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DILLEY ISD BENEFIT OVERVIEW GUIDE

Plan Year: September 1, 2016 through August 31, 2017

Benefit Information Provided By: First Financial Group of America

Austin Branch Office 2009 Ranch Road 620N, Ste # 123

Austin, TX 78734 800-672-9666

Table of Contents

Topic Page Benefit Overview .............................................................................................................................................. 1

Section 125 Cafeteria Plan Overview ............................................................................................................ 2

Medical Reimbursement/ Dependent Care ................................................................................................... 3 -4

Benefit Summary ............................................................................................................................................. 5-6

Disability Insurance...........................................................................................................................................7-14

Cancer Insurance ...........................................................................................................................................15-22

Accident Insurance .......................................................................................................................................... 23-30

Vision Insurance .............................................................................................................................................. 31

Dental Insurance ............................................................................................................................................. 32-35

Permanent Life Insurance ............................................................................................................................... 36-38

Group Life Insurance........................................................................................................................................39-42

Health Savings Account .................................................................................................................................. 43-44

Customer Service Numbers and Websites ................................................................................................... 45

2016 Benefit Overview

DilIey ISD and First Financial Group of America would like to take this opportunity to present to you the benefit information for the upcoming plan year. This information has been created to bring forth a brief overview of your benefit choices as well as offer you a reference guide when questions may arise regarding your insurance plans. Please take the time to look over the information contained in this booklet to familiarize yourself with the benefits that are provided to you as an employee with DilleyISD. Representatives from First Financial will be at the district during the month of April to review plan options and make changes to your supplementary benefit elections under the Cafeteria Plan. The Plan Year for Dilley ISD is September 1, 2016 through August 31, 2017. Payroll deductions for your benefits will begin in September. This guide contains a summary of the benefits offered by Dilley ISD. 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 First Financial Administrators at 1-800-672-9666 or visit the website listed below.

Your Benefits Website:

Visit benefits.ffga.com/dilleyisd for detailed information.

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Available Benefits at a Glance Disability Income Insurance This insurance is designed to protect your ability to earn an income. This plan will provide you with income (70% of your gross monthly income) should you become disabled as a result of a covered accident or illness. The plan has various waiting periods that you can select. There is a doctor bill benefit payable (if you are sick, miss a day of work, and go to a doctor) for out-of-pocket expenses up to $50 for illness and $150 for an accidental injury.

Cancer Insurance Cancer insurance is designed to be a supplemental insurance that pays for many of the costs not covered by your major medical. This plan pays in addition to other coverage you may have. There are several option riders available such as the option for family coverage, Critical Illness rider, and an ICU rider, giving you the flexibility for the best coverage to meet your needs.

Accident Insurance Accident Insurance helps to cover the expenses for emergency room costs, follow-up

treatments, medical imaging, hospital confinement, and many other expenses associated with

accidental injuries. This plan can help with medical expenses and living costs when you get hurt unexpectedly.

Dental Insurance – Humana Dental Human Dental is the dental provider for Dilley ISD. Two plans available to choese from. Child orthodontia is available on the traditional plan through the age of 18. Two exams, and cleanings each year on either plan.

Vision Insurance - Superior Vision Superior Vision is the vision provider for Dilley ISD. Benefits for exam, lenses, contact lenses, and frames are available every 12 months. You may go to any provider but if you stay within the network you save money.

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Available Benefits at a Glance cont…..

Health Savings Account (HSA) A Health Savings Account (HSA) is an individually owned savings account that allows you to set aside money for health care tax free. Money left in the account can accumulate interest tax free and money used to pay for qualified medical expenses can be distributed tax free.

Flexible Spending Plans ‐ First Financial Administrators, Inc. Dilley ISD allows employees to set aside up to $2,550 per year for unreimbursed medical expenses and/or up to $5,000 per year for dependent day care expenses on a pre-tax basis. Federal regulations effective January 1, 2011, will exclude over-the-counter medications from being eligible expenses.

Life Insurance Individual Life Insurance ‐ Texas Life Employees have the opportunity to purchase individual permanent life insurance through Texas Life. These policies are portable at the same price and coverage. Coverage can be purchased for dependents including spouses, children, and grandchildren. Coverage is guaranteed to age 121.

Group Life Insurance Dilley ISD gives employees the opportunity to purchase Group life insurance through Dearborn

National at affordable group rates. You may purchase coverage for yourself, spouse, and dependent

children.

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Enhanced PLUS Disability Income Plan

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

LONG-TERM DISABILITYIncome Insurance

First Financial Capital Corporation P.O.Box670329•Houston,TX77267-0329

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

Marketed by:

Underwritten by: American Fidelity Assurance Company

Underwritten and administered by:

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Disabilities Happen. Are You Prepared?What would you do if you experienced a disability today and your paycheck suddenly stopped? Nearly 70% of American employees live paycheck to paycheck1, staying current on bill payments, but not preparing for the loss of that valuable income.

How Long Would You Go Without A Paycheck? A Week... A Month... A Year...The example below shows the potential lost income from a typical disability. This example also shows the estimated benefit payment this customer would have received under their Disability Income Insurance Plan.

SAMPLE CLAIM - Hypothetical Example*

STROKEAnnual Salary $50,000

Length of Disability 2.5 years

Lost Income $125,000

Disability Income Insurance Can Help! Monthly Benefit (70% of income) $2,900

Elimination (Waiting) Period 30 days

Month 1 $0 (not paid due to 30 day waiting period)

Month2 $2,900

Month 3 $290 (Full Potential Sick Leave Deducted)

Month 4 thru 30 $22,050 (816.67 a month after Disability Retirement deducted)

Total Benefit Payment $25,240 (Paid directly to you!)

Plus participation in an “Immediate Hospital” elimination period would increase your benefit more!

“I’ll use my sick leave or savings.”

68%

68% of American employees live from paycheck to paycheck.1

1/3 of Americans entering the work force today will become disabled before they retire.2

“I don’t have a significant risk of being disabled.”

Ready To Learn More?Contact your First Financial Account Representative for more details or to schedule a one-on-one appointment.

Think It Couldn’t Happen to You?

Know The Facts:

1 Reuters. “More than two-thirds in U.S. live paycheck to paycheck: survey,” September 19, 2012. 2”Chances of Disability: Overview.” Council for Disability Awareness. 2010. Web. 24 Mar. 2011

*The example above is an illustration only. Every disability claim event is unique. Based on pre-existing conditions, offsets related to fully-paid sick leave, retirement pay, state disability, and other Sources of Income could support this employee’s lost income and would be offset against their disability benefit, meaning the insurance payment would be less. The illustration above includes reductions due to fully-paid sick leave and state disability/retirement offsets.

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SALARY BENEFIT ELIMINATION PERIOD/MONTHLY PREMIUM

Annual Salary Monthly Salary*

Monthly Disability Benefit**

Accidental Death

Benefit

Immediate Day Injury

or 3 day

Sickness Elimination

Period

14 day Elimination

Period

30 day Elimination

Period

60 day Elimination

Period

90 day Elimination

Period

150 day Elimination

Period

$3,432.00 - $5,147.99 $286.00 - $428.99 $200.00 $20,000.00 $10.16 $7.28 $5.80 $4.92 $4.16 $3.12

$5,148.00 - $6,863.99 $429.00 - $571.99 $300.00 $20,000.00 $15.24 $10.92 $8.70 $7.38 $6.24 $4.68

$6,864.00 - $8,579.99 $572.00 - $714.99 $400.00 $20,000.00 $20.32 $14.56 $11.60 $9.84 $8.32 $6.24

$8,580.00 - $10,295.99 $715.00 - $857.99 $500.00 $20,000.00 $25.40 $18.20 $14.50 $12.30 $10.40 $7.80

$10,296.00 - $11,999.99 $858.00 - $999.99 $600.00 $20,000.00 $30.48 $21.84 $17.40 $14.76 $12.48 $9.36

$12,000.00 - $13,715.99 $1,000.00 - $1,142.99 $700.00 $20,000.00 $35.56 $25.48 $20.30 $17.22 $14.56 $10.92

$13,716.00 - $15,431.99 $1,143.00 - $1,285.99 $800.00 $20,000.00 $40.64 $29.12 $23.20 $19.68 $16.64 $12.48

$15,432.00 - $17,147.99 $1,286.00 - $1,428.99 $900.00 $20,000.00 $45.72 $32.76 $26.10 $22.14 $18.72 $14.04

$17,148.00 - $18,863.99 $1,429.00 - $1,571.99 $1,000.00 $20,000.00 $50.80 $36.40 $29.00 $24.60 $20.80 $15.60

$18,864.00 - $20,579.99 $1,572.00 - $1,714.99 $1,100.00 $20,000.00 $55.88 $40.04 $31.90 $27.06 $22.88 $17.16

$20,580.00 - $22,295.99 $1,715.00 - $1,857.99 $1,200.00 $20,000.00 $60.96 $43.68 $34.80 $29.52 $24.96 $18.72

$22,296.00 - $23,999.99 $1,858.00 - $1,999.99 $1,300.00 $20,000.00 $66.04 $47.32 $37.70 $31.98 $27.04 $20.28

$24,000.00 - $25,715.99 $2,000.00 - $2,142.99 $1,400.00 $20,000.00 $71.12 $50.96 $40.60 $34.44 $29.12 $21.84

$25,716.00 - $27,431.99 $2,143.00 - $2,285.99 $1,500.00 $20,000.00 $76.20 $54.60 $43.50 $36.90 $31.20 $23.40

$27,432.00 - $29,147.99 $2,286.00 - $2,428.99 $1,600.00 $20,000.00 $81.28 $58.24 $46.40 $39.36 $33.28 $24.96

$29,148.00 - $30,863.99 $2,429.00 - $2,571.99 $1,700.00 $20,000.00 $86.36 $61.88 $49.30 $41.82 $35.36 $26.52

$30,864.00 - $32,579.99 $2,572.00 - $2,714.99 $1,800.00 $20,000.00 $91.44 $65.52 $52.20 $44.28 $37.44 $28.08

$32,580.00 - $34,295.99 $2,715.00 - $2,857.99 $1,900.00 $20,000.00 $96.52 $69.16 $55.10 $46.74 $39.52 $29.64

$34,296.00 - $35,999.99 $2,858.00 - $2,999.99 $2,000.00 $20,000.00 $101.60 $72.80 $58.00 $49.20 $41.60 $31.20

$36,000.00 - $37,715.99 $3,000.00 - $3,142.99 $2,100.00 $20,000.00 $106.68 $76.44 $60.90 $51.66 $43.68 $32.76

$37,716.00 - $39,431.99 $3,143.00 - $3,285.99 $2,200.00 $20,000.00 $111.76 $80.08 $63.80 $54.12 $45.76 $34.32

$39,432.00 - $41,147.99 $3,286.00 - $3,428.99 $2,300.00 $20,000.00 $116.84 $83.72 $66.70 $56.58 $47.84 $35.88

$41,148.00 - $42,863.99 $3,429.00 - $3,571.99 $2,400.00 $20,000.00 $121.92 $87.36 $69.60 $59.04 $49.92 $37.44

$42,864.00 - $44,579.99 $3,572.00 - $3,714.99 $2,500.00 $20,000.00 $127.00 $91.00 $72.50 $61.50 $52.00 $39.00

$44,580.00 - $46,295.99 $3,715.00 - $3,857.99 $2,600.00 $20,000.00 $132.08 $94.64 $75.40 $63.96 $54.08 $40.56

$46,296.00 - $47,999.99 $3,858.00 - $3,999.99 $2,700.00 $20,000.00 $137.16 $98.28 $78.30 $66.42 $56.16 $42.12

$48,000.00 - $49,715.99 $4,000.00 - $4,142.99 $2,800.00 $20,000.00 $142.24 $101.92 $81.20 $68.88 $58.24 $43.68

$49,716.00 - $51,431.99 $4,143.00 - $4,285.99 $2,900.00 $20,000.00 $147.32 $105.56 $84.10 $71.34 $60.32 $45.24

$51,432.00 - $53,147.99 $4,286.00 - $4,428.99 $3,000.00 $20,000.00 $152.40 $109.20 $87.00 $73.80 $62.40 $46.80

$53,148.00 - $54,863.99 $4,429.00 - $4,571.99 $3,100.00 $20,000.00 $157.48 $112.84 $89.90 $76.26 $64.48 $48.36

$54,864.00 - $56,579.99 $4,572.00 - $4,714.99 $3,200.00 $20,000.00 $162.56 $116.48 $92.80 $78.72 $66.56 $49.92

$56,580.00 - $58,295.99 $4,715.00 - $4,857.99 $3,300.00 $20,000.00 $167.64 $120.12 $95.70 $81.18 $68.64 $51.48

$58,296.00 - $59,999.99 $4,858.00 - $4,999.99 $3,400.00 $20,000.00 $172.72 $123.76 $98.60 $83.64 $70.72 $53.04

$60,000.00 - $61,715.99 $5,000.00 - $5,142.99 $3,500.00 $20,000.00 $177.80 $127.40 $101.50 $86.10 $72.80 $54.60

$61,716.00 - $63,431.99 $5,143.00 - $5,285.99 $3,600.00 $20,000.00 $182.88 $131.04 $104.40 $88.56 $74.88 $56.16

$63,432.00 - $65,147.99 $5,286.00 - $5,428.99 $3,700.00 $20,000.00 $187.96 $134.68 $107.30 $91.02 $76.96 $57.72

$65,148.00 - $66,863.99 $5,429.00 - $5,571.99 $3,800.00 $20,000.00 $193.04 $138.32 $110.20 $93.48 $79.04 $59.28

$66,864.00 - $68,579.99 $5,572.00 - $5,714.99 $3,900.00 $20,000.00 $198.12 $141.96 $113.10 $95.94 $81.12 $60.84

$68,580.00 - $70,295.99 $5,715.00 - $5,857.99 $4,000.00 $20,000.00 $203.20 $145.60 $116.00 $98.40 $83.20 $62.40

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

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

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

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

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

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

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

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

PHYSICIAN EXPENSE BENEFIT » Injury - $150.00 per Injury

» Sickness - $50.00If 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 Active Employment for at least 14 consecutive scheduled workdays.

