CLINT ISD
BENEFIT GUIDE EFFECTIVE:
01/01/2018 - 12/31/2018 WWW.MYBENEFITSHUB.COM/CLINTISD
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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 HSA Bank Health Savings Account (HSA) APL MEDlink® MDLIVE Telehealth Cigna Dental Superior Vision The Hartford Long Term Disability APL Cancer APL Accident Sun Life Financial Critical Illness The Hartford Life and AD&D Texas Life Individual Life ID Watchdog Identity Theft NBS Flexible Spending Account (FSA) Nationwide Pet Insurance LifeWorks Employee Assistance Plan (EAP) MASA Medical Transport Legal Shield Legal Services Zebit Financial Wellness 2
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FLIP TO... PG. 4 HOW TO HOW TO ENROLL ENROLL
PG. 6 SUMMARY PAGES
PG. 12 YOUR BENEFITS
Benefit Contact Information CLINT ISD BENEFITS
CANCER AND ACCIDENT
EMPLOYEE ASSISTANCE PLAN
Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/clintisd
American Public Life (800) 256-8606 www.ampublic.com
LifeWorks (888) 456-1324 Español: (888) 732-9020 www.lifeworks.com
HEALTH SAVINGS ACCOUNT
CRITICAL ILLNESS
MEDICAL TRANSPORT
HSA Bank (800) 357-6246 www.hsabank.com
Sun Life Financial (800) 451-4531 http://www.sunlife.com/us
MASA U.S. (800) 423-3226 International (800) 643-9023 www.masamts.com
MEDLINK®
LIFE AND AD&D
LEGAL SERVICES
American Public Life (800) 256-8606 www.ampublic.com
The Hartford (800) 583-6908 www.mybenefitshub.com/clintisd
Legal Shield (800) 654-7757 https://www.legalshield.com
TELEHEALTH
INDIVIDUAL LIFE
FINANCIAL WELLNESS
MDLIVE (888) 365-1663 www.consultmdlive.com
Texas Life (800) 283-9233 www.texaslife.com
Zebit (855) 449-3248 www.zebit.com/hi/clint
DENTAL
IDENTITY THEFT
COBRA
Cigna (800) 244-6224 www.mycigna.com
ID Watchdog (800) 774-3772 www.idwatchdog.com
For Dental, Vision, Medical Supplement, and Medical Flex National Benefit Services (800) 274-0503 www.nbsbenefits.com
VISION
FLEXIBLE SPENDING ACCOUNT
Superior Vision (800) 507-3800 www.superiorvision.com
National Benefit Services (800) 274-0503 www.nbsbenefits.com
DISABILITY
PET INSURANCE
The Hartford (866) 278-2655 www.mybenefitshub.com/clintisd
Nationwide (877) 738-7874 www.petinsurance.com/clintisd Vet Help Line: (855) 331-2833 www.petinsurance.com/vethelpline 3
MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS CLINT ” to 313131 and get access to everything you need to complete your benefits enrollment:
Benefit Information
Online Support
Interactive Tools
And more.
PLAY VIDEO
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Text “FBS CLINT” to 313131 OR SCAN
How to Log In
1 BENEFIT INFO
INTERACTIVE TOOLS
2 3
www.mybenefitshub.com/clintisd
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: NEW RATES! Long Term Disability provides
a monthly income to an individual that is disabled due to an accident or illness. This plan offers a 4-week benefit for pre-existing conditions for all new enrollees or increase in coverage. Benefit options are offered by percent of salary Zebit offers free financial education, interest free
financing and access to a closed market place of competitively priced products. Members pay back over time without any interest, fees, penalties or credit checks. No need to enroll in the hub, eligible employees can register today for free at www.zebit.com/hi/clint (you must be over 18 years of age, employed by CISD over 1 year, and annual income over $10,000 for the interest free credit). Voluntary and AD&D by The Hartford: Existing and new
participants who increase life coverage will be contacted by The Hartford in December with a link to complete the required Health Statement.
funds will be available mid January. New participants in the Healthcare FSA will receive flex cards in late January. If you participate in an HSA, you are not eligible for a health FSA. Health Savings Accounts with HSA Bank: Medical savings
accounts are available to employees enrolled in a highdeductible health plan. Unlike a flex account, funds roll over each year and are not prefunded. $1.75 /month service fee on balances under $3000.00. You are not eligible if you or your spouse have access to funds in a health FSA or you are covered on the MEDlink® medical supplement. MEDlink® with APL: MEDlink® provides supplemental
coverage to help offset deductibles and coinsurance of hospitalization. You must be enrolled in CISD medical insurance to enroll in this plan. If enrolled in a MEDlink® plan you are not eligible for an HSA.
Flexible Spending with National Benefit Services: Flexible
spending accounts allow you to set aside dollars to pay for health care and dependent daycare. Eligible expenses must be incurred within the plan year and 75day grace period, contributions are use-it or lose-it. You MUST re-elect a new contribution amount every year to continue to participate. KEEP your FSA debit card! New
Login and complete your benefit enrollment from 10/30/2017 - 11/09/2017 Enrollers will be on site from 10/30/2017 - 11/03/2017. Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202 to speak to a representative Monday—Friday between 8am – 5pm CST Update your profile information: home address, phone numbers, email, beneficiaries REQUIRED: Provide correct dependent social security numbers 6
SUMMARY PAGES
Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 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/clintisd
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/clintisd
included in the dependent profile. Additionally, you must
Click on the benefit plan you need information on (i.e.,
notify your employer of any discrepancy in personal and/or benefit information.
For benefit summaries and claim forms, go to your school
Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that
particular benefit.
Dental) and you can find provider search links under the Quick Links section. When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and
New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.
Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 800-583-6908 for assistance.
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SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 20 or more
Dependent Eligibility: You can cover eligible dependent
regularly scheduled hours each work week. Employer Paid Basic
children under a benefit that offers dependent coverage,
Life and EAP are provided for employees who work 30+ hours
provided you participate in the same benefit, through the
each work week.
maximum age listed below. Dependents cannot be double covered by married spouses within the Clint ISD or as both
Eligible employees must be actively at work on the plan effective
employees and dependents.
date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2018 benefits become effective on January 1, 2018, you must be actively-at-work on January 1, 2018 to be eligible for your new benefits. PLAN
CARRIER
MAXIMUM AGE
Health Savings Account
HSA Bank
Tax Dependent
MEDlink® Medical Supplement
American Public Life
To age 26
Telehealth
MDLIVE
Unmarried to age 26
Dental
Cigna
To age 26
Vision
Superior Vision
To age 26
Cancer
American Public Life
To age 26
Accident
American Public Life
To age 26
Critical Illness
Sun Life Financial
To age 26
Voluntary Life
The Hartford
Unmarried to age 26
Individual Life
Texas Life
Issue to age 18; Keep to age 121
Identity Theft
ID Watchdog
Unmarried to age 26
Medical Flex
National Benefit Services
To age 26
Dependent Flex
National Benefit Services
12 or younger or qualified individual unable to care for themselves and claimed as tax dependent
Employee Assistance Plan
LifeWorks
To age 26
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. 9
SUMMARY PAGES
Helpful Definitions Actively at Work
In-Network
You are performing your regular occupation for the employer
Doctors, hospitals, optometrists, dentists and other providers
on a full-time basis, either at one of the employer’s usual
who have contracted with the plan as a network provider.
places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 1/1/2018 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 January 1st through December 31st
Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescriptions drugs or is under a health care provider’s orders to take drugs, or received medical care or services
Calendar Year January 1st through December 31st
Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or pre-existing condition exclusion provisions do apply, as applicable by carrier.
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(including diagnostic and/or consultation services).
SUMMARY PAGES
HSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, tax-free. This also allows employees to pay for qualifying dependent care tax-free.
Employer Eligibility
A qualified high deductible health plan.
All employers
Contribution Source Account Owner Underlying Insurance Requirement
Employee and/or employer Individual
Employee and/or employer Employer
High deductible health plan
None
Description
Minimum Deductible Maximum Contribution
$1,300 single (2018) $2,650 family (2018) $3,450 single (2018) $6,900 family (2018)
N/A Varies per employer
Permissible Use Of Funds
If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Cash-Outs of Unused Amounts (if no medical expenses)
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65).
Not permitted
Year-to-year rollover of account balance?
Yes, will roll over to use for subsequent year’s health coverage.
No. Access to some funds can may be extended if your employer’s plan contains a 2 1/2 –month grace period or $500 rollover provision.
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
FLIP TO FOR HSA INFORMATION
PG. 12
FLIP TO FOR FSA INFORMATION
PG. 54
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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 12 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
HSA (Health Savings Account) HSA Bank has teamed up with your employer to create an affordable health coverage option that helps you save on healthcare expenses. This plan is only available for those who are participating in the Active Care 1-HD medical plan. You may not enroll in the MEDlink® plan if you participate in the HSA. You cannot participate in the HSA plan if you or your spouse participate in an FSA. You can use your Health Savings Account (HSA) to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free.
What is an HSA?
A tax-advantaged savings account that you use to pay for eligible medical expenses as well as deductible, co-insurance, prescriptions, vision and dental care. Allows you to save while reducing your taxable income. Unused funds that will roll over year to year. There’s no “use it or lose it” penalty. A way to accumulate additional retirement savings. After age 65, funds can be withdrawn for any purpose without penalty.
Authorized Signers who are 55 or older must have their own HSA in order to make the catch-up contribution Monthly Fee: Your account will be charged a monthly fee of $1.75, waived with an average daily balance at or above $3,000.
Examples of Qualified Medical Expenses
Surgery Braces Contact lenses Dentures Eyeglasses Vaccines
For a list of sample expenses, please refer to your school district’s benefits website at www.mybenefitshub.com/clintisd
HSA Bank Contact Information 605 N. 8th Street, Ste 320 Sheboygan, WI 53081 Phone: 800-357-6246 www.hsabank.com
Using Funds Debit Card You may use the card to pay merchants or service providers that accept VISA credit cards, so there is no need to pay cash up front and wait for reimbursements. You can make a withdrawal at any time. Reimbursements for qualified medical expenses are tax free. If you are disabled or reach age 65, you can receive non-medical distributions without penalty, but you must report the distributions as taxable income. You may also use your funds for a spouse or tax dependent not covered by your HDHP.
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) Not enrolled in Medicare (if an accountholder enrolls in Medicare mid-year, catch-up contributions should be prorated) 13
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. 14
2018 Annual HSA Contribution Limits Individual = $3,450 Family = $6,900
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). 15
AMERICAN PUBLIC LIFE YOUR BENEFITS PACKAGE
MEDlinkÂŽ
PLAY VIDEO
About this Benefit Medical supplement is designed to help supplement your Employer's major medical plan. This plan provides supplemental coverage to help offset outof-pocket costs that you may experience due to deductibles, co-payments and coinsurance of your medical plan.
