BROWNFIELD ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2017 - 8/31/2018 WWW.MYBENEFITSHUB.COM/ BROWNFIELDISD
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Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) TRS-ActiveCare and TRS-FirstCare APL MEDlink® Medical Supplement HSA Bank Health Savings Account (HSA) MDLIVE Telehealth Boon-Chapman Dental Superior Vision Unum Disability Loyal American Cancer ID Watchdog Identity Theft APL Accident Voya Critical Illness AUL a OneAmerica Company Life and AD&D AUL a OneAmerica Company EAP Texas Life Individual Life NBS Flexible Spending Account (FSA)
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3 4-5 6-11 6 7 8 9 10
11 12-15 16-19 20-23 24-25 26-27 28-29 30-33 34-37 38-39 40-43 44-47 48-51 52-53 54-55 56-59
FLIP TO...
PG. 4 HOW TO HOW TO ENROLL ENROLL
PG. 6 SUMMARY PAGES
PG. 12 YOUR BENEFITS
Benefit Contact Information
Benefit Contact Information BROWNFIELD ISD BENEFITS
TELEHEALTH
ACCIDENT
Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/brownfieldisd
MDLIVE (888) 365-1663 www.consultmdlive.com
American Public Life (800) 256-8606 www.ampublic.com
BROWNFIELD ISD BENEFITS OFFICE
DENTAL
LIFE AND AD&D
(806) 637-2591 www.brownfieldisd.net
Boon-Chapman (877) 277-6872 www.ppousa.com
AUL a OneAmerica Company (800) 583-6908 www.oneamerica.com
TRS ACTIVECARE MEDICAL
VISION
EMPLOYEE ASSISTANCE PROGRAM
Aetna (800) 222-9205 www.trsactivecareaetna.com
Network: Superior Select Southwest Superior Vision (800) 507-3800 www.superiorvision.com
AUL a OneAmerica Company (800) 869-0276 www.oneamerica.com
TRS FIRSTCARE MEDICAL
DISABILITY
INDIVIDUAL LIFE
FirstCare (800) 884-4901 www.firstcare.com/trs
Unum (800) 583-6908 File a claim: (800) 858-6843 www.unum.com
Texas Life (800) 283-9233 www.texaslife.com
MEDICAL SUPPLEMENT—MEDLINK ®
CANCER
CRITICAL ILLNESS
American Public Life (800) 256-8606 www.ampublic.com
Loyal American (800) 366-8354
Voya (800) 955-7736 www.voya.com
HEALTH SAVINGS ACCOUNT
IDENTITY THEFT
FLEXIBLE SPENDING ACCOUNT
HSA Bank (800) 357-6246 www.hsabank.com
ID Watchdog (866) 513-1518 www.idwatchdog.com
National Benefit Services (800) 274-0503 www.nbsbenefits.com 3
MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS BISD” to 313131 and get access to everything you need to complete your benefits enrollment:
Benefit Information
Online Support
Interactive Tools
And more. PLAY VIDEO
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Text “FBS BISD” to 313131 OR SCAN
How to Log In
1 BENEFIT INFO
INTERACTIVE TOOLS
2 3
www.mybenefitshub.com/ brownfieldisd
CLICK LOGIN
ENTER USERNAME & PASSWORD All login credentials have been RESET to the default described below:
Username: Your Red Oak ISD email address.
Default Password: ONLIINE SUPPORT
Last Name (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number.
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Annual Benefit Enrollment
SUMMARY PAGES
Benefit Updates - What’s New:
If you currently participate in a Healthcare or Dependent Care FSA, you MUST re-elect a new contribution amount every year to continue to participate. Employees who currently participate must spend current plan year funds by 8/31/17 to avoid forfeitures. You can view account balance using the CHECK FSA link on the Benefit website or use the NBS smart phone app.
diseases or conditions such as Heart Attack, Stroke, End Stage Renal (Kidney) Failure, Coronary Artery Bypass (25%), Coma, Major Organ Failure, and Permanent Paralysis. Employees can elect up to $30,000 on a Guarantee Issue and up to $15,000 on their spouse and up to $10,000 on dependent children.
Telehealth by MDLIVE! Plan provides you and your family with around-the-clock access to U.S-based, licensed physicians for telephone consultations. Regardless of your location, it’s easy to connect with a doctor in real-time for treatment or diagnosis of common conditions. Doctors can diagnose conditions, recommend treatment and prescribe medication, if deemed appropriate. MDLIVE is an affordable solution to the challenge of healthcare access. This service is for non-emergency conditions. If you have an emergency, please call 911 or go to your nearest hospital emergency room.
Benefit elections will become effective 9/01/2017 (elections requiring evidence of insurability, such as life Insurance, may have a later effective date, if approved). After annual enrollment closes, benefit changes can only be made if you experience a qualifying event and changes must be made within 30 days of event. Online Benefit Access: www.mybenefitshub.com/ brownfieldisd You have access to benefit information 24/7 on the employee benefits provided. You can review and print the consolidated enrollment form or benefit guide, download claim forms and website plan summaries, links to carrier websites and provider searches.
Critical Illness Plan by Voya! Compass Critical Illness Insurance provides an immediate, lump-sum benefit following the diagnosis of one of a number of specified
Don’t Forget!
Login and complete your benefit enrollment from 08/01/2017 - 08/22/2017
Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202 to speak to a representative Monday—Friday between 8am – 5pm CST
Update your profile information: home address, phone numbers, email, beneficiaries
REQUIRED: Provide correct depended social security numbers 6
SUMMARY PAGES
Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
CHANGES IN STATUS (CIS):
QUALIFYING EVENTS
Marital Status
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
Change in Number of Tax Dependents
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Change in Status of Employment Affecting Coverage Eligibility
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.
An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements Gain/Loss of Dependents' under an employer's plan may include change in age, student, marital, employment or tax dependent Eligibility Status status. If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order Judgment/Decree/Order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage. Eligibility for Government Programs
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
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SUMMARY PAGES
Annual Enrollment During your annual enrollment period, you have the opportunity
Where can I find forms?
to review, change or continue benefit elections each year.
For benefit summaries and claim forms, go to your school
Changes are not permitted during the plan year (outside of
district’s benefit website: www.mybenefitshub.com/
annual enrollment) unless a Section 125 qualifying event occurs.
brownfieldisd. Click on the benefit plan you need information on (i.e., Dental) and you can find the forms you need under
Changes, additions or drops may be made only during the
the Benefits and Forms section.
annual enrollment period without a qualifying event. How can I find a Network Provider?
Employees must review their personal information and verify that dependents they wish to provide coverage for are
go to your school district’s benefit website:
included in the dependent profile. Additionally, you must
www.mybenefitshub.com/brownfieldisd. Click on the benefit
notify your employer of any discrepancy in personal and/or benefit information.
For network providers, benefit summaries, and claim forms,
Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section. When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and
New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.
Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.
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SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 20 or more
Dependent Eligibility: You can cover eligible dependent
regularly scheduled hours each work week.
children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the
Eligible employees must be actively at work on the plan effective
maximum age listed below. Dependents cannot be double
date for new benefits to be effective, meaning you are physically
covered by married spouses within Brownfield ISD or as both
capable of performing the functions of your job on the first day of
employees and dependents.
work concurrent with the plan effective date. For example, if your 2017 benefits become effective on September 1, 2017, you must be actively-at-work on September 1, 2017 to be eligible for your new benefits. PLAN
CARRIER
MAXIMUM AGE
CONTINUATION
Medical
Aetna/First Care
To 26
COBRA (Wellsystems)
Medical Supplement
American Public Life
To 26
COBRA (NBS)
Health Savings Account
HSA Bank
Tax Dependent
Contact HSA Bank
Telehealth
MDLIVE
Unmarried To 26
Direct Pay*
Dental
Boon-Chapman
Unmarried To 26
COBRA (NBS)
Vision
Superior Vision
To 26
COBRA (NBS)
Cancer
Loyal American
Unmarried To 25
Portable after 12 mos. coverage*
Identity Theft Protection
ID Watchdog
Unmarried To 26
Direct Pay*
Accident
American Public Life
To 26
Portable*
Basic & Voluntary Life
AUL a OneAmerica Company
Unmarried To 26
Port/Convert*
Critical Illness
Voya
To 26
Portable*
Individual Life
Texas Life
Issuable to age 18
Direct Pay
Medical Flex
National Benefit Services
To 26
COBRA (NBS)
Dependent Flex
National Benefit Services
12 or younger or qualified individual unable to care for themselves & claimed as a dependent on your taxes
N/A
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. *Contact carrier within 30 days of termination to be eligible for continuation.
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Helpful Definitions
SUMMARY PAGES
Actively at Work
In-Network
You are performing your regular occupation for the employer
Doctors, hospitals, optometrists, dentists and other providers
on a full-time basis, either at one of the employer’s usual
who have contracted with the plan as a network provider.
places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2017 please notify your benefits administrator.
Annual Enrollment The period during which existing employees are given the opportunity to enroll in or change their current elections.
Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.
Out of Pocket Maximum The most an eligible or insured person can pay in co-insurance for covered expenses.
Plan Year September 1st through August 31st
Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescriptions drugs or is under a health care provider’s orders to take drugs, or received medical care or services
Calendar Year January 1st through December 31st
Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or pre-existing condition exclusion provisions do apply, as applicable by carrier.
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(including diagnostic and/or consultation services).
SUMMARY PAGES
HSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, tax-free. This also allows employees to pay for qualifying dependent care tax-free.
Employer Eligibility
A qualified high deductible health plan.
All employers
Contribution Source Account Owner Underlying Insurance Requirement
Employee and/or employer Individual
Employee and/or employer Employer
High deductible health plan
None
Description
Minimum Deductible Maximum Contribution
$1,300 single (2017) $2,600 family (2017) $3,400 single (2017) $6,750 family (2017)
N/A Varies per employer
Permissible Use Of Funds
If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Cash-Outs of Unused Amounts (if no medical expenses)
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65).
Not permitted
Year-to-year rollover of account balance?
Yes, will roll over to use for subsequent year’s health coverage.
No. Access to some funds can may be extended if your employer’s plan contains a 2 1/2 –month grace period or $500 rollover provision.
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
FLIP TO FOR HSA INFORMATION
PG. 20
FLIP TO FOR FSA INFORMATION
PG. 56
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2017 – 2018 TRS-ActiveCare Plan Highlights Effective September 1, 2017 through August 31, 2018 | In-Network Level of Benefits*
Deductible (per plan year) In-Network Out-of-Network Out-of-Pocket Maximum (per plan year; medical and prescription drug deductibles, copays, and coinsurance count toward the out-of-pocket maximum) In-Network Out-of-Network Coinsurance In-Network Participant pays (after deductible) Out-of-Network Participant pays (after deductible) Office Visit Copay Participant pays Diagnostic Lab Participant pays
Preventive Care See below for examples Teladoc® Physician Services
High-Tech Radiology (CT scan, MRI, nuclear medicine) Participant pays Inpatient Hospital (preauthorization required) (facility charges) Participant pays Emergency Room (true emergency use) Participant pays Outpatient Surgery Participant pays Bariatric Surgery Physician charges (only covered if performed at an IOQ facility) Participant pays Annual Vision Examination (one per plan year; performed by an ophthalmologist or optometrist using calibrated instruments) Participant pays Annual Hearing Examination Participant pays Preventive Care Routine physicals – annually age 12 and over Mammograms – 1 every year age 35 and over Smokingcessationcounseling– 8 visits per 12 months
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• Well-child care – unlimited up to age 12 • Colonoscopy – 1 every 10 years age 50 and over •Healthydiet/obesitycounseling– unlimited to
• Well woman exam & pap smear – annually age 18 and over • Prostatecancer screening–1 per year age 50 and over • Breastfeeding support – 6 lactation counseling visits
Drug Deductible Short-Term Supply at a Retail Location
Extended-Day Supply at Mail Order or Retail-Plus Pharmacy Location (60- to
90-day supply)****
Specialty Medications Short-Term Supply of a Maintenance Medication at Retail Location (up to a 31-day supply)
What is a maintenance medication? Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes.
