NEW HIRE BENEFITS INFORMATION

The San Jacinto College District is committed to equal opportunity for all students, employees, and applicants without regard to race, creed, color, national origin, citizenship status, age, disability, pregnancy, religion, gender, sexual orientation, gender expression or identity, genetic information, marital status, or veteran status in accordance with applicable federal and state laws. The following College official has been designated to handle inquiries regarding the College’s non-discrimination policies: Vice Chancellor of Human Resources, 4624 Fairmont Pkwy., Pasadena, TX 77504; 281-991-2659; [email protected].

El distrito de formación superior San Jacinto College District está comprometido para proporcionar oportunidades de igualdad para todos los estudiantes, empleados, y sus solicitantes sin importar su raza, casta, color, origen nacional, estado de ciudadanía, edad, discapacidad, estado de maternidad, religión, género, orientación sexual, expresión o identidad de género, información genética, estado civil, o veterano del servicio militar en concordancia con las leyes federales y estatales que apliquen. La siguiente funcionaria de la institución ha sido designada para administrar cuestiones con respecto a las pólizas de prevención de discriminación: La vicecanciller de Recursos Humanos, 4624 Fairmont Pkwy., Pasadena, TX 77504; 281-991-2659; [email protected]. SJC 403(b)/457(b) Retirement Program News

San Jacinto College (SJC) offers a variety of voluntary retirement programs [403(b) and 457(b)] for its employees. Student workers and private contractors are not eligible to participate. The IRS has issued new regulations regarding 403(b) plans which significantly increase the administrative and reporting responsibilities of San Jacinto College.

In response to these requirements, SJC has selected the TSA Consulting Group, Inc. (TSACG) to facilitate the administration of these plans effective immediately. TSACG is a privately held Florida based corporation founded solely for the purpose of providing compliance administration services to 403(b) eligible employers in public school systems and colleges. Currently TSACG has more than 1500 clients in the United States.

TSACG provides a variety of services to public education employees that relate to the administration of 403(b) and 457(b) retirement plans in compliance with guidelines established by the Internal Revenue Service. TSACG was founded in 1994 and its experience with public colleges and school systems in the 403(b) arena was one of the key factors in the selection process by the Texas Investment Provider Selection Committee (TIPSC) which SJC is a member. A few of the other member colleges are Alvin Community College, Alamo Community College, Brazosport Community College, College of the Mainland, Lee College, Dallas County Community College District, Houston Community College, and Temple Community College.

All enrollments and change in either plan must be processed through the TSACG. If you wish to enroll in either plan you must first select a provider and investment product(s) authorized under the plan by SJC. Once you have established an account, you must complete a Salary Reduction Agreement (SRA) form for your 403(b), and/or a Deferred Compensation form for your 457(b) plan. This form authorizes SJC to withhold contributions from your pay on a pre-tax basis and send the funds to your selected investment company on your behalf. The SRA from and/or Deferred Compensation form is necessary to begin or restart contributions, change allocation between providers, change the total amount of contributions, or terminate contributions. The current list of authorized 403(b) providers and current SJC forms are available on the TSACG web page. There is also an informational online video presentation about SJC’s 403(b) retirement plan that you are encouraged to view. The video is short and is designed to help you better understand the Plan and how it can help you reach your retirement goals.

To access the TSACG-San Jacinto information: Go to https://www.tsacg.com and click on Plan Sponsor Pages. From the drop-down select Texas. Then another drop-down will appear and select San Jacinto College District.

Participation in either plan is voluntary and should be based on your financial objectives and resources. TSACG and SJC are not liable for any loss that may result from your investment decisions. Therefore, you may want to consult a tax advisor or financial advisor before enrolling.

Optional Retirement Program

The Optional Retirement Program (ORP) is an individual 403(b) retirement plan funded by tax deferred contributions made by eligible employees and the state. Enrolling in ORP, in lieu of TRS, can only be done within 90 days of hire into an ORP eligible position and is an irreversible decision. You can only enroll with a SJC approved ORP investment provider. You can also find this list on the TSACG-SJC web page.

Should you have any questions, please contact the HR-Benefits office.

Authorized Retirement Providers (As of August 2019)

Providers with Assigned Agents AXA Equitable AIG Retirement Services (VALIC) Customer Service: 800.777.6510 Customer Service: 800.448.2542 www.us.axa.com www.valic.com

Agent: Mark Cavazos Agent: Ramona Dalton (South & District) Cell: 832.647.4892 Cell: 832.457.2353 [email protected] [email protected]

Regional Vice President: Jim Watkins Agent: Brian Orner (Central & Maritime) Cell 713.303.6863 Cell: 713.298.9558 [email protected] [email protected]

Agent: Amanda Sadler Cell: 281-381-9177 [email protected] Pentegra Retirement Services Security Benefit Customer Service: 866.633.4015 Customer Service: 800.888.2461 www.pentegra.com www.securitybenefit.com

Agent: John Hudson Agent: John Hudson Office: 281.277.6400 Office: 281.277.6400 Email: [email protected] Email: [email protected] MetLife Voya Financial Customer Service: 800.638.5433 Customer Service: 866.865.2660 www.metlife.com www.voya.com

Agent: Alicia Ten Eyck Cell: 713.459.4112

Providers without Assigned Agents American Century Investments Aspire Customer Service: 800.345.3533 Customer Service: 866.634.5873 www.americancentury.com www.aspirefinserv.com Fidelity Investments TIAA CREF Financial Services Customer Service: 800.343.0860 Customer Service: 888.842.7782 www.fidelity.com www.tiaacref.com

HOLIDAYS FOR 12 MONTH EMPLOYEES

ACADEMIC YEAR 2019 – 2020

Dates Holiday Total Days

September 2, 2019 Labor Day 1

November 27 – 29, 2019 (No Weekend Classes) Thanksgiving 3

December 23, 2019 – January 1, 2020 Winter Break 8

January 20, 2020 Martin Luther King, Jr. Day 1

March 9 – 15, 2020 (No Weekend Classes) Spring Break 5

April 10 – April 12, 2020 (No Weekend Classes) Spring Holidays 1

May 25, 2020 Memorial Day 1

July 3 – 5, 2020 Independence Day 1

Total Holidays 21 Days

ERS® EMPLOYEE AND NON-MEDICARE-ELIGIBLE RETIREE EMPLOYEESQRETIREMENT HEALTH PLANS COMPARISON CHART SYSTEM OF TEXAS Effective September 1, 2019

Consumer Directed HealthSelect of Texas HMOs HealthSelect Benefits Living and Working in Texas HealthSelect Out-of-State Community Scott and Network Non-Network Network Non-Network Network Non-Network First White $2,100 per $4,200 per $500 per person1 $500 per person1 person1 Annual Deductible None None person1 None None $1,500 per family1 $1,500 per family1 $4,200 per $8,400 per family1 family1 Out-of-pocket $2,000 $7,000 $2,000 $7,000 $2,000 $2,000 coinsurance None None per person1 per person1 per person1 per person1 per person3 per person3 maximum2

