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HIGH DEDUCTIBLE HEALTH PLAN (HDHP) OPTIONS:United HealthCare 1.844.554.9709HDHP 4000CHOICEHDHP 4000 CHOICE PLUSBenefit SummaryDeductible Individual FamilyOut-of-Pocket Max Individual FamilyReferrals RequiredDoctor Visits Preventive careHDHP 4000 rk Tier 1In-Network Tier 2 4,000 8,000 8,000 16,000 4,000 8,000 4,000 8,000 6,650 13,300No 10,000 20,000No 6,650 13,300NoYes 6,650 13,300100%100%100%100%80% afterdeductible80% AfterDeductible50% AfterDeductible80% afterdeductible80% afterdeductible50% afterdeductibleYes80% afterdeductible Specialist80% afterdeductibleMinor diagnostic lab,xrays & other officeservices80% afterdeductible80% afterdeductible80% afterdeductible80% afterdeductible80% afterdeductibleVirtual Visit80% afterdeductible50% after out-ofnetworkdeductible80% afterdeductible80% afterdeductible80% afterdeductibleUrgent Care Clinic80% afterdeductible50% after out-ofnetworkdeductible80% afterdeductible80% afterdeductible80% afterdeductibleHospital Emergency Room80% afterdeductible80% afterdeductible80% afterdeductible80% afterdeductible80% afterdeductible80% afterdeductible50% after out-ofnetworkdeductible80% afterdeductible80% afterdeductible 500 per admissionthen plan pays 50%after deductibleOther ServicesCoinsurance80% afterdeductible50% afterdeductible80% afterdeductible80% afterdeductible50% afterdeductiblePrescription Drugs Retail100% afterdeductible100% afterdeductible100% afterdeductible100% afterdeductible100% afterdeductible100% afterdeductible100% afterdeductible100% afterdeductible100% afterdeductible100% afterdeductible InpatientMONTHLY Mail-OrderCostEmployeeOnlyEmployee& SpouseEmployee&Child(ren)Employee& FamilyHDHP 4000Choice PlusHDHP 4000ChoiceHDHP 4000NexusACO 71.98 40.67 18.73 317.31 247.00 166.28 170.91 118.12 68.26 410.18 331.14 233.43BI-WEEKLY* Primary Care50% after out-ofnetworkdeductible50% after out-ofnetworkdeductible50% after out-ofnetworkdeductibleCostEmployeeOnlyEmployee& SpouseEmployee&Child(ren)Employee& FamilyHDHP 4000Choice PlusHDHP 4000ChoiceHDHP 4000NexusACO 35.99 20.33 9.37 158.66 123.50 83.14 85.46 59.06 34.13 205.09 165.57 116.71*Deductions will vary for Child Nutrition and Transportation employees due toadvanced deductions to cover summer premiums in advance.Pg. 9

MEDICAL PLAN COMPARISON:Employee only coverageHOW WILL MY PLAN WORK FOR ME?Use the chart below to compare how your plan will work for you using the following scenario.Scenario 1: This is Employee Only coverage with the member having a combination ofmedical services and receiving prescription drugs totaling 2094.PPO 2000Choice PlusPrimaryAdvantage3000 EPOHMO 2000NexusACOHDHP 4000Choice PlusHDHP 4000ChoiceHDHP 4000NexusACOAnnualEmployeeOnly Premium 3,060.00 1,201.08 774.24 863.76 488.04 224.764 PrimaryOffice Visits @ 80/Visit 30 Copay X 4Visits 120 0 Copay X 4Visits 0 30 Copay X 4Visits 120 80 X 4 Visits 320TowardsDeductible 80 X 4 Visits 320TowardsDeductible 80 X 4 Visits 320TowardsDeductible2 SpecialistOffice Visits @ 162/Visit 45 Copay X 2Visits 90 100 Copay X2 Visits 200 45 Copay X 2Visits 90 162 X 2Visits 324TowardsDeductible 162 X 2Visits 324TowardsDeductible 162 X 2Visits 324TowardsDeductible1 Urgent CareVisit @ 250/Visit 45 Copay 50 Copay 45 Copay 250 TowardsDeductible 250 TowardsDeductible 250 TowardsDeductible1 Brand Name 100 RX PerMonth 35 Copay X12 (1 PerMonth) 420 50 Copay X12 (1 PerMonth) 600 35 Copay X12 (1 PerMonth) 420 100 X 12 (1Per Month) 1200TowardsDeductible 100 X 12 (1Per Month) 1200TowardsDeductible 100 X 12 (1Per Month) 1200TowardsDeductibleTotal Out-ofPocket Paid byEmployee 120 90 45 420 675 0 200 50 600 850 120 90 45 420 675 320 324 250 1200 2094TowardsDeductible 320 324 250 1200 2094TowardsDeductible 320 324 250 1200 2094TowardsDeductibleTotal Cost ToEmployee(Premium Out-ofPocket)Premium: 3060 TotalOut-ofPocket: 675 3,735Premium: 1201.08 Total Out-ofPocket: 850 2,051.08Premium: 774.24 Total Out-ofPocket: 675 1,449.24Premium: 863.76 Total Out-ofPocket: 2094 2,957.76Premium: 488.04 Total Out-ofPocket: 2094 2,582.04Premium: 224.76 Total Out-ofPocket: 2094 2,318.76Pg. 10