33% of total healthcare costs are paid out-of-pocket.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 16 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
MEDlink® Limited Benefit Medical Expense Supplemental Insurance Clint ISD THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON‐SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON‐SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.
SUMMARY OF BENEFITS Base Policy
Option 1
In‐Hospital Benefit ‐ Maximum In‐Hospital Benefit
$2,500 per confinement
Outpatient Benefit
up to $200 per treatment
Physician Outpatient Treatment Benefit
$25 per treatment; $125 max per family per Calendar Year
Option 1 Total Monthly Premiums by Plan* Issue Ages
17‐54
55‐69
60+
Employee Only
$28.00
$44.50
$68.50
Employee + Spouse
$51.50
$81.50
$122.50
Employee + Child(ren)
$45.50
$62.00
$86.00
Family Coverage
$69.00
$99.00
$140.00
Plans available to employees age 70 and over if You work for an employer employing 20 or more employees on a typical workday in the preceding Calendar Year. *Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with no ce. The premium and amount of benefits vary dependent upon the Plan selected at me of applica on.
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APSB‐22330(TX)‐0116 MGM/FBS Clint ISD
MEDlink® Limited Benefit Medical Expense Supplemental Insurance Eligibility
Exclusions
This policy will be issued to those persons who meet American Public Life Insurance Company’s insurability requirements. Evidence of insurability acceptable to us may be required. If our underwri ng rules are met, you are on ac ve service, you are covered under your Employer’s Medical Plan and premium has been paid, your insurance will take effect on the requested Effec ve Date or the Effec ve Date assigned by us upon approval of your wri en applica on, whichever is later.
We will pay no benefits for any expenses incurred during any period the Covered Person does not have coverage under your Employer’s Medical Plan, except as provided in the Absence of your Employer’s Medical Plan provision or which result from: (a) suicide or any a empt, thereof, while sane or insane; (b) any inten onally self‐inflicted injury or Sickness; (c) rest care or rehabilita ve care and treatment; (d) outpa ent rou ne newborn care; (e) voluntary abor on except, with respect to You or Your covered Dependent spouse: (1) where Your or Your Dependent spouse’s life would be endangered if the fetus were carried to term; or (2) where medical complica ons have arisen from abor on; (f) pregnancy of a Dependent child; (g) par cipa on in a riot, civil commo on, civil disobedience, or unlawful assembly. This does not include a loss which occurs while ac ng in a lawful manner within the scope of authority; (h) commission of a felony; (i) par cipa on in a contest of speed in power driven vehicles, parachu ng, or hang gliding; (j) air travel, except: (1) as a fare‐paying passenger on a commercial airline on a regularly scheduled route; or (2) as a passenger for transporta on only and not as a pilot or crew member; (k) intoxica on; (Whether or not a person is intoxicated is determined and defined by the laws and jurisdic on of the geographical area in which the loss occurred.) (l) alcoholism or drug use, unless such drugs were taken on the advice of a Physician and taken as prescribed; (m) sex changes; (n) experimental treatment, drugs, or surgery; (o) an act of war, whether declared or undeclared, or while performing police duty as a member of any military or naval organiza on; (This exclusion includes Accident sustained or Sickness contracted while in the service of any military, naval, or air force of any country engaged in war. We will refund the pro rata unearned premium for any such period the Covered Person is not covered.) (p) Accident or Sickness arising out of and in the course of any occupa on for compensa on, wage or profit; (This does not apply to those sole proprietors or partners not covered by Workers’ Compensa on.) (q) mental illness or func onal or organic nervous disorders, regardless of the cause; (r) dental or vision services, including treatment, surgery, extrac ons, or x‐rays, unless: (1) resul ng from an Accident occurring while the Covered Person’s coverage is in force and if performed within 12 months of the date of such Accident; or (2) due to congenital disease or anomaly of a covered newborn child. (s) rou ne examina ons, such as health exams, periodic check‐ups, or rou ne physicals, except when part of Inpa ent rou ne newborn care; (t) any expense for which benefits are not payable under the Covered Person’s Employer’s Medical Plan; or (u) air or ground ambulance.
Covered Charges mean those charges that are incurred by a Covered Person because of an Accident or Sickness; are for necessary treatment, services and medical supplies and recommended by a Physician; are incurred in a covered facility as defined in the Policy or any a ached rider; are not more than any dollar limit set forth in the Schedule; are incurred while insured under the Policy, subject to any Extension of Benefits; and are not excluded under the Policy. Covered charges also include Inpa ent rou ne newborn care and are subject to above. A Hospital is not any ins tu on used as a place for rehabilita on; a place for rest, or for the aged; a nursing or convalescent home; a long term nursing unit or geriatrics ward; or an extended care facility for the care of convalescent, rehabilita ve or ambulatory pa ents.
In‐Hospital Benefit Benefits payable are limited to any out‐of‐pocket deduc ble amount; any out‐of‐pocket co‐payment or coinsurance amounts the Covered Person actually incurs a er the Employer’s Medical Plan has paid; any out‐of‐pocket amount the Covered Person actually incurs for surgery performed by a Physician a er the Employer’s Medical Plan has paid; and the Maximum In‐Hospital Benefit shown in the Policy Schedule. The Covered Person must be an Inpa ent and covered by your Employer’s Medical Plan when the Covered Charges are incurred.
Outpa ent Benefits Treatment is for the same or related condi ons, unless separated by a period of 90 consecu ve days. A er 90 consecu ve days, a new Outpa ent Benefit will be payable. The Covered Person must be covered by your Employer’s Medical Plan when the Covered Charges are incurred.
Physician Outpa ent Treatment Benefit Benefit maximum of $125 per family per Calendar Year. The Covered Person must be covered by your Employer’s Medical Plan when the Covered Charges are incurred. The Covered Person must not be an Inpa ent when the Covered Charges are incurred.
Premiums The premium rates may be changed by Us. If the rates are changed, We will give You at least 31 days advance wri en no ce. If a change in benefits increases Our liability, premium rates may be changed on the date Our liability is increased. This plan may be con nued in accordance with the Consolidated Omnibus Reconcilia on Act of 1986.
18
APSB‐22330(TX)‐0116 MGM/FBS Clint ISD
MEDlink® Limited Benefit Medical Expense Supplemental Insurance Termina on of Coverage Your Insurance coverage will end on the earliest of these dates: the date You no longer qualify as an Insured; the end of the last period for which premium has been paid; the date the Policy is discon nued; the date You re re; if You work for an employer employing less than 20 employees on a typical work day in the preceding Calendar Year, the date You a ain age 70; the date You cease to be on Ac ve Service; the date Your coverage under your Employer’s Medical Plan ends; or the date You cease employment with the employer through whom You originally became insured under the Policy. Insurance coverage on a Dependent will end on the earliest of these dates: the date Your coverage terminates; the end of the last period for which premium has been paid; the date the Dependent no longer meets the defini on of Dependent; the date the Dependent’s coverage under your Employer’s Medical Plan ends; or the date the Policy is modified so as to exclude Dependent coverage. We may end the coverage of any Covered Person who submits a fraudulent claim. We may end the coverage of a Subscribing Unit if fewer persons are insured than the Policyholder’s applica on requires.
2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606 This is a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the policy and riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form MEDlink® Series | Texas | Limited Benefit Medical Expense Supplemental Insurance | (10/14) | Clint ISD
APSB‐22330(TX)‐0116 MGM/FBS Clint ISD
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 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
Telehealth When should I use MDLIVE? If you’re considering the ER or urgent care for a non-emergency medical issue Your primary care physician is not available At home, traveling, or at work 24/7/365, even holidays!
What can be treated?
Allergies Asthma Bronchitis Cold and Flu Ear Infections Joint Aches and Pain Respiratory Infection Sinus Problems And More!
Pediatric Care related to:
Cold & Flu Constipation Ear Infection Fever Nausea & Vomiting Pink Eye And More!
Are children eligible? Yes. MDLIVE has local pediatricians on-call 24/7/365. Please note, a parent or guardian must be present during any interactions involving minors. We ask parents to establish a child record under their account. Parents must be present on each call for children 18 or younger.
How much does it cost? $10 Covers you, your spouse, and unmarried children up to age 26, with unlimited phone consultations.
Download the App Doctor visits are easier and more convenient with the MDLIVE App. Be prepared. Download today. www.mdlive.com/getapp
Access to a doctor anywhere: at home, at work, or on the go Choose doctors from one of the nation's largest telehealth networks Available 24/7 by video or phone Private, secure and confidential visits Connect instantly with MDLIVE Assist
Who are our doctors? MDLIVE has the nation’s largest network of telehealth doctors. On average, our doctors have 15 years of experience practicing medicine and are licensed in the state where patients are located. Their specialties include primary care, pediatrics, emergency medicine and family medicine. Our doctors are committed to providing convenient, quality care and are always ready to take your call.
Scan with your smartphone to get the app.
Call us at (888) 365-1663 or visit us at www.consultmdlive.com
Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for 21 abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit www.mdlive.com/pages/terms.html 010113
CIGNA
Dental
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, treatment and dental disease.
Good dental care may improve your overall health. Also Women with gum disease may be at greater risk of giving birth to a preterm or low birth weight baby.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 22 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
Dental PPO Benefits Network
Cigna Dental Choice Plan
Monthly PPO Premiums
In-Network
Out-of-Network
Total Cigna DPPO Network
No Network
$1,000
$1,000
Calendar Year Maximum (Class I, II, III and IV expenses) Annual Deductible Individual Family
$50 per person $150 per family
$50 per person $150 per family
Reimbursement Levels
Based on Contracted Fees
Maximum Allowable Charge
Plan Pays
You Pay
Plan Pays
You Pay*
Class I - Diagnostic & Preventive Oral Exams Cleanings X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain
100% No Deductible
No Charge
100% No Deductible
No Charge*
Class II - Basic Restorative Restorative: fillings Endodontics: minor and major Periodontics: minor and major Oral Surgery: minor and major Anesthesia: general and IV sedation Repairs: Bridges, Crowns and Inlays
80% After Deductible
20% After Deductible
80% After Deductible
20%* After Deductible
Class III - Major Restorative Repairs: Dentures Denture Relines, Rebases and Adjustments Inlays and Onlays Prosthesis Over Implant Crowns, Bridges and Dentures
50% After Deductible
50% After Deductible
50% After Deductible
50%* After Deductible
50%
50%
50%
50%*
50% After Plan Deductible
50% After Plan Deductible
50% After Plan Deductible
50%* After Plan Deductible
Class IV - Orthodontia Coverage for Employee and All Dependents Orthodontia Lifetime Maximum: $1,000
Class IX - Implants
Tier
Rate
EE Only
$24.50
EE + Spouse
$51.90
EE + Child(ren)
$61.18
Family Coverage
$98.48
*The dentist may balance bill up to their usual fees. 23
Dental PPO Benefit Plan Provisions In-Network Reimbursement- For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule. *Out-of-Network Reimbursement- For services provided by an out of network dentist, Cigna Dental will reimburse according to the Maximum Allowable Charge. The dentist may balance bill up to their usual fees. Cross Accumulation- All deductibles, plan maximums, and service specific maximums cross accumulate between in and out of network. Benefit frequency limitations are based on the date of service and cross accumulate between in and out of network.
prescription dental products are available through Cigna Home Delivery Pharmacy only, and you are required to pay the entire discounted charge. For more information including how to enroll in this program and a complete list of program terms and eligible medical conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24.
