.75 104.25 129.75 155.25 7337 15.50 28.75 42.00 55.25 81.75 108.25 134.75 161.25 7338 16.25 30.25 44.25 58.25 86.25 114.25 142.25 170.25 7439 17.25 32.25 47.25 62.25 92.25 122.25 152.25 182.25 7540 8.65 18.25 34.25 50.25 66.25 98.25 130.25 162.25 194.25 7641 9.15 19.50 36.75 54.00 71.25 105.75 140.25 174.75 209.25 7742 9.85 21.25 40.25 59.25 78.25 116.25 154.25 192.25 230.25 7843 10.55 23.00 43.75 64.50 85.25 126.75 168.25 209.75 251.25 8044 11.25 24.75 47.25 69.75 92.25 137.25 182.25 227.25 272.25 8145 12.05 26.75 51.25 75.75 100.25 149.25 198.25 247.25 296.25 8246 12.85 28.75 55.25 81.75 108.25 161.25 214.25 267.25 320.25 8347 13.55 30.50 58.75 87.00 115.25 171.75 228.25 284.75 341.25 8348 14.35 32.50 62.75 93.00 123.25 183.75 244.25 304.75 365.25 8449 15.25 34.75 67.25 99.75 132.25 197.25 262.25 327.25 392.25 8550 16.35 37.50 72.75 108.00 143.25 8651 17.65 40.75 79.25 117.75 156.25 8752 19.25 44.75 87.25 129.75 172.25 8853 20.85 48.75 95.25 141.75 188.25 9054 21.95 51.50 100.75 150.00 199.25 9055 22.95 54.00 105.75 157.50 209.25 9156 23.95 56.50 110.75 165.00 219.25 9157 25.05 59.25 116.25 173.25 230.25 9158 26.25 62.25 122.25 182.25 242.25 9159 27.35 65.00 127.75 190.50 253.25 9160 28.05 66.75 131.25 195.75 260.25 9161 29.55 70.50 138.75 207.00 275.25 9162 31.15 74.50 146.75 219.00 291.25 9263 32.85 78.75 155.25 231.75 308.25 9264 34.65 83.25 164.25 245.25 326.25 9265 36.55 88.00 173.75 259.50 345.25 9266 38.65 9267 40.95 9268 43.45 9269 46.05 9370 48.65 93

PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After theGuaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under ”Permanent Coverage”.

Form: 18M049-ICC EXP-K-M-3AD

Easy Application Process · No Medical Exams · Excellent Customer Service · Learn More » »

Term Life Insurance

First Financial Capital Corporation P.O. Box 670329 • Houston, TX 77267-0329

Local (281) 847-8422 | Toll Free (800) 523-8422 ffga.com

Marketed by:

Underwritten by: American Fidelity Assurance Company

10, 20 & 30 Year Renewable and Convertible

4Premiums remain level for the initial term period selected. If you choose the 10 or 20 Year Term Life Plan, the renewal date will be every 10 or 20 years until the policy anniversary following age 70 or 60 respectively. Thereafter, premiums are renewable annually. The 30 Year Term Life Plan is renewable annually after the initial term period. All term plans expire the policy anniversary following age 90. Rates will be adjusted on each renewed term period; 5Example is based on a 20-year term, monthly, non-tobacco, base policy with no attached riders. For specific ages, rates, term periods or face amounts, see your American Fidelity account manager.

EMPLOYEE ISSUE AGES SPOUSE ISSUE AGES AND MAXIMUMS

10 Year Term: 17-6520 Year Term: 17-6030 Year Term: 17-50

Ages 17-49: $50,000Ages 50-60: $25,000

EMPLOYEE ISSUE MAXIMUM RATES BASED ON ISSUE AGE AND TOBACCO STATUS

Ages 17-49: $300,000Ages 50-65: $100,000

Your premiums will be based on your age on the date your policy becomes effective. You can be eligible for reduced rates if you are a non-tobacco user.

GUARANTEED LEVEL DEATH BENEFIT RENEWABLE AND CONVERTIBLE4

You will receive the full face amount of your policy.(Provided no accelerated benefits are paid.)

You may renew your coverage to age 90. You may convert to a whole life policy prior to age 70.

SAMPLE 20-YEAR TERM NON- TOBACCO MONTHLY PREMIUM RATES5

$25K+ $50K+ $100K $150K $300K

25 $6.50 $9.00 $16.00 $20.00 $38.00

35 $7.50 $11.50 $21.00 $27.50 $53.00

45 $11.75 $20.50 $39.00 $56.00 $110.00

55 $25.25 $38.50 $75.00 n/a n/a+Shaded amounts available for spouse base policy purchases.

Waiver of Premium RiderThis rider waives the premium if the base Insured becomes totally disabled, as defined in the rider, for at least six consecutive months. Premiums are waived for the base policy and any attached riders. Issue age is 17-60. The rider terminates at age 65.

Accidental Death and Dismemberment RiderThis rider provides coverage upon death, dismemberment, or paralysis of the base Insured prior to age 70 if such death, dismemberment, or paralysis results from accidental causes, as defined in the rider. This rider also provides an additional 10% seatbelt benefit, if the police accident report certifies the base Insured was wearing a properly fastened seatbelt at time of death. Benefits are payable once per Covered Accident.

Spouse Term RiderThis rider provides level Term Life Insurance coverage on your spouse. The premiums for this rider are based on the spouse’s age and tobacco usage. Coverage may be renewed for each additional renewal period up to the spouse’s age 90, while the base policy is in force. 4Premiums adjust upon renewal. Face amount must be equal to or less than the base policy.

