High School Dean

2027 BENEFIT GUIDE

Quick Reference Guide to Employee Benefits Accessing Employee Benefit Information - Employee Benefits Guide, Enrollment Information, Forms… Go to your employee benefit account OR go to D203 website and select Department Services Human Resources Health & Well-Being 203 Accessing YOUR Employee Benefits Account Go to www.naperville203.org select I am a…. Staff Member select District Resource Center click on the Employee Benefits Icon (smaller icon) log in to your account (Company Key: D203) Go to employeebenefits.naperville203.org (Company Key: D203) Experiencing an IRS Qualifying Life Event - Marriage/Divorce, Baby/Adoption, Loss of Insurance Coverage, etc. Employees have 31 days from the date of a Qualifying Life Event to make changes to their employee benefits. To make new elections due to a Qualifying Life Event, the employee must make the change to their Employee Benefits Account and submit required documentation to the D203 Benefits Specialist within 31 days of the Qualifying Life Event date. Consistency Rule Benefit eligibility and plan offerings are applied consistently to employees who fall within the same eligible employee class. This helps ensure employees in similar circumstances are treated the same under the plan's established rules. Considering a Leave of Absence Contact your Human Resources Generalist Changing Personal Information - Name, Address, Phone, Emergency Contact Contact your Human Resources Generalist Address, Phone, Emergency Contact: Go to www.naperville203.org select I am a…. Staff Member select District Resource Center click on Human Resources select D203 Staff Resource Library Select Address or Name Change Process Annual Benefits Enrollment Starts mid-October with a January 1 effective date Wellness Program Naperville has a wellness program through Marathon Health that you can participate in to stay healthy and help keep your medical premiums lower. Benefits Plan Carriers Medical BlueCross BlueShield of Illinois Prescription Drugs Prime Therapeutics Dental Guardian Vision Guardian Health Care Flexible Spending Account Inspira Financial Dependent Care Flexible Spending Account Inspira Financial Health Savings Account Lively Employee Assistance Program ComPsych Telehealth Medical Teladoc Telehealth Behavioral Health Teladoc Basic Life Insurance Guardian Voluntary Life, Critical Illness, Accident Insurance Guardian Near site clinic on Ogden Ave for Naperville 203 medical participants only! The clinic is called Priority Care - powered by Marathon Health. See page 12 for more information. 2 Table of Contents Introduction 4 Enrollment 5 Medical/Prescription Plan 6 Dental Plan 15 Vision Plan 16 Payroll Contributions 17 Wellness Program 18 Teladoc - General 19 Teladoc - Behavioral Health 20 Teladoc - Nutrition & Dermatology 21 Teladoc - Livongo 22 Hinge Health 23 Flexible Spending Accounts 24 Health Savings Accounts (HSA) 25 Life and AD&D Plan 26 Long-Term Disability Plan 27 Voluntary Life Insurance Plan 28 Voluntary Critical Illness Plan 30 Voluntary Accident Plan 32 Retirement Savings Plan 403(b) / 457 34 Employee Assistance Program 35 Health Care Terms 36 Important Notices Appendix A BCBSIL Helpful Information Blue Access for Members Provider Finder Understanding Your Explanation of Benefits Guardian Helpful Information Dental Provider Finder Instructions Vision Provider Finder Instructions Wellness Tools Appendix B Member Advocacy Inside Back Cover Contact Information Back Cover 3 Hello! Naperville Community Unit School District 203 offers a comprehensive suite of benefits to help support the physical and financial health of you and your family. These benefits help you pay for health care and provide financial protection for you and your family. Read this guide carefully to fully understand your benefits and how they work in order to make the best decision for you and your family. Being thoughtful about your benefits is a good thing - it's the first step to ensuring your family has the protection needed to be healthy throughout the year. Effective January 1, 2027, medical benefits will renew with BCBS. and all ancillary lines will remain with Guardian. Our near-site clinic, Priority Care, is available for all members enrolled in medical to utilize for preventive, acute, mental health and more. See more details in the guide. This guide provides highlights of your benefits programs. Keep this guide with your other important papers so you can refer to it as needed. For a complete description of your benefits, please refer to your benefit plan certificates, located on your employee benefits account. 4 New Employee Enrollment As a newly hired employee of Naperville Community Unit School District 203, you are eligible to make an election of benefits within 31 days of your effective date. Existing Employee Enrollment Annual Benefits Enrollment starts mid-October to make elections for benefits effective January 1 to December 31. If you wish to change benefits outside of the Annual Benefits Enrollment period, you may only do so within 31 days of an IRS qualifying life event , such as:

• Change in legal marital status (marriage, divorce, death of spouse)
• Change in employment status for you, your spouse, or a dependent that affects eligibility
• Birth, adoption, or placement for adoption of a child
• Death of a spouse or dependent
• Change in a dependent's eligibility Benefi t changes due to a qualifying life event must satisfy a consistency rule. That is, any change must be consistent with the qualifying event. Example: If you get a divorce, you can remove your spouse but cannot add existing dependents who were not on your plan. Voluntarily terminating existing benefits does not qualify as an IRS qualifying life event . You have the right to terminate your benefits with Naperville CUSD 203 during the Annual Benefits Enrollment period. The last effective date of coverage will be December 31; you may not rejoin the plan until the next Annual Benefits Enrollment period unless you experience an IRS qualifying life event. It is your responsibility to notify your Employee Benefits Specialist and take action within 31 days of an IRS qualifying life event date. Any misrepresentations, inaccurate information, or failure to provide information could result in the loss of coverage. If you cover an individual who is not eligible for benefits, you will be required to reimburse the plan for any expenses incurred as a result and further disciplinary actions may be taken. Enrollment in Naperville CUSD 203's family health care plan requires proof of dependent eligibility. Eligible dependents are spouses, civil union partners, and children (biological, adopted and those for whom you have legal guardianship and accompanying documentation) under age 26. You will be required to provide the following documents (as applicable) to the Employee Benefits Specialist:
• A copy of your Marriage or Civil Union Certificate OR a copy of your most recent joint Federal Tax Return
• A copy of the Birth Certificate for each dependent to be covered under the plan, excluding your spou se, OR Adoption Certificate or Court Order
• Spousal/Civil Union Partner Affidavit Divor ced or legally separated spouses are ineligible for coverage as of the day of the divorce or legal separation. Dependent children are eligible for coverage through the month they turn age 26. It is essential to notify your Benefits Specialist of a change in eligibility within a timely manner to ensure your dependent's right to COBRA Continuation .

