DUNCANVILLE ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2018 - 8/31/2019 WWW.MYBENEFITSHUB.COM/ DUNCANVILLEISD
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Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) TRS-ActiveCare and Scott & White HMO APL MEDlink® Medical Supplement HSA Bank Health Savings Account (HSA) NBS Flexible Spending Account (FSA) MDLIVE Telehealth Cigna Dental VSP Vision The Hartford Disability APL Cancer Voya Accident The Hartford Critical Illness UNUM Life and AD&D Texas Life Individual Life LegalShield Identity Theft & Legal Protection NBS 403(b) 2
3 4-5 6-11 6 7 8 9 10
11 12-17 18-21 22-23 24-25 26-27 28-33 34-35 36-37 38-41 42-45 46-49 50-51 52-53 54-55 56-57
FLIP TO... PG. 4 HOW TO HOW TO ENROLL ENROLL
PG. 6 SUMMARY PAGES
PG. 12 YOUR BENEFITS
Benefit Contact Information DUNCANVILLE ISD BENEFITS
VISION
INDIVIDUAL LIFE
Financial Benefit Services (866) 914-5202 www.mybenefitshub.com/duncanvilleisd
Group # 30020362 VSP (800) 877-7195 www.vsp.com
Texas Life (800) 283-9233 www.texaslife.com
TRS ACTIVECARE MEDICAL
DISABILITY
HEALTH SAVINGS ACCOUNT
Aetna Group # 866344 (800) 222-9205 www.trsactivecareaetna.com
Group # 395320 The Hartford (800) 583-6908 File a Claim: (866) 278-2655 www.thehartford.com
HSA Bank (800) 357-6246 www.hsabank.com
TRS ACTIVECARE PHARMACY
CANCER
FLEXIBLE SPENDING ACCOUNT
CVS Caremark (800) 222-9205 Opt 2 www.caremark.com/trsactivecare
Group # 15668 American Public Life File a Claim (800) 256-8606 www.ampublic.com
National Benefit Services (800) 274-0503 www.nbsbenefits.com
TRS HMO MEDICAL
ACCIDENT
IDENTITY THEFT/LEGAL PROTECTION
Scott & White HMO Group # 085000 (800) 321-7947 www.trs.swhp.org Pharmacy 800-728-7947 prescriptionservices@sw.org
Voya Group # 70124-6 (972) 225-1524 www.voya.com
Group # 47012 LegalShield (800) 654-7757 www.legalshield.com
MEDICAL SUPPLEMENT—MEDLINK ®
CRITICAL ILLNESS
403(b)
Group # 15668 American Public Life (800) 256-8606 www.ampublic.com
Group # 460138 The Hartford (877) 248-5077 www.thehartford.com
National Benefit Services (800) 274-0503 www.nbsbenefits.com
TELEHEALTH
LIFE AND AD&D
DENTAL
MDLIVE (888) 365-1663 www.consultmdlive.com
Group # 469014 UNUM (800) 583-6908 www.unum.com
Group # 3336999 Cigna (800) 244-6224 www.mycigna.com
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MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS DISD” 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 DISD” to 313131 OR SCAN
How to Log In
1 BENEFIT INFO
INTERACTIVE TOOLS
2 3
www.mybenefitshub.com/duncanvilleisd
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.
ONLINE SUPPORT
If you have less than six (6) characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.
Default Password: Last Name* (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number.
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Annual Benefit Enrollment
SUMMARY PAGES
Benefit Updates - What’s New:
Benefit elections will become effective 9/1/2018, however, elections requiring evidence of insurability, such as life Insurance, may have a later effective date, if approved. After annual enrollment closes, benefit changes can only be made if you experience a qualifying event and changes must be made within 31 days of event.
provider, you may be responsible for some of the costs.
Accident Insurance pays you benefits for specific injuries and events resulting from a covered accident that occurs while you are not at work, on or after your coverage effective date. The benefit amount depends on the type of injury and care received.
The Dental DHMO plan requires you to visit an innetwork provider. No annual maximums or waiting periods. All services are paid per the plan schedule and co-pay amount so plan participants always know the out-of-pocket costs. Employees must choose a dentist upon enrollment in the DHMO.
If you currently participate in a Healthcare or Dependent Care FSA, you MUST re-elect a new contribution amount every year to continue to participate. The Medical FSA plan year maximum is increasing to $2,650. If you are currently participating and will participate in 2018-2019, please keep your FSA card.
Vision coverage with VSP members pay a co-pay for innetwork benefits. Out-of-network vision services are reimbursed up to a certain dollar amount. Exam co-pay is $10.00 and materials co-pay is $10.00. Exam and lenses are covered every 12 months; frames covered every 24 months for employees and dependents over 18 years old. Children 18 and under will have a 12 month frame frequency.
Cigna Dental offers two PPO options and a DHMO option to eligible employees. The PPO plans allow you the freedom to choose your dentist. Each plan covers Preventive at 100%, Basic services are paid at 80% and Major services are paid at 50%. Orthodontics are covered only for children to age 19, with a $1,500 lifetime maximum on the High plan and $1,000 on the MAC. No waiting periods and a $1,500 annual maximum on the High plan and $1,000 annual maximum on the MAC plan. The Low option is a MAC plan, which means that if you visit an out-of-network
Telehealth with MDLIVE gives you access to telephone consultations with a licensed physician for evaluation, diagnosis and prescriptions, as appropriate, for minor illnesses. This covers you, your spouse and dependent children to age 26. This benefit is provided to you at no cost from Duncanville ISD.
Login and complete your supplemental benefit enrollment from 07/16/2018 - 08/17/2018 Enrollment assistance is available by calling Financial Benefit Services at 866-914-5202 to speak to an enrollment representative Monday—Thursday, 8am—5:30pm, Friday 8am-3pm. Bilingual assistance is available. Update your profile information: home address, phone numbers, email. IMPORTANT!! Due to the Affordable Care Act (ACA) reporting requirements, please add your dependent’s social security numbers in the HUB. If you have questions, please contact your Benefits Administrator. 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 office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
CHANGES IN STATUS (CIS):
QUALIFYING EVENTS
Marital Status
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
Change in Number of Tax Dependents
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Change in Status of Employment Affecting Coverage Eligibility
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.
An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements Gain/Loss of Dependents' under an employer's plan may include change in age, student, marital, employment or tax dependent Eligibility Status status. If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order Judgment/Decree/Order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage. Eligibility for Government Programs
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
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SUMMARY PAGES
Annual Enrollment During your annual enrollment period, you have the opportunity
Where can I find forms?
to review, change or continue benefit elections each year.
For benefit summaries and claim forms, go to your school
Changes are not permitted during the plan year (outside of
district’s benefit website: www.mybenefitshub.com/
annual enrollment) unless a Section 125 qualifying event occurs.
duncanvilleisd. Then click the benefit plan you need information on (i.e., Dental) and you can find the forms you
Changes, additions or drops may be made only during the
need under the Benefits and Forms section.
annual enrollment period without a qualifying event. How can I find a Network Provider?
Employees must review their personal information and verify that dependents they wish to provide coverage for are
district’s benefit website: www.mybenefitshub.com/
included in the dependent profile. Additionally, you must
duncanvilleisd. Then click on the benefit plan you need
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.
information on (i.e., Dental) and you can find provider search links under the Quick Links section. When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and
New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.
Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits department or you can call Financial Benefit Services at 866-914-5202 for assistance.
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SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 30 or more
Dependent Eligibility: You can cover eligible dependent
regularly scheduled hours each work week.
children under a benefit that offers dependent coverage, provided you par cipate in the same benefit, through the
Eligible employees must be ac vely at work on the plan effec ve
maximum age listed below. Dependents cannot be double
date for new benefits to be effec ve, meaning you are physically
covered by married spouses within Duncanville ISD or as both
capable of performing the func ons of your job on the first day of
employees and dependents.
work concurrent with the plan effec ve date. For example, if your 2018 benefits become effec ve on September 1, 2018, you must be ac vely‐at‐work on September 1, 2018 to be eligible for your new benefits. PLAN
CARRIER
MAXIMUM AGE
Accident
Voya
26
Cancer
American Public Life
26
Cri cal Illness
The Har ord
26
Dental
Cigna
26
Flexible Spending Account (FSA)
Na onal Benefit Services
26 or IRS Tax Dependent
Health Savings Account (HSA)
HSA Bank
26 or IRS Tax Dependent
Iden ty The and Legal Protec on
LegalShield
18 for full services ID The (26 for restora on and Legal Protec on only)
Individual Life
Texas Life
25
Life and AD&D
UNUM
26
MEDlink®
American Public Life
26
Telehealth
MDLIVE
26
TRS Medical
Aetna and Sco & White HMO
26
Vision
VSP
26
If your dependent is disabled, coverage may be able to con nue 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 Benefit Administrator to request a con nua on of coverage. 9
Helpful Definitions
SUMMARY PAGES
Actively at Work
In-Network
You are performing your regular occupation for the employer
Doctors, hospitals, optometrists, dentists and other providers
on a full-time basis, either at one of the employer’s usual
who have contracted with the plan as a network provider.
places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2018 please notify your benefits administrator.
Annual Enrollment The period during which existing employees are given the opportunity to enroll in or change their current elections.
Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.
Out of Pocket Maximum The most an eligible or insured person can pay in co-insurance for covered expenses.
Plan Year September 1st through August 31st
Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescriptions drugs or is under a health care provider’s orders to take drugs, or received medical care or services
Calendar Year January 1st through December 31st
Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or pre-existing condition exclusion provisions do apply, as applicable by carrier.
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(including diagnostic and/or consultation services).
SUMMARY PAGES
HSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
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 taxfree.
Employer Eligibility
A qualified high deductible health plan.
Duncanville ISD
Contribution Source
Employee
Employee
Account Owner Underlying Insurance Requirement
Individual
Duncanville ISD
Enrollment in ActiveCare 1-HD ONLY
None
Description
Minimum Deductible Maximum Contribution
Permissible Use Of Funds
$1,350 single (2018) $2,700 family (2018) $3,450 single (2018) $6,900 family (2018) Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
N/A $2,650 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, however, your plan does allow a $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. 22
FLIP TO FOR FSA INFORMATION
PG. 24
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TRS Aetna
Medical
YOUR BENEFITS PACKAGE
About this Benefit Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis. More than 70% of adults across the United States are already being diagnosed with a chronic disease.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 12 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
Duncanville ISD Plan Year September 1, 2018—August 31, 2019
TRS Medical Insurance Rates include $271 district contribution. Monthly (12 pay) ActiveCare 1-HD
ActiveCare Select
ActiveCare 2
Scott & White HMO
Employee Only
$96.00
$269.00
$511.00
$307.36
Employee + Spouse
$764.00
$1,056.00
$1,584.00
$1,082.40
Employee + Child(ren)
$430.00
$605.00
$892.00
$637.06
$1,103.00
$1,397.00
$1,923.00
$1,238.56
Employee + Family
Semi-Monthly (24 pay) ActiveCare 1-HD
ActiveCare Select
ActiveCare 2
Scott & White HMO
Employee Only
$48.00
$134.50
$255.50
$153.68
Employee + Spouse
$382.00
$528.00
$792.00
$541.20
Employee + Child(ren)
$215.00
$302.50
$446.00
$318.53
Employee + Family
$551.50
$698.50
$961.50
$619.28
18 pay ActiveCare 1-HD
ActiveCare Select
ActiveCare 2
Scott & White HMO
Employee Only
$64.00
$179.33
$340.67
$204.91
Employee + Spouse
$509.33
$704.00
$1,056.00
$721.60
Employee + Child(ren)
$286.67
$403.33
$594.67
$424.71
Employee + Family
$735.33
$931.33
$1,282.00
$825.71
*Please note the rates above are per paycheck and after the district has contributed.
