MCKINNEY ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2019 - 8/31/2020 WWW.MYBENEFITSHUB.COM/MCKINNEYISD 1
Table of Contents
Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Section 125 Cafeteria Plan Guidelines 2. Annual Enrollment 3. Eligibility Requirements 4. Helpful Definitions TRS-ActiveCare Scott & White HMO Delta Dental Avesis Vision Discovery Benefits FSA UNUM Life and AD&D UNUM Disability UNUM Hospital Indemnity & Accident UNUM Critical Illness
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3 4-5 6-11 6 7 8 9 10-13 14-15 16-17 18-19 20-21 22-23 24-29 30-31 32-33
FLIP TO... PG. 4
HOW TO ENROLL
PG. 8
SUMMARY PAGES
PG. 14
YOUR BENEFITS
Benefit Contact Information MCKINNEY ISD BENEFITS
MCKINNEY ISD BENEFITS OFFICE
Financial Benefit Services (469) 385-4685 www.mybenefitshub.com/mckinneyisd
benefits@mckinneyisd.net
TRS ACTIVECARE MEDICAL
TRS HMO MEDICAL
HOSPITAL INDEMNITY
Aetna (800) 222-9205 www.trsactivecareaetna.com
Scott & White HMO (800) 321-7947 www.trs.swhp.org
Unum Group #R0747188 (866) 679-3054 www.unum.com
DENTAL
VISION
FLEXIBLE SPENDING ACCOUNT
Delta Dental Group #4370 (800) 521-2651 www.deltadental.com
Avesis High Group #10771-1205-01 Base Group #10771-1205 (800) 522-0258 www.avesis.com
Discovery Benefits 866-451-3399 customerservice@discoverybenefits.com www.discoverybenefits.com
LIFE AND AD&D
DISABILITY
ACCIDENT
Unum Group #148506 (866) 679-3054 www.unum.com
Unum Group #125328 (866) 679-3054 www.unum.com
Unum Group #R0747188 (866) 679-3054 www.unum.com
CRITICAL ILLNESS
COBRA– MEDICAL
COBRA- DENTAL/VISION/FLEX
Unum Group #473073 (866) 679-3054 www.unum.com
BSWIFT 833.682.8972
National Benefit Services (800) 274-0503 www.nbsbenefits.com
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MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS MCKINNEY” to 313131 and get access to everything you need to complete your benefits enrollment:
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•
Benefit Information
•
Online Support
•
Interactive Tools And more.
Text “FBS MCKINNEY” to 313131 OR SCAN
How to Log In
1 BENEFIT INFO
INTERACTIVE TOOLS
2 3
www.mybenefitshub.com/mckinneyisd
CLICK LOGIN
ENTER USERNAME & PASSWORD Your login credentials will be the same as your McKinney ISD login. Username: Employee ID Password: district password
ONLINE SUPPORT
If you do not know your username and password please contact the Help Desk at 469-3024048 or Email support@mckinneyisd.net
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SUMMARY PAGES
Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Elections made during annual enrollment will become effective on the plan effective date or upon required underwriting approval 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 submit a Family Status Change Form and proof of a qualifying event to your Benefit Office with 31 days of your qualifying event 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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SUMMARY PAGES
Annual Enrollment During your annual enrollment period, you have the opportunity
Where can I find forms?
to review, change or continue benefit elections each year.
For benefit summaries and claim forms, go to your school
Changes are not permitted during the plan year (outside of
district’s benefit website:
annual enrollment) unless a Section 125 qualifying event occurs.
www.mybenefitshub.com/mckinneyisd. Click on the benefit plan you need information on (i.e., Dental) and you can find
•
Changes, additions or drops may be made only during the
the forms you need under the Benefits and Forms section.
annual enrollment period without a qualifying event. How can I find a Network Provider?
• Employees must review their personal information and verify that dependents they wish to provide coverage for are
district’s benefit website:
included in the dependent profile. Additionally, you must
www.mybenefitshub.com/mckinneyisd. Click on the benefit
notify your employer of any discrepancy in personal and/or benefit information.
•
For benefit summaries and claim forms, go to your school
Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section. When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and
New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligibility employment. Failure to complete elections during this time frame 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.
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SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 20 or more
Dependent Eligibility: You can cover eligible dependent
regularly scheduled hours each work week.
children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the
Eligible employees must be actively at work on the plan effective
maximum age listed below. Dependents cannot be double
date for new benefits to be effective, meaning you are physically
covered by married spouses within the district 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 2019 benefits become effective on September 1, 2019, you must be actively-at-work on September 1, 2019 to be eligible for your new benefits.
PLAN
CARRIER
MAXIMUM AGE
Medical
TRS
To 26
Dental
Delta Dental
To 26
Vision
Avesis
To 26
FSA
Discovery Benefits
To 26
Life and AD&D
UNUM
To 26
Accident
UNUM
Unmarried to 26
Hospital Indemnity
UNUM
Unmarried to 26
Critical Illness
UNUM
Unmarried to 26
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. 8
Helpful Definitions
SUMMARY PAGES
Actively at Work
In-Network
You are performing your regular occupation for the employer
Doctors, hospitals, optometrists, dentists and other providers
on a full-time basis, either at one of the employer’s usual
who have contracted with the plan as a network provider.
places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2019, 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 order to take drugs, or received medical care or services
Calendar Year
(including diagnostic and/or consultation services).
January 1st through December 31st
Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or pre-existing condition exclusion provisions do apply, as applicable by carrier.
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AETNA
Medical
YOUR BENEFITS PACKAGE
About this Benefit Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis. More than 70% of adults across the United States are already being diagnosed with a chronic disease.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 10 details on covered expenses, limitations and exclusions are included in the summary plan description located on the McKinney ISD Benefits Website: www.mybenefitshub.com/mckinneyisd
2019-2020 TRS-ActiveCare Plans Employee Premium The 19-20 MISD Monthly Contribution is $306 per month for active members in TRS.