Benefit Exclusions Covered Expenses will not include, and no payment will be made for the following:
Calendar Year Benefits Maximum- The plan will only pay for covered charges up to the plan maximum (when applicable). Benefit-specific maximums may also apply. Annual Deductible- This is the amount you must pay before the plan begins to pay for covered charges (when applicable). Benefit-specific deductibles may also apply. Late Entrant Limitation Provision- 50% coverage on Class III and IV for 12 months.
Pretreatment Review- Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed.
Alternate Benefit Provision- When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses.
Oral Health Integration Program- Cigna Dental Oral Health Integration Program offers enhanced dental coverage for customers with the following medical conditions: diabetes, heart disease, stroke, maternity, head and neck cancer radiation, organ transplants and chronic kidney disease. There’s no additional charge for the program, those who qualify get reimbursed 100% of coinsurance for certain related dental procedures. Eligible customers can also receive guidance on behavioral issues related to oral health and discounts on prescription and nonprescription dental products. Reimbursements under this program are not subject to the plan deductible, but will be applied to and are subject to the plan annual maximum. Discounts on certain prescription and non24
Procedures and services not listed under Benefit Highlights; Diagnostic: cone beam imaging; Preventive Services: instruction for plaque control, oral hygiene and diet; Restorative: Porcelain or acrylic veneers of crowns or pontics on, or replacing the upper and lower first, second and third molars; Periodontic: bite registrations; splinting; Prosthodontic: precision or semi-precision attachments; Procedures, appliances or restorations, except full dentures, whose main purpose is to: change vertical dimension; diagnose or treat conditions or dysfunction of the temporomandibular joint (TMJ); stabilize periodontally involved teeth; or restore occlusion; Athletic mouth guards; Replacement of a lost or stolen appliance; Services performed primarily for cosmetic reasons; Personalization; Services that are deemed to be medical in nature; Services and supplies received from a hospital; Drugs: prescription drugs; Charges in excess of the Maximum Allowable Charge; Contracted providers are not obligated to provide discounts on non-covered services and may charge their usual fees.
Dental PPO Procedure
Exclusions and Limitations
Missing Tooth Limitation
For teeth missing prior to coverage with Cigna, the amount payable is 50% of the amount otherwise payable until covered for 12 months; thereafter, considered a Class III expense. 2 per year Bitewings: 2 per year Full mouth or panoramic: 1 every 3 years Payable only in conjunction with orthodontic workup 2 per year, including periodontal maintenance procedures following active therapy 1 per year for children under age 19 Limited to posterior tooth. 1 treatment per tooth every 3 years for children under age 14 Limited to non-orthodontic treatment for children under age 19 Various limitations depending on the service Replacement every 5 years if unserviceable and cannot be repaired Replacement every 5 years if unserviceable and cannot be repaired Reviewed if more than once Covered if more than 6 months after installation
Oral Exams X-rays (routine) X-rays (non-routine) Diagnostic Casts Cleanings Fluoride Application Sealants (per tooth) Space Maintainers Periodontal Treatment Inlays, Crowns and Bridges Dentures and Partials Denture and Bridge Repairs Denture Adjustments, Rebases and Relines Prosthesis Over Implant
1 every 5 years if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth colored material on molar crowns or bridges.
This document provides a summary only. It is not a contract. If there are any differences between this summary and the official plan documents, the terms of the official plan documents will prevail. Cigna Dental PPO plans are insured and/or administered by Cigna Health and Life Insurance Company (CHLIC) or Connecticut General Life Insurance Company (CGLIC), with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Texas, the insured dental plan is known as Cigna Dental Choice, and this plan uses the national Cigna DPPO network. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. Policy forms (for insured dental plans) in OK: HPPOL99 (CHLIC), GM6000 ELI288 et al (CGLIC); OR: HP-POL68; TN: HP-POL69/HC-CER2V1 et al (CHLIC). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. BSD62115 © 2017 Cigna
25
SUPERIOR VISION YOUR BENEFITS PACKAGE
Vision
PLAY VIDEO
About this Benefit Vision insurance provides coverage for routine eye examinations and may cover all or part of the costs associated with contact lenses, eyeglasses and vision correction, depending on the plan.
75% of U.S. residents between age 25 and 64 require some sort of vision correction.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 26 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
Vision Superior Select Southwest Network Benefits Exam Frames Contact Lenses1
In-Network
Out-of-Network
Covered in full $125 retail allowance $150 retail allowance
Up to $35 retail Up to $70 retail Up to $80 retail
Covered in full
Up to $150 retail
Medically Necessary Contact Lenses Lasik Vision Correction
$200 allowance2
Lenses (standard) per pair Single Vision Bifocal Trifocal Progressive Lenticular
Covered in full Covered in full Covered in full See description3 Covered in full
Up to $25 retail Up to $40 retail Up to $45 retail Up to $45 retail Up to $80 retail
Co-pays apply to in-network benefits; co-pays for out-ofnetwork visits are deducted from reimbursements. 1 Contact lenses and related professional services (fitting, evaluation and followup) are covered in lieu of eyeglass lenses and frames benefit. 2 Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limitations 3 Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay.
Discount Features Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.
Monthly Premiums EE Only EE + Spouse EE + Child(ren) EE + Family
$7.49 $14.46 $14.98 $22.52
Co-Pays Exam Materials
$10 $25
Services/Frequency Exam Frame Lenses Contact Lenses
12 months 12 months 12 months 12 months
(Based on date of service) The Plan discount features are not insurance. All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan. Discounts are subject to change without notice. Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions
SuperiorVision.com Customer Service 800.507.3800
Glasses available online at www.ditto.com Contacts available online at www.ContactsDirect.com/ superiorvision
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 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
Long Term Disability What is Long-Term Disability Insurance?
When can I enroll?
Long-Term Disability Insurance pays you a portion of your earnings if you cannot work because of a disabling illness or injury. You have the opportunity to purchase Long-Term Disability Insurance through your employer. This highlight sheet is an overview of your Long-Term Disability Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail.
If you choose not to elect coverage during your annual enrollment period, you will not be eligible to elect coverage until the next annual enrollment period without a qualifying change in family status.
Why do I need Long-Term Disability Coverage? Most accidents and injuries that keep people off the job happen outside the workplace and therefore are not covered by worker’s compensation. When you consider that nearly three in 10 workers entering the workforce today will become disabled before retiring1, it’s protection you won’t want to be without. 1 Social Security Administration, Fact Sheet 2009.
What is disability? Disability is defined in The Hartford’s* contract with your employer. Typically, disability means that you cannot perform one or more of the essential duties of your occupation due to injury, sickness, pregnancy or other medical condition covered by the insurance, and as a result, your current monthly earnings are 80% or less of your predisability earnings. Once you have been disabled for 24 months, you must be prevented from performing one or more of the essential duties of any occupation and as a result, your current monthly earnings are 66 2/3% or less of your pre-disability earnings.
Am I eligible?
When is it effective? 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.
What is does “Actively at Work” mean? You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session.
How long do I have to wait before I can receive my benefit? You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a Long-Term Disability benefit payment. For those employees electing an elimination period of 30 days or less, if your are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day.
What is an elimination period?
How much coverage would I have?
The elimination period that you select consists of two numbers. The first number shows the number of days you must be disabled by an accident before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin.
You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $8,000 that cannot exceed 66 2/3% of your current monthly earnings.
I already have Disability coverage; do I have to do anything?
You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis.
Your plan includes a minimum benefit of 10% of your elected benefit. Earnings are defined in The Hartford’s contract with your employer.
If you are not changing the amount of your coverage or your elimination period option, you do not have to do anything. If you want to purchase Long-Term Disability insurance for the first time or change your coverage, please be sure to complete the online enrollment, which indicates your election.
29
Long Term Disability What other benefits are included in my disability coverage?
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. 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. 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. 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.
30
How long will my disability benefits continue if I elect the Premium benefit option? Premium Option: For the Premium benefit option – the table below applies to disabilities resulting from sickness or injury: 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
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 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.
Mental Illness, Alcoholism and Substance Abuse
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.
Long Term Disability 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. 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 next section 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.) 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 The portion of your Long -Term Disability payment that you place in an IRS-approved account to fund your future retirement. Your personal savings, investments, IRAs or Keoghs Profit-sharing Most personal disability policies Social Security increases
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 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
GC13 Limited Benefit Group Cancer Indemnity Insurance Clint 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 NONSUBSCRIBERS 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 Clint 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 Clint 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.
GC13 Limited Benefit Group Cancer Indemnity Insurance 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.
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, limitations, exclusions and other provisions, please refer to the policy and riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and 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) | Clint ISD
APSB-22331(TX) MGM/FBS Clint ISD
35
AMERICAN PUBLIC LIFE YOUR BENEFITS PACKAGE
Accident
PLAY VIDEO
About this Benefit
2/3
Accident insurance is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or a not-soserious, injury. Accident coverage is low cost protection available to you and your family without evidence of insurability.
of disabling injuries suffered by American workers are not work related.
American workers 36% ofreport they always or
usually live paycheck to paycheck.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 36 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
A3 Supplemental Limited Benefit Accident Expense Insurance Clint ISD
AMERICAN PUBLIC LIFE YOUR BENEFITS
Accident
THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.
Summary of Benefits* Benefit Description Accidental Death - per unit Medical Expense Accidental Injury Benefit - per unit Daily Hospital Confinement Benefit Air and Ground Ambulance Benefit
DID YOU KNOW?