When does the convenience fee apply? For example, if you are covered under TRS-ActiveCare Select, the first time you fill a 31-day supply of a generic maintenance drug at a retail pharmacy you will pay $20, then you will pay $35 each month that you fill a 31-day supply of that generic maintenance drug at a retail pharmacy. A 90-day supply of that same generic maintenance medication would cost $45, and you would save $225 over the year by filling a 90-day supply.
Premium Information for ALEX You will need to enter the applicable amount – YOUR ANNUAL COST – from the table below into ALEX when prompted. To determine this cost, ask your Benefits Administrator for your monthly cost (this is the amount you will owe each month after your employer contributes to your coverage). Then multiply your monthly cost by 12 to get YOUR ANNUAL COST (use this amount for ALEX) Individual
$351
$514
$714
+Spouse
$991
$1,264
$1,694
+Children
$671
$834
$1,062
+Family
$1,316
$1,589
$2,004
A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. *Illustrates benefits when in-network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits under the ActiveCare Select or ActiveCare Select Whole Health Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for this balance bill amount, which maybe considerable. **For ActiveCare 1-HD, certain generic preventive drugs are covered at 100%. Participants do not have to meet the deductible ($2,500 - individual, $5,000 - family) and they pay nothing out of pocket for these drugs. The list of drugs is on the TRS-ActiveCare website. ***If a participant obtains a brand-name drug when a generic equivalent is available, they are responsible for the generic copay plus the cost difference between the brand-name drug and the generic drug. 13 ****Participants can fill 32-day to 90-day supply through mail order.
2017-2018 TRS-FirstCare Plan Highlights Plan Summary 2017 -2018 Medical Plan Year Deductible Out-of-Pocket Maximum (includes medical & drug deductibles, copayments & coinsurance) Annual Maximum
$750 Individual; $2,250 Family $6,000 Individual; $12,000 Family Unlimited
Primary Care Provider (PCP) Office Visit Includes routine lab/X-ray services, injectables, and supplies Other services provided in a physician’s office are subject to additional deductible and copayments/coinsurance
$20 copayment
PCP Office Visit-Dependents, through age 19
$0 copayment
Specialist Office Visit Includes routine lab/X-ray services Other services provided in a physician’s office are subject to additional deductible and copayments/coinsurance
$60 copayment
Preventive Care Well-woman exam, immunizations, physicals, mammograms, colorectal cancer screening
No copayment
Surgical Procedures Performed in the Physician's Office
25% copayment1
Minor Emergency/Urgency Care Visit
$75 copayment
Emergency Room
$500 copayment1
Ambulance Air/Ground
25% copayment1
Inpatient Services Facility charges, physician services, surgical procedures, pre-admission testing, operating/recovery room, newborn delivery and nursery, ICU/coronary care units, laboratory tests/X-rays, rehabilitation facility, behavioral health (mental health/chemical dependency)
25% copayment1
Outpatient Services Facility charges, physician services, surgical procedures, observation unit
25% copayment1
MRI, CT Scan, PET Scan (Facility/Physician)
$250 copayment1
Diagnostic Tests Sleep study; Stress test; EKG; Ultrasound; Cardiac imaging; Genetic testing; Non-preventive Colonoscopy (Facility/Physician)
25% copayment1
Home Health Care Limited to 60 visits per plan year
25% copayment1
Hospice Care
25% copayment1
Skilled Nursing Facility Limited to 30 days per plan year
25% copayment1
Accidental Dental Care
25% copayment1
Prosthetics
25% copayment1
Orthotics
25% copayment1
Spinal Manipulation Limited to 10 visits per year
25% copayment1
Durable Medical Equipment
25% copayment1
All Other Covered Services
25% copayment1
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Prescription Drug Plan Year Deductible
$100 Individual: $300 Family
Annual Maximum
Unlimited
Participating Retail Pharmacy Select Generic/ACA (Tier 1) deductible waived Preferred Generic (Tier 2) deductible waived Preferred Brand/Non-Preferred Generic (Tier 3) Non-Preferred Brand/Non-Preferred Generic (Tier 4) Specialty/Injectables (Tier 5)
Standard Drugs/30-day supply $0 per prescription $15 per prescription $40 per prescription2 $100 per prescription2 20% per prescription2
Participating Mail Order Pharmacy Select Generic/ACA (Tier 1) deductible waived Preferred Generic (Tier 2) deductible waived Preferred Brand/Non-Preferred Generic (Tier 3) Non-Preferred Brand/Non-Preferred Generic (Tier 4) Specialty/Injectables (Tier 5)
Maintenance Drugs/90-day supply $0 per prescription $45 per prescription $120 per prescription2 $300 per prescription2 20% per prescription2
1
Subject to medical deductible
2
Subject to prescription drug deductible
Gross Monthly Cost for Coverage Effective September 1, 2017 - August 31, 2018 Coverage Category Employee only Employee and spouse Employee and child(ren) Employee and family
Total Cost - Active* $514.82 $1,287.60 $816.07 $1,298.52
*District and state fund are provided each month to active contributing TRS members to use toward the cost of TRS-ActiveCare coverage. State funding is subject to appropriation by the Texas Legislature. Please contact your Benefits Administrator to determine your net monthly cost for your coverage.
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AMERICAN PUBLIC LIFE YOUR BENEFITS PACKAGE
MEDlink ÂŽ
PLAY VIDEO
About this Benefit Medical supplement is designed to help supplement your Employer's major medical plan. This plan provides supplemental coverage to help offset outof-pocket costs that you may experience due to deductibles, co-payments and coinsurance of your medical plan.
33% of total healthcare costs are paid out-of-pocket.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 16 Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
MEDlink® Limited Benefit Medical Expense Supplemental Insurance Brownfield ISD THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON‐SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON‐SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED. SUMMARY OF BENEFITS Base Policy In‐Hospital Benefit ‐ Maximum In‐Hospital Benefit Outpatient Benefit Physician Outpatient Treatment Benefit
Option 1
Option 2
Option 3
$500 per confinement
$1,500 per confinement
$2,500 per confinement
up to $200 per treatment
up to $200 per treatment
up to $200 per treatment
$25 per treatment; $125 max per family per Calendar Year
$25 per treatment; $125 max per family per Calendar Year
$25 per treatment; $125 max per family per Calendar Year
Option 1 Total Monthly Premiums by Plan* Issue Ages
17‐54
55‐59
60‐69
Employee Only
$15.50
$22.00
$33.50
Employee + Spouse
$28.50
$41.50
$61.00
Employee + Child(ren)
$28.00
$34.50
$46.00
Family Coverage
$41.00
$54.00
$73.50
Option 2 Total Monthly Premiums by Plan* Issue Ages
17‐54
55‐59
60‐69
Employee Only
$21.50
$32.00
$49.00
Employee + Spouse
$39.50
$59.00
$88.00
Employee + Child(ren)
$36.50
$47.00
$64.00
Family Coverage
$54.50
$74.00
$103.00
Option 3 Total Monthly Premiums by Plan* Issue Ages
17‐54
55‐59
60‐69
Employee Only
$28.00
$44.50
$68.50
Employee + Spouse
$51.50
$81.50
$122.50
Employee + Child(ren)
$45.50
$62.00
$86.00
Family Coverage
$69.00
$99.00
$140.00
Plans available to employees age 70 and over if You work for an employer employing 20 or more employees on a typical workday in the preceding Calendar Year. *Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with no ce. The premium and amount of benefits vary dependent upon the Plan selected at me of applica on.
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APSB‐22330(TX)‐0116 MGM/FBS Brownfield ISD
MEDlink® Limited Benefit Medical Expense Supplemental Insurance Eligibility
Exclusions
This policy will be issued to those persons who meet American Public Life Insurance Company’s insurability requirements. Evidence of insurability acceptable to us may be required. If our underwri ng rules are met, you are on ac ve service, you are covered under your Employer’s Medical Plan and premium has been paid, your insurance will take effect on the requested Effec ve Date or the Effec ve Date assigned by us upon approval of your wri en applica on, whichever is later.
We will pay no benefits for any expenses incurred during any period the Covered Person does not have coverage under your Employer’s Medical Plan, except as provided in the Absence of your Employer’s Medical Plan provision or which result from: (a) suicide or any a empt, thereof, while sane or insane; (b) any inten onally self‐inflicted injury or Sickness; (c) rest care or rehabilita ve care and treatment; (d) outpa ent rou ne newborn care; (e) voluntary abor on except, with respect to You or Your covered Dependent spouse: (1) where Your or Your Dependent spouse’s life would be endangered if the fetus were carried to term; or (2) where medical complica ons have arisen from abor on; (f) pregnancy of a Dependent child; (g) par cipa on in a riot, civil commo on, civil disobedience, or unlawful assembly. This does not include a loss which occurs while ac ng in a lawful manner within the scope of authority; (h) commission of a felony; (i) par cipa on in a contest of speed in power driven vehicles, parachu ng, or hang gliding; (j) air travel, except: (1) as a fare‐paying passenger on a commercial airline on a regularly scheduled route; or (2) as a passenger for transporta on only and not as a pilot or crew member; (k) intoxica on; (Whether or not a person is intoxicated is determined and defined by the laws and jurisdic on of the geographical area in which the loss occurred.) (l) alcoholism or drug use, unless such drugs were taken on the advice of a Physician and taken as prescribed; (m) sex changes; (n) experimental treatment, drugs, or surgery; (o) an act of war, whether declared or undeclared, or while performing police duty as a member of any military or naval organiza on; (This exclusion includes Accident sustained or Sickness contracted while in the service of any military, naval, or air force of any country engaged in war. We will refund the pro rata unearned premium for any such period the Covered Person is not covered.) (p) Accident or Sickness arising out of and in the course of any occupa on for compensa on, wage or profit; (This does not apply to those sole proprietors or partners not covered by Workers’ Compensa on.) (q) mental illness or func onal or organic nervous disorders, regardless of the cause; (r) dental or vision services, including treatment, surgery, extrac ons, or x‐rays, unless: (1) resul ng from an Accident occurring while the Covered Person’s coverage is in force and if performed within 12 months of the date of such Accident; or (2) due to congenital disease or anomaly of a covered newborn child. (s) rou ne examina ons, such as health exams, periodic check‐ups, or rou ne physicals, except when part of Inpa ent rou ne newborn care; (t) any expense for which benefits are not payable under the Covered Person’s Employer’s Medical Plan; or (u) air or ground ambulance.
Covered Charges mean those charges that are incurred by a Covered Person because of an Accident or Sickness; are for necessary treatment, services and medical supplies and recommended by a Physician; are incurred in a covered facility as defined in the Policy or any a ached rider; are not more than any dollar limit set forth in the Schedule; are incurred while insured under the Policy, subject to any Extension of Benefits; and are not excluded under the Policy. Covered charges also include Inpa ent rou ne newborn care and are subject to above. A Hospital is not any ins tu on used as a place for rehabilita on; a place for rest, or for the aged; a nursing or convalescent home; a long term nursing unit or geriatrics ward; or an extended care facility for the care of convalescent, rehabilita ve or ambulatory pa ents.
In‐Hospital Benefit Benefits payable are limited to any out‐of‐pocket deduc ble amount; any out‐of‐pocket co‐payment or coinsurance amounts the Covered Person actually incurs a er the Employer’s Medical Plan has paid; any out‐of‐pocket amount the Covered Person actually incurs for surgery performed by a Physician a er the Employer’s Medical Plan has paid; and the Maximum In‐Hospital Benefit shown in the Policy Schedule. The Covered Person must be an Inpa ent and covered by your Employer’s Medical Plan when the Covered Charges are incurred.
Outpa ent Benefits Treatment is for the same or related condi ons, unless separated by a period of 90 consecu ve days. A er 90 consecu ve days, a new Outpa ent Benefit will be payable. The Covered Person must be covered by your Employer’s Medical Plan when the Covered Charges are incurred.
Physician Outpa ent Treatment Benefit Benefit maximum of $125 per family per Calendar Year. The Covered Person must be covered by your Employer’s Medical Plan when the Covered Charges are incurred. The Covered Person must not be an Inpa ent when the Covered Charges are incurred.
