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PLAN YEAR: january 1, 2018 december 31, 2018 waco 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/WACOISD KELLN SMALL, ACCOUNT MANAGER 2009 RANCH RD 620 N STE 123, AUSTIN TX 78734 OFFICE: 800-672-9666 | CELL: 817-455-9347 EMAIL: [email protected]

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Page 1: Waco-Revised II sm (002)...Legal LegalShield 512-740-3322  Medical FSA and Dependent Care First Financial 800-523-8422  Kelln small, ACCOUNT MANAGER OFFICE: 800-672-9666 | …

PLAN YEAR:

january 1, 2018 �december 31, 2018

waco 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/WACOISD

KELLN SMALL, ACCOUNT MANAGER 2009 RANCH RD 620 N STE 123, AUSTIN TX 78734

OFFICE: 800-672-9666 | CELL: 817-455-9347

EMAIL: [email protected]

Page 2: Waco-Revised II sm (002)...Legal LegalShield 512-740-3322  Medical FSA and Dependent Care First Financial 800-523-8422  Kelln small, ACCOUNT MANAGER OFFICE: 800-672-9666 | …

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.

Page 3: Waco-Revised II sm (002)...Legal LegalShield 512-740-3322  Medical FSA and Dependent Care First Financial 800-523-8422  Kelln small, ACCOUNT MANAGER OFFICE: 800-672-9666 | …

IMPORTANT CONTACTS

Benefit Vendor Phone Website Medical United Health Care 8 www.uhc.com

Redi MD 281-633-0148 www.rediMD.com

Dental Metlife 800-438-6388 www.metlife.com

QCD of America Dental 800-229-0304 www.qcdofamerica.com

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

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

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

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

Cancer Metlife 800-438-6388 www.metlife.com

Critical Illness Metlife 800-438-6388 www.metlife.com

Hospital Indemnity

AFLAC 800-992-3522 www.aflac.com

EAP (Employee Assistance Prgm)

American Fidelity 800-456-0018 www.lifeworks.com

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

Group Life Sunlife 800-862-6266 www.sunlife.com

Identity Theft iLOCK360 855-287-8888 www.iLOCK360.com

Legal LegalShield 512-740-3322 www.legalshield.com

Medical FSA and Dependent Care

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

Kelln small, ACCOUNT MANAGEROFFICE: 800-672-9666 | CELL: 817-455-9347 | EMAIL: [email protected]

Page 4: Waco-Revised II sm (002)...Legal LegalShield 512-740-3322  Medical FSA and Dependent Care First Financial 800-523-8422  Kelln small, ACCOUNT MANAGER OFFICE: 800-672-9666 | …

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Page 5: Waco-Revised II sm (002)...Legal LegalShield 512-740-3322  Medical FSA and Dependent Care First Financial 800-523-8422  Kelln small, ACCOUNT MANAGER OFFICE: 800-672-9666 | …

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Page 6: Waco-Revised II sm (002)...Legal LegalShield 512-740-3322  Medical FSA and Dependent Care First Financial 800-523-8422  Kelln small, ACCOUNT MANAGER OFFICE: 800-672-9666 | …

� � � � � � � � ! � � " # $ % & ' ( " # $ % & ' ( " ( & ( ( " ( & ( (� � � � � � � � ) * � � + , � " - . / & % % " # $ % & ' ( " ' / ' & / % " / $ / & $ 0� � � � � � � � ) 1 2 3 � 4 5 6 � ! 7 " $ % $ & $ 8 " # $ % & ' ( " # ( . & 8 8 " 8 ' 0 & ' $� � � � � � � � ) 9 : � 3 � � " 8 ; 8 0 - & 8 0 " # $ % & ' ( " % - ( & $ 0 " # . ( & # /� � � � � � � � ! � � " 0 8 % & - ' " # $ % & ' ( " ' ( & # ' " / ' & 8 -� � � � � � � � ) * � � + , � " . - ( & / / " # $ % & ' ( " $ 8 / & % / " # ( $ & # $� � � � � � � � ) 1 2 3 � 4 5 6 � ! 7 " % 0 / & 0 . " # $ % & ' ( " # % 0 & . . " 8 - % & ' (� � � � � � � � ) 9 : � 3 � � " 8 ; / $ 8 & 8 # " # $ % & ' ( " - . # & $ # " 0 0 $ & - /� � � � � � � � ! � � " 0 0 - & 0 . " # $ % & ' ( " - ( & . . " 0 ( & ' (� � � � � � � � ) * � � + , � " 8 ; ( ' # & . # " # $ % & ' ( " $ - $ & 0 # " # 0 # & / /� � � � � � � � ) 1 2 3 � 4 5 6 � ! 7 " % . % & . % " # $ % & ' ( " 0 # ( & 0 % " / 8 ' & / 0� � � � � � � � ) 9 : � 3 � � " 8 ; # ' $ & # # " # $ % & ' ( " . - - & - # " 0 . 0 & 0 /

Page 7: Waco-Revised II sm (002)...Legal LegalShield 512-740-3322  Medical FSA and Dependent Care First Financial 800-523-8422  Kelln small, ACCOUNT MANAGER OFFICE: 800-672-9666 | …

It used to be difficult to find answers to your health care questions. Questions like:

• What is the status of my claim?

