2022-23 WTXEBC Benefit Guide (TSHBP) by FBS

WTXEBC BENEFIT GUIDE EFFECTIVE: 09/01/2022 8/31/2023 WWW.WTXEBC.COM 2022 - 2023 PlanYear

Table of Contents FLIP TO... HOW TO ENROLLPG. 4 SUMMARYPAGESPG. 6 BENEFITSYOURPG. 11 How to Enroll 4-5 Annual Benefit Enrollment 6-10 1. Section 125 Cafeteria Plan Guidelines 6 2. Annual Enrollment 7 3. Eligibility Requirements 8 4. Helpful Definitions 9 5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 10 Medical 11-12 Health Savings Account (HSA) 13-14 Hospital Indemnity 15 Telehealth 16 Dental 17-18 Vision 19-20 Disability 21 Life and AD&D 22-23 Individual Life 24 Emergency Medical Transportation 25 Cancer 26-27 Accident 28-29 Critical Illness 30-31 Identity Theft 32 Flexible Spending Account (FSA) 33-34 FBS Benefits App Group # Index 35-36

WTXEBC BENEFITS MEDICAL HEALTH SAVINGS ACCOUNT (HSA) Financial Benefit Services (469) 385 www.wtxebc.com4685 Texas Schools Health Benefits Program (TSHBP) (888) 803 0081 All Plans: https://tshbp.info/DrugPhamGroupPharmacywww.tshbp.orgBenefits:SouthernScripts#50000 (817)EECU 882 www.eecu.org0800 HOSPITAL INDEMNITY TELEHEALTH DENTAL Aetna Group #802466 (800) 607 https://www.aetna.com3366 MD (888)Live365 www.consultmdlive.com1663 Lincoln Financial Group (800) 423 https://www.lfg.com2765 VISION DISABILITY LIFE AND AD&D Superior Vision Group #28790 (800) 507 www.superiorvision.com3800 (866)Unum679 www.unum.com3054 (866)Unum679 www.unum.com3054 INDIVIDUAL LIFE EMERGENCY MEDICAL TRANSPORT CANCER 5Star Life Insurance Company (866) 863 www.5starlifeinsurance.com9753 (800)MASA423 www.masamts.com3226 American Public Life (800) 256 www.ampublic.com8606 ACCIDENT CRITICAL ILLNESS IDENTITY THEFT American Public Life (800) 256 www.ampublic.com8606 GroupAetna #802466 (800) 607 https://www.aetna.com3366 www.IDWatchdog.com(800)IDWatchdog7743772 FLEXIBLE SPENDING ACCOUNT (FSA) (855)NBS 399 3035 www.nbsbenefits.com Benefit Contact Information

Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS WTX” to (800) 583-6908 App Group #: Go to PAGE 35 to find your district’s group # Text “FBS WTX” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment: • Benefit Resources • Online Enrollment • Interactive Tools • And more!

1 www.wtxebc.com How to Log In 2 CLICK LOGIN 3 ENTER USERNAME & PASSWORD TheUsername:firstsix (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number. If you have six (6) or less characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number. Default Password: Last Name* (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number.

A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).

Gain/Loss EligibilityDependents'ofStatus

If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.

Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.

Change in Status of Employment Affecting Coverage Eligibility

A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.

Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 31 days of your qualifying event and meet with your Benefit Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

Section 125 Cafeteria Plan Guidelines SUMMARY PAGESAnnual Benefit Enrollment

CHANGES IN (CIS):STATUS QUALIFYING EVENTS

A Cafeteria plan enables you to save money by using pre tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.

Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.

An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements under an employer's plan may include change in age, student, marital, employment or tax dependent status.

Change in Number of Tax Dependents

Marital Status

Judgment/Decree/Order

Eligibility for Government Programs

For benefit summaries and claim forms, go to your benefit website: www.wtxebc.com. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section.

SUMMARY PAGESAnnual Benefit Enrollment

During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.

Annual Enrollment

All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

New Hire Enrollment

• Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.

When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3 4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.

Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefit Office or you can call Financial Benefit Services at 866 914 5202 for assistance.

• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.

• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.

For benefit summaries and claim forms, go to your benefit website: www.wtxebc.com. Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms section. How can I find a Network Provider?

Where can I find forms?

You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee's enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.

Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week. Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2022 benefits become effective on September 1, 2022, you must be actively at work on September 1, 2022 to be eligible for your new benefits.

Dependent RequirementsEligibility

SUMMARY PAGES

Annual Benefit Enrollment

Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further Potentialguidance.Dependent

Employee RequirementsEligibility

Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.

Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.

If your dependent is disabled, coverage may be able to continue past the maximum age under certain If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your Benefit Office to request a continuation of coverage.

plans.

PLAN MAXIMUM AGE Accident Through 25 Cancer Through 25 Critical Illness Through 25 Dental Through 25 Dependent Flex 12 or younger or qualified individual unable to care for themselves & claimed as a dependent on your taxes Individual Life Issue through 23; Keep to 100 Healthcare FSA Through 25 or IRS Tax Dependent HealthAccountSavings IRS Tax Dependent Identity Theft Through 25 Medical Supplement Through 25 Telehealth Through 25 Vision Through 25 Life and AD&D Through 25 TransportationMedical Through 25

Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent Disclaimer:eligibility.

Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse FSA/HSAeligibility.Limitations:

Plan Year 1st through August 31st Pre Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescriptions drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).

The most an eligible or insured person can pay in co insurance for covered expenses.

SUMMARY PAGESHelpful Definitions

In Network Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider. Out of Pocket Maximum

The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively at work and/or pre existing condition exclusion provisions do apply, as applicable by carrier.

January 1st through December 31st Co-insurance any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service. Coverage

After

You are performing your regular occupation for the employer on a full time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel If you will not be actively at work beginning 9/1/2022 please notify your benefits administrator. Enrollment

Annual

Calendar Year

September

The period during which existing employees are given the opportunity to enroll in or change their current elections. Deductible The amount you pay each plan year before the plan begins to pay covered expenses.

Guaranteed

Annual

Actively at Work

FLIP TO FOR HSA INFORMATION PG. 13 FLIP TO FOR FSA INFORMATION PG. 33 Health Savings Account (HSA) (IRC Sec. 223) Flexible Spending Account (FSA) (IRC Sec. 125) Description Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax free. Allows employees to pay out of pocket expenses for copays, deductibles and certain services not covered by medical plan, tax free. This also allows employees to pay for qualifying dependent care tax free. Employer Eligibility A qualified high deductible health plan. All employers Contribution Source Employee and/or employer Employee and/or employer Account Owner Individual Employer Underlying RequirementInsurance High deductible health plan None Minimum Deductible $1,400 single (2022) $2,800 family (2022) N/A Maximum Contribution $3,650 single (2022) $7,300 family (2022) 55+ catch up +$1,000 $2,850 (2022) Permissible Use Of Funds Employees may use funds any way they wish. If used for non qualified medical expenses, subject to current tax rate plus 20% penalty. Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC). Cash Outs of Unused Amounts (if no medical expenses) Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65). Not permitted Year to year rollover of account balance? Yes, will roll over to use for subsequent year’s health coverage. No. Access to some funds may be extended if your employer’s plan contains a 2 1/2 month grace period or $550 rollover provision. Does the account earn interest? Yes No Portable? Yes, portable year to year and between jobs. No SUMMARY PAGESHSA vs. FSA

Medical Insurance Texas Schools Health Benefits Program

For full plan details, please visit your benefit website: www.wtxebc.com

The TSHBP Directed Care Plans utilize a national network to provide physician and ancillary services access to all members. Enrolled school districts will access the HealthSmart practitioner and ancillary only network to gain access to over 478,000 providers in over 1,222,000 unique locations across the United States, Please note, hospitals are excluded from the PPO networks. All hospital and other medical facility based services are accessed via an assigned Care Coordinator.

