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Benefits Guide

2027

Effective January 1st, 2027 Summary for Review Purposes Only

WELCOME TO FOOTHILLS REGIONAL HIGH SCHOOL!

Foothills Regional High School offers a comprehensive and valuable benefits program to all eligible employees. Our benefits package is designed to provide security and assistance during a time of need. Please become familiar with the various options and select the best coverage for the upcoming plan year.

IMPORTANT REMINDERS - TAKE ACTION • • • • •

Eligibility for benefits enrollment must take place within 30 days of your hire date. Remember: Please review and/or update beneficiaries annually for all benefits including, Basic Life, Voluntary Term Life & AD&D and Permanent Life policies. Important: Review and Understand Guaranteed Issue Options (New Hires). Life Events - You are required to submit any life event changes for you and eligible dependents within 30 days of an event. This Guide - This guide is presented for illustrative purposes only and is not intended to offer insurance advice. It is important you review each benefit’s summary plan description (SPD) and other carrier materials before making any selections.

There are two separate benefit enrollments: 1. Campus Benefits Voluntary Benefits 2. State Health Benefit Plan Medical Insurance Benefits enrollment must take place within 30 days of hire date

How to Enroll in Campus Benefits Voluntary Benefits

How to Enroll in your State Health Benefit Medical Plan

1. Visit www.foothillsregionalbenefits.com 2. Select the “Enroll” tab or the “Campus Connect” tab 3. Follow the on-screen instructions OR 4. Contact Campus Benefits at 1.866.433.7661, opt 5

1. Visit www.foothillsregionalbenefits.com 2. Select the “State Health” tab 3. Select “SHBP Enrollment Link” (Refer to the SHBP section of this guide for additional details) OR 4. Contact SHBP at 1.800.610.1863

Foothills Regional High School 2027

Version #09032026

Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

INSIDE THIS GUIDE Important Reminders................................ 1 Eligibility....................................................... 2 Benefits Portal............................................ 3 Enrollment.................................................. 4 Service Hub/Support Center.................... 5 Employee Assistance Program................ 6 Short-Term Disability................................. 7 Long-Term Disability.................................. 8 Life Insurance 101...................................... 9-10 Basic Life Insurance................................... 11 Voluntary Term Life and AD&D................ 12 Permanent Life Insurance........................ 13 Vision........................................................... 14 Dental.......................................................... 15-16 Critical Illness............................................. 17 Accident...................................................... 18 Hospital Indemnity.................................... 19 Wellness Incentives................................... 20 MedCareComplete.................................... 21 Legal............................................................ 22 Flexible Spending Accounts..................... 23-24 SHBP........................................................... 25-26 SHBP Disclosure Notices......................... 27-28 Retirement................................................. 29 Notes.......................................................... 30 Campus Benefits For Me.......................... 31-34

FOOTHILLS CONTACT: Bethany Burns Human Resource Manager Phone: 706.395.5783 Email: bethany.burns@foothillsrhs.org Need Help? Start Here: MyBenefits@CampusBenefits.com 1.866.433.7661, opt 5

Eligibility • • • • •

Generally, full-time employees working 30 or more hours per week Superintendent, Site Directors, and Regional Staff working 10 or more hours a week (eligible for all benefits – except disability) Superintendent, Site Directors, and Regional Staff working 8 or more hours a week (eligible for Basic Life, VTL, Legal, MCC) Part-time employees are only eligible for MedCareComplete and MetLife Legal benefits Specific plan eligibility is listed on the top of each page. Specific employee and dependent eligibility rules are governed by each plan’s policy document/certificate, which is available on your employee benefits website, or by contacting Campus Benefits.

Enrollment • • •

Open Enrollment: October - November New Hire: Benefits enrollment must take place within 30 days of hire date. Plan Year: January 1 – December 31

When do Benefits Begin •

The effective date of benefits coverage depends on your hire date. Typically, benefits will begin the first of the month following 30 days of employment.

Changes • •

Employee benefit elections are allowed as a new hire and during the annual open enrollment period. The selected benefits will remain in effect throughout the plan year. A qualifying life event allows eligible changes to benefit elections throughout the plan year. All qualifying life events must be submitted within 30 days of the event date.

Please Note: •

Foothills Regional High School provides eligible employees $10 toward dental premiums and $30,000 of basic term life insurance at no cost

Foothills Regional High School 2027

BENEFITS PORTAL! foothillsregionalbenefits.com

What can you find on the Benefits Portal? • • • •

Plan Highlight Sheets Policy Documents and Certificates Claim Forms Links to Carrier Websites

Foothills Regional High School 2027

What can the Service Hub assist you with? • • • •

Claims Card Requests Benefit Questions Qualified Life Events

CAMPUS BENEFITS ENROLLMENT Steps To Log In:

1 2 3

Visit www.foothillsregionalbenefits.com New User Registration

Select the “Enroll” tab or the “Campus Connect” tab

Existing User Login 1. 2. 3. 4.

Enter your username Enter your password Click “LOGIN” Click on the “Start Benefits” button and begin the enrollment process

Frequently Asked Questions What is my username? • Work email address OR • Email address you provided to HR when hired OR • Email address you used to previously change your username What is my password? To create or reset a forgotten password follow the steps on the login page using tips below. • • •

Company Identifier: FCH18

Password must be at least 6 characters It must contain a symbol and a number Using uppercase, numbers and symbols greatly improves security

What can I find on the portal? • Plan highlight sheets • Policy Documents and Certificates • Claim forms • Links to Carrier Websites

1. On Login page click on “Register as a new user” and enter information below • First Name • • • •

Last Name Company Identifier: FCH18 PIN: Last 4 Digits of SSN Birthdate

2. Click “Next” 3. Username: Work email address or one you have provided to HR when you were hired 4. Password: Must be at least 6 characters and contain a symbol and a number 5. Click on “Register” 6. On the next page, it will show your selected Username. Click on “Login” 7. Enter Username and Password 8. Click “Start Benefits” to begin the enrollment What can the Service Hub assist you with? • Claims • Card requests • Benefits Questions • Qualified Life Events

Need Help? Start Here: mybenefits@campusbenefits.com 1.866.433.7661, opt 5

Foothills Regional High School 2027

SERVICE HUB/ SUPPORT CENTER Campus Benefits is your dedicated advocate for all your voluntary benefits. When to contact the Campus Benefits Service Hub • Portability/Conversion • Card Requests • Benefits Education • Benefit Questions The • Evidence of Insurability • COBRA Campus • Qualified Life Event Information Benefits team understands the claims Changes process and leverages • Claims the necessary carrier How to File a Claim: relationships to expedite 1. Contact Campus Benefits via phone or email the paperwork efficiently to ensure claims are 2. Work with Campus Benefits’ claims specialist to not delayed due to complete the necessary paperwork improper paperwork • Employee Portion completion. • Physician Portion • Employer Portion 3. Submit the necessary paperwork to Campus Benefits via the secure upload • Secure upload located at www.foothillsregionalbenefits.com/contact-campus Frequently Asked Questions (FAQs): Q: When must a qualifying life event change be made? A: Please notify Campus Benefits within 30 days of the life event date. All SHBP life events must be made directly through the SHBP website. Q: Am I required to contact Campus Benefits to file a claim? A: No. However, in our experience the number one reason for claim denial or delay is due to incomplete or inaccurate paperwork. By working with Campus Benefits’ claim specialist, we can advocate on your behalf. Q: How can I access the group dental card or vision card quickly? A: The group dental and vision plan information is available at: www.foothillsregionalbenefits.com

Phone: 1.866.433.7661, opt 5 Email: mybenefits@campusbenefits.com Website: FoothillsRegionalBenefits.com 5

Foothills Regional High School 2027

EMPLOYEE ASSISTANCE PROGRAMS What is an EAP? A program offered to Foothills Regional High School employees to provide guidance with personal issues, planning for life events or simply managing daily life which can affect your work, health and family. OneAmerica EAP Eligibility: All Foothills Regional High School employees, their eligible household members and unmarried children (up to age 26) • Coverage through OneAmerica • Provides support, resources, and information for personal and work-life challenges • Receive up to three sessions per issue per year • CALL 1.855.387.9727 or visit www.guidanceresources.com, Web ID: ONEAMERICA3

Confidential Counseling • •

Helps employees address stress, relationship and other personal issues for you and your family Sessions with highly trained master’s and doctoral level clinicians • Stress anxiety and depression • Job pressures • Relationship/marital conflicts • Grief and loss • Problems with children • Substance abuse

Work-Life Solutions

Work-Life Specialists do the research for you, providing qualified referrals and customized resources: • Child and elder care • College planning • Moving and relocation • Pet care • Making major purchases • Home repair

Financial Information and Resources

Speak by phone with a Certified Public Accountants and Certified Financial Planners on a wide range of financial issues, including: • Getting out of debt • Retirement planning • Credit card or loan problems • Estate planning • Tax questions • Saving for college

Online Resources • •

Timely articles, HelpSheets, tutorials, streaming videos and self-assessments Child care, elder care, attorney and financial planner searches

Free Online Will Preparation • • •

EstateGuidance lets you quickly and easily write a will on your computer Go to www.guidanceresources.com and click on EstateGuidance link Follow the prompts to create and download your will at no COST • Name an executor to manage your estate • • •

Choose a guardian for your children Specify your wishes for your property Provide funeral and burial instructions

Plan Rates Coverage provided at no cost to you.