• Am I choosing a doctor in the network?

• Is this procedure covered?

• How much will it cost me?

• What hospital has the best ratings for this procedure?

Now you can simplify your health care experience with online and mobile resources to help you manage your

health and money. These tools give you information about your benefits, health care costs and claims.

MANAGE YOUR BENEFITS. ANYWHERE. ANYTIME.

Our goal is to make it easy for you to find the information you need

when it comes to your benefits:

• Understand your benefits and coverage

• View or print an ID card, or email or fax it to your provider

• Connect directly to UnitedHealthcare for answers to your benefits questions

• Use EasyConnect to let us know you want to talk about something and

we’ll call you right back

Working to Improve Your Health Care Experience

Page 8: Waco-Revised II sm (002)...Legal LegalShield 512-740-3322  Medical FSA and Dependent Care First Financial 800-523-8422  Kelln small, ACCOUNT MANAGER OFFICE: 800-672-9666 | …

Understand Your Care Options and Costs. Before You Get Care.

You can access step-by-step explanations for over 500 of the most common

procedures, learn about doctors and hospitals from their quality and

cost-efficiency ratings, and estimate the costs for office visits, treatments,

lab tests and medications. And because the information is based on your

individual benefits, there’s less of a chance for surprises.

• Learn about procedures and treatments

• Know what questions to ask the doctor

• Review hospital quality and safety data

• Locate providers near home or work

• Access maps and get driving directions

Understand and Track Your Health Care Costs and Payments.

Quickly and Easily.

IT’S A FACT: Many consumers receive care without knowing the costs

beforehand. Now you can compare your estimated treatment costs before

seeing the doctor and, after the treatment, view detailed graphic explanations

of how each claim was processed, what was billed, what your health plan

paid, what you owe and why.

• See which of your claims have been processed

• Note claims you want to watch or follow up on

• Add personalized notes

• Pay health care providers online or with the UnitedHealthcare

Health4Me® mobile app when the claim is final

Information at Your Fingertips

You don’t always know when you’ll

need to use your health benefits.

But we want you to know that you

can easily access and manage your

health whenever that need arises.

Begin using these resources today.

There are two ways for you to

access them.

myuhc.com®

• A website designed for your

health care interactions

Health4Me mobile app

• A mobile app designed for your

health care interactions

• Download the app through the Apple®

App StoreSM

or Google Play™ store for

Android® devices

Page 9: Waco-Revised II sm (002)...Legal LegalShield 512-740-3322  Medical FSA and Dependent Care First Financial 800-523-8422  Kelln small, ACCOUNT MANAGER OFFICE: 800-672-9666 | …

Rally Health provides health and well-being information and support as part of your health plan. It does

not provide medical advice or other health services, and is not a substitute for your doctor’s care. If you

have specific health care needs, consult an appropriate health care professional. Participation in the

health survey is voluntary. Your responses will be kept confidential in accordance with the law and will

only be used to provide health and wellness recommendations or conduct other plan activities.

Apple and iPhone are registered trademarks of Apple, Inc. App Store is a service mark of Apple, Inc.

Google Play is a trademark of Google, Inc. Android is a registered trademark of Google, Inc. Fitbit is a

registered trademark of Fitbit, Inc.

Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates.

Administrative services provided by United HealthCare Services, Inc. or their affiliates.

100-17011 9/15 © 2015 United HealthCare Services, Inc.

Questions?

If you have questions about these tools and how they can help you

better manage your health and finances, call the number on your

health plan ID card.

Fun, Personalized Wellness Recommendations and Tracking

RallySM

is the personalized UnitedHealthcare wellness resource that helps you make

healthier choices, shake up your daily routine and start feeling better. Rally shows

you how to make simple changes for the better in your life, set smart goals and stay

on target. You’ll get personalized recommendations on how to move more, eat better

and have fun doing it.

Rally is also available as a mobile app. Once you’ve created a Rally account on

myuhc.com, you can access your Missions, sync with your wearable device like

Fitbit®, earn coins and more, all on your phone. The Rally app is currently available

for the iPhone® and will be available for Android devices in the fall of 2015.

Chat with other members.

Track your progress

as you go.

See all your Missions

at a glance.

Join challenges and go for the gold!

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© Real Appeal 2017 #MSC1240

If you’re already a member of our UnitedHealthcare

plan, learn more and join today at

realappeal.com

Real Appeal is a free digital

weight loss program available

to you as part of your

employee bene=t plan.*

*Real Appeal is available at no additional cost to eligible employees, spouses, domestic partners and

dependents 18 years and older covered under our UnitedHealthcare insurance with a BMI of 23 or greater

as part of your beneKts. If you choose UnitedHealthcare for your bene:ts, you can enroll once you are

active in the new plan.

Weight loss

that’s free.*

A transformation

that’s real.

10average weight loss after 4 sessions

Lose

lbs+

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RediMD gives you the option to have a

regular doctor’s visit by phone .

at : www. edi .com

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Show this to your doctor and discuss ways to pay less with your consumer-

directed healthplan.

