2018 Benefit Guide HEB ISD by Higginbotham Public Sector

HEB ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2018 - 8/31/2019 WWW.MYBENEFITSHUB.COM/HEBISD

Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. New Hires 2. Benefit Enrollment 3. Section 125 Cafeteria Plan Guidelines 4. Annual Enrollment 5. Eligibility Requirements 6. Helpful Definitions 7. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 8. Workers Compensation 9. Sick Leave Bank Summary 10. Health Insurance 11. Maximum Annual Costs 2018-2019 12. Finding Healthcare Providers (TRS ActiveCare) 13. Finding Healthcare Providers (Scott & White HMO) TRS-ActiveCare Scott & White HMO Voya Hospital Indemnity Plan HSA Bank Health Savings Account (HSA) Cigna Dental Superior Vision The Standard Disability UNUM Critical Illness UNUM Life and AD&D NBS Flexible Spending Account (FSA) Legal Ease Legal Services 2

3 4-5 6-11 6-7 8 9 10 11 12

13 14 15 16 17 18 19 20-21 22-23 24-27 28-31 32-39 40-41 42-45 46-47 48-51 52-55 56-61

FLIP TO... PG. 4 HOW TO HOW TO ENROLL ENROLL

PG. 6 BENEFIT UPDATES.

PG. 20 YOUR BENEFITS

Benefit Contact Information

Benefit Contact Information HEB ISD BENEFITS

HOSPITAL INDEMNITY

CRITICAL ILLNESS

Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/hebisd

Voya (800) 955-7736 www.voya.com

UNUM (800) 858-6843 www.unum.com

HEB ISD â&#x20AC;&#x201C; BENEFITS OFFICE

DENTAL

LIFE AND AD&D

817-399-2056 mariaortiz@hebisd.edu

Cigna (800) 244-6224 www.cigna.com

UNUM (800) 858-6843 www.unum.com

TRS-ACTIVECARE MEDICAL

VISION

FLEXIBLE SPENDING ACCOUNT

Aetna (800) 222-9205 www.trsactivecareaetna.com

Superior Vision (800) 507-3800 www.superiorvision.com

National Benefit Services (800) 274-0503 www.nbsbenefits.com

TRS HMO MEDICAL

DISABILITY

LEGAL SERVICES

Scott & White HMO (800) 321-7947 www.trs.swhp.org

The Standard (800) 368-1135 www.standard.com

Legal Ease (800) 248-9000 www.legaleaseplan.com/content/heb

HEALTH SAVINGS ACCOUNT

CAREMARK PHARMACY

457 TCG ADMINISTRATORS

HSA Bank (800) 357-6246 www.hsabank.com

800-222-9205 www.caremark.com/trsactivecare

(800) 943-9179 http://tcgservices.com/documents/ #/255/457b

403B THE OMNI GROUP

EMPLOYEE ASSISTANCE PROGRAM (EAP)

TELEHEALTH

(877) 544-6664 www.omni403b.com

(800) 854-1446: English Teladoc (877) 858-2147: Spanish 855-TELADOC www.lifebalance.net - user ID & password: www.teladoc.com lifebalance

MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS HEB” to 313131 and get access to everything you need to complete your benefits enrollment: 

Benefit Information

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Online Support

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Interactive Tools

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And more. PLAY VIDEO

Text “FBS HEB” to 313131 OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

2 3

www.mybenefitshub.com/hebisd

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.

New Hires Plan Year The plan year for all benefits is September 1st through August 31st.

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unique HEB ID number and your default password is your social security number without the dashes.

You may also download the app for your phone by searching for eFinance Plus Employee in your app store. Effective Dates for Insurance Type in “Hurst” as the employer name and then select Health Insurance can begin your hire date or the 1st of the “Hurst-Euless-Bedford Independent SD”. Follow the login following month. Please make sure you notify the benefits instructions to view your account. office if you want your health insurance to begin on your LONG TERM CARE hire date. TRS offers a Long Term Care plan through Genworth Life All other benefits will automatically begin the 1st of the Insurance Co. Long Term Care is insurance that will help monthly following your 1st day of employment. pay for services provided by Assisted Living Facilities, Nursing Homes, etc. If you are interested in enrolling in New Hires the Long Term Care plan or have questions, please call 866 New hires must enroll in benefits within 30 days of his/her -659-1970 or visit www.genworth.com/trsactivemember. hire date. Failure to complete elections during this LEAVES & ABSENCES timeframe will result in the forfeiture of coverage. Click on the link below to review HEB ISD’s Policies DEC TEACHER RETIREMENT SYSTEM OF TEXAS (LOCAL) & DEC (REGULATION) - these policies contain the latest information regarding leaves & absences http:// (TRS) HEB ISD requires all employees to participate in TRS pol.tasb.org/Home/Index/1110 instead of Social Security. The membership contribution Paid Leave Days rate is 7.7% of your annual salary. You may contact TRS by Every school year all full time employees in eligible calling 1-800-223-8778 or www.trs.state.tx.us to learn positions will receive: more about TRS Retirement.  5 local sick leave days  5 state personal leave days TRS INSURANCE (TRS INS)  10 vacation days (only available for 240 & 248 day Mandatory active member contribution to TRS-Care employees) (Health Insurance for retirees) is .65% of your annual salary.

Availability of Days  Days for the current year are available for use at the PAYCHECKS beginning of the school year. Professional and paraprofessional employees receive a  If you start in the middle of a school year, the days are paycheck on the 20th of each month. pro-rated based on the actual time employed. th th  Unused days may carry over from year to year. Auxiliary employees receive a paycheck on the 5 and 20 of each month. One-half of your monthly premium will be State Personal Leave taken out of each paycheck.  You may use up to 5 days in a row.

EMPLOYEE ACCESS CENTER

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From the Employee Benefits website, you can log on to the Employee Access Center to change your address, view  your paycheck stubs, see your current salary and benefit information and much more! Your login is your 6 digit 6

You may use no more than 5 days per school year. You must submit a written request to use a personal day at least three workdays in advance. The supervisor will determine if your request is approved or denied based on the effect your absence

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would have on the educational program or district operations. Requests are approved on a first-come, first-served basis. You may not use a personal leave day on a restricted day (i.e. day before or after a holiday, etc.). Please  review the restricted day calendar for the specific dates. If you worked for another public school district in the state of Texas, your service record will indicate if you are bringing any personal leave days with you.  If you leave the district, your personal leave days will go with you.

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To care for the employee’s spouse, child, or parent who has a qualifying serious health condition For the employee’s own qualifying serious health condition that makes the employee unable to perform the employee’s job

Eligibility:  Have worked for HEB ISD for at least 12 months; AND  Have at least 1250 hours of service in the 12 months before taking leave. If you need to be out for more than 4 consecutive work days due to sickness self or family sickness or want to request FMLA, please contact: Karen Rose, Benefits & Risk Manager, (817) 399-2056, karenrose@hebisd.edu

Local Sick Leave Local sick leave day may be used if you or immediate Order of Use  Employees have the right to designate the order of family members are sick. use for local sick & state personal leave days. Definition of immediate family:  For example, if you are absent due to sickness self, you  Spouse have the right to have the day pulled from your local  Son or daughter, including a biological, sick leave bank or your personal leave bank. As long adopted, step or foster child, a son- or as the absence is code sickness-using a personal day, daughter-in-law the day will NOT be counted as one of your 5 allowed  Parent, stepparent, parent-in-law personal leave days during a school year.  Sibling, stepsibling, and sibling-in-law  Grandparent and grandchild Bereavement (Funeral Leave)  Use of state leave and/or local sick leave for a death in Medical certification (doctor’s note) must be provided if: the immediate family must not exceed ten workdays  The employee is absent more than 4 per occurrence, subject to the approval of the District. consecutive work days because of personal The ten workdays do not have to be used illness or illness in the immediate family consecutively but must be taken within the  There is a questionable pattern of absences employee’s duty year of when the family member’s If an employee runs out of sick days, the payroll system death occurred. will automatically use a day from the next leave bank that  Use of state leave for the death of a non-immediate has available days. (The next bank is typically your family member must not exceed a total of five personal leave bank.) workdays per school year, subject to the approval of the District. Bereavement documentation may be FMLA (Family & Medical Leave Act) required. Provides eligible employees up to 12 work-weeks of unpaid, job-protected leave in a 12-month period; and requires group health benefits to be maintained during the leave. Employees are entitled to return to their same or an equivalent job at the end of their FMLA leave. 

EMPLOYEE BENEFITS FACEBOOK We have created a HEB ISD Employee Benefits Facebook

Leave available for: account. Please visit http://www.facebook.com/  Birth of child or placement of a child for adoption or hebbenefits and “Like” our page. foster care 7

Annual Benefit Enrollment

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Benefit Updates - What’s New:  Important! No new enrollments in the ActiveCare 2 plan will be allowed but if you are currently enrolled in ActiveCare2 you can continue with this coverage.

 Medical Rate Increase - Aetna remains the carrier for Medical Plans: ActiveCare 1 HD, ActiveCare 2 and Select. The Scott & White HMO Plan is available for all employees working or residing in Dallas, Ellis, Denton, Collin, Rockwall and Tarrant counties. All eligible employees, including active, contributing TRS members and employees regularly working 10 hours per week MUST either enroll for coverage or decline coverage in THEbenefitsHUB. For TRS medical information, please visit: www.trsactivecareaetna.com

 Increase in Health Savings Account annual maximum to $3,450 for an individual and $6,900 for a family.

 Benefit elections will become effective 9/1/2018. (elections requiring evidence of insurability, such as Life Insurance, may have a later effective date, if approved.) After annual enrollment closes, benefit changes can only be made if you experience a qualifying event (and changes must be made within 31 days of event).

 Allstate- Effective 9/1/2018 Hurst Euless Bedford ISD will no longer be offering the Allstate Cancer plan as a benefits option for payroll deduction. We have worked with our Benefits Consultant to find an alternative that offers coverage for more illnesses, with premium rates lower than the current Allstate plan. Beginning in September, 2018, HEB ISD will be offering a Critical Illness Plan, provided by Unum, in place of the current cancer plan. The Critical Illness plan includes coverage for cancer diagnosis, heart attack, stroke, ALS, Alzheimer’s, and a number of other conditions. The plan pays claims in a lump sum upon diagnosis of any covered illness. Increments of $10,000 in coverage can be elected from $10,000 to $30,000 for employees and their spouses. Coverage for children is automatically included in the employee’s coverage. If you would prefer to retain your current Allstate Cancer plan, you will be able to do so through

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bank draft. Bank draft forms will be available during annual enrollment on the HEB ISD benefits site, http:// www.mybenefitshub.com/hebisd. If you do not log into the benefits enrollment platform during annual enrollment, you will automatically be moved from the Allstate Cancer Plan to the new Unum Critical Illness Plan.

 NEW! Critical Illness plan by Unum available for you and your dependents. Critical Illness insurance helps offset the financial effects of a catastrophic illness by paying a lump sum benefit when employees or their family members are diagnosed with a covered illness and includes cancer coverage.

 SIS- Effective 9/1/2018 Hurst Euless Bedford ISD will no longer be offering the GAP plan offer through SIS as a benefits option for payroll deduction. We have worked with our Benefits Consultant to find an alternative that offers increased coverage for any in-patient hospital confinement, with premium rates lower than the current GAP plan. Beginning in September, 2018, HEB ISD will be offering a Hospital Indemnity Plan, through Voya, in place of the current GAP plan. The Hospital Indemnity plan offers either $100 or $200 per day payable for each day a participant is hospitalized. Additionally, there is a hospital admission benefit included that is either $1,000 or $2,000 dependent on which option is chosen. There is no pre-existing condition limitation on the new Voya plan. So for example, if you are currently pregnant or expecting a procedure that will result in a hospital stay, you can enroll in this plan and receive benefits immediately. More information on the new Hospital indemnity plan is located on our benefits website, www.mybenefitshub.com/hebisd. If you do not log into the benefits enrollment platform during annual enrollment, you will automatically be moved from the SIS GAP plan to the new Voya Hospital Indemnity plan.

