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Welcome!Welcome to your 2023-2024 benefits! Your health and the health of your family is as important to us as it is to you. That’s why we have carefully considered the available healthcare options and selected the plans that we feel offer first-rate benefits at a good value. During this enrollment period, please carefully review each of your options so that you can choose the plans that will best meet your needs. If you have any questions regarding your benefits, please contact us in Human Resources.02. Santa Maria Bonita School DistrictHR Contact: Hannah Class, Benefits Clerk805-361-8124 | hclass@smbsd.net 03. Eligibility04. Employee Assistance ProgramSISC – Anthem 800-999-7222 | AnthemEAP.com (enter SISC)04. OneDigital AdvocacyEmployee Advocate: Theresa Lomeli 800-264-9918 x 53830 | tlomeli@onedigital.com 05. Common Terms06. Medical PlansSISC – Anthem | Group #SISC 40421800-825-5541 | www.anthem.com/ca/sisc 07. Medical Resources08. Medical – Learn More09. Supplemental PlansEnrollment Benefits Counselor: Jose Blanco208-794-2522 | jose_blanco@us.aflac.com 10. Dental PlanGuardian | Group #432972800-541-7846 | www.guardianlife.com2Contents & Contacts11. Vision PlanVSP | Group #12223015800-877-7195 | www.vsp.com 12. Provider Search13. Carrier Resources14. Flexible Spending AccountsAFLACEnrollment Benefits Counselor: Jose Blanco208-794-2522 | jose_blanco@us.aflac.com 15. Life Plan15. Disability PlanGuardian | Group #452215 800-538-4583 | www.guardianlife.com

When can I make changes?Mid-year, you can make changes if one of these qualifying events occur: Marriage, Birth of a child, Adoption, Involuntary loss of coverage from a qualified group plan, Divorce, Legal separation, Death of spouse or dependent child.Open Enrollment happens once a year and allows you to freely make changes to your plans and who is enrolled. For your company, this happens during the months of August & September each year for an effective date of October 1st. You can enroll on the plans included in this guide if you are at benefits eligible status. As a new hire, your benefits will be effective on the first of the month following your date of hire.Your dependents can be enrolled on the plan with you if they meet one of the following:• Legal spouse or qualified domestic partner• Dependent children• Children of your spouse or qualified domestic partner• Dependent children of any age who are incapable of self-sustaining employment because of mental or physical handicap, and who receive from you or your spouse all of their support and maintenance, and who were continuously enrolled on the current medical plan before the age of 26How much will it cost?You will pay for your portion of the benefit cost through payroll deductions. The deduction amounts are subject to change at any time as deemed appropriate. Any revisions and changes will be provided in writing with a minimum of 30 days prior to the implementation of the change in contributions.Employee NoticesPlease review the required employee notices detailing your rights and options by clicking the link below. You can also request a paper copy of any of these notices at any time. SBC & Uniform GlossaryYour employer is required to provide you with an easy-to-understand summary about the health plan benefits available to you, aka Summary of Benefits and Coverage (SBC) and a Uniform Glossary that outlines insurance definitions. SUMMARY OF BENEFITS & COVERAGE (SBCs) are available free of charge from your HR department. Please contact HR to request copies of any or all of the medical plans that are offered to you during your plan year.The UNIFORM GLOSSARY is a glossary of insurance definitions in standard, consumer-friendly terms. You may find this helpful as you are evaluating your options. To access the glossary visit: www.healthcare.gov/glossary Who can enroll in benefits?Eligibility3Dependent Age LimitsYour dependent children will no longer be eligible to be enrolled on your plan beyond these age limits:MEDICAL: Until age 26DENTAL:under age 19 (under age 24 if student)VISION:under age 19 (under age 24 if student)DOWNLOAD NOTICES HERE

