January 1, 202 December 31, 202 Ector County isd

PLAN YEAR: January 1, 2021 – December 31, 2021

Ector County isd

What’s inside? EMPLOYEE BENEFITS CENTER

HOW TO ENROLL

S125 PLAN INFORMATION

FLEXIBLE SPENDING ACCOUNTS

HEALTH SAVINGS ACCOUNTS

AVAILABLE RESOURCES

BENEFITS AT A GLANCE

BENEFIT BROCHURES

CONTACT INFORMATION

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

Morgan Harris, Account manageR OFFICE: 432.456.9783

EMAIL: [email protected]

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

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

Employee benefits center NEW employee benefits center - your guide to your benefits!

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

http://benefits.ffga.com/ectorcountyisd

How to Enroll Your First Financial Account Manager will be available by phone to assist you in enrolling in your benefits. 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.

Employee Assistance Center (EAC)To enroll by phone, call the Enrollment Assistance Center (EAC) at 855-765-4473 – select option 4 for West Texas.

In an effort to minimize the risk of exposure the EAC will replace the in-person enrollment this year. Each campus will have dedicated days to call in to the EAC to enroll. If you call in, an agent can enroll you over the phone, answer any questions you may have and also share their screen if you are using a device that can accept a Microsoft Teams meeting request.

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

event

Enroll online at

https://fga.benselect.com/enroll

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!

Flexible Spending Accounts Medical FSA Medical Flexible Spending Accounts (FSA) allow you to set aside pre-tax payroll deductions each paycheck to pay for out of pocket medical, dental and vision expenses for you and your family.

During open enrollment you will estimate the amount you think you will need during the year. This amount will be taken out of each paycheck. Your full annual election will be available to you at the beginning of the plan year.

Your employer has chosen the $500 Roll-Over Option for your plan. This option allows you the opportunity to roll over $500 of unclaimed Medical FSA funds into the following plan year. Any amount in excess of $500 will be forfeited under the use-it-or-lose-it rule.

FSA Plan Year is: January 1, 2021 – December 31, 2021 FSA MAX: The maximum amount you can set aside is $2,750

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

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

This account allows you to pay for day care expenses for your qualifying dependent/child with pre-tax dollars while you (and your spouse) are working, seeking employment, and/or attending school as a full time student (for at least five months of the year).

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

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).

Health Savings Accounts

A Health Savings Account (HSA) provides a savings vehicle that allows you to set aside money to pay for higher deductibles associated with lower monthly premium High Deductible Health Plans (HDHP). The money you save in monthly insurance premiums may be set aside for eligible medical expenses you incur in the future. Your HSA balance is accrued each month but rolls over from year-to-year earning interest along the way. The account is portable. Upon retirement or separation of service, you take the HSA with you because it’s your money and your account. You may also make changes to your HSA at any time.

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.

Examples of eligible HSA expenses

» Copays & Deductibles

» Prescriptions

» Dental Care

» Contacts & Eyeglasses

» Hearing aids

» Laser Eye Surgery

» Orthodontia

» Chiropractic Care

2020 Annual HSA Contribution Limits Individual Medical Coverage - $3,600

Family Medical Coverage - $7,200

$1,000 Catch-up Over 55

RESOURCES FOR FSA/HSA MANAGEMENT

FLEXIBLE BENEFITS CARD The Flex Benefits Card is available to all employees that participate in Medical FSA, HSA, and or a Dependent Care FSA. The Benefits Flex 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.

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

FSA and HSA STORE First Financial has partnered with the FSA & HSA Store to bring you an easy to use online store to better understand and manage your account.

• Shop at the online Store for eligible items from bandages to wheel chairs and thousands ofproducts 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

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

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

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

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

CANCER INSURANCE – American fidelity and allstate If cancer touches someone in your family, this plan may help ease the impact on your finances. Benefit payments are made directly to you, allowing you to pay for expenses like copayments, hospital stays, and house and car payments.

Accident Insurance – American fidelity Accidents are inevitable. Even though you can’t always prepare for unforeseen events, you can plan ahead. Accident Insurance is designed to help cover some of the expenses that can result from a covered accident, and benefit payments are made directly to you.

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.

Benefits at a Glance

GROUP LIFE – sunlife financial Group life insurance allows you to purchase affordable life insurance on yourself, spouse and dependent children. This is term insurance, available as long as you are employed by district.

Employees enrolling in the coverage after the first 31 days of their employment will be subject to insurability and must complete a health questionnaire prior to coverage being issued.

Legal – Legalshield Pre-paid legal provides access to a variety of legal services for you and your family at an affordable monthly cost. These services include, but are not limited to, advice on unlimited issues, attorney letters or calls made on your behalf, and contract and document review. Simply call an 800 number to access legal counsel and advice from qualified lawyers. This product provides peace of mind in today’s litigious environment.

ID Theft Protection – ilock360 Protect yourself and your family from the fastest growing crime in the US: Identity Theft. A low monthly cost provides protection by scouring the dark web for any compromised accounts and restores your identity with 24/7/365 support. This protection saves you money and time by relying on a service to handle all the details involved when your identity is stolen.

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

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

Roth 403(b) With A Roth 403(b) is a provision that permits employees to irrevocably designate all or a portion of their 403(b) as an after-tax Roth contribution. This type of contribution will not lower the employee's taxable income. However, distribution of Roth designated funds in retirement will not be subject to taxation.

Participants have the option of making pre-tax 403(b) contributions, Roth 403(b) contributions, or as a combination of the two. Total contributions cannot exceed the year's contribution limit. Not all employers offer a Roth 403(b), nor are they required to do so. Check with your employer for details.

Roth 457(b) When you choose to make Roth 457 contributions to the Plan, you'll pay taxes upfront — when your money goes into the Plan. Then you'll enjoy tax-free withdrawals — as long as you're at least 59½ and do not take withdrawals from your Roth account for at least five years after your first Roth contribution is made to the plan.

You can choose to allocate part of all of your salary deferral to the Roth, or all or part of your salary deferral to your traditional 457(b) pre-tax account.

ECTOR COUNTY INDEPENDENT SCHOOL DISTRICT SCHEDULE OF MEDICAL BENEFITS

NON-PPO INPATIENT HOSPITAL DEDUCTIBLE $250 Individual

ANNUAL INDIVIDUAL BENEFIT MAXIMUM UNLIMITED

OPTION I

ANNUAL DEDUCTIBLE ANNUAL OUT-OF-POCKET MAXIMUM PPO $1,300 Individual

$2,600 Family PPO $7,900 Individual (Includes Deductible) Non-PPO $2,600 Individual $15,800 Family (Includes Deductible)

$5,200 Family Non-PPO Unlimited

OPTION III (OPTION III offers the employee the opportunity to open a health savings account where the district

contributes $35 per month to the HSA Account of the employee) ANNUAL DEDUCTIBLE ANNUAL OUT-OF-POCKET MAXIMUM PPO $1,00 Individual PPO $6,750 Individual Medical & Rx (Includes Deductible)

$3,800 Family & $13,500 Family Medical & Rx (Includes Deductible) Non-PPO $3,800 Individual non-PPO

$7,600 Family

The following schedule summarizes amounts paid by you and the Plan, benefit maximums and additional explanation needed for your benefits. The Plan’s benefits will be reduced for all related covered expenses if you do not follow the procedures outlined in the Utilization Management and Pre-certification sections of this Plan. Please refer to the entire Plan for additional plan provisions that may affect your benefits.

Benefit and Deductible Benefit Percentage Additional Limitations And Explanations

Physician Office Visits Deductible:

PPO: Option 1 No Option III Yes

Non PPO: Yes

OPTION I PPO: PCP - $50 Co-Pay

Specialist $80 Co-Pay Non PPO: 60%

OPTION III PPO: 80% Non PPO: 60%

Use of an out-of-network provider or out-of-network facility will result in a higher deductible, higher coinsurance, and possible usual and customary differences that you will be required to pay out of pocket.

Urgent Care OPTION I PPO: $60 Co-Pay Non PPO: 60%


Use of an out-of-network provider or out-of-network facility will result in a higher deductible, higher coinsurance, and possible usual and customary differences that you will be required to pay out of pocket.

Adult Routine and Preventive Care

Deductible: PPO Only: No

Non PPO: Not Covered

OPTION I PPO: 100% Non PPO:None

OPTION III PPO: 100% Non PPO: None

Male & Female Benefits include: Physician physical; chest x- ray; health profile; CBC & lipid panel blood work; screening for anemia, bacteriuria, blood pressure, cholesterol, diabetes, hepatitis B, and other documented tests in the PPACA regs. Children: Pediatrician well-child exam; vision & hearing screening; developmental assessments; screening & counseling for childhood obesity.

Annual Routine PAP, Annual Mammogram, and

Annual PSA Deductible:

PPO: No Non PPO: Not Covered

OPTION I PPO: 100% Non PPO: None


Female: Annual GYN exam; one annual routine PAP; annual Mammogram for woman age 40 & older (unless family history warrants); genetic counseling for breast cancer; screening for osteoporosis age 50 & older; breastfeeding education.

Male: Annual prostate exam for men 40 years of age & older

Colorectal Cancer Screening Deductible:




Limited to persons age 50 & older and at normal risk for developing colon cancer (unless family history warrants). Benefits include Fecal Occult Blood Test annually, Flexible Sigmoidoscopy & Colonoscopy once every five years.

Childhood Immunizations Deductible:




Immunizations required by law before a child’s 19th birthday: Diphtheria & tetanus toxoids and boosters; DtaP; MMR & boosters; polio; chicken pox; influenza; hepatitis A & B; pneumonia; HIB; HPV; rotovirus; shingles; and any other required by federal or state law.

Home Health Care Deductible: PPO: Yes

Non PPO: Yes

OPTION I PPO: 80% Non PPO: 60%


Limited to 100 visits per year.

Home Hospice/Hospice Facility

Deductible: PPO: Yes

Non PPO: Yes



Skilled Nursing Facility Deductible: PPO: Yes

Non PPO: Yes



Limited to 60 days per year.

Hearing Aids Deductible: PPO: Yes

Non PPO: Yes



Must be due to a covered illness or accidental injury. Limited to one per ear per 36 months

Emergency Room Deductible: PPO: Yes

Non PPO: Yes

OPTION I PPO: After Deductible $200

Co-Pay then 80% Non PPO: $200 Co-Pay then

60% OPTION III

PPO: After Deductible $200 Co-Pay then 80%

Non PPO: After Deductible $200 Co-Pay then 60%

Inpatient Hospital Services Deductible: PPO: Yes

Non PPO: Yes



Also subject to the Non-PPO Inpatient Hospital Deductible. Benefits will be reduced by $1,000 for failure to pre-certify. Penalty does not apply to the out-of-pocket maximum.

Human Organ and Tissue Transplants Deductible: PPO: Yes




Requires use of Center of Excellence Facility.

Chiropractic Services Deductible: PPO: Yes

Non PPO: Yes



Limited to 24 visits per year.

Wigs/ Artificial Hair pieces Deductible: PPO: Yes

Non PPO: Yes



Limited to $100 lifetime maximum. Only after chemotherapy or radiation therapy.

Inpatient Mental/Nervous and Substance Abuse


Non PPO: Yes



Also subject to the Non-PPO Inpatient Hospital Deductible. Inpatient mental/nervous treatment is limited to 30 days per year. Treatment of serious mental/nervous disorders will be paid as All Other Covered Medical Expenses.

Outpatient Mental/Nervous and Substance Abuse


Non PPO: Yes

OPTION I PPO: $80 Co-pay Non PPO:

60% OPTION III

PPO: 80% Non PPO: 60%

Outpatient mental/nervous treatment is limited to 45 visits per year. Treatment of serious mental/nervous disorders will be paid as All Other Covered Medical Expenses.

Pathology and Radiology Deductible: PPO: Yes

Non PPO: Yes



Charges must be billed by an independent pathologist or radiologist. If billed by a physician in conjunction with an office visit, see Physician Office Visit for benefits. Reasonable and Customary apply to Non-PPO providers.

Anesthesia Deductible: PPO: Yes

Non PPO: Yes



Reasonable and Customary apply to Non-PPO providers.

Medical & Surgical Treatment of Morbid

Obesity Deductible: PPO: Yes




Regular plan benefits for Treatment of Morbid Obesity. 1 treatment series lifetime maximum benefit for Surgical Treatment of Morbid Obesity and requires pre-certification.

Diabetic Education Deductible: PPO: No




Sleep Disorders OPTION I Benefits are limited to 1 treatment series lifetime maximum. Deductible: PPO: 80% Non PPO: 60%

PPO: Yes OPTION III

Non PPO: Yes PPO: 80% Non PPO: 60%

All Other Covered Medical OPTION I Benefits provided for expenses listed in the Covered Medical Expenses PPO: 80% Non PPO: 60% Expenses section of this plan.

Deductible: OPTION III

PPO: Yes PPO: 80% Non PPO: 60%

Non PPO: Yes

Employee Benefits Ector County Independent School District

802 N. Sam Houston, Odessa, Texas 79761

Office: 432-456-9780 * Fax: 432-456-9358

There are no Program Cost Increases for our 2020 Prescription Coverage.

PRESCRIPTION BENEFIT FOR OPTION I – EFFECTIVE 1-1-21 (NO CHANGES)

Tier Title Retail Networks Mail

Specialty Rx’s may require authorization. Maximum

out-of-pocket of $7,900 individual and $15,800 family

includes medical and Rx out- of-pocket expenses, including deductibles and co-pays.

Co-pays / Minimum Payment Restricted National

1 Generic $12 $20 $25

2 Preferred $80 $90 $160

3 Non-Formulary $100 $110 $200

Specialty Rx

Formulary 20% Until Maximum Out-of-

Pocket of $1,900 per Rx is

reached

N/A

Non-Formulary

PRESCRIPTION BENEFIT FOR OPTION III – EFFECTIVE 1-1-21 (NO CHANGES)

Tier Title Retail Mail Maximum out-of-pocket for any Rx is part of the

maximum annual out-of-pocket for all medical and

prescription services including deductibles and co-pays.

Maximum out of pocket if $6,750 individual and $13,500

family

Co-pays and/or Minimum Payment

1 Generic

Must Meet Plan Deductible, then the Plan

pays 80% of the cost of the prescription up to the maximum annual Medical and/ or Rx out-of-pocket.

2 Preferred

3 Non-Formulary

Specialty Rx Formulary

Non-Formulary

LIMITATIONS ON Rx COVERAGE FOR PLAN 1: All Mail Order Rx’s must be provided by Express Scripts. Charges for contraceptive drugs, medicines, or devices used to prevent pregnancy are covered as benefits are provided by the Express Scripts prescription drug benefit or specifically listed under Major Medical Benefits. SPECIALITY DRUGS: Very expensive drugs used to treat chronic diseases are obtained through Accredo Specialty Pharmacy mail order services at 866-848-9870. Specialty medications do require prior authorization through KPCM Specialty, and providers should contact 844-744-4410. These medications treat chronic disorders such as hemophilia, growth hormone deficiency, multiple sclerosis, immune disorders, hepatitis c, cystic fibrosis, respiratory syncytial virus, genetic emphysema, and others. NOTES: Express Scripts 1-866-229-0772

Ector County Independent School District | Phone: (432) 456-0000 | P.O. Box 3912, Odessa, Texas 79760 | www.ectorcountyisd.org

Option I (Rx Co-Pay) Employee + Dependent = Monthly Cost

Employee Only 125.00 = 125.00

125.00 + 228.00 = 353.00

125.00 + 276.00 = 401.00

125.00 + 380.00 = 505.00

125.00 + 467.00 = 592.00

Option III (No Rx Co-Pay) Employee + Dependent = Monthly Cost


60.00 + 213.00 = 273.00

60.00 + 250.00 = 310.00

60.00 + 330.00 = 390.00

60.00 + 403.00 = 463.00

Hospital Indemnity


Optional Benefits:

MetLife (Dental)

Dental Only

Employee 31.41

Employee + Family 84.07

Superior Vision

Vision Only

Employee 7.79


Employees who get paid once a month

Employee + Two or more Children

Employee + Spouse

Employee + Family (Individual Deductible: $1,900) OPT III (Family Deductible: $3,800)

(OPT III No Co-Pay)

Employee + Family (Individual Deductible: $1,300) OPT I (Family Deductible: $2,600)

(OPT I: In-Network Co-Pay $50.00 & In-Network Specialist Physician Co-Pay $80.00)(Also includes an In-Network Urgent Care Co-Pay of $60.00)

Employee + One Child

INSURANCE RATESEFFECTIVE 01/01/2021



Employee + Spouse

Option I (Rx Co-Pay) Employee + Dependent = Semi-Monthly


88.24 + 160.94 = 249.18

88.24 + 194.82 = 283.06

88.24 + 268.24 = 356.48

88.27 + 329.65 = 417.92

Option III (No Rx Co-Pay) Employee + Dependent = Semi-Monthly


42.35 + 150.36 = 192.71

42.35 + 176.47 = 218.82

42.35 + 232.94 = 275.29

42.35 + 284.47 = 326.82

Hospital Indemnity Employee Only 0.00 = 0.00

Optional Benefits:

MetLife (Dental)

Dental Only

Employee 22.17


Superior Vision

Vision Only

Employee 5.50



INSURANCE RATESEFFECTIVE 01/01/2021



Employee + Spouse

Employee + Family (Individual Deductible: $1,300) OPT I (Family Deductible: $2,600)

(OPT I: In-Network Co-Pay $50.00 & In-Network Specialist Physician Co-Pay $80.00)

(Also includes an In-Network Urgent Care Co-Pay of $60.00)

Employees who get paid twice a month – premiums are covered for a year – paid out by 17 checks


Employee + Spouse

Employee + Family (Individual Deductible: $1,900) OPT III (Family Deductible: $3,800)

(OPT III No Co-Pay)

Fee - Per Employee Per Month

$31.41

$84.07

Coverage

Dental - Actives Employee only

Emplo

yee + Family

Dental Insurance

It’s easy to protect your smile with one of the largest networks of participating dentists

Choose MetLife Dental insurance during your annual enrollment to cover the costsof preventive care and lower the out-of-pocket expenses for unexpected treatments.

Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. For complete details of coverage and availability, please refer to the group policy form GPNP99 or contact MetLife.

Effective 01/01/2021

F r e q u e n t l y A s k e d Q u e s t i o n s

Who is a participating dentist? A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for covered services provided to plan members. Negotiated fees typically range from 15%-45% below the average fees charged in a dentist’s community for the same or substantially similar services.†

How do I find a participating dentist? There are thousands of general dentists and specialists to choose from nationwide --so you are sure to find one that meets your needs. You can receive a list of these participating dentists online at www.metlife.com/mybenefits or call 1-800-942-0854 to have a list faxed or mailed to you.

What services are covered under this plan? All services defined under the group dental benefits plan are covered. Please review the enclosed plan benefits to learn more.

May I choose a non-participating dentist? Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. He/she hasn’t agreed to accept negotiated fees. So you may be responsible for any difference in cost between the dentist's fee and your plan's benefit payment.

Can my dentist apply for participation in the network? Yes. If your current dentist does not participate in the network and you would like to encourage him/her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application. †† The website and phone number are for use by dental professionals only.

How are claims processed? Dentists may submit your claims for you which means you have little or no paperwork. You can track your claims online and even receive email alerts when a claim has been processed. If you need a claim form, visit www.metlife.com/mybenefits or request one by calling 1-800-942-0854. Can I find out what my out-of-pocket expenses will be before receiving a service? Yes. You can ask for a pretreatment estimate. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. The estimate helps you prepare for the cost of dental services. We recommend that you request a pre-treatment estimate for services in excess of $300. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment.

Can MetLife help me find a dentist outside of the U.S. if I am traveling? Yes. Through international dental travel assistance services* you can obtain a referral to a local dentist by calling +1-312-356-5970 (collect) when outside the U.S. to receive immediate care until you can see your dentist. Coverage will be considered under your out-of-network benefits.** Please remember to hold on to all receipts to submit a dental claim.

How does MetLife coordinate benefits with other insurance plans? Coordination of benefits provisions in dental benefits plans are a set of rules that are followed when a patient is covered by more than one dental benefits plan. These rules determine the order in which the plans will pay benefits. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan, subject to applicable law. If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law.

Do I need an ID card? No. You do not need to present an ID card to confirm that you are eligible. You should notify your dentist that you are enrolled in the MetLife Preferred Dentist Program. Your dentist can easily verify information about your coverage through a toll-free automated Computer Voice Response system.

†Based on internal analysis by MetLife. Negotiated Fees refer to the fees that in-network dentists have

http://www.metlife.com/mybenefits

agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. ††Due to contractual requirements, MetLife is prevented from soliciting certain providers. *AXA Assistance USA, Inc. provides Dental referral services only. AXA Assistance is not affiliated withMetLife, and the services and benefits they provide are separate and apart from the insurance providedby MetLife. Referral services are not available in all locations.**Refer to your dental benefits plan summary for your out-of-network dental coverage.

E x c l u s i o n s

This plan does not cover the following services, treatments and supplies:

• Services which are not Dentally Necessary, those which do not meet generally accepted standards ofcare for treating the particular dental condition, or which we deem experimental in nature;

• Services for which you would not be required to pay in the absence of Dental Insurance;

• Services or supplies received by you or your Dependent before the Dental Insurance starts for thatperson;

• Services which are primarily cosmetic (for Texas residents, see notice page section in Certificate);

• Services which are neither performed nor prescribed by a Dentist except for those services of alicensed dental hygienist which are supervised and billed by a Dentist and which are for:

o Scaling and polishing of teeth; oro Fluoride treatments;

• Services or appliances which restore or alter occlusion or vertical dimension;

• Restoration of tooth structure damaged by attrition, abrasion or erosion;

• Restorations or appliances used for the purpose of periodontal splinting;

• Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco;

• Personal supplies or devices including, but not limited to: water picks, toothbrushes, or dental floss;

• Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work;

• Missed appointments;

• Services:o Covered under any workers’ compensation or occupational disease law;o Covered under any employer liability law;o For which the employer of the person receiving such services is not required to pay; oro Received at a facility maintained by the Employer, labor union, mutual benefit association, or VA

hospital;

• Services covered under other coverage provided by the Employer;

• Temporary or provisional restorations;

• Temporary or provisional appliances;

• Prescription drugs;

• Services for which the submitted documentation indicates a poor prognosis;

• The following when charged by the Dentist on a separate basis:o Claim form completion;o Infection control such as gloves, masks, and sterilization of supplies; oro Local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.

• Dental services arising out of accidental injury to the teeth and supporting structures, except for injuriesto the teeth due to chewing or biting of food;

• Caries susceptibility tests;

• Initial installation of a fixed and permanent Denture to replace one or more natural teeth which weremissing before such person was insured for Dental Insurance, except for congenitally missing naturalteeth;

• Other fixed Denture prosthetic services not described elsewhere in the certificate;

• Precision attachments, except when the precision attachment is related to implant prosthetics;

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 L0318503480[exp1019][xNM] © 2018 MetLife Services and Solutions, LLC

DN-ANY-PPO-STAND

• Initial installation of a full or removable Denture to replace one or more natural teeth which weremissing before such person was insured for Dental Insurance, except for congenitally missing naturalteeth;

• Addition of teeth to a partial removable Denture to replace one or more natural teeth which weremissing before such person was insured for Dental Insurance, except for congenitally missing naturalteeth;

• Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it;

• Implants supported prosthetics to replace one or more natural teeth which were missing before suchperson was insured for Dental Insurance, except for congenitally missing natural teeth;

• Fixed and removable appliances for correction of harmful habits;

• Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards andnight guards;

• Diagnosis and treatment of temporomandibular joint (TMJ) disorders;

• Repair or replacement of an orthodontic device;

• Duplicate prosthetic devices or appliances;

• Replacement of a lost or stolen appliance, Cast Restoration, or Denture; and

• Intra and extraoral photographic images

L i m i t a t i o n s

Alternate Benefits: Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. To avoid any misunderstandings, we suggest you discuss treatment options with your dentist before services are rendered, and obtain a pre-treatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plan’s reimbursement for those services, and your out-of-pocket expense. Procedure charge schedules are subject to change each plan year. You can obtain an updated procedure charge schedule for your area via fax by calling 1-800-942-0854 and using the MetLife Dental Automated Information Service. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment.

Cancellation/Termination of Benefits: Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. Coverage terminates when your membership ceases, when your dental contributions cease or upon termination of the group policy by the Policyholder or MetLife. The group policy terminates for non-payment of premium and may terminate if participation requirements are not met or if the Policyholder fails to perform any obligations under the policy. The following services that are in progress while coverage is in effect will be paid after the coverage ends, if the applicable installment or the treatment is finished within 31 days after individual termination of coverage: Completion of a prosthetic device, crown or root canal therapy.

Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. For complete details of coverage and availability, please refer to the group policy form GPNP99 or contact MetLife.

Superior Vision Services, Inc. P.O. Box 967 Rancho Cordova, CA 95741 (800) 507-3800 superiorvision.com The Superior Vision Plan is underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with

The Guardian Life Insurance Company of America, AKA The Guardian or Guardian Life NVIGRP 5-07 0820-BSv2/TX

superiorvision.com

(800) 507-3800

Vision plan benefits for Ector County ISD Copays Premiums Services/frequency

Exam $10 12 pay period 17 pay period Exam 12 months

Materials1 $10 Emp. only $7.79 $5.50 Frame 12 months

Contact lens fitting $25 Emp. + family $21.02 $14.84 Contact lens fitting 12 months

(standard & specialty) Lenses 12 months

Contact lenses 12 months (based on date of service)

Benefits through Superior National network 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 $50 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 $26 retail Bifocal Covered in full Up to $34 retail Trifocal Covered in full Up to $50 retail Progressives lens upgrade See description3 Up to $50 retail

Contact lenses4 $150 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 lenses2 Standard contact lens fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty contact lens fitting applies to

new contact wearers and/or a member who wear toric, gas permeable, or multi-focal lenses. 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

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%-30%) prior to service as they vary.

Discounts on covered materials

Frames: 20% off amount over allowance Conventional contacts 20% off amount over allowance Disposable contact 20% off amount over allowance

Lens type* Member out-of-pocket5

Scratch coat $15 Ultraviolet coat $12 Tints, solid $15 Tints, gradient $18 Polycarbonate $40 Blue light filtering $15 Digital single vision $30 Progressive lensesStandard/Premium/Ultra/Ultimate $55 / $110 / $150 / $225 Anti-reflective coatingStandard/Premium/Ultra/Ultimate $50 / $70 / $85 / $120 Polarized lenses $75 Plastic photochromic lenses $80 High Index (1.67 / 1.74) $80 / $120 * The above table highlights some of the most popular lens type and isnot a complete listing.

5 Discounts and maximums may vary by lens type. Please check with your provider

Discounts are subject to change without notice.

.

Discounts on non-covered exam, services and materials

Exams, frames, and prescription lenses: 30% off retail Contacts, miscellaneous options: 20% off retail Disposable contact lenses: 10% off retail Retinal imaging: $39 maximum out-of-pocket

Laser vision correction (LASIK)

Laser vision correction (LASIK) is a procedure that can reduce or eliminate your dependency on glasses or contact lenses. This corrective service is available to you and your eligible dependents at a special discount (20-50%) with your Superior Vision plan. Contact QualSight LASIK at (877) 201-3602 for more information.

Hearing discounts A National Hearing Network of hearing care professionals, featuring Your Hearing Network, offers Superior Vision members discounts on services, hearing aids and accessories. These discounts should be verified prior to service.

The Plan discount features are not insurance.

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

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

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

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

Long-Term Disability Income Insurance

Ector County ISD

Disability / Long-Term Disability Income Insurance

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

Long-Term Disability Income InsuranceLong-Term Disability Income Insurance

Benefits Are PayableBenefits are payable to the period of time shown in the chart below, based on your age as of the date Disability due to a covered Injury or Sickness begins.

• Salary Protection for You and Your Loved OnesProvides a steady benefit to cover expenses while you are unable to work. The plan makes it easy to help protect your future income in case of a sudden injury or sickness.

• Several Elimination Periods AvailableBased on your individual need, there are various elimination periods for you to choose from. The plan pays a percentage of your gross monthly income once you have satisfied the elimination period.

• Benefit Payments Made Directly to YouYour monthly benefit payments may be deposited directly into your bank account. This gives you the freedom to pay your living expenses and make other purchases as you see fit.

• Social Security Filing Assistance If we determine you are a likely candidate for social security disability benefits, we can assist you with the application and appeal process.

Choose the Right Plan for YouBenefits BeginPlan I - On the 15th day of Disability due to a covered Injury or Sickness.

Plan II - On the 31st day of Disability due to a covered Injury or Sickness.

Plan III - On the 61st day of Disability due to a covered Injury or Sickness.

Plan IV - On the 91st day of Disability due to a covered Injury or Sickness.

Plan V - On the 151st day of Disability due to a covered Injury or Sickness.

Injury means physical harm or damage to the body you sustained which results directly from an accidental bodily injury, is independent of disease or bodily infirmity; and takes place while your coverage is in force.

Sickness means a disease or illness (including pregnancy). Disability must begin while your coverage is in force.

Hospital- the term “Hospital” shall not include an institution used by you as a place for rehabilitation; a place for rest or for the aged; a nursing or convalescent home; a long-term nursing unit or geriatrics ward; or an extended care facility for the care of convalescent, rehabilitative, or ambulatory patients.

Age Maximum Benefit Period

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

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









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

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

Disability income insurance is here for you.

77%In 2015, 77% of injuries requiring medical attention suffered by workers occured off the job.National Safety Council, Injury Facts, 2017 Edition, p. 63.

EligibilityAll permanent employees in covered group working 20 hours or more per week. Regarding your eligibility, we may require proof of good health and will rely on answers given on your application to determine if coverage can be issued. Regardless of your health at the time of application, if coverage is approved and issued, claims incurred while coverage is in force will be subject to all terms of the Policy including any Pre-Existing Condition limitation.

When Coverage BeginsCertificates will become effective on the requested effective date following the date we approve the application, provided you are on active employment and premium has been paid.

Physician Expense BenefitInjury - $150.00 per InjurySickness - $50.00If you need personal treatment by a Physician due to an Injury or Sickness, we will pay the amount shown above provided no other claim has been paid under the Policy. This benefit will be paid for Sickness only if the treatment is received during one full day of Disability during which you missed one full day of work. To be eligible for more than one payment for the same or related condition due to Sickness, you must have returned to work for at least 14 consecutive scheduled workdays. You are not required to miss one full day of work in order to receive the Injury benefit.

Accidental Death BenefitA lump sum of $20,000 will be paid to your designated beneficiary if you die as the direct result of an injury within 90 days after the injury.

Hospital Confinement BenefitA Hospital Confinement Benefit will be paid each day you are confined as a patient in a Hospital due to an Injury or Sickness, for up to 60 days. The amount payable is 1 times the Disability Benefit which will be pro-rated on a daily basis. This benefit will not be reduced by Deductible Sources of Income. The Hospital confinement must be at least 18 continuous hours in duration. This benefit will begin after your satisfaction of the elimination period.

Waiver of PremiumNo premium payments are required while you are receiving payments under the plan after disability payments have been received for 180 consecutive days. We will require proof annually that you remain disabled during that time.

Donor BenefitIf you are disabled as a result of being an organ or tissue donor, we will pay your benefit as any other sickness under the terms of the plan.

Offsets With Other Sources of Income Deductible Sources of Income include: • Other group disability income.• Governmental or other retirement system, whether due to disability,

normal retirement or voluntary election of retirement benefits.• United States Social Security Act or similar plan or act, including

any amounts due your dependent(s) on account of your disability.• State Disability.• Unemployment compensation.• Sick leave or other salary or wage continuance plans provided by

the Employer which extend beyond 60 (Plans I, II, and III), 90 (Plan IV), and 150 (Plan V) calendar days from the date of disability.

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

Minimum Disability BenefitThe Minimum Disability Benefit is 10% of the Monthly Disability Benefit or $100.00, whichever is greater.

If You Are Disabled Due to a Covered Disability and Not WorkingYour disability payment will be calculated as follows:

For the first 36 months disability payments are provided, the disability payment will be the lesser of: (a) the disability benefit described in the benefit schedule; or (b) 70% of your monthly compensation, less any deductible sources of income you receive or are entitled to receive.

After 36 months your disability payment will be the disability benefit described in the benefit schedule less any deductible sources of income you receive or are entitled to receive. No disability payment will be provided for any period in which you are not under the regular and appropriate care of a physician.

Disability or disabled for the first 12 months of disability means that you are unable to perform the material and substantial duties of your regular occupation. After that, disability means you are unable to perform the material and substantial duties of any gainful occupation for wage or profit for which you are reasonably qualified by training, education, or experience.

Return To Work Incentives: Disabled and WorkingIf you are disabled and working, you may be eligible to continue to receive a percentage of your disability payment in addition to your disability earnings. If your disability earnings exceed 80% of your monthly compensation, payments will stop and your claim will end.

• Family Care BenefitIf you are disabled and working and have one or more eligible family members, you may be eligible for a family care benefit. This benefit is for expenses incurred up to 25% of your monthly disability benefit. Your disability earnings, gross disability benefit, and family care benefit cannot exceed 100% of your monthly compensation. Payment of this benefit ends when you cease to be eligible for benefits under the Disabled and Working provision of the policy.

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

Policy Provisions and Plan Features

Long-Term Disability Income Insurance

Pre-existing condition means a disease, Injury, Sickness, physical condition or mental illness for which you: had treatment; incurred expense; took medication; received care or services including diagnostic testing or related measures; or received a diagnosis or advice from a physician, during the 12 month period immediately before your effective date of coverage. The term pre-existing condition will also include conditions which are related to such disease, injury, sickness, physical condition, or mental illness.

ExclusionsThe Policy does not cover any loss, fatal or non-fatal, resulting from:• Intentionally self-inflicted injury while sane or insane.• An act of war, declared or undeclared.• Injury sustained or Sickness contracted while in the

service of the armed forces of any country.• Committing a felony.• Penal incarceration. We will not pay benefits for Disability

or any other loss during any period for which you are incarcerated in a penal or correctional institution for a period of 30 consecutive days or longer.

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

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

Your coverage may be continued for up to 1 year during a leave of absence approved in writing by your employer. Coverage will continue as long as the group policy remains in force, the premiums are paid and you remain eligible for the coverage under the policy. Your coverage will end when you no longer qualify as an insured, you retire, you are not on active employment, or your employment terminates. Your coverage can be terminated on any premium due date with 31 days advance notice. If premium rates are increased, we will provide a 60 day advance notice.

Mental Illness Limited Benefit If you are disabled due to a mental illness, benefits will be provided for up to 2 years, not to exceed the maximum disability period.

Alcoholism and Drug Addiction Limited Benefit If you are disabled due to alcoholism or drug addiction, a limited benefit of up to 15 days for each disability will be paid. Benefits will not be paid beyond the maximum benefit period. If drug addiction is sustained at the hands of, or while under the regular and appropriate care of a physician in the course of treatment for injury or sickness, it will be covered the same as any other sickness.

Special Conditions Limited BenefitIf you are disabled due to special conditions and under the regular and appropriate care of a physician, benefits will be provided for up to 2 years. Special conditions means: chronic fatigue syndrome; fibromyalgia; any disease, disorder, accident or injury of the neck or back not resulting in hemiplegia, paraplegia, or quadriplegia; environmental allergic illness including, but not limited to sick building syndrome and multiple chemical sensitivity; and self-reported symptoms. Self-reported symptoms are symptoms that the insured tells their physician that are not verifiable using tests, procedures or clinical examinations. Examples include: headaches, pain, fatigue, stiffness, soreness, ringing in ears, dizziness, numbness, or loss of energy.

Pre-Existing Condition LimitationNo disability benefit will be payable if disability is caused by or resulting from a Pre-Existing Condition and begins before you have been continuously covered under the policy for 24 months. This provision will not apply if you have: gone treatment-free; incurred no expense; taken no medication; and received no diagnosis or advice from a Physician, for 12 consecutive months for such condition(s).

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

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

Policy Benefit Limitations and Exclusions

There is a 3 in 10 chance of a person suffering a disabling illness or injury that would keep them out of work for three months or more.LIMRA: 2015 Disability Insurance Awareness Month; May 2015.

Benefit Policy Schedule

Monthly Premiums

Monthly SalaryMonthly

Disability Benefit

Accidental Death

Benefit

Plan I (15th)

Plan II (31st)

Plan III (61st)

Plan IV (91st)

Plan V (151st)

$286.00 - $428.99 $200.00 $20,000.00 $6.16 $4.96 $4.20 $3.52 $2.64

$429.00 - $571.99 $300.00 $20,000.00 $9.24 $7.44 $6.30 $5.28 $3.96

$572.00 - $714.99 $400.00 $20,000.00 $12.32 $9.92 $8.40 $7.04 $5.28

$715.00 - $857.99 $500.00 $20,000.00 $15.40 $12.40 $10.50 $8.80 $6.60

$858.00 - $999.99 $600.00 $20,000.00 $18.48 $14.88 $12.60 $10.56 $7.92

$1,000.00 - $1,142.99 $700.00 $20,000.00 $21.56 $17.36 $14.70 $12.32 $9.24

$1,143.00 - $1,285.99 $800.00 $20,000.00 $24.64 $19.84 $16.80 $14.08 $10.56

$1,286.00 - $1,428.99 $900.00 $20,000.00 $27.72 $22.32 $18.90 $15.84 $11.88

$1,429.00 - $1,571.99 $1,000.00 $20,000.00 $30.80 $24.80 $21.00 $17.60 $13.20

$1,572.00 - $1,714.99 $1,100.00 $20,000.00 $33.88 $27.28 $23.10 $19.36 $14.52

$1,715.00 - $1,857.99 $1,200.00 $20,000.00 $36.96 $29.76 $25.20 $21.12 $15.84

$1,858.00 - $1,999.99 $1,300.00 $20,000.00 $40.04 $32.24 $27.30 $22.88 $17.16

$2,000.00 - $2,142.99 $1,400.00 $20,000.00 $43.12 $34.72 $29.40 $24.64 $18.48

$2,143.00 - $2,285.99 $1,500.00 $20,000.00 $46.20 $37.20 $31.50 $26.40 $19.80

$2,286.00 - $2,428.99 $1,600.00 $20,000.00 $49.28 $39.68 $33.60 $28.16 $21.12

$2,429.00 - $2,571.99 $1,700.00 $20,000.00 $52.36 $42.16 $35.70 $29.92 $22.44

$2,572.00 - $2,714.99 $1,800.00 $20,000.00 $55.44 $44.64 $37.80 $31.68 $23.76

$2,715.00 - $2,857.99 $1,900.00 $20,000.00 $58.52 $47.12 $39.90 $33.44 $25.08

$2,858.00 - $2,999.99 $2,000.00 $20,000.00 $61.60 $49.60 $42.00 $35.20 $26.40

$3,000.00 - $3,142.99 $2,100.00 $20,000.00 $64.68 $52.08 $44.10 $36.96 $27.72

$3,143.00 - $3,285.99 $2,200.00 $20,000.00 $67.76 $54.56 $46.20 $38.72 $29.04

$3,286.00 - $3,428.99 $2,300.00 $20,000.00 $70.84 $57.04 $48.30 $40.48 $30.36

$3,429.00 - $3,571.99 $2,400.00 $20,000.00 $73.92 $59.52 $50.40 $42.24 $31.68

$3,572.00 - $3,714.99 $2,500.00 $20,000.00 $77.00 $62.00 $52.50 $44.00 $33.00

$3,715.00 - $3,857.99 $2,600.00 $20,000.00 $80.08 $64.48 $54.60 $45.76 $34.32

$3,858.00 - $3,999.99 $2,700.00 $20,000.00 $83.16 $66.96 $56.70 $47.52 $35.64

$4,000.00 - $4,142.99 $2,800.00 $20,000.00 $86.24 $69.44 $58.80 $49.28 $36.96

$4,143.00 - $4,285.99 $2,900.00 $20,000.00 $89.32 $71.92 $60.90 $51.04 $38.28

$4,286.00 - $4,428.99 $3,000.00 $20,000.00 $92.40 $74.40 $63.00 $52.80 $39.60

$4,429.00 - $4,571.99 $3,100.00 $20,000.00 $95.48 $76.88 $65.10 $54.56 $40.92

$4,572.00 - $4,714.99 $3,200.00 $20,000.00 $98.56 $79.36 $67.20 $56.32 $42.24

$4,715.00 - $4,857.99 $3,300.00 $20,000.00 $101.64 $81.84 $69.30 $58.08 $43.56

$4,858.00 - $4,999.99 $3,400.00 $20,000.00 $104.72 $84.32 $71.40 $59.84 $44.88

$5,000.00 - $5,142.99 $3,500.00 $20,000.00 $107.80 $86.80 $73.50 $61.60 $46.20

$5,143.00 - $5,285.99 $3,600.00 $20,000.00 $110.88 $89.28 $75.60 $63.36 $47.52

$5,286.00 - $5,428.99 $3,700.00 $20,000.00 $113.96 $91.76 $77.70 $65.12 $48.84

$5,429.00 - $5,571.99 $3,800.00 $20,000.00 $117.04 $94.24 $79.80 $66.88 $50.16

Several benefit options are available to you. You may participate in the Plan under any one of the benefit levels outlined below, provided the Monthly Disability Benefit level selected does not exceed 70% of your Monthly Compensation.

Long-Term Disability Income InsuranceBenefit Policy Schedule (continued)

Monthly Premiums

Monthly SalaryMonthly

Disability Benefit

Accidental Death

Benefit

Plan I (15th)

Plan II (31st)

Plan III (61st)

Plan IV (91st)

Plan V (151st)

$5,572.00 - $5,714.99 $3,900.00 $20,000.00 $120.12 $96.72 $81.90 $68.64 $51.48

$5,715.00 - $5,857.99 $4,000.00 $20,000.00 $123.20 $99.20 $84.00 $70.40 $52.80

$5,858.00 - $5,999.99 $4,100.00 $20,000.00 $126.28 $101.68 $86.10 $72.16 $54.12

$6,000.00 - $6,142.99 $4,200.00 $20,000.00 $129.36 $104.16 $88.20 $73.92 $55.44

$6,143.00 - $6,285.99 $4,300.00 $20,000.00 $132.44 $106.64 $90.30 $75.68 $56.76

$6,286.00 - $6,428.99 $4,400.00 $20,000.00 $135.52 $109.12 $92.40 $77.44 $58.08

$6,429.00 - $6,571.99 $4,500.00 $20,000.00 $138.60 $111.60 $94.50 $79.20 $59.40

$6,572.00 - $6,714.99 $4,600.00 $20,000.00 $141.68 $114.08 $96.60 $80.96 $60.72

$6,715.00 - $6,857.99 $4,700.00 $20,000.00 $144.76 $116.56 $98.70 $82.72 $62.04

$6,858.00 - $6,999.99 $4,800.00 $20,000.00 $147.84 $119.04 $100.80 $84.48 $63.36

$7,000.00 - $7,142.99 $4,900.00 $20,000.00 $150.92 $121.52 $102.90 $86.24 $64.68

$7,143.00 - $7,285.99 $5,000.00 $20,000.00 $154.00 $124.00 $105.00 $88.00 $66.00

$7,286.00 - $7,428.99 $5,100.00 $20,000.00 $157.08 $126.48 $107.10 $89.76 $67.32

$7,429.00 - $7,571.99 $5,200.00 $20,000.00 $160.16 $128.96 $109.20 $91.52 $68.64

$7,572.00 - $7,714.99 $5,300.00 $20,000.00 $163.24 $131.44 $111.30 $93.28 $69.96

$7,715.00 - $7,857.99 $5,400.00 $20,000.00 $166.32 $133.92 $113.40 $95.04 $71.28

$7,858.00 - $7,999.99 $5,500.00 $20,000.00 $169.40 $136.40 $115.50 $96.80 $72.60

$8,000.00 - $8,142.99 $5,600.00 $20,000.00 $172.48 $138.88 $117.60 $98.56 $73.92

$8,143.00 - $8,285.99 $5,700.00 $20,000.00 $175.56 $141.36 $119.70 $100.32 $75.24

$8,286.00 - $8,428.99 $5,800.00 $20,000.00 $178.64 $143.84 $121.80 $102.08 $76.56

$8,429.00 - $8,571.99 $5,900.00 $20,000.00 $181.72 $146.32 $123.90 $103.84 $77.88

$8,572.00 - $8,713.99 $6,000.00 $20,000.00 $184.80 $148.80 $126.00 $105.60 $79.20

$8,714.00 - $8,856.99 $6,100.00 $20,000.00 $187.88 $151.28 $128.10 $107.36 $80.52

$8,857.00 - $8,999.99 $6,200.00 $20,000.00 $190.96 $153.76 $130.20 $109.12 $81.84

$9,000.00 - $9,142.99 $6,300.00 $20,000.00 $194.04 $156.24 $132.30 $110.88 $83.16

$9,143.00 - $9,285.99 $6,400.00 $20,000.00 $197.12 $158.72 $134.40 $112.64 $84.48

$9,286.00 - $9,428.99 $6,500.00 $20,000.00 $200.20 $161.20 $136.50 $114.40 $85.80

$9,429.00 - $9,570.99 $6,600.00 $20,000.00 $203.28 $163.68 $138.60 $116.16 $87.12

$9,571.00 - $9,713.99 $6,700.00 $20,000.00 $206.36 $166.16 $140.70 $117.92 $88.44

$9,714.00 - $9,856.99 $6,800.00 $20,000.00 $209.44 $168.64 $142.80 $119.68 $89.76

$9,857.00 - $9,999.99 $6,900.00 $20,000.00 $212.52 $171.12 $144.90 $121.44 $91.08

$10,000.00 - $10,142.99 $7,000.00 $20,000.00 $215.60 $173.60 $147.00 $123.20 $92.40

$10,143.00 - $10,285.99 $7,100.00 $20,000.00 $218.68 $176.08 $149.10 $124.96 $93.72

$10,286.00 - $10,428.99 $7,200.00 $20,000.00 $221.76 $178.56 $151.20 $126.72 $95.04

$10,429.00 - $10,570.99 $7,300.00 $20,000.00 $224.84 $181.04 $153.30 $128.48 $96.36

$10,571.00 - $10,713.99 $7,400.00 $20,000.00 $227.92 $183.52 $155.40 $130.24 $97.68

$10,714.00 - And Over $7,500.00 $20,000.00 $231.00 $186.00 $157.50 $132.00 $99.00

Several benefit options are available to you. You may participate in the Plan under any one of the benefit levels outlined below, provided the Monthly Disability Benefit level selected does not exceed 70% of your Monthly Compensation.

Benefit Riders and Limitations

Hospital Indemnity Limited Benefit RiderThis rider is designed to pay a daily benefit amount for a Hospital Confinement, up to a maximum of 90 days, if you are confined to a Hospital.

Summary of Hospital Indemnity Limited Benefit Rider Benefits:Benefits are not payable for Injury or Sickness incurred in the first 12 months of coverage due to a pre-existing condition as defined in the base policy. Patient must be confined to a Hospital for a minimum of 18 hours and charged room and board.

Spousal Accident Only Disability Benefit RiderThis rider is designed to provide a monthly benefit if your spouse suffers a Disability due to a non-occupational accident.

Summary of Accident Only Spousal Benefit Rider Benefits:Pays a monthly benefit amount to you for your spouse who is disabled as a result of a non-occupational accident. Benefits begin on the 31st consecutive day after the Injury and will continue for up to two years.

COBRA Funding RiderThis rider is designed to help cover the cost of COBRA premiums if you elect COBRA coverage while you are receiving Disability Benefits.

Summary of COBRA Funding Rider Benefits:In order to receive benefits under this Rider, you must: be receiving benefits under your Disability base plan; elect medical COBRA coverage; and be paying medical COBRA premiums. This benefit will pay up to the end of the disability benefit period or to the end of your medical COBRA benefit period, whichever occurs first.

Survivor Benefit RiderThis rider is designed to provide a benefit to your beneficiary or estate, if you die while receiving Disability Benefits.

Summary of Survivor Benefit Rider Benefits:Benefits are payable if you have been disabled and not working for at least 90 days, and die while receiving Disability Benefits. Pays a monthly benefit up to one year or until the maximum disability period is exhausted, whichever occurs first.

Critical Illness Benefit RiderThis rider is designed to provide a lump sum benefit based on diagnosis of a certain critical illness.

Summary of Critical Illness Benefit Rider Benefits:Benefits are payable at a one-time lump sum benefit amount based on diagnosis of the following conditions Heart Attack, Stroke, Kidney Failure, Paralysis, or Major Organ Failure. In the case of Heart Attack, a physician must make the diagnosis and treatment must occur within 72 hours of the onset of symptoms.