Enrollment 5 Medical insurance is one of your most important benefits. When you enroll in one of the BCBS of Illinois medical plans offered by Naperville Community Unit School District 203, you have peace of mind knowing that you have coverage for medical services if you need them for you or your family. Prime Therapeutics (BlueCross BlueShield's prescription partner) administers the prescription drug plan, providing you a single ID card for medical and prescription drug coverage. Please note that CVS/Target is not covered as an in -network pharmacy benefit. District 203 offers four choices for medical/prescription plans through BlueCross BlueShield of Illinois. Each of the plans uses a specific BCBS network. To take full advantage of each plan, it is important to confirm in - network status with BCBSIL prior to services being rendered. Visit BCBSIL.com or call 1.800.458.6024 to check for in-network providers for your chosen medical plan Blue Choice Options (BCO) Plan: This 3-tier PPO plan features a low deductible, co-insurance, and copays for office visits and prescriptions. This plan has two in-network tiers. Tier 1 utilizes the Blue Choice Options (BCO) network and offers the highest level of benefits. Tier 2 utilizes the larger Participating Provider Organization (PPO) but has a slightly higher deductible and out-of-pocket costs. Tier 1 and Tier 2 cross-feed deductible and out-of-pocket costs. If you use Tier 2 benefits after meeting the deductible and/or out -of-pocket costs on Tier 1, Tier 1 costs will count towards your Tier 2 total. Blue Choice Select (BCS) Plan: This plan features a low deductible and co-insurance with copays for office visits and prescriptions along with the claims savings that come from using a narrower network. This plan utilizes the Blue Choice Select (BCS) network which is a smaller network of providers but features greater average discounts and lower negotiated in-network fees. Blue Choice Options (BCO) HDHP: This 3-tier HDHP features a higher deductible, no copays for office visits and prescriptions, and is a health savings account (HSA) eligible plan. This plan has two in -network tiers. Tier 1 utilizes the Blue Choice Options (BCO) network and offers the highest level of benefits. Tier 2 utilizes the larger Participating Provider Organization (PPO) network but has a slightly higher deductible and out- of-pocket costs. Tier 1 and Tier 2 cross-feed deductible and out-of-pocket costs. If you use Tier 2 benefits after meeting the deductible and/or out-of-pocket costs on Tier 1, costs will count towards your Tier 2 total. The annual District contribution to an employee's active Lively HSA is $1,500 for individual coverage and $3,000 for family coverage. Blue Choice Select (BCS) HDHP: This plan features a higher deductible, no copays for office visits and prescriptions and health savings account (HSA) eligibility along with the claims savings that come from using a narrower network. This plan utilizes the Blue Choice Select (BCS) network which is a smaller network of providers but features greater average discounts and lower negotiated in -network fees. The annual District contribution to an employee's active Lively HSA is $1,500 for individual coverage and $3 ,000 for family coverage. Medical/Prescription Drug Plan 6 Medical/Prescription Drug Plan BlueCross BlueShield of Illinois' Benefits Value Advisor: When you enroll in any one of the District 203 Health Plans, you gain access to BCBSIL's Benefits Value Advisor (BVA), a customer service program to help you improve your quality of care and achieve cost savings.

• Find and compare In-Netw ork providers based on quality, patient reviews and cost
• Compare treatment cost estimates among facilities to access savings
• Obtain preauthorization, schedule appointments and connect to clinical programs
• Review benefits, claims and coverage guidelines BlueCr oss BlueShield of Illinois' Utilization Management Programs Utilization Review Program: Utilization Review assists you in determining the course of treatment that will maximize your benefits. The program requires a review of inpatient hospital, skilled nursing facility, coordinated home care program, and private duty nursing services before they are rendered. Members are required to contact the Utilization Review department at the toll -free telephone number identified on your ID card one business day prior to elective admission or within two business days after an emergency or maternity admission. Failure to receive Preauthorization will result in a $200 reduction of benefits. Mental Health Unit: The Mental Health Unit assists in the administration of Mental Illness and Substance Abuse Rehabilitation Treatment benefits. The Mental Health Unit requires a review of inpatient hospital, emergency mental illness or substance abuse admission, partial hospitalization and outpatient services before they are rendered. Members are required to contact the Mental Health Unit at 1.800.851.7498 at least one business day prior to non-emergency inpatient hospital admission and outpatient services or within two business days after an emergency admission or partial hospitalization treatment. Failure to receive preauthorization will result in a $200 reduction of benefits. Prescription Prior Authorization: Certain medications and drug classes require authorization from Prime Therapeutics for benefits to be provided. To receive prior authorization, your physician must send a letter to Prime Therapeutics explaining the reason for the prescription; you and your physician will be notified of the determination. To review the formulary list of medications and drug classes which require prior authorization, contact your pharmacy or call the customer service toll-free number on your identification card. Step Therapy: Certain medications and drug classes require documented treatment with a generic or brand therapeutic alternative medication prior to coverage of brand name medication. If your physician prescribes such a medication, they must complete a questionnaire regarding your previous treatment; you and your physician will be notified of the determination. To review the formulary list of medications and drug classes which require prior authorization, contact your Pharmacy or call the Customer Service toll -free number on your identification card. 7 BCBS Medical/Prescription Drug Plan Plan Features In-Network - Tier 1 Blue Choice Options (BCO Network) In-Network - Tier 2 Participating Provider Organization (PPO Network) Out-of-Network Calendar Year Deductible Individual $1,500 $2,000 $3,000 Family $1,500 x 2 = $3,000 $2,000 x 2 = $4,000 $3,000 x 2 = $6,000 Medical Out-of-Pocket (excludes Deductible) Individual $1,500 $2,000 $3,000 Family $1,500 x 2 = $3,000 $2,000 x 2 = $4,000 $3,000 x 2 = $6,000 Total Medical Out-of-Pocket Maximum Individual $3,000 $4,000 $6,000 Family $3,000 x 2 = $6,000 $4,000 x 2 = $8,000 $6,000 x 2 = $12,000 Prescription Out-of-Pocket Limit Individual $3,000 $3,000 $3,000 Family $6,000 $6,000 $6,000 Preventive Care - Immunizations, Pap Smear, Mammogram, Prostate Exam, Routine Physical Exam 100%, Deductible Waived 100%, Deductible Waived 50% after Deductible Office Visit $30 Copay $45 Copay 50% after Deductible MARATHON PRIORITY CARE CLINIC OFFICE VISIT $0 Copay $0 Copay NA Inpatient Hospital Services 90% after Deductible 70% after Deductible 50% after Deductible Outpatient Surgical Care 90% after Deductible 70% after Deductible 50% after Deductible Outpatient Lab & X-ray 100% Deductible Waived 100% Deductible Waived 50% after Deductible Emergency Room (Copay waived if admitted) $500 Copay then 90% Deductible Waived $500Copay then 90% Deductible Waived $500 Copay then 90% Deductible Waived Ambulance 90% after Deductible 70% after Deductible 50% after Deductible Durable Medical Equipment 90% after Deductible 70% after Deductible 50% after Deductible Rehabilitation Services 90% after Deductible 70% after Deductible 50% after Deductible Mental Health/Substance Abuse Inpatient 90% Deductible Waived 70% Deductible Waived 50% after Deductible Mental Health/Substance Abuse Outpatient 90% after Deductible 70% after Deductible 50% after Deductible Mental Health/Substance Abuse Office Visit $30 Copay $45 Copay 50% after Deductible Prescription Drug Coverage Retail / Mail Order Level One $5 / $7.50 Copay $5 / $7.50 Copay $5 Copay + 25% Level