Foothills Regional High School 2027

SHORT-TERM DISABILITY What is Short-Term Disability Insurance? A type of coverage that replaces a portion of your income, for a short period of time, if injury or illness prevents you from working. It provides financial security for you and any loved ones who may depend on your most valuable asset — your ability to earn a paycheck. You may also hear disability insurance referred to as disability income insurance or income protection. Eligibility: Eligible employees as described on page 2 • Coverage through OneAmerica • Employee must be actively at work on the effective date of coverage • NO HEALTH QUESTIONS EVERY YEAR! (Pre-existing condition will apply to new enrollees) • Employees DO NOT have to exhaust sick leave. Employees can stop sick leave (if available) at the end of the elimination period. The decision must be made at the beginning of leave. • Plan does not pay in addition to sick leave • Plan pays in-addition to Paid Parental Leave and must be used concurrent to FMLA Short Term Disability Quick Summary Elimination Period

Benefits begin after you have been out of work due to an accident or sickness for 7 days

Benefit Duration

Covers accidents and sicknesses up to 13 weeks

Benefit Percentage (weekly)

60% of your gross weekly salary

Maximum Benefit Amount (weekly)

Pre-existing condition

$1,250 3/6 - Any illness or injury for which you received treatment the 3 months prior to your effective date will not be covered for the first 6 months (Applies to new enrollees only)

Monthly Rate Calculation Step 1

Divide your annual salary by 52. This is your weekly salary.

Multiply weekly salary in Step 1 by 60%. If 60% of weekly salary exceeds $1,250, Step 2 then enter $1,250. This is your maximum weekly benefit amount. Step 3 Divide weekly amount in Step 2 by $10.

Short-Term Disability Monthly Rates Rate per $10 of benefit

$0.50

*Enrollment system will calculate based on payroll information provided by the employer

Multiply Step 3 by the monthly rate in the Step 4 table to the right. This is your monthly premium.

Foothills Regional High School 2027

LONG-TERM DISABILITY What is Long-Term Disability Insurance? A type of coverage that replaces a portion of your income, for a longer period of time, if injury or illness prevents you from working. It provides financial security for you and any loved ones who may depend on your most valuable asset — your ability to earn a paycheck. You may also hear disability insurance referred to as disability income insurance or income protection. Eligibility: Eligible employees as described on page 2 • Coverage through OneAmerica • Employee must be actively at work on the effective date of coverage • NO HEALTH QUESTIONS EVERY YEAR! (Pre-existing condition will apply to new enrollees) • Employees DO NOT have to exhaust sick leave. Employees can stop sick leave (if available) at the end of the elimination period. The decision must be made at the beginning of leave. • Plan does not pay in addition to sick leave Long Term Disability Quick Summary Elimination Period

Benefits begin after you have been out of work due to an injury or illness for 90 calendar days

Benefit Duration

Covers accidents and sicknesses up to Social Security normal age of retirement (Please note exclusions or limitations may apply, see plan certificate for details)

Benefit Percentage (monthly)

60% of your gross monthly salary

Maximum Benefit Amount (monthly)

$5,000

Pre-existing condition

3/3/12 - Any illness or injury for which you received treatment the 3 months prior to your effective date will not be covered for the first 12 months, unless you go treatment free for 3 consecutive months following your effective date of coverage (Applies to new enrollees only)

Monthly Rate Calculation Step 1

Divide your Annual Salary by 12. This is your monthly salary.

Step 2

Divide monthly amount in Step 1 by 100.

Step 3

Multiply Step 2 by the Monthly Rate in the table to the right. This is your monthly premium.

Long-Term Disability Monthly Rates Per $100 of Covered Payroll

*Enrollment system will calculate based on payroll information provided by the employer Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

0-24

$0.22

25-29

$0.26

30-34

$0.36

35-39

$0.49

40-44

$0.65

45-49

$0.89

50-54

$1.14

55-59

$1.38

60+

$1.37

Foothills Regional High School 2027

LIFE INSU The need for life insurance depends on each individual life situation. If loved ones are financially dependent on you, then buying life insurance coverage can absolutely be worth it. Even if you don’t have financial dependents yet, life insurance can be a valuable solution for making death easier on a family (at least financially.) There are two voluntary life insurance options offered through your employer: Term Life Insurance and Permanent Life Insurance. To follow is an overview of differences. Term Life and Permanent Life work best used in conjunction with one another. Term Life can protect your family in your younger working years and Permanent Life can protect your family in your retirement years.

Foothills Regional High School 2027

RANCE 101 TERM LIFE INSURANCE Term Life insurance is illustrated on the bell curve below. The term life offered is a group policy which allows you to get more benefit for less premium. • Term life insurance is for the unexpected death • Includes an Accidental Death & Dismemberment Benefit • Term life insurance is flexible and allows changes to your benefit amount each year depending on life changes. For example, as you get married and have children the need for term insurance often increases. As you near retirement, the need for term life insurance often decreases. • Coverage is portable at retirement or if you leave the employer (premium will increase) • Premiums are based on age and increase as you get older

PERMANENT LIFE INSURANCE Permanent Life Insurance is illustrated above along the bottom of the graph with a straight blue arrow. • Permanent life insurance offers a stable premium along the lifetime of the policy • Permanent life offers a level premium and is meant to take into retirement • Permanent life is an issue age policy and is based on the age when the policy is issued • This is an individual plan you can take with you regardless of where you work

Foothills Regional High School 2027

BASIC LIFE & AD&D What is Basic Life Insurance and AD&D? A financial and family protection plan paid for by Foothills Regional High School which provides a lump-sum payment, known as a death benefit, to a beneficiary upon the death of the insured. AD&D coverage is included as a part of life insurance benefits, and will pay out a lump-sum death benefit in the event you die accidentally or pass away later as the direct result of an accident. This plan also has a dismemberment benefit which provides an additional lump sum payment if an insured becomes dismembered in an accident. Eligibility: Eligible employees as described on page 2 • Coverage through OneAmerica • Must be actively at work on the effective date • Important to confirm your beneficiaries every year • No cost to the employee- Premiums paid by Foothills Regional High School Basic Life Quick Summary All Eligible Employees

$30,000 (AD&D amount matches the life amount)

Age Reduction

50% at age 70

Portability

Included

Conversion

Included ADDITIONAL FEATURES Up to 75% Accelerated Life Benefit & Will Preparation

Plan Rates Coverage paid for by Foothills Regional High School at no cost to you!

