2016 Benefit Guide - City of Stephenville

EFFECTIVE:

05/01/2016 - 4/30/2017

BENEFIT GUIDE

www.mybenefitshub.com/cityofstephenville

CITY OF STEPHENVILLE

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Benefit Contact Information 3 How to Enroll 4-5 Annual Benefit Enrollment 6-11 1. Benefit Updates 6 2. Section 125 Cafeteria Plan Guidelines 7 3. Annual Enrollment 8 4. Eligibility Requirements 9 5. Helpful Definitions 10 6. ACA Employee Responsibilities 11 UnitedHealthcare Medical 12-15 MDLIVE Telehealth 16-17 APL MEDlink® Medical Supplement 18-21 APL Accident 22-25 UnitedHealthcare Dental 26-29 UnitedHealthcare Vision 30-31 APL Short Term Disability 32-35 UnitedHealthcare Long Term Disability 36-39 APL Cancer 40-43

Texas Life Individual Life 44-45

5Star Family Protection Plan Term Life Insurance with Long Term Care 46-49

UnitedHealthcare Life and AD&D 50-53 NBS Flexible Spending Account (FSA) 54-57 NBS 457(b) Plan 58-59 Naturally Slim Weight Loss 60-61

Table of Contents

HOW TO ENROLL

PG. 4

YOUR BENEFIT UPDATES: WHAT’S NEW

PG. 6

YOUR MEDICAL BENEFITS

PG. 12

FLIP TO...

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Benefit Contact Information

CITY OF STEPHENVILLE BENEFITS DENTAL FAMILY PROTECTION PLAN-TERMINAL ILLNESS AND LTC RIDER

Financial Benefit Services (800) 583-6908 http://www.mybenefitshub.com/cityofstephenville

Group # 904974 UnitedHealthcare (877) 816-3596 http://www.myuhcdental.com

Group # 01925 5Star Life Insurance Company (866) 863-9753 http://5starlifeinsurance.com

MEDICAL VISION LIFE AND AD&D

Group # 904974 UnitedHealthcare (888) 299-2070 http://www.myuhc.com

Group # 904974 UnitedHealthcare (800) 638-3120 https://www.myuhcvision.com


TELEHEALTH SHORT TERM DISABILITY FLEXIBLE SPENDING ACCOUNT

MDLIVE (888) 365-1663 http://www.consultmdlive.com

Group # 16991 American Public Life (800) 256-8606 http://www.ampublic.com

National Benefit Services (800) 274-0503 http://www.nbsbenefits.com

MEDICAL SUPPLEMENT—MEDLINK ® LONG TERM DISABILITY 457(B) PLAN



National Benefit Services (800) 274-0503 http://www.nbsbenefits.com

ACCIDENT CANCER WEIGHT LOSS



Naturally Slim (214) 265-6660 http://www.naturallyslim.com

Benefit Contact Information

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!

How to Enroll

On Your Computer Access THEbenefitsHUB from your

computer, tablet or smartphone!

Our online benefit enrollment

platform provides a simple and

easy to navigate process. Enroll

at your own pace, whether at

home or at work.

www.mybenefitshub.com/

cityofstephenville delivers

important benefit information

with 24/7 access, as well as

detailed plan information, rates

and product videos.

TEXT

“stephville”

TO

313131

On Your Device Enrolling in your benefits just got

a lot easier! Text “stephville” to

313131 to receive everything you

need to complete your

enrollment.

Avoid typing long URLs and scan

directly to your benefits website,

to access plan information,

benefit guide, benefit videos, and

more!

SCAN: TRY ME

4

GO www.mybenefitshub.com/cityofstephenville 1

2

Login Steps

3

Go to:

Click Login

Enter Username & Password

OR SCAN

All login credentials have been RESET to the default

described below:

Username:

The first six (6) characters of your last name, followed

by the first letter of your first name, followed by the

last four (4) digits of your Social Security Number.

If you have six (6) or less characters in your last name,

use your full last name, followed by the first letter of

your first name, followed by the last four (4) digits of

your Social Security Number.

Default Password:

Last Name* (lowercase, excluding punctuation)

followed by the last four (4) digits of your Social

Security Number.

Sample Password

l incola1234

l incoln1234

If you have trouble

logging in, click on the

“Login Help Video”

for assistance.

Click on “Enrollment Instructions” for more information about how to enroll.

Sample Username

LOGIN

Open Enrollment Tip

For your User ID: If you have less than six (6) characters in your last

name, use your full last name, followed by the first letter of your first

name, followed by the last four (4) digits of your Social Security Number.

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Financial Benefit Services (FBS) is the Third PartyAdministrator for the City of Stephenville. FBS willconduct the annual enrollment and provide benefitsupport for the City of Stephenville employees.

UPDATE! The UHC Medical Plan will be changingeffective 5/1/2016. The 2016 plan is an ExclusiveProvider Organization Plan (EPO). The medical plan is anin-network only plan. The UHC EPO Plan has the samenetwork as the current PPO plan, and you shouldexperience little or no disruption with your currentproviders. True emergencies are covered if you have tovisit an out of network facility. Medical cards will bemailed to your home address approximately in mid May.You can log on to www.myuhc.com to print additionalcards.

UPDATE! UHC Long Term Disability Effective 5/1/2016there will be two options for LTD. During enrollment, youmay elect either a 40% or a 60% of monthly earningsbenefit. The premiums and coverage are based on yourtotal annual earnings and your age. Your specific amountwill be viewable during enrollment.

NEW! 5 Star Term Life to 100 with Quality of LifeEmployees may elect up to $100,000 and may elect$30,000 on their spouse. You may elect up to $20,000for eligible children up to age 23. This plan includes aQuality of Life component which will pay up to 18months of long term care if the insured is unable to

perform at least 2 of the 6 Activities of Daily Living (ADLs) without substantial assistance or if the insured suffers an impairment such as dementia, Alzheimer’s or other forms of senility requiring substantial supervision. Quality of Life is not available for children. Premiums are locked and do not increase.

NEW! Naturally Slim This program offers a provensolution to help employees and/or their spouses loseweight and reduce their Metabolic Syndrome (MetS)risk. MetS is a cluster of factors that predict seriousconditions such as diabetes, heart disease and stroke.This is NOT a diet. It is an online program that teachesskills focused on behavioral modification resulting inproven, lasting clinical results.

NEW! MDLive This is a new benefit provided by the Cityof Stephenville for all full time employees, their spousesand dependent children up to the age of 26. MDLiveprovides unlimited 24/7/365 access to a licensedphysician to treat common illnesses such as pink eye,urinary tract infections, allergies, sinus infections, gout,nausea, etc. If a prescription is needed, the MDLivephysician will send the prescription to your chosenpharmacy (will not prescribe narcotic medications).There is no cost to the employee to utilize this service.Get fast convenient care when you and your family needit, even when traveling!

Don’t Forget!

Login and complete your benefit enrollment from 04/15/2016 - 04/25/2016

On-site enrollment assistance will be available at the Police Department, MSC and City Hall.

Add dependents to the system—please bring dependent Social Security numbers and date of birth.

Benefit Updates - What’s New:

SUMMARY PAGES

Annual Benefit Enrollment

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SUMMARY PAGES

CHANGES IN STATUS (CIS):

QUALIFYING EVENTS

Marital Status A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).

Change in Number of Tax Dependents

A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.

Change in Status of Employment Affecting

Coverage Eligibility

Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.

Gain/Loss of Dependents' Eligibility Status

An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements under an employer's plan may include change in age, student, marital, employment or tax dependent status.

Judgment/Decree/Order

If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.

Eligibility for Government Programs

Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.

A Cafeteria plan enables you to save money by using pre-tax 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 will 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 qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

Section 125 Cafeteria Plan Guidelines

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Annual EnrollmentDuring your annual enrollment period, you have the opportunity

to review, change or continue benefit elections each year.

Changes are not permitted during the plan year (outside of

annual enrollment) unless a Section 125 qualifying event occurs.

Changes, additions or drops may be made only during the

annual enrollment period without a qualifying event.

Employees must review their personal information and verify

that dependents they wish to provide coverage for are

included in the dependent profile. Additionally, you must

notify your employer of any discrepancy in personal and/or

benefit information.

Employees must confirm on each benefit screen (medical,

dental, vision, etc.) that each dependent to be covered is

selected in order to be included in the coverage for that

particular benefit.

New Hire EnrollmentAll new hire enrollment elections must be completed in the

online enrollment system within the first 31 days of benefit

eligibility employment. Failure to complete elections during this

timeframe will result in the forfeiture of coverage.

Q&AWho do I contact with Questions?

For supplemental benefit questions, you can contact your

Benefits/HR department or you can call Financial Benefit Services

at 866-914-5202 for assistance.

Where can I find forms?

For benefit summaries and claim forms, go to your benefit

website:

www.mybenefitshub.com/cityofstephenville. Click on the

benefit plan you need information on (i.e., Dental) and you

can find the forms you need under the Benefits and Forms

section.

How can I find a Network Provider?

For benefit summaries and claim forms, go to the City of

Stephenville benefit website: www.mybenefitshub.com/

cityofstephenville. Click on the benefit plan you need

information on (i.e., Dental) and you can find provider search

links under the Quick Links section.

When will I receive ID cards?

If the insurance carrier provides ID cards, you can expect to

receive those 3-4 weeks after your effective date. For most

dental and vision plans, you can login to the carrier website

and print a temporary ID card or simply give your provider the

insurance company’s phone number and they can call and

verify your coverage if you do not have an ID card at that

time. If you do not receive your ID card, you can call the

carrier’s customer service number to request another card.

SUMMARY PAGES

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PLAN CARRIER MAXIMUM AGE

Accident American Public Life Through 25

Cancer American Public Life Through 25

Dental UnitedHealthcare Through 25

Dependent Flex National Benefit Services 12 or younger or qualified individual

unable to care for themselves & claimed as a dependent on your taxes

Family Protection Plan w/ LTC 5Star Life Issue through 23; Keep to 100

Healthcare FSA National Benefit Services Through 25 or IRS Tax Dependent

Individual Life Texas Life Through 24

Medical UnitedHealthcare Through 25

Medical Supplement Plan American Public Life Through 25

Pharmacy UnitedHealthcare Through 25

Telehealth MDLIVE Through 25

Vision UnitedHealthcare Through 25

Employee Eligibility RequirementsSupplemental Benefits: Eligible employees must work 30 or more

regularly scheduled hours each work week.

Eligible employees must be actively at work on the plan effective

date for new benefits to be effective, meaning you are physically

capable of performing the functions of your job on the first day of

work concurrent with the plan effective date. For example, if

your 2016 benefits become effective on September 1, 2016, you

must be actively-at-work on September 1, 2016 to be eligible for

your new benefits.

Dependent Eligibility RequirementsDependent Eligibility: You can cover eligible dependent

children under a benefit that offers dependent coverage,

provided you participate in the same benefit, through the

maximum age listed below. Dependents cannot be double

covered by married spouses within the City of Stephenville or

as both employees and dependents.

If your dependent is disabled, coverage can continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage.

SUMMARY PAGES

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Actively at Work You are performing your regular occupation for the employer

on a full-time basis, either at one of the employer’s usual

places of business or at some location to which the employer’s

business requires you to travel. If you will not be actively at

work beginning 5/1/2016 please notify your benefits

administrator.

Annual Enrollment The period during which existing employees are given the

opportunity to enroll in or change their current elections.

Annual Deductible The amount you pay each plan year before the plan begins to

pay covered expenses.

Calendar Year January 1st through December 31st

Co-insurance After any applicable deductible, your share of the cost of a

covered health care service, calculated as a percentage (for

example, 20%) of the allowed amount for the service.

Guaranteed Coverage The amount of coverage you can elect without answering any

medical questions or taking a health exam. Guaranteed

coverage is only available during initial eligibility period.

Actively-at-work and/or pre-existing condition exclusion

provisions do apply, as applicable by carrier.

In-Network Doctors, hospitals, optometrists, dentists and other providers

who have contracted with the plan as a network provider.

Out of Pocket Maximum The most an eligible or insured person can pay in co-insurance

for covered expenses.

Plan Year May 1st through April 30th

Pre-Existing Conditions Applies to any illness, injury or condition for which the

participant has been under the care of a health care provider,

taken prescriptions drugs or is under a health care provider’s

orders to take drugs, or received medical care or services

(including diagnostic and/or consultation services).

Helpful Definitions SUMMARY PAGES

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SUMMARY PAGES ACA Employee Responsibilities

Mandatory Medical Enrollment

After becoming eligible, you must elect or

decline medical coverage offered through

your employer.

Medical Election Employee chooses to elect on the Medical

Plans offered.

Play or Pay Rules If you elect a medical plan offered through

your employer, you will receive the IRS Tax

Form 1095 -C. You will use this document to

file your 1040 Tax Return.

However, if you choose to decline medical

coverage, you will be subject to the Individual

Mandate Penalties, unless you have a

minimum essential health plan.

2016 & Beyond

Penalty is $695 per adult and

$347.50 per child ( up to $2,085 for a

family) OR 2.5% of family income,

whichever is greater.

RECEIVE 1095 -C NO PENALTIES

Are you electing to enroll in the

medical plan?

Are you receiving medical coverage

elsewhere? *See examples below

YES

NO

NO

YES RECEIVE 1095 -C NO PENALTIES

PENALTIES ASSESSED

*Examples ofother coverage:

-Military

-Medicare

-Medicaid

-Through a spouse

-Marketplace exchange

ACA 101

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Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis.

About this Benefit

MedicalYOUR BENEFITS PACKAGE

DID YOU KNOW?

UNITEDHEALTHCARE

More than 70% of adults across the United States are already being diagnosed with

a chronic disease.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the

City of Stephenville Benefits Website: www.mybenefitshub.com/cityofstephenville 12

We know that when people know more about their health and health care, they can make better informed health care decisions. We want to help you understand more about your health care and the resources that are available to you.

www.myuhc.com® – Take advantage of easy, time-savingonline tools. You can check your eligibility, benefits, claims,claim payments, search for a doctor and hospital and much,much more.

24-hour nurse support – A nurse is a phone call away and youhave other health resources available 24-hours a day, 7 daysa week to provide you with information that can help youmake informed decisions. Just call the number on the backof your ID card.

Customer Care telephone support – Need more help? Call acustomer care professional using the toll-free number on theback of your ID card. Get answers to your benefit questionsor receive help looking for a doctor or hospital.

Plan Highlights

Copayments do not accumulate towards the Deductibleunless otherwise notated within the specific Benefit categorybelow.

All individual Deductible amounts will count toward thefamily Deductible, but an individual will not have to paymore than the individual Deductible amount.

All individual Out-of-Pocket Maximum amounts will counttoward the family Out-of-Pocket Maximum, but an individualwill not have to pay more than the individual Out-of-PocketMaximum amount.

