RUSK ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2017 - 8/31/2018 WWW.MYBENEFITSHUB.COM/ RUSKISD
1
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 HSA Bank Health Savings Account (HSA) MDLIVE Telehealth Cigna Dental Superior Vision UNUM Educator Select Disability Philadelphia American Cancer The Hartford Life and AD&D NBS Flexible Spending Account (FSA) 5 Star FPP TI with Quality of Life Rider
2
3 4-5 6-11 6 7 8 9 10
FLIP TO... PG. 4 HOW TO HOW TO ENROLL ENROLL
11 12-15 16-19 20-21 22-25 26-27 28-31 32-35 36-39 40-43 44-47
PG. 6 SUMMARY PAGES
PG. 12 YOUR BENEFITS
Benefit Contact Information
Benefit Contact Information RUSK ISD BENEFITS
DENTAL
CANCER
Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/ruskisd
Cigna (800) 244-6224 www.mycigna.com
Philadelphia American (800) 554-0092 www.neweralife.com
RUSK ISD BENEFITS OFFICE
VISION
LIFE AND AD&D
(903) 683-5592 www.ruskisd.net
Superior Vision (800) 507-3800 www.superiorvision.com
The Hartford (800) 583-6908 www.thehartford.com
MEDICAL
DISABILITY
FLEXIBLE SPENDING ACCOUNT
Aetna (800) 222-9205 www.trsactivecareaetna.com
UNUM (800) 858-6843 www.unum.com
National Benefit Services (800) 274-0503 www.nbsbenefits.com
TELEHEALTH
FAMILY PROTECTION PLAN – TERM LIFE WITH QUALITY OF LIFE RIDER
MDLIVE (888) 365-1663 www.consultmdlive.com
5Star Life Insurance Company (866) 863-9753 www.5starlifeinsurance.com
3
MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS RUSKISD” to 313131 and get access to everything you need to complete your benefits enrollment:
Benefit Information
Online Support
Interactive Tools
And more. PLAY VIDEO
4
Text “FBS RUSKISD” to 313131 OR SCAN
How to Log In
1 BENEFIT INFO
INTERACTIVE TOOLS
2 3
www.mybenefitshub.com/ruskisd
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.
5
Annual Benefit Enrollment
SUMMARY PAGES
Benefit Updates - What’s New: New Benefit!! Individual Life Insurance: NEW! 5Star
Family Protection Plan with a Quality of Life Rider. This is a new individual life policy
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.
Update! Health Savings Account (HSA): The Individual
HSA Max has increased to $3,400. Your TRS ActiveCare plans are experiencing a rate
increase and some plans have an increased out-ofpocket maximum. Please refer to the TRS Aetna Website for more details visit www.trsactivecareaetna.com.
Flexible Spending Account Use-it or Roll-Over $500: You
are able to roll over HealthCare Reimbursement FSA funds up to $500 into the following plan year. If you elect the HSA you are not eligible to participate in
the FSA and vice versa. The HSA Family annual contribution max is increasing.
Due to the Affordable Care Act (ACA), every employee
is required to login & complete the enrollment process, even if you are declining benefits by 8/18/17!
Social Security Numbers for your dependents are
required regardless if they are enrolled in coverage or not. Please make sure you have these items on hand when going through your open enrollment.
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).
Don’t Forget!
For questions about benefits or enrollment assistance, please call the FBS Call Center at 469-385-4685 Bilingual assistance is available by calling this number. Login & complete your benefit enrollment from 7/25/2017-8/18/2017. Changes made after 8/18/17 must go through the payroll department. Update your profile information: home address, phone numbers, email.
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):
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
QUALIFYING EVENTS
Marital Status
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
Change in Number of Tax Dependents
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Change in Status of Employment Affecting Coverage Eligibility
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.
An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements Gain/Loss of Dependents' under an employer's plan may include change in age, student, marital, employment or tax dependent Eligibility Status status. If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order Judgment/Decree/Order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage. Eligibility for Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Government Programs
7
SUMMARY PAGES
Annual Enrollment During your annual enrollment period, you have the opportunity
Where can I find forms?
to review, change or continue benefit elections each year.
For benefit summaries and claim forms, go to your school
Changes are not permitted during the plan year (outside of
district’s benefit website: www.mybenefitshub.com/ruskisd.
annual enrollment) unless a Section 125 qualifying event occurs.
Click on the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the
Changes, additions or drops may be made only during 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: www.mybenefitshub.com/ruskisd.
included in the dependent profile. Additionally, you must
Click on the benefit plan you need information on (i.e.,
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.
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.
8
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 Rusk ISD or as both
capable of performing the functions of your job on the first day of
employees and dependents.
work concurrent with the plan effective date. For example, if your 2017 benefits become effective on September 1, 2017, you must be actively-at-work on September 1, 2017 to be eligible for your new benefits. PLAN
CARRIER
MAXIMUM AGE
Medical
Aetna
To age 26
Dental
Cigna
To age 26
Vision
Superior Vision
To age 26
Cancer
Philadelphia American
To age 25
Voluntary Life
The Hartford
To age 26
Long Term Care
UNUM
To age 26
AD&D
The Hartford
To age 25
Telehealth
MDLIVE
To age 26
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.
9
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.
10
(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. 16
FLIP TO FOR FSA INFORMATION
PG. 40
11
AETNA
Medical
YOUR BENEFITS PACKAGE
About this Benefit 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 Rusk ISD Benefits Website: www.mybenefitshub.com/ruskisd
Medical Rates TRS-ActiveCare 2017-18 Premium
State and District Contribution
Employee Deduction for 2017-18
Employee Only
$351
$225
$126
Employee and Spouse
$991
$225
$766
Employee and Child(ren)
$671
$225
$446
$1,316
$225
$1,091
$514
$225
$289
$1,264
$225
$1,039
$834
$225
$609
$1,589
$225
$1,364
$714
$225
$489
Employee and Spouse
$1,694
$225
$1,469
Employee and Child(ren)
$1,062
$225
$837
Employee and Family
$2,004
$225
$1,779
Plan Type
Plan 1-HD
Employee and Family
Select Plan Employee Only Employee and Spouse Employee and Child(ren) Employee and Family
Plan 2 Employee Only
13
2017 – 2018 TRS-ActiveCare Plan Highlights Effective September 1, 2017 through August 31, 2018 | In-Network Level of Benefits*
Deductible (per plan year) In-Network Out-of-Network Out-of-Pocket Maximum (per plan year; medical and prescription drug deductibles, copays, and coinsurance count toward the out-of-pocket maximum) In-Network Out-of-Network Coinsurance In-Network Participant pays (after deductible) Out-of-Network Participant pays (after deductible) Office Visit Copay Participant pays Diagnostic Lab Participant pays
Preventive Care See below for examples Teladoc® Physician Services
High-Tech Radiology (CT scan, MRI, nuclear medicine) Participant pays Inpatient Hospital (preauthorization required) (facility charges) Participant pays Emergency Room (true emergency use) Participant pays Outpatient Surgery Participant pays Bariatric Surgery Physician charges (only covered if performed at an IOQ facility) Participant pays Annual Vision Examination (one per plan year; performed by an ophthalmologist or optometrist using calibrated instruments) Participant pays Annual Hearing Examination Participant pays Preventive Care Routine physicals – annually age 12 and over Mammograms – 1 every year age 35 and over Smokingcessationcounseling– 8 visits per 12 months
14
• Well-child care – unlimited up to age 12 • Colonoscopy – 1 every 10 years age 50 and over •Healthydiet/obesitycounseling– unlimited to
• Well woman exam & pap smear – annually age 18 and over • Prostatecancer screening–1 per year age 50 and over • Breastfeeding support – 6 lactation counseling visits
Drug Deductible Short-Term Supply at a Retail Location
Extended-Day Supply at Mail Order or Retail-Plus Pharmacy Location (60- to
90-day supply)****
Specialty Medications Short-Term Supply of a Maintenance Medication at Retail Location (up to a 31-day supply)
What is a maintenance medication? Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes.