With the Aetna PPO plans, if you choose to utilize the services of a Care Coordinator for a procedure or admission to a facility, you will receive a $500 credit toward your deductible1. If you have already met your deductible, the $500 credit will apply to your out of pocket maximum!

Aetna Network Highlights

You want a network that is comprehensive, is easy to use and can help you save on costs. Look no further. You can now find support through our Aetna Signature Administrators® preferred provider organization network. Discover provider options and reduced costs.

On the HDHP plan, a member must meet a minimum of $1,400 of the deductible accumulation before receiving the credit to comply with HSA requirements. Scan the QR code with your mobile device or visit tshbp.org/myrates to view your rates!

ABOUT TSHBP

Directed Care Highlights

EMPLOYEE BENEFITS

You’ll also have access to over 600 Institutes of Excellence™ facilities and Institutes of Quality® facilities. We measure these publicly recognized institutes by clinical performance, outcomes and efficiency. Then, we pass this guidance along to you so you can choose the best facility.

No one likes changing doctors every year. We make it easier, so you don’t have to. Our local network teams work with doctors and hospitals to promote effective member care and better customer satisfaction. As a result, the turnover in our network is remarkably low, year after year.

PPO Deductible Credits

Ready to search our network? Just visit http://aetna.com/asa

TSHBP members will experience the lowest out of pocket costs for physician and ancillary medical services when utilizing network providers. HealthSmart Network Solutions’ Physician and Ancillary Only Primary PPO contains approximately 478,000 contracted providers in over 1,222,000 unique locations across the country. It is easy to look up providers in your area by looking up providers in your area by clicking on the link below. Your searches can be saved to your computer or sent to your email.

The TSHBP is proud to offer a variety of plans and benefits to meet your school district’s needs. All plans are designed so members can easily navigate through their health medical needs.

https://tshbp.info/HSNetwork

With our network, you now have access to over 1.2 million participating doctors, 8,700 hospitals, and strong, negotiated discounts. We know quality care is important. So we make sure our doctors successfully complete our credentialing requirements. Our credentialing process meets industry standards, as well as state and federal requirements.

EMPLOYEE BENEFITS Medical Insurance Texas Schools Health Benefits Program PLAN SUMMARY DIRECTED CARE PLANS AETNA NETWORK PLANS High Deductible CoPay Aetna HD Aetna Signature Directed Care Plan • Use CC for Hospital/ Surgical Services • Compatible with an HSA • Lowest HD Premium Plan • Out of Network Benefits Directed Care Plan • Use CC for Hospital/ Surgical Services • Co payments for Services • Reduce Out of Pocket • Out of Network Benefits Traditional PPO Plan • Compatible with an HSA • Network for all physician and hospital services Traditional PPO Plan • Lowest Deductible Plan • Brand Drug Deductible • Network for all physician and hospital services Plan Features In Network In Network In Network In Network Individual/FamilyDeductible $3,000/$9,000 $0 Deductible $3,000/$6,000 $2,000/$4,000 Coinsurance None Plan Pays 100% after deductible None Plan Pays 100% after out of pocket is met You pay 30% deductibleafter You pay 25% deductibleafter Ind/Fam Out of Pocket $3,000/$9,000 $3,500/$10,500 $7,000/$14,000 $7,500/$15,000 National Network HealthSmart HealthSmart Aetna Aetna PCP Required No No No No PCP ReferralSpecialistto No No No No Doctor Visits Preventive Care Yes $0 copay Yes $0 copay Yes $0 copay Yes $0 Copay Primary Care Deductible, then Plan pays 100% $35 copay You pay 30% deductibleafter $30 copay Specialist Deductible, then Plan pays 100% $35 copay You pay 30% deductibleafter $70 copay Virtual Health $30 per consultation $0 per consultation $30 per consultation $0 per consultation Care FacilitiesUrgent Care Deductible, then Plan pays 100% $50 copay You pay 30% deductibleafter $50 copay Emergency Care Deductible, then Plan pays 100% $500 copay You pay 30% deductibleafter You pay $500 copay + 25% after deductible Outpatient Surgery Deductible, then Plan pays 100% $500 copay You pay 30% deductibleafter You pay 25% deductibleafter PrescriptionsDrugDeductible Integrated with medical No deductible Integrated with medical $500 brand deductible Days Supply 30 Day Supply / 90 Day Supply 30 Day Supply / 90 Day Supply 30 Day Supply / 90 Day Supply 30 Day Supply / 90 Day Supply Generics Deductible, then Plan pays 100% $0 at selected pharmacies; others $10/$20 copay You pay 20% deductible;after $0 for certain generics $15/$45 copay Preferred Brand Deductible, then Plan pays 100% $35 copay or 50% copay (max $100) You pay 25% deductibleafter You pay 25% deductibleafter Non preferred Brand Deductible, then Plan pays 100% $70 copay or 50% copay (max $200) You pay 50% deductibleafter You pay 50% deductibleafter Specialty Limited PAP Required Limited PAP Required Full Coverage PAP Required Full Coverage PAP Required

You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered under your HDHP.

• Not eligible to be claimed as a dependent on someone else’s tax return

ABOUT HSA

• Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account

A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used.

Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2022 is based on the coverage option you elect:

A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs it is also a tax exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.

Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP).

HSA Eligibility

• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan

Maximum Contributions

You are eligible to open and contribute to an HSA if you are: Enrolled in an HSA eligible HDHP (High Deductible Health Plan)

•

• Not enrolled in Medicare or TRICARE

• Not receiving Veterans Administration benefits

• Family (filing jointly) $7,300 You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are 55 or older, you may make a yearly catch up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch up contribution for the entire plan year.

A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax free and spends tax free if used to pay for qualified medical expenses. There is no “use it or lose it” rule you do not lose your money if you do not spend it in the calendar year and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.

For full plan details, please visit your benefit website: www.wtxebc.com

EECU EMPLOYEE BENEFITS

• Individual $3,650

Health Savings Account (HSA)

Opening an HSA If you meet the eligibility requirements, you may open an HSA administered by EECU. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA. Important HSA Information • Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount. • You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit. You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions. How to Use your HSA • Online/Mobile: Sign in for 24/7 account access to check your balance, pay bills and more. • Call/Text: (817) 882 0800. EECU’s dedicated member service representatives are available to assist you with any questions. Their hours of operation are Monday through Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. 1:00 p.m. CT and closed on Sunday. • Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333 9934 • Stop by a local EECU financial center for in person assistance; find EECU locations & service hours a www.eecu.org/locations EMPLOYEE BENEFITSHealth Savings Account (HSA) EECU

Employee and

What is considered a hospital stay?

Hospital Indemnity $1,500 $2,500 Employee Only $21.47 $37.36 Employee Spouse $43.17 $75.46 Child(ren) $30.71 $53.40 Family $50.12 $87.33

ABOUT HOSPITAL INDEMNITY

Hospital Indemnity Aetna EMPLOYEE BENEFITS Important information about your benefits IN ORDER FOR THE HOSPITAL INDEMNITY BENEFITS TO BE PAYABLE, THE INITIAL DAY OF YOUR STAY AND OTHER SERVICES MUST BE ON OR AFTER YOUR

1 Option

How do I file a claim? Go to myaetnasupplemental.com and either “Log In” or “Register”, depending on if you’ve set up your account. Click the “Create a new claim” button and answer a few quick questions. You can even save your claim to finish later. You can also print/ mail in form(s) to: Aetna Voluntary Plans, PO Box 14079, Lexington, KY 40512 4079, or you can ask us to mail you a printed form.

Portability Your plan includes a Portability option which allows you to keep your existing coverage by making direct payments to the carrier. You may exercise this option if your employment ceases for any reason. Refer to your Certificate for additional Portability provisions.

details,

$1,500 $2,500 Hospital stay Daily Pays a daily benefit, beginning on day two of your stay in a non ICU room of a hospital. Maximum 30 days per plan year $100 $200 Hospital stay (ICU) Daily Pays a daily benefit, beginning on day two of your stay in an ICU room of a hospital. Maximum 30 days per plan year $150 $250 Newborn routine care Provides a lump sum benefit after the birth of your newborn. This will not pay for an outpatient birth.