Copayments, Coinsurance and Deductibles accumulatetowards the Out-of-Pocket Maximum, including Pharmacy.

Prescription Drug Benefits Prescription drug benefits are shown under separate cover.

Additional Benefit Information Refer to your Certificate of Coverage or Summary of

Benefits and Coverage to determine if the AnnualDeductible, Out-of-Pocket Maximum and Benefit limitsare calculated on a Policy or Calendar year basis.

Refer to your Certificate of Coverage and your Riders forthe definition of Eligible Expenses and information onhow Benefits are paid. In order to obtain the highestlevel of Benefits, you should confirm the Network statusof all providers prior to obtaining Covered HealthServices.

When Benefit limits apply, the limit refers to anycombination of Network and Non-Network Benefitsunless specifically stated in the Benefit category.

The UnitedHealth Premium program can help you choose a doctor with confidence. The program evaluates doctors in 27 different medical specialties, using national standards for quality and local benchmarks for cost efficiency.

*City of Stephenville members will pay a lower Co-pay whenchoosing UnitedHealth Premium Tier 1 specialist. Search fora Tier 1 provider at www.myuhc.com.

Medical

Types of Coverage Network Benefits

Annual Deductible

Individual Deductible $1,500 per year

Family Deductible $3,000 per year


Out-of-Pocket Maximum

Individual Out-of-Pocket Maximum

$5,000 per year

Family Out-of-Pocket Maximum

$10,000 per year

Benefits At-A-Glance What you may pay for network care

Co-payment Individual Deductible

Co-insurance

$25* $1,500 20%

Monthly Premium

Employee $0

Employee + Spouse $736.19

Employee + Child(ren) $384.62

Employee + Family $1,120.51

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Medical


Physician’s Office Services—Sickness and Injury

Primary Physician Office Visit No deductible is applicable to necessary diagnostic follow-up care relating to the screening test for hearing loss of newborn Dependents, from birth through 24 months.

Covered persons less than age 19: 100% after you pay a

$0 Copayment per visit.

All other Covered Persons:

Tier 1 Provider Network: 100% after you pay a $25 Copayment

per visit.

Network: 100% after you pay

a $25 Copayment per visit.

Specialist Physician Office Visit No deductible is applicable to necessary diagnostic follow-up care relating to the screening test for hearing loss of newborn Dependents, from birth through 24 months.

Tier 1 Provider Network: 100% after you pay


Network: 100% after you pay


In addition to the office visit Copayment stated in this section, the Copayment/Coinsurance and any deductible applies when these services are done: CT, PET, MRI, MRA, Nuclear Medicine; Pharmaceutical Products, Scopic Procedures; Surgery; Therapeutic

Treatments. Prior Authorization is required for Genetic Testing - BRCA.


Preventive Care Services Covered Health Services include but are not limited to:

Primary Physician Office Visit 100%,

Copayments and Deductibles do not apply

Specialist Physician Office Visit 100%,

$50 copayment per visit. A deductible does not apply.

Lab, X-Ray and Diagnostics—Outpatient 100%,

Copayments and Deductibles do not apply

The health care reform law provides for coverage of certain preventive services, based on your age, gender and other health factors, with no cost-sharing. The preventive care services covered under this section are those preventive services specified in

the health care reform law. UnitedHealthcare also covers other routine services as described in other areas of this summary, which may require a copayment, coinsurance or deductible. Always refer to your plan documents for your specific coverage.

Most Commonly Used Benefits


Urgent Care Center Services

100% after you pay a $75 Copayment per visit. A deductible does not apply.

Additional copays, deductible, or coinsurance may apply when you receive other services at the urgent care facility.

For example, surgery.

Emergency Health Services—Outpatient 80% after you pay a

$250 Copayment per visit

Hospital—Inpatient Stay 50% after Deductible has been met

Lab, X-Ray and Major Diagnostics—CT, PET, MRI, MRA and Nuclear Medicine—Outpatient

20% Coinsurance, after the medical deductible has been met

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Prescription Drug

Your Copayment and/or Coinsurance is determined by the tier to which the Prescription Drug List (PDL) Management Committee has assigned the Prescription Drug Product. All Prescription Drug Products on the Prescription Drug List are assigned to Tier 1, Tier 2 or Tier 3. Find individualized information on your benefit coverage, determine tier status, check the status of claims and search for network pharmacies by logging on to www.myuhc.com® or calling the Customer Care number on your ID card.

Annual Drug Deductible

Individual Deductible No Deductible

Family Deductible No Deductible

Out-of-Pocket Drug Maximum

Individual Out-of-Pocket Maximum See Medical Benefit Summary

Family Out-of-Pocket Maximum See Medical Benefit Summary

Tier Level Retail

Up to 31-day supply *Mail Order

Up to 90-day supply

Network Network

Tier 1 $20 $50

Tier 2 $35 $87.50

Tier 3 $70 $175

*Only certain Prescription Drug Products are available through mail order; please visit www.myuhc.com or call Customer Care at the telephonenumber on the back of your ID card for more information.

Other Important Information about your Outpatient Prescription Drug Benefits You are responsible for paying the lower of the applicable Copayment and/or Coinsurance or the retail Network Pharmacy's Usual and Customary Charge, or the lower of the applicable Copayment and/or Coinsurance or the mail order Network Pharmacy's Prescription Drug Cost. For a single Copayment and/or Coinsurance, you may receive a Prescription Drug Product up to the stated supply limit. Some products are subject to additional supply limits.

Specialty Prescription Drug Products supply limits are as written by the provider, up to a consecutive 31-day supply of the Specialty Prescription Drug Product, unless adjusted based on the drug manufacturer's packaging size, or based on supply limits. Supply limits apply to Specialty Prescription Drug Products whether obtained at a retail pharmacy or through a mail order pharmacy.

Some Prescription Drug Products or Pharmaceutical Products for which Benefits are described under the Prescription Drug Rider or Certificate are subject to step therapy requirements. This means that in order to receive Benefits for such Prescription Drug Products or Pharmaceutical Products you are required to use a different Prescription Drug Product(s) or Pharmaceutical Product(s) first.

Also note that some Prescription Drug Products require that you obtain prior authorization from us in advance to determine whether the Prescription Drug Product meets the definition of a Covered Health Service and is not Experimental, Investigational or Unproven.

If you require certain Prescription Drug Products, we may direct you to a Designated Pharmacy with whom we have an arrangement to provide those Prescription Drug Products. If you are directed to a Designated Pharmacy and you choose not to obtain your Prescription Drug Product from the Designated Pharmacy, no Benefit will be paid for that Prescription Drug Product. You may be required to fill an initial Prescription Drug Product order and obtain one refill through a retail pharmacy prior to using a mail order Network Pharmacy. Benefits are available for refills of Prescription Drug Products only when dispensed as ordered by a duly licensed health care provider and only after 3/4 of the original Prescription Drug Product has been used.

If you require certain Maintenance Medications, we may direct you to the Mail Order Network Pharmacy to obtain those Maintenance Medications. If you choose not to obtain your Maintenance Medications from the Mail Order Network Pharmacy, you may opt-out of the Maintenance Medication Program each year through the Internet at www.myuhc.com or by calling Customer Care at the telephone number on your ID card.

15

Telehealth provides 24/7/365 access to board-certified doctors via telephone consultations that can diagnose, recommend treatment and prescribe medication. Whether you are at home, traveling or at work, Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.

About this Benefit

Telehealth YOUR BENEFITS PACKAGE

DID YOU KNOW?

75%

of all doctor, urgent care, and ER visits could be handled safely and effectively via

telehealth.

MDLIVE



Telehealth

When should I use MDLIVE? If you’re considering the ER or urgent care for a

non-emergency medical issue

Your primary care physician is not available

At home, traveling, or at work

24/7/365, even holidays!

What can be treated? Allergies

Asthma

Bronchitis

Cold and Flu

Ear Infections

Joint Aches and Pain

Respiratory Infection

Sinus Problems

And More!

Pediatric Care related to: Cold & Flu

Constipation

Ear Infection

Fever

Nausea & Vomiting

Pink Eye

And More!

Who are our doctors? MDLIVE has the nation’s largest network of telehealth doctors. On average, our doctors have 15 years of experience practicing medicine and are licensed in the state where patients are located. Their specialties include primary care, pediatrics, emergency medicine and family medicine. Our doctors are committed to providing convenient, quality care and are always ready to take your call.

Are children eligible? Yes. MDLIVE has local pediatricians on-call 24/7/365. Please note, a parent or guardian must be present during any interactions involving minors. We ask parents to establish a child record under their account. Parents must be present on each call for children 18 or younger.

How much does it cost? $0 Covers you, your spouse, and children up to age 26, with unlimited phone consultations.

Download the App Doctor visits are easier and more convenient with the MDLIVE App. Be prepared. Download today. www.mdlive.com/getapp

Access to a doctor anywhere:at home, at work, or on the go

Choose doctors from one of the nation's largesttelehealth networks

Available 24/7 by video or phone

Private, secure and confidential visits

Connect instantly with MDLIVE Assist

Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit www.mdlive.com/pages/terms.html 010113

Call us at (888) 365-1663 or visit us at www.consultmdlive.com

Scan with your smartphone to get the app.

17

MEDlink® is designed to help supplement your Employer's major medical plan. This plan provides supplemental coverage to help offset out-of-pocket costs that you may experience due to deductibles, co-payments and coinsurance of your medical plan.

About this Benefit

MEDlink®IV YOUR

BENEFITS

DID YOU KNOW?

33%

of total healthcare costs are paid

out-of-pocket.


City of Stephenville Benefits Website: www.mybenefitshub.com/cityofstephenville

AMERICAN PUBLIC LIFE

18


APSB-22354(TX) MGM/FBS City of Stephenville

*Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with notice.The premium and amount of benefits vary dependent upon the Plan selected at time of application.

Total Monthly Premiums by Plan*

Employee Employee & Spouse Employee & Child Employee & Family

Ages 18-54 $39.02 $90.17 $69.86 $120.92

Ages 55+ $56.50 $130.38 $99.58 $173.37

ENHANCED PLAN SUMMARY OF BENEFITS*

Base Policy Option 1

Maximum In-Hospital Benefits $2,500 per Covered Person per Calendar Year

In-Hospital Ambulance Benefit Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation where a Covered Person is Confined as an Inpatient. Limited to one trip per day.

In-Hospital Deductible $0 per Covered Person per Calendar Year

Outpatient Benefit Rider

Maximum Outpatient Benefits $1,000 per Covered Person per Calendar Year for Covered Outpatient Services

Outpatient Ambulance Benefit Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation where a Covered Person resides less than 18 hours. Limited to one trip per day.

Outpatient Deductible $0 per Covered Person per Calendar Year

Covered Outpatient ServicesHospital Emergency Room Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Urgent Care Facility Maximum of three Urgent Care visits per Covered Person per Calendar Year. Maximum of six Urgent Care visits per Calendar Year for all Covered Persons combined. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Outpatient Surgery Outpatient Surgery in Hospital Outpatient Facility or Freestanding Outpatient Surgery Center. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Diagnostic Testing Diagnostic Testing in a Hospital Outpatient Facility or MRI Facility. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Outpatient Treatment for a Serious Mental Illness in a Hospital Outpatient Facility

Maximum of 60 days of treatment per Covered Person per Calendar Year. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Benefit RiderPhysician Outpatient Treatment Benefit Rider

$25 per visit; Maximum of four visits per Covered Person per Calendar Year and eight visits per Calendar Year for all Covered Persons combined for treatment in a:s Hospital Outpatient Facilitys Freestanding Emergency Care Clinics Urgent Care Facility/Clinics Physician Office

MEDlink® IV EnhancedLimited Benefit Group Medical Expense Supplemental InsuranceCity of StephenvilleTHE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

19

EligibilityYou are eligible to be covered under this Policy/Certificate if you are Actively At Work, qualify for coverage as defined in the Master Application, are covered under your Employer’s Medical Plan and are under age 70 (if you work for an employer employing less than 20 employees). Your Eligible Dependents, as defined in the Policy/Certificate, are eligible for coverage if they are covered under the Employer’s Medical Plan. You must apply for insurance during the Initial Enrollment period or on the date the person first becomes eligible for coverage. If you do not apply during the Initial Enrollment period or on the date you become eligible for coverage, you may be subject to additional underwriting by APL. Evidence of coverage under your Employer’s Medical Plan is required.

When Coverage BeginsCoverage will begin on the requested Certificate Effective Date or the Certificate Effective Date assigned by us, upon approval of your application, if our underwriting rules are met, the premium has been paid and all persons to be insured are covered under your Employer’s Medical Plan and you are Actively At Work on the Certificate Effective Date. If you are not Actively At Work on the Certificate Effective Date due to disability, Injury, Sickness, temporary layoff, leave of absence or Family and Medical Leave of Absence, coverage begins on the date you return to Actively At Work.

Limitations & ExclusionsNo benefits will be payable for expenses incurred during any period the Covered Person does not have coverage under your Employer’s Medical Plan, except as provided in the Absence of the Insured’s Employer’s Medical Plan provision, described in the Policy.

A hospital is not an institution, or part thereof, used as: a place for rehabilitation, a place for rest or for the aged, a nursing or convalescent home, a long term nursing unit or geriatrics ward, or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients.

Pre-Existing Condition LimitationNo benefits are payable during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date for any loss resulting from a Pre-Existing Condition. The Pre-Existing Condition Limitation will apply only if the Covered Person is subject to a Pre-Existing Condition Limitation under the Employer’s Medical Plan. Therefore, any Pre-Existing Condition Limitation applied to the Major Medical plan would, in effect, limit coverage under this plan.