Split Rates (Employee + Family)
Employee + Family
ActiveCare 1-HD
ActiveCare Select
ActiveCare 2
Scott & White HMO
$416.00
$563.00
$826.00
$483.78
Employee works for Duncanville ISD and their spouse works at another school district offering TRS-ActiveCare Medical.
Pooled Rates (Employee + Family) ActiveCare 1-HD Employee + Family
ActiveCare Select
$832.00
Both employee and their spouse works for Duncanville ISD.
$1,126.00
ActiveCare 2
Scott & White HMO
$1,652.00
$967.56 13
2018 – 2019 TRS-ActiveCare Plan Highlights Effective September 1, 2018 through August 31, 2019 | In-Network Level of Benefits1
Deductible (per plan year) In-Network Out-of-Network Out-of-Pocket Maximum (per plan year; medical and prescription drug deductibles, copays, and coinsurance count toward the out-of-pocket maximum) In-Network Out-of-Network Coinsurance In-Network Participant pays (after deductible) Out-of-Network Participant pays (after deductible) Office Visit Copay Participant pays Diagnostic Lab Participant pays Preventive Care See below for examples Teladoc® Physician Services
High-Tech Radiology (CT scan, MRI, nuclear medicine) Participant pays Inpatient Hospital (preauthorization required) (facility charges) Participant pays Freestanding Emergency Room Participant pays
$500 copay per visit plus 20% after deductible
$500 copay per visit plus 20% after deductible
$500 copay per visit plus 20% after deductible
Emergency Room (true emergency use) Participant pays Outpatient Surgery Participant pays Bariatric Surgery Physician charges (only covered if performed at an IOQ facility) Participant pays Annual Vision Examination (one per plan year; performed by an ophthalmologist or optometrist using calibrated instruments) Participant pays Annual Hearing Examination Participant pays Preventive Care Routine physicals – annually age 12 and over Mammograms – 1 every year age 35 and over Smoking cessation counseling– 8 visits per 12 months
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• Well-child care – unlimited up to age 12 • Colonoscopy – 1 every 10 years age 50 and over •Healthydiet/obesity counseling– unlimited to
• Well woman exam & pap smear – annually age 18 and over • Prostatecancerscreening–1 per year age 50 and over • Breastfeeding support – 6 lactation counseling visits
Drug Deductible Short-Term Supply at a Retail Location 20% coinsurance after deductible, except for certain generic preventive drugs that are covered at 100%.2 20% coinsurance after deductible 50% coinsurance after deductible Extended-Day Supply at Mail Order or Retail-Plus Pharmacy Location (60- to 90-day supply)5 20% coinsurance after deductible
$20 for a 1- to 31-day supply $20 for a 1- to 31-day supply $40 for a 1- to 31-day supply3 $40 for a 1- to 31-day supply3 50% coinsurance for a 1- to 31-day supply3 50% coinsurance for a 1- to 31-day supply (Min. $654; Max. $130)3
$45 for a 60- to 90-day supply
$45 for a 60- to 90-day supply
$105 for a 60- to 90-day supply3 $105 for a 60- to 90-day supply3 3 50% coinsurance for a 60- to 90-day supply 50% coinsurance for a 60- to 90-day supply3 (min. $1804 , max $360)3 Specialty Medications 20% coinsurance after deductible 20% coinsurance 20% coinsurance (up to a 31-day supply) (min. $2004 , max $900) Short-Term Supply of a Maintenance Medication at Retail Location (up to a 31-day supply) 20% coinsurance after deductible 50% coinsurance after deductible
Tier 1 – Generic Tier 2 – Preferred Brand Tier 3 – Non-Preferred Brand
20% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible
$35 for a 1- to 31-day supply $35 for a 1- to 31-day supply $60 for a 1- to 31-day supply $60 for a 1- to 31-day supply 50% coinsurance for a 1- to 31-day supply3
What is a maintenance medication? Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes.
When does the convenience fee apply? For example, if you are covered under TRS-ActiveCare Select, the first time you fill a 31-day supply of a generic maintenance drug at a retail pharmacy you will pay $20, then you will pay $35 each month that you fill a 31-day supply of that generic maintenance drug at a retail pharmacy. A 90-day supply of that same generic maintenance medication would cost $45, and you would save $225 over the year by filling a 90-day supply. A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. 1 Illustrates benefits when in-network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits under the ActiveCare Select or ActiveCare Select Whole Health Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for this balance bill amount, which maybe considerable. 2 For ActiveCare 1-HD, certain generic preventive drugs are covered at 100%. Participants do not have to meet the deductible ($2,750 - individual, $5,500 - family) and they pay nothing out of pocket for these drugs. Find the list of drugs at info.caremark.com/trsactivecare. 3 If a participant obtains a brand-name drug when a generic equivalent is available, they are responsible for the generic copay plus the cost difference between the brand-name drug and the generic drug. 4 If the cost of the drug is less than the minimum, you will pay the cost of the drug. 5 Participants can fill 32-day to 90-day supply through mail order.
Full monthly premium*
Premium with min. state/ district contribution**
$367
+Spouse +Children +Family
Individual
Your Monthly Premium***
Full monthly premium*
Premium with min. state/ district contribution**
$142
$540
$1,035
$810
$701
$476
$1,374
$1,149
Your Monthly Premium***
Full monthly premium*
Premium with min. state/ district contribution**
$315
$782
$557
$1,327
$1,102
$1,855
$1,630
$876
$651
$1,163
$938
$1,668
$1,443
$2,194
$1,969
Your Monthly Premium***
* If you are not eligible for the state/district subsidy, you will pay the full monthly premium. Please contact your Benefits Administrator for your monthly premium. ** The premium after state, $75 and district, $150 contribution is the maximum you pay per month. Ask your Benefits Administrator for your monthly cost. (This is the amount you will owe each month after all available subsidies are applied to your premium.) *** Completed by your benefits administrator. The state/district contribution may be greater than $225. 15
2018-2019 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare Fully Covered Health Care Services
Copay
Preventive Services
No Charge
Standard Lab and X-ray
No Charge
Disease Management and Complex Case Management
No Charge
Well Child Care Annual Exams
No Charge
Immunizations (age appropriate)
No Charge
Plan Provisions
Copay
Annual Deductible
$1,000 Individual/ $3,000 Family
Annual out-of-pocket maximum (including medical and prescription co-pays and coinsurance)
Lifetime Paid Benefit Maximum
Outpatient Services
$7,000 Individual/ $14,000 Family (includes combined Medical and RX copays, deductibles and coinsurance)
None
Copay $15 co-pay
Primary Care1
(First Primary Care Visit for Illness $0 Copay2)
Specialty Care
$70 co-pay
Other Outpatient Services
20% after deductible3
Diagnostic/Radiology Procedures
20% after deductible
Eye Exam (one annually) Allergy Serum & Injections
No Charge 20% after deductible
Outpatient Surgery
$150 co-pay and 20% of charges after deductible
Maternity Care
Copay
Prenatal Care
No Charge $150 per day4 and 20% of charges after deductible
Inpatient Delivery
Inpatient Services
Copay
Overnight hospital stay: includes all medical services including semi -private room or intensive care
Diagnostic & Therapeutic Services Physical and Speech Therapy Manipulative Therapy
5
Equipment and Supplies Preferred Diabetic Supplies and Equipment Non-Preferred Diabetic Supplies and Equipment Durable Medical Equipment/ Prosthetics 16
$150 per day4 and 20% of charges after deductible
Copay $70 copay 20% without office visit $40 plus 20% with office visit
Copay $5/$12.50 copay; no deductible 30% after Rx deductible 20% after deductible
2018-2019 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare Home Health Services
Copay
Home Health Care Visit
$70 co-pay
Worldwide Emergency Care
Copay
Nurse Advice Line
1-877-505-7947
Online Services
No Charge — go to http://trs.swhp.org
After Hours Primary Care Clinics
$20 co-pay
Ambulance and Helicopter
$40 copay plus 20% of charges after deductible
Emergency Room6
$250 copay plus 20% of charges after deductible
Urgent Care Facility
$50 copay per visit; deductible does not apply
Prescription Drugs (Group Value Formulary)
Copay
Annual Benefit Maximum
Unlimited
Rx Deductible
$150
Does not apply to preferred generic drugs
Ask an SWHP Pharmacy representative how to save money on your prescriptions.
Maintenance Quantity Retail Quantity (Up to a 30-day supply)
BSW Pharmacies Only, including Mail Order (Up to a 90-day supply)
$5 copay
$12.50 copay
Preferred Brand
30% after Rx deductible
30% after Rx deductible
Non-preferred
50% after Rx deductible
50% after Rx deductible
Preferred Generic
Online Refills Mail Order
Specialty Medications
http://trs.swhp.org 1-817-388-3090
Copay Tier 1: 15% after Rx deductible
(Up to a 30-day supply)
Tier 2: 15% after Rx deductible Tier 3: 25% after Rx deductible
1
Including all services billed with office visit Does not apply to wellness or preventive visits 3 Includes other services, treatments, or procedures received at time of office visit 4 $750 maximum copay per admission and 20% after deductible 5 35 max visit per year 6 Copay waived if admitted within 24 hours 2
The SWHP MOMS Program provides you with professional staff who are notified of the delivery of your baby. These licensed professionals will contact you after you return home and help you with everything from the general well-being of both you and your baby, to breast/bottle feeding, to information on how to add your baby to your health plan.
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APL YOUR BENEFITS PACKAGE
MEDlinkÂŽ IV
PLAY VIDEO
About this Benefit Medical supplement is designed to help supplement your Employer's major medical plan. This plan provides supplemental coverage to help offset outof-pocket costs that you may experience due to deductibles, co-payments and coinsurance of your medical plan.
33% of total healthcare costs are paid out-of-pocket.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 18 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
MEDlink® IV Enhanced
Limited Benefit Group Medical Expense Supplemental Insurance Duncanville 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.
ENHANCED PLAN SUMMARY OF BENEFITS*
Base Policy
Option 1
Option 2
Maximum In-Hospital Benefits
$1,500 per Covered Person per Confinement
$2,500 per Covered Person per Confinement
In-Hospital Ambulance Benefit Up to $350 per trip for ground transportation or up to $1,000 Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation where a Covered Person is per trip for air transportation where a Covered Person is Confined as an Inpatient. Limited to one trip per day. Confined as an Inpatient. Limited to one trip per day. In-Hospital Deductible
$0 per Covered Person per Confinement
$0 per Covered Person per Confinement
Outpatient Benefit Rider Maximum Outpatient Benefits
$500 per Covered Person per Occurrence for Covered $500 per Covered Person per Occurrence for Covered Outpatient Services Outpatient Services
Outpatient Ambulance Benefit Up to $350 per trip for ground transportation or up to $1,000 Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation where a Covered Person per trip for air transportation where a Covered Person resides resides less than 18 hours. Limited to one trip per day. less than 18 hours. Limited to one trip per day. Outpatient Deductible
$0 per Covered Person Per Occurrence
$0 per Covered Person Per Occurrence
Covered Outpatient Services Hospital Emergency Room
Payable up to the Maximum Outpatient Benefit, subject to Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above. the Outpatient Benefit Deductible, as shown above.