Total out-of- pocket $6,750 per $6,750 per $6,750 per $6,750 per $6,750 per

maximum person1 person1 person1 person3 person3 (including deductibles, None None None $13,500 per $13,500 per $13,500 per $13,500 per $13,500 per coinsurance and 1 1 1 3 3 copays)4, 5 family family family family family Primary care provider Yes No No No No No Yes No required Primary care provider $25 copay 40%* $25 copay 40%* 20%** 40%* $25 $25 office visit a. Outpatient physician or mental health $25 copay 40%* $25 copay 40%* 20%** 40%* $25 $25 provider office visit $150/day copay $150/day copay $150/day copay $150/day copay $150/day copay $150/day copay plus 20% plus 40%* plus 20% plus 40%* plus 20% plus 20% ($750 copay ($750 copay ($750 copay ($750 copay ($750 copay ($750 copay b. Inpatient hospital max, up to 5 max, up to 5 max, up to 5 max, up to 5 max, up to 5 max, up to 5 20%** 40%* mental health stay6 days per hospital days per hospital days per hospital days per hospital days per hospital days per hospital stay. $2,250 stay. $2,250 stay. $2,250 stay. $2,250 stay. $2,250 stay. $2,250 copay max per copay max per copay max per copay max per copay max per copay max per calendar year per calendar year per calendar year per calendar year per plan year per plan year per person) person) person) person) person) person) c. Outpatient facility care (partial hospitalization/ 20% 40%* 20% 40%* 20%** 40%* 20% 20% day treatment and extensive outpatient treatment)7 Specialty physicians’ $40 copay13 40%* $40 copay 40%* 20%** 40%* $40 copay13 $40 copay13 office visits Routine eye exam, one per year per $40 copay 40%* $40 copay 40%* 20%** 40%* $40 copay3 $40 copay3 participant Routine preventive No cost to No cost to No cost to No cost to No cost to 40%* 40%* 40%* care# participant(s) participant(s) participant(s) participant(s) participant(s) Diagnostic x-rays, lab tests, and 20% 40%* 20% 40%* 20%** 40%* 20% 20% mammography Office surgery and diagnostic 20% 40%* 20% 40%* 20%** 40%* 20% 20% procedures No charge for No charge for No charge for No charge for No charge for Maternity Care routine prenatal routine prenatal routine prenatal routine prenatal routine prenatal doctor charges only; appointments $25 40%* appointments $25 40%* appointments 40%* appointments $25 appointments $25 inpatient hospital or $40 for first or $40 for first or $40 for first or $40 for first copays will apply 20%** for first post-natal visit8 post-natal visit8 post-natal visit post-natal visit post-natal visit8 High-tech radiology $100 copay $100 copay $100 copay $100 copay $100 copay $100 copay (CT scan, MRI, and 20%** 40%* plus 20% plus 20% plus 20% plus 40%* plus 20% plus 40%* nuclear medicine)6,7,9 coinsurance coinsurance

Chart_2019_Comparison 1 6/11/2019 Consumer Directed HealthSelect of Texas HMOs HealthSelect Benefits Living and Working in Texas HealthSelect Out-of-State Community Scott and Network Non-Network Network Non-Network Network Non-Network First White $50 copay $50 copay $50 copay $50 copay Urgent care clinic 40%* 40%* 20%** 40%* plus 20% plus 20% plus 20% plus 20%

20%; $40 copay 20%; $40 copay $40 copay Chiropractic Care $40 copay plus 20% with 40%* plus 20% with 40%* 20%** 40%* plus 20% with a. Coinsurance plus 20% office visit office visit office visit

b. Maximum benefit $75 $75 $75 $75 $75 $75 $75 None per visit c. Maximum visits 35 (maximum Each participant Per 30 30 30 30 30 30 30 manipulative calendar year therapy visits) $150/day copay $150/day copay $150/day copay $150/day copay $150/day copay $150/day copay plus 20% plus 20% plus 20% plus 40%* plus 20% plus 40%* ($750 copay ($750 copay Inpatient hospital ($750 copay max, ($750 copay max, ($750 copay max, ($750 copay max, max, up to 5 max, up to 5 (semi-private room up to 5 days per up to 5 days per up to 5 days per up to 5 days per 20%** 40%* days per hospital days per hospital and day’s board, and hospital stay. hospital stay. hospital stay. hospital stay. 6 stay. $2,250 stay. $2,250 intensive care unit) $2,250 copay $2,250 copay $2,250 copay $2,250 copay copay max per copay max per max per calendar max per calendar max per calendar max per calendar plan year per plan year per year per person) year per person) year per person) year per person) person) person) $150 plus 20% $150 plus 20% $150 plus 20% $150 plus 20% $150 plus 20% $150 plus 20% (if admitted copay (if admitted copay (if admitted copay (if admitted copay (if admitted (if admitted Emergency care 20%**10 20%**10 will apply to will apply to will apply to will apply to copay will apply copay will apply hospital copay)10 hospital copay)10 hospital copay)10 hospital copay)10 to hospital copay) to hospital copay) Outpatient surgery $100 copay $100 copay $100 copay $100 copay $100 copay $100 copay other than in 20%** 40%* plus 20% plus 40%* plus 20% plus 40%* plus 20% plus 20% physician’s office Deductible: Deductible: $5,000 $5,000 Coinsurance: Coinsurance: Bariatric surgery11,12 Not covered Not covered Not covered Not covered Not covered Not covered 20% 20% Lifetime max: Lifetime max: $13,000 $13,000 20%** Plan pays up to $1,000 per ear Plan pays up to $1,000 per ear every Hearing aids14 Plan pays up to $1,000 per ear every three years (no deductible) every three years (after deductible three years (no deductible) is met) Durable medical 20% 40%* 20% 40%* 20%** 40%* 20% 20% equipment6 Ambulance Services 20% 20% 20% 20% 20%** 20%** 20% 20% *Note: 40% coinsurance after you meet the annual out-of-network deductible **Note: 20% coinsurance after you meet the annual in-network deductible 1Applies to calendar year, January 1 - December 31. 2Does not include copays. 3Applies to plan year, September 1 - August 31. 4Out-of-pocket maximums are not mutually exclusive from other out-of-pocket limits. This means that a participant’s total network out-of-pocket maximum could contain a combination of coinsurance and/or copayments. 5Includes medical and prescription drug copays, coinsurance and deductibles. Excludes non-network and bariatric services. 6Preauthorization required. 7Outpatient testing only. Does not apply to inpatient services. 8Copay depends on whether treatment is given by PCP or specialist. 9No copay if high-tech radiology is performed during ER visit or inpatient admission. 10Benefits shown do not apply to out-of-network freestanding ERs. For information about this coverage, see your plan’s Master Benefit Plan Document. 11The deductible and coinsurance paid for bariatric surgery does not apply to the total out-of-pocket maximum. 12Active employees only; see health plan for additional requirements/limitations. 13 Referrals to see specialists are required from your designated PCP on file in order to receive in-network benefits for specialist office visits, even if the specialist is in your plan’s network. 14The $1,000 hearing aid maximum benefit does not apply to hearing aids for minors 18 years and younger. #Under the Affordable Care Act, certain preventive and women’s health services are paid at 100% (at no cost to the participant), dependent upon physician billing.

Chart_2019_Comparison 2 6/11/2019 SM HealtHSelect of texaS PreScriPtion Drug PrograM

Benefits At-A-Glance

As a HealthSelectSM member, your prescription drug benefits manager is OptumRx®, an affiliate of UnitedHealthcare®. Below is a summary of your prescription drug benefits and frequently asked questions about your prescription benefit program.

Your Personal In Network Prescription Retail pharmacy Network Extended Days’ Supply (EDS) Benefit (1- to 30- day supply) Retail Pharmacy or OptumRx Program Mail Service Pharmacy For long-term medications (Up to a 90-day supply) Where You can use your prescription benefit at To locate an EDS retail pharmacy in your more than 67,000 HealthSelect participating area, go to www.HealthSelectRx.com pharmacies, including more than 20,000 and use the Locate a Pharmacy tool independent community pharmacies. To or call a customer care representative locate a participating retail pharmacy in your toll-free (866) 336-9371 (TTY 711). area, go to www.HealthSelectRx.com and use the Locate a Pharmacy tool or call a customer care representative toll-free at (866) 336-9371 (TTY 711). Our representatives can answer both medical and prescription drug questions. Tier 1 $10 for non-maintenance medications $20 for a 31-60 day supply $10 for maintenance medications $30 for a 61-90 day supply Tier 2* $35 for non-maintenance medications $70 for a 31-60 day supply $45 for maintenance medications $105 for a 61-90 day supply Tier 3* $60 for non-maintenance medications $120 for a 31-60 day supply $75 for maintenance medications $180 for a 61-90 day supply Out of Network Extra 40% coinsurance added to amounts shown for Tiers 1, 2 and 3 for both non-maintenance and maintenance medication. Annual Deductible Each participant must pay an annual $50 deductible before the program begins to cover your prescription drug expenses. The deductible starts over each January. Web Services Visit www.HealthSelectRx.com to locate a network pharmacy; estimate the cost of your medications; and find out more about your prescription benefits. Customer Care Visit www.HealthSelectRx.com or call toll-free (866) 336-9371 (TTY 711).

