Issuu

Jasper County Benefits Guide

2027

Effective January 1st, 2027 Summary for Review Purposes Only

INTRODUCTION 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, 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 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.jasperbenefits.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 • Plan year is 1/1 - 12/31 • Scheduled open enrollment occurs in the Fall (October/November) • FSA Plan Year: 7/1 - 6/30

1. Visit www.jasperbenefits.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 • Plan year is 1/1 - 12/31 • Annual open enrollment occurs in the Fall (October/November)

Benefits Guide 2027 Version #09222026

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

1 Take Action Reminders............................... 2 Eligibility....................................................... 3 Employee Assistance Programs................ 4 Additional Resources.................................. 5 Campus Service Hub & Support............... 6 Benefits Enrollment Portal......................... 7 Short-Term Disability.................................. 8 Long-Term Disability ................................. 9 Life Insurance 101...................................... Basic Life Insurance.................................... 10 Voluntary Life Insurance............................ 11 Permanent Life Insurance.......................... 12 Dental Insurance......................................... 13 Vision Insurance.......................................... 14 Critical Illness Insurance............................. 15 Cancer Insurance........................................ 16 Accident Insurance...................................... 17 Wellness Incentives..................................... 18 MedCareComplete..................................... 19 Legal Plan..................................................... 20 Flexible Spending Accounts.................... 21-22 State Health Benefit Plan Info................ 23-24 25 Pet Insurance........................................... State Health Benefit Plan disclosures... 26-27 Notes......................................................... 28-29

JASPER COUNTY CHARTER SYSTEM CONTACT Derek VanderVen Director of Human Resources 706.468.6350 x 5106 dvanderven@jasper.k12.ga.us Need Help? Start Here: mybenefits@campusbenefits.com 1.866.433.7661, opt 5 Jasper County Charter System Benefit Plan Information Available At: www.jasperbenefits.com

Eligibility • •

Generally, full-time employees working 25 or more hours a week are eligible to enroll in the benefits described in this guide. 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.

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. You must be actively at work on the effective date of coverage for all benefits listed within the guide.

When to Enroll • • • •

Campus Benefits Enrollment: October - November SHBP Open Enrollment: October - November FSA Enrollment: In the spring (April) New Hire: Enroll within 30 days of your date of hire

How to Make Changes • • •

Once you make your benefit elections as a new hire or during Open Enrollment, you cannot make changes to those elections until the next Open Enrollment period. The only exception is a qualifying life event which allows you to make eligible changes to your benefit elections during the plan year. Please contact Campus Benefits or SHBP for qualifying life event changes.

Benefits Guide 2027

EMPLOYEE ASSISTANCE PROGRAMS What is an EAP? Programs offered to eligible Jasper County Charter System employees to provide guidance with personal issues, planning for life events or simply managing daily life which can affect your work, health and family. Mutual of Omaha EAP Eligibility: Eligible employees, their eligible household members and unmarried children up to age 26 • Coverage through Mutual of Omaha • Provides support, resources, and information for personal and work-life challenges • Receive three sessions with a counselor per person, per issue, per year • CALL 800.272.7255 or visit www.guidanceresources.com • Web ID: COM589

Life’s not always easy. Sometimes a personal or professional issue can get in the way of maintaining a healthy, productive life. Your Employee Assistance Program (EAP) can be the answer for you and your family. We’re Here to Help

Mutual of Omaha’s EAP assists employees and their eligible dependents with personal or jobrelated concerns, including: • • • • •

Emotional well-being Family and relationships Legal and financial matters Healthy lifestyles Work and life transitions

EAP Benefits •

•

Access to a library of educational articles, handouts, and resources via www.mutualofomaha.com/eap *Face-to-face visits can also be used toward legal consultations *California Residents: Knox-Keene Statute limits no more than three face-to-face sessions per six-month period.

Access to EAP professionals 24 hours a day, seven days a week. Information and referral services Service for employees and eligible dependents Robust network of licensed mental health professionals Legal assistance and financial resources • Online will preparation • Legal library and online forms • Financial tools & resources Resources for: • Substance use and other addictions • Dependent and Elder Care resources

• • •

•

What to Expect

You can trust your EAP professional to assess your needs and handle your concerns in a confidential, respectful manner. Our goal is to collaborate with you and find solutions that are responsive to your needs. Your EAP benefits are provided through your employer. There is no cost to you for utilizing EAP services. If additional resources are needed, your EAP professional will help locate appropriate resources in your area.

Plan Rates Coverage provided at no cost to you by Jasper County Charter System!

