FARMERSVILLE ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2017 - 8/31/2018 WWW.MYBENEFITSHUB.COM/ FARMERSVILLEISD
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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 Scott & White HMO HSA Bank Health Savings Account (HSA) NBS Flexible Spending Account (FSA) Lincoln Financial Dental Superior Vision UNUM Disability Loyal American Cancer 5Star Term Life and AD&D 5Star Family Protection Plan Term Life Insurance with Quality of Life Rider
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FLIP TO...
PG. 4 HOW TO HOW TO ENROLL ENROLL
11 12-17 18-21 22-25 26-29 30-31 32-35 36-39 40-43 44-47
PG. 6 SUMMARY PAGES
PG. 12 YOUR BENEFITS
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Benefit Contact Information
Benefit Contact Information FARMERSVILLE ISD BENEFITS
HEALTH SAVINGS ACCOUNT
DISABILITY
Financial Benefit Services (469) 385-4685 www.mybenefitshub.com/farmersvilleisd
HSA Bank (800) 357-6246 www.hsabank.com
Policy # 147161 UNUM (800) 583-6908 File a claim: (800) 848-6843 www.unum.com
FARMERSVILLE ISD BENEFITS OFFICE
FLEXIBLE SPENDING ACCOUNT
CANCER
Doris Dillon (972) 782-6601 ddillon@farmersvilleisd.net
National Benefit Services (800) 274-0503 www.nbsbenefits.com
Group# LY0311 Loyal American (800) 366-8354
TRS ACTIVECARE MEDICAL
DENTAL
LIFE AND AD&D
Aetna (800) 222-9205 www.trsactivecareaetna.com
Group# 00001D030566 Reference ID: FARMERSISD Lincoln Financial (800) 423-2765 www.lfg.com
Group# M00009 5Star Life Insurance Company (800) 776-2322 www.5starima.com
TRS HMO MEDICAL
VISION
FAMILY PROTECTION PLAN
Baylor Scott & White (800) 321-7947 www.trs.swhp.org
Group# 28342 Superior Vision (800) 507-3800 www.superiorvision.com
5Star Life Insurance Company (866) 863-9753 www.5starlifeinsurance.com
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MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS FISD” 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 FISD” to 313131 OR SCAN
How to Log In
1 BENEFIT INFO
INTERACTIVE TOOLS
2 3
www.mybenefitshub.com/ farmersvilleisd
CLICK LOGIN
ENTER USERNAME & PASSWORD All login credentials have been RESET to the default described below:
Username: The first six (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.
ONLIINE SUPPORT
If you have less than six (6) characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.
Default Password: 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:
Benefit elections will become effective 9/1/2017 (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).
Due to the ACA, you MUST login to www.mybenefitshub.com/ farmersvilleisd in August 2017 & either waive or elect medical insurance by 8/20/17!
Important! Scott and White HMO Plan is available for all employees working or residing in Dallas, Ellis, Denton, Collin, Rockwall and Tarrant counties. Aetna remains the carrier for TRS ActiveCare Medical Plans: ActiveCare 1 HD, ActiveCare 2 and ActiveCare Select. All eligible employees, including active, contributing TRS members and employees regularly working 10 hours per week MUST either enroll for coverage or decline coverage in the Benefits HUB. For comprehensive TRS medical information, please visit the TRS website, www.trs.state.tx.us
Guarantee Issue!!- Individual Life Family Protection plan with a Quality of Life Rider by 5Star. For one more year only, this individual life policy is guarantee issue. This means you may elect coverage up to a certain amount without answering health questions for yourself and your spouse!!
Disability Insurance is offered on a Guarantee Issue (GI) basis through UNUM. No Evidence of Insurability forms are required. All new amounts of coverage are subject to preexisting condition limitations. See Plan summary for specific information
UPDATE! If you currently participate in a Health Care or Dependent Care FSA, you MUST re-elect a new contribution amount every year to continue to participate. This benefit does not roll over. The 2017 FSA contribution limit has increased to $2,600. If you are electing this benefit for the first time, you will receive your debit card by mid-September. You can manually submit claims prior to receiving your cards.
Don’t Forget!
Login and complete your benefit enrollment from 8/1/2017—8/20/2017
Update your profile information: home address, phone numbers, email.
Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5204 to speak to a representative.
Bilingual assistance is available by calling this number. 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 STATUS (CIS): Marital Status
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 31 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.
QUALIFYING EVENTS A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for adoption. Change in Number of Tax You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a Dependents 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 Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Programs
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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:
annual enrollment) unless a Section 125 qualifying event occurs.
www.mybenefitshub.com/farmersvilleisd. Click on the benefit plan you need information on (i.e., Dental) and you can find
Changes, additions or drops may be made only during the
the forms you need under 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
district’s benefit website:
included in the dependent profile. Additionally, you must
www.mybenefitshub.com/farmersvilleisd. Click on the benefit
notify your employer of any discrepancy in personal and/or benefit information.
For benefit summaries and claim forms, go to your school
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 the Farmersville ISD or as
capable of performing the functions of your job on the first day of
both 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
Medical
Aetna
To Age 26
Medical
Baylor Scott & White
To Age 26
Dental
Lincoln Financial
To Age 26
Vision
Superior Vision
To Age 26
Cancer
Loyal American
To Age 25
Child(ren) Life
5Star
To Age 21 or to Age 25 if full time student
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.
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SUMMARY PAGES
Helpful Definitions 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. 18
FLIP TO FOR FSA INFORMATION
PG. 22
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AETNA / SCOTT & WHITE
Medical
About this Benefit
YOUR BENEFITS PACKAGE
DID YOU KNOW?
Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis. More than 70% of adults across the United States are already being diagnosed with a chronic disease.