ExclusionsNo benefits are payable for any loss resulting from or caused, whether directly or indirectly, by:

s war or any act of war, whether declared or undeclared, oractive service in the armed forces; (This exclusion includes Accident sustained or Sickness contracted while in the service of any military, naval or air force of any country engaged in war. If coverage is suspended for any Covered Person during a period of military service, APL will refund the pro-rata portion of any premium paid for any such Covered Person upon receipt of your written request)

s an intentionally self-inflicted Injury or Sickness;s suicide or attempted suicide, while sane or insane;s rest care or rehabilitative care and treatment;s outpatient routine newborn care;s voluntary abortion except, with respect to you or your covered

Eligible Dependent spouse:s where you or your Dependent spouse’s life would be

endangered if the fetus were carried to term; ors where medical complications have arisen from abortion;

s pregnancy of an Eligible Dependent child;

s participating in a riot, insurrection, rebellion, civil commotion,civil disobedience or unlawful assembly; (This does not includea loss which occurs while acting in a lawful manner within thescope of authority.)

s committing, or attempting to commit, an illegal act that isdefined as a felony; (Felony is as defined by the law of thejurisdiction in which the act takes place.)

s participation in a contest of speed in power driven vehicles,parachuting or hang gliding;

s air travel, except:s as a fare-paying passenger on a commercial airline on a

regularly scheduled route; ors as a passenger for transportation only and not as a pilot or

crew member;s being intoxicated or under the influence of any narcotic unless

administered by a Physician or taken according to the Physician’sinstructions; (Intoxication means that which is determined anddefined by the laws and jurisdiction of the geographical area inwhich the event that caused the loss occurred.)

s alcoholism or drug addiction;s sex changes;s experimental treatment, drugs or surgery;s Accident or Sickness arising out of, and in the course of, any

occupation for compensation, wage or profit; (This does notapply to those sole proprietors or partners not covered byWorkers’ Compensation.)

s dental or vision services, including treatment, surgery,extractions or x-rays, unless:s resulting from an Accident occurring while the Covered

Person’s coverage is in force and if performed within 12months of the date of such Accident; ors due to congenital disease or anomaly of a covered newborn

child.s routine examinations, such as health exams, periodic check-ups

or routine physicals, except when part of Inpatient routinenewborn care;

s elective cosmetic surgery;s drugs (prescription and non-prescription for use outside of a

covered facility as defined in this Policy/Certificate or anyattached rider);

s sterilization and reversal of sterilization;s an expense that does not meet the definition of Covered Charges;s an expense or service that exceeds any of the Maximum

Benefits, as shown in the Schedule of Benefits; ors any expense for which benefits are not payable under your Other

Medical Plan.

Premium ChangesThe premium rates may be changed by APL at the first anniversary date of this Policy or any premium due date thereafter. No such increase in rates will be made unless 60 days prior notice is given to the Policyholder. Premiums will not increase during the initial 12 months of coverage.

Optionally RenewableThis Policy is renewable at the option of APL. The Policyholder or APL may terminate this Policy on any premium due date after the first anniversary following the Policy Effective Date, subject to 60 days written notice.

Termination of CertificateYour insurance coverage under this Certificate and any attached riders will end on the earliest of these dates:s the date the Policy terminates;s the end of the grace period if the premium remains unpaid;s the date you no longer qualify as an Insured;s the date you attain age 70 (if you work for an employer employing

less than 20 employees);s the date your coverage under your Employer’s Medical Plan ends; ors the date of your death.

Important Policy Provisions

MEDlink® IV EnhancedLimited Benefit Group Medical Expense Supplemental Insurance

APSB-22354(TX) MGM/FBS City of Stephenville20

Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the certificate/policy and riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form MEDlink® Series | Texas | Limited Benefit Group Medical Expense Supplemental Insurance | (10/14) | City of Stephenville


2305 Lakeland Drive | Flowood, MS 39232ampublic.com | 800.256.8606

Termination of CoverageYour insurance coverage under this Certificate and any attached riders for a Covered Person will end as follows:s the date the Policy terminates;s the date the Certificate terminates;s the end of the Certificate Month in which APL receives a written request

from you to terminate the Covered Person’s coverage;s the date a Covered Person no longer qualifies as an Insured or

Eligible Dependent; ors the date of the Covered Person’s death.

APL may end the coverage of any Covered Person who submits a fraudulent claim.

Cobra Continuation of CoverageThis plan may be continued in accordance with the Consolidated Omnibus Reconciliation Act of 1986.

MEDlink® IV EnhancedLimited Benefit Group Medical Expense Supplemental Insurance

21

Accident insurance is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or a not-so-serious, injury. Accident coverage is low cost protection available to you and your family without evidence of insurability.

About this Benefit

Accident YOUR

BENEFITS

A-3 Supplemental Limited Benefit Accident Expense Insurance

THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A

SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES

THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’

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

Summary of Benefits*

Benefit Description Level 2 - 2 Unit

Accidental Death - per unit $10,000

Medical Expense Accidental Injury Benefit - per unit actual charges up to $1,000

Daily Hospital Confinement Benefit $150 per day

Air and Ground Ambulance Benefit actual charges up to $2,500

Accidental Dismemberment BenefitSingle finger or toe Multiple fingers or toesSingle hand, arm, foot or legMultiple hands, arms, feet or legs

$1,000 $1,000 $5,000

$10,000

Accidental Loss of Sight Benefit - per unit Loss of Sight in one eye Loss of Sight in both eyes

$5,000 $10,000

Optional Benefit Riders

Gunshot Wound Benefit Rider(Primary Insured Only/Public Safety Personnel Only)

once per 24 hours$1,000 benefit

Individual Individual & Spouse 1 Parent Family 2 Parent Family

Level 2 - 2 Unit $17.10 $29.80 $34.90 $47.60

*The premium and amount of benefits vary dependent upon the Plan selected at time of application. Premiums are subject to increase with notice.

of disabling injuries

suffered by American

workers are not work

related.

DID YOU KNOW?

36% of American workers

report they always or

usually live paycheck

to paycheck.

2/3


City of Stephenville Website: www.mybenefitshub.com/cityofstephenville


APSB-22329(TX)-MGM/FBS City of Stephenville

City of Stephenville


Gunshot Wound Benefit Rider

Monthly

Premium

Benefit per 24

Hour Period

$1.00 $1,000

22


Accident insurance is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or a not-so-serious,injury. Accident coverage is low cost protectionavailable to you and your family without evidence of insurability.

About this Benefit

AccidentYOUR

BENEFITS

A-3 Supplemental Limited Benefit Accident Expense Insurance

THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A

SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES

THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’

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

Summary of Benefits*

Benefit Description Level 2 - 2 Unit

Accidental Death - per unit $10,000

Medical Expense Accidental Injury Benefit - per unit actual charges up to $1,000

Daily Hospital Confinement Benefit $150 per day

Air and Ground Ambulance Benefit actual charges up to $2,500

Accidental Dismemberment BenefitSingle finger or toe Multiple fingers or toes Single hand, arm, foot or leg Multiple hands, arms, feet or legs

$1,000 $1,000 $5,000

$10,000

Accidental Loss of Sight Benefit - per unit Loss of Sight in one eye

Loss of Sight in both eyes $5,000

$10,000


Gunshot Wound Benefit Rider (Primary Insured Only/Public Safety Personnel Only)

once per 24 hours $1,000 benefit

Individual Individual & Spouse 1 Parent Family 2 Parent Family

Level 2 - 2 Unit $17.10 $29.80 $34.90 $47.60

*The premium and amount of benefits vary dependent upon the Plan selected at time of application. Premiums are subject to increase with notice.

of disabling injuries

suffered by American

workers are not work

related.

DID YOU KNOW?

36% of American workers

report they always or

usually live paycheck

to paycheck.

2/3


City of Stephenville Website: www.mybenefitshub.com/cityofstephenville


APSB-22329(TX)-MGM/FBS City of Stephenville

City of Stephenville


Gunshot Wound Benefit Rider

Monthly

Premium

Benefit per 24

Hour Period

$1.00 $1,000

23

A-3 Supplemental Limited Benefit Accident Expense Insurance A-3 Supplemental Limited Benefit Accident Expense Insurance

Underwritten by American Life Insurance Company. This is a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the certificate/policy and riders. This coverage does not replace Workers’ Compensation Insurance. | This product is inappropriate for people whoare eligible for Medicaid coverage. | Policy Form A3 Series | Texas | Supplemental Limited Benefit Accident Expense Insurance Policy | (10/14) | City of Stephenville

Eligibility This policy will be issued to only those persons who meet American Public Life Insurance Company’s insurability requirements. Persons not meeting APL’s insurability requirements will be excluded from coverage by an endorsement attached to the policy.

Base Policy and Optional Benefits No benefits are payable for a pre-existing condition. Pre-existing condition means an Injury that pertains solely to an Accidental Bodily Injury which resulted from an accident sustained before the Effective Date of coverage. Pre-Existing Conditions specifically named or described as permanently excluded in any part of this contract are never covered.

A Hospital is not an institution which is primarily a place for alcoholics or drug addicts; the aged; a nursing, rest or convalescent nursing home; a mental institution or sanitarium; a facility contracted for or operated by the United States Government for treatment of members or ex-members of the armed forces (unless You are legally required to pay for services rendered in the absence of insurance); or, a long-term nursing unit or geriatrics ward.

Medical Expense Accidental Injury Benefit Expenses must commence within 60 days of the covered accident. The maximum benefit amount payable for any one accident for the Insured Person shall not exceed the Medical Expense Benefit.

Air and Ground Ambulance Benefit Emergency transportation must occur within 21 calendar days of the accident causing such Injury.

Daily Hospital Confinement Benefit The maximum benefit period for this benefit is 30 days per covered accident.

Accidental Death Accidental Death must result within 90 days of the covered accident causing the injury.

Accidental Dismemberment Benefit The total amount payable for all Losses resulting from the same accident will not exceed the Maximum Dismemberment Benefit of $5,000 cumulative per unit, per Accident. Loss must be within 90 days of the accident causing such Injury.

Gunshot Wound Benefit Rider Only This Rider does not pay benefits for: any non-fatal Gunshot Wound received in a non - occupational related shooting; or, non - fatal Gunshot Wounds received while on active duty in the armed services (the company will return any premium paid past the time of entry into the armed forces when notice is received).

This Rider does not pay benefits for self-inflected Gunshot Wound.

This Rider is subject to all the Provisions, Conditions, Limitations and Exclusions of the Policy to which it is attached, which are not in conflict with those of the Rider.

Gunshot Wound Benefit Rider is only available through payroll deduction.

The Gunshot Wound Benefit Rider is guaranteed renewable to age 65 or age 70, if actively at work. While this Rider is in effect, premiums are due according to the terms of the Policy. We reserve the right to change premium rates by class.

Exclusions Benefits otherwise provided by this Policy will not be payable for services or expenses or any such Loss resulting from or in connection with:

(1) sickness, illness or bodily infirmity;(2) suicide, attempted suicide or intentional self-inflicted

Injury, whether sane or insane;(3) dental care or treatment unless due to accidental Injury

to natural teeth;(4) war or any act of war (whether declared or undeclared)

or participating in a riot or felony;(5) alcoholism or drug addiction;(6) travel or flight in or descent from any aircraft or device

which can fly above the earth’s surface in any capacityother than as a fare paying passenger on a regularlyscheduled airline;

(7) Injury originating prior to the effective date of thePolicy;

(8) Injury occurring while intoxicated (Intoxication meansthat which is determined and defined by the laws andjurisdiction of the geographical area in which the loss orcause of loss is incurred.);

(9) Voluntary inhalation of gas or fumes or taking ofpoison or asphyxiation;

(10) Voluntary ingestion or injection of any drug, narcotic orsedative, unless administered on the advice and takenin such doses as prescribed by a Physician;

(11) Injury sustained or sickness which first manifests itself while on full-time duty in the armed forces; (Upon notice, We will refund the proportion of unearned premium while in such forces.)

(12) Injury incurred while engaging in an illegal occupation; (13) Injury incurred while attempting to commit a felony or

an assault; (14) Injury to a covered person while practicing for or being

a part of organized or competitive rodeo, sky diving, hang gliding, parachuting or scuba diving;

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

(16) hernia, carpal tunnel syndrome or any complication therefrom;

If You are entitled to benefits under this Policy as a result of sprained or lame back, or any intervertebral disk conditions, such benefits shall be payable for a maximum period of time, not exceeding in the aggregate three (3) months for any Injury.

Guaranteed Renewable You have the right to renew this Policy until the first premium due date on or after Your 69th birthday, if you pay the correctpremium when due or within the Grace Period. When an Insured’s coverage terminates at age 70, coverage for other Insured Persons, if any, shall continue under this Policy. We have the right to change premium rates by class.

APSB-22329(TX)-MGM/FBS City of Stephenville APSB-22329(TX)-MGM/FBS City of Stephenville

2305 Lakeland Drive | Flowood, MS 39232

ampublic.com | 800.256.8606

24

A-3 Supplemental Limited Benefit Accident Expense Insurance A-3 Supplemental Limited Benefit Accident Expense Insurance

Underwritten by American Life Insurance Company. This is a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the certificate/policy and riders. This coverage does not replace Workers’ Compensation Insurance. | This product is inappropriate for people who are eligible for Medicaid coverage. | Policy Form A3 Series | Texas | Supplemental Limited Benefit Accident Expense Insurance Policy | (10/14) | City of Stephenville

EligibilityThis policy will be issued to only those persons who meet American Public Life Insurance Company’s insurability requirements. Persons not meeting APL’s insurability requirements will be excluded from coverage by an endorsement attached to the policy.

Base Policy and Optional Benefits No benefits are payable for a pre-existing condition. Pre-existing condition means an Injury that pertains solely to an AccidentalBodily Injury which resulted from an accident sustained before the Effective Date of coverage. Pre-Existing Conditions specifically named or described as permanently excluded in anypart of this contract are never covered.

A Hospital is not an institution which is primarily a place for alcoholics or drug addicts; the aged; a nursing, rest orconvalescent nursing home; a mental institution or sanitarium; a facility contracted for or operated by the United States Government for treatment of members or ex-members of the armed forces (unless You are legally required to pay for services rendered in the absence of insurance); or, a long-term nursing unit or geriatrics ward.

Medical Expense Accidental Injury BenefitExpenses must commence within 60 days of the covered accident. The maximum benefit amount payable for any one accident for the Insured Person shall not exceed the Medical Expense Benefit.

Air and Ground Ambulance BenefitEmergency transportation must occur within 21 calendar days of the accident causing such Injury.

Daily Hospital Confinement BenefitThe maximum benefit period for this benefit is 30 days per covered accident.

Accidental DeathAccidental Death must result within 90 days of the covered accident causing the injury.

Accidental Dismemberment Benefit The total amount payable for all Losses resulting from the same accident will not exceed the Maximum Dismemberment Benefit of $5,000 cumulative per unit, per Accident. Loss must be within 90 days of the accident causing such Injury.

Gunshot Wound Benefit Rider OnlyThis Rider does not pay benefits for: any non-fatal Gunshot Wound received in a non - occupational related shooting; or, non - fatal Gunshot Wounds received while on active duty in the armed services (the company will return any premium paid past the time of entry into the armed forces when notice is received).

This Rider does not pay benefits for self-inflected Gunshot Wound.

This Rider is subject to all the Provisions, Conditions, Limitations and Exclusions of the Policy to which it is attached, which are not in conflict with those of the Rider.

Gunshot Wound Benefit Rider is only available through payrolldeduction.

The Gunshot Wound Benefit Rider is guaranteed renewable to age 65 or age 70, if actively at work. While this Rider is in effect, premiums are due according to the terms of the Policy. We reserve the right to change premium rates by class.