SM

HealthSelect of Texas Frequently asked questions

About the retail program About the mail service program Q. H ow can I find a network pharmacy? Q. How does OptumRx mail service work? A. Go to www.HealthSelectRx.com and click on the A. Order up to a 90-day supply of medications you Locate a Pharmacy tool link, or call a customer care take regularly. You can submit your order via representative toll-free at (866) 336-9371 (TTY 711). phone, mail, online or through the OptumRx App. Our representatives can answer both medical and Additionally, your physician can electronically prescription drug questions. submit your prescription to OptumRx. OptumRx fills your order and mails it to you within 10 days of Q. M y pharmacy is currently not in the OptumRx placing the order. OptumRx will notify you if there network. Do I have to transfer my prescription will be a delay in delivering your order. to a network pharmacy? A. N o, but if you continue to fill your medication at the Q. H ow do I order my prescriptions from OptumRx non-network pharmacy, you may pay much more home delivery pharmacy? for your prescription. You will need to transfer your A. Y ou have four ways to place a mail service order: prescription to a network pharmacy to continue receiving network benefits. • Online. Visit www.OptumRx.com/HealthSelectRx or open the OptumRx App Q. H ow do I know what my copayment is for my • On the phone. Call the toll-free number medication at a retail pharmacy? at (866) 336-9371 (TTY 711) A. T o get an estimate of your prescription drug costs, • V ia mail. Download a form from visit www.HealthSelectRx.com and click on the www.HealthSelectRx.com, then complete Drug Pricing Tool. You can also call a customer care and mail with your prescription representative toll-free at (866) 336-9371 (TTY 711). Our representatives can answer both medical and • Via ePrescribe. Your doctor can send an electronic prescription drug questions. prescription to OptumRx

Q. C an I get more than a 30-day supply of a Q. O nce I place a mail service order, how quickly medication at an EDS Network Pharmacy will I get my medication? through OptumRx? A. N ew prescription orders are delivered by standard A. Yes. OptumRx has an EDS network where you U.S. mail and will arrive within 10 business days will be able to fill more than a 30-day supply from the date OptumRx receives the order. Refills of a medication at a retail pharmacy. To find normally arrive within seven business days. a list of EDS pharmacies in network, visit www.HealthSelectRx.com. About the OptumRx drug list Questions? Q. W here can I see the Prescription Drug List/ formulary list of covered drugs? A. Visit www.HealthSelectRx.com to find the Call a customer care representative Prescription Drug List/formulary list of covered drugs. toll-free at (866) 336-9371 (TTY 711). Our representatives can answer both medical and prescription drug questions. Or visit www.HealthSelectRx.com.

* Tier 2 and Tier 3 : If a generic is available and you choose to buy the brand-name medication, you will pay the generic copay plus the cost difference between the brand-name and the generic medication.

All trademarks are the property of their respective owners. WL7508A-ERS_170213 HEALTHY LIVING IS JUST A DEAL AWAY. Join Blue365® and start saving today!

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© 2000-2017 Blue Cross Blue Shield Association – All Rights Reserved. The Blue365 program is brought to you by the Blue Cross Blue Shield Association. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and/or Blue Shield Companies. Blue365 offers access to savings on health and wellness products and services and other interesting items that Members may purchase from independent vendors, which are different from covered benefits under your policies with your local Blue Company, its contracts with Medicare, or any other applicable federal healthcare program. To find out what is covered under your policies, contact your local Blue Company. The products and services described on the Site are neither offered nor guaranteed under your Blue Company’s contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding your health insurance products and services may be subject to your Blue Company’s grievance process. BCBSA may receive payments from vendors providing products and services on or accessible through the Site. Neither BCBSA nor any Blue Company recommends, endorses, warrants, or guarantees any specific vendor, product or service available under or through the Blue365 Program or Site. 16-021-V01 ERS® DENTAL COMPARISON CHART EMPLOYEESVRETIREMENT Effective September 1, 2019 SYSTEM OF TEXAS

State of Texas Dental Choice

This is a preferred provider organization (PPO) dental insurance plan. You can see any dentist you want, but will pay less if you go to a dentist in one of the two Delta Dental networks: • Delta Dental PPO • Dental Premier Dentists of both the Delta Premier and Delta Dental PPO are in-network providers. Making a smooth move to Delta Dental You will get the same coverage in either network, but We are transitioning to a new third-party administrator you may pay less for covered services in the Delta so we get the best value for dental services, while Dental PPO network. Delta Premier dentists can charge keeping the cost to participants in the plan as low higher rates for the same coverage. as possible. ERS will mail a Welcome Letter to all Benefits are available in the United States, Canada and participants. These letters will include the policy Mexico, if you live in the United States. holder’s Delta Dental member number. Here are some tips to make the process go a little more smoothly: • Before September 1, 2019, be sure to check and see if your PCD is in network at www.ERSdentalplans.com. • Once you’ve enrolled, watch your mailbox for your Welcome Letter, which will include your member number. The letter should be mailed to you in August. DeltaCare® USA • Dentists who participate in the Delta Dental networks should not require ID cards. If you want This is a dental health maintenance organization a card, however, you can download and print a (DHMO) dental insurance plan. paper copy of your dental insurance information • Coverage applies only to dentists in the Texas from your Delta Dental online account. service area. Before you enroll, make sure there is a Please note: only the policy holder’s name will be DHMO network dentist in your area. listed on the card. Dependents’ names will not be • You must choose a primary care dentist (PCD) from listed. a list of approved providers. You and your enrolled • Be sure to let your dependents know that Delta dependents can choose different PCDs. Dental manages their dental plan. • Services from participating specialty dentists cost Please note: A dependent can get coverage at 25% less than the dentists’ usual charges. an in-network dentist by giving their own name, or the policy holder’s name and member number. If you have any questions, call Delta Dental toll-free at (888) 818-7925 (TTY: 711), Monday – Friday from 7 a.m. to 8 p.m. CT.