Premiums The premium rates may be changed by Us. If the rates are changed, We will give You at least 31 days advance wri en no ce. If a change in benefits increases Our liability, premium rates may be changed on the date Our liability is increased. This plan may be con nued in accordance with the Consolidated Omnibus Reconcilia on Act of 1986.
18
APSB‐22330(TX)‐0116 MGM/FBS Brownfield ISD
MEDlink® Limited Benefit Medical Expense Supplemental Insurance Termina on of Coverage Your Insurance coverage will end on the earliest of these dates: the date You no longer qualify as an Insured; the end of the last period for which premium has been paid; the date the Policy is discon nued; the date You re re; if You work for an employer employing less than 20 employees on a typical work day in the preceding Calendar Year, the date You a ain age 70; the date You cease to be on Ac ve Service; the date Your coverage under your Employer’s Medical Plan ends; or the date You cease employment with the employer through whom You originally became insured under the Policy. Insurance coverage on a Dependent will end on the earliest of these dates: the date Your coverage terminates; the end of the last period for which premium has been paid; the date the Dependent no longer meets the defini on of Dependent; the date the Dependent’s coverage under your Employer’s Medical Plan ends; or the date the Policy is modified so as to exclude Dependent coverage. We may end the coverage of any Covered Person who submits a fraudulent claim. We may end the coverage of a Subscribing Unit if fewer persons are insured than the Policyholder’s applica on requires.
2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606 This is a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the policy and riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and en‐ forced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form MEDlink® Series | Texas | Limited Benefit Medical Expense Supplemental Insurance | (10/14) | Brownfield ISD
19
APSB‐22330(TX)‐0116 MGM/FBS Brownfield ISD
HSA BANK
HSA (Health Savings Account)
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit A Health Savings Account is a tax-advantaged medical savings account available to employees who are enrolled in a high-deductible health plan. The funds contributed to the account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent.
The interest earned in an HSA is tax free.
Money withdrawn for medical spending never falls under taxable income.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 20 Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
HSA (Health Savings Account) HSA Bank has teamed up with your employer to create an affordable health coverage option that helps you save on healthcare expenses. This plan is only available for those who are participating in the Active Care 1-HD medical plan. You may not enroll in the MEDlink® plan if you participate in the HSA. You may not participate in the FSA plan if you participate in HSA. Medicare, Medicaid, and Tricare participants are not eligible to participate in an HSA. You can use your Health Savings Account (HSA) to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free.
What is an HSA?
A tax-advantaged savings account that you use to pay for eligible medical expenses as well as deductible, co-insurance, prescriptions, vision and dental care. Allows you to save while reducing your taxable income. Unused funds that will roll over year to year. There’s no “use it or lose it” penalty. A way to accumulate additional retirement savings. After age 65, funds can be withdrawn for any purpose without penalty.
Authorized Signers who are 55 or older must have their own HSA in order to make the catch-up contribution Monthly Fee: Your account will be charged a monthly fee of $1.75, waived with an average daily balance at or above $3,000.
Examples of Qualified Medical Expenses
Surgery Braces Contact lenses Dentures Eyeglasses Vaccines
For a list of sample expenses, please refer to your benefits website at: www.mybenefitshub.com/brownfieldisd
HSA Bank Contact Information 605 N. 8th Street, Ste 320 Sheboygan, WI 53081 Phone: 800-357-6246 www.hsabank.com
Using Funds Debit Card You may use the card to pay merchants or service providers that accept VISA credit cards, so there is no need to pay cash up front and wait for reimbursements. You can make a withdrawal at any time. Reimbursements for qualified medical expenses are tax free. If you are disabled or reach age 65, you can receive non-medical distributions without penalty, but you must report the distributions as taxable income. You may also use your funds for a spouse or tax dependent not covered by your HDHP.
2017 Annual HSA Contribution Limits Individual: $3,400 Family: $6,750 Catch-Up Contributions: Accountholders who meet the qualifications noted below are eligible to make an HSA catch-up contribution of an additional $1,000. Health Savings accountholder Age 55 or older (regardless of when in the year an accountholder turns 55) Not enrolled in Medicare (if an accountholder enrolls in Medicare mid-year, catch-up contributions should be prorated)
21
How the HSA Plan Works A Health Savings Account (HSA) is an individually-owned, tax-advantaged account that you can use to pay for current or future IRS-qualified medical expenses. With an HSA, you’ll have the potential to build more savings for healthcare expenses or additional retirement savings through self-directed investment options1.
How an HSA works:
You can contribute to your HSA via payroll deduction, online banking transfer, or by sending a personal check to HSA Bank. Your employer or third parties, such as a spouse or parent, may contribute to your account as well. You can pay for qualified medical expenses with your HSA Bank Debit Card directly to your medical provider or pay out-of-pocket. You can either choose to reimburse yourself or keep the funds in your HSA to grow your savings. Unused funds will roll over year to year. After age 65, funds can be withdrawn for any purpose without penalty (subject to ordinary income taxes). Check balances and account information via HSA Bank’s Internet Banking 24/7.
Are you eligible for an HSA? If you have a qualified High Deductible Health Plan (HDHP) either through your employer, through your spouse, or one you’ve purchased on your own - chances are you can open an HSA. Additionally: You cannot be covered by any other non-HSA-compatible health plan, including Medicare Parts A and B. You cannot be covered by TriCare. You cannot have accessed your VA medical benefits in the past 90 days (to contribute to an HSA). You cannot be claimed as a dependent on another person’s tax return (unless it’s your spouse). You must be covered by the qualified HDHP on the first day of the month. When you open an account, HSA Bank will request certain information to verify your identity and to process your application.
What are the annual IRS contribution limits? Contributions made by all parties to an HSA cannot exceed the annual HSA limit set by the Internal Revenue Service (IRS). Anyone can contribute to your HSA, but only the accountholder and employer can receive tax deductions on those contributions. Combined annual contributions for the accountholder, employer, and third parties (i.e., parent, spouse, or anyone else) must not exceed these limits2. 22
2017 Annual HSA Contribution Limits Individual = $3,400 Family = $6,750
Catch-up Contributions Accountholders who meet these qualifications are eligible to make an HSA catch-up contribution of $1,000: Health Savings accountholder; age 55 or older (regardless of when in the year an accountholder turns 55); not enrolled in Medicare (if an accountholder enrolls in Medicare mid-year, catch-up contributions should be prorated). Authorized signers who are 55 or older must have their own HSA in order to make the catch-up contribution. According to IRS guidelines, each year you have until the tax filing deadline to contribute to your HSA (typically April 15 of the following year). Online contributions must be submitted by 2:00 p.m., Central Time, the business day before the tax filing deadline. Wire contributions must be received by noon, Central Time, on the tax filing deadline, and contribution forms with checks must be received by the tax filing deadline.
How can you benefit from tax savings? An HSA provides triple tax savings3. Here’s how: Contributions to your HSA can be made with pre-tax dollars and any after-tax contributions that you make to your HSA are tax deductible. HSA funds earn interest and investment earnings are tax free. When used for IRS-qualified medical expenses, distributions are free from tax.
IRS-Qualified Medical Expenses You can use your HSA to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse, or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free. HSA funds can be used to reimburse yourself for past medical expenses if the expense was incurred after your HSA was established. While you do not need to submit any receipts to HSA Bank, you must save your bills and receipts for tax purposes.
How the HSA Plan Works Examples of IRS-Qualified Medical Expenses4: Acupuncture Alcoholism treatment Ambulance services Annual physical examination Artificial limb or prosthesis Birth control pills (by prescription) Chiropractor Childbirth/delivery Convalescent home (for medical treatment only) Crutches Doctor’s fees Dental treatments (including x-rays, braces, dentures, fillings, oral surgery) Dermatologist Diagnostic services Disabled dependent care Drug addiction therapy Fertility enhancement (including in-vitro fertilization) Guide dog (or other service animal)
Gynecologist Hearing aids and batteries Hospital bills Insurance premiums5 Laboratory fees Lactation expenses Lodging (away from home for outpatient care) Nursing home Nursing services Obstetrician Osteopath Oxygen Pregnancy test kit Podiatrist Prescription drugs and medicines (over-the-counter drugs are not IRSqualified medical expenses unless prescribed by a doctor) Prenatal care & postnatal treatments Psychiatrist Psychologist Smoking cessation programs
Special education tutoring Surgery Telephone or TV equipment to assist the hearing or vision impaired Therapy or counseling Medical transportation expenses Transplants Vaccines Vasectomy Vision care (including eyeglasses, contact lenses, lasik surgery) Weight loss programs (for a specific disease diagnosed by a physician – such as obesity, hypertension, or heart disease) Wheelchairs X-rays
For assistance, please contact the Client Assistance Center 800-357-6246 Monday – Friday, 7 a.m. – 9 p.m., and Saturday, 9 a.m. - 1 p.m., CT www.hsabank.com | 605 N. 8th Street, Ste. 320, Sheboygan, WI 53081
1 Investment accounts are not FDIC insured, may lose value and are not a deposit or other obligation of, or guarantee by the bank. Investment losses which are replaced are subject to the annual contribution limits of the HSA. 2 HSA funds contributed in excess of these limits are subject to penalty and tax unless the excess and earnings are withdrawn prior to the due date, including any extensions for filing Federal Tax returns. Accountholders should consult with a qualified tax advisor in connection with excess contribution removal. The Internal Revenue Service requires HSA Bank to report withdrawals that are considered refunds of excess contributions. In order for the withdrawal to be accurately reported, accountholders may not withdraw the excess directly. Instead, an excess contribution refund must be requested from HSA Bank and an Excess Contribution Removal Form completed. 3 Federal Tax savings are available no matter where you live and HSAs are taxable in AL, CA, and NJ. HSA Bank does not provide tax advice. Consult your tax professional for tax‐related questions. 4 This list is not comprehensive. It is provided to you with the understanding that HSA Bank is not engaged in rendering tax advice. The information provided is not intended to be used to avoid Federal tax penalties. For more detailed information, please refer to IRS Publication 502 titled, “Medical and Dental Expenses”. Publications can be ordered directly from the IRS by calling 1-800-TAXFORM. If tax advice is required, you should seek the services of a professional. 5 Insurance premiums only qualify as an IRS-qualified medical expense: while continuing coverage under COBRA; for qualified long-term care coverage; coverage while receiving unemployment compensation; for any healthcare coverage for those over age 65 including Medicare (except Medicare supplemental coverage). 23
MDLIVE YOUR BENEFITS PACKAGE
Telehealth
PLAY VIDEO
About this Benefit Telehealth provides 24/7/365 access to boardcertified doctors via telephone consultations that can diagnose, recommend treatment and prescribe medication. Whether you are at home, traveling or at work, Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.
75%
of all doctor, urgent care, and ER visits could be handled safely and effectively via telehealth.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 24 Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
Telehealth When should I use MDLIVE? If you’re considering the ER or urgent care for a non-emergency medical issue Your primary care physician is not available At home, traveling, or at work 24/7/365, even holidays!
What can be treated?
Allergies Asthma Bronchitis Cold and Flu Ear Infections Joint Aches and Pain Respiratory Infection Sinus Problems And More!
Pediatric Care related to:
Cold & Flu Constipation Ear Infection Fever Nausea & Vomiting Pink Eye And More!
Are children eligible? Yes. MDLIVE has local pediatricians on-call 24/7/365. Please note, a parent or guardian must be present during any interactions involving minors. We ask parents to establish a child record under their account. Parents must be present on each call for children 18 or younger.
How much does it cost? $0 Covers you, your spouse, and children up to age 26, with unlimited phone consultations.
Download the App Doctor visits are easier and more convenient with the MDLIVE App. Be prepared. Download today. www.mdlive.com/getapp
Access to a doctor anywhere: at home, at work, or on the go Choose doctors from one of the nation's largest telehealth networks Available 24/7 by video or phone Private, secure and confidential visits Connect instantly with MDLIVE Assist
Who are our doctors? MDLIVE has the nation’s largest network of telehealth doctors. On average, our doctors have 15 years of experience practicing medicine and are licensed in the state where patients are located. Their specialties include primary care, pediatrics, emergency medicine and family medicine. Our doctors are committed to providing convenient, quality care and are always ready to take your call.
