New Hire Benefits Information

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 2020 – 2021

Dates Holiday Total Days

September 7, 2020 Labor Day 1

November 25 – 29, 2020 (No Weekend Classes) Thanksgiving 3

December 23, 2020 – January 3, 2021 Winter Break 8

January 18, 2021 Martin Luther King, Jr. Day 1

March 15 – 21, 2021 (No Weekend Classes) Spring Break 5

April 2 – April 4, 2021 (No Weekend Classes) Spring Holidays 1

May 31, 2021 Memorial Day 1

July 3 – 5, 2021 Independence Day 1

Total Holidays 21 Days

EMPLOYEE AND NON-MEDICARE-ELIGIBLE RETIREE HEALTH PLANS COMPARISON CHART EFFECTIVE SEPTEMBER 1, 2020

HealthSelect of Texas® HealthSelect of Texas Consumer Directed Consumer Directed Community First Scott and White and HealthSelect and HealthSelect HealthSelectSM HealthSelect Health Plans HMO Health Plan HMO Out-of-State Out-of-State High-deductible Plan High-deductible Plan In Network In Network In Network Out of Network In Network Out of Network $2,100 per individual, $4,200 per individual, $4,200 per family $8,400 per family Note: To help cover Note: To help cover part of the deductible, part of the deductible, $500 per individual, the State contibutes to the State contibutes to Annual deductible None None None $1,500 per family an eligible member’s an eligible member’s health savings health savings account: $540/year for account: $540/year for an individual, $1,080/ an individual, $1,080/ year for a family. year for a family. No, except for No, except for emergency and emergency and urgent care services, urgent care services, services provided by services provided by Yes. See below for Yes. See below for out-of-network facility- out-of-network facility- Out-of-network benefit details for out- benefit details for out- based providers in based providers in benefits? of-network services. of-network services. a network facility, a network facility, and out-of-network and out-of-network services that are services that are authorized in advance authorized in advance by the plan. by the plan. Balance billing? No. Out-of-network (Balance billing is Yes. Balance billing Yes. Balance billing No. Out-of-network benefits are not when an out-of- may apply to certain may apply to certain benefits are not covered unless network provider out-of-network out-network services. covered unless authorized in advance charges you the services. For more For more information, authorized in advance or an emergency, difference between information, see the see the plan’s or an emergency, so so typically balance their billed charges plan’s Master Benefit Master Benefit Plan balance billing does billing should not and the plan’s Plan Document. Document. not apply. apply. allowed amount.) Total in-network out-of-pocket $6,750 per person, $6,750 per person, $6,750 per person, $6,750 per person, maximum $13,500 per family $13,500 per family $13,500 per family $13,500 per family (including These reset on These reset on These reset on These reset on deductibles, January 1. January 1. September 1. September 1. coinsurance and copays)1 Out-of-pocket coinsurance $2,000 per person $7,000 per person None None $2,000 per person $2,000 per person maximum $750 copay max, $750 copay max, $750 copay max, $750 copay max, up to five days per up to five days per up to five days per up to five days per Inpatient copay hospital stay hospital stay None None hospital stay hospital stay $2,250 maximum $2,250 copay max $2,250 copay max $2,250 copay max per copay max per plan per calendar year per per calendar year per plan year per person year per person person person Yes for participants Primary care who live and work in provider (PCP) Texas; No No No Yes No required? No for out-of-state participants Yes for participants who live and work in Referrals required? Texas; No No No No No No for out-of-state DRAFT participants as well 1Includes medical and prescription drug copays, coinsurance and deductibles. Excludes non-network and bariatric services.