Benefits Guide 2027

ADDITIONAL RESOURCES Additional Benefits to Support Your Wellbeing and Peace of Mind As part of your Mutual of Omaha benefits package, you have access to additional services such as a hearing discount program, identity theft assistance, travel assistance and will preparation services. Available to all benefit eligible employees, no enrollment requirement. Hearing Discount Program

Enjoy savings and support through Amplifon Hearing Health Care. • Variety of industry leading brands’ hearing aids to choose from • 60-day risk free trial with money back guarantee • 3 year warranty for loss, repairs or damage • Follow up care, battery supplies and financing options available • Family and friends receive a discount • Call Amplifon at 1.888.534.1747 to speak with a Patient Care Advocate who will connect you with a provider near you • To learn more visit www.amplifonusa.com/mutualofomaha

Identity Theft Assistance

Receive essential identity protection and recovery help through AXA Assistance. • Education and awareness to reduce risk of identity theft • Guidance on recognizing and responding to fraud • Recovery support if personal information is stolen, including steps to restore your identity and contacts for financial institutions and credit bureaus • Call AXA Assistance at 1.800.856.9947

Worldwide Travel Assistance

Feel secure knowing you and your family are covered while traveling more than 100 miles from home. • 24/7 emergency support for medical referrals, legal help and translation services • Pre-trip planning support including passport/visa requirement, health advisories, and currency exchange rates • Assistance with lost baggage, emergency cash, emergency messages between you and others, vehicle return and document replacement (credit card, passport, tickets) • Call World Travel Assistance at 1.800.856.9947 (within the U.S.) or 312.935.3658 (outside of the U.S.)

Will Preparation Services

Create important legal documents at no cost through Epoq, Inc. • Easy online platform to prepare: living will and trust, power of attorney, healthcare directive, pourover will, last will and testament • Print and share instantly and update as needed for major life changes • Make the document legally binding (check with your state for requirements) • To learn more visit www.willprepservices.com and use code MUTUALWILLS to register

Please visit www.jasperbenefits.com for more information. 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.

Benefits Guide 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 • Claims • Benefits Education • Card Requests • Evidence of Insurability • Benefit Questions • Qualified Life Event • COBRA Information Changes

The Campus Benefits team understands the claims process and leverages the necessary carrier relationships to expedite the paperwork efficiently to ensure claims are not delayed due to improper paperwork completion.

How to File a Claim 1. Contact Campus Benefits via phone or email 2. Work with Campus Benefits’ claims specialist to complete the necessary paperwork • Employee Portion • Physician Portion • Employer Portion 3. Submit the necessary paperwork to Campus Benefits via the secure upload • Secure upload located at: www.jasperbenefits.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 my dental card or vision card quickly? A: Your group dental and vision plan information is available at: www.jasperbenefits.com

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

Benefits Guide 2027

CAMPUS BENEFITS ENROLLMENT Jasper County Charter System

Company Identifier: JCCS16

1 2 3

www.jasperbenefits.com

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

Select “Campus Connect” to login

Existing User Login 1. Enter your username 2. Enter your password 3. Click “LOGIN” 4. Click on the “Start Benefits” button and begin the enrollment process

FAQ’S 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. • • •

New User Registration

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

• • • • •

First Name Last Name Company Identifier: JCCS16 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

STILL NEED HELP? Contact Campus Benefits Email mybenefits@campusbenefits.com Call 1.866.433.7661, opt 5

Record Login Information Below Username: _______________________________ Password: ________________________________

Benefits Guide 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 ability to earn a paycheck. You may also hear disability insurance referred to as disability income insurance or income protection. Eligibility: Eligible full-time employees working more than 25 hours/week • Coverage through Mutual of Omaha • Must be actively at work on the effective date • Scheduled Open Enrollment – No Health Questions Every Year! • Pre-existing condition limitation will apply to new enrollees • Paid Parental Leave: Must use in conjunction with FMLA. Does NOT pay in addition to sick leave or paid parental leave; must exhaust sick leave prior to benefit starting. Short-Term Disability Quick Summary Elimination Period Benefit Duration

14 Days 11 weeks

Benefit Percentage (weekly)

60% of Earnings

Maximum Benefit Amount Weekly

$500

Pre-existing Condition Limitation

3/6 Any sickness or injury for which you received medical treatment, consultation, care, or services during the specified months (3 months) prior to your coverage effective date. A disability arising from any such sickness or injury will be covered only if it begins after you have performed your regular occupation on a full-time basis for the specified months (6 months) following the coverage effective date.

