HILLSBORO ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2020 - 8/31/2021 WWW.MYBENEFITSHUB.COM/HILLSBOROISD 1
Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. What’s New 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. HSA vs FSA Comparison TRS Medical EECU Health Savings Account (HSA) The Hartford Hospital Indemnity Plan MDLIVE Telehealth Cigna Dental Superior Vision AUL a OneAmerica Company Disability APL Cancer Voya Accident UNUM Critical Illness AUL a OneAmerica Company Life and AD&D 5Star Permanent Life Identity Guard ID Theft Protection Legal Shield Legal Services MASA Emergency Transport NBS Flexible Spending Accounts (FSA) NBS 403(b) Retirement Plan NBS 457 Retirement Plan 2
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FLIP TO... PG. 4
HOW TO ENROLL
PG. 6
SUMMARY PAGES
PG. 12
YOUR BENEFITS
Benefit Contact Information HILLSBORO BENEFITS Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/hillsboroisd
DISABILITY AUL a OneAmerica Company (800) 537-6442 https://www.oneamerica.com
LEGAL SERVICES LegalShield (800) 654-7757 www.legalshield.com
MEDICAL TRS Medical - BCBSTX (866) 355-5999 www.bcbstx.com/trsactivecare
CANCER American Public Life (800) 256-8606 www.ampublic.com
403(B) RETIREMENT PLAN National Benefit Services (855) 399-3035 www.nbsbenefits.com
PHARMACY Caremark 866-355-5999 https://info.caremark.com/trsactivecare
CRITICAL ILLNESS UNUM (866) 679-3054 www.unum.com
457 RETIREMENT PLAN National Benefit Services (800) 274-0503 www.nbsbenefits.com
HOSPITAL INDEMNITY PLAN The Hartford (800) 523-2233 File a claim: (866) 547-4205 www.thehartford.com
ACCIDENT Voya (877) 236-7564 www.voya.com
3121 FICA ALTERNATIVE PLAN National Benefit Services (855) 399-3035 www.nbsbenefits.com
DENTAL Cigna (800) 244-6224 www.mycigna.com
BASIC AND VOLUNTARY LIFE AUL a OneAmerica Company (800) 537-6442 https://www.oneamerica.com
FLEXIBLE SPENDING ACCOUNT (FSA) National Benefit Services (855) 399-3035 www.nbsbenefits.com
VISION
INDIVIDUAL LIFE
COBRA (DENTAL AND VISION)
Superior Vision (800) 507-3800 www.superiorvision.com HEALTH SAVINGS ACCOUNT (HSA) EECU (817) 882-0800 www.eecu.org TELEHEALTH MDLive (888) 365-1663 consultmdlive.com
5Star Life Insurance Company (866) 863-9753 http://5starlifeinsurance.com ID THEFT MONITORING Identity Guard (855) 443-7748 www.identityguard.com
National Benefit Services (800) 274-0503 www.nbsbenefits.com MEDICAL EMERGENCY TRANSPORTATION MASA (800) 423-3226 www.masamts.com
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MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS HILSB” to 313131 and get access to everything you need to complete your benefits enrollment:
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•
Benefit Information
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Online Support
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Interactive Tools
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And more.
Text “FBS HILSB” to 313131 OR SCAN
How to Log In
1 BENEFIT INFO
INTERACTIVE TOOLS
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www.mybenefitshub.com/ hillsboroisd
CLICK LOGIN
ENTER USERNAME & PASSWORD All login credentials have been RESET to the default described below:
Username: The first six (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.
ONLINE SUPPORT
If you have less than six (6) characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.
Default Password: Last Name* (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number.
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Annual Benefit Enrollment
SUMMARY PAGES
Benefit Updates - What’s New: MEDICAL Effective 9/1/2020, Blue Cross and Blue Shield of Texas (BCBSTX) will be the new health plan administrator for TRS -ActiveCare medical benefits. Benefit and premium changes will apply to all TRS-ActiveCare plans for the next plan year. Plan Options • TRS-ActiveCare Primary NEW - lower deductible and copays for doctor visits. PCP and referrals required, statewide network, lowest cost option. • TRS-ActiveCare HD (formerly 1-HD) - If currently enrolled in TRS-AC1HD and make no changes, you will be enrolled in this plan. • TRS-ActiveCare Primary+ (formerly Select) - If currently enrolled in TRS-AC Select and make no changes, you will be enrolled in this plan, PCP and referrals required. HMO Plan Options • Central, North Texas Scott & White - If currently enrolled in BSW and make no changes, you will be enrolled in this plan. To review new premiums and plan options, refer to 202021 TRS-ActiveCare Plan Highlights on your benefit website.
HEALTH SAVINGS ACCOUNT (HSA) NEW ANNUAL MAXIMUM! Effective 9/1/2020 the Annual Contribution Limit increased to $3,550 Individual and $7,100 Family for the 2020-2021 Plan Year. CRITICAL ILLNESS NEW CARRIER AND LOWER RATES! Effective 09/01/2020 the Critical Illness carrier will change. Critical Illness will no longer include a wellness benefit. Critical Illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non-medical costs related to the illness, including transportation, child care, etc. IDENTITY THEFT NEW CARRIER! Effective 9/1/2020 the Identity Theft benefits will change. Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered. Legal services benefits will remain with Legal Shield.