Chart_2020_Comparison 1 7/14/2020 Medical Benefits - Member’s Share of the Cost HealthSelect of Texas HealthSelect of Texas Consumer Directed Consumer Directed Community First Scott and White and HealthSelect and HealthSelect HealthSelect HealthSelect Health Plans HMO Health Plan HMO Out-of-State Out-of-State High-deductible Plan High-deductible Plan In Network In Network In Network Out of Network In Network Out of Network No cost to participant(s) if administered in a 40% coinsurance after 20% coinsurance after 40% coinsurance after Allergy treatment physician’s office, 20% the annual deductible the annual deductible the annual deductible 20% 20% in any other outpatient is met is met is met location Ambulance 20%, annual 20% coinsurance after 20% coinsurance after services 20% deductible does not the annual deductible the annual in-network 20% 20% (for emergencies) apply is met deductible is met Deductible: $5,000 Bariatric surgery2 Coinsurance: 20% Not covered Not covered Not covered Not covered Not covered Lifetime max: $13,000 20% if billed without 40% coinsurance after 20% coinsurance after 40% coinsurance after $40 copay plus 20% an office visit; the annual deductible the annual deductible the annual deductible $40 copay plus 20%; with office visit; $40 copay plus 20% is met is met is met $75 maximum benefit No per-visit limit on with office visit; Chiropractic care $75 maximum benefit $75 maximum benefit $75 maximum benefit per visit; 30 visits max maximum; $75 maximum benefit per visit; 30 visits max per visit; 30 visits max per visit; 30 visits max per participant per 35 visits max per per visit; 30 visits max per participant per per participant per per participant per calendar year participant per per participant per calendar year calendar year calendar year calendar year calendar year 40% coinsurance after 20% coinsurance after 40% coinsurance after Diabetes 20% the annual deductible the annual deductible the annual deductible 20% 20% equipment2 is met is met is met 20% coinsurance after 20% for in-network 20% for in-network 20%. Covered under 20%, annual the annual deductible 20% coinsurance after supplies only, no out- supplies only, no out- Diabetes supplies the medical and deductible does not is met. Covered under the annual in-network of-network coverage. of-network coverage. pharmacy plan* apply the medical and deductible is met Covered under the Covered under the pharmacy plan* pharmacy plan pharmacy plan 40% coinsurance after 20% coinsurance after 40% coinsurance after Diagnostic X-rays 20% the annual deductible the annual deductible the annual deductible 20% 20% and lab tests is met is met is met 40% coinsurance after 20% coinsurance after 40% coinsurance after Diagnostic No cost to No cost to No cost to the annual deductible the annual deductible the annual deductible mammography participant(s) participant(s) participant(s) is met is met is met 40% coinsurance after 20% coinsurance after 40% coinsurance after Durable medical 20% the annual deductible the annual deductible the annual deductible 20% 20% equipment2 is met is met is met Facility-based For emergencies, For emergencies, 20% providers 20% coinsurance and coinsurance after the (radiologists, annual deductible annual in-network 20% coinsurance after pathologists does not apply. For deductible is met. For 20% the annual deductible 20% 20% and labs, non-emergencies, non-emergencies, 40% is met anesthesiologists, 40% coinsurance after coinsurance after the emergency room the annual deductible annual out-of-network physicians etc.) is met deductible is met. Facility emergency $150 copay plus 20% care and (If admitted, copay For emergencies, hospital-affiliated will apply to hospital 20% coinsurance after freestanding copay.) Annual $150 copay plus 20% the annual in-network $150 plus 20% $150 plus 20% emergency deductible does not 20% coinsurance after (If admitted, copay deductible is met. For (If admitted, copay (If admitted, copay departments apply. For non- the annual deductible will apply to hospital non-emergencies, 40% will apply to hospital will apply to hospital (Does not apply emergencies, $150 is met copay.) coinsurance after the copay.) copay.) to freestanding copay plus 40% annual out-of-network emergency rooms coinsurance after the deductible is met not affiliated with a annual out-of-network hospital.) deductible is met *Some diabetic supplies are covered at no cost to participant(s) under the pharmacy plan. (Consumer Directed HealthSelect participants must meet their annual deductible first.) For more information, see your pharmacy plan’s Master Benefit Plan Document. 2Preauthorization may be required. 2 HealthSelect of Texas HealthSelect of Texas Consumer Directed Consumer Directed Community First Scott and White and HealthSelect and HealthSelect HealthSelect HealthSelect Health Plans HMO Health Plan HMO Out-of-State Out-of-State High-deductible Plan High-deductible Plan In Network In Network In Network Out of Network In Network Out of Network $300 copay plus 20%. For emergencies, 20% Annual deductible coinsurance after the does not apply. annual in-network Freestanding 20% coinsurance after $150 copay plus 20% $150 copay plus 20% For non-emergencies, deductible is met. For emergency room $150 copay plus 20% the annual deductible for in-network and for in-network and $300 copay plus 40% non-emergencies, 40% facility is met out-of-network out-of-network coinsurance after the coinsurance after the annual out-of-network annual out-of-network deductible is met deductible is met Habilitation and rehabilitation 20% coinsurance 20% coinsurance services - 40% coinsurance after 20% coinsurance after 40% coinsurance after without office visit, without office visit, outpatient 20% the annual deductible the annual deductible the annual deductible $40 plus 20% $40 plus 20% therapy (including is met is met is met coinsurance with coinsurance with physical therapy, office visit office visit occupational therapy and speech therapy) Consumer Directed HealthSelect pays up Plan pays up to Plan pays up to Hearing aids HealthSelect of Texas and HealthSelect Out- to $1,000 per ear every three years (after $1,000 per ear every $1,000 per ear every (for covered of-State pay up to $1,000 per ear every three deductible is met) and covers in-network three years. No out- three years. No out- participants over years and cover in-network and out-of-network and out-of-network hearing aids at the same of-network benefits of-network benefits age 18) hearing aids at the same benefit level. benefit level. available available HealthSelect of Texas and HealthSelect Out- Consumer Directed HealthSelect pays 80% Hearing aids of-State pay 100%, limit of one per ear every after the annual in-network deductible is met 20%, limit of one per 20%, limit of one per (for participants age three years, and cover in-network and out-of- and covers in-network and out-of-network ear every 3 years ear every 3 years 18 and under) network hearing aids at the same benefit level. hearing aids at the same benefit level. High-tech $100 copay plus 40% 20% coinsurance after 40% coinsurance after radiology (CT scan, coinsurance after the $100 copay plus 20% the annual deductible the annual deductible $100 copay plus 20% $100 copay plus 20% MRI and nuclear annual deductible is met is met medicine)2 is met 40% coinsurance after 20% coinsurance after 40% coinsurance after Home health care2 20% the annual deductible the annual deductible the annual deductible 20% 20% is met is met is met 40% coinsurance after 20% coinsurance after 40% coinsurance after Hospice care2 20% the annual deductible the annual deductible the annual deductible 20% 20% is met is met is met $150/day copay plus $150/day copay plus 40% after the annual $150/day copay plus $150/day copay plus 20% Inpatient hospital deductible is met. 20% 20% ($750 copay max, facility (semi-private ($750 copay max, 20% coinsurance after 40% coinsurance after ($750 copay max, ($750 copay max, up to five days per room and day’s up to five days per the annual deductible the annual deductible up to five days per up to five days per hospital stay. $2,250 board, and intensive hospital stay. $2,250 is met is met hospital stay. $2,250 hospital stay. $2,250 copay max per care unit)2 copay max per copay max per plan copay max per plan calendar year per calendar year per year per person) year per person) person) person) No charge for routine Maternity care $25 or $40 for first prenatal appointments. No charge for routine No charge for routine doctor charges 40% coinsurance after 40% coinsurance after prenatal visit. No 20% coinsurance for prenatal appointments. prenatal appointments. only; inpatient the annual deductible the annual deductible charge for routine post first postnatal visit after $25 or $40 for first $25 or $40 for first hospital copays will is met is met natal appointments the annual deductible postnatal visit postnatal visit apply is met No cost to participant(s) Medications after you pay the copay Covered at benefits Covered at benefits and injections if administered in a 20% coinsurance after throughout chart throughout chart administered by physician's office*, 20% 40% coinsurance after the annual deductible 40% coinsurance after dependent on where dependent on where a provider (see in any other outpatient the annual deductible is met. the annual deductible they are administered. they are administered. below for outpatient location. is met Preventive vaccines is met Preventive vaccines Preventive vaccines medications and *No cost to participant(s) covered at 100% covered at 100% covered at 100% injections)2 if no office visit charge is assessed. Preventive vaccines covered at 100% 2Preauthorization may be required. 3 HealthSelect of Texas HealthSelect of Texas Consumer Directed Consumer Directed Community First Scott and White and HealthSelect and HealthSelect HealthSelect HealthSelect Health Plans HMO Health Plan HMO Out-of-State Out-of-State High-deductible Plan High-deductible Plan In Network In Network In Network Out of Network In Network Out of Network