You are not required to miss one full day of work in order to receive the Injury benefit.

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

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

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

During the first 24 months of payments while Disabled and Working: » Your Disability Payment will not be reduced as long as the Disability

Earnings plus the gross Disability Benefit does not exceed 80% of your Monthly Compensation.

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

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

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

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

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

Plan Features

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

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

WORKSITE ACCOMMODATIONIf worksite modifications may assist your return to work, we will evaluate your claim for appropriate action.

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

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

IF YOU ARE DISABLED DUE TO A COVERED DISABILITY AND NOT WORKINGYour Disability Payment will be the Disability Benefit described in the Benefit Schedule less any Deductible Sources of Income you receive or are entitled to receive.

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 (on Immediate/3 day plan, 14, 30, 60 day Elimination Periods), 90 (on 90 day Elimination Period) and 150 (on 150 day Elimination Period) calendar days from the Date of Disability.

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

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

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

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

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

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

» gone treatment-free;

» incurred no expense;

» taken no medication; and

» received no diagnosis or advice from a Physician,

for 12 consecutive months for such condition(s).

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

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

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

» Intentionally self-inflicted injury while sane or insane.

» An act of war, declared or undeclared.

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

» Committing a felony.

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

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

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

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

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

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

» the date you retire; » the date you cease to be on Active Employment, except as provided

for under the Leave of Absence provision; » the end of the last period for which premium has been paid; » the date the Policy is discontinued; or » the date your employment terminates.

If: » your coverage ends as a result of your termination of Active

Employment; » such termination is caused by an Injury or Sickness for which

Disability Benefits would be payable; and » Disability is established prior to the termination of Active

Employment,

then:

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

Termination of the Policy will have no affect on Disability Payments which began before termination. We may end your coverage if you submit a fraudulent claim.

DEFINITIONS

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

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

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

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

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

» living in your household; » dependent upon you for support; and » in need of supervision or assistance due to physical or mental

incapacity.

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

» a place for rehabilitation; » a place for rest or for the aged; » a nursing or convalescent home; » a long-term nursing unit or geriatrics ward; or » as an extended care facility for the care of convalescent, rehabilitative,

or ambulatory patients.

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

» subtract your Disability Earnings from your Monthly Compensation;

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

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

PRE-EXISTING CONDITION: The term “Pre-Existing Condition” means a disease, Injury, Sickness, physical condition or mental illness for which you:

» had treatment; » incurred expense; » took medication; » received care or services including diagnostic testing or related

measures; or

» received a diagnosis or advice from a Physician,

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

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Marketed by: First Financial Group of AmericaOPTIONAL RIDERSSee your First Financial Account Representative regarding available riders, including Critical Illness Rider, Accident Only Spousal Rider, Hospital Indemnity Rider, Survivor Benefit Rider, and COBRA Funding Rider.

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

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

Immediate Day Injury / 3 Day Elimination Period Sickness: Benefits begin on the 1st day of Disability due to covered Injury and on the 4th day of Disability due to a covered Sickness. 14 Day Elimination Period: Benefits begin on the 15th day of Disability due to a covered Injury or Sickness. 30 Day Elimination Period: Benefits begin on the 31st day of Disability due to a covered Injury or Sickness. 60 Day Elimination Period: Benefits begin on the 61st day of Disability due to a covered Injury or Sickness. 90 Day Elimination Period: Benefits begin on the 91st day of Disability due to a covered Injury or Sickness. 150 Day Elimination Period: Benefits begin on the 151st day of Disability due to a covered Injury or Sickness.

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

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

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

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









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

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

Disability Income Insurance Can Help! Ask Your First Financial Account

Representative For More Details.

13

SB-26000(FF)(ENHANCED PLUS)-1113 G-120-TX-100-060; MCH#1309; 014400-7, 014405-8, 014406-9, 014407-10, 014408-11, 014410-12

PLAN HIGHLIGHTS

Please review the full benefit definition of each section above under “Plan Features” inside this brochure for plan details, limitations and exclusions.

» Effective DateYour Effective Date is different than the date you sign your application. Your Effective Date of coverage is the date shown on your certificate. Please be sure to view your group certificate to understand when your coverage begins upon approval of application it can either be mailed to you or you can receive an email with a link to view securely online.

» Hospital Confinement Benefit Pays an immediate benefit each day you are confined to a hospital for an injury or sickness, and will not begin until the elimination period has been satisfied. Benefit will pay up to 60 days.

» Limitations and ExclusionsThis policy has limitations and/or exclusions to select benefits during certain situations, including self inflicted injury, an act of war, injuries contracted not to cover any loss, fatal or non-fatal, resulting from while serving in the armed forces, while committing a felony or during penal incarceration, or an injury or sickness in which you are entitled to Workers’ Compensation.

» Physicians Expense BenefitReceive a benefit if you receive treatment by a Physician due to a covered Injury.

» Pre-Existing Means a disease, Injury, Sickness, physical condition or mental illness that received medical advice or treatment prior to enrollment in a new disability insurance plan.

» OffsetsIf applicable, your disability benefit will be reduced by deductible sources of Income that include, but are not limited to:

» Salary Increases Your Monthly Disability Benefit does not automatically increase if you have an increase in pay! It is important to notify your Account Manager when applying for a new, higher benefit that is aligned with your current income.

» Waiver of PremiumPremiums may be waived while you are disabled based on the length of your disability and the plan selected.

• other group disability income benefits;• government or retirement system benefits; • Social Security benefits (if applicable in your

state), including any amounts due to your dependent(s) on account of your disability;

• sick leave or other salary or wage continuance plans provided by your employer that extend over 60 days, State disability benefits and unemployment benefits.

2000 N. Classen BoulevardOklahoma City, Oklahoma 73106

800-654-8489www.americanfidelity.com

Underwritten and administered by:Sign up for online secured access to view and print your

policies at americanfidelity.com. American Fidelity’s Online Service Center provides you convenient,

secure 24/7 access to your detailed certificate. We understand your privacy is important so we will not use your e-mail address for

solicitation purposes.

14

ABJ29704X Page 1 of 6

Group Cancer InsuranceSupplements existing coverage and can provide cash to help with medical and living expensesGroup Voluntary Cancer coverage from Allstate Benefits pays cash benefits for cancer and 29 specified diseases to help with the costs associated with treatments and expenses as they happen.

Are you protected from

a diagnosis of cancer?

There are daily living expenses you must pay

for even if you are sick and cannot work.

GROCERIES SCHOOL

CAR

ELECTRICITY

How will you pay for them?

THE POLICY IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE 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.

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of 6 ABJ29704X

cancer and specified diseaseReceiving a diagnosis of cancer or a specified disease can be difficult on anyone, both emotionally and financially. Having the right coverage to help when undergoing treatments for cancer or a specified disease is important. Our coverage can help provide added financial support when it is needed most.

Our coverage helps offer peace of mind when a diagnosis of cancer or a specified disease occurs. Below is an example of how benefits might be paid.*

benefit coverage highlightsCancer and specified disease benefits can help cover the costs of specific treatments and expenses as they happen. Terms and conditions for each benefit will vary. Benefit amounts are shown on pages 2a and/or 2b.

Specified Diseases - 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.

HOSPITAL AND RELATED BENEFITS Continuous Hospital Confinement - Pays a benefit for each day of inpatient confinement.

Government or Charity Hospital - Pays a benefit for each day of inpatient confinement to a U.S. government hospital or a hospital that does not charge for its services. In lieu of all other benefits.

Private Duty Nursing Services - Pays a daily benefit when receiving physician-authorized inpatient private nursing services.

Extended Care Facility - Pays a daily benefit for physician-authorized inpatient confinement (within 14 days of a hospital stay).

At Home Nursing - Pays a daily benefit for physician-authorized private nursing care (up to the number of days of the previous hospital stay).

meeting your needsOur cancer coverage can help offer you and your family financial support.

• Benefits paid directly to you unless otherwise assigned

• Coverage for you or your entire family

• No evidence of insurability required at initial enrollment†

• Waiver of premium after 90 days of disability due to cancer for as long as your disability lasts**

• Portable † Enrolling after your initial enrollment period requires evidence of insurability.** Primary insured only.

Jane undergoes her annual wellness test and is diagnosed with cancer.

Our cancer insurance policy paid Jane the following:Wellness Exam $ 50Hospital Confinement $ 300Cancer Initial Diagnosis $ 1,000Non-Local Transportation $ 160Surgery $ 1,500Anesthesia $ 375Radiation/Chemo $ 10,000Medical Imaging $ 500Inpatient Medicine $ 75Physician Visits $ 150Anti-Nausea $ 200

Jane chooses benefit coverage under her

Employer Approved Plan

Jane’s doctor recommends pre-op testing and provides her with the location of the hospital. Jane must travel 200 miles to have pre-op testing (medical imaging) and is admitted to the hospital for surgery.

Jane undergoes surgery, anesthesia, radiation/chemo, and is visited by a doctor during a 3-day hospital stay. And every 2 weeks she has radiation/ chemotherapy at a local facility, is given anti-nausea medication, and sees her doctor during her follow-up visits. Total Benefits: $14,310

*The example shown may vary from the plan your employer is offering. Your individual experience may also vary. Please see pages 2a and/or 2b for your plan details.

16


Hospice Care - Pays a benefit when a physician determines terminal illness and approves hospice care at home (1 visit per day) or in a freestanding hospice care center.

RADIATION, CHEMOTHERAPY AND RELATED BENEFITSRadiation/Chemotherapy for Cancer - Pays a benefit for covered treatment to destroy or modify cancerous tissue.

Blood, Plasma, and Platelets - Pays a benefit for blood, plasma, and platelets. Includes charges for transfusions, administration, processing, procurement and cross-matching. Does not include donor replaced blood or immunoglobulins.

Medical Imaging - Pays a benefit for an initial diagnosis or follow-up evaluation.

Hematological Drugs - Pays a benefit for drugs to boost cell lines when Radiation/Chemotherapy for Cancer benefit is paid.

SURGERY AND RELATED BENEFITSSurgery*- Pays a benefit for an inpatient or outpatient operation listed in the Schedule of Surgical Procedures.

Anesthesia - Pays 25% of surgery benefit.

Ambulatory Surgical Center - Pays a benefit for surgery at an ambulatory surgical center.

Second Opinion - Pays a benefit for a second surgical opinion.

Bone Marrow or Stem Cell Transplant - Pays a benefit for transplants.

MISCELLANEOUS BENEFITS Inpatient Drugs and Medicine - Pays a daily benefit for inpatient drugs and medicine.

Physician’s Attendance - Pays a daily benefit for one inpatient visit.

Ambulance - Pays a benefit for transfer by ambulance service to or from a hospital.

Non-Local Transportation - Pays a benefit for transportation for treatment not available locally (up to 700 miles).