If you are in a hospital for more than 30 days in a row, we will waive the premium beginning on the first premium due date that occurs after the 30th day of your stay, through the next 6 months of coverage. During your stay, you must remain employed with the ThisExclusionspolicyholder.andLimitationsplanhasexclusionsand limitations. Refer to the actual policy and certificate to determine which benefits are not payable. The following is a partial list of services and supplies that are generally not covered. However, the plan may contain exceptions to this list based on state mandates or the plan design purchased.

A stay is a period during which you are admitted as an inpatient; and are confined in a hospital or non hospital residential facility; and are charged for room, board and general nursing services. A stay does not include time in the hospital because of custodial or personal needs that do not require medical skills or training. A stay specifically excludes time in the hospital for observation or in the emergency room unless this leads to a stay.

This is an affordable supplemental plan that pays you should you be in patient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance. plan please visit your benefit website: www.wtxebc.com EFFECTIVE DATE

Inpatient StaysCovered Benefit Option 2

Hospital stay Admission Provides a lump sum benefit for the initial day of your stay in a hospital. Maximum 1 stay per plan year

Important Note: All daily inpatient stay benefits begin on day two and count toward the plan year maximum.

and

Employee and

OF COVERAGE.

$100 $200

$100 $200 Observation unit Provides a lump sum benefit for the initial day of your stay in an observation unit as the result of an illness or accidental injury. Maximum 1 day per plan year

Waiver of premium

For full

ABOUT TELEHEALTH Telehealth provides 24/7/365 access to board certified doctors via telephone or video consultations that can diagnose, recommend treatment and prescribe medication. Telehealth makes care more convenient and accessible for non emergency care when your primary care physician is not available. For full plan details, please visit your benefit website: www.wtxebc.com Telehealth MDLive EMPLOYEE BENEFITS Alongside your medical coverage is access to quality telehealth services through MDLIVE. Connect anytime day or night with a board certified doctor via your mobile device or computer. While MDLIVE does not replace your primary care physician, it is a convenient and cost effective option when you need care and: • Have a non emergency issue and are considering a convenience care clinic, urgent care clinic or emergency room for treatment • Are on a business trip, vacation or away from home • Are unable to see your primary care physician When to Use MDLIVE: At a cost that is the same or less than a visit to your physician, use telehealth services for minor conditions such as: • Sore throat • Headache • Stomachache • Cold • Flu • Allergies • Fever • Urinary tract infections Do not use telemedicine for serious or life threatening emergencies. Registration is Easy Register with MDLIVE so you are ready to use this valuable service when and where you need it. • Online www.mdlive.com/fbs • Phone 888 365 1663 • Mobile download the MDLIVE mobile app to your smartphone or mobile device • Select “MDLIVE as a benefit” and “FBS” as your Employer/Organization when registering your account. Telehealth Employee & Family $9.00

ABOUT DENTAL Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and Fordisease.fullplan details, please visit your benefit website: www.wtxebc.com Dental Insurance Lincoln Financial Group EMPLOYEE BENEFITS Benefit Highlights Some plans may not be offered at every district within WTXEBC. Check your district benefit website for details. Low Base High Calendar (Annual) Deductible Individual: $50 Family: Waived$150forPreventive Individual: $50 Family: Waived$150forPreventive Individual: $50 Family: Waived$150forPreventive Deductibles are combined for basic and major Contracting Dentists’ services. Deductibles are combined for basic and major Non Contracting Dentists’ services. Annual Maximum $1,500 $1,500 $1,500 Lifetime Orthodontic Max $1,000 $1,000 $1,000 Orthodontic Coverage is available for dependent children. Waiting Period There are no benefit waiting periods for any service types Visit LincolnFinancial.com/FindADentist You can search by: • Location • Dentist name or office name • Distance you are willing to travel • Specialty, language and more Your search will automatically provide up to 100 dentists that most closely match your criteria. If your search does not locate the dentist you prefer, you can nominate one just click the Nominate a Dentist link and complete the onlineTheform.Lincoln DentalConnect® PPO Plans: • Cover many preventive, basic, and major dental care services • Also cover orthodontic treatment for children • Feature group rates for WTXEBC employees • Let you choose any dentist you wish, though you can lower your out of pocket costs by selecting a contracting dentist • Do not make you and your loved ones wait six months between routine cleanings Dental Low Plan High Plan Employee Only $20.10 $34.87 Employee and Spouse $38.49 $66.66 Employee and Child(ren) $48.83 $84.88 Employee and Family $67.33 $116.77

Plan Features Some plans may not be offered at every district within WTXEBC. Check your district benefit website for details. Preventive Services Low Base High Routine oral exams Bitewing X rays Full mouth or panoramic X rays Other dental X rays including periapical films Routine SpaceFluoridecleaningstreatmentsmaintainersfor children Palliative treatment including emergency relief of dental pain Sealants 90% No Deductible 100% No Deductible 100% No Deductible Basic Services Low Base High Problem focused exams Injections of antibiotics and other therapeutic medications SimpleFillings Generalextractionsanesthesia and I.V. sedation 50% After Deductible 80% After Deductible 80% After Deductible Major Services Low Base High Consultations Prefabricated stainless steel and resin crowns Surgical extractions Oral Biopsysurgeryandexamination of oral tissue including brush biopsy Prosthetic repair and recementation services Endodontics including root canal treatment 50% After Deductible 50% After Deductible 50% After Deductible Orthodontics Low Base High Orthodontic exams X AppliancesStudyExtractionsraysmodels 50% 50% 50% Contracting Dentists/Non Contracting Dentists Contracting Dentists Non Contracting Dentists To find a contracting dentist near you, However,Thiswww.LincolnFinancial.com/FindADentistvisitplanletsyouchooseanydentistyouwish.youroutofpocketcostsarelikelyto be lower when you choose a contracting dentist. For example, if you need a crown you pay a deductible (if applicable), then 50% of the remaining discounted fee for PPO members. This is known as a PPO contracted fee. you pay a deductible (if applicable), then 50% of the usual and customary fee, which is the maximum expense covered by the plan. You are responsible for the different between the usual and customary fee and the dentist’s billed charge. EMPLOYEE BENEFITS Dental Insurance Lincoln Financial Group

ABOUT VISION Vision insurance provides coverage for routine eye examinations and can help with covering some of the costs for eyeglass frames, lenses or contact lenses. For full plan details, please visit your benefit website: www.wtxebc.com Vision Insurance Superior Vision EMPLOYEE BENEFITS In network Out of network Exam (ophthalmologist) Covered in full Up to $42 retail Exam (optometrist) Covered in full Up to $37 retail Frames $125 retail allowance Up to $68 retail Contact lens fitting (standard2) Covered in full Not covered Contact lens fitting (specialty2) $50 retail allowance Not covered Lenses (standard) per pair Single vision Covered in full Up to $32 retail Bifocal Covered in full Up to $46 retail Trifocal Covered in full Up to $61 retail Scratch Coat (factory) Covered in full Not covered Progressives lens upgrade See description3 Up to $61 retail Contact lenses4 $120 retail allowance Up to $100 retail Co pays apply to in network benefits; co pays for out of network visits are deducted from reimbursements 1. Materials co pay applies to lenses and frames only, not contact lenses 2. See your benefits materials for definitions of standard and specialty contact lens fittings 3. Covered 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 are in lieu of eyeglass lenses and frames benefit Copays Services/frequency Monthly Premiums Exam $10 Exam 12 months Employee Only $7.80 Materials1 $25 Frame 12 months Employee and Spouse $15.46 Contact lens fitting (standard & specialty) Contact lens fitting 12 months Employee and Child(ren) $15.17$0 Lenses 12 months Employee and Family $22.95 Contact lenses 12 months How to Print your Vision ID Card: You can request your vision id card by contacting Superior Vision directly at 800 507 3800. You can also go to www.superiorvision.com and register/login to access your account by clicking on “Members” at the top of the page. You can also download the Superior Vision mobile app on your smart phone.