STD Rates/$10 Weekly Benefit Age

0 - 24

25- 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 +

Rates

$0.71

$0.63

$0.47

$0.44

$0.50

$0.53

$0.59

$0.62

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

Rate Calculator: Short-Term Disability

Annual Salary / 52 x 0.60 / 10 x STD Rate Factor

Benefits Guide 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 ability to earn a paycheck. You may also hear disability insurance referred to as disability income insurance or income protection. Eligibility: Eligible full-time employees working more than 25 hours/week • Coverage through Mutual of Omaha • Must be actively at work on the effective date • Must exhaust all sick leave prior to using benefit • Disability benefits do not pay in-addition to sick leave • Scheduled Open Enrollment – No Health Questions Every Year! • Pre-existing condition limitation will apply to new enrollees Long-Term Disability Quick Summary Elimination Period

90 Days

Benefit Duration

Social Security normal retirement age (Please note exclusions or limitations may apply, see plan certificate for details)

Benefit Percentage (monthly)

60% of Earnings

Maximum Benefit Amount Monthly

$5,000

Pre-existing Condition Limitation

6/12 Any illness or injury for which you received treatment the 6 months prior to your effective date will not be covered for the first 12 months. LTD Rates/$100 Covered Pay

Age

0-29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 - 99

Rates

$0.10

$0.17

$0.28

$0.40

$0.60

$0.72

$0.81

$0.77

$0.70

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

Rate Calculator: Long-Term Disability

Monthly Salary / 100 x LTD Rate Factor

Benefits Guide 2027

LIFE INSURANCE 101 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. Below 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. 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 your age when the policy is issued • This is an individual plan you can take with you regardless of where you work 9

Benefits Guide 2027

BASIC TERM LIFE & AD&D INSURANCE What is Basic Life Insurance and AD&D? A financial and family protection plan 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 or a covered loved one dies accidentally or passes 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 employee becomes dismembered in an accident. Eligibility: Eligible full-time employees working more than 25 hours/week, spouse & children up to age 26 • Coverage through Mutual of Omaha • Must be actively at work on the effective date • Employee must elect coverage to cover spouse and/or children • Evidence of Insurability is no longer needed for dependent children after initial open enrollment. It is required for employees and spouses who elect coverage after initial open enrollment period. Basic Life Quick Summary LIFE AMOUNT Employee Coverage

$50,000

Dependent Coverage

$10,000 - Spouse $5,000 - Child(ren) $1,000 - Child(ren) 0 days - 6 months AD&D AMOUNT

Employee

Equal to Life Amount

Spouse and Child(ren)

None BENEFITS

Guaranteed Issue (for first time enrollees) Age Reduction Portability Conversion

Employee: $50,000 Spouse: $10,000 Children: $5,000 None Included (Rates increase when ported) Included (Rates increase when converted)

Living Care Benefit

80% up to $40,000

Waiver of Premium

Included BASIC LIFE & AD&D

Employee Coverage Dependent Coverage

$9.25 $2.00

Benefits Guide 2027

VOLUNTARY TERM LIFE & AD&D INSURANCE 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 or a covered loved one 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 full-time employees working more than 25 hours/week, spouse & children* up to age 26 • Coverage through Mutual of Omaha • Must be actively at work on the effective date • Employees do not have to elect Basic Life to enroll in Voluntary Life • If electing for the first time outside of the initial enrollment period, health questions will be required • Employee must elect coverage for themselves in order to cover spouse and/or children * Child marital status does not impact benefits eligibility Voluntary Life and AD&D Quick Summary LIFE AMOUNT Employee

$1,000 increments up to $500,000

Spouse

$500 increments up to $250,000 (not to exceed 100% of employee amount) Spouse term at employee age 80

Child(ren)

Choice of $5,000 or $10,000

Child > 6 months

$0 AD&D AMOUNT MATCH LIFE AMOUNT GUARANTEED ISSUE (GI)

Employee

$200,000

Spouse

$50,000

Child(ren)

$10,000 ADDITIONAL FEATURES

GUARANTEED INCREASE IN BENEFIT Age Reduction Portability Provision Conversion

Employee: If enrolled, can increase by $20,000 up to the Guaranteed Issue Amount Spouse: If enrolled, can increase by $10,000 up to the Guaranteed Issue Amount 50% at age 80 (Based on Employee Age) Included ($250,000 max; premium will increase at the time of port) Included

Living Care Benefit

80% of Life Benefit (Up to $400,000)

Waiver of Premium

Included (6 month elimination period)

Plan Rates Cost of coverage depends on your age and the amount of coverage. Spouse rate is based on employee’s rate. Please consult with a Campus Benefits Counselor or log into the enrollment system for rate details. 11

Benefits Guide 2027

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

Eligibility: Eligible full-time employees working more than 25 hours/week, spouse & children up to age 26 • Coverage through UNUM • Upon termination or retirement, coverage can be ported on bank draft Permanent Life Insurance Quick Summary LIFE AMOUNTS Employee

$2,000 - $300,000

Spouse

$2,000 - $75,000

Child

$5,000 - $50,000 (increments of $5,000)

Paid Up Option

Payable to age 120 Paid up option at age 70 Child always Paid Up at age 70

Issue Age

Employee & Spouse: 15-80 Child: 14 days - 26 years

Evidence of Insurability

Required for most policies GUARANTEED ISSUE (NEW HIRE; INITIAL ENROLLMENT)

Employee

Up to $12.00 of weekly cost (no health questions)

Spouse

Up to $3.00 of weekly cost (one health question)

Child

Up to $50,000

Plan Rates Cost of coverage depends on your age and the amount of coverage. 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.