Scan with your smartphone to get the app.
Call us at (888) 365-1663 or visit us at www.consultmdlive.com
Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for 25 abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit www.mdlive.com/pages/terms.html 010113
BOON - CHAPMAN
Dental
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, treatment and dental disease.
Good dental care may improve your overall health. Also Women with gum disease may be at greater risk of giving birth to a preterm or low birth weight baby.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 26 Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
Dental Employees who choose to participate pay 100% of the premium through payroll deduction. Features include: Voluntary participation Immediate coverage—no benefit waiting periods No deductible for Preventive or Orthodontia services $50 deductible for Basic and Major services $1000 annual maximum (includes $375 ortho maximum) $1000 lifetime Orthodontia maximum Single and family coverage Benefits improve in the second and third year of participation
Monthly Rates EE Only EE + 1 Dependent EE + 2 or More Dependents
$23.10 $44.99 $77.33
*Rates based on 12 pay periods per year
This is not a certificate of insurance. It is a brief description only. The Group Policy alone determines all rights and benefits.
Covered Services (Pay up to $1,000 Annual Benefit for Certain Procedures) TYPE I Preventive Services
TYPE II Basic Services
TYPE III Major Services
Coinsurance 1st/2nd/3rd yr:
Coinsurance 1st/2nd/3rd yr:
Coinsurance 1st/2nd/3rd yr:
80/100/100% $0 individual deductible*
50/65/80% $50 individual deductible*
80/100/100% $0 individual deductible*
TYPE IV Orthodontic
Coinsurance 1st/2nd/3rd yr: 80/100/100%
$0 family deductible*
Unlimited family deductible*
$0 family deductible*
$0 individual deductible* $0 family deductible*
-Routine Exam -Bitewing X-rays (one complete series per 36 months) -Prophylaxis (cleaning) -Sealants (to age 14) -Fluoride Treatments (to age 19) -Space Maintainers (to age 12) -Certain Lab Tests -Emergency Palliative Treatment
-Restorative -Basic Fillings -Oral Surgery (extractions and impacted teeth) -Endodontics (root canal & pulpal therapy) -Periodontics (treatment of gums excluding surgery) -Denture and Crown Repair
-Restorative (inlays & onlays) -Prosthetics (dentures & bridges) -Periodontal Surgery
-Orthodontia (orthodontic care for proper alignment of teeth) -Orthodontia is provided only to dependent children who are under age 19 when treatment is received. -$375 Annual Maximum -$1000 Lifetime Maximum
*Deductible is per calendar year
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SUPERIOR VISION YOUR BENEFITS PACKAGE
Vision
PLAY VIDEO
About this Benefit Vision insurance provides coverage for routine eye examinations and may cover all or part of the costs associated with contact lenses, eyeglasses and vision correction, depending on the plan.
75% of U.S. residents between age 25 and 64 require some sort of vision correction.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 28 Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
Vision Benefits
In-Network
Exam
Out-of-Network
Covered in full
Up to $40 retail
Frames
$150 retail allowance
Up to $45 retail
Contact Lenses1
$150 retail allowance
Up to $105 retail
Covered in full
Up to $210 retail
Medically Necessary Contact Lenses
Exam Materials
Single Vision
Covered in full
Up to $40 retail
Bifocal
Covered in full
Up to $60 retail
Trifocal
Covered in full
Up to $80 retail
See description2
Up to $80 retail
Covered in full
Up to $80 retail
Lenticular
$8.67 $14.80 $15.68 $23.54
Co-Pays
Lenses (standard) per pair
Progressive
Monthly Premiums EE Only EE + Spouse EE + Child(ren) EE + Family
$10 $25
Services/Frequency Exam Frame Lenses Contact Lenses
12 months 12 months 12 months 12 months
(Based on date of service)
Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements. 1
Contact lenses and related professional services (fitting, evaluation and followup) are covered in lieu of eyeglass lenses and frames benefit. 2 Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay.
Discount Features Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.
SuperiorVision.com Customer Service 800.507.3800
The Plan discount features are not insurance. All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan. Discounts are subject to change without notice. Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions
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UNUM YOUR BENEFITS PACKAGE
Disability
PLAY VIDEO
About this Benefit Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.
Just over 1 in 4 of today's 20 year -olds will become disabled before they retire.
34.6 months is the duration of the average disability claim.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 30 Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
Disability Policy # 94836
Benefit Duration
Please read carefully the following description of your Unum Educator Select Income Protection Plan insurance.
Your duration of benefits is based on your age when the disability occurs.
Eligibility
Plan: ADEA II: Your duration of benefits is based on the following table:
You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. The date you are eligible for coverage is the later of: the plan effective date; or the day after you complete the waiting period.
Guarantee Issue Current Employees: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may enroll on or before the enrollment deadline. After the initial enrollment period, you can apply only during an annual enrollment period. New Hires: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may apply for coverage within 60 days after your eligibility date. If you do not apply within 60 days after your eligibility date, you can apply only during an annual enrollment period. Benefits are subject to the pre-existing condition exclusion referenced later in this document.
For disabilities due to injury: Age at Disability Less than age 60 Age 60 through 64 Age 65 through 69 Age 70 and over
Maximum Duration of Benefits To age 65, but not less than 5 years 5 years To age 70, but not less than 1 year 1 year
Next Steps How to Apply/Effective Date of Coverage Current employees: To apply for coverage, complete your enrollment form by the enrollment deadline. Your effective date of coverage is January 1. New Hires: To apply for coverage, complete your enrollment form within 60 days of your eligibility date. Please see your Plan Administrator for your effective date. If you do not enroll during the initial enrollment period, you may apply only during an annual enrollment.
Please see your Plan Administrator for your eligibility date.
Benefit Amount You may purchase a monthly benefit in $100 units, starting at a minimum of $200, up to 66 2/3% of your monthly earnings rounded to the nearest $100, but not to exceed a monthly maximum benefit of $8,000. Please see your Plan Administrator for the definition of monthly earnings. The total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 100% of your monthly earnings unless the excess amount is payable as a Cost of Living Adjustment. However, if you are participating in Unum’s Rehabilitation and Return to Work Assistance program, the total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 110% of your monthly earnings (unless the excess amount is payable as a Cost of Living Adjustment).
Elimination Period The Elimination Period is the length of time of continuous disability, due to sickness or injury, which must be satisfied before you are eligible to receive benefits.
Delayed Effective Date of Coverage If you are absent from work due to injury, sickness, temporary layoff or leave of absence, your coverage will not take effect until you return to active employment. Please contact your Plan Administrator after you return to active employment for when your coverage will begin.
Questions If you should have any questions about your coverage or how to enroll, please contact your Plan Administrator. This plan highlight is a summary provided to help you understand your insurance coverage from Unum. Some provisions may vary or not be available in all states. Please refer to your certificate booklet for your complete plan description. If the terms of this plan highlight summary or your certificate differ from your policy, the policy will govern. For complete details of coverage, please refer to policy form number C.FP-1, et al. Underwritten by: Unum Life Insurance Company of America 2211 Congress Street, Portland, Maine 04122, www.unum.com Š2007 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.
You may choose an Elimination Period (injury/sickness) of 14/14, 30/30, 60/60, 90/90 or 180/180 days. If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.) 31
Disability BROWNFIELD INDEPENDENT SCHOOL DISTRICT Costs below are based on a Monthly payroll deduction (Employer billing mode is based on 12 Payments per year) Plan A Product: Educator Select Income ADEA II Duration of Benefits Protection Plan Elimination Period (Days) Injury (Days) Sickness (Days) Maximum Annual Monthly Monthly Earnings Earnings Benefit 3600 300 200 5400 450 300 7200 600 400 9000 750 500 10800 900 600 12600 1050 700 14400 1200 800 16200 1350 900 18000 1500 1000 19800 1650 1100 21600 1800 1200 23400 1950 1300 25200 2100 1400 27000 2250 1500 28800 2400 1600 30600 2550 1700 32400 2700 1800 34200 2850 1900 36000 3000 2000 37800 3150 2100 39600 3300 2200 41400 3450 2300 43200 3600 2400 45000 3750 2500 46800 3900 2600 48600 4050 2700 50400 4200 2800 52200 4350 2900 54000 4500 3000 55800 4650 3100 57600 4800 3200 59400 4950 3300 61200 5100 3400 63000 5250 3500 64800 5400 3600 66600 5550 3700 68400 5700 3800 70200 5850 3900 72000 6000 4000 73800 6150 4100 75600 6300 4200 77400 6450 4300 79200 6600 4400 81000 6750 4500 82800 6900 4600 8460032 7050 4700
14* 14*
30* 30*
60 60
90 90
180 180
6.08 9.12 12.16 15.20 18.24 21.28 24.32 27.36 30.40 33.44 36.48 39.52 42.56 45.60 48.64 51.68 54.72 57.76 60.80 63.84 66.88 69.92 72.96 76.00 79.04 82.08 85.12 88.16 91.20 94.24 97.28 100.32 103.36 106.40 109.44 112.48 115.52 118.56 121.60 124.64 127.68 130.72 133.76 136.80 139.84 142.88
5.22 7.83 10.44 13.05 15.66 18.27 20.88 23.49 26.10 28.71 31.32 33.93 36.54 39.15 41.76 44.37 46.98 49.59 52.20 54.81 57.42 60.03 62.64 65.25 67.86 70.47 73.08 75.69 78.30 80.91 83.52 86.13 88.74 91.35 93.96 96.57 99.18 101.79 104.40 107.01 109.62 112.23 114.84 117.45 120.06 122.67
4.18 6.27 8.36 10.45 12.54 14.63 16.72 18.81 20.90 22.99 25.08 27.17 29.26 31.35 33.44 35.53 37.62 39.71 41.80 43.89 45.98 48.07 50.16 52.25 54.34 56.43 58.52 60.61 62.70 64.79 66.88 68.97 71.06 73.15 75.24 77.33 79.42 81.51 83.60 85.69 87.78 89.87 91.96 94.05 96.14 98.23
2.38 3.57 4.76 5.95 7.14 8.33 9.52 10.71 11.90 13.09 14.28 15.47 16.66 17.85 19.04 20.23 21.42 22.61 23.80 24.99 26.18 27.37 28.56 29.75 30.94 32.13 33.32 34.51 35.70 36.89 38.08 39.27 40.46 41.65 42.84 44.03 45.22 46.41 47.60 48.79 49.98 51.17 52.36 53.55 54.74 55.93
1.66 2.49 3.32 4.15 4.98 5.81 6.64 7.47 8.30 9.13 9.96 10.79 11.62 12.45 13.28 14.11 14.94 15.77 16.60 17.43 18.26 19.09 19.92 20.75 21.58 22.41 23.24 24.07 24.90 25.73 26.56 27.39 28.22 29.05 29.88 30.71 31.54 32.37 33.20 34.03 34.86 35.69 36.52 37.35 38.18 39.01
Disability BROWNFIELD INDEPENDENT SCHOOL DISTRICT Costs below are based on a Monthly payroll deduction (Employer billing mode is based on 12 Payments per year) Plan A Product: Educator Select Income ADEA II Duration of Benefits Protection Plan Elimination Period (Days) Injury (Days) Sickness (Days) Maximum Annual Monthly Monthly Earnings Earnings Benefit 86400 7200 4800 88200 7350 4900 90000 7500 5000 91800 7650 5100 93600 7800 5200 95400 7950 5300 97200 8100 5400 99000 8250 5500 100800 8400 5600 102600 8550 5700 104400 8700 5800 106200 8850 5900 108000 9000 6000 109800 9150 6100 111600 9300 6200 113400 9450 6300 115200 9600 6400 117000 9750 6500 118800 9900 6600 120600 10050 6700 122400 10200 6800 124200 10350 6900 126000 10500 7000 127800 10650 7100 129600 10800 7200 131400 10950 7300 133200 11100 7400 135000 11250 7500 136800 11400 7600 138600 11550 7700 140400 11700 7800 142200 11850 7900 144000 12000 8000
14* 14*
30* 30*
60 60
90 90
180 180
145.92 148.96 152.00 155.04 158.08 161.12 164.16 167.20 170.24 173.28 176.32 179.36 182.40 185.44 188.48 191.52 194.56 197.60 200.64 203.68 206.72 209.76 212.80 215.84 218.88 221.92 224.96 228.00 231.04 234.08 237.12 240.16 243.20
125.28 127.89 130.50 133.11 135.72 138.33 140.94 143.55 146.16 148.77 151.38 153.99 156.60 159.21 161.82 164.43 167.04 169.65 172.26 174.87 177.48 180.09 182.70 185.31 187.92 190.53 193.14 195.75 198.36 200.97 203.58 206.19 208.80
100.32 102.41 104.50 106.59 108.68 110.77 112.86 114.95 117.04 119.13 121.22 123.31 125.40 127.49 129.58 131.67 133.76 135.85 137.94 140.03 142.12 144.21 146.30 148.39 150.48 152.57 154.66 156.75 158.84 160.93 163.02 165.11 167.20
57.12 58.31 59.50 60.69 61.88 63.07 64.26 65.45 66.64 67.83 69.02 70.21 71.40 72.59 73.78 74.97 76.16 77.35 78.54 79.73 80.92 82.11 83.30 84.49 85.68 86.87 88.06 89.25 90.44 91.63 92.82 94.01 95.20
39.84 40.67 41.50 42.33 43.16 43.99 44.82 45.65 46.48 47.31 48.14 48.97 49.80 50.63 51.46 52.29 53.12 53.95 54.78 55.61 56.44 57.27 58.10 58.93 59.76 60.59 61.42 62.25 63.08 63.91 64.74 65.57 66.40
33
LOYAL AMERICAN
Cancer
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.