Employee Assistance ProgramSometimes life is stressful. When situations seem too tough to get through on your own, you have a lifeline for help. You and your household members can access confidential, professional assistance from an Employee Assistance Program (EAP). Through the EAP plan, you have access to personal resources and practical solutions to help make your life work better. Whether you need help managing stress or managing relationships, preparing for a new baby or caring for a loved one, EAP offers a wealth of information and support. It’s confidential and available 24/7 at no cost to you.To get started:• Go to www.AnthemEAP.com • Log into your account using the access code SISC• Or call 800-999-7222 (available 24-hours a day, 7 days a week)OneDigital Employee AdvocacyWe get it, insurance is confusing. That’s why you have a dedicated OneDigital employee advocate that loves to help! Get assistance with:• Your enrollment As a new hire, during open enrollment and if you have a mid-year qualifying event• Accessing Care Locating in-network medical, dental and vision providers, hospitals and urgent care facilities near you and how to receive treatment by a specialist through the referral and authorization process• Understanding your Benefits Helping you understand the benefits available to you and how to use your insurance plans• Determining your Costs Explain the cost of service for in-network providers• Claims Resolution Effectively resolving claims disputes and confirming your claims were processed correctly by your carrierMeet your OneDigital Employee Advocate!Theresa Lomeli800-264-9918 ext. 53830 tlomeli@onedigital.comLearn more about Employee Advocacy HERE! Employee SupportEAP BENEFITSANTHEM SISCFACE TO FACE VISITSVisits Covered6Visits Frequency LimitationPer YearPHONE COUNSELINGCalls CoveredUnlimited4

PPO Network PlanWith a Preferred Provider Organization (PPO) plan you have greater flexibility and choice to use both in-network and out-of-network physicians. However, you are encouraged to receive services from the in-network doctors, specialists or facilities. By doing so, you obtain a higher level of benefit than if services were rendered from an out-of-network provider.PremiumA premium is the total cost for your medical insurance. You and your company share this cost. You pay your portion through payroll deductions.Evidence of Insurability (EOI)Evidence of Insurability (EOI) is a record of a person's past and current health events. It's used by insurance companies to verify whether a person meets the definition of good health. You may have to submit this form to a carrier before you are able to elect certain amounts of coverage for voluntary plans. DeductibleA deductible is the amount you must pay before the medical plan begins sharing the cost of services. You pay this full amount, if required by your plan, before the plan pays benefits.• Embedded Deductible: A policy with a deductible for each person covered. Benefits kick in for a family member when they meet their individual deductible and for the whole family when at least two members do so. Embedded policies tend to have higher premiums to accommodate lower deductible options.CoinsuranceYour share of the costs of a covered health care service,calculated as a percent of the allowed amount for theservice. You pay coinsurance plus any deductibles you owe.Out-of-pocket MaximumThe annual out-of-pocket maximum protects you from major medical expenses. This is the most you would pay, including your deductible and copay, for eligible expenses during the year. Once you reach the out-of-pocket maximum, the plan pays 100% of the usual, customary and reasonable charges for covered services.Want to learn the language of insurance? Watch this video HERE.Common Terms5CopayA fixed amount (for example, $20) you pay for covered health care services to providers who contract with your health insurance or plan. In-network copayments usually are less than out-of-network copayments.

MEDICAL PLAN DETAILSANTHEM PREMIER PPO 250/20/10 (PBI 90/70) - SMEEA/AIMSIN-NETWORK BENEFITSNetwork NamePrudent Buyer PPO NetworkCalendar Year Deductible (Single/Family)$250/$750EmbeddedCalendar Year Max Out-Of-Pocket (Single/Family)$1,250/$3,750Rx $5,350/$9,450EmbeddedPHYSICIAN SERVICESPrimary Care Office Visit$0 Copay visits 1-3$20 Copay thereafterSpecialist Office Visit$20 CopayUrgent Care $20 CopayDiagnostic Lab/X-Ray 10%*HOSPITAL SERVICESInpatient Care(Includes Maternity)10%*Outpatient Surgery10%*Emergency Room (waived if admitted)$200 Copay;10%*PRESCRIPTIONSRX Deductible NoneGeneric $7 CopayBrand $25 CopayOUT-OF-NETWORK BENEFITSCalendar Year Deductible(Single/Family)$250/$750 Coinsurance 30%*Calendar Year Max Out-Of-Pocket (Single/Family)$3,000/$9,000Preventive Care CoveredPrescription Drugs Not CoveredMedical PlansThe co-insurance percentages listed are the amounts that you must pay for the service. For a more complete listing of what is covered, please consult the detailed benefit summary from the insurance carrier.6*Benefits with an asterisk (*) require that the deductible be met before the plan begins to pay.

