Your Benefits Plan - 2025 Open Enrollment

Your Benefits Plan 2025 Open Enrollment

Your 2025 Benefits The health and financial security of you and your family is important to us. Our benefit program provides a variety of plans that can enhance the lives of you and your family – both now and in the future. As an eligible employee, you will be asked to make decisions about the employee benefits described in this booklet. This guide provides information to enable you to effectively enroll in your benefits. Take time to read it carefully and use the available resources to ensure you make the decisions that are right for you and your family.

Eligibility Employees Spouse & Legal Dependents Qualifying Events All employees working 30 hours per week or more Your legal spouse and children are eligible for medical, You may make a change to your benefits if you are eligible for the benefits program. For new hires, dental, and vision to age 26. Your children of any age are have a qualified status change such as: marriage your benefits begin on the first day of the month also eligible if you support them, and they are incapable of divorce, birth/adoption, death, changes in following your day of hire, or date of hire if hired self-support due to disability. As required by our insurance spouse’s benefits, and more. on the first of the month. You may insure yourself contracts, you may be required to provide proof of eligibility and eligible family members under the program. for your dependents. If your dependent becomes ineligible for coverage during the year, you must contact your plan administrator within 30 days.

Employee Cost Monthly Premiums Monthly Premiums Medical Monthly Premiums DENTAL VISION PPO #1 PPO #2 Employee + Family Employee + Family Employee Only $36.56 Teachers $189.04 $539.25 $178.10 $508.06 Employee Only $5.20 Employee + Spouse $66.16 Administrators $75.61 $215.70 $71.24 $203.23 Employee + Spouse $10.41 Employee + Child(ren) $80.25 12mo. Classified $75.61 $215.70 $71.24 $203.23 Employee + Child(ren) $11.14 Family $128.24 9/10mo. Classified $75.61 $1,466.76 $71.24 $1,381.93 Family $17.80 Pre-65 Retirees $756.14 $2,157.00 $712.38 $2,032.25 SEE THIS PLAN SEE THIS PLAN SEE THIS PLAN

Medical BENEFITS For 2025, HCCSC is moving our health insurance coverage to Anthem. You can choose between two HealthSync PPO plans with a tiered deductible system. View Your Anthem Portal

PPO Plan #1 PPO Plan #2 TIER #1 TIER #2 TIER #1 TIER #2 Embedded Deductible $2,000 / $4,000 $5,000 / $10,000 $3,000 / $6,000 $6,000 / $12,000 (Single/Family) Out-of-Pocket Max $7,000 / $14,000 $7,000 / $14,000 $7,350 / $14,700 $7,350 / $14,700 (Single/Family) Coinsurance 20% 40% 20% 40% Physician Office Visit $15 $40 $15 $40 Specialist Visit $30 $80 $30 $80 Emergency Room $250 + Ded. + Coins. $250 + Ded. + Coins. $250 + Ded. + Coins. $250 + Ded. + Coins. Urgent Care Centers $75 Ded. + Coins. $75 Ded. + Coins.

Anthem’s Sydney Health App Manage Your Claims With Sydney Health, you can submit and track your claims, anytime, anywhere. Watch Sydney Health App Video Compare Care & Costs Our digital tools can help you find doctors in your plan’s network and compare care costs up front. Schedule Virtual Appointments Schedule same-day virtual appointments with licensed physicians. Download the App

Prescription DRUGS Live chat with a TrueScripts professional to get assistance with a claim, drug pricing information, explanation of benefits, and more! Receive SMS text notifications for savings opportunities, confirmation of refills, plan updates, and more. Visit True Scripts Portal Hold onto your insurance 90-day supply prescriptions If you have a Prior Authorization card! New ID cards will only can be filled at any retail or are taking Specialty be delivered if you newly pharmacy or through mail Medications, please contact enroll in insurance this year. order. Member Care staff prior to 1/1/2025 to prevent disruption!

PPO Plan #1 PPO Plan #2 IN-NETWORK OUT-OF-NETWORK IN-NETWORK OUT-OF-NETWORK Retail Prescriptions: $10 copay Not Covered $10 copay Not Covered Generic Retail Prescriptions: $75 copay Not Covered $75 copay Not Covered Preferred Retail Prescriptions: $150 copay Not Covered $150 copay Not Covered Non-Preferred Retail Prescriptions: $400 copay Not Covered $400 copay Not Covered Specialty Mail Order Prescriptions: $25 copay Not Covered $25 copay Not Covered Generic Mail Order Prescriptions: $187.50 copay Not Covered $187.50 copay Not Covered Preferred Mail Order Prescriptions: $375 copay Not Covered $375 copay Not Covered Non-Preferred Mail Order Prescriptions: $400 copay Not Covered $400 copay Not Covered Specialty