Two $30 / $45 Copay $30 / $45 Copay $30 Copay + 25% Level Three $50 / $75 Copay $50 / $75 Copay $50 Copay +25% OTC Program (Select Antihistamines and Proton Pump Inhibitors) $0 Copay / Not Applicable $0 Copay / Not Applicable Not Applicable BlueCross BlueShield of Illinois - Blue Choice Options (BCO) Plan Group Number 309000 8 BCBS Medical/Prescription Drug Plan Plan Features In-Network Blue Choice Select (BCS Network) Out-of-Network Calendar Year Deductible Individual $500 $1,000 Family $500 x 2 = $1,000 $1,000 x 2 = $2,000 Medical Out-of-Pocket (excludes Deductible) Individual $1,000 $2,000 Family $1,000 x 2 = $2,000 $2,000 x 2 = $4,000 Total Medical Out-of-Pocket Maximum Individual $1,500 $3,000 Family $1,500 x 2 = $3,000 $3,000 x 2 = $6,000 Prescription Out-of-Pocket Limit Individual $3,000 $3,000 Family $3,000 x 2 = $6,000 $3,000 x 2 = $6,000 Preventive Care - Immunizations, Pap Smear, Mammogram, Prostate Exam, Routine Physical Exam 100% Deductible Waived 100% Deductible Waived Office Visit - PCP / Specialty $30 Copay / $50 Copay 60% after Deductible MARATHON PRIORITY CARE CLINIC OFFICE VISIT $0 Copay NA Inpatient Hospital Services 80% after Deductible 60% after Deductible Outpatient Surgical Care 80% after Deductible 60% after Deductible Outpatient Lab & X-ray 100% Deductible Waived 60% after Deductible Emergency Room (Copay waived if admitted) $500 Copay then 80% Deductible Waived $500 Copay then 80% Deductible Waived Ambulance 80% after Deductible 80% after Deductible Durable Medical Equipment 80% after Deductible 60% after Deductible Rehabilitation Services 80% after Deductible 60% after Deductible Mental Health/Substance Abuse Inpatient 80% after Deductible 60% after Deductible Mental Health/Substance Abuse Outpatient 100% Deductible Waived 60% after Deductible Mental Health/Substance Abuse Office Visit - PCP / Specialty $30 Copay / $50 Copay 60% after Deductible Prescription Drug Coverage Retail / Mail Order Retail Level One $5 / $7.50 Copay $5 Copay + 25% Level Two $30 / $45 Copay $30 Copay + 25% Level Three $50 / $75 Copay $50 Copay +25% OTC Program (Select Antihistamines and Proton Pump Inhibitors) $0 Copay / Not Applicable Not Applicable BlueCross BlueShield of Illinois - Blue Choice Select (BCS) Plan Group Number OMB995 9 BCBS Medical/Prescription Drug Plan Plan Features In-Network - Tier 1 Blue Choice Options (BCO Network) In-Network - Tier 2 Participating Provider Organization (PPO Network) Out-of-Network Calendar Year Deductible Individual $4,750 6,000 7,500 Family $4,750 x 2 = $9,500 $6,000 x 2 = $12,000 $7,500 x 2 = $15,000 Medical Out-of-Pocket (excludes Deductible) Individual $0 $1,500 $2,500 Family $0 $1,500 x 2 = $3,000 $2,500 x 2 = $5,000 Total Out-of-Pocket Maximum Individual $4,750 $7,500 $10,000 Family $4,750 x 2 = $9,500 $7,500 x 2 = $15,000 $10,000 x 2 = $20,000 Preventive Care - Immunizations, Pap Smear, Mammogram, Prostate Exam, Routine Physical Exam 100%, Deductible Waived 100%, Deductible Waived 50% after Deductible Office Visit 100% after Deductible 70% after Deductible 50% after Deductible MARATHON PRIORITY CARE CLINIC OFFICE VISIT Preventive - $0 Diagnostic - $25 Preventive - $0 Diagnostic - $25 NA Inpatient Hospital Services 100% after Deductible 70% after Deductible 50% after Deductible Outpatient Surgical Care 100% after Deductible 70% after Deductible 50% after Deductible Outpatient Lab & X-ray 100% after Deductible 70% after Deductible 50% after Deductible Emergency Room (Copay waived if admitted) 100% after Deductible 100% after Deductible 100% after Deductible Ambulance 100% after Deductible 100% after Deductible 100% after Deductible Durable Medical Equipment 100% after Deductible 70% after Deductible 50% after Deductible Rehabilitation Services 100% after Deductible 70% after Deductible 50% after Deductible Mental Health/Substance Abuse Inpatient 100% after Deductible 70% after Deductible 50% after Deductible Mental Health/Substance Abuse Outpatient 100% after Deductible 70% after Deductible 50% after Deductible Mental Health/Substance Abuse Office Visit 100% after Deductible 70% after Deductible 50% after Deductible Prescription Drug Coverage Retail / Mail Order Level One 100% after Deductible 100% after Deductible 100% after Deductible Level Two 100% after Deductible 100% after Deductible 100% after Deductible Level Three 100% after Deductible 100% after Deductible 100% after Deductible OTC Program (Select Antihistamines and Proton Pump Inhibitors) 100% after Deductible 100% after Deductible Not Covered BlueCross BlueShield of Illinois - Blue Choice Options (BCO) HDHP Group Number 309007 10 BCBS Medical/Prescription Drug Plan Plan Features In-Network Blue Choice Select (BCS Network) Out-of-Network Calendar Year Deductible Individual $3,800 $7,500 Family $3,800 x 2 = $7,600 $7,500 x 2 = $15,000 Medical Out-of-Pocket (excludes Deductible) Individual $0 $2,500 Family $0 $2,500 x 2 = $5,000 Total Out-of-Pocket Maximum Individual $3,800 $10,000 Family $7,600 $20,000 Preventive Care - Immunizations, Pap Smear, Mammogram, Prostate Exam, Routine Physical Exam 100% Deductible Waived 70% after Deductible Office Visit 100% after Deductible 70% after Deductible MARATHON PRIORITY CARE CLINIC OFFICE VISIT Preventive - $0 Diagnostic - $25 NA Inpatient Hospital Services 100% after Deductible 70% after Deductible Outpatient Surgical Care 100% after Deductible 70% after Deductible Outpatient Lab & X-ray 100% after Deductible 70% after Deductible Emergency Room (Copay waived if admitted) 100% after Deductible 100% after Deductible Ambulance 100% after Deductible 100% after Deductible Durable Medical Equipment 100% after Deductible 70% after Deductible Rehabilitation Services 100% after Deductible 70% after Deductible Mental Health/Substance Abuse Inpatient 100% after Deductible 70% after Deductible Mental Health/Substance Abuse Outpatient 100% after Deductible 70% after Deductible Mental Health/Substance Abuse Office Visit 100% after Deductible 70% after Deductible Prescription Drug Coverage Retail / Mail Order Retail Level One 100% after Deductible 70% after Deductible Level Two 100% after Deductible 70% after Deductible Level Three 100% after Deductible 70% after Deductible OTC Program (Select Antihistamines and Proton Pump Inhibitors) Not Covered Not Covered BlueCross BlueShield of Illinois - Blue Choice Select (BCS) HDHP Group Number OMB996 11 Near Site Clinic for Medical Participants: Priority Care 12

Near Site Clinic for Medical Participants: Priority Care 13 Get started With Marathon Health The Marathon Health patient portal and mobile app are quick and easy ways to manage your healthcare needs. This guide walks you through the process of creating your account and exploring all features. Key features

• Appointment scheduling: Book appointments with your provider
• Video visits: Meet virtually with your care team
• Messaging: Communicate securely with your care team
• Medications: Manage your prescriptions and request refills
• Health records: Easily access your medical records
• Incentives: Earn rewards by prioritizing your health

Near Site Clinic for Medical Participants: Priority Care 14 How to Schedule an Appointment Visit the Marathon Health portal at my.marathon.health (if you have not downloaded the app, its available on iOS and Android) and sign in. Click on Schedule an appointment. Select the reason for your visit. Use the quick access buttons to select a common visit reason or utilize the type ahead search bar to find a visit reason by symptom, condition, or illness. You can also click the link to view the complete list of visit reasons. Select your visit type and click Search Availability. If you select Virtual Visit you will be prompted to select the state that you will be in at the time of your visit. Use the filters to narrow your search by specific providers, health center, location, and more. You can select a specific provider from the Provider drop-down menu, select a specific date on the calendar, or click the arrows to see availability for weeks at a time. Click Search Next Available Day and select the day and time of your appointment. Review your contact and insurance information as well as appointment details. Click Confirm and Schedule Appointment. Marathon Health will send you a reminder email and text message with appointment details 7 days in advance of the appointment, or immediately