CELINA ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2018 - 08/31/2019 WWW.MYBENEFITSHUB.COM/CELINAISD
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Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. HSA vs FSA Comparison TRS-ActiveCare and Scott & White HMO HSA Bank Health Savings Account MDLIVE Telehealth First Continental Life (FCL) Dental Superior Vision The Hartford Long Term Disability APL Cancer Loyal American Accident The Hartford Basic Life, Voluntary Life and AD&D 5Star Family Protection Plan Term Life Insurance with Quality of Life Rider NBS Flexible Spending Account
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3 4-5 6-11 6 7 8 9 10 11 12-15 16-19 20-21 22-25 26-27 28-31 32-35 36-39 40-43
FLIP TO... PG. 4 HOW TO HOW TO ENROLL ENROLL
PG. 6 SUMMARY PAGES
44-47
PG. 12
48-51
YOUR BENEFITS
Benefit Contact Information BENEFIT ADMINISTRATORS
CELINA ISD BENFITS OFFICE
TRS ACTIVECARE MEDICAL
Financial Benefit Services (800) 583-6908 www.mybenefits hub.com/celinaisd
(469) 742-9100 www.celinaisd.com
Aetna (800) 222-9205 www.trsactivecareaetna.com
HEALTH SAVINGS ACCOUNT
TELEHEALTH
DENTAL
HSA Bank (800) 357-6246 www.hsabank.com
MDLIVE (888) 365-1663 www.consultmdlive.com
Group # 1245-D First Continental Life (FCL) Dental (800) 660-6064 Find a provider: (800) 752-1547 www.fcldental.com
VISION
DISABILITY
CANCER
Group # 324700 Superior Vision (800) 507-3800 www.superiorvision.com
Group # 873302 The Hartford (800) 583-6908 File a claim: (866) 278-2655 www.thehartford.com
American Public Life (APL) (800) 256-8606 File a claim: (800) 256-8606 www.ampublic.com
ACCIDENT
LIFE AND AD&D
FLEXIBLE SPENDING ACCOUNT
Loyal American (800) 366-8354
The Hartford (469) 385-4685 File a claim: 1 (888) 563-1124 www.thehartford.com
National Benefit Services (800) 274-0503 www.nbsbenefits.com
INDIVIDUAL LIFE 5Star Life Insurance Company (866) 863-9753 www.5starlifeinsurance.com
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MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS CISD” to 313131 and get access to everything you need to complete your benefits enrollment: •
Benefit Information
•
Online Support
•
Interactive Tools
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And more. PLAY VIDEO
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Text “FBS CISD” to 313131 OR SCAN
How to Log In
1 BENEFIT INFO
INTERACTIVE TOOLS
2 3
www.mybenefitshub.com/ celinaisd
CLICK LOGIN
ENTER USERNAME & PASSWORD All login credentials have been RESET to the default described below:
Username: The first six (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.
ONLIINE SUPPORT
If you have less than six (6) characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.
Default Password: Last Name* (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number.
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Annual Benefit Enrollment
SUMMARY PAGES
Benefit Updates - What’s New: •
IMPORTANT! 5Star Individual Life will be Guarantee Issue • for New Hires which means no health questions. Coverage is available for the following amounts: Employees up to $100,000, Spouses up to $30,000 and Children & Grandchildren up to $20,000. Rates are locked at time of election which means your rate does not increase as you get older.
•
UPDATE! Health Savings Account (HSA) Annual Individual maximum contribution increased to $3,450 and Family maximum contribution increased to $6,900 for 2018. Remember you can only contribute to an HSA if you are enrolled in ActiveCare 1-HD.
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UPDATE! Flexible Spending Account (FSA) Annual Maximum contribution limit increased to $2,650 for 2018.
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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. The maximum for FSA will be increasing for the 2018‐2019 plan year to $2,650.
Benefit elections will become effective 9/1/2018 (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 31 days of event).
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NEW! Got Zoom fills a critical void in the benefit marketplace. Student loan debt is our country's largest debt class behind mortgages. They find the best program options available that suit your needs, confirm eligibility and facilitate all the administrative needs - including annual re-certification to ensure your compliance and peace of mind.
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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.
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 7/1/2018‐8/24/2018. Update your profile information: home address, phone numbers, email. Update dependent social security numbers and student status for college aged children.
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SUMMARY PAGES
Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 31 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
CHANGES IN STATUS (CIS):
QUALIFYING EVENTS
Marital Status
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
Change in Number of Tax Dependents
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Change in Status of Employment Affecting Coverage Eligibility
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.
An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements Gain/Loss of Dependents' under an employer's plan may include change in age, student, marital, employment or tax dependent Eligibility Status status. If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order Judgment/Decree/Order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage. Eligibility for Government Programs
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
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SUMMARY PAGES
Annual Enrollment During your annual enrollment period, you have the opportunity
Where can I find forms?
to review, change or continue benefit elections each year.
For benefit summaries and claim forms, go to your school
Changes are not permitted during the plan year (outside of
district’s benefit website: www.mybenefitshub.com/celinaisd.
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/celinaisd.
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 network providers 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 Celina 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 2018 benefits become effective on September 1, 2018, you must be actively-at-work on September 1, 2018 to be eligible for your new benefits. PLAN
CARRIER
MAXIMUM AGE
Medical
Aetna
To age 26
Cancer
American Public Life
To age 26
Dental PPO
OraQuest/First Continental Life
To age 26
The Hartford
To age 25
Individual Life
5 Star
To age 24
Vision
Superior Vision
To age 26
Voluntary Life
The Hartford
To age 26
AD&D
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage.
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Helpful Definitions
SUMMARY PAGES
Actively at Work
In-Network
You are performing your regular occupation for the employer
Doctors, hospitals, optometrists, dentists and other providers
on a full-time basis, either at one of the employer’s usual
who have contracted with the plan as a network provider.
places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2018 please notify your benefits administrator.
Annual Enrollment The period during which existing employees are given the opportunity to enroll in or change their current elections.
Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.
Out of Pocket Maximum The most an eligible or insured person can pay in co-insurance for covered expenses.
Plan Year September 1st through August 31st
Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescriptions drugs or is under a health care provider’s orders to take drugs, or received medical care or services
Calendar Year January 1st through December 31st
Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or pre-existing condition exclusion provisions do apply, as applicable by carrier.
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(including diagnostic and/or consultation services).
SUMMARY PAGES
HSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Description
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
Minimum Deductible Maximum Contribution
$1,350 single (2018) $2,700 family (2018) $3,450 single (2018) $6,900 family (2018)
N/A $2,650
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. 48
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2018 – 2019 TRS-ActiveCare Plan Highlights Effective September 1, 2018 through August 31, 2019 | In-Network Level of Benefits1
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 Freestanding Emergency Room Participant pays
$500 copay per visit plus 20% after deductible
$500 copay per visit plus 20% after deductible
$500 copay per visit plus 20% after deductible
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 ParticipantCare pays Preventive Routine physicals – annually age 12 and over Mammograms – 1 every year age 35 and over Smoking cessation counseling– 8 visits per 12 months
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• Well-child care – unlimited up to age 12 • Colonoscopy – 1 every 10 years age 50 and over •Healthydiet/obesity counseling– unlimited to
• Well woman exam & pap smear – annually age 18 and over • Prostatecancerscreening–1 per year age 50 and over • Breastfeeding support – 6 lactation counseling visits
Drug Deductible Short-Term Supply at a Retail Location 20% coinsurance after deductible, except for certain generic preventive drugs that are covered at 100%.2 20% coinsurance after deductible 50% coinsurance after deductible Extended-Day Supply at Mail Order or Retail-Plus Pharmacy Location (60- to 90-day supply)5 20% coinsurance after deductible
$20 for a 1- to 31-day supply $20 for a 1- to 31-day supply $40 for a 1- to 31-day supply3 $40 for a 1- to 31-day supply3 50% coinsurance for a 1- to 31-day supply3 50% coinsurance for a 1- to 31-day supply (Min. $654; Max. $130)3
$45 for a 60- to 90-day supply
$45 for a 60- to 90-day supply
$105 for a 60- to 90-day supply3 $105 for a 60- to 90-day supply3 3 50% coinsurance for a 60- to 90-day supply 50% coinsurance for a 60- to 90-day supply3 (min. $1804 , max $360)3 Specialty Medications 20% coinsurance after deductible 20% coinsurance 20% coinsurance (up to a 31-day supply) (min. $2004 , max $900) Short-Term Supply of a Maintenance Medication at Retail Location (up to a 31-day supply) 20% coinsurance after deductible 50% coinsurance after deductible
Tier 1 – Generic Tier 2 – Preferred Brand Tier 3 – Non-Preferred Brand
20% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible
$35 for a 1- to 31-day supply $35 for a 1- to 31-day supply $60 for a 1- to 31-day supply $60 for a 1- to 31-day supply 50% coinsurance for a 1- to 31-day supply3
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. A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. 1 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. 2 For ActiveCare 1-HD, certain generic preventive drugs are covered at 100%. Participants do not have to meet the deductible ($2,750 - individual, $5,500 - family) and they pay nothing out of pocket for these drugs. Find the list of drugs at info.caremark.com/trsactivecare. 3 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. 4 If the cost of the drug is less than the minimum, you will pay the cost of the drug. 5 Participants can fill 32-day to 90-day supply through mail order.