Urgent Care Facility
Maximum of three Urgent Care visits per Covered Person per Calendar Year. Maximum of six Urgent Care visits per Calendar Year for all Covered Persons combined. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Maximum of three Urgent Care visits per Covered Person per Calendar Year. Maximum of six Urgent Care visits per Calendar Year for all Covered Persons combined. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Outpatient Surgery
Outpatient Surgery in Hospital Outpatient Facility or Freestanding Outpatient Surgery Center. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Outpatient Surgery in Hospital Outpatient Facility or Freestanding Outpatient Surgery Center. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Diagnostic Testing
Diagnostic Testing in a Hospital Outpatient Facility or MRI Facility. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Diagnostic Testing in a Hospital Outpatient Facility or MRI Facility. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Outpatient Treatment for a Serious Mental Illness in a Hospital Outpatient Facility
Maximum of 60 days of treatment per Covered Person per Calendar Year. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Maximum of 60 days of treatment per Covered Person per Calendar Year. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
$25 per visit; Maximum of four visits per Covered Person per Calendar Year and eight visits per Calendar Year for all Covered Persons combined for treatment in a: Hospital Outpatient Facility s s Freestanding Emergency Care Clinic s Urgent Care Facility/Clinic s Physician Office
$25 per visit; Maximum of four visits per Covered Person per Calendar Year and eight visits per Calendar Year for all Covered Persons combined for treatment in a: Hospital Outpatient Facility s s Freestanding Emergency Care Clinic s Urgent Care Facility/Clinic s Physician Office
Benefit Rider Physician Outpatient Treatment Benefit Rider
19 APSB-22354(TX) MGM/FBS Duncanville ISD
MEDlink® IV Enhanced
Limited Benefit Group Medical Expense Supplemental Insurance Total Monthly Premiums by Plan* 18+
Option 1
Option 2
Employee
$33.60
$40.44
Employee & Spouse
$77.72
$93.45
Employee & Child
$60.66
$72.29
Employee & Family
$104.68
$125.20
Total Semi-Monthly Premiums by Plan* 18+
Option 1
Option 2
Employee
$16.80
$20.22
Employee & Spouse
$38.86
$46.72
Employee & Child
$30.33
$36.14
Employee & Family
$52.34
$62.60
*Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with notice. The premium and amount of benefits vary dependent upon the Plan selected at time of application.
Important Policy Provisions Eligibility
You are eligible to be covered under this Policy/Certificate if you are Actively At Work, qualify for coverage as defined in the Master Application, are covered under your Employer’s Medical Plan and are under age 70 (if you work for an employer employing less than 20 employees). Your Eligible Dependents, as defined in the Policy/Certificate, are eligible for coverage if they are covered under the Employer’s Medical Plan. You must apply for insurance during the Initial Enrollment period or on the date the person first becomes eligible for coverage. If you do not apply during the Initial Enrollment period or on the date you become eligible for coverage, you may be subject to additional underwriting by APL. Evidence of coverage under your Employer’s Medical Plan is required.
When Coverage Begins
Coverage will begin on the requested Certificate Effective Date or the Certificate Effective Date assigned by us, upon approval of your application, if our underwriting rules are met, the premium has been paid and all persons to be insured are covered under your Employer’s Medical Plan and you are Actively At Work on the Certificate Effective Date. If you are not Actively At Work on the Certificate Effective Date due to disability, Injury, Sickness, temporary layoff, leave of absence or Family and Medical Leave of Absence, coverage begins on the date you return to Actively At Work.
Limitations & Exclusions No benefits will be payable for 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 the Insured’s Employer’s Medical Plan provision, described in the Policy. A hospital is not an institution, or part thereof, used as: a place for rehabilitation, 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, rehabilitative or ambulatory patients.
Pre-Existing Condition Limitation
No benefits are payable during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date for any loss resulting from a Pre-Existing Condition. The Pre-Existing Condition Limitation will apply only if the Covered Person is subject to a Pre-Existing Condition Limitation under the Employer’s Medical Plan. Therefore, any Pre-Existing Condition Limitation applied to the Major Medical plan would, in effect, limit coverage under this plan. 20
APSB-22354(TX) MGM/FBS Duncanville ISD
Exclusions
No benefits are payable for any loss resulting from or caused, whether directly or indirectly, by: s war or any act of war, whether declared or undeclared, or active service in the armed forces; (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. If coverage is suspended for any Covered Person during a period of military service, APL will refund the pro-rata portion of any premium paid for any such Covered Person upon receipt of your written request) s an intentionally self-inflicted Injury or Sickness; s suicide or attempted suicide, while sane or insane; s rest care or rehabilitative care and treatment; s outpatient routine newborn care; s voluntary abortion except, with respect to you or your covered Eligible Dependent spouse: s where you or your Dependent spouse’s life would be endangered if the fetus were carried to term; or s where medical complications have arisen from abortion; s pregnancy of an Eligible Dependent child; s participating in a riot, insurrection, rebellion, civil commotion, civil disobedience or unlawful assembly; (This does not include a loss which occurs while acting in a lawful manner within the scope of authority.) s committing, or attempting to commit, an illegal act that is defined as a felony; (Felony is as defined by the law of the jurisdiction in which the act takes place.) s participation in a contest of speed in power driven vehicles, parachuting or hang gliding; s air travel, except: s as a fare-paying passenger on a commercial airline on a regularly scheduled route; or s as a passenger for transportation only and not as a pilot or crew member; s being intoxicated or under the influence of any narcotic unless administered by a Physician or taken according to the Physician’s instructions; (Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the event that caused the loss occurred.) s alcoholism or drug addiction; s sex changes; s experimental treatment, drugs or surgery;
MEDlink® IV Enhanced
Limited Benefit Group Medical Expense Supplemental Insurance
Exclusions continued s Accident or Sickness arising out of, and in the course of, any occupation for compensation, wage or profit; (This does not apply to those sole proprietors or partners not covered by Workers’ Compensation.) s dental or vision services, including treatment, surgery, extractions or x-rays, unless: s resulting 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 s due to congenital disease or anomaly of a covered newborn child. s routine examinations, such as health exams, periodic check-ups or routine physicals, except when part of Inpatient routine newborn care; s elective cosmetic surgery; s drugs (prescription and non-prescription for use outside of a covered facility as defined in this Policy/Certificate or any attached rider); s sterilization and reversal of sterilization; s an expense that does not meet the definition of Covered Charges; s an expense or service that exceeds any of the Maximum Benefits, as shown in the Schedule of Benefits; or s any expense for which benefits are not payable under your Other Medical Plan.
Premium Changes
Termination of Certificate
Your insurance coverage under this Certificate and any attached riders will end on the earliest of these dates: s the date the Policy terminates; s the end of the grace period if the premium remains unpaid; s the date you no longer qualify as an Insured; s the date you attain age 70 (if you work for an employer employing less than 20 employees); s the date your coverage under your Employer’s Medical Plan ends; or s the date of your death.
Termination of Coverage
Your insurance coverage under this Certificate and any attached riders for a Covered Person will end as follows: s the date the Policy terminates; s the date the Certificate terminates; s the end of the Certificate Month in which APL receives a written request from you to terminate the Covered Person’s coverage; s the date a Covered Person no longer qualifies as an Insured or Eligible Dependent; or s the date of the Covered Person’s death. APL may end the coverage of any Covered Person who submits a fraudulent claim.
Cobra Continuation of Coverage
This plan may be continued in accordance with the Consolidated Omnibus Reconciliation Act of 1986.
The premium rates may be changed by APL at the first anniversary date of this Policy or any premium due date thereafter. No such increase in rates will be made unless 60 days prior notice is given to the Policyholder. Premiums will not increase during the initial 12 months of coverage.
Optionally Renewable
This Policy is renewable at the option of APL. The Policyholder or APL may terminate this Policy on any premium due date after the first anniversary following the Policy Effective Date, subject to 60 days written notice.
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 certificate/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 Group Medical Expense Supplemental Insurance | (10/14) |Duncanville ISD
APSB-22354(TX) MGM/FBS Duncanville ISD
21
HSA BANK
HSA (Health Savings Account)
YOUR BENEFITS PACKAGE
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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 22 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
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 ActiveCare 1-HD medical plan. You may not enroll in the MEDlink® plan if you participate in the HSA. You are not eligible to participate in the FSA plan if you participate in HSA. Medicare, Medicaid, and Tricare participants are not eligible to participate in an HSA.
2018 Annual HSA Contribution Limits
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 a HDHP?
What is an HSA? An HSA, or health savings account, is a unique tax-advantaged account that you can use to pay for current or future IRS qualified medical expenses. With an HSA, you’ll have: A tax-advantaged savings account that you can use to pay for IRS-qualified medical expenses as well as deductibles, co-insurance, prescriptions, vision, and dental care. Unused funds that will roll over year to year. There’s no “use it or lose it” penalty. Potential to build more savings through investing. You can choose from a variety of HSA self-directed investment options with no minimum balance required. Additional retirement savings. After you turn 65, funds can be withdrawn for any purpose without penalty. 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.
Individual: $3,450 Family: $6,900 Catch-Up Contributions: Account holders over the age of 55 who have not yet enrolled in Medicare are eligible to make an additional $1,000 “catch-up” contribution to their HSA.
A HDHP, or high-deductible health plan, is a major-medical health insurance plan that has a lower premium than traditional health plans. Your HDHP: Is a major-medical health plan that is HSA-compatible. That means it can be used with a health savings account from HSA Bank. Has a higher annual deductible with lower monthly premiums, which means you’ll have less taken out of your paycheck and more to add to you HSA. Covers 100% of preventative care, including annual physicals, immunizations, well-women and well-child exams, and more–all without having to meet your deductible. Providers coverage for health screenings, such as blood pressure, cholesterol, diabetes, vision, and more.
HSA Bank Contact Information 605 N. 8th Street, Ste 320 Sheboygan, WI 53081 Phone: 800-357-6246 Mon.-Fri. 7am to 9pm, and Saturday 9am to 1pm www.hsabank.com
For a list of sample expenses, please refer to the Duncanville ISD website at: www.mybenefitshub.com/duncanvilleisd
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.
23
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.
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 24 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
FSA (Flexible Spending Account) What is a Flexible Spending Account? A Flexible Spending Account allows you to save money by paying out-of-pocket health and/or dependent care related expenses with pre-tax dollars. Your contributions are deducted from your pay before taxes are withheld and your account is up fronted with an annual amount. Because you are taxed on a lower amount of pay, you pay less in taxes and you have more to spend.
How does a Flexible Spending Account Benefit Me? A Cafeteria plan enables you to save money on group insurance, health-related expenses, and dependent-care expenses. You may save as much as 35 percent on the cost of each benefit option! Eligible expenses must be incurred within the plan year and contributions are use-it-or- lose-it. Remember to retain all your receipts.
What Can I Use My Flexible Spending Account On? For a list of sample expenses, please refer to the Duncanville ISD benefit website: www.mybenefitshub.com/duncanvilleisd
FSA Annual Contribution Max: $2,650 Dependent Care Annual Max: $5,000 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
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!