Outpatient Lodging - Pays a daily benefit for lodging when receiving radiation or chemotherapy on an outpatient basis non-locally (more than 100 miles from home).

Family Member Lodging and Transportation - Pays a benefit for one adult family member when confined at a non-local hospital for specialized treatment (more than 100 miles from family member’s home).

Physical or Speech Therapy - Pays a daily benefit for physical or speech therapy to restore normal body function.

New or Experimental Treatment - Pays a benefit for physician-approved new or experimental treatments not paid under other benefits.

Prosthesis - Pays a benefit for a prosthetic device that requires surgical implanting.

Hair Prosthesis - Pays a benefit for a wig or hairpiece when hair loss is experienced.

Nonsurgical External Breast Prosthesis - Pays a benefit for the initial nonsurgical breast prosthesis after a covered mastectomy.

Anti-Nausea Benefit - Pays a benefit for prescribed anti- nausea medication administered on an outpatient basis.

Waiver of Premium (primary insured only) - Pays premiums after disabled 90 days in a row due to cancer, for as long as disability lasts.

ADDITIONAL BENEFITSCancer Initial Diagnosis - Pays a one-time benefit if diagnosed for the first time with cancer (except skin cancer).

Wellness - Pays a benefit each calendar year for one of the following: Biopsy for skin cancer; Blood tests for triglycerides, CA15-3 (breast cancer), CA125 (ovarian cancer), CEA (colon cancer) and 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.

Intensive Care - Pays a daily benefit for Intensive Care Unit Confinements for any illness or accident (up to 45 days for each stay), Step-down Intensive Care Unit Confinements (up to 45 days for each stay) and air or surface ambulance to a hospital intensive care unit.

*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.

Wellness tests A doctor visit is scheduledannually

You get paid cash

Tests are run and results received

October

18

17


Intensive Care Benefits Exclusions and Limitations - (a) Benefits are not paid for: (1) attempted suicide or intentional self-inflicted injury; (2) intoxication or being under the influence of drugs not prescribed by a physician; or (3) alcoholism or drug addiction. (b) 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, step-down and other lesser care units. (c) 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. (d) Benefits are not paid for confinements occurring during a hospitalization prior to the effective date. (e) 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. (f) We do not pay for ambulance if paid under the cancer and specified disease ambulance benefit.

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

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

Portability Privilege - Coverage may be continued under the Portability Provision when coverage under the policy ends.

LIMITS, EXCLUSIONS AND EXCEPTIONSPre-Existing Condition - (a) Allstate Benefits does not pay benefits for a pre-existing condition during the 12-month period beginning on the date that person’s coverage starts. (b) A pre-existing condition is a disease or condition for which symptoms existed within the 12-month period prior to the effective date; or (c) medical advice or treatment was recommended or received from a medical professional within the 12-month period prior to the effective date. (d) A pre-existing condition can exist even though a diagnosis has not yet been made.

Cancer and Specified Disease Benefits Exclusions and Limitations - (a) Allstate Benefits does not pay for any loss, except for losses due to cancer or a specified disease. (b) 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.

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

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

18

of 6 ABJ29704X

Now Is The Time...Don’t wait for a diagnosisBeing diagnosed with cancer can be one of the most frightening experiences anyone has to face, especially if you are unprepared. The out-of-pocket costs associated with cancer treatment may reduce your finances. Don’t wait for a diagnosis to decide you need coverage, because by that time it will be too late. Get the protection you need today, and rest easy knowing you are protected in the event you are diagnosed.

Budget friendlySometimes, receiving proper cancer treatment is difficult if money is tight. That’s where we can help. Your employer has worked with us to create a supplemental benefit package that can fit your needs and work within your budget.

Our supplemental insurance can help you and your family cover expenses for cancer and specified disease treatments if a diagnosis occurs.

It’s never too early to prepare for the future.

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of 6 ABJ29704X

This material is valid as long as information remains current, but in no event later than March 15, 2018. Group Cancer and Specified Disease benefits provided by policy GVCP3, or state variations thereof.

Coverage is provided by 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.

This brochure highlights some features of the policy but is not the insurance contract. For complete details, contact your Allstate Benefits Agent. This is a brief overview of the benefits available under the Group Voluntary Policy underwritten by American Heritage Life Insurance Company (Home Office, Jacksonville, FL). Details of the insurance, including exclusions, restrictions and other provisions are included in the certificates issued.

This 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.

This brochure is for use in enrollments which are sitused in: TX

Allstate Benefits is the marketing name used by American Heritage Life Insurance Company, a subsidiary of The Allstate Corporation.

©2015 Allstate Insurance Company. www.allstate.com or allstatebenefits.com.

20

HOSPITAL AND RELATED BENEFITS LOW MEDIUM HIGH Continuous Hospital Confinement (daily) $100 $200 $300Government or Charity Hospital (daily) $100 $200 $300Private Duty Nursing Services (daily) $100 $200 $300Extended Care Facility (daily) $100 $200 $300At Home Nursing (daily) $100 $200 $300Hospice Care Center (daily) or 1. $100 1. $200 1. $300 Hospice Care Team (per visit) 2. $100 2. $200 2. $300

RADIATION, CHEMOTHERAPY AND RELATED BENEFITSRadiation/Chemotherapy for Cancer (every 12 mos.) $10,000* $15,000* $20,000*Blood, Plasma, and Platelets (every 12 mos.) $10,000* $15,000* $20,000*Medical Imaging (yearly) $500*4 $750*4 $1000*4

Hematological Drugs (yearly) $200* $300* $400*

SURGERY AND RELATED BENEFITSSurgery $1,500*2 $4,500*2 $6,000*2

Anesthesia (% of surgery) 25% 25% 25%

Ambulatory Surgical Center (daily) $250 $750 $1,000Second Opinion $200 $600 $800Bone Marrow or Stem Cell Transplant 1. Autologous 1. $5004 1. $1,5004 1. $2,0004

2. Non-autologous 2. $1,2504 2. $3,7504 2. $5,0004

3. Non-autologous for L eukemia 3. $2,5004 3. $7,5004 3. $10,0004

MISCELLANEOUS BENEFITSInpatient Drugs and Medicine (daily) $25 $25 $25Physician’s Attendance (daily) $50 $50 $50Ambulance (per confinement) $100 $100 $100Non-Local Transportation (per trip or mile) Coach Fare Coach Fare Coach Fare or $0.40 or $0.40 or $0.40Outpatient Lodging (daily) $50*1 $50*1 $50*1

Family Member Lodging (daily) $50* $50* $50*and Transportation (per trip or mile) Coach Fare Coach Fare Coach Fare or $0.40 or $0.40 or $0.40Physical or Speech Therapy (daily) $50 $50 $50New or Experimental Treatment (every 12 mos.) $5,000* $5,000* $5,000*Prosthesis $2,000*3 $2,000*3 $2,000*3

Hair Prosthesis (every 2 years) $25 $25 $25Nonsurgical External Breast Prosthesis $50* $50* $50*Anti-Nausea Benefit (yearly) $200* $200* $200*Waiver of Premium (primary insured only) Yes Yes Yes

ADDITIONAL BENEFITS Cancer Initial Diagnosis $1,0005 $2,0005 $3,0005

Wellness (yearly) $504 $754 $1004

Intensive Care 1. Intensive Care Confinement (daily) 1. $200 1. $400 1. $600 2. Step-down Confinement (daily) 2. $100 2. $200 2. $300 3. Air/Surface Ambulance 3. Charges 3. Charges 3. Charges

group voluntary cancer

ABJ29704X-Insert-FFGA Page 2a

Listed above are benefit amounts associated with the benefits described in the brochure.* Benefit pays for charges/costs up to amount listed 1Limit $2,000/12 mo. period2 Based on procedure up to maximum shown 3 Per amputation 4 Payable once/covered person/calendar year 5 One-time benefit

21

premiums

Low $18.68 $28.99 $26.49 $36.78

Medium $32.06 $49.82 $45.69 $63.43

High $43.54 $67.80 $62.09 $86.35

MODE PLAN EE EE + SP EE + CH F

Monthly

This insert is part of brochure ABJ29704X and is not to be used on its own. Allstate Benefits is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a subsidiary of The Allstate Corporation. ©2015 Allstate Insurance Company. www.allstate.com or allstatebenefits.com.

This insert is for use in: TX

ABJ29704X-Insert-FFGA Page 2b

EE = Employee; EE + SP = Employee + Spouse; EE + CH = Employee + Children; F = Family. Issue Ages: 18 and over if Actively at Work

22

Even when you live well, accidents happen. Treatment can be vital to recovery, but it can also be expensive. And if an accident keeps you away from work during recovery, the financial worries can grow quickly.

Accident Insurancefrom Allstate Benefits

Benefits are paid to you

1National Safety Council, Injury Facts®, 2014 Edition

Allstate Benefits | allstatebenefits.com

Key Features• Guaranteed Issue coverage,

meaning no medical questions to answer

• Coverage available for spouse and child(ren)

• Premiums are affordable and are conveniently payroll deducted

• Coverage can be continued, as long as premiums are paid to Allstate Benefits

See reverse for plan details

ABJ30591X

Most major medical insurance plans only pay a portion of the bills. Our coverage can help pick up where other insurance leaves off and provide cash to help cover the expenses.

With accident insurance from Allstate Benefits, you can gain the advantage of financial protection, thanks to the cash benefits paid directly to you. You also gain the financial empowerment to seek the treatment needed to get well.

Here’s How It WorksOur coverage pays you cash benefits that correspond with hospital and intensive care confinement. Your plan may also include coverage for a variety of occurrences, such as: dismemberment; dislocation or fracture; ambulance services; physical therapy and more. The cash benefits can be used to help pay for deductibles, treatment, rent and more.

With Allstate Benefits, you can protect your finances against life’s slips and falls.

Are you in Good Hands? You can be.

You choose the benefits to help protect yourself and any family members from accidental injury expenses

CHOOSEYou or a covered family member experience an accidental injury and seek medical attention

USEYou go online and file a claim. The cash benefits are paid to you, to use however you wish

CLAIM

Protection for accidental injuries on- and off-the-job, 24-hours a day

The number of injuries (in millions) suffered by workers in one year, both on- and off-the-job.1

4.9m 8.3m 3.6m 2.0m

ON-THE-JOB OFF-THE-JOB

Work Home Non-auto Auto

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.

23

Allstate Benefits is the marketing name used by American Heritage Life Insurance Company, a subsidiary of The Allstate Corporation. ©2015 Allstate Insurance Company. www.allstate.com or allstatebenefits.com

For use in enrollments sitused in TX.

This material is valid as long as information remains current, but in no event later than August 1, 2018. Group Accident benefits are provided by policy form GVAP6 and the following riders, or state variations thereof, if included: Accidental Death, Dismemberment and Functional Loss Rider GP6ADD, Accident Treatment and Urgent Care Rider GP6AUC, Benefit Enhancement Rider GP6BE, Dislocation/Fracture Rider GP6DF, Emergency Room Services Rider GP6ERS and Outpatient Physician’s Benefit Rider GP6OPT.Coverage is provided by Limited Benefit Supplemental Accident Insurance. The policy is not a Medicare Supplement Policy. If eligible for Medicare, review Medicare Supplement Buyer’s Guide available from Allstate Benefits. This information highlights some features of the policy but is not the insurance contract. For complete details, contact your Allstate Benefits Agent. This is a brief overview of the benefits available under the Group Voluntary Policy underwritten by American Heritage Life Insurance Company (Home Office, Jacksonville, FL). Details of the insurance, including exclusions, restrictions and other provisions are included in the certificates issued.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.

Benefits

Lacerations Burns

Skin Graft Brain Injury Diagnosis

Paralysis Coma with Respiratory Assistance

Open Abdominal or Thoracic Surgery Ruptured Spinal Disc Surgery

Eye Surgery General Anesthesia

Blood and Plasma Appliance

Medical Supplies Medicine

Prosthesis Physical, Occupational, or Speech Therapy

Rehabilitation Unit Non-Local Transportation

Family Member Lodging Post-Accident Transportation

Broken Tooth Residence/Vehicle Modification

Pain Management Miscellaneous Outpatient Surgery

Accident Follow-up Treatment

Tendon, Ligament, Rotator Cuff or Knee Cartilage Surgery

Computed Tomography (CT) Scan and Magnetic Resonance Imaging (MRI)

Initial Hospital Confinement Daily Hospital Confinement

Intensive Care

Base Policy

Benefit Enhancement Rider

Additional Riders

Access Your Benefits and Claim Filings Accessing your benefit information using MyBenefits has never been easier.