For medications you takeon a long-term basis, you’ll save money by using the Express Scripts PharmacyÆ Ç .

Whatyou’llpayaftermeetingyourdeductible Retail pharmacy(in network)30 day supply HomedeliveryfromtheExpressScriptsPharmacy90 day supplyÈ É Ê É Ë Ì Í Î Ï Ð Ñ Ò Ñ Ñ Ï Ó Ô Ò Ñ ÑÕ Ë É Ö É Ë Ë É × Ø Ë Ù Ê × Î Ï Ú Ô Ò Ñ Ñ Ï Û Ü Ò Ô ÑÝ Þ Ê ß Ë É Ö É Ë Ë É × Ø Ë Ù Ê × Î à Ê Þ á É Ê É Ë Ì Í â Ï ã Ñ Ò Ñ Ñ Ï Ð Ô Ñ Ò Ñ ÑÝ Þ Ê ß Ë É Ö É Ë Ë É × Ø Ë Ù Ê × Î à á É Ê É Ë Ì Í Î Ù ä Ù Ì å Ù Ø å É â Ï ã Ñ Ò Ñ Ñ æ æ Ï Ð Ô Ñ Ò Ñ Ñ æ æYou might pay different amounts for eligible medications, depending on which phase of your

plan’s three phasesyou’re in:

1. Deductible:Ï ç Ñ Ñ Ñ Ö Þ Ë è Þ é Þ Ë Ï Û Ñ Ñ Ñ Ö Þ Ë è Þ é Ë Ö Ù ê Ì å è ë ì Þ é ß Ù è Ù å å Þ Ö è Þ é Ë ê É × Ì Í Ù å Ù Ê × ß Ë É Î Í Ë Ì ß í Ì Þ Ê É î ß É Ê Î É Îé Ê í Ì å è Þ é ê É É í í ï Ì Î Ù ê Þ é Ê í ë

2. Copayment or Coinsurance:í ï É Ù ê Þ é Ê í Î ï Þ ð Ê Ì Ê í ï É í Ù Ø å É ë ñ ï Ì Î Ì Î ð ï Ù í è Þ é ß Ù è Ù Ö í É Ë í ï É × É × é Í í Ì Ø å É Ø é íØ É Ö Þ Ë É í ï É Ù Ê Ê é Ù å Þ é í ò Þ Ö ò ß Þ Í ó É í ê Ù î Ì ê é ê ë

3. Out-of-Pocket Maximum:Ï ã Ú Ô Ñ Ö Þ Ë è Þ é Þ Ë Ï Ð Ó Ü Ñ Ñ Ö Þ Ë è Þ é Ë Ö Ù ê Ì å è ë ô Ö è Þ é ß Ù è í ï Ì Î ê é Í ï Ì Ê Ù è É Ù Ë õ ê Þ Î íê É × Ì Í Ù í Ì Þ Ê Î Ö Þ Ë í ï É Ë É Î í Þ Ö í ï É è É Ù Ë Ù Ë É Í Þ ä É Ë É × ö ÷ ÷ ø ëù ù ú û ü ý þ ÿ � û � � ý � � û ý � � þ � û � � � û ü � þ þ � ü � � ý ü � � û � � � ý ÿ � ü � � � û ü ý û ü û � � � û � � � � ý þ û ü ÿ � � ý � ý � þ ý � þ û �

Savewithhomedeliveryandgenerics

Home Delivery:� Ì í ï ï Þ ê É × É å Ì ä É Ë è õ è Þ é Í Þ é å × á É í é ß í Þ Ù � ÷ ò × Ù è Î é ß ß å è ð Ì í ï

freeÎ í Ù Ê × Ù Ë × Î ï Ì ß ß Ì Ê á õ× É å Ì ä É Ë É × � � � � � � � � � � �

Call us at the number on your member ID card or visit Express-Scripts.com to get

started.

Generics: � � � ò Ù ß ß Ë Þ ä É × á É Ê É Ë Ì Í Î Ù Ë É é Î í Ù Î Î Ù Ö É Ù Ê × É Ö Ö É Í í Ì ä É Ù Î Ø Ë Ù Ê × ò Ê Ù ê É × Ë é á Î Ù Ê × í ï É è Í Þ Î í Ù Ø Þ é í! ÷ ø í Þ " ÷ ø å É Î Î ë # $ Þ é Ê × Î á Þ Þ × õ Ë Ì á ï í % � Î ó è Þ é Ë × Þ Í í Þ Ë Ì Ö Ù å É Î Î É î ß É Ê Î Ì ä É á É Ê É Ë Ì Í Í Þ é å × ï É å ß è Þ é ëManageyourprescriptionsonlineandonthego• Refill home delivery prescriptions• Find potential lower-cost options• Check order status• Find the nearest in-network pharmacy

Express-Scripts.comSign in today!The Express Scripts Mobile App Download it for FREE today from your app store!& ' ( ' ) ' * + + , - . , / 0 1 2 3 , 4 5 . 5 6 7 0 - 7 5 + . ' 8 7 7 9 : ; ; < < < ' = , - ' 2 + > ; 0 ? 2 1 @ - 7 + 0 A 5 . = + 0 4 - 7 5 + . ; @ ? 2 5 6 @ - 7 5 + . ; = ? , ? 0 - @ = + + , , 0 1 2 - . , B + 6 4 ? 7 5 B - B 7 = , B - B 7 ;6 5 2 . 5 = 5 B - . 7 - 4 ? . , 4 ? . 7 6 7 + 7 8 ? = , B - B 7 ; = , - 6 5 - ; 1 B 4 C & D E E F ' 8 7 4 ' 3 B B ? 6 6 ? , 3 1 2 1 6 7 G H F D & I '

Show this to your docr tor and discuss ways to pay less with your cr onsumer-

directed healthplan.