Breast Cancer is the most commonly diagnosed cancer in women.
If caught early, prostate cancer is one of the most treatable malignancies.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 34 Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
Cancer ADDITIONAL BENEFIT AMOUNTS
PLAN A Maximum
PLAN B Maximum
ANNUAL CANCER SCREENING BENEFIT RIDER (form LG-6041) A.Basic Benefit We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule, once per calendar year per Insured Person for screening tests performed to determine whether Cancer $50 $50 exists in an Insured Person. Covered annual Cancer screening tests include but are not limited to: mammogram, pap Per Calendar Year Per Calendar Year smear, breast ultrasound, ThinPrep, biopsy, chest x-ray, thermography, colonoscopy, flexible sigmoidoscopy, hemocult stool specimen, PSA (blood test for prostate cancer), CEA (blood tests for colon cancer), CA125 (blood test for ovarian cancer), CA15-3 (blood test for breast cancer), serum protein electrophesis (blood test for myeloma).
B.Additional Benefit We will pay the expense incurred, but not to exceed two times the maximum benefit amount per calendar year as shown on the Certificate Schedule, for one additional invasive diagnostic procedure required as the result of an abnormal cancer screening test for which benefits are payable under the Basic Benefit above for an Insured Person. This additional benefit is payable regardless of the results of the additional diagnostic procedure. However, the amount payable will be reduced dollar for dollar for any amount payable under the Positive Diagnosis Benefit contained in the base Certificate.
FIRST OCCURRENCE BENEFIT RIDER (form LG-6043)
$100 $100 Per Calendar Year Per Calendar Year
$2,000
$500
If an Insured Person receives a positive diagnosis of Internal Cancer, We will pay the First Occurrence benefit amount Once per Lifetime Once per Lifetime shown on the Certificate Schedule. $3,000 $750 If the Insured Person receiving the positive diagnosis of Internal Cancer is a child under the age of 21, we will pay one Once per Lifetime Once per Lifetime and one-half times the First Occurrence benefit amount shown on the Certificate Schedule.
DAILY RADIATION, CHEMOTHERAPY, IMMUNOTHERAPY and EXPERIMENTAL TREATMENT BENEFIT RIDER (form LG-6046) We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule, per calendar year per Insured Person for Radiation Treatment, Chemotherapy, Hormonal Therapy, Immunotherapy or Experimental Treatment. The Radiation Treatment, Chemotherapy, Hormonal Therapy, Immunotherapy or Experimental Treatment must be for the treatment of an Insured Person’s Cancer. The benefit amount shown on the Certificate Schedule is the maximum calendar year benefit available per Insured Person regardless of the number or types of Cancer treatments received in the same year.
SURGICAL BENEFIT RIDER (form LG-6048) Surgical Expense We will pay the Surgical Expense benefit for a surgical procedure for the treatment of an Insured Person’s Cancer (except Skin Cancer) according to the Surgical Schedule shown in this rider. However, in no event will the amount payable exceed the maximum Surgical Expense benefit shown on the Certificate Schedule, nor will it exceed the expense incurred.
Anesthesia Expense We will pay the anesthesia expense incurred, not to exceed 25% of the covered Surgical Expense benefit for the operation performed. This includes the services of an anesthesiologist or of an anesthetist under supervision of a physician for the purpose of administering anesthesia.
$400 Per Day
$200 Per Day
$5,000 Procedure Maximum
$500 Procedure Maximum
$1,250 Procedure Maximum
$125 Procedure Maximum
$4,500 Procedure Maximum
$450 Procedure Maximum
Per Procedure
Per Procedure
$200 Per Day
$100 Per Day
$400 Per Day
$200 Per Day
$400/ $800 Per Day
$200/ $400 Per Day
Breast Reconstruction With transverse rectus adominis myocutaneous flap (TRAM), single pedicle, including closure of donor site, with microvascular anastomosis (supercharging) is one of the surgical procedures listed in the Surgical Schedule. If this procedure is performed on an Insured Person as the result of a mastectomy for which We paid a Surgical Expense benefit for the treatment of Breast Cancer, We will pay the expense incurred not to exceed $900 per $1,000 of the Surgical Benefit issued.
Skin Cancer Surgery Expense We will pay the expense incurred, not to exceed the procedure amount listed in this rider ($125 to $750 depending on the procedure) when a surgical operation is performed on an Insured Person for treatment of a diagnosed Skin Cancer. This benefit is payable in lieu of any benefits for Surgical Expense and Anesthesia Expense which are not applicable to Skin Cancer.
DAILY HOSPITAL CONFINEMENT BENEFIT RIDER (form LG-6042) Confinements of 30 Days or Less We will pay the Daily Hospital Confinement benefit amount shown on the Certificate Schedule for each of the first 30 days in each period of hospital confinement during which an Insured Person is confined to a hospital, including a government or charity hospital, for the treatment of Cancer.
Confinements of 31 Days or More If an Insured Person is continuously confined to a hospital, including a government or charity hospital, for longer than 30 consecutive days for the treatment of Cancer, We will pay two times the Daily Hospital Confinement benefit amount shown on the Certificate Schedule. This benefit payment will begin on the 31st continuous day of such confinement and continue for each day of confinement until the Insured Person is discharged from the Hospital.
Benefits for an Insured Dependent Child under Age 21 The amount payable under this benefit will be double the Daily Hospital Confinement benefit shown on the Certificate Schedule if the Insured Person so confined is a dependent child under the age of 21.
35
Cancer Additional Benefits Amounts SPECIFIED DISEASE BENEFIT RIDER (form LG-6052) If an Insured Person is first diagnosed with one or more covered Specified Diseases and is hospitalized for the definitive treatment of any covered Specified Disease, We will pay benefits according to the provisions of this rider. Covers These 38 Specified Diseases Addison’s Disease Amyotrophic Lateral Sclerosis Botulism Bovine Spongiform Encephalopathy Budd-Chiari Syndrome Cystic Fibrosis Diptheria Encephalitis Epilepsy Hansen’s Disease Histoplasmosis Legionnaire’s Disease Lyme Disease
Lupus Erythematosus Malaria Meningitis Multiple Sclerosis Muscular Dystrophy Myasthenia Gravis Neimann-Pick Disease Osteomyelitis Poliomyelitis Q Fever Rabies Reye’s Syndrome Rheumatic Fever
Rocky Mountain Spotted Fever Sickle Cell Anemia Tay-Sachs Disease Tetanus Toxic Epidermal Necrolysis Tuberculosis Tularemia Typhoid Fever Undulant Fever West Nile Virus Whipple’s Disease Whooping Cough
Benefits If an Insured Person is first diagnosed with one or more covered Specified Diseases and is hospitalized for the definitive treatment of any covered Specified Disease, We will pay benefits according to the provisions of this rider. An applicant may select 1, 2 or 3 units of coverage. Initial Hospitalization Benefit We will pay a benefit of $1,500 per unit of coverage selected when an Insured Person is confined to a hospital (for 12 or more hours, not applicable in SD) as a result of receiving treatment for a Specified Disease. This benefit is payable only once per period of confinement and once per calendar year for each Insured Person. Hospital Confinement Benefit We will pay a benefit of $300 per day per unit of coverage selected when an Insured Person is hospitalized during any continuous period of 30 days or less for the treatment of a covered Specified Disease. Benefits will double per day beginning with the 31st day of continuous confinement. If the hospital confinement follows a previously covered confinement, it will be deemed a continuation of the first confinement unless it is the result of an entirely different Specified Disease, or unless the confinements are separated by 30 days or more. *SPECIFIED DISEASE BENEFIT RIDER IS NOT INCLUDED IN PLAN A
Monthly Rates
36
Employee
Employee and Children
Employee and Family
Plan A
$19.92
$22.56
$31.97
Plan B
$11.56
$13.03
$18.36
Cancer
OPTIONAL BENEFITS YOU MAY SELECT FOR ADDITIONAL PREMIUM
HOSPITAL INTENSIVE CARE UNIT BENEFIT RIDER (form LG-6047) Intensive Care Unit Benefit We will pay the daily Hospital Intensive Care Unit Benefit shown on the Certificate Schedule for an Insured Person’s confinement in an ICU for sickness or injury.
$1,000 Per Day
Double Intensive Care Unit Benefit We will pay double the daily Hospital Intensive Care Unit benefit amount shown on the Certificate Schedule for an Insured Person’s confinement in an ICU as a result of Cancer. We will also double this ICU benefit for only the initial ICU confinement resulting from an Insured Person’s travel related injury, provided that the ICU confinement begins within 24 hours of the accident causing the travel related injury. A travel related injury includes being struck by an automobile, bus, truck, van, motorcycle, train or airplane; or being involved in an accident where the Insured Person was the operator or passenger in or on such vehicle.
$2,000 Per Day
Step Down Unit Benefit We will pay one-half of the daily Hospital Intensive Care Unit benefit amount shown on the Certificate Schedule for an Insured Person’s confinement in a Step Down Unit for a sickness or injury.
$500 Per Day
Additional Limitations and Exclusions for the Hospital Intensive Care Unit Benefit Rider If the rider is issued and coverage is in force, it will provide benefits if an Insured Person goes into a hospital Intensive Care Unit (including a Cardiac Intensive Care Unit or Neonatal Intensive Care Unit). Benefits start the first day of confinement in an ICU for sickness or injury. Any combination of benefits payable under this rider is limited to a maximum of 45 days per each period of confinement. ALL BENEFITS CONTAINED IN THIS HOSPITAL INTENSIVE CARE UNIT BENEFIT RIDER REDUCE BY ONE-HALF AT AGE 75. Benefits are not payable for any ICU or Step Down Unit confinement that results from intentional self-inflicted injury; or the Insured Person’s being intoxicated or under the influence of alcohol, drugs or any narcotics, unless administered on and according to the advice of a medical practitioner. THIS IS A LIMITED RIDER.
Monthly Rates
Employee
Employee and Children
Employee and Family
Plan A with ICU & Specified Disease
$25.06
$31.38
$43.26
Plan B with ICU & Specified Disease
$16.70
$21.85
$29.65
37
ID WATCHDOG
Identity Theft
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered. An identity is stolen every 2 seconds, and takes over
300 hours
to resolve, causing an average loss of $9,650.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 38 Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
Identity Theft Identity theft can strike anyone, at any time. More than 11 million Americans were victimized by identity theft in 2011, including more than 500,000 children.