Full monthly premium*
Premium with min. state/ district contribution**
$367
+Spouse +Children +Family
Individual
Your Monthly Premium***
Full monthly premium*
Premium with min. state/ district contribution**
$142
$540
$1,035
$810
$701
$476
$1,374
$1,149
Your Monthly Premium***
Full monthly premium*
Premium with min. state/ district contribution**
$315
$782
$557
$1,327
$1,102
$1,855
$1,630
$876
$651
$1,163
$938
$1,668
$1,443
$2,194
$1,969
Your Monthly Premium***
* If you are not eligible for the state/district subsidy, you will pay the full monthly premium. Please contact your Benefits Administrator for your monthly premium. ** The premium after state, $75 and district, $150 contribution is the maximum you pay per month. Ask your Benefits Administrator for your monthly cost. (This is the amount you will owe each month after all available subsidies are applied to your premium.) *** Completed by your benefits administrator. The state/district contribution may be greater than $225. 13
2018-2019 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare Fully Covered Health Care Services
Copay
Preventive Services
No Charge
Standard Lab and X-ray
No Charge
Disease Management and Complex Case Management
No Charge
Well Child Care Annual Exams
No Charge
Immunizations (age appropriate)
No Charge
Plan Provisions
Copay
Annual Deductible
$1,000 Individual/ $3,000 Family
Annual out-of-pocket maximum (including medical and prescription co-pays and coinsurance)
Lifetime Paid Benefit Maximum
Outpatient Services
$7,000 Individual/ $14,000 Family (includes combined Medical and RX copays, deductibles and coinsurance)
None
Copay $15 co-pay
Primary Care1
(First Primary Care Visit for Illness $0 Copay2)
Specialty Care
$70 co-pay
Other Outpatient Services
20% after deductible3
Diagnostic/Radiology Procedures
20% after deductible
Eye Exam (one annually) Allergy Serum & Injections
No Charge 20% after deductible
Outpatient Surgery
$150 co-pay and 20% of charges after deductible
Maternity Care
Copay
Prenatal Care
No Charge $150 per day4 and 20% of charges after deductible
Inpatient Delivery
Inpatient Services
Copay
Overnight hospital stay: includes all medical services including semi -private room or intensive care
Diagnostic & Therapeutic Services Physical and Speech Therapy Manipulative Therapy
5
Equipment and Supplies Preferred Diabetic Supplies and Equipment Non-Preferred Diabetic Supplies and Equipment Durable Medical Equipment/ Prosthetics 14
$150 per day4 and 20% of charges after deductible
Copay $70 copay 20% without office visit $40 plus 20% with office visit
Copay $5/$12.50 copay; no deductible 30% after Rx deductible 20% after deductible
2018-2019 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare Home Health Services
Copay
Home Health Care Visit
$70 co-pay
Worldwide Emergency Care
Copay
Nurse Advice Line
1-877-505-7947
Online Services
No Charge — go to http://trs.swhp.org
After Hours Primary Care Clinics
$20 co-pay
Ambulance and Helicopter
$40 copay plus 20% of charges after deductible
Emergency Room6
$250 copay plus 20% of charges after deductible
Urgent Care Facility
$50 copay per visit; deductible does not apply
Prescription Drugs (Group Value Formulary)
Copay
Annual Benefit Maximum
Unlimited
Rx Deductible
$150
Does not apply to preferred generic drugs
Ask an SWHP Pharmacy representative how to save money on your prescriptions.
Maintenance Quantity Retail Quantity (Up to a 30-day supply)
BSW Pharmacies Only, including Mail Order (Up to a 90-day supply)
$5 copay
$12.50 copay
Preferred Brand
30% after Rx deductible
30% after Rx deductible
Non-preferred
50% after Rx deductible
50% after Rx deductible
Preferred Generic
Online Refills Mail Order
Specialty Medications
http://trs.swhp.org 1-817-388-3090
Copay Tier 1: 15% after Rx deductible
(Up to a 30-day supply)
Tier 2: 15% after Rx deductible Tier 3: 25% after Rx deductible
1
Including all services billed with office visit Does not apply to wellness or preventive visits 3 Includes other services, treatments, or procedures received at time of office visit 4 $750 maximum copay per admission and 20% after deductible 5 35 max visit per year 6 Copay waived if admitted within 24 hours 2
The SWHP MOMS Program provides you with professional staff who are notified of the delivery of your baby. These licensed professionals will contact you after you return home and help you with everything from the general well-being of both you and your baby, to breast/bottle feeding, to information on how to add your baby to your health plan.
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HSA BANK
HSA (Health Savings Account)
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit A Health Savings Account is a tax-advantaged medical savings account available to employees who are enrolled in a high-deductible health plan. The funds contributed to the account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent.
The interest earned in an HSA is tax free.
Money withdrawn for medical spending never falls under taxable income.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 16 Celina ISD Benefits Website: www.mybenefitshub.com/celinaisd
HSA (Health Savings Account) HSA Bank has teamed up with your employer to create an • Not enrolled in Medicare (if an accountholder enrolls in affordable health coverage option that helps you save on Medicare mid-year, catch-up contributions should be healthcare expenses. This plan is only available for those who are prorated) participating in the ActiveCare 1-HD medical plan. If you choose Authorized Signers who are 55 or older must have their own to elect the HSA plan you are still eligible to enroll in the Limited HSA in order to make the catch-up contribution Flexible Spending plan offered by the district. Medicare, Medicaid, and Tricare participants are not eligible to participate Monthly Fee: Your account will be charged a monthly fee of in an HSA. $1.75, waived with an average daily balance at or above $3,000. 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 • Surgery medical expenses are always tax-free. • Braces
Examples of Qualified Medical Expenses
What is an HSA? •
• •
A tax-advantaged savings account that you use to pay for eligible medical expenses as well as deductible, co-insurance, prescriptions, vision and dental care. Allows you to save while reducing your taxable income. Unused funds that will roll over year to year. There’s no “use it or lose it” penalty. A way to accumulate additional retirement savings. After age 65, funds can be withdrawn for any purpose without penalty.
Using Funds
• • • •
Contact lenses Dentures Eyeglasses Vaccines
For a list of sample expenses, please refer to the Celina ISD website at www.thebenefitshub.com/celinaisd
HSA Bank Contact Information 605 N. 8th Street, Ste 320 Sheboygan, WI 53081 Phone: 800-357-6246 www.hsabank.com
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.
2018 Annual HSA Contribution Limits Individual: $3,450 Family: $6,900 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)
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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
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 Celina ISD Benefits Website: www.mybenefitshub.com/celinaisd
Telehealth When should I use MDLIVE? • If you’re considering the ER or urgent care for a non-emergency medical issue • Your primary care physician is not available • At home, traveling, or at work • 24/7/365, even holidays!
What can be treated? • • • • • • • • •
Allergies Asthma Bronchitis Cold and Flu Ear Infections Joint Aches and Pain Respiratory Infection Sinus Problems And More!
Pediatric Care related to: • • • • • • •
Cold & Flu Constipation Ear Infection Fever Nausea & Vomiting Pink Eye And More!
Are children eligible? Yes. MDLIVE has local pediatricians on-call 24/7/365. Please note, a parent or guardian must be present during any interactions involving minors. We ask parents to establish a child record under their account. Parents must be present on each call for children 18 or younger.
How much does it cost? $0 Covers you, your spouse, and children up to age 26, with unlimited phone consultations.
Download the App Doctor visits are easier and more convenient with the MDLIVE App. Be prepared. Download today. www.mdlive.com/getapp • • • • •
Access to a doctor anywhere: at home, at work, or on the go Choose doctors from one of the nation's largest telehealth networks Available 24/7 by video or phone Private, secure and confidential visits Connect instantly with MDLIVE Assist
Who are our doctors? MDLIVE has the nation’s largest network of telehealth doctors. On average, our doctors have 15 years of experience practicing medicine and are licensed in the state where patients are located. Their specialties include primary care, pediatrics, emergency medicine and family medicine. Our doctors are committed to providing convenient, quality care and are always ready to take your call.
Scan with your smartphone to get the app.
Call us at (888) 365-1663 or visit us at www.consultmdlive.com
Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for 21 abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit www.mdlive.com/terms-of-use/ 010113
FCL DENTAL
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 Celina ISD Benefits Website: www.mybenefitshub.com/celinaisd
Passive PPO Dental Plan (100/80/50) Annual Benefit Per Person: $1,500 Rates for: Celina ISD Effective Date September 1, 2018
Percentage of Covered Benefits Per Policy Year Type I
Type II
Type III*
During the 1st Year
100%
80%
2nd Year and Thereafter
100%
80%
EE Only
$33.34
0%
EE + Spouse
$65.92
50%
EE + Child(ren)
$74.08
EE + Family
$113.94
12-month waiting period (unless replacing prior coverage as described under “Takeover Benefit”) (Use Network Offices for Additional Savings) Dentist List at Dentemax.com
Calendar Year Deductible, Per Person: $50/$150 Payment is based upon allowable charges in the area in which service is rendered. Services provided at a non-contracting provider are paid at the 90th percentile.