Exclusions Benefits otherwise provided by this Policy will not be payable for services or expenses or any such Loss resulting from or in connection with:

(1) sickness, illness or bodily infirmity; (2) suicide, attempted suicide or intentional self-inflicted

Injury, whether sane or insane; (3) dental care or treatment unless due to accidental Injury

to natural teeth; (4) war or any act of war (whether declared or undeclared)

or participating in a riot or felony; (5) alcoholism or drug addiction;(6) travel or flight in or descent from any aircraft or device

which can fly above the earth’s surface in any capacity other than as a fare paying passenger on a regularlyscheduled airline;

(7) Injury originating prior to the effective date of the Policy;

(8) Injury occurring while intoxicated (Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the loss or cause of loss is incurred.);

(9) Voluntary inhalation of gas or fumes or taking of poison or asphyxiation;

(10) Voluntary ingestion or injection of any drug, narcotic orsedative, unless administered on the advice and taken in such doses as prescribed by a Physician;

(11) Injury sustained or sickness which first manifests itselfwhile on full-time duty in the armed forces; (Uponnotice, We will refund the proportion of unearnedpremium while in such forces.)

(12) Injury incurred while engaging in an illegal occupation;(13) Injury incurred while attempting to commit a felony or

an assault;(14) Injury to a covered person while practicing for or being

a part of organized or competitive rodeo, sky diving,hang gliding, parachuting or scuba diving;

(15) driving in any race or speed test or while testing anautomobile or any vehicle on any racetrack orspeedway;

(16) hernia, carpal tunnel syndrome or any complicationtherefrom;

If You are entitled to benefits under this Policy as a result of sprained or lame back, or any intervertebral disk conditions, such benefits shall be payable for a maximum period of time, not exceeding in the aggregate three (3) months for any Injury.

Guaranteed Renewable You have the right to renew this Policy until the first premium due date on or after Your 69th birthday, if you pay the correct premium when due or within the Grace Period. When an Insured’s coverage terminates at age 70, coverage for other Insured Persons, if any, shall continue under this Policy. We have the right to change premium rates by class.

APSB-22329(TX)-MGM/FBS City of Stephenville APSB-22329(TX)-MGM/FBS City of Stephenville

2305 Lakeland Drive | Flowood, MS 39232

ampublic.com | 800.256.8606

25

www.ampublic.com

Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, treatment and dental disease.

About this Benefit

Dental YOUR BENEFITS PACKAGE

Good dental care may improve your overall health.

Also Women with gum disease may be at greater risk of giving birth to a preterm or low birth weight baby.

DID YOU KNOW?

UNITEDHEALTHCARE



Dental PPO

United Healthcare Insurance Company (30100)® Dental Plan Contributory Options PPO 30 /covered dental services New Standard/2P027/U90

NON-ORTHODONTICS ORTHODONTICS

NETWORK NON-NETWORK NETWORK NON-NETWORK

Individual Annual Deductible $50 $50 $0 $0

Family Annual Deductible dependent child(ren) to age 26

$150 $150 $0 $0

Maximum (the sum of all Network and Non-Network benefits will not exceed Annual maximum)

$1,000 per person per Calendar Year

$1,000 per person per Calendar Year

$1,000 per person per Lifetime

$1,000 per person per Lifetime

New enrollee's waiting period None

Annual deductible applies to preventive and diagnostic services

No (In Network) No (Out Network)

Annual deductible applies to orthodontic services No

Orthodontic Eligibility Requirement Child Only (Up to Age 19)

CMM-Annual Roll-Over Yes

COVERED SERVICES * NETWORK PLAN

PAYS** NON-NETWORK PLAN PAYS***

BENEFIT GUIDELINES

DIAGNOSTIC SERVICES

Periodic Oral Evaluation Radiographs Lab and Other Diagnostic Tests

100% 100% See Exclusions and Limitations section

for benefit guidelines.

PREVENTIVE SERVICES

Prophylaxis (Cleaning) Fluoride Treatment (Preventive) Sealants Space Maintainers



BASIC SERVICES

Restorations (Amalgams or Composite)* Emergency Treatment/General Services Simple Extractions



MAJOR SERVICES

Oral Surgery (incl. surgical extractions) Periodontics Endodontics Inlays/Onlays/Crowns Dentures and Removable Prosthetics Fixed Partial Dentures (Bridges)



ORTHODONTIC SERVICES

Diagnose or correct misalignment of the teeth or bite 50% 50%

# This plan includes a roll-over maximum benefit. Some of the unused portion of your annual maximum may be available in future periods.

* Your dental plan provides that where two or more professionally acceptable dental treatments for a dental condition exist, your plan bases reimbursement on the least costly treatment alternative. If you and your dentist agreed on a treatment which is more costly than the treatment on which the plan benefit is based, you will be responsible for the difference between the fee for service rendered and the fee covered by the plan. In addition, a pre-treatment estimate is recommended for any service estimated to cost over $500; please consult your dentist.**The network percentage of benefits is based on the discounted fees negotiated with the provider.***The non-network percentage of benefits is based on the usual and customary fees in the geographic areas in which the expenses are incurred.In accordance with the Illinois state requirement, a partner in a Civil Union is included in the definition of Dependent. For a complete description of Dependent Coverage, please refer to your Certificate of Coverage.

The Prenatal Dental Care (not available in WA) and Oral Cancer Screening programs are covered under this plan.

Rates

Employee $24.93

Employee + Spouse $50.33

Employee + Child(ren) $66.66

Employee + Family $92.06

27

Dental PPO

UnitedHealthcare/Dental Exclusions and Limitations Dental Services described in this section are covered when such services are: 1. Necessary;2. Provided by or under the direction of a Dentist or other

appropriate provider as specifically described;3. The least costly, clinically accepted treatment, and4. Not excluded as described in the Section entitled. General

Exclusions.

General Limitations PERIODIC ORAL EVALUATION

Limited to 2 times per consecutive 12 months.

COMPLETE SERIES OR PANOREX RADIOGRAPHSLimited to 1 time per consecutive 36 months.

BITEWING RADIOGRAPHSLimited to 1 series of films per calendar year.

EXTRAORAL RADIOGRAPHSLimited to 2 films per calendar year.

DENTAL PROPHLYAXISLimited to 2 times per consecutive 12 months.

FLUORIDE TREATMENTSLimited to covered persons under the age of 16 years, andlimited to 2 times per consecutive 12 months.

SPACE MAINTAINERSLimited to covered persons under the age of 16 years,limited to 1 per consecutive 60 months. Benefit includesall adjustments within 6 months of installation.

SEALANTSLimited to covered persons under the age of 16 years, andonce per first or second permanent molar everyconsecutive 36 months.

RESTORATIONS(Amalgam or Composite) Multiple restorations on onesurface will be treated as a single filling.

PIN RETENTIONLimited to 2 pins per tooth; not covered in addition to castrestoration.

INLAYS AND ONLAYSLimited to 1 time per tooth per consecutive 60 months.Covered only when a filling cannot restore the tooth.

CROWNSLimited to 1 time per tooth per consecutive 60 months.Covered only when a filling cannot restore the tooth.

POST AND CORESCovered only for teeth that have had root canal therapy.

SEDATIVE FILLINGSCovered as a separate benefit only if no other service,other than x-rays and exam, were performed on the sametooth during the visit.

SCALING AND ROOT PLANINGLimited to 1 time per quadrant per consecutive 24months.

ROOT CANAL THERAPYLimited to 1 time per tooth per lifetime.

PERIODONTAL MAINTENANCELimited to 2 times per consecutive 12 months followingactive or adjunctive periodontal therapy, exclusive ofgross debridement.

FULL DENTURESLimited to 1 time every consecutive 60 months. Noadditional allowances for precision or semi-precisionattachments.

PARTIAL DENTURESLimited to 1 time every consecutive 60 months. Noadditional allowances for precision or semi-precisionattachments.

RELINING AND REBASING DENTURESLimited to relining/rebasing performed more than 6months after the initial insertion. Limited to 1 time perconsecutive 12 months.

REPAIRS TO FULL DENTURES, PARTIAL DENTURES,BRIDGESLimited to repairs or adjustments performed more than12 months after the initial insertion. Limited to 1 perconsecutive 6 months.

PALLIATIVE TREATMENTCovered as a separate benefit only if no other service,other than the exam and radiographs, were performed onthe same tooth during the visit.

OCCLUSAL GUARDSLimited to 1 guard every consecutive 36 months and onlycovered if prescribed to control habitual grinding.

FULL MOUTH DEBRIDEMENTLimited to 1 time every consecutive 36 months.

GENERAL ANESTHESIACovered only when clinically necessary.

OSSEOUS GRAFTSLimited to 1 per quadrant or site per consecutive 36months.

PERIODONTAL SURGERYHard tissue and soft tissue periodontal surgery are limitedto 1 quadrant or site per consecutive 36 months persurgical area.

REPLACEMENT OF COMPLETE DENTURES, FIXED ORREMOVABLE PARTIAL DENTURES, CROWNS, INLAYS ORONLAYSReplacement of complete dentures, fixed or removablepartial dentures, crowns, inlays or onlays previouslysubmitted for payment under the plan is limited to 1 timeper consecutive 60 months from initial or supplementalplacement. This includes retainers, habit appliances, andany fixed or removable interceptive orthodonticappliances.

28

Dental PPO

General ExclusionsThe following are not covered:

Dental Services that are not Necessary.

Hospitalization or other facility charges.

Any Dental Procedure performed solely for cosmetic/aesthetic reasons. (Cosmetic procedures are thoseprocedures that improve physical appearance.)

Reconstructive surgery, regardless of whether or not thesurgery is incidental to a dental disease, injury, orCongenital Anomaly, when the primary purpose is toimprove physiological functioning of the involved part ofthe body.

Any Dental Procedure not directly associated with dentaldisease.

Any Dental Procedure not performed in a dental setting.

Procedures that are considered to be Experimental,Investigational or Unproven. This includes pharmacologicalregimens not accepted by the American Dental Association(ADA) Council on Dental Therapeutics. The fact that anExperimental, Investigational or Unproven Service,treatment, device or pharmacological regimen is the onlyavailable treatment for a particular condition will not resultin Coverage if the procedure is considered to beExperimental, Investigational or Unproven in the treatmentof that particular condition.

Placement of dental implants, implant-supportedabutments and prostheses.

Drugs/medications, obtainable with or without aprescription, unless they are dispensed and utilized in thedental office during the patient visit.

Setting of facial bony fractures and any treatmentassociated with the dislocation of facial skeletal hardtissue.

Treatment of benign neoplasms, cysts, or other pathologyinvolving benign lesions, except excisional removal.Treatment of malignant neoplasms or CongenitalAnomalies of hard or soft tissue, including excision.

Replacement of complete dentures, fixed and removablepartial dentures or crowns if damage or breakage wasdirectly related to provider error. This type of replacementis the responsibility of the Dentist. If replacement isNecessary because of patient non-compliance, the patientis liable for the cost of replacement.

Services related to the temporomandibular joint (TMJ),either bilateral or unilateral. Upper and lower jaw bonesurgery (including that related to the temporomandibularjoint). No Coverage is provided for orthognathic surgery,jaw alignment, or treatment for the temporomandibularjoint.

Charges for failure to keep a scheduled appointmentwithout giving the dental office 24 hours notice.

Expenses for Dental Procedures begun prior to theCovered Person becoming enrolled under the Policy.

Fixed or removable prosthodontic restorationprocedures for complete oral rehabilitation orreconstruction.

Attachments to conventional removable prostheses orfixed bridgework. This includes semi-precision orprecision attachments associated with partial dentures,crown or bridge abutments, full or partial overdentures,any internal attachment associated with an implantprosthesis, and any elective endodontic procedurerelated to a tooth or root involved in the constructionof a prosthesis of this nature.

Procedures related to the reconstruction of a patient'scorrect vertical dimension of occlusion (VDO).

Occlusal guards used as safety items or to affectperformance primarily in sports-related activities.

Placement of fixed partial dentures solely for thepurpose of achieving periodontal stability.

Services rendered by a provider with the same legalresidence as a Covered Person or who is a member of aCovered Person's family, including spouse, brother,sister, parent or child.

Dental Services otherwise Covered under the Policy, butrendered after the date individual Coverage under thePolicy terminates, including Dental Services for dentalconditions arising prior to the date individual Coverageunder the Policy terminates.

Acupuncture; acupressure and other forms ofalternative treatment, whether or not used asanesthesia.

Orthodontic service Coverage does not include theinstallation of a space maintainer, any treatmentrelated to treatment of the temporomandibular joint,or a surgical procedure to correct a malocclusion,replacement of retainers, habit appliances, and anyfixed or removable interceptive orthodontic appliancespreviously submitted for payment under the plan.

Foreign Services are not Covered unless required as anEmergency.

Dental Services received as a result of war or any act ofwar, whether declared or undeclared or caused duringservice in the armed forces of any country.

Services for injuries or conditions covered by Worker’sCompensation or employer liability laws, and servicesthat are provided without cost to the Covered Personby any municipality, county, or other politicalsubdivision. Covered Person by any municipality,county, or other political subdivision. This exclusiondoes not apply to any services covered by Medicaid orMedicare.

29

Vision insurance provides coverage for routine eye examinations and may cover all or part of the costs associated with contact lenses, eyeglasses and vision correction, depending on the plan.

About this Benefit

Vision YOUR BENEFITS PACKAGE

75%

DID YOU KNOW?

of U.S. residents between age 25 and 64 require some sort of vision

correction.

UNITEDHEALTHCARE



Vision

Important to Remember Benefit frequency based on last date of service.

Your $150.00 contact lens allowance is applied to thefitting/evaluation fees as well as the purchase ofcontact lenses. For example, if the fitting/evaluationfee is $30, you will have $120.00 toward thepurchase of contact lenses. The allowance may beseparated at some retail chain locations between theexamining physician and the optical store.

You can log on to our website to print off yourpersonalized ID card. An ID card is not required forservice, but is available as a convenience to youshould you wish to have an ID card to take to yourappointment.

Out-of-Network Reimbursement, when applicable:Receipts for services and materials purchased ondifferent dates must be submitted together at thesame time to receive reimbursement. Receipts mustbe submitted within 12 months of date of service tothe following address: UnitedHealthcare VisionAttn. Claims Department P.O. Box 30978 Salt LakeCity, UT 84130 FAX: 248.733.6060.

At a participating network provider you will receive a20% discount on an additional pair of eyeglasses orcontact lenses. This program is available after yourvision benefits have been exhausted. Please notethat this discount shall not be considered insurance,and that UnitedHealthcare Vision shall neither paynor reimburse the provider or member for any fundsowed or spent. Not all providers may offer thisdiscount. Please contact your provider to see if theyparticipate. Discounts on contact lenses may vary byprovider. Additional materials do not have to bepurchased at the time of initial material purchase.Additional materials can be purchased at a discountany time after the insured benefit has been used.