Office surgery 40% coinsurance after 20% coinsurance after 40% coinsurance after and diagnostic 20% the annual deductible the annual deductible the annual deductible 20% 20% procedures is met is met is met

40% coinsurance after 20% coinsurance after 40% coinsurance after PCP office visit $25 copay the annual deductible the annual deductible the annual deductible $25 copay $25 copay is met is met is met

40% coinsurance after 20% coinsurance after 40% coinsurance after Private-duty 20% the annual deductible the annual deductible the annual deductible 20% 20% nursing2 is met is met is met

Retail health/ 40% coinsurance after 20% coinsurance after 40% coinsurance after convenience care $25 copay the annual deductible the annual deductible the annual deductible Not covered $25 copay clinic is met is met is met

Routine eye exam, 40% coinsurance after 20% coinsurance after 40% coinsurance after one per year per $40 copay the annual deductible the annual deductible the annual deductible $40 copay $40 copay participant is met is met is met

40% coinsurance after 40% coinsurance after Routine preventive No cost to No cost to No cost to No cost to the annual deductible the annual deductible care participant(s) participant(s) participant(s) participant(s) is met is met

Skilled nursing 40% coinsurance after 20% coinsurance after 40% coinsurance after facility/inpatient 20% the annual deductible the annual deductible the annual deductible 20% 20% rehabilitation is met is met is met facility services2

Specialist 40% coinsurance after 20% coinsurance after 40% coinsurance after physician office $40 copay the annual deductible the annual deductible the annual deductible $40 copay $40 copay visit is met is met is met