Hospital Indemnity Limited Benefit Rider

Daily Benefit Amount Monthly Premium

$100.00 $6.00

$150.00 $9.00

Spousal Accident Only Disability Benefit Rider

Monthly Benefit Amount Annual Salary Monthly Premium

$500.00 up to $10,000.00 $4.00

$1,000.00 $10,001.00 - $20,000.00 $8.00

$1,500.00 $20,001.00 - $30,000.00 $12.00

$2,000.00 $30,001.00 and over. $16.00

COBRA Funding Rider

Monthly Benefit Amount Monthly Premium

$300.00 $4.50

$600.00 $9.00

Survivor Benefit Rider

Monthly Benefit Amount Monthly Premium

$2,000.00 $6.80

Critical Illness Benefit Rider

Benefit Amount Monthly Premium

$10,000.00 $9.80

$15,000.00 $13.18

$20,000.00 $16.56

$25,000.00 $19.94

G120-123 MCH#8962 014405-1, 014406-2, 014407-3, 014408-4, 014410-5, 014709-R1, 014710-R1, 014708-R1, 014002-R1, 014707-R1

View and print your policies plus file a claim at americanfidelity.com

SB-32612(FF)-0620

Hospital Indemnity Limited Benefit RiderThe Hospital Confinement Benefit will not be payable for an Injury or Sickness incurred in the first 12 months of coverage if the Injury or Sickness is caused by or resulting from a Pre-Existing Condition as defined in the Policy. In addition to the Exclusions listed in the Policy, no benefits will be payable under this Rider for any Hospital Confinement that is caused by or resulting from Mental Illness or Drug or Alcohol Abuse. Benefits are reduced by 50% at age 70. Successive Hospital stays will be considered as one confinement if they are separated by less than 90 days of confinement to a Hospital.

The term “Hospital” shall not include an institution used by you as a place for rehabilitation; a place for rest or for the aged; a nursing or convalescent home; a long-term nursing unit or geriatrics ward; or as an extended care facility for the care of convalescent, rehabilitative , or ambulatory patients.

Critical Illness Benefit RiderThe Critical Illness Rider will not be payable for any loss caused by or resulting from: (a) a Critical Illness when the Date of Diagnosis occurs during the Waiting Period; (b) a Critical Illness diagnosed outside of the United States; or (c) a Sickness or Injury not specifically defined in this Rider.

No Critical Illness Benefit will be payable for a Critical Illness which is caused by or resulting from a Pre-Existing Condition when the Critical Illness Date of Diagnosis occurs before you have been continuously covered under this Rider for 12 consecutive months. Following 12 consecutive months this exclusion does not apply.

Pre-Existing Condition means a disease, Injury, Sickness, physical condition or mental illness for which you have experienced any of the following: (a) treatment; (b) incurred expense; (c) took medication; (d) received care or services including diagnostic testing or related measures; or (e) received a diagnosis or advise from a Physician, during the 12-month period immediately before the Effective Date of this Rider. The term Pre-Existing Condition will also include conditions which are related to such disease, Injury, Sickness, physical condition or mental illness. Benefits reduce by 50% at age 70. No benefits will be paid for a Critical Illness when the Date of Diagnosis occurs during the Critical Illness Waiting Period. The waiting period is 30 days from the Effective Date of this Rider.

COBRA Funding Benefit RiderProof of election of medical COBRA continuation must be provided to American Fidelity. Proof of continued medical COBRA participation will be required before benefits are paid under this Rider. Your employment must have terminated for the benefit to be payable.

Spousal Accident Only Disability Benefit RiderThis Rider does not provide benefits for your Spouse for any Disability, fatal or non-fatal, which results from any of the following: (a) Intentionally self-inflicted Injury while sane or insane; (b) An act of war, declared or undeclared; (c) Injury sustained or contracted while in the service of the armed forces of any country; (d) Committing a felony; (e) Penal incarceration. American Fidelity will not pay benefits during any period

for which your Spouse is incarcerated in a penal or correctional institution or for any Injury that occurs while your Spouse is incarcerated in a penal or correctional institution; (f ) Injury arising out of and in the course of any occupation for wage or profit or for which your Spouse is entitled to Workers’ Compensation. The term “entitled to Workers’ Compensation” shall also include Workers’ Compensation claim settlements which occur via compromise and release. Further, no benefits will be paid under this Policy for any period during which your Spouse is entitled to Workers’ Compensation benefits; (g) Participation in any sport for wage or profit; (h) Participation in any contest of speed in a power driven vehicle for wage or profit.

Spouse means the person you are lawfully married to who is less than age 70. No benefits are payable for your Spouse under this Rider for a Disability from an Injury that occurred outside of the United States or its territories. No benefit will be provided for any period in which your Spouse is not under the regular and appropriate care of a Physician. No benefits will be paid for any Injury to your Spouse which is caused by or resulting from spousal abuse.

Survivor Benefit RiderThe Policy does not cover any loss, fatal or non-fatal, which results from: intentionally self-inflicted injury while sane or insane; an act of war, declared or undeclared; Injury sustained or Sickness contracted while in the service of the armed forces of any country; committing a felony; penal incarceration. American Fidelity will not pay benefits for Disability or any other loss for any period for which you are incarcerated in a penal or correctional institution for a period of 30 consecutive days or longer; or Injury or Sickness arising out of and in the course of any occupation for wage or profit or for which you are entitled to Workers’ Compensation. No Disability Payment will be provided for any period in which you are not under the regular and appropriate care of a physician.

Your coverage with respect to the riders listed above will end on the earliest of these dates: the end of the last period for which premium has been paid; the date you notify us in writing to terminate coverage; the date the rider is discontinued; the date the policy is discontinued; or the date your employment terminates.

Availability of riders may vary by state, employer and short-term coverage with a benefit period of less than 12 months. Additional riders are subject to our general underwriting guidelines and coverage is not guaranteed. Riders have limitations, exclusions, and waiting periods. Refer to your policy for complete details. These Riders will terminate on the same date as the Policy or Certificate to which it is attached.

Benefit Rider Limitations and Exclusions

Disability / Long-Term Disability Income Insurance


800-654-8489 • americanfidelity.com


American Fidelity’s Online Service Center provides you convenient, secure 24/7 access to manage your account or file a claim.

Underwritten and administered by: Marketed by:

Protection for the treatment of cancer and

29 specified diseases

Receiving a cancer diagnosis can be one of life’s most frightening events.Unfortunately, statistics show you probably know someone who has been in this situation.

With Cancer insurance from Allstate Benefits, you can rest a little easier. Our coveragepays you a cash benefit to help with the costs associated with treatments, to pay fordaily living expenses, and more importantly, to empower you to seek the care you need.

Here’s How It WorksYou choose the coverage that’s right for you and your family. Our Cancer insurance pays cash benefits for cancer and 29 specified diseases to help with the cost of treatments and expenses as they happen. Benefits are paid directly to you unless otherwise assigned. With the cash benefits you can receive from this coverage, you may not need to use the funds from your Health Savings Account (HSA) for cancer or specified diseasetreatments and expenses.

Meeting Your Needs• Guaranteed Issue, meaning no medical questions to answer at initial enrollment• Includes coverage for cancer and 29 specified diseases• Benefits are paid directly to you unless otherwise assigned

• Coverage available for dependents• Waiver of premium after 90 days of disability due to cancer for as long as your disability

lasts (employee only)• Coverage may be continued; refer to your certificate for details

• Additional benefits have been added to enhance your coverage

With Allstate Benefits, you can protect your finances if faced with an unexpected cancer or specified disease diagnosis. Are you in Good Hands? You can be.

Cancer Insurance

1Life After Cancer: Survivorship by the Numbers, American Cancer Society, 2017 2Cancer Treatment & Survivorship Facts & Figures, 2016-2017

ABJ34874X-1

Offered to the employees of:

Ector County ISD

DID YOU KNOW

The number of cancer survivors in the U.S. is increasing, and is expected to jump to nearly 20.3 million by 20262

?Early detection, improved treatments and access to care are factors that influence cancer survival1

20.3 million

Receiving a cancer diagnosis can be one of life’s most frightening events.Unfortunately, statistics show you probably know someone who has been in this situation. With Cancer insurance from Allstate Benefits, you can rest a little easier. Our coverage pays you a cash benefit to help with the costs associated with treatments, to pay for daily living expenses, and more importantly, to empower you to seek the care you need.

Here’s How It WorksYou choose the coverage that’s right for you and your family. Our Cancer insurance payscash benefits for cancer and 29 specified diseases to help with the cost of treatments and expenses as they happen. Benefits are paid directly to you unless otherwise assigned. With the cash benefits you can receive from this coverage, you may not need to use the funds from your Health Savings Account (HSA) for cancer or specified disease treatments and expenses.

Meeting Your Needs• Guaranteed Issue, meaning no medical questions to answer at initial enrollment• Includes coverage for cancer and 29 specified diseases• Benefits are paid directly to you unless otherwise assigned• Coverage available for dependents• Waiver of premium after 90 days of disability due to cancer for as long as your disability lasts (employee only)• Coverage may be continued; refer to your certificate for details• Additional benefits have been added to enhance your coverage

With Allstate Benefits, you can protect your finances if faced with an unexpected cancer or specified disease diagnosis. Are you in Good Hands? You can be.

THIS IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THIS POLICY, AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYER LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.1Life After Cancer: Survivorship by the Numbers, American Cancer Society, 2017 2Cancer Treatment & Survivorship Facts & Figures, 2016-2017

Cancer Insurance

Here’s how TJ’s story of diagnosis and treatment turned into a happy ending, because he had supplemental Cancer Insurance to help with expenses.

TJ undergoes his annual wellness test and is diagnosed for the first time with prostate cancer. His doctor reviews the results with him and recommends pre-op testing and surgery.

Here’s TJ’s treatment path:• TJ travels to a specialized hospital 400 miles

from where he lives and undergoes pre-op testing• He is admitted to the hospital for laparoscopic

prostate cancer surgery • TJ undergoes surgery and spends several hours

in the recovery waiting room• He is transferred to his room where he is visited

by his doctor during a 2-day hospital stay• TJ is released under doctor required treatment and

care during a 2-month recovery period

TJ continues to fight his cancer and follow his doctor recommended treatments.

CHOOSE CLAIMUSETJ chooses benefits to helpprotect himself and his wife if diagnosed with cancer or a specified disease

Meet TJTJ is like anyone else who has been diagnosed with cancer. He is concerned about his wife and how she will cope with his disease and its treatment. Most importantly, he worries about how he will pay for his treatment.

Here is what weighs heavily on his mind:• Major medical only pays a portion of the

expenses associated with my treatment

• I have copays I am responsible for until I meet my deductible

• If I am not working due to treatments, I must cover my bills, rent/mortgage, groceries and other daily expenses

• If the right treatment is not available locally, I will have to travel to get the treatment I need

TJ’s Cancer claim paid him cash benefits for the following:Wellness Cancer Initial DiagnosisContinuous Hospital ConfinementNon-Local TransportationSurgeryAnesthesiaMedical ImagingInpatient Drugs and MedicinePhysician’s AttendanceAnti-Nausea

For a listing of benefits and benefit amounts, see your company’s rate insert.

Benefits (subject to maximums as listed on the attached rate insert)

HOSPITAL CONFINEMENT AND RELATED BENEFITSContinuous Hospital Confinement - inpatient admission and confinement Government or Charity Hospital - confinements in lieu of all other benefits, except Waiver of Premium

Private Duty Nursing Services - full-time nursing services authorized by attending physician

Extended Care Facility - within 14 days of a hospital stay; payable up to the number of days of the hospital stay

At Home Nursing - private nursing care must begin within 14 days of a covered hospital stay; payable up to the number of days of the previous hospital stay

Hospice Care Center or Team - terminal illness care in a facility or at home; one visit per day

RADIATION/CHEMOTHERAPY AND RELATED BENEFITSRadiation/Chemotherapy for Cancer - covered treatments to destroy or modify cancerous tissue

Blood, Plasma and Platelets - transfusions, administration, processing, procurement, cross matching

Hematological Drugs - boosts cell lines for white/red cell counts and platelets; payable when Radiation/Chemotherapy for Cancer benefit is paid

Medical Imaging - initial diagnosis or follow-up evaluation based on covered imaging exam

SURGERY AND RELATED BENEFITS

Surgery* - based on Certificate Schedule of Surgical Procedures Anesthesia - 25% of Surgery benefit for anesthesia received by an anesthetist

Bone Marrow or Stem Cell Transplant - autologous, non-autologous for treatment of cancer or specified disease other than Leukemia, or non-autologous for treatment of Leukemia

Ambulatory Surgical Center - payable only if Surgery benefit is paid

Second Opinion - second opinion for surgery or treatment by a doctor not in practice with your doctor

MISCELLANEOUS BENEFITS Inpatient Drugs and Medicine - not including drugs/medicine covered under the Radiation/Chemotherapy for Cancer or Anti-Nausea benefits

Physician’s Attendance - one inpatient visit by one physician

Ambulance - transfer to or from hospital where confined by a licensed service or hospital-owned ambulance

Non-Local Transportation - obtaining treatment not available locally

Outpatient Lodging - more than 100 miles from home

Family Member Lodging and Transportation - adult family member travels with you during non-local hospital stays for specialized treatment. Transportation not paid if Non-Local Transportation benefit is paid

Physical or Speech Therapy - to restore normal body function

New or Experimental Treatment - payable if physician judges to be necessary and only for treatment not covered under other policy benefits

Prosthesis - surgical implantation of prosthetic device for each amputation

Hair Prosthesis - wig or hairpiece every two years due to hair loss

Nonsurgical External Breast Prosthesis - initial prosthesis after a covered mastectomy

Anti-Nausea Benefit - prescribed anti-nausea medication administered on outpatient basis

Waiver of Premium** - must be disabled 90 days in a row due to cancer, as long as disability lasts

ADDITIONAL BENEFITS Cancer Initial Diagnosis - for first-time diagnosis of cancer other than skin cancer

Intensive Care (ICU) a. ICU Confinement - illness or accident confinements up to 45 days/stay b. Step-down ICU Confinement - confinements up to 45 days/stay c. Ambulance - licensed air or surface ambulance service to ICU

Wellness Benefit - once per year for one of 23 exams. See left for list of wellness tests

SPECIFIED DISEASES29 Specified Diseases Covered - Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease), Muscular Dystrophy, Poliomyelitis, Multiple Sclerosis, Encephalitis, Rabies, Tetanus, Tuberculosis, Osteomyelitis, Diphtheria, Scarlet Fever, Cerebrospinal Meningitis, Brucellosis, Sickle Cell Anemia, Thalassemia, Rocky Mountain Spotted Fever, Legionnaires’ Disease, Addison’s Disease, Hansen’s Disease, Tularemia, Hepatitis (Chronic B or C), Typhoid Fever, Myasthenia Gravis, Reye’s Syndrome, Primary Sclerosing Cholangitis (Walter Payton’s Disease), Lyme Disease, Systemic Lupus Erythematosus, Cystic Fibrosis, and Primary Biliary Cirrhosis

*Two or more surgeries done at the same time are considered one operation. The operation with the largest benefit will be paid. Outpatient is paid at 150% of the amount listed in the Schedule of Surgical Procedures. Does not pay for other surgeries covered by other benefits **Premiums waived for employee only

Wellness BenefitBiopsy for skin cancer; Blood tests for triglycerides, CA15-3 (breast cancer), CA125 (ovarian cancer), CEA (colon cancer), PSA (prostate cancer); Bone Marrow Testing; Chest X-ray; Colonoscopy; Doppler screening for carotids or peripheral vascular disease; Echocardiogram; EKG; Flexible sigmoidoscopy; Hemoccult stool analysis; HPV (Human Papillomavirus) Vaccination; Lipid panel (total cholesterol count); Mammography, including Breast Ultrasound; Pap Smear, including ThinPrep Pap Test; Serum Protein Electrophoresis (test for myeloma); Stress test on bike or treadmill; Thermography; and Ultrasound screening for abdominal aortic aneurysms.

An easy-to-use website that offers 24/7 access to important information about your benefits. Plus, you can submit and check your claims (including claim history), request your cash benefit to be direct deposited, make changes to personal information, and more.

MyBenefits: 24/7 Accessallstatebenefits.com/mybenefits

Using your cash benefitsCash benefits provide you with options, because you decide how to use them.

Finances Can help protect HSAs, savings, retirement plans and 401(k)s from being depleted.

Travel Can help pay for expenses while receiving treatment in another city.

Home Can help pay the mortgage, continue rental payments, or perform needed home repairs for after care.

Expenses Can help pay your family’s living expenses such as bills, electricity, and gas.

CERTIFICATE SPECIFICATIONSEligibilityCoverage may include you, your spouse or domestic partner, and children under age 26.

Termination of Coverage Coverage under the policy ends on the date the policy is canceled; the last day premium payments were made; the last day of active employment, unless coverage is continued due to Temporary Layoff, Leave of Absence or Family and Medical Leave of Absence; the date you or your class is no longer eligible.

Spouse/domestic partner coverage ends upon divorce/termination of partnership or your death. Coverage for children ends when the child reaches age 26, unless he or she continues to meet the requirements of an eligible dependent.

Portability PrivilegeCoverage may be continued under the Portability Provision when coverage under the policy ends. Refer to your Certificate of Insurance for details.

LIMITATIONS AND EXCLUSIONSPre-Existing Condition LimitationWe do not pay benefits for a pre-existing condition during the 12-month period beginning on the date that person’s coverage starts. A pre-existing condition is a disease or condition for which symptoms existed within the 12-month period prior to the effective date, or medical advice or treatment was recommended or received from a medical professional within the 12-month period prior to the effective date. A pre-existing condition can exist even though a diagnosis has not yet been made.

Exclusions and LimitationsWe do not pay for any loss except for losses due to cancer or a specified disease. Benefits are not paid for conditions caused or aggravated by cancer or a specified disease. Treatment and services must be needed due to cancer or a specified disease and be received in the United States or its territories.

Hospice Care Team Limitation: Services are not covered for food or meals, well-baby care, volunteers or support for the family after covered person’s death.

Blood, Plasma and Platelets Limitation: Does not include immunoglobulins or blood replaced by donors.

For the Surgery, New or Experimental Treatment and Prosthesis benefits, we pay 50% of the applicable maximum when specific charges are not obtainable as proof of loss.

For the Radiation/Chemotherapy for Cancer benefit, we do not pay for: any other chemical substance which may be administered with or in conjunction with radiation/chemotherapy; treatment planning, consultation or management; the design and construction of treatment devices; basic radiation dosimetry calculation; any type of laboratory tests; X-ray or other imaging used for diagnosis or monitoring; the diagnostic tests related to these treatments; or any devices or supplies including intravenous solutions and needles related to these treatments.

Intensive Care Exclusions and LimitationsBenefits are not paid for attempted suicide or intentional self-inflicted injury, intoxication or being under the influence of drugs not prescribed by a physician, or alcoholism or drug addiction. Benefits are not paid for confinements to a care unit that does not qualify as a hospital intensive care unit, including progressive care, subacute intensive care, intermediate care, private rooms with monitoring, or step-down and other lesser care units. Benefits are not paid for step-down confinements in the following units: telemetry or surgical recovery rooms; post-anesthesia care; progressive care; intermediate care; private monitored rooms; observation units in emergency rooms or outpatient surgery units; beds, wards, or private or semi-private rooms; emergency, labor or delivery rooms; or other facilities that do not meet the standards for a step-down hospital intensive care unit. Benefits are not paid for continuous confinements occurring during a hospitalization prior to the effective date. Children born within 10 months of the effective date are not covered for confinement occurring or beginning during the first 30 days of the child’s life. We do not pay for ambulance if paid under the Cancer and Specified Disease Ambulance benefit.

This brochure is for use in enrollments sitused in TX and is incomplete without the accompanying rate insert.Rev. 9/18. This material is valid as long as information remains current, but in no event later than September 15, 2021.Group Cancer benefits are provided under policy form GVCP3 or state variations thereof. The coverage provided is limited benefit supplemental cancer and specified disease insurance. The policy is not a Medicare Supplement Policy. If eligible for Medicare, review Medicare Supplement Buyer’s Guide available from Allstate Benefits. There may be instances when a law requires that benefits under this coverage be paid to a third party, rather than to you. If you or a dependent have coverage under Medicare, Medicaid, or a state variation, please refer to your health insurance documents to confirm whether assignments or liens may apply.This is a brief overview of the benefits available under the group policy underwritten by American Heritage Life Insurance Company (Home Office, Jacksonville, FL). Details of the coverage, including exclusions and other limitations are included in the certificates issued. For additional information, you may contact your Allstate Benefits Representative.The coverage does not constitute comprehensive health insurance coverage (often referred to as “major medical coverage”) and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

DEFINITIONSActual Charges vs. Actual CostActual Charge – Amount billed for a treatment or service before any insurance discounts or payments.

Actual Cost – Amount actually paid by or on behalf of you, accepted as full payment by the provider of goods or services.

Allstate Benefits is the marketing name used by American Heritage Life Insurance Company, a subsidiary of The Allstate Corporation. ©2018 Allstate Insurance Company.www.allstate.com or allstatebenefits.com

BENEFIT AMOUNTS

1 Pays actual cost up to amount listed. 2 Pays actual charges up to amount listed in certificate Schedule of Surgical Procedures. Amount paid depends on surgery. 3Pays actual charges up to amount listed. Maximum of 700 miles.

Offered to the employees of:Ector County ISDCancer Insurance (GVCP3)

Includes coverage for 29 Specified Diseases from Allstate Benefits

ABJ34874X-1-Insert-Ector

See reverse for premiums

HOSPITAL CONFINEMENT AND RELATED BENEFITS PLAN 1 PLAN 2Continuous Hospital Confinement (daily) $100 $200Government or Charity Hospital (daily) $100 $200Private Duty Nursing Services (daily) $100 $200Extended Care Facility (daily) $100 $200At Home Nursing (daily) $100 $200Hospice Care Center (daily) or $100 $200 Hospice Care Team (per visit) $100 $200 RADIATION/CHEMOTHERAPY/RELATED BENEFITS PLAN 1 PLAN 2Radiation/Chemotherapy for Cancer1 (every 12 months) $10,000 $20,000Blood, Plasma, and Platelets1 (every 12 months) $10,000 $20,000Hematological Drugs1 (every 12 months) $200 $400Medical Imaging1 (every 12 months) $500 $1,000 SURGERY AND RELATED BENEFITS PLAN 1 PLAN 2Surgery2 $1,500 $4,500Anesthesia (% of surgery benefit) 25% 25%Bone Marrow or Stem Cell Transplant (once/year) 1. Autologous 1. $500 1. $1,500 2. Non-autologous (cancer or specified disease treatment) 2. $1,250 2. $3,750 3. Non-autologous (Leukemia) 3. $2,500 3. $7,500Ambulatory Surgical Center (daily) $250 $750Second Opinion $200 $600 MISCELLANEOUS BENEFITS PLAN 1 PLAN 2Inpatient Drugs and Medicine (daily) $25 $25Physician’s Attendance (daily) $50 $50Ambulance (per confinement) $100 $100Non-Local Transportation1 (coach fare or amount shown per mile) $0.40/mi $0.40/miOutpatient Lodging (daily; limit $2,000/12 mo. period) $50 $50Family Member Lodging (daily per trip; max. 60 days) $50 $50 and Transportation (coach fare or amount shown per mile) $0.40/mi $0.40/miPhysical or Speech Therapy (daily) $50 $50New or Experimental Treatment3 (every 12 months) $5,000 $5,000Prosthesis3 (per amputation) $2,000 $2,000Hair Prosthesis (every 2 years) $25 $25Nonsurgical External Breast Prosthesis1 $50 $50Anti-Nausea Benefit1 $200 $200Waiver of Premium (employee only) Yes Yes ADDITIONAL BENEFITS PLAN 1 PLAN 2Cancer Initial Diagnosis (one-time benefit) $1,000 $3,000Intensive Care (ICU) ICU (daily) $200 $300 Step-down (daily) $100 $150 Ambulance Charges ChargesWellness Benefit $50 $100

Issue ages: 18 and over if actively at work

EE = Employee; EE + SP = Employee + Spouse; EE + CH = Employee + Child(ren); F = Family

PLAN 1 PREMIUMS

MODE EE EE + SP EE + CH F 17thly $13.19 $20.47 $18.70 $25.97

Monthly $18.68 $28.99 $26.49 $36.78

PLAN 2 PREMIUMS

MODE EE EE + SP EE + CH F 17thly $27.37 $42.40 $38.86 $53.88

Monthly $38.77 $60.06 $55.05 $76.33

ABJ34874X-1-Insert-Ector

For use in enrollments sitused in: TX This rate insert is part of form ABJ34874X-1 and is not to be used on its own. This material is valid as long as information remains current, but in no event later than September 15, 2021. Allstate Benefits is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a subsidiary of The Allstate Corporation. ©2018 Allstate Insurance Company. www.allstate.com or allstatebenefits.com.