Discount Features Look for providers in the provider directory who accept discounts, as some do not; please verify their services and discounts (range from 10% 40%) prior to service as they vary. Discounts on covered materials Frames: 20% off amount over allowance Lens options: 20% off retail Progressives: 20% off amount over retail lined trifocal lens, including lens options Discounts on non covered exam, services and materials Exams, frames, and prescription lenses: 30% off retail Lens options, contacts, prescription materials options: 20% off retail Disposable contact lenses: 10% off retail Maximum member out of pocket The following options have out of pocket maximums5 on standard (not premium, brand, or progressive) lenses. Single Vision Bifocal & Trifocals Ultraviolet coat $15 $15 Tints, solid or gradients $25 $25 Anti reflective coat $50 $50 High index 1.6 $55 20% off retail Photochromics $80 20% off retail 5. Discounts and maximums may vary by lens type. Please check with your provider. EMPLOYEE BENEFITS Vision Insurance Superior Vision Refractive Surgery Superior Vision has a nationwide network of independent refractive surgeons and partnerships with leading LASIK networks who offer members a discount. These discounts range from 5% 50%, and are the best possible discounts available to Superior Vision. 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 Benefit Office if you have any questions.

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Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.

Disability Insurance

•

What is considered a pre existing condition?

You can elect to purchase a benefit of 30% 40% 50% 60% or 70% of your monthly earnings.

Elimination Period 30% 40% 50% 60% 7/7 $1.68 $1.76 $2.03 $2.34 14/14 $1.56 $1.65 $1.91 $2.20 30/30 $1.30 $1.37 $1.59 $1.85 60/60 $0.80 $0.84 $0.98 $1.21 90/90 $0.71 $0.75 $0.88 $1.09

• The disability begins in the first 12 months after your effective date of Benefitscoverage.underthis provision are payable for no more than 90 days of benefit from the date of disability. After 90 days, benefits are subject to a 3/12 pre existing condition exclusion. In no event will benefits be paid beyond the applicable benefit duration. This applies to the 9/1/2021 enrollment only and new hires. 4 week pre ex benefit included in years 2 and beyond. Please refer to policy for a detailed description of this Whenprovision.does my coverage end? Your coverage under the policy ends on the earliest of the following:

The elimination period is the length of time you must be continuously disabled before you can receive benefits.

Disability (per $100 in benefit)

You have a pre existing condition if:

You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. You are considered in active employment, if on the day you apply for coverage, you are being paid regularly by your employer for the required minimum hours each week and you are performing the material and substantial duties of your regular occupation.

•

What is my maximum monthly benefit amount?

• You received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and

Who is eligible?

•

Elimination Period Options: Option 1: 7 days/7 days first day hospital Option 2: 14 days/14 days first day hospital Option 3: 30 days/30 days first day hospital Option 4: 60 days/60 days Option 5: 90 days/90 days

Unum EMPLOYEE BENEFITS

Your total monthly benefit (including all benefits provided under this plan) will not exceed 100% of your monthly earnings unless the excess amount is payable as a Cost of Living Adjustment.

During your elimination period, you will be considered disabled if you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury, you are under the regular care of a physician and you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury.

For full plan details, please visit your benefit website: www.wtxebc.com

To apply for coverage, complete your enrollment online by the enrollment deadline. If you were hired after 9/1/2022, check with your plan administrator for your eligibility date, and complete your enrollment online within 31 days of that date.

The date the policy or plan is cancelled The date you no longer are in an eligible group The date your eligible group is no longer covered The last day of the period for which you made any required contributions The last day you are in active employment except as provided under the covered layoff or leave of absence provision. Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan.

•

How can I apply for coverage?

How long do I have to wait to receive benefits?

benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. Your admission and discharge dates and time must be 23 or more consecutive hours apart. (Applies to Elimination Periods of 30 days or less.)

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What if I am out of work when insurance goes into effect? Insurance will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

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What is my monthly benefit amount?

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

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ABOUT DISABILITY

For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness or disorder, your dependent spouse and children: are confined in a hospital or similar institution; are confined at home under the care of a physician for a sickness or injury; or your spouse has a life threatening condition. Exception: Infants are insured from live birth. Is this coverage portable (can I keep it when I leave my employer)?

VOLUNTARY LIFE AND AD&D Who is eligible?

• Spouse: up to 100% of employee amount in increments of $10,000; not to exceed $500,000.

Do my life insurance benefits decrease with age?

Current employees: If you and your eligible dependents are enrolled in the plan and wish to increase your life insurance coverage, you may apply on or before the enrollment deadline for any amount of additional coverage up to $200,000 for yourself and any amount of additional coverage up to $50,000 for your spouse. Any life insurance coverage over the guaranteed amount(s) will be subject to answers to health questions. If you and your eligible dependents are not currently enrolled in the plan, you may apply for coverage on or before the enrollment deadline and will be required to answer health questions for any amount of coverage.

Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

All actively employed employees working at least 20 hours each week for your employer in the U.S. and their eligible spouses and children to age 26. What are the Voluntary Life and AD&D coverage amounts?

Coverage amounts will reduce according to the following schedule:Age: Insurance amount reduces to: 70: 50% of original amount Coverage may not be increased after a reduction. Can I be denied coverage?

Group term life is the most inexpensive way to purchase life insurance.

BASIC LIFE AND AD&D

Life and AD&D Unum EMPLOYEE BENEFITS ABOUT LIFE AND AD&D

What are the Basic Life and AD&D coverage amounts?

• Employee: up to 7 times salary in increments of $10,000; not to exceed $500,000.

• Child: up to 100% of employee coverage amount in increments of $5,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and 14 days is $1,000 and 14 days to six months is $2,000.

When is coverage effective? Please see your plan administrator for your effective date. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

All actively employed employees working at least 15 hours each week for your employer in the U.S. and their eligible spouses and children to age 26.

• AD&D: Your employer is providing you with either $10,000, $20,000, $30,000, $40,000 or $50,000.

You have the freedom to select an amount of life insurance coverage you need to help protect the well being of your family.

Who is eligible?

• Life: Your employer is providing you with either $10,000, $20,000, $30,000, $40,000 or $50,000.

If you retire, reduce your hours, or leave your employer, you can continue coverage for yourself your spouse and your dependent children at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy but they may be able to convert their term life policy to an individual life insurance policy.

Coverage amounts will reduce according to the following schedule:Age: Insurance amount reduces to: 70: 50% of original amount

Do my life insurance benefits decrease with age?

Coverage may not be increased after a reduction.

For full plan details, please visit your benefit website: www.wtxebc.com

Life and AD&D Unum EMPLOYEE BENEFITS Age band Employee and Spouse Rate per

• the date your eligible group is no longer covered

When does my coverage end?

• for a spouse, the date of a divorce or annulment and

eye • speech and hearing Other losses may be covered as

• the date your dependent ceases to be an eligible dependent

Please see your plan administrator for your effective date. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

for loss of: • Life • both hands or both feet or sight of both eyes • one hand and

foot • one hand or

foot and

In addition, coverage for any one dependent will end on the earliest of:

Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.

Howadministrator.muchdoes coverage cost? • Employee: $0.40 per $10,000 in coverage • Employee and Family: $0.70 per $10,000 in coverage

If you become disabled (as defined by your plan) and are no longer able to work, your life premium payments will be waived until your disability period ends. $10,000

• the date you no longer are in an eligible group

• the date the policy or plan is cancelled

• the last day of the period for which you made any required contributions • the last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness, as described in the certificate of coverage.