Benefits Guide 2027

DENTAL INSURANCE What is Dental Insurance? A health and wellness plan designed to pay a portion of dental costs associated with preventive, basic and some major dental care, as well as orthodontia. Eligibility: Eligible full-time employees working more than 25 hours/week, spouse & children up to age 26 • Coverage through Mutual of Omaha • Claims must be submitted within 90 days of date of service • In-Network Provider Directory: www.mutualofomaha.com (Network: Mutually Preferred) • Orthodontia available for adult employees & spouse and children up to age 26 (subject to takeover provision) • No waiting periods • The chart below is a sample of covered services. Please see Plan Certificate for a detailed listing of services in their entirety. Plan certificate available at www.jasperbenefits.com. Coinsurance

High Plan

Low Plan

Preventive (Type 1)

100%

Basic (Type 2)

80%

Major (Type 3)

50%

Not Covered

Orthodontia

50%

Not Covered

Dental Benefits Quick Summary Calendar Year Deductible (Excludes Preventive)

$50/person, $150/family

Reimbursement Allowances

90th percentile UCR

Calendar Year Plan Maximum

$1,000

Orthodontia (Lifetime Max, High Plan Only)

$1,500

Plan Rates Employee Employee + Family

Services

High

Low

Exams (2 in 12 month period)

100%

Bitewing X-rays (4 in 12 month period)

100%

Panoramic X-ray (1 in 3 year period)

100%

Cleaning (2 in 12 month period)

100%

Fluoride (child up to age 19)

100%

Space Maintainers (children up to 16)

100%

Sealants (children up to 16)

80%

Amalgam Fillings

80%

Simple Extractions

80%

Surgical Extractions

80%

Anesthesia

80%

Endodontics (non-surgical)

80%

Endodontics (surgical)

80%

Periodontics (non-surgical)

80%

Periodontics (surgical)

80%

Dentures (full or partial)

50%

High

Low

Cast Crowns/Inlays/Onlays

50%

$43.34 $120.74

$30.70 $91.94

Bridges

50%

Implants

50%

DENTAL DENTAL DENTAL DENTALID ID ID IDCARD CARD CARD CARD JASPER COUNTY CHARTER SYSTEM NAME: (EMPLOYEE NAME) GROUP ID: G000CT2P Questions call: 1.800.487.5553. Visit www.mutualofomaha.com to register for account access.

*Click on id card for more information and printable version (electronic guide) 13

Benefits Guide 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 eyewear (eyeglasses and contact lenses). Eligibility: Eligible full-time employees working more than 25 hours/week, spouse & children up to age 26 • Coverage through NVA • Claims must be submitted within 90 days of date of service. • In-network Provider Directory www.e-nva.com • Log in information: Username: jaspercountysd Password: vision1 • The chart below is a sample of covered services. Please see Plan Certificate for a detailed listing of services in their entirety. Plan certificate available at www.jasperbenefits.com. Vision Benefits Quick Summary Eye Exam

$10 Co-pay

Frames

$160 Allowance + 20% off balance

Single/Bifocal/Trifocal/Lenticular Lenses (12 months)

$15 Co-pay Up to $160 Allowance + 15% off Conventional lenses and 10% off Disposable lenses

Elective Contacts Medically Necessary Contacts

Covered in Full

Frequencies (Date of service)

Exams and Lens - every 12 months Frames - every 24 months

Lasik or PRK

Discount Arrangement

VISION COVERAGE VERIFICATION

Rates Employee Employee + Spouse Employee + Children Employee + Family

$6.20 $12.38 $19.81 $22.90

JASPER COUNTY CHARTER SCHOOLS GROUP #: 8849000001 Providers and members can call 1.800.672.7723 to verify coverage and benefits. *Click on id card for more information and printable version (electronic guide)

Benefits Guide 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 full-time employees working more than 25 hours/week, spouse & children up to age 26 • Coverage through Cigna • Elect Critical Illness with or without Cancer coverage based on your individual needs • Issue Age - Rates lock-in at your current age and will never increase • No health questions - EVERY YEAR!! • The chart below is a sample of covered services. Please see the Plan Certificate for a detailed listing of services in their entirety. Plan certificate available at www.jasperbenefits.com.