TYPE I (PREVENTIVE SERVICES)
TYPE III (MAJOR SERVICES)
Including:
Including:
•
No waiting period
•
12 month waiting period (new enrollees)
•
Routine Exams
•
Major restorative services (crowns and inlays)
•
Prophylaxis (cleanings-one per 6 months)
•
Prosthetics (bridges, dentures)
•
Emergency exams for dental pain (minor procedures)
•
Replacement of prosthodontics, dentures, crowns
•
Fluoride treatments for dependent children under age
•
and inlays
19 (one per 12 months)
•
Denture relines
Bitewing X-rays (once per 6 months)
•
Endodontics/root canal therapy
•
Periodontics
•
Space maintainers
•
Complex Oral Surgery
•
General anesthesia (for services dentally necessary)
TYPE II (BASIC SERVICES) Including: •
No waiting period
•
Periapical X-rays
•
Full mouth or panorex X-rays (one per 36 months)
ORTHODONTIC SERVICES - (12 MONTH WAIT)
•
Simple restorative services (fillings)
•
50% coverage
•
Simple extractions
•
$1,000 lifetime maximum benefit
•
Palliative treatment for dental pain, local anesthesia
•
Children under 19 only
•
Sealants for children ages 6-15 (one per tooth)
23
Passive PPO Dental Plan (100/80/50) Limitations and Exclusions Covered Expenses Will not Include and No Benefits Will be Payable: 1.
For major services in the first 12 months that the Insured is covered, except as may be provided in the Takeover Benefits provision. 2. For any treatment which is for cosmetic purposes or to correct congenital malformations, except for medically necessary care and treatment of congenital cleft lip and palate. 3. To replace any prosthetic appliance, crown, inlay or onlay restoration, or fixed bridge within five years of the date of the last placement of these items, unless required because of an accidental bodily injury sustained while the Insured is covered. Replacement is not covered if the item can be repaired. 4. For initial placement of any prosthetic appliance or fixed bridge unless such placement is needed because of the extraction of natural teeth during the same period of continuous coverage. But the extraction of a third molar (wisdom tooth) will not qualify the item for payment. Any such appliance or fixed bridge must include the replacement of the extracted tooth or teeth. Coverage does not include the part of the cost that applies specifically to replacement of teeth extracted prior to the period of coverage. 5. For addition of teeth to an existing prosthetic appliance or fixed bridge unless for replacement of natural teeth extracted during the same period of continuous coverage. 6. For any expense incurred or procedure begun before the Insured’s current period of continuous coverage. 7. For any expense incurred or procedure begun after the Insured’s insurance under this section terminates, except for a prosthetic appliance, fixed bridge, crown, or inlay or onlay restoration for which both (a) the procedure begins before insurance ends and (b) the item’s final placement is within 90 days after insurance ends. 8. To duplicate appliances or replace lost or stolen appliances. 9. For appliances, restorations or procedures to: a. alter vertical dimension; b. restore or maintain occlusion; c. splint or replace tooth structure lost as a result of abrasion or attrition; d. or treat jaw fractures or disturbances of the temporomandibular joint. 10. For education or training in, and supplies used for, dietary or nutritional counseling, personal oral hygiene or dental plaque control.
24
11. For broken appointments or the completion of claim forms. 12. For orthodontia service or for any services associated with orthodontic therapy when this optional coverage is not elected and the premium is not paid. 13. For sealants which are: j. not applied to a permanent molar; k. applied before age 6 or after attaining age 16; or l. reapplied to a molar within three years from the date of a previous sealant application. 14. For subgingival curettage or root planing (procedure numbers 4220 and 4341) unless the presence of periodontal disease is confirmed by both x-rays and pocket depth summaries of each tooth involved. 15. Because of an Insured’s injury arising out of, or in the course of, work for wage or profit. 16. For an Insured’s sickness, injury or condition for which he or she is eligible for benefits under any Workers Compensation Act or similar laws. 17. For charges for which the Insured is not liable or which would not have been made had no insurance been in force. 18. For services which are not recommended by a dentist, not required for necessary care and treatment, or do not have a reasonably favorable prognosis. 19. Because of war or any act of war, declared or not, or while on fulltime active duty in the armed forces of any country. 20. To an Insured if payment is not legal where the Insured is living when expenses are incurred. 21. For any services related to: equilibration, bite registration or bite analysis. 22. For crowns for the purpose of periodontal splinting. 23. For charges for: any implants; overdentures; precision or semiprecision attachments and associated endodontic treatment; other customized attachments; or specialized prosthodontic techniques or characterizations. 24. For charges for myofunctional therapy, orthognathic surgery or athletic mouthguards. 25. For procedures for which benefits are payable under the employer’s medical expense benefits plan for employees and their dependents. 26. Services or supplies provided by a family member or a member of the Insured’s household. Note: This is a general outline of covered benefits and does not include all the benefits, limitations and exclusions of the policy. See your certificate for details.
Passive PPO Dental Plan (100/80/50) Predetermination of Benefits: As a service to protect the Insured, First Continental Life & Accident Insurance Co. will provide predetermination of benefits for recommended treatment plans that exceed $300. This predetermination of benefits explains which of the recommended procedures will be covered and at what amount. This benefit helps Insured's better understand their coverage. The Insured should submit the treatment plan to First Continental Life & Accident Insurance Co. for
TAKEOVER BENEFITS Takeover means that you are given credit for waiting periods for like coverage's accumulated under your existing plan. No credit is given for deductibles satisfied under your existing plan. 1. In order to provide Takeover Benefits your employer’s current dental plan must have been in effect continuously for at least 12 months prior to the effective date of this plan. 2. All employees insured on the effective date with continuous coverage from the prior group dental contract are eligible for Takeover Benefits. Waiting periods will be reduced by the amount of time insured under the prior plan. 3. A minimum of five (5) enrolled members are needed for an employer to be eligible for Takeover Benefits. 4. Takeover Benefits must be requested and are subject to the approval of First Continental Life & Accident Insurance Co. Submission of Claims: First Continental Life & Accident Insurance Co. ATTN: Claims Department 101 Parklane Blvd, Suite 301 Sugar Land, TX 77478 Verification of Claims: 281-313-7170 (local) 1-877-493-6282 (toll free)
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 Celina ISD Benefits Website: www.mybenefitshub.com/celinaisd
Vision Benefits
In-Network
Out-of-Network
Covered in full
Up to $35 retail
Frames
$125 retail allowance
Up to $70 retail
Contact Lenses2
$150 retail allowance
Up to $80 retail
Covered in full
Up to $150 retail
Exam
Medically Necessary Contact Lenses
Lenses (standard) per pair Single Vision
Covered in full
Up to $25 retail
Bifocal
Covered in full
Up to $40 retail
Trifocal
Covered in full
Up to $45 retail
See description1
Up to $45 retail
Covered in full
Up to $80 retail
Progressive Lenticular
Monthly Premiums EE Only
$9.20
EE + Spouse
$15.70
EE + Family
$23.04
Co-Pays Exam
$10
Materials₁
$10
Services/Frequency Exam
12 months
Frame
12 months
Lenses
12 months
Contact Lenses
12 months
Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 2 Contact lenses and related professional services (fitting, evaluation and followup) are covered in lieu of eyeglass lenses and frames benefit
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
27
THE HARTFORD 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 Celina ISD Benefits Website: www.mybenefitshub.com/celinaisd
Long Term Disability Disability is designed to provide a monthly income to an individual that is disabled due to an accident or illness. There are different plans available with benefits becoming available from the 1st day of disability to as late as the 180th day. For specific details on how benefits are paid, refer to carrier brochure. Your disability coverage amount and premium can be accessed during your enrollment.
Pre-existing Conditions Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have not received treatment for the disabling condition within 3 months, while insured under this policy, before the disability begins, or You have been insured under this policy for 12 months before your disability begins. You may also be covered if you have already satisfied the pre-existing condition requirement of your previous insurer. If your disability is a result of a pre-existing condition we will pay benefits for a maximum of 4 weeks.
• • •
Mental Illness, Alcoholism and Substance Abuse •
•
•
•
•
•
Your benefit payments will not be reduced by certain kinds of other income, such as: • Retirement benefits if you were already receiving them before you became disabled • Retirement benefits that are funded by your after-tax contributions • Your personal savings, investment, IRAs or Keoghs • Profit-sharing • Most personal disability policies • Social Security increases Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.
Exclusions You cannot receive Disability benefit payments for disabilities that are caused or contributed to by: • War or act of war (declared or not) • Military service for any country engaged in war or other armed conflict
You can receive benefit payments for Long-Term Disabilities resulting from mental illness, alcoholism and substance abuse for a total of 24 months for all disability periods during your lifetime. Any period of time that you are confined in a hospital or other facility licensed to provide medical care for mental illness, alcoholism and substance abuse does not count toward the 24 month lifetime limit.
What other benefits are included in my disability coverage?
Benefit Reductions Your benefit payments may be reduced by other income you receive or are eligible to receive due to your disability, such as: • Social Security Disability Insurance (please see • www.mybenefitshub.com/celinaisd for exceptions) • Workers' Compensation • Other employer-based Insurance coverage you may have • Unemployment benefits • Settlements or judgments for income loss • Retirement benefits that your employer fully or partially pays for (such as a pension plan.)
