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2026-27 EMPLOYEE BENEFITS

Working Towards Wellness

A comprehensive guide to understanding your 2026-2027 employee benefits program

What’s Inside 3

Important Contacts

Eligibility

How to Enroll

Enrollment Frequently Asked Questions

Medical

Welcome We are pleased to offer a full benefits program to you and your eligible dependents. Read this guide to know what benefits are available.

11 Telehealth 12 Health Care Options 13 Preventive Care 14 Health Savings Account 15 Flexible Spending Accounts 17 HSA and FSA Comparison 18 Qualified HSA and FSA Expenses 19 Dental Coverage

Availability of Medical Plan Benefits Information Coverage details for each medical plan offered are available in a Summary of Benefits and Coverage (also referred to as an SBC), which can be viewed at www.mybenefitshub.com/clevelandisd

20 Vision Coverage 21 Life and AD&D Insurance 23 Individual Life Insurance 24 Educator Disability Insurance 26 Hospital Cash Insurance

Your Benefits Are In Effect

27 Accident Insurance

September 1, 2026

28 Critical Illness Insurance

through

29 Cancer Insurance

August 31, 2027

30 Emergency Medical Transport 31 Employee Assistance Program 32 Identity Theft and Financial Wellness 33 Legal Assistance 34 Glossary of Terms

Flip to …

37 Important Legal Notices

Visit www.mybenefitshub.com/clevelandisd for full plan details.

How to Enroll

Enrollment FAQ

Medical

Important Contacts Cleveland ISD Benefits Higginbotham Public Sector 833-861-7662 www.mybenefitshub.com/ clevelandisd clevelandisd@hps.higginbotham.net

Medical Coverage TRS ActiveCare 866-355-5999 www.bcbstx.com/trsactivecare

Health Savings Account Gulf Coast Educators Federal Credit Union 281-487-9333 www.gcefcu.org

Flexible Spending Accounts National Benefit Services (NBS) 855-399-3035 www.nbsbenefits.com

Telehealth Recuro 855-673-2876 www.recurohealth.com

Dental Coverage Lincoln Financial Group 00001D042548 800-423-2765 www.lfg.com

Vision Coverage VSP SLH-100035 800-877-7195 www.vsp.com

Basic Life and AD&D Lincoln Financial Group 400276016 800-423-2765 www.lfg.com

Voluntary Life and AD&D Lincoln Financial Group 400276016 800-423-2765 www.lfg.com

Financial Wellness and ID Protection Experian 855-797-0052 www.experian.com

Individual Life

Legal Support

5Star 866-863-9753 www.5starlifeinsurance.com

LegalShield 800-654-7757 www.legalshield.com

Educator Disability Insurance New York Life SLH-100035 888-842-4462 www.newyorklife.com

Hospital Cash Insurance Chubb 100000121 888-499-0425 www.chubb.com

Accident Insurance Cigna AI110774 800-754-3207 https://my.cigna.com/web/public/ guest

Critical Illness Insurance Chubb 100000121 888-499-0425 www.chubb.com

Cancer Insurance Chubb 100000121 888-499-0425 www.chubb.com

Emergency Medical Transportation MASA 800-423-3226 www.masamts.com

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Eligibility

OE: Open Enrollment QLE: Qualifying Life Event

Who is Eligible for Benefits New Hire

Employee

Dependent(s)

• A regular, full-time employee working an average of 30 hours or more per week

• Your legal spouse • Children under age 26 regardless of student, dependency, or marital status • Children age 26 or older who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return

• By the deadline given by the Benefits Office

• During OE or for a QLE

• During OE or for a QLE • When covering dependents, you must enroll for and be on the same plans

• Next first of the month following date of hire

• OE: Start of the plan year • QLE: Ask the Benefits Office

• Ask the Benefits Office

STATUS

Who is Eligible

When to Enroll When Coverage Starts

Maximum Dependent Eligibility Age by Plan

To Age 26

Medical/Dental/Vision/Life/Accident/Hospital Cash/Critical Illness/AD&D/Cancer/Individual Life/Legal Support/Financial Wellness and ID Support/Emergency Medical Transport

Qualifying Life Events You may only enroll for or make changes to coverage during the plan year if you are a new hire or if you have a QLE, such as:

Marriage

Birth

Divorce

Adoption/placement for adoption

Annulment Death

Change in benefits eligibility Death of child

FMLA, COBRA event, judgment, or decree

Gain or loss of benefits coverage

Becoming eligible for Medicare, Medicaid, or TRICARE

Change in employment status affecting benefits

Receiving a Qualified Medical Child Support Order

You have 31 days from the event to notify the Benefits Office and complete your changes. You may need to provide documents to verify the change.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

How to Enroll Enrolling in benefits is simple through THEbenefitsHUB. 1.

Go to www.mybenefitshub.com/clevelandisd or scan the QR code.

2. Click Login. 3. Enter your: Last name Date of birth Social Security number (last four digits only) 4. Once confirmed, the Additional Security Verification page will list contact options. Select either the Text, Email, Call, or Ask Admin option to receive a code for completing final verification. 5. Enter the code, and click Verify to begin your enrollment. 6. Review your personal information and verify covered dependents. Contact your employer with any discrepancies. 7.

After dependent information is confirmed, you may select the benefits shown. To make your selections, click the drop-down list next to the plan name. Once the desired coverage amount is selected, your contribution amount will be displayed. Click Save & Continue. Repeat for each benefit. You may be asked to provide evidence of insurability for certain benefits.

8. If enrolling in Life insurance coverage, you must identify your beneficiary(ies).

Select your beneficiary designation. Click Sign & Continue. Review and confirm your information. Click Finished.

SCAN THE QR CODE TO ENROLL

Benefits Questions? Employee benefits can be complicated. The Higginbotham Public Sector benefits team is available to help you with the following:

Enrollment Benefits Eligibility Claims and Billing

Call 833-861-7662 Monday through Friday from 7:00 a.m. to 6:00 p.m. CT. If you leave a message after 3:00 p.m. CT, your call will be returned the next business day. You can also email clevelandisd@hps.higginbotham.net. Bilingual representatives are available.

SECTION 125 CAFETERIA PLAN GUIDELINES A cafeteria plan enables you to save money by using pretax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment become effective on the plan effective date and will remain in effect during the entire plan year. Changes in benefit elections can occur only if you experience a QLE. You must present proof of the QLE to your Benefits Office within 31 days of the event. Meeting with the Benefits Office to complete and sign the necessary paperwork is also required to make benefit election changes effective. Changes must be consistent with the QLE. Visit www.mybenefitshub.com/clevelandisd for full plan details.

Enrollment Frequently Asked Questions What if I miss the enrollment deadline?

Where can I find benefits summaries and forms?

How can I find in-network providers?

Contact your Benefits Office for guidance if you miss a benefits enrollment deadline. Under normal circumstances, you may only enroll for or make changes to coverage during Open Enrollment (OE), if you have a Qualifying Life Event (QLE), or if you are a new hire.

To access medical plan Summary of Benefits and Coverage (SBC) documents, plan documents for other coverages, and forms, go to the Benefit Information section at www.mybenefitshub.com/ clevelandisd. Click on each benefit (e.g., medical, vision, etc.) for details.

Go to www.mybenefitshub.com/ clevelandisd and click on the Provider Search link, where you will see all available plan provider searches.

Is there an age limit for dependents to be covered under my benefits? Yes. See the Eligibility page for details.

BENEFITS QUESTIONS? Call the Higginbotham Public Sector benefits team at 833-861-7662.

When will I get my ID cards? If the medical carrier provides ID cards and there is a plan change, new cards usually arrive within four weeks of your effective date. If there are no plan changes, a new card may not be issued. You may not need or receive an ID card for dental and vision plans. Simply share the carrier name and phone number with your health care provider to have benefits verified.

Important Limitations and Exclusions Information The following limitations and exclusions may apply when obtaining coverage as a married couple or for your dependents. Can I cover family members (a spouse and/or dependent) as dependents on my benefits if I and my spouse work for the same employer? Some benefits may not allow for this type of coverage if you both work for the same employer. Review the benefit plan documents, contact Higginbotham Public Sector, or contact the carrier for eligibility details.

Are there FSA and HSA limitations for married couples? Yes, generally. Married couples may not enroll in both a Health Care Flexible Spending Account (FSA) and a Health Savings Account (HSA) at the same time. If your spouse is covered under a Health Care FSA that reimburses for qualified health care expenses, then you and your spouse are not HSA-eligible – even if you do not use your spouse’s Health Care FSA to reimburse your expenses. However, there are some exceptions to the general limitation for other types of FSAs (e.g., Limited Purpose Health Care FSA; Dependent Care FSA). Contact the FSA and/or HSA administrator before you enroll, or consult your tax advisor for further guidance.

Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in FSAs and an HSA as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Higginbotham Public Sector, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of your enrollment in spouse and/or dependent coverage, including enrollment in FSAs and an HSA.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Medical Working Towards Health

Our medical plans protect you and your family from major financial hardship in the event of illness or injury. All TRS-Active participants may enroll in one of the following plans: TRS-ActiveCare Primary TRS-ActiveCare Primary+ TRS-ActiveCare HD

Medical Provider:

The TRS-ActiveCare 2 plan is closed to new enrollments, but you may continue in the plan if you are a currently enrolled participant.

TRS Region 4 Monthly Medical Rates Region 4

TRS MEDICAL Total Monthly Premium

Employer Contribution

Employee Monthly Cost

Employee Only

$569.00

$416.00

$153.00

Employee and Spouse

$1,537.00

$500.00

$1,037.00

Employee and Child(ren)

$968.00

$400.00

$568.00

Employee and Family

$1,935.00

$500.00

$1,435.00

Employee Only

$669.00

$400.00

$269.00

Employee and Spouse

$1,740.00

$500.00

$1,240.00

Employee and Child(ren)

$1,138.00

$400.00

$738.00

Employee and Family

$2,208.00

$500.00

$1,708.00

Employee Only

$583.00

$380.00

$203.00

Employee and Spouse

$1,575.00

$500.00

$1,075.00

Employee and Child(ren)

$992.00

$380.00

$612.00

Employee and Family

$1,983.00

$500.00

$1,483.00

ACTIVECARE PRIMARY

ACTIVECARE PRIMARY+

ACTIVECARE HD

ACTIVECARE 2 (Closed to new enrollments) Employee Only

$1,013.00

$350.00

$663.00

Employee and Spouse

$2,402.00

$608.00

$1,794.00

Employee and Child(ren)

$1,507.00

$560.00

$947.00

Employee and Family

$2,841.00

$674.00

$2,167.00

Visit www.mybenefitshub.com/clevelandisd for full plan details.

2026-27 TRS-ActiveCare Plan Highlights Sept. 1, 2026 – A

You have three plan options — one regional plan and two stand

How to Calculate Your Monthly Premium

TRS-ActiveCare Primary x Region 4 • Lowest premium of the three available plans • Copays for doctor visits before you meet your deductible • Statewide network • Primary Care Provider referrals required to see specialists • Not compatible with a Health Savings Account • No out-of-network coverage • New! Tiering options that lower your out-of-pocket costs when you choose certain facilities.

Total Monthly Premium Your Employer Contribution

Plan Summary

Your Premium

TRS-A

• Highest premium o • Copays for many s • Lower deductible t • Statewide network • Primary Care Provi • Not compatible wit • No out-of-network

Ask your Benefits Administrator for your district’s specific premiums.

Monthly Premiums

Being Healthy is Easy • $0 preventive services • One-on-one health coaches • Weight loss programs and nutrition • TRS Virtual Health • Member Rewards is even better. Now you’ll get a check when you use Member Rewards and choose low-cost, highquality doctors and facilities – up to $599* per tax year. • Airrosti Remote Recovery gives you inhome virtual physical therapy to relieve common aches and pains at no cost.*

Total Premium

Employer Contribution

Your Premium

Total Premium

Employee Only

$569

Employee and Spouse

$1,537

$1,740

Employee and Children

$968

$1,138

Employee and Family

$1,935

$2,208

$669

Plan Features Type of Coverage Individual/Family Deductible Coinsurance Individual/Family Maximum Out of Pocket

In-Network Coverage Only

$2,500/$5,000 You pay 30% after deductible

You

$8,050/$16,100

PCP Required

Yes

Primary Care

$30 copay

Specialist

$70 copay

Urgent Care

$50 copay

Doctor Visits

* Eligibility rules may apply.

See the Annual Enrollment Guide for more details.

Immediate Care

Mental Health You have in-office and virtual benefits: • TRS-ActiveCare Primary x Region 4 Plan: $30 copay for office visits or $0 with Teladoc • TRS-ActiveCare Primary+ Plan: $15 copay for office visits or $0 with Teladoc • TRS-ActiveCare HD Plan: 30% coinsurance after deductible or $42 with Teladoc • TRS-ActiveCare 2 Plan: $20 copay for office visits or $12 with Teladoc

Emergency Care

You pay 30% after deductible

TRS Virtual Health-RediMDTM

$0 per medical consultation

TRS Virtual Health-Teladoc®

$12 per medical consultation

$12

You

Prescription Drugs Drug Deductible

Integrated with medical

$200 deductib

Generics (31-Day Supply/90-Day Supply)

$15/$45 copay; $0 copay for certain generics

Preferred (Max does not apply if brand is selected and generic is available)

You pay 30% after deductible

You pay 25 You pay 2

Non-preferred

You pay 50% after deductible

You

Specialty (31-Day Max) Call 1-844-367-6108 to see if your specialty medication is covered by SaveOnSP.

You pay 30% after deductible; $0 if SaveOnSP eligible

You pay 2 $

Insulin Out-of-Pocket Costs

$25 copay for 31-day supply; $75 for 61- to 90-day supply

$25 $75

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Aug. 31, 2027 This plan is closed to new enrollees. Current TRS-ActiveCare 2 participants can stay enrolled.

dard plans — with a wide range of wellness benefits.

ActiveCare Primary+

of the three available plans services and drugs than the HD and Primary plans k ider referrals required to see specialists th a Health Savings Account k coverage

Employer Contribution

Your Premium

n-Network Coverage Only

TRS-ActiveCare HD

TRS-ActiveCare 2

• Higher premium of the three available plans • Must meet your deductible before plan pays for non-preventive care • Nationwide network with out-of-network coverage • No requirement for Primary Care Providers or referrals • Compatible with a Health Savings Account

Employer Contribution

Total Premium

Your Premium

• Closed to new enrollees • Current enrollees can choose to stay in the plan • Lower deductible • Copays for many services and drugs • Nationwide network with out-of-network coverage • No requirement for Primary Care Providers or referrals

$583

$1,013

$1,575

$2,402

$992

$1,507

$1,983

$2,841

In-Network

Employer Contribution

Total Premium

Your Premium

Out-of-Network

In-Network

Out-of-Network $2,000/$6,000

$1,200/$2,400

$3,400/$6,800

$6,800/$13,600

$1,000/$3,000

u pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible

You pay 40% after deductible

$20,500/$41,000

$7,900/$15,800

$23,700/$47,400

$6,900/$13,800

$8,300/$16,600

Yes

$15 copay

You pay 30% after deductible

You pay 50% after deductible

Tier 1: $20 copay Tier 2: $40 copay

You pay 40% after deductible

$70 copay

You pay 30% after deductible

You pay 50% after deductible

Tier 1: $55 copay Tier 2: $85 copay

You pay 40% after deductible

$50 copay

You pay 30% after deductible

You pay 50% after deductible

$50 copay

You pay 40% after deductible

You pay a $250 copay plus 20% after deductible

u pay 20% after deductible

You pay 30% after deductible

0 per medical consultation

$30 per medical consultation

$0 per medical consultation

2 per medical consultation

$42 per medical consultation

$12 per medical consultation

Integrated with medical

$200 brand deductible

ble per participant (brand drugs only)

You pay 20% after deductible; $0 coinsurance for certain generics

$20/$45 copay

5% after deductible ($100 max)/ 25% after deductible ($265 max)

You pay 25% after deductible

You pay 25% after deductible ($40 min/$80 max)/ You pay 25% after deductible ($105 min/$210 max)

u pay 50% after deductible

You pay 50% after deductible

You pay 50% after deductible ($100 min/$200 max)/ You pay 50% after deductible ($215 min/$430 max)

20% after deductible ($500 max); $0 if SaveOnSP eligible

You pay 20% after deductible

You pay 30% after deductible ($200 min/$900 max); $0 if SaveOnSP eligible

5 copay for 31-day supply; 5 for 61- to 90-day supply

You pay 25% after deductible

$25 copay for 31-day supply; $75 for 61- to 90-day supply

$15/$45 copay

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Questions?

Call a Personal Health Guide at 1-866-355-5999 for help with medical services. Call Express Scripts® by Evernorth Pharmacy Benefit Services at 1-844-367-6108 for help with your pharmacy benefits.