What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)? Balances $500 and under will rollover into the next plan year. Eligible expenses must be incurred within the plan year and contributions are use-it-or- lose-it. Remember to retain all your receipts.
How Do I File a Claim? In most situations, you will be able to swipe your card however, in the event you lose your card or are waiting to received one you can visit www.mybenefitshub.com/ duncanvilleisd and complete the “Claim Form” to send to NBS.
How Do I View My Account Balance? Go to: http://my.nbsbenefits.com
New User? Create a username and password. Employee ID: Please enter your Social Security Number Employer ID: NBS151265
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 25
MDLIVE YOUR BENEFITS PACKAGE
Telehealth
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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 26 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
Telehealth When should I use MDLIVE? If you’re considering the ER or urgent care for a nonemergency medical issue Your primary care physician is not available At home, traveling, or at work 24/7/365, even holidays!
What can be treated?
Allergies Asthma Bronchitis Cold and Flu Ear Infections Joint Aches and Pain Respiratory Infection Sinus Problems And More!
Pediatric Care related to:
Cold & Flu Constipation Ear Infection Fever Nausea & Vomiting Pink Eye And More!
Are children eligible? Yes. MDLIVE has local pediatricians on-call 24/7/365. Please note, a parent or guardian must be present during any interactions involving minors. We ask parents to establish a child record under their account. Parents must be present on each call for children 18 or younger.
How much does it cost? $0 Covers you, your spouse, and children up to age 26, with unlimited phone consultations.
Download the App Doctor visits are easier and more convenient with the MDLIVE App. Be prepared. Download today. www.mdlive.com/getapp
Access to a doctor anywhere: at home, at work, or on the go Choose doctors from one of the nation's largest telehealth networks Available 24/7 by video or phone Private, secure and confidential visits Connect instantly with MDLIVE Assist
Who are our doctors? MDLIVE has the nation’s largest network of telehealth doctors. On average, our doctors have 15 years of experience practicing medicine and are licensed in the state where patients are located. Their specialties include primary care, pediatrics, emergency medicine and family medicine. Our doctors are committed to providing convenient, quality care and are always ready to take your call.
Scan with your smartphone to get the app.
Call us at (888) 365-1663 or visit us at www.consultmdlive.com
Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for 27 abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit www.mdlive.com/terms-of-use/ 010113
CIGNA
Dental
YOUR BENEFITS PACKAGE
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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 28 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
Dental PPO - High Plan Benefits Network Plan Year Maximum (Class II and III expenses) Annual Deductible Individual Family Reimbursement Levels**
Cigna Dental Choice In-Network Out-of-Network Total Cigna DPPO $1,500 Class I Does Not Apply
$1,500 Class I Does Not Apply
$50 per person $150 per family
$50 per person $150 per family
Based on Reduced Contracted Fees
Maximum Reimbursable Charge
Plan Pays
You Pay
Plan Pays
You Pay
Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Full Mouth X-rays Bitewing X-rays Panoramic X-ray Periapical X-rays Fluoride Application Sealants Space Maintainers Emergency Care to Relieve Pain
100%
No Charge
100%
No Charge
Class II - Basic Restorative Care Fillings Root Canal Therapy/Endodontics Osseous Surgery Periodontal Scaling and Root Planning Denture Adjustments and Repairs Oral Surgery – Simple Extractions Oral Surgery – all except simple extractions Anesthetics Surgical Extractions of Impacted Teeth Repairs to Bridges, Crowns and Inlays
80%**
20%**
80%**
20%**
Class III - Major Restorative Care Crowns Dentures Bridges Inlays/Onlays Prosthesis Over Implant
50%**
50%**
50%**
50%**
50%
50% $1,500 Dependent children to age 19
50%
Class IV - Orthodontia Lifetime Maximum
50% $1,500 Dependent children to age 19
Monthly PPO Premiums Tier
Rate
EE Only
$59.44
EE + Spouse
$77.00
EE + Child(ren)
$88.02
Family Coverage
$149.58
Missing Tooth Limitation – The amount payable is 50% of the amount otherwise payable until insured for 12 months; thereafter, considered a Class III expense. Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed. * Subject to annual deductible Dental Oral Health Integration Program (OHIP) - All dental customers = Clinical research shows an association between oral health and overall health. The Cigna Dental Oral Health Integration Program (OHIP)® is designed to provide enhanced dental coverage for customers with certain eligible medical conditions. Eligible conditions for the program include cardiovascular disease, cerebrovascular disease (stroke), diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation. The program provides: 100% coverage for certain dental procedures guidance on behavioral issues related to oral health discounts on prescription and non-prescription dental products For more information and to see the complete list of eligible conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24. **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to Reasonable and Customary Allowances but the dentist may balance bill up 29to their usual fees.
Dental PPO - Low MAC Plan Benefits Network Plan Year Maximum (Class II and III expenses) Annual Deductible Individual Family Reimbursement Levels**
Cigna Dental Choice In-Network Out-of-Network Total Cigna DPPO $1,000 Class I Does Not Apply
$1,000 Class I Does Not Apply
$50 per person $150 per family
$50 per person $150 per family
Based on Reduced Contracted Fees
Based on Maximum Allowable Charge (In-network fee level)
Plan Pays
You Pay
Plan Pays
You Pay
Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Full Mouth X-rays Bitewing X-rays Panoramic X-ray Periapical X-rays Fluoride Application Sealants Space Maintainers Emergency Care to Relieve Pain
100%
No Charge
100%
No Charge
Class II - Basic Restorative Care Fillings Root Canal Therapy/Endodontics Osseous Surgery Periodontal Scaling and Root Planing Denture Adjustments and Repairs Oral Surgery – Simple Extractions Oral Surgery – all except simple extractions Anesthetics Surgical Extractions of Impacted Teeth Repairs to Bridges, Crowns and Inlays
80%**
20%**
80%**
20%**
Class III - Major Restorative Care Crowns Dentures Bridges Inlays/Onlays Prosthesis Over Implant
50%**
50%**
50%**
50%**
50%
50% $1,000 Dependent children to age 19
50%
Class IV - Orthodontia Lifetime Maximum
50% $1,000 Dependent children to age 19
Monthly PPO Premiums Tier
Rate
EE Only
$38.10
EE + Spouse
$57.98
EE + Child(ren)
$66.28
Family Coverage
$112.68
Missing Tooth Limitation – The amount payable is 50% of the amount otherwise payable until insured for 12 months; thereafter, considered a Class III expense. Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed. * Subject to annual deductible Dental Oral Health Integration Program (OHIP) - All dental customers = Clinical research shows an association between oral health and overall health. The Cigna Dental Oral Health Integration Program (OHIP)® is designed to provide enhanced dental coverage for customers with certain eligible medical conditions. Eligible conditions for the program include cardiovascular disease, cerebrovascular disease (stroke), diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation. The program provides: 100% coverage for certain dental procedures guidance on behavioral issues related to oral health discounts on prescription and non-prescription dental products For more information and to see the complete list of eligible conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24. **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to the Contracted Fee Schedule but the dentist may balance bill up to their usual fees. 30
Dental PPO - High and Low Option Procedure
Exclusions and Limitations
Late Entrants Limit Exams Prophylaxis (Cleanings) Fluoride X-Rays (routine) X-Rays (non-routine) Model Minor Perio (non-surgical) Perio Surgery Crowns and Inlays Bridges Dentures and Partials Relines, Rebases Adjustments Repairs - Bridges Repairs - Dentures Sealants Space Maintainers Prosthesis Over Implant
50% coverage on Class III and IV for 12 months Two per Plan year Two per Plan year 1 per Plan year for people under 19 Bitewings: 2 per Plan year Full mouth: 1 every 36 consecutive months., Panorex: 1 every 36 consecutive months Payable only when in conjunction with Ortho workup Various limitations depending on the service Various limitations depending on the service Replacement every 5 years Replacement every 5 years Replacement every 5 years Covered if more than 6 months after installation Covered if more than 6 months after installation Reviewed if more than once Reviewed if more than once Limited to posterior tooth. One treatment per tooth every three years up to age 14 Limited to non-Orthodontic treatment 1 per 60 consecutive months if unserviceable and cannot be repaired. Benefits are based on the amount payable for nonprecious metals. No porcelain or white/tooth colored material on molar crowns or bridges When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses
Alternate Benefit
Benefit Exclusions
Services performed primarily for cosmetic reasons Replacement of a lost or stolen appliance Replacement of a bridge or denture within five years following the date of its original installation Replacement of a bridge or denture which can be made useable according to accepted dental standards Procedures, appliances or restorations, other than full dentures, whose main purpose is to change vertical dimension, diagnose or treat conditions of TMJ, stabilize periodontally involved teeth, or restore occlusion Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and third molars Bite registrations; precision or semi-precision attachments; splinting A surgical implant of any type Instruction for plaque control, oral hygiene and diet Dental services that do not meet common dental standards Services that are deemed to be medical services Services and supplies received from a hospital Charges which the person is not legally required to pay Charges made by a hospital which performs services for the U.S. Government if the charges are directly related to a condition connected to a military service Experimental or investigational procedures and treatments Any injury resulting from, or in the course of, any employment for wage or profit Any sickness covered under any workers’ compensation or similar law Charges in excess of the reasonable and customary allowances To the extent that payment is unlawful where the person resides when the expenses are incurred; Procedures performed by a Dentist who is a member of the covered person’s family (covered person’s family is limited to a spouse, siblings, parents, children, grandparents, and the spouse’s siblings and parents); For charges which would not have been made if the person had no insurance; For charges for unnecessary care, treatment or surgery; To the extent that you or any of your Dependents is in any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid; To the extent that benefits are paid or payable for those expenses under the mandatory part of any auto insurance policy written to comply with a “no-fault” insurance law or an uninsured motorist insurance law. Cigna HealthCare will take into account any adjustment option chosen under such part by you or any one of your Dependents. In addition, these benefits will be reduced so that the total payment will not be more than 100% of the charge made for the Dental Service if benefits are provided for that service under this plan and any medical expense plan or prepaid treatment program sponsored or made available by your Employer.