if the appointment is within 7 days. For video visits: Please enter a valid email address. You will receive an email or text message after you've scheduled and prior to your appointment with instructions on how to begin your video visit. For telephonic visits: Please enter a valid phone number. Your provider will call the phone number(s) listed at the time of your appointment. Your appointment is now scheduled! Marathon Health will send you a confirmation email with your appointment details. Guardian Dental Plan - Group Number 068729 When you enroll in one of Naperville Community Unit School District 203's medical/prescription plans, you are automatically enrolled in the dental plan through Guardian. Regular dental checkups are important to your overall health and can reveal early indications of serious conditions like osteoporosis and cardiovascular disease. An oral exam can help keep your teeth and gums healthy throughout your life. Guardian's PPO Plan has access to one of the largest networks of dentists with two reimbursement levels that give you more control over savings. You will always save money with any dentist in Guardian's network and when the dentist belongs to a Tier 1 reimbursement level you will maximize your savings. Reimbursement for covered services received from a non -contracted dentist will be based on a percentile of the prevailing fee data for the dentist's zip code. To find a dentist in Guardian's PPO Network (DentalGuard Preferred), log on to www.Guardianlife.com or call 1.888.600.1600. The information below highlights some of the plan features for covered services. Please contact Guardian for the benefit plan certificate for full coverage information. Plan Features - Group # 068729 Tier 1 Tier 2 Calendar Year Deductible $50 per Member $50 per Member Annual Maximum $2,500 per Member (applies to all levels) Preventive Services 80% after deductible 80% of 90th UCR after deductible Basic Services 80% after deductible 80% of 90th UCR after deductible Major Services 50% after deductible 50% of 90th UCR after deductible Orthodontic Services (children under age 19) 50% after deductible 50% of 90th UCR after deductible Orthodontia Lifetime Maximum $2,000 per Member (applies to all levels) Preventive Services include oral examinations (two per calendar year), x- rays, cleanings (two per calendar year), topical fluoride treatment (one per benefit year for children under age 19), and sealants. Basic Services include fillings, oral surgery, general anesthesia (in conjunction with oral surgery), periodontics, and endodontics (root canals). Major Services include crowns, fixed/removable bridges, partial/full dentures, and implants.

• Please note: Out-of-Network providers are paid based on the 90th UCR (Usual, Customary, and Reasonable). This means that 90% of providers in your area charge that amount or less for a given procedure. This is the amount that the insurance company will pay from an out of network provider. This results in lower out of pocket fees for the member. Please contact Guardian for more information. 15 Guardian Vision Plan - Group Number 068729 When you enroll in one of Naperville Community Unit School District 203's medical/prescription plans, you are given the option to enroll in a vision care plan through Guardian. Vision health impacts your overall health. Routine eye exams can lead to early detection of vision problems and other diseases such as diabetes, hypertension, multiple sclerosis, high blood pressure, osteoporosis, and rheumatoid arthritis. It is recommended that you have an eye exam once every 12 months. To find an in-network vision provider (Davis Vision), visit www.guardianlife.com or call 1.888.600.1600. The information below highlights some of your plan features. Please contact Guardian for the benefit plan certificate for full coverage information. Plan Features - Group #68729 Participating Provider Non-Participating Provider Eye Examinations (1x every Calendar Year) $10 Copay $50 allowance Lenses (1x every Calendar Year) Single $10 Copay $48 allowance Bifocal $10 Copay $67 allowance Trifocal $10 Copay $86 allowance Contact Lenses (1x every Calendar Year) Elective (conventional and disposable) $150 allowance,
• 15% discount $105 allowance Medically Necessary 100% $210 allowance Frames (1x every 2 Calendar Years) $150 allowance,
• 20% discount $48 allowance Members will receive significant lens option discounts which will range from 20- 60% off the Usual & Customary charge. For example, standard progressive lenses will cost $50 and scratch resistant coating will cost $20. Oversized lenses and fashion or gradient tinting of plastic lenses are covered in full. Second pair of glasses is 50% off at Visionworks, and 30% off at other in network eye care professionals. Savings of 40-50% off the national average price of traditional Lasik is available at over 1,000 locations across the Davis nationwide network of laser vision correction providers. 16 Payroll Contributions As an employee of Naperville Community Unit School District 203, you have a variety of benefits. You share the cost of your Medical/Prescription, Dental, and Vision benefits with Naperville Community School District 203, as illustrated in the chart below. Basic Life Insurance and Long-Term Disability are provided to you at no cost. Naperville Community Unit School District 203 withholds premium contributions on a pre -tax basis by use of an Internal Revenue Code Section 125 Premium Conversion Plan. Pre- tax premiums are not subject to Federal, FICA, and in some instances, state taxes. You may request premium contributions to be deducted post -tax by contacting your Employee Benefits Specialist. Premium contributions for a Civil Union Partner, however, are subject to federal income taxes, and as such, may only be withdrawn through a post-tax payroll deduction. EMPLOYEE ONLY FAMILY Full-rate Monthly Premium 26-pay Employee Contribution 20-pay Employee Contribution Full-rate Monthly Premium 26-pay Employee Contribution 20-pay Employee Contribution Medical/Prescription Blue Choice Options PPO $974.53 $67.47 $87.71 $2,924.53 $202.47 $263.21 Medical/Prescription Blue Choice Select PPO $738.28 $51.12 $66.45 $2,208.53 $152.90 $198.77 Medical/Prescription Blue Choice Options HDHP $718.58 $49.75 $64.67 $2,149.58 $148.82 $193.46 Medical/Prescription Blue Choice Select HDHP $594.12 $41.13 $53.47 $1,777.30 $123.04 $159.96 Dental $44.47 $3.08 $4.00 $108.26 $7.50 $9.75 Vision $5.31 $0.37 $0.48 $13.35 $0.92 $1.20
• Contribution amounts listed above assume the following: Full-time Status: Empl oyee contribution amounts are increased for employees who do not work full time. These employees should refer to their union contracts or contact the Employee Benefits Specialist for specific contribution amounts Wellness Program Participation: Empl oyees and spouses must show proof of an annual physical obtained at Marathon Health Clinic or with your PCP. If you fail to provide proof an additional $300 surcharge will be applied to your premiums annually for each person that does not comply. Employee contributions will be adjusted accordingly on the first payroll in January. Spousal/Civil Union Partner Surcharge Exemption: If y ou enroll your spouse or civil union partner in a District 203 medical plan and they have access to medical coverage through their own employer that meets Affordable Care Act (ACA) essential benefits, minimum value, and affordability requirements, a spousal surcharge will apply. You will be assessed a surcharge of $3,600 annually ($138.46 per payroll based on 26 pays and $180 per payroll based on 20 pays) for the BCO plans. You will be assessed a surcharge of $2,600 annually ($100 per payroll based on 26 pays and $130 per payroll based on 20 pays) if you elect a select (BCS) plan. In addition, if you enroll your spouse and have a household income of $402,000 or more, regardless of group coverage, there will be an additional $7,200 annually. If both spouses work in the district, the additional surcharge will not apply. The surcharge applies regardless if the District 203 coverage is primary or secondary but does not apply to spouses/civil union partners with non-company sponsored health plans such as COBRA, Medicare and Veteran's Affairs. 17 Wellness Program - Powered by Marathon 18 Wellness begins with awareness and Naperville Community Unit School District 203 continues to take proactive steps to promote overall well-being. District 203 encourages you, and your spouse or civil union partner, if applicable, to participate in the Wellness Program to receive a bigger picture of your overall health and to help identify any early warning signs of disease. Updated Wellness Program D203 now offers two options for completing your wellness check to earn the 2028 Wellness Premium Rate. As a valued Naperville employee and Marathon Heath patient, your health and well -being are our top priority. We are proud to support you every step of the way on your journey toward better health. Employees and spouses covered under the District health plan can participate in our Wellness Incentive Program to qualify for the Wellness Premium Rate. This rate provides a $300 savings for the 2028 plan year. Each participant, employee and spouse, can earn their own $300 premium savings. How to Earn Your Incentive: Complete your Wellness Check any time between November 1, 2026 -October 31, 2027. Option 1: Complete a biometric screening at your Marathon Clinic.