Critical Illness Benefits Quick Summary

Critical Illness WITHOUT Cancer

Critical Illness WITH Cancer

Employee

$5,000 - $20,000

Spouse

50% of EE Amount

Dependent Children

25% of EE Amount

COVERED SPECIFIED CRITICAL ILLNESSES

Pays % of Face Amount

Heart Attack (Myocardial Infarction)

100%

Stroke, Major Organ Failure

100%

End Stage Renal Failure (Kidney)

100%

Permanent Paralysis

100%

Loss of Hearing, Speech, or Blindness

100%

Coronary Artery Disease, Coma

25%

Advanced Alzheimer’s Disease

25%

ALS (Lou Gehrig’s Disease)

25%

Parkinson’s; Multiple Sclerosis

25%

Benign Brain Tumor

100%

Invasive Cancer

None

100%

Carcinoma in Situ

None

25%

Skin Cancer

None

$250

GUARANTEED ISSUE (No health questions)

Employee: $20,000 / Spouse: $10,000

WELLNESS INCENTIVE

$50 - (See Wellness Incentives page)

Age Reduction Pre-existing Condition

50% at age 70 None

Re-occurrence Benefit

Payments available for a second covered condition after 180 days. Receive a second payout for the same condition after 12 months.

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. 15

Benefits Guide 2027

CANCER INSURANCE What is Cancer Insurance? Cancer insurance is a form of supplemental insurance meant to offset cancer-related expenses so you can focus on recovery. Eligibility: Eligible full-time employees working more than 25 hours/week, spouse & children up to age 26 • Coverage through Guardian • Payments made directly to you and do not offset with medical insurance • Keep your coverage at the same cost even if you retire or change employers • No health questions – EVERY YEAR!! (Pre-existing condition will apply to new enrollees) • The chart below is a sample of covered services. Please see the Plan Certificate for a detailed listing of services in their entirety. Plan certificate available at www.jasperbenefits.com. Cancer Benefit Quick Summary

Basic Option HOSPITAL AND RELATED BENEFITS - DAILY BENEFIT

Initial Diagnosis Benefit Amount (must be first time diagnosis)

Enhanced Option

$2,500

$5,000

Initial Diagnosis Waiting Period

30 days

Hospital Confinement

$300 (1st 30 days) $600 (after 30 days)

$400 (first 30 days) $800 (after 30 days)

ICU Confinement

$400 (1st 30 days) $600 (after 30 days)

$600 (first 30 days) $800 (after 30 days)

$100/day up to 90 days per year

$150/day up to 90 days per year

Extended Care Facility (daily) Hospice Care Radiation Therapy Chemotherapy Blood/Plasma/Platelets (every 12 months)

$50 per day/100 days $100 per day/100 days RADIATION,CHEMOTHERAPY & RELATED BENEFITS Scheduled amounts up to $10,000 a year Scheduled amounts up to $15,000 a year

Medical Imaging (up to 2 per year)

$100/day up to $5,000/year

$200/day up to $10,00 per year

$200

$400

SURGERY AND RELATED BENEFITS Surgical Benefit (Scheduled Amount) Reconstructive Surgery

up to $4,125

up to $5,500

Breast TRAM Flap $2,000 Breast reconstruction $500 Breast Symmetry $250 Facial reconstruction $500

Breast TRAM $3,000 Breast reconstruction $700 Breast Symmetry $350 Facial reconstruction $700

Anesthesia (% of surgery)

25%

Second Surgical Opinion

$200/surgical procedure

$300/surgical procedure

Bone Marrow/Stem Cell

Bone Marrow: $7,500 Stem Cell: $1,500 50% benefit for 2nd transplant

Bone Marrow: $10,000 Stem Cell: $2,500 50% benefit for 2nd transplant

MISCELLANEOUS BENEFITS Ambulance (per confinement/2 trip limit)

$200/trip, limit 2 trips per hospital confinement

$250/trip, limit 2 trips per hospital confinement

Air Ambulance (per confinement/2 trip limit)

$1,500 per trip

$2,000 per trip

Transportation (local or non-local)

$0.50 per mile ($1,000 round trip)

$0.50 per mile ($1,500 round trip)

Outpatient or Family Lodging (daily)

$75 (max 90 days per year)

$100 (max 90 days per year)

Physical or Speech Therapy (daily)

$25/visit ($400 lifetime max)

$50/visit ($1,000 lifetime max)

Experimental Treatment (every 12 months)

$100/day up to $1,000/month

$200/day up to $2,400/month

Surgically Implanted: $2,000/device, $4,000 lifetime max, Non-Surgically: $200/device, $400 lifetime max

Surgically Implanted: $3,000/device, $6,000 lifetime max, Non-Surgically: $300/device, $600 lifetime max

Prosthetic

Skin Cancer

Biopsy: $100 Reconstructive Surgery: $250 Excision of a skin cancer: $375 Excision of a skin cancer with flap or graft: $600

Portability

Included (must port prior to age 70)

Cancer Screening (see Wellness Incentives page)

$50/$50 for follow up screening

Pre-existing condition limitation

12/12 (Applies to new enrollees only)