This benefit summary highlights some of the benefits available under the proposed plan. A complete description regarding the terms of coverage, exclusions and limitations, including legislated benefits, will be provided in your insurance certificate or plan description. Benefits are insured and/or administered by Connecticut General Life Insurance Company. "Cigna HealthCare" refers to various operating subsidiaries of Cigna Corporation. Products and services are provided by these subsidiaries and not by Cigna Corporation. These subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. DPPO insurance coverage is set forth on the following policy form numbers: AR: HP-POL77; CA: HP-POL57; CO: HP-POL78; CT: HP-POL58; DE: HP-POL79; FL: HP-POL60; ID: HPPOL82; IL: HP-POL62; KS: HP-POL84; LA: HPPOL86: MA: HP-POL 63; MI: HP-POL88; MO: HP- POL65; MS: HP-POL90; NC: HP-POL96; NE: HP-POL92; NH: HP-POL94; NM: HP-POL95; NV: HP-POL93; NY: HP-POL67; OH: HP-POL98; OK: HP-POL99; OR: HP-POL68; PA: HP-POL100; RI: HP-POL101; SC: HP-POL102; SD: HP-POL103; TN: HP-POL69; TX: HP-POL70; UT: HP-POL104; VA: HP-POL72; VT: HP-POL71; WA: POL-07/08; WI: HP-POL107; WV: HP-POL106; and WY: HP-POL108. “Cigna,” the “Tree of Life” logo and “Cigna Dental Care” are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Cigna Dental PPO plans are underwritten or administered by CGLIC or CHLIC, with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Arizona and Louisiana, the insured Dental PPO plan offered by CGLIC is known as the “CG Dental PPO”. In Texas, the insured dental product offered by CGLIC and CHLIC is referred to as the Cigna Dental Choice Plan, and this plan utilizes the national Cigna Dental PPO network. Cigna Dental Care (DHMO) plans are underwritten or administered by Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska), Cigna Dental Health of Kentucky, Inc. (Kentucky and Illinois), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. In other states, Cigna Dental Care plans are underwritten by CGLIC, CHLIC, or Cigna HealthCare of Connecticut, Inc. and administered by Cigna Dental Health, Inc. BSD58696 © 2015 Cigna
31
Dental DHMO
This Patient Charge Schedule applies only when covered dental services are performed by your Network Dentist, unless otherwise authorized by Cigna Dental as described in your plan documents. Not all Network Dentists perform all listed services and it is suggested to check with your Network Dentist in advance of receiving services. This Patient Charge Schedule applies to Specialty Care when an appropriate referral is made to a Network Specialty Periodontist or Oral Surgeon. You must verify with the Network Specialty Dentist that your treatment plan has been authorized for payment by Cigna Dental. Prior authorization is not required for specialty referrals for Pediatric, Orthodontic and Endodontic services. You may select a Network Pediatric Dentist for your child under the age of 7 by calling Customer Service at 1.800.Cigna24 to get a list of Network Pediatric Dentists in your area. Coverage for treatment by a Pediatric Dentist ends on your child’s 7th birthday; however, exceptions for medical reasons may be considered on an individual basis. Your Network General Dentist will provide care upon your child’s 7th birthday.
Monthly DHMO Premiums Tier
Rate
EE Only
$16.65
EE + Spouse
$22.06
EE + Child(ren)
$25.26
Family Coverage
$42.89
If more than one professionally accepted and appropriate method of treatment can be used to treat a dental condition, coverage will be limited to the less costly Covered Service. If you choose the more costly service, the fee listed on the Patient Charge Schedule will not apply. Discuss your options and increased financial obligations with your dentist.
This Patient Charge Schedule is subject to annual change in accordance with the terms of the group agreement.
After your enrollment is effective: Call the dental office identified in your Welcome Kit. If you wish to change dental offices, a transfer can be arranged at no charge by calling Cigna Dental at the toll free number listed on your ID card or plan materials. Multiple ways to locate a *DHMO Network General Dentist: Online provider directory at www.Cigna.com Online provider directory on www.myCigna.com Call the number located on your ID card to: - Use the Dental Office Locator via Speech Recognition - Speak to a Customer Service Representative EMERGENCY: If you have a dental emergency as defined in your group’s plan documents, contact your Network General Dentist as soon as possible. If you are out of your service area or unable to contact your Network Office, emergency care can be rendered by any dental office, dental clinic or other comparable facility. Definitive treatment (e.g., root canal) is not considered emergency care and should be performed or referred by your Network General Dentist. Consult your group’s plan documents for a complete definition of dental emergency, your emergency benefit and a listing of Exclusions and Limitations. For full Patient Charge Schedule, go to www.mybenefitshub.com/duncanvilleisd Code
Procedure Description
Member Pays
Office visit fee (per patient, per office visit in addition to any other applicable patient charges) Office visit fee
$ 5.00
Diagnostic/preventive – Oral evaluations are limited to a combined total of 4 of the following evaluations during a 12 consecutive month period: Periodic oral evaluations (D0120), comprehensive oral evaluations (D0150), comprehensive periodontal evaluations (D0180), and oral evaluations for patients under 3 years of age (D0145). The frequency of certain Covered Services, like cleanings, is limited. If your Network General Dentist certifies to Cigna Dental that, due to medical necessity, you require certain Covered Services more frequently than the limitation allows, Cigna Dental will waive the applicable limitation. The relevant Covered Services are identified with a Δ.
Code
Procedure Description
Member Pays
Diagnostic/preventive (cont.) D0210
X-rays intraoral – Complete series of radiographic images (limit 1 every 3 years)Δ
$0.00
D0240
X-rays intraoral – Occlusal radiographic image
$0.00
D0274
X-rays (bitewings) – 4 radiographic images
$0.00
D0330
X-rays (panoramic radiographic image) – (limit 1 every 3 years)Δ
$0.00
D1110
Prophylaxis (cleaning) – Adult (limit 2 per calendar year)Δ
$0.00
D0120
Periodic oral evaluation – Established patient
$0.00
D1120
Prophylaxis (cleaning) – Child (limit 2 per calendar year)Δ
$0.00
D0150
Comprehensive oral evaluation – New or established patient
$0.00
D1351
Sealant – Per tooth
$12.00
32
Dental DHMO Code
Procedure Description
Member Pays
Restorative (fillings, including polishing) D2140
Amalgam – 1 surface, primary or permanent
$0.00
D2330
Resin-based composite – 1 surface, anterior
$0.00
D2391
Resin-based composite – 1 surface, posterior
$47.00
Crown and bridge – All charges for crowns and bridges (fixed partial dentures) are per unit (each replacement or supporting tooth equals 1 unit). Coverage for replacement of crowns and bridges is limited to 1 every 5 years. For single crowns, retainer (“abutment”) crowns, and pontics: The charges below include the cost of predominantly base metal alloy. You may be charged up to these additional amounts, based on the type of material the dentist uses for your restoration. No more than $80.00 per tooth for any noble metal alloys No more than $130.00 per tooth for any high noble metal alloys, titanium or titanium alloys No more than $100.00 per tooth for any porcelain fused to metal (only on molar teeth) Porcelain/ceramic substrate crowns on molar teeth are not covered D2510
Inlay – Metallic – 1 surface
$410.00
D2542
Onlay – Metallic – 2 surfaces
$470.00
D2740
Crown – Porcelain/ceramic substrate
$490.00
D2792
Crown – Full cast noble metal
$355.00
D2950
Core buildup – Including any pins
$135.00
Endodontics (root canal treatment, excluding final restorations)
Code
Procedure Description
Prosthetics (removable tooth replacement – dentures) includes up to 4 adjustments within first 6 months after insertion – Replacement limit 1 every 5 years. Characterization is considered an upgrade with maximum additional charge to the member of $225.00 per denture. D5110
Full upper denture
$400.00
D5120
Full lower denture
$400.00
D5211
Upper partial denture – Resin base (including clasps, rests and teeth)
$300.00
D5212
Lower partial denture – Resin base (including clasps, rests and teeth)
$300.00
Oral surgery (includes routine postoperative treatment) Surgical removal of impacted tooth – Not covered for ages below 15 unless pathology (disease) exists. D7140
Extraction, erupted tooth or exposed root – Elevation and/or forceps removal
$12.00
D7210
Surgical removal of erupted tooth – Removal of bone and/or section of tooth
$53.00
D7220
Removal of impacted tooth – Soft tissue
$46.00
D7240
Removal of impacted tooth – Completely bony
$115.00
Orthodontics (tooth movement) Orthodontic treatment (maximum benefit of 24 months of interceptive and/or comprehensive treatment. Atypical cases or cases beyond 24 months require an additional payment by the patient.) D8080
Comprehensive orthodontic treatment of the adolescent dentition – Banding
$515.00 $515.00
D3220
Pulpotomy – Removal of pulp, not part of a root canal
$72.00
D8090
Comprehensive orthodontic treatment of the adult dentition – Banding
D3330
Molar root canal – Permanent tooth (excluding final restoration)
$335.00
D8670
Periodic orthodontic treatment visit – As part of contract
Periodontics (treatment of supporting tissues [gum and bone] of the teeth) periodontal regenerative procedures are limited to 1 regenerative procedure per site (or per tooth, if applicable), when covered on the Patient Charge Schedule. The relevant procedure codes are D4263, D4264, D4266 and D4267. Localized delivery of antimicrobial agents is limited to 8 teeth (or 8 sites, if applicable) per 12 consecutive months when covered on the Patient Charge Schedule. If your Network Dentist certifies to Cigna Dental that, due to medical necessity, you require certain Covered Services more frequently than the limitation allows, Cigna Dental will waive the applicable limitation. The relevant Covered Services are identified with a Δ. D4211
Gingivectomy or gingivoplasty – 1 to 3 teeth per quadrant
$91.00
D4341
Periodontal scaling and root planing – 4 or more teeth per quadrant (limit 4 quadrants per consecutive 12 months) Δ
$83.00
D4381
Localized delivery of antimicrobial agents per tooth
$45.00
D4910
Periodontal maintenance (limit 4 per calendar year) (only covered after active periodontal therapy)Δ
$53.00
Member Pays
Children – Up to 19th birthday: 24-month treatment fee Charge per month for 24 months
$2,040.00 $85.00
Adults: 24-month treatment fee Charge per month for 24 months
$2,376.00 $99.00
General anesthesia/IV sedation – General anesthesia is covered when performed by an oral surgeon when medically necessary for covered procedures listed on the patient charge schedule. IV sedation is covered when performed by a periodontist or oral surgeon when medically necessary for covered procedures listed on the patient charge schedule. Plan limitation for this benefit is 1 hour per appointment. There is no coverage for general anesthesia or intravenous sedation when used for the purpose of anxiety control or patient management. D9220
General anesthesia – First 30 minutes
$190.00
D9221
General anesthesia – Each additional 15 minutes
$84.00
D9241
IV conscious sedation – First 30 minutes
$190.00
D9242
IV conscious sedation – Each additional 15 minutes
$73.00
33
VSP 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 34 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
Vision Using your VSP benefit is easy.
Monthly PPO Premiums Register at www.vsp.com - Once your plan is effective, review your benefit information. EE Only $7.58 Find an eye care provider who’s right for you. To find a VSP provider, visit www.vsp.com or call 800.877.7195. EE + Spouse $15.16 At your appointment, tell them you have VSP. There’s no ID card necessary. If you’d like a EE + Child(ren) $17.48 card as a reference, you can print one on www.vsp.com. That’s it! We’ll handle the rest—there are no claim forms to complete when you see a VSP Family Coverage $27.94 provider. BENEFIT DESCRIPTION COPAY FREQUENCY Your Coverage with a VSP Provider Focuses on your eyes and overall wellness WellVision Exam $10 Every plan year* KidsCare Plan: Children under 18 have two, fully covered WellVision
exams if needed Prescription Glasses
Frame
Lenses
$130 allowance for a wide selection of frames $150 allowance for featured frame brands 20% savings on the amount over your allowance KidsCare Plan: Children under 18 receive frames every plan year Single vision, lined bifocal, and lined trifocal lenses Polycarbonate lenses for dependent children KidsCare Plan: Additional lenses for children under 18 fully covered when needed. Minimum prescription change required. Standard progressive lenses Premium progressive lenses Custom progressive lenses Average savings of 20-25% on other lens enhancements
Lens Enhancements
Contacts (instead of glasses)
$130 allowance for contacts; copay does not apply Contact lens exam (fitting and evaluation)
Diabetic Eyecare Plus Program
Extra Savings
Your Monthly Contribution
$10
See frame and lenses
Included in Prescription Glasses
Every other plan year/ Every plan year for children
Included in Prescription Glasses
Every plan year
$55 $95 - $105 $150 - $175
Every plan year
Up to $25
Every plan year
$20
As needed
Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD). Retinal screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details.