19-20 Active Employee Monthly Premium
19-20 Active Employee "Per Paycheck" Premium
19-20 Sub/Temp Employee Monthly Premium
Active Care 1 - HD Employee Only Employee/Spouse Employee/Child(ren) Employee/Family
$72.00 $760.00 $416.00 $1,109.00
$36.00 $380.00 $208.00 $554.50
$378.00 $1,066.00 $722.00 $1,415.00
Active Care Select Employee Only Employee/Spouse Employee/Child(ren) Employee/Family
$250.00 $1,061.00 $596.00 $1,412.00
$125.00 $530.50 $298.00 $706.00
$556.00 $1,367.00 $902.00 $1,718.00
Scott and White Plan (HMO) Employee Only Employee/Spouse Employee/Child(ren) Employee/Family
$272.36 $1,047.40 $602.06 $1,203.56
$136.18 $523.70 $301.03 $601.78
$578.36 $1,353.40 $908.06 $1,509.56
Medical Plan
Active Care 2 Employee Only Employee/Spouse Employee/Child(ren) Employee/Family
$546.00 $1,714.00 $961.00 $2,083.00
Grandfathered plan / No new enrollees for 18-19 $273.00 $857.00 $480.50 $1,041.50
$852.00 $2,020.00 $1,267.00 $2,389.00
*Note: The IRS allows changes, other than at open enrollment, if the change is necessary because of a Family Status Change. Any changes to your benefits must be made within 31 days of the Family Status Change. Verification of Status Change will be required. District Monthly Contribution applies to all employees greater than 50% (greater than half-time) all plan year. For all active Employees using payroll deductions. All Medical Insurance premiums will default to Pre-Tax status unless a Post - Tax Request Form is returned to the Benefits Office. MISD Benefits Office cautions employees considering the selection of TRS Active Care Select or Scott & White Plan (HMO) options for the following reasons: Extremely limited Physician choices available (specifically Specialists), Plan is defined as an In-Network Only Plan that provides NO coverage for out of network physicians.
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2019 – 20 TRS-ActiveCare Plan Highlights Effective Sept. 1, 2019 through Aug. 31, 2020 | In-Network Level of Benefits1 TRS-ActiveCare 1-HD
TRS-ActiveCare Select or TRS-ActiveCare Select Whole Health
ActiveCare 2
$500 copay per visit plus 20% after deductible
$500 copay per visit plus 20% after deductible
$500 copay per visit plus 20% after deductible
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 Facility Charges Only (preauthorization required) In-Network
Out-of-Network
Urgent Care Freestanding Emergency Room Participant pays Emergency Room (true emergency use) Participant pays Outpatient Surgery Participant pays Bariatric Surgery (only covered if performed at an 10Q facility) Physician charges; Participant pays Annual Vision Examination (one per plan year; performed by an ophthalmologist or optometrist)Participant pays Annual Hearing Examination Participant pays Preventive Care Some examples of preventive care frequency and services: • • • •
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 – one every 10 years age 50 and over Healthy diet/obesity counseling – unlimited to age 22; age 22 and over – 26 visits per 12 months Well woman exam & pap smear – annually age 18 and over
• •
Prostate cancer screening – one per year age 50 and over Breastfeeding support – six lactation counseling visits per 12 months
Note: Covered services under this benefit must be billed by the provider as “preventive care.” Non-network preventive care is not paid at 100%. If you receive preventive services from a non-network provider, you will be responsible for any applicable deductible and coinsurance under the TRS-ActiveCare 1-HD and TRS-ActiveCare 2. There is no coverage for non-network services under the TRS-ActiveCare Select plan or TRS-ActiveCare Select Whole Health. For more information, please view the Benefits Booklet at www.trsactivecareaetna.com. TRS-ActiveCare is 12administered by Aetna Life Insurance Company. Aetna provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug benefits are administered by Caremark
2019 – 20 TRS-ActiveCare Plan Highlights
Drug Deductible Short-Term Supply at a Retail Location 20% coinsurance after deductible, except for certain generic preventive $15 copay drugs that are covered at 100%.2 3 25% coinsurance after deductible 25% coinsurance (min. $404; max. $80)3 3 50% coinsurance after deductible 50% coinsurance3 Extended-Day Supply at Mail Order or Retail-Plus Pharmacy Location (60- to 90-day supply)5 20% coinsurance after deductible $45 copay 25% coinsurance after deductible3 25% coinsurance (min. $1054; max. $210)3 3 50% coinsurance after deductible 50% coinsurance3 Specialty Medications (up to a 31-day supply)
$20 copay 25% coinsurance (min. $404; max. $80)3 50% coinsurance (min. $1004; max. $200)3 $45 copay 25% coinsurance (min. $1054; max. $210)3 50% coinsurance (min. $2154; max. $430)3 20% coinsurance (min. $2004 , max $900)
Specialty Medications
20% coinsurance after deductible 20% coinsurance Short-Term Supply of a Maintenance Medication at Retail Location up to a 31-day supply
The second time a participant fills a short-term supply of a maintenance medication at a retail pharmacy, they will be charged the coinsurance and copays in the rows below. Participants can save more over the plan year by filling a larger day supply of a maintenance medication through mail order or at a Retail-Plus location.
Tier 1 – Generic Tier 2 – Preferred Brand Tier 3 – Non-Preferred Brand
20% coinsurance after deductible 25% coinsurance after deductible3 50% coinsurance after deductible3
$30 copay 25% coinsurance (min. $604; max. $120)3 50% coinsurance3
$35 copay 25% coinsurance (min. $604; max. $120)3 50% coinsurance (min. $1054; max. $210)3
What is a maintenance medication? Maintenance medications 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 $15, then you will pay $30 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 $180 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 TRS-ActiveCare Select or TRS-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 TRS-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.