FLEXIBLE SPENDING ACCOUNT NEW ANNUAL MAXIMUM! Effective 9/1/2020 Annual Contribution Limit increased to $2,750 for the 2020-2021 Plan Year. • • • •
Login and complete your supplemental benefit enrollment from 07/15/2020 - 08/21/2020 Enrollment assistance is available by calling Financial Benefit Services at 866-914-5202 to speak to an enrollment representative Monday-Friday 8am-7pm. 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. 6
Annual Benefit Enrollment
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): Marital Status
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 A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for adoption. Change in Number of Tax You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a Dependents result of a valid change in status event. Change in Status of Employment Affecting Coverage Eligibility
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.
An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements Gain/Loss of Dependents' under an employer's plan may include change in age, student, marital, employment or tax dependent Eligibility Status status. If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order Judgment/Decree/Order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage. Eligibility for Government Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. 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 the Hillsboro
Changes are not permitted during the plan year (outside of
ISD benefit website: www.mybenefitshub.com/hillsboroisd.
annual enrollment) unless a Section 125 qualifying event occurs.
Click on your school district, then click on the benefit plan you need information on (i.e., Dental) and you can find the forms
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Changes, additions or drops may be made only during the
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
ISD benefit website: www.mybenefitshub.com/hillsboroisd.
included in the dependent profile. Additionally, you must
Click on your school district, then click on the benefit plan you
notify your employer of any discrepancy in personal and/or
need information on (i.e., Dental) and you can find provider
benefit information.
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For benefit summaries and claim forms, go to the Hillsboro
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.
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.
Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits department or you can call Financial Benefit Services at 866-914-5202 for assistance.
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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.
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 Hillsboro 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 2020 benefits become effective on September 1, 2020, you must be actively-at-work on September 1, 2020 to be eligible for
your new benefits. PLAN
CARRIER
MAXIMUM AGE
Accident
Voya
To Age 26
Cancer
APL
To Age 26
Critical Illness
Voya
To Age 26
Dental
Cigna
To Age 26
Identity Theft
Legal Shield
To Age 25
Individual Life
5Star
To Age 24
Hospital Indemnity
The Hartford
To Age 26
Vision
Superior Vision
To Age 26
Voluntary Life and AD&D
AUL a OneAmerica Company
To Age 26
Medical Transportation
MASA
To Age 26
If your dependent is disabled, coverage can 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 Benefit Administrator to request a continuation of coverage. 9
Helpful Definitions
SUMMARY PAGES
Actively-at-Work
In-Network
You are performing your regular occupation for the employer
Doctors, hospitals, optometrists, dentists and other providers
on a full-time basis, either at one of the employer’s usual
who have contracted with the plan as a network provider.
places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2020 please notify your benefits administrator.
Annual Enrollment The period during which existing employees are given the
opportunity to enroll in or change their current elections.
Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.
Out-of-Pocket Maximum The most an eligible or insured person can pay in co-insurance for covered expenses.
Plan Year September 1st through August 31st
Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescriptions drugs or is under a health care provider’s orders to take drugs, or received medical care or services
Calendar Year January 1st through December 31st
Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
Guaranteed Coverage The amount of coverage you can elect without answering
any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or pre-existing condition exclusion provisions do apply, as applicable by carrier.
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(including diagnostic and/or consultation services).
SUMMARY PAGES
HSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, tax-free. This also allows employees to pay for qualifying dependent care tax-free.
Employer Eligibility
A qualified high deductible health plan.
All employers
Contribution Source Account Owner Underlying Insurance Requirement
Employee and/or employer Individual
Employee and/or employer Employer
High deductible health plan
None
Description
Minimum Deductible Maximum Contribution
$1,400 single (2020) $2,800 family (2020) $3,550 single (2020) $7,100 family (2020)
N/A $2,750
Permissible Use Of Funds
If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Cash-Outs of Unused Amounts (if no medical expenses)
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65).
Not permitted
Year-to-year rollover of account balance?
Yes, funds will roll over to use for subsequent year’s health coverage.
No. Access to some funds may be extended if your employer’s plan contains a 2 1/2 - month grace period or $500 rollover provision.
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
FLIP TO FOR HSA INFORMATION
PG. 16
FLIP TO FOR FSA INFORMATION
PG. 62 11
BCBSTX
Medical
About this Benefit
YOUR BENEFITS PACKAGE
DID YOU KNOW?
