Goshen Community Schools Employee Benefits Guide Website

2026 Open Enrollment Employee Benefits Package

Tracey Noe DIRECTOR OF HR Your 2026 Benefits Beginning January 1, 2026, our Dental and Vision Plans will be administered by MetLife and our Healthcare FSA and Dependent Care FSA accounts will be administered by Lively. We also are enhancing our identity theft coverage through Allstate by adding the Pro+Cyber plan. MetLife Dental You will continue to have access to a large network of providers and if you choose to seek care at an out of network provider you will have a better reimbursement than you do today. MetLife Vision MetLife vision is powered by the VSP network. You will have access to the same network of vision providers that you have today. FSA and DCA Transitioning to Lively Lively will serve as our new administrator for the Flexible Spending Account (FSA) and Dependent Care Account (DCA) programs. This change is designed to enhance your experience with improved tools and support for managing your pre-tax savings. Enhancements to Identity Theft Protection: Now offering Pro+Cyber Plan. This upgraded plans offer 24/7 monitoring, advanced scam detection, and expert identity recovery support – helping you and your family stay ahead of evolving digital threats. Read on in the guide for additional details

Employees All eligible employees who work at least 15 hours a week are eligible to participate in voluntary benefits Our comprehensive benefits package is available to those employees working 30 or more hours per week. Spouse & Legal Dependents Your children are eligible for medical, dental, and vision to age 26. Your children of any age are also eligible if you support them, and they are incapable of self-support due to disability. As required by our insurance contracts, you may be required to provide proof of eligibility for your dependents. If your dependent becomes ineligible for coverage during the year, you must contact your plan administrator within 30 days. Qualifying Events You may make a change to your benefits if you have a qualified status change such as: marriage divorce, birth/adoption, death, changes in spouse’s benefits, and more. Eligibility

Employee Cost: Medical Goshen Schools Pays Goshen Employee Pays Total Cost Employee Only $9.88 $19.76 $30.00 Employee + Spouse $39.17 $78.34 $59.00 Employee + Child(ren) $28.66 $57.32 $49.00 Family $53.62 $107.84 $74.00 Goshen Schools Pays Goshen Employee Pays Total Cost Employee Only $9.88 $19.76 $30.00 Employee + Spouse $39.17 $78.34 $59.00 Employee + Child(ren) $28.66 $57.32 $49.00 Family $53.62 $107.84 $74.00 Goshen Schools Pays Goshen Employee Pays Total Cost Employee Only $9.88 $19.76 $30.00 Employee + Spouse $39.17 $78.34 $59.00 Employee + Child(ren) $28.66 $57.32 $49.00 Family $53.62 $107.84 $74.00 Goshen Schools Pays Goshen Employee Pays Total Cost Employee Only $9.88 $19.76 $30.00 Employee + Spouse $39.17 $78.34 $59.00 Employee + Child(ren) $28.66 $57.32 $49.00 Family $53.62 $107.84 $74.00 PPO PLAN A PPO PLAN B HDHP C HDHP D Goshen Pays (26 Pays) You Pay (26 Pays) Goshen Pays (20 Pays) You Pay (20 Pays) Goshen Pays (26 Pays) You Pay (26 Pays) Goshen Pays (20 Pays) You Pay (20 Pays) Goshen Pays (26 Pays) You Pay (26 Pays) Goshen Pays (20 Pays) You Pay (20 Pays) Goshen Pays (26 Pays) You Pay (26 Pays) Goshen Pays (20 Pays) You Pay (20 Pays) ALL ELIGIBLE EMPLOYEES (Including 75/80/90/100% Teachers) Employee $207.84 $125.26 $207.16 $100.16 $207.30 $105.48 $206.44 $74.08 Employee + Spouse $457.73 $275.09 $456.22 $219.87 $456.54 $231.58 $454.66 $162.49 Employee + Child(ren) $372.86 $226.72 $371.63 $181.54 $371.89 $191.12 $370.35 $134.58 Family $657.08 $342.22 $655.02 $266.92 $655.46 $282.89 $652.89 $188.67 40/50/60/70% TEACHER Employee $148.14 $184.96 $147.46 $159.86 $147.60 $165.18 $146.74 $133.77 Employee + Spouse $326.24 $406.57 $324.74 $351.36 $325.06 $363.06 $323.17 $293.97 Employee + Child(ren) $265.78 $333.80 $264.54 $288.62 $264.81 $298.20 $263.26 $241.67 Family $467.91 $531.38 $465.86 $456.09 $466.29 $472.06 $463.72 $377.84 SUPPORT SCHOOL YEAR / SEC / BOOKKEEP Employee $270.19 $162.83 $269.30 $130.21 $309.37 $97.24 $308.26 $56.42 Employee + Spouse $595.04 $357.62 $593.09 $285.84 $593.50 $301.06 $591.05 $211.23 Employee + Child(ren) $484.72 $294.73 $483.12 $236.00 $483.46 $248.46 $481.45 $174.96 Family $854.20 $444.89 $851.53 $347.00 $852.10 $367.76 $848.76 $245.27 GOSHEN EMPLOYEE MARRIED TO GOSHEN EMPLOYEE Employee $319.25 $13.85 $415.03 $18.00 $298.08 $9.23 $387.51 $12.00 $308.16 $4.62 $400.61 $6.00 $280.06 $0.46 $364.07 $0.60 Employee + Spouse $718.97 $13.85 $934.66 $18.00 $666.86 $9.23 $866.92 $12.00 $683.51 $4.62 $888.56 $6.00 $616.68 $0.46 $801.68 $0.60 Employee + Child(ren) $585.73 $13.85 $761.45 $18.00 $543.93 $9.23 $707.11 $12.00 $558.40 $4.62 $725.92 $6.00 $504.47 $0.46 $655.81 $0.60 Family $985.45 $13.85 $1,281.08 $18.00 $912.71 $9.23 $1,186.52 $12.00 $933.73 $4.62 $1,213.85 $6.00 $841.10 $0.46 $1,093.43 $0.60