2/3 of disabling injuries suffered by American workers are not work American workers 36% ofreport they always or
Level 2 - 2 Units
Level 3 - 3 Units
Level 4 - 4 Units
$5,000
$10,000
$15,000
$20,000
actual charges up to actual charges up to actual charges up to actual charges up to $500 $1,000 $1,500 $2,000 $75 per day
$150 per day
$225 per day
$300 per day
actual charges up to actual charges up to actual charges up to actual charges up to $1,250 $2,500 $3,750 $5,000
Accidental Dismemberment Benefit Single finger or toe Multiple fingers or toes Single hand, arm, foot or leg Multiple hands, arms, feet or legs
$500 $500 $2,500 $5,000
$1,000 $1,000 $5,000 $10,000
$1,500 $1,500 $7,500 $15,000
$2,000 $2,000 $10,000 $20,000
Accidental Loss of Sight Benefit - per unit Loss of Sight in one eye Loss of Sight in both eyes
$2,500 $5,000
$5,000 $10,000
$7,500 $15,000
$10,000 $20,000
Individual
Individual & Spouse
1 Parent Family
2 Parent Family
$10.80 $17.10 $21.50 $24.50
$19.40
$21.20 $34.90 $45.20 $52.00
$29.80 $47.60 $62.60 $72.40
About this Benefit Accident insurance is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or a not-so-serious, injury. Accident coverage is low cost protection available to you and your family without evidence of insurability.
Level 1 - 1 Unit
Level 1 - 1 Unit Level 2 - 2 Units Level 3 - 3 Units Level 4 - 4 Units
$29.80 $38.90 $44.90
*Total premium includes the Plan selected and any applicable rider premium. The premium and amount of benefits vary dependent upon the Plan selected at time of application. Premiums are subject to increase with notice.
usually live paycheck to paycheck.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
37
APSB-22329(TX)-MGM/FBS Clint ISD
A3 Supplemental Limited Benefit Accident Expense Insurance Limitations and Exclusions Eligibility This policy will be issued to only those persons who meet American Public Life Insurance Company’s insurability requirements. Persons not meeting APL’s insurability requirements will be excluded from coverage by an endorsement attached to the policy.
Base Policy and Optional Benefits
Exclusions Benefits otherwise provided by this Policy will not be payable for services or expenses or any such Loss resulting from or in connection with: (1) (2) (3)
No benefits are payable for a pre-existing condition. Preexisting condition means an Injury that pertains solely to an Accidental Bodily Injury which resulted from an accident sustained before the Effective Date of coverage. Pre-Existing Conditions specifically named or described as permanently excluded in any part of this contract are never covered.
(4)
A Hospital is not an institution which is primarily a place for alcoholics or drug addicts; the aged; a nursing, rest or convalescent nursing home; a mental institution or sanitarium; a facility contracted for or operated by the United States Government for treatment of members or ex-members of the armed forces (unless You are legally required to pay for services rendered in the absence of insurance); or, a long-term nursing unit or geriatrics ward.
(7)
(5) (6)
(8)
(9) (10)
Medical Expense Accidental Injury Benefit Expenses must commence within 60 days of the covered accident. The maximum benefit amount payable for any one accident for the Insured Person shall not exceed the Medical Expense Benefit.
Air and Ground Ambulance Benefit Emergency transportation must occur within 21 calendar days of the accident causing such Injury.
Daily Hospital Confinement Benefit
(11)
(12) (13) (14)
The maximum benefit period for this benefit is 30 days per covered accident.
(15)
Accidental Death
(16)
Accidental Death must result within 90 days of the covered accident causing the injury.
sickness, illness or bodily infirmity; suicide, attempted suicide or intentional self-inflicted Injury, whether sane or insane; dental care or treatment unless due to accidental Injury to natural teeth; war or any act of war (whether declared or undeclared) or participating in a riot or felony; alcoholism or drug addiction; travel or flight in or descent from any aircraft or device which can fly above the earth’s surface in any capacity other than as a fare paying passenger on a regularly scheduled airline; Injury originating prior to the effective date of the Policy; Injury occurring while intoxicated (Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the loss or cause of loss is incurred.); Voluntary inhalation of gas or fumes or taking of poison or asphyxiation; Voluntary ingestion or injection of any drug, narcotic or sedative, unless administered on the advice and taken in such doses as prescribed by a Physician; Injury sustained or sickness which first manifests itself while on full-time duty in the armed forces; (Upon notice, We will refund the proportion of unearned premium while in such forces.) Injury incurred while engaging in an illegal occupation; Injury incurred while attempting to commit a felony or an assault; Injury to a covered person while practicing for or being a part of organized or competitive rodeo, sky diving, hang gliding, parachuting or scuba diving; driving in any race or speed test or while testing an automobile or any vehicle on any racetrack or speedway; hernia, carpal tunnel syndrome or any complication therefrom;
A3 Supplemental Limited Benefit Accident Expense Insurance If You are entitled to benefits under this Policy as a result of sprained or lame back, or any intervertebral disk conditions, such benefits shall be payable for a maximum period of time, not exceeding in the aggregate three (3) months for any Injury.
Guaranteed Renewable You have the right to renew this Policy until the first premium due date on or after Your 69th birthday, if you pay the correct premium when due or within the Grace Period. When an Insured’s coverage terminates at age 70, coverage for other Insured Persons, if any, shall continue under this Policy. We have the right to change premium rates by class.
2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606
Accidental Dismemberment Benefit The total amount payable for all Losses resulting from the same accident will not exceed the Maximum Dismemberment Benefit of $5,000 cumulative per unit, per Accident. Loss must be within 90 days of the accident causing such Injury.
Underwritten by American Life Insurance Company. This is a brief description of the coverage. For actual benefits, limitations, exclusions and other provisions, please refer to the policy and riders. This coverage does not replace Workers’ Compensation Insurance. | This product is inappropriate for people who are eligible for Medicaid coverage. | Policy Form A3 Series | Texas | Supplemental Limited Benefit Accident Expense Insurance Policy | (10/14) | Clint ISD
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APSB-22329(TX)-MGM/FBS Clint ISD
APSB-22329(TX)-MGM/FBS Clint ISD
A3 Supplemental Limited Benefit Accident Expense Insurance Limitations and Exclusions Eligibility This policy will be issued to only those persons who meet American Public Life Insurance Company’s insurability requirements. Persons not meeting APL’s insurability requirements will be excluded from coverage by an endorsement attached to the policy.
Base Policy and Optional Benefits
Exclusions Benefits otherwise provided by this Policy will not be payable for services or expenses or any such Loss resulting from or in connection with: (1) (2) (3)
No benefits are payable for a pre-existing condition. Preexisting condition means an Injury that pertains solely to an Accidental Bodily Injury which resulted from an accident sustained before the Effective Date of coverage. Pre-Existing Conditions specifically named or described as permanently excluded in any part of this contract are never covered.
(4)
A Hospital is not an institution which is primarily a place for alcoholics or drug addicts; the aged; a nursing, rest or convalescent nursing home; a mental institution or sanitarium; a facility contracted for or operated by the United States Government for treatment of members or ex-members of the armed forces (unless You are legally required to pay for services rendered in the absence of insurance); or, a long-term nursing unit or geriatrics ward.
(7)
(5) (6)
(8)
(9) (10)
Medical Expense Accidental Injury Benefit Expenses must commence within 60 days of the covered accident. The maximum benefit amount payable for any one accident for the Insured Person shall not exceed the Medical Expense Benefit.
Air and Ground Ambulance Benefit Emergency transportation must occur within 21 calendar days of the accident causing such Injury.
Daily Hospital Confinement Benefit
(11)
(12) (13) (14)
The maximum benefit period for this benefit is 30 days per covered accident.
(15)
Accidental Death
(16)
Accidental Death must result within 90 days of the covered accident causing the injury.
sickness, illness or bodily infirmity; suicide, attempted suicide or intentional self-inflicted Injury, whether sane or insane; dental care or treatment unless due to accidental Injury to natural teeth; war or any act of war (whether declared or undeclared) or participating in a riot or felony; alcoholism or drug addiction; travel or flight in or descent from any aircraft or device which can fly above the earth’s surface in any capacity other than as a fare paying passenger on a regularly scheduled airline; Injury originating prior to the effective date of the Policy; Injury occurring while intoxicated (Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the loss or cause of loss is incurred.); Voluntary inhalation of gas or fumes or taking of poison or asphyxiation; Voluntary ingestion or injection of any drug, narcotic or sedative, unless administered on the advice and taken in such doses as prescribed by a Physician; Injury sustained or sickness which first manifests itself while on full-time duty in the armed forces; (Upon notice, We will refund the proportion of unearned premium while in such forces.) Injury incurred while engaging in an illegal occupation; Injury incurred while attempting to commit a felony or an assault; Injury to a covered person while practicing for or being a part of organized or competitive rodeo, sky diving, hang gliding, parachuting or scuba diving; driving in any race or speed test or while testing an automobile or any vehicle on any racetrack or speedway; hernia, carpal tunnel syndrome or any complication therefrom;
A3 Supplemental Limited Benefit Accident Expense Insurance If You are entitled to benefits under this Policy as a result of sprained or lame back, or any intervertebral disk conditions, such benefits shall be payable for a maximum period of time, not exceeding in the aggregate three (3) months for any Injury.
Guaranteed Renewable You have the right to renew this Policy until the first premium due date on or after Your 69th birthday, if you pay the correct premium when due or within the Grace Period. When an Insured’s coverage terminates at age 70, coverage for other Insured Persons, if any, shall continue under this Policy. We have the right to change premium rates by class.
2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606
Accidental Dismemberment Benefit The total amount payable for all Losses resulting from the same accident will not exceed the Maximum Dismemberment Benefit of $5,000 cumulative per unit, per Accident. Loss must be within 90 days of the accident causing such Injury.
Underwritten by American Life Insurance Company. This is a brief description of the coverage. For actual benefits, limitations, exclusions and other provisions, please refer to the policy and riders. This coverage does not replace Workers’ Compensation Insurance. | This product is inappropriate for people who are eligible for Medicaid coverage. | Policy Form A3 Series | Texas | Supplemental Limited Benefit Accident Expense Insurance Policy | (10/14) | Clint ISD
39
APSB-22329(TX)-MGM/FBS Clint ISD
APSB-22329(TX)-MGM/FBS Clint ISD
SUN LIFE FINANCIAL
Critical Illness
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit Critical illness insurance is designed to supplement your medical and disability coverage easing the financial impacts by covering some of your additional expenses. It provides a benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke.
$16,500 Is the aggregate cost of a hospital stay for a heart attack.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 40 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
Critical Illness Living longer… worrying less Maybe it’s happened to someone you know. A sudden illness such as a heart attack or stroke with devastating physical and financial consequences. Thanks to advances in modern medicine, the probability of surviving a critical illness is almost twice that of dying.1 The question is, will your financial security survive? For many, a critical illness can expose an individual to an unexpected gap in protection. While health plans may help cover many of the direct costs associated with a critical illness, related expenses such as lost income, child care, travel to and from treatment, high deductibles and co-pays may quickly diminish savings. Critical Illness insurance pays a fixed benefit upon initial diagnosis of a covered critical illness. Unlike most life insurance plans, critical illness insurance provides a benefit to you while you are living – and when you may need it most.
