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Basic Life Benefit Summary

OneAmerica Financial (American United Life Insurance Company)

Employer-paid basic term life insurance providing a $50,000 death benefit with a matching $50,000 AD&D Principal Sum. Includes accelerated life benefit, waiver of premium, and a full dismemberment/paralysis loss schedule.

Basic Term Life and AD&D

Employer-provided $50,000 basic term life with matching AD&D coverage. Benefit reduces to 50% at age 70.

✓ Accelerated Life Benefit

Employee may request payment of 25%, 50%, or 75% of the $50,000 Life Amount upon diagnosis of a terminal condition as defined in the Certificate.
✓ Waiver of Premium

AUL may waive premium payments if the employee becomes Totally Disabled before age 60 while insured, and remains continuously Totally Disabled for 6 months, with proof of Total Disability submitted.
✓ Seat Belt Benefit

Additional AD&D benefit payable if loss occurs while wearing a seat belt.
✓ Air Bag Benefit

Additional AD&D benefit payable if loss occurs in a vehicle equipped with an air bag.
✓ Exposure Benefit

AD&D benefit for loss resulting from exposure to the elements following an accident.
✓ Disappearance Benefit

AD&D benefit if the insured disappears and is presumed dead following a covered accident.
✓ Repatriation Benefit

AD&D benefit to cover costs of returning remains to the employee's home following an accidental death.
✓ Child Higher Education Benefit

Benefit to assist with higher education costs for dependent children following the employee's accidental death.
✓ Child Care Benefit

Benefit to assist with child care costs following the employee's accidental death.
✓ Conversion Privilege

If life insurance coverage ceases, the employee may be entitled to convert the life amount to an individual policy. See Certificate for details.

Is This Right for You?

Full-time employees seeking baseline employer-paid life protection
Employees wanting built-in accidental death and dismemberment coverage
Employees with dependents who need a financial safety net

Who Can Enroll

✅Guarantee Issue — no medical exam required
💼30+ hrs/week to be eligible

Questions about Basic Life Benefit Summary?

Violet explains your coverage in plain English.

This Benefits Guide is intended for general informational purposes only. Employees are encouraged to review their official plan documents and contact their HR or Benefits Administrator with any further questions regarding their specific coverage. This guide was prepared based on information provided by the employer and/or insurance carriers and may be subject to change. Benevibe assumes no liability for errors or omissions. In the event of any conflict or discrepancy between the information presented in this Benefits Guide and the official plan documents or group Policy, the official plan documents and group Policy will govern and prevail in all cases.

Medicare Part D Creditable Coverage Notice

Important Notice from Vanguard Academy Charter School About your Prescription Drug Coverage and Medicare

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage offered by the HSA 8500, PPO 6000, Blue Essentials HMO 2500, PPO 1500 through Vanguard Academy Charter School and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. Vanguard Academy Charter School has determined that the prescription drug coverage offered by the HSA 8500, PPO 6000, Blue Essentials HMO 2500, PPO 1500 is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When Can You Join A Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 th through December 7 th .

However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?

If you decide to join a Medicare drug plan and drop your current group health coverage through Vanguard Academy Charter School, be aware that you and your dependents will not be able to get this coverage back. If you are able to get this coverage back, reentry into the plan is subject to the underlying terms of the Plan.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

You should also know that if you drop or lose your current group health coverage through Vanguard Academy Charter School and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

For More Information About This Notice Or Your Current Prescription Drug Coverage…

Contact the Plan Administrator listed below for further information. NOTE: You’ll get this notice each year or if the creditable coverage status of this plan through Vanguard Academy Charter School changes. You may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage…

More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage:

Visit www.medicare.gov
Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help ∙ Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage, and therefore, whether or not you are required to pay a higher premium (a penalty).