C11 CANCER Insurance Plan

Underwritten by American Fidelity Assurance Company

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

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

Limited Benefit Cancer Expense Insurance Policy

Marketed by:

A cancer diagnosis may be both a physical and emotional drain. Thanks to advances in medicine and procedures to treat cancer, more and more people are beating the disease. However, with the arrival of these advances also comes the continuing rise in the cost of cancer treatment.The financial impact of a cancer diagnosis can affect anyone’s financial situation. American Fidelity Assurance Company’s Limited Benefit Cancer Insurance may offer a solution to help you and your family focus on fighting the disease. This plan may assist with the expenses that may not be covered by other medical insurance.

Cancer C11 Insurance

Cancer can be a costly disease.

How It WorksThis plan is designed to help cover expenses, should you be diagnosed with cancer. With more than 25 built-in plan benefits, this plan provides benefits for the treatment of cancer, transportation, hospitalization, and more.

In addition, this is a portable plan, so you own the policy. You can take the coverage with you if you choose to leave your current job, and your premiums will not increase because you left your employment.

American Fidelity’s Limited Benefit Cancer Insurance features:

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

• Policy is guaranteed renewable for as long as premiums are paid as required.

• The company has the right to change premium rates by class.

• Employee, Single Parent, and Family plans are available.

Plan OptionsYou can take advantage of the following options to extend coverage to your family:

• Individual PlanThe Insured, age 18 through 70, at the date of policy issue, is the only Covered Person.

• Single Parent Family PlanThe Insured, age 18 through 70, at the date of policy issue, and each Eligible Child, to age 26, or as defined in the policy.

• Family PlanThe Insured and spouse age 18 through 70, at the date of policy issue, and Eligible Child, to age 26, or as defined in the policy.

DIAGNOSTIC AND PREVENTION BENEFIT(per calendar year)

Basic$60

Enhanced$75

SCREENING BENEFIT+

Receive a benefit for your annual internal cancer screening test, including but not limited to Mammogram, PAP, Prostate-Specific Antigen Blood Test (PSA), Chest X-ray, Flexible Sigmoidoscopy, ThinPrep Pap test, and Colonoscopy.

Over 1.6 million new cases of cancer will be diagnosed this year.*

Did You Know?According to the American Institute for Cancer Research about one-third of cases of the most common cancers in the U.S.

could be prevented by eating healthy, being active, and staying lean.** It is essential to have a plan in place that could help if you were diagnosed.

*American Cancer Society: Cancer Facts and Figures 2017, pg. 1. **American Institute for Cancer Research: For Cancer Prevention Month; accessed at www.aicr.org January 31, 2017.+The premium and amount of benefits vary based upon the plan selected.

Marketed by: First Financial Group of America

Schedule of Benefits by Plan+

Basic EnhancedSCREENING BENEFITS

Diagnostic and Prevention Benefit (one per calendar year) $60 $75

Cancer Screening Follow-Up Benefit (one per calendar year) $60 $75

TREATMENT BENEFITSRadiation Therapy/Chemotherapy/Immunotherapy Benefit (per 12-month period) (Actual Charges)

up to $15,000 up to $20,000

Medical Imaging Benefit (per image - max 2 per calendar year) $200 $300

Hormone Therapy Benefit (per treatment - max 12 treatments/calendar year) $50 $50

Administrative/Lab Work Benefit (per calendar month) $75 $100

Blood, Plasma, and Platelets Benefit (per day)(per calendar year max)

$150$7,500

$200$10,000

AMBULANCE, TRANSPORTATION, & LODGING BENEFITSAmbulance Benefit (per trip - max 2 trips any combination per confinement)

GroundAir

$200$2,000

$200$2,000

Transportation & Lodging Benefit (Patient and/or Family) Transportation($1,500 max per round trip; max 12 trips/calendar year)Outpatient Lodging(per day up to 90 days per calendar year)

Coach fare or $.50/mile by car

$60

Coach fare or $.50/mile by car

$80

HOSPITALIZATION BENEFITSHospital Confinement Benefit***

(per day for the first 30 days)(per day after the first 30 days of Hospital Confinement)

$200$400

$300$600

Drugs & Medicine BenefitHospital Confinement (per Confinement)Outpatient (per prescription - $100 monthly max for Basic; $150 for Enhanced) per calendar month

$200$50

$300$50

Attending Physician Benefit (per day while Hospital Confined) $40 $50

U.S. Government/Charity Hospital or HMO Benefit (per day in lieu of most benefits)

Hospital ConfinementOutpatient Services

$200$200

$300$300

Experimental Treatment Benefit Paid as any non-experimental benefit

Bone Marrow/Stem Cell Transplant BenefitAutologous (Patient provided) (per calendar year)Non-autologous (Donor provided) (per calendar year)

$1,000$3,000

$1,500$4,500

Donor Benefit $1,000 per donation

Inpatient Special Nursing Services Benefit (benefit per day while Hospital Confined) $150 $150

Dread Disease Benefit (benefit per day for the first 30 days per Hospital Confinement) (benefit per day thereafter)

$200$400

$300$600

+The premium and amount of benefits provided vary based upon the plan selected. ++Availability of riders may vary by state and employer. Additional riders are subject to our general underwriting guidelines and coverage is not guaranteed.

Physical or Speech Therapy Benefit(per visit up to 4 per calendar month - lifetime max of $1,000) $25 $25

Hospice Care Benefit(per day - $13,500 lifetime max for Basic; $18,000 lifetime max for Enhanced)

$75 $100

Home Health Care Benefit(per day for up to the same number of days of paid Hospital Confinement) $75 $100

Prosthesis Benefit Non-Surgical (per device - 1 per site, lifetime max of 3)Surgical Implantation (per device, includes surgical fee - 1 per site, lifetime max of 2)

Hair Prosthesis (once per life)

$150$1,500

$150

$200$2,000

$200

Extended Care Facility Benefit(per day for up to the same number of days of paid Hospital Confinement) $75 $100

Basic EnhancedSURGICAL TREATMENT BENEFITS

Surgical Benefit Unit Dollar Amount (per surgical unit) Maximum Per Operation

$30$3,000

$40$4,000

Anesthesia Benefit 25% of the amount paid for covered surgery

Outpatient Hospital or Ambulatory Surgical Center Benefit (per day) $400 $600

Second & Third Surgical Opinion Benefit (per diagnosis)(Additional $300 for 3rd if required)

$300 $300

CONTINUING CARE BENEFITS

Summary of Critical Illness Rider Benefits:• Pays when diagnosed after 30-day Critical Illness

Waiting Period with Internal Cancer or Heart Attack/Stroke, depending upon the Critical Illness coverage elected at time of application.

• Pays the specified Maximum Benefit Amount per Covered Critical Illness, as defined under this rider.

• Each benefit is a one-time paid benefit. • All Critical Illness amounts reduce by 50% at age 70.

Critical Illness Rider Thanks to medical technology, more people are surviving critical illnesses. This rider is designed to help with the cost associated with surviving these types of illnesses.

Schedule of Benefits

Cancer Benefit(per unit - maximum $10,000) $2,500

Heart Attack/Stroke Benefit(per unit - maximum $10,000) $2,500

Hospital Intensive Care Unit Rider This rider can provide a benefit to help by paying for each day a Covered Person is confined in an Intensive Care Unit (ICU), as defined in the rider.

Schedule of Benefits

ICU Confinement Benefit(per day up to 30 days) $600

Ambulance Benefit(per admission in an ICU) $100

Summary of Hospital ICU Rider Benefits:• Confinement must be due to an accident or sickness and

begin after the effective date of coverage under this rider. • A day is defined as a 24-hour period. • If confined to an ICU for a portion of a day, a

pro rata share of the daily benefit will be paid. • Under age 70, pays $100 per admission for ambulance

charges, or age 70 or older, $50 for transportation to a Hospital where the Covered Person is admitted to an ICU within 24 hours of arrival.

• All ICU amounts reduce by 50% at age 70.

Enhance your plan++

Refer to Plan Benefit Highlights for more complete Benefit Descriptions and limits on the Cancer Insurance Plan.

Schedule of Benefits by Plan+ (continued)

Physical or Speech Therapy Benefit(per visit up to 4 per calendar month - lifetime max of $1,000) $25 $25

Hospice Care Benefit(per day - $13,500 lifetime max for Basic; $18,000 lifetime max forEnhanced)

$75 $100

Home Health Care Benefit(per day for up to the same number of days of paid Hospital Confinement) $75 $100

Prosthesis BenefitNon-Surgical (per device - 1 per site, lifetime max of 3)Surgical Implantation (per device, includes surgical fee - 1 per site,lifetime max of 2)

Hair Prosthesis (once per life)

$150$1,500

$150

$200$2,000

$200

Extended Care Facility Benefit(per day for up to the same number of days of paid Hospital Confinement) $75 $100

Basic Enhanced

Surgical Benefit Unit Dollar Amount (per surgical unit) Maximum Per Operation

$30$3,000

$40$4,000

Anesthesia Benefit 25% of the amount paidfor covered surgery

Outpatient Hospital or Ambulatory Surgical Center Benefit (per day) $400 $600

Second & Third Surgical Opinion Benefit (per diagnosis)(Additional $300 for 3rd if required)

$300 $300

CONTINUING CARE BENEFITS

Refer to Plan Benefit Highlights for more complete Benefit Descriptions and limits on the Cancer Insurance Plan.

Diagnostic, Prevention and Cancer Screening Follow-up BenefitsPays the indemnity amount for one generally medically recognized internal Cancer screening test per Covered Person per Calendar Year. Tests include but are not limited to Mammogram, ThinPrep Pap test, Prostate-Specific Antigen Blood Test (PSA), Colonoscopy, and Chest X–ray. Refer to the policy for a complete listing. Screening tests payable under this benefit will ONLY be paid under this benefit and does not include any test payable under the Medical Imaging Benefit. Benefits will only be paid for tests performed after the 30–day period following the Covered Person’s effective date of coverage. Cancer Screening Follow-Up Benefit pays the indemnity amount for a Covered Person to receive one invasive follow–up test needed due to an abnormal covered cancer screening result. Diagnostic surgeries which result in a positive diagnosis of Cancer will be paid under the Surgical Benefit. Radiation/Chemotherapy/Immunotherapy BenefitPays the Actual Charges up to the maximum amount shown when a Covered Person receives Radiation Therapy, Chemotherapy, or Immunotherapy as defined in the policy, per 12-month period. The 12-month period begins on the first day the Covered Person receives covered Radiation Therapy, Chemotherapy, or Immunotherapy. This benefit does not cover other procedures related to Radiation/Chemotherapy/Immunotherapy. Anti-nausea drugs are not covered under this benefit. This benefit does not include any drugs/medicines covered under the Drugs and Medicine Benefit or the Hormone Therapy Benefit. Actual Charges means the amount actually paid by or on behalf of the insured person and accepted by the provider for services provided.Medical Imaging BenefitPays the indemnity amount for a Covered Person who has been diagnosed with Cancer who receives either an MRI; CT scan; CAT scan; or PET scan when performed at the request of a Physician due to Cancer or the treatment of Cancer.Hormone Therapy BenefitPays the indemnity amount for hormone therapy treatments as defined in the policy, prescribed by a Physician. This benefit covers drugs and medicines only and does not include associated administrative processes. This benefit does not include drugs/medicines covered under the Radiation/Chemotherapy/Immunotherapy Benefit or the Drugs and Medicine Benefit.Administrative/Lab Work BenefitPays the indemnity amount once per calendar month, when the Covered Person is receiving Radiation/Chemotherapy/Immunotherapy Benefit that month, for related procedures such as treatment planning, treatment management, etc. Blood, Plasma and Platelets BenefitPays the indemnity amount for blood, plasma and platelets. This does not include any laboratory processes. Colony stimulating factors are not covered under this benefit. Benefits for Blood, Plasma and Platelets are ONLY provided under this benefit.Bone Marrow Benefit/Stem Cell Transplant BenefitPays the indemnity amount when a bone marrow transplant or peripheral blood stem cell transplant is performed on a Covered Person as treatment for a diagnosed Cancer. This benefit will not be paid for the harvest of bone marrow or stem cells from a donor.

Hospital Confinement BenefitPays the indemnity amount for a Covered Person while confined to a Hospital for at least 18 continuous hours for the treatment of Cancer. ***A Hospital is not an institution, or part thereof, used as: a hospice unit, including any bed designated as a hospice or swing bed; a convalescent home; a rest or nursing facility; a rehabilitative facility; an extended care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction. Drugs and Medicines BenefitPays the indemnity amount for anti–nausea and pain medication prescribed by a Physician for a Covered Person for treatment of Cancer, who is also receiving Radiation Therapy/Chemotherapy/Immunotherapy, a covered surgery, or a Bone Marrow/Stem Cell Transplant. This benefit does not cover associated administrative processes. This benefit does not include drugs/medicines covered under the Radiation/Chemotherapy/Immunotherapy Benefit or the Hormone Therapy Benefit.Attending Physician BenefitPays the indemnity amount for one Physician’s visit per day when a Covered Person requires the services of a Physician, other than a surgeon while Hospital Confined for the treatment of Cancer.U.S. Government/Charity Hospital /HMO BenefitIf an itemized list of services is not available because a Covered Person is: confined in a charity Hospital or U.S. Government owned Hospital; or covered under a Health Maintenance Organization (H.M.O.) or Diagnostic Related Group (D.R.G.) where no charges are made to the Covered Person, the Primary Insured may convert benefits under the policy to pay the indemnity amount shown in schedule of benefits. This benefit will be paid in lieu of most benefits under the policy. Ambulance BenefitPays the indemnity amount per day for either licensed air or ground ambulance transportation of a Covered Person to a Hospital or from one medical facility to another where the Covered Person is admitted as an Inpatient and Hospital Confined for at least 18 consecutive hours for treatment of Cancer.Transportation and Lodging BenefitsThese benefits pay for the transportation of a Covered Person and/or one adult family member when the Covered Person has been diagnosed with Cancer and receives covered Radiation Therapy, Chemotherapy, Immunotherapy, Bone Marrow/Stem Cell Transplant, or surgery due to Cancer in the nearest Physician prescribed Hospital providing such treatment that is at least 50 miles away from the Covered Person’s residence, using the most direct route. Travel must be by scheduled bus, plane or train, or by car and be within the United States or its Territories. Benefits will be provided for only one mode of transportation per round trip and will be paid for up to 12 round trips per Calendar Year. Benefits for travel of the Covered Person and/or family member will be paid: once per Covered Person’s Hospital Confinement; or only on days of the Covered Person’s outpatient specialized treatment. Benefits for lodging of the Covered Person and/or family member will be paid: once per Covered Person’s Hospital Confinement; or only on days of the Covered Person’s outpatient specialized treatment. If the family member and the Covered Person travel in the same car or lodge in the same room, benefits for travel and lodging will only be paid under the Transportation and Lodging Benefit for the patient.

Plan Benefits Highlights

Surgical BenefitPays an indemnity benefit up to the Maximum Per Operation amount shown in the Schedule of Benefits in the policy when a surgical operation is performed on a Covered Person for covered diagnosed Cancer, Skin Cancer, or reconstructive surgery due to Cancer. Benefits will be calculated by multiplying the surgical unit value assigned to the procedure, as shown in the most current Physician’s Relative Value Table, by the Unit Dollar Amount shown in the Schedule of Benefits. Two or more surgical procedures performed through the same incision will be considered one operation and benefits will be limited to the most expensive procedure. Diagnostic surgeries that result in a negative diagnosis of Cancer are not covered under this benefit. Any diagnostic surgery covered under the Diagnostic and Prevention Benefit will not be covered under this benefit. Bone marrow surgeries are paid under the Bone Marrow Transplant Benefit. Surgeries required to implant a permanent prosthetic device are covered under the Prosthesis Benefit. This benefit is payable for reconstructive breast surgery performed on a non-diseased breast to establish symmetry with a diseased breast when reconstructive surgery on the diseased breast is performed while covered under this policy. Reconstructive surgery to the non-diseased breast must occur within 24 months of the reconstructive surgery of the diseased breast.Anesthesia BenefitPays 25% of the amount paid for a covered surgery for the services of an anesthesiologist. Services of an anesthesiologist for bone marrow transplants, Skin Cancer, or surgical prosthesis implantation are not covered under this benefit.Outpatient Hospital or Ambulatory Surgical Center BenefitWe will pay the indemnity amount shown towards the facility fee charges of an Ambulatory Surgical Center or Hospital for an outpatient surgical procedure of a diagnosed Cancer. Surgical procedures for Skin Cancer are not covered under this benefit. Second and Third Surgical Opinion BenefitPays the indemnity amount once per diagnosis for a Covered Person’s second surgical opinion and if the second disagrees with the first, a third opinion, when the attending Physician recommends surgery for the treatment of Cancer. Surgical opinions for reconstructive, Skin Cancer, or prosthesis surgeries are not covered under this benefit. Prosthesis BenefitsPays the indemnity amount for a prosthetic device received due to Cancer that manifested after the 30th day following the Effective Date, and its surgical implantation if required as a direct result of surgery for Cancer. This benefit does not cover prosthetic related supplies. Temporary prosthetic devices used as tissue expanders are covered under the Surgical Benefit. Hair Prosthesis benefit pays the indemnity amount for a Covered Person’s hair prosthesis needed as a direct result of Cancer or the treatment of Cancer. This benefit is payable once per Covered Person per lifetime.Extended Care Facility BenefitPays the indemnity amount for each day room and board charges are incurred while a Covered Person is confined in an Extended Care Facility due to Cancer at the direction of a Physician that begins within 14 days after a covered Hospital Confinement. Paid for up to the same number of days benefits were paid for the Covered Person’s preceding Hospital Confinement. Physical or Speech Therapy BenefitPays the indemnity amount if a Physician advises a Covered Person to seek physical therapy or speech therapy. Physical or speech therapy must be performed by a caregiver licensed in physical or speech therapy and be needed as a result of Cancer or the treatment of Cancer. We will pay for one treatment per day up to four treatments per calendar month per Covered Person for any combination of physical or speech therapy treatments up to a lifetime maximum of $1,000.

Hospice Care BenefitPays the indemnity amount for Hospice Care directed by a licensed Hospice organization, as defined in the policy, of a Covered Person expected to live six months or less due to Cancer. This benefit does not include: well baby care; volunteer services; meals; housekeeping services; or family support after the death of the Covered Person. Home Health Care BenefitPays the indemnity amount for a Covered Person’s Home Health Care, as described in the policy, required due to Cancer when prescribed by a Physician in lieu of Hospital Confinement beginning within 14 days after a Hospital Confinement. This benefit does not include: nutrition counseling; medical social services; medical supplies; prosthesis or orthopedic appliances; rental or purchase of durable medical equipment; drugs or medicines; child care; meals or housekeeping services. This benefit does not include physical or speech therapy. This benefit will be paid for up to the same number of days benefits were paid for the Covered Person’s preceding Hospital Confinement. If the Covered Person qualifies for coverage under the Hospice Care Benefit, the Hospice Care Benefit will be paid in lieu of this benefit. Waiver of PremiumIf the Primary Insured becomes disabled due to Cancer and remains so for more than 90 continuous days, we will pay all premiums due after the 90th day so long as the Primary Insured remains disabled. “Disabled” means the Primary Insured’s inability because of Cancer: to work at any job for which (s)he is qualified by education, training or experience; not working at any job for pay or benefits; and under the care of a Physician for the treatment of Cancer. This policy must be in force at the time disability begins and the Primary Insured must be under age 65.Experimental Treatment BenefitWe will provide coverage for Experimental Treatment prescribed by a Physician, as defined in the policy, the same as any other benefit covered under this policy. This benefit does not provide coverage for treatments received outside of the United States or its territories.Donor BenefitPays the indemnity amount shown for a donor’s expenses incurred on behalf of a Covered Person for a covered surgery due to organ transplant or a Bone Marrow/Stem Cell Transplant. Blood donor expenses are not covered under this benefit.Dread Disease BenefitPays an indemnity amount for each period of Hospital Confinement for treatment of a Dread Disease as defined in the policy, including: Addison’s Disease, Amyotrophic Lateral Sclerosis, Cystic Fibrosis, Diphtheria, Encephalitis, Grand Mal Epilepsy, Legionnaire’s Disease, Meningitis, Multiple Sclerosis, Muscular Dystrophy, Myasthenia Gravis, Niemann-Pick Disease, Osteomyelitis, Poliomyelitis, Reye’s Syndrome, Rheumatic Fever, Rocky Mountain Spotted Fever, Sickle Cell Anemia, Systemic Lupus Erythematosus, Tay-Sachs Disease, Tetanus, Toxic Epidermal Necrolysis, Toxic Shock Syndrome, Tuberculosis, Tularemia, Typhoid Fever, and Whipple’s Disease. Benefits for Dread Disease are ONLY provided under this benefit.Inpatient Special Nursing Services BenefitPays the indemnity amount shown for Full-time special nursing care (other than that regularly furnished by a Hospital) while a Covered Person is Hospital Confined for treatment of Cancer. “Full-time” means at least eight consecutive hours during a 24 hour period. Care must be provided by a Nurse, as defined by the Policy, be prescribed by a Physician and be Medically Necessary for the treatment of Cancer.See your policy for more information regarding the benefits listed above.

Plan Benefit Highlights (continued)

EligibilityThis policy will be issued only to those persons who meet American Fidelity’s insurability requirements, which includes satisfactory responses to medical questions. The Hospital Intensive Care Unit Rider will not cover heart conditions for a period of two years following the Effective Date of coverage for anyone who has been diagnosed or treated for any heart related condition prior to the 30th day following the Covered Person’s Effective Date of coverage.Cancer means a disease which is manifested by autonomous growth (malignancy) in which there is uncontrolled growth, function, or spread (local or distant) of cells in any part of the body. This includes Cancer in situ and malignant melanoma. It does not include other conditions which may be considered precancerous or having malignant potential such as: leukoplakia; hyperplasia; polycythemia; actinic keratosis; myelodysplastic and non–malignant myeloproliferative disorders; aplastic anemia; atypia; non–malignant monoclonal gamopathy; carcinoid; or pre–malignant lesions, benign tumors or polyps.This product is inappropriate for those people who are eligible for Medicaid Coverage.

Base PolicyAll diagnosis of Cancer must be positively diagnosed by a legally licensed doctor of medicine certified by the American Board of Pathology or American Board of Osteopathic Pathology. This policy pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. This policy also covers other conditions or diseases directly caused by Cancer or the treatment of Cancer. No benefits are payable for any Covered Person for any loss incurred during the first year of this policy as a result of a Pre–Existing Condition. A Pre-Existing Condition is a Specified Disease for which, within 12 months prior to the Effective Date of coverage, medical advice, consultation or treatment, including prescribed medications, was recommended by or received from a member of the medical profession; for which symptoms manifested in such a manner as would cause an ordinarily prudent person to seek diagnosis, medical advice, or treatment. Pre–Existing Conditions specifically named or described as excluded in any part of this contract are never covered. This policy contains a 30-day waiting period during which no benefits will be paid under this policy. If any Covered Person has a Specified Disease diagnosed before the end of the 30-day period immediately following the Covered Person’s Effective Date, coverage for that person will apply only to loss that is incurred after one year from the Effective Date of such person’s coverage. If any Covered Person is diagnosed as having a Specified Disease during the 30-day period immediately following the Effective Date, you may elect to void the policy from the beginning and receive a full refund of premium. All benefits are payable only up to the maximum amount listed in the Schedule of Benefits in the policy.

Critical Illness RiderBenefits will only be paid for a Covered Critical Illness as shown on the Policy Schedule page in the policy. No benefits will be provided for any loss caused by or resulting from: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; or intentional self-injury; or alcoholism or drug addiction; or any act of war, declared or undeclared or any act related to war; or military service for any country at war; or a Pre-Existing Condition during the 12 month period following the Covered Person’s Effective Date (Pre-Existing Condition, as defined in this rider means any sickness or condition for which, within 12 months prior to the Effective Date of coverage under this rider, medical advice, consultation or treatment, including prescribed medications, was recommended by or received from a member of the medical profession, or for which symptoms manifested in such a manner as would cause an ordinarily prudent person to seek diagnosis, medical advice or treatment.); or a Covered Critical Illness when the Date of Diagnosis occurs during the waiting period, if applicable; or participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a Physician or taken according to the Physician’s instructions; or participation in, or attempting to participate in, a felony, riot or insurrection (A felony is as defined by the law of the jurisdiction in which the activity takes place.). Internal Cancer does not include: other conditions that may be considered pre–cancerous or having malignant potential such as: acquired immune deficiency syndrome (AIDS); or actinic keratosis; or myelodysplastic and non–malignant myeloproliferative disorders; or aplastic anemia; or atypia; or non–malignant monoclonal gamopathy; or pre–malignant lesions, benign tumors or polyps; or Leukoplakia; or Hyperplasia; or Carcinoid; or Polycythemia; or cancer in situ or any skin cancer other than invasive malignant melanoma into the dermis or deeper.