Monthly Premiums EE Only $7.06

EE + Spouse $12.00

EE + Family $17.66

Co-Pays for In-Network Services Exam $10

Materials $25

Benefit Frequency Comprehensive Exam Once every 12 months

Spectacle Lenses Once every 12 months

Frames Once every 24 months

Contact Lenses in Lieu of Eye Glasses

Once every 12 months

Frame Benefit Private Practice Provider $130.00 retail frame allowance

Retail Chain Provider $130.00 retail frame allowance

Lens Options Standard scratch-resistant coating—covered in full. Other optional lens upgrades may be offered at a discount. (Discount varies by provider.)

Contact Lens Benefit Covered-in-full elective contact lenses1

The fitting/evaluation fees, contact lenses, and up to two follow-up visits are covered in full (after copay). If you choose disposable contacts, up to 6 boxes are included when obtained from a network provider.

All other elective contact lenses A $150.00 allowance is applied toward the fitting/evaluation fees and purchase of contact lenses outside the covered selection (materials copay does not apply). Toric, gas permeable and bifocal contact lenses are examples of contact lenses that are outside of our covered contacts.

Necessary contact lenses2

Covered in full after applicable copay.

Laser Vision Benefit

UnitedHealthcare Vision has partnered with the Laser Vision Network of America (LVNA) to provide our members with access to discounted laser vision correction providers. Members receive 15% off usual and customary pricing, 5% off promotional pricing at over 500 network provider locations and even greater discounts through set pricing at LasikPlus locations. For more information, call 1-888-563-4497 or visit us at www.uhclasik.com.

Out-of-Network Reimbursements Up To: (copays do not apply)

Exams $40.00

Frames $45.00

Single Vision Lenses $40.00

Bifocal Lenses $60.00

Trifocal Lenses $80.00

Lenticular Lenses $80.00

Elective Contacts in Lieu of Eye Glasses3

$150.00

Necessary Contacts in Lieu of Eye Glasses2

$210.00

1Coverage for Covered Contact Lens Selection does not apply at Costco, Walmart or Sam’s Club locations. The allowance for non-selection contact lenses will be applied toward the fitting/evaluation fee and purchase of all contacts.

2Necessary contact lenses are determined at the provider’s discretion for one or more of the following conditions: Following post cataract surgery without intraocular lens implant; to correct extreme vision problems that cannot be corrected with spectacle lenses; with certain conditions such as keratoconus, anisometropia, irregular corneal/astigmatism, aphakia, facial deformity or corneal deformity. If your provider considers your contacts necessary, you should ask your provider to contact UnitedHealthcare Vision confirming reimbursement that UnitedHealthcare Vision will make before you purchase such contacts.

3The out-of-network reimbursement applies to materials only. The fitting/evaluation is not included.

31

Disability insurance protects one of your most valuable assets, your ability to earn a living. This insurance will replace a portion of your income in the event that you become physically unable to work. Short term disability coverage provides benefits when you are unable to work for a short period of time due to a covered sickness or injury.

About this Benefit

Short Term Disability YOUR BENEFITS PACKAGE




DID YOU KNOW?

60% of Americans do not have a “rainy day” fund to cover three

months of unanticipated financial emergencies.

32


APSB-22336(TX)- City of Stephenville

GDIS11APL Group Short-Term Disability Income InsuranceCity of Stephenville

THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

SUMMARY OF BENEFITS FOR CITY OF STEPHENVILLE Plan: Standard Industry Non-Takeover: No consideration will be given to prior group disability income coverage in determining the effect of Pre-Exist-ing Conditions on benefits payable.

Eligibility: All active, permanent employees or members and employees of members on Active Employment working 20 hours or more per week who have satisfied the employer’s waiting period for Eligibility, which shall be no less than 90 days from date of hire. Evidence of insurability acceptable by APL may be required.

Age at Entry: Premiums are based on age at entry and do not increase solely with attained age.

Pre-Existing Condition Limitation: No Disability Benefit is payable if Disability is caused by or resulting from a Pre-Existing Condition and begins before you have been continuously covered under the policy for 12 months. This provision will not apply if you have gone treatment free, incurred no expense, taken no medication and received no diagnosis or advice from a Physician for 12 consecutive months after the Effective Date of coverage for such condition(s). This limitation will not apply to a Disability resulting from a Pre-Existing Condition that begins after you have been continuously covered under the policy for 12 months. Any increase in benefits will be subject to this Pre-Existing Condition Limitation. A new Pre-Existing Condition period must be satisfied with respect to any increase applied for and approved by APL.

GROUP SHORT-TERM DISABILITY PREMIUMS*Monthly Premium per $100 of Covered Monthly Benefit

Option I Elimination Period: 0 Days injury 7 Days sickness s Benefit Period: 180 Days

Ages 18-39 Ages 40-49 Ages 50-59 Ages 60+

$2.16 $2.34 $2.70 $3.40

*The premium and amount of benefits vary dependent upon Plan selected at time of application.

Policy BenefitsDisability Payments are payable when you are Disabled due to a covered Injury or Sickness while coverage is in force. Disability Payments will be provided for each period you remain Disabled due to a covered Disability and under the Regular and Appropriate Care of a Physician, which continues beyond the Elimination Period. Disability Payments will be provided for only one Disability when more than one Disability exists at the same time or a Disability results from two or more causes. Disability will be considered to have begun on the date you were seen and treated by a Physician following continuous cessation of work.

Survivor BenefitUpon notification of your death, we will pay your eligible survivor(s) a lump sum benefit equal to two times your Disability Payment, for which you were eligible for during the calendar month preceding death, if on the date of your death your Disability continued for 90 or more consecutive days and you were receiving or were entitled to receive Disability Payments under the Policy. If you have no eligible survivor(s), no payment will be made.

Accelerated Survivor BenefitYou may elect to receive the Survivor Benefit prior to your death if you have a Terminal Illness and you are receiving Disability Payments. You may elect the Accelerated Survivor Benefit only once during your lifetime. If you elect to receive the Accelerated Survivor Benefit prior to death, no Survivor Benefit will be paid upon your death.

Accidental Death Benefit The Accidental Death Benefit of $10,000 will be paid if you die as the direct result of an Injury and death occurs within 90 days after the date of the Injury. If you die and the Accidental Death Benefit applies, such benefit will be increased 1% for each full month that your Certificate was continuously in force just prior to death. The total increase shall not be more than 60%.

Waiver of Premium Benefit (not available for 90 Day Plan)If you become Disabled due to a covered Injury or Sickness and are eligible to receive a Disability Payment, your insurance will be continued without payment of premium. Waiver of Premium will begin the first of the month following your satisfaction of the Elimination Period or 90 days of continuous Disability, whichever is later, provided premium has been paid from the beginning of Disability to the date Waiver of Premium begins. Waiver of Premium will continue until the a) end of your Disability, b) end of the Maximum Benefit Period, c) date you are no longer eligibleto receive a Disability Payment, d) date the Policy terminates or e) dateyour employment with the Policyholder or subscribing Employer unit ends,whichever first occurs. We will require proof on an annual basis that youremain Disabled during said period.

Mental Illness Limited BenefitIf you become Disabled due to Mental Illness, Disability Payments will be paid up to the following: 90 Day Plan - 3 Months; 180 Day Plan - 3 Months; 1 Year Plan - 6 Months; 2 Year Plan - 1 Year provided you are under the Regular and Appropriate Care of a Physician, and receive medical treatment from either: a registered specialist in psychiatry; a Physician administering treatment on the advice of a registered specialist in psychiatry who certifies that such treatment is medically necessary; or a Physician, if in Our opinion, a specialist in psychiatry is not required to certify that such treatment is medically necessary.

Alcohol and Drug Addiction Limited Benefit If you are Disabled due to alcoholism or drug addiction, a limited benefit of up to 15 days for each Disability will be paid. In no event will benefits be paid beyond the Maximum Disability Period shown in the Policy Schedule of Benefits. If drug addiction is sustained at the hands of, or while under the Regular and Appropriate Care of a Physician in the course of treatment for Injury or Sickness, it will be covered the same as any other illness.

33

GDIS11APL Group Short-Term Disability Income

APSB-22336(TX)- City of Stephenville

Special Conditions Limited Benefit (2 Year Plan Only)If you are disabled due to a Special Condition and you are under the Regular and Appropriate Care of a Physician, Disability Payments will be provided for one year, not to exceed the Maximum Disability Period. Special Conditions means Chronic Fatigue Syndrome; Fibromyalgia; Environmental allergic illness; Self-Reported Symptoms; any disease, disorder, accident or injury of the neck or back not resulting in hemiplegia, paraplegia or quadriplegia. See your Policy for more specific information.

Disabled and Not Working BenefitYour Disability Payment will be the lesser of the Disability Benefit described in the Policy Schedule of Benefits or 60% of your Monthly Compensation less any Deductible Sources of Income you receive or are entitled to receive.

Disabled and Working BenefitAmerican Public Life will provide a Disability Payment if you are Disabled and your monthly Disability Earnings, if any, are less than 20% of your Monthly Compensation due to the same Injury or Sickness. If you are Disabled and your Disability Earnings are greater than 20% of your Monthly Compensation due to the same Injury or Sickness, we will figure your payment as follows: your Disability Payment will not be reduced as long as the Disability Earnings plus the gross Disability Benefit does not exceed 100% of your Monthly Compensation. If the Disability Earnings plus the gross Disability Benefit exceeds 100% of your Monthly Compensation, the Disability Payment will be reduced by the amount exceeding your Monthly Compensation. We will stop payments and your claim will end, if at any time you are no longer Disabled or if your Disability Earnings exceed 80% of your Monthly Compensation. The Elimination Period cannot be satisfied with days you are Disabled and working.

Successive DisabilitiesDisabilities which result from the same or related causes for which benefits are payable will be considered one period of Disability unless the Disabilities are separated by your return to Active Employment or any other gainful occupation for at least three consecutive months. A Disability due to a different or unrelated cause will be considered a new period of Disability.

Coverage or changes in coverage including increases will begin on the later of the requested Effective Date or the date we approve the written application, if you apply in writing on or before said Effective Date, meet our underwriting rules, are on Active Employment and have paid all applicable premiums due. If you are not on Active Employment due to an Injury or Sickness when your coverage would otherwise take effect, coverage will take effect on the first of the month following the date you return to Active Employment for at least five consecutive workdays. Any change in coverage will apply only to a Disability that begins after the Effective Date of such change, subject to all the provisions of the Policy. Increases or changes in coverage will be subject to an additional Pre-Existing Condition Limitation.

Deductible Sources of IncomeDeductible Sources of Income will include all of the following: Other group disability income Governmental or other retirement system, whether due to

disability, normal retirement or voluntary election of retirementbenefits

United States Social Security Act or similar plan or act, includingany amounts due your dependent(s) on account of your Disability

State Disability Unemployment compensation Sick leave or other salary or wage continuance plans provided

by the Employer which extend beyond 30 calendar days from thedate of Disability.

Minimum Disability BenefitThe Disability Payment payable will be no less than 10% or $100 of your Monthly Disability Benefit, whichever is greater.

Leave of AbsenceYour coverage may be continued for up to one year during a Leave of Absence approved in writing by your employer.

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

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

other loss during any period for which you are incarcerated in apenal or correctional institution for a period of 30 consecutivedays or longer

Injury or Sickness arising out of and in the course of anyoccupation for wage or profit, or for which you are entitled toWorkers’ Compensation.*

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

Termination of InsuranceYour insurance coverage will end on the earliest of these dates: the date you do not meet the Eligibility requirements as defined

in the Eligibility section of this brochure; the date you retire; the date you cease to be on Active Employment, except as

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

If your coverage ends as a result of your termination of Active Employment, such termination is caused by an Injury or Sickness for which Disability Benefits would be payable, and Disability is established prior to the termination of Active Employment, then Disability Benefits will be paid as if such termination had not occurred. Termination of the Policy will have no effect on Disability Payments that began before such termination. American Public Life may end your coverage if you make a fraudulent claim.

Underwritten by American Life Insurance Company. This brochure highlights important features of the policy. For complete details, please refer to your certificate/policy. Policy provisions and benefits may vary depending on the location of your employer or, where required by law, your state of residence. This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. | Policy Form GDIS11APL Series | Texas | Group Short-Term Disability Income Insurance Policy | (03/15) | MGM/FBS | City of Stephenville

Important Policy Provisions When Coverage Begins


34

www.ampublic.com

GDIS11APL Group Short-Term Disability Income

35

Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.

About this Benefit

Long Term Disability YOUR BENEFITS PACKAGE

Just over 1 in 4 of today's 20 year-olds will become disabled before

they retire.

DID YOU KNOW?

34.6 months is the duration of the

average disability claim.

UNITEDHEALTHCARE



Long Term Disability

Am I eligible? You are eligible if you are an active, full-time employee who works at least 30 hours per week on a regularly scheduled basis. You must choose to elect either the 40% plan or the 60% plan.

What is Long Term Disability Insurance?Long Term Disability Insurance pays you a portion of your Earnings if you cannot work because of a disabling illness or injury. This highlight sheet is an overview of your Long Term Disability Insurance. Once a group policy is issued to your employer, a certificate of coverage will be available to explain your benefits in detail.

Why do I need Long Term Disability Insurance? Voluntary Long Term Disability Insurance protects the financial security for you and your family. The ability to earn an income is something to be cherished and protected – disabilities happen, and they happen more frequently than most think. Can you afford to be disabled? Did You Know: 3 in 10 workers will be disabled for more than 90 days before the age of 65. Many American families live paycheck to paycheck, and the majority could not afford to go one month or one week, let alone 2 or 3 years, without the support of regular income. http://www.disabilitycanhappen.org

What is disability? Disability is defined in the UnitedHealthcare contract with your employer.

The Covered Person is Disabled or has a Disability when We determine that: 1. You are not Actively at Work and are unable to perform

some or all of the Material and Substantial Duties of yourRegular Occupation due to your Sickness or Injury; and

2. You have a 20% or more loss in Indexed Pre-DisabilityMonthly Earnings due solely to the same Sickness orInjury; and

3. You are under the Regular Care of a Physician.

Disability must begin while the Covered Person is insured under the Policy.

After 24 months of payments, the Covered Person is Disabled when We determine that due to the same Sickness or Injury, you are unable to perform some or all of the material and substantial duties of any Gainful Occupation for which you are reasonably fitted by education, training or experience and you continue to suffer a 40% or more loss in Indexed Pre-Disability Monthly Earnings due solely to the Sickness or Injury.

How much coverage would I have? 40% Plan—You may purchase coverage that pays you a benefit of 40% of your monthly Earnings to a maximum monthly benefit of $5,000 per month.

60% Plan—You may purchase coverage that pays you a benefit of 60% of your monthly Earnings to a maximum monthly benefit of $5,000 per month.

These plans include a minimum benefit of the greater of: 10% of the benefit based on Monthly Income Loss before the deduction of Other Income Benefits or $100 per month. Earnings are defined in the UnitedHealthcare contract with your employer.

How long do I have to wait before I can receive payment? (Elimination Period) You must be disabled for at least 90 days before you can receive a Long Term Disability Insurance benefit payment.