For purposes of this notice, the Plan Administrator is:

Abraham Gallegos, MBA

956-781-1701

HIPAA NOTICE OF PRIVACY PRACTICES

Vanguard Academy

NOTICE OF PRIVACY PRACTICES

Vanguard Academy Employee Benefits Plan
Effective Date: January 1, 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY

1. Our Commitment to Your Privacy

This Notice of Privacy Practices (“Notice”) describes how Vanguard Academy (the “Plan”), as a group health plan sponsor, may use and disclose your protected health information (“PHI”) to carry out treatment, payment, health care operations, and for other purposes permitted or required by law. This Notice also describes your rights regarding your PHI and how you may exercise those rights. The Plan is required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and its implementing regulations to maintain the privacy of your PHI, provide you with this Notice of its legal duties and privacy practices, follow the terms of the Notice currently in effect, and notify you if a breach of your unsecured PHI occurs.

2. Protected Health Information (PHI)

PHI is individually identifiable health information, including demographic information, that relates to your past, present, or future physical or mental health condition, the provision of health care to you, or the past, present, or future payment for health care, and that identifies you or for which there is a reasonable basis to believe can be used to identify you. PHI includes information held or transmitted in any form or medium, whether electronic, paper, or oral.

3. Uses and Disclosures of PHI Without Your Authorization

The Plan may use or disclose your PHI without your authorization for the following purposes:

A. Treatment

The Plan may disclose your PHI to a health care provider who requests it in connection with your treatment.

B. Payment

The Plan may use and disclose your PHI to pay claims for covered health care services, determine eligibility for benefits, coordinate benefits with other health plans, review services for medical necessity, and perform utilization management activities.

C. Health Care Operations

The Plan may use and disclose your PHI for health care operations. These activities include, but are not limited to, quality assessment and improvement, employee review activities, provider performance analysis, underwriting and premium rating, plan administration, and disease management programs.

D. Business Associates

The Plan may disclose your PHI to its business associates that perform functions on its behalf or provide services to the Plan, provided the business associates agree in writing to appropriately safeguard your information.

E. Other Permitted

Uses and Disclosures The Plan may also use or disclose your PHI without your authorization for the following purposes, to the extent permitted or required by law:

As required by law, including laws that require the reporting of certain types of wounds or injuries.
For public health activities, such as preventing or controlling disease, injury, or disability, or reporting adverse events with respect to food or dietary supplements.
For reporting suspected abuse, neglect, or domestic violence.
For health oversight activities, such as audits, inspections, and licensure actions.
In connection with judicial or administrative proceedings, in response to a court order, subpoena, or other lawful process.
For law enforcement purposes, such as in response to a court order or warrant.
To avert a serious and imminent threat to health or safety.
For government functions, such as military and veterans’ activities, national security and intelligence, and protective services for the President.
For workers’ compensation purposes as authorized by, and to the extent necessary to comply with, workers’ compensation laws.
To a coroner, medical examiner, or funeral director as necessary for them to carry out their duties.
For organ and tissue donation purposes, to organizations that handle organ procurement or organ, eye, or tissue transplantation.
For research purposes under certain conditions.
To the U.S. Department of Health and Human Services (HHS) for investigating or determining compliance with HIPAA requirements.

4. Uses and Disclosures That Require Your Written Authorization

The Plan will obtain your written authorization before using or disclosing your PHI for purposes other than those described above or otherwise permitted by law. Specifically, the Plan must obtain your authorization for:

Most uses and disclosures of psychotherapy notes.
Uses and disclosures of PHI for marketing purposes.
Disclosures that constitute a sale of PHI.
Other uses and disclosures not described in this Notice.

You may revoke your authorization at any time, in writing, except to the extent that the Plan has already taken action in reliance on your authorization. To revoke an authorization, you must submit your request in writing to the Privacy Officer at the address listed at the end of this Notice.

5. Your Rights Regarding Your PHI

You have the following rights regarding the PHI that the Plan maintains about you:

A. Right to Request Restrictions

You have the right to request that the Plan restrict the uses and disclosures of your PHI. The Plan is not required to agree to your request unless you request a restriction on disclosures to a health plan for payment or health care operations purposes and the PHI pertains solely to a health care item or service for which you have paid out-of-pocket in full. To request a restriction, submit your request in writing to the Privacy Officer.