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 12 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
2020-2020 TRS-ActiveCare Plan Premiums TRS-ActiveCare HD Employee only Employee & Spouse Employee & Child(ren) Employee & Family
TRS-ActiveCare Primary Employee only Employee & Spouse Employee & Child(ren) Employee & Family
TRS-ActiveCare Primary+ Employee only Employee & Spouse Employee & Child(ren) Employee & Family
ActiveCare 2 Employee only Employee & Spouse Employee & Child(ren) Employee & Family
Total Monthly Premium
Hillsboro ISD Contribution
Employee Monthly Deduction
$397.00 $1,120.00 $715.00 $1,330.00
$235.00 $235.00 $235.00 $235.00
$162.00 $885.00 $480.00 $1,095.00
Total Monthly Premium
Hillsboro ISD Contribution
Employee Monthly Deduction
$386.00 $1,089.00 $695.00 $1,301.00
$235.00 $235.00 $235.00 $235.00
$151.00 $854.00 $460.00 $1,066.00
Total Monthly Premium
Hillsboro ISD Contribution
Employee Monthly Deduction
$514.00 $1,264.00 $834.00 $1,588.00
$235.00 $235.00 $235.00 $235.00
$279.00 $1,029.00 $599.00 $1,353.00
Total Monthly Premium
Hillsboro ISD Contribution
Employee Monthly Deduction
$937.00 $2,222.00 $1,393.00 $2,627.00
$235.00 $235.00 $235.00 $235.00
$702.00 $1,987.00 $1,158.00 $2,392.00
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2020-21 TRS-ActiveCare Plan Highlights Sept. 1, 2020 — Aug. 31, 2021 All TRS-ActiveCare participants have three plan options. Each is designed with the unique needs of our members in mind. TRS-ActiveCare 2 NEW: TRS-ActiveCare Primary • Lower premium • Copays for doctor visits
TRS-ActiveCare HD • Similar to current 1-HD • Lower premium • Compatible with health savings
TRS-ActiveCare Primary+
(This plan is closed and not accepting new enrollees. If you’re currently enrolled in TRS-ActiveCare 2, you can remain in this plan.)
• Simpler version of the current Select
• Closed to new enrollees plan • Current enrollees can choose to before you meet deductible • Lower deductible than HD and primary stay in plan • Statewide network account (HSA) plans • Lower deductible • PCP referrals required to see • Nationwide network with out-of • Copays for many services and drugs • Copays for many drugs and specialists -network coverage • Higher premium services Plan summary • Not compatible with health • No requirement for PCPs or • Statewide network • Nationwide network with out-ofsavings account (HSA) referrals • PCP referrals required to see specialists network coverage • No out-of-network coverage • Must meet deductible before • Not compatible with a health savings • No requirement for PCPs or plan pays for non-preventive account (HSA) referrals care • No out-of-network coverage If you make no changes Only employees that choose If you’re currently in TRSIf you’re currently in TRS-ActiveCare Select If you’re currently in TRS-ActiveCare during Annual this new plan during Annual ActiveCare 1-HD and you make no and you make no changes during Annual 2, and you make no changes during Enrollment, you’ll have Enrollment will be enrolled in change during Annual Enrollment, Enrollment, this will be your plan next Annual Enrollment, you will remain the following plan... it. this will be your plan next year. year. in TRS-ActiveCare 2 next year.
Total Monthly Premiums Employee Only Employee and Spouse Employee and Children Employee and Family
$386 $1,089 $695 $1,301
$397 $1,120 $715 $1,338
$514 $1,264 $834 $1,588
$937 $2,222 $1,393 $2,627
Plan Features Type of Coverage Individual/Family Deductible Coinsurance Individual/Family Maximum Out-ofPocket Network Primary Care Provider (PCP) Required
In-Network Coverage Only
In-Network
Out-of-Network
In-Network Coverage Only
$2,500/$5,000
$2,800/$5,600
$5,500/$11,000
$1,200/$3,600
You pay 20% You pay 40% after You pay 30% after deductible after deductible deductible
You pay 20% after deductible
In-Network
Out-of-Network
$1,000/$3,000
$2,000/$6,000
You pay 20% after You pay 40% after deductible deductible
$8,150/$16,300
$6,900/$13,800 $20,250/$40,500
$6,900/$13,800
$7,900/$15,800
$23,700/$47,400
Statewide Network
Nationwide Network
Statewide Network
Nationwide Network
Yes
No
Yes
No
Doctor Visits Primary Care
$30 copay
Specialist
$70 copay
TRS Virtual Health
$0 per consultation
You pay 20% You pay 40% after after deductible deductible You pay 20% You pay 40% after after deductible deductible $30 per consultation
$30 copay $70 copay $0 per consultation
You pay 40% after deductible You pay 40% after $70 copay deductible $0 per consultation $30 copay
Immediate Care Urgent Care Emergency Care TRS Virtual Health
$50 copay
You pay 20% You pay 40% after after deductible deductible
$50 copay
You pay 30% after deductible
You pay 20% after deductible
You pay 20% after deductible
$0 per consultation
$30 per consultation
$0 per consultation
You pay 40% after deductible You pay a $250 copay plus 20% after deductible $0 per consultation
Integrated with medical
Integrated with medical
$200 brand deductible
$200 brand deductible
$15/$45 copay
You pay 20% after deductible
$15/$45 copay
$50 copay
Prescription Drugs Drug Deductible Generics (30-Day Supply / 90-Day Supply) Preferred Brand
You pay 30% after deductible
You pay 25% after deductible
You pay 25% after deductible
Non-preferred Brand
You pay 50% after deductible
You pay 50% after deductible
You pay 50% after deductible
Specialty
You pay 30% after deductible
You pay 20% after deductible
You pay 20% after deductible
What’s New
Leverage Your $0 Preventive Care*
• • • •
• • • • • • • • •
Primary plan with a lower premium and copays Primary+ (formerly Select) decreased premiums by up to 8% Broader networks of health care providers Lower premiums for families with children
Did You Know • • •
Our provider search tool will be available in June. Choosing a PCP helps you meet your health goals faster. Generic medications save money! Ask your provider if your medicine has a generic. 14
$20/$45 copay You pay 25% after deductible ($40 min/$80 max)/ You pay 25% after deductible ($105 min/$210 max) You pay 50% after deductible ($100 min/$200 max)/ You pay 50% after deductible ($215 min/$430 max) You pay 20% after deductible ($200 min/$900 max)/ No 90-Day Supply of Specialty Medications
Annual routine physicals (ages 12+) Annual mammogram (ages 40+) Annual OBGYN exam & pap smear (ages 18+) Annual prostate cancer screening (ages 45+) Well-child care (unlimited up to age 12) Healthy diet/obesity counseling (unlimited to age 22; ages 22+ get twenty-six visits per year) Smoking cessation counseling (8 visits per year) Breastfeeding support (six per year) Colonoscopy (ages 50+ once every ten years)
*Available for all plans. See benefits guides for more details.