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 12 Farmersville ISD Benefits Website: www.mybenefitshub.com/farmersvilleisd
Farmersville ISD Plan Year September 1, 2017—August 31, 2018 2017—2018 TRS Medical Rates
TRS Monthly Premium
Farmersville ISD Contribution
Monthly Premium
Employee Only
$351.00
$225.00
$126.00
Employee + Spouse
$991.00
$225.00
$766.00
Employee + Child(ren)
$671.00
$225.00
$446.00
$1,316.00
$225.00
$1,091.00
TRS Monthly Premium
Farmersville ISD Contribution
Monthly Premium
$514.00
$225.00
$289.00
$1,264.00
$225.00
$1,039.00
$834.00
$225.00
$609.00
$1,589.00
$225.00
$1,364.00
TRS Monthly Premium
Farmersville ISD Contribution
Monthly Premium
$714.00
$225.00
$489.00
Employee + Spouse
$1,694.00
$225.00
$1,469.00
Employee + Child(ren)
$1,062.00
$225.00
$837.00
Employee + Family
$2,004.00
$225.00
$1,779.00
TRS Monthly Premium
Farmersville ISD Contribution
Monthly Premium
$561.04
$225.00
$336.04
$1,263.08
$225.00
$1038.08
$888.42
$225.00
$663.42
$1,400.98
$225.00
$1,175.98
TRS-ActiveCare Plan 1-HD
Employee + Family
TRS-ActiveCare Plan Select Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
TRS-ActiveCare Plan 2 Employee Only
Scott & White HMO Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
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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 Smoking cessation counseling– 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 •Healthy diet/obesity counseling– unlimited to
• Well - woman exam & pap smear – annually age 18 and over • Prostate cancer 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. 15 ****Participants can fill 32-day to 90-day supply through mail order.
2017-2018 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare 2017 - 2018 Rates
Fully Covered Health Care Services
Employee
$516.00
No Charge
Employee & Spouse
$1263.08
Disease Management and Complex Case Management
No Charge
Employee & Child (ren)
$888.42
Well Child Care Annual Exams
No Charge
Employee & Family
$1400.98
Immunizations (age appropriate)
No Charge
Preventive Services
No Charge
Standard Lab and X-ray
Plan Provisions Annual Deductible Annual out-of-pocket maximum (including medical and prescription co-pays and coinsurance)
Lifetime Paid Benefit Maximum
$1,000 Individual/ $3,000 Family $6,550 Individual/ $13,100 Family (includes combined Medical and Rx copays, deductibles and coinsurance)
None
Outpatient Services Primary Care1 Specialty Care
$20 co-pay (First Primary Care Visit for Illness $0 Copay2)
$50 co-pay
Other Outpatient Services
20% after deductible3
Diagnostic/Radiology Procedures
20% after deductible
Eye Exam (one annually) Allergy Serum & Injections Outpatient Surgery
No Charge 20% after deductible $150 co-pay and 20% of charges after deductible
Maternity Care Prenatal Care Inpatient Delivery
No Charge $150 per day4 and 20% of charges after deductible
Inpatient Services Overnight hospital stay: includes all medical services including semi-private room or intensive care
$150 per day4 and 20% of charges after deductible
Diagnostic & Therapeutic Services Physical and Speech Therapy Manipulative Therapy5
$50 copay 20% without office visit $40 plus 20% with office visit
Equipment and Supplies Preferred Diabetic Supplies and Equipment Non-Preferred Diabetic Supplies and Equipment Durable Medical Equipment/ Prosthetics 16
$5/$10 copay; no deductible 30% after Rx deductible 20% after deductible
2017-2018 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare Home Health Services Home Health Care Visit
$50 co-pay
Worldwide Emergency Care Nurse Advice Line
1-877-505-7947
Online Services
No Charge — go to http://trs.swhp.org
After Hours Primary Care Clinics
$20 co-pay
Ambulance and Helicopter
$40 copay and 20% of charges after deductible
Emergency Room6
$150 copay and 20% of charges after deductible
Urgent Care Facility
$55 copay
Prescription Drugs Annual Benefit Maximum
Unlimited
Rx Deductible
$150
Does not apply to preferred generic drugs
Ask an SWHP Pharmacy representative how to save money on your prescriptions.
Maintenance Quantity
Retail Quantity (Up to a 30-day supply)
(Up to a 90-day supply) Only at BSW Pharmacies, including Mail Order
$5 copay
$10 copay
Preferred Brand7
30% after Rx deductible
30% after Rx deductible
Non-preferred
50% after Rx deductible
50% after Rx deductible
Non-formulary
Greater of $50 or 50% after Rx deductible
Not available
Preferred Generic7
trs.swhp.org
Online Refills
1-800-707-3477 or 1-855-388-3090
Mail Order
Specialty Medications (up to a 30-day supply) The SWHP MOMS Program provides you with specialized nurses who are notified of the delivery of your baby. These licensed professionals will contact you after you return home and help you with everything from the general well-being of both you and your baby, to breast/bottle feeding, to information on how to add your baby to your health plan.
20% after Rx deductible 1
Including all services billed with office visit Does not apply to wellness or preventive visits 3 Includes other services, treatments, or procedures received at time of office visit 4 $750 maximum copay per admission and 20% after deductible 5 5 visits max per month, 35 max visits per year 6 Copay waived if admitted within 24 hours 7 If a brand name drug is dispensed when a generic is available, 50% copay applies 2
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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 18 Farmersville ISD Benefits Website: www.mybenefitshub.com/farmersvilleisd
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 participate in the FSA plan if you participate in the HSA plan. Medicare, Medicaid, and Tricare participants are not eligible to participate in an HSA.
prorated) Authorized Signers who are 55 or older must have their own HSA in order to make the catch-up contribution
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.