Foothills Regional High School 2027

VOLUNTARY TERM LIFE & AD&D What is Voluntary-Term Life and Accidental Death & Dismemberment Insurance? A financial protection plan which provides a cash benefit to a beneficiary upon the death of the insured. Proceeds can be used to replace lost potential income during working years and help ensure your family’s financial goals will still be met. AD&D coverage is included as a part of life insurance benefits, and will pay out a lump-sum death benefit in the event you die or pass away later as the direct result of an accident. This plan also has a dismemberment benefit which provides an additional lump sum payment if an insured becomes dismembered in an accident. Eligibility: Eligible employees as described on page 2, spouse and unmarried children up to age 26 • Coverage through OneAmerica • Must be actively at work on the effective date of coverage • Employee must elect coverage on themselves in order to cover spouse and/or children • If electing for the first time outside of the initial open enrollment period, health questions will be required Voluntary Term Life and AD&D Quick Summary LIFE AND AD&D AMOUNT Employee

Increments of $1,000 up to $400,000 (5 x salary)

Spouse

Increments of $500 up to $400,000 (up to 100% of employee election)

Child(ren)

Increments of $2,500 up to $10,000 GUARANTEED ISSUE (NO HEALTH QUESTIONS - INITIAL NEW HIRE)

Employee

$200,000

Spouse

$50,000

Child(ren)

$10,000

Age Reduction (Employee & Spouse)

Reduces to 65% at the employee’s age 70, reduces to 50% of the original amount at age 75

Guaranteed Increase in Benefit

Employee & Spouse: If currently enrolled, can increase up to the Guaranteed Issue amount at open enrollment with no health questions ADDITIONAL FEATURES

Portability, Conversion, Accelerated Life Benefit, Waiver of Premium

Plan Rates Cost of coverage is based on the level of benefit you choose and your age. Please consult with a Campus Benefits Counselor or log into the enrollment system for rate details. Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

Foothills Regional High School 2027

PERMANENT LIFE INSURANCE What is Permanent Life Insurance? Coverage that provides lifelong protection and the ability to maintain a level premium.

Eligibility: Eligible employees as described on page 2, spouse, children up to age 26 (if a full-time student) • Coverage through Colonial Life • Must be actively at work on the effective date • Underwriting may be required. Coverage is not guaranteed • Permanent life offers the flexibility to meet a variety of personal needs while allowing employees the choice of benefit and premium amounts which fit their paycheck and lifestyle • Keep your coverage, at the same cost, even if you retire or change employers

Permanent Life Quick Summary PLAN MAXIMUMS Employee (Ages 15 - 79)

Up to $500,00

Spouse (Ages 15 - 79)

Up to $50,000

Child (0 - 17) Juvenile Policy Child (18-26 if a full-time student) Adult Policy

Up to $25,000

GUARANTEED ISSUE (FIRST TIME ELIGIBLE/NEW HIRE) Employee

Ages 18-50: Up to $150,000 Ages 51-60: Up to $75,000 Ages 61-79: Up to $25,000

Spouse

Up to $25,000

Child (0-17) Juvenile Policy Child (18-26 if a full-time student) Adult Policy

Up to $10,000

ADDITIONAL FEATURES Options for Paid up to age 70 or age 100 Terminal Illness accelerated death benefit for up to 75% (Up to $150,000)

Plan Rates Cost of coverage is based on the level of benefit you choose and your age. Please consult with a Campus Benefits Counselor or log into the enrollment system for rate details.

Foothills Regional High School 2027

VISION INSURANCE What is Vision Insurance? A health and wellness plan designed to reduce your costs for routine preventive eye care including eye exams and prescription eye wear (eyeglasses and contact lenses). Eligibility: Eligible employees as described on page 2, spouse and dependent children up to age 26 • Coverage through MetLife • Must be actively at work on the effective date • Claims must be submitted within 90 days of service • Provider Network: www.metlife.com/insurance/vision-insurance/#find-a-provider • (Network: VSP Choice) • The chart below is a sample of covered services. Please view the Plan Certificate for a detailed listing of services in their entirety, available on your Employee Benefits Website In-Network Vision Quick Summary

High Plan

Low Plan

Exam (with dilation as necessary) Materials Copay Contact Lens Fit and Follow-Up (Standard) Lasik or PRK Frames (See plan certificate for featured frames allowance)

$10 Copay

Employee

Included in Lens Copay

$13.19

Up to $60 Copay

Employee + Spouse $25.04

15% off retail or 5% off promotional $200 allowance plus 20% off balance $220 allowance on featured frames ($110 allowance at Costco, Walmart, Sams)

$150 allowance plus 20% off balance $170 allowance on featured frames ($85 allowance at Costco, Walmart, Sams)

Lenses Single Vision, Bifocal, Trifocal, Lenticular Progressive Lenses

Covered in Full Covered in Full

Up to $17 - $33 copay

Standard Polycarbonate

Children: Covered in Full Adults: Up to $35 Copay

Standard Anti-Reflective Coating

Up to $41 - $85 Copay

Elective Contacts Medically Necessary

Family $38.83

Standard, Premium, and Custom Covered in Full

Standard UV Treatment

Photochromic Lenses

Employee + Children $26.36

$10 Copay Additional Lens Options

Standard Scratch Resistant

High Plan Rates

Employee $8.36

Up to $47 - $82 Copay Contact Lenses $200 Allowance $150 Allowance Covered in Full after eyewear Copay Frequencies

Exams, Lenses, Contact Lenses and Frames

Every 12 months (based on date of service)

2nd Pair Benefit (Allowance must be invoiced as two separate purchases)

Each covered person can get: • 2 pairs of prescription eyeglasses OR • 1 pair of prescription eyeglasses & an allowance toward contacts OR • Double the contact lens allowance

Exams, Lenses, Contact Lenses: Every 12 Months Frames: Every 24 months 2nd Pair Benefit Not Covered

*Click on id card for more information and printable version (electronic version)

Low Plan Rates

Employee + Spouse $15.88 Employee + Children $16.72 Family $24.59 VSP Choice

Foothills Regional High School

5386498

Group Name

Group Number

Members: 1.800.GET.METS (1.800.438.6388) Providers: 1.855.638.3931 This card is not a guarantee of coverage or eligibility.

Foothills Regional High School 2027

DENTAL What is Dental Insurance? A health and wellness plan designed to pay a portion of dental costs associated with preventive, basic, some major dental care, as well as orthodontia.

• • • • • •

Eligibility: Eligible employees as described on page 2, spouse and dependent children up to age 26 Coverage through MetLife Claims must be submitted within 90 days of service Provider directory: www.providers.online.metlife.com (Network: PDP Plus) Orthodontia is available for adults & children up to age 26 (subject to takeover provision) No waiting periods or late entrant penalty The chart below is a sample of covered services. Please see Plan Certificate for a detailed listing of services in their entirety. The plan certificate is available on your employee benefits website, www.foothillsregionalbenefits.com.

Coinsurance

One Plan

Preventive

100%

Basic

80%

Major Annual Max (Basic & Major services only) Orthodontia

50% $1,250 per person/year 50% (adults & children up to age 26)

Orthodontia (Lifetime Max)

$2,000 per person/per calendar year

Allowance (Out-of-Network)

90th UCR

Preventive & Diagnostic Waiver Deductible

*Preventive services do not apply to annual maximum. Annual Maximum applies only to Basic and Major Services. $75 per person/$225 per family (Basic & Major)

Waiting Period

None

Monthly Rates *$10.00 employer contribution reflected in rates Employee Employee + Spouse Employee + Children Family

Foothills Regional High School 2027

$36.30 $76.58 $102.92 $138.12

DENTAL INSURANCE Dental Services Quick Summary

One Plan

Exams & Cleanings (2 per calendar year)

100%

Bitewing X-Rays

100%

Full Mouth X-Rays

100%

Fluoride (children to age 19)

100%

Sealants (children to age 17)

100%

Space Maintainers

100%

Amalgam Fillings

80%

Simple Extractions

80%

Resin Composite Fillings (excludes coverage for composite fillings on molars)

80%

Root Canal

80%

Scaling & Root Planing

80%

Dentures - Rebases/Relines General Anesthesia

80% 80%

Pulpotomy/Pulp Capping/Pulp Therapy

80%

Prefabricated Crowns Crown Repairs Endodontics (non-surgical)

80% 80% 80%

Endodontics (surgical)

80%

Periodontics (non-surgical)

80%

Periodontal Surgery

50%

Inlays/Onlays/Crowns

50%

Oral Surgery

50%

Prosthodontics

50%

Fixed Bridges

50%

Dentures

50%

Surgical Extractions

50%

Implants

How to Register for the MetLife website: 1. Go to: www.metlife.com/mybenefits 2. Under Access MyBenefits, enter: Foothills Regional High School 3. Select “Next” and follow the prompts to register (If you have previously registered, select “Login” - If you have never registered, select “Register”). If you previously registered with MetLife/mybenefits, you will utilize the same username and password for vision and dental.

PDP Plus Foothills Regional High School

5386498

Group Name

Members: 1.800.GET.METS (1.800.438.6388) Providers: 1.855.638.3931 This card is not a guarantee of coverage or eligibility.