Glasses and Sunglasses Extra $20 to spend on featured frame brands. Go to www.vsp.com/specialoffers for details. 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12 months of your last WellVision Exam. Retinal Screening No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam Laser Vision Correction Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities
$7.58 Member only $15.16 Member + spouse $17.48 Member + child(ren) $27.94 Member + family
Your Coverage with Out-of-Network Providers Visit www.vsp.com for details, if you plan to see a provider other than a VSP network provider. Exam………………………………………….up to $45 Frame…………………………………………up to $70 Single Vision Lenses……………………up to $30
Lined Bifocal Lenses……………………up to $50 Lined Trifocal Lenses………………….up to $65
Progressive Lenses……………………..up to $50 Contacts ……………………………………up to $105
VSP guarantees coverage from VSP network providers only. Coverage information is subject to change. In the event of a conflict between this information and your organization’s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location. 35 *Plan year begins in September
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 36 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
Long Term Disability Disability is designed to provide a monthly income to an individual that is disabled due to an accident or illness. There are different plans available with benefits becoming available from the 1st day of disability to as late as the 180th day. Benefits can be payable to age 65 if disability occurs prior to age 65. All new or increases in coverage are subject to pre-existing condition exclusions.
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.
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
Benefit Reductions Your benefit payments may be reduced by other income you receive or are eligible to receive due to your disability, such as: Social Security Disability Insurance (please see www.mybenefitshub.com/duncanvilleisd 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.)
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.
For the Premium benefit option – the table below applies to disabilities resulting from injury or sickness:
Your benefit payments will not be reduced by certain kinds of other income, such as: Retirement benefits if you were already receiving them before you became disabled Retirement benefits that are funded by your after-tax contributions Your personal savings, investment, IRAs or Keoghs Profit-sharing Most personal disability policies Social Security increases Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.
Age Disabled
Benefits Payable
Prior to Age 63
To Normal Retirement Age or 48 months if greater
Age 63
To Normal Retirement Age or 42 months if greater
Age 64 Age 65 Age 66 Age 67 Age 68
36 months 30 months 27 months 24 months 21 months
Age 69 & older
18 months
MONTHLY PREMIUMS Accident / Sickness Elimination Period Annual Earnings
Monthly Earnings
Monthly Benefit
0/3 day*
$3,600
$300
$200
$8.68
$9,000
$750
$500
$21.70
$18,000 $27,000
$1,500 $2,250
$1,000 $1,500
$43.40 $65.10
$36,000 $45,000
$3,000 $3,750
$2,000 $2,500
$54,000
$4,500
$63,000 $72,000
$5,250 $6,000
14 day*
30 day*
60 day
90 day
180 day
$6.76
$5.74
$3.72
$3.22
$2.44
$16.90
$14.35
$9.30
$8.05
$6.10
$33.80 $50.70
$28.70 $43.05
$18.60 $27.90
$16.10 $24.15
$12.20 $18.30
$86.80 $108.50
$67.60 $84.50
$57.40 $71.75
$37.20 $46.50
$32.20 $40.25
$24.40 $30.50
$3,000
$130.20
$101.40
$86.10
$55.80
$48.30
$36.60
$3,500 $4,000
$151.90 $173.60
$118.30 $135.20
$100.45 $114.80
$65.10 $74.40
$56.35 $64.40
$42.70 $48.80
37 *For those employees electing an elimination period of 30 days or less, if you are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, & benefits will be payable from the first day of disability.
APL
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 38 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
GC13 Limited Benefit Group Cancer Indemnity Insurance Duncanville ISD
THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.
SUMMARY OF BENEFITS Benefits
Option 1
Option 2
Radiation Therapy/Chemotherapy/Immunotherapy Benefit Maximum per 12-month period
$15,000
$20,000
$50 per treatment
$50 per treatment
Hormone Therapy - Maximum of 12 treatments per Calendar Year Experimental Treatment Benefit Waiver of Premium
Paid in the same manner and under the same maximums as any other benefit Waive Premium
Waive Premium
Lump Sum Benefit Maximum 1 per Covered Person per lifetime
$5,000
$10,000
Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime
$7,500
$15,000
Lump Sum Benefit Maximum 1 per Covered Person per lifetime
$5,000
$10,000
Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime
$7,500
$15,000
Internal Cancer First Occurrence Benefit
Heart Attack/Stroke First Occurrence Benefit
Option 1
Option 2
Individual
Monthly Premium*
$13.66
$23.00
Individual & Spouse
$29.48
$49.94
1 Parent Family
$15.70
$26.50
2 Parent Family
$31.52
$53.48
*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.
39
APSB-22331(TX) MGM/FBS Duncanville ISD
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.
40
APSB-22331(TX) MGM/FBS Duncanville ISD
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.
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).
GC13 Limited Benefit Group Cancer Indemnity Insurance Pre-Existing Condition Exclusion
No benefits are payable for any loss incurred during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date of this rider as the result of a Pre-Existing Condition.
Waiting Period
This rider contains a Waiting Period during which no benefits will be paid. If any Heart Attack or Stroke is diagnosed before the end of the Waiting Period immediately following the Covered Person’s Effective Date of this rider, coverage will apply only to loss that is incurred after one year from the Covered Person’s Effective Date.
Termination
This rider will terminate and coverage will end for all Covered Persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the Policy or Certificate to which this rider is attached terminates; the end of the Certificate Month in which we receive a request from the Policyholder to terminate this rider; the date of your death; or the date the lump sum benefit amount for Heart Attack or Stroke has been paid for all Covered Persons under this rider. Coverage on an Eligible Dependent terminates under this rider when such person ceases to meet the definition of Eligible Dependent.
Internal Cancer First Occurrence Benefit Rider
Pays a lump sum benefit amount when a Covered Person receives a first diagnosis of a covered Internal Cancer and the Date of Diagnosis occurs after the Waiting Period. The Internal Cancer lump sum benefit amount will reduce by 50% at age 70.
Exclusions & Limitations
We will not pay benefits for a diagnosis of Internal Cancer received outside the territorial limits of the United States or a metastasis to a new site of any Cancer diagnosed prior to the Covered Person’s Effective Date, as this is not considered a first diagnosis of an Internal Cancer.
Pre-Existing Condition Exclusion
No benefits are payable for any loss incurred during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date of this rider as the result of a Pre-Existing Condition.
Waiting Period
This rider contains a Waiting Period during which no benefits will be paid. If any Internal Cancer is diagnosed before the end of the Waiting Period immediately following the Covered Person’s Effective Date of this rider, coverage will apply only to loss that is incurred after one year from the Covered Person’s Effective Date of this Rider.
Termination
This rider will terminate and coverage will end for all Covered Persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the Policy or Certificate to which this rider is attached terminates; the end of the Certificate Month in which we receive a request from the Policyholder to terminate this rider; the date of your death; or the date the lump sum benefit amount for Internal Cancer has been paid for all Covered Persons under this rider. Coverage on an Eligible Dependent terminates under this rider when such person ceases to meet the definition of Eligible Dependent.
2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606 Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete benefits and other provisions, please refer to your policy/certificate/rider(s). This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This product contains Limitations and Exclusions | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines | Policy Form GC13APL | Limited Benefit Group Cancer Indemnity Insurance Series | Texas | (10/14) | Duncanville ISD
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APSB-22331(TX) MGM/FBS Duncanville ISD
VOYA 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 42 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
Accident variations by state. For a list of standard exclusions and limitations, go to the end of this document. For a complete The following list is a summary of the benefits provided by description of your available benefits, exclusions and limitations, Accident Insurance. You may be required to seek care for your injury within a set amount of time. Note that there may be some see your certificate of insurance and any benefits.
What accident benefits are available?
EVENT Accident Hospital Care Surgery Open abdominal, thoracic Surgery exploratory or without repair Blood, plasma, platelets Hospital admission Hospital confinement Per day up to 365 Critical care unit confinement per day, up to 15 days Rehabilitation facility confinement per day for 90 days Coma Duration of 14 or more days Transportation per trip, up to 3 per accident Lodging Per day, up to 30 days Family care per child, up to 45 days Accident Care Initial doctor visit Urgent care facility treatment Emergency room treatment Ground ambulance Air ambulance Follow-up doctor treatment Chiropractic treatment up to six per accident Medical equipment Physical or occupational therapy up to six per accident Speech therapy up to 6 per accident Prosthetic device (one) Prosthetic device (two or more) Major diagnostic exam Outpatient surgery (one per accident) X-ray Common Injuries Burns second degree, at least 36% of the body Burns 3rd degree, at least 9 but less than 35 square inches of the body Burns 3rd degree, 35 or more square inches of the body Skin Grafts Emergency dental work Eye Injury removal of foreign object Eye Injury surgery Torn Knee Cartilage surgery with no repair or if cartilage is shaved Torn Knee Cartilage surgical repair Laceration1 treated no sutures Laceration1 sutures up to 2” Laceration1 sutures 2” – 6” Laceration1 sutures over 6” Ruptured Disk surgical repair
BENEFIT $1,200 $175 $600 $1,250 $375 $600 $200 $17,000 $750 $180 $25 $90 $225 $225 $360 $1,500 $90 $45 $120 $45 $45 $750 $1,200 $240 $225 $45 $1,250 $7,500 $15,000 25% of burn benefit $350 crown, $90 extraction $100 $350 $225 $800 $30 $60 $240 $480 $800
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Accident EVENT Tendon/Ligament/Rotator Cuff One, surgical repair Tendon/Ligament/Rotator Cuff Two or more, surgical repair Tendon/Ligament/Rotator Cuff Exploratory Arthroscopic Surgery with no repair Concussion Paralysis quadriplegia Paralysis paraplegia Dislocations Hip joint Knee Ankle or foot bone (s) Other than toes Shoulder Elbow Wrist Finger/toe Hand bone(s) Other than fingers Lower jaw Collarbone Partial dislocations Fractures Hip Leg Ankle Kneecap Foot Excluding toes, heel Upper arm Forearm, Hand, Wrist Except fingers Finger, Toe Vertebral body Vertebral processes Pelvis Except coccyx Coccyx Bones of face Except nose Nose Upper jaw Lower jaw Collarbone Rib or ribs Skull – simple Except bones of face Skull – depressed Except bones of face Sternum Shoulder blade Chip fractures 1 2 3
BENEFIT $825 $1,225 $425 $225 $24,000 $16,000
Closed/open reduction2
$3,850/$7,700 $2,400/$4,800 $1500/$3,000 $1,600/$3,200 $1,100/$2,200 $1,100/$2,200 $275/$550 $1,100/$2,200 $1,100/$2,200 $1,100/$2,200 25% of the closed reduction amount Closed/open reduction3
$3,000/$6,000 $2,500/$5,000 $1,800/$3,600 $1,800/$3,600 $1,800/$3,600 $2,100/$4,200 $1,800/$3,600 $240/$480 $3,360/$6,720 $1,440/$2,880 $3,200/$6,400 $400/$800 $1,200/$2,400 $600/$1,200 $1,500/$3,000 $1,440/$2,880 $1,440/$2,880 $400/$800 $1,400/$2,800 $3,000/$6,000 $360/$720 $1,800/$3,600 25% of the closed reduction amount
Laceration benefits are a total of all lacerations per accident. Closed Reduction of Dislocation = Non-surgical reduction of a completely separated joint. Open Reduction of Dislocation = Surgical reduction of a completely separated joint. Closed Reduction of Fracture = Non-surgical. Open Reduction of Fracture = Surgical.