Age Reduction Portability

Basic Option Monthly Rates Employee $20.88 Employee + Spouse $31.96 Employee + Child(ren) $29.58 Employee + Family $40.66 Enhanced Option Monthly Rates Employee $31.56 Employee + Spouse $48.32 Employee + Child(ren) $39.05 Employee + Family $55.81

None Included (portable prior to age 70)

Benefits Guide 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 full-time employees working more than 25 hours/week, spouse & children up to age 26 • Coverage through Mutual of Omaha • No health questions - EVERY YEAR!! • 24-hour coverage (on or off job) • 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. Plan certificate available at www.jasperbenefits.com Accident Benefits Quick Summary

Low Plan

High Plan

INJURIES

Low Plan Rates Employee $8.62 Employee + Spouse $12.90 Employee + Child(ren) $14.80 Employee + Family $19.08

Emergency Room

$300

$400

Urgent Care Center

$225

$325

Initial Physician Office Visit

$100

$175

Ground Ambulance

$300

$400

Air Ambulance

$1,500

$2,000

Hospital Admission

$1,500

$2,000

Hospital Stay

$300 per day/ Max 365 days

$400 per day/ Max 365 days

ICU Stay (per accident)

$600 per day/ Max 15 days

$800 per day/ Max 15 days

Rehab/Facility Confinement (per accident)

$200 per day/ Max 30 days

$300 per day/ Max 30 days

Concussion

$300

$400

Employee: $25,000 Spouse: $12,500 Children: $5,000

Employee: $35,000 Spouse: $17,500 Children: $5,000

Surgery Benefits

Up to $3,500

Up to $5,000

Fractures (Based on Fractures)

Up to $9,000

Up to $12,000

Coma

High Plan Rates Employee $15.71 Employee + Spouse $23.66 Employee + Child(ren) $27.34 Employee + Family $35.29

Dislocations (Based on Dislocation)

Up to $10,000

Up to $12,000

Burns (Based on Burns)

Up to $20,000

Up to $25,000

Lacerations (Based on length & sutures)

Up to $900

Up to $1,500

$150 (Max 6 per accident) $75 (Max 6 per accident) Employee: $50,000 Spouse: $25,000 Children: $10,000 Employee: $150,000 Spouse: $75,000 Children: $30,000

$175 (Max 6 per accident) $100 (Max 6 per accident) Employee: $70,000 Spouse: $35,000 Children: $10,000 Employee: $210,000 Spouse: $105,000 Children: $30,000

Follow-up Physician Office Visit Follow-up Physical Therapy Visit Accidental Death Benefit - Basic Accidental Death Benefit Common Carrier Child Sports Injury Booster Health Screening Pre-existing Condition Age Reduction Portability

Benefits Guide 2027

10% $50 - see Wellness Incentives page None None Included (Portable prior to age 70)

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 cancer insurance plans. Eligibility: You, spouse and dependents who are covered on the critical illness, accident or cancer 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 benefit can be filed annually as long as your critical illness, accident and cancer plans are in force High Plan

Available Wellness Incentives

Low Plan

Critical Illness Plans with or without Cancer- Cigna

$50

Cancer Plan - Guardian

$50/$50 follow up screening

Accident - Mutual of Omaha

$50 What Qualifies as Wellness?

Critical Illness - Cigna

• • • • • • • • • • • • • • • • • •

Mammography Pap Smear for women over Age 18 Flexible Sigmoidoscopy Hemoccult Stool Specimen Colonoscopy Prostate Specific Antigen (for prostate cancer) Stress test on a bicycle or treadmill Fasting blood glucose test Blood test for triglycerides Serum cholesterol test to determine levels of HDL and LDL Bone marrow testing Breast ultrasound CA 15-3 (blood test for breast cancer) CA125 (blood test for ovarian cancer) CEA (blood test for colon cancer) Chest X-ray Serum Protein Electrophoresis (blood test for myeloma) Thermography

Cancer - Guardian

• • • • • • • • • • • • • • • • • • •

Bone marrow testing BRCA testing Breast ultrasound Breast MRI CA 15-3 (blood test for breast cancer) CA125 (blood test for ovarian cancer) CEA (blood test for colon cancer) Chest x-ray Colonoscopy/Virtual Colonoscopy CT scans /MRI scans Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap smear /ThinPrep pap test PSA (blood test for prostate cancer) Serum protein electrophoresis (blood test for myeloma) Testicular ultrasound Thermograph

Accident - Mutual of Omaha* • • • • • • • • • • • • • • • • • • • • • • • • •

Adult Immunization Bone marrow testing CA 15-3 (blood test for breast cancer) Carotid ultrasound Colonoscopy CT angiography EKG (electrocardiogram) Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Polysomnogram (Sleep Study) Vascular Ultrasound Abdominal aortic aneurysm ultrasound Angiogram Basic or Comprehensive Metabolic Screening Blood test for triglycerides Body Mass Index (BMI Assessment) Bone density screening Breast ultrasound CA 125 (blood test for ovarian cancer) Cancer Testing/Screening/Biopsy CEA (blood test for colon cancer) Chest X-ray Child/Adolescent Exams or Sports Physicals Child/Adolescent Vaccines