MyBenefits is an easy-to-use website that offers you 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.

Our cash benefits provide you with greater coverage options because you get to determine how to use them.

Finances Can help protect your HSAs, savings, retirement plans and 401ks from being depleted

Travel You can use your cash benefits to help pay for expenses while receiving treatment in another city

Home You can use your cash benefits to help pay the mortgage, continue rental payments, or perform needed home repairs for your after care

Expenses The lump-sum cash benefit can be used to pay your family’s living expenses such as bills, electricity and gas

YOU DECIDE how to use the cash benefits

Additional Riders Added to Base Policy

Outpatient Physician’s Benefit

Accidental Death, Dismemberment and Functional Loss Rider, including a benefit for

Common Carrier Accidental Death

Accident Treatment and Urgent Care Rider pays a benefit for:

Ground or Air Ambulance Accident Physician’s Treatment

X-ray Urgent Care

Dislocation/Fracture Rider

Emergency Room Services Rider

24

ABJ30591X-Insert-PISD Allstate Benefits | allstatebenefits.com

Group Voluntary Accident (GVAP6)24-Hour Accident Insurancefrom Allstate BenefitsSee attached Important Information About Coverage.

BENEFIT ENHANCEMENT RIDER PLAN 1 PLAN 2Accident Follow-Up Treatment (Pays daily) $100 $150

Lacerations $100 $150

Burns < 15% of body surface $200 $300 > 15% or more $1,000 $1,500

Skin Graft (% of Burns Benefit) 50% 50%

Brain Injury Diagnosis $600 $900

Computed Tomography (CT) Scan $100 $150 and Magnetic Resonance Imaging (MRI) (Pays once/year)

Paralysis (Pays once) Paraplegia $15,000 $22,500 Quadriplegia $30,000 $45,000

Coma with Respiratory Assistance $20,000 $30,000

Open Abdominal or Thoracic Surgery $2,000 $3,000

Tendon, Ligament, Rotator Cuff Surgery $1,000 $1,500 or Knee Cartilage Surgery Exploratory $300 $450

Ruptured Spinal Disc Surgery $1,000 $1,500

Eye Surgery $200 $300

General Anesthesia $200 $300

Blood and Plasma $600 $900

Appliance $250 $375

Medical Supplies $10 $15

Medicine $10 $15

Prosthesis 1 device $1,000 $1,500 2 or more devices $2,000 $3,000

Physical, Occupational or Speech Therapy (Pays daily) $60 $90

Rehabilitation Unit $200 $300

Non-Local Transportation $500 $750

Family Member Lodging $200 $300

Post-Accident Transportation (Pays once/year) $400 $600

Broken Tooth $200 $300

Residence/Vehicle Modification $1,000 $1,500

Pain Management (Epidural Injection) $100 $150

Miscellaneous Outpatient Surgery $200 $300

BENEFIT AMOUNTS

BASE POLICY BENEFITS PLAN 1 PLAN 2Initial Hospital Confinement (Pays once/year) $1,000 $1,500

Daily Hospital Confinement (Pays daily) $200 $300

Intensive Care (Pays daily) $400 $600ADDITIONAL RIDERS ADDED TO BASE PLAN 1 PLAN 2Accident Treatment and Urgent Care Rider Ambulance Ground $200 $300 Air $600 $900

Accident Physician’s Treatment $100 $150

X-ray $200 $300

Urgent Care $100 $150

Dislocation or Fracture Rider1 $4,000 $6,000 (Pays up to amount shown on reverse)

Emergency Room Services Rider $200 $300ADDITIONAL RIDERS PLAN 1 PLAN 2Outpatient Physician’s Benefit Rider $50 $75

Accidental Death*, Dismemberment1,* $40,000 $60,000 and Functional Loss1,* Rider

Common Carrier Accidental Death

$100,000 $150,000

(fare-paying passenger)

Benefits are paid once per accident unless otherwise noted here or in the Important Information About Coverage.

*Each benefit pays the amount shown. 1Up to amount shown; see Injury Benefit Schedule on reverse. Multiple losses from same injury pay only up to amount shown above.

25

Benefit amounts for coverage and one occurrence are shown below. INJURY BENEFIT SCHEDULE

For use in enrollments sitused in: TX. This rate insert is part of forms ABJ30591X and ABJ29986-2 and is not to be used on its own.

Knee joint (except patella). Bone or bones of the foot (except toes). Bone or bones of the hand (except fingers). Pelvis (except coccyx). Skull (except bones of face or nose). Foot (except toes). Hand or wrist (except fingers). Lower jaw (except alveolar process).

COMPLETE DISLOCATION PLAN 1 PLAN 2

Hip joint $4,000 $6,000

Knee or ankle joint, bone or bones of the foot $1,600 $2,400

Wrist joint $1,400 $2,100

Elbow joint $1,200 $1,800

Shoulder joint $800 $1,200

Bone or bones of the hand, collarbone $600 $900

Two or more fingers or toes $280 $420

One finger or toe $120 $180

COMPLETE, SIMPLE OR CLOSED FRACTURE PLAN 1 PLAN 2

Hip, thigh (femur), pelvis $4,000 $6,000

Skull $3,800 $5,700

Arm, between shoulder and elbow (shaft), shoulder blade (scapula), leg (tibia or fibula)

$2,200 $3,300

Ankle, knee cap (patella), forearm (radius or ulna), collarbone (clavicle)

$1,600 $2,400

Foot, hand or wrist $1,400 $2,100

Lower jaw $800 $1,200

Two or more ribs, fingers or toes, bones of face or nose $600 $900

One rib, finger or toe, coccyx $280 $420

LOSS PLAN 1 PLAN 2

Life, hearing, speech, or both eyes, hands, arms, feet, or legs, or one hand or arm and one foot or leg

$40,000 $60,000

One eye, hand, arm, foot, or leg $20,000 $30,000

One or more entire toes or fingers $4,000 $6,000

This material is valid as long as information remains current, but in no event later than August 1, 2018. Allstate Benefits is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a subsidiary of The Allstate Corporation. ©2015 Allstate Insurance Company. www.allstate.com or allstatebenefits.com.

PLAN 1 PREMIUMS

PLAN 2 PREMIUMS

MODE EE EE + SP EE + CH F

Monthly $13.70 $23.68 $29.12 $37.90

MODE EE EE + SP EE + CH F

Monthly $20.55 $35.52 $43.68 $56.85

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

26

Group Voluntary Accident (GVAP6)24-hour or Off-the-Job Accident Insurance Important Information About CoverageProvides details of base policy and rider coverage in all states where coverage is available. State-specific information is noted when it varies from the standard. Below is a list of base policy and rider benefits available with Group Accident coverage. Please refer to your employer chosen plan for the specific items that apply to your coverage. You will receive a certificate that details the certificate specifications for the coverage you purchased.Group Accident Issue ages are 18 and over if Actively at Work.

Benefits Specifications (see Benefit Amounts)

Daily Hospital Confinement - Max. 365 days/accident.

Intensive Care - Max. 180 days/injury. MD only - Objective Second Opinion - Payable once/accident.

Additional RiderDislocation/Fracture Rider - Multiple dislocations or fractures from the same accident are limited to the amount shown in the Base Accident Benefits on front page of insert.MD - Benefits for diagnostic or surgical procedures involving a bone or joint of the skeletal structure are expanded to also include coverage for bones or joints of the face, neck or head if, under the accepted standards of the profession of the health care provider rendering the service, the procedure is medically necessary to treat a condition caused by the injury.

ABJ29986-2 Allstate Benefits | allstatebenefits.com

Conditions and Limits

PA - When an injury results in a covered loss, and is diagnosed by a physician, Allstate Benefits will pay benefits as stated. Treatment must be received in the United States or its territories.

Most States - When an injury results in a covered loss within 180 days unless otherwise stated, from the date of an accident, and is diagnosed by a physician, Allstate Benefits will pay benefits as stated. Treatment must be received in the United States or its territories.

Dependent Eligibility/Termination (a) Coverage may include you, your spouse or domestic partner, and your children.

Conditions, Limitations and Exclusions Affecting Your Benefits

Your EligibilityAll States - Your employer decides who is eligible for your group (such as length of service and hours worked each week).

DC, IL, NJ, RI - Coverage may include you, your spouse, domestic partner, or civil union partner, and your children.

Optional RidersOutpatient Physician’s Benefit Rider - Benefit limited to 2 days/person/year, not to exceed 4 days/year if coverage includes dependents.CT, DC, KS, MI, NJ, ND - Rider not available.

Outpatient Physician’s Treatment for Accident and Preventive Care Benefit Rider - Benefit limited to 2 days/person/year, not to exceed 4 days/year if coverage includes dependents.HI, ID, IN, KY, MD, MI, NM, ND, OH, RI - Rider not available.TN - The rider name and description is replaced with: Outpatient Physician’s Treatment for Accident and Wellness Benefit Rider - Benefit limited to 2 days/person/year, not to exceed 4 days/year if coverage includes dependents. Wellness Benefit means one of the following: biopsy for skin cancer; blood test for triglycerides; bone marrow testing; CA15-3 (cancer antigen 15-3 - blood test for breast cancer); CA125 (cancer antigen 125 - blood test for ovarian cancer); CEA (carcinoembryonic antigen - blood test for colon cancer); chest X-ray; colonoscopy; Doppler screening for carotids; Doppler screening for peripheral vascular disease; echocardiogram; EKG (electrocardiogram); flexible sigmoidoscopy; Hemoccult stool analysis; HPV (Human Papillomavirus) Vaccination; lipid panel (total cholesterol count); mammography, including breast ultrasound; pap smear, including ThinPrep Pap Test; PSA (prostate specific antigen - blood test for prostate cancer); serum protein electrophoresis (test for myeloma); stress test on bike or treadmill; thermography; and ultrasound screening of the abdominal aorta for abdominal aortic aneurysms.

Accidental Death, Dismemberment and Functional Loss Rider - Multiple dismemberments and functional losses from the same accident are limited to the amount shown in the Base Accident Benefits on front page of insert.PA - Limitation does not apply.

Optional Benefit Enhancement RiderAccident Follow-Up Treatment - Max. 2 treatments/accident. Not paid if Physical, Occupational or Speech Therapy benefit paid.Burns - Other than sunburns.

PA - Limitation does not apply.

Computed Tomography (CT) Scan and Magnetic Resonance Imaging (MRI) - Treatments must be received within 30 days of accident.CO, PA - 30-day limitation does not apply.Coma with Respiratory Assistance - Payable once/accident.GA - Benefit not available. Open Abdominal or Thoracic Surgery; Tendon, Ligament, Rotator Cuff or Knee Cartilage Surgery; Ruptured Spinal Disc Surgery - For each surgical benefit, 2 or more procedures through same entry point are considered 1 operation.

General Anesthesia - Payable only if one of the rider Surgery benefits paid.

Physical, Occupational or Speech Therapy - Max. 6 days/accident. Includes chiropractic services. Not payable if Accident Follow-Up Treatment benefit paid.

Rehabilitation Unit - Per day, max. 30 days confinement, max. 60 days/year. Not paid if Daily Hospital Confinement benefit paid.

Non-Local Transportation - Per trip, max. 3 times/accident. More than 50 miles from your home.

Family Member Lodging - Payable up to 30 days/accident. Not payable if family member lives within 50 miles of hospital.

Post-Accident Transportation - More than 250 miles from your home, by common carrier. Only if Daily Hospital Confinement benefit paid.

Residence/Vehicle Modification - Within 365 days after accident. PA - 365-day limitation does not apply.

Miscellaneous Outpatient Surgery - Not payable if any other Surgery benefit is paid.

TX - The last sentence is replaced with: Treatment must be received in the United States or its territories, except in the case of an emergency.

ID - Congenital anomalies of newborn or newly adopted children are not excluded.

ID - Coverage may include you, your spouse, and children.

HI - Coverage may include you, your spouse or domestic partner, your children, or your certified reciprocal beneficiary.

(b) Coverage for children ends when the child reaches age 26, unless he or she continues to meet the requirements of an eligible dependent.IL - Coverage for children ends when the child reaches age 26 (30 if a military veteran who is an Illinois resident), unless he or she continues to meet the requirements of an eligible dependent.