Compare Prices for Common Medical Services Closed to new enrollees. Benefit

TRS-ActiveCare Primary x Region 4

TRS-ActiveCare Primary+

In-Network Only

Office/Independent Lab: You pay $0

TRS-ActiveCare HD In-Network

Out-of-Network

You pay 50% after deductible

You pay 40% after deductible

Outpatient: You pay 30% after deductible

Outpatient: You pay 20% after deductible

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible + $100 copay per procedure

You pay 40% after deductible + $100 copay per procedure

Tier 1: 30% coinsurance after deductible Tier 2: 40% coinsurance after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible ($150 facility copay per incident)

You pay 40% after deductible ($150 facility copay per incident)

(like childbirth, complex joint replacement and cardiac surgery)

Tier 1: 30% coinsurance after deductible Tier 2: 40% coinsurance after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible ($500 facility per day maximum)

You pay 20% after deductible ($150 facility copay per day)

You pay 40% after deductible ($500 facility copay per incident)

Freestanding Emergency Room

You pay $500 copay + 30% after deductible

You pay $500 copay + 20% after deductible

You pay $500 copay + 30% after deductible

You pay $500 copay + 50% after deductible

You pay $500 copay + 20% after deductible

You pay $500 copay + 40% after deductible

Facility: You pay 30% after deductible

Facility: You pay 20% after deductible

Facility: You pay 20% after deductible ($150 facility copay per day)

Professional Services: You pay $5,000 copay + 30% after deductible

Professional Services: You pay $5,000 copay + 20% after deductible

Only covered if rendered at a BDC+ facility

Specialist: You pay $70 copay

You pay 30% after deductible

You pay 50% after deductible

PCP: $30 copay

PCP: $15 copay

Specialist: $70 copay

You pay 30% after deductible

You pay 50% after deductible

High-Tech Imaging (like CT Scan, Mammogram and MRI)

Outpatient (like colonoscopy, cataract surgery and steroid injections)

Inpatient

Bariatric Surgery

Annual Vision Exam (one per plan year)

Annual Hearing Exam (one per plan year)

Outpatient: You pay 20% after deductible

Not Covered

04/01/2026 Visit www.mybenefitshub.com/clevelandisd for full plan details.

Not Covered

Only covered if rendered at a BDC+ facility

www.trs.texas.gov

In-Network

Office/Independent Lab: You pay $0 You pay 30% after deductible

Diagnostic Labs

TRS-ActiveCare 2

Tier 1 Specialist: $55 copay Tier 2 Specialist: $85 copay Tier 1 PCP: $20 copay Tier 2 PCP: $40 copay Tier 1 Specialist: $55 copay Tier 2 Specialist: $85 copay

You pay 40% after deductible

Telehealth This voluntary telehealth program gives you 24/7 access to board-certified doctors, licensed counselors, and psychiatrists via your mobile device or computer – from home, the office, or on the go. Whether you need medical care or support navigating stress and life changes, confidential help is at your fingertips. It is a standalone program that is NOT tied to your medical plan coverage.

Get More Information and Register Skip the trip to your doctor! Set up your account so you can get on-demand medical care. Visit www.recurohealth.com. Call 855-673-2876. Download the Recuro app.

Telehealth Provider:

While telehealth with behavioral health does not replace your primary care physician, counselor, or psychiatrist, it is a convenient and cost-effective option when you need care and: Have a non-emergency issue and are considering an after-hours health care clinic, urgent care clinic, or emergency room for treatment Are on a business trip, vacation, or away from home Are unable to see your primary care physician, counselor, or psychiatrist

Watch and learn more!

Prescriptions, if needed, are sent to the pharmacy of your choice. $9 covers the employee, spouse, and children to age 26. No copays! Save the cost of an office visit. Telehealth

When to Use Telehealth For common conditions such as: Sore throat

Allergies

Headache

Fever

Stomachache

Urinary tract infections

MONTHLY RATES Employee

$9.00

Employee and Family

$9.00

Cold/flu

Do not use telehealth for serious or life-threatening emergencies.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Health Care Options Becoming familiar with your options for medical care can save you time and money. Health Care Provider

Symptoms

Average Cost

Average Wait

Allergies Cough/cold/flu Rash Stomachache

2-5 minutes

Infections Sore and strep throat Vaccinations Minor injuries/sprains/ strains

15-20 minutes

Common infections Minor injuries Pregnancy tests Vaccinations

15 minutes

Sprains and strains Minor broken bones Small cuts that may require stitches Minor burns and infections

15-30 minutes

Chest pain Difficulty breathing Severe bleeding Blurred or sudden loss of vision Major broken bones

$$$$

4+ hours

Most major injuries except trauma Severe pain

$$$$$$

Minimal

NON-EMERGENCY CARE

Access to care via phone, online video, or mobile app whether you are at home, work, or traveling; medications can be prescribed TELEHEALTH

24 hours a day, 7 days a week

Generally, the best place for routine preventive care; established relationship; able to treat based on medical history DOCTOR’S OFFICE

Office hours vary

Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies RETAIL CLINIC

Hours vary based on store hours

When you need immediate attention; walk-in basis is usually accepted URGENT CARE

Generally includes evening, weekend, and holiday hours

EMERGENCY CARE

Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility HOSPITAL ER

24 hours a day, 7 days a week

Services do not include trauma care; can look similar to an urgent care center, but medical bills may be 10 times higher FREESTANDING ER

24 hours a day, 7 days a week

Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only estimates. This information is not intended as medical advice. If you have questions, please call the phone number on the back of your medical ID card.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Preventive Care Your medical plan offers $0 preventive care for everyone. Preventive care is the care you receive to help prevent chronic illness or disease. It includes exams, lab work, screenings, immunizations, and counseling to prevent health problems, such as diabetes or heart disease.

Having a doctor who knows you and your medical history is a key part of preventive care.

Watch and learn more!

Preventive Care Coverage May Include Adults

Teens

Children

Cholesterol screening Blood pressure screening Colorectal cancer screening Lung cancer screening Hepatitis B screening Well visits Bone density screening Obesity screening Diabetes type 2 screening Depression screening Mammograms Cervical cancer screening Immunizations

Physical exam Blood tests for iron and cholesterol Anxiety screening Growth screening Hearing screening Hepatitis B screening Depression screening Alcohol, tobacco, and drug use assessments Tuberculosis screening Immunizations

Autism screening Blood screening Depression screening Developmental screening Hearing screening Obesity screening and counseling Hypothyroidism screening Behavioral assessments Well visits Immunizations

Frequently Asked Questions Why should I get preventive care?

Why did I get a bill for preventive care?

Preventive care is the fastest and best way to uncover potential risks and avoid chronic health conditions.

Diagnosis codes on the doctor’s bill must meet certain insurance company conditions for them to be processed as preventive and covered at 100%. If you have a medical complaint, or your doctor finds a specific medical issue during your preventive care doctor’s visit, a diagnosis code for that issue or complaint will be on your bill. As a result, the insurance company may process the bill for a specific medical condition, not preventive care. In this case, you must pay the copay or portion of your deductible.

Are all screenings, tests, and procedures covered under preventive care? No. Your doctor will be able to advise you as to the preventive care you need or should obtain, based on your medical and family history.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Health Savings Account

Watch and learn more!

Offset your HDHP health care costs, reduce your taxes, and get a long-term tax-advantaged savings account. A Health Savings Account (HSA) is like a personal savings account that allows you to pay for current or future health care expenses with pretax dollars or save the funds for retirement. The funds can also be used for your dependents, even if they are not covered by the HDHP. An HSA is always yours to keep, even if you change health plans or jobs.

HSA Administrator:.

Two Ways To Use Your HSA USE IT NOW

GROW OVER TIME

Pay for qualified out-ofpocket medical, dental, and vision expenses as they are incurred.

Grow your HSA dollars tax-free. You can use the funds to pay for qualified expenses later.

Triple Tax Benefits

1. Tax-free contributions 2. Tax-free growth 3. Tax-free withdrawals GET MORE INFORMATION OR SUBMIT RECEIPTS Visit www.gcefcu.org for details or to register for an account. Call 281-487-9333. Download the Gulf Coast Educators FCU app.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

HSA Eligibility You are eligible to open and contribute to an HSA if you are: Enrolled in an HSA-eligible HDHP Not covered by another plan that is not a qualified HDHP (e.g., spouse’s health plan) Not enrolled in a Health Care Flexible Spending Account Not eligible to be claimed as a dependent on someone else’s tax return Not enrolled in Medicare, Medicaid, or TRICARE Not receiving Veterans Administration benefits Note: You may have an HSA at the financial institution of your choice, but only accounts opened through Gulf Coast Educators Federal Credit Union are eligible for automatic payroll deductions.