This critical illness only insurance policy provides limited benefits. This limited policy has some specific benefit limits and is not a medical insurance policy, a Medicare Supplement policy or a high deductible health plan. Please refer to the issued insurance policy for complete details and all benefit requirements, including all limitations, exclusions, restrictions and reductions. We reserve the right to cancel the policy with advance written notice to the policyholder. Insurance policies and certain policy benefits are subject to state variations and may not be available in all states. Issued insurance contracts determine all plan features and benefits. Contact Sun Life Employee Benefits for additional details. Sun Life Employee Benefits is the brand name for insurance products underwritten and issued by Union Security Insurance Company.
Critical Illness – the facts 1.5 million 1 in 3 2 times more likely to survive
Families lose their homes due to foreclosure every year due to unaffordable medical costs.2 Men and women have some form of cardio vascular disease.3 For those suffering a critical illness prior to age 65, the probability of surviving is almost twice that of dying.1
1
Comment from David Himmelstein, lead author of Harvard Study on Bankruptcies, February 3, 2005. 2 Robertson, C.T. et al. “Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures,” Health Matrix 2008. 3 Heart Disease and Stroke Statistics – 2007 Update, American Heart Association
Key Advantages of This Plan
Benefits are payable directly to you to be spent any way you choose Pays in addition to any other coverage you may have Flexible coverage options to meet your individual needs Fast and accurate claims service Coverage is fully portable – if you change jobs you can take your coverage with you
41
Critical Illness What benefits are provided under this plan? After your coverage effective date, if you are first diagnosed for a covered critical illness or undergo a covered procedure, you could receive up to $20,000 depending on the amount of coverage you elect.
You cannot collect more than 100% of your elected benefit in any one category unless you qualify for a recurrence benefit. You can receive benefits from a second procedure category if there is at least 6 consecutive months between the diagnosis or procedure dates. Covered Illnesses/Procedures
Category 1 Heart attack, heart failure, stroke Coronary bypass surgery
Percent of Benefit Payable
To elect coverage under this plan, you must be at active work as a full-time employee of the policyholder or an associated company. Full-time employment means you are working 20 hours or more per week. Temporary or seasonal workers are not eligible.
What about coverage for my family?
100% 25%
100%
State variations exist; please contact Sun Life Employee Benefits for additional eligibility information.
Recurrence Benefit If, after 18 months of being treatment free from the initial critical illness, you are diagnosed with the same condition or have the same procedure again, we’ll pay an additional 25% of the previously paid benefit. The recurrence benefit can only be paid once in each category. Note: the recurrence benefit is not payable for Category 3.
Total Benefit You could receive up to 250% of your elected amount (100% of the elected amounts in each category as well as the 25% Recurrence Benefit in Categories 1 and 2).
Annual Wellness Screening Benefit – for you and your covered spouse If both you and your spouse enroll in the plan, each of you are eligible for $50 per benefit year for any one Wellness Screening test from a list of more than 20 covered tests. Covered tests include: Blood test for lipids including total cholesterol, LDL, HDL and triglycerides; breast ultrasound or mammography; chest x-ray; colonoscopy; pap smear; PSA (blood test for prostrate cancer); electrocardiogram (EKG);
42
How do I know if I’m eligible to participate in this plan?
If you elect coverage for yourself, you can elect coverage for your eligible family members. Eligible family members include your lawful spouse and children from live birth up to age 26. Family members cannot be hospital confined on the effective date of coverage.
Category 2 Blindness, major organ failure (excluding heart failure), end stage kidney disease, paralysis (excluding paralysis from stroke), coma
echocardiogram (Echo) and more. In order to receive this benefit, you must submit proof that the wellness screening test was performed by providing us with documentation from your or your dependent’s doctor.
How much coverage can I buy? You may elect coverage for yourself in units of $5,000 up to $20,000. Coverage for your spouse is available in units of $2,500 up to $10,000 and you may cover your children for either $2,500 or $5,000. The amount of coverage for your spouse and children cannot exceed 50% of your own amount of coverage. Child coverage includes all eligible children. Your benefit is subject to a 50% reduction when you turn age 70.
Critical Illness Limitations
Affordable premiums Refer to the charts below to select amounts of coverage that meet your needs and fit your budget. Premiums for you and your spouse are based on your age as of the coverage effective date and will not increase due to a change in age. MONTHLY Critical Illness Premiums Employee, Non-Tobacco and Tobacco
Employee Age
$5,000
$10,000
$15,000
$20,000
Thru 29
$2.80
$5.60
$8.40
$11.20
30-39
$4.40
$8.80
$13.20
$17.60
40-49
$6.65
$13.30
$19.95
$26.60
50-59
$12.30
$24.60
$36.90
$49.20
60-64
$17.25
$34.50
$51.75
$69.00
65+
$20.10
$40.20
$60.30
$80.40
MONTHLY Critical Illness Premiums Spouse, Non-Tobacco and Tobacco
Exclusions
Employee Age
$2,500
$5,000
$7,500
$10,000
Thru 29
$1.40
$2.80
$4.20
$5.60
30-39
$2.20
$4.40
$6.60
$8.80
40-49
$3.33
$6.65
$9.98
$13.30
50-59
$6.15
$12.30
$18.45
$24.60
60-64
$8.63
$17.25
$25.88
$34.50
65+
$10.05
$20.10
$30.15
$40.20
MONTHLY Child Premiums For all children, not per child $2,500
$0.15
$5,000
$0.30
Note: Premiums are approximate based on your payroll deductions.
Do I need to answer any medical questions or be examined by a doctor to enroll? No doctor’s exam or medical questions are required.
All benefit amounts are subject to a pre-existing condition limitation. A pre-existing condition means an injury, sickness, pregnancy, symptom or physical finding, or any related injury, sickness, pregnancy or physical finding, for which you or your covered dependent consulted with or received advice from a licensed medical or dental practitioner; or received medical or dental care, treatment or services, including taking drugs, medicine, insulin or similar substances in the 12 months that end on the day before you or your covered dependent became insured under the policy. We will not pay benefits for claims resulting, directly or indirectly from a pre-existing condition unless you or your covered dependent is initially diagnosed with a critical illness or undergo a procedure after 12 consecutive months during which you or your covered dependent is continuously insured under this plan. State variations exist; please contact Sun Life Employee Benefits for additional information.
We will not pay benefits for you or your covered dependent if the critical illness or procedure is related to or resulting directly or indirectly from: services or treatment not included in the Schedule; services or treatment for which you or your covered dependent are not charged, unless there is no charge because the facility is a United States government facility; services or treatment provided by a family member; any critical illness that is diagnosed outside the United States; services or treatment provided primarily for cosmetic purposes; treatment or complications of treatment not related to a critical illness or procedure; an autologous bone marrow transplant, one in which your or your covered dependent’s own bone marrow is used; service in the armed forces or related auxiliaries such as the National Guard or Army Reserve of any country, combination of countries, or international organization at war, whether declared or not; war or any act of war, whether declared or not; taking part in a riot or insurrection, or an act of riot or insurrection; committing or attempting to commit an assault or felony; incarceration in a penal institution of any kind; intoxication (intoxication means your or your covered dependent’s blood alcohol level exceeds the legal limit for operating a motor vehicle in the jurisdiction in which the injury occurs); use of any drug, unless used as prescribed by a doctor; intentionally self-inflicted injury, while sane or insane; suicide or attempted suicide, while sane or insane. State variations exist; please contact Sun Life Employee Benefits for additional information.
43
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 44 Taylor ISD Benefits Website: www.mybenefitshub.com/taylorisd
Basic Life and AD&D Benefit Highlights What is Basic Life and AD&D Insurance?
Your Employer provides, at no cost to you, Basic Life and AD&D Insurance in an amount equal to $25,000. 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 Basic Life and AD&D Insurance. Once a group policy is issued to your employer, a certificate of Insurance will be available to explain your coverage in detail.
Am I eligible?
You are eligible if you are an active full time employee who works at least 30 hours per week on a regularly scheduled basis.
When can I enroll?
As an eligible Employee, you are automatically covered by Basic Life and AD&D Insurance; you do not have to enroll. If you have not already done so, you must designate a beneficiary as described below.
When is it effective?
Coverage goes into effect subject to the terms and conditions of the policy. You must be Actively at Work with your employer on the day your coverage takes effect.
Benefit Reductions
None. All coverage cancels at retirement. Your beneficiary is the person (or persons) or legal entity (entities) who receives a benefit payment if you
What is a beneficiary? die while you are covered by the policy. You must select your beneficiary when you complete your enrollment application; your selection is legally binding.
AD&D Coverage
AD&D provides benefits due to certain injuries or death from an accident. The covered injuries or death can occur up to 365 days after that accident. The insurance pays: 100% of the amount of coverage you purchase in the event of accidental loss of life, two limbs, the sight of both eyes, one limb and the sight of one eye, or speech and hearing in both ears or quadriplegia. 75% for paraplegia or triplegia (paralysis of three limbs). One-half (50%) for accidental loss of one limb, sight of one eye, or speech or hearing in both ears or hemiplegia. One-quarter (25%) for accidental loss of thumb and index finger of the same hand or uniplegia. Your total benefit for all losses due to the same accident will not be more than 100% of the amount of coverage you purchase.
Can I keep my Life Coverage if I leave my employer?
Yes, subject to the contract, you have the option of: Converting your group Life coverage to your own individual policy (policies). If you leave your employer, Portability is an option that allows you to continue your Life Insurance coverage. To be eligible, you must terminate your employment prior to Social Security Normal Retirement Age. This option allows you to continue all or a portion of your Life Insurance coverage under a separate Portability term policy. Portability is subject to a minimum of $5,000 and a maximum of $250,000 and does not include coverage for your dependents. To elect Portability, you must apply and pay the premium within 31 days of the termination of your Life Insurance. Evidence of Insurability will not be required.
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.
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. AD&D insurance does not cover losses cause by or contributed by: Sickness; disease; or any treatment for either; Any infection, except certain ones cause by an accidental cut or wound; Intentionally self-inflicted injury, suicide or suicide attempt; War or act of war, whether declared or not; Injury sustained while in the armed forces of any country or international authority; Taking prescription or illegal drugs unless prescribed for or administered by a licensed physician; Injury sustained while committing or attempting to commit a felony; The injured person’s intoxication. Other exclusions may apply depending on your coverage. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail. 45
Supplemental Life Insurance Benefit Highlights Clint ISD 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.
What is Supplemental Life Insurance?
Am I eligible? When can I enroll? When is it effective? How much Supplemental Life Insurance can I purchase?