• • • • • • • • • • • • • • • • • • • • • •

Dental/Hearing/Physician Annual Exam Diabetes Health Screening Domestic Violence Screening Double contrast barium enema Echocardiogram (ECHO) Genetic Testing Hepatitis B/C Screening Lower Extremity Ultrasound Mammography Mental Health Evaluation Neurological Health Studies Neurological Imaging Studies Pap smear Prenatal/Perinatal Care PSA (blood test for prostate cancer) Serum cholesterol test (HDL & LDL) SPEP (blood test for myeloma) Stress test (on a bicycle or treadmill) Substance Abuse Screening Thermography Transmitted Diseases/Blood Borne Infection Screening Vascular Ultrasound

How to submit a claim? • • • • •

Call 800.754.3207 Fax completed documents to 860.730.6460 Email completed documents to supphealthclaims@cigna.com Mail completed documents to: Cigna Phoenix Claim Services P.O. Box 55290 Phoenix, AZ 85078 Visit www.supphealthclaims.com

•

Log on to www.guardianlife.com and select “My Account/Login” to register or access your account

• • • • • •

Call 800.775.8805 Fax completed documents to 404.997.1898 Email completed documents to submitgrpacc@mutualofomaha.com Mail completed documents to: 3300 Mutual of Omaha Plaza Omaha, NE 68175 Visit www.mutualofomaha.com/support/forms *Some of these benefits are only available on select accident plans. Please refer to your certificate of coverage for benefits covered under your policy.

Visit www.jasperbenefits.com for claim forms and additional information.

Benefits Guide 2027

MEDCARECOMPLETE

THE SMART WAY TO REDUCE YOUR HEALTHCARE COSTS What is MedCareComplete? Provides a bundle of services constructed to save you time, money, and hassle while simplifying your life. Eligibility: Eligible full-time employees working more than 25 hours/week, spouse & children up to age 26 • This is a supplemental benefit and does not replace health insurance. • Register @ MCC: www.medcarecomplete.com/members to access the full range of benefits • Register @ 1800MD: www.1800md.com or 1.800.388.8785 to access telemedicine benefits • Information Needed: Group Name, Group #, Member ID (on MCC Card)

Included With the MedCareComplete Membership: Medical Bill Negotiator

Restoration Expert

Medication Management

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. Individual Family Rate Rate

Telemedicine

Get 24/7/365 on-demand telephone access to Board-certified physicians for diagnosis and prescriptions for common and acute illnesses.

$10.50 Per Month

$12.50 Per Month

NO CO-PAY Acute Illnesses include but are not limited to the following: Asthma Fever Headache Infections

Migraines Rashes Bacterial Infections Diarrhea

Heartburn Sinus Conditions Urinary Tract Infections

Bronchitis Ear Infection Gout Joint Aches

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. 19

Benefits Guide 2027

LEGAL PLAN What is a Legal Plan? A plan which provides valuable legal and financial educational resources for a variety of lift events and needs. Eligibility: Eligible full-time employees working 25+ hours/week, 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 1.800.821.6400 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 • Plan Certificate available on your Employee Benefits Website at www.jasperbenefits.com Low Plan Quick Summary

High Plan Quick Summary

Money Matters

• • • • •

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

Deeds Mortgages Foreclosure Tenant Negotiations Eviction Defense Security Deposit Assistance

• • • • • •

Deeds Mortgages Foreclosure Tenant Negotiations Eviction Defense Security Deposit Assistance

•

Home & Real Estate

• • • • • •

• • • •

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

Disputes over Consumer Goods & Services Administrative Hearings Incompetency Defense

•

Disputes over Consumer Goods & Services Administrative Hearings Incompetency Defense

• • •

Civil Litigation Defense & Mediation Small Claims Assistance Pet Liabilities

Estate Planning

Family & Personal

Civil Lawsuits

Elder Care Issues

Vehicle & Driving

• • • • • • • • •

• • • • • •

• •

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 • Deeds $8.00 $16.50 • Wills • Power of Attorney Per Month Per Month