How to Pay or Get Reimbursed Use your HSA debit card to pay for qualified expenses. Pay out-of-pocket and submit your receipts for reimbursement online or through the app.

Contributions You may contribute up to the IRS annual maximum. 2026 Maximum HSA Contributions Individual

$4,400

Family

$8,750

If you are age 55 or older, you can contribute an extra $1,000.

Flexible Spending Accounts Set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses. We offer the following Flexible Spending Accounts (FSAs).

Watch and learn more!

Visit fsastore.com for an array of FSA-eligible products.

FSA Administrator:

Health Care FSA The Health Care FSA covers qualified medical, dental, and vision expenses for you and your eligible dependents. Eligible expenses include: Deductibles, copays, and coinsurance

Braces, glasses, and contacts Hearing aids and batteries

Prescription drugs If you enrolled in an HDHP and contribute to an HSA, you may not contribute to a Health Care FSA.

Working Towards Savings

IMPORTANT REMINDERS! FSAs are generally considered “use it or lose it” accounts, and unused remaining funds at the end of the plan year may be forfeited. Your employer may offer some flexibility (e.g., more time via a grace period to incur expenses; or a limited amount of funds that can be carried over into the next plan year). Because options vary by employer, it’s important to review your specific plan details or check with your employer for more information. Planning the amount of your contributions carefully can help you make the most of your FSA and avoid losing unused funds. You cannot change your contribution election during the plan year unless you experience a Qualifying Life Event. Keep itemized receipts to verify debit card payments.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Dependent Care FSA The Dependent Care FSA helps pay expenses associated with caring for children under age 13 and elder dependents so you or your spouse can work or attend school full-time.

DEPENDENT CARE FSA GUIDELINES To be eligible, you (and your spouse, if married) must be gainfully employed, looking for work, a full-time student, or incapable of self-care. You can use funds for daycare or babysitter expenses for your children under age 13, but only for the part of the year when the child is under 13. Only day camps – not overnight camps – can be considered for reimbursement. You can use funds for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care. The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes. Dependent Care FSA claims may be submitted as incurred and will be paid as funds become available after monthly payroll contributions are deposited.

Annual Maximum FSA Contributions 2026

Health Care FSA

Dependent Care FSA

Annual Maximum Contribution

$3,400

$7,500 (Single parent filing head of household; or married filing jointly); $3,750 (married filing separately)

Run-out Period

90 days

No run-out period

Carryover

$680

No carryover (Use it or lose it)

Grace Period

No grace period

How to Access Funds/Pay or Get Reimbursed Use your FSA debit card (excludes the Dependent Care FSA). OR Pay out-of-pocket, and submit your receipts for reimbursement.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Get More Information or Submit Receipts Visit www.nbsbenefits.com. Call 855-399-3035. Fax 844-438-1496. Email service@nbsbenefits.com. Download the NBS Benefits Mobile app. Participant Portal: www.mynbsbenefits.com Mail: National Benefit Services, LLC P.O. Box 219393 Kansas City, MO 64121-9393

HSA and FSA Comparison Knowing the difference between a Health Savings Account (HSA) and a Health Care Flexible Spending Account (FSA) can help you choose the best option for you and your family. Health Savings Account

Flexible Spending Account*

Description

• Acts as a personal savings account. • Funds can be used to pay for current or future health care expenses with pretax dollars; or funds can be saved for retirement. • Funds can also be used for your dependents, even if they are not covered by the HDHP.

Health Care FSA – Use funds to pay qualified medical, dental, and vision expenses. Dependent Care FSA – Use funds to pay qualified dependent care expenses and services.

Contribution Source

Employee (You) and/or your employer

Account Owner

Employee (You)

Employer

Underlying Insurance Requirement

High Deductible Health Plan

None

Maximum Annual Contribution

2026 Health Care FSA – $3,400 Dependent Care FSA • $7,500 (Single parent filing head of household; or married filing jointly) • $3,750 (Married filing separately)

2026 Individual – $4,400 Family – $8,750 Age 55+ Additional Catch-up – $1,000

Permissible Use of Funds

• Pay for qualified out-of-pocket medical, dental, and vision expenses. • If used on nonqualified expenses prior to age 65, subject to income tax plus a 20% penalty.

See details in the Description section above.

Year-to-year rollover of account balance?

Yes. Funds roll over and can be used anytime or saved for future use.

2026 Health Care FSA – Allows for carryover of $680 into the next plan year. Dependent Care FSA – N/A

Does the account earn interest?

Yes

Portable?

Yes. It is always yours to keep, even if you change jobs or medical plans.

Flip to … 14

HSA

FSA

* FSAs are generally considered “use it or lose it” accounts, and unused remaining funds at the end of the plan year may be forfeited. Your employer may offer some flexibility (e.g., more time via a grace period to incur expenses; or a limited amount of funds that can be carried over into the next plan year). Check with your employer for more details.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Qualified HSA and FSA Expenses The products and services listed below are examples of medical expenses eligible for payment from your Health Care FSA or HSA. This list is not all-inclusive; additional expenses may qualify, and the items listed are subject to change in accordance with IRS regulations. Please refer to IRS Publication 502 Medical and Dental Expenses at www.irs.gov for complete details. Abdominal supports

Diagnostic fees

Orthopedic shoes

Acupuncture

Eyeglasses

Orthopedist

Ambulance

Gynecologist

Osteopath

Anesthetist

Healing services

Physician

Arch supports

Hearing aids and batteries

Postnatal treatments

Artificial limbs

Hospital bills

Prenatal care

Blood tests

Insulin treatment

Prescription medicines

Braces

Lab tests

Psychiatrist

Cardiographs

Metabolism tests

Therapy equipment

Chiropractor

Neurologist

Wheelchair

Crutches

Nursing

X-rays

Dental treatment

Obstetrician

Dentures

Operating room costs

Dermatologist

Ophthalmologist/Optician/Optometrist

Working Towards Savings

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Dental Coverage Our dental plans help you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work.

Find an In-Network Provider Visit www.lfg.com.

Dental Provider:

Call 800-423-2765.

Network: Lincoln Dental Connect PPO

DPPO Plans Two levels of benefits are available with the DPPO plans: innetwork and out-of-network. You may see any dental provider for care, but you will pay less and get the highest level of benefits with in-network providers. You could pay more if you use an out-of-network provider.

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Dental Benefits Summary Dental Plans Low Plan

High Plan

$50 $150

$750

$1,750

You Pay

Basic Services Other dental X-rays (including periapical films); space maintainers for children; problem-focused exams; consultations; palliative treatment (including emergency relief of dental pain)

20% after deductible

Major Services Prefabricated stainless steel and resin crowns; prosthetic repair and recementation services; endodontics (including root canal treatment); periodontal maintenance procedures; non-surgical periodontal therapy

50% after deductible

Not covered

50% $1,000 lifetime maximum

Low Plan

High Plan

$19.64 $39.26 $40.22 $59.56

$34.46 $68.90 $72.68 $105.12

Policy Year Deductible • Individual • Family Policy Year Benefit Maximum Per Individual Preventive Services Routine oral exams; bitewing X-rays; full-mouth or panoramic X-rays; routine cleanings; fluoride treatments; sealants

Orthodontia Children to age 26 and adults

EMPLOYEE MONTHLY CONTRIBUTIONS Employee Employee and Spouse Employee and Child(ren) Employee and Family

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Vision Coverage Our vision plan offers quality care to help preserve your health and eyesight. Regular exams can detect certain medical issues such as diabetes and high cholesterol, in addition to vision and eye problems.

Vision Provider:

Visit www.vsp.com. Call 800-877-7195.

Network: VSP Advantage

You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see in-network providers.

Vision Benefits Summary You Pay Exam Once every 12 months

$10 copay

Lenses Once every 12 months • Single vision • Lined bifocals • Lined trifocals • Lenticular Frames Once every 24 months

$10 copay $10 copay $10 copay $10 copay 20% off balance over $150 allowance ($170 featured frame allowance)

Contacts Once every 12 months In lieu of frames and lenses • Fitting and evaluation • Elective • Medically necessary

$55 copay $130 allowance Covered in full

EMPLOYEE MONTHLY CONTRIBUTIONS Employee Employee and Spouse Employee and Child(ren) Employee and Family

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Discounts

VSP Advantage

Find an In-Network Provider

$7.94 $15.90 $17.00 $27.16

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Routine Retinal Screening: No more than a $39 copay for a routine retinal screening as an enhancement to a WellVision Exam. Laser Vision Correction: Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities.