For medications you takeon a long-term basis, youyy ’ll save mll oney by usee ing the Expree ss Scripts Pss harmacyJ K

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See how you can get the most from your benefit.

Showthistoyour doctorand ask ifyoucouldpayless by filling a generic prescription

through home delivery.

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_ d W S N W \ N _ ` M Y Y M S Z pIt’s easy to start! t Q _ d U W V V Q _ W d d ` ] S Q [ u ] \ P S O P Q \ [ ] [ u ] \ v L U W \ N h W S N T ] i V V W _ R O P Q \ N P U d P \ ^ P \ W S ] TY \ ] _ U \ M Y d M P S p w \ W _ R O P Q \ N P U d P \ d P ] c Y \ ] _ U \ M u ] P \ ^ W k W r s c N W O Y \ ] _ U \ M Y d M P S d P Q _ p q P Q U W S W V _ P Z ] d _ d W \ d ] N W dExpress-Scripts.com

pGenerics:benefit foryourhealthandbudgetb L x c W Y Y \ P X ] N Z ] S ] \ M U _ W \ ] y Q _ d W _ _ W ^ ] W S N ] ^ ^ ] U d M X ] W _ u \ W S N c S W [ ] N \ Q Z _ p z ` ] N M ^ ^ ] \ ] S U ] a { ] S ] \ M U _ U W SU P _ d W u P Q d | s } d P ~ s } V ] _ _ p � z P N W O h S ] W \ V O � M S � s Y \ ] _ U \ M Y d M P S _ ^ M V V ] N M S d ` ] � p l p W \ ] ^ P \ Z ] S ] \ M U N \ Q Z _ p �v ^ O P Q i \ ] d W R M S Z W u \ W S N c S W [ ] N \ Q Z h W _ R O P Q \ N P U d P \ M ^ W V ] _ _ ] k Y ] S _ M X ] Z ] S ] \ M U M _ W X W M V W u V ] pWhatyou’llpay

Retail pharmacy (in network)30 day supply HomedeliveryfromtheExpressScriptsPharmacy90 day supply{ ] S ] \ M U _ � � � � � � � � � � � �m \ ] ^ ] \ \ ] N u \ W S N _ � � � � � � � � � � � � �� P S Y \ ] ^ ] \ \ ] N u \ W S N _ e S P Z ] S ] \ M U g � � � � � � � � � � � � �� P S Y \ ] ^ ] \ \ ] N u \ W S N _ e Z ] S ] \ M U _ W X W M V W u V ] g � � � � � � � � � � � � � � �� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �   � ¡ � � � � � � � ¢ � � � £ � � � � � � �   � � � ¡ � ¢ � ¤ ¥ � ¦ � � � � � � � � ¦ � � � � � � � §¨ £ ¥ ¡ � � � � � � � � � £ ¥ � © £ � © � £ ¢ ª � � � � « � � ¥ � £ � ¬ ­ ® ¯ ° ± � £ ¡ � £ ¥ £ ¡ ¬ ² ³ ® ´ ± ± � £ ¡ � £ ¥ ¡ � � � � � � § µ � � £ ¥ � � � � � � � � ¥ ¢ � � � � � � � ¡ ® � £ � � � � � � ¢ � � � £ � � � £ ¡ � � � ¡ � � � £ � � � � � � � ¡ � ¡ � ¢ £ ¦ � ¡ � � ² ± ± ¶ §Manageyourprescriptionsonlineandonthego· ¸ ] ^ M V V ` P [ ] N ] V M X ] \ O Y \ ] _ U \ M Y d M P S _· b M S N Y P d ] S d M W V V P T ] \ c U P _ d P Y d M P S _· ¹ ` ] U R P \ N ] \ _ d W d Q _· b M S N d ` ] S ] W \ ] _ d M S c S ] d T P \ R Y ` W \ [ W U OExpress-Scripts.comSign in today!