Are there other limitations to enrollment? The guaranteed issue amount is the amount of Insurance that you may elect without providing evidence of insurability. If you enroll during this enrollment period, your coverage is provided to you on a guaranteed basis - no medical information is required. If you enroll after this enrollment period, evidence of insurability will be required for all coverage amounts.

You must be Actively at Work with your employer on the day your coverage takes effect.

This coverage, like most group benefit Insurance, requires that a certain percentage of eligible employees participate. If that group participation minimum is not met, the insurance coverage that you have elected may not be in effect.

How long will my disability payments continue? For as long as you remain disabled, or until you reach your Social Security Normal Retirement Age (as stated in the 1983 revision of the United States Social Security Act.), whichever is sooner. If your disability occurs at age 60 or above, your payments may be reduced.

37


Can the duration or amount of my benefit be reduced? Yes. Your benefit duration may be reduced once you reach certain ages specified in the in chart below.

Maximum Benefit Period: Reducing Benefit Duration reflecting Social Security Normal Retirement Age

Age at Disability Maximum Benefit Period Greater of SSNRA * or Less than age 60 To age 65 Age 60 60 Months Age 61 48 Months Age 62 42 Months Age 63 36 Months Age 64 30 Months Age 65 24 Months Age 66 21 Months Age 67 18 Months Age 68 15 Months 69 and over 12 Months

*SSNRA means the Social Security Normal Retirement Age as figured by the 1983 amendment or any later amendment to theSocial Security Act.

In addition, as described below within the Important Details, your monthly Long Term Disability benefit may be reduced by other income you receive.

Cost by Age Band

Age 40% Plan

Monthly Rate 60% Plan

Monthly Rate

<25 $0.090 $0.140

25-29 $0.100 $0.170

30-34 $0.150 $0.250

35-39 $0.220 $0.380

40-44 $0.310 $0.550

45-49 $0.480 $0.800

50-54 $0.630 $1.050

55-59 $0.750 $1.270

60-64 $0.710 $1.130

65+ $0.710 $1.130

Use the formula below to calculate the cost of coverage:

For the 40% Plan To calculate monthly benefits: Annual Earnings ÷ 12 = monthly earnings x .40 = monthly benefit

To calculate monthly cost: monthly earnings x rate ÷ 100 = monthly cost

For the 60% Plan To calculate monthly benefits: Annual Earnings ÷ 12 = monthly earnings x .60 = monthly benefit

To calculate monthly cost: monthly earnings x rate ÷ 100 = monthly cost

38


Important Details This Benefit Highlights Sheet is an overview of the Long Term Disability Insurance being offered and is provided for illustrative purposes only and is not a contract. It in no way changes or affects the policy as actually issued. Only the insurance policy issued to the policyholder (your employer) can fully describe all of the provisions, terms, conditions, limitations and exclusions of your insurance coverage. In the event of any difference between the Benefit Highlights Sheet and the insurance policy, the terms of the insurance policy apply. Once a group policy is issued to your employer, a certificate of coverage will be available to explain your benefits in detail.

Exclusions You cannot receive Long Term Disability Insurance benefit payments for disabilities that are caused or contributed to by:

War or act of war (declared or not)

The commission of, or attempt to commit a felony

An intentionally self-inflicted injury

Any case where your being engaged in an illegaloccupation was a contributing cause to your disability

You must be under the regular care of a physician to receive benefits.

Mental Illness, Alcoholism, or Substance Abuse You can receive benefit payments for Long Term

Disabilities resulting from mental illness, alcoholism andsubstance abuse for a total of 24 months for all disabilityperiods during your lifetime.

Any period of time that you are confined in a hospital orother facility licensed to provide medical care for mentalillness, alcoholism and substance abuse does not counttoward the 24 months lifetime limit.

Pre-Existing Condition Exclusion We will not cover any Disability that begins during the first 12 months after the Covered Person’s Effective Date of insurance that is caused or contributed to by a Pre-Existing Condition.

Pre-Existing Condition means: any Sickness or Injury including Mental Illness, Substance Abuse for which the Covered Person, within 3 months prior to his Effective Date of insurance:

was diagnosed by or received Treatment from a legallyqualified Physician; or

had symptoms for which an ordinarily prudent personwould have sought Treatment.

Your benefit payments will be reduced by other income you receive or are eligible to receive due to your disability, such as:

Social Security Disability Insurance (please see nextsection for exceptions)

Workers' Compensation

Other employer-based Insurance coverage you mayhave

Unemployment benefits

Settlements or judgments for income loss

Retirement benefits that your employer fully or partiallypays for (such as a pension plan)

Loss of time or lost wages from a no-fault motor vehicleinsurance plan.

Benefits from Employer’s sick leave of salarycontinuation plan.

Your benefit payments will not be reduced by certain kinds of other income, such as:

Retirement benefits if you were already receiving thembefore you became disabled

Retirement benefits that are funded by your after-taxcontributions

Your personal savings, investments, IRAs or Keoghs

Profit-sharing

Most personal disability policies

Social Security increases

UnitedHealthcare Life and Disability products are provided by UnitedHealthcare Insurance Company; Unimerica Insurance Company; and in California by Unimerica Life Insurance Company; and in New York by Unimerica Life Insurance Company of New York. Texas Coverage is provided on Form LASD-POL-TX (05/03), Form UHCLD-POL 2/2008-TX, or UICLD-POL-TX 4/5. UnitedHealthcare Insurance Company is located in Hartford, CT; Unimerica Insurance Company and Unimerica Life Insurance Company in Milwaukee, WI; Unimerica Life Insurance Company of NY in New York, NY.

39

Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.

About this Benefit

Cancer YOUR

BENEFITS

Breast Cancer is

the most commonly

diagnosed cancer

in women.

DID YOU KNOW?

If caught early,

prostate cancer is one

of the most treatable

malignancies.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan

details on covered expenses, limitations and exclusions are included in the summary plan description located on the



40



GC13 Limited Benefit Group Cancer Indemnity InsuranceCity of StephenvilleTHE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

SUMMARY OF BENEFITSBenefits Option 1 Option 2

Radiation Therapy/Chemotherapy/Immunotherapy Benefit Maximum per 12-month period

$15,000 $20,000

Hormone Therapy - Maximum of 12 treatments per Calendar Year $50 per treatment $50 per treatment

Experimental Treatment Benefit Paid in the same manner and under the same maximums as any other benefit

Waiver of Premium Waive Premium Waive Premium

Internal Cancer First Occurrence Benefit

Lump Sum Benefit Maximum 1 per Covered Person per lifetime

$5,000 $10,000

Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime

$7,500 $15,000

Heart Attack/Stroke First Occurrence Benefit

Lump Sum Benefit Maximum 1 per Covered Person per lifetime

$5,000 $10,000

Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime

$7,500 $15,000

Monthly Premium* Option 1 Option 2

Individual $13.66 $23.00

Individual & Spouse $29.48 $49.94

1 Parent Family $15.70 $26.50

2 Parent Family $31.52 $53.48

EligibilityYou and your Eligible Dependents are eligible to be insured under the Certificate if you and your Eligible Dependents meet APL’s underwriting rules and you are Actively at Work and qualify for coverage as defined in the Master Application.

Limitations & ExclusionsNo benefits will be paid for care or treatment received outside the territorial limits of the United States, treatment by any program engaged in research that does not meet the definition of Experimental Treatment or losses or medical expenses incurred prior to the Covered Person’s Effective Date regardless of when Cancer was diagnosed.

Only Loss for CancerThe Policy/Certificate pays only for loss resulting from definitive Cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The Policy/Certificate also covers other conditions or diseases directly caused by Cancer or the treatment of Cancer. The Policy/Certificate does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of Cancer, even though after contracting Cancer it may have been complicated, aggravated or affected by Cancer or the treatment of Cancer.

Pre-Existing Condition ExclusionNo benefits are payable for any loss incurred during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date as the result of a Pre-Existing Condition. Pre-Existing Conditions specifically named or described as excluded in any part of the Policy/Certificate are never covered. If any change to coverage after the Certificate Effective Date results in an increase or addition to coverage, the Time Limit on Certain Defenses and Pre-Existing Condition Limitation for such increase will be based on the effective date of such increase.

Waiting PeriodThe Policy/Certificate contains a Waiting Period during which no benefits will be paid. If any Covered Person has a Specified Disease diagnosed before the end of the Waiting Period immediately following the Covered Person’s Effective Date, coverage for that person will apply only to loss that is incurred after one year from the Covered Person’s Effective Date. If any Covered Person is diagnosed as having a Specified Disease during the Waiting Period immediately following the Covered Person’s Effective Date, the Insured may elect to void the Certificate from the beginning and receive a full refund of premium.

If the Policy/Certificate replaced Specified Disease Cancer coverage from another company that terminated within 30 days of the Certificate Effective Date, the Waiting Period will be waived for those Covered Persons that were covered under the prior coverage. However, the Pre-Existing Condition Limitation will still apply.

Termination of CertificateInsurance coverage under the Certificate and any attached riders will end on the earliest of any of the following dates: the date the Policy terminates; the end of the grace period if the premium remains unpaid; the date insurance has ceased on all persons covered under this Certificate; the end of the Certificate Month in which the Policyholder requests to terminate this coverage; the date you no longer qualify as an Insured; or the date of your death.

Termination of CoverageInsurance coverage for a Covered Person under the Certificate and any attached riders for a Covered Person will end as follows: the date the Policy terminates; the date the Certificate terminates; the end of the grace period if the premium remains unpaid; the end of the Certificate Month in which the Policyholder requests to terminate the coverage for an Eligible Dependent; the date a Covered Person no longer qualifies as an Insured or

*The premium and amount of benefits vary dependent upon the option selected at time of application. All benefits are per covered person, per calendar year unless otherwise stated.

41

Optionally RenewableThe policy is optionally renewable. The Policyholder has the right to terminate the policy on any premium due date after the first Anniversary following the Policy Effective Date. APL must give at least 60 days written notice prior to cancellation.

Portability (Voluntary Plans Only)When the Insured no longer meets the definition of Insured, he or she will have the option to continue this coverage, including any attached riders. No Evidence of Insurability will be required. Portability must meet all of the following conditions: the Certificate has been continuously in force for the last 12 months; APL receives a request and payment of the first premium for the portability coverage no later than 30 days after the date the Insured no longer qualifies as an eligible Insured. All future premiums due will be billed directly to the Insured. The Insured is responsible for payment of all premiums for the portability coverage; the Policy, under which this Certificate was issued, continues to be in force on the date the Insured ceases to qualify for coverage.

The benefits, terms and conditions of the portability coverage will be the same as those elected under the Certificate immediately prior to the date the Insured exercised portability. Portability coverage may include any Eligible Dependents who were covered under the Certificate at the time the Insured ceased to qualify as an eligible Insured. No new Eligible Dependents may be added to the portability coverage except as provided in the Newborn and Adopted Children provision. No increases in coverage will be allowed while the Insured is exercising his or her rights under this rider. If the Policy is no longer in force, then portability coverage is not available.

Heart Attack/Stroke First Occurrence Benefit RiderPays a lump sum amount when a Covered Person receives a first diagnosis of Heart Attack/Stroke and the Date of Diagnosis occurs after the Waiting Period. The Heart Attack/Stroke lump sum benefit amount will reduce by 50% at age 70.

Exclusions & LimitationsWe will not pay benefits for any loss caused by or resulting from any of the following: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces; military service for any country at war. If coverage is suspended for any Covered Person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the Policyholder’s written request; participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a Physician or taken according to the Physician’s instructions; or participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place).

Pre-Existing Condition ExclusionNo benefits are payable for any loss incurred during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date of this rider as the result of a Pre-Existing Condition.

Waiting PeriodThis rider contains a Waiting Period during which no benefits will be paid. If any Heart Attack or Stroke is diagnosed before the end of the Waiting Period immediately following the Covered Person’s Effective Date of this rider, coverage will apply only to loss that is incurred after one year from the Covered Person’s Effective Date.

TerminationThis rider will terminate and coverage will end for all Covered Persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the Policy or Certificate to which this rider is attached terminates; the end of the Certificate Month in which we receive a request from the Policyholder to terminate this rider; the date of your death; or the date the lump sum benefit amount for Heart Attack or Stroke has been paid for all Covered Persons under this rider. Coverage on an Eligible Dependent terminates under this rider when such person ceases to meet the definition of Eligible Dependent.

Internal Cancer First Occurrence Benefit RiderPays a lump sum benefit amount when a Covered Person receives a first diagnosis of a covered Internal Cancer and the Date of Diagnosis occurs after the Waiting Period. The Internal Cancer lump sum benefit amount will reduce by 50% at age 70.

Exclusions & LimitationsWe will not pay benefits for a diagnosis of Internal Cancer received outside the territorial limits of the United States or a metastasis to a new site of any Cancer diagnosed prior to the Covered Person’s Effective Date, as this is not considered a first diagnosis of an Internal Cancer.

Pre-Existing Condition ExclusionNo benefits are payable for any loss incurred during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date of this rider as the result of a Pre-Existing Condition.

Waiting PeriodThis rider contains a Waiting Period during which no benefits will be paid. If any Internal Cancer is diagnosed before the end of the Waiting Period immediately following the Covered Person’s Effective Date of this rider, coverage will apply only to loss that is incurred after one year from the Covered Person’s Effective Date of this Rider.

TerminationThis rider will terminate and coverage will end for all Covered Persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the Policy or Certificate to which this rider is attached terminates; the end of the Certificate Month in which we receive a request from the Policyholder to terminate this rider; the date of your death; or the date the lump sum benefit amount for Internal Cancer has been paid for all Covered Persons under this rider. Coverage on an Eligible Dependent terminates under this rider when such person ceases to meet the definition of Eligible Dependent.


Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete benefits and other provisions, please refer to your policy/certificate/rider(s). This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This product contains Limitations and Exclusions | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines | Policy Form GC13APL | Limited Benefit Group Cancer Indemnity Insurance Series | Texas | (10/14) | City of Stephenville

GC13 Limited Benefit Group Cancer Indemnity Insurance


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www.ampublic.com

GC13 Limited Benefit Group Cancer Indemnity Insurance

43

Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.

About this Benefit

Individual Life YOUR BENEFITS PACKAGE

DID YOU KNOW?

TEXAS LIFE

1/3 of Americans would be financially impacted by the loss of the primary wage earner in just one month.



Individual Life

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

The policy, PureLife-plus, is underwritten by Texas Life Insurance Company, and it has these outstanding features:

High Death Benefit. With one of the highest death benefitavailable at the worksite,1 PureLife-plus gives your lovedones peace of mind, knowing there will be significant lifeinsurance in force should you die prematurely.

Minimal Cash Value. Designed to provide high death benefit,PureLife-plus does not compete with the cash accumulationin your employer-sponsored retirement plans.