The commission of, or attempt to commit a felony An intentionally self-inflicted injury Any case where your being engaged in an illegal occupation was a contributing cause to your disability You must be under the regular care of a physician to receive benefits
• •
Workplace Modification provides for reasonable modifications made to a workplace to accommodate your disability and allow you to return to active full-time employment. Survivor Benefit - If you die while receiving disability benefits, a benefit will be paid to your spouse or in equal shares to your surviving children under the age of 25, equal to three times the last monthly gross benefit. Travel Assistance Program – Available 24/7, this program provides assistance to employees and their dependents who travel 100 miles from their home for 90 days or less. Services include pre-trip information, emergency medical assistance and emergency personal services. The Hartford's Ability Assist service is included as a part of your group Long Term Disability (LTD) insurance program. You have access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD benefits. Once you are covered you are eligible for services to provide assistance with child/ elder care, substance abuse, family relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist them with the unique emotional, financial and legal issues that may result from a disability. Ability Assist services are provided through ComPsych®, a leading provider of employee assistance and work/life services. Waiver of Premium – Once your disability claim is approved and you have satisfied your elimination period, your coverage premiums will be waived. Identity Theft Protection – An array of identity fraud support services to help victims restore their identity. Benefits include 24/7 access to an 800 number; direct contact with a certified caseworker who follows the case until it’s resolved; and a personalized fraud resolution kit with instructions and resources for ID theft victims. 29
Long Term Disability For the Premium benefit option – the table below applies to disabilities resulting from injury or sickness: Age Disabled Prior to Age 63 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 and older
Benefits Payable To Normal Retirement Age or 48 months if greater To Normal Retirement Age or 42 months if greater 36 months 30 months 27 months 24 months 21 months 18 months MONTHLY PREMIUMS
Accident / Sickness Elimination Period in Days Annual Earnings
Monthly Earnings
Monthly Benefit
0/7
14 / 14
30 / 30
60 / 60
90 / 90
180 / 180
$3,600 $5,400 $7,200 $9,000 $10,800 $12,600 $14,400 $16,200 $18,000 $19,800 $21,600 $23,400 $25,200 $27,000 $28,800 $30,600 $32,400 $34,200 $36,000 $37,800 $39,600 $41,400 $43,200 $45,000 $46,800 $48,600 $50,400 $52,200 $54,000 $55,800 $57,600 $59,400
$300 $450 $600 $750 $900 $1,050 $1,200 $1,350 $1,500 $1,650 $1,800 $1,950 $2,100 $2,250 $2,400 $2,550 $2,700 $2,850 $3,000 $3,150 $3,300 $3,450 $3,600 $3,750 $3,900 $4,050 $4,200 $4,350 $4,500 $4,650 $4,800 $4,950
$200 $300 $400 $500 $600 $700 $800 $900 $1,000 $1,100 $1,200 $1,300 $1,400 $1,500 $1,600 $1,700 $1,800 $1,900 $2,000 $2,100 $2,200 $2,300 $2,400 $2,500 $2,600 $2,700 $2,800 $2,900 $3,000 $3,100 $3,200 $3,300
$7.92 $11.88 $15.84 $19.80 $23.76 $27.72 $31.68 $35.64 $39.60 $43.56 $47.52 $51.48 $55.44 $59.40 $63.36 $67.32 $71.28 $75.24 $79.20 $83.16 $87.12 $91.08 $95.04 $99.00 $102.96 $106.92 $110.88 $114.84 $118.80 $122.76 $126.72 $130.68
$7.16 $10.74 $14.32 $17.90 $21.48 $25.06 $28.64 $32.22 $35.80 $39.38 $42.96 $46.54 $50.12 $53.70 $57.28 $60.86 $64.44 $68.02 $71.60 $75.18 $78.76 $82.34 $85.92 $89.50 $93.08 $96.66 $100.24 $103.82 $107.40 $110.98 $114.56 $118.14
$6.46 $9.69 $12.92 $16.15 $19.38 $22.61 $25.84 $29.07 $32.30 $35.53 $38.76 $41.99 $45.22 $48.45 $51.68 $54.91 $58.14 $61.37 $64.60 $67.83 $71.06 $74.29 $77.52 $80.75 $83.98 $87.21 $90.44 $93.67 $96.90 $100.13 $103.36 $106.59
$5.24 $7.86 $10.48 $13.10 $15.72 $18.34 $20.96 $23.58 $26.20 $28.82 $31.44 $34.06 $36.68 $39.30 $41.92 $44.54 $47.16 $49.78 $52.40 $55.02 $57.64 $60.26 $62.88 $65.50 $68.12 $70.74 $73.36 $75.98 $78.60 $81.22 $83.84 $86.46
$3.92 $5.88 $7.84 $9.80 $11.76 $13.72 $15.68 $17.64 $19.60 $21.56 $23.52 $25.48 $27.44 $29.40 $31.36 $33.32 $35.28 $37.24 $39.20 $41.16 $43.12 $45.08 $47.04 $49.00 $50.96 $52.92 $54.88 $56.84 $58.80 $60.76 $62.72 $64.68
$2.98 $4.47 $5.96 $7.45 $8.94 $10.43 $11.92 $13.41 $14.90 $16.39 $17.88 $19.37 $20.86 $22.35 $23.84 $25.33 $26.82 $28.31 $29.80 $31.29 $32.78 $34.27 $35.76 $37.25 $38.74 $40.23 $41.72 $43.21 $44.70 $46.19 $47.68 $49.17
30
Long Term Disability MONTHLY PREMIUMS Accident / Sickness Elimination Period in Days Annual Earnings
Monthly Earnings
Monthly Benefit
0/7
14 / 14
30 / 30
60 / 60
90 / 90
180 / 180
$61,200 $63,000 $64,800 $66,600 $68,400 $70,200 $72,000 $73,800 $75,600 $77,400 $79,200 $81,000 $82,800 $84,600 $86,400 $88,200 $90,000 $91,800 $93,600 $95,400 $97,200 $99,000 $100,800 $102,600 $104,400 $106,200 $108,000 $109,800 $111,600 $113,400 $115,200 $117,000 $118,800 $120,600 $122,400 $124,200 $126,000 $127,800 $129,600 $131,400 $133,200 $135,000
$5,100 $5,250 $5,400 $5,550 $5,700 $5,850 $6,000 $6,150 $6,300 $6,450 $6,600 $6,750 $6,900 $7,050 $7,200 $7,350 $7,500 $7,650 $7,800 $7,950 $8,100 $8,250 $8,400 $8,550 $8,700 $8,850 $9,000 $9,150 $9,300 $9,450 $9,600 $9,750 $9,900 $10,050 $10,200 $10,350 $10,500 $10,650 $10,800 $10,950 $11,100 $11,250
$3,400 $3,500 $3,600 $3,700 $3,800 $3,900 $4,000 $4,100 $4,200 $4,300 $4,400 $4,500 $4,600 $4,700 $4,800 $4,900 $5,000 $5,100 $5,200 $5,300 $5,400 $5,500 $5,600 $5,700 $5,800 $5,900 $6,000 $6,100 $6,200 $6,300 $6,400 $6,500 $6,600 $6,700 $6,800 $6,900 $7,000 $7,100 $7,200 $7,300 $7,400 $7,500
$134.64 $138.60 $142.56 $146.52 $150.48 $154.44 $158.40 $162.36 $166.32 $170.28 $174.24 $178.20 $182.16 $186.12 $190.08 $194.04 $198.00 $201.96 $205.92 $209.88 $213.84 $217.80 $221.76 $225.72 $229.68 $233.64 $237.60 $241.56 $245.52 $249.48 $253.44 $257.40 $261.36 $265.32 $269.28 $273.24 $277.20 $281.16 $285.12 $289.08 $293.04 $297.00
$121.72 $125.30 $128.88 $132.46 $136.04 $139.62 $143.20 $146.78 $150.36 $153.94 $157.52 $161.10 $164.68 $168.26 $171.84 $175.42 $179.00 $182.58 $186.16 $189.74 $193.32 $196.90 $200.48 $204.06 $207.64 $211.22 $214.80 $218.38 $221.96 $225.54 $229.12 $232.70 $236.28 $239.86 $243.44 $247.02 $250.60 $254.18 $257.76 $261.34 $264.92 $268.50
$109.82 $113.05 $116.28 $119.51 $122.74 $125.97 $129.20 $132.43 $135.66 $138.89 $142.12 $145.35 $148.58 $151.81 $155.04 $158.27 $161.50 $164.73 $167.96 $171.19 $174.42 $177.65 $180.88 $184.11 $187.34 $190.57 $193.80 $197.03 $200.26 $203.49 $206.72 $209.95 $213.18 $216.41 $219.64 $222.87 $226.10 $229.33 $232.56 $235.79 $239.02 $242.25
$89.08 $91.70 $94.32 $96.94 $99.56 $102.18 $104.80 $107.42 $110.04 $112.66 $115.28 $117.90 $120.52 $123.14 $125.76 $128.38 $131.00 $133.62 $136.24 $138.86 $141.48 $144.10 $146.72 $149.34 $151.96 $154.58 $157.20 $159.82 $162.44 $165.06 $167.68 $170.30 $172.92 $175.54 $178.16 $180.78 $183.40 $186.02 $188.64 $191.26 $193.88 $196.50
$66.64 $68.60 $70.56 $72.52 $74.48 $76.44 $78.40 $80.36 $82.32 $84.28 $86.24 $88.20 $90.16 $92.12 $94.08 $96.04 $98.00 $99.96 $101.92 $103.88 $105.84 $107.80 $109.76 $111.72 $113.68 $115.64 $117.60 $119.56 $121.52 $123.48 $125.44 $127.40 $129.36 $131.32 $133.28 $135.24 $137.20 $139.16 $141.12 $143.08 $145.04 $147.00
$50.66 $52.15 $53.64 $55.13 $56.62 $58.11 $59.60 $61.09 $62.58 $64.07 $65.56 $67.05 $68.54 $70.03 $71.52 $73.01 $74.50 $75.99 $77.48 $78.97 $80.46 $81.95 $83.44 $84.93 $86.42 $87.91 $89.40 $90.89 $92.38 $93.87 $95.36 $96.85 $98.34 $99.83 $101.32 $102.81 $104.30 $105.79 $107.28 $108.77 $110.26 $111.75 31
AMERICAN PUBLIC LIFE
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 Celina ISD Benefits Website: www.mybenefitshub.com/celinaisd
GC13 Limited Benefit Group Cancer Indemnity Insurance Celina ISD
THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.