Examples of Qualified Medical Expenses
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.
Monthly Fee: Your account will be charged a monthly fee of $1.75, waived with an average daily balance at or above $3,000.
Surgery Braces Contact lenses Dentures Eyeglasses Vaccines
For a list of sample expenses, please refer to your benefits website at: www.mybenefitshub.com/farmersvilleisd
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 19
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. 20
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). 21
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 22 Farmersville ISD Benefits Website: www.mybenefitshub.com/farmersvilleisd
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.
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 Farmersville ISD benefit website: www.mybenefitshub.com/farmersvilleisd
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.
DID YOU KNOW?
FSA Annual Contribution Max:
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
23
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. 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/farmersvilleisd
24
What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)? You may rollover up to $500 of unused funds. 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/ farmersvilleisd 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.
25
LINCOLN FINANCIAL
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 Farmersville ISD Benefits Website: www.mybenefitshub.com/farmersvilleisd
Dental  
While you may choose any dentist, using dentists participating in the network should lower your out-of-pocket expenses. A list of in network dentists may be accessed at www.LincolnFinancial.com. You do not need a referral to see a specialist. For dental expenses incurred after satisfying the all benefit waiting period(s) and deductibles, the policy pays the following percentage of allowable expenses up to the maximum benefit.
Monthly Rates EE Only
$35.97
EE + Spouse
$74.06
EE + Child(ren)
$77.24
EE + Family
$111.10
Contracting Dentist
Non-Contracting Dentist
Preventive
Routine Oral Exams Bitewing X-rays Full-mouth or Panoramic X-rays Routine Cleanings Fluoride Treatments Sealants Palliative Treatment (including emergency relief of dental pain)
100%
100%
Basic
Other Dental X-rays (including periapical films) Space Maintainers for children Problem Focused Exams Consultations Injections of antibiotics and other therapeutic medications Fillings Prefabricated Stainless Steel and Resin Crowns Simple Extractions Biopsy and Examination of Oral Tissue (including brush biopsy) General Anesthesia and I.V. Sedation Prosthetic Repair and Recementation Services Periodontal Maintenance procedures
80%
80%
Major
Surgical Extractions Oral Surgery Endodontics (including Root Canal Treatment) Non-surgical Periodontal Therapy Periodontal Surgery Bridges Full and Partial Dentures Denture Reline and Rebase Services Crowns, Inlays, Onlays and related services Implants & Implant Related Services
50%
50%
Orthodontics
Orthodontic Treatment- Including Orthodontic Exams, X-rays, Extractions, Study Models and Appliances
50%
50%
$50 Individual $150 Family
$50 Individual $150 Family
Dental Benefits
Deductible
Calendar Year (Annual) deductible. Waived for : In Network - Preventive and Out of Network Preventive
Maximum Benefit
Calendar year maximum for Preventive, Basic, and Major services:
$1,000
$1,000
Ortho Maximum
Lifetime Ortho Maximum for Family:
$1,000
$1,000
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Dental Dental Benefits Cont'd. Waiting Period
Prior Carrier Credit Lincoln DentalConnect® Predetermination of Benefits
Service Type Benefit Waiting Period Late Entrant Waiting Period Basic Services: 0 Months 12 Months Major Services: 0 Months 12 Months Orthodontics: 0 Months 12 Months For Employees and dependents who elect this coverage on the effective date, and whose coverage was active on the date the employer’s prior dental plan terminated: credit, will be given toward the satisfaction of: benefit waiting periods By enrolling in the dental plan you and your enrolled family members will have access to Lincoln DentalConnect®, our free on-line dental health information Web site. Allows you to find the amount covered prior to having a dental procedure. We recommend that you use this service when expenses are expected to exceed $300.
Enrolling for Coverage If you do not want to enroll at this time, submit the completed waiver form to your plan administrator. If you waive coverage now and want to enroll at a later date, you will be subject to the plan’s Late Entrant provision which may limit covered services and Prior Carrier Credit will not be available.
Employee Dependent Benefit Termination
Unmarried dependent children may be covered to age 25 regardless of Student Status This coverage terminates when you terminate employment with this policyholder, or at your retirement.
Exclusions and Other Limitations This highlights policy exclusions and limitations, see the policy for a full list. The plan does not cover services started before coverage begins or after it ends. Benefits are limited to those appropriate and necessary procedures listed in the policy and any additional procedures required by state law. Benefits are not payable for duplication of services. Covered expenses will not exceed the policy’s usual and customary allowances. Plan benefits are not payable for a condition for which the claimant is eligible for benefits under worker’s compensation or a similar law; are attributed to employment, military service; or are related to self-inflicted injury, involvement in an illegal occupation, felony, or riot. If benefits for orthodontia are included, the plan does not cover any treatment plan started before coverage begins or during the benefit waiting period unless the member was receiving orthodontia benefits from this employer’s previous group dental policy. In that case, Lincoln Financial will continue orthodontia benefits until the combined benefit paid by the two policies is equal to this policy’s lifetime orthodontia. Plan benefits are not payable if the orthodontic appliance was installed after the age of 19. Alternative benefits provision: In certain situations there may be more methods of treating a dental condition. Your policy includes an alternative benefits provision that may reduce benefits to the lowest cost, generally effective and necessary form of treatment.
For assistance or additional information Contact Lincoln Financial Group at (800) 423-2765; reference ID: FARMERSISD
28
www.LincolnFinancial.com
Lincoln Dental Plan Hearing Services Have you heard? New services from Lincoln will be music to your ears. Now if you have a Lincoln PPO or Indemnity dental plan, you get to pump up the volume on your existing coverage with valuable services for hearing. The EPIC Hearing Service Plan (HSP) is a program dedicated to providing quality hearing care and hearing aids—and since it’s added to plans you already have, it comes at no additional cost to you.