*Click on id card for more information and printable version (electronic version)

Foothills Regional High School 2027

CRITICAL ILLNESS INSURANCE What is Critical Illness Insurance? A health and wellness plan in which you receive a lump sum cash payment if diagnosed with one of the specific illnesses on the predetermined list of critical illnesses. Eligibility: Eligible employees as described on page 2, spouse and dependent children* up to age 26 • Coverage through MetLife • Issue Age - Rates are locked in and will not increase with age • No health questions - EVERY YEAR!! • The chart below is a sample of covered services. Please view the Plan Certificate for a detailed listing of services in their entirety, available on your Employee Benefits Website. * Child marital status may impact benefit eligibility Critical Illness with Cancer Quick Summary Employee

$10,000 or $20,000

Spouse

50% of Employee Amount

Dependent Children

50% of Employee Amount

Maximum Payout

500% (not to exceed $250,000)

COVERED SPECIFIED CRITICAL ILLNESSES Invasive Cancer Non-Invasive Cancer Skin Cancer Benign Brain Tumor Coronary Artery Bypass Graft (CABG) Childhood Diseases (Cerebral Palsy, Cleft Lip or Cleft Palate, Cystic Fibrosis, Diabetes (Type 1), Down Syndrome, Sickle Cell Anemia, Spina Bifida)

Pays % of Face Amount 100% 25% 5% (not less than $250) 100% 50% 100% of Child Benefit Amount

Functional Loss (Coma, Loss of: Ability to Speak; Hearing; or Sight,

100%

Heart Attack

100%

Sudden Cardiac Arrest Infectious Diseases (Bacterial Cerebrospinal Meningitis, COVID-19,

50% 25%

Paralysis of 2 or more limbs)

Diphtheria, Encephalitis, Legionnaire’s Disease, Malaria, Necrotizing Fasciitis, Osteomyelitis, Rabies, Tetanus, Tuberculosis)

*For a benefit to be payable, the covered person must have been treated for the disease in a hospital for 3 consecutive days.

Major Organ Transplant (Bone marrow, Heart, Lung, Pancreas,

100%

End Stage Renal Failure (Kidney)

100%

and Liver)

Progressive Diseases (ALS, Alzheimer’s Disease, Multiple

Sclerosis, Muscular Dystrophy, Parkinson’s Disease (Advanced), Systemic Lupus Erythematosus (SLE))

100%

Severe Burn

100%

Stroke ANNUAL WELLNESS INCENTIVE Age Reduction Pre-Existing Condition

100%, 25% for TIA $100 (see Wellness Incentives page) None None

Plan Rates Cost of coverage is based on the level of benefit you choose and your age. Please consult with a Campus Benefits Counselor or log into the enrollment system for rate details. 17

Foothills Regional High School 2027

ACCIDENT INSURANCE What is Accident Insurance? This coverage is designed to help offset medical and out-of-pocket costs associated with unforeseen accidents. Payments made directly to you and benefits do not offset with medical insurance. Eligibility: Eligible employees as described on page 2, spouse and dependent children* up to age 26 • Coverage through MetLife • No health questions - Every Year!! • Payments made directly to you and benefits do not offset with medical coverage • The chart below is a sample of covered services. Please see the Plan Certificate for a detailed listing of services in their entirety, available on your Employee Benefits Website. * Child marital status may impact benefit eligibility Accident Benefits Quick Summary INJURIES Fractures

$200 - $10,000

Dislocations

$200 - $10,000

Second and Third Degree Burns

$100 - $15,000

Concussions

$500

Cuts/Lacerations

$75 - $700

Eye injuries

$400 MEDICAL SERVICES & TREATMENT

Ambulance (Ground)

$400

Emergency Room Treatment

$200

Rates

$200 - $2,000

Employee $12.87

Surgery Physician Office Visit

$100

Employee + Spouse $20.85

ACCIDENTAL DEATH & DISMEMBERMENT Accidental Death

$10,000 - $200,000*

Dismemberment

$1,000 - $40,000*

Employee + Child(ren) $29.15

*Amounts vary by employee, spouse, and children. See policy certificate for details. HOSPITAL COVERAGE (Accident) Hospital Admission Hospital Stay (per day) Intensive Care Unit Stay (per day)

$1,500 $300 (Max 365 Days)

$300 (Max 365 Days)

Age Reduction

None

Pre-existing Condition

None

ANNUAL WELLNESS INCENTIVE

Employee + Family $38.03

$50 (see Wellness Incentives page)

Foothills Regional High School 2027

HOSPITAL INDEMNITY INSURANCE What is Hospital Indemnity Insurance? Supplemental coverage that helps offset costs associated with hospital stays, whether for planned or unplanned reasons. Payments made directly to you and benefits do not offset with medical insurance. Eligibility: Eligible employees as described on page 2, spouse and dependent children* up to age 26 • Coverage through MetLife • No health questions - Every Year!! • No waiting period and no age reduction of benefits • Routine delivery of a child or by non-emergency Cesarean section are covered. • Complications of pregnancy and emergency Cesarean section are covered. • No pre-existing condition limitation • The chart below is a sample of covered services. Please see the Plan Certificate for a detailed listing of services in their entirety, available on your Employee Benefits Website. * Child marital status may impact benefit eligibility High Plan

Low Plan

Hospital Admission

$1,000

$500

ICU Supplemental Admission

$1,000

$500

Hospital Indemnity Quick Summary

Admission Benefit (4 times per calendar year - separated by 90 days) Confinement

$200

$100

ICU Supplemental Confinement

$200

$100

Confinement Benefit (365 days per calendar year) Confinement Benefit for Newborn Nursery Care (2 days per confinement) Wellness Incentive

Foothills Regional High School 2027

$25

$50 (see Wellness Incentives page)

High Plan Rates Employee Employee + Spouse Employee + Child(ren) Employee + Family

$50

Low Plan Rates $25.55 $49.56 $35.94 $59.95

Employee Employee + Spouse Employee + Child(ren) Employee + Family

$13.63 $26.49 $19.44 $32.29

WELLNESS INCENTIVES

GET REWARDED FOR PREVENTIVE CARE What are Wellness Incentives? An annual reimbursement for covered members who complete one of the eligible screening procedures on your critical illness, accident, and hospital indemnity insurance plans. Eligibility: You, spouse and dependents who are covered on the critical illness, accident, or hospital indemnity plans How it works: • If you or a covered dependent get one of the eligible screenings, you can file a wellness claim • Once approved, you will receive a check for the wellness benefit amount • The wellness incentive can be filed annually as long as your critical illness, accident, and hospital indemnity plans are in force Available Wellness Incentives MetLife - Accident and Hospital Indemnity Plans

$50/per covered person/ per year

MetLife - Critical Illness Plan

$100/per covered person/ per year

What Qualifies as Wellness? MetLife Accident, Hospital Indemnity, and Critical Illness Plans • Annual physical exam • Biopsies for cancer • Blood test to determine total cholesterol/triglycerides • Bone marrow testing • Breast MRI, ultrasound, sonogram • Cancer antigen 15-3 and 125 blood test for breast cancer (CA 15-3)/ovarian cancer (CA 125) • Carcinoembryonic antigen blood test for colon cancer (CEA) • Carotid doppler • Chest x-rays • Clinical testicular exam • Colonoscopy; Digital rectal exam (DRE) • Complete blood count (CBC) • Coronavirus Testing • Dental Exam • Doppler screening for cancer • Doppler screening for peripheral vascular disease • Echo cardiogram; Electrocardiogram (EKG) • Electroencephalogram (EEG) • Endoscopy • Eye exam

• Fasting blood glucose/plasma test • Flexible sigmoidoscopy • Hearing test • Hemoccult stool specimen • Hemoglobin A1C • Human papillomavirus (HPV) vaccination • Lipid panel • Mammogram • Oral cancer screening • Pap smears or thin prep pap test • Prostate-specific antigen (PSA) test • Serum cholesterol test to determine LDL or HDL • Serum protein electrophoresis • Skin Exam; Skin cancer biopsy; screening • Stress test on bicycle or treadmill • Successful completion of smoking cessation program • Tests for sexually transmitted infections (STIs) • Thermography • Ultrasounds for abdominal aortic aneurysms • virtual colonoscopy

How to File a Wellness Claim? • •

Call 1-800-GET-MET8. (800-438-6388) File your Health Screening Benefit online through the MyBenefits portal at www.metlife.com/mybenefits or by mail with a paper claim form.