 NEW! Hospital Indemnity plan by Voya. Hospital Indemnity insurance pays lump sum benefit amounts based on the number of days spent in a hospital, critical care unit or rehabilitation facility.

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, 8 AM—5 PM, Friday 8 AM—3 PM. 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 online enrollment system. If you have questions, please contact your Benefits Administrator. 8

SUMMARY PAGES

Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.

CHANGES IN STATUS (CIS):

Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

QUALIFYING EVENTS

Marital Status

A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).

Change in Number of Tax Dependents

A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.

Change in Status of Employment Affecting Coverage Eligibility

Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.

An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements Gain/Loss of Dependents' under an employer's plan may include change in age, student, marital, employment or tax dependent Eligibility Status status. If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order Judgment/Decree/Order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage. Eligibility for Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Government Programs

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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/hebisd.

annual enrollment) unless a Section 125 qualifying event occurs.

Click on the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the



Changes, additions or drops may be made only during the

Benefits and Forms section.

annual enrollment period without a qualifying event. How can I find a Network Provider?

 Employees must review their personal information and verify that dependents they wish to provide coverage for are

district’s website: www.mybenefitshub.com/hebisd. Click on

included in the dependent profile. Additionally, you must

the benefit plan you need information on (i.e., Dental) and

notify your employer of any discrepancy in personal and/or benefit information.

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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.

you can find provider search links under the Quick Links section. When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and

New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.

Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance. 10

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Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more

Dependent Eligibility: You can cover eligible dependent

regularly scheduled hours each work week.

children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the

Eligible employees must be actively at work on the plan effective

maximum age listed below. Dependents cannot be double

date for new benefits to be effective, meaning you are physically

covered by married spouses within HEB ISD or as both

capable of performing the functions of your job on the first day of

employees and dependents.

work concurrent with the plan effective date. For example, if your 2018 benefits become effective on September 1, 2018, you must be actively-at-work on September 1, 2018 to be eligible for your new benefits. PLAN

CARRIER

MAXIMUM AGE

Medical

Aetna

Dental

Cigna

Vision

Superior Vision

Medical Flex

NBS

IRS Tax Dependent

Disability

The Standard

N/A

Voluntary Life

UNUM

Legal Services

Legal Ease

19 or to 26 if full time student*

If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physicianâ&#x20AC;&#x2122;s statement confirming your dependentâ&#x20AC;&#x2122;s disability. Contact your Benefit Administrator to request a continuation of coverage. *Please see LegalEase Plan Information document for full definition of covered dependent

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Helpful Definitions Actively at Work

In-Network

You are performing your regular occupation for the employer

Doctors, hospitals, optometrists, dentists and other providers

on a full-time basis, either at one of the employer’s usual

who have contracted with the plan as a network provider.

places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2018 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.

(including diagnostic and/or consultation services).

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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 employeeâ&#x20AC;&#x2122;s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.

Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, tax-free. This also allows employees to pay for qualifying dependent care tax-free.

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source

Employee

Account Owner

Individual

Employer

Underlying Insurance Requirement

High deductible health plan

None

Description

Minimum Deductible Maximum Contribution Permissible Use Of Funds Cash-Outs of Unused Amounts (if no medical expenses) Year-to-year rollover of account balance? Does the account earn interest?

$1,300 single (2018) $2,600 family (2018) $3,450 single (2018) $6,900 family (2018) If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty. Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65). Yes, will roll over to use for subsequent yearâ&#x20AC;&#x2122;s health coverage.

N/A $2,400 medical reimbursement $5,000 dependent care Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC). Not permitted No.

Yes

Portable?

Yes, portable year-to-year and between jobs.

Are claims substantiated?

Only upon audit

Yes receipts may be required.

Can I access the entire amount No, money is available as it is contributed at the start of the plan year? to the account.

FLIP TO FOR HSA INFORMATION

PG. 28

Yes

FLIP TO FOR FSA INFORMATION

PG. 52 13

Workers Compensation Important Contact Information To locate a provider, go to www.pswca.org. To contact your adjuster at the TASB Risk Management Fund, visit www.tasbrmf.org or call (800) 482-7276.

Information, Instructions, Rights, and Obligations If you are injured at work, tell your supervisor or employer immediately. The information in this notice will help you to seek medical treatment for your injury. Your employer will also help with any questions about how to get treatment. You may also contact your adjuster at the TASB Risk Management Fund (the Fund) for any questions about treatment for a work related injury. The Fund is your employer’s workers’ compensation coverage provider and they are working with your employer to ensure you receive timely and appropriate health care. The goal is to return you to work as soon as it is safe to do so.

How do I choose a treating doctor? If you are hurt at work and you live in the Alliance service area, you are required to choose a treating doctor from the provider list. This is required for you to receive coverage of healthcare costs for your work related injury. A provider listing is available through the Alliance website at www.pswca.org and a link to that site is contained on the Fund’s website at www.tasbrmf.org. It identifies providers who are taking new patients.

How do I change treating doctors?

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with the Alliance only if one of the following situations occurs: Emergencies: You should go to the nearest hospital or emergency care facility. You do not live within an Alliance service area. Your treating doctor refers you to a provider or facility outside of the Alliance. Your adjuster must approve this referral.

What to do when you are injured on the job If you are injured while on the job, tell your employer as soon as possible. A list of Alliance treating doctors in your service area may be available from your employer. A complete list of Alliance treating doctors is also available online at www.pswca.org. Or, you may contact us directly at the following address and/or tollfree telephone number: TASB Risk Management Fund P.O. Box 2010 Austin, TX 78768 (800) 482-7276

In case of an emergency… If you are hurt at work and it is a life threatening emergency, you should go to the nearest emergency room. If you are injured at work after normal business hours or while working outside your service area, you should go to the nearest care facility. After you receive emergency care, you may need ongoing care. You will need to select a treating doctor from the Alliance provider list. This list is available online at www.pswca.org. If you do not have internet access call (800) 482-7276 or contact your employer for a list. The doctor you choose will oversee the care you receive for your work related injury. Except for emergency care you must obtain all health care and specialist referrals through your treating doctor.

Within the first 60 days of beginning treatment, if you become dissatisfied with your first choice of a treating doctor, you can select an alternate treating doctor from the list of Alliance treating doctors in your service area. The Fund will not deny a choice of an alternate treating doctor. However, before you can change treating doctors a second time, you must obtain permisNon-emergency care… sion from your adjuster. Report your injury to your employer as soon as you can. Select a treating doctor from the Alliance provider list. This list is availaWho pays for the healthcare? ble online at www.pswca.org. If you do not have internet access, Alliance providers have agreed to seek payment from the Fund call (800) 482-7276 or contact your employer for a list. for your health care. They should not request payment from you. If you obtain health care from a doctor who is not in the Alliance without prior approval from your adjuster, you may have to pay for the cost of that care and your income benefits may be disputed. You may treat with medical providers that are not contracted

Sick Leave Bank Summary

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PLEASE REFER TO POLICY DEC (LOCAL & REGULATION). BELOW IS ONLY A GENERAL SUMMARY OF THE POLICY.

The purpose of the sick leave bank is to provide additional sick leave days for members of the bank who have exhausted all available paid leave because of the catastrophic injury or illness of the employee or the employee’s immediate family member.

used, whichever is less, at the beginning of the next school year. Qualifying Illness/Injury 

In order to become a member of the sick leave bank, an employee must donate 3 days of local leave. This is a onetime donation. Additional days may be needed, please see the policy for more details. All local sick, state personal, old state and vacation days must be exhausted before days from the sick leave bank may be used.

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Catastrophic illness or injury is a severe condition or combination of conditions affecting the mental or physical health of the employee or a member of the employee’s immediate family that requires the services of a licensed practitioner for a prolonged period of time and that forces the employee to exhaust all leave time earned by that employee and to lose compensation from the District. Such conditions typically require prolonged hospitalization or recovery; not a passing disorder or temporary ailment; or are expected to result in disability or death. Complications of pregnancy and childbirth that pose an immediate medical threat Cancer-related intermittent treatment (i.e. chemo, radiation)

Sick leave bank days are available to use for an employee,  spouse, or child’s illness or injury or for a parent receiving Not Covered: hospice or end-of-life care.  Procedure that could be scheduled, without detriment to the employee’s health, at a time more compatible Employee must be absent for no fewer than 20 workdays with the member’s work responsibilities (i.e. Spring in order to be eligible to request days from the sick leave Break, Summer, Christmas Break) bank. Applications for sick leave bank must be submitted within 15 workdays from the first date of missed work or 15 days prior to the exhaustion of all available leave days.

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Maximum # of days that can be used:   Employee’s illness – 30 days per school year  Spouse or child’s illness – 30 days per school year; 60 days lifetime maximum  Parent -10 days per school year; 20 days lifetime maximum

Pre-existing Conditions – Absences caused by conditions existing at the time of application for bank membership will not be covered for one year from the date of enrollment in the bank Examples of conditions that are not covered – Hysterectomy, joint replacement (hip, knee, shoulder, etc.), general illness (flu, cold, etc.), non-complicated pregnancy, broken bone, general surgery, etc.

A committee will determine whether the request for sick leave days is approved or denied. Members of the bank who, during the previous school year, found it necessary to use the benefits of the bank must donate three days or the actual number of days

Health Insurance

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ActiveCare 1-HD, 2 & Select â&#x20AC;&#x201C; Aetna 800-222-9205 www.trsactivecareaetna.com In-Network Benefits Medical Benefits Deductible Maximum Out-of-Pocket (Includes medical & prescription deductibles, coinsurance & copays) Coinsurance Participant pays (after deductible) Office Visit Copay Preventive Care Diagnostic Lab High-tech Radiology Outpatient Surgery Emergency Room Freestanding ER Inpatient Hospitalization Teladoc

HMO â&#x20AC;&#x201C; Scott & White 800-321-7947 www.trs.swhp.org

ActiveCare 1-HD ActiveCare Select^ Scott & White HMO+ (Participant Pays) (Participant Pays) (Participant Pays) Deductible must be met No out-of-network benefits No out-of-network benefits before benefits are paid

ActiveCare 2 (Participant Pays) Closed to New Enrollees

$2,750 Employee Only $5,500 Family

$1,200 Individual $3,600 Family

$1,000 Individual $3,000 Family

$6,650 Individual $13,300 Family

$7,350 Individual $14,700 Family

$7,000 Individual $14,000 Family

$7,350 Individual $14,700 Family

20%

$30 copay - Primary $70 copay - Specialist Plan pays 100% 20%* $100 copay & 20%* $150 copay & 20%* $250 copay & 20%* $500 copay & 20%* $150 copay/day & 20%* Plan pays 100%

$15 copay - Primary $70 copay - Specialist Plan pays 100% 20%* 20%* $150 copay & 20%* $250 copay & 20%*

$30 copay - Primary $70 copay - Specialist Plan pays 100% 20%* $100 copay & 20%* $150 copay & 20%* $250 copay & 20%* $500 copay & 20%* $150 copay/day & 20%* Plan pays 100%

20%* Plan pays 100% 20%* 20%* 20%* 20%* $500 copay* 20%* $40 consultation fee

$150 copay/day & 20%* Not covered

Prescription Drugs Subject to medical deductible

Drug Deductible

$20 $40#

$35 $60# 50%#

Mail Order or Retail-Plus

$45 30%# 50%# Tier1 & 2: 15%# Tier3: 25%#

Short-Term Maintenance @ Retail Facility

20%#

$0 Generic $200 Brand

Short-Term @ Retail Facility

$45 $105#

Maintenance

20%*

$35 $60# 50%#

$0 Generic $150 Brand

Retail

Specialty Drugs

$20 $40#

Mail Order or Retail-Plus

20%* 20%* 50%*

Short-Term Maintenance @ Retail Facility

Tier 1 - Generic Tier 2 - Preferred Brand Tier 3 - Non-Preferred Brand

Short-Term @ Retail Facility

Certain Generic Preventive Drugs are Covered 100% (Participants deductible does not have to be met)