Life and AD&D Insurance For Dependents / Basic Life and Accidental Death and Dismemberment (AD&D) insurance are important to your financial security, especially if others depend on you for support or vice versa.

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Basic Term Life and AD&D Voluntary Life and AD&D Provider:

With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies).

Basic Term Life and AD&D insurance are provided at no cost to you. You are automatically covered at $10,000 for each benefit.

Designating a Beneficiary A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary, and you can change beneficiaries anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%). The total must add up to 100%.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Life and AD&D Insurance Supplemental Term Life If you need more coverage than Basic Term Life and AD&D, you may buy Supplemental Term Life insurance for yourself and your dependent(s). If you do not elect Supplemental Term Life insurance when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health (Evidence of Insurability).

Supplemental Life and AD&D Insurance Employee

• Increments of $10,000 up to $500,000 • New hire Guaranteed Issue: $280,000 • Current employees not enrolled can apply for up to $40,000 Guaranteed Issue

Spouse

• Increments of $5,000 up to $500,000, not to exceed 100% of employee election • New hire Guaranteed Issue: $60,000 • Current spouses not enrolled can apply for up to $20,000 Guaranteed Issue

Child(ren)

• $10,000 • 1 day old to age 26 • New hire Guaranteed Issue: $10,000

Supplemental AD&D Supplemental AD&D coverage is separate from your Basic and Supplemental Term Life insurance coverage. It provides benefits beyond your Disability or Life insurance for covered losses that are the result of an accidental injury or loss of life. The full amount of AD&D coverage you select is called the Full Amount and is equal to the benefit payable for the loss of life. Benefits for other losses – such as loss of sight, speech, or hearing; coma; or paralysis – are payable as a predetermined percentage of the full amount.

Supplemental Life Rates per $1,000 Age

Employee

Spouse*

<25

$0.047

25-29

$0.047

30-34

$0.072

35-39

$0.081

40-44

$0.100

45-49

$0.150

50-54

$0.230

55-59

$0.430

60-64

$0.660

65-69

$1.194

70+

$1.852

Child(ren) To age 26

$0.130

Supplemental AD&D Monthly Rate $0.018 *Spouse rate is determined by employee age.

Supplemental Coverage Highlights Portable – keep your supplemental coverage if you leave your current employer Convertible – convert your Group Term Life insurance benefits to an individual whole life policy if your coverage ends Accelerated Benefits Option – get up to 80% of your Life insurance benefit if you (or your spouse) are terminally ill and have less than 24 months to live Note: This benefit is not the same as Long Term Care (LTC) insurance. Some limitations and exclusions apply. See the plan documents for details.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Individual Life Insurance

To Enroll and for More Information Visit www.5starlifeinsurance.com. Call 866-863-9753.

Help protect your family with the Family Protection Plan from 5Star Life Insurance Company. This Level Term Life insurance plan offers level premiums and a level death benefit to age 121, as long as there is no lapse in premium payments. The death benefit is paid in a lump-sum cash payment.

Individual Life Insurance Provider:

Plan Highlights Spouse Coverage: Cover your spouse, even if you do not elect coverage for yourself. Dependent Coverage: Financially dependent children ages 14 days to 26 years old can get coverage too (under your coverage or your spouse’s coverage). Portability: If you change jobs or retire, and continue to pay your premium, your coverage continues with no loss of benefits or premium increases. 5Star will bill you directly. Terminal Illness Benefit: Receive 30% of your coverage in a lump-sum payment if a terminal condition limits your life expectancy to less than 12 months. Quality of Life Benefit: This optional rider accelerates a portion of your death benefit on a monthly basis – up to 75% – should the following occur: You have a permanent inability to perform at least two of the six ADLs (Activities of Daily Living) without substantial assistance; or You suffer from a severe cognitive impairment such as dementia, Alzheimer’s disease, or other forms of senility that require substantial supervision. Guaranteed Issue Amounts Employee

$150,000

Spouse

$50,000

Child(ren)

$10,000 Visit www.mybenefitshub.com/clevelandisd for full plan details.

Educator Disability Insurance

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Educator Disability insurance combines features of Short Term and Long Term Disability insurance into one plan. Disability insurance protects part of your income if you are unable to work due to a covered accident, illness, or pregnancy. We offer Educator Disability insurance for you to purchase and allow you to choose the coverage amount and waiting period that best suit your needs.

File a Disability Claim Visit www.newyorklife.com. Call 888-842-4462.

Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, or received medical treatment, care, or services during the three months just prior to the most recent effective date of insurance.

Disability Provider:

Educator Disability Benefits Begin The first number indicates the number of days you must be disabled due to Injury, and the second number indicates the number of days you must be disabled due to Sickness.

0/7, 14/14, 30/30, 60/60, 90/90

Percentage of Earnings You Receive

45%/55%/65%

Maximum Monthly Benefit

$8,000

Maximum Benefit Period

To the end of the benefit or until you no longer qualify for benefits

Pre-existing Condition Exclusion

3/121

Pre-existing Condition Waiver

The pre-existing condition exclusion is waived for the first 12 weeks of disability when the disability is caused by a pre-existing condition.

Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for 12 months. If your disability is a result of a pre-existing condition, benefits will be paid for a maximum of 12 weeks. 1

Option 1 (45% of Monthly Covered Earnings) – Monthly Rate by Type of Plan (per $100 Benefit) Accident in Days

Sickness in Days

$1.95

$1.87

$1.72

$1.54

$0.87

All Ages

Option 2 (55% of Monthly Covered Earnings) – Monthly Rate by Type of Plan (per $100 Benefit) Accident in Days

Sickness in Days

$2.14

$2.05

$1.88

$1.69

$0.96

All Ages

Option 3 (65% of Monthly Covered Earnings) – Monthly Rate by Type of Plan (per $100 Benefit) Accident in Days Sickness in Days All Ages

$2.63

$2.53

$2.35

$2.14

$1.24

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Educator Disability Insurance EDUCATOR DISABILITY FAQS WHAT IS DISABILITY INSURANCE? Disability insurance protects one of your most valuable assets: your paycheck. This insurance replaces part of your income if you are physically unable to work due to sickness or injury for an extended period of time. The Educator Disability plan is unique in that it includes both short- and long-term coverage in one convenient plan.

DOES THIS PLAN HAVE PRE-EXISTING CONDITION LIMITATIONS? Yes. However, all plans will include pre-existing condition limitations that could impact you if you are a first-time enrollee in your employer’s disability plan (including your initial new hire enrollment). Review the plan documents for full details.

WILL I GET ALL OF MY DISABILITY BENEFIT? Your disability benefit may be reduced by other income you receive or are eligible to receive due to your disability, such as: Social Security Disability Insurance State teacher retirement disability plans Workers’ compensation Other employer-based Disability insurance coverage you may have Unemployment benefits Retirement benefits that your employer fully or partially pays for (such as a pension plan)

WHAT IS THE BEST WAY TO CHOOSE WHICH DISABILITY PLAN OPTION TO ENROLL IN? Your disability plan selection should be a two-step approach. Step One: Choose your elimination period, or waiting period. This is how long you are disabled and unable to work before your benefit will begin. It will be displayed as two numbers, such as 0/7, 14/14, 60/60, etc. The first number indicates the number of days you must be disabled due to Injury, and the second number indicates the number of days you must be disabled due to sickness. When choosing your elimination period, determine how long you could go without a paycheck. Choose your elimination period based on your answer. Note: Some plans will waive the elimination period if you choose 30/30 or another lesser option and you are confined as an inpatient to the hospital for a specific time period. Review your plan details to see if this feature is available to you. Step Two: Choose your benefit amount. This is the maximum amount of money you would get from the carrier on a monthly basis once your disability claim is approved by the carrier. When choosing your monthly benefit, consider how much money you need to pay your monthly bills. Choose your monthly benefit amount based on your answer.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Hospital Cash Insurance

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The Hospital Cash plans help you with the high cost of medical care by paying you a cash benefit when you have an inpatient hospital stay or are admitted to an intensive care unit.

Hospital Cash Insurance Provider:

You decide how to use the cash, whether it’s to pay for bills, gas, childcare or eldercare, medication, or other out-ofpocket expenses. Unlike traditional insurance, which pays a benefit to the hospital or doctor, these plans pays you directly. See the plan document for full details.