27

(c) suicide or attempt at suicide;

(d) intentionally self-inflicted injury or action;

(e) any bacterial infection (except pyogenic infections from an accidental cut or wound);

(f) participation in aeronautics unless a fare-paying passenger on a licensed common-carrier aircraft;

Continuation of CoverageYou may be eligible to continue coverage when coverage under the policy ends.

CO - suicide or attempt at suicide, while sane.

DC, IL - (d) is deleted.

(f) discovery of fraud or material misrepresentation when filing a claim.

CT, RI - discovery of material misrepresentation when filing a claim.

NC - (f) is deleted.

(e) the date your class is no longer eligible; or

(d) Domestic partner coverage ends upon termination of the domestic partnership or your death.

DC - Domestic or civil union partner coverage ends upon termination of the domestic or civil union partnership or your death.

(d) the date you are no longer in an eligible class;

When Coverage Ends Coverage under the policy ends on the earliest of: (a) the date the policy or certificate is canceled;

(b) the last day of the period for which you made any required contributions;

(c) the last day you are in active employment, except as provided under the Temporary Layoff, Leave of Absence, or Family and Medical Leave of Absence provision;

NE - discovery of fraud or intentional misrepresentation when filing a claim.

(g) GA only - the date you request to discontinue coverage in writing.

NJ - Coverage may be continued under the Conversion Provision when coverage under the policy ends.

IL - (c) is deleted.

NE - any injury while under the influence of alcohol or any narcotic or illegal drug, unless taken as prescribed by a physician.

AR, ID - (e) is deleted.

TX - bacterial infection (except pyogenic food poisoning and infections from an accidental cut or wound).

IL - bacterial infection (except infections from an accidental injury, or from an accidental, involuntary or unintentional ingestion of contaminated substance).

NJ - aviation unless a fare-paying passenger on a licensed common-carrier aircraft.

Dependent Eligibility/Termination, continued

ID - (d) is deleted.

MI - any injury while under the influence of alcohol (as defined by the laws of the state of Michigan), narcotics or any other controlled substance or drug, unless administered and taken as prescribed by a physician.

Exclusions and LimitationsThe Exclusions and Limitations apply to the base policy and the following riders: Accidental Death, Dismemberment and Functional Loss RiderAccident Treatment and Urgent Care RiderBenefit Enhancement RiderDislocation/Fracture RiderEmergency Room Services Rider

Benefits are not paid for: (a) injury incurred before the effective date;

(g) engaging in an illegal occupation or committing or attempting an assault or felony;CT - committing or attempting an assault or felony.

MD - (g) is deleted.

NE, OK, TX - engaging in an illegal occupation or committing or attempting a felony.

NJ - any loss to which a contributing cause was the covered person’s commission of or attempt to commit a felony or to which a contributing cause was the covered person’s engagement in an illegal occupation.

UT - voluntarily engaging in: an illegal occupation, committing or attempting an assault or felony.

WI - engaging in illegal activities or an illegal occupation that results in the insured’s conviction of a felony.

ID - participation in a felony.

(h) driving in any race or speed test or testing any vehicle on any racetrack or speedway;

ID, OK - (h) is deleted.

(b) act of war or participation in a riot, insurrection or rebellion;

CT - act of war or participation in an insurrection or rebellion.

NC - act of war or active participation in a riot, insurrection or rebellion.

MD - act of war. PA - act of war or participation in a riot or insurrection.

OK - participation in a riot, insurrection or rebellion.

UT - act of war or voluntary participation in a riot, insurrection or rebellion.

ID - any act of war whether or not declared, participation in a riot or rebellion.

(i) hernia, including complications;

PA - hernia, including complications, will be excluded during the first 6 months of coverage, but will be covered thereafter.

IL - all types of hernia, including complications (except for hernia caused by an accident).

AR, ID, MI, WV - (i) is deleted.

MA - Coverage for children ends the earlier of when the child reaches age 26 or 2 years following loss of dependent status under the Internal Revenue Code, unless he or she continues to meet the requirements of an eligible dependent.

PA - Coverage will not terminate due to age on a child who was a full-time student and whose studies were interrupted by active duty service in the military.

(c) Spouse coverage ends upon valid decree of divorce or your death.IL, NJ, RI - Spouse or civil union partner coverage ends upon valid decree of divorce or your death.

28

(f) engaging in an illegal occupation or committing or attempting an assault or felony;

(g) driving in any race or speed test or testing an automobile or any vehicle on any racetrack or speedway;

MD - (f) is deleted.

Exclusions and Limitations, continued

OR - any injury while legally intoxicated as defined by the laws of this state or while under the influence of any drug, unless taken as prescribed by a physician.

PA - any injury sustained or contracted in consequence of the covered person being intoxicated under the influence of any drug, unless administered and taken as prescribed by a physician.

(k) serving as an active member of the Military, Naval, or Air Forces of any country or combination of countries;

For Off-the-Job accident coverage, the following exclusion also applies: (n) an injury that occurred as a result of an on-the-job accident.

IN - any injury while intoxicated or under the influence of any drug, unless taken as prescribed by a physician.

LA - any injury sustained or contracted in consequence of the covered person being intoxicated or under the influence of any narcotic not prescribed or recommended by a physician.

KY, SD - an injury that occurred as a result of an on-the-job accident, unless not payable under any workers’ compensation law.

(m) MD only - health care services that the appropriate regulatory board determines were provided as a result of a prohibited referral.

NJ - any loss sustained or contracted as a consequence of the covered person’s intoxication or being under the influence of any drug, unless administered or consumed and taken as prescribed by a physician.

TX - any injury sustained or contracted in consequence of the covered person’s being intoxicated or under the influence of any narcotic, unless taken as prescribed by a physician.

UT - any injury while under the influence of alcohol or any drug, unless taken as prescribed by a physician, if the use of alcohol or any narcotic substantially contributes to or causes the accident or is over the legal limit.

(l) ID only - an elective abortion (an abortion performed for any reason other than to preserve the life of the covered person);

ID - participation in a felony.


WI - engaging in illegal activities or in an illegal occupation that results in the covered person’s conviction of a felony.

ID, OK - (g) is deleted.

OR - any loss while legally intoxicated as defined by the laws of this state or while under the influence of any drug, unless taken as prescribed by a physician.

(h) any loss while under the influence of alcohol or any drug, unless taken as prescribed by a physician;

ID, MD, NV, OK, SD - (h) is deleted.

IN - any loss while intoxicated or under the influence of any drug, unless taken as prescribed by a physician.

LA - any loss sustained or contracted in consequence of the covered person being intoxicated or under the influence of any narcotic not prescribed or recommended by a physician.

PA - any loss sustained or contracted in consequence of the covered person being intoxicated or under the influence of any drug, unless administered and taken as prescribed by a physician.

AR - any loss sustained or contracted in consequence of being intoxicated or while under the influence of any controlled substance, unless administered and taken as prescribed by a physician.

NE - any loss while under the influence of alcohol or any narcotic or illegal drug, unless taken as prescribed by a physician.

TX - any loss sustained or contracted in consequence of the covered person being intoxicated or under the influence of any narcotic, unless taken as prescribed by a physician.

(i) serving as an active member of the Military, Naval, or Air Forces of any country or combination of countries;Outpatient Physician’s Benefit Rider (if included in your coverage)

CT, DC, KS, MI, NJ, ND - Rider not available. Benefits are not paid for: (a) loss incurred before the effective date;

(b) act of war, participation in a riot, insurrection or rebellion;

(c) suicide or attempt at suicide;

(d) intentionally self-inflicted injury or action;

MD - act of war. PA - act of war, participation in a riot or insurrection.

CO - suicide or attempt at suicide, while sane.

NC - act of war, active participation in a riot, insurrection or rebellion.

ID - any act of war, participation in a riot or rebellion.


IL - (c) is deleted.

IL - (d) is deleted.

(e) participation in aeronautics unless a fare-paying passenger on a licensed common-carrier aircraft;

KY, SD - an injury that occurred as a result of an on-the-job accident, unless not payable under any worker’s compensation law.

For Off-the-Job accident coverage, the following exclusion also applies: (l) an injury that occurred as a result of an on-the-job accident.

(k) MD only - health care services that the appropriate regulatory board determines were provided as a result of a prohibited referral.

(j) ID only - an elective abortion (an abortion performed for any reason other than to preserve the life of the covered person);

(j) any injury while under the influence of alcohol or any drug, unless taken as prescribed by a physician;

CT - the voluntary use of any controlled substance as defined in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as now or hereafter amended, unless prescribed by a physician for the covered person.

ID, MD, NV, OK, SD - (j) is deleted.

AR - any injury sustained or contracted in consequence of being intoxicated or under the influence of any controlled substance, unless taken as prescribed by a physician.

29

Allstate Benefits is the marketing name used by American Heritage Life Insurance Company, a subsidiary of The Allstate Corporation. ©2015 Allstate Insurance Company. www.allstate.com or allstatebenefits.com

This material is valid as long as information remains current, but in no event later than August 1, 2018.Group Accident benefits are provided by policy form GVAP6, or state variations thereof. Accidental Death, Dismemberment and Functional Loss Rider provided by rider GP6ADD, or state variations thereof. Accident Treatment and Urgent Care Rider provided by rider GP6AUC, or state variations thereof. Benefit Enhancement Rider provided by rider form GP6BE, or state variations thereof. Dislocation/Fracture Rider provided by rider GP6DF, or state variations thereof. Emergency Room Services Rider provided by rider GP6ERS, or state variations thereof. Outpatient Physician’s Benefit Rider provided by rider GP6OPT, or state variations thereof. Outpatient Physician’s Treatment for Accident and Preventive Care Benefit Rider provided by rider GC6OPH, or state variations thereof.Coverage is provided by Limited Benefit Supplemental Accident Insurance. The policy is not a Medicare Supplement Policy. If eligible for Medicare, review Medicare Supplement Buyer’s Guide available from Allstate Benefits. This information highlights some features of the policy but is not the insurance contract. For complete details, contact your Allstate Benefits Agent. This is a brief overview of the benefits available under the Group Voluntary Policy underwritten by American Heritage Life Insurance Company (Home Office, Jacksonville, FL). Details of the insurance, including exclusions, restrictions and other provisions are included in the certificates issued.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.

(f) engaging in an illegal occupation or committing or attempting an assault or felony;


WI - engaging in illegal activities or in an illegal occupation that results in the covered person’s conviction of a felony.

(d) intentionally self-inflicted injury or action;IL - (d) is deleted.

(e) participation in aeronautics unless a fare-paying passenger on a licensed common-carrier aircraft;NJ - aviation except as a fare-paying passenger on a licensed common-carrier aircraft.

NJ - any loss to which a contributing cause was the covered person’s commission of or attempt to commit a felony or to which a contributing cause was the covered person’s engagement in an illegal occupation.

UT - voluntary engaging in an illegal occupation, committing or attempting an assault or felony.

(g) driving in any race or speed test or testing an automobile or any vehicle on any racetrack or speedway;

OK - (g) is deleted.

NE - any injury while under the influence of alcohol or any narcotic or illegal drug, unless taken as prescribed by a physician.

NJ - any loss sustained or contracted in consequence of the covered person’s intoxication or being under the influence of any drug, unless administered or consumed and taken as prescribed by a physician.

OR - any injury while legally intoxicated as defined by the laws of this state or while under the influence of any drug, unless taken as prescribed by a physician.

TX - any injury sustained or contracted in consequence of the covered person being intoxicated or under the influence of any narcotic, unless taken as prescribed by a physician.

UT - any injury while under the influence of alcohol or any drug, unless taken as prescribed by a physician, if the use of alcohol or any narcotic substantially contributes to or causes the accident or is over the legal limit.

(i) serving as an active member of the Military, Naval, or Air Forces of any country or combination of countries;

PA - any injury sustained or contracted in consequence of the covered person being intoxicated or under the influence of any drug, unless administered and taken as prescribed by a physician.

SD - an injury that occurred as a result of an on-the-job accident, unless not payable under any workers’ compensation law.

For Off-the-Job accident coverage, the following exclusion also applies: (j) an injury that occurred as a result of an on-the-job accident.

(h) any injury while under the influence of alcohol or any drug, unless taken as prescribed by a physician;

AR - any injury sustained or contracted in consequence of being intoxicated or while under the influence of any controlled substance, unless administered and taken as prescribed by a physician.

NV, OK, SD - (h) is deleted.

LA - any injury sustained or contracted in consequence of the covered person being intoxicated or under the influence of any narcotic not prescribed or recommended by a physician.