2020-21 Health Maintenance Organization Plans and Premiums for Select Regions of the State Remember: Remember that when you choose an HMO, you’re choosing a regional network. TRS also contracts with HMOs in certain regions of the state to bring participants in those areas another regional plan option. Central and North Texas Baylor Scott & White HMO
South Texas Blue Essentials HMO
Brought to you by TRS-ActiveCare
Brought to you by TRS-ActiveCare
You can choose this plan if you live in You can choose this plan if you live in one these counties: Austin, Bastrop, one these counties: Cameron, Bell, Blanco, Bosque, Brazos, Hildalgo, Starr, Willacy Burleson, Burnet, Caldwell, Collin, Coryell, Dallas, Denton, Ellis, Erath, Falls, Freestone, Grimes, Hamilton, Hays, Hill, Hood, Houston, Johnson, Lampasas, Lee, Leon, Limestone, Madison, McLennan, Milam, Mills, Navarro, Robertson, Rockwall, Somervell, Tarrant, Travis, Walker, Waller, Washington, Williamson
West Texas Blue Essentials HMO Brought to you by TRS-ActiveCare You can choose this plan if you live in one these counties: Andrews, Armstrong, Bailey, Borden, Brewster, Briscoe, Callahan, Carson, Castro, Childress, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, Fisher, Floyd, Gaines, Garza, Glasscock, Gray, Hale, Hall, Hansford, Hartley, Haskell, Hemphill, Hockley, Howard, Hutchinson, Irion, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Llano, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, San Saba, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Winkler, Yoakum
Total Monthly Premiums Employee Only
$551.10
$491.54
$534.42
Employee and Spouse
$1,382.06
$1,182.52
$1,287.58
Employee and Children
$883.50
$766.96
$835.68
$1,478.56
$1,258.52
$1,370.12
In-Network Coverage Only
In-Network Coverage Only
In-Network Coverage Only
$950/$2,850
$500/$1,000
$950/$2,850
You pay 20% after deductible
You pay 20% after deductible
You pay 25% after deductible
$7,450/$14,900
$4,500/$9,000
$7,450/$14,900
Primary Care
$20 copay
$25 copay
$20 copay
Specialist
$70 copay
$60 copay
$70 copay
$50 copay
$75 copay
$500 copay after deductible
You pay 20% after deductible
$50 copay $500 copay before deductible plus 25% after deductible
Employee and Family
Plan Features Type of Coverage Individual/Family Deductible Coinsurance Individual/Family Maximum Out-of-Pocket
Doctor Visits
Immediate Care Urgent Care Emergency Care
Prescription Drugs Drug Deductible Days Supply Generics Preferred Brand Non-preferred Brand Specialty
$150 (excl. generics)
$100
$150
30-Day Supply / 90-Day Supply
30-Day Supply / 90-Day Supply
30-Day Supply / 90-Day Supply
$5/$12.50 copay
$10/$30 copay
$5/$12.50 copay ACA Preventative: $0
30% after deductible
$40/$120 copay
30% after deductible
50% after deductible
$65/$195 copay
50% after deductible
15%/25% after deductible (preferred/ nonpreferred)
You pay 20% after deductible
15%/25% after deductible (preferred/nonpreferred)
trs.texas.gov 15
EECU
HSA (Health Savings Account)
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.
YOUR BENEFITS PACKAGE
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 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, limitations and exclusions included in the summary plan description located on the Hillsboro ISD Benefits Website:are www.mybenefitshub.com/hillsboroisd Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
HSA (Health Savings Account) What is an HSA?
How to Use Your Funds
Health Savings Account (HSA) enables you to save for and conveniently pay for qualified healthcare expenses, while you earn tax-free interest and pay no monthly service fees. Opening a Health Savings Account provides both immediate and long term benefits. The money in your HSA is always yours, even if you change jobs, switch your health plan, become unemployed or retire. Your unused HSA balance rolls over from year to year. And best of all, HSAs have tax-free deposits, tax-free earnings and tax-free withdrawals. And after age 65, you can withdraw funds from your HSA penalty-free for any purpose*.
•
HSA Debit Card – use your EECU HSA Mastercard® debit card to pay healthcare providers at point-of-sale or by following the instructions provided on a bill from a medical provider.