When does the convenience fee apply? For example, if you are covered under TRS-ActiveCare Select, the first time you fill a 31-day supply of a generic maintenance drug at a retail pharmacy you will pay $20, then you will pay $35 each month that you fill a 31-day supply of that generic maintenance drug at a retail pharmacy. A 90-day supply of that same generic maintenance medication would cost $45, and you would save $225 over the year by filling a 90-day supply.
Premium Information for ALEX You will need to enter the applicable amount – YOUR ANNUAL COST – from the table below into ALEX when prompted. To determine this cost, ask your Benefits Administrator for your monthly cost (this is the amount you will owe each month after your employer contributes to your coverage). Then multiply your monthly cost by 12 to get YOUR ANNUAL COST (use this amount for ALEX) Individual
$351
$514
$714
+Spouse
$991
$1,264
$1,694
+Children
$671
$834
$1,062
+Family
$1,316
$1,589
$2,004
A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. *Illustrates benefits when in-network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits under the ActiveCare Select or ActiveCare Select Whole Health Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for this balance bill amount, which maybe considerable. **For ActiveCare 1-HD, certain generic preventive drugs are covered at 100%. Participants do not have to meet the deductible ($2,500 - individual, $5,000 - family) and they pay nothing out of pocket for these drugs. The list of drugs is on the TRS-ActiveCare website. ***If a participant obtains a brand-name drug when a generic equivalent is available, they are responsible for the generic copay plus the cost difference between the brand-name drug and the generic drug. 15 ****Participants can fill 32-day to 90-day supply through mail order.
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 16 Rusk ISD Benefits Website: www.mybenefitshub.com/ruskisd
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 HSA. Medicare, Medicaid, and Tricare participants are not eligible to participate in an HSA. You can use your Health Savings Account (HSA) to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free.
What is an HSA?
A tax-advantaged savings account that you use to pay for eligible medical expenses as well as deductible, co-insurance, prescriptions, vision and dental care. Allows you to save while reducing your taxable income. Unused funds that will roll over year to year. There’s no “use it or lose it” penalty. A way to accumulate additional retirement savings. After age 65, funds can be withdrawn for any purpose without penalty.
Authorized Signers who are 55 or older must have their own HSA in order to make the catch-up contribution Monthly Fee: Your account will be charged a monthly fee of $1.75, waived with an average daily balance at or above $3,000.
Examples of Qualified Medical Expenses
Surgery Braces Contact lenses Dentures Eyeglasses Vaccines
For a list of sample expenses, please refer to your school district’s benefits website at www.mybenefitshub.com/ruskisd
HSA Bank Contact Information 605 N. 8th Street, Ste 320 Sheboygan, WI 53081 Phone: 800-357-6246 www.hsabank.com
Using Funds Debit Card You may use the card to pay merchants or service providers that accept VISA credit cards, so there is no need to pay cash up front and wait for reimbursements. You can make a withdrawal at any time. Reimbursements for qualified medical expenses are tax free. If you are disabled or reach age 65, you can receive non-medical distributions without penalty, but you must report the distributions as taxable income. You may also use your funds for a spouse or tax dependent not covered by your HDHP.
2017 Annual HSA Contribution Limits Individual: $3,400 Family: $6,750 Catch-Up Contributions: Accountholders who meet the qualifications noted below are eligible to make an HSA catch-up contribution of an additional $1,000. Health Savings accountholder Age 55 or older (regardless of when in the year an accountholder turns 55) Not enrolled in Medicare (if an accountholder enrolls in Medicare mid-year, catch-up contributions should be prorated) 17
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. 18
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). 19
MDLIVE YOUR BENEFITS PACKAGE
Telehealth
PLAY VIDEO
About this Benefit Telehealth provides 24/7/365 access to boardcertified doctors via telephone consultations that can diagnose, recommend treatment and prescribe medication. Whether you are at home, traveling or at work, Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.
75%
of all doctor, urgent care, and ER visits could be handled safely and effectively via telehealth.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 20 Rusk ISD Benefits Website: www.mybenefitshub.com/ruskisd
Telehealth When should I use MDLIVE? If you’re considering the ER or urgent care for a non-emergency medical issue Your primary care physician is not available At home, traveling, or at work 24/7/365, even holidays!
What can be treated?
Allergies Asthma Bronchitis Cold and Flu Ear Infections Joint Aches and Pain Respiratory Infection Sinus Problems And More!
Pediatric Care related to:
Cold & Flu Constipation Ear Infection Fever Nausea & Vomiting Pink Eye And More!
Are children eligible? Yes. MDLIVE has local pediatricians on-call 24/7/365. Please note, a parent or guardian must be present during any interactions involving minors. We ask parents to establish a child record under their account. Parents must be present on each call for children 18 or younger.
How much does it cost? $10 Covers you, your spouse, and children up to age 26, with unlimited phone consultations.
Download the App Doctor visits are easier and more convenient with the MDLIVE App. Be prepared. Download today. www.mdlive.com/getapp
Access to a doctor anywhere: at home, at work, or on the go Choose doctors from one of the nation's largest telehealth networks Available 24/7 by video or phone Private, secure and confidential visits Connect instantly with MDLIVE Assist
Who are our doctors? MDLIVE has the nation’s largest network of telehealth doctors. On average, our doctors have 15 years of experience practicing medicine and are licensed in the state where patients are located. Their specialties include primary care, pediatrics, emergency medicine and family medicine. Our doctors are committed to providing convenient, quality care and are always ready to take your call.