Identity theft devastates its victims financially. The average victim will lose $4,841, and spend an additional $1,400 in out-of-pocket expenses resolving their case.
Repairing the damage caused by identity theft is frustrating and time consuming. The average victim spends 330 hours repairing the damage from identity theft—the equivalent of working a full-time job for more than 2 months.
ID Watchdog Monthly Rates Plus Individual Plan
$7.95
Family Plan
$14.95
ID Watchdog Services Basic & Advanced Identity Monitoring Cyber Monitoring Full-Service Identity Restoration Non-Credit Loan Monitoring Address Monitoring Credit Report Monitoring 100% Resolution Guarantee
The impact of identity theft follows victims for years. 50% of identity theft victims experience trouble getting loans or credit cards as a result of identity theft. 12% of identity theft victims end up having warrants issued by law enforcement in their name for crimes committed by the identity thief.
Who’s Evaluating your Credit Report? Potential Creditors, Potential Employers, Insurance Companies, Current Creditors, Government Agencies
39
AMERICAN PUBLIC LIFE YOUR BENEFITS PACKAGE
Accident
PLAY VIDEO
About this Benefit
2/3
Accident insurance is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or a not-soserious, injury. Accident coverage is low cost protection available to you and your family without evidence of insurability.
of disabling injuries suffered by American workers are not work related. American workers 36% ofreport they always or
usually live paycheck to paycheck.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 40 Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
A3 Supplemental Limited Benefit Accident Expense Insurance Brownfield ISD
AMERICAN PUBLIC LIFE YOUR BENEFITS
Accident
THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.
Summary of Benefits* Benefit Description Accidental Death - per unit Medical Expense Accidental Injury Benefit - per unit Daily Hospital Confinement Benefit Air and Ground Ambulance Benefit
DID YOU KNOW?
2/3 of disabling injuries suffered by American workers are not work American workers 36% ofreport they always or
Level 2 - 2 Units
Level 3 - 3 Units
Level 4 - 4 Units
$5,000
$10,000
$15,000
$20,000
actual charges up to actual charges up to actual charges up to actual charges up to $500 $1,000 $1,500 $2,000 $75 per day
$150 per day
$225 per day
$300 per day
actual charges up to actual charges up to actual charges up to actual charges up to $1,250 $2,500 $3,750 $5,000
Accidental Dismemberment Benefit Single finger or toe Multiple fingers or toes Single hand, arm, foot or leg Multiple hands, arms, feet or legs
$500 $500 $2,500 $5,000
$1,000 $1,000 $5,000 $10,000
$1,500 $1,500 $7,500 $15,000
$2,000 $2,000 $10,000 $20,000
Accidental Loss of Sight Benefit - per unit Loss of Sight in one eye Loss of Sight in both eyes
$2,500 $5,000
$5,000 $10,000
$7,500 $15,000
$10,000 $20,000
Individual
Individual & Spouse
1 Parent Family
2 Parent Family
$10.80 $17.10 $21.50 $24.50
$19.40
$21.20 $34.90 $45.20 $52.00
$29.80 $47.60 $62.60 $72.40
About this Benefit Accident insurance is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or a not-so-serious, injury. Accident coverage is low cost protection available to you and your family without evidence of insurability.
Level 1 - 1 Unit
Level 1 - 1 Unit Level 2 - 2 Units Level 3 - 3 Units Level 4 - 4 Units
$29.80 $38.90 $44.90
*Total premium includes the Plan selected and any applicable rider premium. The premium and amount of benefits vary dependent upon the Plan selected at time of application. Premiums are subject to increase with notice.
usually live paycheck to paycheck.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
APSB-22329(TX)-MGM/FBS Brownfield ISD
41
A3 Supplemental Limited Benefit Accident Expense Insurance Limitations and Exclusions Eligibility This policy will be issued to only those persons who meet American Public Life Insurance Company’s insurability requirements. Persons not meeting APL’s insurability requirements will be excluded from coverage by an endorsement attached to the policy.
Base Policy and Optional Benefits
Exclusions Benefits otherwise provided by this Policy will not be payable for services or expenses or any such Loss resulting from or in connection with: (1) (2) (3)
No benefits are payable for a pre-existing condition. Preexisting condition means an Injury that pertains solely to an Accidental Bodily Injury which resulted from an accident sustained before the Effective Date of coverage. Pre-Existing Conditions specifically named or described as permanently excluded in any part of this contract are never covered.
(4)
A Hospital is not an institution which is primarily a place for alcoholics or drug addicts; the aged; a nursing, rest or convalescent nursing home; a mental institution or sanitarium; a facility contracted for or operated by the United States Government for treatment of members or ex-members of the armed forces (unless You are legally required to pay for services rendered in the absence of insurance); or, a long-term nursing unit or geriatrics ward.
(7)
(5) (6)
(8)
(9) (10)
Medical Expense Accidental Injury Benefit Expenses must commence within 60 days of the covered accident. The maximum benefit amount payable for any one accident for the Insured Person shall not exceed the Medical Expense Benefit.
Air and Ground Ambulance Benefit Emergency transportation must occur within 21 calendar days of the accident causing such Injury.
Daily Hospital Confinement Benefit
(11)
(12) (13) (14)
The maximum benefit period for this benefit is 30 days per covered accident.
(15)
Accidental Death
(16)
Accidental Death must result within 90 days of the covered accident causing the injury.
sickness, illness or bodily infirmity; suicide, attempted suicide or intentional self-inflicted Injury, whether sane or insane; dental care or treatment unless due to accidental Injury to natural teeth; war or any act of war (whether declared or undeclared) or participating in a riot or felony; alcoholism or drug addiction; travel or flight in or descent from any aircraft or device which can fly above the earth’s surface in any capacity other than as a fare paying passenger on a regularly scheduled airline; Injury originating prior to the effective date of the Policy; Injury occurring while intoxicated (Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the loss or cause of loss is incurred.); Voluntary inhalation of gas or fumes or taking of poison or asphyxiation; Voluntary ingestion or injection of any drug, narcotic or sedative, unless administered on the advice and taken in such doses as prescribed by a Physician; Injury sustained or sickness which first manifests itself while on full-time duty in the armed forces; (Upon notice, We will refund the proportion of unearned premium while in such forces.) Injury incurred while engaging in an illegal occupation; Injury incurred while attempting to commit a felony or an assault; Injury to a covered person while practicing for or being a part of organized or competitive rodeo, sky diving, hang gliding, parachuting or scuba diving; driving in any race or speed test or while testing an automobile or any vehicle on any racetrack or speedway; hernia, carpal tunnel syndrome or any complication therefrom;
A3 Supplemental Limited Benefit Accident Expense Insurance If You are entitled to benefits under this Policy as a result of sprained or lame back, or any intervertebral disk conditions, such benefits shall be payable for a maximum period of time, not exceeding in the aggregate three (3) months for any Injury.
Guaranteed Renewable You have the right to renew this Policy until the first premium due date on or after Your 69th birthday, if you pay the correct premium when due or within the Grace Period. When an Insured’s coverage terminates at age 70, coverage for other Insured Persons, if any, shall continue under this Policy. We have the right to change premium rates by class.
2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606
Accidental Dismemberment Benefit The total amount payable for all Losses resulting from the same accident will not exceed the Maximum Dismemberment Benefit of $5,000 cumulative per unit, per Accident. Loss must be within 90 days of the accident causing such Injury.
Underwritten by American Life Insurance Company. This is a brief description of the coverage. For actual benefits, limitations, exclusions and other provisions, please refer to the policy and riders. This coverage does not replace Workers’ Compensation Insurance. | This product is inappropriate for people who are eligible for Medicaid coverage. | Policy Form A3 Series | Texas | Supplemental Limited Benefit Accident Expense Insurance Policy | (10/14) | Brownfield ISD
42
APSB-22329(TX)-MGM/FBS Brownfield ISD
APSB-22329(TX)-MGM/FBS Brownfield ISD
A3 Supplemental Limited Benefit Accident Expense Insurance Limitations and Exclusions Eligibility This policy will be issued to only those persons who meet American Public Life Insurance Company’s insurability requirements. Persons not meeting APL’s insurability requirements will be excluded from coverage by an endorsement attached to the policy.
Base Policy and Optional Benefits
Exclusions Benefits otherwise provided by this Policy will not be payable for services or expenses or any such Loss resulting from or in connection with: (1) (2) (3)
No benefits are payable for a pre-existing condition. Preexisting condition means an Injury that pertains solely to an Accidental Bodily Injury which resulted from an accident sustained before the Effective Date of coverage. Pre-Existing Conditions specifically named or described as permanently excluded in any part of this contract are never covered.
(4)
A Hospital is not an institution which is primarily a place for alcoholics or drug addicts; the aged; a nursing, rest or convalescent nursing home; a mental institution or sanitarium; a facility contracted for or operated by the United States Government for treatment of members or ex-members of the armed forces (unless You are legally required to pay for services rendered in the absence of insurance); or, a long-term nursing unit or geriatrics ward.
(7)
(5) (6)
(8)
(9) (10)
Medical Expense Accidental Injury Benefit Expenses must commence within 60 days of the covered accident. The maximum benefit amount payable for any one accident for the Insured Person shall not exceed the Medical Expense Benefit.
Air and Ground Ambulance Benefit Emergency transportation must occur within 21 calendar days of the accident causing such Injury.
Daily Hospital Confinement Benefit
(11)
(12) (13) (14)
The maximum benefit period for this benefit is 30 days per covered accident.
(15)
Accidental Death
(16)
Accidental Death must result within 90 days of the covered accident causing the injury.
sickness, illness or bodily infirmity; suicide, attempted suicide or intentional self-inflicted Injury, whether sane or insane; dental care or treatment unless due to accidental Injury to natural teeth; war or any act of war (whether declared or undeclared) or participating in a riot or felony; alcoholism or drug addiction; travel or flight in or descent from any aircraft or device which can fly above the earth’s surface in any capacity other than as a fare paying passenger on a regularly scheduled airline; Injury originating prior to the effective date of the Policy; Injury occurring while intoxicated (Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the loss or cause of loss is incurred.); Voluntary inhalation of gas or fumes or taking of poison or asphyxiation; Voluntary ingestion or injection of any drug, narcotic or sedative, unless administered on the advice and taken in such doses as prescribed by a Physician; Injury sustained or sickness which first manifests itself while on full-time duty in the armed forces; (Upon notice, We will refund the proportion of unearned premium while in such forces.) Injury incurred while engaging in an illegal occupation; Injury incurred while attempting to commit a felony or an assault; Injury to a covered person while practicing for or being a part of organized or competitive rodeo, sky diving, hang gliding, parachuting or scuba diving; driving in any race or speed test or while testing an automobile or any vehicle on any racetrack or speedway; hernia, carpal tunnel syndrome or any complication therefrom;
A3 Supplemental Limited Benefit Accident Expense Insurance If You are entitled to benefits under this Policy as a result of sprained or lame back, or any intervertebral disk conditions, such benefits shall be payable for a maximum period of time, not exceeding in the aggregate three (3) months for any Injury.
Guaranteed Renewable You have the right to renew this Policy until the first premium due date on or after Your 69th birthday, if you pay the correct premium when due or within the Grace Period. When an Insured’s coverage terminates at age 70, coverage for other Insured Persons, if any, shall continue under this Policy. We have the right to change premium rates by class.
2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606
Accidental Dismemberment Benefit The total amount payable for all Losses resulting from the same accident will not exceed the Maximum Dismemberment Benefit of $5,000 cumulative per unit, per Accident. Loss must be within 90 days of the accident causing such Injury.