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Accident Accidental Death Benefits Employee Spouse Children Other Accident Employee Spouse Children Accidental Dismemberment Benefits Loss of both hand or both feet or sight in both eyes Loss of one hand or one foot AND the sight of one eye Loss of one hand AND one foot Loss of one hand OR one foot Loss of Two or more fingers or toes Loss of one finger or one toe
Benefit $100,000 $50,000 $25,000 $50,000 $20,000 $10,000 Benefit $28,000 $22,000 $22,000 $12,500 $1,800 $1,250
How much does Accident Insurance cost? All employees pay the same rate, no matter their age. See the chart below for the premium amounts. Rates shown are guaranteed until September 1st, 2020. Monthly Rates (12 Pay Periods) Employee $11.40
Employee and Spouse
Employee and Children
Family
$18.32 $20.20 $27.12 Semi-Monthly Rates (24 Pay Periods)
Employee $5.70
Employee and Spouse
Employee and Children
$9.16 $10.10 18 Pay Periods
Family $13.56
Employee
Employee and Spouse
Employee and Children
Family
$7.60
$12.21
$13.47
$18.08
What does my Accident Insurance include? The benefits listed below are included with your Accident Insurance coverage. For a list of standard exclusions and limitations, please refer to the end of this document. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any benefits. Sports Accident Benefit: If your accident occurs while participating in an organized sporting activity as defined in the certificate; the accident hospital care, accident care or common injuries benefit will be increased by 25%; to a maximum additional benefit of $1000. Accidental Death and Dismemberment (AD&D) coverage: If you are severely injured or die as a result of a covered accident, an AD&D benefit may be payable to you or your beneficiary.
Common carrier: If the death occurs as a result of a covered accident on a common carrier, a higher benefit will be payable. Common carrier means any commercial transportation that operates on a regularly scheduled basis between predetermined points or cities.
Exclusions and limitations Exclusions for the Certificate, Spouse Accident Insurance, and Children’s Accident Insurance and AD&D are listed below. (These may vary by state.) Benefits are not payable for any loss caused in whole or directly by any of the following*: Participation or attempt to participate in a felony or illegal activity. An accident while the covered person is operating a motorized vehicle while intoxicated. Intoxication means the covered person’s blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the accident occurred. Suicide, attempted suicide or any intentionally selfinflicted injury, while sane or insane. War or any act of war, whether declared or undeclared, other than acts of terrorism. Loss sustained while on active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion. Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor. Riding in or driving any motor-driven vehicle in a race, stunt show or speed test. Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded. Performing these acts as part of your employment with the employer is not excluded. Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar activities. Practicing for, or participating in, any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received. Any sickness or declining process caused by a sickness. Work for pay, profit or gain. *See the certificate of insurance and riders for a complete list of available benefits, exclusions and limitations.
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THE HARTFORD
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 46 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
Critical Illness What is critical illness insurance? Critical illness insurance is coverage offered by your employer which you pay for through convenient deductions from your paycheck. It can assist you financially if you or a covered dependent are ever diagnosed with a covered critical illness (shown below). The benefits are paid in lump sum amounts and can serve as a source of cash to use as you wish, whether to help pay for health care expenses not covered by your major medical insurance, help replace income lost while not working, or however you choose. This highlight sheet is an overview of your critical illness insurance. A certificate of insurance will be available after you enroll to explain your coverage in detail.
Who is 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, and are less than age 80. Your spouse’s eligibility is based upon your age, and your dependent child(ren) must be under age 26 to be eligible.
When can I enroll? 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 established by your employer.
How much coverage can I purchase? You may enroll for $5,000, $10,000, $20,000 or $30,000 in coverage. You may also enroll your dependent(s) for the following amounts of coverage: Spouse: 50% of your elected coverage amount Child(ren): $5,000 A benefit reduction of 50% will apply to the coverage amount for you and your dependent(s) when you reach the age of 70.
Am I guaranteed coverage? During designated enrollment periods, this coverage is offered without having to provide information about your health for coverage amounts up to $30,000. This is called
“guaranteed issue (GI)” coverage – all you have to do is check the box to enroll and become insured. All amounts of dependent coverage are guaranteed issue.
I already have medical and disability insurance. Why do I need this too? Costs associated with critical illness can pile up even with other types of insurance. Once treatment for an illness begins, deductibles and cost sharing (co-pays and/or coinsurance), and limitations on benefits found in some medical insurance plans may quickly lead to high out-of-pocket costs. In addition, disability insurance will only replace a portion of your income, not all of it. Critical illness insurance benefits can help cover what other insurance products don’t.
How many times will the policy pay? This insurance will pay a benefit multiple times, in the unfortunate event you or a dependent are diagnosed with more than one covered illness. The total amount of benefits payable for covered illnesses for each covered person under the policy is subject to a maximum, as follows: You – 500% of the coverage amount Spouse – 500% of the coverage amount Child(ren) – 300% of the coverage amount If the benefits paid for a dependent reach the coverage maximum, coverage for the dependent will end. If the benefits paid for you reach the coverage maximum, coverage for you and your dependent(s) will end.
Are any other benefits available? The following benefits are also included with this insurance: Expanded Cancer Benefits – Offers a benefit if a second opinion is sought for a cancer diagnosis, and a benefit for a prosthesis/wig Recurrence Benefit – Pays a benefit for a subsequent diagnosis of a covered illness for which a benefit has already been paid under the policy Health Screening Benefit – Pays a benefit once each year for each covered person when one (or more) of over 25 specified health screening tests occurs
Can I keep this insurance if I leave my employer? Yes, you can take this coverage with you. If you leave your employer, you may continue coverage for you and your dependent(s) under a group portability policy. Your spouse may also continue insurance in certain circumstances.
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Critical Illness What illnesses are covered? This insurance will pay a lump sum benefit if you or a dependent are diagnosed with any of the following covered illnesses while insurance is in effect, subject to any preexisting condition limitation.
Covered Illness
Benefit
Cancer Conditions Invasive Cancer; Benign Brain Tumor Non-Invasive Cancer
100% of coverage amount 25% of coverage amount
Vascular Conditions Heart Attack; Heart Transplant; Stroke Coronary Artery Bypass Graft; Angioplasty/Stent; Aneurysm
100% of coverage amount 25% of coverage amount
Other Specified Conditions Major Organ Transplant; End Stage Renal Failure; Coma; Paralysis; Loss of Vision; Loss of Hearing; Loss of Speech
100% of coverage amount
Bone Marrow Transplant
25% of coverage amount
Important Details Benefit Separation Periods. If a covered person is diagnosed with a covered illness, and is subsequently diagnosed with another covered illness, the following separation periods apply between benefit payments. If the subsequent diagnosis is for: A different, non-related covered illness than the first diagnosis (e.g. a cancer illness then a vascular illness), then no separation period applies A covered illness that is related to the first (e.g. two vascular illnesses, like heart attack and stroke), then a 30 day separation period applies The same covered illness as the first (e.g. two heart attacks), then a 12 month separation period applies Pre-Existing Condition Limitation. We will not pay a benefit or any increase in benefits for any critical illness for a preexisting condition, unless at the time of a positive diagnosis a covered person has been continuously insured under the policy for 12 months. Pre-existing condition, as used in this limitation, means any critical illness for which medical care is received within the 12 month period prior to the effective date of insurance for a covered person, or within the 12 month period prior to the effective date of any increase in coverage for a covered person.
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Exclusions. This insurance does not provide benefits for any covered illness that results from or is caused by: Suicide, attempted suicide or intentionally self-inflicted injury, whether sane or insane War or act of war, declared or undeclared A covered person's participation in a felony, riot or insurrection A covered person's engaging in any illegal occupation A covered person's service in the armed forces or units auxiliary to them All exclusions may not be applicable, or may be adjusted, as required by state regulations in the situs state of a group. Please refer to the certificate for a full listing of exclusions. General Limitations. Benefits under the policy are not payable for any covered illness: Diagnosed prior to the effective date of insurance for a covered person (except for newborn children) Diagnosed during an applicable benefit separation period For which a covered person has already received a benefit payment under the policy, unless the covered illness is included in a recurrence provision For which a covered person has already received a benefit payment under the recurrence provision In addition, benefits are not payable for any critical illness not included as a covered illness in your certificate.
Notices THIS IS A LIMITED BENEFIT POLICY This limited health benefit plan (1) does not constitute major medical coverage, and (2) does not satisfy the individual mandate of the Affordable Care Act (ACA) because the coverage does not meet the requirements of minimum essential coverage. 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 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.