$0 Generic $200 Brand

$45 $105#

20%#

Premiums

Monthly

Semi

Monthly

Semi

Monthly

Semi

Monthly

Semi

Employee Only Employee & Spouse Employee & Child(ren) Employee & Family

$142.00 $810.00 $476.00 $1,149.00

$71.00 $405.00 $238.00 $574.50

$315.00 $1,102.00 $651.00 $1,443.00

$157.50 $551.00 $325.50 $721.50

$353.36 $1,128.40 $683.06 $1,284.56

$176.68 $564.20 $341.53 $642.28

$557.00 $1,630.00 $938.00 $1,969.00

$278.50 $815.00 $469.00 $984.50

* After the MEDICAL deductible has been met ^ Visit www.trsactivecareaetna.com to search for providers in 1-HD & 2. For the Select Plan choose the Baylor Scott & White Quality Alliance (DFW Area) option. + Visit www.trs.swhp.org to search for providers in the Baylor Scott & White HMO plan # After the PRESCRIPTION deductible has been met 16

Maximum Annual Costs 2018-2019

SUMMARY PAGES

For Illustration Purposes Only Employee Only Deductible (Medical)

1-HD $2,750

Select $1,200

HMO $1,000

2 $1,000

$200

$150

$200

$3,900

$5,950

$5,850

$6,150

$6,650

$7,350

$7,000

$7,350

Annual Premium

$1,704

$3,780

$4,240

$6,684

Grand Total

$8,354

$11,130

$11,240

$14,034

Employee & Spouse

1-HD

Select

HMO

Deductible (Medical)

$5,500

$2,400

$2,000

$400

$300

$400

$7,800

$11,900

$11,700

$12,300

$13,300

$14,700

$14,000

$14,700

Annual Premium

$9,720

$13,224

$13,541

$19,560

Grand Total

$23,020

$27,924

$27,541

$34,260

1-HD

Select

HMO

$5,500

$3,600

$3,000

$600

$450

$600

$7,800

$10,500

$10,550

$11,100

$13,300

$14,700

$14,000

$14,700

Annual Premium

$5,712

$7,812

$8,197

$11,256

Grand Total

$19,012

$22,512

$22,197

$25,956

1-HD

Select

HMO

$5,500

$3,600

$3,000

$800

$600

$800

$7,800

$10,300

$10,400

$10,900

Deductible (Prescription) Maximum Out of Pocket (co-ins & copays) Subtotal Medical & Prescription Costs

Employee & Child(ren) Assumes employee & 2 children Deductible (Medical) Deductible (Prescription) Maximum Out of Pocket (co-ins & copays) Subtotal Medical & Prescription Costs

Employee & Family Assumes 4 family members Deductible (Medical) Deductible (Prescription) Maximum Out of Pocket (co-ins & copays)

$13,300

$14,700

$14,000

$14,700

Annual Premium

Subtotal Medical & Prescription Costs

$13,788

$17,316

$15,415

$23,628

Grand Total

$27,088

$32,016

$29,415

$38,328 17

Finding Healthcare Providers (TRS ActiveCare)

SUMMARY PAGES

To locate an in network provider for a medical plan go to: www.trsactivecareaetna.com Click on:

In the search bar, you may search by name, specialty, procedure or condition.

Choose your health plan:

ActiveCare Select â&#x20AC;&#x201C; Make sure you choose Baylor Scott & White Quality Alliance (DFW Region) NOT ActiveCare Select

ActiveCare 1-HD ActiveCare 2

Finding Healthcare Providers (Scott & White HMO)

SUMMARY PAGES

To locate an in network provider for a medical plan go to: www.trs.swhp.org

Click on Provider Information:

Click on Browse providers online:

Choose the TRS â&#x20AC;&#x201C; Active Care Participants Network then you may search by doctor, facility or specialty:

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

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

• 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

$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. 21

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

Equipment and Supplies Preferred Diabetic Supplies and Equipment Non-Preferred Diabetic Supplies and Equipment Durable Medical Equipment/ Prosthetics 22

$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 â&#x20AC;&#x201D; 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

Non-preferred

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

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.

VOYA YOUR BENEFITS PACKAGE

Hospital Indemnity

PLAY VIDEO

About this Benefit Hospital Confinement Indemnity Insurance pays a daily benefit if you have a covered stay in a hospital*, critical care unit and rehabilitation facility. The benefit amount is determined based on the type of facility and the number of days you stay. Hospital Confinement Indemnity Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

The median hospital costs per stay have steadily grown to over $10,000.

$8,800

9,600

10,400

2003

2008

2012

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 HEB ISD Benefits Website: www.mybenefitshub.com/hebisd

Hospital Indemnity Consider the following:

 The average cost per day for an hospital stay in the United States is more than $4,000.1  About 1 in 16 U.S. residents age 18 to 44 required one or more hospital stays in 2012. For ages 45 to 64, it was about 1 in 13.2 1

“As Hospital Prices Soar, a Stitch Tops $500.” New York Times, Dec. 2, 2013. 2 “Health, United States.” National Center for Health Statistics, Centers for Disease Control and Prevention, 2013. The costs of a hospital stay aren’t confined to hospital bills, either. There’s transportation, parking, food and drink for visitors, rehabilitation expenses, and potentially lost work time. Compass Hospital Confinement Indemnity Insurance can help reduce your financial stress during recovery.

About Compass Hospital Confinement Indemnity Insurance Compass Hospital Confinement Indemnity Insurance is a limited benefit policy. This is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act. Hospital confinement indemnity insurance pays lump sum benefit amounts based on the number of days spent in a hospital*, critical care unit, or rehabilitation facility. You can use this benefit for any purpose you like, for example: to help pay for expenses not covered by your medical plan, lost wages, child care, travel, home health care costs, or any of your regular household expenses. *A hospital does not include an institution or part of an institution used as: a hospice unit; a convalescent home; a rest or nursing facility; a free-standing surgical center; a rehabilitative facility; an extended-care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction.

This policy is portable – which means that if you leave your employer, you can maintain your coverage. If you choose to keep your coverage, you will be billed directly.

Your Compass Hospital Confinement Indemnity Insurance Plan The plan pays a daily benefit based on the coverage level you select. See accompanying rate sheet for available coverage levels. You will be asked for supporting documentation in order for a benefit to be paid. Please see the complete certificate and any applicable rider(s) for details. Please refer to the back pages of this document for a list of the exclusions and limitations that apply to this coverage.

Spouse Hospital Confinement Indemnity Insurance Rider The spouse/domestic partner daily benefit may or may not match the employee benefit amount, so see your available election choices on the accompanying rate sheet or review the complete certificate for details. You must have coverage for yourself in order to select this rider. Please refer to the back pages of this document for a list of the exclusions and limitations that apply to this coverage.

Children’s Hospital Confinement Indemnity Insurance Rider You may elect hospital confinement indemnity insurance coverage for your child or children, up to age 26. One rider covers all of your eligible children. The child daily benefit amount may be different from what is available to employees and spouses, so see your election choices on the accompanying rate sheet or the complete certificate for details. You must have coverage for yourself in order to select this rider. Please refer to the back pages of this document for a list of the exclusions and limitations that apply to this coverage.

Uni-Tobacco $100

Uni-Tobacco $200

Employee

$16.19

$32.38

Employee + Spouse

$32.47

$64.95

Employee + Children

$24.18

$48.36

Family

$40.46

$80.93

If you are an employee who works at least 20 hours a week you qualify for this insurance. There are no medical questions you need to answer or medical tests you need to take to get coverage.

Composite Monthly Rate

This is an optional benefit that you can purchase. Premium payments will be made through automatic deduction from your paycheck. This brochure will describe the coverage and options available to you.

Hospital Indemnity Exclusions and Limitations* Exclusions for the Certificate, Initial Confinement Benefit, Spouse Hospital Confinement Indemnity Insurance and Children’s Hospital Confinement Indemnity Insurance 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.  Operation of a motorized vehicle while intoxicated.  Suicide, attempted suicide or any intentionally self-inflicted injury, while sane or insane.  War or any act of war, whether declared or undeclared, other than acts of terrorism.  Loss that occurs while on full-time 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.  Elective surgery, except when required for appropriate care as a result of the covered person’s injury or sickness.**  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.  Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar activities.  Practicing for, or participating in, any semiprofessional or professional competitive athletic contests for which any type of compensation or remuneration is received. *See the certificate and any riders for a complete list of available benefits, along with applicable provisions, exclusions and limitations. **Not applicable to Accident Benefit Rider.

Hospital Indemnity

HSA BANK

HSA (Health Savings Account)

YOUR BENEFITS PACKAGE

PLAY VIDEO

About this Benefit A Health Savings Account is a tax-advantaged medical savings account available to employees who are enrolled in a high-deductible health plan. The funds contributed to the account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent.

The interest earned in an HSA is tax free.

Money withdrawn for medical spending never falls under taxable income.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 28 HEB ISD Benefits Website: www.mybenefitshub.com/hebisd

HSA (Health Savings Account) HSA Bank has teamed up with your employer to create an affordable health coverage option that helps you save on healthcare expenses. This plan is only available for those who are participating in the Active Care 1-HD medical plan. You may not enroll in the HSA if you participate in the FSA. Medicare, Medicaid, and Tricare participants are not eligible to participate in an HSA. You can use your Health Savings Account (HSA) to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free.

What is an HSA? 

 

A tax-advantaged savings account that you use to pay for eligible medical expenses as well as deductible, co-insurance, prescriptions, vision and dental care. Allows you to save while reducing your taxable income. Unused funds that will roll over year to year. There’s no “use it or lose it” penalty. A way to accumulate additional retirement savings. After age 65, funds can be withdrawn for any purpose without penalty.

prorated) Authorized Signers who are 55 or older must have their own HSA in order to make the catch-up contribution

Examples of Qualified Medical Expenses      

Surgery Braces Contact lenses Dentures Eyeglasses Vaccines

For a list of sample expenses, please refer to the benefit website at www.mybenefitshub.com/hebisd

HSA Bank Contact Information 605 N. 8th Street, Ste 320 Sheboygan, WI 53081 Phone: 800-357-6246 www.hsabank.com

Using Funds Debit Card  You may use the card to pay merchants or service providers that accept VISA credit cards, so there is no need to pay cash up front and wait for reimbursements.  You can make a withdrawal at any time. Reimbursements for qualified medical expenses are tax free. If you are disabled or reach age 65, you can receive non-medical distributions without penalty, but you must report the distributions as taxable income. You may also use your funds for a spouse or tax dependent not covered by your HDHP.

2018 Annual HSA Contribution Limits Individual: $3,450 Family: $6,900 Catch-Up Contributions: Accountholders who meet the qualifications noted below are eligible to make an HSA catch-up contribution of an additional $1,000.  Health Savings accountholder  Age 55 or older (regardless of when in the year an accountholder turns 55)  Not enrolled in Medicare (if an accountholder enrolls in Medicare mid-year, catch-up contributions should be

How the HSA Plan Works A Health Savings Account (HSA) is an individually-owned, tax-advantaged account that you can use to pay for current or future IRS-qualified medical expenses. With an HSA, you’ll have the potential to build more savings for healthcare expenses or additional retirement savings through self-directed investment options1.

How an HSA works: 



 

You can contribute to your HSA via payroll deduction, online banking transfer, or by sending a personal check to HSA Bank. Your employer or third parties, such as a spouse or parent, may contribute to your account as well. You can pay for qualified medical expenses with your HSA Bank Debit Card directly to your medical provider or pay out-of-pocket. You can either choose to reimburse yourself or keep the funds in your HSA to grow your savings. Unused funds will roll over year to year. After age 65, funds can be withdrawn for any purpose without penalty (subject to ordinary income taxes). Check balances and account information via HSA Bank’s Internet Banking 24/7.

Are you eligible for an HSA? If you participate in TRS ActiveCare 1HD you are eligible to open an HSA.  You cannot be covered by any other non-HSA-compatible health plan, including Medicare Parts A and B.  You cannot be covered by TriCare.  You cannot have accessed your VA medical benefits in the past 90 days (to contribute to an HSA).  You cannot be claimed as a dependent on another person’s tax return (unless it’s your spouse).  You must be covered by the qualified HDHP on the first day of the month.  You cannot be enrolled in the GAP plan.  You cannot be enrolled in the Healthcare Reimbursement (Flexible Spending Plan)  You can be enrolled in the Dependent Care Reimbursement Plan When you open an account, HSA Bank will request certain information to verify your identity and to process your application.