MEDICAL PLAN COMPARISON:Family coverageHOW WILL MY PLAN WORK FOR ME?Use the chart below to compare how your plan will work for you using the following scenario.Scenario 2: This is Family coverage with members having a combination of medical servicesand receiving prescription drugs totaling 2498.PPO 2000Choice PlusAnnual FamilyPremium 12,099.48PrimaryAdvantage3000 EPO 6,823.92HMO 2000NexusACOHDHP 4000Choice PlusHDHP 4000ChoiceHDHP 4000NexusACO 5,848.08 4,922.16 3,973.68 2,801.16 80 X 5 Visits 400TowardsDeductible 80 X 5 Visits 400TowardsDeductible5 PrimaryOffice Visits@ 80/Visit 30 Copay X 5Visits 150 0 Copay X 5Visits 0 30 Copay X 5Visits 150 80 X 5 Visits 400TowardsDeductible4 SpecialistOffice Visits@ 162/Visit 45 Copay X 4Visits 180 100 Copay X4 Visits 400 45 Copay X 4Visits 180 162 X 4Visits 648TowardsDeductible 162 X 4Visits 648TowardsDeductible 162 X 4Visits 648TowardsDeductible1 Urgent CareVisit @ 250/Visit 45 Copay 50 Copay 45 Copay 250 TowardsDeductible 250 TowardsDeductible 250 TowardsDeductible1 Brand Name 100 RX PerMonth 35 Copay X12 (1 PerMonth) 420 50 Copay X12 (1 PerMonth) 600 35 Copay X12 (1 PerMonth) 420 100 X 12 (1Per Month) 1200TowardsDeductible 100 X 12 (1Per Month) 1200TowardsDeductible 100 X 12 (1Per Month) 1200TowardsDeductibleTotal Out-ofPocket Paidby Employee 150 180 45 420 795 0 400 50 600 1050 150 180 45 420 795 400 648 250 1200 2498TowardsDeductible 400 648 250 1200 2498TowardsDeductible 400 648 250 1200 2498TowardsDeductibleTotal Cost ToEmployee(Premium Out-ofPocket)Premium: 12099.48 Total Out-ofPocket: 795 12,894.48Premium: 6823.92 Total Out-ofPocket: 1050 7,873.92Premium: 5848.08 Total Out-ofPocket: 795 6,643.08Premium: 4922.16 Total Out-ofPocket: 2498 7,420.16Premium: 3973.68 Total Out-ofPocket: 2498 6,471.68Premium: 2801.16 Total Out-ofPocket: 2498 5,299.16Pg. 11