•
Online Bill Pay – sign up, at eecu.org, and use EECU’s free online banking and bill pay to make payments to medical providers directly from your HSA. Online Transfers – use EECU’s online banking or mobile app; reimburse yourself for out-of-pocket expenses by making a transfer from your HSA to your personal checking or savings account. Check – optional HSA checks can be ordered upon request for a fee. You can use these checks to pay healthcare providers and suppliers.
EECU HSA Benefits •
•
Save money tax-free for healthcare expenses – contributions are not subject to federal income taxes and can be made by • you, your employer or a third party* • No monthly service fee – so you can save more and earn more • Earn competitive dividends on your entire balance – Save your receipts – for all qualified medical expenses. compounded daily and paid monthly from deposit to EECU does not verify eligibility. You are responsible for withdrawal making sure payments are for qualified medical expenses. • Conveniently pay for qualified healthcare expenses – with a free, no annual fee EECU HSA Debit Mastercard® or via EECU’s free online bill pay. (HSA checks are also available How To Manage Your Account upon request, for a nominal fee**) • Online - check your balance, pay healthcare providers and • Free online, mobile and branch access – allows you to arrange deposits; sign-up for online banking at actively manage your account however you prefer www.eecu.org. • Comprehensive service and support – to assist you in • Mobile - EECU’s mobile app allows you to manage your optimizing your healthcare saving and spending account on the go; download “EECU Mobile Banking” in • Federally insured – to at least $250,000 by NCUA Apple’s App Store and Google Play. • Contact Member Service – call 817-882-0800 for help with 2020 Annual HSA Contribution Limits your HSA questions or transactions. You can also chat with Individual: $3,550 us online at eecu.org or use our secure email. Member Family: $7,100 Service is available Monday through Friday from 8:00am – Catch-Up Contributions: Accountholders who meet the 7:00pm CT, Saturdays from 9am – 1pm CT and closed on qualifications noted below are eligible to make an HSA Sunday. catch-up contribution of an additional $1,000. • Account Statements – monthly statements show all your • Health Savings accountholder account activity for that period. You can receive free online • Age 55 or older (regardless of when in the year an statements or pay $2 per printed statement. accountholder turns 55) * Contributions, investment earnings, and distributions are tax free for federal tax purposes if • Not enrolled in Medicare (if an accountholder enrolls in used to pay for qualified medical expenses, and may or may not be subject to state taxation. Medicare mid-year, catch-up contributions should be A list of Eligible Medical Expenses can be found in IRS Publication 502, http://www.irs.gov/ pub/irs-pdf/p502.pdf. As described in IRS publication 969, http://www.irs.gov/pub/irs-pdf/ prorated) p969.pdf, certain over-the-counter medications (when prescribed by a doctor) are Authorized Signers who are 55 or older must have their own considered eligible medical expenses for HSA purposes. If an individual is 65 or older, there is no penalty to withdraw HSA funds. However, income taxes will apply if the distribution is not HSA in order to make the catch-up contribution used for qualified medical expenses. For more information consult a tax adviser or your state department of revenue. All contributions and distributions are your responsibility and must be within IRS regulatory limits. ** Call 817-882-0800 or stop-by an EECU branch to order standard checks at no charge (excludes shipping and handling) or order custom checks - prices vary.
17
THE HARTFORD YOUR BENEFITS PACKAGE
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 $10,000.
$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 18 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
Hospital Indemnity Plan GROUP VOLUNTARY HOSPITAL INDEMNITY INSURANCE BENEFIT HIGHLIGHTS
A 4-day stay in the hospital could cost around $10,000.1
Hospital indemnity (HI) insurance pays a cash benefit if you or an insured dependent (spouse or child) are confined in a hospital for a covered illness or injury. Even with the best primary health insurance plan, out-of-pocket costs from a hospital stay can add up. The benefits are paid in lump sum amounts to you, and can help offset expenses that primary health insurance doesn’t cover (like deductibles, co-insurance amounts or co- pays), or benefits can be used for any non-medical expenses (like housing costs, groceries, car expenses, etc.). To learn more about Hospital Indemnity insurance, visit thehartford.com/employeebenefits
Coverage Information You have a choice of two hospital indemnity plans, which allows you the flexibility to enroll for the coverage that best meets your needs. Benefit amounts are based on the plan in effect for you or an insured dependent at the time the covered event occurs. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s). PLAN INFORMATION
PLAN 1
PLAN 3
Coverage Type
On and off-job (24 hour)
On and off-job (24 hour)
Covered Events
Illness and injury
Illness and injury
HSA Compatible
Yes
Yes
PLAN 1
PLAN 3
$1,000
$2,500
BENEFITS HOSPITAL CARE
First Day Hospital Confinement
Up to 1 day per year
Daily Hospital Confinement (Day 2+)
Up to 90 days per year
$100
$100
Daily ICU Confinement (Day 1+)
Up to 30 days per year
$200
$400
VALUE ADDED SERVICES Ability Assist® EAP4 – 24/7/365 access to help for financial, legal or emotional issues HealthChampionSM5 – Administrative & clinical support following serious illness or injury
PLAN 1
PLAN 3
Included
Included
Included
Not Included
ASKED & ANSWERED
Monthly Premiums PLAN 1 $13.67 ($0.45 per day) $28.33 ($0.93 per day) $25.90 ($0.85 per day) $42.38 ($1.39 per day)
PLAN 3 IS THIS COVERAGE HSA COMPATIBLE? Employee Only $23.72 ($0.78 per day) If you (or any dependent(s)) currently participate Employee & Spouse $49.21 ($1.62 per day) in a Health Saving Account (HSA) or if you plan to Employee & Child(ren) $44.64 ($1.47 per day) do so in the future, you should be aware that the Employee & Family $73.24 ($2.41 per day) IRS limits the types of supplemental insurance you may have in addition to a HSA, while still maintaining the tax exempt status of the HSA. This plan design was designed to be compatible with Health Savings Accounts (HSAs). However, if you have or plan to open an HSA, please consult your tax and legal advisors to determine which supplemental benefits may be purchased by employees with an HSA.