SUMMARY OF BENEFITS Benefits
Option 1
Option 2
Radiation Therapy/Chemotherapy/Immunotherapy Benefit Maximum per 12-month period
$15,000
$20,000
$50 per treatment
$50 per treatment
Hormone Therapy - Maximum of 12 treatments per Calendar Year Experimental Treatment Benefit Waiver of Premium
Paid in the same manner and under the same maximums as any other benefit Waive Premium
Waive Premium
Lump Sum Benefit Maximum 1 per Covered Person per lifetime
$5,000
$10,000
Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime
$7,500
$15,000
Lump Sum Benefit Maximum 1 per Covered Person per lifetime
$5,000
$10,000
Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime
$7,500
$15,000
Option 1
Option 2
Individual
$13.66
$23.00
Individual & Spouse
$29.48
$49.94
1 Parent Family
$15.70
$26.50
2 Parent Family
$31.52
$53.48
Internal Cancer First Occurrence Benefit
Heart Attack/Stroke First Occurrence Benefit
Monthly Premium*
*The premium and amount of benefits vary dependent upon the option selected at time of application. All benefits are per covered person, per calendar year unless otherwise stated.
APSB-22331(TX) MGM/FBS Celina ISD
33
GC13 Limited Benefit Group Cancer Indemnity Insurance Eligibility
You and your Eligible Dependents are eligible to be insured under the Certificate if you and your Eligible Dependents meet APL’s underwriting rules and you are Actively at Work and qualify for coverage as defined in the Master Application.
Limitations & Exclusions
No benefits will be paid for care or treatment received outside the territorial limits of the United States, treatment by any program engaged in research that does not meet the definition of Experimental Treatment or losses or medical expenses incurred prior to the Covered Person’s Effective Date regardless of when Cancer was diagnosed.
Only Loss for Cancer
The Policy/Certificate pays only for loss resulting from definitive Cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The Policy/Certificate also covers other conditions or diseases directly caused by Cancer or the treatment of Cancer. The Policy/Certificate does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of Cancer, even though after contracting Cancer it may have been complicated, aggravated or affected by Cancer or the treatment of Cancer.
Pre-Existing Condition Exclusion
No benefits are payable for any loss incurred during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date as the result of a Pre-Existing Condition. Pre-Existing Conditions specifically named or described as excluded in any part of the Policy/Certificate are never covered. If any change to coverage after the Certificate Effective Date results in an increase or addition to coverage, the Time Limit on Certain Defenses and Pre-Existing Condition Limitation for such increase will be based on the effective date of such increase.
Waiting Period
The Policy/Certificate contains a Waiting Period during which no benefits will be paid. If any Covered Person has a Specified Disease diagnosed before the end of the Waiting Period immediately following the Covered Person’s Effective Date, coverage for that person will apply only to loss that is incurred after one year from the Covered Person’s Effective Date. If any Covered Person is diagnosed as having a Specified Disease during the Waiting Period immediately following the Covered Person’s Effective Date, the Insured may elect to void the Certificate from the beginning and receive a full refund of premium. If the Policy/Certificate replaced Specified Disease Cancer coverage from another company that terminated within 30 days of the Certificate Effective Date, the Waiting Period will be waived for those Covered Persons that were covered under the prior coverage. However, the Pre-Existing Condition Limitation will still apply.
Termination of Certificate
Insurance coverage under the Certificate and any attached riders will end on the earliest of any of the following dates: the date the Policy terminates; the end of the grace period if the premium remains unpaid; the date insurance has ceased on all persons covered under this Certificate; the end of the Certificate Month in which the Policyholder requests to terminate this coverage; the date you no longer qualify as an Insured; or the date of your death.
Termination of Coverage
Insurance coverage for a Covered Person under the Certificate and any attached riders for a Covered Person will end as follows: the date the Policy terminates; the date the Certificate terminates; the end of the grace period if the premium remains unpaid; the end of the Certificate Month in which the Policyholder requests to terminate the coverage for an Eligible Dependent; the date a Covered Person no longer qualifies as an Insured or Eligible Dependent; or the date of the Covered Person’s death. 34
APSB-22331(TX) MGM/FBS Celina ISD
Optionally Renewable
The policy is optionally renewable. The Policyholder has the right to terminate the policy on any premium due date after the first Anniversary following the Policy Effective Date. APL must give at least 60 days written notice prior to cancellation.
Portability (Voluntary Plans Only)
When the Insured no longer meets the definition of Insured, he or she will have the option to continue this coverage, including any attached riders. No Evidence of Insurability will be required. Portability must meet all of the following conditions: the Certificate has been continuously in force for the last 12 months; APL receives a request and payment of the first premium for the portability coverage no later than 30 days after the date the Insured no longer qualifies as an eligible Insured. All future premiums due will be billed directly to the Insured. The Insured is responsible for payment of all premiums for the portability coverage; the Policy, under which this Certificate was issued, continues to be in force on the date the Insured ceases to qualify for coverage. The benefits, terms and conditions of the portability coverage will be the same as those elected under the Certificate immediately prior to the date the Insured exercised portability. Portability coverage may include any Eligible Dependents who were covered under the Certificate at the time the Insured ceased to qualify as an eligible Insured. No new Eligible Dependents may be added to the portability coverage except as provided in the Newborn and Adopted Children provision. No increases in coverage will be allowed while the Insured is exercising his or her rights under this rider. If the Policy is no longer in force, then portability coverage is not available.
Heart Attack/Stroke First Occurrence Benefit Rider
Pays a lump sum amount when a Covered Person receives a first diagnosis of Heart Attack/Stroke and the Date of Diagnosis occurs after the Waiting Period. The Heart Attack/Stroke lump sum benefit amount will reduce by 50% at age 70.
Exclusions & Limitations
We will not pay benefits for any loss caused by or resulting from any of the following: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces; military service for any country at war. If coverage is suspended for any Covered Person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the Policyholder’s written request; participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a Physician or taken according to the Physician’s instructions; or participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place).
Pre-Existing Condition Exclusion
No benefits are payable for any loss incurred during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date of this rider as the result of a Pre-Existing Condition.
Waiting Period
This rider contains a Waiting Period during which no benefits will be paid. If any Heart Attack or Stroke is diagnosed before the end of the Waiting Period immediately following the Covered Person’s Effective Date of this rider, coverage will apply only to loss that is incurred after one year from the Covered Person’s Effective Date.
GC13 Limited Benefit Group Cancer Indemnity Insurance Termination
This rider will terminate and coverage will end for all Covered Persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the Policy or Certificate to which this rider is attached terminates; the end of the Certificate Month in which we receive a request from the Policyholder to terminate this rider; the date of your death; or the date the lump sum benefit amount for Heart Attack or Stroke has been paid for all Covered Persons under this rider. Coverage on an Eligible Dependent terminates under this rider when such person ceases to meet the definition of Eligible Dependent.
Internal Cancer First Occurrence Benefit Rider
Pays a lump sum benefit amount when a Covered Person receives a first diagnosis of a covered Internal Cancer and the Date of Diagnosis occurs after the Waiting Period. The Internal Cancer lump sum benefit amount will reduce by 50% at age 70.
Exclusions & Limitations
We will not pay benefits for a diagnosis of Internal Cancer received outside the territorial limits of the United States or a metastasis to a new site of any Cancer diagnosed prior to the Covered Person’s Effective Date, as this is not considered a first diagnosis of an Internal Cancer.
Pre-Existing Condition Exclusion
No benefits are payable for any loss incurred during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date of this rider as the result of a Pre-Existing Condition.
Waiting Period
This rider contains a Waiting Period during which no benefits will be paid. If any Internal Cancer is diagnosed before the end of the Waiting Period immediately following the Covered Person’s Effective Date of this rider, coverage will apply only to loss that is incurred after one year from the Covered Person’s Effective Date of this Rider.
Termination
This rider will terminate and coverage will end for all Covered Persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the Policy or Certificate to which this rider is attached terminates; the end of the Certificate Month in which we receive a request from the Policyholder to terminate this rider; the date of your death; or the date the lump sum benefit amount for Internal Cancer has been paid for all Covered Persons under this rider. Coverage on an Eligible Dependent terminates under this rider when such person ceases to meet the definition of Eligible Dependent.