What are the annual IRS contribution limits? Contributions made by all parties to an HSA cannot exceed the annual HSA limit set by the Internal Revenue Service (IRS). Anyone can contribute to your HSA, but only the

accountholder and employer can receive tax deductions on those contributions. Combined annual contributions for the accountholder, employer, and third parties (i.e., parent, spouse, or anyone else) must not exceed these limits2.

2018 Annual HSA Contribution Limits Individual = $3,450 Family = $6,900

Catch-up Contributions Accountholders who meet these qualifications are eligible to make an HSA catch-up contribution of $1,000: Health Savings accountholder; age 55 or older (regardless of when in the year an accountholder turns 55); not enrolled in Medicare (if an accountholder enrolls in Medicare mid-year, catch-up contributions should be prorated). Authorized signers who are 55 or older must have their own HSA in order to make the catch-up contribution. According to IRS guidelines, each year you have until the tax filing deadline to contribute to your HSA (typically April 15 of the following year). Online contributions must be submitted by 2:00 p.m., Central Time, the business day before the tax filing deadline. Wire contributions must be received by noon, Central Time, on the tax filing deadline, and contribution forms with checks must be received by the tax filing deadline.

How can you benefit from tax savings? An HSA provides triple tax savings3. Here’s how:  Contributions to your HSA can be made with pre-tax dollars and any after-tax contributions that you make to your HSA are tax deductible.  HSA funds earn interest and investment earnings are tax free.  When used for IRS-qualified medical expenses, distributions are free from tax.

IRS-Qualified Medical Expenses You can use your HSA to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse, or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free. HSA funds can be used to reimburse yourself for past medical expenses if the expense was incurred after your HSA was established. While you do not need to submit any receipts to HSA Bank, you must save your bills and receipts for tax purposes.

How the HSA Plan Works Examples of IRS-Qualified Medical Expenses4: Acupuncture Alcoholism treatment Ambulance services Annual physical examination Artificial limb or prosthesis Birth control pills (by prescription) Chiropractor Childbirth/delivery Convalescent home (for medical treatment only) Crutches Doctor’s fees Dental treatments (including x-rays, braces, dentures, fillings, oral surgery) Dermatologist Diagnostic services Disabled dependent care Drug addiction therapy Fertility enhancement (including in-vitro fertilization) Guide dog (or other service animal)

Gynecologist Hearing aids and batteries Hospital bills Insurance premiums5 Laboratory fees Lactation expenses Lodging (away from home for outpatient care) Nursing home Nursing services Obstetrician Osteopath Oxygen Pregnancy test kit Podiatrist Prescription drugs and medicines (over-the-counter drugs are not IRSqualified medical expenses unless prescribed by a doctor) Prenatal care & postnatal treatments Psychiatrist Psychologist Smoking cessation programs

Special education tutoring Surgery Telephone or TV equipment to assist the hearing or vision impaired Therapy or counseling Medical transportation expenses Transplants Vaccines Vasectomy Vision care (including eyeglasses, contact lenses, lasik surgery) Weight loss programs (for a specific disease diagnosed by a physician – such as obesity, hypertension, or heart disease) Wheelchairs X-rays

For assistance, please contact the Client Assistance Center 800-357-6246 Monday – Friday, 7 a.m. – 9 p.m., and Saturday, 9 a.m. - 1 p.m., CT www.hsabank.com | 605 N. 8th Street, Ste. 320, Sheboygan, WI 53081

1 Investment accounts are not FDIC insured, may lose value and are not a deposit or other obligation of, or guarantee by the bank. Investment losses which are replaced are subject to the annual contribution limits of the HSA. 2 HSA funds contributed in excess of these limits are subject to penalty and tax unless the excess and earnings are withdrawn prior to the due date, including any extensions for filing Federal Tax returns. Accountholders should consult with a qualified tax advisor in connection with excess contribution removal. The Internal Revenue Service requires HSA Bank to report withdrawals that are considered refunds of excess contributions. In order for the withdrawal to be accurately reported, accountholders may not withdraw the excess directly. Instead, an excess contribution refund must be requested from HSA Bank and an Excess Contribution Removal Form completed. 3 Federal Tax savings are available no matter where you live and HSAs are taxable in AL, CA, and NJ. HSA Bank does not provide tax advice. Consult your tax professional for tax‐related questions. 4 This list is not comprehensive. It is provided to you with the understanding that HSA Bank is not engaged in rendering tax advice. The information provided is not intended to be used to avoid Federal tax penalties. For more detailed information, please refer to IRS Publication 502 titled, “Medical and Dental Expenses”. Publications can be ordered directly from the IRS by calling 1-800-TAXFORM. If tax advice is required, you should seek the services of a professional. 5 Insurance premiums only qualify as an IRS-qualified medical expense: while continuing coverage under COBRA; for qualified long-term care coverage; coverage while receiving unemployment compensation; for any healthcare coverage for those over age 65 including Medicare (except Medicare supplemental coverage). 31

CIGNA

Dental

YOUR BENEFITS PACKAGE

PLAY VIDEO

About this Benefit Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, treatment and dental disease.

Good dental care may improve your overall health. Also Women with gum disease may be at greater risk of giving birth to a preterm or low birth weight baby.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 32 HEB ISD Benefits Website: www.mybenefitshub.com/hebisd

Dental Plans Cigna

800-224-6224

www.cigna.com

The district offers a choice of three different dental plans. A summary of the respective plans follows. PPO High

PPO Low

DHMO

Plan Pays 100%

Fixed Co-Pays

Plan Pays 80%

Plan Pays 70%

Deductible Applies

Fixed Co-Pays

Class III – Major Restorative

Plan Pays 50%

(crowns, bridges, dentures, etc.)

Deductible Applies

Plan Pays 50%

Not Covered

Fixed Co-Pays

Ortho. Lifetime Maximum

$1,000

Not Covered

N/A

Deductible (Per Plan Year)

$50 Person $150 Family

$25 Person $75 Family

None

$1,000

$750

$1,125

$875

$1,250

$1,000

$1,375

$1,125

Primary Care Dentist Required

Yes

Out of Network Benefits

Yes

Maximum Reimbursable Charge

Maximum Allowable Charge

None

Class I – Diagnostic & Preventative (cleanings, exams, x-rays, sealants, etc.)

Class II – Basic Restorative (fillings, extractions, oral surgery, etc.)

Orthodontics (Children & Adults)

Fixed Co-Pays

Progressive Maximum Benefit Year 1 Year 2 (Contingent upon receiving preventive services in Year 1)

Year 3 (Contingent upon receiving preventive services in Years 1 & 2)

Year 4 (Contingent upon receiving preventive services in Years 2 & 3)

Out of Network Reimbursement

N/A

Premiums

Monthly

SemiMonthly

Monthly

SemiMonthly

Monthly

SemiMonthly

Employee Only

$37.52

$18.76

$24.50

$12.25

$13.21

$6.61

Employee + 1

$74.54

$37.27

$50.47

$25.24

$25.10

$12.55

Employee + Family

$113.06

$56.53

$68.11

$34.06

$39.63

$19.82 33

Dental PPO - High Option Benefits

Network

Reimbursement Levels

Cigna Dental Choice

Monthly PPO Premiums

In-Network

Out-of-Network

Total Cigna DPPO

See Non-Network Reimbursement

Based on Contracted Fees

Maximum Reimbursable Charge

Progressive Maximum Benefit Progressive Benefit Year 2: Increase contingent upon receiving Preventive Services in Plan Year 1. Progressive Benefit Year 3: Increase contingent upon receiving Preventive Services in Plan Years 1 and 2. Progressive Benefit Year 4: Increase contingent upon receiving Preventive Services in Plan Years 2 and 3

Policy Year Benefits Maximum Applies to: Class I, II & III expenses Policy Year Deductible Individual Family

Year 1: $1,000 Year 2: $1,125 Year 3: $1,250 Year 4: $1,375

$50 $150

Plan Pays

You Pay

Plan Pays

You Pay

100% No Deductible

No Charge

100% No Deductible

No Charge

80% After Deductible

20% After Deductible

80% After Deductible

20% After Deductible

50% After deductible

Class I - Diagnostic & Preventative Oral Evaluations Prophylaxis: routine cleanings X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain

Class II - Basic Restorative Restorative: fillings Periodontics: minor and major Oral Surgery: minor and major Anesthesia: general and IV sedation Repairs: Bridges, Crowns and Inlays Repairs: Dentures Denture Relines, Rebases and Adjustments Crowns: prefabricated stainless steel/resin

Class III - Major Restorative Inlays and Onlays Crowns: permanent cast and porcelain Bridges and Dentures Endodontics: minor and major

Class IV - Orthodontia Coverage for Employee and All Dependents Lifetime Benefits Maximum: $1,000

50% No Deductible

50% 50% No Deductible No Deductible

50% No Deductible

Tier

Rate

EE Only

$37.52

EE + 1 Dep

$74.54

EE + 2 or more Deps

$113.06

Dental PPO - Low Option Benefits

Network

Reimbursement Levels

Cigna Dental Choice

Monthly PPO Premiums

In-Network

Out-of-Network

Total Cigna DPPO

See Non-Network Reimbursement

Based on Contracted Fees

Tier

Rate

EE Only

$24.50

EE + 1 Dep

$50.47

EE + 2 or more Deps

$68.11

Maximum Allowable Charge

Policy Year Benefits Maximum Applies to: Class I, II & III expenses

Year 1: $750 Year 2: $875 Year 3: $1,000 Year 4: $1,125

$25 $75

Policy Year Deductible Individual Family

Plan Pays

You Pay

Plan Pays

You Pay

100% No Deductible

No Charge

100% No Deductible

No Charge

70% After Deductible

30% After Deductible

70% After Deductible

30% After Deductible

50% After deductible

Class II - Basic Restorative Restorative: fillings Periodontics: minor and major Endodontics: minor and major Oral Surgery: minor and major Anesthesia: general and IV sedation Repairs: Bridges, Crowns and Inlays Repairs: Dentures Denture Relines, Rebases and Adjustments Crowns: prefabricated stainless steel/resin

Class III - Major Restorative Inlays and Onlays Crowns: permanent cast and porcelain Bridges and Dentures

Dental PPO - High & Low Options Benefit Plan Provisions:

Benefit Plan Provisions:

In-Network Reimbursement

For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule.

Non-Network Reimbursement

For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Allowable Charge. The MRC is calculated at the 90th percentile of all provider charges in the geographic area. The dentist may balance bill up to their usual fees. All deductibles, plan maximums, and service specific maximums cross accumulate between in-network and out-of-network. Benefit frequency limitations are based on the date of service and cross accumulate between in and out of network. The plan will only pay for covered charges up to the yearly Benefits Maximum, when applicable. Benefit-specific Maximums may also apply. This is the amount you must pay before the plan begins to pay for covered charges, when applicable. Benefit-specific deductibles may also apply. Payment will be reduced by 50% for Class III and IV services for 12 months for eligible members that are allowed to enroll in this plan outside of the designated open enrollment period. This provision does not apply to new hires. Pretreatment review is available on a voluntary basis when dental work in excess of $200 is proposed.