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. You can enroll during your scheduled enrollment period, within 31 days of the date you have a change in family status, or within 31 days of the completion of your eligibility waiting period as stated in your group policy. 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. You can purchase Supplemental Life Insurance in increments of $10,000. The maximum amount you can purchase cannot be more than $500,000. Annual earnings are as defined in The Hartford’s contract with your employer.
I already have Supplemental Life Insurance coverage; do I have to do anything?
If you take no action, your coverage and coverage for your eligible dependents will automatically continue with The Hartford subject to the terms of the contract.
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 $200,000, 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. This coverage, like most group benefit insurance, requires that a certain percentage of eligible employees participate. If that group participation minimum is not met, the insurance coverage that you have elected may not be in effect. If you elect supplemental life insurance for yourself, you may choose to purchase spouse voluntary life insurance in increments of $5,000, 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 fulltime military service or is already covered as an employee under this policy.
Spouse Voluntary Life Insurance
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 annual enrollment period or are newly eligible and elect an amount that exceeds the guaranteed issue amount of $50,000, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you enroll after your annual or initial enrollment period, evidence of insurability will be required for all coverage amounts.
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Supplemental Life Insurance
Child(ren) Voluntary Life Insurance
If you elect supplemental life insurance for yourself, you may choose to purchase child (ren) voluntary life insurance coverage in the amount(s) of $10,000 for each child – no medical information is required. If your dependent child(ren) is confined in a hospital or elsewhere because of disability on the date his or her insurance would normally have become effective, coverage (or an increase in coverage) will be deferred until that dependent is no longer confined and has performed all the normal activities of a healthy person of the same age for at least 15 consecutive days. Your child(ren) must be at least 15 days but not yet age 26 to be covered. Child(ren) age 26 or older may be covered if they were disabled prior to attaining age 26.
Does my coverage reduce as I get older?
No. All coverage cancels at retirement.
Can I keep my life coverage if I leave my employer?
Yes, subject to the contract, you have the option of: Converting your group life coverage to your own individual policy (policies). If you leave your employer, portability is an option that allows you to continue your life insurance coverage. To be eligible, you must terminate your employment prior to Social Security Normal Retirement Age. This option allows you to continue all or a portion of your life insurance coverage under a separate portability term policy. Portability is subject to a minimum of $5,000 and a maximum of $250,000 and does include coverage for your spouse and child(ren). To elect portability, you must apply and pay the premium within 31 days of the termination of your life insurance. Evidence of insurability will not be required. Dependent spouse portability is subject to a maximum of $50,000. Dependent child(ren) portability is subject to a maximum of $10,000.
What is the living benefits option?
If you are diagnosed as terminally ill with a 12 month life expectancy, you may be eligible to receive payment of a portion of your life insurance. The remaining amount of your life insurance would be paid to your beneficiary when you die.
Do I still pay my life insurance premiums if I become disabled?
If you become totally disabled before age 60 and your disability lasts for at least 9 months, your life insurance premium may be waived. The premium for your dependent’s coverage will also be waived if you are disabled and approved for waiver of premium. Coverage for your dependents will end if the policy terminates.
Important Details As is standard with most term life insurance, this insurance coverage includes certain limitations and exclusions: the amount of your coverage may be reduced when you reach certain ages. death by suicide (two years). Other exclusions may apply depending upon your coverage. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail. This benefit highlights sheet is an overview of the insurance being offered and is provided for illustrative purposes only and is not a contract. It in no way changes or affects the policy as actually issued. Only the insurance policy issued to the policyholder (your employer) can fully describe all of the provisions, terms, conditions, limitations and exclusions of your insurance coverage. In the event of any difference between the benefit highlights sheet and the insurance policy, the terms of the insurance policy apply.
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Voluntary AD&D Benefit Highlights Clint ISD
What is Voluntary Accidental Death and Dismemberment Insurance?
Voluntary accidental death and dismemberment insurance pays your beneficiary (please see below) a death benefit if you die due to a covered accident while you are insured. It also pays you a benefit for certain accidental losses. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail. Death benefits are paid in addition to any life insurance benefits. Voluntary accidental death and dismemberment insurance pays benefits for accidental loss of limbs, thumb and index finger, speech, hearing, and sight. Voluntary accidental death and dismemberment insurance covers losses that occur away from work or at work. Benefits are paid regardless of any worker’s compensation benefits you collect. This highlight sheet is an overview of your voluntary accidental death and dismemberment insurance.
What does Voluntary Accidental Death and Dismemberment Insurance cover?
You may receive benefits due to certain losses or death from an accident. The covered losses or death can occur up to 365 days after that accident. The policy pays for: 100% of the amount of coverage you purchase in the event of accidental loss of life, or speech and hearing in both ears. One-half (50%) for accidental loss of one hand or foot, sight of one eye, or speech or hearing in both ears. One-quarter (25%) for accidental loss of thumb and index finger of the same hand. Additionally, your employer may have elected optional/supplemental benefits as part of your AD&D coverage. Refer to the certificate of insurance for further information. Your total benefit for all losses due to the same accident will not be more than 100% of the amount of coverage you purchase.
What optional benefits has my employer selected as part of my Voluntary Accidental Death and Dismemberment Insurance? Am I eligible? When can I enroll? When is it effective? How much Voluntary Accidental Death and Dismemberment Insurance can I purchase? Does my coverage reduce as I get older? Do I have to provide medical information to receive coverage? 48
Child Education Benefit Coma Benefit Conversion Privilege Paralysis Benefit Repatriation Benefit Seat Belt & Air Bag Spouse Education Benefit You are eligible if you are an active full time employee who works at least 20 hours per week on a regularly scheduled basis. You can enroll during your scheduled enrollment period, within 31 days of the date you have a change in family status, or within 31 days of the completion of your eligibility waiting period as stated in your group policy. 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. You can purchase voluntary accidental death and dismemberment insurance in increments of $10,000. The maximum amount you can purchase cannot be more than 5 times your annual earnings or $500,000. Earnings are as defined in The Hartford’s contract with your employer. No. No medical information is required. You are guaranteed the amount of coverage that you select, subject to maximum amounts defined in your policy.
Voluntary AD&D
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. You are automatically the beneficiary for any dependent coverage and for any AD&D losses other than life.
Are there other limitations to enrollment?
This coverage, like most group benefit insurance, requires that a certain percentage of eligible employees participate. If that group participation minimum is not met, the insurance coverage that you have elected may not be in effect. You may also choose voluntary accidental death and dismemberment insurance for your spouse and/or dependent child(ren).
Voluntary Accidental Death and Dismemberment Insurance for your dependents
You may choose voluntary accidental death and dismemberment insurance for your spouse in the following amounts: 50% of the amount you select for yourself if you do not have any child(ren) whom you cover under this voluntary accidental death and dismemberment insurance policy. 40% if you have child(ren) whom you cover under this voluntary accidental death and dismemberment insurance policy. You may not elect coverage for your spouse if your spouse is already covered as an employee under this policy. You may choose guaranteed voluntary accidental death and dismemberment insurance for each child at least 15 days but under age 25 in the following amounts: 15% of the amount you select for yourself if you do not have a spouse whom you cover under this voluntary accidental death and dismemberment insurance policy 10% if you have a spouse whom you cover under this voluntary accidental death and dismemberment insurance policy
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. AD&D insurance does not cover losses cause by or contributed by: Sickness; disease; or any treatment for either; Any infection, except certain ones cause by an accidental cut or wound; Intentionally self-inflicted injury, suicide or suicide attempt; War or act of war, whether declared or not; Injury sustained while in the armed forces of any country or international authority; Taking prescription or illegal drugs unless prescribed for or administered by a licensed physician; Injury sustained while committing or attempting to commit a felony; The injured person’s intoxication.
Other exclusions may apply depending on 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 general purposes of the voluntary accidental death and dismemberment 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 policy, the terms of the insurance policy apply.
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TEXAS LIFE
Individual Life
YOUR BENEFITS PACKAGE
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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 50 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
Individual Life Life Insurance Highlights Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. Designed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually costs more and declines in death benefit.
DID YOU KNOW? Those with no life insurance think it’s 3 times more expensive than it actually is.
The policy, PureLife-plus, is underwritten by Texas Life Insurance Company, and it has these outstanding features:
High Death Benefit. With one of the highest death benefit available at the worksite,1 PureLife-plus gives your loved ones peace of mind, knowing there will be significant life insurance in force should you die prematurely.
Minimal Cash Value. Designed to provide high death benefit, PureLife-plus does not compete with the cash accumulation in your employer-sponsored retirement plans.
Long Guarantees. Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time (after the guaranteed period, premiums may go down, stay the same, or go up).
Refund of Premium. Unique in the marketplace, PureLifeplus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.)
Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.)
You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, minor children and grandchildren. Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details. 1
Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 2008 51
ID WATCHDOG
Identity Theft
YOUR BENEFITS PACKAGE
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About this Benefit Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered. An identity is stolen every 2 seconds, and takes over
300 hours
to resolve, causing an average loss of $9,650.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 52 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
Identity Theft Identity theft can strike anyone, at any time. More than 11 million Americans were victimized by identity theft in 2011, including more than 500,000 children.
Identity theft devastates its victims financially. The average victim will lose $4,841, and spend an additional $1,400 in out-of-pocket expenses resolving their case.
Repairing the damage caused by identity theft is frustrating and time consuming. The average victim spends 330 hours repairing the damage from identity theft—the equivalent of working a full-time job for more than 2 months.
ID Watchdog Monthly Rates Employee Only
$7.95
Employee + Family
$14.95
ID Watchdog Services Basic & Advanced Identity Monitoring Cyber Monitoring Full-Service Identity Restoration Non-Credit Loan Monitoring Address Monitoring Credit Report Monitoring 100% Resolution Guarantee
The impact of identity theft follows victims for years. 50% of identity theft victims experience trouble getting loans or credit cards as a result of identity theft. 12% of identity theft victims end up having warrants issued by law enforcement in their name for crimes committed by the identity thief.
Who’s Evaluating your Credit Report? Potential Creditors, Potential Employers, Insurance Companies, Current Creditors, Government Agencies
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NBS
FSA (Flexible Spending Account)
YOUR BENEFITS PACKAGE
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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 54 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
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. You can expect your existing card to be funded by mid-January. If you need a replacement card please contact NBS directly at (800) 274-0503.
New Plan Participants NBS will mail out your new benefit cards to the address listed in THEbenefitsHUB. They will be sent in unmarked envelopes so please watch for them as they should arrive within 21 business days of effective date. NBS debit cards are good for 3 years.
New Members can expect Flex Cards to be delivered to the address listed in THEbenefitsHUB near the end of January. Don’t forget, Flex Cards Are Good For 3 Years!
For a list of sample expenses, please refer to the Clint ISD benefit website: www.mybenefitshub.com/clintisd
NBS Contact Information: 8523 South Redwood Road West Jordan, UT 84088 Phone (800) 274‐0503 Fax (800) 478‐1528 Email: service@nbsbenefits.com
DID YOU KNOW? FSAs use tax-free funds to help pay for your Health Care Expenses.