Monthly Premiums
Full monthly premium*
Premium with min. state/ district contribution**
$378
+Spouse +Children +Family
Individual
Your Monthly Premium***
Full monthly premium*
Premium with min. state/ district contribution**
$153
$556
$1,066
$841
$722
$497
$1,415
$1,190
Your Monthly Premium***
Full monthly premium*
Premium with min. state/ district contribution**
$331
$852
$627
$1,367
$1,142
$2,020
$1,795
$902
$677
$1,267
$1,042
$1,718
$1,493
$2,389
$2,164
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 may pay per month. Ask your Benefits Administrator for your monthly cost. (This is the amount you will owe each month after all available subsidies are applied to your premium.) *** Completed by your benefits administrator. The state/district contribution may be greater than $225. 13
2019-2020 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare Fully Covered Healthcare 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
$950 Individual/ $2,850 Family
Annual out-of-pocket maximum (including medical and prescription copays and coinsurance)
Lifetime Paid Benefit Maximum
Outpatient Services
$7,450 Individual/ $14,900 Family (includes combined Medical and RX copays, deductibles and coinsurance)
None
Copay $20 copay
Primary Care1
(First Primary Care Visit for Illness - $0 Copay2) / $0 Copay for primary visit for dependents age 19 and under)
Specialty Care
$70 copay
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 copay and 20% of charges after deductible
Maternity Care
Copay
Prenatal Care Inpatient Delivery
Inpatient Services Overnight hospital stay: includes all medical services including semi -private room or intensive care
Diagnostic & Therapeutic Services Physical and Speech Therapy Manipulative Therapy5
Equipment and Supplies Preferred Diabetic Supplies and Equipment Non-Preferred Diabetic Supplies and Equipment Durable Medical Equipment/ Prosthetics 14
No Charge $150 per day4 and 20% of charges after deductible
Copay $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
2019-2020 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare Home Health Services
Copay
Home Healthcare Visit
$70 copay
Worldwide Emergency Care
Copay
Nurse Advice Line
1-877-505-7947
Online Services
No Charge — go to trs.swhp.org
After-Hours Primary Care Clinics
$20 copay
Ambulance and Helicopter
$40 copay and 20% of charges after deductible
Emergency Room6
$500 copay after deductible
Urgent Care Facility
$50 copay
Prescription Drugs
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 (Up to a 30-day supply)
(Up to a 90-day supply) Available at BSW Pharmacies, in-network retail pharmacies and mail order
$5 copay
$12.50 copay
Preferred Brand
30% after Rx deductible
30% after Rx deductible
Non-Preferred
50% after Rx deductible
50% after Rx deductible
Preferred Generic
Online Refills Mail Order
Specialty Medications
Retail Quantity
trs.swhp.org BSWH: 1-817-388-3090 OptumRx: 1-855-205-9182
Copay Tier 1: 15% after Rx deductible
(Up to a 30-day supply)
Tier 2: 15% after Rx deductible Tier 3: 25% after Rx deductible
1
Including all services billed with office visit Does not apply to wellness or preventive visits 3 Includes other services, treatments, or procedures received at time of office visit 4 $750 maximum copay per admission and 20% after deductible 5 35 maximum visit per year 6 Copay waived if admitted within 24 hours 2
The SWHP MOMS Program provides you with professional nurses who are notified of the delivery of your baby. These licensed professionals will contact you after you return home and help you with everything from the general well-being of both you and your baby, to breast/bottle feeding, to information on how to add your baby to your health plan.
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DELTA DENTAL
Dental
YOUR BENEFITS PACKAGE
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 This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 16 details on covered expenses,Frisco limitations and exclusions included in the summary plan description located on the ISD Benefits Website:are www.mybenefitshub.com/friscoisd McKinney ISD Benefits Website: www.mybenefitshub.com/mckinneyisd
Dental DPO - High Option Employee PPO Premiums Tier
Monthly
Per Paycheck
EE Only
$42.32
$21.16
EE + 1 Dep
$74.89
$37.45
EE + 2 or more Deps
$96.61
$48.31
Eligibility
Primary enrollee, spouse and eligible dependent children to age 26
Deductibles
$50 per person / $150 per family each plan year
Deductibles waived for Diagnostic & Preventive (D & P) and Orthodontics?
Yes
Maximums
$1,500 per person each plan year
D & P counts toward maximum?
Yes
Waiting Period(s)
Benefits and Covered Services*
Basic Benefits
Major Benefits
Prosthodontics
Orthodontics
None
None
None
None
Delta Dental DPO dentists**
Non-Delta Dental DPO dentists**
100%
100%
80%
80%
80%
80%
80%
80%
80%
80%
50%
50%
50%
50%
50%
50%
$1,500 Lifetime
$1,500 Lifetime
Diagnostic & Preventive Services (D&P) Exams, cleanings, x-rays and sealants
Basic Services Fillings and denture repair/reline/rebase
Endodontics (root canals) Covered Under Basic Services
Periodontics (gum treatment) Covered Under Basic Services
Oral Surgery Covered Under Basic Services
Major Services Crowns, inlays, onlays and cast restorations
Prosthodontics Bridges, dentures and implants
Orthodontic Benefits Dependent children
Orthodontic Maximums
* Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist’s submitted fees. ** Reimbursement is based on DPO contracted fees for DPO dentists, Premier contracted fees for Premier dentists and program allowance for non-Delta Dental dentists. Out-of-network dentists may bill the difference between their usual fee and Delta Dental’s contracted rate - a process known as “balance billing”.