Cross Accumulation

Policy Year Benefits Maximum Policy Year Deductible Late Entrant Limitation Provision Pretreatment Review Alternate Benefit Provision Oral Health Integration Program (OHIP)

Timely Filing Benefit Limitations: Missing Tooth Limitation Oral Evaluations X-rays (routine) X-rays (non-routine) Diagnostic Casts Cleanings Fluoride Application Sealants (per tooth) Space Maintainers Inlays, Crowns, Bridges, Dentures and Partials

Denture and Bridge Repairs Denture Adjustments, Rebases and Relines Prosthesis Over Implant

When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses. Cigna Dental Oral Health Integration Program offers enhanced dental coverage for customers with the following medical conditions: diabetes, heart disease, stroke, maternity, head and neck cancer radiation, organ transplants and chronic kidney disease. Thereâ&#x20AC;&#x2122;s no additional charge for the program â&#x20AC;&#x201C; those who qualify get reimbursed 100% of coinsurance for certain related dental procedures. Eligible customers can also receive guidance on behavioral issues related to oral health and discounts on prescription and nonprescription dental products. Reimbursements under this program are not subject to the plan deductible, but will be applied to and are subject to the plan annual maximum. Discounts on certain prescription and non-prescription dental products are available through Cigna Home Delivery Pharmacy only, and you are required to pay the entire discounted charge. For more information including how to enroll in this program and a complete list of program terms and eligible medical conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24. Out of network claims submitted to Cigna after 365 days from date of service will be denied. For teeth missing prior to coverage with Cigna, the amount payable is 50% of the amount otherwise payable until covered for 12 months; thereafter, considered a Class III expense. 2 per policy year Bitewings: 2 per policy year Complete series of radiographic images and panoramic radiographic images: Limited to a combined total of 1 per 36 consecutive months Payable only in conjunction with orthodontic workup 2 per policy year, including periodontal maintenance procedures following active therapy 1 per policy year for children under age 19 Limited to posterior tooth. 1 treatment per tooth every 36 months for children under age 14 Limited to non-orthodontic treatment for children under age 19 Replacement every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth-colored material on molar crowns or bridges. Reviewed if more than once Covered if more than 6 months after installation 1 every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth colored material on molar crowns or bridges.

Benefit Exclusions: Covered Expenses will not include, and no payment will be made for the following: Procedures and services not listed under Benefit Highlights; Diagnostic: cone beam imaging; Preventive Services: instruction for plaque control, oral hygiene and diet; Restorative: Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and/or third molars; Periodontic: bite registrations; splinting; Prosthodontic: precision or semi-precision attachments; Implants: implants or implant related services; Orthodontia: Orthodontic treatment. Procedures, appliances or restorations, except full dentures, whose main purpose is to: change vertical dimension; diagnose or treat conditions or dysfunction of the temporomandibular joint (TMJ); stabilize periodontally involved teeth; or restore occlusion; Athletic mouth guards; Replacement of a lost or stolen appliance; Services performed primarily for cosmetic reasons; Personalization; Services that are deemed to be medical in nature; Services and supplies received from a hospital; Drugs: prescription drugs Charges in36 excess of the Maximum Reimbursable Charge. Contracted providers are not obligated to provide discounts on non-covered services and may charge their usual fees.

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.

DHMO Premiums Tier

Rate

EE Only

$13.21

EE + 1 Dep

$25.10

EE + 2 or more Deps

$39.63



Procedures listed on the Patient Charge Schedule are subject to the plan limitations and exclusions described in your plan book/certificate of coverage and/or group contract.



All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated.



The American Dental Association may periodically change CDT Codes or definitions. Different codes may be used to describe these covered procedures.



The administration of IV sedation, general anesthesia, and/or nitrous oxide is not covered except as specifically listed on this Patient Charge Schedule. The application of local anesthetic is covered as part of your dental treatment.



Cigna Dental considers infection control and/or sterilization to be incidental to and part of the charges for services provided and not separately chargeable.



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 For full Patient Charge Schedule, go to www.mybenefitshub.com/hebisd 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).

Code

Procedure Description

Member Pays

Diagnostic/preventive (cont.) D0145

Oral evaluation for a patient under 3 years of age and counseling with primary caregiver

$0.00

D0150

Comprehensive oral evaluation – New or established patient

$0.00

D0210

X-rays intraoral – Complete series of radiographic images (limit 1 every 3 years)

$0.00

D9310

Consultation (diagnostic service provided by dentist or physician other than requesting dentist or physician)

$10.00

D0240

X-rays intraoral – Occlusal radiographic image

$0.00

D9430

Office visit for observation – No other services performed

$5.00

D0270

X-rays (bitewing) – Single radiographic image

$0.00

D0120

Periodic oral evaluation – Established patient

$0.00

D0330

X-rays (panoramic radiographic image) – (limit 1 every 3 years)

$0.00

D0140

Limited oral evaluation – Problem focused

$0.00

D0431

Oral cancer screening using a special light source

$50.00 37

Dental - DHMO Code

Procedure Description

Member Pays

Diagnostic/preventive (cont.)

D1110

D1120

Prophylaxis (cleaning) – Adult (limit 2 per calendar year) Additional Prophylaxis (Cleaning) – In Addition to the 2 Prophylaxes (Cleanings) Allowed per Calendar Year Prophylaxis (cleaning) – Child (limit 2 per calendar year) Additional Prophylaxis (Cleaning) – In Addition to the 2 Prophylaxes (Cleanings) Allowed per Calendar Year

Code

Procedure Description

Member Pays

Periodontics (cont.) $0.00

D4341

Periodontal scaling and root planing – 4 or more teeth per quadrant (limit 4 quadrants per consecutive 12 months)

$40.00

D4342

Periodontal scaling and root planing – 1 to 3 teeth per quadrant (limit 4 quadrants per consecutive 12 months)

$30.00

D4910

Periodontal maintenance (limit 2 per calendar year) (only covered after active periodontal therapy)

$30.00

Additional periodontal maintenance procedures (beyond 2 per calendar year)

$55.00

Periodontal charting for planning treatment of periodontal disease

$0.00

Periodontal hygiene instruction

$0.00

$45.00

$0.00 $35.00

D1206

Topical application of fluoride varnish (limit 2 per calendar year). There is a combined limit of a total of 2 D1206s and/or D1208s per calendar year.

$0.00

D1351

Sealant – Per tooth

$10.00

Restorative (fillings, including polishing)

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 $200.00 per denture.

D2140

Amalgam – 1 surface, primary or permanent

$0.00

D2330

Resin-based composite – 1 surface, anterior

$0.00

D5110

Full upper denture

$150.00

$35.00

D5120

Full lower denture

$150.00

Crown and bridge – All charges for crown and bridge (fixed partial denture) are per unit (each replacement or supporting tooth equals 1 unit) – Replacement limit 1 every 5 years. The charges below include the cost of base metal. Noble metal and high noble metal (precious) or titanium metal, if used, will be charged to the Member at an additional maximum amount of $150.00 per tooth. If a cast post and core is made of high noble metal, an additional fee up to $100.00 per tooth may be charged for the upgraded post and core. Porcelain, if used on molar teeth, will be charged to the Member at an additional maximum amount of $75.00 per tooth. Porcelain/Ceramic

D5211

Upper partial denture – Resin base (including clasps, rests and teeth)

$150.00

D5212

Lower partial denture – Resin base (including clasps, rests and teeth)

$150.00

D7111

Extraction of coronal remnants – Deciduous tooth

$5.00

D2740

Crown – Porcelain/ceramic substrate

$225.00

D7140

$5.00

D2792

Crown – Full cast noble metal

$185.00

Extraction, erupted tooth or exposed root – Elevation and/or forceps removal

D2722

Crown – Resin with noble metal

$185.00

D7220

Removal of impacted tooth – Soft tissue

$50.00

D2950

Core buildup – Including any pins

$50.00

D7240

Removal of impacted tooth – Completely bony

$90.00

D2390

Resin-based composite crown, anterior

Endodontics (root canal treatment, excluding final restorations) D3310

Anterior root canal – Permanent tooth (excluding final restoration)

$80.00

D3330

Molar root canal – Permanent tooth (excluding final restoration)

$250.00

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. D4211

Gingivectomy or gingivoplasty – 1 to 3 teeth per quadrant

$80.00

D4240

Gingival flap (including root planing) – 4 or more teeth per quadrant

$150.00

Oral surgery (includes routine postoperative treatment) Surgical removal of impacted tooth – Not covered for ages below 15 unless pathology (disease) exists.

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.) D8670

Periodic orthodontic treatment visit – As part of contract Children – Up to 19th birthday: 24-month treatment fee Charge per month for 24 months

$1,340.00 $56.00

Adults: 24-month treatment fee Charge per month for 24 months

$1,940.00 $81.00

SUPERIOR YOUR BENEFITS PACKAGE

Vision

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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 40 HEB ISD Benefits Website: www.mybenefitshub.com/hebisd

Vision Benefits

Monthly Premiums

In-Network

Out-of-Network

Exam (Opthalmologist)

Covered in full

Up to $42 retail

Exam (Optometrist)

Covered in full

Up to $37 retail

$130 retail allowance

Up to $68 retail

Covered in full

Not covered

Exam

$10

$50 retail allowance

Not covered

Materialsâ&#x201A; Contact Lens Fitting (standard & specialty)

$25

Frames Contact Lens Fitting (standard) Contact Lens Fitting (specialty2)

Lenses (standard) per pair Single Vision

Covered in full

Up to $32 retail

Bifocal

Covered in full

Up to $46 retail

Trifocal

Covered in full

Up to $61 retail

See description3

Up to $61 retail

Progressive lens upgrade Contact Lenses 4

EE Only

$7.18

EE + 1 dependent

$13.94

EE + family

$20.47

Co-Pays

Services/Frequency Exam

12 months

Frame

24 months

Contact Lens Fitting

12 Months

Lenses

12 months

Contact Lenses

12 months

$150 retail allowance Up to $100 retail

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1 Materials co-pay applies to lenses and frames only, not contact lenses 2 The specialty contact lens fitting is for new contact lens wearers and/or a member who wears toric, gas permeable, or multifocal lenses. 3 Covered to providerâ&#x20AC;&#x2122;s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 4 Contact lenses are in lieu of eyeglass lenses and frames benefit

Discount Features

Discounts on Non-Covered Exam and Materials

Look for providers in the Provider Directory who accept discounts, as some do not; please verify their services and discounts (range from 10%-30%) prior to service as they vary. Discounts on Covered Materials Frames: 20% off amount over allowance Lens options: 20% off retail Progressives: 20% off amount over retail lined trifocal lens, including lens options The following options have out-of-pocket maximums5 on standard (not premium, brand, or progressive) lenses. Maximum Member Out-of-Pocket Single Vision

Bifocal & Trifocal

Scratch coat

$13

Ultraviolet coat

$15

Tints, solid or gradients

$25

Anti-reflective coat

$50

Polycarbonate

$40

20% off retail

High index 1.6

$55

20% off retail

Photochromics

$80

20% off retail

Exams, frames, and prescription lenses: Lens options, contacts, other prescription materials: Disposable contact lenses:

20% off retail 10% off retail

Refractive Surgery Superior Vision has a nationwide network of refractive surgeons and leading LASIK networks who offer members a discount. These discounts range from 15%-50%, and are the best possible discounts available to Superior Vision. The Plan discount features are not insurance. All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan. Discounts are subject to change without notice. Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions.

Discounts and maximums may vary by lens type. Please check with your provider.