TheExpressScriptsMobileApp. Download it for FREE today from your app store! º » ¼ ½ ¾ ½ ¿ À À Á  à Á Ä Å Æ Ç È Á É Ê Ã Ê Ë Ì Å Â Ì Ê À à ½ Í Ì Ì Î Ï Ð Ð Ñ Ñ Ñ ½ Ò Á  ½ Ç À Ó Ð Å Ô Ç Æ Õ Â Ì À Å Ö Ê Ã Ò À Å É Â Ì Ê À Ã Ð Õ Ô Ç Ê Ë Õ Â Ì Ê À Ã Ð Ò Ô Á Ô Å Â Õ Ò À À Á Á Å Æ Ç Â Ã Á × À Ë É Ô Ì Ê × Â × Ì Ò Á × Â × Ì ÐØ Ù Ú Û Ù Ü Ù Ý Þ Û ß Þ à á Û â à á Û ß Ø ß ã ß ä á Ü â Ý Þ Ý ß å Ü â Þ Ø Ù Þ å æ Ý à ç º è é é ê » ä ß à » ë Ý Ý á Ø Ø á â ë æ Ú æ Ø ß ì í ê è º î »ê » ï » ð » ñ ã ã â Þ Û â ò ó æ Ú ë â à Ù Û Ù Ø ß ó Þ ß Ù ã Û » ä ß ß ô õ å å ö ö ö » Ü â Þ » Ú ã ÷ å ò ó æ Ú Ø å ø á Ø ã æ ó Ý á Ø ñ ã ó ù ã æ » ë Ý Ý á Ø Ø á â ë æ Ú æ Ø ß ì í ê è º î »ú û ü ý þ ÿ � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � þ � û þ � �

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Home delivery is easy, safe and convenient

Your health plan recommends home delivery pharmacy services from Express Scripts.1

© 2013 Express Scripts Holding Company. All Rights Reserved. 13-0695

1 Includes services provided by the Medco Pharmacy® and the Express Scripts PharmacySM. 2 Visit Express-Scripts.com and click on “Forms” on the left-hand side of your computer screen or call the phone number on your

member ID card to request a home delivery order form.3 Contact Express Scripts at the phone number on your member ID card if you don’t know your home delivery copayment.

Join the millions of Americans who already enjoy the safety and convenience

of home delivery pharmacy services – from Express Scripts – to your door.

Get up to a 90-day supply of your medicine for a single home delivery copayment by using home delivery

for the prescriptions you take regularly. This valuable part of your prescription benefit includes free

standard shipping.

OR

For transfers from a retail pharmacy, sign in at

Express-Scripts.com or

Speak to a prescription benefits specialist

800.698.3757(7:30 a.m. – 5 p.m., Central, Monday-Friday)

Let Us Help You Do It Yourself

1. Complete a home delivery order form2

2. Get a 90-day prescription from your doctor

plus refills for up to one year (if applicable)

3. Include your home delivery copayment

(acceptable forms include credit/debit card,

check or money order)3

4. Mail your form and prescription to

Express Scripts at the address on the form

You can also have your doctor ePrescribe or fax

your prescription.

Get refills

Order a refill online or by phone 24/7

when you have 30 days (or one month)

of medication remaining

so you don’t run out.

Choose Worry-Free Fills®

and we’ll automatically refill for you.

If you have any questions about home delivery pharmacy services from Express Scripts or your

prescription benefit, please call the number on your member ID card.

OR

Get started

Your medication will arrive by mail within 8 days of receipt of your initial prescription.

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2016 Express Scripts Holding Company. All Rights Reserved. 2016 Express Scripts Holding C EME37401 CRP16_2460

Registering with Express Scripts

Online access to savings and convenience

Manage your medicines anywhere, any time with

express-scripts.com and the Express Scripts

mobile app

Register now so you can experience: More savings.Compare prices of medicines at multiple pharmacies. Get freestandard shipping* from the Express Scripts Pharmacysm.

More convenience.Get up to 90-day supplies of your long-term medicine sent toyour home. Order refills, check order status, and track shipments.Print forms and ID cards, if needed.

More confidence.Talk with a pharmacist from the privacy of your homeany time, from anywhere. Find the latest information on yourmedicine, including possible side effects and interactions.

More flexibility.Download the Express Scripts mobile app to manage your medicines, find nearbypharmacies and get directions, and use your virtual ID card while on the go.

Get Started Today!

Registering is safe and simple. Your information is secure and confidential. Please have your member ID number or SSN available.

Go to express-scripts.com, select Register Now or download the Express Scripts Mobile App for

free from your mobile device’s app store and select Register Now

Complete the information requested, including personal information and member ID number or

Social Security Number (SSN), create your user name and password, along with security

information in case you ever forget your password

Click Register now and you’re registered

On the final page, you can set preferences** now, or later in My Account on express-scripts.com

Click Continue

Members who have Apple’s touch ID authentication on their iPhone or iPad devices can enable it to login to their Express Scripts account on the mobile app, if desired.

* Standard shipping costs are included as part of your prescription plan benefit.

** Preferences include the option to share your prescription information with other adult members of your household (aged 18+)

covered under your prescription drug plan.

All covered adults (aged 18+) in the household need to register separately.

When you grant permission to share your prescription information with other registered household members, they can view your information, place orders on your behalf and more.

The Express Scripts mobile app is available for iPhone®, AndroidTM

, Windows Phone®, Amazon, and Blackberry® mobile devices.

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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/wacoisd

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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. 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 ENROLLMENTWhat to have ready for your enrollment:

Social Security Numbers for all dependents

Any Status/Life Event or address changes

Questions about available benefits

ONLINE ENROLLMENTTo 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 KNOWWrite 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

Plan Information and Rules

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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 WorksA 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!