Features to make some noise about The EPIC Hearing Service Plan takes a consistent and inclusive approach to hearing health—for you, your dependents and your extended family—by providing valuable services and discounts to help you with your hearing needs. With the EPIC HSP, a network of more than 4,400 credentialed professionals provides comprehensive services. And you have access to the most advanced hearing aid technology manufactured today, along with a variety of other useful features for maintaining your hearing:
Services for hearing tests and hearing aids provided at a negotiated fee, saving you money 20% to 50% savings on name brand hearing aids Audiogram provided at no cost (retail value of $70 to $125) if results indicate hearing aids are needed and purchased through the EPIC HSP One-year supply of batteries provided with purchase of a hearing aid, plus a battery fulfillment program with 35% lower cost than retail stores
A sound choice It’s not just about the savings. The EPIC HSP advocates the value of incorporating hearing services into your health habits. With the addition of this value-added service, you’ve got yourself a new option for keeping yourself and your family hearing loud and clear. Contact EPIC Hearing Services at 888-899-1459 for more information. You’ll like what you hear.
Insurance products (policy series GL11, GL11LG) are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit business in New York, nor is it licensed to do so. In New York, insurance products (policy series GL11) are issued by Lincoln Life & Annuity Company of New York (Syracuse, NY). Both are Lincoln Financial Group® companies. Product availability and/or features may vary by state. Limitations and exclusions apply. Hearing services are provided by EPIC Hearing Health Care. EPIC Hearing Health Care is not a Lincoln Financial Group® company. Coverage is subject to actual contract language. Each independent company is solely responsible for its own obligations. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations.
29
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 30 Farmersville ISD Benefits Website: www.mybenefitshub.com/farmersvilleisd
Vision Benefits
In-Network
Out-of-Network
Exam (ophthalmologist)
Covered in full
Up to $42 retail
Exam (optometrist)
Covered in full
Up to $37 retail
Frames
$100 retail allowance
Up to $48 retail
Contact Lenses2
$120 retail allowance Up to $100 retail
Monthly Premiums
Lenses (standard) per pair Covered in full
Up to $32 retail
Bifocal
Covered in full
Up to $46 retail
Trifocal
Covered in full
Up to $61 retail
See description3
Up to $61 retail
Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements.
EE + Spouse
$16.33
EE + Child(ren)
$15.98
EE + Family
$24.34
Discounts on Covered Materials5 20% off amount over allowance 20% off retail 20% off amount over retail lined trifocal lens, including lens options
The following options have out-of-pocket maximums on standard (not premium, brand, or progressive) plastic lenses.
Exam
$10
Materials₁
$25
Services/Frequency Exam
12 months
Frame
24 months
Contact Lens Fitting
12 months
Lenses
12 months
Contact Lenses
12 months
₁Materials co-pay applies to lenses & frames only, not contact lenses. 2Contact lenses are in lieu of eyeglass lenses and frames benefit. ₃Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay.
Frames: Lens options: Progressives:
$8.25
Co-Pays
Single Vision
Progressive lens upgrade
EE Only
Discounts on Non-Covered Exam and Materials5 Exams, frames, and prescription lenses: Lens options, contacts, other prescription materials: Disposable contact lenses: 5Discounts
30% off retail 20% off retail 10% off retail
and maximums may vary by lens type. Please check with your
provider. 5Discounts
and maximums may vary by lens type. Please check with your
provider.
Refractive Surgery Maximum Member Out-of-Pocket Scratch coat Ultraviolet coat Tints, solid or gradients Anti-reflective coat Polycarbonate High index 1.6 Photochromics
Single Vision $13 $15 $25 $50 $40 $55 $80
Bifocal & Trifocal $13 $15 $25 $50 20% off retail 20% off retail 20% off retail
Superior Vision has a nationwide network of refractive surgeons and leading LASIK networks who offer members a discount. These discounts range from 15%-50%, and are the best possible discounts available to Superior Vision. The Plan discount features are not insurance. All allowances are retail; member is responsible for any amount over the allowance, minus available discounts. 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.
31
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 32 Farmersville ISD Benefits Website: www.mybenefitshub.com/farmersvilleisd
Disability Policy # 147161
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. Employees hired on or after the plan effective date: 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. 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 $7,500. Please see your Plan Administrator for the definition of monthly earnings.
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
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.
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. You may choose an Elimination Period (injury/sickness) of 0/7, 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.)