Employee Cost: Dental & Vision Goshen Schools Pays Goshen Employee Pays Total Cost Employee Only $9.88 $19.76 $30.00 Employee + Spouse $39.17 $78.34 $59.00 Employee + Child(ren) $28.66 $57.32 $49.00 Family $53.62 $107.84 $74.00 Dental Vision Goshen Pays (26 Pays) You Pay (26 Pays) Goshen Pays (20 Pays) You Pay (20 Pays) You Pay (26 Pays) You Pay (20 Pays) ALL ELIGIBLE EMPLOYEES (Including 75/80/90/100% Teachers) Employee $12.37 $4.87 $16.08 $6.33 ALL EMPLOYEES Employee $3.30 $4.29 Employee + Spouse $25.09 $7.07 $32.62 $9.19 Employee + Spouse $6.60 $8.58 Employee + Child(ren) $27.10 $7.63 $35.23 $9.92 Employee + Child(ren) $7.07 $9.19 Family $41.53 $11.69 $53.99 $15.20 Family $11.29 $14.68 40/50/90/70% TEACHER Employee $8.42 $8.82 $10.94 $11.47 Employee + Spouse $17.12 $15.04 $22.26 $19.55 Employee + Child(ren) $18.49 $16.25 $24.04 $21.12 Family $28.33 $24.89 $36.83 $32.35 SUPPORT SCHOOL YEAR / SEC / BOOKKEEP Employee $10.38 $6.85 $13.50 $8.91 Employee + Spouse $21.40 $10.76 $27.82 $13.99 Employee + Child(ren) $23.10 $11.63 $30.04 $15.12 Family $35.40 $17.82 $46.03 $23.16