Hospital Intensive Care Unit RiderNo benefits will be provided during the first two years of this rider for Hospital Intensive Care Unit confinement caused by any heart condition when any heart condition was diagnosed or treated prior to the 30th day following the Covered Person’s Effective Date of this rider (The heart condition causing the confinement need not be the same condition diagnosed or treated prior to the Effective Date.). Confinement caused by any other pre-existing condition will be covered as long as the confinement begins on or after the effective date of this rider. No benefits will be provided if the loss results from: attempted suicide whether sane or insane; intentional self–injury; alcoholism or drug addiction; or any act of war, declared or undeclared, or any act related to war; or military service for any country at war. No benefits will be paid for confinements in units such as: Surgical Recovery Rooms, Progressive Care, Burn Units, Intermediate Care, Private Monitored Rooms, Observation Units, Telemetry Units or Psychiatric Units not involving intensive medical care; or other facilities which do not meet the standards for Intensive Care Unit as defined in the Rider. For a newborn child born within the ten–month period following the effective date of this rider, no benefits will be provided for Hospital Intensive Care Unit Confinement that begins within the first 30 days following the birth of such child

Termination of InsuranceThis policy/rider(s) will terminate and coverage will end for all Covered Persons on the earliest of: the end of the grace period if the premium remains unpaid; or the end of the Policy/Rider(s) Month in which we receive a written request from you to terminate this policy/rider(s); or the date of your death, if this is an Individual Plan; or the date insurance has ceased on all persons covered under this policy/rider(s).

Limitations and Exclusions

SB-32223(TX)-0818 Policy Form Series C11 Plan Codes 013-746, 013-747

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

Underwritten and administered by:

Optional Benefit Rider Monthly Premiums*

Critical Illness Rider Monthly Premiums

Base Plan Monthly Premiums*

CanCer Only$2,500 $5,000 $7,500 $10,000

Ind 1 ParentFamily

2 ParentFamily Ind 1 Parent

Family2 ParentFamily Ind 1 Parent


Family2 ParentFamily

18-40 1.50 2.20 2.90 3.00 4.40 5.80 4.50 6.60 8.70 6.00 8.80 11.60

41-50 3.00 4.50 5.80 6.00 9.00 11.60 9.00 13.50 17.40 12.00 18.00 23.20

51-60 4.90 7.30 9.40 9.80 14.60 18.80 14.70 21.90 28.20 19.60 29.20 37.60

61+ 7.10 10.60 13.80 14.20 21.20 27.60 21.30 31.80 41.40 28.40 42.40 55.20

Heart attaCk/StrOke Only$2,500 $5,000 $7,500 $10,000

Ind 1 ParentFamily

2 ParentFamily Ind 1 Parent



Family2 ParentFamily

18-40 0.80 1.20 1.50 1.60 2.40 3.00 2.40 3.60 4.50 3.20 4.80 6.00

41-50 2.10 3.10 4.10 4.20 6.20 8.20 6.30 9.30 12.30 8.40 12.40 16.40

51-60 3.10 4.60 6.00 6.20 9.20 12.00 9.30 13.80 18.00 12.40 18.40 24.00

61+ 4.60 6.90 8.90 9.20 13.80 17.80 13.80 20.70 26.70 18.40 27.60 35.60

Hospital Intensive Care Unit Rider Monthly Premiums

*The premium and amount of benefits provided vary based upon the plan selected. This is a brief description of the coverage. For complete benefits and other provisions, please refer to the policy and riders. This coverage does not replace Workers’ Compensation Insurance. These products are inappropriate for people who are eligible for Medicaid Coverage.

View and print your policies or file a claim at americanfidelity.com

American Fidelity’s Online Service Center provides you convenient, secure access to manage your account.

BaSiC 18-40 41-50 51-60 61+

Individual 16.30 23.60 32.60 44.20

1 Parent Family 24.40 35.20 48.70 65.90

2 Parent Family 31.80 45.70 63.30 85.80

enHanCed 18-40 41-50 51-60 61+

Individual 21.00 30.80 42.40 57.30

1 Parent Family 31.40 45.80 63.30 85.60

2 Parent Family 40.80 59.50 82.30 111.30

iCU rider 18-40 41-50 51-60 61+

Individual 3.40 4.20 5.50 7.10

1 Parent Family 5.10 6.30 8.20 10.60

2 Parent Family 6.60 8.20 10.70 13.80

Optional Benefit Rider Monthly Premiums*

Guaranteed RenewableYou are guaranteed the right to renew your base policy during your lifetime as long as you pay premiums when due or within the premium grace period. We have the right to increase premiums by class.

Cancer Insurance Premiums

ACCIDENTAL DEATH & DISMEMBERMENT BENEFIT

BASIC PRIMARY SPOUSE CHILD

Common Carrier $50,000 $50,000 $25,000

Other Accident $15,000 $15,000 $7,500

Dismemberment $1,000 to $15,000 $1,000 to $15,000 $500 to $7,500

ENHANCED PRIMARY SPOUSE CHILD

Common Carrier $100,000 $100,000 $50,000

Other Accident $30,000 $30,000 $15,000

Dismemberment $1,500 to $30,000 $1,500 to $30,000 $750 to $15,000

Benefits for Policy and Enhancement Rider

AF™ Limited Benefit Accident Only Insurance

AF™ Accident Only Insurance

1Hypothetical example of a covered accident based on policy AO-03 and rider AMDI-258 Series.

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

THIS IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER

DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM

BY PURCHASING THIS POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER,

THE EMPLOYER LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE

UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY

WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

BASIC ENHANCED

Accident Emergency Treatment $150 $200

Accident Follow-Up Treatment (4 visits) $200 $200

Physical Therapy (8 treatments) $200 $200

Medical Imaging $200 $200

X-Ray $50 $100

Appliances $100 $100

Surgical Facility $150 $250

Torn Knee Cartilage Repair $500 $500

Anesthesia $150 $200

Prepare for the unexpected.You cannot plan for when an accident will happen, but you can plan for unexpected medical expenses. AF™ Limited Benefit Accident Only Insurance provides coverage to help with unforeseen accident expenses. Start providing financial protection today if an accident suddenly occurs.

TOTAL $1,700 1,950

Paid directly to you!

Annual Wellness Benefit

$75

ENHANCED

$50

BASIC

An Accident is defined as a sudden, unexpected and unintended event, which results in bodily injury, which is independent of disease or bodily infirmity or any other cause.

EMERGENCY ACCIDENT Hypothetical Example 1

Twisted knee in the parking lot resulting in a torn meniscus and treatment is received within 72 hours.

WELLNESS BENEFIT BASIC ENHANCED

WELLNESS

Annual Routine Physical Exam Requires a 12-month waiting period before use. One exam per policy per calendar year

$50 $75

MONTHLY PREMIUMS For Policy And Benefit Enhancement Rider**

BASIC ENHANCED

Individual $19.90 $26.10

Individual & Spouse $28.30 $34.90

Individual & Child(ren) $31.50 $41.00

Family $39.90 $49.80

ALL COVERAGE LEVELS

Schedule of Benefits for Policy and Enhancement Rider

ACCIDENT BENEFITS BASIC ENHANCED

EMERGENCY ACCIDENT TREATMENT

Accident Emergency Treatment $150 $200

Emergency Accident Follow-up Treatment (up to four treatments)

$50 $50

NON-EMERGENCY ACCIDENT TREATMENT

Non-Emergency Accident Initial Treatment

$75 $100

Non-Emergency Accident Follow-up Treatment (up to two treatments)

$50 $50

MEDICAL IMAGING

MRI, CT, CAT, PET, US $200 $200

X-Rays $50 $100

HOSPITAL CONFINEMENT

Hospital Admission $500 $1,000

Intensive Care Unit (up to 15 days)

$300 $600

Hospital Confinement (up to 365 days)

$100 $200

AMBULANCE

Ground $300 $300

Air $1,500 $1,500

TREATMENT

Outpatient Hospital or Ambulatory Surgical Center $150 $250

Anesthesia $150 $200

TRANSPORTATION BENEFITS

Transportation Patient only, per round trip for up to 3 round trips per calendar year

$300 $300

Family Member Lodging and MealsPer day per accident; up to 30 days per confinement

$100 $100

ALL COVERAGE LEVELS

ACCIDENT INJURY BENEFITS ALL COVERAGE LEVELS

INJURY TREATMENT

Fractures Benefit Depending on open or closed reduction, bone involved, or chip fracture

$25 to $3,000

Lacerations Benefit Not requiring sutures

Sutured lacerations up to two inches

Sutured lacerations totaling two to six inches

Sutured lacerations totaling over six inches

$25

$100$200$400

Appliances Benefit Crutches, leg braces, etc.

$100

Torn Knee Cartilage or Ruptured Disc Benefit $500

Eye Injury BenefitInjury with surgical repair, for one or both eyes

Removal of foreign body by a physician, for one or both eyes

$250$50

Dislocations BenefitDepending on open or closed reduction, with or without anesthesia and joint involved.

$25 to $3,000

Concussion Benefit $200

2nd & 3rd Degree BurnsSkin grafts are 25% of benefit

$100 to $10,000

Internal Injuries BenefitResulting in open abdominal or thoracic surgery

$1,000

Paralysis Benefit: Paraplegia / Quadriplegia$5,000 / $10,000

Tendons, Ligaments, and Rotator Cuff BenefitOne tendon, ligament, or rotator cuff

More than one tendon, ligament, or rotator cuff

$500$750

Blood, Plasma, and Platelets Benefit $250

Exploratory Surgery without Surgical Repair Benefit $250

Physical Therapy Benefit Per treatment up to eight treatments

$25

Prosthesis Benefit $500

Emergency Dental Work Benefit Broken teeth repaired with crownExtraction of broken teeth (regardless of number)

$150$50

**The premium and amount of benefits provided vary based upon the plan selected.

Eye Injury Benefit Payable for one or both eyes requiring treatment by a Physician due to an Accident.

Family Member Lodging and Meals Benefit Payable for lodging and meals for a family member to be near a Person who is Hospital Confined in a non-local Hospital. The Hospital must be at least 50 miles away, one way from closer of the Covered Person’s residence or site of the Accident.

Fractures Benefit Varies based on the bone involved, type of fracture and type of treatment. If the Person fractures more than one bone, payment is made for all fractures up to two times the amount for the bone involved that has the highest benefit amount.

Hospital Admission Benefit Pays per admission for confinement to a Hospital. This benefit does not pay for outpatient treatment, emergency room treatment, or a stay of less than 18 hours in an observation unit.

Hospital Confinement Benefit Pays a daily benefit for a Hospital Confinement that is longer than 18 hours for up to 365 days.

Intensive Care Unit Benefit Payable for each day of confinement in an Intensive Care Unit, as defined in the policy, up to 15 days. This benefit is paid in addition to the Hospital Confinement Benefit amount.

Internal Injuries Benefit Payable for an open abdominal or thoracic surgery performed within 72 hours.

Lacerations Benefit This benefit varies based on the severity of the laceration due to an Accident.

Medical Imaging Benefit Payable for a Magnetic Resonance Imaging (MRI), a Computed Tomography (CT) scan, a Computed Axial Tomography (CAT) scan, a Positron Emission Tomography (PET) scan or an ultrasound due to an Accident.

Non-Emergency Accident Initial Treatment Benefit Payable for initial medical treatment when treatment is received more than 72 hours after the Accident. Initial medical treatment must: (1) be received in a Physician’s office or emergency room; and (2) be the first treatment; and (3) occur within 30 days.

Non-Emergency Accident Follow-Up Treatment Benefit Payable only if the Non-Emergency Accident Initial Treatment Benefit is payable and later requires additional follow-up treatment. We will pay for up to two follow-up treatments. Not payable for the same visit that the Physical Therapy Benefit or the Accident Follow-Up Benefit is paid.

Outpatient Hospital or Ambulatory Surgical Center Benefit When a surgical procedure is performed on an outpatient basis in a Hospital or at an Ambulatory Surgical Center, we will pay the indemnity amount shown in the Schedule of Benefits for the facility fee charged by such Hospital or Ambulatory Surgical Center. We will only pay one Outpatient Hospital or Ambulatory Surgical Center Benefit in a 24-hour period even if more than one surgical procedure is performed. This benefit will not be paid for surgery performed in a Hospital emergency room or in a Physician’s office.

Paralysis Benefit The duration of the Paralysis must be a minimum of 3 consecutive months. Paid once per lifetime per Person.

Physical Therapy Benefit Payable for one treatment per day for up to eight treatments by a caregiver licensed in physical therapy. This benefit is not payable for the same visit that the Accident Follow-Up Treatment Benefit or Non-Emergency Follow-Up Benefit is paid.

Prosthesis Benefit Payable for the use of a Prosthesis. This benefit is not payable for hearing aids; dental aids; eyeglasses; false teeth; cosmetic aids such as wigs ; or joint replacements such as artificial hips or knees.

A Covered Person (thereafter referred to as “Person”) under AF™ Limited Benefit Accident Only Insurance Policy can expect the following benefits when a Covered Accident (thereafter referred to as “Accident”) happens. All benefits are paid once per Person per Accident unless otherwise specified. All benefits are only paid as a result of Injuries received in an Accident that occurs while coverage is in force. All treatment, procedures, and medical equipment must be diagnosed, recommended and treated by a Physician. These references are not intended to change or modify any definitions in the AO-03 policy series.

Accident Emergency Treatment Benefit Payable for receiving emergency treatment in a Physician’s office or emergency room within 72 hours, including physician fees and emergency services.

Accident Follow-Up Treatment Benefit Payable for necessary follow-up treatment of Injuries in addition to the emergency treatment administered within 72 hours for up to four treatments. Not payable for a visit in which a Physical Therapy Benefit or Non-Emergency Follow-Up Benefit is paid.

Accidental Death and Dismemberment Benefit The applicable benefits apply when an Accidental Death or Dismemberment occurs within 90 days of an Accident. In the event that Accidental Death and Dismemberment result from the same Accident, only the Accidental Death Benefit will be paid.

Ambulance Benefit If air and ground ambulance transportation is required for the same Accident, only the highest benefit will be paid.

Anesthesia Benefit Pays the amount shown in the Schedule of Benefits for the services of an anesthesiologist for a surgery performed due to an Accident. Hospital Confinement is not required to receive this benefit. We will only pay one Anesthesia Benefit per Person in a 24-hour period even if more than one surgical procedure is performed. This benefit is not payable for local anesthesia.

Appliances Benefit Payable for one of the following: crutches, leg braces, back braces, walkers, or wheel chairs. Not payable for Prosthetic Devices.

Blood, Plasma and Platelets Benefit Payable for blood, plasma and platelets. This benefit does not provide benefits for immunoglobulins.

Burns Benefit Payable for 2nd and 3rd degree burns when treated by a Physician within 72 hours.

Concussion Benefit Payable for a Person who sustains a concussion and is diagnosed by a Physician within 72 hours using any type of medical imaging.

Dislocations Benefit Amount payable varies by the joint involved, type of treatment, and type of anesthesia. If a Person receives more than one Dislocation in an Accident, we will pay for all Dislocations up to two times the amount shown in the Schedule of Benefits for the Dislocation involved that has the highest benefit amount. No other amount will be paid under this benefit. Benefits are payable only for the first dislocation of a joint which occurs while this policy is in force.

Emergency Dental Work Benefit Payable for repair to natural teeth when treated by a Physician or dentist. Initial dental treatment must be received within 72 hours.

Exploratory Surgery without Surgical Repair Benefit Payable when an exploratory surgical operation without surgical repair is performed.

Plan Highlights

Tendons, Ligaments and Rotator Cuff Benefit Payable for the repair of one or more tendons, ligaments, or rotator cuffs. The tendons, ligaments, or rotator cuff must be repaired through surgery performed by a Physician, as a result of an Accident.

Torn Knee Cartilage or Ruptured Disc Benefit Payable for surgical repair as a result of an Accident.

Transportation Benefit Payable for the transportation when specialized treatment and Hospital Confinement in a non-local Hospital is required. A non-local Hospital must be at least 50 miles away, one way, using the most direct route, from the closer of the Person’s residence or site of the Accident. Travel must be by scheduled bus, plane, train, or by car. Ambulance service does not qualify for this benefit. The treatment must be prescribed by a Physician and not be available locally. This benefit is payable up to three round trips per Calendar Year.

Wellness Benefit After coverage is in force for the waiting period shown, you can receive a benefit for an annual routine physical exam, including immunizations and preventive testing. Services must be supervised by a Physician and a charge must be incurred for the service. The benefit does not apply to dental or eye exams and is payable once per policy per calendar year.

Limitations and Exclusions For Policy and Benefit Enhancement Rider

No benefits will be provided for an Accident that is caused by or occurs as a result of: (1) intentionally self-inflicted bodily injury, suicide or attempted

suicide, whether sane or insane;(2) participation in any form of flight aviation other than as a fare-

paying passenger in a fully licensed/passenger-carrying aircraft;(3) any act that was caused by war, declared or undeclared, or

service in any of the armed forces;(4) participation in any activity or event while under the influence

of any narcotic unless administered by a Physician or taken according to the Physician’s instructions;

(5) participation in, or attempting to participate in, a felony, riot or insurrection. (A felony is as defined by the law of the jurisdiction in which the activity takes place.)

(6) participation in any sport for pay or profit;(7) participation in any contest of speed in a power driven vehicle

for pay or profit;(8) participation in parachuting, bungee jumping, rappelling,

mountain climbing or hang gliding.

Plan Highlights (cont.)Benefits will not be provided for medical treatment for an Accident received outside the United States or its territories. Benefits will not be paid for services rendered by a member of the immediate family of a Covered Person.

An Accident is defined as a sudden, unexpected and unintended event, which results in bodily injury, which is independent of disease or bodily infirmity or any other cause. The policy will not pay benefits for injuries received prior to the Effective Date of coverage that are aggravated or re-injured by any event that occurs after the Effective Date.

A hospital is not an institution, or part thereof, used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a rehabilitative facility; an extended-care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction.

Eligibility includes you, your lawful spouse and each unmarried natural, adopted or step child who is under 26 years of age.

Guaranteed Renewable

You cannot be singled out for a rate increase for any reason. The Insurer has the right to increase premium rates only if rates for all policies in this class change.

Termination Notice

Policy/rider(s) will terminate and coverage will end for all Covered Persons on the earliest of: the end of the grace period if the premium remains unpaid; or the end of the Policy/Rider(s) Month in which we receive a written request from you to terminate this policy/rider(s); or the date of your death, if this is an Individual Plan. If the plan is other than Individual the remaining Covered Persons may have the right to continue or convert their coverage. Coverage for any Covered Person will terminate when they no longer meet the eligibility requirements.

SB-25787(TX)(FFGA)-0619 Policy AO-03 Series and AMDI-258 Series

013-383, 013-384

Refer to Plan Benefit Highlights section for more Benefit Descriptions on the Accident Only Insurance Policy and Benefit Enhancement Rider.

This brochure contains a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the policy, AO-03, and Accident Only Benefit Enhancement Rider, AMDI-258 series. This coverage does NOT replace Workers’ compensation Insurance. Availability of riders may vary by employer. This product is inappropriate for people who are eligible for Medicaid coverage.

First Financial Group of America11811 N. Freeway, Suite 900 Houston, TX 77060Local: (281) 847-8422 / Toll Free: (800)523-8422www.ffga.com

Marketed by:

Underwritten and administered by:

AF™ Limited Benefit Accident Only Insurance

American Fidelity Assurance Company 9000 Cameron Parkway, Oklahoma City, Oklahoma 73114800-662-1113 • americanfidelity.com

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

Underwritten By

purelife-plusPortable, Permanent Individual Life Insurance for the Employee and Family

Flexible Premium Life Insuranceto Age 121

Policy Form: ICC18-PRFNG-NI-18

Product HighlightsPermanent Life Insurance

to Age 121

Minimal Cash ValuePremiumsDedicated Primarily

to Purchase Life Insurance

Level PremiumGuaranteesCoverage for a Significant

Period of Time

Unique Limited Right to PartialRefund of Premium if Future

Premium Required toContinue Coverage Increases

No Surrender Charges Apply

Accelerated Death Benefit Dueto Terminal Illness Included

ConvenientPremiumPaymentsThrough Payroll Deduction

Portable When You LeaveEmployment

Accidental Death BenefitIncluded for Selected Ages

Accelerated Death Benefit Dueto Chronic Illness Included

For Employee Only

Application for Life InsuranceExpress Issue | Monthly Pay

for use only inTexas

For the eligible employees ofECTOR COUNTY ISD

Marketed by

Portable, Permanent, Individual Life Insurance for Employees and Their FamiliesAs an employee, you can apply for valuable life insurance protection on you and your family under eligibility guidelinesestablished for your employer. Your employer has conveniently agreed to permit you to pay premiums through payrolldeduction. This is a summary only. Policy provisions prevail. This brochure is not a contract or an offer to contract.

Minimal Cash Values Buy this policy for its life insurance pro-tection, not its cash value. The primary benefit is life insurance.Payment of the Table Premiumproduces a small cash value (Bench-mark Cash Value).

Permanent Life Insurance Coverage Unlike group term life insur-ance, PureLife-plus is a personally owned, permanent individual lifeinsurance policy to age 121 that can never be canceled or reducedas long as you pay the necessary premiums, even if your healthchanges.

Guaranteed Period Continuous, timely, and uninterrupted pay-mentof theTablePremiumguaranteescoverage for theGuaranteedPeriod shown. Texas Life (We) cannot legally predict the premiumrequired to continue coverage after the Guaranteed Period. It maybe lower, the same, or higher than the Table Premium. However, ifthe premium to continue coverage is ever higher, We guarantee alimited right to a partial refund of premium (described below).

Guaranteed Limited Right to Partial Refund of Premium If a pre-mium higher than the Table Premium is ever required to continuecoverage after the Guaranteed Period, you have the choice to:

a. Pay the higher premium(s) required to continue coverage; or,b. Surrender the policy and receive a partial refund of premium

equal to 120 times the minimum monthly premium due atissue (ten years worth of Table Premium). You are eligiblefor this refund if the actual cash value equals or exceeds theBenchmark Cash Value and you have taken no prior partialsurrenders.

Portable Once issued, continued employment is not a conditionto continue coverage. Coverage is guaranteed as long as requiredpremiums are paid, even after you retire or terminate employment.When employment ends, you can pay equivalent monthly premi-ums directly or by bank draft (for monthly direct payments we addamonthly fee not to exceed $2.00). Other modes are available.

Accelerated Death Benefit Due to Terminal Illness Rider This policyincludes, at no additional premium, an Accelerated Death BenefitDue to Terminal Illness Rider (Form ICC07-ULABR-07). See details onnext page.

Individual and Family Coverage is Easy to Apply For Subject toage and amount restrictions, you may apply for an individualpolicy on your life or your spouse’s life (see chart next page forspouse’s minimum/maximum amounts). An individual policy is

also available on each of your children ages 15 days — 26, andeven on each of your grandchildren ages 15 days — 18. Proof ofinsurability is required. Most policies are issued based upon theanswers to three work and health related application questions.

Optional Benefits According to the guidelines established for youremployer, your application will include the following benefit for anadditional cost depending upon your issue age.

Accidental Death Benefit This benefit to age 65 (Issue Ages17-59) doubles the coverage when death occurs by accidentalbodily injury within 180 days of an accident. Maximum in-forcelimits and exclusions apply. (Form ICC07-ULCL-ADB-07).

Accelerated Death Benefit Rider For Chronic Illness ForEmployee Only This benefit provides an accelerated deathbenefit if an insured becomes chronically ill as defined in therider. (Form ICC15-ULABR-CI-15). See details on next page.

Interim Insurance: Interim insurancewill be inforceontheapplica-tion date if these conditions are met: (1) the insurance is purchasedthroughpayroll deduction; (2) the Salary DeductionAuthorization issigned; and, (3) the proposed insured is insurable at standard ratesunder Our rules and usual practice. Interim insurance remainsin effect until the earlier of: (a) the Policy Date; (b) the date Wedecline the application; (c) the date We notify the applicant thats/he is ineligible for interim insurance; or, (d) the 180th day afterthe application date.