• If you go to the clinic, Marathon will submit the necessary paperwork to receive the incentive. Option 2: Complete an Annual Exam with Preventive Labs with an outside provider.
• If you have your annual physical with preventive labs with your outside primary care physician, download the required form and upload it in the Marathon Portal by October 31 st, 2027. Be sure to visit BCBSIL.com to find in network providers. To schedule an appointment at your Marathon Clinic, call 331-226-0315 or visit my.marathon.health. Teladoc - General Medical Naperville Community Unit School District 203 offers employees that select one of our health insurance plans access to Teladoc. Teladoc is health care made simple. They are the first and largest provider of telehealth medical consults in the United States, giving you 24/7/365 access to quality health care through phone and video consults. Teladoc has board certified doctors in internal medicine, family practice and pediatrics committed to providing covered employees and families quality health care options. Teladoc does not replace your primary care physician, although it is a convenient and affordable option for quality care. Request a consult anytime and anywhere by phone - 1.800.TELADOC (835-2362) - or online at Teladoc.com. You will talk with a physician within one hour of setting up your account and calling for a consult. The physician will conduct a medical consult and assess your medical needs. When can I use Teladoc?
• You need care now
• If you're considering the ER or urgent care for a n on-emergency issue
• On vacation, on a business trip, or away from home
• For short-term prescription refills What conditions can the doctor evaluate?
• Cold and Flu Symptoms
• Allergies
• Bronchitis
• Urinary Tract Infection
• Respiratory Infection
• Sinus Problems
• Sprains and Strains
• And More! Who are the doctors at Teladoc?
• Practicing PCPs, pediatricians, and family medical physicians
• Average 15 years of experience
• U.S. board-cert ified and licensed in your state
• Credentialed every three years, meeting NCQA Standards What d oes it cost for a consult with Teladoc?
• Blue Choice Options PPO and Blue Choice Select PPO members pay $5.00 per consult
• Blue Choice Options HDHP and Blue Choice Select HDHP members pay $55.00 per consult 19 Teladoc - Behavioral Health Naperville Community Unit School District 203 offers a Behavioral Health option in conjunction with current Teladoc services. Teladoc behavioral health providers are experienced psychiatrists, psychologists, therapists and social workers. They provide assistance for issues like stress and anxiety, depression, abuse, and more. Quality behavioral health care is available through phone or video. Request a consult by phone - 1.800.TELADOC (835-2362) - or online at Teladoc.com. Benefits of using the Behavioral Health option through Teladoc Can be used from the comfort of your own home, when you are traveling, or if you have a student away at school. It can be accessed from anywhere at anytime Can provide significant cost savings versus going in-person If there is a need for multiple appointments, you can receive care from the same Behavioral Health expert throughout the duration of treatment Cost for Blue Choice Options PPO and Blue Choice Select PPO Plans $30 Copay for the first Behavioral Health Consultation with a psychiatrist $30 Copay for all subsequent Behavioral Health Consultations with a psychiatrist $30 Copay for each Behavioral Health Consultation with a therapist other than a psychiatrist Cost for Blue Choice Options HDHP and Blue Choice Select HDHP Plans $235 for the first Behavioral Health Consultation with a psychiatrist $105 for all subsequent Behavioral Health Consultations with a psychiatrist $95 for each Behavioral Health Consultation with a therapist other than a psychiatrist 20 Teladoc - Nutrition & Dermatology Naperville Community Unit School District 203 offers Nutrition and Dermatology options in conjunction with current Teladoc services. Teladoc nutrition providers are registered dieticians and supports a wide range of specialty conditions such as diabetes, sports nutrition, gastrointestinal disorders and prenatal care. Teladoc dermatology providers are licensed dermatologists that can provide services on a wide variety of skin issues. Initiate services online at Teladoc.com or via the mobile app. Benefits of using the Nutrition option through Teladoc Can be used from the comfort of your own home, when you are traveling, or if you have a student away at school. It can be accessed from anywhere at anytime. Members can receive a personalized nutrition guide with custom meal plan, shopping guide, and more. Nutrition integrates with other Teladoc Health clinical services for easy access to comprehensive care. Benefits of using the Dermatology option through Teladoc Can be used from the comfort of your own home, when you are traveling, or if you have a student away at school. It can be accessed from anywhere at anytime. A dermatologist will review images, make a diagnosis and provide a personalized treatment plan right in the app. Interact with the same dermatologist for the next 7 days for follow -up needs after initial appointment. Treats acute or ongoing skin issues like psoriasis, skin infection, rosacea and more. Providers can prescribe approved medications. Cost for Blue Choice Options PPO and Blue Choice Select PPO Plans $30 Copay for Nutrition consults $30 Copay for Dermatology consults Cost for Blue Choice Options HDHP and Blue Choice Select HDHP Plans $61 for Nutrition consults $89 for Dermatology consults 21 Teladoc - Livongo (Chronic Care Management Plus) Healthcare is going digital and with Livongo, you have the means to live healthier. The Livongo program, also known as Chronic Care Management Plus (CCM+) aims to help members struggling with diabetes, hypertension, and/or prevention. The best part? It's no cost to you! This program is covered in full through the District as we continue to strive to offer our members benefits that make a difference. Livongo (CCM+) offers the following:
• Diabetes - provi des a high-tech meter, unlimited strips and lancets, and expert assistance
• Hypertension - prov ides a connected monitor and one-on-one coaching
• Healthy Living and Diabetes Prevention - provi des a connected scale and expert guidance
• Health experts, personalized plans and more! VisitTeladocHealth.com/Goor call 800-835-2362 22 Hinge Health 23 Inspira Flexible Spending Accounts (FSA) Flexible Spending Accounts (FSAs) are optional plans offered by Naperville Community Unit School District 203 through Inspira Financial that allow you to save money by using pre-tax dollars to pay for your out-of-pocket health care and dependent care expenses. The amount you select will be deducted biweekly on a pre -tax basis from your pay (based on 26 or 20 pays). The FSA plan year aligns with the calendar year, running January 1 to December 31. Health Care Flexible Spending Account (HFSA) The HFSA allows you to pledge pre-tax money for qualified health care expenses that you, your spouse and/or your dependent children incur throughout the plan year. You do not need to be enrolled in medical, dental or vision coverage through the District to enroll in the HFSA.