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Flexible Spending Accounts

Medical FSAMedical 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

FSA Plan Year is: 1 - 31, 201 FSA Max: The maximum you can set aside each year is $2,600

DEPENDENT CARE FSAWith 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/AKer School Care• Mothers-Day-Out Program• Nursery Schools• Babysitters• Nanny• Au Pair• Day Camps

You may allocate up to $5,000 per tax year for reimbursement of dependent day care services

($2,500 if you are married and file a separate tax return).

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 claimed as an exemption on your tax return. For full plan details, view the FSA Booklet available on the Employee Benefit Center.

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health savings accountAn HSA is a personal savings account that can be used to pay for medical, dental, vision and other quali-fied expenses now or later in life. To contribute to an HSA you must be enrolled in a qualified high-deduct-ible health plan and your contributions are limited annually. If your employer offers payroll deduction, you’ll see immediate tax savings on your contributions.

You can use the money tax-free to pay for eligible expenses such as:• Copays & Deductibles• Prescriptions• Dental Care• Contacts & Eyeglasses• Hearing aids• Laser Eye Surgery• Orthodontia• Chiropractic Care

201 Annual hsa Contribution LimitsIndividual Coverage - $3,400

Family Coverage - $6,750

You may not participate in an HSA if you are covered by a general purpose Health Flexible Spending Account (Health FSA) or a general purpose Health Reimbursement

Arrangement (HRA). In addition, if your spouse has a general purpose Health FSA that allows reimbursements for your expenses, you may not participate.

FSA

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BENEFITS CARD The Benefits Card is available to all employees that participate in Medical FSA, HSA, Limited Purpose FSA 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.

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.

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.

Your Employer ID Number is FFA . You must have this number or your Benefits Card number to register your account on the FF Flex Mobile App.

FSA store and hsa STORE First Financial has partnered with the FSA Store & the HSA Store to bring you an easy to use online store to

better understand and manage your FSA. Visit http://www.ffga.com/fsaextras for more details & special

deals!

Shop for eligible items from bandages to wheel chairs and thousands of products in between

Browse or search for eligible products and services using the Eligibility List

Visit the Learning Center to help find answers to questions you may have

RESOURCES FOR FSA/hsa MANAGEMENT

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Dental -

Vision - $10 co-pay for eye exam.$25 co-pay for eyeglass basic lenses.$1 0 frame allowance and 20% off balance OR $1 0 contact lens allowance and 15% off balance.

FREQUENCY: Exam—once every 12 months; lenses orcontact lenses—once every 12 months; frame—once every 24 months.

Must choose in-network provider for pricing above.

accident Coverage includes—but is not limited to—accidents, fractured bones, burns, concussions,broken teeth, emergency room treatment, ambulance, hospital.

No deductible.

Portable

DENTAL PLAN rates (MONTHLY) � � ! " # $ $ % & ! # '� � ! " # $ $ ( '� � ! " # $ $ ( '

vision PLAN rates (MONTHLY) � � ! " # $ $ % & ! # ' ) *' +�

accident PLAN rates (MONTHLY)

� � ! " # $ $ % & ! # ' '� � ! " # $ $ ( , " - . $ ' / '� � ! " # $ $ ( 0 1 2 ! 3 4 5 $ & 6 ' '7 8 � 2 ! # ' ' 9

Benefits at a Glance

Dental - DENTAL PLAN rates (MONTHLY) � � ! " # $ $ % & ! # '� � ! " # $ $ ( '� � ! " # $ $ ( '

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Voluntary Group Life Insurance - Guarantee Issue up to $1 0,000 for the employee at

Voluntary group life

rates (MONTHLY) '''''''''' +

critical illness metlife

Long-Term Disability American fidelity assurance company

(MONTHLY) '''' '

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Personal Legal Advice on unlimited issues

Letters/calls made on your behalf

Contracts & documents reviewed (up to 15 pages)

Residential Loan Document Assistance

Lawyers prepare your Will, your Living Will and your Health Care Power of Attorney

Moving Traffic Violations (available 15 days after enrollment)

IRS Audit Assistance

Trial Defense (if named defendant/respondent in a covered civil action suit)

Uncontested Divorce, Separation, Adoption and/or Name Change Representation (available 90 days after enrollment)

25% Preferred Member Discount (Bankruptcy, Criminal Charges, DUI, Other Matters, etc.)

24/7 Emergency Access for covered situations

iLock 360 MEMBERSHIP INCLUDES:

Social Security Number Tracing

Credit Monitoring

Full Service Restoration

$1 Million in Identity Theft Insurance

MONTHLY Rates Individual Family 2 : " ; < = ) > ' ' + ? * @ A: $ B 8 ! , 1 2 $ ! 3 ' '0 " � C 2 & $ 3 ' / D * @ > ' = = * @ >

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.

ID Theft Protection and legal plan iLock 360 and legalshield LEGALSHIELD MEMBERSHIP INCLUDES:

Employee Assistance Program A

24 Hour Call Center and Solution Focused Counseling

Convenient Counseling Locations accessible and geo-matched from home/work

Drug and Alcohol Awareness Program

Tobacco Cessation Courses

(MONTHLY)

� � ! " # $ $ % & ! # ' '� � ! " # $ $ ( , " - . $ ' '� � ! " # $ $ ( 0 1 2 ! 3 4 5 $ & 6 ' '7 8 � 2 ! # ' '

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

RETIREMENT OPTIONS First Financial offers a variety of options to help supplement your future income and help achieve your financial goals

Which One Is Right for Me? A 403(b) Plan allows you to reduce your federal taxable income by the amount you choose to contribute.