2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606 Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete benefits and other provisions, please refer to your policy/certificate/rider(s). This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This product contains Limitations and Exclusions | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines | Policy Form GC13APL | Limited Benefit Group Cancer Indemnity Insurance Series | Texas | (10/14) | Celina ISD
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APSB-22331(TX) MGM/FBS Celina ISD
LOYAL AMERICAN YOUR BENEFITS PACKAGE
Accident
PLAY VIDEO
About this Benefit
2/3
Accident insurance is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or a not-soserious, injury. Accident coverage is low cost protection available to you and your family without evidence of insurability.
of disabling injuries suffered by American workers are not work related. American workers 36% ofreport they always or
usually live paycheck to paycheck.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 36 Celina ISD Benefits Website: www.mybenefitshub.com/celinaisd
Accident Summary of Benefits Ambulance Ground Ambulance Benefit: Loyal American will pay this benefit if you require transportation by a licensed professional ambulance company to or from a hospital or between medical facilities within 90 days for injuries sustained after a covered accident. Payable once per accident. Air Ambulance Benefit: Loyal American will pay this benefit if you require transportation by a license professional air ambulance company to or from a hospital or between medical facilities within 48 hours for injuries sustained after a covered accident. Payable once per accident. Indemnity Benefits Emergency Room Treatment Benefit: Loyal American will pay this benefit if you received hospital emergency room treatment within 72 hours of injuries sustained in a covered accident and for which charges are submitted. Accident Follow-Up Treatment Benefit: Loyal American will pay this benefit for three additional treatments of injuries sustained in a covered accident over and above emergency treatment administered during the first 72 hours following the accident. Treatment must begin within 30 days of the covered accident and must be within the 6 month period following the covered accident. Specific Sum Injuries Benefit: The specific indemnity amount as listed in the policy’s Benefit Schedule will be paid according to the type of injury received in a covered accident. Loyal American will pay for dislocations (separated joint), burns, tendon (torn, ruptured, severed, ligaments, or rotator cuff), torn knee cartilage, eye injuries, lacerations, and fractures (broken bones). Blood, Plasma, Platelets Benefit: Loyal American will pay this benefit if you require transfusion, administration, cross matching, typing and processing of blood, plasma or platelets when administered within 90 days for injuries sustained in a covered accident. Payable once per accident. Hospital Benefits Initial Accident Hospitalization Benefit: Loyal American will pay this benefit if hospital confinement is required within six (6) months for injuries sustained in a covered accident. Payable once per accident. Hospital Confinement Benefit: Loyal American will pay this benefit for a maximum of 180 days per confinement.* if you require confinement in a hospital or in a hospital intensive care unit– sub acute within six (6) months for injuries sustained in a covered accident. Intensive Care Hospital Intensive Care Unit Confinement Benefit: Loyal American will pay this benefit for a maximum of 15 days per confinement* if you are confined in a hospital intensive care unit within 30 days because of injuries received in a covered accident. *Confinements separated by less than 90 days will be considered as the same period of confinement. Physical Therapy Physical Therapy Benefit: Loyal American will pay this benefit, not to exceed five treatments per accident, for services prescribed by a doctor and rendered by a licensed physical therapist. Physical therapy must be for injuries sustained in a covered accident and must start within 60 days after the accident. Treatment must be completed within 6 months after the accident. Prostheses Benefit: Loyal American will pay this benefit if a doctor prescribes the use of a prosthetic device due to the loss of a hand, foot or sight of an eye in a covered accident. The prosthetic must be received within 1 year of the covered accident. This benefit is payable once per accident and is not payable for hearing aids, dental aids, false teeth or for cosmetic prosthesis (e.g. hair wigs). We will not pay for joint replacement (e.g. artificial hip or knee). Appliance Benefit: Loyal American will pay this benefit if a doctor advises you to use a medical appliance as an aid to personal locomotion within 90 days as a result of injuries sustained in a covered accident. Benefits are payable for crutches, wheelchairs, braces, etc. Benefits are payable for crutches and wheelchairs once per accident.
Plan A Pays
$150
$600
Insured/Spouse: $150 Child: $75 $50 per visit
See Benefit Schedule
$100
$500 $200 per day
$400 per day
$50 per treatment
1 prosthetic device/artificial limb: $100 More than 1: $500
$50
37
Accident Summary of Benefits
Plan A Pays
Family Lodging & Transportation Family Lodging Benefit: Loyal American will pay this benefit for a maximum of 30 days per accident, during the time you are confined in a hospital, for one motel/hotel room for a family member to accompany you if injuries sustained in a covered accident require hospital confinement, and if the hospital and motel/hotel are more than 100 miles from your residence. Transportation Benefit: Loyal American will pay this benefit for a maximum of three trips per calendar year if you require special treatment and confinement in a hospital located more than 100 miles from your residence or site of the accident for injuries sustained in a covered accident.
$100 per day
$300
Accidental Death Accidental Death* Benefit: This policy will pay the following benefit for death if it is the result of injuries sustained in a covered accident. Death must occur within 90 days of a covered accident. Common-Carrier: You must be a fare paying passenger on a common-carrier. Common-carrier Insured: $100,000 vehicles are limited to commercial airplanes, trains, buses, trolleys, subways, ferries and boats Spouse: $50,000 that operate on a regularly scheduled basis between predetermined points or cities. Taxis and Child: $15,000 privately chartered vehicles are not included. Other Accidents: Other Accidents are those not classified as common-carrier and are not specifically excluded in the limitations and exclusions section of the policy.
Insured: $25,000 Spouse: $10,000 Child: $5,000
Dismemberment Accidental Dismemberment* Benefit This policy will pay a percentage of the Accidental Death-Other Accidents Benefit for the selected plan. Both arms and both legs
100%
Two arms or legs
50%
Sight of two eyes, hands, or feet
50%
Sight of one eye, hand, foot, arm, or leg
20%
One or more fingers and/or one or more toes
5%
*Death or dismemberment must occur within 90 days of the accident. Only the highest single benefit will be paid for accidental dismemberment.
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Accident This is a limited benefit policy. This policy does not pay for losses resulting from sickness. RENEWABILITY CONDITIONS: The policy is guaranteed renewable. Premium rates may be changed on a class basis. A class may be defined by age, sex, occupation, premium payment method, issue state, elimination period, benefit period, etc. WHAT IS NOT COVERED BY THIS POLICY. We will not pay benefits for any injury as a result of you(r): • Operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft. Aircraft includes those which are not motor-driven. • Engaging in hang gliding, bungee jumping, parachuting, sailgliding, parakiting, or hot-air ballooning. • Participating or attempting to participate in an illegal activity. • Riding in or driving any motor-driven vehicle in a race, stunt show, or speed test. • Intentionally causing a self-inflicted injury. • Having any sickness or declining process caused by a sickness, including physical or mental infirmity. We also will not pay benefits to diagnose or treat the sickness. Sickness means any disease or disorder that is not caused by an injury. • Practicing for or participating in any semi-professional or professional competitive athletic contest for which any type of compensation or remuneration is received. • Committing or trying to commit suicide, whether sane or insane. • Being in an accident which occurs more than 40 miles outside the territorial limits of the United States, Canada, Puerto Rico, and Virgin Islands. • Involvement in any period of armed conflict, even if it is not declared. This brochure contains a summary of the Accident Insurance Policy form L-6020. Coverage as described in the brochure is provided only through the issuance of a policy. The policy should be consulted for full terms and conditions of coverage. Payroll Deduction Rates - Available for Issue Ages 18 - 64
PLAN A Option MONTHLY
SEMI MONTHLY
INDIVIDUAL
$12.70
$6.35
SINGLE PARENT
$20.40
$10.20
INSURED & SPOUSE
$19.50
$9.75
FAMILY
$27.20
$13.60
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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 40 Celina ISD Benefits Website: www.mybenefitshub.com/celinaisd
Voluntary Group Term Life and AD&D Benefit Highlights Celina ISD What is Supplemental Life Insurance?
Am I eligible? When is it effective?
Supplemental Life Insurance is coverage that you pay for. Supplemental 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 Supplemental Life Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail. You are eligible if you are an active full time employee who works at least 20 hours per week on a regularly scheduled basis. 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 Supplemental Life Insurance can I purchase?
You can purchase Supplemental 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 enroll during your initial enrollment period or 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 enroll after your initial enrollment period, evidence of insurability will be required for all coverage amounts.
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.
Spouse Supplemental Life Insurance
If you elect Supplemental Life Insurance for yourself, you may choose to purchase Spouse Supplemental Life Insurance in increments of $10,000, to a maximum of $250,000. 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 enroll during your initial enrollment period or are newly eligible and elect an amount that exceeds the guaranteed issue amount of $30,000, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you enroll after your initial enrollment period, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective.
41
Voluntary Group Term Life and AD&D
Child(ren) Supplemental Life Insurance
If you elect Supplemental Life Insurance for yourself, you may choose to purchase Child(ren) Supplemental 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?
Yes by 35% at 65, and 50% at 70. 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 you and your dependent(s)' 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.
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.
42
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
$100,000
$0.40 $0.40 $0.50 $0.70 $1.10 $1.80 $2.90 $4.60 $6.00 $9.70 $17.00 $30.80
$0.80 $0.80 $1.00 $1.40 $2.20 $3.60 $5.80 $9.20 $12.00 $19.40 $34.00 $61.60
$1.20 $1.20 $1.50 $2.10 $3.30 $5.40 $8.70 $13.80 $18.00 $29.10 $51.00 $92.40
$1.60 $1.60 $2.00 $2.80 $4.40 $7.20 $11.60 $18.40 $24.00 $38.80 $68.00 $123.20
$2.00 $2.00 $2.50 $3.50 $5.50 $9.00 $14.50 $23.00 $30.00 $48.50 $85.00 $154.00
$2.40 $2.40 $3.00 $4.20 $6.60 $10.80 $17.40 $27.60 $36.00 $58.20 $102.00 $184.80
$2.80 $2.80 $3.50 $4.90 $7.70 $12.60 $20.30 $32.20 $42.00 $67.90 $119.00 $215.60
$3.20 $3.20 $4.00 $5.60 $8.80 $14.40 $23.20 $36.80 $48.00 $77.60 $136.00 $246.40
$4.00 $4.00 $5.00 $7.00 $11.00 $18.00 $29.00 $46.00 $60.00 $97.00 $170.00 $308.00
Any amount over $150,000 will be medically underwritten. You must complete an Evidence of Insurability Form.