Underwritten by American Life Insurance Company. This is a brief description of the coverage. For actual benefits, limitations, exclusions and other provisions, please refer to the policy and riders. This coverage does not replace Workers’ Compensation Insurance. | This product is inappropriate for people who are eligible for Medicaid coverage. | Policy Form A3 Series | Texas | Supplemental Limited Benefit Accident Expense Insurance Policy | (10/14) | Brownfield ISD
43
APSB-22329(TX)-MGM/FBS Brownfield ISD
APSB-22329(TX)-MGM/FBS Brownfield ISD
VOYA
Critical Illness
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit Critical illness insurance is designed to supplement your medical and disability coverage easing the financial impacts by covering some of your additional expenses. It provides a benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke.
$16,500 Is the aggregate cost of a hospital stay for a heart attack.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 44 Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
Critical Illness What is Cri cal Illness Insurance?
How can Cri cal Illness Insurance help?
Cri cal Illness Insurance pays a lump‐sum benefit if you are diagnosed a er your effec ve date of coverage with a covered illness or condi on listed below. Please review cer ficates of coverage for any limita ons that may apply. Cri cal Illness Insurance is a limited benefit policy. It is not health insurance and does not sa sfy the requirement of minimum essen al coverage under the Affordable Care Act.
Below are a few examples of how your Cri cal Illness Insurance benefit could be used (coverage amounts may vary): Medical expenses, such as deduc bles and copays Child care Home healthcare costs Mortgage payment/rent and home maintenance
Features of Cri cal Illness Insurance include: Guaranteed Issue: No medical ques ons or tests required for coverage. Flexible: You can use the benefit money for any purpose you like. Payroll deduc ons: Premiums are paid through convenient payroll deduc ons. Portable: Should you leave your current employer or re re, you can take your coverage with you.
For what cri cal illnesses and condi ons are benefits available? Cri cal Illness Insurance provides a benefit for the following illnesses and condi ons. Covered illnesses/condi ons are broken out into groups called “modules”. Benefits are paid at 100% of the Maximum Cri cal Illness Benefit amount unless otherwise stated. For a complete descrip on of your benefits, along with applicable provisions, condi ons on benefit determina on, exclusions and limita ons, see your cer ficate of insurance and any riders. Base Module Heart a ack Stroke Coronary artery bypass (25%) Coma Major organ failure Permanent paralysis End stage renal (kidney) failure
Who is eligible for Cri cal Illness Insurance?
You—all ac ve employees working 15 hours per week. Your spouse*— under age 70. Coverage is available only if employee coverage is elected. Your child(ren)— to age 26. Coverage is available only if employee coverage is elected.
*The use of “spouse” in this document means a person insured as a spouse as described in the cer ficate of insurance or rider.
What Maximum Cri cal Illness Benefit am I eligible for?
For you You have the opportunity to purchase a Maximum Cri cal Illness Benefit of $5,000 ‐ $30,000 in $5,000 increments. For your spouse You also have the opportunity to purchase a Maximum Cri cal Illness Benefit of $5,000 ‐ $15,000 in $5,000 increments for your spouse. For your children You also have the opportunity to purchase a Maximum Cri cal Illness Benefit of $1,000, $2,500, $5,000 or $10,000 for each covered child.
How many mes can I receive the Maximum Cri cal Illness Benefit? Usually you are only able to receive the Maximum Cri cal Illness Benefit for one covered illness or disease. Your plan includes the Restora on Benefit, which provides a one‐ me restora on of 100% of the maximum benefit amount in order to pay an addi onal benefit if you experience a second covered illness for a different condi on. Your plan also includes the Recurrence Benefit, which allows you to receive a benefit for the same condi on a second me. It’s important to note that in order for the second covered illness or the second occurrence of the illness to be covered, it must occur a er 12 consecu ve months without the occurrence of any covered cri cal illness named in your cer ficate, including the illness from the first benefit payment. If a par al benefit is paid out, it will not reduce the available maximum benefit amount for the illnesses or diseases in that same module. If you have reached the benefit limit by receiving the maximum benefit in each module, you may choose to end your coverage; however, if you have coverage for your spouse and/or child(ren), you must con nue your coverage in order to keep their coverage ac ve. Please see the cer ficate of coverage for details.
45
Critical Illness What optional benefits are available?
Exclusions and Limitations
You may choose to include the optional benefits below with your critical illness coverage. For a list of standard exclusions and limitations, please refer to the end of this document. For a complete description of your available benefits, along with applicable provisions, exclusions and limitations, see your certificate of insurance and any riders.
Benefits are not payable for any critical illness caused in whole or directly by any of the following*: Participation or attempt to participate in a felony or illegal activity. Suicide, attempted suicide or any intentionally selfinflicted injury, while sane or insane. War or any act of war, whether declared or undeclared, other than acts of terrorism. Loss that occurs while on full-time active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion. Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor.
Spouse Critical Illness Insurance: If you have coverage for yourself, you may enroll your spouse, as long as your spouse is under age 70 and is not covered under the Policy as an employee. Your spouse will receive coverage for the same covered conditions as you. Your spouse will be able to receive a benefit the same number of times as you, as outlined above. Guaranteed issue: No medical questions or tests required for coverage. Children’s Critical Illness Insurance: As long as you have critical illness coverage on yourself, your natural child(ren), stepchild (ren), adopted child(ren) or child(ren) for whom you are a legal guardian are eligible to be covered under your employer’s plan, up to the age of 26. Your children are covered for the same covered conditions as you are with the exception of carcinoma in situ and coronary artery bypass; however, actual benefit amounts may vary. Your child(ren) will be able to receive a benefit the same number of times as you, as outlined above. One premium amount covers all of your eligible children. Guaranteed issue: No medical questions or tests required for coverage. If both you and your spouse are covered under the policy as an employee, then only one, but not both, may cover the same child(ren) under this benefit. If the parent who is covering the child(ren) stops being insured as an employee then the other parent may apply for children’s coverage.
46
Benefits reduce 50% for the employee and/or covered spouse on the policy anniversary following the 70th birthday, however, premiums do not reduce as a result of this benefit change. *See the certificate of insurance and any riders for a complete list of available benefits, along with applicable provisions, exclusions and limitations.
Who do I contact with questions? For more information, please call the Voya Employee Benefits Customer Service Team at (800) 955-7736.
Critical Illness How much does Critical Illness Insurance cost? See the chart below for the premium amounts.
Employee Coverage—Uni-Tobacco Monthly Rates Issue Age
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
Under 30
$1.85
$3.70
$5.55
$7.40
$9.25
$11.10
30-39
$2.65
$5.30
$7.95
$10.60
$13.25
$15.90
40-49
$4.95
$9.90
$14.85
$19.80
$24.75
$29.70
50-59
$8.05
$16.10
$24.15
$32.20
$40.25
$48.30
60-64
$12.15
$24.30
$36.45
$48.60
$60.75
$72.90
65-69
$16.50
$33.00
$49.50
$66.00
$82.50
$99.00
70+
$31.25
$62.50
$93.75
$125.00
$156.25
$187.50
Spouse Coverage—Uni-Tobacco Monthly Rates Issue Age
$5,000
$10,000
$15,000
Under 30
$2.45
$4.90
$7.35
30-39
$3.30
$6.60
$9.90
40-49
$6.90
$13.80
$20.70
50-59
$11.80
$23.60
$35.40
60-64
$15.35
$30.70
$46.05
65-69
$16.80
$33.60
$50.40
70+
$27.40
$54.80
$82.20
Child(ren) Coverage Monthly Rates
Coverage Amount
Rate
$1,000
$0.13
$2,500
$0.33
$5,000
$0.65
$10,000
$1.30
47
AULA ONEAMERICA COMPANY YOUR BENEFITS PACKAGE
Life and AD&D
PLAY VIDEO
About this Benefit Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family. Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.
Motor vehicle crashes are the
#1
cause of accidental deaths in the US, followed by poisoning, falls, drowning, and choking.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 48 Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
Life and AD&D Group Term Life including matching AD&D Coverage
Life and AD&D insurance coverage amount of $10,000 or $50,000 at no cost to you Waiver of premium benefit Accelerated life benefit Additional AD&D Benefits: Seat Belt, Air Bag, Repatriation, Child Higher Education, Child Care, Paralysis/Loss of Use, Severe Burns
AUL's Group Voluntary Term Life Insurance Terms and Definitions Eligible Employees This benefit is available for employees who are actively at work on the effective date and working a minimum of 20 hours per week.
Flexible Choices Since everyone's needs are different, this plan offers flexibility for you to choose a benefit amount that fits your needs and budget.
Accidental Death & Dismemberment (AD&D) If approved for this benefit, additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract.
Annual Increase in Benefit If eligible, this benefit allows you to increase your coverage every year as your life insurance needs change. You may be able to increase your benefit amount and your spouses benefit amount by $10,000 every year until you reach the guaranteed issue amount, without providing Evidence of Insurability. NOTE: If Evidence of Insurability is applied for and denied, please be aware Annual Increase in Benefits will not be made available to you in the future.
Continuation of Coverage Options Portability Should your coverage terminate for any reason, you may be eligible to take this term life insurance with you without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible. The Portability option is available until you reach age 70.
OR Conversion Should your life insurance coverage, or a portion of it, cease for any reason, you may be eligible to convert your Group Term Coverage to Individual Coverage without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible. Accelerated Life Benefit If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose.
Guaranteed Issue Amounts This is the most coverage you can purchase without having to answer any health questions. If you decline insurance coverage now and decide to enroll later, you will need to provide Evidence of Insurability. Employee Guaranteed Issue Amount
$200,000
Spouse Guaranteed Issue Amount
$50,000
Child Guaranteed Issue Amount
$10,000
Timely Enrollment Enrolling timely means you have enrolled during the initial enrollment period when benefits were first offered by AUL, or as a newly hired employee within 31 days following completion of any applicable waiting period.
Evidence of Insurability
Waiver of Premium If approved, this benefit waives your and your dependents' insurance premium in case you become totally disabled and are unable to collect a paycheck. Reductions Upon reaching certain ages, your original benefit amount will reduce to a percentage as shown in the following schedule. Age:
65
70
Reduces To:
65%
50%
This invitation to inquire allows eligible employees an opportunity to inquire further about AUL's group insurance and is limited to a brief description of any losses for which benefits are payable. The contract has exclusions, limitations reduction of benefits, and terms under which the contract may be continued in force or discontinued.
If you elect a benefit amount over the Guaranteed Issue Amount shown above for you or your eligible dependents, or you do not enroll timely, you will need to submit a Statement of Insurability form for review. Based on health history, you and / or your dependents will be approved or declined for insurance coverage by AUL.
49
Life and AD&D Monthly Payroll Deduction Illustration About your benefit options:
You may select a minimum benefit of $10,000 up to a maximum amount of $500,000, in increments of $10,000, not to exceed 5 times your annual base salary only, rounded to the next higher $10,000. AD&D coverage is not included for dependents. Amounts requested above $250,000 for an Employee, $50,000 for a Spouse, or any amount not requested timely will require Evidence of Insurability. Employee must select coverage to select any Dependent coverage. Dependent coverage cannot exceed 100% of the Voluntary Term Life amount selected by the Employee.