Surgery $100 copay plus 40% 20% coinsurance after 40% coinsurance after (outpatient) other coinsurance after the $100 copay plus 20% the annual deductible the annual deductible $100 copay plus 20% $100 copay plus 20% than in physician’s annual deductible is met is met office2 is met Coverage is based Coverage is based Coverage is based on place of treatment on place of treatment on place of treatment billed ($25/$40 40% coinsurance after 20% coinsurance after 40% coinsurance after billed ( $25 copay billed ($25 copay Telemedicine visit copay if physician's the annual deductible the annual deductible the annual deductible if physician's office if physician's office office visit, 20% for is met is met is met visit, 20% for any visit, 20% for any any other outpatient other outpatient other outpatient telemedicine). telemedicine). telemedicine). Therapeutic 40% coinsurance after 20% coinsurance after 40% coinsurance after treatments - 20% the annual deductible the annual deductible the annual deductible 20% 20% outpatient is met is met is met 40% coinsurance after 20% coinsurance after 40% coinsurance after Urgent care clinic $50 copay plus 20% the annual deductible the annual deductible the annual deductible $50 copay plus 20% $50 copay plus 20% is met is met is met Virtual Visits/E-visits No cost to with a Scott and White 20% coinsurance after Virtual visits/ participant(s) if Doctor No virtual visit or Health Plan provider Not covered the annual deductible Not covered e-visits (medical) on Demand or MDLive e-visit benefits offered covered at 100% is met is used through online portal or app 2Preauthorization may be required.

4 Mental Health/Behavioral Health/Substance Abuse Benefits – Member’s Share of Cost HealthSelect of Texas HealthSelect of Texas Consumer Directed Consumer Directed Community First Scott and White and HealthSelect and HealthSelect HealthSelect HealthSelect Health Plans HMO Health Plan HMO Out-of-State Out-of-State High-deductible Plan High-deductible Plan In Network In Network In Network Out of Network In Network Out of Network Mental health BCBSTX effective BCBSTX effective BCBSTX effective BCBSTX effective administrator and CFHP SWHP September 1, 2020 September 1, 2020 September 1, 2020 September 1, 2020 network $150/day copay $150/day copay plus plus 40% after the $150/day copay plus $150/day copay plus 20% annual deductible 20% 20% ($750 copay max, is met. ($750 copay 20% coinsurance after 40% coinsurance after ($750 copay max, ($750 copay max, Inpatient hospital up to five days per max, up to five days the annual deductible the annual deductible up to five days per up to five days per mental health stay2 hospital stay. $2,250 per hospital stay. is met is met hospital stay. $2,250 hospital stay. $2,250 copay max per $2,250 copay max copay max per plan copay max per plan calendar year per per calendar year per year per person) year per person) person) person) Coverage is based Coverage is based on place of treatment on place of treatment billed ($25 copay if 40% coinsurance after 20% coinsurance after 40% coinsurance after Coverage is based billed ($25 copay if Mental health mental health office the annual deductible the annual deductible the annual deductible on place of treatment mental health office telemedicine visit, 20% for any is met is met is met billed. visit, 20% for any other outpatient other outpatient telemedicine) telemedicine) Outpatient facility care (partial 40% coinsurance after 20% coinsurance after 40% coinsurance after hospitalization/ 20% the annual deductible the annual deductible the annual deductible 20% 20% day treatment and is met is met is met extensive outpatient treatment)2 Outpatient 40% coinsurance after 20% coinsurance after 40% coinsurance after physician or $25 copay the annual deductible the annual deductible the annual deductible $25 copay $25 copay mental health is met is met is met provider office visit $25 copay for mental Virtual visits / 20% coinsurance after health virtual visits e-visits (mental Not covered the annual deductible Not covered Not covered Not covered provided by Doctor on health) is met Demand or MDLive 2Preauthorization may be required. Benefits listed in cells above apply to all covered mental health/behavioral health/substance abuse services (including serious mental illness treatment, substance abuse treatment, autism spectrum disorder services etc.).