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+
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$100,000
$0.40 $0.40 $0.50 $0.70 $1.10 $1.80 $2.90 $4.60 $6.00 $9.70 $17.00 $30.80
$0.80 $0.80 $1.00 $1.40 $2.20 $3.60 $5.80 $9.20 $12.00 $19.40 $34.00 $61.60
$1.20 $1.20 $1.50 $2.10 $3.30 $5.40 $8.70 $13.80 $18.00 $29.10 $51.00 $92.40
$1.60 $1.60 $2.00 $2.80 $4.40 $7.20 $11.60 $18.40 $24.00 $38.80 $68.00 $123.20
$2.00 $2.00 $2.50 $3.50 $5.50 $9.00 $14.50 $23.00 $30.00 $48.50 $85.00 $154.00
$2.40 $2.40 $3.00 $4.20 $6.60 $10.80 $17.40 $27.60 $36.00 $58.20 $102.00 $184.80
$2.80 $2.80 $3.50 $4.90 $7.70 $12.60 $20.30 $32.20 $42.00 $67.90 $119.00 $215.60
$3.20 $3.20 $4.00 $5.60 $8.80 $14.40 $23.20 $36.80 $48.00 $77.60 $136.00 $246.40
$4.00 $4.00 $5.00 $7.00 $11.00 $18.00 $29.00 $46.00 $60.00 $97.00 $170.00 $308.00
Any amount over $30,000 will be medically underwritten. You must complete an Evidence of Insurability Form.
Child Life Rates $10,000 $2.00 Per Child Unit
AD&D Rates EMPLOYEE FAMILY
$10,000 $0.30 $0.60
$20,000 $0.60 $1.20
$30,000 $0.90 $1.80
$40,000 $1.20 $2.40
$50,000 $1.50 $3.00
$60,000 $1.80 $3.60
$70,000 $2.10 $4.20
$80,000 $2.40 $4.80
$100,000 $3.00 $6.00
NOTE: FINAL RATES MAY VARY SLIGHTLY DUE TO ROUNDING. THESE GRIDS ARE PRICES OF FREQUENTLY SELECTED AMOUNTS. YOU MAY CHOOSE ANY INCREMENT OF $10,000 UP TO $500,000 (NOT TO EXCEED 7 TIMES YOUR ANNUAL SALARY). FOR SPOUSE ANY INCREMENT OF $10,000 UP TO $250,000 (NOT TO EXCEED 50% OF EMPLOYEE LIFE AMOUNT) TO PURCHASE AN AMOUNT OTHER THAN THOSE LEVELS INDICATED ABOVE, SIMPLY ADD LEVELS TOGETHER. 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 Celina ISD Benefits Website: www.mybenefitshub.com/celinaisd
Individual Life with Terminal Illness and Quality of Life Rider The Family Protection Plan: Individual Life Insurance with Terminal Illness Coverage to Age 100 With the Family Protection Plan (FPP), you can provide financial stability for your loved ones should something happen to you. You have peace of mind that you are covered up to age 100.* No matter what the future brings, you and your family will be protected. If faced with a chronic medical condition that required continuous care, would you be able to protect yourself? Traditionally, expenses associated with treatment and care necessitated by a chronic injury or illness have accounted for 86% of all health care spending and can place strain on your assets when you need them most. To provide protection during this time of need, 5Star Life Insurance Company (5Star Life) is pleased to offer the Quality of Life Rider, which is included with your FPP life insurance coverage. This rider accelerates a portion of the death benefit on a monthly basis—4% each month as scheduled by your employer at the group level, and payable directly to you on a tax favored basis. You can receive up to 75% of the current face amount of the life benefit, following a diagnosis of either a chronic illness or cognitive impairment that requires substantial assistance. Benefits are paid for the following: • Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance, or • A permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility requiring substantial supervision. Example
Weekly Premium
Death Benefit
Accelerated Benefit
Your age at issue: 35
$10.00
$89,655
4% $3,586.20 a month
Affordability—With several options to choose from, select the coverage that best meets the needs of your family. Terminal Illness—This plan pays the insured 30% (25% in Connecticut and Michigan) of the policy coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months. Portability—You and your family continue coverage with no loss of benefits or increase in cost should you terminate employment after the first premium is paid. If this happens, we can simply bill you directly. Coverage can never be cancelled by the insurance company or your employer unless you stop paying premiums. Family Protection—Individual policies can be purchased on the employee, their spouse, children and grandchildren. Children & Grandchildren Plan—Policies can be purchased for children and grandchildren ages 15 days to age 24. Convenience—Premiums are taken care of simply and easily through payroll deductions. Protection You Can Count On—Within 24 hours after receiving notice of an insured’s death, an emergency death benefit of the lesser of 50% of the coverage amount, or $10,000, will be mailed to the insured’s beneficiary, unless the death is within the two-year contestability period and/or under investigation. This product also contains no war or terrorism exclusions.
For example, in case of chronic illness, you would receive $3,586 each month up to $67,241.25. The remainder death benefit of $22,413.75 would be made payable to your beneficiary.
* Life insurance product underwritten by 5Star Life Insurance Company (a Baton Rouge, Louisiana company). Product may not be available in all states or territories. Request FPP insurance from Dell Perot, Post Office Box 83043, Lincoln, Nebraska 68501, (866) 863-9753.
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Family Protection Plan - Terminal Illness Employee Coverage Amounts
Spouse Coverage Amounts
Age on Eff. Date
$10,000
$25,000
$50,000
$75,000
$100,000
$10,000
$20,000
$30,000
18-25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66* 67* 68* 69* 70*
$7.56 $7.58 $7.65 $7.74 $7.88 $8.07 $8.27 $8.49 $8.73 $9.00 $9.30 $9.64 $10.02 $10.41 $10.84 $11.31 $11.83 $12.41 $13.00 $13.63 $14.28 $14.97 $15.69 $16.43 $17.22 $18.08 $19.04 $20.16 $21.40 $22.79 $24.27 $25.93 $27.66 $29.42 $31.23 $33.12 $35.08 $37.13 $39.31 $41.68 $44.33 $44.93 $48.25 $52.03 $56.33 $61.17
$12.40 $12.46 $12.63 $12.85 $13.21 $13.67 $14.17 $14.73 $15.31 $16.00 $16.75 $17.60 $18.54 $19.52 $20.60 $21.77 $23.08 $24.52 $26.00 $27.56 $29.19 $30.92 $32.73 $34.56 $36.54 $38.69 $41.10 $43.90 $47.00 $50.48 $54.17 $58.33 $62.65 $67.04 $71.56 $76.29 $81.19 $86.31 $91.77 $97.71 $104.33 $105.81 $114.13 $123.58 $134.31 $146.42
$20.46 $20.58 $20.92 $21.38 $22.08 $23.00 $24.00 $25.13 $26.29 $27.67 $29.17 $30.88 $32.75 $34.71 $36.88 $39.21 $41.83 $44.71 $47.67 $50.79 $54.04 $57.50 $61.13 $64.79 $68.75 $73.04 $77.88 $83.46 $89.67 $96.63 $104.00 $112.33 $120.96 $129.75 $138.79 $148.25 $158.04 $168.29 $179.21 $191.08 $204.33 $207.29 $223.92 $242.83 $264.29 $288.50
$28.52 $28.71 $29.21 $29.90 $30.96 $32.33 $33.83 $35.52 $37.27 $39.33 $41.58 $44.15 $46.96 $49.90 $53.15 $56.65 $60.58 $64.90 $69.33 $74.02 $78.90 $84.08 $89.52 $95.02 $100.96 $107.40 $114.65 $123.02 $132.33 $142.77 $153.83 $166.33 $179.27 $192.46 $206.02 $220.21 $234.90 $250.27 $266.65 $284.46 $304.33 $308.77 $333.71 $362.08 $394.27 $430.58
$36.58 $36.83 $37.50 $38.42 $39.83 $41.67 $43.67 $45.92 $48.25 $51.00 $54.00 $57.42 $61.17 $65.08 $69.42 $74.08 $79.33 $85.08 $91.00 $97.25 $103.75 $110.67 $117.92 $125.25 $133.17 $141.75 $151.42 $162.58 $175.00 $188.92 $203.67 $220.33 $237.58 $255.17 $273.25 $292.17 $311.75 $332.25 $354.08 $377.83 $404.33 $410.25 $443.50 $481.33 $524.25 $572.67
$7.56 $7.58 $7.65 $7.74 $7.88 $8.07 $8.27 $8.49 $8.73 $9.00 $9.30 $9.64 $10.02 $10.41 $10.84 $11.31 $11.83 $12.41 $13.00 $13.63 $14.28 $14.97 $15.69 $16.43 $17.22 $18.08 $19.04 $20.16 $21.40 $22.79 $24.27 $25.93 $27.66 $29.42 $31.23 $33.12 $35.08 $37.13 $39.31 $41.68 $44.33 $44.93 $48.25 $52.03 $56.33 $61.17
$10.78 $10.83 $10.97 $11.15 $11.43 $11.80 $12.20 $12.65 $13.12 $13.67 $14.27 $14.95 $15.70 $16.48 $17.35 $18.28 $19.33 $20.48 $21.67 $22.92 $24.22 $25.60 $27.05 $28.52 $30.10 $31.82 $33.75 $35.98 $38.47 $41.25 $44.20 $47.53 $50.98 $54.50 $58.12 $61.90 $65.82 $69.92 $74.28 $79.03 $84.33 $85.52 $92.17 $99.73 $108.32 $118.00
$14.01 $14.08 $14.28 $14.56 $14.98 $15.53 $16.13 $16.81 $17.51 $18.33 $19.23 $20.26 $21.38 $22.56 $23.86 $25.26 $26.83 $28.56 $30.33 $32.21 $34.16 $36.23 $38.41 $40.61 $42.98 $45.56 $48.46 $51.81 $55.53 $59.71 $64.13 $69.13 $74.31 $79.58 $85.01 $90.68 $96.56 $102.71 $109.26 $116.38 $124.33 $126.11 $136.08 $147.43 $160.31 $174.83
46
Family Protection Plan - Terminal Illness *Quality of Life not available ages 66 - 70. Quality of Life benefits not available for children. Child life coverage available only on children and grandchildren of employee (age on application date: 15 days to age 24 years). $4.98 monthly for $10,000 coverage and $9.97 monthly for $20,000 coverage.