Virtual CareVirtual care through MD Live combines in-office quality with in-home privacy and convenience. HOW MUCH DOES IT COST?• Both Plans: $0 Copay for all visits through September 2024!GETTING STARTED:• Web: www.MDLIVE.com/sisc • Mobile App: MDLive Mobile App• Phone: (800) 657-6169Medical ResourcesSISC is providing PPO members with free access to Maven virtual care for pregnancy and postpartum support. Eligible SISC PPO members are matched with a Care Advocate who connects them to trustworthy maternity and postpartum content. Through Maven Maternity you are also eligible for a FREE 6-month diaper subscription if you: • Enroll during your first or second trimester• Have an intro call with a Care Advocate• Have two appointments with Maven providers during pregnancy • Complete the exit survey when your baby is bornDownload and log into the Maven Clinic app toaccess maternity and postpartum doctors, specialists, coaches, mental health experts, and so much more! Scan the QR code to the right or visit www.mavenclinic.com/join/SISC to get started. Maven MaternityTo better understand the benefits of Telehealth, watch this quick educational video HERE. 7Hinge Health is a free benefit for your back and joint health. We provide all the tools you need to get moving again from the comfort of your home. You’ll get exercise therapy tailored to your condition and a personal care team of experts. Best of all, it’s free - 100% covered by SISC!Sign up today for help with any of the following:• Conquer pain or limited movement• Recover from a recent or past injury• Keep joints healthy and pain free• Get a second opinion on your treatment planCall (855) 902-2777, visit www.hingehealth.com/sisc, or scan the QR code above to learn more!Hinge HealthScan here!Scan here!Eden Health – New benefit starting 10/1/23!Need a Primary Care Doctor? Just ask Eden. You’ll get connected to an entire health care team – at no cost to you. As a part of your SISC PPO Medical Benefits, you have 24/7 access to a Care Team who works together to offer you primary care, mental health support, and answers to follow-up care questions through one app. This program is available to you and your enrolled dependents. Features include: Diagnoses and treatments • prescription refills • scheduled video visits or live chat with a primary care physician • answer to follow up care questions • specialist referrals • mental health support • and more! These services are 100% confidential and will never be shared with your employer. Scan the QR code to the right to download the Eden Health app and register for your membership. Scan here!

Preventive CarePreventive care visits can help detect unhealthy habits before they become a risk and potentially save your life. Our health plans offer an annual in-network well check at no cost to you. When you get these services from doctors in your plan’s network, you don’t have to pay anything out of your own pocket.Learn More…Get more out of your well checks by preparing yourself:• Make a list of health concerns.• Make a list of medications you are taking.• If you are seeing a new doctor, get copies of your medical records and your family medical history.• Review your health plan in advance to be sure you understand your coverage.• Call your doctor in advance to see which tests/screenings are usually run. You can request that your doctor not perform tests not covered by your health plan.Where to Seek CareBenefit from significant savings using an urgent care or virtual care facility versus a hospital Emergency Room (ER) without sacrificing quality of care. Urgent Care ServicesFor injuries and illnesses that aren’t life threatening but need fast care. Some conditions you can use urgent care for include: sprains, strains, minor broken bones, mild asthma attacks, minor infections, small cuts, minor burns, urinary tract infections, pelvic infections, & sore throats.Emergency Care ServicesFor serious and/or life-threatening conditions such as: heavy bleeding, trouble breathing, severe head injury or changes in mental status, sudden or severe pain, sudden dizziness, weakness, or changes in vision, severe or persistent vomiting or diarrhea, & loss of consciousness. Virtual Care ServicesFor minor conditions and convenience. Get care from the comfort of your own home or on the road. Some conditions you can use virtual care for include: flu, minor rashes, tooth pain, pink eye, allergies, cold & fever, sore throat, skin infections, headache, & diarrhea.To learn more about Urgent Care vs Emergency Room care, watch this quick educational video HERE.To learn more about preventive care benefits, watch this quick educational video HERE.8