5 Prescription Drug Benefits and Coverage – Member’s Share of Cost NOTE: PBMs have different formularies and covered drugs, based on the determinations of their own pharmacy and therapeutics committees and individual formulary strategies. Drugs covered under the HealthSelect plan may not be the same drugs covered under CFHP or SWHP. Pharmacy benefits OptumRx OptumRx OptumRx OptumRx Navitus SWHP manager (PBM) (UnitedHealthcare) (UnitedHealthcare) (UnitedHealthcare) (UnitedHealthcare) Out-of-network Yes Yes No No benefits? $50 prescription $50 prescription $2,100 per individual, $4,200 per individual, drug deductible drug deductible $50 deductible per $50 deductible per $4,200 per family. $8,400 per family. per participant per per participant per participant per plan participant per plan Medical and Medical and Deductible calendar year applies calendar year applies year applies before year applies before prescription drug prescription drug before the plan pays before the plan pays the plan pays for any the plan pays for any expenses apply to the expenses apply to the for any prescription for any prescription prescription drugs prescription drugs deductible. deductible. drugs drugs $10 copayment plus $10 copayment 40% coinsurance $10 copayment (non- $10 copayment (non- (nonmaintenance), (non-maintenance) maintenance), maintenance), $10 copayment $10 copayment plus $10 copayment $10 copayment Tier 1 20% coinsurance after 40% coinsurance after (maintenance); 40% coinsurance (maintenance), (maintenance), (mostly generic the annual deductible the annual deductible $30 copayment (maintenance); $30 copayment $30 copayment drugs) is met is met (90-day supply mail $30 copayment plus (90-day supply mail (90-day supply mail order or extended day 40% coinsurance order or extended day order or extended day supply pharmacy) (mail order or supply) supply) extended day supply) $35 copayment plus 40% coinsurance $35 copayment $35 copayment $35 copayment (non-maintenance) (nonmaintenance), (nonmaintenance), (nonmaintenance), Tier 2 $45 copayment plus $45 copayment 20% coinsurance after 40% coinsurance after $45 copayment $45 copayment (mostly preferred 40% coinsurance (maintenance); the annual deductible the annual deductible (maintenance); (maintenance); brand-name (maintenance); $105 $105 copayment (mail is met is met $105 copayment (mail $105 copayment (mail drugs)2,3 copayment plus 40% order or extended day order or extended day order or extended day coinsurance (mail supply supply supply order or extended day supply) $60 copayment plus 40% coinsurance $60 copayment (non- $60 copayment (non- $60 copayment (non- (non-maintenance) maintenance), maintenance), maintenance), Tier 3 $75 copayment plus $75 copayment 20% coinsurance after 40% coinsurance after $75 copayment $75 copayment (mostly non- 40% coinsurance (maintenance); the annual deductible the annual deductible (maintenance); (maintenance); preferred brand- (maintenance); $180 copayment (mail is met is met $180 copayment (mail $180 copayment (mail name drugs)2,3 $180 copayment plus order or extended day order or extended day order or extended day 40% coinsurance supply) supply) supply) (mail order or extended day supply) If purchased through If purchased through If purchased through If purchased through a pharmacy, specialty a pharmacy, specialty a pharmacy, specialty a pharmacy, specialty drugs are covered as drugs are covered as drugs are covered as drugs are covered as 20% coinsurance after 40% coinsurance after preferred brand drugs preferred brand drugs preferred brand drugs preferred brand drugs Specialty drugs2,3 the annual deductible the annual deductible or nonpreferred brand or nonpreferred brand or nonpreferred brand or nonpreferred brand is met is met drugs as listed above. drugs as listed above. drugs as listed above. drugs as listed above. Otherwise, covered as Otherwise, covered as Otherwise, covered as Otherwise, covered as a medical benefit. a medical benefit. a medical benefit. a medical benefit. $35 copay for 30 $35 copay for 30 Syringes days' supply, $105 days' supply, $105 for insulin $0 copay $0 copay $0 copay $0 copay copay for 90-day copay for 90-day administration supply supply 2Preauthorization may be required. 3Tier 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.

6 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 DENTAL INSURANCE AND COMPARISON CHART

State of Texas Dental Choice State of Texas Dental Choice is a preferred provider organization (PPO) dental insurance plan. You can see any dentist you want, but you will pay less if you go to a dentist in one of two Delta Dental networks: • Delta Dental PPO State of Texas Dental Choice • Delta Premier All Delta Dental PPO and Delta Premier dentists are in-network providers. You get the same coverage in either network, but you may pay less for covered services in the Delta Dental PPO network. Delta Premier dentists can charge higher rates for the same coverage. Benefits are available in the United States, Canada and Mexico, if you live in the United States.

DeltaCare USA dental health maintenance organization This is a dental health maintenance organization (DHMO) dental insurance plan. • Coverage applies only to dentists in the Texas service area. Before you enroll, make sure there is a DHMO network dentist in your area. • You must choose a primary care dentist (PCD) from a list of approved providers. You and your enrolled dependents can choose different PCDs. • Services from participating specialty dentists cost 25% less than the dentists’ usual charges.

What is a “smart” ID card? Check the Discount To keep costs low, active employees who sign up for GBP dental Purchase Program for insurance will not get an ID card, and participating Delta dentists dental discounts shouldn’t require them. The Discount Purchase ProgramSM, You can download a virtual ID card to your smartphone through the administered by Beneplace, offers Delta Dental app. You can also download and print your ID information dental discount programs and from www.ERSdentalplans.com or call Delta Dental toll-free at (888) discounted dental services. View 818-7925 (TTY: 711) and they will mail a paper copy to you. them at https://www.beneplace. Covered dependents cannot access the app, and their names aren’t listed com/discountprogramers/. (To on the card. A dependent can verify coverage with a provider by giving access discounts, you will need to either their name or the GBP member’s name and plan ID number. register using your email address.)

Handout_2020_DentalComparison 6/8/2020 Dental plans comparison chart This chart is a summary of benefits in the two dental insurance plans. See plan booklets for actual coverage and limitations. Delta Dental administers both plans. Before starting treatment, discuss the treatment plan and all charges with your dentist.