47
NBS
FSA (Flexible Spending Account)
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit A Cafeteria Plan is designed to take advantage of Section 125 of the Internal Revenue Code. It allows you to pay certain qualified expenses on a pre-tax basis, thereby reducing your taxable income. You can set aside a pre-established amount of money per plan year in a Healthcare Flexible Spending Account (FSA). Funds allocated to a healthcare FSA must be used during the plan year or are forfeited unless your plan contains a $500 rollover or grace period provision.
Unlimited FSA (Non HSA Compatible) The funds in the unlimited healthcare FSA can be used to pay for eligible medical expenses like deductibles, co-payments, orthodontics, glasses and contacts.
FLIP TO‌ PG. 11 FOR HSA VS. FSA COMPARISON
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 48 Celina ISD Benefits Website: www.mybenefitshub.com/celinaisd
FSA (Flexible Spending Account) NBS Flexcard
When Will I Receive My Flex Card?
You may use the card to pay merchants or service providers that accept MasterCard® credit cards, so there is no need to pay cash up front, then wait for reimbursement. If you are participating in the Dependent Care portion, the money isn’t loaded to the card. You must file web or paper claims or enroll in continual reimbursement.
NBS Prepaid MasterCard® Debit Card
Current plan participants: KEEP YOUR CARDS! NBS debit cards are good for 3 years. If you throw away your cards, there is a $5.00 fee to replace them.
Expect Flex Cards to be delivered to the address listed in THEbenefitsHUB near the end of September. Don’t forget, Flex Cards Are Good For 3 Years!
For a list of sample expenses, please refer to the Celina ISD benefit website: www.mybenefitshub.com/celinaisd
NBS Contact Information: 8523 South Redwood Road West Jordan, UT 84088 Phone (800) 274‐0503 Fax (800) 478‐1528 Email: service@nbsbenefits.com
New Plan Participants NBS will mail out your new benefit cards to the address listed in THEbenefitsHUB. They will be sent in unmarked envelopes so please watch for them as they should arrive within 21 business days of effective date. NBS debit cards are good for 3 years.
FSA Annual Contribution Max:
DID YOU KNOW? FSAs use tax-free funds to help pay for your Health Care Expenses.
$2,650
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 claims FAQs 49
FSA Frequently Asked Questions What is a Flexible Spending Account? A Flexible Spending Account allows you to save money by paying out-of-pocket health and/or dependent care related expenses with pre-tax dollars. Your contributions are deducted from your pay before taxes are withheld and your account is up fronted with an annual amount. Because you are taxed on a lower amount of pay, you pay less in taxes and you have more to spend.
How does a Flexible Spending Account Benefit Me? A Cafeteria plan enables you to save money on group insurance, health-related expenses, and dependent-care expenses. You may save as much as 35 percent on the cost of each benefit option! Eligible expenses must be incurred within the plan year and contributions are use-it-or-lose-it. Remember to retain all your receipts.
Health Care Expense Account Example Expenses: • • • • • • • • • •
Acupuncture Body scans Breast pumps Chiropractor Co-payments Deductible Diabetes Maintenance Eye Exam & Glasses Fertility treatment First aid
• • • • • • • • •
Hearing aids & batteries Lab fees Laser Surgery Orthodontia Expenses Physical exams Pregnancy tests Prescription drugs Vaccinations Vaporizers or humidifiers
Dependent Care Expense Account Example Expenses: • • • •
Before and After School and/or Extended Day Programs The actual care of the dependent in your home. Preschool tuition. The base costs for day camps or similar programs used as care for a qualifying individual.
What Can I Use My Flexible Spending Account On? For a full list of eligible expenses, please refer to www.mybenefitshub.com/celinaisd
50
What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)? Eligible expenses must be incurred within the plan year +75 day grace period. Contributions are use-it-or-lose-it. Remember to retain all your receipts (including receipts for card swipes).
How Do I File A Claim? In most situations, you will be able to swipe your card however, in the event you lose your card or are waiting to receive one, you can visit www.mybenefitshub.com/celinaisd and complete the “Claim Form” to send to NBS or use the web or phone app to file online.
How To Receive Your Dependent Care Reimbursement Faster. A Direct Deposit form is available on the Benefits Website which will help you get reimbursed quicker!
How the FSA Plan Works You designate an annual election of pre-tax dollars to be deposited into your health and dependent-care spending accounts. Your total election is divided by the number of pay periods in the Plan year and deducted equally from each paycheck before taxes are calculated. By the end of the Plan year, your total election will be fully deposited. However, you may make a claim for eligible health FSA expenses as soon as they are incurred during the Plan year. Eligible claims will be paid up to your total annual election even if you have not yet contributed that amount to your account.
Get Your Money 1. 2. 3. 4.
Complete and sign a claim form (available on our website) or an online claim. Attach documentation; such as an itemized bill or an Explanation of Benefits (EOB) statement from a health insurance provider. Fax or mail signed form and documentation to NBS. Receive your non-taxable reimbursement after your claim is processed either by check or direct deposit.
NBS Flexcard—FSA Pre-paid Benefit Card Your employer may sponsor the use of the NBS Flexcard, making access to your flex dollars easier than ever. You may use the card to pay merchants or service providers that accept credit cards, so there is no need to pay cash up front then wait for reimbursement.
Account Information Participants may call NBS and talk to a representative during our regular business hours, Monday–Friday, 7am to 6pm Mountain Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to our website: www.NBSbenefits.com Information includes: • Detailed claim history and processing status • Health Care and Dependent Care account balances • Claim forms, worksheets, etc. • Online Claim Submission
Enrollment Considerations After the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying “change of status” (marriage status, employment change, dependent change). Be conservative in the total amount you elect to avoid forfeiting money that may be left in your account at the end of the year. Your employer may allow a short grace period after the Plan year ends for you to submit qualified claims for any unused funds.
51
GotZoom
Student Loan Repayment Assistance
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit Student Loan Debt in the United States currently exceeds $1.4 trillion dollars. If you are one of the millions of Americans that are stressed and struggling with high levels of student loan debt, GotZoom is the perfect solution to give you much needed student loan relief.
The average student loan debt is around
$38,000
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 52 Celina ISD Benefits Website: www.mybenefitshub.com/celinaisd
GotZoom
Reduce your student loan debt by 65% The Facts: • Educators and Public Service employees enjoy special status with the Department of Education (DOE) and are eligible for the best available student loan repayment and loan forgiveness programs • Only 2 in 10 borrowers take advantage of the programs • $350 Million of additional DOE funding became available in Mar. 2018 (first come, first serve)
GotZoom Average Annual Student Loan Payment Reduction
The Best Solution: GotZoom was created to fill a critical void. Student loan debt is our country' second largest debt class behind mortgages • With nearly 70 federal student loan repayment and forgiveness programs in place today the options to reduce your student debt are exceptional • GotZoom finds the best program options that suit your needs, confirms eligibility and facilitates all the administration
•
What’s GotZoom? •
Where to Start
Employee Benefits
$468
$5,616
GotZoom Average Monthly Student Loan Payment Reduction
The leader in student debt reduction services An established company with a seven year track record of performance and customer satisfaction
•
Go to the enrollment page: https://mystudentloan2.net/1/?broid=00002000
•
Click on Enroll Now
•
Average student debt reduction of 65%
•
All administrative details are managed by GotZoom for the employee
•
GotZoom monitors DOE programs and reviews the employee's status annually to find any additional debt reduction options
•
Employee's loan analysis and Benefits Summary are free (no obligation)
Service Fee • •
Service fees apply only after the employee has reviewed and approved repayment/ forgiveness programs Application Fee: $307. Annual Fee: $359.40 (Monthly Option: $32.95)
53
NOTES
54
NOTES
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WWW.MYBENEFITSHUB.COM/ CELINAISD 56