DENTAL DELTA DENTAL OF INDIANA 225 S East St Indianapolis, IN 46202 317-842-4022 Dental Coverage with Delta Dental KRISTEN JONES Group Delta Dental PPO Delta Dental offer three levels of benefits coverage; PPO Dentist, Premier Dentist, and Non-Participating Dentist. Find providers, view your ID card, and more online or using the mobile app. Online Portal Download the App

Deductible $50 / $150 (Single/Family) Annual Plan Maximum $1,000 Preventive Services 100% Covered Exams, Cleanings, Fluoride, X-Rays Basic Services 80% Covered Fillings, Extractions, Endodontics, Crown Repairs Major Services 50% Covered Crowns, Dentures, In/Outlays, Periodontics Orthodontia Services 50% Covered Orthodontia Lifetime Maximum $1,000

VISION Delta Vision In 2025 HCCSC is moving to Delta Vision as our vision insurance carrier. Since they utilize the VSP Choice network, your preferred eye doctor should still be covered! Be sure to visit the Delta Vision Portal to view a digital copy of your ID card. Online Portal

IN NETWORK OUT-OF-NETWORK Exam $10 copay Reimbursement up to $45 Glasses Lenses $25 copay Reimbursement from $30-$65 Glasses Frames $130 Allowance Reimbursement up to $70 Contact Lenses Covered in Full / Reimbursement (Medically Necessary / Elective) $130 reimbursement up to $210 / $105 Each material benefit is paid out every 12 months, frames are every 24 months.

Additional BENEFITS HCCSC provides full-time employees with employer- paid basic life/AD&D insurance and long-term disability income protection at no cost.

Basic Life Insurance Long-Term Disability The basic life insurance policy is available to all full- Disability benefits protect your income during a period in time employees. In the event of your death, your which you are unable to work because of an illness or accident beneficiaries will receive a lump-sum payment based not related to your job. HCCSC pays all but $1.00 of the total on your employee classification. HCCSC pays all but annual premiums for these benefits. $1.00 of the total annual premiums for these benefits. th Benefits begin on the 90 day after the date of the incident Basic Accidental Death & and will cover 60% of your earnings (up to $5,000/month). Dismemberment Insurance • Policy Number: 01-020575-00 The basic AD&D insurance policy is available to all • Policyholder: Huntington County Community School Corp. full-time employees. In the event of death, loss of (or loss of use of) a body part or function, speech, • Email Support: LADCLA@symetra.com eyesight, or hearing, your beneficiaries will receive a lump-sum payment based on your employee classification. This benefit is bundled with Basic Life. File an LTD Claim

Retirement You may contribute tax-deferred income to 403(b) retirement accounts with 403(b) Corebridge Financial. Funds grow with potentially greater accumulation as tax withholding is deferred until distribution. Open an Account Option #1: Traditional 403(b) Option #2: Roth 403(b) Contribute pre-tax dollars today to reduce taxable Contribute after-tax dollars today. Take tax-free distributions income. Funds grow with potentially greater accumulation if the following conditions are met: Distribution must be as tax withholding is deferred until distribution. Take made after the end of the five-year period beginning with the distributions if the following conditions are met: Age 59½; first year for which a Roth contribution was made to the plan, Severance from employment; Your death or disability; and you turn age 59½, or your total disability or death. Financial hardship Note: a 10% federal early withdrawal Reduce taxable income during retirement, and possibly help tax penalty may apply to withdrawals prior to age 59½. reduce taxation of Social Security benefits under current law. IRS Contribution Limits Contact Information • 100% of annual includible income up to $23,000 You can reach out directly to your financial professional. • $7,500 age-based catch-up for those aged 50+ • Jared Roush, Financial Advisor • $3,000 extra if 15+ years of service with a qualifying • (260) 415-9498 employer and have under-contributed in prior years • jared.roush@corebridgefinancial.com

Employee Clinical Assistance Confidential assistance for a range of concerns including addictions, depression, anxiety, stress, PROGRAM relationships, and parenting. All full-time employees are automatically (even if you are Wellness not enrolled in medical benefits) provided access to Telephone based wellness coaching for tobacco Parkview’s Employee Assistance Program. The EAP is a cessation, weight loss management, fitness and confidential resource available 24/7/365 to help you deal exercise, stress management, parenting, and with a variety of life stages and concerns. The program relationship support. includes up to 4 confidential consultations a year. Work-Life Get Help Assistance for daily challenges at home and work including financial, legal, child/elder care, and identity theft.

PlanSource Get Enrolled Today! User: First initial of your first name, your full last name, and the first four digits of your date of birth Example: John Smith, Date of Birth 3-15-1970. Username jsmith0315 Password: Birthday in format of YYYYMMDD Enroll Online