Plan 1

Plan 2

$1,500

$3,000

PLAN FEATURES Hospital Admission Benefit Amount Hospital Admission Benefit

3 per calendar year

Daily Hospital Stay Benefit Amount and Maximum Days per Calendar Year

$100 per day, max. 30 days

$200 per day, max. 30 days

Hospital ICU Admission Benefit Amount

$3,000

$6,000

2 per calendar year

$200 per day, max. 30 days

$400 per day, max. 30 days

Observation Benefit Amount and Maximum Days per Calendar Year

$500, 2 per calendar year for less than 20 hours

Newborn Care Stay Benefit and Maximum Days

$500 per day, max. days per confinement: 2

$50 per covered individual per year (includes immunizations and physicals)

Hospital ICU Admission Benefit Daily Hospital ICU Benefit Amount and Maximum Days per Calendar Year

WELLNESS BENEFIT Health Screening/Wellness Benefit PLAN PROVISIONS HSA-Compatible

Yes

Pre-existing Condition Limitation Period

None

Included

$13.94 $33.22 $24.80 $42.50

$22.12 $54.34 $42.80 $71.58

Portability

EMPLOYEE MONTHLY CONTRIBUTIONS Employee Employee and Spouse Employee and Child(ren) Employee and Family

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Accident Insurance Accident insurance provides affordable protection against a sudden, unforeseen accident.

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Accident Insurance Provider:

Accident insurance helps offset the direct and indirect expenses such as copayments, deductibles, ambulance, physical therapy, childcare, rent, and other costs not covered by traditional health plans. You will be paid a specific sum of money directly based on the care and services provided for your covered accident. Use the money any way you see fit. See the plan document for full details.

Accident Insurance Benefits Summary Low Plan

High Plan

Ambulance • Ground • Air

$500 $1,500

$750 $2,000

Emergency Room

$150

$300

Admission • Hospital • ICU

$1,000 $500

$1,500 $1,000

$250 per day $500 per day

$300 per day $600 per day

$100-$8,000

$150-$10,000

Loss of life: $50,000$100,000 Dismemberment: $2,000-$30,000

Loss of life: $75,000$100,000 Dismemberment: $3,000-$40,000

Confinement • Hospital – up to 365 days • ICU – up to 15 days Specific Sum Injuries Dislocations, ruptured discs, eye injuries, fractures, lacerations, concussions, and more

Accidental Death & Dismemberment1

EMPLOYEE MONTHLY CONTRIBUTIONS Employee Employee and Spouse Employee and Child(ren) Employee and Family 1

$9.46 $18.06 $21.10 $29.26

Working towards Protection

$13.92 $26.46 $30.78 $34.70

Percentage of benefit paid for dismemberment is dependent on type of loss.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Critical Illness Insurance

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Critical Illness insurance helps pay the cost of non-medical expenses related to a covered critical illness or cancer.

Critical Illness Insurance Provider:

The plan provides a lump-sum benefit payment to you upon first and second diagnosis of any covered critical illness or cancer. The benefit can help cover expenses such as lost income, out-of-town treatments, special diets, daily living, and household upkeep costs. This coverage is portable. See the plan document for full details.

Critical Illness Insurance Benefits Summary Critical Illness Insurance Plan

Sample Rates Based on $10,000 Policy

Employee – $10,000, $20,000, $30,000, or $40,000

Employee or Employee + Children

Spouse – $10,000, $20,000, $30,000, or $40,000 Child(ren) – Included in employee rate First Occurrence Benefit Full Coverage Advanced multiple sclerosis; advanced Parkinson’s disease; ALS (aka Lou Gehrig’s disease); Alzheimer’s disease; benign brain tumor; coma/brain injury; coronary artery bypass; end-stage renal failure; full benefit cancer; heart attack; heart transplant; heart, kidney, or organ failure; invasive cancer; loss of sight, speech, or hearing; major burns; paralysis; stroke

100% of benefit amount

Partial Coverage Carcinoma in situ; coronary artery obstruction

10%-25% of benefit amount

Childhood Diseases Autism spectrum disorder; cerebral palsy; congenital birth defects; cleft lip palate; cystic fibrosis; Down syndrome; Gaucher disease; muscular dystrophy; type 1 diabetes

100% of benefit amount

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Attained Age

Employee + Spouse or Employee + Family

Monthly Premiums

18-25

$1.50

$3.00

26-30

$1.70

$3.40

31-35

$2.70

$5.40

36-40

$2.90

$5.80

41-45

$4.30

$8.60

46-50

$4.60

$9.20

51-55

$8.50

$17.00

56-60

$8.70

$17.40

61-65

$24.00

$48.00

66-70

$24.00

$48.00

71-75

$24.00

$48.00

76-80

$24.00

$48.00

81+

$24.00

$48.00

Cancer Insurance Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town treatments, special diets, daily living, and household upkeep. In addition to these non-medical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance helps pay for these direct and indirect treatment costs so you can focus on your health.

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Cancer Insurance Provider:

Cancer Insurance Benefits Summary Cancer Insurance Plan 1

Plan 2

Medical Imaging

$500 - 2 per year

Radiation and Chemotherapy

$10,000 maximum

$20,000 maximum

$5,000

$10,000

$75

Plan 1

Plan 2

$20.04

$30.88

Employee and Spouse

$38.28

$58.90

Employee and Child(ren)

$26.60

$39.46

Employee and Family

$46.44

$69.58

Internal Cancer – First Occurrence* Wellness Benefit

EMPLOYEE MONTHLY CONTRIBUTIONS Employee

Carcinoma in situ is not considered internal cancer.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Emergency Medical Transport MASA Medical Transport Solutions (MASA MTS) helps you prepare for the unexpected with affordable medical emergency air and ground transportation.

For More Information Visit www.masamts.com. Call 800-423-3226. Download the MASA Global app.

Emergency Medical Transport Provider:

If you or your family members need emergency medical transport, your insurance coverage and Medicare may not cover all of the costs. Following your medical crisis, MASA MTS will negotiate with your medical plan provider and cover your remaining balance on your medical transportation bills. Participation in this plan is voluntary. Emergency Medical Transport Rates Employee and Family

$14.00

Visit www.mybenefitshub.com/clevelandisd for full plan details.

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Employee Assistance Program For 24/7 Support and More Information

The Employee Assistance Program (EAP) helps you and your family members cope with a variety of personal and work-related issues.

Visit www.guidanceresources.com. Call 888-628-4824. Download the GuidanceNow app. Use username LFGSupport and password LFGSupport1.

EAP Provider:

Support at Any Hour of the Day or Night!

This program provides confidential counseling and support services at little or no cost to you to help with: Relationships Work-life balance Stress and anxiety

Will preparation and estate resolution Grief and loss Childcare and eldercare issues

Substance abuse Financial and legal matters And more

Working Towards Support Visit www.mybenefitshub.com/clevelandisd for full plan details.

Identity Theft and Financial Wellness Millions of people have their identity stolen each year. Protect yourself, restore your identity, and take control of your financial health with coverage that includes: Identity theft insurance (up to $1 million in fraud recovery expenses) CreditLock, dark web monitoring, and credit alerts Digital Identity Manager, Secure VPN, Password Manager, and Safe Browser Identity restoration with licensed, trained agents 24/7 emergency ID protection access and mobile app Automated budgeting, spending summaries, and cash flow management Financial goal planning, net worth tracking, and credit score tools

Identity Theft Provider:

EMPLOYEE MONTHLY CONTRIBUTIONS Elite Plan

Employee Only

Employee and Family

$7.50

$14.00

Visit www.mybenefitshub.com/clevelandisd for full plan details.

To Learn More Visit www.experian.com. Call 855-797-0052. Download the Experian IdentityWorks app.

Legal Assistance At many points in your life, you may need legal assistance. Getting legal help can be a stressful and expensive process – many firms may charge up to $350 an hour. For these reasons, your employer offers a legal assistance plan to help you get the guidance you need.

To Learn More Visit www.legalshield.com. Call 800-654-7757. Download the LegalShield app.