FSA Annual Contribution Max: $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 claim FAQs
55
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 + 75 day grace period 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/clintisd
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What Happens If I Don’t Use All of My Funds by The End of the Plan Year (December 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 for a medical claim. However, in the event you lose your card or are waiting to receive one, you can visit www.mybenefitshub.com/clintisd and complete the “Claim Form” to send medical or daycare claims to NBS or use the web or phone app to file online. Remember you cannot use your debit card for dependent daycare claims.
How To Receive Your Dependent Care Reimbursement Faster. A Direct Deposit form is available on the Benefits Website which will help you get reimbursed quicker!
How the FSA Plan Works You designate an annual election of pre-tax dollars to be deposited into your health and dependent-care spending accounts. Your total election is divided by the number of pay periods in the Plan year and deducted equally from each paycheck before taxes are calculated. By the end of the Plan year, your total election will be fully deposited. However, you may make a claim for eligible health FSA expenses as soon as they are incurred during the Plan year. Eligible claims will be paid up to your total annual election even if you have not yet contributed that amount to your account.
Get Your Money 1. 2. 3. 4.
Complete and sign a claim form (available on our website) or an online claim. Attach documentation; such as an itemized bill or an Explanation of Benefits (EOB) statement from a health insurance provider. Fax or mail signed form and documentation to NBS. Receive your non-taxable reimbursement after your claim is processed either by check or direct deposit.
NBS Flexcard—FSA Pre-paid Benefit Card Your employer may sponsor the use of the NBS Flexcard, making access to your flex dollars easier than ever. You may use the card to pay merchants or service providers that accept credit cards, so there is no need to pay cash up front then wait for reimbursement.
Account Information Participants may call NBS and talk to a representative during our regular business hours, Monday–Friday, 7am to 6pm Mountain Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to our website: www.NBSbenefits.com Information includes: Detailed claim history and processing status Health Care and Dependent Care account balances Claim forms, worksheets, etc. Online Claim Submission
Enrollment Considerations After the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying “change of status” (marriage status, employment change, dependent change). Be conservative in the total amount you elect to avoid forfeiting money that may be left in your account at the end of the year. Your employer may allow a short grace period or rollover after the Plan year ends for you to submit qualified claims for any unused funds. If you choose to enroll in the HSA you are not eligible to enroll in the FSA.
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NATIONWIDE
Pet Insurance
YOUR BENEFITS PACKAGE
About this Benefit Pet insurance is a tool to help pet parents avoid a financial crisis due to unexpected veterinary expenses from accidents and illnesses.
1 in 3 pets will need emergency veterinary treatment every year.
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 58 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
Pet Insurance Major Medical Plan Comprehensive AND Pet Wellness Plan Plus Everyday care
Major Medical Plan Comprehensive
Pet Wellness Plan Plus Everyday care
Use any vet Accidents, including poisonings, cuts and broken bones Common illnesses, including ear infections, rashes, vomiting and diarrhea Serious/chronic illnesses†, including cancer, diabetes and allergies Hereditary conditions‡ Procedures/services, including surgeries, Rx meds, testing and hospitalization Wellness services, including exams, vaccinations and flea/ heartworm preventives Annual deductible
$250 for medical claims $0 for wellness claims
How to apply for Pet Insurance Major Medical Plan Comprehensive provides coverage for veterinary expenses related to accidents and illnesses. Policies are available for dogs, cats, birds, reptiles and other exotic pets. Optional Pet Wellness Plan Plus Everyday Care wellness coverage is also available for dogs and cats, providing reimbursement for the preventive care necessary to keep pets healthy year after year. Choose from two easy ways to sign up: Call 877-738-7874 and tell the pet insurance specialist that you're an employee of Clint Independent School District. You'll receive a group discount on your base medical policy. Visit: www.petinsurance.com/clintisd and enter Clint Independent School District to enroll online. The rates given will include your group discount.
$250
$0
During enrollment, you will be asked for the following information: Home or primary telephone number Name Address E-mail address Name of your pet Pet’s species (canine, feline, etc.) Pet’s date of birth Pet’s sex Pet’s breed Pet’s color Medical questions about pet’s current and past health, medications and date of last veterinary visit Preferred animal hospital (note: policyholders are free to use any veterinarian) Payment information/plan* *If payroll plan is available to you: applications approved between the 1st and the 15th of the month become effective on the 1st of the following month. Applications approved from the 16th through the end of the month become effective on the 1st of not the following month, but the month thereafter. Example: May 1 approval = June 1 effective date May 16 approval = July 1 effective date
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LIFEWORKS
EAP (Employee Assistance Program)
YOUR BENEFITS PACKAGE
About this Benefit An Employee Assistance Plan (EAP) is an employee benefit program offered to help employees manage personal and professional problems that might adversely impact their work performance, health, and well-being. Employee Assistance Plans generally include short-term counseling and referral services for employees and their household members. Your Employee Assistance Program benefit is provided to you by your employer.
38%
of employees have missed life events because of bad worklife balance.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 60 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
Employee Assistance Program With LifeWorks Integrated EAP and Work-life services, employees and their families will have access to confidential assistance and support on a wide range of issues in the areas of life, health, family, work and money. Topic
Description
Emotions and Stress
Relationship issues, depression and anxiety – even an online “calm room
Parenting
Parenting skills, adoption, talking with your teenager, help in finding child care
Midlife and Retirement
Financial considerations, work and career in midlife, relationships with adult children, growing as a couple
Addictive Behaviors
Drug and alcohol abuse, eating disorders, gambling
Education
Applying to college, understanding financial aid and scholarships, advocating in the schools
Caring of older adults
Caregiver support, referrals to in-home and other services, and federally funded programs
Disability
Special needs programs, advocacy and specific disabilities information
Everyday Issues
Community resources and consumer information
Financial Issues
Credit management, budget analysis, 401(k) plan questions, basic estate planning, and questions about federal tax planning and preparation
Legal Issues
On-staff attorneys provide information and referrals for family matters, real estate, consumer credit and criminal matters. Also online program with forms, guides and simple wills.
Work
Special content for managers includes employee relations, interpersonal conflicts, performance issues, discrimination and workplace change. Also general support for co-worker relationships and stress.
Employees and their families have anytime access to LifeWorks Integrated EAP and Work-life services in a variety of ways that fit their preferences and unique needs.
Telephone (888) 456-1324 / Español: (888) 732-9020 All calls are answered live by Lifeworks employees who are trained clinical consultants with master’s/doctorate degrees. LifeWorks is a 24/7 operation, so there are no changes in our service delivery during non-business hours — your employees will not be directed to leave messages. A fully staffed bilingual clinical consultant team answers calls from service centers in St. Petersburg, FL; Minneapolis, MN; Blue Bell, PA; Toronto, Winnipeg and Montreal, Canada.
Mobile An app for mobile devices makes the LifeWorks site accessible from anywhere at any time for iPhone, Android and Blackberry users. www.lifeworks.com Username: clint Password: lifeworks
In-Person Employees and their families will have access to 6 face-to-face assessments and short- term, solution-focused counseling with EAP clinicians. Lifeworks develops close relationships and carefully evaluates the national network of EAP providers who deliver in-person counseling to your employees. This cohesive team includes consultants that complete the initial screening assessment and connect participants to the EAP provider and EAP affiliate managers to ensure a high quality experience. Lifeworks also employs a Clinical Supervisor within Provider Network Services for case consultation and assistance to the local EAP affiliate. Our North American network of 11,300 EAP providers includes all 50 U.S. states, Puerto Rico, the Virgin Islands, Mexico, Canada and U.S. Territories. Our entire network is composed of licensed mental health professionals. Minimum qualifications include a license to practice independently in the state in which services are provided along with five years post graduate experience and three years providing EAP services. Our counselors and providers possess strong EAP and work-life skills, and we aggressively recruit Certified Employee Assistance Professionals (CEAPs) whose focus is on helping employees quickly resolve issues that may interfere with their work. 61
MASA YOUR BENEFITS PACKAGE
Medical Transport
About this Benefit Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out-of-pocket costs that are not covered by insurance. It includes emergency transportation via ground ambulance, air ambulance and helicopter.
A ground ambulance can cost up to
$2,400
and a helicopter transportation fee can cost
over $30,000
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 62 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
Medical Transport MASA provides medical emergency transportation solutions and covers your out of pocket medical transport cost when your insurance falls short. MASA does not use a network, which means you are covered anywhere.
Emergent Card Example:
THE TRUTH... Americans today suffer from a false sense of security that their medical coverage will pay for all costs associated with emergency or critical care transport. The reality is that a majority of Americans are only partially covered for these high costs. Most healthcare policies will only pay based off of the “Usual and Customary Charges” while Medicare pays based off a set fee schedule, both leaving you with the remainder of the bill. You face the possibility that your medical coverage will deny the claim leaving you responsible for the ENTIRE bill.
Plan Comparison BENEFIT
MASA provides medical emergency transportation solutions AND cover your out of pocket medical transport cost when your insurance falls short.
EMERGENT PLATINUM
Emergency Helicopter Transport
✔
✔
Emergency Ground Ambulance Transport
✔
✔
“All I had to do was send the bill which was never paid by Medicare and TriCare for Life --- and the rest is history. When MASA received that bill, it was paid and all amounts owed satisfied.” --- MASA Member, 2015
Fixed Wing (Airplane) Transport
✔
Minor Child/Grandchild Return
✔
Organ Recipient Transport
✔
MASA MTS for Employees Ensures...
Organ Retrieval
✔
Repatriation/Recuperation with worldwide coverage
✔
Non-injury Transport
✔
Pet Return
✔
Vehicle Return
✔
Return Transportation
✔
Escort Transportation
✔
Mortal Remains Transport
✔
NO health questions NO age limits NO claim forms NO deductibles NO provider network limitations NO dollar limits on emergency transport costs
What is Covered?
Emergency Helicopter Transport Emergency Ground Ambulance Transport
How Much Does It Cost? MASA Emergent rates are $9 a month, per employee only/family coverage. MASA Platinum is $24.50/employee per month and $32.50/family per month.