THE STANDARD YOUR BENEFITS PACKAGE

Long Term 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 42 HEB ISD Benefits Website: www.mybenefitshub.com/hebisd

Long Term Disability Voluntary Long Term Disability Insurance Standard Insurance Company has developed this document to provide you with information about the optional insurance coverage you may select through HEB ISD. Written in non-technical language, this is not intended as a complete description of the coverage. If you have additional questions, please refer to the group Voluntary Long Term Disability Insurance for Educators and Administrators brochure included in your packet or check with your human resources representative. Employer Plan Effective Date The group policy effective date was September 1, 2011. Eligibility To become insured, you must be:  A regular employee of Hurst-Euless-Bedford Independent School District, excluding temporary or seasonal employees, full-time members of the armed forced, leased employees or independent contractors  Actively at work at least 20 hours each week  A citizen or resident of the Unites States or Canada Employee Coverage Effective Date Please contact your benefit administrator for more information regarding the following requirements that must be satisfied for your insurance to become effective. You must satisfy:  Eligibility requirements  An eligibility waiting period of the first day of the month that follows or coincides with the date you become an eligible employee  An evidence of insurability requirement, if applicable  An active work requirement. This means that if you are not actively at work on the day before the scheduled effective date of insurance, your insurance will not become effective until the day after you complete one full day of active work as an eligible employee. Benefit Amount You may select a monthly benefit amount in $100 increments from $200 to $8,000; based on the tables and guidelines presented in the Rates section of these Coverage Highlights. The monthly benefit amount must not exceed 66 2/3 percent of your monthly earnings. Benefits are payable for non-occupational disabilities only. Occupational disabilities are not covered. Plan Maximum Monthly Benefit: 66 2/3 percent of predisability earnings. Plan Minimum Monthly Benefit: 10 percent of your LTD benefit before reduction by deductible income. Benefit Waiting Period The benefit waiting period is the period of time that you must be continuously disabled before benefits become payable. Benefits are not payable during the benefit waiting period. The maximum benefit period is the period for which benefits are payable. The benefit waiting period options associated with your plan include: Option 1 2 3 4 5 6

Accidental Injury 0 days 14 days 30 days 60 days 90 days 180 days

Other Disabilities 7 days 14 days 30 days 60 days 90 days 180 days

Maximum Benefit Period To Age 65 for both Sickness and Accident To Age 65 for both Sickness and Accident To Age 65 for both Sickness and Accident To Age 65 for both Sickness and Accident To Age 65 for both Sickness and Accident To Age 65 for both Sickness and Accident

First Day Hospital Benefit: With this benefit, if an insured employee is admitted as a hospital inpatient for at least for hours during the Benefit Waiting Period, the Benefit Waiting Period will be satisfied. Benefits become payable on the date of the hospitalization; the maximum benefit period also begins on that date. This feature is included only on LTD plans with Benefit Waiting Periods of 30 days or less.

Preexisting Condition Exclusion A general description of the Pre-existing Condition Exclusion is included in the Group Voluntary Long Term Disability insurance for Educators and Administrators brochure. If you have questions, please check with your benefit administrator. Pre-existing Condition Period: The 90-days period just before your insurance become effective Exclusions Period: 12 months. Preexisting Condition Waiver For the first 45 days of disability, The Standard will pay full benefits even if you have a preexisting condition. After 45 days, The Standard will continue benefits only if the preexisting condition exclusion does not apply. Own Occupation Period For the plan’s definition of disability, as described in your brochure, the own occupation period is the first 12 months for which LTD benefits are paid. Any Occupation Period The any occupation period begins at the end of the own occupation period and continues until the end of the maximum benefit period. Maximum Benefit Period Maximum benefit to age 65 for any covered disability. The maximum period for which benefits are payable is shown in the tables below. If you become disabled before age 62, LTD benefits may continue during disability until you reach age 65. If you become disabled at age 62 or older, the benefit duration is determined by your age when disability begins: Age 62 63 64 65 66 67 68 69+

Maximum Benefit Period 3 years 6 months 3 years 2 years 6 months 2 years 1 year 9 months 1 year 6 months 1 year 3 months 1 year

Other LTD Benefits  Employee Assistance Program (EAP) - This program offers support, guidance and resources that help an employee resolve personal issues and meet life’s challenges.  Special Dismemberment Provision—If an employee suffers a lost as a result of an accident, the employee will be considered disabled for the applicable Minimum Benefit Period and can extend beyond the end of the Maximum Benefit Period.  Reasonable Accommodation Expense Benefit—Subject to The Standard’s prior approval, this benefit allows us to pay up to $25,000 of employer’s expenses toward work-site modifications that result in a disabled employee’s return to work.  Survivor Benefit—A Survivor Benefit may also be payable. This benefit can help to address a family’s financial need in the event of the employee’s death.  Return to Work (RTW) Incentive - The Standard’s RTW Incentive is one of the most comprehensive in the employee benefits history. For the first 12 months after returning to work, the employee’s LTD benefit will not be reduced by work earnings until work earnings pays the LTD benefit exceed 100 percent of predisability earnings. After that period, only 50 percent of work earnings are deducted. Rehabilitation Plan Provision—Subject to The Standard’s prior approval, rehabilitation incentives may include training and education expense, family (child and elder) care expenses, and job-related and job search expenses.

Long Term Disability When Benefits End LTD benefits end automatically on the earliest of:  The date you are no longer disabled  The date your maximum benefit period ends  The date you die  The date benefits become payable under any other LTD plan under which you become insured through employment during a period of temporary recovery  The date you fail to provide proof of continued disability and entitlement to benefits Rates Employees can select a monthly LTD benefit ranging from a minimum of $200 to a maximum amount based on how much they earn. Follow these steps, referencing the attached charts, to find the monthly cost for your desired level of monthly LTD benefit and benefit waiting period: 1. Find the maximum LTD benefit by locating the amount of your earnings in either the Annual Earnings or Monthly Earnings

Annual Earnings

Monthly Earnings

3,600 5,400 7,200 9,000 10,800 12,600 14,400 16,200 18,000 19,800 21,600 23,400 25,200 27,000 28,800 30,600 32,400 34,200 36,000 37,800 39,600 41,400 43,200 45,000 46,800 48,600 50,400 52,200 54,000 55,800 57,600 59,400 61,200 63,000 64,800 44 66,600

300 450 600 750 900 1,050 1,200 1,350 1,500 1,650 1,800 1,950 2,100 2,250 2,400 2,550 2,700 2,850 3,000 3,150 3,300 3,450 3,600 3,750 3,900 4,050 4,200 4,350 4,500 4,650 4,800 4,950 5,100 5,250 5,400 5,550

column. The LTD benefit amount shown associated with these earnings is the maximum amount you can receive. If your earnings fall between two amounts, you must select the lower amount. 2. Select the desired monthly LTD benefit between the minimum of $200 and the determined maximum amount, making sure not exceed the maximum for your earnings. 3. In the same row, select the desired benefit waiting period to see the monthly cost for that selection. If you have questions regarding how to determine your monthly LTD benefit, the benefit waiting period, or the premium payment of your desired benefit, please contact your human resources representative. Group Insurance Certificate If you become insured, you will receive a group insurance certificate containing a detailed description of the insurance coverage. The information presented above is controlled by the group policy and does not modify it in any way. The controlling provisions are in the group policy issued by Standard Insurance Company.

Options 1 –6: Maximum benefit to age 65 for both accident and sickness Accident / Sickness Benefit Waiting Period Cost Per Month Monthly Disability 0-7 14 - 14 30 - 30 60 - 60 90 - 90 180 - 180 Benefit 200 300 400 500 600 700 800 900 1,000 1,100 1,200 1,300 1,400 1,500 1,600 1,700 1,800 1,900 2,000 2,100 2,200 2,300 2,400 2,500 2,600 2,700 2,800 2,900 3,000 3,100 3,200 3,300 3,400 3,500 3,600 3,700

9.74 14.61 19.48 24.35 29.22 34.09 38.96 43.83 48.70 53.57 58.44 63.31 68.18 73.05 77.92 82.79 87.66 92.53 97.40 102.27 107.14 112.01 116.88 121.75 126.62 131.49 136.36 141.23 146.10 150.97 155.84 160.71 165.58 170.45 175.32 180.19

7.78 11.67 15.56 19.45 23.34 27.23 31.12 35.01 38.90 42.79 46.68 50.57 54.46 58.35 62.24 66.13 70.02 73.91 77.80 81.69 85.58 89.47 93.36 97.25 101.14 105.03 108.92 112.81 116.70 120.59 124.48 128.37 132.26 136.15 140.04 143.93

6.42 9.63 12.84 16.05 19.26 22.47 25.68 28.89 32.10 35.31 38.52 41.73 44.94 48.15 51.36 54.57 57.78 60.99 64.20 67.41 70.62 73.83 77.04 80.25 83.46 86.67 89.88 93.09 96.30 99.51 102.72 105.93 109.14 112.35 115.56 118.77

4.38 6.57 8.76 10.95 13.14 15.33 17.52 19.71 21.90 24.09 26.28 28.47 30.66 32.85 35.04 37.23 39.42 41.61 43.80 45.99 48.18 50.37 52.56 54.75 56.94 59.13 61.32 63.51 65.70 67.89 70.08 72.27 74.46 76.65 78.84 81.03

3.80 5.70 7.60 9.50 11.40 13.30 15.20 17.10 19.00 20.90 22.80 24.70 26.60 28.50 30.40 32.30 34.20 36.10 38.00 39.90 41.80 43.70 45.60 47.50 49.40 51.30 53.20 55.10 57.00 58.90 60.80 62.70 64.60 66.50 68.40 70.30

2.94 4.41 5.88 7.35 8.82 10.29 11.76 13.23 14.70 16.17 17.64 19.11 20.58 22.05 23.52 24.99 26.46 27.93 29.40 30.87 32.34 33.81 35.28 36.75 38.22 39.69 41.16 42.63 44.10 45.57 47.04 48.51 49.98 51.45 52.92 54.39

Long Term Disability Options 1 â&#x20AC;&#x201C;6: Maximum benefit to age 65 for both accident and sickness (cntd.) Accident / Sickness Benefit Waiting Period Cost Per Month Annual Earnings

Monthly Earnings

Monthly Benefit

0-7

14 - 14

30 - 30

60 - 60

90 - 90

180 - 180

68,400

5,700

3,800

185.06

147.82

121.98

83.22

72.20

55.86

70,200

5,850

3,900

189.93

151.71

125.19

85.41

74.10

57.33

72,000

6,000

4,000

194.80

155.60

128.40

87.60

76.00

58.80

$73,800

$6,150

$4,100

199.67

159.49

131.61

89.79

77.90

60.27

75,600

6,300

4,200

204.54

163.38

134.82

91.98

79.80

61.74

77,400

6,450

4,300

209.41

167.27

138.03

94.17

81.70

63.21

79,200

6,600

4,400

214.28

171.16

141.24

96.36

83.60

64.68

81,000

6,750

4,500

219.15

175.05

144.45

98.55

85.50

66.15

82,800

6,900

4,600

224.02

178.94

147.66

100.74

87.40

67.62

84,600

7,050

4,700

228.89

182.83

150.87

102.93

89.30

69.09

86,400

7,200

4,800

233.76

186.72

154.08

105.12

91.20

70.56

88,200

7,350

4,900

238.63

190.61

157.29

107.31

93.10

72.03

90,000

7,500

5,000

243.50

194.50

160.50

109.50

95.00

73.50

91,800

7,650

5,100

248.37

198.39

163.71

111.69

96.90

74.97

93,600

7,800

5,200

253.24

202.28

166.92

113.88

98.80

76.44

95,400

7,950

5,300

258.11

206.17

170.13

116.07

100.70

77.91

97,200

8,100

5,400

262.98

210.06

173.34

118.26

102.60

79.38

99,000

8,250

5,500

267.85

213.95

176.55

120.45

104.50

80.85

100,800

8,400

5,600

272.72

217.84

179.76

122.64

106.40

82.32

102,600

8,550

5,700

277.59

221.73

182.97

124.83

108.30

83.79

104,400

8,700

5,800

282.46

225.62

186.16

127.02

110.20

85.26

106,200

8,850

5,900

287.33

229.51

189.39

129.21

112.10

86.73

108,000

9,000

6,000

292.20

233.40

192.60

131.40

114.00

88.20

109,800

9,150

6,100

297.07

237.29

195.81

133.59

115.90

89.67

111,600

9,300

6,200

301.94

241.18

199.02

135.78

117.80

91.14

113,400

9,450

6,300

306.81

245.07

202.23

137.97

119.70

92.61

115,200

9,600

6,400

311.68

248.96

205.44

140.16

121.60

94.08

117,000

9,750

6,500

316.55

252.85

208.65

142.35

123.50

95.55

118,800

9,900

6,600

321.42

256.74

211.86

144.54

125.40

97.02

120,600

10,050

6,700

326.29

260.63

215.07

146.73

127.30

98.49

122,400

10,200

6,800

331.16

264.52

218.28

148.92

129.20

99.96

124,200

10,350

6,900

336.03

268.41

221.49

151.11

131.10

101.43

126,000

10,500

7,000

340.90

272.30

224.70

153.30

133.00

102.90

127,800

10,650

7,100

345.77

276.19

227.91

155.49

134.90

104.37

129,600

10,800

7,200

350.64

280.08

231.12

157.68

136.80

105.84

131,400

10,950

7,300

355.51

283.97

234.33

159.87

138.70

107.31

133,200

11,100

7,400

360.38

287.86

237.54

162.06

140.60

108.78

135,000

11,250

7,500

365.25

291.75

240.75

164.25

142.50

110.25

136,800

11,400

7,600

370.12

295.64

243.96

166.44

144.40

111.72

138,600

11,550

7,700

374.99

299.53

247.17

168.63

146.30

113.19

140,400

11,700

7,800

379.86

303.42

250.38

170.82

148.20

114.66

142,200

11,850

7,900

384.73

307.31

253.59

173.01

150.10

116.13

152.00

45 117.60

144,000

12,000

8,000

389.60

311.20

256.80

175.20

UNUM

Critical Illness

YOUR BENEFITS PACKAGE

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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 HEB ISD Benefits Website: www.mybenefitshub.com/hebisd

Critical Illness How can critical illness insurance help? Critical Illness insurance helps offset the financial effects of a catastrophic illness by paying a lump sum benefit when employees or their family members are diagnosed with a covered illness. The benefit is based on the amount of coverage inforce, the illness diagnosed and all other terms and provisions of the policy.