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

WELCOME TO STATE OF TEXAS VISION

Your vision benefits State of Texas Vision offers vision care benefits through Superior Vision Services, Inc. These include:  eye exams  prescription eyewear, including prescription sunglasses, and  contact lenses. Participants have access to Superior's National provider network of independent ophthalmologists and optometrists and the country's top 50 optical retail chains.1

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 an eye disease such as glaucoma, you will need to see a medical doctor and you should refer to your health plan. If your health plan does not offer benefits for corneal diseases or injuries, please contact Superior Vision for information about 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, 2020 – August 31, 2021   during Summer or Fall Enrollment and  within 31 days of a qualifying life event. COBRA COBRA disability You only $5.12 $5.22 $7.68 Learn more: You and spouse $10.24 $10.44 $15.36 Email: [email protected] You and child(ren) $11.01 $11.23 $16.52 Phone: (877) 396-4128 TTY: 711 Monday–Friday: 7 a.m. – 8 p.m. CT You and family $16.13 $16.45 $24.20 Saturday: 10 a.m. – 3:30 p.m. CT Surviving spouse only $5.12 Visit www.StateofTexasVision.com for

Surviving spouse and children $11.01 details about:  Vision benefits Surviving child(ren) only $5.89  Locating an in-network provider or nominating a provider for the network  Reimbursement for non-network claims  Navigating the website 1 Based on SVS National Network, 2019.

Plan Year 2021 www.StateofTexasVision.com Page 1 QUALITY BENEFITS

Vision Benefits Summary

BENEFITS IN-NETWORK NON-NETWORK 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 $200 retail allowance4 Up to $75 or Up to $150 retail5

Each vision plan benefit 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. 4 All costs and allowances are retail; you are responsible for any charges in excess of the retail allowances. 5 Up to $75 retail reimbursed for non-network frames or up to $150 retail reimbursed for non-network contact lenses .

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

Plan Year 2021 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 its network. 95%

The average percentage of If your eye care provider does not participate in the Superior National vision plan participants who network, you may nominate him or her by submitting a Provider Nomination see an in-network provider1 form which can be found on the website, or by calling Customer Service.

The credentialing process can take up to 60 days. Superior considers all nominations; however, the provider's response, location, or other qualifying guidelines may restrict their participation. 165.1 million In-Network and Non-Network Providers Adults over age 18 who wear glasses2 1. What do I pay my in-network provider?

Pay your in-network provider any applicable copays, plus the cost of 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, submit a Provider Nomination form or call Customer Service to nominate a provider. 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 via fax or email to Superior Vision. You will be reimbursed up to the allowable amount as outlined in your plan details. Download a claim form from the State of Texas Vision website.

Additional Discounts Superior Vision offers discounts through certain in-network providers. These discounts can 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—contact your provider before your visit to verify their participation. Discounts are subject to change without notice and do not apply if prohibited by the manufacturer.

Vision Correction Surgery (LASIK) Superior Vision offers discounts on vision correction surgery through a nationwide network of refractive surgeons. These discounts range from 15% to 50% off the typical cost of these procedures.

1 Based on internal Superior Vision data, 2013–2016. 2 Based on data from The Vision Council, US Optical Overview and Outlook June 2019. Plan Year 2021 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

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

provider to receive services? Your in-network benefits and discounts cannot be

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

 Do I need an authorization number or will You are responsible for the full amount of any I need to file a claim for services from an materials and services that are not covered by your in-network provider? benefits. This may include allowance overages,

No, the in-network providers will handle the certain lens options, or materials after you have authorization and claims-filing process for you. exhausted your benefits. Based on the provider selected, discounts may apply.  May I go to one provider for the eye exam and another provider for eyewear?  Do I need to purchase “insurance” on my glasses from the provider? Yes. With State of Texas Vision you have the flexibility to choose the provider who best matches your needs Some providers offer a warranty on broken, lost, and budget. Each provider will contact Superior Vision or stolen materials. This warranty is not a covered to verify your eligibility. benefit nor administered by State of Texas Vision or Superior Vision. Should you decide to purchase a  How does the retail frame allowance work? warranty policy, it will be at your own expense.

Your frame allowance is $200. If the retail price of the frame is greater than $200, you will pay the difference. 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. A CLF exam measures and examines your eyes to evaluate them for contacts. It 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. See details in the benefits chart.  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—you can choose to use it all at once or throughout the plan year until you spend the full $200. Your benefit is greater when dispensed by an in-network provider.