Children’s Term RiderThis rider provides level term life insurance protection for all your eligible children who are between the ages of one month through age 19. Coverage remains on each child until age 26 or marriage of the child prior to age 26. Your covered child may also convert this rider for up to five times the amount of coverage (subject to a $100,000 limit overall) to any form of permanent insurance offered by American Fidelity for conversions. One premium covers all eligible children. Three benefit levels are available: $10,000, $20,000, and $30,000.

Enhance Your Plan6

Accelerated Benefit Rider for Long Term Illness (Available with 30-Year Term Life Only)

This rider provides for two equal advances of a portion of the base policy’s death benefit due to a Long Term Illness if we receive satisfactory proof of Long Term Illness prior to each annual payment. Coverage is available on the base Insured only.

4Premiums remain level for the initial term period selected. If you choose the 10 or 20 Year Term Life Plan, the renewal date will be every 10 or 20 years until the policy anniversary following age 70 or 60 respectively. Thereafter, premiums are renewable annually. The 30 Year Term Life Plan is renewable annually after the initial term period. All term plans expire the policy anniversary following age 90. Rates will be adjusted on each renewed term period; 6Additional riders are subject to our general underwriting criteria and coverage is not guaranteed. Rider availability may vary by state.

TERM LIFE INSURANCERenewable and Convertible

ISSU

E A

GE

10 YE

AR RA

TES N

on-To

bacc

o Us

ers R

ates

SB-30357 (Rate Insert-10 year)-0817 For Use In: AZ, LA, NM, NC, TX, SC, VA RCTL14 Series

Spouse Coverage Available1

DEATH BENEFIT Monthly Premium Including Policy Fee

$25,000 $30,000 $50,000 $75,000 $100,000 $125,000 $150,000 $175,000 $200,000 $250,000 $300,000

17 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 18 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 19 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 20 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 21 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 22 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 23 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 24 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 25 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 26 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 27 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 28 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 29 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 30 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 31 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 32 6.50 7.40 8.50 11.75 15.00 15.75 18.50 21.25 24.00 29.50 35.00 33 6.75 7.70 9.00 12.50 16.00 17.00 20.00 23.00 26.00 32.00 38.00 34 6.75 7.70 9.00 12.50 16.00 17.00 20.00 23.00 26.00 32.00 38.00 35 6.75 7.70 9.00 12.50 16.00 17.00 20.00 23.00 26.00 32.00 38.00 36 7.00 8.00 9.50 13.25 17.00 18.25 21.50 24.75 28.00 34.50 41.00 37 7.25 8.30 10.00 14.00 18.00 19.50 23.00 26.50 30.00 37.00 44.00 38 7.50 8.60 10.50 14.75 19.00 20.75 24.50 28.25 32.00 39.50 47.00 39 7.75 8.90 11.00 15.50 20.00 22.00 26.00 30.00 34.00 42.00 50.00 40 8.00 9.20 11.50 16.25 21.00 23.25 27.50 31.75 36.00 44.50 53.00 41 8.25 9.50 12.00 17.00 22.00 24.50 29.00 33.50 38.00 47.00 56.00 42 8.75 10.10 13.00 18.50 24.00 27.00 32.00 37.00 42.00 52.00 62.00 43 9.00 10.40 13.50 19.25 25.00 28.25 33.50 38.75 44.00 54.50 65.00 44 9.25 10.70 14.00 20.00 26.00 29.50 35.00 40.50 46.00 57.00 68.00 45 9.75 11.30 15.00 21.50 28.00 32.00 38.00 44.00 50.00 62.00 74.00 46 10.50 12.20 16.00 23.00 30.00 34.50 41.00 47.50 54.00 67.00 80.00 47 11.50 13.40 17.50 25.25 33.00 37.00 44.00 51.00 58.00 72.00 86.00 48 12.50 14.60 18.50 26.75 35.00 40.75 48.50 56.25 64.00 79.50 95.00 49 13.50 15.80 20.00 29.00 38.00 44.50 53.00 61.50 70.00 87.00 104.00 50 14.75 17.30 21.50 31.25 41.00 -- -- -- -- -- --51 15.50 18.20 23.00 33.50 44.00 -- -- -- -- -- --52 16.50 19.40 24.00 35.00 46.00 -- -- -- -- -- --53 17.50 20.60 25.50 37.25 49.00 -- -- -- -- -- --54 18.50 21.80 27.50 40.25 53.00 -- -- -- -- -- --55 19.50 23.00 29.00 42.50 56.00 -- -- -- -- -- --56 21.25 25.10 32.00 47.00 62.00 -- -- -- -- -- --57 23.00 27.20 35.00 51.50 68.00 -- -- -- -- -- --58 25.00 29.60 38.50 56.75 75.00 -- -- -- -- -- --59 27.25 32.30 42.50 62.75 83.00 -- -- -- -- -- --60 29.75 35.30 46.50 68.75 91.00 -- -- -- -- -- --61 31.00 36.80 50.50 74.75 99.00 -- -- -- -- -- --62 32.00 38.00 54.50 80.75 107.00 -- -- -- -- -- --63 33.25 39.50 59.00 87.50 116.00 -- -- -- -- -- --64 34.75 41.30 64.00 95.00 126.00 -- -- -- -- -- --65 36.00 42.80 69.50 103.25 137.00 -- -- -- -- -- --

This insert must be used in conjunction with SB-30357 and any state specific deviations thereof. Rates are guaranteed not to increase during the initial term period. However, they will increase upon renewal. This is a brief description of the coverage and does not constitute the complete policy. For additional details, limitations, exclusions and other provisions, please refer to the policy/rider. Rider availability may vary by state. Not eligible under section 125. 1 Maximum face amount available is $50,000.