Scan with your smartphone to get the app.
Call us at (888) 365-1663 or visit us at www.consultmdlive.com
Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for 21 abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit www.mdlive.com/pages/terms.html 010113
CIGNA
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 22 Rusk ISD Benefits Website: www.mybenefitshub.com/ruskisd
Dental PPO Benefits Network Calendar Year Maximum (Class I, II and III expenses) Annual Deductible Individual Family Reimbursement Levels**
Cigna Dental Choice In-Network Out-of-Network Cigna Choice - Radius Cigna Savings - Radius $1,200
$1,200
$50 per person $150 per family
$50 per person $150 per family
Based on Reduced Contracted Fees
90th percentile of Reasonable and Customary Allowances
Plan Pays
You Pay
Plan Pays
You Pay
100%
No Charge
100%
No Charge
80%*
20%*
80%*
20%*
50%*
50%*
50%*
50%*
50%
50% $1,000 Dependent children to age 19
50%
Monthly PPO Premiums Tier
Rate
EE Only
$30.15
EE + Spouse
$60.29
EE + Child(ren)
$66.48
Family Coverage
$91.31
Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Bitewing X-rays Full Mouth X-rays Panoramic X-ray Fluoride Application Sealants
Class II - Basic Restorative Care Fillings Emergency Care to Relieve Pain Brush Biopsies Oral Surgery – Simple Extractions Space Maintainers Minor Periodontal
Class III - Major Restorative Care Crowns Root Canal Therapy/Endodontics Major Periodontal Scaling Osseous Surgery Surgical Extractions of Impacted Teeth Oral Surgery - all except simple extractions Anesthetics Denture Repairs Denture Relines, Rebases and Adjustments Repairs to Bridges, Crowns and Inlays Dentures Bridges Inlays/Onlays Prosthesis Over Implant
Class IV - Orthodontia Lifetime Maximum
50% $1,000 Dependent children to age 19
Missing Tooth Limitation – The amount payable is 50% of the amount otherwise payable until insured for 12 months; thereafter, considered a Class III expense. Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed. * Subject to annual deductible Dental Oral Health Integration Program (OHIP) - All dental customers = Clinical research shows an association between oral health and overall health. The Cigna Dental Oral Health Integration Program (OHIP)® is designed to provide enhanced dental coverage for customers with certain eligible medical conditions. Eligible conditions for the program include cardiovascular disease, cerebrovascular disease (stroke), diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation. The program provides: 100% coverage for certain dental procedures
guidance on behavioral issues related to oral health discounts on prescription and non-prescription dental products For more information and to see the complete list of eligible conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24. **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to Reasonable and Customary Allowances but the dentist may balance bill up to their usual fees. 23
Dental PPO Benefit Exclusions
Services performed primarily for cosmetic reasons Replacement of a lost or stolen appliance Replacement of a bridge or denture within five years following the date of its original installation Replacement of a bridge or denture which can be made useable according to accepted dental standards Procedures, appliances or restorations, other than full dentures, whose main purpose is to change vertical dimension, diagnose or treat conditions of TMJ, stabilize periodontally involved teeth, or restore occlusion Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and third molars Bite registrations; precision or semi-precision attachments; splinting A surgical implant of any type Instruction for plaque control, oral hygiene and diet Dental services that do not meet common dental standards Services that are deemed to be medical services Services and supplies received from a hospital Charges which the person is not legally required to pay Charges made by a hospital which performs services for the U.S. Government if the charges are directly related to a condition connected to a military service Experimental or investigational procedures and treatments Any injury resulting from, or in the course of, any employment for wage or profit Any sickness covered under any workers’ compensation or similar law Charges in excess of the reasonable and customary allowances To the extent that payment is unlawful where the person resides when the expenses are incurred; Procedures performed by a Dentist who is a member of the covered person’s family (covered person’s family is limited to a spouse, siblings, parents, children, grandparents, and the spouse’s siblings and parents); For charges which would not have been made if the person had no insurance; For charges for unnecessary care, treatment or surgery; To the extent that you or any of your Dependents is in any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid; To the extent that benefits are paid or payable for those expenses under the mandatory part of any auto insurance policy written to comply with a “no-fault” insurance law or an uninsured motorist insurance law. Cigna HealthCare will take into account any adjustment option chosen under such part by you or any one of your Dependents. In addition, these benefits will be reduced so that the total payment will not be more than 100% of the charge made for the Dental Service if benefits are provided for that service under this plan and any medical expense plan or prepaid treatment program sponsored or made available by your Employer.
24
Dental PPO Procedure
Exclusions and Limitations
Late Entrants Limit Exams Prophylaxis (Cleanings) Fluoride Histopathologic Exams X-Rays (routine) X-Rays (non-routine) Model Minor Perio (non-surgical) Perio Surgery Crowns and Inlays Bridges Dentures and Partials Relines, Rebases Adjustments Repairs - Bridges Repairs - Dentures Sealants Space Maintainers Prosthesis Over Implant
50% coverage on Class III and IV for 12 months Two per Plan year Two per Plan year 1 per Plan year for people under 19 Various limits per Plan year depending on specific test Bitewings: 2 per Plan year Full mouth: 1 every 36 consecutive months., Panorex: 1 every 36 consecutive months Payable only when in conjunction with Ortho workup Various limitations depending on the service Various limitations depending on the service Replacement every 5 years Replacement every 5 years Replacement every 5 years Covered if more than 6 months after installation Covered if more than 6 months after installation Reviewed if more than once Reviewed if more than once Limited to posterior teeth. One treatment per tooth every three years up to age 14 Limited to non-Orthodontic treatment 1 per 60 consecutive months if unserviceable and cannot be repaired. Benefits are based on the amount payable for nonprecious metals. No porcelain or white/tooth colored material on molar crowns or bridges When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses
Alternate Benefit