1130 Sanctuary Parkway, Suite 600 Alpharetta, GA 30009
800-521-2651
P.O. Box 1809 Alpharetta, GA 30023-1809
This benefit information is not intended or designed to replace or serve as the plan’s Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company’s benefits representative. 17
AVESIS
Vision
YOUR BENEFITS PACKAGE
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 This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 18 details on covered expenses,Frisco limitations and exclusions included in the summary plan description located on the ISD Benefits Website:are www.mybenefitshub.com/friscoisd McKinney ISD Benefits Website: www.mybenefitshub.com/mckinneyisd
Vision HIGH OPTION Vision Care Services
In-Network Member Cost
Vision Examination (Includes Refraction)
Covered in full after $10 copay
Contact Lens Fit and Follow-up Standard Contact Lens Fitting Custom Contact Lens Fitting
out-of-pocket maximum: Up to $50 Up to $75
Materials*
Frame Allowance (Up to 20% discount above frame allowance.) Standard Spectacle Lenses Single Vision Bifocal Trifocal Lenticular Preferred Pricing Options Level 7 Option Package Polycarbonate (Single Vision/Multi-Focal) Standard Scratch-Resistant Coating Ultra-Violet Screening Solid or Gradient Tint Standard Anti-Reflective Coating Level 1 Progressives Level 2 Progressives All Other Progressives
LOW OPTION
Out-of-Network Reimbursement Up to $35 N/A
In-Network Member Cost Covered in full after $10 copay out-of-pocket maximum: Up to $50 Up to $75
Out-of-Network Reimbursement Covered in full after $10 copay N/A
$ 20 copay
$ 20 copay
$ 20 copay
(Materials copay applies to frame or spectacle lenses, if applicable.)
(Materials copay applies to frame or spectacle lenses, if applicable.)
(Materials copay applies to frame or spectacle lenses, if applicable.)
$150 allowance
Up to $45
$150 allowance
Up to $45
Covered in full after copay Covered in full after copay Covered in full after copay Covered in full after copay
Up to $25 Up to $40 Up to $50 Up to $80
Covered in full after copay Covered in full after copay Covered in full after copay Covered in full after copay
Up to $25 Up to $40 Up to $50 Up to $80
Covered in full
Up to $10
Covered in full
Up to $5
$40/$44 (Covered in full up $40/$44 (Covered in full up to age 19) to age 19) $17 N/A
Covered in full Covered in full Covered in full
Up to $6 Up to $4
$15 $17
N/A N/A
Up to $24 Up to $40 Up to $48 Up to $48
N/A Up to $40 Up to $40 Up to $40
N/A
$45 $75 $110 $50 allowance + 20% discount $70/$80
N/A N/A N/A
$75 $40 Up to 20% discount
N/A N/A N/A
Covered in full Covered in full $140 allowance + 20% discount $70/$80
TransitionsŽ (Single Vision/ Multi-Focal) Polarized $75 PGX/PBX $40 Other Lens Options Up to 20% discount Contact Lenses†(in lieu of frame and spectacle lenses)
N/A
Elective Medically Necessary
$150 allowance Covered in full
Up to $128 Up to $250
$150 allowance Covered in full
Up to $128 Up to $250
Refractive Laser Surgery
Onetime/lifetime $150 allowance Provider discount up to 25%
Onetime/lifetime $150 allowance
Onetime/lifetime $150 allowance Provider discount up to 25%
Onetime/lifetime $150 allowance
Benefit Frequency (All Plans) Eye Examination Once every 12 months Lenses or Contact Lenses Once every 12 months Frame Once every 12 months
Employee Paid Rates Employee Employee + Spouse Employee + Child(ren) Employee + Family
HIGH OPTION Monthly Per Pay Check $8.90 $4.45 $15.80 $7.90 $18.34 $9.17 $23.26 $11.63
LOW OPTION Monthly Per Pay Check $5.90 $2.95 $10.30 $5.15 $12.14 $6.07 $15.05 $7.53 19
DISCOVERY BENEFITS
FSA (Flexible Spending Account)
YOUR BENEFITS PACKAGE
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.
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 20 details on covered expenses, limitations and exclusions are included in the summary plan description located on the McKinney ISD Benefits Website: www.mybenefitshub.com/mckinneyisd
FSA (Flexible Spending Account) An FSA That Simplifies Savings • • • •
One online account, one mobile app, and one debit card for all your benefits Averages debit card auto-substantiation rate of more than 85% Easy documentation uploading using mobile app Thousands of eligible expense for purchase at the FSA store
A Flexible Spending Account (FSA) allows you to budget and save for qualified medical expenses incurred over the course of your plan year. Dollars invested in an FSA are tax-free, and the entire election amount is available on the first day of the plan year. That makes an FSA a great tool for saving money, especially For easy access to your FSA funds, you can swipe your Discovery when big expenses are anticipated. Benefits debit card and avoid out-of-pocket costs. If you use your card at a provider with an Inventory Information Approval System (IIAS), the expense will automatically be approved at the Medical FSA point of sale. If the card is swiped at a merchant that meets the Pair a traditional health plan with a Medical FSA, which covers IRS’ 90% rule, you may need to provide documentation to show eligible medical, dental and vision expenses. the expense is eligible. Dependent Care Account (DCA) FSA funds are use-it-or-lose-it. You must use your funds before A DCA allows you to put money aside for dependent care for the end of the plan year or you will lose them. There is not a children up to age 13, a disabled dependent of any age or a grace period to use your FSA balance after the end of the plan disabled spouse. year but you do have 90 days from the end of the plan year to You may receive reimbursement up to the current balance in submit any claims for reimbursement on any incurred charges. your account at the time the request is made. To be eligible for a DCA, you and your spouse (if applicable) must work, be looking for work or be full- time students. Eligible Expense List www.DiscoveryBenefits.com/eligibleexpenses Medical FSA Annual Contribution Max: FSA Calculator $2,700 effective 9/1/2019 www.DiscoveryBenefits.com/fsacalculator Mobile App Video Dependent Care Annual Max: www.DiscoveryBenefits.com/mobileappvideo $5,000 FSA 101 Video www.DiscoveryBenefits.com/fsa101 FSA Store Common eligible expenses for a Medical FSA are prescriptions, www.DiscoveryBenefits.com/fsastore hearing aids, orthopedic goods, doctor visits and dentist visits,
Using Funds
Types of FSAs
Resources
Eligible Expenses
while a Limited FSA is limited to dental and vision expenses. A DCA covers expenses such as work-related daycare and elderly care costs. To find out which specific expenses are eligible, view our searchable eligibility list at www.DiscoveryBenefits.com/ eligibleexpenses.