26 Deduction 20 Deduction Pay and Deduction Calendar JANUARY FEBRUARY MARCH APRIL 1 2 3 1 2 3 4 5 6 7 1 2 3 4 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 11 12 13 14 5 6 7 8 9 10 11 11 12 13 14 15 16 17 8 9 10 11 12 13 14 15 16 17 18 19 20 21 12 13 14 15 16 17 18 18 19 20 21 22 23 24 15 16 17 18 19 20 21 22 23 24 25 26 27 28 19 20 21 22 23 24 25 25 26 27 28 29 30 31 22 23 24 25 26 27 28 29 30 31 26 27 28 29 30 MAY JUNE JULY AUGUST 1 2 1 2 3 4 5 6 1 2 3 4 1 3 4 5 6 7 8 9 7 8 9 10 11 12 13 5 6 7 8 9 10 11 2 3 4 5 6 7 8 10 11 12 13 14 15 16 14 15 16 17 18 19 20 12 13 14 15 16 17 18 9 10 11 12 13 14 15 17 18 19 20 21 22 23 21 22 23 24 25 26 27 19 20 21 22 23 24 25 16 17 18 19 20 21 22 24/ 31 25 26 27 28 29 30 28 29 30 26 27 28 29 30 31 23/ 30 24/ 31 25 26 27 28 29 SEPTEMBER OCTOBER NOVEMBER DECEMBER 1 2 3 4 5 1 2 3 1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 9 10 11 12 4 5 6 7 8 9 10 8 9 10 11 12 13 14 6 7 8 9 10 11 12 13 14 15 16 17 18 19 11 12 13 14 15 16 17 15 16 17 18 19 20 21 13 14 15 16 17 18 19 20 21 22 23 24 25 26 18 19 20 21 22 23 24 22 23 24 25 26 27 28 20 21 22 23 24 25 26 27 28 29 30 25 26 27 28 29 30 31 29 30 27 28 29 30 31 26 Deductions 20 Deductions

Medical BENEFITS Log in to PlanSource to view your employee contributions. View Your Anthem Portal

Embedded Deductible (Single/Family) $600 / $1,200 $2,000 / $4,000 $3,400 / $6,800 $6,000 / $12,000 Out-of-Pocket Max (Single/Family) $3,000 / $6,000 $6,000 / $12,000 $3,400 / $6,800 $6,000 / $12,000 Coinsurance 10% 20% 0% 0% Preventive Care 100% covered 100% covered 100% covered 100% covered Physician Office Visit $40 copay $40 copay Deductible + coinsurance Deductible + coinsurance Specialist Visit $45 copay $45 copay Deductible + coinsurance Deductible + coinsurance Emergency Room $100 copay + coinsurance $200 copay + coinsurance Deductible + coinsurance Deductible + coinsurance Urgent Care Centers $40 copay $40 copay Deductible + coinsurance Deductible + coinsurance Inpatient Services $150 copay + coinsurance $200 copay + coinsurance Deductible + coinsurance Deductible + coinsurance Outpatient Services Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance PPO PLAN A PPO PLAN B HDHP C HDHP D Out-of-network benefits: PPO A out-of-pocket max is $5,000 / $9,000 and PPO B out-of-pocket max is $10,000 / $20,000. Coinsurance for Plans A & B is 30%. No coinsurance for Plans C & D All four plans are available to eligible employees

Anthem’s Sydney Health App Manage Your Claims With Sydney Health, you can submit and track your claims, anytime, anywhere. Compare Care & Costs Our digital tools can help you find doctors in your plan’s network and compare care costs up front. Access Your ID Card Your digital ID card is always with you when you need it. Download the App Watch Sydney Health App Video Telehealth Use Anthem’s Sydney app to connect with a board-certified doctor through video visits or have a virtual chat visit for no or low cost, depending on your plan.

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Prescription DRUGS Your pharmacy plan is through NAVITUS. View Your Navitus Portal