• You may contribute up to $3,400 t o your HFSA for the 2027 Plan Year. This contribution limit is subject to change per IRS regulations.
• Your share of expenses which are not reimbursed by a health care plan, such as copays, deductibles, and out-of-poc ket expenses, are eligible to be claimed from the HFSA plan.
• The IRS and Naperville Community Unit School District 203 allow you to claim any unused HFSA amounts afte r the end of the plan year for expenses incurred until March 15 of the new plan year. All claims, including those incurred during the grace period, must be submitted by March 31. The "Use It or Lose It" rule applies to any funds left in your HFSA account after the grace period has expired. Dependent Care Flexible Spending Account (DCA) The DCA allows you to pledge pre-tax money for qualified dependent care expenses you incur throughout the plan year. Eligible dependents are those whom you are entitled to claim as dependents on your federal tax return, are under age 13, and/or a disabled spouse or other disabled tax- qualified dependent who spends at least eight hours a day in your home. If you are married, your spouse must also work, be a full -time student or be disabled.
• You may contribute up to $7,500 to your DCA for the 2027 Plan Year if you are single or if you are married and file a joint return.
• You may contribute up to $3,750 to your DCA for the 2027 Plan year if you are married and file separate income tax returns.
• Expenses such as day care, before- and afte r-school programs, summer day camp and adult day care are eligible to be claimed from the DCA plan. All DCA expenses must be incurred during the plan year and submitted by March 31. The "Use It or Lose It" rule applies to any DCA funds left in your account at the end of the plan year. There is no grace period for the DCA. 24 Lively Health Savings Account (HSA) If you enroll in the Blue Choice Options HDHP or Blue Choice Select HDHP medical/prescription plan offered by Naperville Community School District 203, you may be eligible to open a Health Savings Account (HSA) with Lively to help you save pre-tax dollars to pay for out-of-pocket health care expenses. The funds in your HSA belong to you and may be used tax-free for current or future IRS qualified medical expenses or may be left to accumulate for use during retirement. The funds deposited into the account and the earnings are tax - deferred; funds withdrawn for IRS qualified medical expenses are tax -free. To be eligible to open or contribute to an HSA, you must be: Covered by a qualified HDHP Not enrolled in Medicare Not listed as a dependent on another person's income tax return Not covered by another non-HSA q ualified medical plan - including an HFSA Your spouse's non-HSA qualified coverage does not affect your ability to contribute to an HSA as long as it does not cover you. However, if you or your spouse participates in a Health Flexible Spending Account (HFSA), you are considered "covered" by a non-HSA qualified plan and as such cannot contribute to an HSA unless the FSA is limited-purpose and applies only to dental and/or vision expenses. Note for Annual Benefits Enrollment: If you switch to one of the HDHPs from a PPO and have a health care flexible spending account, the balance in your HFSA account must be zero ($0.00) on December 31, 2026. If you carry any balance into the following year, you cannot become HSA -eligible until the first day of the month after the grace period ends - April 1, 2027. Your 2027 total HSA contribution cannot exceed the maximum based on a nine-month year. The employer contribution to your Health Savings Account will be prorated accordingly, as well as your employee contribution, as applicable. If you have funds in your HFSA, you may continue to claim expenses against your HFSA through the grace period. Contributions to an HSA may be made by an employee using pre- tax payroll deductions, bank deposits, or a one-time rollover from an IRA, as well as those made by District 203. HSA contributions are limited by the U.S. Internal Revenue Service based on the calendar year. The maximum amount that can be contributed to an HSA for 2027 (employee and employer contributions combined) is $4,500 for employee only coverage and $9,000 for family coverage. Individuals over age 55 may make an additional "catch-up" contribution of $1,000 annually. District 203 has committed to contributing to the Lively HSA of each eligible employee who participates in the Blue Choice Options HDHP or Blue Choice Select HDHP for the 2027 Plan Year. District 203 will contribute $1,500 for employee only coverage and $3,000 for family coverage to employees who remain in or elect a high-deductible health plan during Annual Benefits Enrollment. The annual district contribution will be deposited in January 2027 as long as the employee has an active Lively HSA through Naperville 203. For the balance of the year, contributions will be prorated for employees not eligible for an HSA for the entire year. To maximize the tax advantages of your contributions, we highly encourage you to contribute through payroll deductions. This method ensures your contributions are made on a pre -tax basis, which can reduce your taxable income. If you choose to contribute to your plan outside of payroll, please let your Naperville Benefits team know, and we can provide you with instructions on adjusting your payroll contributions if needed. Please remember that contributions made outside of the benefits/payroll system will not have the same pre -tax advantages. You may withdraw funds from your HSA for any purpose at any time. However, funds withdrawn for reasons other than IRS qualified medical expenses will be taxed and, for those under age 65, subject to a penalty. Funds for IRS qualified medical expenses may be withdrawn tax - and penalty-free as long as the expenses are incurred after the HSA was established. You may even use HSA funds tax - and penalty-free for the qualified medical expenses of your IRS-defined tax dependents even if they are not covered under the HDHP. Qualified medical expenses are defined under Section 213 of the IRS Code (see IRS Publication 502). If at any point, you no longer meet the eligibility requirements for an HSA, you may no longer make contributions. However, the balance of your HSA will not be affected, and you may use any existing funds in your account to pay for IRS qualified medical expenses tax -free (even if you no longer have HDHP coverage) or continue to save the funds with tax-free interest until used. If you are not HSA eligible for the entire tax year, it is generally prudent to prorate your contributions. 25 Guardian Life and AD&D Plan Group # 068729 Planning your financial security is a challenging task under the best of circumstances, but what happens if you die or are sidelined due to a lengthy illness or injury? How will your family pay the monthly bills? That's where your income protection benefits come into play. One of those benefits is life insurance. Naperville Community Unit School District 203 provides basic life insurance and accidental death and dismemberment (AD&D) insurance through Guardian at no cost to you. The information below highlights some of the plan features. Please contact Guardian for the benefit plan certificate for full coverage information.