Foothills Regional High School 2027

MEDCARECOMPLETE

THE SMART WAY TO REDUCE YOUR HEALTHCARE COSTS What is MedCareComplete? A bundle of services constructed to save you time and money while simplifying your life. Eligibility: Eligible employees as described on page 2, spouse and unmarried children up to age 26 • Coverage through MedCareComplete • Register at MCC: medcarecomplete.com/members • Register at 1800MD: 1800md.com or call 800.388.8785 • Information Needed: Group Name, Group Number, Member ID (on MCC Card) • This is a supplemental benefit and does not replace health insurance

Included with the MedCareComplete Membership: Medical Bill Negotiator

Restoration Expert

Medication Management

Identity Loss Expense Reimbursement

Telemedicine

Social Media Tracking

Medical & ID Theft Monitoring

Sex Offender Alerts

Medical Bill Negotiator A medical bill advocate will identify and appeal common billing errors and overcharges on your behalf. Advocates provide continuous support throughout the appeal that typically results in an average savings of 40% on 80% of the bills reviewed.

Telemedicine Get 24/7/365 on-demand telephone access to Board-certified physicians for diagnosis, and prescriptions for common and acute illnesses. There are no copays and no limit to how many times you can utilize this feature. Acute Illnesses include but are not limited to the following: Asthma Migraines Heartburn Fever Rashes Sinus Conditions Headache Bacterial Infections Urinary Tract Infections Diarrhea Infections

Bronchitis Ear Infection Gout Joint Aches

Individual Monthly Rate

Family Monthly Rate

$10.50 Per Month

$12.50 Per Month

NO COPAY Pink Eye Sore Throat Cold & Flu Nausea & Vomiting

Medical & ID Theft Protection Service monitors the internet for instances of your personal health and financial information to protect you from becoming a victim of identity theft. The security of your personal health information (PHI) can have a large impact on the medical care you receive.

Foothills Regional High School 2027

LEGAL PLAN What is a Legal Plan? A plan which provides valuable legal and financial educational resources for a variety of life events and needs. Eligibility: Eligible employees as described on page 2, spouse and dependent children (up to age 26) • Coverage through MetLife • Elder Care extends to parents and in-laws • Visit www.legalplans.com/why-enroll or call 800.821.6400 for additional information • Non-members & members create an account and select Employer for plan information (creating an account doesn’t enroll you in plans) • High Plan: For non-covered matters that are not otherwise excluded, your plan provides four hours of network attorney time and services per year • Additional information available on your Employee Benefits Website, www.foothillsregionalbenefits.com Low Plan Quick Summary Money Matters

Home & Real Estate

Estate Planning

Family & Personal

• • • • •

Identity Theft Defense Negotiations with Creditors Promissory Notes Debt Collection Defense Tax Collection Defense

• • • • •

Identity Theft Defense Negotiations with Creditors Promissory Notes Debt Collection Defense Tax Collection Defense

• • • • •

Personal Bankruptcy LifeStages Identity Management Tax Audit Representation Financial Education Workshops Tax Preparation & Filing

• • • • • •

Deeds Mortgages Foreclosure Tenant Negotiations Eviction Defense Security Deposit Assistance

• • • • • •

Deeds Mortgages Foreclosure Tenant Negotiations Eviction Defense Security Deposit Assistance

• • • • •

Sale or Purchase (Primary or Vacation Home) Refinancing & Home Equity Property Tax Assessments Boundary & Title Disputes Zoning Applications

• • • • •

Simple and Complex Wills Healthcare Proxies Living Wills Codicils Powers of Attorney (Healthcare, Financial, Childcare, Immigration

• • • • •

Simple and Complex Wills Healthcare Proxies Living Wills Codicils Powers of Attorney (Healthcare, Financial, Childcare, Immigration

•

Revocable & Irrevocable Trusts

• • • •

Guardianship Conservatorship Name Change Review of ANY Personal Legal Document School Hearings Demand Letters Affidavits Personal Property Issues Garnishment Defense Domestic Violence Protection

• • • •

Guardianship Conservatorship Name Change Review of ANY Personal Legal Document School Hearings Demand Letters Affidavits Personal Property Issues Garnishment Defense Domestic Violence Protection

•

Juvenile Court Defense (Including Criminal Matters) Parental Responsibility Matters Review of Immigration Documents Prenuptial Agreement Adoption Caregiving Support (Family First)

Disputes over Consumer Goods & Services Administrative Hearings Incompetency Defense

•

• • • • • •

Civil

•

Lawsuits

• •

Elder Care Issues

Vehicle & Driving

High Plan Quick Summary

• • • • • •

• •

Disputes over Consumer Goods & Services Administrative Hearings Incompetency Defense

• • • • •

• • •

Civil Litigation Defense & Mediation Small Claims Assistance Pet Liabilities

Consultation & Document review for issues related to your (or spouses) parents: • Medicare • Medicaid • Prescription Plans • Nursing Home Agreements • Leases • Promissory Notes • Deeds • Wills • Power of Attorney

Consultation & Document review for issues related to your (or spouses) parents: • Medicare • Medicaid • Prescription Plans • Nursing Home Agreements Low Plan High Plan • Leases • Promissory Notes Monthly Rate Monthly Rate • Deeds • Wills • Power of Attorney $8.00 $19.50

• • • •

Repossession Defense of Traffic Tickets Driving Privileges Restoration License Suspension due to DUI

NO COPAY

Foothills Regional High School 2027

FLEXIBLE SPENDING ACCOUNTS What are Medical Flexible Spending Accounts (FSAs)? A pre-tax benefit account used to pay for out-of-pocket health care costs such as deductibles, co-pays, prescribed medication, and some over the counter medications. What are Dependent Care Accounts? A pre-tax benefit account used to pay for dependent care services such as preschool, summer day camp, before or after school programs, and child or elder daycare. Eligibility: Eligible employees as described on page 2, spouse and dependent children (Medical FSA: up to age 26/Dependent Care FSA: children ages 12 and under) • Coverage through MedCom • Plan year is from January 1 - December 31 and employees must re-enroll each year • Married and not filing jointly participants limited to $3,750 deferral for DCFSA • Transfer of funds between Dependent Care and unreimbursed Medical are prohibited • Only family status changes will allow you to change your annual election. The altered election must be consistent with the status change. • Please visit your Employee Benefits Website for a complete and up-to date listing of eligible expenses. FSA Benefits Summary MEDICAL FSA ACCOUNT Minimum Contribution

$300 annually

Maximum Contribution

$3,400 annually

Carryover Maximum - Amount of funds carried over to the next year. Must enroll in medical FSA to access carryover funds.

$680

Total elected amount is available at the beginning of the plan year *Carryover funds are only available if re-electing the plan for the next year DEPENDENT CARE ACCOUNT Minimum Contribution

$300 annually

Maximum Contribution

$7,500 annually

Carryover Maximum

$0 - Unused funds are forfeited Funds are only available as they are payroll deducted Plan Rules

RUNOUT PERIOD

30 Days after the end of the plan year *All receipts should be kept to submit if verification is requested Admin Fee

Fee Per Participant Per Month (One fee even if electing both

$3.50

Medical FSA and Dependent Care)

Replacement Card Fee

Foothills Regional High School 2027

$7.50

IMPORTANT NOTE: Dependent Care FSA is for eligible expenses related to the care of your child, disabled spouse, elderly parent, or other dependent who is physically or mentally unable for self-care (i.e. day care, adult day care) or is disabled. Medical expenses for your dependent are not eligible for reimbursement under the Dependent Care.