PolicyMechanicsandOther ImportantDetails Premiums are flexi-ble. However, wehighly recommendpayment of the Table Premiumduring the Guaranteed Period, and no partial surrenders or policyloans. Table Premium produces a small cash value (BenchmarkCash Value). Paying a lesser premium results in an actual cashvalue which is less than Benchmark Cash Value, causing the policyto lapse. Premiums less a premium load create cash value to paymonthly administrative loads and cost of insurance. Cash value iscurrently credited at the guaranteed interest rate of 3.00% per year.We may, at any time, credit higher than the guaranteed interestrate. Likewise,Wemay charge cost of insurance rates which are lessthan the policy’s maximum rates, but only when actual cash valueequals or exceeds Benchmark Cash Value. No surrender chargesapply. Loads include 10.00% of premium, $2.03 per month andmonthly administrative loads. Two year suicide and contestableclauses apply. The policy loan rate is 7.40% in advance. Surrendersand loans may be deferred for up to six months.


Since 1901 900 washington ave post office box 830 waco, texas 76703-0830 800-283-9233 254-752-6521 www.texaslife.com

A Summary of the Accelerated Death Benefit Rider

Terminal Illness - included at no additional cost

The policy includes an Accelerated Death Benefit Due to Terminal Illness Rider. If the Insured has a terminal illness, in lieu of

the insurance proceeds otherwise payable at death, you may elect to claim an accelerated benefit while the Insured is still alive.

The single sum benefit is 92% of the insurance proceeds less an administrative fee of the lesser of $150 or 7% of the insurance

proceeds. Terminal Illness is an injury or sickness diagnosed and certified by a qualifying physician that, despite the appropri-

ate medical care, is reasonably expected to result in death within 12 months. This benefit is intended to qualify for favorable

income tax treatment and may not be subject to federal income tax. (See Important Notices below.)

Chronic Illness - included with an additional premium, for employee only

For an additional premium of 10% of the base policy premium, this policy may include an Accelerated Death Benefit Due to

Chronic Illness Rider. If the Insured has a chronic illness, in lieu of the insurance proceeds otherwise payable at death, you

may elect to claim an accelerated benefit while the Insured is still alive. The single sum benefit is 92% of the insurance pro-

ceeds less an administrative fee of the lesser of $150 or 7% of the insurance proceeds. Chronic Illness means the Insured per-

manently: (a) is unable to perform, without substantial assistance from another individual, at least two Activities of Daily Liv-

ing due to a loss of functional capacity and will need services for the rest of his or her life; or (b) requires substantial supervi-

sion to protect the Insured from threats to health and safety due to severe cognitive impairment and will need services for the

rest of his or her life. Activities of Daily Living include: bathing, continence, dressing, eating, toileting, and transferring. Se-

vere cognitive impairment means deterioration or loss of intellectual capacity that: (1) places the Insured in jeopardy of harm-

ing himself or herself or others, and therefore, the Insured requires substantial supervision by another person; and (2) is mea-

sured by clinical evidence and standardized tests which reliably measure impairment in: (a) short or long term memory; (b) ori-

entation to people, places or time; and (c) deductive or abstract reasoning.

This benefit will be calculated and paid as a lump sum only. This lump sum is intended to serve as a per diem accelerated

death benefit as described under Section 101(g) of the Internal Revenue Code. You may be able to exclude certain portions of

this accelerated death benefit (specifically, the greater of: (a) the lump sum equivalent of the per diem amount; or (b) the actual

cost incurred for Services provided in the year the Accelerated Death Benefit is paid) from your taxable income. Your benefit

for Chronic Illness will be calculated in accordance with the rider and you may, in some circumstances, be paid more than the

excludable per diem amount.

Important Notices

Tax laws related to the acceleration of life insurance benefits are complex. The information presented in this Summary is gen-

eral in nature. You should consult a qualified tax or legal advisor to determine the effect of receiving this benefit. Texas Life

Insurance Company and its agents do not provide tax or legal advice.

Receipt of any accelerated death benefit under your policy may affect your, your spouse’s and your family’s eligibility for medical

assistance (Medicaid), Aid to Families with Dependent Children (AFDC), Supplemental Social Security Income (SSI), and drug

assistance programs. You should consult with a qualified tax or legal advisor and the relevant social service agencies to deter-

mine how receiving the benefit may affect your, your spouse’s, and your family’s eligibility for public assistance.

An accelerated death benefit is not long term care insurance. This summary provides a general description of any accelerated

death benefit under your policy. Your policy and riders contain certain exclusions, limitations, and exceptions. Please refer to

your policy and rider for details. The right to accelerate benefits under any accelerated death benefit does not extend to any

Child Term Life Insurance Rider. However, if the accelerated death benefit under any rider is paid, any coverage provided un-

der the Child Term Life Insurance Rider attached to this policy becomes a paid up term insurance policy on each covered child.

This paid up coverage on each child will terminate on each covered child’s 25th birthday. Payment under any accelerated death

benefit rider terminates the policy and all other optional benefits/riders and reduces all insurance proceeds, cash values and

loan values to zero.

18P061 PLP18 CI

Representation of benefit payable - Terminal or Chronic Illness

The following chart shows the effect of exercising an accelerated benefit on the base policy. This example is using a $50,000 pol-

icy with a $2,000 policy loan balance and all premiums are current. This chart is for representation purposes only. Your bene-

fits may be higher or lower, depending on your face amount of coverage, any unpaid policy loan balance, and any overdue pre-

miums.

Terminal Chronic

Illness Illness

Death Benefit $50,000 $50,000

Policy Loan Balance - $2,000 - $2,000

Available for Acceleration = $48,000 = $48,000

Acceleration Percentage x 92% x 92%

Gross Benefit = $44,160 = $44,160

Administration Fee - $150 - $150

Overdue Premiums - $0 - $0

Accelerated Benefit Payable = $44,010 = $44,010

Note: The benefit will be paid for either Terminal Illness or Chronic Illness. In no instance will benefits be paid

under both riders.

18P061 PLP18 CI

optional benefits monthly cost:

Accidental Death Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $0.08 per $1,000 of Face AmountAccelerated Death Benefit Rider For Chronic Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10% of Base Plan Table Premium

Express Issue Amounts of Coverage Available on Spouse

Spouse’s Minimum MaximumIssue Age Face Amount Face Amount

17-34 $25,000 $50,000

35-39 15,000 50,000

40-49 10,000 50,00050-60 10,000 25,000

61 & Older N/A N/A


Monthly Administrative Loads Per $1,000 of Face Amount for Issue Ages Shown

(Non-Tobacco Class)

Issue Age −−−→ 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Highest Load 0.1975 0.1975 0.2067 0.2067 0.2167 0.2167 0.2167 0.2167 0.2167 0.2159 0.2150 0.2225 0.2184 0.2117 0.2017Lowest Load 0.0292 0.0234 0.1892 0.1950 0.1642 0.1717 0.1792 0.1884 0.1992 0.0009 0.0250 0.0142 0.0609 0.1192 0.0009

Zero After Year 6 6 5 5 5 5 5 5 5 6 6 6 6 6 7

Issue Age −−−→ 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29


Zero After Year 7 7 7 7 7 7 7 7 7 7 7 7 6 6 6

Issue Age −−−→ 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44


Zero After Year 6 7 7 6 6 6 6 6 6 5 5 5 4 4 4

Issue Age −−−→ 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59


Zero After Year 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2

Issue Age −−−→ 60 61 62 63 64 65 66 67 68 69 70

Highest Load 1.9175 2.0117 2.1084 2.2075 2.3109 2.4184 2.5400 2.6734 2.8159 2.9534 3.0742Lowest Load 1.3500 1.3950 1.4484 1.5092 1.5767 1.6525 1.7284 1.8067 1.8934 1.8875 1.7592

Zero After Year 2 2 2 2 2 2 2 2 2 2 2

Monthly Administrative Loads Per $1,000 of Face Amount for Issue Ages Shown

(Tobacco Class)

Issue Age −−−→ 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


Zero After Year 4 5 5 5 5 5 4 5 5 5 5 5 5 4 4

Issue Age −−−→ 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46


Zero After Year 4 4 4 4 4 4 4 4 4 4 3 3 3 3 3

Issue Age −−−→ 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61


Zero After Year 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2

Issue Age −−−→ 62 63 64 65 66 67 68 69 70

Highest Load 2.5217 2.5917 2.6484 2.7000 2.7609 2.8300 2.8967 2.9625 3.0192Lowest Load 2.2692 2.2692 2.2084 2.1534 2.0884 2.0150 1.9434 1.8725 1.8117

Zero After Year 2 2 2 2 2 2 2 2 2


Non

-Tob

acco

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

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

Monthly Premiums for Life Insurance Face Amounts Shown PERIOD

Includes Added Cost for Age to Which

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

Age Guaranteed at

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

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

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

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


Tob

acco


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

Monthly Premiums for Life Insurance Face Amounts Shown PERIOD

Includes Added Cost for Age to Which

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

Age Guaranteed at

(ALB) $10,000 $25,000 $50,000 $75,000 $100,000 $150,000 $200,000 $250,000 $300,000 Table Premium15D-1 832-3 834-10 7911-16 7517-20 15.00 27.75 40.50 53.25 78.75 104.25 129.75 155.25 7021-22 15.50 28.75 42.00 55.25 81.75 108.25 134.75 161.25 7023-25 16.25 30.25 44.25 58.25 86.25 114.25 142.25 170.25 69

26 16.50 30.75 45.00 59.25 87.75 116.25 144.75 173.25 6927 16.75 31.25 45.75 60.25 89.25 118.25 147.25 176.25 6828 17.00 31.75 46.50 61.25 90.75 120.25 149.75 179.25 6829 17.25 32.25 47.25 62.25 92.25 122.25 152.25 182.25 68

30-31 19.25 36.25 53.25 70.25 104.25 138.25 172.25 206.25 6932 19.75 37.25 54.75 72.25 107.25 142.25 177.25 212.25 6933 20.00 37.75 55.50 73.25 108.75 144.25 179.75 215.25 6934 20.25 38.25 56.25 74.25 110.25 146.25 182.25 218.25 6835 21.50 40.75 60.00 79.25 117.75 156.25 194.75 233.25 6936 22.25 42.25 62.25 82.25 122.25 162.25 202.25 242.25 6937 23.50 44.75 66.00 87.25 129.75 172.25 214.75 257.25 7038 24.25 46.25 68.25 90.25 134.25 178.25 222.25 266.25 7039 25.75 49.25 72.75 96.25 143.25 190.25 237.25 284.25 7040 12.55 28.00 53.75 79.50 105.25 156.75 208.25 259.75 311.25 7241 13.25 29.75 57.25 84.75 112.25 167.25 222.25 277.25 332.25 7342 14.15 32.00 61.75 91.50 121.25 180.75 240.25 299.75 359.25 7443 15.55 35.50 68.75 102.00 135.25 201.75 268.25 334.75 401.25 7644 16.35 37.50 72.75 108.00 143.25 213.75 284.25 354.75 425.25 7745 17.45 40.25 78.25 116.25 154.25 230.25 306.25 382.25 458.25 7846 18.45 42.75 83.25 123.75 164.25 245.25 326.25 407.25 488.25 7947 19.45 45.25 88.25 131.25 174.25 260.25 346.25 432.25 518.25 7948 20.45 47.75 93.25 138.75 184.25 275.25 366.25 457.25 548.25 8049 22.05 51.75 101.25 150.75 200.25 299.25 398.25 497.25 596.25 8250 23.15 54.50 106.75 159.00 211.25 8251 24.85 58.75 115.25 171.75 228.25 8352 26.95 64.00 125.75 187.50 249.25 8553 28.65 68.25 134.25 200.25 266.25 8754 30.05 71.75 141.25 210.75 280.25 8755 31.45 75.25 148.25 221.25 294.25 8756 33.05 79.25 156.25 233.25 310.25 8757 34.55 83.00 163.75 244.50 325.25 8758 36.35 87.50 172.75 258.00 343.25 8759 37.85 91.25 180.25 269.25 358.25 8760 38.85 93.75 185.25 276.75 368.25 8761 41.45 100.25 198.25 296.25 394.25 8862 43.85 106.25 210.25 314.25 418.25 8863 46.15 112.00 221.75 331.50 441.25 8864 48.45 117.75 233.25 348.75 464.25 8965 50.85 123.75 245.25 366.75 488.25 8966 53.45 8967 56.25 8968 59.15 8969 62.25 8970 65.55 90



Non

-Tob

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

Life Insurance Face Amounts for Monthly Premiums Shown PERIOD

Prem Includes Added Cost for Age to Which

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

Age $10,000 Guaranteed at

(ALB) Face $18.00 $20.00 $24.00 $28.00 $30.00 $32.00 $35.00 $40.00 Table Premium15D-1 832-3 834-10 7911-16 7517-20 46,324 52,206 63,971 75,736 81,618 87,500 96,324 111,030 7321-22 45,000 50,715 62,143 73,572 79,286 85,001 93,572 107,858 7323-25 43,750 49,306 60,417 71,528 77,084 82,639 90,973 104,862 71

26 42,568 47,973 58,784 69,595 75,000 80,406 88,514 102,028 7227 41,448 46,711 57,237 67,764 73,027 78,290 86,185 99,343 7228 41,448 46,711 57,237 67,764 73,027 78,290 86,185 99,343 7129 40,385 45,513 55,770 66,026 71,154 76,283 83,975 96,795 71

30-31 39,375 44,375 54,375 64,375 69,375 74,375 81,875 94,375 7032 37,500 42,262 51,786 61,310 66,072 70,834 77,977 89,881 7033 35,796 40,341 49,432 58,523 63,069 67,614 74,432 85,796 7134 34,240 38,587 47,283 55,979 60,327 64,674 71,196 82,065 7235 32,143 36,225 44,388 52,552 56,633 60,715 66,837 77,041 7336 30,883 34,804 42,648 50,491 54,412 58,334 64,216 74,020 7337 29,717 33,491 41,038 48,585 52,359 56,133 61,793 71,227 7338 28,125 31,697 38,840 45,983 49,554 53,125 58,483 67,411 7439 26,250 29,584 36,250 42,917 46,250 49,584 54,584 62,917 7540 8.65 24,610 27,735 33,985 40,235 43,360 46,485 51,172 58,985 7641 9.15 22,827 25,725 31,522 37,319 40,218 43,116 47,464 54,711 7742 9.85 20,724 23,356 28,619 33,882 36,514 39,145 43,093 49,672 7843 10.55 18,976 21,386 26,205 31,025 33,434 35,844 39,458 45,482 8044 11.25 17,500 19,723 24,167 28,612 30,834 33,056 36,389 41,945 8145 12.05 16,072 18,113 22,194 26,276 28,316 30,358 33,419 38,521 8246 12.85 14,859 16,746 20,519 24,293 26,180 28,066 30,897 35,614 8347 13.55 13,938 15,708 19,248 22,788 24,558 26,328 28,983 33,408 8348 14.35 13,017 14,670 17,976 21,281 22,934 24,587 27,066 31,199 8449 15.25 12,116 13,654 16,731 19,808 21,347 22,885 25,192 29,039 8550 16.35 11,171 12,589 15,426 18,263 19,681 21,100 23,227 26,774 8651 17.65 10,228 11,526 14,124 16,721 18,020 19,318 21,267 24,513 8752 19.25 10,438 12,795 15,148 16,324 17,500 19,265 22,206 8853 20.85 11,693 13,845 14,920 15,995 17,608 20,296 9054 21.95 11,041 13,071 14,087 15,102 16,625 19,163 9055 22.95 10,508 12,439 13,406 14,372 15,821 18,237 9156 23.95 10,024 11,867 12,789 13,710 15,093 17,397 9157 25.05 11,294 12,172 13,049 14,365 16,558 9158 26.25 10,730 11,563 12,396 13,646 15,730 9159 27.35 10,259 11,056 11,853 13,048 15,040 9160 28.05 10,756 11,532 12,694 14,632 9161 29.55 10,165 10,898 11,997 13,828 9162 31.15 10,295 11,333 13,063 9263 32.85 10,703 12,337 9264 34.65 10,109 11,652 9265 36.55 11,006 9266 38.65 9267 40.95 9268 43.45 9269 46.05 9370 48.65 93



Tob

acco


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

Life Insurance Face Amounts for Monthly Premiums Shown PERIOD

Prem Includes Added Cost for Age to Which

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

Age $10,000 Guaranteed at

(ALB) Face $26.00 $28.00 $30.00 $35.00 $40.00 $45.00 $50.00 $55.00 Table Premium15D-1 832-3 834-10 7911-16 7517-20 46,569 50,491 54,412 64,216 74,020 83,824 93,628 103,432 7021-22 44,812 48,585 52,359 61,793 71,227 80,661 90,095 99,529 7023-25 42,411 45,983 49,554 58,483 67,411 76,340 85,268 94,197 69

26 41,667 45,176 48,685 57,457 66,229 75,000 83,772 92,544 6927 40,949 44,397 47,845 56,466 65,087 73,707 82,328 90,949 6828 40,255 43,645 47,034 55,509 63,984 72,458 80,933 89,407 6829 39,584 42,917 46,250 54,584 62,917 71,250 79,584 87,917 68

30-31 34,927 37,868 40,809 48,162 55,515 62,868 70,221 77,574 6932 33,929 36,786 39,643 46,786 53,929 61,072 68,215 75,358 6933 33,451 36,268 39,085 46,127 53,170 60,212 67,254 74,296 6934 32,987 35,764 38,542 45,487 52,431 59,375 66,320 73,264 6835 30,845 33,442 36,039 42,533 49,026 55,520 62,013 68,507 6936 29,688 32,188 34,688 40,938 47,188 53,438 59,688 65,938 6937 27,941 30,295 32,648 38,530 44,412 50,295 56,177 62,059 7038 26,989 29,262 31,535 37,216 42,898 48,580 54,262 59,943 7039 25,266 27,394 29,522 34,841 40,160 45,479 50,798 56,118 7040 12.55 23,059 25,001 26,942 31,797 36,651 41,505 46,360 51,214 7241 13.25 21,591 23,410 25,228 29,773 34,318 38,864 43,410 47,955 7342 14.15 19,958 21,639 23,319 27,522 31,723 35,925 40,127 44,328 7443 15.55 17,858 19,361 20,865 24,625 28,384 32,143 35,903 39,662 7644 16.35 16,844 18,263 19,681 23,227 26,774 30,319 33,866 37,412 7745 17.45 15,625 16,940 18,257 21,547 24,836 28,125 31,415 34,704 7846 18.45 14,661 15,896 17,130 20,217 23,303 26,389 29,476 32,562 7947 19.45 13,809 14,971 16,134 19,041 21,948 24,855 27,762 30,669 7948 20.45 13,050 14,149 15,248 17,995 20,742 23,490 26,237 28,984 8049 22.05 11,995 13,006 14,016 16,541 19,065 21,591 24,117 26,642 8250 23.15 11,364 12,320 13,278 15,670 18,063 20,455 22,847 25,240 8251 24.85 10,509 11,394 12,279 14,492 16,704 18,916 21,129 23,341 8352 26.95 10,426 11,235 13,260 15,284 17,308 19,332 21,357 8553 28.65 10,512 12,406 14,300 16,193 18,087 19,982 8754 30.05 11,781 13,579 15,378 17,177 18,975 8755 31.45 11,216 12,929 14,641 16,353 18,065 8756 33.05 10,634 12,257 13,880 15,504 17,127 8757 34.55 10,140 11,688 13,236 14,784 16,331 8758 36.35 11,070 12,537 14,003 15,469 8759 37.85 10,604 12,009 13,413 14,817 8760 38.85 10,315 11,681 13,047 14,413 8761 41.45 10,906 12,182 13,457 8862 43.85 10,277 11,479 12,681 8863 46.15 10,877 12,016 8864 48.45 10,336 11,418 8965 50.85 10,854 8966 53.45 8967 56.25 8968 59.15 8969 62.25 8970 65.55 90



sunlife.com 800-247-6875

Sun Life Assurance Company of Canada

Optional Life insurance Ector County Independent School District | All Eligible Employees | 241756

Protect your family The people you love and support could face financial challenges if you were no longer around. Life insurance provides your loved ones with money they can use for household expenses, tuition, mortgage payments and more.

How it works Your employer is offering you and your coworkers this coverage as a group, at a group rate. You are responsible for paying all or a portion of the cost. Choose the benefit that best meets your needs and your budget.

Benefits

For you You can choose from $5,000 to $500,000—in increments of $5,000—with no medical questions asked up to the Guaranteed Issue amount of $150,000.

The benefit amount is reduced to 67% at age 70 and to 50% at age 75.

Your coverage ends at termination of employment or retirement.

For your spouse

If you elect coverage for yourself, you can choose from $5,000 to $250,000—in increments of $5,000 —with no medical questions asked up to the Guaranteed Issue amount of $25,000.

(The amount you select for your spouse cannot exceed 50% of your coverage amount.)

Spouse rates are based on spouse age.

The benefit amount is reduced to 67% when your spouse turns age 70 and to 50% at age 75.

The benefit amount may be reduced when the employee benefit amount is reduced.

For your child(ren)

If you elect coverage for yourself, you can choose $5,000 or $10,000—with no medical questions asked.

(The amount you select for your child(ren) cannot exceed 50% of your coverage amount.)

The benefit amount may be reduced when the employee benefit amount is reduced.

A full benefit is payable for a dependent child from birth to 26 years old.

What does life insurance mean for the Jones family? Jason and Charlotte just bought their first house and are expecting their first child. They didn’t think they could afford life insurance—and they didn’t think they needed it because they’re young and healthy.

However, Jason’s best friend from high school was recently killed in a car accident. Sadly, his wife is selling their home because she can’t afford the mortgage on her own.

Jason and Charlotte started to rethink life insurance, and were surprised to find options at work that meet their budget.

Since most people would have trouble paying living expenses after several months if their primary wage earner died,* it may be worth asking, who depends on you?


Additional considerations

If I become terminally ill

You may apply to receive a portion of your life insurance to help cover medical and living expenses. This is not long-term-care insurance. It will reduce the total amount of the life insurance payment we pay to your beneficiary(ies). Receipt of the Accelerated Benefit may be taxable and may impact your eligibility for public assistance programs.

If I become Totally Disabled

If we determine that you are Totally Disabled and cannot work, your life insurance coverage may continue at no cost. You must meet certain requirements, as detailed in the Certificate.

If I leave my employer

Depending upon state variations and your employer’s plan, you may have an option to continue group coverage when your employment terminates. Your employer can advise you about your options.

If I’ve had a life change

You may be able to adjust your coverage as your needs change (e.g., you get married or have a baby). Certain changes require you to answer health questions. Ask your employer for details.

Life FAQ Do I have to answer health questions to enroll? You will be required to answer health questions if (1) you do not elect coverage when it’s first available to you and you want to elect at a later date; (2) you request an amount higher than the Guaranteed Issue amount noted in the table, if offered; or (3) you want to increase coverage at a later date. You will need to fill out and submit our Evidence of Insurability application which must be approved by Sun Life before the coverage takes effect.

How is my benefit claim filed and paid? You or your beneficiary(ies) and your employer will complete the appropriate claims forms and submit these to Sun Life. Our claims examiners review the claim and gather additional information if necessary. We will notify you or your beneficiaries when the decision is made. If your death claim is approved, beneficiaries may elect to receive a lump sum payment or to have the benefit paid into an account where the funds accumulate interest and can be withdrawn at any time. (State restrictions apply and options may vary by state.)

Read the important plan provisions section for more information including limitations and exclusions. * Facts About Life 2016, LIMRA.com, September 2016, accessed June 2018.

sunlife.com 800-SUN-LIFE (247-6875)

Important plan provisions The following coverage(s) do not constitute comprehensive health insurance (often referred to as “major medical coverage”) and do not satisfy the requirement for Minimum Essential Coverage under the Affordable Care Act. They do NOT provide basic hospital, basic medical, or major medical insurance as defined by the New York State Department of Financial Services.

To become insured, all persons must be actively at work and performing their regular duties at their usual place of business on the proposed effective date or their date of coverage will be deferred until they return to active work. Refer to the Certificate for details and similar requirements for dependent coverage.

Limitations and exclusions The below exclusions and limitations may vary by state law and regulations. This list may not be comprehensive. Please see the Certificate or ask your benefits administrator for details.

Life If cause of death is suicide, no amount of contributory Life insurance will be paid if suicide occurs within a specific time period after the insurance or increase in insurance becomes effective. Please see the Certificate for details.