HEALTH SAVINGS ACCOUNT (HSA):Optum Bank 1.800.791.9361IMPORTANT: You MUST make a New Election Each YearEnrolling in one of the High Deductible Health Plans offered by NISD could result in a lowerpayroll deduction and more take home pay. If you are enrolled in a qualifying highdeductible health plan (HDHP), your HSA can help you and your family plan, save and payfor health care.HDHP 4000Choice PlusWHAT IS A HEALTH SAVINGSACCOUNT (HSA)?HSAs are tax-advantagedsavings accounts availableto people enrolled in HighDeductible Health Plans(HDHPs), like NISD’s HDHP4000 Choice Plus, HDHP 4000Choice, and HDHP 4000NexusACO.HDHP 4000ChoiceHDHP 4000NexusACOHigh Deductible Health Plans (HDHP): Could they be a perfectmatch for you?Concerned you may have trouble paying a 4,000 deductible?Pairing an HDHP 4000 plan with a Health Savings Account couldease your mind. The HDHP 4000 protects you from big medicalbills and provides 100% coverage for preventive care. Use themoney for times when you may need help paying for medicalexpenses before your deductible is met or out-of-pocket eligibleexpenses after your deductible is met. With the HSA administeredby OptumBank, you choose the amount to save throughconvenient payroll deductions on a before-tax basis.Health Savings Accounts are designed to work with HDHP plans.The money you save in a HSA is payroll deducted and grows taxfree until the funds are used. Access to your account is availableHSAs let you set aside moneyby phone or tablet using the Health4Me mobile app or anyto pay for medical expensesthroughout your lifetime.internet-connected device on myuhc.com. Best of all, HSAbalances are never forfeited and are portable if you leave or retirefrom NISD. You make the decision when to use funds for qualified medical expenses or tosave and invest fund balances as an additional retirement account.2022 MaximumContributionLimits Individual - 3,650 Family - 7,300Catch-Up Contribution: 1,000 for age55 or olderPg. 12

SECTION 125 CAFETERIA PLAN:Proficient Benefit Solutions 210.659.8100The Cafeteria Plan is one of the most valuable benefits NISD offers. It allowsyou to pay for certain group insurance (health, dental, vision, term life)premiums using pre-tax earnings. It also allows you to set aside money for nonreimbursed health care and/or dependent daycare expenses using pretaxed earnings. The bottom line is you increase your spendable incomebecause your deductions are made on a pre-tax basis.Increase Your Spendable IncomeThere are four components to the plan:Premium Tax Sheltering:Allows you to use pre-taxearnings for deductionsto pay for your groupinsurance premiums(medical, dental, vision,etc.). This means that youreduce your taxableincome, and by doing so,your take home payincreases.Health (FSA) FlexibleSpending Account:Allows you to have pretax deductions placed inan account that is usedfor reimbursement ofeligible expenses notpaid by your medical,dental or vision plan.How the Plan WorksDependent Care FlexibleSpending Account:Allows an individual to havepre-tax deductions to pay fordependent care expenses.Most people use this accountfor reimbursement of childdaycare expenses but it can beused for reimbursement ofadult daycare expenses as longas the adult satisfies the IRSdefinition of a Tax Dependent.Health Savings Account:If you are enrolled in HDHP4000 Choice Plus, HDHP 4000Choice or HDHP 4000 NexusACO you can establish asavings account funded bypre-taxed deductions to paycertain medical expenses. Seethe Health Savings Accountsection of this guide orcontact the Benefits Office fordetails.IMPORTANT: You MUST make a New Election Each YearAll NISD benefit-eligible employees are enrolled in premium tax sheltering. When completing your on-linebenefits enrollment decide whether you want to participate in one or more of the spending or savingsaccount options. If you choose to participate, minimum and maximum monthly deductions countMaximum AnnualContribution: 2,750Maximum AnnualContribution:Individual: 3,650Family: 7,300DependentCare FlexibleSpendingAccountMaximum Annual Contribution: 5,000 single or married filing jointreturns; 2,500 for married and filingseparately. Married couples cannoteach elect 5,000. This maximum is acombined maximum for both.Each pay period, a portion of your annual election amount is deducted from your gross pay in equalinstallments and transferred to your account where it waits until you file a reimbursement claim. Themoney you deposit in your accounts is automatically deducted from your gross pay prior to calculatingfederal taxes. Since your taxable income is reduced, so are your taxes.IMPORTANTUse-or-Lose RuleYou can roll over up to 550 at the end of the plan year. Anyunclaimed amounts over 550 left in the Health FlexibleSpending Account or any balance remaining in the DependentCare Flexible Spending Account at the end of the year areforfeited by you. You can avoid forfeitures by planning carefullyand only setting aside money for predictable costs.Deadline for Filing ClaimsYou must claim reimbursements within 90 days of the end ofthe plan year, December 31, or within 90 days of your end ofemployment with NISD, whichever is sooner. Any funds notclaimed within this time limit are forfeited. Only claims forexpenses incurred prior to the end of the plan year or the dateyour employment ends are eligible for reimbursement.Pg. 13