Outpatient Physician’s Treatment for Accident and Preventive Care Benefit Rider (if included in your coverage)

HI, ID, IN, KY, MD, MI, NM, ND, OH, RI - Rider not available. Benefits are not paid for: (a) loss incurred before the effective date;

NC - act of war, active participation in a riot, insurrection or rebellion.


PA - act of war, participation in a riot or insurrection.

UT - act of war, voluntary participation in a riot, insurrection or rebellion.

(c) suicide or attempt at suicide;IL - (c) is deleted.

(b) act of war, participation in a riot, insurrection or rebellion;

30

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 0216-BSv2/TX

Vision Plan Benefits for Dilley ISD

Co-Pays Monthly Premiums Services/Frequency Exam $10 Emp. only $6.67 Exam 12 months

Materials1 $25 Emp. + spouse $13.25 Frame 12 months

Contact Lens Fitting $25 Emp. + child(ren) $12.97 Contact Lens Fitting 12 months

(standard & specialty) Emp. + family $19.74 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 Progressive lens upgrade See description3 Up to $50 retail Contact Lenses4 $120 retail allowance Up to $100 retail

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1 Materials co-pay applies to lenses and frames only, not contact lenses

2 See your benefits materials for definitions of standard and specialty contact lens fittings 3 Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay.

4 Contact lenses are in lieu of eyeglass lenses and frames benefit

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 Lens options: 20% off retail Progressives: 20% off amount over standard progressive retail

The following options have out-of-pocket maximums5 on standard (not premium, brand, or progressive) lenses.

Maximum Member Out-of-Pocket Single Vision Bifocal & Trifocal Scratch coat $13 $13 Ultraviolet coat $15 $15 Tints, solid or gradients $25 $25 Anti-reflective coat $50 $50 Polycarbonate $40 20% off retail High index 1.6 $55 20% off retail Photochromics $80 20% off retail

Discounts on Non-Covered Exam and Materials

Exams, frames, and prescription lenses: 30% off retail Lens options, contacts, other prescription materials: 20% off retail Disposable contact lenses: 10% off retail .

Refractive Surgery

Superior Vision has a nationwide network of refractive surgeons and leading LASIK networks who offer members a discount. These discounts range from 15%-50%, and are the best possible discounts available to Superior Vision.

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

The Plan discount features are not insurance.

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

Discounts are subject to change without notice.

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

SuperiorVision.com Customer Service

800.507.3800

31

TEXAS

Dilley ISD

SGB0139A

Humana Dental Traditional Plus 14

Page 1 of 31-800-233-4013 • Humana.com

If you use anIN-NETWORK dentist

If you use anOUT-OF-NETWORK dentist

Calendar-year deductible(excludes orthodontia services)

Individual$50

Family$150

Individual$50

Family$150

Deductible applies to all services excluding preventive services.

Calendar-year annual maximum (excludes orthodontia services)

$1,000After you reach the annual maximum amount, you will receive30 percent coinsurance on preventive, basic, and majorservices for the rest of the year (excludes orthodontia.)

Preventive services•Routine oral examinations (2 per year)•Bitewing x-rays (2 films under age 10, up to 4 films

ages 10 and older)•Routine cleanings (2 per year)•Fluoride treatment (1 per year, through age 14)•Sealants (permanent molars, through age 14)•Space maintainers (primary teeth, through age 14)•Oral Cancer Screening (1 per year, ages 40 and older)

100% no deductible 100% no deductible

Basic services •Emergency care for pain relief•Amalgam fillings (1 per tooth every 2 years, composite

for anterior/front teeth)•Composite fillings (1 per tooth every 2 years, molar teeth)•Oral surgery (tooth extractions including impacted teeth)•Stainless steel crowns•Harmful habit appliances for children (1 per lifetime,

through age 14)

80% after deductible 80% after deductible

do not delete

Major services•Crowns (1 per tooth every 5 years)•Inlays/onlays (1 per tooth every 5 years)•Bridges (1 per tooth every 5 years)•Dentures (1 per tooth ever 5 years)•Denture relines/rebases (1 every 3 years, following 6

months of denture use)


•Denture repair and adjustments (following 6months of denture use)

•Implants (1 every 5 years limited to crowns, bridges,and dentures. Coverage limited to equivalent cost of anon-implant service. Implant placement itself is notcovered)

•Periodontics (periodontal cleanings 4 per year,scaling/root planing and surgery 1 per quadrantevery 3 years)

•Endodontics (root canals 1 per tooth per lifetimeand 1 re-treatment)

do not delete

32

Humana Dental Traditional Plus 14

1-800-233-4013 • Humana.comPage 2 of 3

Orthodontia services Child orthodontia - Covers children through age 18. Plan pays50 percent (no deductible) of the covered orthodontiaservices, up to: $1,000 lifetime orthodontia maximum.

Non-participating dentists can bill you for charges above the amount covered by your HumanaDental plan. To ensure you do not receive additional charges, visit a participating PPO Network dentist. Members and their families benefit from negotiated discounts on covered services by choosing dentists in our network. If a member visits a participating network dentist, the member will not receive a bill for charges more than the negotiated fee for covered services. If a member sees an out-of-network dentist, coinsurance will apply to the usual and customary charge. Out-of-network dentists may bill you for charges above the amount covered by your dental plan.

Waiting periods

Employer-sponsored funding: 10+ enrolled employees

Enrollment type Preventive Basic Major Orthodontia Initial enrollment, open enrollment No No No Noand timely add-on

Late applicant 1, 2 No 12 months 12 months 12 months

1 Late applicants not allowed with open enrollment option.2 Waiting periods do not apply to endodontic or periodontic services unless a late applicant.

Monthly rates* (12 deductions per year)Employee $22.03

Employee + 1: $43.94

Family: $71.75

* This is not a substitute for a quote. Rates must be approvedby HumanaDental underwriting.

33

TEXAS

Dilley ISD

SGB0139A

Humana Dental Preventive Plus 14

Page 1 of 31-800-233-4013 • Humana.com

If you use anIN-NETWORK dentist

If you use anOUT-OF-NETWORK dentist

Calendar-year deductible(excludes orthodontia services)

Individual$50

Family$150

Individual$50

Family$150

Deductible applies to all services excluding preventive services.

Calendar-year annual maximum (excludes orthodontia services)

$1,000

Preventive services•Routine oral examinations (2 per year)•Bitewing x-rays (2 films under age 10, up to 4 films

ages 10 and older)•Routine cleanings (2 per year)•Fluoride treatment (1 per year, through age 14)•Sealants (permanent molars, through age 14)•Space maintainers (primary teeth, through age 14)•Oral Cancer Screening (1 per year, ages 40 and older)

100% no deductible 100% no deductible

Basic services •Emergency care for pain relief•Amalgam fillings (1 per tooth every 2 years,

composite for anterior/front teeth)•Composite fillings (1 per tooth every 2 years, molar teeth)•Oral surgery (routine extractions)


do not delete

More Value Basic services•Stainless steel crowns•Harmful habit appliances for childrenMajor services•Crowns•Inlays and onlays•Bridges•Dentures•Denture relines/rebases•Denture repair and adjustments•Implants•Periodontics (gums)•Endodontics (root canals)Orthodontia services•Adult and child orthodontia

These services are not covered under this plan. Members mayreceive a discount on non-covered services and may contacttheir participating provider to determine if any discounts areavailable on non-covered services.

Non-participating dentists can bill you for charges above the amount covered by your HumanaDental plan. To ensure you do not receive additional charges, visit a participating PPO Network dentist. Members and their families benefit from negotiated discounts on covered services by choosing dentists in our network. If a member visits a participating network dentist, the member will not receive a bill for charges more than the negotiated fee for covered services. If a member sees an out-of-network dentist, coinsurance will apply to the maximum allowable charge of one or more network providers in your geographic area. Out-of-network dentists may bill you for charges above the amount covered by your dental plan.

34

Humana Dental Preventive Plus 14

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Waiting periods

Employer-sponsored funding: 10+ enrolled employees

Enrollment type Preventive Basic Major Orthodontia Initial enrollment, open enrollment No No Not available Not availableand timely add-on

Late applicant 1 No 12 months Not available Not available

1 Late applicants not allowed with open enrollment option.

Monthly rates* (12 deductions per year)Employee $11.14

Employee + 1: $26.53

Family: $44.53

* This is not a substitute for a quote. Rates must be approvedby HumanaDental underwriting.

35

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

The policy, purelife-plus, is underwritten by Texas Life Insurance Company, and it has the following features:• HighDeathBenefit. With one of the highest death benefits available at the worksite,1 purelife-plus gives your loved ones

peace of mind.• MinimalCashValue.Designed to provide a high death benefit at a reasonable premium, purelife-plus provides peace of

mind for you and your beneficiaries while freeing investment dollars to be directed toward such tax-favored retirement plans as 403(b), 457 and 401(k).

• LongGuarantees.2 Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time.3

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

• AcceleratedDeathBenefitRider.Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.) (Form ICC07-ULABR-07 or Form Series ULABR-07)

You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, children and grandchildren by answering just 3 questions:4

During the last six months, has the proposed insured:a. Been actively at work on a full time basis, performing usual duties?b. Been absent from work due to illness or medical treatment for a period of

more than five consecutive working days?c. Been disabled or received tests, treatment or care of any kind in a hospital or

nursing home or received chemotherapy, hormonal therapy for cancer, radia-tion therapy, dialysis treatment, or treatment for alcohol or drug abuse?

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

See the purelife-plus brochure for details.

1 Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 20122 Guarantees are subject to product terms, exclusions and limitations and

the insurer’s claims-paying ability and financial strength.3After the guaranteed period, premiums may go down, stay the same, or go up.

4Coverage and spouse/domestic partner eligibility may vary by state. Texas Life complies with all state laws regarding marriages, domestic and civil union partnerships, and legally recognized

familial relationships. Coverage not available on children and grandchildren in Washington.

Life Insurance HighlightsFor the employee

purelife-plus

Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, excep-tions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details.

16M009-C 1006 (exp0118) purelife-plus is not available in NJ, NY or PA.36

Individual Life InsuranceTexas Life Insurance Company

Voluntary permanent life insurance can be an ideal compliment to the group term and optional term your employer might provide. De-signed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and even if you can keep it after you retire, usually costs more and declines in death benefit.

You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, and minor children and grandchildren.1,2

Please see purelife-plus brochure for additional information and rates. PRFNG-NI-10 N

on-T

obac

co

monthly p r em i um 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 Premium

15D-10 7.75 14.00 75

11-16 8.00 14.50 70

17-20 10.00 18.50 27.00 35.50 52.50 69.50 86.50 103.50 66

21 10.25 19.00 27.75 36.50 54.00 71.50 89.00 106.50 66

22 10.25 19.00 27.75 36.50 54.00 71.50 89.00 106.50 65

23-25 10.50 19.50 28.50 37.50 55.50 73.50 91.50 109.50 63

26 10.75 20.00 29.25 38.50 57.00 75.50 94.00 112.50 63

27 11.00 20.50 30.00 39.50 58.50 77.50 96.50 115.50 63

28 11.00 20.50 30.00 39.50 58.50 77.50 96.50 115.50 62

29 11.25 21.00 30.75 40.50 60.00 79.50 99.00 118.50 62

30-31 11.50 21.50 31.50 41.50 61.50 81.50 101.50 121.50 60

32 12.00 22.50 33.00 43.50 64.50 85.50 106.50 127.50 61

33 12.50 23.50 34.50 45.50 67.50 89.50 111.50 133.50 62

34 13.00 24.50 36.00 47.50 70.50 93.50 116.50 139.50 62

35 13.75 26.00 38.25 50.50 75.00 99.50 124.00 148.50 64

36 14.25 27.00 39.75 52.50 78.00 103.50 129.00 154.50 64

37 14.75 28.00 41.25 54.50 81.00 107.50 134.00 160.50 64

38 15.50 29.50 43.50 57.50 85.50 113.50 141.50 169.50 65

39 16.50 31.50 46.50 61.50 91.50 121.50 151.50 181.50 66

40 7.90 17.50 33.50 49.50 65.50 97.50 129.50 161.50 193.50 67

41 8.40 18.75 36.00 53.25 70.50 105.00 139.50 174.00 208.50 68

42 9.10 20.50 39.50 58.50 77.50 115.50 153.50 191.50 229.50 70

43 9.80 22.25 43.00 63.75 84.50 126.00 167.50 209.00 250.50 72

44 10.50 24.00 46.50 69.00 91.50 136.50 181.50 226.50 271.50 73

45 11.30 26.00 50.50 75.00 99.50 148.50 197.50 246.50 295.50 74

46 12.10 28.00 54.50 81.00 107.50 160.50 213.50 266.50 319.50 75

47 12.80 29.75 58.00 86.25 114.50 171.00 227.50 284.00 340.50 76

48 13.60 31.75 62.00 92.25 122.50 183.00 243.50 304.00 364.50 77

49 14.50 34.00 66.50 99.00 131.50 196.50 261.50 326.50 391.50 78

50 15.60 36.75 72.00 107.25 142.50 79

51 16.90 40.00 78.50 117.00 155.50 80

52 18.50 44.00 86.50 129.00 171.50 82

53 20.10 48.00 94.50 141.00 187.50 83

54 21.70 52.00 102.50 153.00 203.50 85

55 23.10 55.50 109.50 163.50 217.50 86

56 24.10 58.00 114.50 171.00 227.50 85

57 24.80 59.75 118.00 176.25 234.50 84

58 25.60 61.75 122.00 182.25 242.50 84

59 26.60 64.25 127.00 189.75 252.50 84

60 27.30 66.00 130.50 195.00 259.50 84

61 29.60 71.75 142.00 212.25 282.50 85

62 32.40 78.75 156.00 233.25 310.50 87

63 35.50 86.50 171.50 256.50 341.50 89

64 39.60 96.75 192.00 287.25 382.50 93

65 42.50 104.00 206.50 309.00 411.50 94

66 45.30 95

67 47.80 96

68 50.40 96

69 53.20 96

70 56.20 95

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

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

Form: 10M014-AZrplt EXP-K-M-1AD R 05-01-1515M104-C 1031 (exp0417) 1Policies not available for children and grandchildren in Washington.