This benefit summary highlights some of the benefits available under the proposed plan. A complete description regarding the terms of coverage, exclusions and limitations, including legislated benefits, will be provided in your insurance certificate or plan description. Benefits are insured and/or administered by Con necticut General Life Insurance Company. "Cigna HealthCare" refers to various operating subsidiaries of Cigna Corporation. Products and services are provided by these subsidiaries and not by Cigna Corporation. These subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. DPPO insurance coverage is set forth on the following policy form numbers: AR: HP-POL77; CA: HP-POL57; CO: HP-POL78; CT: HP-POL58; DE: HP-POL79; FL: HPPOL60; ID: HPPOL82; IL: HP-POL62; KS: HP-POL84; LA: HP-POL86: MA: HP-POL 63; MI: HP-POL88; MO: HP- POL65; MS: HP-POL90; NC: HP-POL96; NE: HP-POL92; NH: HP-POL94; NM: HP-POL95; NV: HP-POL93; NY: HP-POL67; OH: HP-POL98; OK: HP-POL99; OR: HP-POL68; PA: HP-POL100; RI: HP-POL101; SC: HP-POL102; SD: HP-POL103; TN: HP-POL69; TX: HP-POL70; UT: HP-POL104; VA: HP-POL72; VT: HP-POL71; WA: POL-07/08; WI: HP-POL107; WV: HP-POL106; and WY: HP-POL108. “Cigna,” the “Tree of Life” logo and “Cigna Dental Care” are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Cigna Dental PPO plans are underwritten or administered by CGLIC or CHLIC, with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Arizona and Louisiana, the insured Dental PPO plan offered by CGLIC is known as the “CG Dental PPO”. In Texas, the insured dental product offered by CGLIC and CHLIC is referred to as the Cigna Dental Choice Plan, and this plan utilizes the national Cigna Dental PPO network. Cigna Dental Care (DHMO) plans are underwritten or administered by Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska), Cigna Dental Health of Kentucky, Inc. (Kentucky and Illinois), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. In other states, Cigna Dental Care plans are underwritten by CGLIC, CHLIC, or Cigna HealthCare of Connecticut, Inc. and administered by Cigna Dental Health, Inc. BSD48011 ©2014 Cigna
25
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 26 Rusk ISD Benefits Website: www.mybenefitshub.com/ruskisd
Vision Benefits Exam Frames Contact Lenses1
In-Network
Out-of-Network
Covered in full $150 retail allowance $175 retail allowance
Up to $35 retail Up to $70 retail Up to $80 retail
Covered in full
Up to $150 retail
Medically Necessary Contact Lenses Lasik Vision Correction
$200 allowance2 (in or out of network)
Lenses (standard) per pair Single Vision Bifocal Trifocal Progressive Lenticular
Monthly Premiums EE Only EE + Family
$7.80 $19.66
Co-Pays Exam Materials
$10 $25
Services/Frequency Covered in full Covered in full Covered in full See description3 Covered in full
Up to $25 retail Up to $40 retail Up to $45 retail Up to $45 retail Up to $80 retail
Exam Frame Lenses Contact Lenses
12 months 24 months 12 months 12 months
(Based on date of service)
Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements. 1
Contact lenses and related professional services (fitting, evaluation and followup) are covered in lieu of eyeglass lenses and frames benefit. 2 Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limitations 3 Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay.
Discount Features Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.
SuperiorVision.com Customer Service 800.507.3800
The Plan discount features are not insurance. All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan. Discounts are subject to change without notice. Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions
27
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 28 Rusk ISD Benefits Website: www.mybenefitshub.com/ruskisd
Disability Policy # 147245
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/5 yR ADEA: 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. Newly Hired Employees: 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.
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
For disabilities due to sickness: Age at Disability Less than age 60 Age 60 through 68 Age 69 and over
Maximum Duration of Benefits 5 years To age 70, but not less than 1 year 1 year
Benefits are subject to the pre-existing condition exclusion referenced later in this document.
Next Steps How to Apply/Effective Date of Coverage
Please see your Plan Administrator for your eligibility date.
Current employees: To apply for coverage, complete your enrollment form by the enrollment deadline. Your effective date of coverage is 9/1.
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. 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.)
Newly Hired Employees: To apply for coverage, complete your enrollment form within 60 days of your eligibility date. Please see your Plan Administrator for your effective date. If you do not enroll during the initial enrollment period, you may apply only during an annual enrollment.
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.
29
Disability RUSK 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 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 7740030 6450 4300
0* 7*
14* 14*
30* 30*
60 60
90 90
180 180
8.04 12.06 16.08 20.10 24.12 28.14 32.16 36.18 40.20 44.22 48.24 52.26 56.28 60.30 64.32 68.34 72.36 76.38 80.40 84.42 88.44 92.46 96.48 100.50 104.52 108.54 112.56 116.58 120.60 124.62 128.64 132.66 136.68 140.70 144.72 148.74 152.76 156.78 160.80 164.82 168.84 172.86
6.36 9.54 12.72 15.90 19.08 22.26 25.44 28.62 31.80 34.98 38.16 41.34 44.52 47.70 50.88 54.06 57.24 60.42 63.60 66.78 69.96 73.14 76.32 79.50 82.68 85.86 89.04 92.22 95.40 98.58 101.76 104.94 108.12 111.30 114.48 117.66 120.84 124.02 127.20 130.38 133.56 136.74
5.32 7.98 10.64 13.30 15.96 18.62 21.28 23.94 26.60 29.26 31.92 34.58 37.24 39.90 42.56 45.22 47.88 50.54 53.20 55.86 58.52 61.18 63.84 66.50 69.16 71.82 74.48 77.14 79.80 82.46 85.12 87.78 90.44 93.10 95.76 98.42 101.08 103.74 106.40 109.06 111.72 114.38
3.62 5.43 7.24 9.05 10.86 12.67 14.48 16.29 18.10 19.91 21.72 23.53 25.34 27.15 28.96 30.77 32.58 34.39 36.20 38.01 39.82 41.63 43.44 45.25 47.06 48.87 50.68 52.49 54.30 56.11 57.92 59.73 61.54 63.35 65.16 66.97 68.78 70.59 72.40 74.21 76.02 77.83
3.14 4.71 6.28 7.85 9.42 10.99 12.56 14.13 15.70 17.27 18.84 20.41 21.98 23.55 25.12 26.69 28.26 29.83 31.40 32.97 34.54 36.11 37.68 39.25 40.82 42.39 43.96 45.53 47.10 48.67 50.24 51.81 53.38 54.95 56.52 58.09 59.66 61.23 62.80 64.37 65.94 67.51
2.42 3.63 4.84 6.05 7.26 8.47 9.68 10.89 12.10 13.31 14.52 15.73 16.94 18.15 19.36 20.57 21.78 22.99 24.20 25.41 26.62 27.83 29.04 30.25 31.46 32.67 33.88 35.09 36.30 37.51 38.72 39.93 41.14 42.35 43.56 44.77 45.98 47.19 48.40 49.61 50.82 52.03
Disability RUSK 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
176.88 180.90 184.92 188.94 192.96 196.98 201.00 205.02 209.04 213.06 217.08 221.10 225.12 229.14 233.16 237.18 241.20 245.22 249.24 253.26 257.28 261.30 265.32 269.34 273.36 277.38 281.40 285.42 289.44 293.46 297.48 301.50
139.92 143.10 146.28 149.46 152.64 155.82 159.00 162.18 165.36 168.54 171.72 174.90 178.08 181.26 184.44 187.62 190.80 193.98 197.16 200.34 203.52 206.70 209.88 213.06 216.24 219.42 222.60 225.78 228.96 232.14 235.32 238.50
117.04 119.70 122.36 125.02 127.68 130.34 133.00 135.66 138.32 140.98 143.64 146.30 148.96 151.62 154.28 156.94 159.60 162.26 164.92 167.58 170.24 172.90 175.56 178.22 180.88 183.54 186.20 188.86 191.52 194.18 196.84 199.50
79.64 81.45 83.26 85.07 86.88 88.69 90.50 92.31 94.12 95.93 97.74 99.55 101.36 103.17 104.98 106.79 108.60 110.41 112.22 114.03 115.84 117.65 119.46 121.27 123.08 124.89 126.70 128.51 130.32 132.13 133.94 135.75
69.08 70.65 72.22 73.79 75.36 76.93 78.50 80.07 81.64 83.21 84.78 86.35 87.92 89.49 91.06 92.63 94.20 95.77 97.34 98.91 100.48 102.05 103.62 105.19 106.76 108.33 109.90 111.47 113.04 114.61 116.18 117.75
53.24 54.45 55.66 56.87 58.08 59.29 60.50 61.71 62.92 64.13 65.34 66.55 67.76 68.97 70.18 71.39 72.60 73.81 75.02 76.23 77.44 78.65 79.86 81.07 82.28 83.49 84.70 85.91 87.12 88.33 89.54 90.75
31
PHILADELPHIA 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 32 Rusk ISD Benefits Website: www.mybenefitshub.com/ruskisd
Cancer A Cancer Expense Program
A supplemental cancer insurance program designed to protect your savings at the time when you need it the most. This program helps to cover the costs associated with treating cancer that are not fully reimbursed by your present coverage. It is a flexible benefit plan that offers you a variety of valuable coverage options.