• the date your coverage under a plan ends

• for dependent coverage, the date of your death

Will my premiums be waived if I become disabled?

You and your dependents’ coverage under the Summary of Benefits ends on the earliest of:

New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s Howexpense.much does coverage cost? Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date. Spouse rate is based on your Spouse’s insurance age, which is their age immediately prior to and including the anniversary/ effective date. What are the AD&D coverage amounts? • Employee: up to 10 times salary in increments of $10,000; not to exceed $500,000 • Spouse: up to 50% of employee amount in increments to a maximum of $250,000 • Child: up to 10% of employee coverage amount to a maximum of $50,000 Note: You may purchase AD&D coverage for yourself regardless of whether you purchase term life coverage. To purchase AD&D coverage for your dependents, you must buy coverage for yourself. What does AD&D insurance pay for?

When is coverage effective?

<25 $0.54 25 29 $0.54 30 34 $0.72 35 39 $0.81 40 44 $0.99 45 49 $1.53 50 54 $2.88 55 59 $4.95 60 64 $7.92 65 69 $11.04 70 74 $18.54 75+ $18.54 Child life monthly rate is $1.00 per $5,000.

Is this coverage portable (can I keep it when I leave my employer)?

The full benefit amount is paid one one the sight of one well. Please contact your plan

ADDITIONAL DETAILS: Quality of Life not available ages 66 70. Quality of Life benefits not available for children. Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 years). $7.15 monthly for $10,000 coverage per child. Find full details and rates at www.wtxebc.com Should you need to file a claim, contact 5Star directly at 866 863 9753.

CoveragePROTECTION:isavailablefor

For

ABOUT INDIVIDUAL LIFE

With several options to choose from, employees select the coverage that best meets the needs of their families.

TERMINAL ILLNESS ACCELERATION OF BENEFITS: Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL). with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly. through payroll deduction.

CoveragePORTABLE:continues

Individual Life Insurance 5Star EMPLOYEE BENEFITS Enhanced

QUALITY OF LIFE: Optional benefit that accelerates a portion of the death benefit monthly, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following:

Individual insurance is a policy that covers a single person and is intended to meet the financial needs of the beneficiary, in the event of the insured’s death. This coverage is portable and can continue after you leave employment or retire. full plan details, please visit your benefit website: www.wtxebc.com coverage options for employees. Easy and flexible enrollment for employers. The 5Star Life Insurance Company’s Family Protection Plan offers both Individual and Group products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your CUSTOMIZABLE:employees

EasyCONVENIENCE:payments

FAMILY spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves.*Financially dependent children 14 days to 23 years old.

PROTECTION TO COUNT ON: Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two year contestability period and/or under investigation. This coverage has no war or terrorism exclusions.

• Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or • Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.

MASA EMPLOYEE BENEFITS

In the event that a member is in stable condition in a medical facility but requires a heightened level of care that is not available at their current medical facility, Members have access to non emergency air or ground transportation between medical

Should you need assistance with a claim contact MASA at 800 643 9023. You can find full benefit details at www.wtxebc.com

In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities.

For full plan details, please visit your benefit website: www.wtxebc.com

Employee &

Emergency Medical Transportation Family $14.00

Emergency Medical Transport

Emergent Ground Transportation

Emergent Air Transportation

Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out of pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan.

A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. If a member has a high deductible health plan that is compatible with a health savings account, benefits will become available under the MASA membership for expenses incurred for medical care (as defined under Internal Revenue Code (“IRC”) section 213 (d)) once a member satisfies the applicable statutory minimum deductible under IRC section 223(c) for high deductible health plan coverage that is compatible with a health savings account.

In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities.

Non Emergency Inter Facility Transportation

SupposeRepatriation/Recuperationfacilities.youorafamilymember is hospitalized more than 100 miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for recuperation.

ABOUT MEDICAL TRANSPORT

ABOUT CANCER Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment. For full plan details, please visit your benefit website: www.wtxebc.com Cancer Insurance APL EMPLOYEE BENEFITS Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non medical expenses, such as out of town treatments, special diets, daily living and household upkeep. In addition to these non medical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance through American Public Life helps pay for these direct and indirect treatment costs so you can focus on your health. Summary of Benefits Low High Cancer Treatment Policy Benefits Level 3 Level 4 Radiation Therapy, Chemotherapy, Immunotherapy Maximum per 12 month period $15,000 $20,000 Hormone Therapy Maximum of 12 treatments per calendar year $50 per treatment Experimental Treatment paid in same manner and under the same maximums as any other benefit Surgical Rider Benefits Level 1 Level 4 Surgical $30 unit dollar amount Max $3,000 per operation $60 unit dollar amount Max $6,000 per operation Anesthesia 25% of amount paid for covered surgery Bone Marrow Transplant Maximum per lifetime $6,000 $12,000 Stem Cell Transplant Maximum per lifetime $600 $1,200 Prosthesis Surgical Implantation/Non Surgical (not Hair Piece) 1 device per site, per lifetime $1,000 / $100 $3,000 / $300 Miscellaneous Care Rider Benefits Level 4 Level 4 Cancer Treatment Center Evaluation or Consultation 1 per lifetime $750 $750 Evaluation or Consultation Travel and Lodging 1 per lifetime $350 $350 Second / Third Surgical Opinion per diagnosis of cancer $300 / $300 $300 / $300 Drugs and Medicine Inpatient / Outpatient (maximum $150 per month) $150 per confinement $50 per prescription Hair Piece (Wig) 1 per lifetime $150 $150 Transportation Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane, or train Travel by car Lodging up to a maximum of 100 days per calendar year actual coach fare or $0.75 per mile $0.75 per mile $100 per day Family Transportation Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car actual coach fare or $0.75 per mile $0.75 per mile

Miscellaneous Care Rider Benefits (cont’d) Level 4 Level 4 Blood, Plasma and Platelets $300 per day Ambulance Ground/Air Maximum of 2 trips per Hospital Confinement for all modes of transportation combined $200 / $2,000 per trip Inpatient Special Nursing Services per day of Hospital Confinement $150 per day Outpatient Special Nursing Services Up to same number of Hospital Confinement days $150 per day Medical Equipment Maximum of 1 benefit per calendar year $150 Physical, Occupational, Speech, Audio Therapy & Psychotherapy / Maximum per calendar year $25 per visit / $1,000 Waiver of Premium Waive Premium Internal Cancer First Occurrence Rider Benefits Level 2 Level 4 Lump Sum Benefit Maximum 1 per Covered Person per lifetime $5,000 $10,000 Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime $7,500 $15,000 Heart Attack/Stroke First Occurrence Rider Benefits Level 1 Level 1 Lump Sum Benefit Maximum 1 per Covered Person per lifetime $2,500 Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime $3,750 Hospital Intensive Care Unit Rider Benefits Intensive Care Unit $600 per day Step Down Unit Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit $300 per day Should you need to file a claim contact APL at 800 256 8606 or online at www.ampublic.com You can find additional claim forms and materials at www.wtxebc.com Cancer Insurance APL EMPLOYEE BENEFITS HospitalLowIndemnity High Employee Only $21.24 $34.30 Employee and Spouse $38.10 $61.40 Employee and Child(ren) $26.24 $42.30 Employee and Family $39.94 $64.48