Substantiation The IRS requires FSA participants to provide documentation (e.g. an Explanation of Benefits) to show that an expense is FSAeligible. You can easily upload documentation to a claim by logging in to your online account or taking a photo of your documentation with your phone’s camera and uploading it through the Discovery Benefits mobile app.
Benefits Participant Services 6 a.m. to 9 p.m. CST M-F Toll-Free: 866-451-3399 Toll-Free Fax: 866-451-3245 customerservice@discoverybenefits.com Live chat available at: www.DiscoveryBenefits.com/contact
21
UNUM
Life and AD&D
About this Benefit Group term life is the most inexpensive way to purchase purchase life insurance. You have the freedom to select select an amount of life insurance coverage you need to to help protect the well-being of your family.
YOUR BENEFITS PACKAGE
Experts recommend at least
x 10 your gross annual income in coverage when purchasing life insurance.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 22 details on covered expenses, limitations and exclusions are included in the summary plan description located on the McKinney ISD Benefits Website: www.mybenefitshub.com/mckinneyisd
Life and AD&D Eligibility All actively employed employees working at least 20 hours each week for your employer in the U.S. and their eligible spouses and children to age 26.
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 $500,000. Child: Up to 100% of employee coverage amount in increments of $2,000, not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and 6 months is $1,000.
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.
Additional Benefits Portability/Conversion If you retire, reduce your hours or leave your employer, you can continue coverage for yourself your spouse and your dependent children at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy.
Your AD&D coverage options are:
Waiver of Premium
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 $500,000. Child: Up to 100% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $1,000.
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.
Note: 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 foot and the sight of one eye • Speech and hearing Other losses may be covered as well. Please see your Plan Administrator. Coverage amount(s) will reduce according to the following schedule: Age: Insurance Amount Reduces to: 70 65% of original amount 75 50% of original amount Coverage may not be increased after reduction
Guarantee Issue Current Employees: If you and your eligible dependents are enrolled in the plan and wish to increase your life insurance coverage, you may apply on or before the enrollment deadline for any amount of additional coverage up to the plan max for yourself and any amount of additional coverage up to $50,000 for your spouse. Any life insurance coverage over the guaranteed amount(s) will be subject to answers to health questions.
Monthly Premium Term Life Age band
Employee rate per $1,000
Spouse rate per $1,000
<25
0.019
0.019
25-29 0.019 0.019 30-34 0.028 0.028 35-39 0.048 0.048 40-44 0.057 0.057 45-49 0.085 0.085 50-54 0.143 0.143 55-59 0.247 0.247 60-64 0.323 0.323 65-69 0.599 0.599 70-74 0.960 0.960 75+ 0.960 0.960 Child life monthly rate is $0.26 per $1,000. One life premium covers all children. AD&D (You must purchase life coverage to purchase AD&D coverage) Employee
AD&D cost Per $1,000
Monthly Cost $0.02
Spouse Child
Per $1,000 Per $1,000
$0.02 $0.02
If you and your eligible dependents are not currently enrolled in the plan, you may apply for coverage on or before the enrollment deadline and will be required to answer health questions for any amount of coverage. 23
UNUM
YOUR BENEFITS PACKAGE
Disability
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 24 details on covered expenses, limitations and exclusions are included in the summary plan description located on the McKinney ISD Benefits Website: www.mybenefitshub.com/mckinneyisd
Long Term Disability Policy # 125328 Please read carefully the following description of your Unum Educator Select Income Protection Plan insurance.
Eligibility You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. The date you are eligible for coverage is the later of: the plan effective date; or the day after you complete the waiting period.
Guarantee Issue Current Employees: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may enroll on or before the enrollment deadline during an annual open enrollment period. New Hires: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may apply for coverage within 60 days after your eligibility date. If you do not apply within 60 days after your eligibility date, you can apply only during an annual enrollment period. Benefits are subject to the pre-existing condition exclusion referenced later in this document.
Benefit Amount You may purchase a monthly benefit in $100 units, starting at a minimum of $200, up to 66 2/3% of your monthly earnings rounded to the nearest $100, but not to exceed a monthly maximum benefit of $8,000. Please see your Plan Administrator for the definition of monthly earnings. The total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 100% of your monthly earnings unless the excess amount is payable as a Cost of Living Adjustment. However, if you are participating in Unum’s Rehabilitation and Return to Work Assistance program, the total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 110% of your monthly earnings (unless the excess amount is payable as a Cost of Living Adjustment).
Elimination Period The Elimination Period is the length of time of continuous disability, due to sickness or injury, which must be satisfied before you are eligible to receive benefits. You may choose an Elimination Period (injury/sickness) of 14/14, 30/30, 60/60, 90/90 or 180/180 days. If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.)
Benefit Duration Your duration of benefits is based on your age when the disability occurs.
Plan: ADEA II: Your duration of benefits is based on the following table: Age at Disability Less than age 60 Age 60 through 64 Age 65 through 69 Age 70 and over
Maximum Duration of Benefits To age 65, but not less than 5 years 5 years To age 70, but not less than 1 year 1 year
Federal Income Taxation The taxability of benefits depends on how premium was taxed during the plan year in which you become disabled. If you paid 100% of the premium for the plan year with post-tax dollars, your benefits will not be taxed. If premium for the plan year is paid with pre-tax dollars, your benefits will be taxed. If premium for the plan year is paid partially with post-tax dollars and partially with pre-tax dollars, or if you and your Employer share in the cost, then a portion of your benefits will be taxed.