Summary of Benefits: Cancer Screening Pays a scheduled amount up to $100 per calendar year for each insured person for any one or more of the following cancer screening tests that are performed more than 60 days after the policy effective date. Mammography Screening Pap Smear/Thin Prep Pap (test only) CA125 (blood test for ovarian cancer) PSA (blood test for prostate) Hemocult stool specimen CA 15-3 (blood test for breast cancer) Flexible Sigmoidoscopy CEA (blood test for colon cancer) Colonoscopy Chest X-ray Thermography Serum protein electrophoresis Biopsy for Skin Cancer
Hospital Confinement: Pays the selected amount for each day of covered hospital confinement. Benefit options: $150 per day $250 per day $350 per day
Experimental Treatment Benefits for experimental treatment are payable on the same basis as any other benefit under this policy.
Chemotherapy, Radiation Treatment, Hormone Therapy, Immunotherapy and Related Services Benefit:
Surgical Benefit Pays a scheduled amount for surgical procedures. The maximum amount payable is $10,000 per calendar year per insured person. The maximum amount payable for surgical procedures related to skin cancer is $500 per calendar year per insured person.
Outpatient Surgery Facility Benefit Pays two times the selected daily hospital confinement benefit for covered outpatient surgery in a hospital or freestanding surgical facility. This benefit is not payable for skin cancer.
Second Surgical Opinion Pays up to $250 for the charges incurred for a second surgical opinion.
Home Health Care Services Pays up to $100 per day for charges incurred for services provided at home, not to exceed a maximum of 60 days per calendar year.
Hospice Care Pays up to $100 per day for charges incurred for care provided by a hospice. This benefit is payable for a lifetime maximum of 120 days.
Artificial Limb After amputation, pays up to a lifetime maximum of $2,500 per insured person for an artificial limb and the procedure to affix or implant it.
Additional Benefits
Ambulance Anesthesia Blood and Blood Plasma Bone Marrow Donors Breast Prosthesis/Breast Reconstruction Durable Medical Equipment Extended Care Facility Government or Charity Hospital Hairpiece Physical or Speech Therapy Transportation and Lodging for Insured and Adult Companion Waiver of Premium
This benefit pays for charges incurred, as defined in the rider, up to the benefit amount selected. See the Outline of Coverage for a description of the available options.
33
Cancer Specified Disease Benefit Rider 8311N Available for additional premium Benefits for treatment of 24 specified diseases are subject to a lifetime maximum of $50,000 for each insured person. (Maximums vary in Texas) Hospital Confinement Pays $250 per day for each day of covered hospital confinement. Radiation Treatment, Chemotherapy, Hormone Therapy and Immunotherapy Benefit for the Treatment of Specified Disease Pays 50 percent of the charges incurred, as defined in the rider, up to a maximum of $1,200 per calendar month per insured person for covered treatment of a specified disease. Oral or self-administered chemotherapy, hormone therapy and immunotherapy drugs are limited to 50 percent up to a maximum of $300 for each filled prescription.
Internal Cancer First Occurrence Benefit Rider 8288N Available for additional premium Pays the first time an insured person has been diagnosed as having internal cancer. Benefit Options: $2,500 $5,000
34
Hospital Intensive Care Confinement Benefit Rider 8290N Available for additional premium Pays for each day beginning with the first day of confinement in an Intensive Care Unit (ICU) of a hospital as the result of any sickness or any accident. Benefit Options: $300 per day $600 per day Pays $150 for each day of confinement in a sub-acute ICU, if confinement immediately follows an ICU confinement. Pays $150 per day for confinement in a regular hospital room if the confinement was immediately preceded by an ICU confinement, or by sub-acute intensive care confinement which was immediately preceded by an ICU confinement. The number of days paid will not exceed the number of covered days of hospital ICU confinement. Total benefits for any one period of confinement are limited to 30 days.
Ambulance Benefit Pays the ambulance charges incurred per trip to transfer an insured person to the hospital for an ICU confinement. This ambulance benefit is limited to $5,000 per calendar year per insured person. All ICU benefits under this rider reduce 50 percent after an insured person is age 70 or older.