ABOUT ACCIDENT Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you. For full plan details, please visit your benefit website: www.wtxebc.com Accident Insurance APL EMPLOYEE BENEFITS Summary of Benefits* Benefit Description Level 1 1 Unit Level 2 2 Units Level 3 3 Units Level 4 4 Units Accidental Death per unit $5,000 $10,000 $15,000 $20,000 Medical Expense Accidental Injury Benefit per unit actual charges up to $500 actual charges up to $1,000 actual charges up to $1,500 actual charges up to $2,000 Daily Hospital Confinement Benefit $75 per day $150 per day $225 per day $300 per day Air and Ground Ambulance Benefit actual charges up to $1,250 actual charges up to $2,500 actual charges up to $3,750 actual charges up to $5,000 Accidental Dismemberment Benefit Single finger or toe Multiple fingers or toes Single hand, arm, foot or Multipleleghands, arms, feet or legs $5,000$2,500$500$500 $10,000$5,000$1,000$1,000 $15,000$7,500$1,500$1,500 $20,000$10,000$2,000$2,000 Accidental Loss of Sight Benefit per unit Loss of Sight in one eye Loss of Sight in both eyes $5,000$2,500 $10,000$5,000 $15,000$7,500 $20,000$10,000 Benefit Rider Hospital Admission Benefit upon$100admission upon$100admission upon$100admission upon$100admission Accident Only Intensive Care Benefit $150 per day $150 per day $150 per day $150 per day Accident 1 Unit 2 Units 3 Units 4 Units Employee Only $11.70 $18.00 $22.40 $25.40 Employee and Spouse $20.70 $31.10 $40.20 $46.20 Employee and Child(ren) $22.70 $36.40 $46.70 $53.50 Employee and Family $31.70 $49.50 $64.50 $74.30

No benefits are payable for a pre existing condition. Pre existing condition means an Injury that pertains solely to an Accidental Bodily Injury which resulted from an accident sustained before the Effective Date of coverage. Pre Existing Conditions specifically named or described as permanently excluded in any part of this contract are never covered.

Guaranteed Renewable You have the right to renew this Policy until the first premium due date on or after Your 69th birthday, if you pay the correct premium when due or within the Grace Period. When an Insured’s coverage terminates at age 70, coverage for other Insured Persons, if any, shall continue under this Policy. We have the right to change premium rates by class.

ThisEligibilitypolicy will be issued to only those persons who meet American Public Life Insurance Company’s insurability requirements. Persons not meeting APL’s insurability requirements will be excluded from coverage by an endorsement attached to the policy.

The maximum benefit period for this benefit is 30 days per covered AccidentalAccidentalaccident.DeathDeathmust result within 90 days of the covered accident causing the injury. Hospital Admission Benefit

A Hospital is not an institution which is primarily a place for alcoholics or drug addicts; the aged; a nursing, rest or convalescent nursing home; a mental institution or sanitarium; a facility contracted for or operated by the United States Government for treatment of members or ex members of the armed forces (unless You are legally required to pay for services rendered in the absence of insurance); or, a long term nursing unit or geriatrics ward.

15. Injury incurred while engaging in an illegal occupation; 16. Injury incurred while attempting to commit a felony or an assault; 17. Injury to a covered person while practicing for or being a part of organized or competitive rodeo, sky diving, 18. hang gliding, parachuting or scuba diving; 19. driving in any race or speed test or while testing an automobile or any vehicle on any racetrack or 20. speedway; 21. hernia, carpal tunnel syndrome or any complication therefrom; If You are entitled to benefits under this Policy as a result of sprained or lame back, or any intervertebral disk conditions, such benefits shall be payable for a maximum period of time, not exceeding in the aggregate three (3) months for any Injury.

Accident

Exclusions Benefits otherwise provided by this Policy will not be payable for services or expenses or any such Loss resulting from or in connection with:

Insurance APL EMPLOYEE BENEFITS

Emergency transportation must occur within 21 calendar days of the accident causing such Injury.

Expenses must commence within 60 days of the covered accident. The maximum benefit amount payable for any one accident for the Insured Person shall not exceed the Medical Expense Benefit.

Air and Ground Ambulance Benefit

The maximum benefit is 4 units.

Limitations and Exclusions

Medical Expense Accidental Injury Benefit

Base Policy and Optional Benefits

1. sickness, illness or bodily infirmity; 2. suicide, attempted suicide or intentional self inflicted Injury, whether sane or insane; 3. dental care or treatment unless due to accidental Injury to natural teeth; 4. war or any act of war (whether declared or 5. undeclared) or participating in a riot or felony; 6. alcoholism or drug addiction; 7. travel or flight in or descent from any aircraft or 8. device which can fly above the earth’s surface in any capacity other than as a fare paying passenger on a regularly scheduled airline; 9. Injury originating prior to the effective date of the Policy; 10. Injury occurring while intoxicated (Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the loss or cause of loss is incurred.);

Daily Hospital Confinement Benefit

11. Voluntary inhalation of gas or fumes or taking of poison or asphyxiation; 12. Voluntary ingestion or injection of any drug, narcotic or sedative, unless administered on the advice and taken in such doses as prescribed by a Physician; 13. Injury sustained or sickness which first manifests itself while on full time duty in the armed forces; (Upon notice, We will refund the proportion of 14. unearned premium while in such forces.)

Parkinson's Disease Pays a benefit when you are diagnosed with Parkinson’s disease by a psychiatrist or neurologist. 25% Lupus Pays a benefit when you are diagnosed with Lupus by a physician. 25%

Illness Insurance Aetna EMPLOYEE BENEFITS

For full plan details, please visit your benefit website: www.wtxebc.com

Critical

Covered Critical Illness Conditions % of Face Amount (Employee):

ABOUT CRITICAL ILLNESS

Alzheimer's Disease Pays a benefit when you are diagnosed with Alzheimer’s disease, diagnosis of the disease by a psychiatrist or neurologist. 25%

Loss of Speech Pays a benefit when you are diagnosed with Loss of speech that cannot be corrected to any functional degree by any procedure, aid or device. Loss of speech has to continue for a period of 90 consecutive days. 100% Loss of Hearing Pays a benefit when you are diagnosed with Loss of hearing in both ears that cannot be corrected to any functional degree by any procedure, aid or device. Loss of hearing has to continue for a period of 90 consecutive days. 100% Occupational HIV Pays a benefit when you are diagnosed with Occupational HIV. The date of a positive antibody test for HIV subsequent to a prior negative test for the same condition with a lapse of between 180 days between the two tests. 100% Coma Pays a benefit when you are diagnosed with Coma, characterized by the absence of eye opening, verbal response and motor response, and the individual requires intubation for respiratory assistance (a medically induced coms is not covered). The Coma must last for a period of 14 or more consecutive days. 100% Benign Brain Tumor Pays a benefit when you are diagnosed with a Benign brain tumor by a physician. 100% Third Degree Burns Pays a benefit when you are diagnosed with a Third degree burn that covers more than 10% of total body surface (also called full thickness burn). 100%

Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non medical costs related to the illness, including transportation, child care, etc.

End Stage Renal Failure Pays a benefit when you are diagnosed with End stage renal failure, and the insured person has to undergo regular hemodialysis or peritoneal dialysis at least weekly. 100% Paralysis Pays a benefit when you are diagnosed with Paralysis, resulting in paraplegia or quadriplegia (complete, total and permanent loss of use of two or more limbs) confirmed by the insured person’s attending physician. The paralysis has to continue for a period of 60 consecutive days: 100% Loss of Sight (Blindness) Pays a benefit when you are diagnosed with Loss of sight (blindness) that is total and irrecoverable loss of sight in both eyes. Loss of sight (blindness), has to continue for a period of 90 consecutive days. 100%

100%

% of Face Amount (Employee): Multiple Sclerosis Pays a benefit when you are diagnosed with Multiple sclerosis by a physician. 25% Muscular Dystrophy Pays a benefit when you are diagnosed with Muscular dystrophy by a physician. 25% Heart Attack (Myocardial Infarction) Pays a benefit when you are diagnosed with a Heart attack (Myocardial Infarction) resulting from a blockage of one or more coronary arteries. 100% Stroke Pays a benefit when you are diagnosed with a Stroke resulting in paralysis or other measurable objective neurological defect persisting for at least 30 days. 100% Coronary Artery Condition Requiring Bypass Surgery Pays a benefit when you are diagnosed with a Coronary artery condition requiring bypass surgery.