SPOUSE TERM RIDER: Use the rate sheet to find the the spouse’s coordinating age, face amount, and tobacco use and deduct $2.00.CHILDREN’S TERM RIDER: $10,000: $4.80 / $20,000: $9.60 / $30,000: $14.40. Issue ages 1mo thru 19. Subject to the overall child maximum of $50,000. Grandchildren are not eligible for this rider.ACCIDENTAL DEATH & DISMEMBERMENT RIDER: For the monthly rate, multiply .08 per $1,000 of coverage.WAIVER OF PREMIUM RIDER: Add the base policy and all other riders and multiply by 7% to get the premium amount for the rider.

RIDER RATES (Monthly Premium)

ISSU

E A

GE

TERM LIFE INSURANCE Renewable and Convertible

20 YE

AR RA

TES N

on-To

bacc

o Us

ers R

ates

SB-30357 (Rate Insert 20 Year)-0817 For Use In: AZ, LA, NM, NC, TX, SC, VA RCTL14 Series

Spouse Coverage Available1

DEATH BENEFIT Monthly Premium Including Policy Fee

$25,000 $30,000 $50,000 $75,000 $100,000 $125,000 $150,000 $175,000 $200,000 $250,000 $300,000

17 6.50 7.40 9.00 12.50 16.00 15.75 18.50 21.25 24.00 29.50 35.00 18 6.50 7.40 9.00 12.50 16.00 15.75 18.50 21.25 24.00 29.50 35.00 19 6.50 7.40 9.00 12.50 16.00 15.75 18.50 21.25 24.00 29.50 35.00 20 6.50 7.40 9.00 12.50 16.00 15.75 18.50 21.25 24.00 29.50 35.00 21 6.50 7.40 9.00 12.50 16.00 15.75 18.50 21.25 24.00 29.50 35.00 22 6.50 7.40 9.00 12.50 16.00 15.75 18.50 21.25 24.00 29.50 35.00 23 6.50 7.40 9.00 12.50 16.00 17.00 20.00 23.00 26.00 32.00 38.00 24 6.50 7.40 9.00 12.50 16.00 17.00 20.00 23.00 26.00 32.00 38.00 25 6.50 7.40 9.00 12.50 16.00 17.00 20.00 23.00 26.00 32.00 38.00 26 6.50 7.40 9.00 12.50 16.00 17.00 20.00 23.00 26.00 32.00 38.00 27 6.50 7.40 9.00 12.50 16.00 18.25 21.50 24.75 28.00 34.50 41.00 28 6.50 7.40 9.50 13.25 17.00 18.25 21.50 24.75 28.00 34.50 41.00 29 6.50 7.40 9.50 13.25 17.00 19.50 23.00 26.50 30.00 37.00 44.00 30 6.50 7.40 9.50 13.25 17.00 19.50 23.00 26.50 30.00 37.00 44.00 31 6.75 7.70 10.00 14.00 18.00 20.75 24.50 28.25 32.00 39.50 47.00 32 7.00 8.00 10.00 14.00 18.00 20.75 24.50 28.25 32.00 39.50 47.00 33 7.00 8.00 10.50 14.75 19.00 22.00 26.00 30.00 34.00 42.00 50.00 34 7.25 8.30 11.00 15.50 20.00 22.00 26.00 30.00 34.00 42.00 50.00 35 7.50 8.60 11.50 16.25 21.00 23.25 27.50 31.75 36.00 44.50 53.00 36 7.75 8.90 12.00 17.00 22.00 24.50 29.00 33.50 38.00 47.00 56.00 37 8.00 9.20 13.00 18.50 24.00 27.00 32.00 37.00 42.00 52.00 62.00 38 8.25 9.50 13.50 19.25 25.00 28.25 33.50 38.75 44.00 54.50 65.00 39 8.75 10.10 14.00 20.00 26.00 30.75 36.50 42.25 48.00 59.50 71.00 40 9.00 10.40 15.00 21.50 28.00 33.25 39.50 45.75 52.00 64.50 77.00 41 9.50 11.00 16.00 23.00 30.00 35.75 42.50 49.25 56.00 69.50 83.00 42 10.00 11.60 17.00 24.50 32.00 38.25 45.50 52.75 60.00 74.50 89.00 43 10.50 12.20 18.00 26.00 34.00 40.75 48.50 56.25 64.00 79.50 95.00 44 11.00 12.80 19.00 27.50 36.00 43.25 51.50 59.75 68.00 84.50 101.00 45 11.75 13.70 20.50 29.75 39.00 47.00 56.00 65.00 74.00 92.00 110.00 46 12.75 14.90 21.50 31.25 41.00 49.50 59.00 68.50 78.00 97.00 116.00 47 14.00 16.40 22.50 32.75 43.00 52.00 62.00 72.00 82.00 102.00 122.00 48 15.25 17.90 24.00 35.00 46.00 55.75 66.50 77.25 88.00 109.50 131.00 49 16.75 19.70 25.00 36.50 48.00 58.25 69.50 80.75 92.00 114.50 137.00 50 18.50 21.80 26.50 38.75 51.00 -- -- -- -- -- --51 19.75 23.30 28.50 41.75 55.00 -- -- -- -- -- --52 21.00 24.80 30.50 44.75 59.00 -- -- -- -- -- --53 22.25 26.30 33.00 48.50 64.00 -- -- -- -- -- --54 23.75 28.10 35.50 52.25 69.00 -- -- -- -- -- --55 25.25 29.90 38.50 56.75 75.00 -- -- -- -- -- --56 27.50 32.60 42.50 62.75 83.00 -- -- -- -- -- --57 30.00 35.60 47.00 69.50 92.00 -- -- -- -- -- --58 32.50 38.60 52.00 77.00 102.00 -- -- -- -- -- --59 35.50 42.20 58.00 86.00 114.00 -- -- -- -- -- --60 38.75 46.10 64.00 95.00 126.00 -- -- -- -- -- --