2Texas Life complies with all state laws regarding marriages, domestic and civil union partnerships, and legally recognized familial relationships.

37

Individual Life InsuranceTexas Life Insurance Company

Voluntary permanent life insurance can be an ideal compliment to the group term and optional term your employer might provide. De-signed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and even if you can keep it after you retire, usually costs more and declines in death benefit.

You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, and minor children and grandchildren.1,2

Please see purelife-plus brochure for additional information and rates. PRFNG-NI-10

Tob

acco

monthly p r em i um s

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 Premium

15D-10

11-16

17-20 14.25 27.00 39.75 52.50 78.00 103.50 129.00 154.50 66

21 14.75 28.00 41.25 54.50 81.00 107.50 134.00 160.50 66

22 14.75 28.00 41.25 54.50 81.00 107.50 134.00 160.50 65

23-25 15.50 29.50 43.50 57.50 85.50 113.50 141.50 169.50 63

26 15.75 30.00 44.25 58.50 87.00 115.50 144.00 172.50 63

27 16.00 30.50 45.00 59.50 88.50 117.50 146.50 175.50 63

28 16.25 31.00 45.75 60.50 90.00 119.50 149.00 178.50 62

29 16.50 31.50 46.50 61.50 91.50 121.50 151.50 181.50 62

30-31 18.50 35.50 52.50 69.50 103.50 137.50 171.50 205.50 60

32 19.00 36.50 54.00 71.50 106.50 141.50 176.50 211.50 61

33 19.25 37.00 54.75 72.50 108.00 143.50 179.00 214.50 62

34 19.50 37.50 55.50 73.50 109.50 145.50 181.50 217.50 62

35 20.75 40.00 59.25 78.50 117.00 155.50 194.00 232.50 64

36 21.50 41.50 61.50 81.50 121.50 161.50 201.50 241.50 64

37 22.75 44.00 65.25 86.50 129.00 171.50 214.00 256.50 64

38 23.50 45.50 67.50 89.50 133.50 177.50 221.50 265.50 65

39 25.00 48.50 72.00 95.50 142.50 189.50 236.50 283.50 66

40 11.80 27.25 53.00 78.75 104.50 156.00 207.50 259.00 310.50 67

41 12.50 29.00 56.50 84.00 111.50 166.50 221.50 276.50 331.50 68

42 13.40 31.25 61.00 90.75 120.50 180.00 239.50 299.00 358.50 70

43 14.80 34.75 68.00 101.25 134.50 201.00 267.50 334.00 400.50 72

44 15.60 36.75 72.00 107.25 142.50 213.00 283.50 354.00 424.50 73

45 16.70 39.50 77.50 115.50 153.50 229.50 305.50 381.50 457.50 74

46 17.70 42.00 82.50 123.00 163.50 244.50 325.50 406.50 487.50 75

47 18.70 44.50 87.50 130.50 173.50 259.50 345.50 431.50 517.50 76

48 19.70 47.00 92.50 138.00 183.50 274.50 365.50 456.50 547.50 77

49 21.30 51.00 100.50 150.00 199.50 298.50 397.50 496.50 595.50 78

50 22.40 53.75 106.00 158.25 210.50 79

51 24.10 58.00 114.50 171.00 227.50 80

52 26.20 63.25 125.00 186.75 248.50 82

53 27.90 67.50 133.50 199.50 265.50 83

54 30.00 72.75 144.00 215.25 286.50 85

55 31.50 76.50 151.50 226.50 301.50 86

56 32.80 79.75 158.00 236.25 314.50 85

57 33.80 82.25 163.00 243.75 324.50 84

58 35.60 86.75 172.00 257.25 342.50 84

59 37.10 90.50 179.50 268.50 357.50 84

60 38.10 93.00 184.50 276.00 367.50 84

61 40.70 99.50 197.50 295.50 393.50 85

62 44.00 107.75 214.00 320.25 426.50 87

63 47.40 116.25 231.00 345.75 460.50 89

64 51.10 125.50 249.50 373.50 497.50 93

65 53.60 131.75 262.00 392.25 522.50 94

66 56.40 95

67 59.20 96

68 62.30 96

69 65.50 96

70 69.00 95

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

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

Form: 10M014-AZrplt EXP-K-M-1AD R 05-01-1514M037-C 1027 R0415 (exp0316) 1Policies not available for children and grandchildren in Washington.

2Texas Life complies with all state laws regarding marriages, domestic and civil union partnerships, and legally recognized familial relationships.

38

GROUP BENEFIT PROGRAM SUMMARY

For DILLEY ISD

The death of a family provider can mean that a family will not only find itself facing the loss of a loved one, but also the loss of financial security. With our Group Term Life plan, an employee can achieve peace of mind by giving their family the security they can depend on.

GROUP TERM LIFE/AD&D

This information is only a product highlight. Life benefits may be subject to medical underwriting. Coverage for a medically underwritten benefit is not effective until the date the insurer has approved the employee’s application. The policy has exclusions, limitations, and reduction of benefits and/or terms under which the policy may be continued or discontinued. The policy may be cancelled by the insurer at any time. The insurer reserves the right to change premium rates, but not more than once in a 12-month period.

Products and services marketed under the Dearborn National® brand and the star logo are underwritten and/or provided by Dearborn National® Life Insurance Company, (Downers Grove, IL) in all states (excluding New York), the District of Columbia, the United States Virgin Islands, the British Virgin Islands, Guam and Puerto Rico. Product features and availability vary by state and company, and are solely the responsibility of each affiliate. Refer to your certificate for complete details and limitations of coverage. (For internal use only: Policy number FDL1-504-707)

For employee distribution

Eligibility All Eligible Active Full Time Employees & Bus Drivers

Group Term Life/AD&D Benefit:

$10,000

Guarantee Issue Amount – Employee $10,000

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

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

Definition of Disability Diagnosed by a doctor to be completely unable, because of sickness or injury to engage in any occupation for wage or profit or any occupation for which they become qualified by education, training or experience.

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

Conversion Privilege Included.

Beneficiary Resource Services Includes grief, legal and financial counseling for beneficiaries, funeral planning; and online legal library, including templates to create a legal will and other legal documents.

Travel Resource Services Helps travelers deal with the unexpected that may take place while traveling. Services include emergency medical assistance, financial, legal and communication assistance, and access to other critical services and resources available via the internet.

39

GROUP ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) PROGRAM SUMMARY

Group AD&D is an additional death benefit that pays in the event a covered employee dies or is dismembered in a covered accident. AD&D benefit is 24-hour coverage.

AD&D Schedule of Loss* Principal Sum

Loss of Life 100%

Loss of Both Hands or Both Feet 100%

Loss of One Hand and One Foot 100%

Loss of Speech and Hearing 100%

Loss of Sight of Both Eyes 100%

Loss of One Hand and the Sight of One Eye 100%

Loss of One Foot and the Sight of One Eye 100%

Quadriplegia 100%

Paraplegia 75%

Hemiplegia 50%

Loss of Sight of One Eye 50%

Loss of One Hand or One Foot 50%

Loss of Speech or Hearing 50%

Loss of Thumb and Index Finger of Same Hand 25%

Uniplegia 25% * Loss must occur within 365 days of the accident.

AD&D Product Features Included:

Seatbelt and Airbag Benefits Repatriation Benefit Education Benefit

Exclusions – Unless specifically covered in the policy, or required by state law, we will not pay any AD&D benefit for any loss that, directly or indirectly, results in any way from or is contributed to by: 1. disease of the mind or body, or any treatment thereof; 2. infections, except those from an accidental cut or wound; 3. suicide or attempted suicide; 4. intentionally self-inflicted injury; 5. war or act of war; 6. travel or flight in any aircraft while a member of the crew; 7. commission of, or participation in a felony; 8. under the influence of certain drugs, narcotics, or hallucinogen unless properly used as prescribed by a physician; or 9. intoxication as defined in the jurisdiction where the accident occurred; 10. participation in a riot.

This information is only a product highlight. Life benefits may be subject to medical underwriting. Coverage for a medically underwritten benefit is not effective until the date the insurer has approved the employee’s application. The policy has exclusions, limitations, and reduction of benefits and/or terms under which the policy may be continued or discontinued. The policy may be cancelled by the insurer at any time. The insurer reserves the right to change premium rates, but not more than once in a 12-month period. Products and services marketed under the Dearborn National® brand and the star logo are underwritten and/or provided by Dearborn National® Life Insurance Company, (Downers Grove, IL) in all states (excluding New York), the District of Columbia, the United States Virgin Islands, the British Virgin Islands, Guam and Puerto Rico. Product features and availability vary by state and company, and are solely the responsibility of each affiliate. Refer to your certificate for complete details and limitations of coverage. (For internal use only: Policy number FDL1-504-707)


40

BENEFIT PROGRAM SUMMARY

For DILLEY ISD

SUPPLEMENTAL GROUP TERM LIFE/AD&D

Eligibility All Eligible Active Full Time Employees & Bus Drivers

Group Term Life/AD&D Benefit: Employee

$10,000 - $500,000, in increments of $10,000, not to exceed 5 times your annual earnings.

Guarantee Issue Amount – Employee $150,000, under age 65, $30,000 age 65-69

Group Term Life/AD&D Benefit: Spouse

(Includes Domestic Partners)

$5,000 - $250,000, in increments of $5,000, not to exceed 50% of the employee benefit amount.

Guarantee Issue Amount – Spouse $50,000 under age 60, $10,000 Age 60-69

Group Term Life/AD&D Benefit: Child(ren) Live Birth to 26 years: $10,000

Age Reduction Schedule Employee Basic and Supplemental Group Term Life benefits reduce by 50% of the original amount at age 70. Benefits terminate at retirement.

Spouse Supplemental Group Term Life and AD&D benefits terminate upon the Employee’s attainment of age 70.

Employee Contribution 100%

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

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

Portability Feature (Life coverage) Included. (Employee)

Conversion Privilege (Life coverage) Included.

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

This information is only a product highlight. Life benefits may be subject to medical underwriting. Coverage for a medically underwritten benefit is not effective until the date the insurer has approved the employee’s application. The policy has exclusions, limitations, and reduction of benefits and/or terms under which the policy may be continued or discontinued. The policy may be cancelled by the insurer at any time. The insurer reserves the right to change premium rates, but not more than once in a 12-month period. Products and services marketed under the Dearborn National® brand and the star logo are underwritten and/or provided by Dearborn National® Life Insurance Company, (Downers Grove, IL) in all states (excluding New York), the District of Columbia, the United States Virgin Islands, the British Virgin Islands, Guam and Puerto Rico. Product features and availability vary by state and company, and are solely the responsibility of each affiliate. Refer to your certificate for complete details and limitations of coverage. (For internal use only: Policy number FDL1-504-707)


41

SUPPLEMENTAL GROUP LIFE AND AD&DPREMIUM RATE GRID

Eligibility

You are eligible to enroll if you work the minimum number of hours per week by your employer, and you have satisfied any waiting period.