Health Flexible Spending Account or Health Savings Account:Is one right for you?Helpful Tips: Know your coverage: Every health plan will have out of pocket costs in the form ofdeductible copays, and coinsurance. Consider your budget: Ensure your contributions fit into your overall personal finances. Askyourself how many office visits, prescriptions, specialists, labs, and other procedures you oryour family is likely to need. Factor in major purchases: Look up average costs for any major planned treatments orprocedures. Look back at prior years: Your prior year spending may give you a hint as to how much youare likely to spend this year.FSA/HSAComparisonFSAHSAMaximum AnnualContribution2022:Up to 2,750 per planyear2022:Employee Only - 3,650Family - 7,300Catch up contribution: 1,000 for age 55 orolderEligibilityEmployee who is offered grouphealth, regardless of election andwho has met any establishedeligibility requirements of theemployer. FSA has NO specifichealth coverage restrictionsEmployee who is covered under a HighDeductible Health PlanEligibilityExclusionsAny employee who isnot also offered the group healthplan or otherwise does not meetestablished eligibilityrequirementsAny employee who is enrolled in a non-HDHPplan, enrolled in Medicare (any Part, includingPart A), enrolled in Tri-Care, claimed as a taxdependent, covered under a general purposeFSA (including spouse’s FSA), “RolloverAccounts” – balance other than 0.00 on thelast day of the previous plan yearDistributionsTax freeTax freeQualifiedExpensesQualified medical expense asdefined in IRC 213(d); coverage isfor employee, spouse and children(under the age of 27 as ofDecember 31)Qualified medical expenses as defined in IRC213(d), includes COBRA premiums, long termcare and Medicare premiums; coverage is foraccount holder, spouse and tax dependentchildrenInsurancePremiumsNot allowedYes, COBRA, Medicare and Long Term CareReported on TaxesNoYesCarryoverYes, up to 550Yes, no exclusions and no time limitsCOBRA ContinuationBased on a balance at terminationNoIMPORTANT: You must make a new election each yearPg. 14

LIFE INSURANCE:The Standard 210.545.6030Employee Basic Life InsuranceNorthside ISD provides all benefit-eligible employees with Term Life and Accidental Death &Dismemberment (AD&D) insurance. Your amount of coverage depends on whether youelect to participate in one of the District’s medical plans.BASIC LIFE INSURANCEMedical PlanEmployees participating in a NISD medical plan: 5,000 basic life insurance at no additional costNo Medical PlanEmployees NOT participating in a NISD Medical Plan, have a choice of:1) 50,000 (no imputed income (tax liability) to employee)OR2) 80,000 ( 50,000 tax free / 30,000 imputed income based on IRS agerate tables)Employee Supplemental and Spouse/Child Voluntary Life InsuranceEmployees may purchase additional life insurance for themselves, their spouses and children.EMPLOYEE SUPPLEMENTAL AND SPOUSE/CHILD VOLUNTARY LIFE INSURANCEEmployeeUp to 5 times your annual salary.SpouseChoice of 5,000, 10,000, 20,000, 30,000, 40,000 or 50,000 not toexceed 100% of employee coverage amount.Child(ren)Choice of 5,000 or 10,000 not to exceed 100% of employee coverageamount.Guarantee Issue:During Open Enrollment 2022, new entrants have the opportunity to enroll for coverage up to the maximum 5times salary multiple or 300,000 for you, 30,000 for your spouse and 10,000 for your child(ren) without ahealth questionnaire. Employees may request one times their salary multiple up to the 300,000 Guarantee Issuelimit if coverage was previously declined or to add to existing coverage levels. Employees can also elect to addspouses and children for one level increase at the same time. All new requests that exceed the 300,000 limitrequire an Evidence of Insurability (EOI) form to be completed and returned to The Standard. Coverage becomeseffective on January 1, 2022 or Standard’s approval date for EOI requests.Rates:Employee Supplemental Life 0.190 per 1,000 of CoverageEmployee AD&D 0.017 per 1,000 of CoverageSpouse Voluntary Life and AD&D 0.445 per 1,000 of CoverageChild Voluntary Life and AD&D 1.650 per 5,000 of CoverageCost:Cost of coverage varies based on salary and other factors, see enrollment system forpersonalized rates. Current life volume and costs will stay the same unless you make a change.*Deductions will vary for Child Nutrition and Transportation employees due toadvanced deductions to cover summer premiums in advance.Pg. 15