This insert must be used in conjunction with SB-30357 and any state specific deviations thereof. Rates are guaranteed not to increase during the initial term period. However, they will increase upon renewal. This is a brief description of the coverage and does not constitute the complete policy. For specific details, limitations, and exclusions, please refer to the policy/rider. Rider availability may vary by state. Not eligible under section 125. 1 Maximum face amount available is $50,000.

SPOUSE TERM RIDER: Use the rate sheet to find the the spouse’s coordinating age, face amount, and tobacco use and deduct $2.00.CHILDREN’S TERM RIDER: $10,000: $4.80 / $20,000: $9.60 / $30,000: $14.40. Issue ages 1mo thru 19. Subject to the overall child maximum of $50,000. Grandchildren are not eligible for this rider.ACCIDENTAL DEATH & DISMEMBERMENT RIDER: For the monthly rate, multiply .08 per $1,000 of coverage.WAIVER OF PREMIUM RIDER: Add the base policy and all other riders and multiply by 7% to get the premium amount for the rider.

RIDER RATES (Monthly Premium)

TERM LIFE INSURANCERenewable and Convertible

SB-30357 (Rate Insert-30 year)-0817 For Use In: AZ, LA, NM, NC, TX, SC, VA RCTL14 Series

30 YEAR RATES Non-Tobacco Users Rates

Spouse Coverage Available1

DEATH BENEFIT Monthly Premium Including Policy Fee

$10,000 $25,000 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000Base ABLTI Base ABLTI Base ABLTI Base ABLTI Base ABLTI Base ABLTI Base ABLTI Base ABLTI

17 4.00 0.08 7.00 0.20 10.50 0.39 19.00 0.78 24.50 1.17 32.00 1.56 39.50 1.95 47.00 2.34 18 4.00 0.08 7.00 0.20 10.50 0.39 19.00 0.78 24.50 1.17 32.00 1.56 39.50 1.95 47.00 2.34 19 4.00 0.08 7.00 0.20 10.50 0.39 19.00 0.78 24.50 1.17 32.00 1.56 39.50 1.95 47.00 2.34 20 4.00 0.08 7.00 0.20 10.50 0.39 19.00 0.78 24.50 1.17 32.00 1.56 39.50 1.95 47.00 2.34 21 4.00 0.08 7.00 0.20 10.50 0.40 19.00 0.80 24.50 1.20 32.00 1.60 39.50 2.00 47.00 2.40 22 4.00 0.08 7.00 0.21 10.50 0.42 19.00 0.83 24.50 1.25 32.00 1.66 39.50 2.08 47.00 2.49 23 4.10 0.09 7.25 0.21 11.00 0.43 20.00 0.85 26.00 1.28 34.00 1.70 42.00 2.13 50.00 2.55 24 4.10 0.09 7.25 0.22 11.00 0.44 20.00 0.88 26.00 1.32 34.00 1.76 42.00 2.20 50.00 2.64 25 4.10 0.09 7.25 0.23 11.00 0.47 20.00 0.93 26.00 1.40 34.00 1.86 42.00 2.33 50.00 2.79 26 4.10 0.10 7.25 0.25 11.00 0.50 20.00 1.00 27.50 1.50 36.00 2.00 44.50 2.50 53.00 3.00 27 4.20 0.11 7.50 0.27 11.50 0.54 21.00 1.08 27.50 1.62 36.00 2.16 44.50 2.70 53.00 3.24 28 4.20 0.12 7.50 0.29 11.50 0.58 21.00 1.15 29.00 1.73 38.00 2.30 47.00 2.88 56.00 3.45 29 4.30 0.12 7.75 0.31 12.00 0.62 22.00 1.23 29.00 1.85 38.00 2.46 47.00 3.08 56.00 3.69 30 4.30 0.13 7.75 0.33 12.00 0.65 22.00 1.30 30.50 1.95 40.00 2.60 49.50 3.25 59.00 3.90 31 4.40 0.14 8.00 0.35 12.50 0.70 23.00 1.40 32.00 2.10 42.00 2.80 52.00 3.50 62.00 4.20 32 4.50 0.15 8.25 0.38 13.00 0.75 24.00 1.50 32.00 2.25 42.00 3.00 52.00 3.75 62.00 4.50 33 4.50 0.16 8.25 0.40 13.00 0.80 24.00 1.60 33.50 2.40 44.00 3.20 54.50 4.00 65.00 4.80 34 4.60 0.17 8.50 0.43 13.50 0.85 25.00 1.70 33.50 2.55 44.00 3.40 54.50 4.25 65.00 5.10 35 4.70 0.18 8.75 0.45 14.00 0.90 26.00 1.80 35.00 2.70 46.00 3.60 57.00 4.50 68.00 5.40 36 4.90 0.19 9.25 0.48 15.00 0.97 28.00 1.93 38.00 2.90 50.00 3.86 62.00 4.83 74.00 5.79 37 5.10 0.21 9.75 0.51 16.00 1.03 30.00 2.05 41.00 3.08 54.00 4.10 67.00 5.13 80.00 6.15 38 5.30 0.22 10.25 0.55 17.00 1.09 32.00 2.18 44.00 3.27 58.00 4.36 72.00 5.45 86.00 6.54 39 5.50 0.23 10.75 0.58 18.00 1.15 34.00 2.30 47.00 3.45 62.00 4.60 77.00 5.75 92.00 6.90 40 5.80 0.24 11.50 0.60 19.50 1.20 37.00 2.39 51.50 3.59 68.00 4.78 84.50 5.98 101.00 7.17 41 6.10 0.26 12.25 0.64 21.00 1.28 40.00 2.56 56.00 3.84 74.00 5.12 92.00 6.40 110.00 7.68 42 6.50 0.27 13.25 0.68 23.00 1.36 44.00 2.71 62.00 4.07 82.00 5.42 102.00 6.78 122.00 8.13 43 6.90 0.29 14.25 0.72 24.50 1.43 47.00 2.86 66.50 4.29 88.00 5.72 109.50 7.15 131.00 8.58 44 7.30 0.30 15.25 0.75 27.00 1.51 52.00 3.01 72.50 4.52 96.00 6.02 119.50 7.53 143.00 9.03 45 7.80 0.32 16.50 0.79 29.00 1.58 56.00 3.15 80.00 4.73 106.00 6.30 132.00 7.88 158.00 9.45 46 8.30 0.35 17.75 0.86 31.50 1.73 61.00 3.45 87.50 5.18 116.00 6.90 144.50 8.63 173.00 10.35 47 8.80 0.37 19.00 0.93 34.00 1.87 66.00 3.73 95.00 5.60 126.00 7.46 157.00 9.33 188.00 11.19 48 9.30 0.40 20.25 1.00 37.00 2.00 72.00 4.00 104.00 6.00 138.00 8.00 172.00 10.00 206.00 12.00 49 9.90 0.43 21.75 1.07 40.50 2.14 79.00 4.27 114.50 6.41 152.00 8.54 189.50 10.68 227.00 12.81 50 10.60 0.45 23.50 1.13 44.00 2.25 86.00 4.50 -- -- -- --