Information about services offered Value-added services are not insurance, are offered only on specific lines of coverage and carry a separate charge, which is added to the cost of the insurance. The cost is included in the total amount billed. The entities that provide the value-added services are not subcontractors of Sun Life and Sun Life is not responsible or liable for the care, services, or advice provided by them. Sun Life reserves the right to discontinue any of the Services at any time.

This Overview is preliminary to the issuance of the Policy. Refer to your Certificate for details. Receipt of this Overview does not constitute approval of coverage under the Policy. In the event of a discrepancy between this Overview, the Certificate and the Policy, the terms of the Policy will govern. Product offerings may not be available in all states and may vary depending on state laws and regulations.

Sun Life Financial companies include Sun Life and Health Insurance Company (U.S.) and Sun Life Assurance Company of Canada (collectively, “Sun Life Financial” or “Sun Life”).

Group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series P-LH, P-ADD, -GP-, -ADD-C-, -GP-, -LF-C-, -ADD-C-, -DI-C-, -DI-C-, TDBPOLICY-, TDI-POLICY, -AC-C-, -AC-C-, -SD-C-, -SD-C-, and -CAN-C-.

© Sun Life Assurance Company of Canada, Wellesley Hills, MA . All rights reserved. Sun Life Financial and the globe symbol are registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us.

GVBH-EE- SLPC / (exp /)

Rate SheetEmployee - Coverage and monthly cost for Employee Optional Life.

Rates are effective as of January 01, 2020.

The chart below shows possible coverage amounts and corresponding costs per month.

Find your age bracket (as of the effective date of coverage) to determine the associated cost for the coverage amount you choose.

Age and Cost

CoverageAmounts <25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+

$5,000 0.30 0.30 0.45 0.45 0.65 0.95 1.50 2.80 4.30 8.30 8.30$10,000 0.60 0.60 0.90 0.90 1.30 1.90 3.00 5.60 8.60 16.60 16.60$15,000 0.90 0.90 1.35 1.35 1.95 2.85 4.50 8.40 12.90 24.90 24.90

$20,000 1.20 1.20 1.80 1.80 2.60 3.80 6.00 11.20 17.20 33.20 33.20$25,000 1.50 1.50 2.25 2.25 3.25 4.75 7.50 14.00 21.50 41.50 41.50$30,000 1.80 1.80 2.70 2.70 3.90 5.70 9.00 16.80 25.80 49.80 49.80$35,000 2.10 2.10 3.15 3.15 4.55 6.65 10.50 19.60 30.10 58.10 58.10$40,000 2.40 2.40 3.60 3.60 5.20 7.60 12.00 22.40 34.40 66.40 66.40$45,000 2.70 2.70 4.05 4.05 5.85 8.55 13.50 25.20 38.70 74.70 74.70$50,000 3.00 3.00 4.50 4.50 6.50 9.50 15.00 28.00 43.00 83.00 83.00$55,000 3.30 3.30 4.95 4.95 7.15 10.45 16.50 30.80 47.30 91.30 91.30$60,000 3.60 3.60 5.40 5.40 7.80 11.40 18.00 33.60 51.60 99.60 99.60$65,000 3.90 3.90 5.85 5.85 8.45 12.35 19.50 36.40 55.90 107.90 107.90$70,000 4.20 4.20 6.30 6.30 9.10 13.30 21.00 39.20 60.20 116.20 116.20$75,000 4.50 4.50 6.75 6.75 9.75 14.25 22.50 42.00 64.50 124.50 124.50$80,000 4.80 4.80 7.20 7.20 10.40 15.20 24.00 44.80 68.80 132.80 132.80$85,000 5.10 5.10 7.65 7.65 11.05 16.15 25.50 47.60 73.10 141.10 141.10$90,000 5.40 5.40 8.10 8.10 11.70 17.10 27.00 50.40 77.40 149.40 149.40$95,000 5.70 5.70 8.55 8.55 12.35 18.05 28.50 53.20 81.70 157.70 157.70

$100,000 6.00 6.00 9.00 9.00 13.00 19.00 30.00 56.00 86.00 166.00 166.00$105,000 6.30 6.30 9.45 9.45 13.65 19.95 31.50 58.80 90.30 174.30 174.30$110,000 6.60 6.60 9.90 9.90 14.30 20.90 33.00 61.60 94.60 182.60 182.60$115,000 6.90 6.90 10.35 10.35 14.95 21.85 34.50 64.40 98.90 190.90 190.90

$120,000 7.20 7.20 10.80 10.80 15.60 22.80 36.00 67.20 103.20 199.20 199.20$125,000 7.50 7.50 11.25 11.25 16.25 23.75 37.50 70.00 107.50 207.50 207.50$130,000 7.80 7.80 11.70 11.70 16.90 24.70 39.00 72.80 111.80 215.80 215.80$135,000 8.10 8.10 12.15 12.15 17.55 25.65 40.50 75.60 116.10 224.10 224.10$140,000 8.40 8.40 12.60 12.60 18.20 26.60 42.00 78.40 120.40 232.40 232.40$145,000 8.70 8.70 13.05 13.05 18.85 27.55 43.50 81.20 124.70 240.70 240.70$150,000 9.00 9.00 13.50 13.50 19.50 28.50 45.00 84.00 129.00 249.00 249.00$155,000 9.30 9.30 13.95 13.95 20.15 29.45 46.50 86.80 133.30 257.30 257.30$160,000 9.60 9.60 14.40 14.40 20.80 30.40 48.00 89.60 137.60 265.60 265.60$165,000 9.90 9.90 14.85 14.85 21.45 31.35 49.50 92.40 141.90 273.90 273.90$170,000 10.20 10.20 15.30 15.30 22.10 32.30 51.00 95.20 146.20 282.20 282.20$175,000 10.50 10.50 15.75 15.75 22.75 33.25 52.50 98.00 150.50 290.50 290.50$180,000 10.80 10.80 16.20 16.20 23.40 34.20 54.00 100.80 154.80 298.80 298.80$185,000 11.10 11.10 16.65 16.65 24.05 35.15 55.50 103.60 159.10 307.10 307.10$190,000 11.40 11.40 17.10 17.10 24.70 36.10 57.00 106.40 163.40 315.40 315.40$195,000 11.70 11.70 17.55 17.55 25.35 37.05 58.50 109.20 167.70 323.70 323.70

$200,000 12.00 12.00 18.00 18.00 26.00 38.00 60.00 112.00 172.00 332.00 332.00$205,000 12.30 12.30 18.45 18.45 26.65 38.95 61.50 114.80 176.30 340.30 340.30$210,000 12.60 12.60 18.90 18.90 27.30 39.90 63.00 117.60 180.60 348.60 348.60$215,000 12.90 12.90 19.35 19.35 27.95 40.85 64.50 120.40 184.90 356.90 356.90

$220,000 13.20 13.20 19.80 19.80 28.60 41.80 66.00 123.20 189.20 365.20 365.20$225,000 13.50 13.50 20.25 20.25 29.25 42.75 67.50 126.00 193.50 373.50 373.50$230,000 13.80 13.80 20.70 20.70 29.90 43.70 69.00 128.80 197.80 381.80 381.80$235,000 14.10 14.10 21.15 21.15 30.55 44.65 70.50 131.60 202.10 390.10 390.10$240,000 14.40 14.40 21.60 21.60 31.20 45.60 72.00 134.40 206.40 398.40 398.40$245,000 14.70 14.70 22.05 22.05 31.85 46.55 73.50 137.20 210.70 406.70 406.70$250,000 15.00 15.00 22.50 22.50 32.50 47.50 75.00 140.00 215.00 415.00 415.00

Age and Cost


$255,000 15.30 15.30 22.95 22.95 33.15 48.45 76.50 142.80 219.30 423.30 423.30$260,000 15.60 15.60 23.40 23.40 33.80 49.40 78.00 145.60 223.60 431.60 431.60$265,000 15.90 15.90 23.85 23.85 34.45 50.35 79.50 148.40 227.90 439.90 439.90$270,000 16.20 16.20 24.30 24.30 35.10 51.30 81.00 151.20 232.20 448.20 448.20$275,000 16.50 16.50 24.75 24.75 35.75 52.25 82.50 154.00 236.50 456.50 456.50$280,000 16.80 16.80 25.20 25.20 36.40 53.20 84.00 156.80 240.80 464.80 464.80$285,000 17.10 17.10 25.65 25.65 37.05 54.15 85.50 159.60 245.10 473.10 473.10$290,000 17.40 17.40 26.10 26.10 37.70 55.10 87.00 162.40 249.40 481.40 481.40$295,000 17.70 17.70 26.55 26.55 38.35 56.05 88.50 165.20 253.70 489.70 489.70$300,000 18.00 18.00 27.00 27.00 39.00 57.00 90.00 168.00 258.00 498.00 498.00$305,000 18.30 18.30 27.45 27.45 39.65 57.95 91.50 170.80 262.30 506.30 506.30$310,000 18.60 18.60 27.90 27.90 40.30 58.90 93.00 173.60 266.60 514.60 514.60$315,000 18.90 18.90 28.35 28.35 40.95 59.85 94.50 176.40 270.90 522.90 522.90

$320,000 19.20 19.20 28.80 28.80 41.60 60.80 96.00 179.20 275.20 531.20 531.20$325,000 19.50 19.50 29.25 29.25 42.25 61.75 97.50 182.00 279.50 539.50 539.50$330,000 19.80 19.80 29.70 29.70 42.90 62.70 99.00 184.80 283.80 547.80 547.80$335,000 20.10 20.10 30.15 30.15 43.55 63.65 100.50 187.60 288.10 556.10 556.10$340,000 20.40 20.40 30.60 30.60 44.20 64.60 102.00 190.40 292.40 564.40 564.40$345,000 20.70 20.70 31.05 31.05 44.85 65.55 103.50 193.20 296.70 572.70 572.70$350,000 21.00 21.00 31.50 31.50 45.50 66.50 105.00 196.00 301.00 581.00 581.00$355,000 21.30 21.30 31.95 31.95 46.15 67.45 106.50 198.80 305.30 589.30 589.30$360,000 21.60 21.60 32.40 32.40 46.80 68.40 108.00 201.60 309.60 597.60 597.60$365,000 21.90 21.90 32.85 32.85 47.45 69.35 109.50 204.40 313.90 605.90 605.90$370,000 22.20 22.20 33.30 33.30 48.10 70.30 111.00 207.20 318.20 614.20 614.20$375,000 22.50 22.50 33.75 33.75 48.75 71.25 112.50 210.00 322.50 622.50 622.50$380,000 22.80 22.80 34.20 34.20 49.40 72.20 114.00 212.80 326.80 630.80 630.80$385,000 23.10 23.10 34.65 34.65 50.05 73.15 115.50 215.60 331.10 639.10 639.10$390,000 23.40 23.40 35.10 35.10 50.70 74.10 117.00 218.40 335.40 647.40 647.40$395,000 23.70 23.70 35.55 35.55 51.35 75.05 118.50 221.20 339.70 655.70 655.70$400,000 24.00 24.00 36.00 36.00 52.00 76.00 120.00 224.00 344.00 664.00 664.00$405,000 24.30 24.30 36.45 36.45 52.65 76.95 121.50 226.80 348.30 672.30 672.30$410,000 24.60 24.60 36.90 36.90 53.30 77.90 123.00 229.60 352.60 680.60 680.60$415,000 24.90 24.90 37.35 37.35 53.95 78.85 124.50 232.40 356.90 688.90 688.90

$420,000 25.20 25.20 37.80 37.80 54.60 79.80 126.00 235.20 361.20 697.20 697.20$425,000 25.50 25.50 38.25 38.25 55.25 80.75 127.50 238.00 365.50 705.50 705.50$430,000 25.80 25.80 38.70 38.70 55.90 81.70 129.00 240.80 369.80 713.80 713.80$435,000 26.10 26.10 39.15 39.15 56.55 82.65 130.50 243.60 374.10 722.10 722.10$440,000 26.40 26.40 39.60 39.60 57.20 83.60 132.00 246.40 378.40 730.40 730.40$445,000 26.70 26.70 40.05 40.05 57.85 84.55 133.50 249.20 382.70 738.70 738.70$450,000 27.00 27.00 40.50 40.50 58.50 85.50 135.00 252.00 387.00 747.00 747.00$455,000 27.30 27.30 40.95 40.95 59.15 86.45 136.50 254.80 391.30 755.30 755.30$460,000 27.60 27.60 41.40 41.40 59.80 87.40 138.00 257.60 395.60 763.60 763.60$465,000 27.90 27.90 41.85 41.85 60.45 88.35 139.50 260.40 399.90 771.90 771.90$470,000 28.20 28.20 42.30 42.30 61.10 89.30 141.00 263.20 404.20 780.20 780.20$475,000 28.50 28.50 42.75 42.75 61.75 90.25 142.50 266.00 408.50 788.50 788.50$480,000 28.80 28.80 43.20 43.20 62.40 91.20 144.00 268.80 412.80 796.80 796.80$485,000 29.10 29.10 43.65 43.65 63.05 92.15 145.50 271.60 417.10 805.10 805.10$490,000 29.40 29.40 44.10 44.10 63.70 93.10 147.00 274.40 421.40 813.40 813.40$495,000 29.70 29.70 44.55 44.55 64.35 94.05 148.50 277.20 425.70 821.70 821.70$500,000 30.00 30.00 45.00 45.00 65.00 95.00 150.00 280.00 430.00 830.00 830.00

Spouse - Coverage and monthly cost for Spouse Optional Life.



Find your age bracket (as of the effective date of coverage) to determine the associated cost for the coverage amount you choose.

Age and Cost


$5,000 0.30 0.30 0.45 0.45 0.65 0.95 1.50 2.80 4.30 8.30 8.30$10,000 0.60 0.60 0.90 0.90 1.30 1.90 3.00 5.60 8.60 16.60 16.60$15,000 0.90 0.90 1.35 1.35 1.95 2.85 4.50 8.40 12.90 24.90 24.90

$20,000 1.20 1.20 1.80 1.80 2.60 3.80 6.00 11.20 17.20 33.20 33.20$25,000 1.50 1.50 2.25 2.25 3.25 4.75 7.50 14.00 21.50 41.50 41.50$30,000 1.80 1.80 2.70 2.70 3.90 5.70 9.00 16.80 25.80 49.80 49.80$35,000 2.10 2.10 3.15 3.15 4.55 6.65 10.50 19.60 30.10 58.10 58.10$40,000 2.40 2.40 3.60 3.60 5.20 7.60 12.00 22.40 34.40 66.40 66.40$45,000 2.70 2.70 4.05 4.05 5.85 8.55 13.50 25.20 38.70 74.70 74.70$50,000 3.00 3.00 4.50 4.50 6.50 9.50 15.00 28.00 43.00 83.00 83.00$55,000 3.30 3.30 4.95 4.95 7.15 10.45 16.50 30.80 47.30 91.30 91.30$60,000 3.60 3.60 5.40 5.40 7.80 11.40 18.00 33.60 51.60 99.60 99.60$65,000 3.90 3.90 5.85 5.85 8.45 12.35 19.50 36.40 55.90 107.90 107.90$70,000 4.20 4.20 6.30 6.30 9.10 13.30 21.00 39.20 60.20 116.20 116.20$75,000 4.50 4.50 6.75 6.75 9.75 14.25 22.50 42.00 64.50 124.50 124.50$80,000 4.80 4.80 7.20 7.20 10.40 15.20 24.00 44.80 68.80 132.80 132.80$85,000 5.10 5.10 7.65 7.65 11.05 16.15 25.50 47.60 73.10 141.10 141.10$90,000 5.40 5.40 8.10 8.10 11.70 17.10 27.00 50.40 77.40 149.40 149.40$95,000 5.70 5.70 8.55 8.55 12.35 18.05 28.50 53.20 81.70 157.70 157.70

$100,000 6.00 6.00 9.00 9.00 13.00 19.00 30.00 56.00 86.00 166.00 166.00$105,000 6.30 6.30 9.45 9.45 13.65 19.95 31.50 58.80 90.30 174.30 174.30$110,000 6.60 6.60 9.90 9.90 14.30 20.90 33.00 61.60 94.60 182.60 182.60$115,000 6.90 6.90 10.35 10.35 14.95 21.85 34.50 64.40 98.90 190.90 190.90

$120,000 7.20 7.20 10.80 10.80 15.60 22.80 36.00 67.20 103.20 199.20 199.20$125,000 7.50 7.50 11.25 11.25 16.25 23.75 37.50 70.00 107.50 207.50 207.50$130,000 7.80 7.80 11.70 11.70 16.90 24.70 39.00 72.80 111.80 215.80 215.80$135,000 8.10 8.10 12.15 12.15 17.55 25.65 40.50 75.60 116.10 224.10 224.10$140,000 8.40 8.40 12.60 12.60 18.20 26.60 42.00 78.40 120.40 232.40 232.40$145,000 8.70 8.70 13.05 13.05 18.85 27.55 43.50 81.20 124.70 240.70 240.70$150,000 9.00 9.00 13.50 13.50 19.50 28.50 45.00 84.00 129.00 249.00 249.00$155,000 9.30 9.30 13.95 13.95 20.15 29.45 46.50 86.80 133.30 257.30 257.30$160,000 9.60 9.60 14.40 14.40 20.80 30.40 48.00 89.60 137.60 265.60 265.60$165,000 9.90 9.90 14.85 14.85 21.45 31.35 49.50 92.40 141.90 273.90 273.90$170,000 10.20 10.20 15.30 15.30 22.10 32.30 51.00 95.20 146.20 282.20 282.20$175,000 10.50 10.50 15.75 15.75 22.75 33.25 52.50 98.00 150.50 290.50 290.50$180,000 10.80 10.80 16.20 16.20 23.40 34.20 54.00 100.80 154.80 298.80 298.80$185,000 11.10 11.10 16.65 16.65 24.05 35.15 55.50 103.60 159.10 307.10 307.10$190,000 11.40 11.40 17.10 17.10 24.70 36.10 57.00 106.40 163.40 315.40 315.40$195,000 11.70 11.70 17.55 17.55 25.35 37.05 58.50 109.20 167.70 323.70 323.70

$200,000 12.00 12.00 18.00 18.00 26.00 38.00 60.00 112.00 172.00 332.00 332.00$205,000 12.30 12.30 18.45 18.45 26.65 38.95 61.50 114.80 176.30 340.30 340.30$210,000 12.60 12.60 18.90 18.90 27.30 39.90 63.00 117.60 180.60 348.60 348.60$215,000 12.90 12.90 19.35 19.35 27.95 40.85 64.50 120.40 184.90 356.90 356.90

$220,000 13.20 13.20 19.80 19.80 28.60 41.80 66.00 123.20 189.20 365.20 365.20$225,000 13.50 13.50 20.25 20.25 29.25 42.75 67.50 126.00 193.50 373.50 373.50$230,000 13.80 13.80 20.70 20.70 29.90 43.70 69.00 128.80 197.80 381.80 381.80$235,000 14.10 14.10 21.15 21.15 30.55 44.65 70.50 131.60 202.10 390.10 390.10$240,000 14.40 14.40 21.60 21.60 31.20 45.60 72.00 134.40 206.40 398.40 398.40$245,000 14.70 14.70 22.05 22.05 31.85 46.55 73.50 137.20 210.70 406.70 406.70$250,000 15.00 15.00 22.50 22.50 32.50 47.50 75.00 140.00 215.00 415.00 415.00

Child - Coverage and monthly cost for Child Optional Life.



CostCoverage perAmounts Month

$5,000 0.25$10,000 0.50


Sun Life Assurance Company of Canada

Life and Accidental Death and Dismemberment (AD&D) Ector County Independent School District | All Eligible Employees | 241756

Protect your family Life insurance provides the people you love with financial support when you can’t be there—and when they need it most.

How it works Your employer is providing employee coverage at no cost to you! You are responsible for paying all or a portion of the cost for coverage for your spouse and child(ren).

Benefits

For you $10,000, with no medical questions asked.

Benefits are reduced to 67% at age 70 and to 50% at age 75.

Your coverage ends at termination of employment or retirement.

For your spouse

$5,000, with no medical questions asked.

Benefits are reduced to 67% at age 70 and to 50% at age 75.

For your child(ren)

$2,000 benefit amount.

A full benefit is payable for a dependent child from birth to 26 years.

Benefit may be reduced when the employee benefit amount is reduced.

Reasons why you may need life insurance

Provide financial support for others

Pay household expenses

Pay tuition

Leave an inheritance or philanthropic gift

Pay funeral or medical expenses


Accidental Death and Dismemberment (AD&D) This coverage includes an equal amount of AD&D insurance that provides a benefit if you suffer a covered accidental injury or die from a covered accident.

Benefits – This is a partial list. Refer to the certificate for the full list of covered accidental injuries.

Accidental injury The plan pays Accidental injury The plan pays

Accidental death 100% Loss of speech only or hearing only 50%

Quadriplegia 100% Loss of limb (arm or leg) 50%

Loss of sight of one eye 50% Loss of thumb and index finger on same hand 25%

Additional considerations

If I become terminally ill

You may apply to receive a portion of your life insurance to help cover medical and living expenses. This is not long-term-care insurance. It will reduce the total amount of the life insurance payment we pay to your beneficiary(ies). Receipt of the Accelerated Benefit may be taxable and may affect your eligibility for public assistance programs.

If I become Totally Disabled

If we determine that you are Totally Disabled and cannot work, your life insurance coverage may continue at no cost. You must meet certain requirements, as detailed in the Certificate.

If I leave my employer

Depending upon state variations and your employer’s plan, you may have an option to continue group coverage when your employment terminates. Your employer can advise you about your options.

Life and AD&D FAQ

How is my benefit claim filed and paid? You or your beneficiary(ies) and your employer will complete the appropriate claims forms and submit these to Sun Life. Our claims examiners review the claim and gather additional information if necessary. We will notify you or your beneficiaries when the decision is made. If your death claim is approved, beneficiaries may

elect to receive a lump sum payment or to have the benefit paid into an account where the funds accumulate interest and can be withdrawn at any time. (State restrictions apply and options may vary by state.) If your AD&D claim for an accidental injury is approved, the benefit amount will be paid directly to you.

Read the important plan provisions section for more information including limitations and exclusions.


Important plan provisions The following coverage(s) do not constitute comprehensive health insurance (often referred to as “major medical coverage”) and do not satisfy the requirement for Minimum Essential Coverage under the Affordable Care Act. They do NOT provide basic hospital, basic medical, or major medical insurance as defined by the New York State Department of Financial Services.

To become insured, all persons must be actively at work and performing their regular duties at their usual place of business on the proposed effective date or their date of coverage will be deferred until they return to active work. Refer to the Certificate for details and similar requirements for dependent coverage.

Limitations and exclusions The below exclusions and limitations may vary by state law and regulations. This list may not be comprehensive. Please see the Certificate or ask your benefits administrator for details.

Accidental Death and Dismemberment We will not pay a benefit that is due to or results from: suicide while sane or insane; injuring oneself intentionally; committing or attempting to commit an assault, felony or other criminal act; war or an act of war; active participation in a riot, rebellion or insurrection; voluntary use of any controlled substance/illegal drugs; operation of a motorized vehicle while intoxicated; bodily or mental infirmity or disease or infection unless due to an accidental injury; riding in or driving any motor-driven vehicle in a race, stunt show, or speed test.

Information about services offered Value-added services are not insurance, are offered only on specific lines of coverage and carry a separate charge, which is added to the cost of the insurance. The cost is included in the total amount billed. The entities that provide the value-added services are not subcontractors of Sun Life and Sun Life is not responsible or liable for the care, services, or advice provided by them. Sun Life reserves the right to discontinue any of the Services at any time.

This Overview is preliminary to the issuance of the Policy. Refer to your Certificate for details. Receipt of this Overview does not constitute approval of coverage under the Policy. In the event of a discrepancy between this Overview, the Certificate and the Policy, the terms of the Policy will govern. Product offerings may not be available in all states and may vary depending on state laws and regulations.

Sun Life Financial companies include Sun Life and Health Insurance Company (U.S.) and Sun Life Assurance Company of Canada (collectively, “Sun Life Financial” or “Sun Life”).

Group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series P-LH, P-ADD, -GP-, -ADD-C-, -GP-, -LF-C-, -ADD-C-, -DI-C-, -DI-C-, TDBPOLICY-, TDI-POLICY, -AC-C-, -AC-C-, -SD-C-, -SD-C-, and -CAN-C-.

© Sun Life Assurance Company of Canada, Wellesley Hills, MA . All rights reserved. Sun Life Financial and the globe symbol are registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us.

GVBH-EE- SLPC / (exp /)

Rate Sheet Coverage and monthly rates for Life Insurance. Dependent Basic Life insurance is contributory, meaning that you are responsible for paying for all or a portion of the cost through payroll deduction.