Medical SupplementalAccidents are unexpected. How you care for them shouldn’t be. Accident insurance can help prepare you for what happens after you or a covered family member has an accident by providing you benefits to help pay the unexpected costs that aren’t covered under your health insurance.Accident CoverageThrough Aflac, you have access to a Critical Illness insurance plan that complements major medical coverage by helping you pay the direct and indirect out-of-pocket costs if you, or a covered dependent is diagnosed with a specified critical illness. Your employer covers the base Critical Illness plan that includes $5,000 of coverage at no cost to you! In addition to this base coverage, you also have the option to purchase voluntary buy-up pan options that includes more coverage for you and your dependents. Critical Illness CoverageHospital indemnity provides a fixed benefit for covered persons when they incur a hospital stay resulting from a covered injury or illness.010203Hospital Indemnity CoverageFor added protection, we are pleased to offer supplemental insurance options through AFLAC. These coverages are voluntary and are paid for by you, the employee, directly through AFLAC. All benefits through these plans are paid directly to you, or a specified beneficiary, regardless of any insurance you may have. Listed below are some coverages available through AFLAC.904Cancer insurance helps offset out-of-pocket expenses incurred from initial diagnosis through recovery. Benefits are paid directly to you. Cancer InsuranceEnrollmentTo enroll in coverage and to obtain full plan offerings, rates and detailed information on your plans, please contact your AFLAC Enrollment Benefit Counselor directly at the number below and refer to the benefit summary published by the carrier.AFLAC Benefit Counselor: Jose Blanco208-794-2522 | jose_blanco@us.aflac.com Additional ResourcesScan the QR code to see the Aflac insurance products offered to you! You can also click HERE to be taken to your Aflac benefits website. You can receive a $200 benefit if you receive an annual mammography screening!

DENTAL PLAN DETAILSGUARDIAN DENTAL GUARD 2000 (DENTAL GUARD PREFERRED)IN-NETWORK BENEFITSNetwork NameDentalGuard Preferred NetworkCalendar Year Deductible (Single/Family) $25/$50 Calendar Year Max Benefit $2,000 PREVENTATIVE SERVICESOral Exam 0%X-Rays 0%BASIC SERVICESResin-Based Fillings10%*Root Canal10%*Deep Cleaning10%*Single Extraction10%*Impaction10%*MAJOR SERVICESComplete Denture40%*Partial Denture40%*Crowns10%*ImplantsNot CoveredORTHODONTICSChild/Adult50%$2,000 Lifetime Max BenefitOUT-OF-NETWORK FEE SCHEDULEUCR 90thDental PlanThe co-insurance percentages listed are the amounts that you must pay for the service. For a more complete listing of what is covered, including out-of-network benefits, please consult the detailed benefit summary from the insurance carrier.10*Benefits with an asterisk (*) require that the deductible be met before the plan begins to pay.

VISION PLAN DETAILSVSP SIGNATURE PLANIN-NETWORK BENEFITSOUT-OF-NETWORK BENEFITSNetwork NameSignature NetworkBENEFIT FREQUENCYExaminationEvery Calendar YearLensesEvery Calendar YearFramesEvery Other Calendar YearVISION EXAM $0 Copay Up to $45*LENSES & FRAMESSingle Vision$0 Copay Up to $45*Bifocals$0 Copay Up to $65*Trifocals$0 Copay Up to $85*FramesUp to $130* Up to $47*ELECTIVE CONTACTS Up to $130* Up to $105**For In-Network, this is an Allowance Amount. For Out-of-Network, Insurance provider reimburses up to this amount.The copays listed are the amounts that you must pay for the service. For a more complete listing of what is covered, please consult the detailed benefit summary from the insurance carrier.Vision Plan11

Medical ProviderDental ProviderVision ProviderProvider Search12Visit: www.anthem.com/ca/sisc/find-care/ • Click on PPO, and then select “Search for a PPO Network Provider”• This will direct you to Anthem’s provider search website. Entire your Zip Code and ensure that “Prudent Buyer PPO/EPO” is selected as your plan• You can then search by type of care providerVisit: www.guardianlife.com • Under “Connect with us,” click on “Find a dental provider”• Under Plan Type, select “PPO: DentalGuard Preferred” • Enter your location information and any applicable search parameters, and then click the search icon to be taken to a list of providers Visit: www.vsp.com • Choose the Members tab on the home page.• Under the tab, hover over “Find a Doctor”• Choose how you would like to search. If you want to find providers in your area, click “Search by Location”• Enter your zip code and select “Advanced Search”• Make sure the Doctor Network is set to “Signature”. Then click “Apply Filters”• You will then be taken to a list of providers in your area

Carrier ResourcesCarrier Mobile AppsWhen you’re in your car, at the doctor’s office, at home, or on the go, your carrier mobile apps will get you the answers you need instantly! Features of Mobile Apps:• Search for physicians by location or specialty• Estimate medication costs, manage Rx claims and find pharmacies• View and share member ID card info• Contact a registered nurse 24/7 for advice about medical questions• View, sort and pay claimsAvailable as free downloads from the App Store and Google Play.Carrier Perks13Gym Discount ProgramSISC is proud to provide members with a gym discount program through Active&Fit Direct! The Active&Fit Direct program includes: A gym membership to your choice of 11,500+ standard fitness centers for $25/month, and/or 4,500+ premium exercise studios with 20% - 70% discounts on most. Active&Fit Direct also offers the ability to switch fitness centers anytime with no long-term contracts, and you can cancel anytime. Once enrolled, you will have access to over 6,500 digital workout videos so you can work out at home or on the go. To learn more, visit https://www.activeandfitdirect.com/fitness/anthemSO.