ISSU

E A

GE

RIDER RATES (Monthly Premium)

This insert must be used in conjunction with SB-30357 and any state specific deviations thereof. Rates are guaranteed not to increase during the initial term period. However, they will increase upon renewal. This is a brief description of the coverage and does not constitute the complete policy. For specific details, limitations, exclusions and other provisions, please refer to the policy/rider. Rider availability may vary by state. Not eligible under section 125. 1 Maximum face amount available is $50,000.

SPOUSE TERM RIDER: Use the rate sheet to find the the spouse’s coordinating age, face amount, and tobacco use and deduct $2.00.

CHILDREN’S TERM RIDER: $10,000: $4.80 / $20,000: $9.60 / $30,000: $14.40. Issue ages 1mo thru 19. Subject to the overall child maximum of $50,000. Grandchildren are not eligible for this rider.

ACCIDENTAL DEATH & DISMEMBERMENT RIDER:

For the monthly rate, multiply .08 per $1,000 of coverage.

WAIVER OF PREMIUM RIDER: Add the base policy and all other riders and multiply by 7% to get the premium amount for the rider.

ACCELERATED BENEFIT FOR LONG TERM ILLNESS RIDER (ABLTI):

Add the rate shown in the ABLTI column to the base rate.

Group Disability

GROUP BENEFIT PROGRAM HIGHLIGHTS

When the death of a family provider occurs, families find themselves facing

not only the loss of a loved one but also the loss of their financial security.

With Dearborn National’s Group Term Life insurance, employees may

achieve peace of mind by giving their families security they can depend on.

BASIC GROUP TERM LIFE INSURANCE

Eligibility All eligible active employees of the District regularly working 10 hours or more per week, including bus drivers.

Group Term Life/AD&D Benefit See your Benefits Administrator for specific details.

Age Reduction Schedule Life and AD&D benefits reduce by 50% of the original amount at age 70. All benefits terminate at retirement.

Waiver of Premium If an employee is unable to engage in any occupation as a result of injury or sickness for a minimum of 9 months, prior to age 60, premium will be waived for the employee’s life insurance benefit until the employee is no longer disabled or reaches age 65, whichever occurs first.

Accelerated Death Benefit (ADB)

This benefit pays a lump sum up to 75% of the employee’s Life insurance, if the employee is diagnosed with a terminal illness, has a life expectancy of 12 months or less, and provides satisfactory proof. Minimum: $7,500. Maximum: $250,000. The amount of Group Term Life insurance otherwise payable upon the employee’s death will be reduced by the ADB.

Conversion Privilege Included

Beneficiary Resource Services1 Includes grief, legal and financial counseling for beneficiaries.

Travel Resource Services2 Helps employees deal with unexpected needs that may arise while traveling. Services include emergency medical assistance, financial, legal and communication assistance, and access to other critical services and resources available online.

BASIC GROUP ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) BENEFITGroup AD&D is an additional death benefit that pays the life insurance benefit for a covered accidental death or a percentage of that benefit for a covered dismemberment in the event a covered employee dies or is dismembered due to a covered accident. AD&D benefit is 24-hour coverage.