100%

100% Cystic Fibrosis Pays a benefit when you are diagnosed with Cystic fibrosis by a physician. The diagnosis must be confirmed with sweat chloride concentrations greater than 60 mmol/L.

Covered Benefit

Critical Illness Insurance Aetna EMPLOYEE BENEFITS Critical Illness Age Band <20 20 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70+ $10,000 Employee Only $0.93 $1.16 $1.20 $1.60 $2.06 $2.82 $3.55 $6.14 $9.56 $15.21 $19.27 $29.32 Employee and Spouse $1.62 $1.97 $2.17 $2.70 $3.52 $4.89 $6.86 $10.84 $16.00 $23.33 $31.34 $42.49 Employee and Child(ren) $0.93 $1.16 $1.20 $1.60 $2.06 $2.82 $3.55 $6.14 $9.56 $15.21 $19.27 $29.32 Employee and Family $1.62 $1.97 $2.17 $2.70 $3.52 $4.89 $6.86 $10.84 $16.00 $23.33 $31.34 $42.49 $20,000 Employee Only $1.87 $2.32 $2.40 $3.19 $4.11 $5.63 $7.10 $12.29 $19.12 $30.41 $38.53 $58.63 Employee and Spouse $3.23 $3.93 $4.34 $5.40 $7.05 $9.79 $13.71 $21.68 $32.01 $46.66 $62.69 $84.97 Employee and Child(ren) $1.87 $2.32 $2.40 $3.19 $4.11 $5.63 $7.10 $12.29 $19.12 $30.14 $38.53 $58.63 Employee and Family $3.23 $3.93 $4.34 $5.40 $7.05 $9.79 $13.71 $21.68 $32.01 $46.66 $62.69 $84.97 $30,000 Employee Only $2.80 $3.48 $3.61 $4.79 $6.17 $8.45 $10.65 $18.43 $28.68 $45.62 $57.80 $87.95 Employee and Spouse $4.85 $5.90 $6.51 $8.11 $10.57 $14.68 $20.57 $32.52 $48.01 $70.00 $94.03 $127.46 Employee and Child(ren) $2.80 $3.48 $3.61 $4.79 $6.17 $8.45 $10.65 $18.43 $28.68 $45.62 $57.80 $87.95 Employee and Family $4.85 $5.90 $6.51 $8.11 $10.57 $14.68 $20.57 $32.52 $48.01 $70.00 $94.03 $127.46 *Rates are based on your (the subscribers) current age but will increase as you move into a higher age band.

25% Major Organ Failure Pays a benefit when you are diagnosed with a Major organ failure of the heart, kidney, liver, lung, or pancreas resulting in the insured person being placed on the UNOS (United Network for Organ Sharing) list for a transplant.

Covered Childhood Critical Illness Conditions % of Face Amount (Employee): Cerebral Palsy Pays a benefit when you are diagnosed with Cerebral palsy by a physician. Diagnosis must be made before the insured child reaches the age of 5. Other similar conditions that can be outgrown, are not included in this definition.

100% Cleft Lip or Cleft Palate Pays a benefit when you are diagnosed with a Cleft Lip or Cleft Palate after live birth by a physician.

100% Spina Bifida Pays a benefit when you are diagnosed with Spina bifida by a specialist physician and must be associated with neurologic symptoms including motor impairment. Spina bifida does not include spina bifida occulta.

100% Down Syndrome Pays a benefit when you are diagnosed with Down Syndrome, the first date after live birth and based on the physician’s study of the 21st chromosome revealing trisomy 21, translocation, or mosaicism.

ABOUT IDENTITY THEFT PROTECTION Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered. For full plan details, please visit your benefit website:

Resolution

And,

Identity Theft IDWatchdog EMPLOYEE BENEFITS

And,

WHY CHOOSE ID WATCHDOG Credit Lock:

Easy & Affordable Identity Protection With ID Watchdog®, you have an easy and affordable way to help better protect and monitor the identities of you and your family. You’ll be alerted to potentially suspicious activity and enjoy the peace of mind that comes with the support of dedicated resolution specialists. a customer care team that’s available any time, every day. With our online and in app feature, lock your Equifax® credit report2 and your child’s Equifax credit report to help provide additional protection against unauthorized access to your credit. for Families: Our family plan helps you better protect your loved ones, with each adult getting their own account with all plan features. we offer more features that help protect minors than any other Dedicatedprovider. Specialists: If you become a victim, you don’t have to face it alone. One of our certified resolution specialists will fully manage the case for you until your identity is restored. Watchdog Is Here for You: ID Watchdog is everywhere you can’t be monitoring credit reports, social media, transaction records, public records Watchdog, which provide you with access to your credit report or credit score, or monitor your credit report as part of a subscription or similar service; companies that provide you with a copy of your credit report or credit score, upon your request; federal, state, and local government agencies and courts in certain circumstances; companies using the information in connection with the underwriting of insurance, or for employment, tenant or background screening purposes; companies that have a current account or relationship with you, and collection agencies acting on behalf of those whom you owe; companies that authenticate a consumer’s identity for purposes other than granting credit, or for investigating or preventing actual or potential fraud; and companies that wish to make pre approved offers of credit or insurance to you. To opt out of such pre approved offers, visit www.optoutprescreen.com. 4 Locking your child’s Equifax credit report helps prevent access to it by lenders and creditors. It will not prevent access to your child’s credit report at any other credit reporting agency.

5 The Identity Theft Insurance is underwritten and administered by American Bankers Insurance Company of Florida, an Assurant company. Please refer to the actual policies for terms, conditions, and exclusions of coverage. Coverage may not be available in all jurisdictions. www.wtxebc.com

Identity Theft Employee Only $7.95 Employee and Family $14.95 Your identity is important it’s what makes you, you. You’ve spent a lifetime building your name and financial reputation. Let us help you better protect it. And, we’ll even go one step further and help you better protect the identities of your family.

and more to help you better protect your identity. And don’t worry, we’re always here for you. In fact, our U.S. based customer care team is available 24/7/365 at 866.513.1518. Monitor & Detect • Credit Score Tracker 1 Bureau Monthly • Credit Report Monitoring | 1 Bureau • Dark Web Monitoring1 • High Risk Transactions Monitoring2 • Subprime Loan Monitoring2 • Public Records Monitoring • USPS Change of Address Monitoring • Identity Profile Report Manage & Alert • Credit Report Lock3 | 1 Bureau • Child Credit Lock4 | 1 Bureau • Financial Accounts Monitoring • Social Network Alerts • Registered Sex Offender Reporting • Customizable Alert Options • Breach Alert Emails • Mobile App • National Provider ID Alerts Support & Restore • Identity Theft Resolution Specialists (Resolution for Pre existing Conditions) • 24/7/365 U.S. based Customer Care Center • Up to $1M Identity Theft Insurance5 • Lost Wallet Vault & Assistance • Deceased Family Member Fraud Remediation • Fraud Alert & Credit Freeze Assistance 1 Dark Web Monitoring scans thousands of internet sites where consumers’ personal information is suspected of being bought and sold, and is constantly adding new sites to those it searches. However, the internet addresses of these suspected internet trading sites are not published and frequently change, so there is no guarantee that ID Watchdog is able to locate and search every possible internet site where consumers’ personal information is at risk of being traded. 2 The monitored network does not cover all businesses or transactions. 3 Locking your Equifax credit report will prevent access to it by certain third parties. Locking your Equifax credit report will not prevent access to your credit report at any other credit reporting agency. Entities that may still have access to your Equifax credit report include: companies like ID

ABOUT FSA A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (unless your plan contains a $550 rollover or grace period provision). For full plan details, please visit your benefit website: www.wtxebc.com Flexible Spending Account (FSA) NBS EMPLOYEE BENEFITS Health Care FSA The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $2,850 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include: • Dental and vision expenses • Medical deductibles and coinsurance • Prescription copays • Hearing aids and batteries You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA). How the Health Care FSAs Work You can access the funds in your Health Care FSA two different ways: • Use your NBS Debit Card to pay for qualified expenses, doctor visits and prescription copays. • Pay out of pocket and submit your receipts for reimbursement:  Fax 844 438 1496  Email service@nbsbenefits.com  Online my.nbsbenefits.com  Call for Account Balance: 855 399 3035  Mail: PO Box 6980 West Jordan, UT 84084 Contact NBS • Hours of Operation: 6:00 AM 6:00 PM MST, Mon Fri • Phone: (800) 274 0503 • Email: service@nbsbenefits.com • Mail: PO Box 6980 • West Jordan, UT 84084 Dependent Care FSA The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full time student.