Benefit Overview Critical illness insurance is designed to help employees offset the financial effects of a catastrophic illness with a lump sum benefit if an insured is diagnosed with a covered critical illness. The Critical Illness benefit is based on the amount of coverage in effect on the date of diagnosis of a critical illness or the date treatment is received according to the terms and provisions of the policy. Coverage Amounts

Guarantee Issue

Pre-Existing Condition Benefit Waiting Period Portability Wellness Benefit Recurrence Benefit Premium Rate Information

Employee - $10,000 to $30,000 in increments of $10,000 Spouse/Child - 100% of Employee Coverage Amount Employee - $30,000 Spouse /Child– 100% of Employee Coverage Amount 3/12 exclusion 0 days Included $100 per insured per calendar year 100% Paid by the Employee Wellness benefit premium is in addition to the base premium.

Covered Conditions Critical Illnesses:  Coronary Artery Disease (major) (50%)  Coronary Artery Disease (minor) (10%)  End Stage Renal (Kidney) Failure  Heart Attack (Myocardial Infarction)  Major Organ Failure Requiring Transplant  Stroke Cancer:  Invasive Cancer (including all Breast Cancer)  Non-Invasive Cancer  Skin Cancer Supplemental Critical Illnesses:  Benign Brain Tumor  Coma  Loss of Hearing  Infectious Disease (25%)  Loss of Sight  Loss of Speech  Occupational Human Immunodeficiency Virus (HIV) or Hepatitis  Permanent Paralysis Progressive Diseases:  Amyotrophic Lateral Sclerosis (ALS)  Dementia (including Alzheimer's Disease)  Functional Loss  Multiple Sclerosis (MS)  Parkinson's Disease Additional Critical Illnesses for your Children:  Cerebral Palsy  Cleft Lip or Palate  Cystic Fibrosis  Down Syndrome  Spina Bifida Please refer to the policy for complete definitions of covered conditions Employee/Spouse Cost

Employee Age

$10,000

$20,000

$30,000

<25 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+

$7.12 $8.02 $9.12 $11.02 $13.32 $16.32 $19.82 $25.52 $34.02 $47.62 $71.92 $104.12 $149.62 $238.62

$9.22 $11.02 $13.22 $17.02 $21.62 $27.62 $34.62 $46.02 $63.02 $90.22 $138.82 $203.22 $294.22 $472.22

$11.32 $14.02 $17.32 $23.02 $29.92 $38.92 $49.42 $66.52 $92.02 $132.82 $205.72 $302.32 $438.82 $705.82 47

UNUM YOUR BENEFITS PACKAGE

Life and AD&D

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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

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 48 HEB ISD Benefits Website: www.mybenefitshub.com/hebisd

Life and AD&D Eligibility All employees working at least 20 hours each week in active employment in the U.S. with the employer, and their eligible spouses and children to age 26.

Basic Coverage Amounts Employee: $5,000 Term Life and AD&D

Voluntary Coverage Amounts Your Term Life coverage options are: Employee: Up to 5 times salary 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 $75,000. Benefits will be paid to the employee. Child: Up to 100% of employee coverage amount in increments of $5,000; not to exceed $10,000. Benefits will be paid to the employee. The maximum death benefit for a child between the ages of live birth and six months is $500. In order to purchase Life coverage for your spouse and/or child, you must purchase Life coverage for yourself. Your AD&D coverage options are: Employee: Up to 10 times salary in increments of $10,000. Not to exceed $500,000. Spouse: Up to 50% of employee amount in increments of $250,000. Child: Up to 15% of employee coverage amount in increments of $30,000; Spouse & Child: Spouse 40% of employee coverage amount and 10% of employee coverage amount; not to exceed $30,000. You may purchase AD&D coverage for yourself regardless of whether you purchase term life coverage. In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself. AD&D Benefit Schedule: The full benefit amount is paid for loss of:  Life  Both hands or both feet or sight of both eyes  One hand and one foot  One hand or one foot and the sight of one eye  Speech and hearing Other losses may be covered as well. Please see your Plan Administrator.

Guarantee Issue If you and your eligible dependents enroll during this enrollment period, you may apply for any amount of coverage up to $300,000 for yourself and any amount of coverage up to $50,000 for your spouse, without answering any medical questions.

If you want coverage over the amount you are guaranteed, you will need to provide answers to health questions. In addition, if you and your eligible dependents do not enroll during this enrollment period, you will have to wait for a future annual enrollment period to apply — and then you will need to answer health questions for the entire amount of coverage you apply for. New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense.

Why Buy Now? As long as you buy $10,000 of life coverage now, you an buy more coverage later - up to $300,000 - without answering any medical questions.

Portability/Conversion If you retire, reduce your hours or leave your employer, you can take this coverage with you according to the terms outlined in the contract. However, if you have a medical condition which has a material effect on life expectancy, you will be ineligible to port your coverage. You may also have the option to convert your Term life coverage to an individual life insurance policy.

Waiver of Premium If you become disabled (as defined by your plan) and are no longer able to work, your premium payments will be waived during the period of disability.

Does this plan include help with work-life balance? Yes. Our work-life balance employee assistance program (EAP) provides professional advice for a wide range of personal and work-related issues. The service is available to you and your family members 24 hours a day, 365 days a year. It provides resources to help you find solutions to everyday issues — such as financing a car or selecting child care — as well as more serious problems, such as alcohol or drug addiction, divorce or relationship problems. There is no additional charge for using the program, and you do not have to have filed a disability claim or be receiving benefits to use the program

Emergency Travel Assist Worldwide emergency travel assistance is included with this long term disability plan. Emergency travel assistance is available to you, your spouse* and your dependent children when you travel to any foreign country, including Canada or Mexico. It is also available anywhere in the United States when you travel just 100 or more miles from home. * A spouse traveling on business for his or her employer is not covered by the program. 49

Life and AD&D Limitations/Exclusions/Termination of Coverage Suicide Exclusion Life benefits will not be paid for deaths caused by suicide in the first twenty-four months after your effective date of coverage. No increased or additional benefits will be payable for deaths caused by suicide occurring within 24 months after the day such increased or additional insurance is effective.

AD&D Benefit Exclusions AD&D benefits will not be paid for losses caused by, contributed to by, or resulting from:  Disease of the body or diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders;  Suicide, self-destruction while sane, intentionally self-inflicted injury while sane, or self-inflicted injury while insane;  War, declared or undeclared, or any act of war;  Active participation in a riot;  Attempt to commit or commission of a crime;  The voluntary use of any prescription or non-prescription drug, poison, fume, or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol;  Intoxication. (“Intoxicated” means that the individual’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.)

Termination of Coverage Your coverage and your dependents’ coverage under the Summary of Benefits ends on the earliest of:  The date the policy or plan is cancelled;  The date you no longer are in an eligible group;  The date your eligible group is no longer covered;  The last day of the period for which you made any required contributions;  The last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness, as described in the certificate of coverage;  For dependent’s coverage, the date of your death. In addition, coverage for any one dependent will end on the earliest of:  The date your coverage under a plan ends;  The date your dependent ceases to be an eligible dependent;  For a spouse, the date of divorce or annulment.  For a dependent coverage, the date of your death. Unum will provide coverage for a payable claim which occurs while you and your dependents are covered under the policy or plan. 50

Next Steps How to Apply Current Employees: To apply for coverage, complete your enrollment by the enrollment deadline New Hires: To apply for coverage, complete your enrollment within 31 days of your eligibility date. All Employees: If you apply for coverage after your effective date, or if you choose coverage over the guarantee issue amount, you will need to complete a medical questionnaire which you can get from your Plan Administrator. You may also be required to take certain medical tests at Unum’s expense.

Effective Date of Coverage Please see your Plan Administrator for your effective date.

Delayed Effective Date of Coverage Employee: Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. Dependent: Insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Exception: infants are insured from live birth. “Totally disabled” means that, as a result of an injury, a sickness or a disorder, your dependent is confined in a hospital or similar institution; is unable to perform two or more activities of daily living (ADLs) because of a physical or mental incapacity resulting from an injury or a sickness; is cognitively impaired; or has a life threatening condition.

Changes to Coverage Each year you and your spouse will be given the opportunity to change your Life coverage and AD&D coverage. You and your spouse may purchase additional Life coverage up to one benefit unit increase without evidence of insurability if you are already enrolled in the plan. Elected Life coverage over the one benefit unit increase will be medically underwritten and will require evidence of insurability and approval by Unum’s Medical Underwriters. The suicide exclusion will apply to any increase in coverage. AD&D coverage does not require evidence of insurability for increase amounts.

Questions If you should have any questions about your coverage or how to enroll, please contact your Plan Administrator.

Life and AD&D Term Life Rate Chart Anniversary aging: Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date. Spouse aging: Spouse rate is based on employeeâ&#x20AC;&#x2122;s insurance age. Age band

Employee rate per $10,000

<20 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95+

$0.24 $0.38 $0.40 $0.53 $0.75 $0.95 $1.36 $2.24 $3.96 $5.72 $10.09 $16.15 $15.44 $15.44 $28.44 $46.44 $70.50

Spouse rate per $5,000 $0.12 $0.19 $0.20 $0.265 $0.375 $0.475 $0.68 $1.12 $1.98 $2.86 $5.045 $8.075 $7.72 $7.72 $14.22 $23.22 $35.25

Child life monthly rate is $0.60 for $5,000 or $1.20 for $10,000. One life premium covers all children.

AD&D Rate Chart Employee Employee & Family

AD&D cost Per $10,000 Per $10,000

Monthly Cost $0.24 $0.33

Term Life Calculation Worksheet Coverage amount Employee Spouse

Increment $10,000 $5,000

Rate

Monthly cost

AD&D Calculation Worksheet Coverage amount Employee Employee + Family

Increment $10,000 $10,000

Rate

Monthly cost

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.

Unlimited FSA (Non HSA Compatible) The funds in the unlimited healthcare FSA can be used to pay for eligible medical expenses like deductibles, co-payments, orthodontics, glasses and contacts.

FLIP TOâ&#x20AC;Ś PG. 13 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 52 HEB ISD Benefits Website: www.mybenefitshub.com/hebisd

FSA (Flexible Spending Account) NBS Flexcard

When Will I Receive My Flex Card?

You may use the card to pay merchants or service providers that accept MasterCard® credit cards, so there is no need to pay cash up front, then wait for reimbursement. If you are participating in the Dependent Care portion, the money isn’t loaded to the card. You must file web or paper claims or enroll in continual reimbursement.

NBS Prepaid MasterCard® Debit Card

New Plan Participants NBS will mail out your new benefit cards to the address listed in THEbenefitsHUB. They will be sent in unmarked envelopes so please watch for them as they should arrive within 21 business days of effective date. NBS debit cards are good for 3 years.