Chart_2019_Dental_Comparison 1 6/11/2019 Dental plans comparison chart State of Texas Dental Choice PlanSM DeltaCare USA DHMO Preferred Provider Organization (PPO) or Premier Provider Network Administered by Delta Dental You must select a primary care dentist (PCD). Dentists NOTE: Not all participating dentists In-network / participating dentist Out-of-network / non-participating dentist1 accept new patients. Dentists are not required to stay on the plan for the entire year. Preventive: Individual-$0; Family-$0 Preventive: Individual-$50; Family-$150 Deductibles None Combined Basic/Major: Individual-$50; Family-$150 Combined Basic/Major: Individual-$100; Family-$300 Orthodontic services: no deductible Orthodontic services: no deductible Preventive and Diagnostic Services: 10% coinsurance Preventive and Diagnostic Services: No charge. after meeting the Preventive and Diagnostic deductible. Basic Services: 10% coinsurance after meeting the PCD: Copays vary according Basic Services: 30% coinsurance after meeting the Basic Services deductible. to service and are listed in the Basic Services deductible. “Schedule of Dental Benefits” Major Services: 50% coinsurance after meeting the Copays/ Major Services: 60% coinsurance after meeting the booklet. Major Services deductible. coinsurance Major Services deductible. Specialty dentistry: 75% of the There is no charge for anything over the allowed Participants may be required to pay the difference dentist’s usual and customary fee. amount. 2 between the allowed amount and billed charges. DHMO pays nothing Once the Maximum Calendar Year Benefit is reached, Once the Maximum Calendar Year Benefit is reached, the participant pays 60% until January 1. the participant pays 100% until January 1. Maximum calendar $2,000 per covered individual $2,000 per covered individual Unlimited year benefits (includes orthodontic extractions) (includes orthodontic extractions) Maximum lifetime Unlimited $2,000 per covered individual for orthodontic services $2,000 per covered individual for orthodontic services benefit Vary according to service and are Average cost of listed in the “Schedule of Dental No charge. 10% of the allowed amount after deductible is met. cleaning / oral Benefits” booklet. Up to two cleaning/oral exams per calendar year Up to two cleaning/oral exams per calendar year exams Up to two cleaning/oral exams per allowed. allowed. calendar year allowed. Orthodontic services performed by a general dentist listed in the directory with an “0” treatment code: 50% of the allowed amount. Orthodontic child - $1,800; 50% of the allowed amount. coverage Participants may be required to pay the difference adult- $2,100. between the allowed amount and billed charges. Orthodontic services performed by specialist: 75% of the usual fee. DHMO pays nothing.

NOTE: The comparison chart is a summary of the benefits offered by the two dental insurance plans. See plan booklet for actual coverage and limitations. Prior to starting treatment, discuss with your dentist the treatment plan and all charges. 1In the State of Texas Dental Choice Plan PPO, deductibles and annual maximums are per calendar year. Non-participating dentists can bill for charges above the amount covered by Delta Dental. Visit a participating dentist to ensure you do not receive additional charges. 2This comparison chart reflects participant responsibility for services received from participating primary care dentists only. Services from participating specialty dentists are 25% less than the dentist’s usual charge.

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Discount dental plan no longer available through ERS Effective September 1, 2019 the State of Texas Dental Discount PlanSM, administered by Careington International Corporation, will not be offered through the Texas Employees Group Benefits Program (GBP). For more information, review the Delta Dental flier that came in your Summer Enrollment packet.

Chart_2019_Dental_Comparison 2 6/11/2019 Vision plan administered by

WELCOME TO STATE OF TEXAS VISION

Your vision benefits State of Texas Vision offers voluntary vision benefits through Superior Vision Services, Inc. Benefits include:  eye exams and  prescription eyewear (frame and lenses or contact lenses). The vision benefits include access to the Superior National network. The Superior National network is a broad and diverse mix of independent ophthalmologists and optometrists and 50 of the Top 501 optical retail chains across the country.

Importance of an Eye Exam A routine eye exam is important for correcting vision problems and maintaining healthy eyes and overall wellness. During an eye exam, providers look for signs that may indicate other vision and health issues — from macular degeneration and glaucoma to diabetes and high cholesterol. If you are diagnosed with a disease such as glaucoma, you will need to see a medical doctor; reference the Master Benefits Plan Document for your health plan. Whether or not you sign up for State of Texas Vision, you still have access to your health plan benefits. If your health plan does not offer benefits for corneal diseases or injuries, please contact Superior Vision for information on benefits offered through State of Texas Vision. Enrolling is Easy Choose Your Savings You can enroll in State of Texas Vision: Monthly rates effective within 31 days of your hire or rehire date, September 1, 2019—August 31, 2020   during Summer or Fall Enrollment and  within 31 days of experiencing a qualifying COBRA COBRA life event. disability You only $5.12 $5.22 $7.68 You and spouse $10.24 $10.44 $15.36 Contact Customer Service You and child(ren) $11.01 $11.23 $16.52 www.StateofTexasVision.com You and family $16.13 $16.45 $24.20 Email: [email protected] Surviving spouse only $5.12 Phone: (877) 396-4128 TTY: 711 Monday-Friday: 7:00 a.m. - 8:00 p.m. CT Surviving spouse and children $11.01 Saturday: 10:00 a.m. - 3:30 p.m. CT Surviving child(ren) only $5.89  Vision benefits  Locating an in-network provider  Nominating a provider  Non-network claim reimbursement 1 Based on SVS National Network, 2019 .

Plan Year 2020 www.StateofTexasVision.com Page 1 QUALITY BENEFITS

Vision Benefits Summary

BENEFITS IN-NETWORK NON-NETWORK7 Exam $15 copay1 Up to $40 after $15 copay Contact lens fitting (standard2) $25 copay1 Up to $100 retail Contact lens fitting (specialty2) $35 copay1 Up to $100 retail Lenses (standard) per pair:  Single vision $10 copay1 Up to $30 retail  Bifocal $15 copay1 Up to $45 retail  Trifocal $20 copay1 Up to $60 retail Lens Options (standard):  Progressive $70 copay1 Not covered  Polycarbonate Up to $50 copay1 Not covered  Scratch coat Up to $10 copay1 Not covered  Ultraviolet coat Up to $10 copay1 Not covered  Tints, solid or gradient Up to $10 copay1 Not covered  Anti-reflective coat Up to $40 copay1 Not covered Frames or Contact Lenses3 $150 retail allowance4,5,6 Up to $50 or Up to $100 retail8

Each benefit in the vision plan can be used every plan year, per person. All allowances are at retail value; participant is responsible for any amount over the allowance, minus available discounts.

1 Covered in full after copay is met. 2 A Contact Lens Fitting exam has its own copay and is separate from the eye exam copay. Standard Contact Lens Fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty Contact Lens Fitting applies to new contact wearers and/or a participant, who wears toric, gas permeable, or multi-focal lenses. 3 Contact lenses are in lieu of eyeglass lenses and frame benefit. This allowance can be used once every plan year. 4All costs and allowances are retail; you are responsible for any charges in excess of the retail allowances. 5The frame allowance allows you to purchase one (1) frame up to $150 with no out-of-pocket cost. If you purchase a frame that costs more than $150, you are responsible to pay the difference. Should you purchase frames that are under $150, you will forfeit the remaining allowance. 6The contact lens allowance of $150 allows you to choose to use the full allowance on one purchase or divide it up throughout the benefit year for multiple contact lens purchases. If your contact lens purchase(s) total more than $150, you are responsible to pay the difference. 7If you use non-network providers, you will be required to pay in-full which will be higher. See the Member Handbook for more information. 8Up to $50 retail reimbursed for non-network frames or up to $100 retail reimbursed for non-network contact lenses.

All final determinations of benefits, administrative duties, and definitions are governed by the Master Benefits Plan Document.

Plan Year 2020 www.StateofTexasVision.com Page 2 Nominate a Provider The Superior National network is made up of more than 90,000 providers nationwide. Superior Vision continuously works to enhance 95% the network. The average percentage of vision plan participants who If your eye care provider does not participate in the Superior National 1 network, you may nominate him or her by submitting a Provider see an in-network provider Nomination form or calling Customer Service.

The credentialing process can take up to 60 days and every effort will be made to consider your nomination. However, the provider’s response, geographical location or qualifying guidelines may restrict provider participation. 159.2 million In-Network and Non-Network Providers Adults over age 18 wear glasses2 1. What do I need to pay my in-network provider?

You pay your in-network provider any applicable copays, plus you are also responsible for paying for any services or materials that are not covered by or exceed your benefit plan coverage. 2. What if my eye doctor is not listed as an in-network provider?

If you have verified that your provider does not participate in the Superior National network, you may submit a Provider Nomination form or call Customer Service to nominate a provider over the phone. 3. May I go to a non-network provider?