Plan Year 2021 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 Guardian Life Insurance, 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 donated sick leave, 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 ofsick 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 a total of 150 days after you Until you are able to return to work or, complete 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 01-2018 Save Money on Health Care and Dependent Care Plan Year 2021

Enroll in TexFlex and use pre-tax money to There are three types of TexFlex accounts: save on eligible out-of-pocket health care and • h ealth care FSA – use 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 $2,750 for your annual contribution. • prescriptions, • limited-purpose FSA – use to pay eligible vision and • dental, dental expenses. You can elect from $180 to $2,750 for • vision, your annual contribution. You must be enrolled in • day care, and Consumer Directed HealthSelectSM to participate in the • much more! limited-purpose FSA.

What is TexFlex? • d ependent care FSA – use to pay eligible expenses including child day care and adult care day programs. You A TexFlex account is a flexible spending account (FSA that can elect from $180 to $5,000 for your annual contribution. 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, limited-purpose care and/or a dependent care accounts. 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 through the end of Plan Year 2021 (August 31, 2021). TexFlex Facts 2

How can TexFlex save you money? TexFlex website – www.TexFlexERS.com You pay less in taxes. Here’s an example: Visit the TexFlex website now to learn more about the: • TexFlex Program with TexFlex without TexFlex • eligible expenses, and Annual pay $50,000 $50,000 • TexFlex debit card. TexFlex pre-tax ($2,000) $0 Also, be sure to check out the informative videos and access contribution the contribution calculation worksheet. Taxable income $48,000 $50,000 Online Account Services: Federal income, Social • access your TexFlex account 24/7; see how much you Security and Medicare ($10,966) ($11,616) elected, how much has been paid, what’s pending and how taxes much is available in your account, After-tax dollars spent $0 ($2,000) on eligible expenses • view claim status alerts and notifications with important information about your account, Real spendable $37,034 $36,384 income • quickly search for all current and past claims, payments and contributions, Annual Savings $650 $0 • upload documentation to support a card swipe or submit a * Sample tax savings for a single taxpayer with no dependents. Actual savings will claim for reimbursement, vary based on your individual tax situation. Please consult a tax professional for more information. • download reimbursement claim forms and • sign up for direct deposit. Should I enroll? If any of the following expenses apply to you or your eligible FREE! TexFlex debit card for the health family members, enrolling in TexFlex can save you money on: care or limited-purpose FSA If you sign up for TexFlex for Plan Year 2021 and you’re new Health Care FSA to the program, you will receive a FREE TexFlex debit card • c opays, deductibles or coinsurance for medical, dental or for easy access to your TexFlex health care or limited- vision plans, purpose FSA funds in late-August. After you activate your • prescription medications, card, you can begin using the card on September 1 to pay • g lasses or contacts, or plan on having laser eye surgery and for eligible expenses. If you're a current Texflex participant, you may use your current debit card until its expiration date. • orthodontia treatments, such as braces. TexFlex will automatically mail you a new debit card two Limited-Purpose FSA weeks before your card's expiration date. • g lasses or contacts, or plan on having laser eye surgery, • orthodontia treatments, such as braces Fast reimbursement • routine dental exams and cleanings (excludes bleaching Claims and reimbursements are processed on a daily basis. or whitening) Sign up for direct deposit and get your reimbursement faster Note: You must be enrolled in Consumer Directed than by check. HealthSelectSM (CDHS) to participate in the Limited- Purpose FSA. When do I enroll? Dependent Care FSA • you and your spouse (if married) are working, looking for You can enroll in the TexFlex program: work or attend school full-time, and • within 31 days of your hire date, - have children under age 13 who attend day care, • during Summer Enrollment or before/after-school care or summer day camp, or • within 31 days of experiencing a qualifying life event. - you provide care for any other person of any age who is mentally or physically incapable of caring for himself or herself, and comply with other IRS requirements. For a detailed list of TexFlex eligible expenses, visit www.TexFlexERS.com and click on “Program Resources.” TexFlex Facts 3

TexFlex account overview for Plan Year 2021 Note: TexFlex health care and limited-purpose FSA participants have access to the full contribution amount Health Care Dependent Care Account Account at the beginning of the plan year. Annual maximum $2,750 $5,000 contribution $550 TexFlex carry over Submit claims A carry-over up to $500 is allowed from the plan year online, by fax or Yes Yes ending August 31, 2020 and up to $550 from the plan mail year ending August 31, 2021. Use the TexFlex No, all claims submitted Yes 1 debit card online, by fax or mail. With the carry over benefit, there is less risk of giving up Full annual contribution Monthly; as funds are unspent money in your TexFlex health care account, Availability of is available starting added to your account funds September 1, 2020 from your paycheck because of the carry-over option.