• • • •

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

NO COPAY

Benefits Guide 2027

FLEXIBLE SPENDING ACCOUNTS What are Medical Flexible Spending Accounts? A pre-tax benefit account used to pay for out-of-pocket healthcare costs such as deductibles, co-pays, prescribed medication, and other medical costs. 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 full-time employees working more than 25 hours/week, spouse & taxable dependent children up to age 26 for medical and ages 12 and under for dependent care or qualifying adults for adult care • Coverage through Medcom • Plan Year: July 1 - June 30 • Employees must actively enroll each year • Only family status changes will allow you to change your annual election. The altered election must be consistent with the status change. • Married and not filing jointly participants limited to $3,750 deferral for Dependent Care • Transfer of funds between the Dependent Care and Medical Care accounts are prohibited • Please visit medcombenefits.com for a complete listing of eligible expenses and qualifying dependent care services. • NOTE: Enrollment for FSA occurs in the spring FSA Benefits Quick Summary MEDICAL FSA ACCOUNT Minimum Contribution

$300

Maximum Contribution

$3,400 DEPENDENT CARE ACCOUNT

Minimum Contribution

$300

Maximum Contribution

$7,500 Plan Rules

RUNOUT PERIOD (Time to turn in receipts for services rendered during the plan year)

30 days after the plan year ends to file claims

CARRY OVER MAXIMUM

N/A

All receipts should be kept to submit if verification is requested Any balance remaining at the end of the year will be forfeited Rates FSA/DCAP Fee Per Participant Per Month

$3.75

Replacement Card Fee

$5.00

Benefits Guide 2027

HELPFUL FSA RESOURCES What is covered under Medical FSA Account? • Medical coinsurance and deductible FSA Eligibility List • Doctor’s office visit co-pays www.fsastore.com/FSA-Eligibility-List.aspx • Emergency Room costs FSA Calculator • Dental co-pays and out-of-pocket costs (estimates how much you can save with an FSA) • Vision co-pays and out-of-pocket costs www.fsastore.com/fsa-calculator • Contacts and glasses • Prescriptions • Please see the full eligibility list for other covered expenses Who is covered under a 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). 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.

Benefits Guide 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 scheduled open enrollment, you have the opportunity to review all available options and make elections for the upcoming plan year.

SHBP Enrollment Portal:

SHBP Wellness Portal:

www.myshbpga.adp.com

www.bewellshbp.com

SHBP Decision Guide: In this guide, you will find a brief explanation about each health benefit option, a benefit comparison guide, and a list of things to consider before making your election decision. You can access the decision guide at www.shbp.georgia.gov/enrollment/openenrollment

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 Spouse

480 credits 480 credits

$500* $500*

480 credits 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 match with a maximum combined up to 480 well-being incentive credits. The credits will be added to your HIA. 23

Benefits Guide 2027

2027 STATE HEALTH

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

Specialist Visit

Coins after ded

$45 copay

Coins after ded

$45 copay

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.

Benefits Guide 2027

PET INSURANCE What is Pet Insurance? Pet insurance helps cover the cost of unexpected veterinary care for your cats, dogs, birds and other exotic animals. Get reimbursed for covered expenses such as accidents, illnesses, diagnostic tests, surgeries and prescriptions (based on the specific plan chosen). Please check with plan options to see if preventive care and check ups are covered. This is an individual plan that is not a part of the benefits package offered by Bryan County Schools. How to apply for pet insurance: • Follow website: campusbenefits.com/campusbenefitsforme/pet • Click Enroll Today! • Select which pet you’re applying coverage to. *If you have a bird or another kind of animal(s), please call 877.738.7874 for assistance. • Go through the prompts to register information on your pet(s) • Click “Get a quote” and it will populate different quotes based on the information entered • View the plan detail and select which one best suit your needs • There will be an option to add another pet and save 5% • Important Notes: • Pet Insurance is not in the enrollment portal and will not be payroll deducted. If you elect the coverage, payment is made directly to Nationwide. • Coverage can be elected at any time during the year • Coverage available for accidents, illnesses, hereditary & congenital conditions, and wellness • Use any licensed veterinarian, anywhere in the world—including emergency and specialty providers (claims are submitted for reimbursement) • Unlimited 24/7 pet telehealth support with Nationwide VetHelpline • Effortless, low-cost pet prescriptions with Nationwide PetRxExpress

Benefits Guide 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 thirtyone (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 1-800610-1863 or visit the SHBP Enrollment Portal: www.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.

Benefits Guide 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.

Benefits Guide 2027

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 www.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: www.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. Address to File HIPAA Complaints: Georgia Department of Community Health SHBP HIPAA Privacy Unit P.O. Box 1990 Atlanta, GA 30301 1-800-610-1863 U.S. Department of Health & Human Services Office for Civil Rights Region IV Atlanta Federal Center 61 Forsyth Street SW Suite 3B70 Atlanta, GA 30303-8909 1-877-696-6775 For more information about this Notice, contact: Georgia Department of Community Health State Health Benefit Plan P.O. Box 1990 Atlanta, GA 30301 1-800-610-1863

IMPORTANT NOTES

Benefits Guide 2027

IMPORTANT NOTES

Benefits Guide 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 Benefits website address: www.jasperbenefits.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 www.jasperbenefits.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.