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Medical Transport
PLATINUM MEMBERSHIP BENEFITS
Emergency Air Medical Transportation
Should a member suffer serious life or limb threatening emergency that requires immediate transport by fixed wing or helicopter air ambulance of that member to the nearest most appropriate medical facility capable of providing required emergency medical treatments, also referred to as “golden hour transports”, MASA MTS will cover the out-of-pocket expenses resulting from that transport. (U.S. and Canada only)
Emergency Ground Transportation
Should a member suffer a life or limb emergency requiring emergent ground transport from the site of serious illness or injury, or from a transferring medical facility that is unable to provide services required, to the nearest most appropriate medical facility capable of attending to the member’s medical needs MASA MTS will cover the out-of-pocket expenses resulting from that transport. (U.S. and Canada only)
Air Transportation – Hospital to Hospital
Should a member suffer a serious illness or injury resulting in hospitalization and if the member is in need of specialized treatment not available locally, then MASA MTS will fly him/her to the nearest appropriate medical facility capable of providing such specialized treatment (Worldwide coverage)
Organ Retrieval**
MASA MTS will provide air transportation of an organ to be used in an organ transplant. (U.S. only)
Organ Recipient Transportation**
MASA MTS will fly a member to the commercial airport nearest the medical facility where an organ transplant is scheduled to happen. (U.S. only)
Recuperation / Repatriation
If a member is hospitalized while away from home, MASA MTS will fly them home to recuperate in familiar surroundings. (Worldwide coverage)
Escort Transportation
If a member requires emergency air transport, MASA MTS will fly the member's spouse, family member or friend to accompany them in the air. (Worldwide coverage)
Non-injury Transportation
If a member is hospitalized while away from his/her home for more than 7 days, the member may select a family member to visit them during confinement. MASA MTS will provide round trip, common carrier air transportation for the person selected. (Basic coverage area only*)
Minor Children / Grandchildren Return
When minor children or grandchildren are left unattended as a result of a member using MASA MTS air ambulance service, MASA MTS will provide one-way common carrier air transport for return of the children to the commercial airport nearest the place of residence of the children. (Basic coverage only*)
*Basic Coverage Area includes U.S., Canada, Mexico, and Caribbean (excluding Cuba). **One (1) year waiting period if pre-existing condition requiring transplant. There is a 90 day waiting period on pre-existing conditions. This clause is WAIVED for emergent ground and air transports.
64
Medical Transport
PLATINUM MEMBERSHIP BENEFITS
Vehicle Return
MASA MTS will return vehicles such as cars, vans, RVs or trucks owned or rented by the member when illness, injury or death requires use of the air ambulance services provided by MASA MTS. The vehicle will be carried to the member's place of residence or rental vehicles will be returned to the nearest rental company office or agent. (Basic coverage area only*)
Mortal Remains Transport
In the event a member dies while away from his/her place of residence, MASA Assist will return his/her remains to the commercial airport nearest his/her residence. (Worldwide coverage)
Pet Return
MASA MTS will return the Member’s dog, cat or smaller animal, should the Member be flown to a hospital near their residence on an air ambulance arranged by the MASA MTS. (Basic coverage area only*)
*Basic Coverage Area includes U.S., Canada, Mexico, and Caribbean (excluding Cuba). There is a 90 day waiting period on pre-existing conditions. This clause is WAIVED for emergent ground and air transports.
65
LEGAL SHIELD YOUR BENEFITS PACKAGE
Legal Services
About this Benefit Having an affordable, qualified lawyer on your side can be an invaluable asset. Legal plans provide valuable benefits that cover the most common legal needs you may encounter - like creating a standard will, living will, healthcare power of attorney or buying a home. This plan also provides access to quality law firms for advice, consultation and representation.
55% of American adults do not have a will or other estate plan in place.
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 66 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
Legal Services Everyone deserves legal protection. At LegalShield, we’ve been offering legal plans to our members for over 40 years, creating a world where everyone can access legal protection—and everyone can afford it. Unexpected legal questions arise every day and with LegalShield on your side, you’ll have access to a quality law firm 24/7, for covered personal situations. From real estate to speeding tickets to Will preparation, and beyond, we’re here to help you with any personal legal matter—no matter how traumatic or how trivial it may seem. Because our dedicated law firms are prepaid, their sole focus is on serving you, rather than billing you.
Our Promise to You
ada. And with over 650 employees dedicated to serving you, our promise remains the same: to provide outstanding legal services by quality law firms at an affordable price.
Why LegalShield For as little as $20 a month, LegalShield gives you the ability to talk to an attorney on any personal legal matter without worrying about high hourly costs. That’s why, under the protection of LegalShield, you or your family can live your lives worry free.
Even better, you don’t have to worry about figuring out which attorney to use—we’ll do that for you. Our experienced attorneys focus specifically on our members and provide 24/7 access for covered emergencies.
As one of the first companies in North America to provide legal Learn more about the LegalShield Legal Plan at expense plans to consumers, we are currently protecting and empowering more than 4.1 million lives across the U.S. and Can- www.legalshield.com/info/legalplan Advice & Consultation Advice Toll-free phone consultations with your Provider Law Firm for any personal legal matter, even on pre-existing conditions Letters and Phone Calls on Your Behalf Available at the discretion of your Provider Lawyer Contract and Document Review Contract/document review up to 15 pages each 24/7 Emergency Assistance After-hours legal consultation for covered legal emergencies. Specific coverage depends on plan, such as: you’re arrested or detained, if you’re seriously injured, if you’re served with a warrant, or if the state tries to take your child(ren).
Family Matters (family plan only) Uncontested Name Change Assistance* One (1) uncontested name change prepared per member year by Provider Law Firm Uncontested Adoption Representation* Representation by your Provider Law Firm for uncontested adoption proceedings Uncontested Separation/Divorce Representation* Representation by your Provider Law Firm for uncontested legal separation, uncontested civil annulment and uncontested divorce proceedings
Representation Trial Defense Services Assistance if you or your spouse are named defendant or respondent in a covered civil action filed in court Year 1 2 3 4 5
Pre-Trial Time 2.5 3 3.5 4 4.5
Trial Time
Total
57.5 117 176.5 236 295.5
60 120 180 240 300
Document Preparation Standard Will Preparation Will preparation and annual reviews and updates for covered members Other documents available: Living Will, Health Care Power of Attorney
Residential Loan Document Assistance (family plan only) Mortgage documents (as required of the borrower by the lending institution) prepared by your Provider Law Firm for the purchase of your primary residence
Auto Motor Vehicle Services Non-criminal moving traffic violation assistance coverage depends on plan, such as: you’re arrested or detained, if you’re seriously injured, if you’re served with a warrant, or if the state tries to take your child(ren). Motor vehicle-related criminal charge assistance
Up to 2.5 hours of help with driver’s license reinstatement and property damage collection assistance of $5,000 or less per claim Available 15 days after enrollment Available only if member has a valid driver’s license and is driving a non- commercial motor vehicle
IRS IRS Audit Legal Services One hour of consultation, advice or assistance when you are notified of an audit by the IRS An additional 2.5 hours if a settlement is not achieved within 30 days If your case goes to court, you’ll receive 46.5 hours of your Provider Law Firm’s services Coverage for this service begins with the tax return due April 15 of the year you enroll
Additional Benefits 25% Preferred Member Discount You may continue to use your Provider Law Firm for legal situations that extend beyond plan coverage. The additional services are 25% off the law firm’s standard hourly rates. Your Provider Law Firm will let you know when the 25% discount applies, and go over these fees with you.
Your Plan Covers Family Plan: The member
The member’s spouse/ domestic partner Never-married dependent children under age 26 living at home Dependent children under age 18 for whom the member is legal guardian Never married, dependent, children who are full-time college students up to age 26 Physically or mentally disabled children living at home
Individual Plan: An individual rate is available for those enrollees who are not married, do not have a domestic partner and do not have minor children or dependents. No family benefits are available to individual plan members. Ask your Independent Associate for details. *These services are available 90 consecutive days from the effective date of your membership. For detailed information about the legal services provided for personal matters by the LegalShield contract, go to http:// www.legalshield.com/info/legalplan. Business issues are not included; however, plans providing those services are available.
Download the free app from the App Store or Google Play.
67
ZEBIT YOUR BENEFITS PACKAGE
Financial Wellness
About this Benefit Zebit is a free employee financial wellness benefit that provides financial resources and access to no-cost credit options to relieve the number one cause of stress—financial stress. Zebit helps you plan, manage, and respond to life events.
Tips for Saving Money
Save your loose change. Keep track of your spending. Never purchase expensive items on impulse. Create a budget. Aim for short-term savings goals Save money by buying items online, in bulk.
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 68 Clint ISD Benefits Website: www.mybenefitshub.com/clintisd
Financial Wellness Welcome to Zebit, Clint ISD!
Zebitline Eligibility
Shop thousands of products and eCertificates. From school supplies to furnishing the home, we’ve got it all. Zebit Market has over 30,000 products at competitive retail prices. Pay over time with no interest or fees. Ever.
Even if you’re not eligible for Zebitline credit yet, you can still use the Instant Budget app and wellness education modules.
How to Register for Zebit
How Zebit Works
JOIN: Verify your employment. No credit check. SHOP: Visit the Zebit Market and shop with your credit. The first payment is due at checkout. Your order ships within a few days. PAY OVER TIME: Use your debit or credit card to make payments interest free over time.
Instant Budget App
GET YOUR BUDGET. Answer 4 simple questions—your zip code, income, household composition and size—and receive an instant budget comparison of people just like you. COMPARE YOUR BUDGET. Enter your actual expenses to see how you compare. How do you match up? SET SAVINGS GOALS. We identify where you can cut back and give advice to reach your saving goal.
Available for download on the App Store, Google Play, and Amazon.
Wellness Education Zebit Financial Wellness Education contains 20 interactive modules to help you learn the basics and improve your financial life. Education topics include: Home Ownership Savings Investments Payday Loans Auto Loans Prepaid Cards Mobile Payments Checking Accounts Credit Cards Credit Scores & Reports
Insurance Taxes Education Financing 529 Plans Identity Protection Retirement Emergency Savings Overdraft Mortgages Social Security
You must be employed by Clint ISD for at least one year You must be at least 18 years old You must make at least $10,000 annually You are enrolled in direct deposit
STEP 1 Have your Employee ID & Date of Hire/Employment available. Please refer to your Consolidated Enrollment Form for your Employee Payroll ID# and Date of Hire/ Employment. If you are not sure of your Employee ID or Date of Hire/ Employment, please contact your HR Department at 915-926-4066. STEP 2 Go to www.zebit.com/hi/clint Find out how Zebit works and click on “Register Now”. STEP 3 Enter in your email address We’ll send you an email that you need to open and click on. STEP 4 Select the first checkbox that says “I work at an employer… that offers Zebit as a voluntary benefit” Type in “Clint ISD” and select it from the list. STEP 5 Enter in your Employee ID & Date of Hire/Employment. It will be a 2 to 6-digit number STEP 6 Enter in a few other pieces of information. Then submit your registration STEP 7 Zebit sends you an email. The email confirms the status of your application. STEP 8 Upon approval, create a password. Then you can log in and shop the Zebit Market!
Contact (855) 449-3248 help@zebit.com
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