EMPLOYEE ONLY OPTIONS (based on Employee's age as of 09/01) Life and AD&D
0-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75+
$10,000
$.65
$.65
$.65
$.80
$.80
$1.20
$1.90
$3.60
$5.00
$6.20
$7.87
$7.45
$13.20
$20,000
$1.30
$1.30
$1.30
$1.60
$1.60
$2.40
$3.80
$7.20
$10.00
$12.40
$15.74
$14.90
$26.40
$30,000
$1.95
$1.95
$1.95
$2.40
$2.40
$3.60
$5.70
$10.80
$15.00
$18.60
$23.61
$22.35
$39.60
$40,000
$2.60
$2.60
$2.60
$3.20
$3.20
$4.80
$7.60
$14.40
$20.00
$24.80
$31.48
$29.80
$52.80
$50,000
$3.25
$3.25
$3.25
$4.00
$4.00
$6.00
$9.50
$18.00
$25.00
$31.00
$39.35
$37.25
$66.00
$80,000
$5.20
$5.20
$5.20
$6.40
$6.40
$9.60
$15.20
$28.80
$40.00
$49.60
$62.96
$59.60
$105.60
$90,000
$5.85
$5.85
$5.85
$7.20
$7.20
$10.80
$17.10
$32.40
$45.00
$55.80
$70.83
$67.05
$118.80
$100,000
$6.50
$6.50
$6.50
$8.00
$8.00
$12.00
$19.00
$36.00
$50.00
$62.00
$78.70
$74.50
$132.00
$150,000
$9.75
$9.75
$9.75
$12.00
$12.00
$18.00
$28.50
$54.00
$75.00
$93.00
$118.05 $111.75 $198.00
$200,000
$13.00
$13.00
$13.00
$16.00
$16.00
$24.00
$38.00
$72.00
$100.00 $124.00 $157.40 $149.00 $264.00
SPOUSE ONLY OPTIONS (based on Employee's Age as of 09/01) Life Options
0-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75+
$10,000
$.65
$.65
$.65
$.80
$.80
$1.20
$1.90
$3.60
$5.00
$6.20
$7.87
$7.45
$13.20
$20,000
$1.30
$1.30
$1.30
$1.60
$1.60
$2.40
$3.80
$7.20
$10.00
$12.40
$15.74
$14.90
$26.40
$30,000
$1.95
$1.95
$1.95
$2.40
$2.40
$3.60
$5.70
$10.80
$15.00
$18.60
$23.61
$22.35
$39.60
$40,000
$2.60
$2.60
$2.60
$3.20
$3.20
$4.80
$7.60
$14.40
$20.00
$24.80
$31.48
$29.80
$52.80
$50,000
$3.25
$3.25
$3.25
$4.00
$4.00
$6.00
$9.50
$18.00
$25.00
$31.00
$39.35
$37.25
$66.00
50
Life and AD&D CHILD(REN) OPTIONS (Premium shown for Child(ren) reflects the cost for all eligible dependent children) Child(ren) 6 months to age 26 Option 1:
$10,000
Child(ren) live birth to 6 months $1,000
Monthly Payroll Deduction Life Amount $1.00
About Premiums: The premiums shown above may vary slightly due to rounding; actual premiums will be calculated by American United Life Insurance CompanyÂŽ (AUL), and may increase upon reaching certain age brackets, according to contract terms, and are subject to change.
51
AULA ONEAMERICA COMPANY
EAP (Employee Assistance Program)
YOUR BENEFITS PACKAGE
About this Benefit An Employee Assistance Plan (EAP) is an employee benefit program offered to help employees manage personal and professional problems that might adversely impact their work performance, health, and well-being. Employee Assistance Plans generally include short-term counseling and referral services for employees and their household members. Your Employee Assistance Program benefit is provided to you by your employer.
38%
of employees have missed life events because of bad worklife balance.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 52 Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
Employee Assistance Program (EAP) What is an EAP?
Legal
An EAP is a confidential worksite-based program designed to assist both employees and employers. An EAP provides assessment and referral — in person and over the phone — for personal matters. Each eligible employee1, along with each eligible employee’s dependents, is entitled to three visits (or sessions) free-of-charge per calendar year. Also, telephone intakes and information calls regarding EAP services are free and unlimited.
Personal Concerns
Stress Crisis Psychiatric disorders Medical problems Work-related difficulties Marital and family issues Emotional concerns Relationship issues Life adjustments Alcohol and drug problems
Financial
Financial planning Retirement planning Investment strategies Money management
Childcare
Adoption resources Referrals for an array of childcare arrangements
Stress management course Legal/financial library -Legal/financial articles -Sample legal documents Smoking cessation program Identity theft resources Behavioral health library -Information on numerous life issues Wellness information Depression and substance abuse screenings
Eldercare
Academic Resources
SAT and other testing resources Tutors College planning guides Sources of financial assistance
Pet Services
Referrals for breeders, kennels, veterinarians, etc. Pet services guide
Who is EAPC? EAP services are provided through EAP Consultants, LLC (EAPC). EAPC is a private company with a diverse network of licensed professionals, including clinical providers and consultants. All EAP services are completely confidential pursuant to current US laws and regulations. EAPC’s services include access to highly experienced clinical providers that include licensed psychologists, clinical social workers, professional counselors, marriage and family therapists and alcohol and drug counselors.
Assess childcare needs and explore care options
Online services
Consultation provided for an array of legal issues, including family law, housing and real estate and estate planning Simple will prepared at no cost 25 percent discount on standard attorney hourly rate for services rendered beyond scope of EAP
Resources and referral for both public and private eldercare facilities Consultation on evaluation of facilities
Consultants include attorneys, financial advisors and elder care and child care specialists. EAPC also offers online services to fit a wider array of needs. EAP professionals will help employees identify and clarify concerns and develop a plan of action to create solutions that work. If additional assistance is needed, EAPC will assist employees in finding resources that may be covered by their insurance and meet their financial capabilities.
Questions For detailed information, contact EAP Consultants, LLC at 1-800-869-0276. To confidentially request services online, visit the member access page at www.eapconsultants.com. The password is OneAmericaEAP. Note: EAPC is neither affiliated nor under common control with OneAmerica or AUL, and AUL only markets EAPC products. 53
TEXAS LIFE
Individual Life
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.
Experts recommend at least
x 10 your gross annual income in coverage when purchasing life insurance.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 54 Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
Individual Life Life Insurance Highlights Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. Designed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually costs more and declines in death benefit.
DID YOU KNOW? Those with no life insurance think it’s 3 times more expensive than it actually is.
The policy, PureLife-plus, is underwritten by Texas Life Insurance Company, and it has these outstanding features:
High Death Benefit. With one of the highest death benefit available at the worksite,1 PureLife-plus gives your loved ones peace of mind, knowing there will be significant life insurance in force should you die prematurely.
Minimal Cash Value. Designed to provide high death benefit, PureLife-plus does not compete with the cash accumulation in your employer-sponsored retirement plans.
Long Guarantees. Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time (after the guaranteed period, premiums may go down, stay the same, or go up).
Refund of Premium. Unique in the marketplace, PureLifeplus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.)
Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.)
You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, minor children and grandchildren. Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details. 1
Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 2008 55
NBS
FSA (Flexible Spending Account)
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit A Cafeteria Plan is designed to take advantage of Section 125 of the Internal Revenue Code. It allows you to pay certain qualified expenses on a pre-tax basis, thereby reducing your taxable income. You can set aside a pre-established amount of money per plan year in a Healthcare Flexible Spending Account (FSA). Funds allocated to a healthcare FSA must be used during the plan year or are forfeited unless your plan contains a $500 rollover or grace period provision.
Unlimited FSA (Non HSA Compatible) The funds in the unlimited healthcare FSA can be used to pay for eligible medical expenses like deductibles, co-payments, orthodontics, glasses and contacts.
FLIP TO‌ PG. 11 FOR HSA VS. FSA COMPARISON
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 56 Brownfield ISD Benefits Website: www.mybenefitshub.com/brownfieldisd
FSA (Flexible Spending Account) NBS Flexcard
When Will I Receive My Flex Card?
You may use the card to pay merchants or service providers that accept MasterCard® credit cards, so there is no need to pay cash up front, then wait for reimbursement. If you are participating in the Dependent Care portion, the money isn’t loaded to the card. You must file web or paper claims or enroll in continual reimbursement.
NBS Prepaid MasterCard® Debit Card
Current plan participants: KEEP YOUR CARDS! NBS debit cards are good for 3 years. If you throw away your cards, there is a $5.00 fee to replace them.
Expect Flex Cards to be delivered to the address listed in THEbenefitsHUB near the end of September. Don’t forget, Flex Cards Are Good For 3 Years!
For a list of sample expenses, please refer to the Brownfield ISD benefit website: www.mybenefitshub.com/brownfieldisd
NBS Contact Information: 8523 South Redwood Road West Jordan, UT 84088 Phone (800) 274‐0503 Fax (800) 478‐1528 Email: claims@nbsbenefits.com
New Plan Participants NBS will mail out your new benefit cards to the address listed in THEbenefitsHUB. They will be sent in unmarked envelopes so please watch for them as they should arrive within 21 business days of effective date. NBS debit cards are good for 3 years.
FSA Annual Contribution Max:
DID YOU KNOW? FSAs use tax-free funds to help pay for your Health Care Expenses.
$2,600
Dependent Care Annual Max: $5,000
Account Information: Participant Account Web Access: www.participant.nbsbenefits.com Participants may call NBS and talk to a representative during regular business hours, Monday-Friday, 8 am to 7 pm Central Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to the NBS website: www.NBSbenefits.com
Detailed claim history and processing status Health Care and Dependent Care account balances Claim forms, Direct Deposit form, worksheets, etc. Online claim FAQs 57
FSA Frequently Asked Questions What is a Flexible Spending Account? A Flexible Spending Account allows you to save money by paying out-of-pocket health and/or dependent care related expenses with pre-tax dollars. Your contributions are deducted from your pay before taxes are withheld and your account is up fronted with an annual amount. Because you are taxed on a lower amount of pay, you pay less in taxes and you have more to spend.
How does a Flexible Spending Account Benefit Me? A Cafeteria plan enables you to save money on group insurance, health-related expenses, and dependent-care expenses. You may save as much as 35 percent on the cost of each benefit option! Eligible expenses must be incurred within the plan year and contributions are use-it-or- lose-it. Remember to retain all your receipts.
Health Care Expense Account Example Expenses:
Acupuncture Body scans Breast pumps Chiropractor Co-payments Deductible Diabetes Maintenance Eye Exam & Glasses Fertility treatment First aid
Hearing aids & batteries Lab fees Laser Surgery Orthodontia Expenses Physical exams Pregnancy tests Prescription drugs Vaccinations Vaporizers or humidifiers
Dependent Care Expense Account Example Expenses:
Before and After School and/or Extended Day Programs The actual care of the dependent in your home. Preschool tuition. The base costs for day camps or similar programs used as care for a qualifying individual.
What Can I Use My Flexible Spending Account On? For a full list of eligible expenses, please refer to www.mybenefitshub.com/brownfieldisd
58
What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)? Eligible expenses must be incurred within the plan year +75 day grace period. Contributions are use-it-or- lose-it. Remember to retain all your receipts (including receipts for card swipes).
How Do I File A Claim? In most situations, you will be able to swipe your card however, in the event you lose your card or are waiting to receive one, you can visit www.mybenefitshub.com/ brownfieldisd and complete the “Claim Form” to send to NBS or use the web or phone app to file online.
How To Receive Your Dependent Care Reimbursement Faster. A Direct Deposit form is available on the Benefits Website which will help you get reimbursed quicker!
How the FSA Plan Works You designate an annual election of pre-tax dollars to be deposited into your health and dependent-care spending accounts. Your total election is divided by the number of pay periods in the Plan year and deducted equally from each paycheck before taxes are calculated. By the end of the Plan year, your total election will be fully deposited. However, you may make a claim for eligible health FSA expenses as soon as they are incurred during the Plan year. Eligible claims will be paid up to your total annual election even if you have not yet contributed that amount to your account.
Get Your Money 1. 2. 3. 4.
Complete and sign a claim form (available on our website) or an online claim. Attach documentation; such as an itemized bill or an Explanation of Benefits (EOB) statement from a health insurance provider. Fax or mail signed form and documentation to NBS. Receive your non-taxable reimbursement after your claim is processed either by check or direct deposit.
NBS Flexcard—FSA Pre-paid Benefit Card Your employer may sponsor the use of the NBS Flexcard, making access to your flex dollars easier than ever. You may use the card to pay merchants or service providers that accept credit cards, so there is no need to pay cash up front then wait for reimbursement.
Account Information Participants may call NBS and talk to a representative during our regular business hours, Monday–Friday, 7am to 6pm Mountain Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to our website: www.NBSbenefits.com Information includes: Detailed claim history and processing status Health Care and Dependent Care account balances Claim forms, worksheets, etc. Online Claim Submission
Enrollment Considerations After the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying “change of status” (marriage status, employment change, dependent change). Be conservative in the total amount you elect to avoid forfeiting money that may be left in your account at the end of the year. Your employer may allow a short grace period after the Plan year ends for you to submit qualified claims for any unused funds.
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