Additional Benefits Work/Life Balance Employee Assistance Program: Work-life balance is a comprehensive resource providing access to professional assistance for a wide range of personal and work-related issues. The service is available to you and your family members twenty- four hours a day, 365 days a year, and provides resources to help employees 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. Services include: toll-free phone access to master’s-level consultants, up to three face-to-face sessions to help with more serious issues; and online resources. There is no additional charge for utilizing the program. Participation is confidential and strictly voluntary, and employees do not have to have filed a disability claim or be receiving benefits to use the program. However, if you become disabled and are receiving benefits, Unum's On Claim Support can provide additional resources including: coaching on how to communicate effectively with medical personnel, conducting consumer research for medical equipment and supplies, assessing emotional needs and locating counseling resources. Return to Work/Work Incentive Benefit: Unum supports efforts that enable a disabled employee to remain on the job or return to work as soon as possible. If you are disabled but working part time with monthly disability earnings of 20% or more of your indexed monthly earnings, during the first 12 months, the monthly benefit will not be reduced by any earnings until the gross disability payment plus your disability earnings, exceeds 100% of your indexed monthly earnings. The monthly benefit will then be reduced by that amount. Rehabilitation and Return to Work Assistance: Unum has a vocational Rehabilitation and Return to Work Assistance program available to assist you in returning to work. We will make the final determination of your eligibility for participation in the program, and will provide you with a written Rehabilitation and Return to Work Assistance plan developed specifically for you. This program may include, but is not limited to the following benefits: • coordination with your Employer to assist your return to work; • adaptive equipment or job accommodations to allow you to work; • vocational evaluation to determine how your disability may impact your employment options; 25 • job placement services;
Disability • • •
resume preparation; job seeking skills training; or education and retraining expenses for a new occupation.
If you are participating in a Rehabilitation and Return to Work Assistance program, we will also pay an additional disability benefit of 10% of your gross disability payment to a maximum of $1,000 per month. In addition, we will make monthly payments to you for 3 months following the date your disability ends, if we determine you are no longer disabled while: • you are participating in a Rehabilitation and Return to Work Assistance program; and • you are not able to find employment. (This benefit is not allowed in New Jersey.) Worksite Modification: If a worksite modification will enable you to remain at work or return to work, a designated Unum professional will assist in identifying what’s needed. A written agreement must be signed by you, your employer and Unum, and we will reimburse your employer for the greater of $1,000 or the equivalent of two months of your disability benefit. Waiver of Premium: After you have received disability payments under the plan for 90 consecutive days, from that point forward you will not be required to pay premiums as long as you are receiving disability benefits.
Eligible student means your unmarried dependent child(ren) who are: • less than 25 years of age; and • attending an accredited post-secondary school beyond the 12th grade level on a full-time basis. Medical Treatment Benefit: A Medical Treatment Benefit will be paid when you receive treatment by a doctor as a result of a sickness or injury, provided no other benefits are payable under the plan as a result of the condition for which the treatment was rendered. The Medical Treatment Benefit will be the doctor's actual charge for services rendered, up to a maximum benefit of $50 for sickness or $100 for injury. In addition, the charges must be for medically necessary care and treatment and in keeping with the extent of the sickness or injury. No benefit will be paid unless you are personally seen and treated by a doctor and the treatment is not for routine medical examinations or dental work. Note: No more than one Medical Treatment Benefit will be paid for the same or related condition(s) unless the treatment dates are separated by at least 14 consecutive days. In addition, no more than one benefit will be paid for treatment during any 24 hour period and the benefit will not be paid more than 4 times per calendar year.
Worldwide Emergency Travel Assistance Services : Whether your travel is for business or pleasure, our worldwide emergency travel assistance program is there to help you when an unexpected emergency occurs. With one phone call anytime of the day or night, you, your spouse and Survivor Benefit: Unum will pay your eligible survivor a lump sum dependent children can get immediate assistance anywhere in the benefit equal to 3 months of your gross disability payment. world3. Emergency travel assistance is available to you when you travel This benefit will be paid if, on the date of your death, your disability had to any foreign country, including neighboring Canada or Mexico. It is continued for 180 or more consecutive days, and you were receiving or also available anywhere in the United States for those traveling more than 100 miles from home. Your spouse and dependent children do not were entitled to receive payments under the plan. If you have no eligible survivors, payment will be made to your estate, unless there is have to be traveling with you to be eligible. However, spouses traveling on business for their employer are not covered by this program. none. In that case, no payment will be made. However, we will first apply the survivor benefit to any overpayment which may exist on your claim.
Other Important Provisions
Pre-Existing Condition Exclusion : Benefits will not be paid for disabilities caused by, contributed to by, or resulting from a pre-existing condition. You have a pre-existing condition if: • you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and • the disability begins in the first 12 months after your effective date Dependent Care Expense Benefit: If you are disabled and participating in of coverage. Unum’s Rehabilitation and Return to Work Assistance program, Unum will pay a Dependent Care Expense Benefit when you are disabled and Continuity of Coverage: If you are actively at work at the time you convert to Unum’s plan and become disabled due to a pre-existing you provide satisfactory proof that you: • are incurring expenses to provide care for a child under the age of condition, benefits may be payable if you were: • in active employment and insured under the plan on its effective 15; date; and • and/or start incurring expenses to provide care for a child age 15 • insured by the prior plan at the time of change. or older or a family member who needs personal care assistance. The payment will be $350 per month per dependent, to a maximum of To receive a payment, you must satisfy the pre-existing condition under $1,000 per month for all dependent care expenses combined. the Unum policy or the prior carrier’s policy. If you satisfy Unum’s preexisting condition provision, payments will be determined by the Unum Education Benefit: If you are disabled and receiving monthly disability policy. benefits, you may receive an additional monthly Education Benefit of $200 for each child who is an eligible student. Benefits will be payable in between terms provided the eligible student is enrolled for the next If you only satisfy the pre-existing condition provision for the prior carrier’s policy, the claim will be administered according to the Unum scheduled term. You may receive your survivor benefit prior to your death if you are receiving monthly payments and your physician certifies in writing that you have been diagnosed as terminally ill and your life expectancy has been reduced to less than 12 months. This benefit is only payable once and if you elect to receive this benefit, no survivor benefit will be payable to your eligible survivor upon your death. (Note this “Accelerated Survivor Benefit” is not available in Connecticut.)