WHO IS ELIGIBLE? You are eligible for this insurance if you are an active full-time employee who works at least 20 hours per week on a regularly scheduled basis. Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26. AM I GUARANTEED COVERAGE? This insurance is guaranteed issue coverage – it is available without having to provide information about your or your family’s health. All you have to do is elect the coverage to become insured.5 19
Hospital Indemnity HOW MUCH DOES IT COST AND HOW DO I PAY FOR THIS INSURANCE? Premiums are provided above. You have a choice of plan options. You may elect insurance for you only, or for you and your dependent(s), by choosing the applicable coverage tier. Premiums will be automatically paid through payroll deduction, as authorized by you during the enrollment process. This ensures you don’t have to worry about writing a check or missing a payment.
WHEN CAN I ENROLL? You may enroll during any scheduled enrollment period, within 31 days of the date you have a change in family status, or within 31 days of the completion of any eligibility waiting period established by your employer.
WHEN DOES THIS INSURANCE BEGIN? The initial effective date of this coverage is September 1, 2018. Subject to any eligibility waiting period established by your employer, if you enroll for coverage prior to this date, insurance will become effective on this date. If you enroll for coverage after this date, insurance will become effective in accordance with the terms of the certificate (usually the first day of the month following the date you elect coverage). You must be actively at work with your employer on the day your coverage takes effect. Your spouse and child(ren) must be performing normal activities and not be confined (at home or in a hospital/care facility).
WHEN DOES THIS INSURANCE END? This insurance will end when you or your dependents no longer satisfy the applicable eligibility conditions, premium is unpaid, you are no longer actively working, you leave your employer, or the coverage is no longer offered. CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO LONGER A MEMBER OF THIS GROUP? Yes, you can take this coverage with you. Coverage may be continued for you and your dependent(s) under a group portability policy. Your spouse may also continue insurance in certain circumstances. The specific terms and qualifying events for portability are described in the certificate. 1“Hospital Adjusted Expenses per Inpatient Day.” Kaiser Family Foundation. 2015. Web. 2 Mar. 2017. 2For Hospital Care benefits, when an insured is eligible for more than one benefit in a single day, only the highest benefit will be paid. 3Rates and/or benefits may be changed. Prepare. Protect. Prevail. With The Hartford. ® The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. 5962h NS 08/16 © 2016 The Hartford Financial Services Group, Inc. All rights reserved. This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy, the terms of the policy apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the policyholder. Hospital does not include: convalescent homes, or convalescent, rest or nursing facilities; facilities affording primarily custodial, educational or rehabilitory care; or facilities primarily for care of the aged/elderly, persons with substance abuse issues/disorders or mental/nervous disorders. Confinement means the assignment to a bed in a medical facility for a period of at least 20 consecutive hours. Required hours may vary by state. The Hartford compensates both internal and external producers, as well as others, for the sale and service of our products. For additional information regarding Hartford’s compensation practices, please review our website http://thehartford.com/group-benefits-producer-compensation. Hospital Income Plan Form Series includes GBD-2800, GBD-2900, or state equivalent.