DENTAL INSURANCE:Delta Dental PPO 1-800-521-2651 / DHMO 1-800-422-4234Choose from four Dental options - three PPOs and a DHMO - that best fits the needs of youand your family.LOWHIGHPLATINUMDHMODELTACARE 50 150 50 150 75 225N/A 1,250 2,000 4,000N/ADiagnostic/Preventive Services:Exams, cleanings, x-rays, andsealants100% nodeductible100% nodeductible100% nodeductible 0 to 10 copayBasic Services: Space maintainers& appliances for children thru age14, emergency care for pain relief,non-surgical extractions, fillings80% afterdeductible80% afterdeductible80% afterdeductible 0 to 150 copayWaiting Period ForMajor AND Ortho Services12 months12 months12 monthsN/AMajor Services: Crowns, inlays,onlays, bridges, dentures, implants,oral surgery, periodontics (gumtreatment), endodontics (rootcanals)50% afterdeductible50% afterdeductible50% afterdeductible 0 to 415 copayDeductible: Individual FamilyAnnual Maximum BenefitPer PersonDiagnostic & Preventive do notapply to maximumMONTHLYEmployeeOnlyEmployee& SpouseEmployee&Child(ren)Employee& Family*see schedule ofbenefits50%50% 1,150 to 2,100copay 1,000 1,500 1,500N/AOrthodontic Lifetime MaximumCost*see schedule ofbenefits50%children onlyDHMOLowHighPlatinumDeltaCare 27.70 31.35 38.44 12.06 51.03 57.78 69.74 21.00 50.23 56.86 70.86 22.83 77.63 87.89 107.79 30.41CostBI-WEEKLY*Orthodontic Benefits*see schedule ofbenefitsEmployeeOnlyEmployee& SpouseEmployee&Child(ren)Employee& Family*see schedule ofbenefitsDHMOLowHighPlatinumDeltaCare 13.85 15.68 19.22 6.03 25.52 28.89 34.87 10.50 25.12 28.43 35.43 11.42 38.82 43.95 53.90 15.21*Deductions will vary for Child Nutrition and Transportation employees due toadvanced deductions to cover summer premiums in advance. Delta Dental does not give waiting period credit for prior coverage under a non-Delta plan.Delta Dental PPO participants can move between Delta Dental PPO plans and time enrolled willapply to waiting period.Pg. 16

VISION INSURANCE:Davis Vision 1.877.923.2847Healthy eyes and clear vision are an important part of your overall health and quality of life.VISION PLANIN-NETWORK BENEFITSEye ExaminationEyeglassesSpectacle LensesFramesOnce per calendar year, covered in full after 10 copayOnce per calendar year, covered in full.For standard single-vision, lined bifocal, or trifocal lenses after 10 copayOnce per calendar year, covered in full for any fashion or designer frame from DavisVision’s collection (value up to 160) OR 120 in retail allowance toward any framefrom provider plus 20% off balance OR 170 in retail allowance toward any frame froma Visionworks family of store locationsContact LensesContact Lens Evaluation,Fitting and Follow UpOnce per calendar yearDavis Vision’s Collection Contacts: Covered in fullNon-Collection Contacts: 15% discountContact LensesOnce per calendar yearCollection Contacts: Covered in fullNon-Collection Contacts: 120 retail allowance toward provider supplied contactlenses plus 15% off balanceOut of NetworkReimbursement ScheduleEye Examination up to 45 Frame up to 85 Spectacle Lenses (per pair) up to:Single Vision 50; Bifocal/Progressive Lenses 60; Trifo

Are you interested in a plan with lower payroll deductions and paying out of pocket for all initial costs for medical/pharmacy services until a deductible is met? If YES, consider a High Deductible Health Plan. (HDHP 4000 Choice Plus, HDHP 4000 Choice, HDHP 4000 NexusACO). Tip: These plans work best when combined with an HSA account.