HELPFUL FSA RESOURCES

What is covered under Medical FSA Account? • Medical coinsurance and deductible FSA Eligibility List • Doctor’s office visit co-pays fsastore.com/fsa-eligibility-list • Emergency Room costs • Dental co-pays and out-of-pocket costs FSA Calculator • Vision co-pays and out-of-pocket costs (estimates how much you can save with an FSA) fsastore.com/fsa-calculator • Contacts and glasses • Prescriptions • Please see the full eligibility list for other covered expenses Who is covered under Dependent Care Account? • Children ages 12 and under (including stepchildren, grandchildren, adopted or foster children, and children related to you who are eligible for a tax exemption on your federal tax return). • Tax dependents residing with you and incapable of self-care (this could include your spouse, a child age 13 and over, and elderly parents). The CARES Act permanently reinstates over-the counter products, and adds menstrual care products for the first time, as eligible expenses for your FSA funds WITHOUT A PRESCRIPTION! Eligible items for purchase without a prescription now include, but are not limited to: • Pain relief medications, e.g., acetaminophen, ibuprofen, naproxen sodium • Cold & flu medications • Allergy medications • Acne treatments • Eye drops • Stomach & digestive aids • Pads, Tampons and Menstrual sponges • Sleep aids • Children’s pain relievers, allergy medicines, and digestive aids

In the App Store go to: MedCom Mobile Online Portal and Access to information: www.medcom.wealthcareportal.com IMPORTANT NOTE: Dependent Care FSA is for eligible expenses related to the care of your child, disabled spouse, elderly parent, or other dependent who is physically or mentally unable for self-care (i.e. day care, adult day care) or is disabled. Medical expenses for your dependent are not eligible for reimbursement under the Dependent Care account. Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

Foothills Regional High School 2027

STATE HEALTH BENEFIT PLAN Eligibility: Please review the SHBP Decision Guide for plan eligibility rules. • • • •

Coverage through Anthem, United Healthcare, or Kaiser Permanente All qualifying life events must be submitted via the SHBP Portal. Notice: Your employer offers all eligible employees health insurance through the Georgia State Health Benefit Plan. During the annual open enrollment, you have the opportunity to review all available options and make elections for the 2027 Plan Year. Attention to participants approaching age 65 and/or retirement: Please review: www.shbp.georgia.gov/retirees-0/turning-age-65

SHBP Enrollment Portal:

SHBP Wellness Portal:

www.myshbpga.adp.com

www.bewellshbp.com

SHBP Decision Guide:

SHBP Decision Guide: 1. Go to www.myshbpga.adp.com 2. Enter your Username and Password and click Login. If you need assistance, click on “Forgot User ID?” or “Forgot Your Password?”. 3. If you have not registered, click “Register Here”. 4. Your registration code is SHBP-GA.

In this Guide, is a brief explanation about each health benefit option, a benefit comparison guide, and a list of things to consider before making plan decisions. Access the decision guide at www.dch.georgia.gov/shbp

SHBP Phone Number: 1.800.610.1863 SHBP 2027 Wellness Incentives Overview: Anthem HMO MyIncentive Account (MIA)

Anthem Health Reimbursement Arrangement (HRA)

Up to

Member

480 credits

$500*

480 credits

Spouse

480 credits

$500*

480 credits

Reward Card credits for member/spouse

N/A

$250 Reward Card (covered member & spouse)

Potential Total credits/dollars

960 credits

$1,000*

1,460 credits

Wellness Credits

Kaiser Permanente (KP) Regional HMO

UHC HMO & HDHP Health Incentive Account (HIA)

Up to

Please review the Active Decision Guide for full incentive program details and requirements. *Kaiser members will receive a $500 gift card after satisfying KP’s Wellness Program requirements. **Members and their covered spouses enrolled in UHC can earn a 240 well-being incentive credit march with a maximum combined up to 480 well-being incentive credits. The credits will be added to you HIA. 25

Foothills Regional High School 2027

SHBP PLANS & PRICING The table below is a high level overview, for official details and plan information please review the SHBP Decision Guide. Plan Designs for 2027 Anthem Gold Plan HRA In Out

Anthem Silver Plan HRA In Out

Anthem Bronze Plan HRA In Out

Anthem HMO In

UHC HMO In

You

$1,500

$3,000

$2,000

$4,000

$2,500

$5,000

$1,300

$3,500

$7,000

You + Spouse

$2,250

$4,500

$3,000

$6,000

You + Child(ren)

$2,250

$4,500

$3,000

$6,000

$3,750

$7,500

$1,950

$7,000

$14,000

$3,750

$7,500

$1,950

$7,000

$14,000

You + Family

$3,000

$6,000

$4,000

$8,000

$5,000

$10,000

$2,600

$7,000

$14,000

UHC HDHP Out

Kaiser HMO* In

Deductible

Medical OOPM (Out of Pocket Maximum) You

$4,000

$8,000

$5,000

$10,000

$6,000

$12,000

$4,000

$6,450

$12,900

$6,350

You + Spouse

$6,000

$12,000

$7,500

$15,000

$9,000

$18,000

$6,500

$12,900

$25,800

$12,700

You + Child(ren)

$6,000

$12,000

$7,500

$15,000

$9,000

$18,000

$6,500

$12,900

$25,800

$12,700

You + Family

$8,000

$16,000

$10,000

$20,000

$12,000

$24,000

$9,000

$12,900

$25,800

$12,700

Coinsurance (Plan Pays. Some outof-network services not covered)

85%

60%

80%

60%

75%

60%

70%

50%

100%

80%

HRA (Health Reimbursement Arrangement) Credits You You + Spouse You + Child(ren)

*See decision guide and summary plan documents for details

You + Family

N/A

Medical ER

Coins after ded

$200 copay

Coins after ded

$200 copay

Urgent Care

Coins after ded

$35 copay

Coins after ded

$35 copay

PCP Visit

Coins after ded

$35 copay

Coins after ded

$35 copay

$45 copay

Coins after ded

$45 copay

100%

Specialist Visit

Coins after ded

Preventative

100%

N/A

100%

N/A

100%

Retail Rx (Not subject to deductible on HRA plans) Tier 1

15%, Min $5, Max $10

$5 copay

Coins after ded

$20 copay

Tier 2

25%, Min $55, Max $85

$55 copay

Coins after ded

$50 copay

Tier 3

25%, Min $85, Max $130

$95 copay

Coins after ded

$80 copay

Tier 1

15%, Min $12.50 Max $25

$12.50 copay

Coins after ded

$50 copay

Tier 2

25%, Min $137.50, Max $212.50

$137.50 copay

Coins after ded

$125 copay

Tier 3

25%, Min $212.50, Max $325

$237.50 copay

Coins after ded

$200 copay

Monthly Premiums

Anthem Gold Plan HRA

Anthem Silver Plan HRA

Anthem Bronze Plan

Anthem HMO

UHC HMO

UHC HDHP

Kaiser HMO*

Employee

$227.19

$153.17

$94.16

$189.29

$232.70

$83.76

$189.29

Employee + CH

$415.51

$289.67

$189.35

$351.08

$424.87

$171.67

$351.08

Employee + SP

$565.89

$410.44

$286.52

$486.30

$577.46

$264.68

$486.30

Family

$754.21

$546.94

$381.71

$648.09

$769.63

$352.59

$648.09

Mail Order Rx

*Kaiser Permanente is available in the Metro Atlanta Service Area and Athens-Clarke, in-network only. There is an $80 tobacco surcharge added to all rates. Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