Cancer Non‐Tobacco Rates INDIVIDUAL
Tobacco Rates
Issue Age
$150 Daily
$250 Daily
$350 Daily
Issue Age
$150 Daily
$250 Daily
$350 Daily
Base Policy with 8306N and 8311N $2500 First Occurrent Rider 8288N
18‐49
$18.65
$20.27
$22.50
18‐49
$20.51
$22.30
$24.75
50‐64
$36.34
$39.51
$43.87
50‐64
$39.99
$43.48
$48.27
Base Policy with 8306N and 8311N $2500 First Occurrent Rider 8288N/$600 ICU Rider 8209N
18‐49
$23.16
$24.78
$27.01
18‐49
$25.47
$27.26
$29.71
50‐64
$45.14
$48.31
$52.67
50‐64
$49.67
$53.16
$57.95
Non‐Tobacco Rates SINGLE-PARENT FAMILY Base Policy with 8306N and 8311N $2500 First Occurrent Rider 8288N Base Policy with 8306N and 8311N $2500 First Occurrent Rider 8288N/$600 ICU Rider 8209N
Tobacco Rates
Issue Age
$150 Daily
$250 Daily
$350 Daily
Issue Age
$150 Daily
$250 Daily
$350 Daily
18‐49
$23.45
$25.48
$28.33
18‐49
$25.80
$28.03
$31.16
50‐64
$45.73
$49.69
$55.24
50‐64
$50.31
$54.67
$60.76
18‐49
$29.47
$31.50
$34.35
18‐49
$32.42
$34.65
$37.78
50‐64
$57.46
$61.42
$66.97
50‐64
$63.21
$67.57
$73.66
Non‐Tobacco Rates FAMILY Base Policy with 8306N and 8311N $2500 First Occurrent Rider 8288N Base Policy with 8306N and 8311N $2500 First Occurrent Rider 8288N/$600 ICU Rider 8209N
Tobacco Rates
Issue Age
$150 Daily
$250 Daily
$350 Daily
Issue Age
$150 Daily
$250 Daily
$350 Daily
18‐49
$31.67
$34.31
$37.96
18‐49
$34.83
$37.74
$41.76
50‐64
$61.77
$66.91
$74.04
50‐64
$80.60
$86.26
$94.10
18‐49
$40.31
$42.95
$46.60
18‐49
$44.34
$47.25
$51.27
50‐64
$78.63
$83.77
$90.90
50‐64
$99.15
$104.81
$112.65
35
THE HARTFORD 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 36 Rusk ISD Benefits Website: www.mybenefitshub.com/ruskisd
Voluntary Group Term Life and AD&D Benefit Highlights Rusk ISD
What is Voluntary Life Insurance?
Voluntary Life Insurance is coverage that you pay for. Voluntary Life Insurance pays your beneficiary (please see below) a benefit if you die while you are covered. This highlight sheet is an overview of your Voluntary Life Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail.
Am I eligible?
You are eligible if you are an active full time employee who works at least 20 hours per week on a regularly scheduled basis.
When is it effective?
Coverage goes into effect subject to the terms and conditions of the policy. You must be actively at work with your employer on the day your coverage takes effect.
How much Voluntary Life Insurance can I purchase?
You can purchase Voluntary Life Insurance in increments of $10,000. The maximum amount you can purchase cannot be more than the lesser of 7 times your annual Earnings or $500,000. Annual Earnings are as defined in The Hartford’s contract with your employer.
Am I guaranteed coverage?
If you are newly eligible and elect an amount that exceeds the guaranteed issue amount of $150,000, you will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you were previously eligible and are electing coverage for the first time or electing to increase your current coverage, you will need to provide evidence of insurability that is satisfactory to The Hartford before coverage can become effective.
What is a beneficiary?
Your beneficiary is the person (or persons) or legal entity (entities) who receives a benefit payment if you die while you are covered by the policy. You must select your beneficiary when you complete your enrollment application; your selection is legally binding.
Are there other limitations to enrollment?
If you do not enroll within 31 days of your first day of eligibility, you will be considered a late entrant. Typically, late entrants may need to show evidence of insurability and may be responsible for the cost of physical exams or other associated costs if they are required. This coverage, like most group benefit insurance, requires that a certain percentage of eligible employees participate. If that group participation minimum is not met, the insurance coverage that you have elected may not be in effect.
Spouse Voluntary Life Insurance
If you elect Voluntary Life Insurance for yourself, you may choose to purchase Spouse Voluntary Life Insurance in increments of $5,000, to a maximum of $100,000. Coverage cannot exceed 50% of the amount of your Employee voluntary/supplemental life insurance coverage. You may not elect coverage for your spouse if they are in active full-time military service or is already covered as an employee under this policy. If your spouse is confined in a hospital or elsewhere because of disability on the date his or her insurance would normally have become effective, coverage (or an increase in coverage) will be deferred until that dependent is no longer confined and has performed all the normal activities of a healthy person of the same age for at least 15 consecutive days. If you are newly eligible and elect an amount that exceeds the guaranteed issue amount of $50,000, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you were previously eligible and are electing coverage for the first time or electing to increase your spouse's current coverage, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before coverage can become effective . 37
Voluntary Group Term Life and AD&D
Child(ren) Voluntary Life Insurance
If you elect Voluntary Life Insurance for yourself, you may choose to purchase Child(ren) Voluntary Life Insurance coverage in the amount(s) of $10,000 for each child – no medical information is required. If your dependent child(ren) is confined in a hospital or elsewhere because of disability on the date his or her insurance would normally have become effective, coverage (or an increase in coverage) will be deferred until that dependent is no longer confined and has performed all the normal activities of a healthy person of the same age for at least 15 consecutive days.
Does my coverage reduce as I get older?
By 35% @ 70, 55% of Original @ 75, 70% of Original @ 80, 80% of Original @ 85, 85% of Original @ 90. All coverage cancels at retirement.
Can I keep my life coverage if I leave my employer?
Yes, subject to the contract, you have the option of: Converting your group life coverage to your own individual policy (policies). If you leave your employer, portability is an option that allows you to continue your life insurance coverage. To be eligible, you must terminate your employment prior to Social Security Normal Retirement Age. This option allows you to continue all or a portion of your life insurance coverage under a separate portability term policy. Portability is subject to a minimum of $5,000 and a maximum of $250,000 and does include coverage for your spouse and child(ren). To elect portability, you must apply and pay the premium within 31 days of the termination of your life insurance. Evidence of insurability will not be required. Dependent spouse portability is subject to a maximum of $50,000. Dependent child(ren) portability is subject to a maximum of $10,000.
What is the living benefits option?
If you are diagnosed as terminally ill with a 12 month life expectancy, you may be eligible to receive payment of a portion of your life insurance. The remaining amount of your life insurance would be paid to your beneficiary when you die.
Do I still pay my life insurance premiums if I become disabled?
If you become totally disabled before age 60 and your disability lasts for at least 9 months, your life insurance premium may be waived. The premium for your dependent’s coverage will also be waived if you are disabled and approved for waiver of premium. Coverage for your dependents will end if the policy terminates.
Important Details As is standard with most term life insurance, this insurance coverage includes certain limitations and exclusions: the amount of your coverage may be reduced when you reach certain ages. death by suicide (two years). Other exclusions may apply depending upon your coverage. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail. This benefit highlights sheet is an overview of the insurance being offered and is provided for illustrative purposes only and is not a contract. It in no way changes or affects the policy as actually issued. Only the insurance policy issued to the policyholder (your employer) can fully describe all of the provisions, terms, conditions, limitations and exclusions of your insurance coverage. In the event of any difference between the benefit highlights sheet and the insurance policy, the terms of the insurance policy apply.