LIMITATIONS & EXCLUSIONS This insurance coverage includes certain limitations and exclusions. The certificate details all provisions, limitations, and exclusions for this
insurance coverage. A copy of the certificate can be obtained from your employer. GROUP HOSPITAL INDEMNITY INSURANCE LIMITATIONS AND EXCLUSIONS The benefits payable are based on the insurance in effect on the date of the covered event, subject to the definitions, limitations, exclusions and other provisions of the policy. You and your dependent(s) must be citizens or legal residents of the United States, its territories and protectorates. Benefit Waiting Period – Illness Only: A covered person must complete a benefit waiting period before becoming eligible for benefits for a covered illness under the policy. A waiting period will also apply to any increase in benefits or benefit amounts, including any changes from the prior policy (if applicable). Credit for time insured under a prior policy, if applicable, is given. This provision does not apply to any newly acquired dependent child (if eligible for coverage). Other Hospital Indemnity Policy Limitation (Over-insurance Limitation): If an employee is insured under any other hospital indemnity policy underwritten by The Hartford, any claim for benefit is only payable under the one policy elected by the employee (or beneficiary or estate, in the 20
Hospital Indemnity event of death). We will return the amount of premium paid for any other policy that is declined by the employee retroactive to the later of: • the last date any benefit was paid for any covered person under the other policy • the effective date of insurance for the employee under the other policy Exclusions. This insurance does not provide benefits for any loss that results from or is caused by: • Suicide or attempted suicide, whether sane or insane, or intentional self-infliction • Voluntary intoxication (as defined by the law of the jurisdiction in which the illness or injury occurred) or while under the influence of any narcotic, drug or controlled substance, unless administered by or taken according to the instruction of a physician or medical professional • Voluntary intoxication through use of poison, gas or fumes, whether by ingestion, injection, inhalation or absorption • Voluntary commission of or attempt to commit a felony, voluntary participation in illegal activities (except for misdemeanor violations), voluntary participation in a riot, or voluntary engagement in an illegal occupation • Incarceration or imprisonment following conviction for a crime • Travel in or descent from any vehicle or device for aviation or aerial navigation, except as a fare-paying passenger in a commercial aircraft (other than a charter airline) on a regularly scheduled passenger flight or while traveling on business of the policyholder • Ride in or on any motor vehicle or aircraft engaged in acrobatic tricks/stunts (for motor vehicles), acrobatic/stunt flying (for aircraft), endurance tests, off-road activities (for motor vehicles), or racing • Participation in any organized sport in a professional or semi-professional capacity • Participation in abseiling, base jumping, Bossaball, bouldering, bungee jumping, cave diving, cliff jumping, free climbing, freediving, freerunning, hang gliding, ice climbing, Jai Alai, jet powered flight, kite surfing, kiteboarding, luging, missed climbing, mountain biking, mountain boarding, mountain climbing, mountaineering, parachuting, paragliding, parakiting, paramotoring, parasailing, Parkour, proximity flying, rock climbing, sail gliding, sandboarding, scuba diving, sepak takraw, slacklining, ski jumping, skydiving, sky surfing, speed flying, speed riding, train surfing, tricking, wingsuit flying, or other similar extreme sports or high risk activities • Travel or activity outside the United States or Canada • Active duty service or training in the military (naval force, air force or National Guard/Reserves or equivalent) for service/training extending beyond 31 days of any state, country or international organization, unless specifically allowed by a provision of the certificate • Involvement in any declared or undeclared war or act of war (not including acts of terrorism), while serving in the military or an auxiliary unit attached to the military, or working in an area of war whether voluntarily or as required by an employer
This insurance also does not provide benefits, unless required by law, for: • Elective abortion or complications thereof • Artificial insemination, in vitro fertilization, test tube fertilization • Gender change, sterilization, tubal ligation or vasectomy, and reversal thereof • Aroma therapeutic, herbal therapeutic, or homeopathic services • Any mental and nervous disorder, unless specifically allowed by a provision of the certificate • Substance abuse, unless specifically allowed by a provision of the certificate • Medical mishap or negligence on the part of any physician, medical professional, or therapist, including malpractice; • Treatment, supplies or services provided by, through or, behalf of any government agency or program; unless payment is • • • • • • •
required by a covered person Custodial care, unless specifically allowed by a benefit provision in the certificate or any rider attached to the policy (if applicable) Elective or cosmetic surgery or procedures, except for reconstructive surgery: Incidental to or following surgery for disease, infection or trauma of the involved body part Due to congenital anomaly or disease of a dependent child which has resulted in a functional defect Dental care or treatment, except for: Treatment due to an Injury to sound natural teeth within 12 months of an accident Treatment necessary due to congenital disease or anomaly Exclusions will vary by the jurisdiction/state in which the policy is issued.
NOTICES THE POLICY IS A HOSPITAL CONFINEMENT INDEMNITY POLICY. THE POLICY PROVIDES LIMITED BENEFITS. This limited health benefit plan (1) does not constitute major medical coverage, and (2) does not satisfy the individual mandate of the Affordable Care Act (ACA) because the coverage does not meet the requirements of minimum essential coverage. The Policy may provide payment of several benefits as a result of claims from a single hospitalization or covered incident. Payment of one benefit under the Policy does not constitute acceptance of liability for all claims made under the Policy nor does it prohibit Us from further investigation of subsequent claims. Please note: For residents of CA, GA, NJ and NY, since this is a limited benefit health product, persons without comprehensive health benefits from an individual or group health insurance policyor an HMO, or an employer plan providing essential health benefits are not eligible for this insurance. For residents of CT, ID, ME, NH, and WV, a person covered by any Title XIX program (Medicaid or any similar name) is not eligible for this insurance. 5962h NS 08/16 © 2016.The Hartford Financial Services Group, Inc. All rights reserved. Hospital Income Plan Form Series includes GBD-2800, GBD-2900, or state equivalent. Prepare. Protect. Prevail. With The Hartford. ® The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance
Company. Home Office is Hartford, CT. This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy, the terms of the policy apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the policyholder.
21
MDLIVE
Telehealth
About this Benefit Telehealth provides 24/7/365 access to boardcertified doctors via telephone consultations that can diagnose, recommend treatment and prescribe medication. Whether you are at home, traveling or at work, Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.
YOUR BENEFITS PACKAGE
75%
of all doctor, urgent care, and ER visits could be handled safely and effectively via telehealth.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included 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 22 details on covered expenses, limitations and exclusions included in the summary plan description located on the Hillsboro ISD Benefits Website:are www.mybenefitshub.com/hillsboroisd Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
Telehealth Need a doctor?