Foothills Regional High School 2027

SHBP DISCLOSURE NOTICES The following important legal notices are posted on the State Health Benefit Plan (SHBP) website at www.shbp.georgia.gov under Plan Documents. Please review these notices in their entirety, Penalties for Misrepresentation: If an SHBP participant misrepresents eligibility information when applying for coverage during change of coverage or when enrolling in benefits, the SHBP may take adverse action against the participants, including, but not limited to terminating coverage (for the participant and his or her dependents) or imposing liability to the SHBP for fraud indemnify (requiring payment for benefits to which the participant or his or her beneficiaries were not entitled). Penalties may include a lawsuit, which may result in payment of charges to the Plan or criminal prosecution in a court of law. To avoid enforcement of the penalties, the participant must notify the SHBP immediately if a dependent is no longer eligible for coverage or if the participant has questions or reservations about the eligibility of a dependent. This policy may be enforced to the fullest extent of the law. Federal Patient Protection and Affordable Care Act (Choice of Primary Care Physician): The Plan generally allows the designation of a Primary Care Physician/ Provider (PCP). You have the right to designate any PCP who participates in the Claims Administrator’s network, and who is available to accept you or your family members. For children, you may also designate a pediatrician as the PCP. For information on how to select a PCP, and for a list of participating PCP’s, call the telephone number on the back of your Identification Card. Access to Obstetrical and Gynecological (OB/GYN) Care: You do not need prior authorization from the Plan or from any other person (including a PCP) in order to obtain access to obstetrical or gynecological care from a health care professional in the Claims Administrator’s network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, call the telephone number on the back of your Identification Card. HIPAA Special Enrollment Notice: If you decline enrollment for yourself or your Dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your Dependents if you or your Dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your Dependents’ other coverage). However, you must request enrollment within 31 days after your or your Dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new Dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your new Dependents. However, you must request enrollment within thirty-one (31) days after the marriage or adoption, or placement for adoption (or within 90 days for a newly eligible dependent child). Eligible Covered Persons and Dependents may also enroll under two additional circumstances: • The Covered Person’s or Dependent’s Medicaid or Children’s Health Insurance Program (CHIP) coverage is terminated as a result of loss of eligibility; or • The Covered Person or Dependent becomes eligible for a subsidy (State Premium Assistance Program). NOTE: The Covered Person or Dependent must request Special Enrollment within sixty (60) days of the loss of Medicaid/CHIP or of the eligibility determination. To request Special Enrollment or obtain more information, call SHBP Member Services at 1-800-610-1863 or visit the SHBP Enrollment Portal: mySHBPga.adp.com. Women’s Health and Cancer Rights Act of 1998: The Plan complies with the Women’s Health and Cancer Rights Act of 1998. Mastectomy, including reconstructive surgery, is covered the same as other medical and surgical benefits under your Plan Option. Following cancer surgery, the SHBP covers: • All stages of reconstruction of the breast on which the mastectomy has been performed • Reconstruction of the other breast to achieve a symmetrical appearance • Prostheses and mastectomy bras • Treatment of physical complications of mastectomy, including lymphedema NOTE: Reconstructive surgery requires prior approval, and all Inpatient admissions require prior notification. For more detailed information on the mastectomy-related benefits available under your Plan option, call the telephone number on the back of your Identification Card. Newborns’ and Mothers’ Health Protection Act of 1996: This The Plan complies with the Newborns’ and Mothers’ Health Protection Act of 1996. Group health plans and health insurance issuers generally may not, under Federal law, restrict Benefits for any hospital length of stay in connection with childbirth for the mother or newborn to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending Provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours, as applicable). In any case, plans and issuers may not, under Federal law, require that a Provider obtain authorization from the Plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours, as applicable). HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT NOTICE OF INFORMATION PRIVACY PRACTICES Georgia Department of Community Health State Health Benefit Plan Notice of Information Privacy Practices The purpose of this notice is to describe how medical information about you, which includes your personal information, may be used and disclosed and how you can get access to this information. Please review it carefully. The Georgia Department of Community Health (DCH) and the State Health Benefit Plan Are Committed to Your Privacy. DCH understands that your information is personal and private. Certain DCH employees and companies hired by DCH to help administer the Plan (Plan Representatives) use and share your personal and private information in order to administer the Plan. This information is called “Protected Health Information” (PHI), and includes any information that identifies you or information in which there is a reasonable basis to believe can be used to identify you and that relates to your past, present, or future physical or mental health or condition, the provision of health care to you, and payment for those services. This notice tells how your PHI is used and shared by DCH and Plan Representatives. DCH follows the information privacy rules of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Only Summary Information is Used When Developing and/or Modifying the Plan. The Board of Community Health, which is the governing Board of DCH, the Commissioner of DCH and the Executive Director of the Plan administer the Plan and make certain decisions about the Plan. During those processes, they may review certain reports that explain costs, problems, and needs of the Plan. These reports never include information that identifies any individual person. If your employer is allowed to leave the Plan entirely, or stop offering the Plan to a portion of its workforce, DCH may provide Summary Health Information (as defined by federal law) for the applicable portion of the workforce. This Summary Health Information may only be used by your employer to obtain health insurance quotes from other sources and make decisions about whether to continue to offer the Plan. Please note that DCH, Plan Representatives, and your employer are prohibited by law from using any PHI that includes genetic information for underwriting purposes. Plan “Enrollment Information” and “Claims Information” are Used in Order to Administer the Plan. PHI includes two kinds of information, “Enrollment Information” and “Claims Information”. “Enrollment Information” includes, but is not limited to, the following types of information regarding your plan enrollment: (1) your name, address, email address, Social Security number and all information that validates you (and/or your Spouse and Dependents) are eligible or enrolled in the Plan; (2) your Plan enrollment choice; (3) how much you pay for premiums; and (4) other health insurance you may have in effect. There are certain types of “Enrollment Information” which may be supplied to the Plan by you or your personal representative, your employer, other Plan vendors or other governmental agencies that may provide other benefits to you.

Foothills Regional High School 2027

SHBP DISCLOSURE NOTICES This “Enrollment Information” is the only kind of PHI your employer is allowed to obtain. Your employer is prohibited by law from using this information for any purpose other than assisting with Plan enrollment. “Claims Information” includes information your health care providers submit to the Plan. For example, claims information may include medical bills, diagnoses, statements, x-rays or lab test results. It also includes information you may submit or communicate directly to the Plan, such as health questionnaires, biometric screening results, enrollment forms, leave forms, letters and/or telephone calls. Lastly, it includes information about you that may be created by the Plan. For example, it may include payment statements and/or other financial transactions related to your health care providers. Your PHI is Protected by HIPAA. Under HIPAA, employees of DCH and employees of outside companies and other vendors hired or contracted either directly or indirectly by DCH to administer the Plan are “Plan Representatives,” and therefore must protect your PHI. These Plan Representatives may only use PHI and share it as allowed by HIPAA, and pursuant to their “Business Associate” agreements with DCH to ensure compliance with HIPAA and DCH requirements. DCH Must Ensure the Plan Complies with HIPAA. DCH must make sure the Plan complies with all applicable laws, including HIPAA. DCH and/or the Plan must provide this notice, follow its terms and update it as needed. Under HIPAA, Plan Representatives may only use and share PHI as allowed by law. If there is a breach of your PHI, DCH must notify you of the breach. Plan Representatives Regularly Use and Share your PHI in Order to Administer the Plan. Plan Representatives may verify your eligibility in order to make payments to your health care providers for services rendered. Certain Plan Representatives may work for contracted companies assisting with the administration of the Plan. By law, these Plan Representative companies also must protect your PHI. HIPAA allows the Plan to use or disclose PHI for treatment, payment, or health care operations. Below are examples of uses and disclosures for treatment, payment and health care operations by Plan Representative Companies and PHI data sharing. Claims Administrator Companies: Plan Representatives process all medical and drug claims; communicate with the Plan Members and/or their health care providers. Wellness Program Administrator Companies: Plan Representatives administer Well- Being programs offered under the Plan; and communicate with the Plan Members and/or their health care providers. Actuarial, Health Care and /or Benefit Consultant Companies: Plan Representatives may have access to PHI in order to conduct financial projections, premium and reserve calculations, and financial impact studies on legislative policy changes affecting the Plan. State of Georgia Attorney General’s Office, Auditing Companies and Outside Law Firms: Plan Representatives may provide legal, accounting and/or auditing assistance to the Plan. Information Technology Companies: Plan Representatives maintain and manage information systems that contain PHI. Enrollment Services Companies: Plan Representatives may provide the enrollment website and/or provide customer service to help Plan Members with enrollment matters. NOTE: Treatment is not provided by the Plan but we may use or disclose PHI in arranging or approving treatment with providers. Under HIPAA, all employees of DCH must protect PHI and all employees must receive and comply with DCH HIPAA privacy training. Only those DCH employees designated by DCH as Plan Representatives for the SHBP health care component are allowed to use and share your PHI. DCH and Plan Representatives May Make Uses or Disclosures Permitted by Law in Special Situations. HIPAA includes a list of special situations when the Plan may use or disclose your PHI without your authorization as permitted by law. The Plan must track these uses or disclosures. Below are some examples of special situations where uses or disclosures for PHI data sharing are permitted by law. These include, but are not limited to, the following: Compliance with a Law or to Prevent Serious Threats to Health or Safety: The Plan may use or share your PHI in order to comply with a law or to prevent a serious threat to health and safety. Public Health Activities: The Plan may give PHI to other government agencies that perform public health activities. Information about Eligibility for the Plan and to Improve Plan Administration: The Plan may give PHI to other government agencies, as applicable, that may provide you or your dependents benefits (such as state retirement systems or other state or federal programs) in order to get information about your or your dependent’s eligibility for the Plan, to improve administration of the Plan, or to facilitate your receipt of other benefits. Research Purposes: Your PHI may be given to researchers for a research project, when the research has been approved by an institutional review board. The institutional review board must review the research project and its rules to ensure the privacy of your information. Plan Representatives Share Some Payment Information with the Employee. Except as described in this notice, Plan Representatives are allowed to share your PHI only with you and/or with your legal personal representative. However, the Plan may provide limited information to the employee about whether the Plan paid or denied a claim for another family member. You May Authorize Other Uses of Your PHI. Plan Representatives may not use or share your PHI for any reason that is not described in this notice without a written authorization by you or your legal representative. For example, use of your PHI for marketing purposes or uses or disclosures that would constitute a sale of PHI are illegal without this written authorization. If you give a written authorization, you may revoke it later. You Have Privacy Rights Related to Plan Enrollment Information and Claims Information that Identifies You. Right to Inspect and Obtain a Copy of your Information, Right to Ask for a Correction: You have the right to obtain a copy of your PHI that is used to make decisions about you. If you think it is incorrect or incomplete, you may contact the Plan to request a correction. Right to Ask for a List of Special Uses and Disclosures: You have the right to ask for a list of all special uses and disclosures. Right to Ask for a Restriction of Uses and Disclosures or for Special Communications: You have the right to ask for added restrictions on uses and disclosures, but the Plan is not required to agree to a requested restriction, except if the disclosure is for the purpose of carrying out payment or health care operations, is not otherwise required by law, and pertains solely to a health care item or service that you or someone else on your behalf has paid in full. You also may ask the Plan to communicate with you at a different address or by an alternative means of communication in order to protect your safety. Right to a Paper Copy of this Notice and Right to File a Complaint: You have the right to a paper copy of this notice. Please contact the SHBP Member Services at 1-800-610-1863 or you may download a copy at shbp.georgia.gov. If you think your HIPAA privacy rights may have been violated, you may file a complaint. You may file the complaint with the Plan and/or the U.S. Department of Health & Human Services, Office of Civil Rights, Region IV. You will never be penalized by the Plan or your employer for filing a complaint. Summaries of Benefits and Coverage Summaries of benefits and coverage describe each Plan Option in the standard format required by the Affordable Care Act. These documents are posted here: shbp.georgia.gov. To request a paper copy, please contact SHBP Member Services at 800-610-1863. Georgia Law Section 33-30-13 Notice: SHBP actuaries have determined that the total cost of coverage (which includes the cost paid by the State and the cost paid by members) under all options is 0% higher than it would be if the Affordable Care Act provisions did not apply.