33
Disability FARMERSVILLE 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 Protection Plan
Injury - ADEAII Duration of Benefits 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 7740034 6450 4300
0* 7*
14* 14*
30* 30*
60 60
90 90
180 180
9.02 13.53 18.04 22.55 27.06 31.57 36.08 40.59 45.10 49.61 54.12 58.63 63.14 67.65 72.16 76.67 81.18 85.69 90.20 94.71 99.22 103.73 108.24 112.75 117.26 121.77 126.28 130.79 135.30 139.81 144.32 148.83 153.34 157.85 162.36 166.87 171.38 175.89 180.40 184.91 189.42 193.93
7.20 10.80 14.40 18.00 21.60 25.20 28.80 32.40 36.00 39.60 43.20 46.80 50.40 54.00 57.60 61.20 64.80 68.40 72.00 75.60 79.20 82.80 86.40 90.00 93.60 97.20 100.80 104.40 108.00 111.60 115.20 118.80 122.40 126.00 129.60 133.20 136.80 140.40 144.00 147.60 151.20 154.80
5.94 8.91 11.88 14.85 17.82 20.79 23.76 26.73 29.70 32.67 35.64 38.61 41.58 44.55 47.52 50.49 53.46 56.43 59.40 62.37 65.34 68.31 71.28 74.25 77.22 80.19 83.16 86.13 89.10 92.07 95.04 98.01 100.98 103.95 106.92 109.89 112.86 115.83 118.80 121.77 124.74 127.71
4.06 6.09 8.12 10.15 12.18 14.21 16.24 18.27 20.30 22.33 24.36 26.39 28.42 30.45 32.48 34.51 36.54 38.57 40.60 42.63 44.66 46.69 48.72 50.75 52.78 54.81 56.84 58.87 60.90 62.93 64.96 66.99 69.02 71.05 73.08 75.11 77.14 79.17 81.20 83.23 85.26 87.29
3.52 5.28 7.04 8.80 10.56 12.32 14.08 15.84 17.60 19.36 21.12 22.88 24.64 26.40 28.16 29.92 31.68 33.44 35.20 36.96 38.72 40.48 42.24 44.00 45.76 47.52 49.28 51.04 52.80 54.56 56.32 58.08 59.84 61.60 63.36 65.12 66.88 68.64 70.40 72.16 73.92 75.68
2.72 4.08 5.44 6.80 8.16 9.52 10.88 12.24 13.60 14.96 16.32 17.68 19.04 20.40 21.76 23.12 24.48 25.84 27.20 28.56 29.92 31.28 32.64 34.00 35.36 36.72 38.08 39.44 40.80 42.16 43.52 44.88 46.24 47.60 48.96 50.32 51.68 53.04 54.40 55.76 57.12 58.48
Disability FARMERSVILLE 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: Injury - ADEAII Duration of Benefits Educator Select Income Sickness - 5YR Duration of Benefits Protection Plan Elimination Period (Days) Injury (Days) Sickness (Days) Maximum Annual Monthly Monthly Earnings Earnings Benefit 79200 6600 4400 81000 6750 4500 82800 6900 4600 84600 7050 4700 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
0* 7*
14* 14*
30* 30*
60 60
90 90
180 180
198.44 202.95 207.46 211.97 216.48 220.99 225.50 230.01 234.52 239.03 243.54 248.05 252.56 257.07 261.58 266.09 270.60 275.11 279.62 284.13 288.64 293.15 297.66 302.17 306.68 311.19 315.70 320.21 324.72 329.23 333.74 338.25
158.40 162.00 165.60 169.20 172.80 176.40 180.00 183.60 187.20 190.80 194.40 198.00 201.60 205.20 208.80 212.40 216.00 219.60 223.20 226.80 230.40 234.00 237.60 241.20 244.80 248.40 252.00 255.60 259.20 262.80 266.40 270.00
130.68 133.65 136.62 139.59 142.56 145.53 148.50 151.47 154.44 157.41 160.38 163.35 166.32 169.29 172.26 175.23 178.20 181.17 184.14 187.11 190.08 193.05 196.02 198.99 201.96 204.93 207.90 210.87 213.84 216.81 219.78 222.75
89.32 91.35 93.38 95.41 97.44 99.47 101.50 103.53 105.56 107.59 109.62 111.65 113.68 115.71 117.74 119.77 121.80 123.83 125.86 127.89 129.92 131.95 133.98 136.01 138.04 140.07 142.10 144.13 146.16 148.19 150.22 152.25
77.44 79.20 80.96 82.72 84.48 86.24 88.00 89.76 91.52 93.28 95.04 96.80 98.56 100.32 102.08 103.84 105.60 107.36 109.12 110.88 112.64 114.40 116.16 117.92 119.68 121.44 123.20 124.96 126.72 128.48 130.24 132.00
59.84 61.20 62.56 63.92 65.28 66.64 68.00 69.36 70.72 72.08 73.44 74.80 76.16 77.52 78.88 80.24 81.60 82.96 84.32 85.68 87.04 88.40 89.76 91.12 92.48 93.84 95.20 96.56 97.92 99.28 100.64 102.00
35
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 36 Farmersville ISD Benefits Website: www.mybenefitshub.com/farmersvilleisd
Cancer ADDITIONAL BENEFIT AMOUNTS
Maximum
ANNUAL CANCER SCREENING BENEFIT RIDER (form LG-6041) A. Basic Benefit We will pay the Actual Charge, 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 exists in an Insured Person. Covered annual Cancer screening tests include but are not limited to: mammogram, pap 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 Actual Charge, 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) If an Insured Person receives a positive diagnosis of Internal Cancer, We will pay the First Occurrence benefit amount shown on the Certificate Schedule. If the Insured Person receiving the positive diagnosis of Internal Cancer is a child under the age of 21, we will pay one and one-half times the First Occurrence benefit amount shown on the Certificate Schedule.
$50 Per Calendar Year
$100 Per Calendar Year
$2,000 Once per Lifetime $3,000 Once per Lifetime
DAILY RADIATION, CHEMOTHERAPY, IMMUNOTHERAPY and EXPERIMENTAL TREATMENT BENEFIT RIDER (form LG6046) We will pay the Actual Charge, but not to exceed the maximum benefit amount shown on the Certificate Schedule for each day that an Insured Person receives one or more of the following treatments for Cancer: (1) Chemotherapy (including Hormonal Therapy) or Immunotherapy; (2) Self-injected Chemotherapy or Immunotherapy drugs, limited to the maximum daily benefit amount per treatment; (3) Chemotherapy or Immunotherapy drugs dispensed by a pump or implant, limited to the maximum daily benefit amount for the initial prescription and an equal amount for each refill; (4) Oral Chemotherapy or Immunotherapy, limited to the maximum daily benefit amount per prescription; (5) Radiation Treatment. Benefits payable for interstitial or intracavitary applications of Radiation Treatments are payable on the day of insertion only and not for each day the Radiation Treatment remains in the body; or (6) Experimental Treatment. The benefit amount shown on the Certificate Schedule is the maximum daily benefit available per Insured Person regardless of the number or types of Cancer treatments received on the same day.