38
Voluntary Group Term Life and AD&D Employee Life Rates Age Band 0-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$0.40 $0.40 $0.50 $0.70 $1.10 $1.80 $3.00 $4.70 $6.20 $9.90 $17.40 $31.50
$0.80 $0.80 $1.00 $1.40 $2.20 $3.60 $6.00 $9.40 $12.40 $19.80 $34.80 $63.00
$1.20 $1.20 $1.50 $2.10 $3.30 $5.40 $9.00 $14.10 $18.60 $29.70 $52.20 $94.50
$1.60 $1.60 $2.00 $2.80 $4.40 $7.20 $12.00 $18.80 $24.80 $39.60 $69.60 $126.00
$2.00 $2.00 $2.50 $3.50 $5.50 $9.00 $15.00 $23.50 $31.00 $49.50 $87.00 $157.50
$2.40 $2.40 $3.00 $4.20 $6.60 $10.80 $18.00 $28.20 $37.20 $59.40 $104.40 $189.00
$2.80 $2.80 $3.50 $4.90 $7.70 $12.60 $21.00 $32.90 $43.40 $69.30 $121.80 $220.50
$3.20 $3.20 $4.00 $5.60 $8.80 $14.40 $24.00 $37.60 $49.60 $79.20 $139.20 $252.00
$4.00 $4.00 $5.00 $7.00 $11.00 $18.00 $30.00 $47.00 $62.00 $99.00 $174.00 $315.00
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$50,000
$0.30 $0.30 $0.35 $0.50 $0.75 $1.15 $1.85 $2.90 $3.85 $6.10 $10.70 $19.35
$0.60 $0.60 $0.70 $1.00 $1.50 $2.30 $3.70 $5.80 $7.70 $12.20 $21.40 $38.70
$0.90 $0.90 $1.05 $1.50 $2.25 $3.45 $5.55 $8.70 $11.55 $18.30 $32.10 $58.05
$1.20 $1.20 $1.40 $2.00 $3.00 $4.60 $7.40 $11.60 $15.40 $24.40 $42.80 $77.40
$1.50 $1.50 $1.75 $2.50 $3.75 $5.75 $9.25 $14.50 $19.25 $30.50 $53.50 $96.75
$1.80 $1.80 $2.10 $3.00 $4.50 $6.90 $11.10 $17.40 $23.10 $36.60 $64.20 $116.10
$2.10 $2.10 $2.45 $3.50 $5.25 $8.05 $12.95 $20.30 $26.95 $42.70 $74.90 $135.45
$2.40 $2.40 $2.80 $4.00 $6.00 $9.20 $14.80 $23.20 $30.80 $48.80 $85.60 $154.80
$3.00 $3.00 $3.50 $5.00 $7.50 $11.50 $18.50 $29.00 $38.50 $61.00 $107.00 $193.50
$20,000 $0.50 $0.80
$30,000 $0.75 $1.20
$40,000 $1.00 $1.60
$50,000 $1.25 $2.00
$60,000 $1.50 $2.40
$70,000 $1.75 $2.80
$80,000 $2.00 $3.20
$2.50 $4.00
Spouse Life Rates Age Band 0-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
Child Life Rates $10,000 $1.25 Per Child Unit
AD&D Rates EMPLOYEE FAMILY
$10,000 $0.25 $0.40
NOTE: FINAL RATES MAY VARY SLIGHTLY DUE TO ROUNDING. THESE GRIDS ARE PRICES OF FREQUENTLY SELECTED AMOUNTS. YOU MAY CHOOSE SEE YOUR PLAN ADMINISTRATOR FOR DETAILS OF COVERAGES. TO PURCHASE AN AMOUNT OTHER THAN THOSE LEVELS INDICATED ABOVE, SIMPLY ADD RATES TOGETHER FROM COLUMNS TO EQUAL AMOUNT ELECTED (I.E ELECTION $170,000, TAKE THE RATE FOR 100K IN YOUR AGE-BRACKET & YOUR AGE-BRACKET RATE FROM THE 70K COLUMN AND ADD TOGETHER, THAT WILL BE THE MONTHLY PREMIUM RATE) 39
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.
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 Rusk ISD Benefits Website: www.mybenefitshub.com/ruskisd
FSA (Flexible Spending Account) NBS Flexcard
When Will I Receive My Flex Card?
You may use the card to pay merchants or service providers that accept MasterCard® credit cards, so there is no need to pay cash up front, then wait for reimbursement. If you are participating in the Dependent Care portion, the money isn’t loaded to the card. You must file web or paper claims or enroll in continual reimbursement.
NBS Prepaid MasterCard® Debit Card
Current plan participants: KEEP YOUR CARDS! NBS debit cards are good for 3 years. If you need a replacement card please contact NBS directly at (800) 274-0503.
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.
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 Rusk ISD benefit website: www.mybenefitshub.com/ruskisd
NBS Contact Information: 8523 South Redwood Road West Jordan, UT 84088 Phone (800) 274‐0503 Fax (800) 478‐1528 Email: claims@nbsbenefits.com
DID YOU KNOW? FSAs use tax-free funds to help pay for your Health Care Expenses.
FSA Annual Contribution Max: $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 41
FSA Frequently Asked Questions What is a Flexible Spending Account? A Flexible Spending Account allows you to save money by paying out-of-pocket health and/or dependent care related expenses with pre-tax dollars. Your contributions are deducted from your pay before taxes are withheld and your account is up fronted with an annual amount. Because you are taxed on a lower amount of pay, you pay less in taxes and you have more to spend.
How does a Flexible Spending Account Benefit Me? A Cafeteria plan enables you to save money on group insurance, health-related expenses, and dependent-care expenses. You may save as much as 35 percent on the cost of each benefit option! Eligible expenses must be incurred within the plan year and contributions are use-it-or-roll $500. 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/ruskisd
42
What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)? Eligible expenses must be incurred within the plan year +75 day grace period. Contributions are use-it-or-roll $500. 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/ruskisd 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 or rollover after the Plan year ends for you to submit qualified claims for any unused funds. If you choose to enroll in the HSA you are not eligible to enroll in the FSA.
43
5STAR
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 Rusk ISD Benefits Website: www.mybenefitshub.com/ruskisd
Term Life with Terminal Illness and Quality of Life Rider The Family Protection Plan: Term Life Insurance with Terminal Illness Coverage to Age 100 Nearly 85% of Americans say most people need life insurance; unfortunately only 62% have coverage and a staggering 33% say they don’t have enough life insurance, including one-fourth who already have life insurance coverage.** Nobody wants to be a statistic - especially during a period of grief. That’s why 5Star Life Insurance Company developed its FPP policy - to ensure you and your loved ones are covered during a period of loss.