• Life Insurance: See cha rt below for benefits. The amount of benefit will be reduced to 65% at age 70 and will be further reduced to 50% at age 75
• Accidental Death or Dismemberment (AD&D): Your b eneficiary will receive 100% of benefit upon your death or if you lose two of the following: hand, foot and/or eye. Fifty percent of benefit will be paid for loss of one hand, one foot or sight of one eye
• Accelerated Benefit (Living Benefit): If you have been diagnosed with a terminal illness and life expectancy is 24 months or less, you can receive 75% of the life benefit. Please note: your death benefit would be reduced by the amount taken through the accelerated benefit upon your death ($37,500 provided through Living Benefit and $12,500 provided upon death for a total benefit of $50,000)
• Convertible: You may convert your policy to an individual whole life policy within 31 days of termination of employment without submitting evidence of insurability Eligibility Life Benefit AD&D Benefit Active full-time administrator, non-union personnel, NUEA, NESPA, NTA and NUMA staff; except any person employed on a temporary or seasonal basis $50,000* Same as life amount
• Minimum life benefit; the amount of benefit will be reduced to 65% at age 70 and will be further reduced to 50% at age 75 Please note: In the event of Total Disability, it is your responsibility to file a Waiver of Premium with Guardian to extend your life insurance coverage. You must submit proof of Total Disability within one year from the date the disability began, and resubmit annual proof thereafter, to continue to extend your benefits an additional 12 months until retirement or up to 12 months past age 65. 26 Guardian Long-Term Disability Plan Group # 068729 Long-Term Disability (LTD) is another income protection benefit offered to you at no cost by Naperville Community Unit School District 203. Long-Term Disability replaces a portion of your earnings if you are disabled for an extended period of time due to illness or injury. All full- time active employees are eligible for Long-Term Disability coverage through Guardian. The information below highlights some of the plan benefits. Please contact Guardian for the benefit plan certificate for full coverage information.
• Benefits begin after 60 consecutive days of disability or the day allotted/accrued sick time is exhausted, whic hever is greater
• Pays 60% of basic monthly income up to a maximum of $10,000 pe r month
• Benefits continue until you reach your normal retirement age under Social Security, as long as you conti nue to be disabled
• Benefits may be available if working on a part-time basis while disabled
• Survivor benefit is equal to three times the insured's last monthly benefit if death occurs after 180 cons ecutive days of total disability Please note: Definition of disabled changes after 60 months of disability. For the first 60 months, you are considered disabled if unable to perform the material duties of your regular occupation. After that time, you are considered disabled if you are unable to perform the material duties of any occupation for which you are suited by education, training, or experience. 27 Guardian Voluntary Life Insurance Plan Group # 068729 Naperville Community Unit School District 203 provides all eligible employees with the opportunity to purchase additional life insurance at group rates through Guardian. You pay the full cost of this coverage through after-tax payroll deductions. The information below highlights some of the plan features; p lease contact Guardian for the benefit plan certificate for full coverage information. Insured Benefit Guaranteed Issue Amount New Employee Option of $10,000 to $500,000 in increments of $10,000 All Ages: $250,000 Current Employee Option of $10,000 to $500,000 in increments of $10,000 Current elected amount, plus an additional $50,000 up to $250,000 Spouse/Civil Union Partner Option of $10,000 to $500,000 in increments of $10,000 (cannot exceed 100% of employee amount) All Ages: $50,000 Dependent Children 14 days to 6 months: $1,000 6 months to Age 26: Choice of $5,000, $10,000, $15,000, or $20,000 $20,000 Employees eligible for supplementary life insurance are active employees working 25 or more hours per week, except those working on a temporary or seasonal basis. Legal spouses of eligible employees and domestic or civil union partners where required by law, are eligible under age 75 but must be under age 70 on the date of application. All Guaranteed Issue amounts are for current plan year and may change in future years. All employee and spouse/civil union partner premium rates are age -banded and based on the age at last birthday. During open enrollment for 2027, employees that are currently enrolled in voluntary life/ADD coverage, may increase current amount up to an additional $50,000, not to exceed the guarantee issue amount without submitting evidence of insurability. Employee and Spouse/Civil Union Partner Rate per Person per $10,000 per Month Age Rate for All Members Under 30 $0.60 30 - 34 $0.80 35 - 39 $0.90 40 - 44 $1.47 45 - 49 $2.56 50 - 54 $4.47 55 - 59 $7.95 60 - 64 $9.69 65 - 69 $14.37 70+ $26.53 28 Guardian Voluntary Life Insurance Plan Group # 068729 Eligible children are unmarried, financially dependent natural, adopted, foster or stepchildren in the custody of an eligible employee. One rate applies for all eligible dependent children in the family, regardless of number. Coverage for dependent children terminates at age 26 but is extended up to age 30 if dependent child is an Illinois resident honorably discharged from the armed forces. Children beyond age 26 will continue to be covered if they are incapable of self-sustaining employment by reason of intellectual disability or physical handicap and are chiefly dependent on the eligible employee for support and maintenance. You may elect child voluntary life coverage, even if the employee or spouse are not electing voluntary life coverage. Dependent Children Rate per Month Option 1 Option 2 Option 3 Option 4 Coverage amount from age 14 days to 6 months $1,000 $1,000 $1,000 $1,000 Coverage amount from age 6 months to 26 years $5,000 $10,000 $15,000 $20,000 Rate $0.82 $1.64 $2.46 $3.28 To comply with the Age Discrimination in Employment Act (ADEA), the following reduction formula applies to insured employees (spouses/civil union partners are ineligible as of age 75): Age Amount of Coverage Reduces to: 75 - 79 60.0% of the amount in force at age 74 80 - 84 35.0% of the amount in force at age 74 85 - 89 28.0% of the amount in force at age 74 90 and over 20.0% of the amount in force at age 74 Guaranteed Issue: Benefit issue amounts are guaranteed to a certain level without regard to health status if enrollment occurs within 31 days of your effective date. The guaranteed issue amount is up to $250,000 for new employees under age 60. Spouses/civil union partners under age 60 are guaranteed an issue of up to $50,000 and dependent children are guaranteed an issue of up to $20,000. At annual enrollment employees may increase their current amounts by up to $50,000 without submitting an Evidence of Insurability (EOI) as long as the elected amount remains under the guaranteed issue amount of $250,000. If you apply for benefits above the guaranteed issue amounts, you may be subjected to evidence of insurability and a health screening prior to coverage approval. Accelerated Benefit (Living Benefit): If you are under age 75 and have been diagnosed with a terminal illness and life expectancy is 24 months or less, you can receive 50% of the life benefit. You can utilize this money for expenses incurred that are not covered by other insurance for your care. Please note: your death benefit would be reduced by the amount taken through the accelerated benefit upon your death. Portability: Coverage can continue if the insured no longer meets the employment eligibility requirements for reasons other than over-all termination of the group policy. Premiums charged will be based on the prevailing rate charged to all insured who continue coverage under this provision and will be billed directly to the insured. 