A 457(b) Plan is a deferred compensation plan that allows eligible employees to save for retirement by deferring compensation with pre-tax dollars.

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

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.

Benefits at a Glance

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E F G H I J K L J M N I M N OP Q R S T U V W S X Y Z [ \ ] X T ^ S _ ` a b [ Z V c ^ Z d P W ] ` c ef Q Z a ^ S g Q _ f Q T h i _ X T j g X Z [ S _ S j k Y X T Vf S l m Q _ T V n Q Z [ S _ V W S X Y Z [ k _ Q Z S ^ Z a Q T c ^ ZP S Y Y T S V V k _ Q b _ X R c Y Z S _ T X Z a o SP S Y Y T S V V k _ Q b _ X R W S X Y Z [ ` a V p c V V S V V R S T Zi q f c] r s ` ct n u c r o S _ o a S l] W q k ` c i S T S _ X Y f Q Z a ^ SW q k c c k _ a o X ^ v ` S R a T j S _W q k c c w x S ^ a X Y y T _ Q Y Y R S T Z Vk X Z a S T Z k _ Q Z S ^ Z a Q T f Q Z a ^ SW S X Y Z [ q T V z _ X T ^ S n X _ p S Z x Y X ^ S f Q Z a ^ Sy R x Y Q v S S ` S R a T j S _ V

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� � � � � ! � � � � � � � � � � � � � � � ) � � � � � � � � � � � � � � � � % � � � � � � � � � � � " ( � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �$ � � � � � � � 1 � � � & � � � � � � � � � � � � � � � � � ) � � � � � � � � 5 � � � � � � � � � � � � � � � 6 � � 7 8 9 : : 8 : ; ; 8 < = = : "> ? @ A B C D B E F G G > D B H I J ? B C D K � L E A B C H J D M D ? EN O P Q R P S P S T Q U U V P S W R P T X Q Y Z Q T P U X [ X \ U P P V R U Q ] P P ^ _ X U U \ P O P U Y X S ` a W Q \ P T < b 7 c de Q f T S P _ \ P S P Z X W ^ _ X U U \ P P Z Z P a W X g P h i S f i T ] 7 j < b 7 9 dk l m n o p q r o s o t u n v w x s l s y z p s { s q p z n l o | z { { w s m r z l z l s y y s q p y n w p } s s l p z w s ~ { r l u s r w � � v w z l � p } sr l l v r { s l w n { { m s l p ~ s w z n � t u n v } r � s p } s n ~ ~ n w p v l z p u p n w s � z s | u n v w x s l s y z p s { s q p z n l or l � m r � s q } r l � s o y n w p } s q n m z l � u s r w �� n v m r u n l { u m r � s q } r l � s o p n u n v w s { s q p z n l o � v w z l � p } s u s r w z y u n v } r � s n l s n y p } sy n { { n | z l � o p r p v o q } r l � s o �� � � � � � � ) � ! � � � � � � � � � � � � � � � � � � � 2 � � � � � � � � � � � � � � � 1 � � � � � � � � � � � � � � � � 3 �� � � � � � � � � � � � � � � � & � � � � � � � � � � � � � � � � � � � � � � � � � � & � � � ) � � � � � � � ) � � � � � � � � � ) � � � & � � � ) � � � � � ) � � � � � �� � � � � � � � � � � � � � � � � � � � � � � �� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � + � � � � � � � � � & � � � � � � ! � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �& � � � � � � � � & � � � "# � � � & � � � � � � � � � � � � � � & � � � � � � � � � $ � � � � � � � � � � � � � � � � � � � � � � � "� � � T P [ f U i W X Q S ^ T P � f X T P W O i W Z Q T P S T Q U U V P S W Y f P W Q W O P � f i U X Z ] X S [ P g P S W ^ i \ Q g P j a O i S [ P ^ V f ^ W \ P ^ f \ V X W W P Y_ X W O X S ; b Y i ] ^ Q Z W O i W � f i U X Z ] X S [ P g P S W d� � � � � � � � � � � 4 � � � � � � � � � � ) � � � � � ! � � � � � � � � � � � � ) � � � ! � � � � % � � � � � � � � � � ) / � 0 + � � � + � � / / $ � � � � �� � � � � � � � "� � � � � � � � � �   ¡ � ¢ � £ � � ¤ � ¥ �¦ � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � ) � � � � � � � � % � � � � $ � � � � � � � � � � � ! � $ � � � � & � � � � � � � � � � � � � � � � � � �� � � � � � � � � � � � � � � � � � � � � � � � � � � � + � � + � � � � " § � � � � � � � � � � � � � � � % � � � � � � � � � � � � � � � � � � � � � � � � � � � � & � � � � � � ¨& � � � � � � � � � � � � ) � � � � � � � � � � � � � � � � � � � � � � ) ! � � � � � � � � ¦ § � § ) � � � � � � ) � � � 0 © * 2 % 3 "ª � � � � � � � � � � � � � ) � � � � � � � � � � 2 � � � � � � � � � � � � � ( � � � � � � � � $ 3 � � � � � � � � � � � � � � � � & � � � � � � � � � � � � � � � � � � �� � � 0 © * 2 % 3 � � � � � " ª � � � � $ � � � � � � � � � � � � � � � � & � � � � � � � � � � � � � � � � � � � � � � ) � � � � � � � � � � � � � � � � � 1 � � � � � � � � � � �� � � � � � � "ª � � � � � � � � � � � � � � � � � � � � � & � � � � � � � � � � � � � � � � � ! � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � ) � � � �� � � � � � � � � � � � ) � � � � � � � � � � � � � � � � � � � � � � � � � � � 2 � " � " ) � � � � � � � 3 � � � � � � � � � � � � � � � � � � � � � � � � � � " # � � � � � � � � � � � � � � $ � � � � � � � � � � � � � ! � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � & � � � � � � � "ª � � � � $ � � � � � � � � � � � � � � 2 � � � � � � � � 3 � � & � � � � � & � � � � � � � 2 � � 3 ) � � � � � � � � � � � � � � � � � � � � � � � $ � � � � � � � � � � �� � ! � � � " « � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � $ � � � � � & � � � � � � � � � � � � � � � � � � � � � � " � � � � � � � � � � � � � �� � � � ¨ � � � � � � � � � � � � � � � ¨ � � � � � � & � � � � � � � � � � � � � ) � � � � � � � � � � � � � ) � � � � � � � � � � � � � � & � � � � � � � � � � �& � � � � � � � � � � � � � � " # � � � � � � � � � � ! � � � � � � � � � � � � � � � � � � � � � � � & � � � $ � � � � � � � � � � � � � � ¬