Legal Assistance Provider:

This plan offers legal help at a fixed and affordable rate to assist with these types of issues: Family (adoption, juvenile court, prenuptial agreements) Financial (bankruptcy, affidavits, tax audits) Home (title disputes, deeds, foreclosures, mortgages) Auto (traffic violations, injuries, driver’s license restoration) General (document review, consultations, wills, estates) And more EMPLOYEE MONTHLY CONTRIBUTIONS Employee and Family

$21.50

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Glossary of Terms ACA (Affordable Care Act) – The ACA is comprehensive health care reform law enacted in March 2010. References to ACA at HPS typically involve reporting requirements, specifically, that obligate employers to report medical coverage for employees and to provide documents for employee tax preparation. HPS partners with ACA service providers to assist clients in meeting these requirements. Actively-at-work – This term refers to being at work as opposed to being on vacation, leave, or away from work for any other reason. Companywide or position-wide reporting dates (like summer breaks or winter breaks for teachers) do not apply here. ADL (Activities of Daily Living) – This is a concept related to eligibility for Long Term Care (LTC) benefits. There are six ADLs: bathing, dressing, toileting, transferring, eating, and continence. Most LTC plans require that the covered individual be unable to perform a certain number of these tasks to be eligible for benefits. Beneficiary – This is who will receive a benefit in the event of the insured’s death. A policy may have more than one beneficiary. Benefit Duration – This is the maximum period of time in which a claimant can receive benefits. Cafeteria/Section 125 Plan – This plan provides participants an opportunity to pay for qualified benefits on a pretax basis. Premiums for most medical, dental, vision, FSA, HSA, accident, and cancer plans are deducted on a pretax basis, which reduces participants’ taxable income. COBRA – COBRA allows participants who lose their health benefits the right to continue group health benefits for limited periods of time under certain circumstances including voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals will have to pay the full premium (including any employer contribution applied when employed) up to 102% of the cost to the plan. Coverage is typically available for 18 months but can be extended in certain situations.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

Copay – Also known as a copayment, this is the fixed amount you pay for health care services received at the time of service. A copay typically goes toward your deductible. Coinsurance – After you have met your deductible, this is your share of the cost of a covered health care service, which is calculated as a percent of the allowed amount for the service. For example, your coinsurance is 20% (while the insurer pays the remaining 80%). Contingent Beneficiary – This is who will receive a benefit in the event of the beneficiary’s (aka the primary beneficiary) death. A policy may have more than one contingent beneficiary. Continuation of Coverage – Many plans offered by HPS clients are continuable under COBRA or portability or conversion options. Standalone clients and cooperatives will have “continuation of coverage” documents that detail plan continuation availability. Covered Expenses – These are health care expenses covered under your health plan. Deductible – This is the amount a participant must cover for health care services before the insurer will share costs and provide coinsurance. Dental Reimbursement Types – Various types of dental plans (except DHMO plans) will pay out-of-network benefits differently. MAC/MRC/NAP (Maximum Allowable Charge/ Maximum Reimbursable Charge/Network Access Plan): Participants will receive the same payouts (contracted fees) for services whether they go in or out of network; and they may be balance billed when going out of network. UCR/R&C(Usual, Customary, and Reasonable/ Reasonable & Customary): When going out of network, the plan will pay an amount determined by the usual cost charged for the service by dentists in a certain geographical area.

Glossary of Terms Eligibility Waiting Period – This period is the amount of time new hires must wait before they are eligible for benefits. Most HPS clients will allow for new hires to be eligible the first of the month following (or coincident with) their date of hire. Elimination Period – Also known as a waiting period, this is the number of calendar days that participants in a Disability plan must be disabled before they are eligible to receive benefits. Employer Contribution – The amount of premium or financial contribution an employer provides to participants for insurance, spending accounts, or retirement. EOB (Explanation of Benefits) – This statement from your insurance carrier explains which procedures and services were provided, how much they cost, what portion of the claim was paid by the plan, and what portion of the claim is your responsibility. It also includes information on how you can appeal the insurer’s decision. These statements are also posted on the carrier’s website for your review. EOI (Evidence of Insurability)/Statement of Health (SOH) – Some plans require an application or a “proof of good health” type of statement to obtain coverage. This is commonly referred to as EOI (Evidence of Insurability). Such applications or statements must be submitted electronically or by mail to the carrier for approval. FMLA (Family and Medical Leave Act) – This act ensures employees have job-protected and unpaid leave for qualified medical and family reasons. FSA (Flexible Spending Account) – An option that allows participants to set aside pretax dollars to pay for qualified expenses (i.e., certain medical care or dependent care expenses) during a specific period (usually a 12-month period). Participants determine how much to contribute to their FSA at the beginning of the plan year. Most funds must be used by the end of the year, depending upon the type of FSA, as there is a limited carryover amount. Grace Period – As it pertains to FSAs, this is the period immediately following the end of the plan year during which participants can incur new claims to use their remaining FSA funds.

Guaranteed Issue – Some plans may include Guaranteed Issue coverage to new enrollees without EOI. HDHP (High Deductible Health Plan) – A qualified health plan that combines lower monthly premiums in exchange for higher deductibles and out-of-pocket limits. These plans are often coupled with an HSA. HMO/DHMO (Health Maintenance Organization/ Dental Health Maintenance Organization) – Medical plans labeled as HMO plans have a specified network of providers, and benefits are generally not available outside of that network except in an emergency. DHMO plans follow this same model for dental coverage. HPS (Higginbotham Public Sector) – HPS is the insurance broker that represents your account. HSA (Health Savings Account) – This is an employeeowned savings account used to pay for eligible health care expenses with pretax dollars. Funds in the account do not have to be used within a specified time period. An HSA must be coupled with qualified HDHP. In-network – Doctors (e.g., a primary care physician or specialist), hospitals, and other providers that contract with your insurance company provide health care services at discounted rates. These providers are on an outlined list of health care practitioners. Inpatient – A person who is treated as a registered patient in a hospital or other health care facility. Medically Necessary – Services or supplies provided by a hospital, health care facility, or physician that meet the following criteria: (1) are appropriate for the symptoms and diagnosis and/or treatment of the condition, illness, disease, or injury; (2) serve to provide diagnosis or direct care and/or treatment of the condition, illness, disease, or injury; (3) are in accordance with standards of good medical practice; (4) are not primarily serving as convenience; and (5) are considered the most appropriate care available. Medicare – An insurance program administered by the federal government to provide health coverage to individuals age 65 or older, or who have certain disabilities or illnesses.

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Glossary of Terms Member – You and those covered become members when you enroll in a health plan. This includes eligible employees, their dependents, COBRA beneficiaries, and surviving spouses. Open Enrollment – Open Enrollment refers to the annual period during which employees may enroll in available benefits or make coverage changes without a Qualifying Life Event. Out-of-network – Doctors, hospitals, and other providers that are not contracted with your insurance company. If you choose an out-of-network provider, you may be responsible for costs over the amount allowed by your insurance carrier. Out-of-pocket Expense – Amount that you must pay toward the cost of health care services. This includes deductibles, copayments, and coinsurance. Out-of-pocket Maximum – Also known as an out-ofpocket limit, this is the most you pay during a policy or benefit period (usually a 12-month period) before your health insurance or plan begins to pay 100% of the allowed amount for covered services. PCP (Primary Care Physician) – A doctor who is selected to coordinate treatment under your health plan. This generally includes family practice physicians, general practitioners, internists, and pediatricians. Plan Year – A 12-month period of benefits coverage under a group health plan, which may or may not coincide with a calendar year. Plan Year Maximum – The maximum amount of benefit available to a participant for each plan year. PPO (Preferred Provider Organization) – Health plans labeled as PPO refer to the network structure and plan availability. In-network PPO plan providers have agreed to offer services at a contracted rate, which means members generally pay less and get the highest level of benefits. Out-of-network services and providers are also available, but you may pay more for care and generally receive fewer benefits. Preventive Care – The care you receive to help prevent illness or disease. It also includes counseling to prevent health problems.

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Pre-existing Condition – A pre-existing condition is a medical event, treatment, or diagnosis that occurs prior to the effective date of insurance coverage. Pre-existing Condition Limitation – Some plans may limit benefits due to pre-existing conditions for a set period of time. Premium – A reference to the cost (usually monthly) of insurance/benefits paid by the employer or employee. QLE (Qualifying Life Event) – These are events that allow changes to pretax benefits outside of Open Enrollment. Changes must typically be made within 30 or 31 days of the event. Examples of QLEs include marriage, birth, divorce, gain or loss of benefits coverage, and change in employment status affecting benefits. Rollover – As it pertains to a Health Care FSA or Limited Purpose Health Care FSA, a client can establish a limit of $680 (for 2026) of unused funds that can be rolled over to the next plan year, provided the participant re-enrolls in the FSA plan. Run-out Period – Related to FSAs, this is a period immediately following the end of the plan year in which participants can submit claims incurred within the plan year. For new onboarding clients, this period can be managed by the current or new administrator. The current administrator may charge a fee. If the new administrator manages the run-out period, it will need a report of the FSA participants and their remaining FSA balances. SSNRA (Social Security Normal Retirement Age) – This is the normal retirement age for an employee under the federal Social Security Act. THEbenefitsHUB – This is the benefits enrollment system used by HPS. Usual, Customary and Reasonable (UCR) Allowance – This is the fee paid for covered services that is: (1) a similar amount to the fee charged by a health care provider to the majority of patients for the same procedure; (2) the customary fee paid to providers with similar training and expertise in a similar geographic area: and (3) reasonable in light of any unusual clinical circumstances.