Yes. You and your dependents may access services from a non-network provider. You will be reimbursed at the non-network rate detailed in your Member Handbook. 4. How can I use my benefit when seeking services from an non-network provider?

First, verify that the provider you wish to see is not in the network. Then, schedule your appointment and pay the provider in-full for the services rendered. When you use non-network providers, you will pay higher out-of-pocket costs. To be reimbursed for a non-network service, submit a claim form and your itemized receipt to Superior Vision, via fax or mail, to be reimbursed up to the allowable amount as outlined in your plan details. Claim forms are available on the State of Texas Vision website.

Additional Discounts Superior Vision offers discounts through certain in-network providers. The discounts can be used to reduce the retail charges for a variety of lens upgrades and add-ons, overages on frame allowances and/or additional frame and lens purchases. Discounts may vary by provider and location. Please contact your provider before your visit to verify their participation in the discount features as some providers do not. Discounts are subject to change without notice and do not apply if prohibited by the manufacturer.

Vision Correction Surgery (LASIK) Superior Vision has a nationwide panel of refractive surgeons and leading LASIK networks who offer participants a discount. These discounts range from 15%-50%, and are the best possible discounts available to plan participants.

1 Based on internal Superior Vision data, 2013-2016. 2 Based on data from The Vision Council, US Optical Overview and Outlook December 2015. Plan Year 2020 www.StateofTexasVision.com Page 3 ID Cards  Does the eye exam include dilation of the eyes?

 Where do I get my ID card? Dilation is not always necessary as part of a

One ID card will be sent to you by your effective date. comprehensive eye exam, but when recommended The card is for you and your dependents covered by by the eye care provider, it is covered as part of the the plan. Additional ID cards are available at no cost eye exam. Retinal imaging, digital retinal exams, from the State of Texas Vision website, Customer and fundus photography are not covered and you Service, or the Superior Vision mobile app. will be responsible for the charges.  Do I need to show my ID card to the in-network  May I use in-store specials, promotions or coupons along with my vision plan benefits? provider to receive services?

No, although the ID card includes helpful information Your in-network benefits and discounts cannot be and phone numbers for the provider to reference used in conjunction with coupons, promotions, sales regarding your benefits or discounts. While you don’t or other types of discounts. If you choose to take need your card, it is important that you always identify advantage of a sale, coupon or other in-store yourself as a State of Texas Vision participant. special—from an in-network or non-network provider—you will need to pay the provider in full and submit your itemized receipt to Superior Vision Using Your Benefits for reimbursement at the non-network rates.  Do I need to obtain an authorization number or  What happens if I select materials and services file a claim when obtaining services from an that are NOT covered?

in-network provider? You will be responsible for the full amount of any

No, the in-network providers will handle the materials and services that are not covered by your authorization and claims filing process for you. benefits. This may include allowance overages, certain lens options, or materials after you have  May I go to one provider for the eye exam and exhausted your benefits. Based on the provider another provider for eyewear? selected, discounts may apply.

Yes. With State of Texas Vision you have the flexibility to choose the provider who best matches your needs  Do I need to purchase “insurance” on my glasses from the provider? and budget. Each provider will contact Superior Vision to verify your eligibility. Some providers offer a warranty on broken, lost, or stolen materials. This warranty is not a covered  How does the retail frame allowance work? benefit nor administered by State of Texas Vision or

Your frame allowance is $150. If the retail price of the Superior Vision. Should you decide to purchase a frame is greater than $150, you will pay the difference. warranty policy, it will be at your own expense. If the price of the frame is less than the allowance—for example $100—you forgo any remaining allowance. You cannot use any remaining allowance for additional purchases.  Is the contact lens fitting exam an additional charge from the eye exam?

Yes, the contact lens fitting (CLF) exam is a separate evaluation of your eye and therefore is a stand-alone benefit. The additional copay for a CLF exam is either $25 or $35 depending on your needs. Details are available in the benefits chart. A CLF exam measures and examines your eyes for the purpose of evaluating them for contacts.  How can I use my elective contact lens allowance?

If you choose to wear contact lenses in lieu of glasses as your vision correction, the allowance may be used to purchase any type of elective contact lenses. The allowance is cumulative—this allows you the choice to use it all at once or divide it up throughout the benefit year until you spend the full $150. Your benefit is greater when dispensed by an in-network provider.

Plan Year 2020 www.StateofTexasVision.com Page 4 Texas Employees Group Benefits Program (GBP) Group Term Life and AD&D Insurance

Buy aordable

ork at W Take advantage of guaranteed coverage opportunities

You have only one chance to elect guaranteed coverage without providing proof of good health, also called evidence of insurability (EOI). Within 31 days of initial eligibility, choose from the following coverage options: • Election 1 – 1x Annual Salary • Election 2 – 2x Annual Salary Elections above these amounts and elections made after initial eligibility require EOI. Group Term Life insurance helps protect your family against the unexpected loss of your life and income during your working years. Accidental Death and Dismemberment (AD&D) insurance provides additional financial protection if an insured person’s death or dismemberment is due to a covered accident, whether it occurs at work or elsewhere.

Underwritten by Minnesota Life Insurance Company Protect your family from the unexpected loss of your life and income during your working years.

Automatic basic coverage Enroll in Optional Term Life

Basic Term Life and Insurance – the power of group AD&D Insurance rates at work make the cost affordable. $5,000 Basic Term Life Monthly rates are shown per $1,000 of annual salary and increase with age. AD&D Age Election 1 Election 2 Election 3 Election 4 $5,000 Under 25 $0.05 $0.10 $0.15 $0.20 This is an automatic benefit for employees 25-29 0.05 0.10 0.15 0.20 enrolled in a GBP health plan. 30-34 0.06 0.12 0.18 0.24 35-39 0.06 0.12 0.18 0.24 40-44 0.08 0.16 0.24 0.32 45-49 0.12 0.24 0.36 0.48 50-54 0.19 0.38 0.57 0.76 55-59 0.33 0.66 0.99 1.32 Here’s the easy math 60-64 0.57 1.14 1.71 2.28 65-69 0.93 1.86 2.79 3.72 to your monthly premium: 70-74 1.48 2.96 4.44 5.92 75-79 2.41 4.82 7.23 9.64 Annual salary $ 80-84 3.92 7.84 11.76 15.68 ÷ 1,000 85-89 6.79 13.58 20.37 27.16 90 and over 10.57 21.14 31.71 42.28 x your election’s rate for your age group $ Dependent Term Life Insurance = $1.38 per month for $5,000 Monthly premium $ Cover your spouse, eligible children or both. One premium provides coverage for all of them.