Out-of-Network Plan A & B Retail prescriptions: copay + difference in cost. Specialty prescriptions: same in or out of network. Mail order: not covered. Out-of-Network Plan C and D not covered. Retail Prescriptions: Tier 1: Generic Greater of $10 or 15% $10 copay Deductible + coinsurance Deductible + coinsurance Retail Prescriptions: Tier 2: Formulary Greater of $40 or 40% Greater of $40 or 40% Deductible + coinsurance Deductible + coinsurance Retail Prescriptions: Tier 3: Non-Formulary Greater of $60 or 60% Greater of $60 or 60% Deductible + coinsurance Deductible + coinsurance Retail Prescriptions: Specialty 10% of prescription cost after deductible 20% of prescription cost after deductible Deductible + coinsurance Deductible + coinsurance Mail Order Prescriptions: Tier 1: Generic Greater of $10 or 15% $10 copay Deductible + coinsurance Deductible + coinsurance Mail Order Prescriptions: Tier 2: Formulary Greater of $40 or 40% Greater of $40 or 40% Deductible + coinsurance Deductible + coinsurance Mail Order Prescriptions: Tier 3: Non-Formulary Greater of $60 or 60% Greater of $60 or 60% Deductible + coinsurance Deductible + coinsurance Mail Order Prescriptions: Specialty 10% of prescription cost 20% of prescription cost Deductible + coinsurance Deductible + coinsurance PPO PLAN A PPO PLAN B HDHP C HDHP D

Health Savings ACCOUNT A Health Savings Account (HSA) is available to those enrolled in a High Deductible Health Plan. HSA funds can be used for a wide variety of qualified medical expenses all tax-free. Any unused earnings rollover from year-to-year. Goshen Community Schools will contribute $1,000 annually for individuals and $2,500 for families. The IRS max contribution is $4,400 for individuals and $8,750 and for families. Company contribution up to $2,500

View Qualified Expenses Example Employee Contribution Company Contribution Annual Total in Employee HSA $1,000 $1,000 $2,000 $500 $1,000 $1,500 + = + = Watch This HSA Video to Learn More Example Employee +1 Contribution Company Contribution Annual Total in Employee HSA $1,000 $2,500 $3,500 $500 $2,500 $3,000 + = + =

Doctor Visit Visit your healthcare provider and the office will submit the claim to your health plan. Amount Owed The health plan will share the amount you owe with your doctor. EOB The health plan send you the Explanation of Benefits (EOB). Bill Received Your doctor will then send you a bill. HDHP and HSA Consumer Experience Pay with HSA You can use your HSA funds to pay the bill from your doctor.

Set Up Your HSA Account Complete the Form Download and complete the HSA set-up form with Interra Credit Union. Fax or mail the form to the contact information located at the bottom of the PDF. Open an Account Call Interra at (574) 534-2506 or (888) 432-2848 to open your account once the set-up form has been completed and submitted. Share Your Account Number Once your account is open, notify the Goshen benefits team with your Interra-provided account number so that contributions can begin. Download the Form

DENTAL View ID cards, find a dentist, check or file a claim, and more in online portal. Dental Coverage with MetLife Online Portal

Annual Plan Maximum $1,500 100% Covered 80% Covered 80% Covered Deductible (Single / Family) $50 / $150 Preventive Services Exams, Cleanings, Fluoride, X-Rays Basic Services Fillings, Extractions, Endodontics, Crown Repairs Major Services Crowns, Dentures, In/Outlays, Periodontics *Usual and customary out of network coverage reimbursable at the 99th percentile

VISION Your vision insurance is through MetLife Vision which utilizes the VSP network. MetLife Vision through the VSP Network Online Portal

Lenses Routine Exam $45 allowance Frames Elective Contacts Each material benefit is paid out once every 12 months, frames every 24 months. $25 copay $130 allowance $130 allowance $10 copay Necessary Contacts 100% covered $30 allowance single vision $50 allowance Bifocal $65 allowance Trifocal $70 allowance $105 allowance $210 allowance IN NETWORK OUT-OF-NETWORK

GENERAL PURPOSE FSA DEPENDENT CARE ACCOUNT Flexible Spending Accounts Flexible Spending Accounts (FSA) are set up to pay for many of out-of- pocket medical expenses with tax-free dollars. The FSA account holder sets aside a pre-tax dollar amount for the year used to pay for medical expenses. Unused FSA funds can expire at the end of the year. 1 General Purpose FSA An FSA is an alternative to an HSA. FSAs are typically paired with a PPO plan while an HSA is paired with an HDHP. HSA funds can be used on various medical, dental, and vision related expenses. 2 Dependent Care Account (DCA) A DCA is a tax-free spending account for dependent care expenses such as daycare, preschool, or day camps for any dependent under the age of 13 or who is physically or mentally incapable of self-care. Watch This FSA Video to Learn More 1 2 View Eligible Expenses Learn More About Your DCA