FlexibleSpendingAccountDependent Care FSAYou can set aside pre-tax dollars to pay for dependent care expenses, such as a child’s day care, extended care, after school care or assistance for an elderly parent or incapacitated dependent. SAMPLE LIST OF ELIGIBLE EXPENSES FOR CHILDREN & ADULT/ELDER CARE:Nanny, babysitter, pre-K, before and after school care through age 12, and nurse fees.Expenses paid to a relative are also eligible if they are age 19 or older and are not a tax dependent of the FSA participant.Health Care FSAYou can set aside pre-tax dollars to pay for health care expenses not covered under the medical, dental or vision plan. This also includes many medical related qualifying items as well, such as over-the-counter medication, contact lens solution, and prescription sunglasses.SAMPLE LIST OF ELIGIBLE EXPENSES:Doctor visits, co-payments, Prescription drugs co-payments, Hospital co-insurance payments, Dental co-payments, Contact Lenses, Prescription Sunglasses.NOTE: IRS law states that you can’t have both a Health Care FSA and an HSA. You may only be enrolled in one of the two plans.How does it work?Regular elected amounts are deducted from your gross wages and credited to your spending account.• Health Care Account funds are completely available the first pay cycle of the plan year.• Dependent Care Account funds are available as they are deducted from your paychecks.• You can use the funds in your accounts to pay for applicable expenses as they arise. • Accounts abide by the “use it or lose it rule”, which means any funds remaining in your accounts at the end of the plan year will be forfeited.AFLACIRS MAXIMUM ANNUAL CONTRIBUTIONHealth Care FSA$3,050Dependent Care FSA$5,000COMMON QUESTIONSDoes my plan have a debit card?YesDoes any funding roll overto the next year?Yes, $610 (Health Care FSA only)Is there a run-out period to submit claims?90 Days (Health Care & Dependent Care FSA)Is the same debit card used for Health & Dependent Accounts?YesIs there a cost for ordering a new or additional debit card?1 free replacement card, then $5 per card afterWhat is an FSA? Watch this video HERE to find out more!A Flexible Spending Account (FSA) allows you to aside money every paycheck on an income tax-free basis. You then can use this money throughout the year to pay for eligible expenses — tax free!14EnrollmentTo enroll for the 2023-2024 plan year, contact your Aflac Enrollment Benefits Counselor directly: Jose Blanco208-794-2522 | jose_blanco@us.aflac.com

These plans are available to you and your dependents. When enrolling, don’t forget to name your beneficiary!Life & Disability PlansGroup Life/AD&DGroup Life and Accidental Death & Dismemberment (AD&D) insurance can help protect your family’s finances if something happens to you.A death might leave your loved ones facing expenses they couldn’t pay without your income. Besides everyday bills, they could run into extra costs for things like final medical care or a funeral. If an accident left you with a serious injury, you might need to pay for special care and modified living arrangements.• Life insurance can be used to help protect the people who depend on your income by paying them an amount of money specified in the policy if you die.• AD&D insurance pays an amount of money specified in the policy if a covered accident results in your death or a severe physical loss, such as a hand, a foot or your eyesight.These benefits can help pay for things like the mortgage, college tuition, child -care costs or daily living expenses.Employer-Paid Long Term DisabilityLong Term Disability insurance will start paying out at the end of the short -term disability coverage period. Please view the carrier’s full plan summary document for a detailed description of what is or is not covered.15GUARDIANMONTHLY BENEFITPercentage of Salary50%Maximum Monthly Benefit$10,000PLAN DETAILSElimination Period150 daysDefinition of Disability2 yearsMaximum Benefit DurationSocial Security Normal Retirement Age (SSNRA)Pre-Existing Limitations3/12**Disabilities that occur during the first 12 months of coverage due to pre-existing condition during the 3 months prior to coverage are excluded.

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