Long Guarantees. Enjoy the assurance of a policy that has aguaranteed death benefit to age 121 and level premium thatguarantees coverage for a significant period of time (afterthe guaranteed period, premiums may go down, stay thesame, or go up).

Refund of Premium. Unique in the marketplace,PureLife-plus offers you a refund of 10 years’ premium,should you surrender the policy if the premium you paywhen you buy the policy ever increases. (Conditions apply.)

Accelerated Death Benefit Rider. Should you be diagnosed asterminally ill with the expectation of death within 12 months(24 months in Illinois), you will have the option to receive92% (84% in Illinois) of the death benefit, minus a $150($100 in Florida) administrative fee. This valuable livingbenefit gives you peace of mind knowing that, should youneed it, you can take the large majority of your death benefitwhile still alive. (Conditions apply.)

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

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

1Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 2008

DID YOU KNOW?

Those with no life insurance think it’s 3 times more expensive than it actually is.

45

Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.

About this Benefit

Family Protection Plan YOUR BENEFITS PACKAGE

x 10

Experts recommend at least

your gross annual income in coverage when purchasing life insurance.

DID YOU KNOW?

5STAR



Term Life with Terminal Illness and Quality of Life Rider

The Family Protection Plan: Term Life Insurance with Terminal Illness Coverage to Age 100

With the Family Protection Plan (FPP), you can provide financial stability for your loved ones should something happen to you. You have peace of mind that you are covered up to age 100.* No matter what the future brings, you and your family will be protected.

If faced with a chronic medical condition that required continuous care, would you be able to protect yourself? Traditionally, expenses associated with treatment and care necessitated by a chronic injury or illness have accounted for 86% of all health care spending and can place strain on your assets when you need them most. To provide protection during this time of need, 5Star Life Insurance Company (5Star Life) is pleased to offer the Quality of Life Rider, which is included with your FPP life insurance coverage.

This rider accelerates a portion of the death benefit on a monthly basis - 4% - each month as scheduled by your employer at the group level, and payable directly to you on a tax favored basis. You can receive up to 75% of the current face amount of the life benefit, following a diagnosis of either a chronic illness or cognitive impairment that requires substantial assistance.

Benefits are paid for the following:

Permanent inability to perform at least two of the sixActivities of Daily Living (ADLs) without substantialassistance, or

A permanent severe cognitive impairment, such asdementia, Alzheimer’s disease and other forms of senilityrequiring substantial supervision.

For example, in case of chronic illness, you would receive $3,586 each month up to $67,241.25. The remainder death benefit of $22,413.75 would be made payable to your beneficiary. This example is for illustration purposes only. You will need to review the chart for your exact benefit.

* Life insurance product underwritten by 5Star Life Insurance Company (a Baton Rouge,Louisiana company). Product may not be available in all states or territories. Request FPP insurance from Dell Perot, Post Office Box 83043, Lincoln, Nebraska 68501, (866) 863-9753.

Affordability—With several options to choose from, select the coverage that best meets the needs of your family.

Terminal Illness—This plan pays the insured 30% (25% in Connecticut and Michigan) of the policy coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months.

Portability—You and your family continue coverage with no loss of benefits or increase in cost should you terminate employment after the first premium is paid. If this happens, we can simply bill you directly. Coverage can never be cancelled by the insurance company or your employer unless you stop paying premiums.

Family Protection—Individual policies can be purchased on the employee, their spouse, children and grandchildren.

Children & Grandchildren Plan— Individual life policies can be purchased for children and grandchildren ages newborn through 23. They are not eligible for the Quality of Life Rider.

Convenience—Premiums are taken care of simply and easily through payroll deductions.

Protection You Can Count On—Within 24 hours after receiving notice of an insured’s death, an emergency death benefit of the lesser of 50% of the coverage amount, or $10,000, will be mailed to the insured’s beneficiary, unless the death is within the two-year contestability period and/or under investigation. This product also contains no war or terrorism exclusions.

Example Weekly

Premium Death

Benefit Accelerated

Benefit

Your age at issue: 35

$10.00 $89,655 4%

$3,586.20 a month

47

Family Protection Plan - Terminal Illness

MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT

Age on App. Date $10,000 $20,000 $25,000 $30,000 $40,000 $50,000 $75,000 $100,000 $125,000 $150,000

18-25 $7.56 $10.78 $12.40 $14.01 $17.23 $20.46 $28.52 $36.58 $44.65 $52.71

26 $7.58 $10.83 $12.46 $14.08 $17.33 $20.58 $28.71 $36.83 $44.96 $53.08

27 $7.65 $10.97 $12.63 $14.28 $17.60 $20.92 $29.21 $37.50 $45.79 $54.08

28 $7.74 $11.15 $12.85 $14.56 $17.97 $21.38 $29.90 $38.42 $46.94 $55.46

29 $7.88 $11.43 $13.21 $14.98 $18.53 $22.08 $30.96 $39.83 $48.71 $57.58

30 $8.07 $11.80 $13.67 $15.53 $19.27 $23.00 $32.33 $41.67 $51.00 $60.33

31 $8.27 $12.20 $14.17 $16.13 $20.07 $24.00 $33.83 $43.67 $53.50 $63.33

32 $8.49 $12.65 $14.73 $16.81 $20.97 $25.13 $35.52 $45.92 $56.31 $66.71

33 $8.73 $13.12 $15.31 $17.51 $21.90 $26.29 $37.27 $48.25 $59.23 $70.21

34 $9.00 $13.67 $16.00 $18.33 $23.00 $27.67 $39.33 $51.00 $62.67 $74.33

35 $9.30 $14.27 $16.75 $19.23 $24.20 $29.17 $41.58 $54.00 $66.42 $78.83

36 $9.64 $14.95 $17.60 $20.26 $25.57 $30.88 $44.15 $57.42 $70.69 $83.96

37 $10.02 $15.70 $18.54 $21.38 $27.07 $32.75 $46.96 $61.17 $75.38 $89.58

38 $10.41 $16.48 $19.52 $22.56 $28.63 $34.71 $49.90 $65.08 $80.27 $95.46

39 $10.84 $17.35 $20.60 $23.86 $30.37 $36.88 $53.15 $69.42 $85.69 $101.96

40 $11.31 $18.28 $21.77 $25.26 $32.23 $39.21 $56.65 $74.08 $91.52 $108.96

41 $11.83 $19.33 $23.08 $26.83 $34.33 $41.83 $60.58 $79.33 $98.08 $116.83

42 $12.41 $20.48 $24.52 $28.56 $36.63 $44.71 $64.90 $85.08 $105.27 $125.46

43 $13.00 $21.67 $26.00 $30.33 $39.00 $47.67 $69.33 $91.00 $112.67 $134.33

44 $13.63 $22.92 $27.56 $32.21 $41.50 $50.79 $74.02 $97.25 $120.48 $143.71

45 $14.28 $24.22 $29.19 $34.16 $44.10 $54.04 $78.90 $103.75 $128.60 $153.46

46 $14.97 $25.60 $30.92 $36.23 $46.87 $57.50 $84.08 $110.67 $137.25 $163.83

47 $15.69 $27.05 $32.73 $38.41 $49.77 $61.13 $89.52 $117.92 $146.31 $174.71

48 $16.43 $28.52 $34.56 $40.61 $52.70 $64.79 $95.02 $125.25 $155.48 $185.71

49 $17.22 $30.10 $36.54 $42.98 $55.87 $68.75 $100.96 $133.17 $165.38 $197.58

50 $18.08 $31.82 $38.69 $45.56 $59.30 $73.04 $107.40 $141.75 $176.10 $210.46

51 $19.04 $33.75 $41.10 $48.46 $63.17 $77.88 $114.65 $151.42 $188.19 $224.96

52 $20.16 $35.98 $43.90 $51.81 $67.63 $83.46 $123.02 $162.58 $202.15 $241.71

53 $21.40 $38.47 $47.00 $55.53 $72.60 $89.67 $132.33 $175.00 $217.67 $260.33

54 $22.79 $41.25 $50.48 $59.71 $78.17 $96.63 $142.77 $188.92 $235.06 $281.21

55 $24.27 $44.20 $54.17 $64.13 $84.07 $104.00 $153.83 $203.67 $253.50 $303.33

56 $25.93 $47.53 $58.33 $69.13 $90.73 $112.33 $166.33 $220.33 $274.33 $328.33

57 $27.66 $50.98 $62.65 $74.31 $97.63 $120.96 $179.27 $237.58 $295.90 $354.21

58 $29.42 $54.50 $67.04 $79.58 $104.67 $129.75 $192.46 $255.17 $317.88 $380.58

59 $31.23 $58.12 $71.56 $85.01 $111.90 $138.79 $206.02 $273.25 $340.48 $407.71

60 $33.12 $61.90 $76.29 $90.68 $119.47 $148.25 $220.21 $292.17 $364.13 $436.08

61 $35.08 $65.82 $81.19 $96.56 $127.30 $158.04 $234.90 $311.75 $388.60 $465.46

62 $37.13 $69.92 $86.31 $102.71 $135.50 $168.29 $250.27 $332.25 $414.23 $496.21

63 $39.31 $74.28 $91.77 $109.26 $144.23 $179.21 $266.65 $354.08 $441.52 $528.96

64 $41.68 $79.03 $97.71 $116.38 $153.73 $191.08 $284.46 $377.83 $471.21 $564.58

65 $44.33 $84.33 $104.33 $124.33 $164.33 $204.33 $304.33 $404.33 $504.33 $604.33

48

Family Protection Plan - Terminal Illness

49

Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family.

Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

About this Benefit

Life and AD&D YOUR BENEFITS PACKAGE

cause of accidental deaths in the US, followed by poisoning, falls,

drowning, and choking.

DID YOU KNOW?

#1

Motor vehicle crashes are the

UNITEDHEALTHCARE



Supplemental Life and AD&D

Am I eligible? You are eligible if you are an active, full-time Employee who works at least 30 hours per week on a regularly scheduled basis.

How much Employee Supplemental Life and AD&D can I purchase?You can purchase Supplemental Life and AD&D Insurance from a minimum of $20,000 to a $500,000 maximum. However, coverage cannot exceed 5 times your Annual Earnings. Annual Earnings are defined in UnitedHealthcare’s contract with your employer.

How much Spouse Supplemental Life and AD&D can I purchase? If you elect Employee Supplemental Life and AD&D Insurance for yourself, you may choose to purchase Spouse Supplemental Life and AD&D Insurance from a minimum of $5,000 to a maximum of $250,000. However, coverage cannot exceed 50% of the employee’s Supplemental Life and AD&D amount. You may not elect coverage for your Spouse if they are already covered as an Employee under this policy.

How much Child(ren) Supplemental Life and AD&D can I purchase? If you elect Supplemental Life and AD&D Insurance for yourself, you may choose to purchase Child(ren)* Supplemental Life and AD&D Insurance from $1,000 minimum to a maximum of $10,000 for each child. However, coverage cannot exceed 50% of the employee’s Supplemental Life and AD&D amount. *Eligible Child(ren) are from 14 days to age 26.

What is the highest amount of Supplemental Life I can buy without filling out a medical questionnaire? (Guarantee Issue Limit) New Hire: Employee- You may elect up to $130,000. Amounts greater will require evidence of good health/insurability.

Spouse- You may elect up to $50,000. Amounts greater will require evidence of good health/insurability. Child(ren)- You may elect up to $10,000.

What does Supplemental AD&D provide me? Accidental Death & Dismemberment (AD&D) provides benefits due to certain injuries or death from an accident.* The covered injuries or death can occur up to 180 days after the accident. The AD&D Insurance pays certain percentages of the benefit amount based on the injury sustained. Refer to the certificate of coverage for the complete AD&D Benefit schedule. Coverage includes 10% additional benefit for use of Seatbelt only or Seatbelt and Air Bag for loss of life.

Your total benefit for all losses due to the same accident will not be more than 100% of the amount of coverage provided to you. *Some state variations may apply.

What is a beneficiary? Your beneficiary is a person (or persons) or legal entity (entities) who receives a benefit payment if you die while you are covered under the policy. You, as the employee, must select your beneficiary when you complete your enrollment application; your selection is legally binding. You are automatically the beneficiary for any Spouse or Child(ren) coverage.

Are any resources available for beneficiaries? Beneficiary Services: Provides beneficiaries with services for grief consultation, financial/legal assistance and referral to community resources. For more information, call 866-302-4480. See below for more details.

Are there other limitations to enrollment? You must be Actively at Work with your employer on the day your coverage takes effect. This coverage, like most group benefit insurance, requires that a certain percentage of eligible employees participate. If that group participation minimum is not met, the insurance coverage that you have elected may not be in effect.

51


Does my coverage reduce as I get older? Yes, Employee Supplemental Life and AD&D coverage reduces to 65% of the face amount at age 65; to 50% of the original amount at age 70.

Spouse Supplemental Life and AD&D coverage reduces the same as the employee’s.

All coverage terminates upon employee’s retirement.

Do I still pay my Life Insurance premiums if I become disabled? If you become totally disabled before age 60 and your disability lasts for at least 9 months, your Employee Supplemental Life Insurance premium may be waived.

What is Accelerated Death Benefit? If you are diagnosed as terminally ill with a 12 month or less life expectancy, you may receive payment of a portion of your Life Insurance. The remaining amount of your Life Insurance would be paid to your beneficiary when you die.

Can I keep my Life coverage if I leave my employer? Yes, subject to the contract, you have the option of:

Converting your group Life coverage to your ownindividual policy (policies).

If you leave your employer, Portability is an option thatallows you to continue your Supplemental Life Insurancecoverage. To be eligible, you must terminate youremployment prior to age 70. This option allows you tocontinue all or a portion of your Life Insurance coverageunder a separate Portability term policy. Portability issubject to a minimum of $5,000 and a maximum of$500,000 and does include coverage for your Spouse andChildren. You must elect portability for your owncoverage in order to elect portability for your Spouse andor Children. To elect Portability, you must apply and paythe premium within 30 days of the termination of yourLife Insurance.

Dependent Spouse Portability is subject to a maximum of $250,000.

Dependent Child Portability is subject to a maximum of $10,000.

Exclusions AD&D Insurance does not cover losses caused by or contributed by: Disease, bodily or mental infirmity, suicide or intentionally self-inflicted injury, commission of an assault or felony, war, use of any drug unless prescribed by physician, driving while intoxicated, engaging in any hazardous activities, or travel in a private aircraft.*

Other exclusions may apply depending upon your coverage. Once a group policy is issued to your employer, a certificate of coverage will be available to explain your benefits in detail.

As is standard with most term life Insurance, this Insurance coverage includes certain limitations and exclusions:

Death by suicide (two years)*.