AD&D Schedule of Loss* Principal Sum

Loss of Life; Loss of Both Hands or Both Feet; Loss of One Hand and One Foot; Loss of Speech and Hearing; Loss of Sight of Both Eyes; Loss of One Hand and the Sight of One Eye; Loss of One Foot and the Sight of One Eye; and Quadriplegia

100%

Paraplegia 75%

Hemiplegia; Loss of Sight of One Eye; Loss of One Hand or One Foot; and Loss of Speech or Hearing

50%

Loss of Thumb and Index Finger of Same Hand; and Uniplegia 25%

AD&D PRODUCT FEATURES INCLUDED: Seatbelt and Airbag Benefits; Repatriation Benefit; and Education Benefit

*AD&D EXCLUSIONS: Unless specifically covered in the policy, or required by state law, we will not pay any AD&D benefit for any loss that, directly or indirectly, results in any way from or is contributed to by: disease of the mind or body, or any treatment thereof; infections, except those from an accidental cut or wound; suicide or attempted suicide; intentionally self-inflicted injury; war or act of war; travel or flight in any aircraft while a member of the crew; commission of, or participation in a felony; being under the influence of certain drugs, narcotics, or hallucinogens unless properly used as prescribed by a physician; intoxication as defined in the jurisdiction where the accident occurred; participation in a riot.

SUPPLEMENTAL GROUP TERM LIFE/AD&DDearborn National’s Supplemental Group Term Life/AD&D coverage is payroll deducted and sponsored by your employer. Most families depend upon each paycheck to pay expenses and plan for the future. In the unexpected event of death, life insurance provides immediate financial assistance for you and your family when it is most needed.

Eligibility: All eligible active employees of the District regularly working 10 hours or more per week, including bus drivers.

EMPLOYEE COVERAGE

Group Term Life/ AD&D Benefit

Your choice of $20,000; $40,000; $60,000; $80,000; or $100,000; or increments of $10,000, up to a maximum of $500,000. AD&D equals the life insurance benefit for a covered accidental death or a percentage of that benefit for a covered dismemberment.

Guaranteed Issue Amount

$150,000 – Employees under age 65

$ 30,000 – Employees age 65 – 69

No Guarantee Issue for employees age 70 and over. Requires satisfactory evidence of insurability.

Age Reduction Schedule

Life and AD&D benefits reduce by 50% of the original amount at age 70. All benefits terminate at retirement.

SPOUSE COVERAGE

Group Term Life/ AD&D Benefit

Your choice of $10,000; $20,000; $30,000; $40,000; $50,000 or increments of $5,000 (maximum coverage not to exceed $250,000 or exceed 50% of the employee’s approved amount for Supplemental Term Life). AD&D equals the life insurance benefit for a covered accidental death or a percentage of that benefit for a covered dismemberment.

Guaranteed Issue Amount

$50,000 – Spouses of employees under age 60

$10,000 – Spouses of employees age 60 – 69

No coverage available for spouses of employees age 70 and over.

Age Reduction Schedule

Life and AD&D benefits terminate once the employee attains age 70.

CHILD(REN) COVERAGE3

Group Term Life Live Birth to age 26: $10,000

NOTE: Employees must purchase the minimum amount ($10,000) of Supplemental Life insurance on themselves in order to purchase child coverage.

Employee Contribution 100%

Accelerated Death Benefit (ADB) This benefit pays a lump sum up to 75% of the employee’s Life insurance, if diagnosed with a terminal illness, has a life expectancy of 12 months or less, and provides satisfactory proof. Minimum: $7,500. Maximum: $250,000. The amount of Group Term Life insurance otherwise payable upon the employee’s death will be reduced by the ADB.

Portability Feature (Life coverage) Included. Employee only. AD&D excluded.

Conversion Privilege (Life coverage) Included. AD&D excluded.

Exclusions One-year suicide exclusion applies to Supplemental Group Term Life coverage. AD&D exclusions are the same as Basic AD&D exclusions.

A division of MASA Global.

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BENEFIT DESCRIPTION

CANCER SCREENING

One $25 benefit per calendar year, per covered person

Benefit increases to three screenings per calendar year after the diagnosis for internal cancer or an associated cancerous condition

PROPHYLACTIC SURGERY (DUE TO A POSITIVE GENETIC TEST RESULT)

$125 per covered person, per lifetime

INITIAL DIAGNOSIS

Named Insured or Spouse: $1,000

Dependent Child: $2,000

Payable once per covered person, per lifetime

ADDITIONAL OPINION $150 per covered person, per lifetime

RADIATION THERAPY, CHEMOTHERAPY, IMMUNOTHERAPY OR EXPERIMENTAL CHEMOTHERAPY

Self-Administered: $100 per calendar month

Physician Administered: $600 per calendar month

This benefit is limited to one self-administered treatment and one physician-administered treatment per calendar month.