26
Disability policy. However, • the payments will be the lesser of the benefit payable under the terms of the prior plan or the benefit under the Unum plan; • the elimination period will be the shorter of the elimination period under the prior plan or the elimination period under the Unum plan; and • benefits will end on the earlier of the end of the maximum period of payment under the Unum plan or the date benefits would have ended under the prior plan. Definition of Disability: You are disabled when Unum determines that: • you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; • you have a 20% or more loss in indexed monthly earnings due to the same sickness or injury; and • during the elimination period you are unable to perform any of the material and substantial duties of your regular occupation. After benefits have been paid for 24 months, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience. You must be under the regular care of a physician in order to be considered disabled. Gainful Occupation: Gainful occupation means an occupation that is or can be expected to provide you with an income within 12 months of your return to work, that exceeds 80% of your indexed monthly earnings if you are working or 60% of your indexed monthly earnings if you are not working. Benefit Integration: Your disability benefit will be reduced by deductible sources of income and any earnings you have while disabled. Your gross disability payment will be reduced immediately by such items as disability income or other amounts you receive or are entitled to receive from workers compensation or similar occupational benefit laws, sabbatical or assault leave plans and the amount of earnings you receive from an extended sick leave plan as described in Louisiana Revised Statutes or any other act or law with similar intent.
Instances When Benefits Would Not Be Paid: Benefits will not be paid for disabilities caused by, contributed to by, or resulting from: • intentionally self-inflicted injuries; • active participation in a riot; • commission of a crime for which you have been convicted; • loss of professional license, occupational license or certification; • pre-existing conditions (see definition). Unum will not cover a disability due to war, declared or undeclared, or any act of war. Unum will not pay a benefit for any period of disability during which you are incarcerated. Termination of Coverage: Your coverage under the policy ends on the earliest of the following: • 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 later of the last day you are in active employment except as provided under the covered layoff or leave of absence provision; or if applicable, the last day of your contract with your Employer but not beyond the end of your Employer’s current school contract year. Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan. Delayed Effective Date of Coverage: If you are absent from work due to injury, sickness, temporary layoff or leave of absence, your coverage will not take effect until you return to active employment. Please contact your Plan Administrator after you return to active employment for when your coverage will begin.
After you have received monthly disability payments for 12 months, your gross disability payment will be reduced by such items as additional deductible sources of income you receive or are entitled to receive under: state compulsory benefit laws; automobile liability insurance; legal judgments and settlements; certain retirement plans; salary continuation or sick leave plans; other group or association disability programs or insurance; and amounts you or your family receive or are entitled to receive from Social Security or similar governmental programs. Regardless of deductible sources of income, an employee who qualifies for disability benefits is guaranteed to receive a minimum benefit amount of 25% of the gross disability payment. Mental Illness/Self-Reported Symptoms: The lifetime cumulative maximum benefit period for all disabilities due to mental illness and disabilities based primarily on self-reported symptoms is 24 months. Only 24 months of benefits will be paid for any combination of such disabilities even if the disabilities are not continuous and/or are not related. Payments would continue beyond 24 months only if you are confined to a hospital or institution as a result of the disability. 27
Long Term Disability MONTHLY PREMIUMS Rates effective 9/1/2019 Accident / Sickness Elimination Period in Days Annual Earnings
28
Monthly Earnings
Monthly Benefit
14 / 14
30 / 30
60 / 60
90 / 90
180 / 180
$7.88
$6.44
$4.32
$3.70
$2.78
$11.82
$9.66
$6.48
$5.55
$4.17
$15.76
$12.88
$8.64
$7.40
$5.56
$19.70
$16.10
$10.80
$9.25
$6.95
$23.64
$19.32
$12.96
$11.10
$8.34
$27.58
$22.54
$15.12
$12.95
$9.73
$31.52
$25.76
$17.28
$14.80
$11.12
$35.46
$28.98
$19.44
$16.65
$12.51
$39.40
$32.20
$21.60
$18.50
$13.90
$43.34
$35.42
$23.76
$20.35
$15.29
$47.28
$38.64
$25.92
$22.20
$16.68
$51.22
$41.86
$28.08
$24.05
$18.07
$55.16
$45.08
$30.24
$25.90
$19.46
$59.10
$48.30
$32.40
$27.75
$20.85
$63.04
$51.52
$34.56
$29.60
$22.24
$66.98
$54.74
$36.72
$31.45
$23.63
$70.92
$57.96
$38.88
$33.30
$25.02
$74.86
$61.18
$41.04
$35.15
$26.41
$78.80
$64.40
$43.20
$37.00
$27.80
$82.74
$67.62
$45.36
$38.85
$29.19
$86.68
$70.84
$47.52
$40.70
$30.58
$90.62
$74.06
$49.68
$42.55
$31.97
$94.56
$77.28
$51.84
$44.40
$33.36
$98.50
$80.50
$54.00
$46.25
$34.75
$102.44
$83.72
$56.16
$48.10
$36.14
$106.38
$86.94
$58.32
$49.95
$37.53
$110.32
$90.16
$60.48
$51.80
$38.92
$114.26
$93.38
$62.64
$53.65
$40.31
$118.20
$96.60
$64.80
$55.50
$41.70
$122.14
$99.82
$66.96
$57.35
$43.09
$126.08
$103.04
$69.12
$59.20
$44.48
$130.02
$106.26
$71.28
$61.05
$45.87
$133.96
$109.48
$73.44
$62.90
$47.26
$137.90
$112.70
$75.60
$64.75
$48.65
$141.84
$115.92
$77.76
$66.60
$50.04
$145.78