Dependent

monthly rate per unit of Life

coverage

$1.000 Cost to You

Your monthly cost

# of Months Annual cost # of pay periods per year (12, 24,

26, 52, etc.)

Your estimated cost per pay

period* $__________ x 12 = $__________ / __________ = $__________

*The rate is in effect for 01/01/2020. Contact your employer to confirm the portion of the cost for which you will be responsible.

For more information, please call your Independent Associate:

JAIME BARRAZA 512-600-5232 | [email protected]

PROTECT YOURSELFAGAINST ONE OF

THE FASTESTGROWING CRIMES

PLAN FEATURES PLUS

CyberAlert™️ monitors:

✔ ✔

Change of Address Monitoring ✔

Court/Criminal Records Monitoring ✔

Bank Account Takeover & Credit Application Monitoring ✔

Payday Loan Monitoring ✔

Social Media Monitoring ✔

Lost Wallet Protection ✔

24/7 Full-Service Identity Theft Restoration ✔ ✔

$1M Identity Theft Insurance ✔

Social Security Number Trace ✔ ✔

Daily monitoring of Experian Credit Bureau ✔

ScoreTracker ✔

✔ adults ✔ children to age 18

• one Social Security Number • one Drivers License Number• one Passport• two Phone Numbers

• two Email Addresses• two Medical ID Numbers• five Credit/Debit Cards• five Bank Accounts

COVERAGE OPTIONSEMPLOYEE $8.95

EMPLOYEE + FAMILY $18.95

MONTHLY PAYROLL DEDUCTION

SEE BACK FOR ADDITIONAL PLAN DETAILS

WHAT’S INCLUDED?

PLEASE NOTE: • A valid email address is required for enrollment in iLOCK360. All iLOCK360

alerts and/or notifications are sent via email. Consider utilizing an email address that you check regularly.

• Account activation & setup of monitored elements is required upon the start of your district’s new benefit plan year.

FULL-SERVICE IDENTITY RESTORATION. Rest assured that iLOCK360 will work on your behalf to restore your identity. Our experts can complete allrestoration activities for you, and we can even help you with pre-existing conditions.

PEACE OF MIND.56% of victims have to take time off work to resolve anidentity theft case on their own. With iLOCK360, you have experienced professionals in your corner to restore your identity, so you can spend your time doing what you do best.

RESTOREiLOCK360 does the work to restore your identity

DEFENDYour personal information

is monitored 24/7/365

PROTECTAlerts inform you of potential threats for immediate action

HOW iLOCK360 HELPS

HAVE YOU EVER?

Known someone that has been a victim of identity theft?ID theft is the fastest growing crime, occurring once every 2 seconds

Been a victim of a data breach?

Had your credit impacted by financial fraud?If a criminal gains access to your personal information, they can open new

accounts in your name that you may not learn of until the damage is done.

Been concerned about your childrens’ and loved ones’ identities being stolen? Child identity theft is projected to affect 25% of kids before turning 18.

TAKE ADVANTAGE OF SPECIAL EDUCATOR PRICING DURING OPEN ENROLLMENT!

PROTECT YOUR IDENTITY TODAY

From 2018 to 2019, data breaches increased by 17%. Every 39 seconds is how often a cyber attack occurs in 2020.

For more information, please call your Independent Associate:

JAIME BARRAZA 512-600-5232 | [email protected]

PLEASE NOTE: • A valid email address is required for enrollment in iLOCK360. All iLOCK360 alerts and notifications are sent via email. Consider utilizing an email address that you check regularly.• Account activation & setup of monitored elements is required upon the start of your district’s new benefit plan year.

• one Social Security Number • one Drivers License Number • one Passport• two Phone Numbers

• two Email Addresses• two Medical ID Numbers • five Credit/Debit Cards• five Bank Accounts

Learn more about the protections that iLOCK360 offers:PLAN FEATURES SERVICE DESCRIPTION

IDENTITY THEFT RESOLUTION SERVICES

Full-Service Identity Theft Restoration & Lost Wallet Protection

If your identity is compromised, a U.S.-based certified Identity Theft Restoration Specialist will work on your behalf to restore your good name, so that you can get on with your life. All restoration activities can be completed for you, and yourcase will be managed until your identity is fully restored. Even pre-existing condi-tions can be dealt with.

Restoration Specialists offer robust case knowledge in both credit and non-credit fraud situations and can help you with closing accounts, re-ordering cards, placing a fraud alert with each of the three credit bureaus, and removing fraudulent activity from your credit report.

✔ ✔

$1M Identity Theft Insurance

If you incur expenses associated with your identity theft recovery, you will be cov-ered with $1M reimbursement ($0 deductible). Covered costs include:

• Lost wages or income• Attorney and legal fees• Expenses incurred for refiling of loans, grants and other lines of credit• Costs of childcare and/or elderly care incurred as a result of identity restoration

✔

COMPREHENSIVE IDENTITY MONITORING

CyberAlert™️ monitors:We scour Internet properties, including the Dark Web, as well as hacker websites, blogs, bulletin boards, peer-to-peer sharing networks and chat rooms to identify the illegal trading and selling of your personal information.

✔ ✔

Change of Address MonitoringA thief may try to establish “your” new identity by changing your address. Receive an alert if your mail is redirected through the USPS National Change of Address(NCOA) Registry.

✔

Court/Criminal Records Monitoring Tracks municipal court systems and notifies you if a crime has been committedunder your name and date of birth.

✔

Payday Loan MonitoringHigh-interest, easy-to-obtain payday loans can negatively impact your credit score. Alerts you if a non-credit loan been opened using your identity at a payday orquick cash loan provider.

✔

Social Security Number TraceProvides you with a report of all names and/or aliases as well as current and reported addresses associated with your Social Security number. If there arefindings that you don’t recognize, this could be a sign of possible identity theft.

✔ ✔

CREDIT MONITORING SERVICES

Bank Account Takeover & Credit Card Application Monitoring

Notifies you when your Social Security number and personal information have been used to apply for or open a new bank or credit card account; or if changeshave been made to your existing bank account - such as an attempt to add a new account holder.

✔

Daily Monitoring of Experian Credit BureauProvides credit protection with monitoring from Experian. Provides you with noti-fications for changes in a credit report such as loan data, inquiries, new accounts, judgments, liens and more.

✔

ScoreTracker Receive a monthly report that helps you understand how your credit score has trended over time and what is impacting it with credit score insight.

✔

ADVANCED TOOLS

Sex Offender Alerts Keep your family safe with awareness of where registered sex offenders live inyour immediate area. You’ll also be notified when a new one moves to your area.

✔

Social Media MonitoringReceive notifications if the content you share on social media could pose a privacy or reputational risk. With Family coverage, you can monitor your child’s social media presence.

✔

✔ adults ✔ children to age 18

• one Social Security Number• two Phone Numbers• two Email Addresses• five Credit/Debit Cards

• two Medical ID Numbers• five Bank Accounts• one Drivers License Number• one Passport

MOST VALUABLE SERVICE. Dependable help that’s just a phone call away!

HAVE YOU EVER?

This is a general overview and is for illustrative purposes only. Plans and services vary from state to state. See a plan contract for your state of residence for

.snoisulcxe dna snoitidnoc ,stnuoma ,egarevoc ,smret etelpmoc

WHAT IS LEGALSHIELD?

Founded in 1972, LegalShield has 1.5 million memberships protecting and empowering 4.1 million lives and serving

140,000 businesses throughout the United States and Canada. Our members can talk to a lawyer on any personal legal

matter, no matter how trivial or traumatic, all without worrying about high hourly costs. LegalShield has provided

identity theft protection since 2003 with Kroll, the world’s leading company in ID Theft consulting and restoration.

Needed your Will prepared or updated

Been overcharged for a repair or paid an unfair bill

Had trouble with a warranty or defective product

Signed a contract

R

Had concerns regarding child support

Worried about being a victim of identity theft

Been concerned about your child’s identity

Lost your wallet

Worried about entering personal information on-line

Feared the security of your medical information

Been pursued by a collection agency

For more information, please contact your Independent Associate:

Prepared for:

AFFORDABLE LEGAL PROTECTION FOR ONE LOW MONTHLY FEE

ADVICE ON ANY LEGAL ISSUE With a LegalShield Legal Plan you will have access to attorneys who can provide advice or assistance on a variety of personal legal issues.

THE LEGALSHIELD® MEMBERSHIP INCLUDES:

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

Moenrollment)

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 situationsLegalShield family legal plans cover the member; member’s spouse; never

married dependent children under 26 living at home; dependent children

under age 18 for whom the member is legal guardian; never married,

dependent children up to age 26 if a full-time college student; and

physically or mentally disabled dependent children.

ELECTION OPTIONS

Family Coverage:

“All securities are offered for sale or purchase by First Financial Securities of America, Inc.”

Dear Ector County ISD Employee,

Right now, you have an opportunity to make a real difference in the future of your retirement.

How? By joining the FFInvest 457(b) Plan!

The Plan we offer is a valuable benefit to help you save for the future. Saving now can help

you have the income you’ll need at retirement. Participating in the Plan is easy. You

contribute a portion of your pay to your Plan account each payday through convenient payroll

deduction. Contributions are then allocated to the Plan’s investment options you select.

There are significant tax advantages, too. For example, if you elect pre-tax deductions, your

qualifying contributions and all earnings on your account are not subject to current federal

income tax (or, where applicable, state or local taxes) until you take them out of the Plan.

This tax deferral gives your retirement savings ability to grow under the most favorable

terms possible. Your district’s retirement plan also offers Roth (after-tax) deductions. By

combining convenience with these special tax benefits, your retirement savings plan offers

you one of the best ways to fund your future.

For 2020 tax year, you may contribute $19,500 or $26,000 annually if you are age 50 or over (or will be age 50 on or before 12/31/2020).

We are excited to offer you this worthwhile benefit and we hope you will use it to help make

your retirement dreams a reality. As with any investment, there are risks involved but

FFInvest offers a wide range of choices that allow you to tailor your investments to match

your risk tolerance. Get started today and take the first step toward a brighter future.

More information may also be found online at http://ffinvest.my457account.com or

http://benefits.ffga.com/ectorcountyisd and selecting “FFInvest” under Benefit Plans & Premiums/2020-2021 Plan Year.

Sincerely,

Cody HarrisSr. Account Administrator Registered Representative Office: (432) 456-9783Cell: (432) 556-1901Email: [email protected]

http://ffinvest.my457account.com/

https://benefits.ffga.com/ectorcountyisd/

mailto:[email protected]?Subject=Ector County ISD 457(b) Plan

http://www.my457account.com/

http://www.ffga.com/

https://ffbenefits.ffga.com/ectorcountyisd/ffinvest/

https://ffbenefits.ffga.com/ectorcountyisd/2020-21-plan-year/

We are excited to announce the FFInvest Retirement Plan that is now available. The FFInvest 457(b) Retirement Plan is a comprehensive plan funded by Net Asset Value Mutual Funds. It is a competitive & simple, yet flexible plan with a 401(k) type of approach.

Plan Highlights:• Multiple Investment Options

The plan provides 21 different investment options to take advantage of changing investment market conditions,including American Funds, Vanguard, Harbor, and Delaware. There are also Bond Funds and Target Date Retirement Funds to choose from.

• Roth (After-Tax) Deduction Option Available

• Rollovers/TransfersRollovers/Transfers are accepted into the plan from other retirement plans, including IRA’s

• Retirement Savings Contributions Credit (Saver’s Credit)An individual may be able to take a tax credit of up to $1,000 ($2,000 if filing jointly) for making eligiblecontributions to an employer-sponsored retirement plan.

• NO IRS PenaltyNO 10% IRS penalty for withdrawals prior to age 59 ½

• NO Front-End Sales ChargeThere are NO sales charges taken from contributions. This means that100% of all contributions are invested and start working for you.

• NO Deferred Sales Charge

• Client Friendly Technology & Communication» Retirement Education Center: http://ffinvest.my457account.com » Toll-free telephone number: 1-866-848-0258» Interactive website: www.my457account.com» Personalized Benefit Projections» Loan Option» Blog / Calculators» Quarterly Newsletter» Quarterly eStatement

Introducing...

FFInvest 457(b) Retirement Plan

$19,500 – under age 50

$26,000 – age 50 (on or before 12/31) or older

Contribution Limits for 2020

IT IS VERY IMPORTANT THAT YOU READ AND UNDERSTAND THE FOLLOWING: All investments involve some degree of risk. The funds are offered by prospectus, which contains more complete information regarding the investment objectives, risks, charges and expenses associated

with an investment in the fund. Please be sure and review the prospectus at http://ffinvest.my457account.com before deciding to invest.

Enroll Now!

If you have questions, please contact an InvesTrust Retirement Plan Specialist at 1-866-848-0258, Monday -Friday, 8:00 a.m. to 5:00 p.m. CST.

» Contact Cody Harris with First Financial Groupof America at [email protected] or call432-456-9783 (office) or 432-556-1901 (cell)

For Questions or Information on how to enroll in the FFInvest 457(b) Retirement Plan, please contact Cody Harris at [email protected]


http://www.my457account.com

http://investrustwealthmanagement.com/blog/

http://investrustwealthmanagement.com/financial-calculators-2/

https://www.superstatement.com/sponsor/News/Newsletter.pdf

http://ffinvest.my457account.com




This FAQ is designed to inform Participants about the Plan. Every attempt is made to convey the Plan accurately; however, if anything varies from the Plan Documents, the Plan Documents will control. Plan Administration Fees, Investment Options, etc. are subject to change without notice. This FAQ is not intended to convey legal or tax advice, nor can it be used to avoid the payment of income taxes or penalties assessed by any U.S. tax authority.

FFInvest 457(b) Frequently Asked Questions (FAQ)

When May I Join?

Eligible employees may join the Plan (Entry date) on the first

day of the month coinciding with or next following the date

on which the eligibility requirement is met, generally Date of

Hire (“DOH”).

How Do I Contribute To The Plan?

» Through payroll deduction, you may make elective deferrals

up to the maximum allowed by law. The dollar limit is $19,500

for calendar year 2020.

» You may also designate your salary deferrals to a Plan

account that accepts Roth after-tax contributions. In 2020,

you may contribute as much as $19,500, in total, to all

accounts (Roth after-tax contributions and pre-tax deferrals).

Roth contributions will be included as taxable income to the

employee. Earnings on the Roth contribution will accumulate

tax free, and retirement withdrawals may be exempt from

federal income tax.

» If you have an existing qualified retirement plan (pre-tax),

403(b) tax deferred arrangement or governmental 457 plan

with a prior employer or hold a taxable IRA account, you may

transfer or roll over that account into the Plan anytime.

May I Make Catchup Contributions To The Plan?

If you are age 50 or older (or will be age 50 on or before

December 31st) and make the maximum allowable deferral to

your Plan, you are entitled to contribute an additional amount

as a "catchup contribution." The catchup contribution is in-

tended to help eligible employees make up for smaller (or no

contributions) made earlier in their career. The maximum

catchup contribution is $6,500 for calendar year 2020. See

your Benefits Administrator for more details.

May I Stop Or Change My Contributions?

» You may stop your contributions anytime online or by

signing a new agreement. Once you discontinue contributions,

you may start again at the next available pay period.

» You may increase or decrease the amount of your pre-tax

and/or Roth contribution(s) at the next available pay period.

How Do I Become “Vested” In My Plan Account?

Vesting refers to your "ownership" of a benefit from the Plan.

You are always 100% vested in your Plan contributions and

your rollover contributions, plus any earnings they generate.

How Are Plan Contributions Invested?

You give investment directions for your 457(b) Plan account

by selecting from investment choices provided under the Plan,

as determined by FFInvest 457(b) Plan.

» If you do not choose any investment options, your account

will be invested in the fund listed below most applicable to

your current age.

Investment Options

Money Market and Fixed Income Symbol Expense

Invesco Treasury Portfolio Shrt-Trm Inv Trust (Instl) TRPXX 0.18

Vanguard GNMA Fund (Admiral (Adm)) VFIJX 0.11

Vanguard Total Bond Market Index (Adm) VBTLX 0.05

Large Cap Equity

American Funds American Mutual Fund (R6) RMFGX 0.30

Delaware Value (R6) DDZRX 0.58

American Funds Growth Fund of America (R6) RGAGX 0.31

Harbor Capital Appreciation Fund (Retirement) HNACX 0.58

Vanguard 500 Index Fund (Adm) VFIAX 0.04

Mid Cap Equity

Vanguard Mid-Cap Index Fund (Adm) VIMAX 0.05

Small Cap Equity

Vanguard Small Cap Value Index Fund (Adm) VSIAX 0.07

Vanguard Small Cap Growth Index (Adm) VSGAX 0.07

International Equity

Harbor International Fund (Retirement Class) HNINX 0.69

Artisan International Fund (Institutional) APHIX 0.96

American Funds EuroPacific Growth Fund (R6) RERGX 0.49

Asset Allocation Funds / Balanced

Vanguard Target Retirement Income Fund (Inv) VTINX 0.12

Vanguard Target Retirement 2015 Fund (Inv) VTXVX 0.13

Vanguard Target Retirement 2025 Fund (Inv) VTTVX 0.13

Vanguard Target Retirement 2035 Fund (Inv) VTTHX 0.14

Vanguard Target Retirement 2045 Fund (Inv) VTIVX 0.15

Vanguard Target Retirement 2055 Fund (Inv) VFFVX 0.15

Vanguard Target Retirement 2065 Fund (Inv) VLXVX 0.15

American Funds American Balanced (R6) RLBGX 0.28

Investment Option Name From Age To Age

Vanguard Target Retirement Income Fund (Inv) 68 99

Vanguard Target Retirement 2015 Fund (Inv) 58 67






https://www.invesco.com/pdf/CM-FFTSY-1.pdf

https://personal.vanguard.com/us/funds/snapshot?FundId=0536&FundIntExt=INT

https://www.sponsorportal.com/content/content.cfm?product=FUNDS&FUNDID=14289&custno=89DF79FE-D326-464A-871D-8BF25DBF1470&plan=069

http://fc.wealthmsi.com/eol/summary_prospectus.vm?cusip=922031794




https://www.americanfunds.com/individual/investments/fund/rmfgx

https://www.sponsorportal.com/content/content.cfm?product=FUNDS&FUNDID=X3238&custno=89DF79FE-D326-464A-871D-8BF25DBF1470&plan=069


https://www.delawareinvestments.com/institutional-investors/products/institutional-class-shares/delaware-value-fund?FundClass=quarterly-commentary

https://www.sponsorportal.com/content/content.cfm?product=FUNDS&FUNDID=XM791&custno=89DF79FE-D326-464A-871D-8BF25DBF1470&plan=069

http://fc.wealthmsi.com/eol/summary_prospectus.vm?cusip=24610C840

https://www.americanfunds.com/individual/investments/fund/rgagx



http://www.harborfunds.com/overview-2512.htm















http://www.harborfunds.com/overview-2511.htm



http://www.artisanfunds.com


http://fc.wealthmsi.com/eol/summary_prospectus.vm?cusip=04314H402

https://www.americanfunds.com/individual/investments/fund/rergx





http://fc.wealthmsi.com/eol/summary_prospectus.vm?cusip=92202E300
















https://investor.vanguard.com/mutual-funds/profile/VLXVX

https://www.sponsorportal.com/content/content.cfm?product=FUNDS&FUNDID=XP437&custno=89DF79FE-D326-464A-871D-8BF25DBF1470&plan=068


https://www.americanfunds.com/individual/investments/fund/rlbgx









https://investor.vanguard.com/mutual-funds/profile/VLXVX

This FAQ is designed to inform Participants about the Plan. Every attempt is made to convey the Plan accurately; however, if anything varies from the Plan Documents, the Plan Documents will control. Plan Administration Fees, Investment Options, etc. are subject to change without notice. This FAQ is not intended to convey legal or tax advice, nor can it be used to avoid the payment of income taxes or penalties assessed by any U.S. tax authority.

FAQ’S

FFInvest 457(b) Frequently Asked Questions (FAQ) (continued)

When May Money Be Withdrawn From My 457(b)

Account?

Money may be withdrawn from your Plan account in these

events:

• Death

• Termination of Employment

• The Participant’s attaining age 70 1/2.

To receive favorable tax treatment, distributions of Roth

contributions must be made after the participant reaches age

59½, or on account of the participant's death or disability, and

must be made at least 5 years after the date the first Roth

contribution was made. Be sure to talk with your tax advisor

before withdrawing any money from your Plan account.

May I Withdraw Money In Case of Unforeseeable

Emergency?

If you have an immediate and heavy financial need created by

an unforeseeable emergency and you lack other reasonably

available resources to meet that need, you may be eligible to

receive an unforeseeable emergency withdrawal from your

account. If you feel you are facing an unforeseeable emer-

gency as defined by the Plan (Reg. Section 1.457-6(c)(2)), you

should contact an InvesTrust Retirement Plan Specialist at

1-866-848-0258, M-F 8 a.m. to 5 p.m. for more details.

May I Borrow Money From My Account?

The Plan is intended to help you put aside money for your

retirement; however, the FFInvest 457(b) Plan includes a Plan

feature that lets you borrow money from the Plan.

» The amount the Plan may loan to you is limited by rules un-

der the tax law. In general, all loans will be limited to the

lesser of: one-half of your vested account balance or $50,000.

» The minimum loan amount is $1,000.

» All loans must generally be repaid within five years.

» A longer term may be available if the loan is to be used to purchase your principal residence.

» You may have 1 loan outstanding at a time.

» You pay interest back to your account. The interest rate on your loan will be the Prime Rate plus 2.00%.

» A $50 processing fee for all new loans is charged to your account.

Other requirements and limits must be met, and certain fees

may apply. Please contact an InvesTrust Retirement Plan

Specialist at 1-866-848-0258, Monday-Friday, 8 a.m.- 5 p.m.

for more details about this participant loan feature.

What are the Plan Administration Fees?

How Do I Obtain Information About my Account?

» You will receive a quarterly email notification that your per-

sonalized account eStatement is available online. The eState-

ment shows your account balance as well as any contributions

and earnings credited to your account during the reporting

period.

» You will also have access to an Internet Site

(www.my457account.com)/Retirement Plan Login which is

designed to give you current information about your Plan ac-

count. You may get up-to-date information about your ac-

count balance, contributions, investment choices, and other

Plan data. You will receive additional information on how to

use the Internet Site.

As a Plan participant, you may request certain information

from InvesTrust Retirement Specialists,

5100 N. Classen Blvd. Suite 620

Oklahoma City, OK 73118

Phone: 1-866-848-0258, M-F 8:00 a.m.—5:00 p.m.

This information includes: annual operating expenses of the

Plan investments; copies of prospectuses, financial state-

ments, reports, or other materials relating to Plan invest-

ments provided to the Plan; a list of assets contained in each

Plan investment portfolio; the value of those assets and fund

units or shares; and the past and current performance of each

Plan investment. More information may also be found online

at http://ffinvest.my457account.com

How Do I Enroll? Contact Cody Harris with First Financial at

432-456-9783 (office), 432-556-1901 (cell), or email

[email protected]

Fee Description Amount

Annual Per Participant Fee* $18 ($4.50 per quarter)

Annual Market Value Fee 0.85%

QDRO (Divorce) Processing $100/each

Loan Processing $50/each

*Inclusive of participants with balances

After I enroll, may I access my account online?

Yes! Go to www.my457account.com Select “Retirement Plan Login” (upper left hand corner, above InvesTrust logo) Default User ID: your Soc. Sec. No. (no dashes) Default Password: last four digits of your SSN

If you have questions, please contact an InvesTrust Retire-ment Plan Specialist at 1-866-848-0258.



mailto:[email protected]?subject=Ector%20County%20ISD%20457(b)%20Plan


https://www.retirementlogin.net/investrust/

IMPORTANT CONTACTS

Benefit Vendor Phone Website Dental MetLife 800-275-4638 www.metlife.com

Vision Superior Vision 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 Allstate 800-521-3535 www.allstatebenefits.com/mybenefits

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

Group Life SunLife 800-247-6875 www.sunlife.com/us

Legal Legalshield 800-654-7757 www.legalshield.com

ID Theft Protection iLock360/Cypher Security 855-287-8888 www.ilock360.com

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

FSA First Financial 866-853-3539 www.ffga.com

HSA First Financial 866-853-3539 www.ffga.com

MORGAN HARRIS, ACCOUNT MANAGEROFFICE: 432.456.9783

EMAIL: [email protected]

FFInvest InvesTrust 866-848-0258 ww.my457account.com

Date post:	03-Dec-2021
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