HORMONAL THERAPY $15 once per calendar month

TOPICAL CHEMOTHERAPY $100 once per calendar month

ANTINAUSEA $50 once per calendar month

STEM CELL AND BONE MARROW TRANSPLANTATION

$3,500; lifetime maximum of $3,500 per covered person

Donor Benefit: $50 for stem cell donation, or $500 for bone marrow donation Payable one time per covered person

BLOOD AND PLASMA Inpatient: $50 times the number of days paid under the Hospital Confinement Benefit, per covered person

Outpatient: $140 per day, per covered person

SURGERY/ANESTHESIA

$50-$1,700

Anesthesia: additional 25% of the Surgery Benefit

Maximum daily benefit will not exceed $2,125; no lifetime maximum on the number of operations

SKIN CANCER SURGERY

Laser or Cryosurgery: $20

Excision of lesion of skin without flap or graft: $85

Flap or graft without excision: $125

Excision of lesion of skin with flap or graft: $200

Maximum daily benefit will not exceed $200. No lifetime maximum on the number of operations

PROPHYLACTIC SURGERY (WITH CORRELATING INTERNAL CANCER DIAGNOSIS)

$125 per covered person, per lifetime

HOSPITALIZATION CONFINEMENT FOR 30 DAYS OR LESS

Named Insured or Spouse: $100

Dependent Child: $125

HOSPITALIZATION CONFINEMENT FOR 31 DAYS OR MORE

Named Insured or Spouse: $200

Dependent Child: $250

OUTPATIENT HOSPITAL SURGICAL ROOM CHARGE

$100 per day, per covered person

AFLAC Cancer - Administered by Finley FinancialCoverage OptionsChoose the Policy and Riders that Fit Your Needs

REFER TO THE OUTL INE OF COVER AGE FOR BENEF IT DETA ILS, L IM ITAT IONS AND E XCLUS IONS.

EXTENDED-CARE FACILITY $75 per day; limited to 30 days in each calendar year, per covered person

HOME HEALTH CARE$50 per day; limited to 10 days per hospitalization, per covered person; and 30 days per calendar year, per covered person

HOSPICE CARE $1,000 for first day; $50 per day thereafter; $12,000 lifetime maximum per covered person

NURSING SERVICES $50 per day; payable for only the number of days the Hospital Confinement Benefit is payable

SURGICAL PROSTHESIS $1,000; lifetime maximum of $2,000 per covered person

NONSURGICAL PROSTHESIS $90 per occurrence, per covered person; lifetime maximum of $180 per covered person

BREAST RECONSTRUCTION

Breast Tissue/Muscle Reconstruction Flap Procedures: $1,000

Breast Reconstruction (occurring within 5 years of breast cancer diagnosis): $250

Breast Symmetry (on the nondiseased breast occurring within 5 years of breast reconstruction): $110

Permanent Areola Repigmentation (on the diseased breast): $50

Maximum daily benefit will not exceed $1,000

OTHER RECONSTRUCTIVE SURGERY

Facial Reconstruction: $250

Anesthesia: additional 25% of the Other Reconstructive Surgery Benefit

Maximum daily benefit will not exceed $250

EGG HARVESTING, STORAGE (CRYOPRESERVATION) AND IMPLANTATION

$500 for a covered person to have oocytes extracted and harvested

$100 for the storage of a covered person’s oocyte(s) or sperm

$100 for embryo transfer

Lifetime maximum of $700 per covered person

ANNUAL CARE$100 on the anniversary date of diagnosis; lifetime maximum of five annual $100 payments per covered person

AMBULANCE$250 ground

$2,000 air ambulance

TRANSPORTATION $.35 cents per mile for transportation; payable up to a combined maximum of $1,050, per round trip

LODGING $50 per day; limited to 90 days per calendar year

WAIVER OF PREMIUM Yes

CONTINUATION OF COVERAGE Yes

OPTIONAL RIDERS DESCRIPTION

INITIAL DIAGNOSIS BUILDING BENEFIT RIDER

This benefit will increase the amount of your Initial Diagnosis Benefit, as shown in the policy, by $100 for each unit purchased, up to five units, for each covered person on the anniversary date of coverage, while coverage remains in force.

SPECIFIED-DISEASE BENEFIT RIDER

When a covered person is diagnosed with any of the diseases listed in the Specified-Disease Rider:

Initial diagnosis Hospitalization

$2,000 30 days or less: $400 per day 31 days or more: $800 per day

DEPENDENT CHILD RIDER$10,000 when a covered dependent child is diagnosed as having internal cancer or an associated cancerous condition; payable only once for each covered dependent child

REFER TO THE OUTLINE OF COVERAGE AND POLICY FOR COMPLETE BENEFIT DETAILS, DEFINITIONS, LIMITATIONS, AND EXCLUSIONS.

BENEFIT NAME BENEFIT AMOUNT

INITIAL ACCIDENT HOSPITALIZATION BENEFIT$1,000 when admitted for a hospital confinement of at least 18 hours or $1,500 when admitted directly to an intensive care unit of a hospital for a covered accident, per calendar year, per covered person

ACCIDENT HOSPITAL CONFINEMENT BENEFIT $200 per day, up to 365 days per covered accident, per covered person

INTENSIVE CARE UNIT CONFINEMENT BENEFIT Additional $400 per day for up to 15 days, per covered accident, per covered person

ACCIDENT TREATMENT BENEFIT

Payable once per 24-hour period and only once per covered accident, per covered person

Hospital emergency room with X-ray: $200Hospital emergency room without X-ray: $170Office or facility (other than a hospital emergency room) with X-ray: $150Office or facility (other than a hospital emergency room) without X-ray: $120

AMBULANCE BENEFIT $150 ground ambulance transportation or $1,000 air ambulance transportation

BLOOD/PLASMA/PLATELETS BENEFIT $100 once per covered accident, per covered person

MAJOR DIAGNOSTIC AND IMAGING EXAMS BENEFIT $150 per calendar year, per covered person

ACCIDENT FOLLOW-UP TREATMENT BENEFIT $25 for one treatment per day (up to a max of 6 treatments), per covered accident, per covered person