Supplemental Life/AD&D Insurance Rates

Employee Benefit: $10,000 - $500,000 in $10,000 increments, not to exceed 5 times $0.080annual salary. $0.090

Spouse Benefit: $5,000 - $250,000 in $5,000 increments, but not to exceed $0.11050% of the employee benefit. $0.130

Note: Spouse may not have coverage unless the employee has coverage. $0.180$0.280

Child Coverage $0.440Live birth to age 26:$10,000 $0.700

$0.870$1.490$1.490

All benefits terminate at retirement. $1.490Spouse: Life and AD&D benefits terminate when the employee attains age 70.

$10,000 $1.00Supplemental Life/AD&D Insurance

Monthly Premium Cost (Based on 12 payroll deductions per year)

EMPLOYEEBenefit

Amount <25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

$10,000 $0.80 $0.90 $1.10 $1.30 $1.80 $2.80 $4.40 $7.00 $8.70 $14.90 $14.90 $14.90$20,000 $1.60 $1.80 $2.20 $2.60 $3.60 $5.60 $8.80 $14.00 $17.40 $29.80 $29.80 $29.80$30,000 $2.40 $2.70 $3.30 $3.90 $5.40 $8.40 $13.20 $21.00 $26.10 $44.70 $44.70 $44.70$40,000 $3.20 $3.60 $4.40 $5.20 $7.20 $11.20 $17.60 $28.00 $34.80 $59.60 $59.60 $59.60$50,000 $4.00 $4.50 $5.50 $6.50 $9.00 $14.00 $22.00 $35.00 $43.50 $74.50 $74.50 $74.50$60,000 $4.80 $5.40 $6.60 $7.80 $10.80 $16.80 $26.40 $42.00 $52.20 $89.40 $89.40 $89.40$70,000 $5.60 $6.30 $7.70 $9.10 $12.60 $19.60 $30.80 $49.00 $60.90 $104.30 $104.30 $104.30$80,000 $6.40 $7.20 $8.80 $10.40 $14.40 $22.40 $35.20 $56.00 $69.60 $119.20 $119.20 $119.20$90,000 $7.20 $8.10 $9.90 $11.70 $16.20 $25.20 $39.60 $63.00 $78.30 $134.10 $134.10 $134.10

$100,000 $8.00 $9.00 $11.00 $13.00 $18.00 $28.00 $44.00 $70.00 $87.00 $149.00 $149.00 $149.00$110,000 $8.80 $9.90 $12.10 $14.30 $19.80 $30.80 $48.40 $77.00 $95.70 $163.90 $163.90 $163.90$120,000 $9.60 $10.80 $13.20 $15.60 $21.60 $33.60 $52.80 $84.00 $104.40 $178.80 $178.80 $178.80$130,000 $10.40 $11.70 $14.30 $16.90 $23.40 $36.40 $57.20 $91.00 $113.10 $193.70 $193.70 $193.70$140,000 $11.20 $12.60 $15.40 $18.20 $25.20 $39.20 $61.60 $98.00 $121.80 $208.60 $208.60 $208.60$150,000 $12.00 $13.50 $16.50 $19.50 $27.00 $42.00 $66.00 $105.00 $130.50 $223.50 $223.50 $223.50

SPOUSE - Employee attained age

$5,000 $0.40 $0.45 $0.55 $0.65 $0.90 $1.40 $2.20 $3.50 $4.35 $7.45$10,000 $0.80 $0.90 $1.10 $1.30 $1.80 $2.80 $4.40 $7.00 $8.70 $14.90$15,000 $1.20 $1.35 $1.65 $1.95 $2.70 $4.20 $6.60 $10.50 $13.05 $22.35$20,000 $1.60 $1.80 $2.20 $2.60 $3.60 $5.60 $8.80 $14.00 $17.40 $29.80$30,000 $2.40 $2.70 $3.30 $3.90 $5.40 $8.40 $13.20 $21.00 $26.10 $44.70$40,000 $3.20 $3.60 $4.40 $5.20 $7.20 $11.20 $17.60 $28.00 $34.80 $59.60$50,000 $4.00 $4.50 $5.50 $6.50 $9.00 $14.00 $22.00 $35.00 $43.50 $74.50

Policy Provisions may vary by state. Refer to a certificate or enrollment brochure for details about coveragefeatures and limitations. For internal use only: Policy number FDL1-504-707 Slife/blend-w/add/12

Products and services marketed under the Dearborn National® brand and the star logo are underwritten and/or provided by Dearborn National® LifeInsurance Company® (Downers Grove, IL) (formerly known as Fort Dearborn Life Insurance Company®) in all states (excluding New York), the District of Columbia, the United States Virgin Islands, the British Virgin Islands, Guam and Puerto Rico.

DILLEY ISD

Monthly rates per $1,000Supplemental Life/AD&D

50-54

ATTAINED AGE

40-4445-49

65-6960-64

EMPLOYEE & SPOUSE

Dependent Life (Children)

Employee: Life and AD&D benefits reduce by 50% of the original amount at age 70. 70-74

30-34

75+

Monthly Premium per Family

Age

55-59

35-39

25-29Under 25

42

SB-22136-0915

HEALTH SAVINGS ACCOUNTS A Health Savings Account (HSA) is an individually owned savings account that allows you to set aside money for health care tax-free whenever you select an HSA qualified High Deducible Health Plan (HDHP). Money left in the account can accumulate interest tax-free and money used to pay for qualified medical expenses can be distributed tax-free. Through your employer’s Section 125 Plan, you can contribute pre-tax amounts up to the yearly maximum allowed.

SOME HIGHLIGHTS OF HSAs - HSA contributions receive tax-favored treatment

(Pre-tax if made through a Section 125 Plan or tax deductible if made directly to the HSA) - Earned interest may be tax-free. - Interest earned is applied to your account starting with first dollar contribution. - Distributions are not taxed when funds are used for qualified medical expenses. - You decide when and how to use your money. - No “use or lose” requirement meaning whatever deposits you make each year may be left on deposit to earn interest and to be

available to pay for medical expenses in future years. - You may pay for qualified medical expenses for yourself, your spouse, and your tax dependents regardless of whether or not they

are on your health plan. - No matter where you go, your account follows you. Even if you change jobs, change medical coverage, become unemployed,

move to another state, or change your marital status, your HSA goes with you. You own it! - If you do not remain a qualified individual, you may continue to earn interest and pay for qualified medical expenses as long as

there are funds in your account.

CONTRIBUTIONS If you are eligible to make contributions, you may contribute up to the annual maximum amount allowed by law in any given tax-year. The IRS establishes the maximum amounts on an annual basis. The 2015 maximum allowable is $3,350 for an individual or $6,650 for a family. The 2016 maximum allowable is $3,350 for an individual or $6,750 for a family. If your HDHP is effective other than January 1 and you wish to make the maximum annual contribution, you must meet certain requirements. Go to www.afhsa.com for more information. If you are age 55 and older, you are eligible to make an annual catch-up contribution of $1,000. HSAs are owned by one individual, so if you and your spouse are covered under the family HDHP and both of you are age 55 or older, only you as the owner of the account may make the catch up contribution. Your spouse would be required to establish his or her own HSA to make catch-up contributions.

QUALIFIED MEDICAL EXPENSES There are many expenses that qualify for tax-free distributions. For a listing, you can refer to the HSA Eligible Expenses listed on www.afhsa.com. If you use funds for any expenses that are not qualified medical expenses, then the funds distributed are subject to income tax and a 20% additional tax penalty. The distributions used for expenses that are not qualified medical expenses must be reported on your income tax return. Additional information on qualified medical expenses can be found in IRS Publication 502 at www.irs.gov. Even though Publication 502 is a valuable resource on what qualifies as a medical expense, it addresses only what expenses are deductible. It does not describe rules specific to HSA distributions.

MAKING WITHDRAWALS FROM YOUR HSA You can withdraw funds from your account in three ways: 1. HSA Debit Card; 2. On-Line Distribution Request; 3. Distribution Form. You can use the money from your HSA as follows:

1. You can only use the funds that have been deposited. 2. You can withdraw funds for qualified medical expenses incurred after the date your account is established. 3. You may elect to make withdrawals from your HSA when the expenses are incurred, or you may make withdrawals for these

expenses anytime in the future. There is no time limit.

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The IRS requires that you keep receipts to prove that your HSA funds were used to pay for qualified medical expenses in order to receive the tax benefit. Although you are not required to send your receipts with your income tax return, keeping your receipts with your tax information is an excellent way to ensure proper documentation. You will receive two forms each year as a result of having an HSA: 1) a 1099-SA which shows the total distributions from your account will be mailed by January 31, and 2) a 5498-SA which shows total contributions to your account will be mailed by May 31. Each of these forms will be sent to the IRS but you are not required to include them with your income tax returns.

ELIGIBILITY REQUIREMENTS To be eligible to establish and contribute to an HSA, you must meet the following requirements:

1. You must participate in an HSA qualified HDHP. 2. You may not be claimed as a dependent on anyone else’s tax return. 3. You may not be covered under non-HDHP coverage other than “permitted coverage” or “permitted insurance” and/or

preventative care. Products such as Cancer, Accident, Long Term Care, and Disability Income are usually considered permitted coverage/insurance. Check with your employer or the insurance provider to be sure.

4. You may not have a general purpose Health Flexible Spending Account (Health FSA) or a general purpose Health Reimbursement Arrangement (HRA). However, you may have a Limited Purpose Health FSA or HRA which allows for dental and vision expense reimbursement only should your employer offer this benefit. Note: If you are covered under your spouse’s general purpose Health FSA or HRA, then you are not eligible to establish and contribute to an HSA. In addition, your eligibility may be affected if you have access to the following: Employer's on-site clinic, VA benefits, Tri-Care or an Indian Clinic.

5. You may not be enrolled in Medicare.

INTEREST & ACCOUNT FEES HSA funds are deposited into an interest bearing FDIC insured account. The more you save the more you earn. Monthly maintenance and transaction fees may apply and will be deducted from your account. Check with your employer for the interest/fee schedule. If you seek higher returns or value security, we do not charge transaction fees or broker commissions when we give you access to investment fund options that cover the spectrum of investment risks. (Fees associated with certain mutual funds may be incurred. Review the mutual funds prospectus for additional information when you are ready to invest.)

SUMMARY HSAs give you savings potential, flexibility, portability, and tax savings unlike any other health plan. By enrolling in a qualified HDHP, you save on premiums. By investing those savings into an HSA, you can save for medical expenses in the future. Individuals who elect an HSA with us will receive a welcome packet outlining all the information associated with the account. This flyer is meant to provide you high level information on HSAs. For more information on HSAs visit our website at www.afhsa.com. There you will find an overview specific to employees/individuals along with other helpful information.

CONTACT INFORMATION American Fidelity Health Services Administration Toll-Free - (866) 326-3600 2000 N. Classen Blvd., 7E Fax - (844) 560-6754 Oklahoma City, OK 73106 Email - [email protected] Website – www.afhsa.com

American Fidelity Health Services Administration and its affiliates do not provide legal or tax advice and the information provided is general in nature and should not be considered legal or tax advice. You should consult with an attorney or tax professional regarding legal or tax advice.

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CONTACTS

First Financial Administrators, Inc. Supplemental and Retirement Benefits 2009 RR 620 N, Suite 123 Austin, TX 78734 www.ffbenefits.com/dilleysd/

Chuck Egli, Senior Account Administrator [email protected] Customer Service [email protected] 800/672-9666 Flexible Spending Accounts PO Box 670329 Houston, TX 77267-0329 1-866-853-3539 1-800-298-7785 fax

American Fidelity Assurance Company Allstate Disability, and HSA (Health Savings Account) Cancer, and Accident Insurance 1-800-654-8489 1-800-521-3535 www.americanfidelity.com www.allstateatwork.com

Texas Life Insurance Company Humana Permanent Life Insurance Dental Insurance 1-800-283-9233 1-888-347-0092 www.texaslife.com www.humana.com

Superior Vision Insurance Dearborn Life Insurance Vision Insurance Group Life Insurance 1-800-507-3800 1-800-348-4512 www.superiorvision.org www.dearbornnational.com

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http://www.ffbenefits.com/dilleysd/

mailto:[email protected]

mailto:[email protected]

http://www.americanfidelity.com/

http://www.texaslife.com/

http://www.humana.com/

http://www.superiorvision.org/

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