Voluntary AD&D Insurance Emloyee: $0.02 per $1,000 per month Employee and Family: $0.04 per $1,000 per month All rates are subject to change. YOUR GROUP LIFE INSURANCE PLAN

Available optional coverages Optional Term Life and AD&D Dependent Term Life and AD&D Voluntary AD&D

For active employees under age 70 Available for your eligible spouse For active employees under age 70 and children • Election 1: 1x your annual salary • Choose a benefit from $10,000 up to $200,000 in increments of $5,000 • Election 2: 2x your annual salary $5,000 Dependent Term Life Insurance • AD&D insurance ends upon your • Election 3: 3x your annual salary retirement, regardless of age • Election 4: 4x your annual salary $5,000 AD&D Dependent coverage Maximum coverage is the lesser of Spouse: 50% of the employee’s amount 4x your annual salary or $400,000 Additional information Each child: Elections include a matching AD&D benefit. • You may not be covered as both a State of Texas employee and as a dependent • 5% of the employee’s amount if there is For active employees age 70 and over of a State of Texas employee a spouse who is eligible for insurance

Choose from the same elections above; • If both parents are GBP-eligible • 10% of the employee’s amount if there is however, your coverage will be reduced employees, each parent may enroll the no spouse who is eligible for insurance to a percentage of your elected amount, same eligible children in Dependent based on your age on September 1 of each Term Life Insurance year, rounded to the next highest $1,000:

• 70-74: 65%

• 75-79: 40%

• 80-84: 25%

• 85-89: 15%

• 90 and over: 10%

ELECT ELECT ELECT What additional plan features are available? • Extended Insurance Benefit – If you become disabled before age 60, your life insurance premiums may be waived. • Accelerated Life Benefit – If you or an insured dependent become terminally ill with a life For more detailed information, please refer to expectancy of 12 months or less, you may request early payment of the life insurance. the Active Employees Benefits Booklet or visit LifeBenefits.com/plandesign/ers • Changing coverage amounts – You may request to increase or decrease coverage when you have a qualifying life event, such as a birth or marriage, or during Annual Enrollment. You will need to provide evidence of insurability (EOI) for increases outside of the initial 31-day period. For more information about EOI, please visit LifeBenefits.com/plandesign/ers. • Conversion – You can convert term life coverage Learn how life insurance can protect your financial to an individual life insurance policy when future by watching a brief video at you leave employment or reduce coverage. LifeBenefits.com/videos/term Premiums may be higher than those paid by active employees. For more information on converting to an individual private policy call us toll-free at 1‑877‑494‑1716.

QUESTIONS? Call Securian’s Austin service office toll-free at 1-877-494-1716 from 8:00 AM to 5:00 PM Central time. Relay Texas, TTY (for hearing impaired or deaf callers only): dial 7-1-1

This is a summary of plan provisions related to the insurance policy issued by Minnesota Life to ERS. In the event of a conflict between this summary and the policy and/ or certificate, the policy and/or certificate shall dictate the insurance provisions, exclusions, all limitations, and terms of coverage. All elections or increases are subject to the actively at work requirement of the policy.

Securian Financial Group, Inc.

Group Insurance – Austin Office 600 Congress Ave, Suite 2160, Austin, TX 78701 • 1-877-494-1716 • www.LifeBenefits.com/plandesign/ers ©2015 Securian Financial Group, Inc. All rights reserved.

F75102-3 REV 9-2016 DOFU 9-2016 65961 Don’t think you need SM Texas Income Protection Plan disability coverage? Consider what would happen if you became disabled and Just the Facts did not receive a paycheck. • Who would pay your rent or mortgage and utility bills? Protection and Peace of Mind • How would you support Most of us rely on our paycheck to cover bills and everyday others who rely on your pay? expenses. But what if you became sick or injured tomorrow? • How would you pay for your Could you afford to go a few months or even a few weeks without insurance? a paycheck? For most of us, the answer is “no.” That’s where • Who would pay for your disability coverage comes in. groceries? The Texas Income Protection PlanSM (TIPP) offers short-term and long-term disability coverage that provides you with a percentage of your paycheck when you can’t work due to illness, injury or pregnancy. TIPP payments can help you take care of essentials like housing, utilities, food and childcare.

Get Disability Coverage The best time to get coverage is within 31 days of your hire date—when you don’t need to provide evidence of insurability (EOI).

1 2 3 NEW HIRE SUMMER ENROLLMENT QUALIFYING LIFE EVENT (QLE) Enroll within 31 days of your Apply during Summer Enrollment Apply within 31 days of a QLE hire date by logging in to your by logging in to your ERS account such as marriage or birth of a Employees Retirement System of and submitting EOI. Coverage is child. Apply by logging in to your Texas (ERS) account. You don’t subject to approval. ERS account and submitting EOI. need to submit EOI. Coverage is subject to approval.

It all boils down to this: get disability coverage within 31 days of your hire date—when you don’t need EOI. EOI is used to determine eligibility for TIPP coverage. EOI is required to apply for coverage during Summer Enrollment or a QLE. This means coverage is subject to approval by Minnesota Life, an affiliate of Securian Financial Group, Inc., the underwriter for TIPP benefits.

Texas Income IP Protection PlanP For State Employees Texas Income Protection Plan Benefit Basics

TIPP offers short-term and long-term disability coverage that protects your income by paying a percentage of your paycheck if you become disabled and can’t work, for reasons such as illness, injury or pregnancy.

Here’s a brief comparison of the TIPP options.

Short-term Disability Coverage Long-term Disability Coverage Monthly payments 66% of your monthly salary up to $10,000 60% of your monthly salary up to $10,000 of salary* of salary* Maximum benefit $6,600 per month (66% of up to $10,000 $6,000 per month (60% of up to $10,000 of salary to a maximum benefit of $6,600) of salary to a maximum benefit of $6,000) Example: If your insured monthly salary Example: If your insured monthly salary is $3,200, your monthly short-term disability is $3,200, your monthly long-term disability payment would be $2,112 ($3,200 × 66% payment would be $1,920 ($3,200 × 60% = $2,112).** = $1,920).** Benefits start after You complete a waiting period of You complete a waiting period of (whichever is longer) 30 consecutive days and at the 180 consecutive days and at the same time use all your sick leave. same time use all your sick leave. This means that you must use all your sick leave (including extended sick leave and sick leave pool) at the same time you are completing the waiting period (30 days or 180 days). If you have more than the specified days of sick leave, benefits are not payable until all of your sick leave is used. You are not required to use your vacation or other annual leave. How long Up to 5 months after you complete Until you are able to return to work or, the waiting period depending on your age when you become disabled, generally until full Social Security retirement age

*The maximum monthly salary covered is $10,000. **This amount is less if you receive payments from other sources. See the User’s Guide at www.texasincomeprotectionplan.com to learn more.

TIPP Resources You have two ways to connect to your TIPP benefits: online or by phone. TIPP website at TIPP Customer Care at ReedGroup www.texasincomeprotectionplan.com Toll-free at (855) 604-6230 (TDD - 711), Monday – Friday, 7 a.m. – 7 p.m. CT • Learn about TIPP benefits • Ask questions about your TIPP benefits • Review plan limitations and exclusions • File a disability claim (what’s not covered) • Check the status of a claim • Access the Master Benefit Plan Document • File a disability claim and check claim status

Self-Service 08-2016 Save Money on Health Care and Dependent Care

Enroll in TexFlexSM and use pre-tax money to There are three types of accounts: save on eligible out-of-pocket health care and • Health care account – used to pay eligible medical, dental, dependent care expenses including: vision, hearing, and prescription drug expenses. You can • medical copays, deductibles and coinsurance, elect from $180 to $2,600 for your annual contribution. • prescriptions, • Dependent care account – used to pay eligible expenses • dental, including child day care and adult care day programs. You • vision, can elect from $180 to $5,000 for your annual contribution. • day care, and • Limited account – used to pay eligible vision and dental • much more! expenses. You can elect from $180 to $2,600 for your What is TexFlex? annual contribution. You must be enrolled in Consumer Directed HealthSelectSM (CDHS) to participate in the limited A TexFlex account is a flexible spending account (FSA) that FSA. lets you set aside money from your paycheck, pre-tax, to use for eligible out-of-pocket expenses. You can contribute to a health care and/or a dependent care account. The TexFlex program is available to all benefits-eligible active employees. TexFlex is a great way to SAVE MONEY by LOWERING YOUR TAXES! There will be an administrative fee holiday for participation in the TexFlex spending accounts for Plan Year 2018. TexFlex Facts 2