B. Right to Receive Confidential Communications

You have the right to request that the Plan communicate with you about your PHI in a certain way or at a certain location. For example, you may request that the Plan contact you at a particular email address or phone number. To request confidential communications, submit your request in writing to the Privacy Officer. The Plan will accommodate all reasonable requests.

C. Right to Inspect and Copy Your PHI

You have the right to inspect and obtain a copy of your PHI maintained by the Plan, subject to certain exceptions. You may request that the Plan provide copies in a format you request if it is readily producible. The Plan may charge a reasonable, cost-based fee. To inspect or copy your PHI, submit your request in writing to the Privacy Officer.

D. Right to Amend Your PHI

You have the right to request that the Plan amend your PHI if you believe it is incorrect or incomplete. The Plan may deny your request under certain circumstances. To request an amendment, submit a written request to the Privacy Officer explaining why the information should be amended.

E. Right to an Accounting of Disclosures

You have the right to receive an accounting of certain disclosures of your PHI made by the Plan during the six (6) years prior to the date of your request. The accounting will not include disclosures made for treatment, payment, or health care operations, or disclosures you authorized in writing. To request an accounting, submit your request in writing to the Privacy Officer.

F. Right to a Copy of This Notice

You have the right to receive a paper copy of this Notice at any time, even if you have previously agreed to receive it electronically. To obtain a paper copy, contact the Privacy Officer.

G. Right to Be Notified of a Breach

You have the right to be notified if the Plan (or a business associate) discovers a breach of your unsecured PHI.

6. Minimum Necessary Standard

When using or disclosing your PHI or when requesting your PHI from another covered entity or business associate, the Plan will make reasonable efforts to limit your PHI to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request.

7. Changes to This Notice

The Plan reserves the right to change the terms of this Notice at any time. Any changes will apply to all PHI the Plan maintains, including information created or received before the changes were made. A revised Notice will be posted on the Plan’s website and made available upon request to the Privacy Officer.

8. Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Plan or with the U.S. Department of Health and Human Services, Office for Civil Rights. To file a complaint with the Plan, contact the Privacy Officer at the address below. You will not be retaliated against for filing a complaint.

U.S. Department of Health and Human Services

Office for Civil Rights

200 Independence Avenue, S.W.

Washington, D.C. 20201

Telephone: 1-877-696-6775

9. Contact Information

For more information about this Notice or to exercise any of your rights, please contact:

Employee Name: Abraham Gallegos

Title: Executive Director, HR

Organization: Vanguard Academy

Address: 2510 S. Veterans Blvd, Edinburg, TX 78539

Telephone: 956-781-1701

Email: hr_dept@vanguardac.net

DISCLAIMER: This template is provided for informational purposes only and does not constitute legal advice. Organizations should consult with qualified legal counsel to ensure compliance with all applicable federal and state privacy laws, including HIPAA, HITECH, and any state-specific health information privacy requirements.

Newborns’ Act Disclosure

Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

General Notice of COBRA Continuation Coverage Rights (For use by single-employer group health plans) **Continuation Coverage Rights Under COBRA**

Introduction:

You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator.

You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally does not accept late enrollees.

What is COBRA continuation coverage?

COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

Your hours of employment are reduced, or
Your employment ends for any reason other than your gross misconduct.

If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

Your spouse dies;
Your spouse’s hours of employment are reduced;
Your spouse’s employment ends for any reason other than his or her gross misconduct;
Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
You become divorced or legally separated from your spouse. ∙Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:
The parent-employee dies;
The parent-employee’s hours of employment are reduced;
The parent-employee’s employment ends for any reason other than his or her gross misconduct;
The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
The parents become divorced or legally separated; or
The child stops being eligible for coverage under the Plan as a “dependent child.”

If the Plan provides retiree health coverage, sometimes, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. If a proceeding in a bankruptcy is filed with respect to Vanguard Academy Charter School and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee will become a qualified beneficiary. The retired employee’s spouse, surviving spouse, and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of coverage under the Plan.