FSA Annual Contribution Max: $2,400

Dependent Care Annual Max: $5,000

Expect Flex Cards to be delivered to the address listed in THEbenefitsHUB near the end of September. Don’t forget, Flex Cards Are Good For 3 Years! For a list of sample expenses, please refer to the HEB ISD benefit website: www.mybenefitshub.com/hebisd

NBS Contact Information: 8523 South Redwood Road West Jordan, UT 84088 Phone (800) 274‐0503 Fax (800) 478‐1528 Email: service@nbsbenefits.com

DID YOU KNOW? FSAs use tax-free funds to help pay for your Health Care Expenses.

Account Information: Participant Account Web Access: www.participant.nbsbenefits.com Participants may call NBS and talk to a representative during regular business hours, Monday-Friday, 8 am to 7 pm Central Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to the NBS website: www.NBSbenefits.com     

Detailed claim history and processing status Health Care and Dependent Care account balances Claim forms, Direct Deposit form, worksheets, etc. Online claims FAQs

FSA Frequently Asked Questions What is a Flexible Spending Account? A Flexible Spending Account allows you to save money by paying out-of-pocket health and/or dependent care related expenses with pre-tax dollars. Your contributions are deducted from your pay before taxes are withheld and your account is up fronted with an annual amount. Because you are taxed on a lower amount of pay, you pay less in taxes and you have more to spend.

How does a Flexible Spending Account Benefit Me? A Cafeteria plan enables you to save money on group insurance, health-related expenses, and dependent-care expenses. You may save as much as 35 percent on the cost of each benefit option! Eligible expenses must be incurred within the plan year and contributions are use-it-or- lose-it. Remember to retain all your receipts.

Health Care Expense Account Example Expenses:          

Acupuncture Body scans Breast pumps Chiropractor Co-payments Deductible Diabetes Maintenance Eye Exam & Glasses Fertility treatment First aid

        

Hearing aids & batteries Lab fees Laser Surgery Orthodontia Expenses Physical exams Pregnancy tests Prescription drugs Vaccinations Vaporizers or humidifiers

Dependent Care Expense Account Example Expenses:    

Before and After School and/or Extended Day Programs The actual care of the dependent in your home. Preschool tuition. The base costs for day camps or similar programs used as care for a qualifying individual.

What Can I Use My Flexible Spending Account On? For a full list of eligible expenses, please refer to www.mybenefitshub.com/hebisd

What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)? Eligible expenses must be incurred within the plan year. Contributions are use-it-or- lose-it. Remember to retain all your receipts (including receipts for card swipes).

How Do I File A Claim? In most situations, you will be able to swipe your card however, in the event you lose your card or are waiting to receive one, you can visit www.mybenefitshub.com/hebisd and complete the “Claim Form” to send to NBS or use the web or phone app to file online.

How To Receive Your Dependent Care Reimbursement Faster. A Direct Deposit form is available on the Benefits Website which will help you get reimbursed quicker!

How the FSA Plan Works You designate an annual election of pre-tax dollars to be deposited into your health and dependent-care spending accounts. Your total election is divided by the number of pay periods in the Plan year and deducted equally from each paycheck before taxes are calculated. By the end of the Plan year, your total election will be fully deposited. However, you may make a claim for eligible health FSA expenses as soon as they are incurred during the Plan year. Eligible claims will be paid up to your total annual election even if you have not yet contributed that amount to your account.

Get Your Money 1. 2. 3. 4.

Complete and sign a claim form (available on our website) or an online claim. Attach documentation; such as an itemized bill or an Explanation of Benefits (EOB) statement from a health insurance provider. Fax or mail signed form and documentation to NBS. Receive your non-taxable reimbursement after your claim is processed either by check or direct deposit.

NBS Flexcard—FSA Pre-paid Benefit Card Your employer may sponsor the use of the NBS Flexcard, making access to your flex dollars easier than ever. You may use the card to pay merchants or service providers that accept credit cards, so there is no need to pay cash up front then wait for reimbursement.

Account Information Participants may call NBS and talk to a representative during our regular business hours, Monday–Friday, 7am to 6pm Mountain Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to our website: www.NBSbenefits.com Information includes:  Detailed claim history and processing status  Health Care and Dependent Care account balances  Claim forms, worksheets, etc.  Online Claim Submission

Enrollment Considerations After the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying “change of status” (marriage status, employment change, dependent change). Be conservative in the total amount you elect to avoid forfeiting money that may be left in your account at the end of the year.

LEGAL EASE YOUR BENEFITS PACKAGE

Legal Services

About this Benefit Finding the right type of attorney when a need arises can be one of the more stressful tasks when dealing with a legal matter. The right help is essential. There are many types of attorneys depending upon what type of issue someone may be facing. We help with this first step. We use our experience and relationships with our network providers to match you to the right type of attorney you need in the right location, with availability to set up a consultation with you. We see this step as a way to save you time, so you can get back to your busy schedule of work, kids or whatever may be just as important.

$1,500 Is the average cost of a basic will and estate planning package. The average yearly premium paid by Texas Legal Members is only $300.

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 HEB ISD Benefits Website: www.mybenefitshub.com/hebisd

Legal Services LegalGUARD Plan Benefits

Plan Cost:

Benefits are designed to meet the typical needs of an employee and their family. There are no deductibles to worry about for covered services. Benefits cover the attorney’s time. Other costs, such as filing fees, are not covered by legal benefits. Listed below are the types of matters that are covered by the LegalGUARD Plan. The LegalGUARD plan offers convenience of In Network and Out of Network benefits. Many of the below areas are fully covered, unless noted.

The LegalGUARD Plan is only $16.91 per month, via payroll deduction. The LegalGUARD Plan + Family Coverage is only $18.88 per month, via payroll deduction.

Consultation  

Office Consultation* Telephone Advice

Consumer   

Consumer Dispute Small Claims Court Representation* Document Preparation: Simple Deed Promissory Note Consumer Dispute Correspondence Installment Sales Agreement Simple Affidavit General Power of Attorney Lease Agreement – Tenant Only Time Share Agreement

Estate Planning and Wills     

Simple Will or Codicil* Living Will Health Care Power of Attorney Living Trust Document Probate of Small Estate*

Financial          

Family

Debt Collection Defense Pre-litigation defense activities Trial defense*

Bankruptcy (chapter 7 or 13)* Tax Audit* Foreclosure* Financial Planning* Savings Coaching* Budgeting Coaching* Credit Coaching* Savings Coaching* Debt Management Programs*

Home    

Civil Litigation Defense*

Uncontested Separation* Consent/default Divorce* Uncontested Divorce* Contested Divorce* Name Change Guardianship/Conservatorship* Governmental Agency Adoptions* Stepparent Adoptions* Juvenile Court Proceedings

Criminal  

Purchase of Primary Residence Sale of Primary Residence Refinancing of Primary Residence Landlord/Tenant Dispute*

Civil 

        



Traffic Defense (resulting in suspension or revocation of license) Administrative Proceeding (regarding suspension or revocation of license) Misdemeanor Defense*

Elder/Parents        

Consultation Review Documents* Standard Wills Prepared* Codicil* Amendment to a single document* Amendment(s) to spousal document* Living Will* Powers of Attorney*

*Some limitations apply

LegalGUARD Covered Family Member Definition: The Member’s lawful spouse and children. Eligible Family Members are the Member’s spouse and Member’s unmarried dependent children, including stepchild, legally adopted child, child placed in the home for adoption and foster child, up to age 19, and from age 19 up to 26 years if they are enrolled in an accredited school or college as full-time student(s) and are primarily dependent upon the Member for support.

Limitations and Exclusions Apply. This benefit summary is intended only to highlight benefits and should not be relied upon to fully determine coverage. More complete descriptions of benefits and the terms under which they are provided are received upon enrolling in the plan. Group legal plans are administered by LegalEASE or The LegalEASE Group, Houston, Texas. Product available in all states. Underwritten by Virginia Surety Company, Inc. Please contact LegalEASE for complete details.

Retirement Planning

403(b) / 457(b)

You may enroll in a 403(b) and/or 457(b) anytime during the year!

403(b) Plan

457(b) Plan

The Omni Group 877-544-6664 www.omni403b.com

TCG Administrators 800-943-9179

What is a 403(b)? A 403(b) plan is a retirement plan for certain employees of public schools, tax-exempt organizations and ministers. Contributions are made under a Salary Reduction Agreement (SRA) with your employer. This agreement allows your employer to withhold money from your paycheck to be contributed directly into a 403(b) account for your benefit. Usually, you do not pay income tax on these contributions until you withdraw them from the account. You have 35 + companies to choose from with a variety of investment types available (fixed annuity, fixed index annuity, variable annuity, investment advisory services, or mutual funds) â&#x20AC;&#x201C; Please visit www.trs.state.tx.us and select 403b Certification and click on View 403(b) Products List to see the list of fees charged by each company/product. How to Enroll: Step 1: Set up your 403b account with an approved vendor (see the link above) Step 2: Complete the Salary Reduction Agreement with The Omni Group (see the following pages for login instructions)

http://tcgservices.com/documents/#/255/457b

What is a 457(b)? The 457(b) plan is a type of deferredcompensation retirement plan that is available for governmental employers. The employer provides the plan and the employee defers compensation into it on a pre-tax basis. For the most part the plan operates similarly to a 401(k) or 403(b) plan. The key difference is that there is no penalty for withdrawal before the age of 59Â˝ (but subject to income tax).

HEB ISD has selected 1 company to provide our employees with the 457(b) plan. TCG Administrators offers several investment options

How to Enroll: Complete the Salary Reduction Agreement with TCG Administrators (see the following pages for login instructions)

There is an additional tax penalty on any funds withdrawn prior to retirement age

No penalty for early withdrawal (upon separation of service)

Maximum Contributions: Annual Maximum - $18,000 Over age 50 Catch-up - $6,000

403(b) - Omni Group WHAT DOES OMNI DO? Your employer has hired The Omni Group to administer their 403(b) plan in accordance with applicable IRS regulations.

WHAT DOES OMNI DO FOR YOU? Ensure you do not exceed your Contribution Limit Process changes to your contributions Process Plan transaction requests (loans, hardships, rollovers, etc.)

HOW DO YOU START A 403(B) RETIREMENT SAVING ACCOUNT? Step 1: Go to your employer’s webpage on our website, http://www.omni403b.com and select the “Participants” button.

Step 2: Select your state, type in name of your employer in the “Employer Plan Info.” Box and click “Show Details.”

403(b) - Omni Group Step 3: Choose your Service Provider & Open your account.

Step 4: Submit a SRA (Salary Reduction Agreement) to Omni

457(b) - TCG The 457(b) Retirement Savings Plan is a voluntary savings program designed to allow employees to defer a portion of their compensation through payroll deductions. These deferrals are made on a pre-tax basis and allow employees the opportunity to save for retirement. The 457(b) Retirement Savings Plan is an attractive alternative to traditional 403(b) “tax sheltered annuity” programs. The Retirement Savings Plan is set up under Section 457(b) of the Internal Revenue Code. The plan is offered through the ESC Region 10 457 Cooperative and Master Plan by means of an interlocal agreement with each participating District. The Plan works for the most part like a 401(k) plan. Employees can enroll in the plan online or with forms without the need to meet with a sales person. Educational meetings are offered to the District by salaried representatives of the companies providing the plan services. No commissions are paid to any individuals or companies from the plan. A 457(b) plan has the same basic features and advantages of 403(b) and 401(k) plans. However, funds paid out of a 457(b) plan are not subject to an early withdrawal excise tax (unlike 403(b), IRAs or 401(k) plans).

457(b) Plan Enrollment Instructions 1. Go to www.tcgservices.com/login/ to set up your salary deferral (contribution amount) and allocation a. Click on "Group Retirement Plan Login" b. Click on "New User" c. Enter the Plan Password from the Summary Plan Description d. Enter Social Security Number without dashes e. Select “Next” 2. Upon entering the site, you will move through several steps: a. Establish username and password b. Create security questions and answers c. Enter your personal information d. Beneficiaries e. Contributions f. Investment Elections g. Confirmation Congratulations, your account has been created. Additionally, the contribution amount to be deducted from your paycheck will be communicated with the District. Please call TCG Administrators at (800) 943-9179 with any questions or concerns.

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