$119.14
$79.92
$68.45
$51.43
$149.72
$122.36
$82.08
$70.30
$52.82
Long Term Disability MONTHLY PREMIUMS Rates effective 9/1/2019 Accident / Sickness Elimination Period in Days Annual Earnings
Monthly Earnings
Monthly Benefit
14 / 14
30 / 30
60 / 60
90 / 90
180 / 180
$153.66
$125.58
$84.24
$72.15
$54.21
$157.60
$128.80
$86.40
$74.00
$55.60
$161.54
$132.02
$88.56
$75.85
$56.99
$165.48
$135.24
$90.72
$77.70
$58.38
$169.42
$138.46
$92.88
$79.55
$59.77
$173.36
$141.68
$95.04
$81.40
$61.16
$177.30
$144.90
$97.20
$83.25
$62.55
$181.24
$148.12
$99.36
$85.10
$63.94
$185.18
$151.34
$101.52
$86.95
$65.33
$189.12
$154.56
$103.68
$88.80
$66.72
$193.06
$157.78
$105.84
$90.65
$68.11
$197.00
$161.00
$108.00
$92.50
$69.50
$200.94
$164.22
$110.16
$94.35
$70.89
$204.88
$167.44
$112.32
$96.20
$72.28
208.82
170.66
114.48
98.05
73.67
212.76
173.88
116.64
99.90
75.06
216.70
177.10
118.80
101.75
76.45
220.64
180.32
120.96
103.60
77.84
224.58
183.54
123.12
105.45
79.23
228.52
186.76
125.28
107.30
80.62
232.46
189.98
127.44
109.15
82.01
236.40
193.20
129.60
111.00
83.40
240.34
196.42
131.76
112.85
84.79
244.28
199.64
133.92
114.70
86.18
248.22
202.86
136.08
116.55
87.57
252.16
206.08
138.24
118.40
88.96
256.10
209.30
140.40
120.25
90.35
260.04
212.52
142.56
122.10
91.74
263.98
215.74
144.72
123.95
93.13
267.92
218.96
146.88
125.80
94.52
271.86
222.18
149.04
127.65
95.91
275.80
225.40
151.20
129.50
97.30
279.74
228.62
153.36
131.35
98.69
283.68
231.84
155.52
133.20
100.08
287.62
235.06
157.68
135.05
101.47
291.56
238.28
159.84
136.90
102.86
295.50
241.50
162.00
138.75
104.25
29
UNUM YOUR BENEFITS PACKAGE
Group Accident & Hospital Indemnity
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 $10,500 per day.
$9,600
$10,400
$10,700
2008
2012
2018
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 30 details on covered expenses, limitations and exclusions are included in the summary plan description located on the McKinney ISD Benefits Website: www.mybenefitshub.com/mckinneyisd
Group Accident Group Accident insurance is designed to help covered employees meet the out-of-pocket expenses and extra bills that can follow an accidental injury, whether minor or catastrophic. Indemnity lump sum benefits are paid directly to the employee based on the amount of coverage listed in the schedule of benefits. The accident base plan is guaranteed issue, so no health questions are required. Plan Type Covered Conditions Wellness Benefit Premium
On/Off Job See Schedule of Benefits Included - $50 per insured per calendar year Paid by the Employee
Monthly Premium (includes Wellness) Employee
Employee and Spouse
Employee and Child
Employee, Spouse and Child
$16.04
$26.30
$28.50
$38.76
Spouse issue ages are 17 through 64 years. Dependent Children issue ages are newborn up to their 26th birthday or to the maximum coverage age defined in the policy.
Group Hospital Indemnity Group Hospital Indemnity insurance is designed to help provide financial protection for covered individuals by paying a benefit due to a hospitalization and in some cases, for treatment received for an accident or sickness, even if that treatment occurs outside the hospital. Employee can use the benefit to meet the out-of-pocket expenses and extra bills that can occur. Indemnity lump sum benefits are paid directly to the employee based on the amount of coverage listed, regardless of the actual cost of treatment. Hospital Admission Wellness Portability Pre-Existing Condition Period Premium
$1,000 per insured per calendar year Included - $50 per insured per calendar year Included 12/12 Exclusion Paid by the Employee
Monthly Premium (includes Wellness) Age Band
Employee
Employee and Spouse
Employee and Child
Employee, Spouse and Child
17 - 49
$12.52
$24.99
$17.82
$30.29
50 - 59
$14.26
$29.14
$19.56
$34.44
60 - 64
$19.04
$39.19
$24.34
$44.49
65 +
$27.42
$56.79
$32.72
$62.09
Note: Family Coverage Options assume Employee and Spouse are in the same Age Band. If Employee and Spouse are in different Age Bands, the final Monthly Premium amounts will be different. Spouse issue ages are 17 through 64 years. Dependent Children issue ages are newborn up to their 26th birthday or to the maximum coverage age defined in the policy. 31
UNUM
Critical Illness
YOUR BENEFITS PACKAGE
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 32 details on covered expenses, limitations and exclusions are included in the summary plan description located on the McKinney ISD Benefits Website: www.mybenefitshub.com/mckinneyisd
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
Employee - $10,000, $20,000, or $30,000 Spouse/Child - 100% of Employee Coverage Amount Guarantee Issue Employee - $30,000 Spouse /Child– 100% of Employee Coverage Amount Pre-Existing Condition 12/12 exclusion Benefit Waiting Period 0 days Portability Included Wellness Benefit $50, $75, or $100 per insured per calendar year (based on elected coverage amount) Recurrence Benefit 100% for select Covered Conditions more than 180 days after prior diagnosis (Marked with *)
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 (25%)* • Skin Cancer ($500) 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 *Covered Condition eligible for Recurrence Benefit
Employee/Spouse Cost Employee Age
$10,000 + $50 Be Well Benefit
$20,000+ $75 Be Well Benefit
$30,000+ $100 Be Well Benefit
<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+
$3.52 $4.42 $5.62 $7.42 $9.72 $12.72 $16.02 $21.52 $29.72 $42.82 $66.72 $98.42 $143.62 $231.42
$7.05 $8.85 $11.25 $14.85 $19.45 $25.45 $32.05 $43.05 $59.45 $85.65 $133.45 $196.85 $287.25 $462.85
$10.57 $13.27 $16.87 $22.27 $29.17 $38.17 $48.07 $64.57 $89.17 $128.47 $200.17 $295.27 $430.87 $694.27 33
NOTES
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NOTES
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WWW.MYBENEFITSHUB.COM/MCKINNEYISD 36