Additional BENEFITS Goshen Community Schools offers additional employer-paid and employee-paid benefits for you and your family. Reliance Standard is the partner for all basic and voluntary term life, short and long- term disability, accident, and critical illness insurance. Online Portal

Voluntary Term Life Insurance Employer-Paid Basic Life and AD&D The group life and accident, death, and dismember policy is available to all full-time employees and is 100% employer- paid in the event of death, loss of (or loss of use of) a body part or function, speech, eyesight, or hearing. Click here to view eligibility, benefits, guarantee issue, and more. Voluntary Short-Term Disability Short-term disability is 100% employee paid and protects your income during a short period of time due to illness or an accident not related to your job. Benefits begin on the 15th day after the date of the incident and the policy will pay 60% of your weekly salary for 13 weeks. Click here to view premium tables and highlight sheets. Employer-Paid Long-Term Disability Long-term disability is 100% employer paid and protects your income for an extended period of time. Benefits begin on the 91st day after the date of the incident and will cover 67% of your earnings. Click here to view highlight sheets. Employees have the option to purchase additional life insurance. Evidence of Insurability is required for new enrollments in the plans or increases in benefit amount. Employee Benefit: Increments of $10,000 up to $500,000. Guarantee issue of $200,000. Spouse Benefit: Increments of $5,000 up to $250,000. Child(ren) Benefit: Increments of $2,000 up to $10,000. Click here to view premium tables and highlight sheets.

Voluntary Accident Employees have the option to purchase accident insurance to cover a variety of occurrences, such as: dismemberment; dislocation or fracture; ambulance services; physical therapy; and more. Click to view benefits, amounts, and premiums. Voluntary Critical Illness Critical illness insurance protects you and your family if diagnosed with a critical illness. Click to view coverage amounts and benefit premiums based on age. Voluntary Whole Life Allstate Benefits Whole Life coverage provides a lump sum death benefit during life changing events such as the death of a wage earner. Our Group Whole Life policy offers coverage amounts from a minimum of $5,000 to a maximum of $100,000. Whole Life can be valuable as another way to buy up to $100,000 in additional guaranteed life insurance. Click to learn more about how it works, long-term rider care, and benefit amounts and premiums. Click to view premiums and highlight sheets. Identity Theft Protect yourself and your loved ones (under your roof or under your wallet) from identity theft and fraud with Privacy Armor from Allstate. Privacy Armor Pro+ and Pro+Cyber plans provides 24/7 monitoring, alerts, fee reimbursements incurred from identity theft, and more. Pro+Cyber offers 24/7 monitoring, advanced scam detection, and expert identity recovery support — helping you and your family stay ahead of evolving digital threats. Learn more here

The Employee Assistance Program (EAP) is available to you and your family from Telus Health (formerly LifeWorks). You, your dependents (children between ages 13-26) and all household members can contact a professional clinician 24/7/365 by phone, live chat or text. Your family has access to up to three (3) in-person or virtual assessment and short-term problem resolution services per presenting problem. Clinical Confidential assistance for a range of concerns including addictions, depression, anxiety, stress, relationships, and parenting. Wellness Telephone based wellness coaching for tobacco cessation, weight loss management, fitness and exercise, stress management, parenting, and relationship support. Work-Life Assistance for daily challenges at home and work including financial planning, legal, child/elder care, and identity theft. Employee Assistance PROGRAM Get Help

Health & Wellness CLINIC Learn More & Book an Appt Primary Care Primary health care services including sick visits, care for chronic illness, free lab tests, and blood work. Free Medicine Medicine prescribed by the clinic provides and available at the clinic is at no charge for GCS employees and covered dependents participating in our medical plan. FAQ’s Contact Us (574)-533-8883 Click here for a list of frequently asked questions

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