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New Health Insurance Marketplace Coverage

Options and Your Health Coverage

PART A: General Information ­What is the Health Insurance Marketplace?

Can I Save Money on my Health Insurance Premiums in the Marketplace?

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

How Can I Get More Information?

Form Approved

OMB No.

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PART B: Information About Health Coverage Offered by Your Employer ® ¯ ° ± ² ³ ´ µ ¶ · ¸ ¹ ± ¶ º ¯ » ¼ ½ ¾ ¿ À Á Â Ã Ä Á Å Æ Ç È Ç É Ê Æ Ç ¿ Å Ë Ì ¼ Í Á Â Î Ï Ð Ñ ÒÓ ¯ ° ± ² ³ ´ µ ¶ · ¹ Ô Ô · ¶ Õ Õ Ö ¯ Ï × Ø Ù Ú Û Ü Ý Ø Þ Ú ß Ü ß à × á Ü Ýâ ã ä Ç Æ À å ¯ æ ç è ç Ü é ¯ ê ë ì É ¿ Ä Áí î ¯ ï ð ´ ñ ¹ ¸ ò ¶ ñ ´ ¸ ó ¹ ñ ó ¹ ô ´ õ ó ¶ ± ² ³ ´ µ ¶ ¶ ð ¶ ¹ ³ ó ð ñ ´ ö ¶ · ¹ ÷ ¶ ¹ ó ó ð ø Õ ù ´ ô úû û ü ý ð ´ ¸ ¶ ¸ õ ± ô ¶ · þ ø ÿ Ô ø ÿ ÿ ¶ · ¶ ¸ ó ÿ · ´ ± ¹ ô ´ ö ¶ � û � ü ° ± ¹ ø ³ ¹ Ô Ô · ¶ Õ Õ� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �� � � � � � � � � � � � �� � � � � � � � � � � � � � � � � � � � � � � !� � � � � � � � � � � � " # $ $ % � & ' % ( " " ) * # + ' , - . � ' / 0 � # 1 , + , # � / ' . / , 0 2 ( 3 ) * # + ' , - . � ' / 0

✔ $ 4 1 ' % ( ( - * 5 ' * ' / 6 # $ , 7 , $ 2 $ ' 8 � � 5 ' 2 / - 4 ( / * ( ( 6 9 # 7 . # / ( $ ( $ & ( / - ' 8 " 5 ( � ( # + 5 ( / � ( " , / ( $ ( 7 " � % - " ( $ ' 8 � ( : # - ;# / ( ( 1 , 0 , & 1 ( 8 ' / 0 / ' 2 4 5 ( # 1 " 5 , 7 - 2 / # 7 + ( + ' < ( / # 0 ( = ( 8 8 ( + " , < ( " 5 ( 8 , / - " . # % ' 8 " 5 ( $ ' 7 " 5 8 ' 1 1 ' * , 7 0 " 5 ( , / . # " ( ' 8 5 , / ( �✔ 1 , 0 , & 1 ( . ( 4 ( 7 . ( 7 " , - # - 4 ' 2 - ( = + 5 , 1 . 9 / ( 7 ; = - " ( 4 + 5 , 1 . 9 / ( 7 ; = 1 ( 0 # 1 1 % # . ' 4 " ( . + 5 , 1 . 9 / ( 7 ; �

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