• The IRS has amended the “use it or lose it rule” to allow you to carry over up to $570 in your Health Care FSA into the next plan year. The carry over rule does not apply to your Dependent Care FSA.

Over the Counter Item Rule Reminder (OTC)

EMPLOYEE

Account Type

Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses and doctor prescribed over the counter medications)

Annual Contribution Limits Benefit Health Care FSA

• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.

Overnight camps are not eligible for reimbursement (only day camps can be considered).

Flexible Spending Accounts

The maximum per plan year you can contribute to a Health Care FSA is $2,850. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately.

Dependent Care FSA

• You cannot change your election during the year unless you experience a Qualifying Life Event.

$2,850 Saves on eligible expenses not covered by insurance, reduces your incometaxable

•

Health care reform legislation requires that certain over the counter (OTC) items require a prescription to qualify as an eligible Health Care FSA expense. You will only need to obtain a one time prescription for the current plan year. You can continue to purchase your regular prescription medications with your FSA debit card. However, the FSA debit card may not be used as payment for an OTC item, even when accompanied by a prescription.

Flexible Spending Account (FSA)

If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.

Eligible Expenses

Dependent care expenses (such as day care, after school programs or elder care programs) so you and your spouse can work or attend school full time $5,000 single $2,500 if married and filing separate tax returns Reduces your incometaxable

•

NBS BENEFITS Dependent Care FSA Guidelines

• You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self care.

Important FSA Rules

• You can continue to file claims incurred during the plan year for another 30 days (up until date).

• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.

District GROUP # Abernathy ISD WTXA Adrian ISD WTXB Amherst ISD WTXC Anthony ISD WTXD Anton ISD WTXE Archer City ISD WTXF Balmorhea ISD WTXG Benjamin ISD WTXI Blackwell CISD WTXJ Blanket ISD WTXK Booker ISD WTXL Borger ISD WTXM Bovina ISD WTXN Brady ISD WTXO Brookesmith ISD WTXP Bryson ISD WTXQ Canadian ISD WTXR Channing ISD WTXS Cherokee ISD WTXT Childress ISD WTXU City View ISD WTXV Clarendon CISD WTXW Coahoma ISD WTXX Cotton Center ISD WTXY Crane ISD WTXBA Crosbyton Consolidated ISD WTXZ Crowell ISD WTXAA Culberson County Allamoore ISD WTXAB Dalhart ISD WTXAC Darrouzett ISD WTXAD Dimmitt ISD WTXAE Dumas ISD WTXAF Eden CISD WTXAG El Paso Education Initiative Inc WTXAH El Paso Leadership Academy WTXAI District GROUP # Electra ISD WTXAJ Farwell ISD WTXAK Floydada ISD WTXAL Follett ISD WTXAM Forestburg ISD WTXAN Forsan ISD WTXAO Fort Elliott CISD WTXAP Fort Stockton ISD WTXAQ Friona ISD WTXAR Garden City Glasscock County ISD WTXAS Grady ISD WTXAT Grandview Hopkins ISD WTXAU Groom ISD WTXAV Gruver ISD WTXAW Guthrie CSD WTXAX Hale Center ISD WTXAY Happy ISD WTXAZ Harrold ISD WTXAZZ4 Hart ISD WTXHA Hartley ISD WTXAAA Hedley ISD WTXABB Henrietta ISD WTXACC Highland Park ISD WTXADD Holliday ISD WTXAEE Idalou ISD WTXAFF Iraan Sheffield ISD WTXAGG3 Jacksboro ISD WTXAGG Jayton ISD WTXAHH Jim Ned CISD WTXAII Kelton ISD WTXAJJ Klondike ISD WTXAKK Kress ISD WTXALL Lazbuddie ISD WTXAMM Lefors ISD WTXANN Lockney ISD WTXAOO WTXEBC Mobile App Login Group #’s

WTXEBC Mobile App Login Group #’s Use your District’s group # to login to the FBS Benefits app. District GROUP # Loop ISD WTXAPP Lorenzo ISD WTXAQQ May ISD WTXARR McLean ISD WTXASS Meadow ISD WTXATT Memphis ISD WTXAUU Menard ISD WTXAVV Miami ISD WTXAWW Midland Academy Charter School WTXAXX Monahans Wickett Pyote ISD WTXAYY Montague ISD WTXAZZ Morton ISD WTXAAA1 Munday CISD WTXABB1 Nazareth ISD WTXACC1 New Home ISD WTXADD1 Newcastle ISD WTXAEE1 Nocona ISD WTXAFF1 Northside ISD WTXAGG1 O'Donnell ISD WTXAHH1 Olfen ISD WTXAII1 Olton ISD WTXAJJ1 Paducah ISD WTXAKK1 Paint Rock ISD WTXALL1 Panhandle ISD WTXAMM1 Panther Creek CISD WTXANN1 Patton Springs ISD WTXAOO1 Petersburg ISD WTXAPP1 Petrolia ISD WTXAQQ1 Plains ISD WTXARR1 Post ISD WTXASS1 Prairie Valley ISD WTXATT1 Pringle Morse CISD WTXAUU1 PSPartners WTXBA Quanah ISD WTXAVV1 Ralls ISD WTXAWW1 Rankin ISD WTXAXX1 District GROUP # Rankin ISD WTXAXX1 RISE Academy WTXAYY1 River Road ISD WTXAZZ1 Robert Lee ISD WTXAAA2 Roosevelt ISD WTXABB2 Ropes ISD WTXACC2 Saint Jo ISD WTXADD2 Sands CISD WTXAEE2 Sanford Fritch ISD WTXAFF2 Santa Anna ISD WTXAGG2 Seagraves ISD WTXAHH2 Shamrock ISD WTXAII2 Sierra Blanca ISD WTXAJJ2 Smyer ISD WTXAHH3 Southland ISD WTXAKK2 Spring Creek ISD WTXALL2 Springlake Earth ISD WTXAFF3 Sudan ISD WTXAMM2 Sunray ISD WTXANN2 Sweetwater ISD WTXAOO2 Tahoka ISD WTXAPP2 Texline ISD WTXAQQ2 Throckmorton ISD WTXARR2 Tulia ISD WTXASS2 Turkey Quitaque ISD WTXATT2 Valentine ISD WTXAUU2 Vega ISD WTXAVV2 Water Valley ISD WTXAWW2 Wellington ISD WTXAXX2 Wheeler ISD WTXAZZ2 White Deer ISD WTXAAA3 Whitharral ISD WTXABB3 Wildorado ISD WTXAZZ3 Wilson ISD WTXACC3 Windthorst ISD WTXADD3 Zephyr ISD WTXAEE3

Notes

Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the WTXEBC Benefits Website. This summary does not replace or amend the underlying plan documentation. In the event of a discrepancy between this summary and the plan documentation the plan documentation governs. All plans and benefits described in this summary may be discontinued, increased, decreased, or altered at any time with or without notice.

Rate Sheet General Disclaimer:

WWW.WTXEBC.COM

2022 - 2023 PlanYear

The rate information provided in this guide is subject to change at any time by your employer and/or the plan provider. The rate information included herein, does not guarantee coverage or change or otherwise interpret the terms of the specific plan documentation, available at the WTXEBC Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.