$600 Per Daily Treatment
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.
$5,000 Procedure Maximum
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 25% of Surgical Benefit anesthesia.
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 the treatment of Breast Cancer. We will pay the expense incurred not to exceed $900 per $1,000 of the Surgical Benefit issued.
$4,500 Procedure Maximum
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.
$125-$750 Based on Procedure $200 Per Day
$400 Per Day
$400/ $800 Per Day 37
Cancer Additional Benefits Amounts SPECIFIED DISEASE BENEFIT RIDER (form LG-6052) Covers These 38 Specified Diseases - This is a Specified Disease Only Rider Addison’s Disease Lupus Erythematosus Rocky Mountain Spotted Fever Amyotrophic Lateral Sclerosis Malaria Sickle Cell Anemia Botulism Meningitis Tay-Sachs Disease Bovine Spongiform Encephalopathy Multiple Sclerosis Tetanus Budd-Chiari Syndrome Muscular Dystrophy Toxic Epidermal Necrolysis Cystic Fibrosis Myasthenia Gravis Tuberculosis Diptheria Neimann-Pick Disease Tularemia Encephalitis Osteomyelitis Typhoid Fever Epilepsy Poliomyelitis Undulant Fever Hansen’s Disease Q Fever West Nile Virus Histoplasmosis Rabies Whipple’s Disease Legionnaire’s Disease Reye’s Syndrome Whooping Cough Lyme Disease Rheumatic Fever
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.
38
Monthly Rates
Employee
Employee and Children
Employee and Family
Base Plan
$22.86
$27.95
$38.50
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
Base Plan with ICU
$27.51
$34.25
$47.30
39
5 STAR 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 40 Farmersville ISD Benefits Website: www.mybenefitshub.com/farmersvilleisd
Life and AD&D It may never be easier to add important coverage to your life insurance program—all you have to do is sign up now to receive a guaranteed amount of coverage without providing evidence of insurability (a completed health application and/or physical examination). This insurance is available to you at competitive group rates. And, you can buy this insurance through the convenience of automatic payroll deduction. By electing coverage during this initial enrollment period, you also protect your ability to buy additional insurance in the future. If your needs change due to marriage or divorce, adoption or birth of a child, death of a spouse, or a spouse’s termination of employment, you can add coverage (up to the Guarantee Issue Limit) to your plan without a health application and/or physical examination. If coverage is waived during the initial enrollment period, satisfactory evidence of insurability, including a completed health application will be required. A physical examination may also be required. Fortunately, you don’t have to die to discover you don’t have enough life insurance. Evaluate your life insurance needs today.
Employee
Spouse
Child
Minimum
$10,000
$5,000
$2,000
Maximum
7 times Annual Salary (up to) $250,000
50% of Employee Benefit (up to) $100,000
50% of Employee Benefit (up to) $10,000
Guarantee Issue Limit
7 times Annual Salary (up to) $150,000
50% of Employee Benefit (up to) $75,000
50% of Employee Benefit (up to) $10,000
Note: Securing coverage up to the guarantee issue limit amounts assumes at least 25% of eligible employees participate in the plan. Lower participation may cause guarantee issue amounts to be reduced, a rate adjustment, or benefit offer to be withdrawn from the group. Your Employer has selected the following features to be included in your plan. A complete description of each provision will be provided in a certificate booklet, which will be issued to you, should you decide to select Voluntary Term Life coverage.
Your plan includes the option to select Spouse and Dependent Children coverage. Dependent children include those 14 days old, up to age 21 (25 if a full-time student). Minimums, maximums and guarantee issue limits are listed above. To determine your cost, use the rate calculation worksheet provided in these materials.
Your Plan includes Continuation of Life Insurance Benefits Due to Total Disability. If you became totally and continuously disabled through the Disability Elimination Period, this feature will keep your life insurance policy in force – without payment of premium.
Your plan includes Portability. This feature allows you to continue this insurance program for you and your dependents should you leave your employer for any reason – without providing information about your health.
Your plan includes an Accelerated Death Benefit of up to 50% of your life benefit not to exceed a maximum of $50,000.