Carry over2 Yes No The carry over does not apply to the dependent care accounts. You will have until December 31, 2021 to submit Grace period3 No Yes your claim paperwork for eligible health care expenses 4 September 1, 2021- September 1, 2021- incurred by August 31, 2021, and on dependent care Run out period December 31, 2021 December 31, 2021 incurred by November 15, 2021. 1 There is no fee for the card. You will receive one card and can request additional cards by calling TexFlex Customer Care. How do I enroll? 2 Health care account funds, up to $500, a carry-over of up to $500 is allowed from the plan year ending August 31, 2020 and up to $550 from the Enroll in TexFlex during Summer Enrollment. Once you have plan year ending August 31,2021. determined your annual TexFlex contribution, the amount you 3 Allows an extra 2 ½ month period after August 31 in which you can incur new specify will be deducted from your paycheck in equal claims using the previous plan year funds. amounts throughout the year, before taxes. 4 Time-frame 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.

continued TexFlex Facts 4

With 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. Does not apply to health care FSA or limited-purpose FSA. Carry over: A carry-over of up to $500 is allowed from the plan year ending August 31, 2020 and up to $550 from the plan year ending August 31, 2021. Any amount over the carry-over amount will be forfeited. Incurred: A charge for a product or service received or delivered.

TexFlex participant support:

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

DISCLAIMERS Actual tax savings depends on your individual circumstances. Please consult a tax professional for more information. Neither WageWorks nor ERS engage in rendering legal or tax services. Any guidance given in this communication is not legal or tax advice. Information contained herein is merely guidance that, at your discretion, you may or may not use in making decisions. If legal or tax advice is desired or required, the services of legal counsel or a tax professional are recommended.

WageWorks, Inc. is the third-party administrator for the TexFlexSM program provided by ERS. 4439 (201805) TexFlex Brochure 2021 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.

Aflac isn't health insurance. Let us show you how we can help Cancer While 1-in-2 men and 1-in-3 women will get cancer in their lifetimes,1 more and more Americans are living with cancer as a manageable disease. Today, 89% of women who are diagnosed with breast cancer will survive it and 98% of men who develop prostate cancer will live with it for five years—or more.2 That’s why we think everyone should have a plan for how to manage the disease if they’re diagnosed. • Initial Diagnosis Benefit $4,000 • Building Benefit $500 per year • Treatment Benefit Up to $1,500 a month • Hospital Confinement $200 a day • Wellness Benefit $75 per person covered per year Accident Aflac Accident Advantage insurance policy helps with the unexpected out-of-pocket costs that can hurt the family budget when accidents happen – like ER visits and hospitalization. In addition, the plan offers multiple coverage options to accommodate almost any budget, and provides new and enhanced benefits not previously available with Aflac accident insurance. • Emergency Room $170 • Initial Hospitalization $1,500 • Daily Confinement $300 daily up to a year • Fractures Up to $4,000 • Annual Wellness $60 Critical Illness Aflac’s Critical Care Protection policy helps provide financial peace of mind if you experience a serious health event, such as a heart attack or stroke. You will receive a lump sum benefit upon diagnosis of a covered event with additional benefits to be paid for things such as a hospital confinement, ambulance, transportation, lodging,and therapy. Specified health events covered by the Critical Care Protection policy include: • Initial Diagnosis $7,500 • Subsequent Event $3,500 per year • Hospital Confinement $300 a day • ICU $800 a day 1/$1,300 a day week 2 Hospital We all know that not all hospital-related expenses are caused by something catastrophic. Even a quick trip to the hospital can be costly and have undesirable impacts on everyday life. Aflac Choice allows you to customize benefits based on your customer’s unique needs. With a simplified base plan and three available riders, policyholders can get the benefits they need and leave the ones they don’t. No one should have to stress about the impact hospital-related visits have on everyday life, so make sure your policyholders aren’t forced to choose between paying for medical bills or paying for their everyday needs.

• Emergency Room $100 • Initial Hospitalization $500, $1,000, $1,500 or $2,000 options • Daily Confinement $100 a day up to a year • ICU $500 a day up to 15 days • Physician Visits/Labs $25/$35

Want to know more? Including information on Short-term Disability and Life Insurance Let your Aflac Rep know you are interested. Live well with Aflac Let us show you how we care

Financial Wellness We care by lessening the burden medical expenses can bring by providing cash in hand for injuries and illness.

Physical Wellness We care by providing cash wellness benefit(s) tied to Accident and Cancer policy payable regardless of cost incurred from your provider.

Social and Emotional Wellness We care by providing support through our policies for things medical doesn't cover when the worst happens. Example: Cash for home modification benefit for someone placed in a wheelchair after an accident or providing the Hospice benefit to someone at the end of their battle with cancer. Mental Wellness We care by offering the physician visit benefit for mental health visits (up to 6 per year based on coverage option selected).

Ready to Get Well, Live More and Stress Less? Lori Osborne-Iselt (281) 658-3858 [email protected]flac.com

How does our Wellness Benefit help you? Early diagnosis can save lives and cut treatment costs

Vision and dental exams Mammogram Mammogram Biopsy PSA test Colonoscopy Physical and more PSA Test About every Other Cancer Screenings seconds File your wellness claim using Aflac SmartClaim®34 and get paid in one day an American suffers a heart attack 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.