* Some state variations may apply

52


Employee & Spouse* Supplemental Life – Current Monthly Cost by Age Band

Coverage Age <25

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

$10,000 0.79 0.79 0.79 0.98 1.38 2.26 3.34 5.40 7.07 12.77

$20,000 1.58 1.58 1.58 1.96 2.76 4.52 6.68 10.80 14.14 25.54

$30,000 2.37 2.37 2.37 2.94 4.14 6.78 10.02 16.20 21.21 38.31

$40,000 3.16 3.16 3.16 3.92 5.52 9.04 13.36 21.60 28.28 51.08

$50,000 3.95 3.95 3.95 4.90 6.90 11.30 16.70 27.00 35.35 63.85

$60,000 4.74 4.74 4.74 5.88 8.28 13.56 20.04 32.40 42.42 76.62

$70,000 5.53 5.53 5.53 6.86 9.66 15.82 23.38 37.80 49.49 89.39

$80,000 6.32 6.32 6.32 7.84 11.04 18.08 26.72 43.20 56.56 102.16

$90,000 7.11 7.11 7.11 8.82 12.42 20.34 30.06 48.60 63.63 114.93

$100,000 7.90 7.90 7.90 9.80 13.80 22.60 33.40 54.00 70.70 127.70

Child(ren) Supplemental Life

$5,000 $10,000

0.91 1.82

Employee** Only Supplemental AD&D – Current Monthly Cost

$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000

0.26 0.52 0.78 1.04 1.30 1.56 1.82 2.08 2.34 2.60

Employee** & Family Supplemental AD&D – Current Monthly Cost

$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000

0.42 0.84 1.26 1.68 2.10 2.52 2.94 3.36 3.78 4.20

** You cannot purchase Supplemental AD&D Insurance without purchasing Supplemental Life Insurance. If you elect Supplemental AD&D Insurance, the amount elected must be equal to the amount of Supplemental Life elected.

* Spouse rate is based on employee’s age and cannot exceed 50% of the employee’s Supplemental Life amount

UnitedHealthcare Life and Disability products are provided by UnitedHealthcare Insurance Company; Unimerica Insurance Company; and in California by Unimerica Life Insurance Company; and in New York by Unimerica Life Insurance Company of New York. Texas Coverage is provided on Form LASD-POL-TX (05/03), Form UHCLD-POL 2/2008-TX, or UICLD-POL-TX 4/5.

UnitedHealthcare Insurance Company is located in Hartford, CT; Unimerica Insurance Company and Unimerica Life Insurance Company in Milwaukee, WI; Unimerica Life Insurance Company of NY in New York, NY.

53

A Cafeteria Plan is designed to take advantage of Section 125 of the Internal Revenue Code. It allows you to pay certain qualified expenses on a pre-tax basis, thereby reducing your taxable income. You can set aside a pre-established amount of money per plan year in a Healthcare Flexible Spending Account (FSA). Funds allocated to a healthcare FSA must be used during the plan year or are forfeited unless your plan contains a $500 rollover or grace period provision.

Unlimited FSA (Non HSA Compatible) The funds in the unlimited healthcare FSA can be used to pay for eligible medical expenses like deductibles, co-payments, orthodontics, glasses and contacts.

About this Benefit

FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

NBS



NBS Flexcard You may use the card to pay merchants or service providers that accept MasterCard® credit cards, so there is no need to pay cash up front, then wait for reimbursement. If you are participating in the Dependent Care portion, the money isn’t loaded to the card. You must file web or paper claims or enroll in continual reimbursement.

Current plan participants: KEEP YOUR CARDS! NBS debit cards are good for 3 years. If you throw away your cards, there is a $5.00 fee to replace them.

New Plan Participants NBS will mail out your new benefit cards to the address listed in THEbenefitsHUB. They will be sent in unmarked envelopes so please watch for them as they should arrive within 21 business days of effective date. NBS debit cards are good for 3 years.

FSA Annual Contribution Max: $2,550

Dependent Care Annual Max: $5,000

Account Information: Participant Account Web Access: www.participant.nbsbenefits.com

Participants may call NBS and talk to a representative during regular business hours, Monday-Friday, 8 am to 7 pm Central Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (888) 353-9125. For immediate access to your account information at any time, log on to the NBS website www.NBSbenefits.com.

Detailed claim history and processing status Health Care and Dependent Care account balances Health Care and Dependent Care account balances Claim forms, Direct Deposit form, worksheets, etc. Online claim FAQs

For a list of sample expenses, please refer to the City of Stephenville benefit website: www.mybenefitshub.com/cityofstephenville

NBS Contact Information:

8523 South Redwood Road West Jordan, UT 84088 Phone‐800‐274‐0503 Fax‐800‐478‐1528 Email: [email protected]

When Will I Receive My Flex Card?

Expect Flex Cards to be delivered to the address listed in THEbenefitsHUB near the end of May.

Don’t forget, Flex Cards Are Good For 3 Years!

FSA (Flexible Spending Account)

DID YOU KNOW?

FSAs use tax-free funds to help pay for your Health Care Expenses?

NBS Prepaid MasterCard® Debit Card

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Health Care Expense Account Example Expenses:

What is a Flexible Spending Account? A Flexible Spending Account allows you to save money by paying out-of-pocket health and/or dependent care related expenses with pre-tax dollars. Your contributions are deducted from your pay before taxes are withheld and your account is up fronted with an annual amount. Because you are taxed on a lower amount of pay, you pay less in taxes and you have more to spend.

How does a Flexible Spending Account Benefit Me? A Cafeteria plan enables you to save money on group insurance, health-related expenses, and dependent-care expenses. You may save as much as 35 percent on the cost of each benefit option! Eligible expenses must be incurred within the plan year and contributions are use-it-or- lose-it. Remember to retain all your receipts.

What Can I Use My Flexible Spending Account On? For a full list of eligible expenses, please refer to www.mybenefitshub.com/cityofstephenville.

What Happens If I Don’t Use All of My Funds by The End of the Plan Year (April 30th)? Eligible expenses must be incurred within the plan year +75 day grace period. Contributions are use-it-or- lose-it. Remember to retain all your receipts (including receipts for card swipes).

How Do I File A Claim? In most situations, you will be able to swipe your card however, in the event you lose your card or are waiting to receive one, you can visit www.mybenefitshub.com/cityofstephenville and complete the “Claim Form” to send to NBS or use the web or phone app to file online.

Dependent Care Expense Account Example Expenses: Before and After School and/or Extended Day Programs

The actual care of the dependent in your home.

Preschool tuition.

The base costs for day camps or similar programs used as carefor a qualifying individual.

Hearing aids &batteries

Lab fees

Laser Surgery

Orthodontia Expenses

Physical exams

Pregnancy tests

Prescription drugs

Vaccinations

Vaporizers orhumidifiers

Acupuncture

Body scans

Breast pumps

Chiropractor

Co-payments

Deductible

Diabetes Maintenance

Eye Exam & Glasses

Fertility treatment

First aid

FSA Frequently Asked Questions

How To Receive Your Dependent Care Reimbursement Faster.

A Direct Deposit form is available on the Benefits Website which will help you get reimbursed quicker!

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How the FSA Plan Works

You designate an annual election of pre-tax dollars to be deposited into your health and dependent-care spending accounts. Your total election is divided by the number of pay periods in the Plan year and deducted equally from each paycheck before taxes are calculated. By the end of the Plan year, your total election will be fully deposited.

However, you may make a claim for eligible health FSA expenses as soon as they are incurred during the Plan year. Eligible claims will be paid up to your total annual election even if you have not yet contributed that amount to your account.

Get Your Money 1. Complete and sign a claim form (available on our website) or an online claim.2. Attach documentation; such as an itemized bill or an Explanation of Benefits (EOB) statement from a health insurance provider.3. Fax or mail signed form and documentation to NBS.4. Receive your non-taxable reimbursement after your claim is processed either by check or direct deposit.

NBS Flexcard—FSA Pre-paid Benefit Card Your employer may sponsor the use of the NBS Flexcard, making access to your flex dollars easier than ever. You may use the card to pay merchants or service providers that accept credit cards, so there is no need to pay cash up front then wait for reimbursement.

Account Information Participants may call NBS and talk to a representative during our regular business hours, Monday–Friday, 7am to 6pm Mountain Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (888) 353-9125. For immediate access to your account information at any time, log on to our websitewww.NBSbenefits.com. Information includes:

Detailed claim history and processing status

Health Care and Dependent Care account balances

Claim forms, worksheets, etc.

Online Claim Submission

Enrollment Considerations After the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying “change of status” (marriage status, employment change, dependent change). Be conservative in the total amount you elect to avoid forfeiting money that may be left in your account at the end of the year. Your employer may allow a short grace period after the Plan year ends for you to submit qualified claims for any unused funds.

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A 457(b) plan is a tax-deferred compensation plan provided for employees of certain tax-exempt, governmental organizations or public education institutions.

About this Benefit

YOUR BENEFITS PACKAGE

DID YOU KNOW?

Only 22% of workers are very confident they

will have enough money in retirement.

NBS

457(b) Plan



What are the benefits of contributing to a 457 Plan? LOWER TAXES The 457 contributions you make can be on a pre-tax basis. This means that the money used to invest in the 457 plan is not taxed until the funds are withdrawn. For example, if your federal marginal income tax rate is 25%, and you contribute $100 a month to a 457 plan, you have reduced your federal income taxes by nearly $25. In effect, your $100 contribution costs you only $75. The tax savings grow with the size of your 457 contribution.

TAX-DEFERRED GROWTH In your 457 plan, interest and earnings grow tax-deferred. This means that your interest will grow tax-free until the time of your withdrawal. The compounding interest on your 457 plan allows your account to grow more quickly than money saved in a taxable account where interest and earnings are taxed each year.

TAKING THE INITIATIVE Contributing to a 457 plan helps you take control of your future retirement needs. Other sources of retirement income, including state pension plans and Social Security, often do not adequately replace a person’s salary upon retirement. A 457 plan can be a great way to supplement your income at retirement.

POSSIBLE TAX CREDITS Pre-tax contributions may put you in a lower tax bracket reducing your overall tax rate.

HIGHER LIMITS Annual contribution limits are much higher than those of an IRA.

How much can you contribute to a 457 Plan? You may elect to save:

100% of your income up to $18,000 (2016)

Extra $6,000 if age 50+

Limits are completely separate from those made to 403(b) or401(k) accounts

REQUIRED MINIMUM DISTRIBUTIONS (RMD) Distributions are required at age 70 ½. Exceptions may apply.

How to Enroll in the Plan Your employer has provided investment option(s) for you. A list of approved vendor(s) and the Salary Reduction Agreement

(“SRA”) can be found by visiting the (NBS) website at NBSbenefits.com/403b or by contacting NBS (contact information below).

Once you have chosen an approved vendor, please open a 457 account directly with them. To begin investing, send the completed SRA form to NBS who will work with your employer to begin contributions.

Investment Choices Annuity contracts made available through insurance companies or custodial accounts through a retirement account custodian are allowed in 457 plans. You will need to contact the vendor for a comprehensive listing and information regarding the available investment options.

Transfers As a participant in the 457 Plan, you have the option to move funds, or “transfer” tax-free between different vendors within the same plan.

Rollovers You also have the option of rolling retirement funds from previous employers to your current employer’s plan thus simplifying retirement management.

Distributions from the Plan You or your beneficiary will be able to withdraw your vested balance when one of the following occurs: 1. Retirement2. Termination of Employment3. Attainment of Age 70 ½4. Total Disability5. Death*The vendors may require additional paperwork.

Loans You may borrow up to 50% of your vested balance up to $50,000 (whichever is less). Contact your current vendor about their specific loan provisions.

Unforeseeable Emergency An unforeseeable emergency distribution may be allowed if you satisfy certain criteria. Contact NBS for more information about the requirements.

457(b) Plan

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Learn how to lose weight and improve your health while eating the foods you love. The Naturally Slim® program has the secret to lasting weight loss and it doesn’t include starving, counting calories or eating diet food. This program offers you the chance to learn how to eat to reduce your chances of getting a serious disease, like diabetes or heart disease, and increase your chance at living a longer, healthier life.

About this Benefit

Weight LossYOUR BENEFITS PACKAGE

DID YOU KNOW?

is the average weight loss per participant in

10 weeks.

NATURALLY SLIM

10.6 lbs



Naturally Slim® is a proven solution to help your employees lose weight and reduce their Metabolic Syndrome (MetS) risk. MetS is a cluster of risk factors that predicts serious conditions such as diabetes, heart disease and stroke. Naturally Slim has helped more than 650 employers reduce their health care spending and measurably improve the health of their employees.

The Problem The prevalence of obesity and the related MetS risk factors is growing at an alarming rate. MetS dramatically increases the chances of developing diabetes, heart disease, depression, stroke, cancer and a number of other serious medical conditions. Individuals with MetS average almost twice as much in medical costs per year as those without MetS. They also have a seven times higher likelihood of being a high-cost claimant.

Finally…there is a weight loss program with proven, lasting clinical results.

The Solution Naturally Slim is a mindful-eating program that helps your employees lose weight and reduce the risks associated with MetS. It starts with ten weeks of skill building focused on behavior modification, not dieting. After the first ten weeks, participants receive ongoing counseling and support for one full year to reinforce skills to ensure long-term, sustainable results. Naturally Slim is an online program, so it is easily deployed across large and geographically-dispersed employee groups. It is a turnkey solution, so it is simple to rollout. It has been successful in helping hundreds of companies reverse the incidence of MetS of their employees – by 50% on average.

What is Naturally Slim? Naturally Slim is a high-value, behavior modification program proven to deliver sustainable weight loss and reverse obesity, pre-diabetes, and MetS. Naturally Slim shares the latest research on mindful eating, focusing on how the learned behaviors of True Thin™ individuals, not dieting, are best for lasting weight loss and risk reduction.

Why Naturally Slim? More than 650 companies have implemented the Naturally Slim program to date with consistent results of dramatically improving obesity, pre-diabetes and MetS risk factors. The consistent results across a variety of industries prove that the program works for all types of organizations.

How is the program delivered? Naturally Slim is delivered via proprietary distance learning technology which makes it simple and scalable for your school district. The first ten weeks of the program are focused on building behavioral skills to promote weight loss. The remainder of the program focuses on reinforcing those skills and fostering long-term weight maintenance.

What’s included? 10 weeks of skill-building video instruction

(approximately 1 hour of instruction made up of 3 - 12minute segments.)

Online dashboard to watch videos, track weight lossprogress, log activity and more

A welcome kit and email reminders to encourageparticipant adherence

Online access to health coaches

One full year of video instruction and support whichincludes seven bi-weekly videos after the first ten weeksand monthly videos during the final six months.

Online community to interact with current participantsand alumni for inspiration and support

Integration with activity devices and wireless scales,such as FitBit® and Jawbone® devices

Employee Weight Loss Program

Monthly Premiums

EE Only $30

EE + Spouse $60

Spouse Only $30

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2016 Benefit Guide - City of Stephenville

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