Benefits are reduced when the insured reaches age 70, and will continue to decrease every five years thereafter. (See the chart below.) Spouse coverage, if available, terminates at age 70. AGE 70 75 80 85 90
% PAYABLE 65% 45% 30% 20% 15% 41
Life and AD&D Employee <30 31 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80+ Employee
$10,000 0.60 0.70 0.90 1.30 2.10 3.60 5.60 8.60 15.50 27.90 45.90 64.20 $10,000
$20,000 1.20 1.40 1.80 2.60 4.20 7.20 11.20 17.20 31.00 55.80 91.80 128.40 $20,000
$30,000 1.80 2.10 2.70 3.90 6.30 10.80 16.80 25.80 46.50 83.70 137.70 192.60 $30,000
$40,000 2.40 2.80 3.60 5.20 8.40 14.40 22.40 34.40 62.00 111.60 183.60 256.80 $40,000
$50,000 3.00 3.50 4.50 6.50 10.50 18.00 28.00 43.00 77.50 139.50 229.50 321.00 $50,000
$60,000 3.60 4.20 5.40 7.80 12.60 21.60 33.60 51.60 93.00 167.40 275.40 385.20 $60,000
$70,000 4.20 4.90 6.30 9.10 14.70 25.20 39.20 60.20 108.50 195.30 321.30 449.40 $70,000
$80,000 4.80 5.60 7.20 10.40 16.80 28.80 44.80 68.80 124.00 223.20 367.20 513.60 $80,000
AD&D
0.30
0.60
0.90
1.20
1.50
1.80
2.10
2.40
$90,000 $100,000 5.40 6.00 6.30 7.00 8.10 9.00 11.70 13.00 18.90 21.00 32.40 36.00 50.40 56.00 77.40 86.00 139.50 155.00 251.10 279.00 413.10 459.00 577.80 642.00 $90,000 $100,000 2.70
3.00
Note: Spouse / Child coverage amounts cannot be more than 50% of the Employee coverage amounts selected. Spouse <30 31 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69
$5,000 0.30 0.35 0.45 0.65 1.05 1.80 2.80 4.30 7.75
$10,000 0.60 0.70 0.90 1.30 2.10 3.60 5.60 8.60 15.50
$15,000 0.90 1.05 1.35 1.95 3.15 5.40 8.40 12.90 23.25
$20,000 1.20 1.40 1.80 2.60 4.20 7.20 11.20 17.20 31.00
$25,000 1.50 1.75 2.25 3.25 5.25 9.00 14.00 21.50 38.75
$30,000 1.80 2.10 2.70 3.90 6.30 10.80 16.80 25.80 46.50
$35,000 2.10 2.45 3.15 4.55 7.35 12.60 19.60 30.10 54.25
$40,000 2.40 2.80 3.60 5.20 8.40 14.40 22.40 34.40 62.00
$45,000 2.70 3.15 4.05 5.85 9.45 16.20 25.20 38.70 69.75
$50,000 3.00 3.50 4.50 6.50 10.50 18.00 28.00 43.00 77.50
Note: Spouse / Child coverage amounts cannot be more than 50% of the Employee coverage amounts selected. Child Per Child
42
$1,000 0.10
$2,000 0.20
$3,000 0.30
$4,000 0.40
$5,000 0.50
$6,000 0.60
$7,000 0.70
$8,000 0.80
$9,000 0.90
$10,000 1.00
Life and AD&D Voluntary Term Life Rate Worksheet To calculate monthly premium: 1. Locate the amount of coverage you wish to select along the top row of the Employee table. Then locate your age bracket along the left column of the table. Your monthly premium is the amount located where the row and column you have identified meet (down from top row and right from left column). If the amount you wish to select is greater than $100,000, select one of the top row numbers that when multiplied by another number, results in your desired life amount (e.g. - selecting the rate for $150,000 can be obtained by multiplying the appropriate rate for $50,000 times 3). Enter the employee rate in the space provided below. 2. Follow the same method to determine your spouse rate. Use the Spouse table (below the Employee table). Enter the spouse rate in the space provided below. 3. Follow the same method to determine your child rate. Use the Child table (below the Spouse table). Make sure you multiply the child rate by the number of children to be covered. Enter the Child rate in the space provided below. 4. Total the Employee, Spouse (if any) and Child (if any) rates to obtain your Total Monthly Premium.
_______________________ + _______________________ + _______________________ = _______________________ Employee Premium Spouse Premium Child(ren) Premium* Total Monthly Premium (*child rate x no. of children)
43
5 STAR 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 44 Farmersville ISD Benefits Website: www.mybenefitshub.com/farmersvilleisd
Individual Life with Terminal Illness and Quality of Life Rider The Family Protection Plan: Individual Life Insurance with Terminal Illness Coverage to Age 100 With the Family Protection Plan (FPP), you can provide financial stability for your loved ones should something happen to you. You have peace of mind that you are covered up to age 100.* No matter what the future brings, you and your family will be protected. If faced with a chronic medical condition that required continuous care, would you be able to protect yourself? Traditionally, expenses associated with treatment and care necessitated by a chronic injury or illness have accounted for 86% of all health care spending and can place strain on your assets when you need them most. To provide protection during this time of need, 5Star Life Insurance Company (5Star Life) is pleased to offer the Quality of Life Rider, which is included with your FPP life insurance coverage. This rider accelerates a portion of the death benefit on a monthly basis—4% each month as scheduled by your employer at the group level, and payable directly to you on a tax favored basis. You can receive up to 75% of the current face amount of the life benefit, following a diagnosis of either a chronic illness or cognitive impairment that requires substantial assistance. Benefits are paid for the following: Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance, or A permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility requiring substantial supervision. Example
Weekly Premium
Death Benefit
Accelerated Benefit
Your age at issue: 35
$10.00
$89,655
4% $3,586.20 a month
Affordability—With several options to choose from, select the coverage that best meets the needs of your family. Terminal Illness—This plan pays the insured 30% (25% in Connecticut and Michigan) of the policy coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months. Portability—You and your family continue coverage with no loss of benefits or increase in cost should you terminate employment after the first premium is paid. If this happens, we can simply bill you directly. Coverage can never be cancelled by the insurance company or your employer unless you stop paying premiums. Family Protection—Individual policies can be purchased on the employee, their spouse, children and grandchildren. Children & Grandchildren Plan—Policies can be purchased for children and grandchildren ages 15 days to age 24. Convenience—Premiums are taken care of simply and easily through payroll deductions. Protection You Can Count On—Within 24 hours after receiving notice of an insured’s death, an emergency death benefit of the lesser of 50% of the coverage amount, or $10,000, will be mailed to the insured’s beneficiary, unless the death is within the two-year contestability period and/or under investigation. This product also contains no war or terrorism exclusions.
For example, in case of chronic illness, you would receive $3,586 each month up to $67,241.25. The remainder death benefit of $22,413.75 would be made payable to your beneficiary.