29 Guardian Voluntary Critical Illness Plan Group # 068729 Critical Illness insurance helps you reduce the potential financial impact of serious illness by providing a lump - sum cash payment upon diagnosis of a covered condition. Naperville Community Unit School District 203 offers employees the ability to purchase Critical Illness coverage for themselves and their dependents at group rates through Guardian. You pay the full cost of this coverage through convenient after -tax payroll deductions. The information below highlights some of the plan features; please contact Guardian for the benefit plan certificate for full coverage information. Insured Benefit Guaranteed Issue Amount Employee Option of $5,000 to $30,000 in increments of $5,000 $30,000 Spouse/Civil Union Partner Option of $5,000 to $30,000 in increments of $5,000 $30.000 Dependent Children 25% of Employee's Benefit limited to $7,500 maximum $7,500 Employees eligible for Critical Illness Insurance are active employees working 25 or more hours per week, except those working on a temporary or seasonal basis. Legal spouses of eligible employees and domestic or civil union partners where required by law, are eligible under age 75 but must be under age 70 on the date of application. Employees must be enrolled in the Critical Illness plan to extend coverage to their spouses/civil union partners and/or dependent children. Employee and Spouse/Civil Union Partner Rate per Person per Month based on the below Age -Bands (child rate is included in employee amount) Benefit Amount Less than 30 30-39 40-49 50-59 60-69 70+ $5,000 $1.55 $3.15 $4.40 $7.40 $12.25 $20.65 $10,000 $3.10 $6.30 $8.80 $14.80 $24.50 $41.30 $15,000 $4.65 $9.45 $13.20 $22.20 $36.75 $61.95 $20,000 $6.20 $12.60 $17.60 $29.60 $49.00 $82.60 $25,000 $7.75 $15.75 $22.00 $37.00 $61.25 $103.25 $30,000 $9.30 $18.90 $26.40 $44.40 $73.50 $123.90 All employee and spouse/civil union partner premium rates are age- banded and based on the age at last birthday. Eligible children are unmarried, financially dependent natural, adopted, foster or stepchildren under age 26 in the custody of an eligible employee. Coverage for dependent children terminates at age 26 but is extended up to age 30 if the child is an Illinois resident honorably discharged from the armed forces. Children beyond age 26 will continue to be covered if they are incapable of self -sustaining employment by reason of intellectual disability or physical handicap and are chiefly dependent on the eligible employee for support and maintenance. 30 Guardian Voluntary Critical Illness Plan Group # 068729 Covered Critical Illnesses fall into one of four categories:
• Cancer Related: Invas ive Cancer, Carcinoma in situ
• Cardiovascular Related: Heart Attack, Stroke, Coronary Artery Bypass
• Pregnancy and Childbirth Related: Infert ility non-surgical, infertility surgical
• Other: Kidney (Renal) Failure, Major Organ Failure Plan Features Benefit Diagnosis of Heart Attack, Invasive Cancer, Severe Stroke, Major Organ Failure or Kidney (Renal) Failure 100% of amount in force Diagnosis of Coronary Artery Bypass, Moderate Stroke 50% of amount in force Recurrence (Same Category) - Same Illness must be separated by 6 Months, Different illness in same category has no time requirement Varies based on Category (50%-0%) Infertility non-surgical: Prescription oral medication, prescription injectable medication, intrauterine insemination (IUI) Infertility surgical: Removal of uterine fibroids, polyps, uterine septum, endometriosis tissue or fallopian tube scare tissue, varicocelectomy, egg removal for the purpose of artificial insemination for the purpose of in vitro fertilization, other surgical intervention performed to treat infertility Infertility non-surgical: 1 time, lifetime benefit of 10% of the elected amount Infertility surgical: 1 time, lifetime benefit of 30% of the elected amount Subsequent Occurrence (Differed Category) diagnosis must be separated by at least 6 months 100% of Basic or Partial Benefit Lifetime Maximum Benefit per Category 2 occurrences per category when applicable Completion of Wellness / Health Screening $50 per 12-month period Guaranteed Issue: Benefit issue amounts are guaranteed to a certain level without regard to health status if enrollment occurs during the Annual Benefits Enrollment period or within 31 days of first becoming eligible. The guaranteed issue amount is up to $30,000 for employees and spouses/civil union partners and $7,500 for dependent children. Pre-Existing Conditions: Diagnosis must be made while covered under the plan in order for the benefit to pa out. Waiting Period: There is no waiting period for benefits to be paid out. Portability: After coverage has been in effect for at least 1 day, coverage can continue if the insured is under the age of 70 and no longer meets the employment eligibility requirements for reasons other than retirement or overall termination of the group policy. Premiums charged will be based on the prevailing rate charged to all insured who continue coverage under this provision and will be billed directly to the insured. 31 Voluntary Accident Plan Group # 068729 Value Plan Advantage Plan Premier Plan Wellness Screening $50 $75 $100 Ambulance $150 $200 $300 Emergency Room Treatment $150 $200 $250 Diagnostic Examination $100 per CT/MRI Scan $200 per CT/MRI Scan $400 per CT/MRI Scan Hospital Admission $500 $1,000 $1,500 ICU Hospital Admission $1,000 $2,000 $3,000 Hospital Confinement $200/day 365-day max $250/day 365-day max $350/day 365-day max ICU Confinement $400/day 15-day max $500/day 15-day max $700/day 15-day max Fractures Up to $5,000 Up to $8,000 Up to $10,000 Dislocations Up to 4,000 Up to $5,000 Up to $7,000 Transfusion $300 $300 $300 Burns 9-18 square inches = $0 - $2,000 18-35 square inches = $1,000 - $4,000 Over 35 square inches = $3,000 - $12,000 Concussion $100 $200 $300 Exploratory Surgery $300 $400 $500 Knee Cartilage Surgery $250 $500 $750 Abdominal/Thoracic Surgery Up to $1,000 Up to $1,500 Up to $2,000 Ruptured Disc Surgery $250 $500 $750 Physical Therapy $25/day up to 10 days $35/day up to 10 days $50/day up to 10 days Accidental Death - Employee $25,000 $50,000 $100,000 Accidental Death - Spouse $12,500 $25,000 $50,000 Accidental Death - Children $5,000 $10,000 $20,000 Dismemberment - One member 50% of Death Benefit 50% of Death Benefit 50% of Death Benefit Dismemberment - Two or more members 100% of Death Benefit 100% of Death Benefit 100% of Death Benefit Accident Insurance can help lessen your financial burden by providing a