How will TexFlex save me money? • Orthodontia treatments, such as braces You pay less in taxes. Here’s an example: • Routine dental exams and cleanings (excludes bleaching or whitening) with TexFlex without TexFlex Note: You must be enrolled in Consumer Directed SM Annual pay $50,000 $50,000 HealthSelect (CDHS) to participate in the Limited FSA. TexFlex pre-tax ($2,000) $0 TexFlex website – www.TexFlexERS.com contribution Visit the TexFlex website now to learn more about the: Taxable income $48,000 $50,000 • TexFlex Program Federal income, Social • Eligible expenses, and Security and Medicare ($10,966) ($11,616) taxes • TexFlex debit card. After-tax dollars spent Also, be sure to check out the informative videos and access $0 ($2,000) on eligible expenses the contribution calculation worksheet. Real spendable $37,034 $36,384 income Online Account Services: • Access your TexFlex account 24/7; see how much you $0 Annual Savings $650 elected, how much has been paid, what’s pending and how * Sample tax savings for a single taxpayer with no dependents. Actual savings will much is available in your account. vary based on your individual tax situation. Please consult a tax professional for more information. • View claim status alerts and notifications with important information about your account. Should I enroll? • Quickly search for all current and past claims, payments and contributions. If any of the following expenses apply to you or your eligible • Download reimbursement claim forms. family members, enrolling in TexFlex can save you money on: • Sign up for direct deposit. Health Care • Copays, deductibles or coinsurance for medical, dental or FREE! TexFlex debit card for the health vision plans care or limited FSA • Prescription medications If you sign up for TexFlex for Plan Year 2018 and you’re new to the program, you will receive a FREE TexFlex debit card for • Glasses or contacts, or plan on having laser eye surgery easy access to your TexFlex health care or limited FSA funds • Orthodontia treatments, such as braces in late-August. After you activate your card, you can begin using the card on September 1 to pay for eligible expenses. If Note: Over-the-counter medications (except insulin) are NOT eligible for reimbursement unless the medication is you’re a current TexFlex participant, you will continue to use prescribed. the debit card you received last year.

Dependent Care Fast reimbursement • You and your spouse (if married) are working, looking for Claims and reimbursements are processed on a daily basis. work or attend school full-time, and Sign up for direct deposit and get your reimbursement faster - have children under age 13 who attend day care, before/ than by check. after-school care or summer day camp, or - you provide care for any other person of any age who is When do I enroll? mentally or physically incapable of caring for himself or You can enroll in the TexFlex program: herself, and comply with other IRS requirements. • within 31 days of your hire date, For a detailed list of TexFlex eligible expenses, visit • during Summer Enrollment and www.TexFlexERS.com and click on “Program • within 31 days of experiencing a qualifying life event. Resources.”

Limited • Glasses or contacts, or plan on having laser eye surgery TexFlex Facts 3

TexFlex account overview for Plan Year 2018 Note: TexFlex health care and limited FSA participants have access to the full contribution amount at the Health Care Dependent Care Account Account beginning of the plan year. Annual maximum $2,600 $5,000 contribution $500 TexFlex carry over Submit claims Carry over up to $500 in your health care or limited FSA online, by fax or Yes Yes to the next plan year! Now there is less risk of giving up mail unspent money in your TexFlex health care account, because Use the TexFlex No, all claims submitted Yes 1 of the $500 carry over option. debit card online, by fax or mail. Full annual contribution Monthly; as funds are The $500 carry over does not apply to the dependent care Availability of is available starting added to your account funds September 1, 2018 from your paycheck accounts; they have the 2½-month grace period and will not be able to carry over funds to the next plan year. You will have 2 Yes No Carry over until December 31, 2018 to submit your claim paperwork Grace period3 No Yes for money spent on health care by August 31, 2018 and on dependent care by November 15, 2018. 4 September 1, 2018- September 1, 2018- Run out period December 31, 2018 December 31, 2018

How do I enroll? 1 There is no fee for the card. You will receive one card and can request additional cards by calling TexFlex Customer Care at toll-free Enroll in TexFlex during Summer Enrollment. Once you have (844) 884-2364. determined your annual TexFlex contribution, the amount 2 Health care account funds, up to $500, that carry over from the previous you specify will be deducted from your pay check in equal plan year to the new plan year. Any amount over $500 will be forfeited. Does amounts throughout the year, before taxes. not apply to the dependent care account. 3 Allows an extra 2 ½-month period after August 31 in which you can incur new claims using the previous plan year funds. 4 Timeframe in which the participant can submit claims for reimbursement for services incurred during the previous plan year. The run-out period applies to both accounts.

How much should I contribute to my TexFlex Account? That’s up to you. The amount you elect to contribute is unique to your health care and day care situation. Look at what you typically spend each year on out-of-pocket health care and dependent care. Use the decision support tool at www.TexFlexERS.com to estimate the amount that’s right for you.

continued TexFlex Facts 4

How do I use TexFlex? You have options! • Pay for an eligible expense, log into your TexFlex spending account and upload your claim.* TexFlex reimburses you from your account by sending a check or through direct deposit. • Pay for an eligible expense and submit a claim by fax or mail. You will be reimbursed from your TexFlex account by sending a check or through direct deposit. • Pay for the eligible health care expenses using the TexFlex debit card.** When you swipe your card at the point of service, the money is automatically deducted from your account. Keep all receipts in case you are asked to provide

verification of eligible expenses at a later time. TexFlex *Claims must include the appropriate proof of purchase documentation. Debit Card **Dependent care account participants cannot use the TexFlex debit card and will need to submit dependent care claims online, by mail or fax for reimbursement.

Where can I learn more? Visit www.TexFlexERS.com for more information about TexFlex, including eligible expense guides and an interactive contribution and tax-savings calculator. Call TexFlex Customer Care toll-free at (844) 884-2364. TexFlex representatives are available Monday - Friday, 7 a.m. - 7 p.m., CT, excluding holidays.

Important terms to know Grace period: Allows an extra 2½-month period after August 31 in which you can incur new claims using the previous plan year funds. Carry over: Health care and Limited FSA funds, up to $500, that carry over from one plan year to the next. Any amount over $500 will be forfeited. Does not apply to dependent care accounts.

TexFlex participant support:

TexFlex Customer Care: Claims fax: Mail: Online: (844) 884-2364 (toll-free) (866) 643-2219 WageWorks, Inc. www.TexFlexERS.com Monday - Friday (toll-free) 5200 Commerce Crossings 7 a.m. - 7 p.m. CT Suite 100 TDD: 711 Louisville, KY 40299

SM WageWorks, Inc. is the third-party administrator for the TexFlex program provided by ERS. TexFlex Brochure 2018 Update ERS Beneficiaries It’s important to select the in­dividuals who will receive your retirement account and life insurance benefits in the event of your death. This person is called your beneficiary. You can have more than one beneficiary. Before going online to se­lect your beneficiary, make sure you have your beneficiary’s Social Security number (SSN), date of birth, and mailing address.

Add a new beneficiary Click “Change Information or Add New Beneficiary” button, Click "Add a New Beneficiary," Enter beneficiary's personal data (Social Security number is required) , Click "Save," and Click "Return to Summary of Beneficiaries"

Change a beneficiary Review your beneficiary designations, Click the blue link under the Plan Description for the benefit you would like to assign, Click “Request Designation Change,” Select your beneficiary(ies), Click “Save Beneficiary Elections,” Click "Submit Changes," Receive the beneficiary designation form by email, or mail if you do not have an email address updated on your ERS account.

Complete and return the beneficiary designation form Review the form, Print and sign your name, Have an unrelated witness (not you or the beneficiary) sign his or her name, and Return the form to ERS

Your designation is not valid until you receive a confirmation from ERS. You can change your beneficiaries anytime of the year. You do not have to wait for Annual Enrollment.