Foothills Regional High School 2027

RETIREMENT OPTIONS Georgia Retired Educators Association (GREA) • • •

www.garetirededucators.org/index.php/benefits Offers various options for dental, vision, long-term care, cancer and other benefits for retirees What is Georgia Retired Educators Association (GRAE)? Georgia Retired Educators Association began in 1958 as Georgia Retired Teachers Association. The organization has evolved, through forty-seven years of specialization and diversity of educational roles, and adopted its current name in 1998 to better describe the membership potential. GRAE continues to be the only organization that concentrates exclusively on the needs of Georgia retired educators.

Foothills Regional High School’s Retirement Academy • • •

www.foothillsrhs.org/ Developed by PlanMember Services, a financial services company specializing in retirement planning, investment management and education. What is Retirement Academy? The Retirement Academy is an online financial literacy resource that helps employers educate their employees about personal finance, saving investing and other important financial topics. It’s a fact that when employees understand the importance of saving for retirement and are financially literate their stress level is reduced, and they are more productive and happier - on and off the job. My name is Benjie Cole, and I am very thankful for the opportunity to partner with Foothills Regional High School and to speak with any and all employees who want to discuss saving for retirement. It is a big decision, one that we all should make as we prepare for life after our teaching careers. I have spent 33 wonderful years in Education serving as a teacher, coach of multiple sports, Assistant Principal, Principal, and Assistant Superintendent. During this time, I have always found value in using the school’s available 403 (b) and/or 457 savings options, and I appreciate every opportunity to assist others in making this decision. I am currently a retirement specialist and have provided literature for your review. I work closely with our Senior Vice President, Seth Hardin, and we are available to assist you. If you have questions, please reach out, and we will gladly assist you with your retirement dreams. At ValuTeachers, we feel that service is key. Either or both of us are always willing to visit you in person or by phone appointment.

Benjie Cole Retirement Specialist/State Coordinator P: 770-328-5496 bcole@valuteachers.com

Foothills Regional High School 2027

Seth Hardin Retirement Specialist/Senior Vice President P: 770-630-3955 shardin@valuteachers.com

IMPORTANT NOTES

Foothills Regional High School 2027

BENEFITS FOR FAMILY, BEYOND THE WORKPLACE AFFORDABLE COVERAGE OPTIONS YOU CAN SHARE WITH THE PEOPLE YOU CARE ABOUT

Individually purchased. Not employer-sponsored or payroll deducted. MEET WOODROW Campus Benefits helps individuals and families explore valuable coverage options. In addition to the benefits we support through employers, we connect people with options they can select and enroll in independently, outside of work. Woodrow is our beloved office mascot and a reminder of the personal care behind everything we do. In his honor, we call this collection of familyfocused coverage options Woodrow’s Picks. Woodrow’s Picks make it easy to share coverage options with adult children, parents, siblings, extended family members, and others who may need benefits outside of work.

CAMPUS BENEFITS SELECTED

EASY TO EXPLORE

FAMILYFOCUSED

SIMPLE TO SHARE

Campusbenefitsforme.com 31

Foothills Regional High School 2027

Who Should You Share These Benefits With? Important:

These plans are purchased individually. They are not employer-sponsored or deducted from your paycheck.

BENEFITS BEYOND THE WORKPLACE These coverage options are available independently through Campus Benefits. They are separate from employersponsored plans, are not deducted from payroll, and are billed directly to the person enrolling. You can explore these options for yourself or share them with family members and loved ones who may need additional coverage.

Consider Sharing Woodrow’s Picks with: Part-time or self-employed family members Adult children choosing their own coverage Parents and grandparents Siblings and extended family members Anyone seeking coverage outside of work

Campusbenefitsforme.com Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

Foothills Regional High School 2027

Woodrow’s Picks for Individual Protection Explore coverage for yourself or share these options with family and loved ones who need benefits outside of work.

Dental*

Vision*

Telemedicine*

Preventive care, cleanings, and major services

Exams, frames, contacts, and lens upgrades

24/7 virtual doctor visits

W Fa ood vo ro ri w te ’s !

*Avoid duplicate coverage: Check what benefits you already have through your employer before enrolling.

Life Insurance

Long-Term Care

Pet Insurance

Term life coverage for you or your family

Coverage for extended care needs

Help with vet bills, accidents, and illnesses

Travel Medical Coverage

Trip Cancellation Insurance

IMPORTANT:

Because most health insurance does not work outside the U.S.

Protect your trip investment for vacations, cruises, and trips abroad

Foothills Regional High School 2027

These are individually purchased plans and are not employer-sponsored or payroll deducted.

3 SIMPLE WAYS TO EXPLORE & ENROLL Scan the QR Code Use your phone camera to explore available coverage options.

Visit Us Online Browse plans, compare options, and enroll at your own pace.

Campusbenefitsforme.com

Contact Campus Benefits Talk with a licensed benefits advisor for personalized help.

1-888-495-8990 Woodrow@campusbenefits.com

Monday-Friday 9:00am-5:00pm ET.

Questions? Campus Benefits is here to help. Whether you are exploring coverage for yourself or sharing options with someone you care about, our team can help you understand your choices and take the next step. Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

Foothills Regional High School 2027

The Service Hub Helps With: • • • •

Portability/Conversion Benefits Education Evidence of Insurability Qualified Life Event Changes

• • • •

Claims Card Requests Benefit Questions COBRA Information

Phone: 1.866.433.7661, Opt 5 Email: mybenefits@campusbenefits.com Benefit website address: foothillsregionalbenefits.com

The 2027 Benefits Enrollment Guide is provided for illustrative purposes only. Actual benefits, services, premiums, claims processes and all other features and plan designs for coverage offered is governed exclusively by the insurance contract and associated Summary Plan Description (SPD). In case of discrepancies between this document and the insurance contract and SPD, the contract and SPD will prevail. We reserve the right to change, modify, revise, amend or terminate these plan offerings at any time. Updates, changes, and notices are available for review at foothillsregionalbenefits.com or by contacting HR or the email above. These should be reviewed fully prior to electing any benefits. Disclosures: All required SPD, legal and plan Disclosures are posted on the Benefit Website. For a written copy please contact Campus Benefits at 866-433-7661, opt. 5.