When is COBRA continuation coverage available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:

The end of employment or reduction of hours of employment;
Death of the employee;
If the Plan provides retiree health coverage, commencement of a proceeding in bankruptcy with respect to the employer; or
The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).

For all qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator in writing within 60 days. You must provide this written notice to Abraham Gallegos, MBA at 2510 S. Veterans Blvd Edinburg, TX 78539.

How is COBRA continuation coverage provided?

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.

There are also ways in which this 18-month period of COBRA continuation coverage can be extended:

Disability extension of 18-month period of COBRA continuation coverage

If you or anyone in your family covered under the Plan is determined by the Social Security Administration (SSA) to be disabled and you timely notify the Plan Administrator in writing, you and your covered dependents may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60 th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage.

In order for this disability extension to apply, you must timely notify the Plan Administrator in writing of the SSA disability determination before the end of the 18-month period of continuation coverage and within 60 days after the later of (i) the date of the initial qualifying event; (ii) the date on which coverage would be lost because of the initial qualifying event; or (iii) the date of the SSA disability determination. This notice must be mailed to Abraham Gallegos, MBA at 2510 S. Veterans Blvd Edinburg, TX 78539. Oral notice, including notice by telephone, is not acceptable. The written notice must include the name and address of the employee covered under the plan; the name of the disabled qualified beneficiary; the date that the qualified beneficiary became disabled; and the date that the SSA made its determination of disability. Your notice must also include a copy of the SSA disability determination. If these procedures are not followed or if written notice is not provided to the Plan Administrator within the required time period, there will be no disability extension of COBRA continuation coverage. You must also notify the Plan Administrator within 30 days of any revocation of Social Security disability benefits.

Second qualifying event extension of 18-month period of continuation coverage

If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

Are there other coverage options besides COBRA Continuation Coverage?

Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, Children’s Health Insurance Program (CHIP), or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.

Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends?

In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial enrollment period, you have an 8-month special enrollment period to sign up for Medicare Part A or B, beginning on the earlier of

The month after your employment ends; or
The month after group health plan coverage based on current employment ends. (see https://www.dol.gov/sites/dolgov/files/EBSA/laws-and-regulations/laws/cobra/model-general notice.docx ).

If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if Medicare Part A or B is effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage.

If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare.

For more information visit https://www.medicare.gov/medicare-and-you.

If you have questions Questions

concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website). For more information about the Marketplace, visit www.HealthCare.gov

Keep your Plan informed of address changes

To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

Plan Contact Information

Vanguard Academy Charter School

Abraham Gallegos

2510 S. Veterans Blvd Edinburg, TX 78539

956-781-1701

Medicare Part D Creditable Coverage Notice

Important Notice from Vanguard Academy Charter School About your Prescription Drug Coverage and Medicare

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
Vanguard Academy Charter School has determined that the prescription drug coverage offered by the HSA 8500, PPO 6000, Blue Essentials HMO 2500, PPO 1500 is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When Can You Join A Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 th through December 7 th .

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?

If you decide to join a Medicare drug plan, your current coverage through Vanguard Academy Charter School will not be affected. You can keep this coverage if you elect Part D, and this plan will coordinate with Part D coverage. If you decide to join a Medicare drug plan and drop your current group health coverage through Vanguard Academy Charter School, be aware that you and your dependents will not be able to get this coverage back. If you are able to get this coverage back, reentry into the plan is subject to the underlying terms of the Plan

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

For More Information About This Notice Or Your Current Prescription Drug Coverage…

Contact the Plan Administrator listed below for further information. NOTE: You’ll get this notice each year or if the creditable coverage status of this plan through Vanguard Academy Charter School changes. You may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage…

For more information about Medicare prescription drug coverage:

Visit www.medicare.gov
Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

For purposes of this notice, the Plan Administrator is:

Abraham Gallegos, MBA

956-781-1701