Critical Illness $5,000
Non Tobacco User Monthly Cost
Age
Employee
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79
$0.85 $1.16 $1.61 $2.46 $4.13 $6.69 $9.81 $13.62 $20.01 $28.15 $19.69 $26.16
$10,000
Employee & Spouse $1.70 $2.30 $3.19 $4.85 $8.19 $13.44 $19.94 $27.99 $41.37 $58.03 $40.58 $53.74
Employee & Child $2.08 $2.39 $2.85 $3.69 $5.37 $7.93 $11.04 $14.86 $21.24 $29.39 $20.33 $26.79
Tobacco User Monthly Cost Employee & Family $3.23 $3.83 $4.72 $6.38 $9.72 $14.97 $21.47 $29.52 $42.91 $59.56 $41.37 $54.52
Employee $0.93 $1.34 $2.01 $3.30 $6.12 $11.09 $17.72 $26.19 $40.54 $60.22 $41.24 $49.11
Non Tobacco User Monthly Cost
Age
Employee
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79
$1.67 $2.28 $3.17 $4.83 $8.15 $13.22 $19.41 $27.00 $39.70 $55.94 $38.97 $51.92
$20,000
Employee & Spouse $2.53 $3.42 $4.75 $7.22 $12.21 $19.97 $29.54 $41.37 $61.07 $85.81 $59.86 $79.50
Employee & Child $2.91 $3.51 $4.41 $6.07 $9.38 $14.46 $20.64 $28.24 $40.94 $57.17 $39.60 $52.56
Age
Employee
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79
$3.32 $4.52 $6.29 $9.58 $16.17 $26.28 $38.61 $53.76 $79.09 $111.51 $77.53 $103.45
$30,000
Employee & Child $4.56 $5.75 $7.52 $10.82 $17.41 $27.51 $39.84 $54.99 $80.33 $112.75 $78.16 $104.08
Employee $1.84 $2.64 $3.95 $6.52 $12.09 $21.95 $35.09 $51.90 $80.37 $119.52 $81.46 $97.41
Age
Employee
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79
$4.98 $6.76 $9.40 $14.34 $24.20 $39.34 $57.81 $80.51 $118.49 $167.08 $116.09 $154.97
Employee & Child $6.21 $8.00 $10.64 $15.57 $25.44 $40.57 $59.04 $81.75 $119.72 $168.32 $116.72 $155.60
Employee & Family $3.40 $4.21 $5.55 $8.17 $13.96 $24.37 $38.18 $55.92 $85.83 $126.37 $86.51 $102.87
Employee & Spouse $2.78 $3.98 $5.97 $9.86 $18.40 $33.70 $54.02 $80.10 $124.13 $184.14 $125.96 $150.38
Employee & Child $3.07 $3.87 $5.19 $7.75 $13.32 $23.19 $36.32 $53.14 $81.61 $120.75 $82.09 $98.04
Employee & Family $4.31 $5.51 $7.50 $11.39 $19.93 $35.23 $55.55 $81.63 $125.66 $185.67 $126.74 $151.17
Tobacco User Monthly Cost Employee & Family $6.54 $8.30 $10.93 $15.83 $25.72 $41.17 $60.23 $83.81 $123.08 $172.45 $119.70 $159.00
Employee $3.65 $5.24 $7.85 $12.95 $24.03 $43.67 $69.83 $103.32 $160.05 $238.11 $161.92 $194.00
Non Tobacco User Monthly Cost Employee & Spouse $7.49 $10.12 $14.05 $21.37 $36.18 $59.31 $87.85 $123.18 $182.03 $256.03 $177.97 $236.93
Employee & Child $2.16 $2.57 $3.24 $4.54 $7.35 $12.32 $18.95 $27.43 $41.77 $61.46 $41.87 $49.74
Tobacco User Monthly Cost Employee & Family $4.06 $4.95 $6.28 $8.75 $13.74 $21.50 $31.07 $42.90 $62.60 $87.34 $60.65 $80.28
Non Tobacco User Monthly Cost Employee & Spouse $5.01 $6.77 $9.40 $14.30 $24.19 $39.64 $58.70 $82.28 $121.55 $170.92 $118.92 $158.22
Employee & Spouse $1.87 $2.68 $4.02 $6.64 $12.43 $22.84 $36.65 $54.39 $84.30 $124.84 $85.73 $102.09
Employee & Spouse $5.51 $7.89 $11.83 $19.55 $36.53 $66.98 $107.38 $159.27 $246.92 $366.49 $249.94 $299.16
Employee & Child $4.88 $6.47 $9.08 $14.18 $25.27 $44.91 $71.06 $104.56 $161.28 $239.35 $162.55 $194.63
Employee & Family $7.04 $9.42 $13.36 $21.08 $38.06 $68.51 $108.91 $160.80 $248.45 $368.02 $250.72 $299.94
Tobacco User Monthly Cost Employee & Family $9.02 $11.65 $15.58 $22.90 $37.71 $60.84 $89.38 $124.72 $183.56 $257.57 $178.75 $237.71
Employee $5.46 $7.84 $11.74 $19.38 $35.97 $65.40 $104.57 $154.74 $239.72 $356.71 $242.37 $290.59
Employee & Spouse $8.24 $11.79 $17.68 $29.24 $54.67 $100.26 $160.74 $238.45 $369.72 $548.83 $373.92 $447.94
Employee & Child $6.70 $9.07 $12.98 $20.61 $37.21 $66.63 $105.80 $155.98 $240.95 $357.94 $243.00 $291.23
Employee & Family $9.77 $13.32 $19.21 $30.77 $56.20 $101.79 $162.27 $239.98 $371.25 $550.36 $374.71 $448.72 49
UNUM 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 50 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
Life and AD&D UNUM Basic Term Life and AD&D—Group #469013 Duncanville ISD provides you with Basic Term Life insurance coverage in the amount of $10,000 at no cost to you. Basic Life and AD&D Eligibility Life Benefit Amount AD&D Benefit Amount Portability & Conversion Survivor Support Benefit Reduction Scheduled Accelerated Death Benefit
Full Time Employee working 30+ hours per week. $10,000 $10,000 Included Included 50% at age 70 75% of life benefit amount
UNUM Supplemental Term Life—Group #469014 Voluntary Life Eligibility Life Benefit Amount
Guarantee Issue*
Portability and Conversion Survivor Support Benefit Reduction Schedule Accelerated Death Benefit
Full Time Employee working 30+ hours per week. Employee - Up to 5 times annual earnings in increments of $10,000. Not to exceed $500,000. Spouse - Up to 100% of employee amount in increments of $5,000. Not to exceed $100,000. Child(ren) - Up to 100% of employee coverage amount in increments of $2,000. Not to exceed $10,000. Employee - $200,000 Spouse - $50,000 Child - $10,000 Included Included 65% at age 70; 45% at age 75; 30% at age 80 and 20% at age 85 75% of life benefit amount to a maximum of $500,000
*Unum allows employees that are currently enrolled in the life insurance and are below the Guaranteed Issue (GI) amount to increase the coverage in increments of $10,000 for self, $5,000 for spouse, and $2,000 for children to the GI without evidence of insurability. For increases in coverage to take effect, employees must be actively at work and spouse/child cannot be disabled. If you are not currently enrolled, you can enroll subject to evidence of insurability not to exceed $500,000 or 5x salary for self, up to $100,000 for spouse and up to $10,000 for children. Age EE Cost per $10,000 Spouse Cost per $10,000 Under 25 $0.50 $0.50 25-29 $0.50 $0.50 30-34 $0.60 $0.60 35-39 $0.80 $0.80 40-44 $1.20 $1.20 45-49 $1.70 $1.70 50-54 $2.70 $2.70 55-59 $4.10 $4.10 60-64 $5.20 $5.20 65-69 $10.10 $10.10 70+ $10.10 $10.10 Cost for your $10,000 $1.60 Child(ren)
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TEXAS LIFE
Individual Life
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.
Experts recommend at least
x 10 your gross annual income in coverage when purchasing life insurance.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 52 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
Individual Life Life Insurance Highlights Flexible Premium Life Insurance to Age 121. Policy Form PRFNGNI-10 See the PURELIFE-plus brochure for details. 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 worksite1, 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 Guarantees2. 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, PURELIFE-plus 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.) ICC ULABR-07 or ULABR07
You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, minor children and grandchildren3. 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.
₁Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 2012 ₂Guarantees are subject to product terms, exclusions, limitations and the insurer's claimspaying ability and financial strength. ₃Coverage and spouse/domestic partner eligibility may vary by state. Coverage for children and grandchildren not available in Washington. Texas Life complies with all state laws regarding marriages, domestic and civil union partnerships, and legally recognized familial relationships. Texas Life is licensed to do business in the District of Columbia and every state but New York.
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LEGAL SHIELD
Identity Theft
YOUR BENEFITS PACKAGE
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 54 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
Identity Theft Have you ever?
Needed your Will prepared or updated Been overcharged for a repair or paid an unfair bill Had trouble with a warranty or defective product Signed a contract Received a moving traffic violation Had concerns regarding child support
Worried about being a victim of Identity theft Been concerned about your child’s identity Lost your wallet Worried about entering personal information on-line Feared the security of your medical information Been pursued by a collection agency
What is LegalShield? LegalShield was founded in 1972, with the mission to make equal justice under law a reality for all North Americans. The 3.5 million individuals enrolled as LegalShield members throughout the United States and Canada can talk to a lawyer on any personal legal matter, no matter how trivial or traumatic, all without worrying about high hourly costs. LegalShield has provided identity theft protection since 2003 with Kroll Advisory Solutions, the world’s leading company in ID Theft consulting and restoration. We have safeguarded over 1 million members, provided more than 200,000 identity consultations, and helped restore nearly 10,000 individual identities.
The LegalShield® Membership Includes:
Personal Legal advice on unlimited issues Letters/calls made on your behalf Contracts & documents reviewed (up to 15 pages) Residential Loan Document Assistance Lawyers prepare your Will, your Living Will and your Health Care Power of Attorney Moving Traffic Violations (available 15 days after enrollment) IRS Audit Assistance Trial Defense (if named defendant/respondent in a covered civil action suit) Uncontested Divorce, Separation, Adoption and/or Name Change Representation (available 90 days after enrollment) 25% Preferred Member Discount (Bankruptcy, Criminal Charges, DUI, Other Matters, etc.) 24/7 Emergency Access for covered situations
LegalShield legal plans cover the member; member’s spouse; never married dependent children under 26 living at home; dependent children under age 18 for whom the member is legal guardian; never married, dependent children up to age 26 if a full-time college student; and physically or mentally disabled dependent children. 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.
The IDShieldSM Membership Includes:
Privacy Monitoring Monitoring your name, SSN, date of birth, email address (up to 10), phone numbers (up to 10), driver license & passport numbers, and medical ID numbers (up to 10) provides you with comprehensive identity protection service that leaves nothing to chance. Security Monitoring SSN, credit cards (up to 10), and bank account (up to 10) monitoring, sex offender search, financial activity alerts and quarterly credit score tracking keep you secure from every angle. With the family plan, Minor Identity Protection is included and provides monitoring for up to 8 children under the age of 18. Consultation Your identity protection plan includes 24/7/365 live support for covered emergencies, unlimited counseling, identity alerts, data breach notifications and lost wallet protection. Full Service Restoration Complete identity recovery services by Kroll Licensed Private Investigators and our $5 million service guarantee ensure that if your identity is stolen, it will be restored to its pretheft status.
IDShield plans are available at individual or family rates. A family rate covers the member; member’s spouse and up to 8 dependents up to the age of 26. *Dependents that are over 18, under 26, and either live at home or are a full time student, and have never been married will receive unlimited consultation and complete restoration. Monitoring is not available for dependents in this category.
Monthly Premiums Individual
Family
LegalShield
$14.95
$15.95
IDShield
$8.45
$15.95
Combined
$23.40
$28.90
For more information, please call your independent associate: Financial Benefit Services This is a general overview and is for illustrative purposes only. Plans and services vary from state to state. See a plan contract for your state of residence for complete terms, coverage, amounts, conditions and exclusions. 55
NBS
Retirement
YOUR BENEFITS PACKAGE
About this Benefit A 403(b) plan is a U.S. tax-advantaged retirement savings plan available for public education organizations. A 457(b) plan is a tax-deferred compensation plan provided for employees of certain tax-exempt, governmental organizations or public education institutions.
Only 22% of workers are very confident they will have enough money in retirement.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 56 Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
Retirement Tax Sheltered 403(b) Annuity (TSA) A Tax Sheltered Annuity (TSA) is otherwise known as a 403(b) plan. 403(b) is a section of the Internal Revenue Code that provides for a Voluntary Tax Deferred Retirement Program that supplements your Teacher Retirement. Reaching your financial goals for retirement takes time and patience. The sooner you start saving in your retirement plan, the faster you may reach your goals. The Texas Teacher Retirement System will provide generous benefits for those retiring within the system. However, chances are that this retirement plan will not provide enough income after retirement to enable you to maintain your standard of living. A TSA allows you to accumulate a retirement nest egg on a highly taxfavored basis. The Internal Revenue Services has made changes to the way the District must administer 403(b) Annuities effective 1/1/2009. Duncanville ISD now works with Region 10’s Retirement Asset Management System with National Benefit Services (NBS) serving as the third party administrator. To start a 403(b) plan, contact an agent and follow the instructions located on the benefits website regarding 403(b) annuities located at www.duncanvilleisd.org/ benefits. A certified vendor list may be found at www.nbsbenefits.com. You may also find information to increase, decrease, or drop your 403(b) contribution on the benefits website. If you need further assistance you can contact your 403(b) plan administrator at 800-2740503.
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WWW.MYBENEFITSHUB.COM/
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