THERAPY BENEFIT $25 for one treatment per day (up to a max of 10 treatments), per covered accident, per covered person

Benefits are payable for the medical appliances listed below:

APPLIANCES BENEFIT

Payable once per covered accident, per covered person

PROSTHESIS BENEFIT $500 once per covered accident, per covered person

PROSTHESIS REPAIR OR REPLACEMENT BENEFIT $500 once per covered person, per lifetime

REHABILITATION FACILITY BENEFIT $100 per day

HOME MODIFICATION BENEFIT $2,000 once per covered accident, per covered person

Pays benefits for the treatments listed below:

ACCIDENT SPECIFIC-SUM INJURIES BENEFITS

DISLOCATIONS ............................$75–$3,000BURNS ..................................... $100–$10,000SKIN GRAFTS .......... 50% of the burns benefit

amount paid for the burn involvedEYE INJURIESSurgical repair ........................................ $250Removal of foreign body by a physician .. $50LACERATIONS Not requiring sutures ............................... $25Less than 5 centimeters .......................... $50At least 5 cm but not more than 15 cm . $200Over 15 centimeters ..............................$400FRACTURES ............................... $100–$2,750CONCUSSION (brain) .............................. $100

EMERGENCY DENTAL WORKBroken tooth repaired with crown .........$300Broken tooth resulting in extraction ....... $100COMA ................................................ $10,000PARALYSISQuadriplegia ..................................... $10,000Paraplegia ...........................................$5,000Hemiplegia ..........................................$4,000SURGICAL PROCEDURES ............$175–$1,000MISCELLANEOUS SURGICAL PROCEDURES ............................... $100–$250PAIN MANAGEMENT (NON-SURGICAL)Epidural.................................................. $100

ACCIDENTAL-DEATH BENEFIT

INSUREDSPOUSE

CHILD

Common-Carrier Accident Other Accident Hazardous Activity

Accident

$100,000 $25,000 $10,000$100,000 $25,000 $10,000$15,000 $10,000 $5,000

ACCIDENTAL-DISMEMBERMENT BENEFIT $250–$25,000

WELLNESS BENEFIT $60 once per calendar year

FAMILY SUPPORT BENEFIT $20 per day (up to 30 days), per covered accident

ORGANIZED SPORTING ACTIVITY BENEFIT Additional 25% of the benefits payable, limited to $1,000 per policy, per calendar year

CONTINUATION OF COVERAGE BENEFIT Waives all monthly premiums for up to two months, if conditions are met

WAIVER OF PREMIUM BENEFIT Yes

TRANSPORTATION BENEFIT $400 per round trip, up to 3 round trips per calendar year, per covered person

FAMILY LODGING BENEFIT $100 per night, up to 30 days per covered accident

AFLAC ACCIDENT ADVANTAGE - Administered by Finley Financial – OPTION 2 BENEFIT OVERVIEW

Back brace: $250Body jacket: $250Knee scooter: $250

Wheelchair: $250Leg brace: $75Crutches: $50

Walker: $50Walking boot: $50Cane: $25

RETIREMENT OPTIONS Finley Financial offers a variety of options to help supplement your future income and help achieve your financial goals. Please contact Finley Financial at 800/896-4400

Which One Is Right for Me? 403(b) A 403(b) plan is a retirement plan for specific employees of public schools & tax-exempt organizations. These plans allow you to invest in either annuities or mutual funds. A 403(b) Plan allows you to reduce your federal taxable income by the amount you choose to contribute. 403(b) contributions can be pre-tax or after-tax (Roth), based on the plan document and investment provider options.

457(b) The 457 Plan is your employer-sponsored group retirement plan, allowing you to save for retirement in a fixed annuity and/or mutual fund options. It is a deferred compensation plan established by state and local governments and tax-exempt employers. Eligible employees are allowed to make salary deferral contributions to the 457 plan. Deductions can be pre-tax or after-tax (Roth), based on the plan document and investment provider options.

Traditional IRA With a Traditional IRA, contributions may be tax deductible, and earnings grow tax-deferred.

Roth IRA With a Roth IRA, contributions are made with after-tax dollars, and it offers the possibility of withdrawing account earnings on a tax-free basis.

IMPORTANT CONTACTS

Benefit Vendor Phone Website Medical TRS ActiveCare Aetna 800-222-9205 www.trsactivecareaetna.com

Dental Ameritas 800-487-5553 www.ameritas.com

Vision Superior 800-507-3800 www.superiorvision.com

Disability American Fidelity 800-654-8489 www.americanfidelity.com

Cancer AFLAC 800-992-3522 www.AFLAC.com

Accident AFLAC 800-992-3522 www.AFLAC.com

Critical Illness American Fidelity 800-654-8489 www.americanfidelity.com

Medical Transport MASA 800-643-9023 www.masamts.com

Life Texas Life 800-283-9233 www.texaslife.com

Term Life American Fidelity 800-654-8489 www.americanfidelity.com

Group Life Dearborn 800-348-4512 www.dearbornnational.com

Medical FSA and Dependent Care

First Financial 800-523-8422 www.ffga.com

Health Savings Account (HSA) First Financial 800-523-8422 www.ffga.com

Retirement Services Finley Financial 830-896-4400 www.finleyfinancialservices.com

Marissa wenning, ACCOUNT MANAGER 2009 RR 620 N STE 123, AUSTIN TX 78734

OFFICE: 800-883-0007 | CELL: 210-380-0832 | EMAIL: MARISSA.WENNING@FFGA.COM