THE EMPLOYEES RETIREMENT SYSTEM OF TEXAS SUMMARY NOTICE OF PRIVACY PRACTICES

The Employees Retirement System of Texas (“ERS”) administers the Texas Employees Group Benefits Program, including your health plan, pursuant to Texas law. THIS NOTICE DESCRIBES HOW ERS MAY USE OR DISCLOSE MEDICAL INFORMATION ABOUT YOU AND HOW YOU CAN GET ACCESS TO YOUR OWN INFORMATION PURSUANT TO THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (“HIPAA”) PRIVACY RULE. PLEASE REVIEW THIS NOTICE CAREFULLY.

Uses and disclosures of health information: ERS and/or a third-party administrator under contract with ERS may use health information about you on behalf of your health plan to authorize treatment, to pay for treatment, and for other allowable health care purposes. Health care providers submit claims for payment for treatment that may be covered by the group health plan. Part of payment includes ascertaining the medical necessity of the treatment and the details of the treatment or service to determine if the group health plan is obligated to pay. Information may be shared by paper mail, electronic mail, fax, or other methods.

By law, ERS may use or disclose identifiable health information about you without your authorization for several reasons, including, subject to certain requirements, for public health purposes, for auditing purposes, for research studies, and for emergencies. ERS provides information when otherwise required by law, such as for law enforcement in specific circumstances. In any other situation, ERS will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures. ERS cannot use or disclose your genetic information for underwriting purposes. ERS may change its policies at any time. When ERS makes a significant change in its policies, ERS will change its notice and post the new notice on the ERS website at www.ers.state.tx.us. Our full notice is available at https://www.ers.state.tx.us/Insurance/HIPAA/HIPAA_Long_Form/.

For more information about our privacy practices, contact the ERS Privacy Officer. ERS originally adopted its Notice of Privacy Practices and HIPAA Privacy Policies and Procedures Document April 14, 2003, and subsequently revised them effective February 17, 2010, and September 23, 2013.

Individual rights: In most cases, you have the right to look at or get a paper or electronic copy of health information about you that ERS uses to make decisions about you. If you request copies, we will charge you the normal copy fees that reflect the actual costs of producing the copies including such items as labor and materials. For all authorized or by law requests made by others, the requestor will be charged for production of medical records per ERS’ schedule of charges. You also have the right to receive a list of instances when we have disclosed health information about you for reasons other than treatment, payment, healthcare operations, related administrative purposes, and when you explicitly authorized it. If you believe that information in your record is incorrect or if important information is missing, you have the right to request that ERS correct the existing information or add the missing information. You have the right to request that ERS restrict the use and disclosure of your health information above what is required by law. If ERS accepts your request for restricted use and disclosure then ERS must abide by the request and may only reverse its position after you have been appropriately notified. You have the right to request an alternative means of communications with ERS. You are not required to explain why you want the alternative means of communication.

Complaints: If you are concerned that ERS has violated your privacy rights, or you disagree with a decision ERS has made about access to your records, you may contact the ERS Privacy Officer. You also may send a written complaint to the U.S. Department of Health and Human Services. The ERS Privacy Officer can provide you with the appropriate address upon request.

Our Legal duty: ERS is required by law to protect the privacy of your information, provide this notice about our information practices, follow the information practices that are described in this Notice, and obtain your acknowledgement of receipt of this Notice.

Detailed Notice of Privacy Practices: For further details about your rights and the federal Privacy Rule, refer to the detailed statement of this Notice. You can ask for a written copy of the detailed Notice by contacting the Office of the Privacy Officer or by visiting ERS’ web site at www.ers.state.tx.us. If you have any questions or complaints, please contact the ERS Privacy Officer by calling (512) 867-7711 or toll-free (877) 275-4377 or by writing to ERS Privacy Officer, The Employees Retirement System of Texas, P.O. Box 13207, Austin, TX 78711-3207.

Let’s Talk Benefits FAQs

1. When do I get paid? a. Non-exempt hourly employees are paid every other week on Wednesdays. b. Exempt salaried employees are paid the last working day of the month. 2. What is SOS and when will I have access? a. SOS is the online self-service module for SJC. This is where employees can clock-in and out (non- exempt), view pay stubs, and make changes to federal withholdings. b. You will have access to SOS whenever you receive your network username and password. Your initial login must be on a network computer on campus. 3. When are my benefits effective? a. Your health insurance is effective on the 1st day of the month following your 60th day of employment, unless you are a direct transfer from another state entity in the TX GBP. b. All other benefits are effective on your first date of hire unless you are a transfer from another state entity. 4. If I submit my election form today, can I still change my mind later? a. Yes, you have 30 days from your date of hire to make changes to your ERS benefit elections. 5. Does SJC contribute to Social Security? a. NO. In lieu of Social Security, San Jacinto College contributes to the Teacher Retirement System of Texas (TRS) or the Optional Retirement Program (ORP). 6. When is my prescription drug plan effective? a. Your prescription drug plan benefits are included with your health insurance coverage and as such will be effective on the same date as your health insurance. 7. How do I setup my beneficiaries? a. ERS Designation of Beneficiaries - Visit www.ers.texas.gov to update your beneficiaries. For assistance, please contact ERS directly at 1-877-275-4377 or refer to the instruction sheet given to you during orientation. b. TRS Designation of Beneficiaries - Complete the TRS 15 form, which was given to you during orientation and submit to TRS at 1000 Red River Street, Austin, TX 78701-2698. 8. Do I receive leave time? If so, how much? a. Sick and Personal Business Leave (PBL) – Sick leave is accrued at 8 hours per month and is prorated for your first year of service. The first 24 hours per fiscal year of your sick leave balance is allocated to PBL. Unused PBL will roll to your sick leave the next fiscal year. b. Vacation Leave – During your first 8 years of service, vacation leave is accrued at 6.667 hours per month. 9. Can I put more money into my TRS or ORP account? a. No. However, you can contribute to a Tax Sheltered or a Tax Deferred Annuity. For more information please contact the HR-Benefits office. 10. The benefit premium rates that are shown on ERS are different than what I was told during orientation. a. The rates shown on ERS documents and their website do not reflect the premiums that SJC employees pay. Please refer to the SJC Rate sheet provided during orientation when reviewing your cost of premiums. 11. What is the dependent audit? a. ERS has hired Alight Solutions to conduct an audit of all dependents covered under the TX GBP. You must provide the required documentation by the due date given to ensure your dependents are not dropped from coverage. If your dependents are dropped, you will not be able to add them back until Summer enrollment or within 30 days of a qualifying life event.

My Benefit Elections

For future reference, please circle the elections that you made today. Remember, you have 30 days from your date of hire to make changes to your ERS benefits. If you have any questions, please contact the HR-Benefits office and we will be happy to assist you.

Health Insurance Dental Insurance State of Texas Vision Optional Life Insurance

Waived State of TX Dental Choice or DHMO Employee Only Waived

Employee Only Waived Employee & Spouse 1x Annual Salary

Employee & Spouse Employee Only Employee & Children 2x Annual Salary

Employee & Children Employee & Spouse Employee & Family 3x Annual Salary

Employee & Family Employee & Children 4x Annual Salary Employee & Family

AD&D Insurance Dependent Life Insurance Short Term Disability Long Term Disability

Waived Waived Waived Waived

Employee Only Elected Elected Elected

Employee & Family

Coverage Amt:______

TexFlex Health TexFlex Day Care Leave Accruals

Waived Waived Sick:______

Amount:______Amount:______PBL:______

Vacation:______

San Jacinto College HR-Benefits

Sara Aranda, Coordinator – South Campus

[email protected] Ext. 2661 Brittany Heim, Coordinator – Central Campus Required Trainings will be uploaded [email protected] Ext. 6358 automatically to your learning plan

Tracy Willis, Manager – North Campus Title IX

[email protected] Ext. 6332 Harassment Prevention

San Jacinto College Policies & Procedures Dept. Fax Number – 281-998-6372 Speak with your leader regarding how to log in Dept. Email – [email protected] and other position specific trainings you may require.