* Life insurance product underwritten by 5Star Life Insurance Company (a Baton Rouge, Louisiana company). Product may not be available in all states or territories. Request FPP insurance from Dell Perot, Post Office Box 83043, Lincoln, Nebraska 68501, (866) 863-9753.
45
Term Life with Terminal Illness and Quality of Life Rider
Age on App. Date 18-25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 46
$10,000 $7.56 $7.58 $7.65 $7.74 $7.88 $8.07 $8.27 $8.49 $8.73 $9.00 $9.30 $9.64 $10.02 $10.41 $10.84 $11.31 $11.83 $12.41 $13.00 $13.63 $14.28 $14.97 $15.69 $16.43 $17.22 $18.08 $19.04 $20.16 $21.40 $22.79 $24.27 $25.93 $27.66 $29.42 $31.23 $33.12 $35.08 $37.13 $39.31 $41.68 $44.33
MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT Employee Coverage Amounts Spouse Coverage Amounts $25,000 $50,000 $75,000 $100,000 $10,000 $20,000 $30,000 $12.40 $20.46 $28.52 $36.58 $7.56 $10.78 $14.01 $12.46 $20.58 $28.71 $36.83 $7.58 $10.83 $14.08 $12.63 $20.92 $29.21 $37.50 $7.65 $10.97 $14.28 $12.85 $21.38 $29.90 $38.42 $7.74 $11.15 $14.56 $13.21 $22.08 $30.96 $39.83 $7.88 $11.43 $14.98 $13.67 $23.00 $32.33 $41.67 $8.07 $11.80 $15.53 $14.17 $24.00 $33.83 $43.67 $8.27 $12.20 $16.13 $14.73 $25.13 $35.52 $45.92 $8.49 $12.65 $16.81 $15.31 $26.29 $37.27 $48.25 $8.73 $13.12 $17.51 $16.00 $27.67 $39.33 $51.00 $9.00 $13.67 $18.33 $16.75 $29.17 $41.58 $54.00 $9.30 $14.27 $19.23 $17.60 $30.88 $44.15 $57.42 $9.64 $14.95 $20.26 $18.54 $32.75 $46.96 $61.17 $10.02 $15.70 $21.38 $19.52 $34.71 $49.90 $65.08 $10.41 $16.48 $22.56 $20.60 $36.88 $53.15 $69.42 $10.84 $17.35 $23.86 $21.77 $39.21 $56.65 $74.08 $11.31 $18.28 $25.26 $23.08 $41.83 $60.58 $79.33 $11.83 $19.33 $26.83 $24.52 $44.71 $64.90 $85.08 $12.41 $20.48 $28.56 $26.00 $47.67 $69.33 $91.00 $13.00 $21.67 $30.33 $27.56 $50.79 $74.02 $97.25 $13.63 $22.92 $32.21 $29.19 $54.04 $78.90 $103.75 $14.28 $24.22 $34.16 $30.92 $57.50 $84.08 $110.67 $14.97 $25.60 $36.23 $32.73 $61.13 $89.52 $117.92 $15.69 $27.05 $38.41 $34.56 $64.79 $95.02 $125.25 $16.43 $28.52 $40.61 $36.54 $68.75 $100.96 $133.17 $17.22 $30.10 $42.98 $38.69 $73.04 $107.40 $141.75 $18.08 $31.82 $45.56 $41.10 $77.88 $114.65 $151.42 $19.04 $33.75 $48.46 $43.90 $83.46 $123.02 $162.58 $20.16 $35.98 $51.81 $47.00 $89.67 $132.33 $175.00 $21.40 $38.47 $55.53 $50.48 $96.63 $142.77 $188.92 $22.79 $41.25 $59.71 $54.17 $104.00 $153.83 $203.67 $24.27 $44.20 $64.13 $58.33 $112.33 $166.33 $220.33 $25.93 $47.53 $69.13 $62.65 $120.96 $179.27 $237.58 $27.66 $50.98 $74.31 $67.04 $129.75 $192.46 $255.17 $29.42 $54.50 $79.58 $71.56 $138.79 $206.02 $273.25 $31.23 $58.12 $85.01 $76.29 $148.25 $220.21 $292.17 $33.12 $61.90 $90.68 $81.19 $158.04 $234.90 $311.75 $35.08 $65.82 $96.56 $86.31 $168.29 $250.27 $332.25 $37.13 $69.92 $102.71 $91.77 $179.21 $266.65 $354.08 $39.31 $74.28 $109.26 $97.71 $191.08 $284.46 $377.83 $41.68 $79.03 $116.38 $104.33 $204.33 $304.33 $404.33 $44.33 $84.33 $124.33
Term Life with Terminal Illness and Quality of Life Rider
Age on App. Date 66* 67* 68* 69* 70*
$10,000 $44.93 $48.25 $52.03 $56.33 $61.17
MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT Employee Coverage Amounts Spouse Coverage Amounts $25,000 $50,000 $75,000 $100,000 $10,000 $20,000 $30,000 $105.81 $207.29 $308.77 $410.25 $44.93 $85.52 $126.11 $114.13 $223.92 $333.71 $443.50 $48.25 $92.17 $136.08 $123.58 $242.83 $362.08 $481.33 $52.03 $99.73 $147.43 $134.31 $264.29 $394.27 $524.25 $56.33 $108.32 $160.31 $146.42 $288.50 $430.58 $572.67 $61.17 $118.00 $174.83
*Quality of Life not available ages 66-70. Quality of Life benefits not available for children. Child life coverage available only on children and grandchildren of employee (age on application date: 15 days to age 24 years). $4.98 monthly for $10,000 coverage and $9.97 monthly for $20,000 coverage.
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