Important Legal Notices Women’s Health and Cancer Rights Act of 1998 In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully. As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits: All stages of reconstruction of the breast on which the mastectomy was performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; and Prostheses and treatment of physical complications of the mastectomy, including lymphedema. Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.

Special Enrollment Rights This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time. Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP)

If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage).

Your Prescription Drug Coverage and Medicare

If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is terminated from, or determined to be eligible for, such assistance.

If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.

Marriage, Birth or Adoption

Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

Cleveland ISD has determined that the prescription drug coverage offered by the Cleveland ISD medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage. The HSA plan is not considered Creditable Coverage.

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Cleveland ISD and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to enroll in a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 31 days after the marriage, birth, or placement for adoption. For More Information or Assistance To request special enrollment or obtain more information, contact: Cleveland ISD 1901 East Houston Cleveland TX 77327 281-592-8717

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Important Legal Notices Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods. You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty). You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Cleveland ISD at the phone number or address listed at the end of this section. If you choose to enroll in a Medicare prescription drug plan and cancel your current Cleveland ISD prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to determine if and when you are allowed to add coverage.

If you cancel or lose your current coverage and do not have prescription drug coverage for 63 days or longer prior to enrolling in the Medicare prescription drug coverage, your monthly premium will be at least 1% per month greater for every month that you did not have coverage for as long as you have Medicare prescription drug coverage. For example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage. For more information about this notice or your current prescription drug coverage: Contact the Human Resources Department at 281-592-8717. NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy. For more information about your options under Medicare prescription drug coverage: More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage: Visit www.medicare.gov. Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help. Call 1-800-MEDICARE (1-800633-4227). TTY users should call 877-486-2048.

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If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778. Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty). September 1, 2026 Cleveland ISD 1901 East Houston Cleveland TX 77327 281-592-8717

Notice of HIPAA Privacy Practices This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information known as protected health information (PHI), includes virtually all individually identifiable health information held by a health plan – whether received in writing, in an electronic medium or as oral communication. This notice describes the privacy practices of the Employee Benefits Plan (referred to in this notice as the Plan), sponsored by Cleveland ISD, hereinafter referred to as the plan sponsor.

Important Legal Notices The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. It is important to note that these rules apply to the Plan, not the plan sponsor as an employer. You have the right to inspect and copy protected health information which is maintained by and for the Plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask the Human Resources Department to amend the information. For a full copy of the Notice of Privacy Practices describing how protected health information about you may be used and disclosed and how you can get access to the information, contact the Human Resources Department. Complaints: If you believe your privacy rights have been violated, you may complain to the Plan and to the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint. To file a complaint, please contact the Privacy Officer. Cleveland ISD 1901 East Houston Cleveland TX 77327 281-592-8717 Conclusion PHI use and disclosure by the Plan is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. The Plan intends to comply with these regulations. This Notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this Notice and the regulations.

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www. healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www. insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www. askebsa.dol.gov or call 1-866-444EBSA (3272). If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of January 31, 2026. Contact your State for more information on eligibility. Colorado – Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+) Health First Colorado website: https:// www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711 CHP+: https://hcpf.colorado.gov/childhealth-plan-plus CHP+ Customer Service: 1-800-3591991/State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/ HIBI Customer Service: 1-855-6926442 Texas – Medicaid Website: https://www.hhs.texas.gov/ services/financial/health-insurancepremium-payment-hipp-program Phone: 1-800-440-0493

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Important Legal Notices To see if any other States have added a premium assistance program since January 31, 2026, or for more information on special enrollment rights, can contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565

Continuation of Coverage Rights Under COBRA Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the Cleveland ISD group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Cleveland ISD plan after you have left employment with the company. If you wish to elect COBRA coverage, contact your Human Resources Department for the applicable deadlines to elect coverage and pay the initial premium. Plan Contact Information National Benefit Services 430 W 7th Street Suite 219893RA Kansas City, MO 64105 800-274-0503

Your Rights and Protections Against Surprise Medical Bills

You are protected from balance billing for:

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

Emergency services – If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these poststabilization services.

What is “balance billing” (sometimes called “surprise billing”)? When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. “Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit. “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-ofnetwork provider.

Certain services at an in-network hospital or ambulatory surgical center – When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-ofnetwork. In these cases, the most those providers may bill you is your plan’s in-network costsharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed. If you get other services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections. You are never required to give up your protections from balance billing. You also are not required to get care out-of-network. You can choose a provider or facility in your plan’s network.

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Important Legal Notices When balance billing is not allowed, you also have the following protections: You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly. Your health plan generally must: • Cover emergency services without requiring you to get approval for services in advance (prior authorization). • Cover emergency services by out-of-network providers. • Base what you owe the provider or facility (costsharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits. • Count any amount you pay for emergency services or out-ofnetwork services toward your deductible and out-of-pocket limit. If you believe you have been wrongly billed, you may contact your insurance provider. Visit www. cms.gov/nosurprises for more information about your rights under federal law.

New Health Insurance Marketplace Coverage Options and Your Health Coverage PART A: General Information Even if you are offered health coverage through your employment, you may have other coverage options through the Health Insurance Marketplace (“Marketplace”). To assist you as you evaluate options for you and your family, this notice provides some basic information about the Health Insurance Marketplace. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options in your geographic area. Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium and other out-of-pocket costs, but only if your employer does not offer coverage, or offers coverage that is not considered affordable for you and doesn’t meet certain minimum value standards (discussed below). The savings on your premium that you’re eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs.

Does Employment-Based Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that is considered affordable for you and meets certain minimum value standards, you will not be eligible for a tax credit, or advance payment of the tax credit, for your Marketplace coverage and may wish to enroll in your employment-based health plan. However, you may be eligible for a tax credit, and advance payments of the credit that lowers your monthly premium, or a reduction in certain cost-sharing, if your employer does not offer coverage to you at all or does not offer coverage that is considered affordable for you or meet minimum value standards. If your share of the premium cost of all plans offered to you through your employment is more than 9.12%1 of your annual household income, or if the coverage through your employment does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit, and advance payment of the credit, if you do not enroll in the employmentbased health coverage. For family members of the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan that would cover all family members does not exceed 9.12% of the employee’s household income.1, 2

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Important Legal Notices Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the employment-based coverage. Also, this employer contribution – as well as your employee contribution to employment-based coverage – is generally excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of these factors in determining whether to purchase a health plan through the Marketplace. When Can I Enroll in Health Insurance Coverage through the Marketplace? You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but generally starts November 1 and continues through at least December 15. Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan.

There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the nationwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage. Marketplace-eligible individuals who live in states served by HealthCare. gov and either submit a new application or update an existing application on HealthCare.gov between March 31, 2023 and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medicaid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn more, visit www.HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325.

Visit www.mybenefitshub.com/clevelandisd for full plan details.

What about Alternatives to Marketplace Health Insurance Coverage? If you or your family are eligible for coverage in an employment-based health plan (such as an employer sponsored health plan), you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employment-based health plan. Confirm the deadline with your employer or your employment-based health plan. Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through your state Medicaid agency. Visit https://www. healthcare.gov/medicaid-chip/ getting-medicaid-chip/ for more details.

Important Legal Notices How Can I Get More Information? For more information about your coverage offered through your employment, please check your health plan’s summary plan description or contact Human Resources. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit www.HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

PART B: Information About Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application. 3. Employer Name: Cleveland ISD 4. Employer Identification Number (EIN): N/A

As your employer, we offer a health plan to all eligible employees (see the Eligibility section of this guide). This coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages. Indexed annually; see https://www.irs.gov/pub/ irs-drop/rp-22-34.pdf for 2023. 1

An employer-sponsored or other employmentbased health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services. 2

5. Employer Address: 1901 East Houston 6. Employer Phone Number: 281-592-8717 7. City: Cleveland 8. State: TX

9. ZIP Code: 77327

10. Who can we contact at this job?: Eduarda Clopton 11. Phone Number (if different from above): 281-592-8717 12. E-Mail Address: eduarda.clopton@clevelandisd.org

Visit www.mybenefitshub.com/clevelandisd for full plan details.

This brochure highlights the main features of the Cleveland ISD employee benefits program. It does not include all plan rules, details, limitations, and exclusions. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be an inconsistency between this brochure and the legal plan documents, the plan documents are the final authority. Cleveland ISD reserves the right to change or discontinue its employee benefits plans anytime.