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.
DID YOU KNOW? Protecting your financial well being is easier than you think. It’s like trading in a daily latte for peace of mind.
$4.30 per day to start your morning with a $1.75
gourmet coffee OR per day to enrich your employee benefits package
It’s less expensive than you think.
Family Protection - Individual policies can be purchased on the employee, their spouse, children and grandchildren (ages 15 days to age 24). Quality of Life Benefit - Following a diagnosis of either a chronic illness or cognitive impairment, this rider accelerates a portion of the death benefit on a monthly basis – 4%; up to 75% of your benefit, and payable directly to you on a tax favored basis for the following: Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision. 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 twoyear contestability period and/or under investigation. This product also contains no war or terrorism exclusions. * Life insurance product underwritten by 5Star Life insurance Company (a Baton Rouge, Louisiana company) with an administrative office at 909 N. Washington Street, Alexandria, VA 22314
45
Family Protection Plan - Terminal Illness Monthly Rates with Quality of Life Rider Defined Benefit Employee Coverage Amounts
Spouse Coverage Amounts
Age on App. Date
$10,000
$25,000
$50,000
$75,000
$100,000
$10,000
$20,000
$30,000
18-25
$7.56
$12.40
$20.46
$28.52
$36.58
$7.56
$10.78
$14.01
26
$7.58
$12.46
$20.58
$28.71
$36.83
$7.58
$10.83
$14.08
27
$7.65
$12.63
$20.92
$29.21
$37.50
$7.65
$10.97
$14.28
28
$7.74
$12.85
$21.38
$29.90
$38.42
$7.74
$11.15
$14.56
29
$7.88
$13.21
$22.08
$30.96
$39.83
$7.88
$11.43
$14.98
30
$8.07
$13.67
$23.00
$32.33
$41.67
$8.07
$11.80
$15.53
31
$8.27
$14.17
$24.00
$33.83
$43.67
$8.27
$12.20
$16.13
32
$8.49
$14.73
$25.13
$35.52
$45.92
$8.49
$12.65
$16.81
33
$8.73
$15.31
$26.29
$37.27
$48.25
$8.73
$13.12
$17.51
34
$9.00
$16.00
$27.67
$39.33
$51.00
$9.00
$13.67
$18.33
35
$9.30
$16.75
$29.17
$41.58
$54.00
$9.30
$14.27
$19.23
36
$9.64
$17.60
$30.88
$44.15
$57.42
$9.64
$14.95
$20.26
37
$10.02
$18.54
$32.75
$46.96
$61.17
$10.02
$15.70
$21.38
38
$10.41
$19.52
$34.71
$49.90
$65.08
$10.41
$16.48
$22.56
39
$10.84
$20.60
$36.88
$53.15
$69.42
$10.84
$17.35
$23.86
40
$11.31
$21.77
$39.21
$56.65
$74.08
$11.31
$18.28
$25.26
41
$11.83
$23.08
$41.83
$60.58
$79.33
$11.83
$19.33
$26.83
42
$12.41
$24.52
$44.71
$64.90
$85.08
$12.41
$20.48
$28.56
43
$13.00
$26.00
$47.67
$69.33
$91.00
$13.00
$21.67
$30.33
44
$13.63
$27.56
$50.79
$74.02
$97.25
$13.63
$22.92
$32.21
45
$14.28
$29.19
$54.04
$78.90
$103.75
$14.28
$24.22
$34.16
46
$14.97
$30.92
$57.50
$84.08
$110.67
$14.97
$25.60
$36.23
47
$15.69
$32.73
$61.13
$89.52
$117.92
$15.69
$27.05
$38.41
48
$16.43
$34.56
$64.79
$95.02
$125.25
$16.43
$28.52
$40.61
49
$17.22
$36.54
$68.75
$100.96
$133.17
$17.22
$30.10
$42.98
50
$18.08
$38.69
$73.04
$107.40
$141.75
$18.08
$31.82
$45.56
51
$19.04
$41.10
$77.88
$114.65
$151.42
$19.04
$33.75
$48.46
52
$20.16
$43.90
$83.46
$123.02
$162.58
$20.16
$35.98
$51.81
53
$21.40
$47.00
$89.67
$132.33
$175.00
$21.40
$38.47
$55.53
54
$22.79
$50.48
$96.63
$142.77
$188.92
$22.79
$41.25
$59.71
55
$24.27
$54.17
$104.00
$153.83
$203.67
$24.27
$44.20
$64.13
56
$25.93
$58.33
$112.33
$166.33
$220.33
$25.93
$47.53
$69.13
57
$27.66
$62.65
$120.96
$179.27
$237.58
$27.66
$50.98
$74.31
58
$29.42
$67.04
$129.75
$192.46
$255.17
$29.42
$54.50
$79.58
59
$31.23
$71.56
$138.79
$206.02
$273.25
$31.23
$58.12
$85.01
46
Family Protection Plan - Terminal Illness Employee Coverage Amounts
Spouse Coverage Amounts
Age on App. Date
$10,000
$25,000
$50,000
$75,000
$100,000
$10,000
$20,000
$30,000
18-25
$7.56
$12.40
$20.46
$28.52
$36.58
$7.56
$10.78
$14.01
60
$33.12
$76.29
$148.25
$220.21
$292.17
$33.12
$61.90
$90.68
61
$35.08
$81.19
$158.04
$234.90
$311.75
$35.08
$65.82
$96.56
62
$37.13
$86.31
$168.29
$250.27
$332.25
$37.13
$69.92
$102.71
63
$39.31
$91.77
$179.21
$266.65
$354.08
$39.31
$74.28
$109.26
64
$41.68
$97.71
$191.08
$284.46
$377.83
$41.68
$79.03
$116.38
65
$44.33
$104.33
$204.33
$304.33
$404.33
$44.33
$84.33
$124.33
66*
$44.93
$105.81
$207.29
$308.77
$410.25
$44.93
$85.52
$126.11
67*
$48.25
$114.13
$223.92
$333.71
$443.50
$48.25
$92.17
$136.08
68*
$52.03
$123.58
$242.83
$362.08
$481.33
$52.03
$99.73
$147.43
69*
$56.33
$134.31
$264.29
$394.27
$524.25
$56.33
$108.32
$160.31
70*
$61.17
$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: 14 days to 23 years old). $4.98 monthly for $10,000 coverage and $9.97 monthly for $20,000 coverage. 47
WWW.MYBENEFITSHUB.COM/ RUSKISD 48