Download the MDLIVE Mobile App
No long wait. No big bill. Always open. With MDLIVE, you can visit with a doctor 24/7 from your home, office or on-the-go.
Quality care now goes where you do. With MDLIVE, you can visit with a doctor or counselor 24/7 from your home, office or on-the-go.
Welcome to MDLIVE! Your anytime, anywhere doctor’s office.
Welcome to MDLIVE!
We treat over 50 routine medical conditions including:
Your virtual doctor is here. Join for free today!
Your anytime, anywhere doctor’s office. Avoid waiting rooms and the inconvenience of going to the Avoid waiting rooms and the inconvenience of going to the doctor’s office. Visit a doctor or counselor by phone, secure video doctor’s office. Visit a doctor by phone, secure video, or MDLIVE or MDLIVE app. Pediatricians are available 24/7, and family App. Pediatricians are available 24/7, and family members are also members are also eligible. eligible. • U.S. board-certified doctors with an average of 15 years of • U.S. board certified doctors and licensed counselors with an experience. average of 15 years of experience. • Consultations are convenient, private and secure. • Consultations are convenient, private and secure • Prescriptions can be sent to your nearest pharmacy, if • Prescriptions can be sent to your nearest pharmacy, if medically necessary. medically necessary.
• • • • • • •
Acne Allergies Cold / Flu Constipation Cough Diarrhea Ear Problems
• • • • • •
Fever Headache Insect Bites Nausea / Vomiting Pink Eye Rash
Your Monthly Premium is
•
• • • •
Respiratory Problems Sore Throats Urinary Problems / UTI Vaginitis And More
The MDLIVE mobile app makes connecting with doctors and behavioral health counselors fast, easy and convenient.
No smartphone? No worries! Register your account using a computer or phone.
Download the app. Join for free. Visit a doctor. consultmdlive.com 888-365-1663
$0 Join for free. Visit a doctor. consulmdlive.com 888-365-1663
Copyright © 2019 MDLIVE Inc. All Rights Reserved. MDLIVE may not be available in certain states and is subject to state regulations. MDLIVE does not replace the primary care physician, is not an insurance product and may not be able to substitute for traditional in person care in every case or for every condition. MDLIVE does not prescribe DEA controlled substances and may not prescribe non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE does not guarantee patients will receive a prescription. Healthcare professionals using the platform have the right to deny care if based on professional judgment a case is inappropriate for telehealth or for misuse of services. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission. For complete terms of use visit https://www.MDLIVE.com/terms-of-use/.
23
CIGNA
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 24 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
Dental PPO Cigna Dental Choice Plan Network Options
Reimbursement Levels Calendar Year Benefits Maximum Applies to: Class II & III expenses Calendar Year Deductible
Out-of-Network: See Non-Network Reimbursement
Based on Contracted Fees
Maximum Reimbursable Charge
$1,000
$1,000
$50 $150
$50 $150
Individual Family
Benefit Highlights Class I: Diagnostic & Preventive 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 Oral Surgery: simple extractions only
Monthly PPO Premiums
In-Network: Total Cigna DPPO Network
Plan Pays
You Pay
100% No Deductible
No Charge
80% After Deductible
20% After Deductible
80% After Deductible
20% After Deductible
50% After Deductible
50% After Deductible
50% After Deductible
50% No Deductible
50% No Deductible
50% No Deductible
Class III: Major Restorative Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures 50% Oral Surgery: all except simple extractions After Surgical Extractions of Impacted Teeth Deductible Anesthesia: general and IV sedation Periodontics: minor and major Endodontics: minor and major Repairs: Bridges, Crowns and Inlays Repairs: Dentures Denture Relines, Rebases and Adjustments Class IV: Orthodontia 50% Coverage for Employee and All No Dependents Lifetime Benefits Maximum: Deductible $1,000
Plan Pays
You Pay
100% No Charge No Deductible
Tier
Rate
EE Only
$30.66
EE + Spouse
$77.79
EE + Children
$85.62
EE + Family
$109.64
Cigna Dental Benefit Summary Hillsboro ISD #3340968 Plan Renewal Date: 09/01/2020 Insured by: Cigna Health and Life Insurance Company This material is for informational purposes only and is designed to highlight some of the benefits available under this plan. Consult the plan documents to determine specific terms of coverage relating to your plan. Terms include covered procedures, applicable waiting periods, exclusions and limitations.
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 Reimbursable 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. Cross Accumulation All deductibles, plan maximums, and service specific maximums cross accumulate between in and out of network. Benefit frequency limitations are based on the date of service and cross accumulate between in and out of network. Calendar Year Benefits Maximum
The plan will only pay for covered charges up to the yearly Benefits Maximum, when applicable. Benefit-specific Maximums may also apply. 25
Dental PPO - Low Option Benefit Plan Provisions: 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
26
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. When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses. Cigna Dental Oral Health Integration Program offers enhanced dental coverage for customers with the following medical conditions: diabetes, heart disease, stroke, maternity, head and neck cancer radiation, organ transplants and chronic kidney disease. There’s no additional charge for the program, those who qualify get reimbursed 100% of coinsurance for certain related dental procedures. Eligible customers can also receive guidance on behavioral issues related to oral health and discounts on prescription and non-prescription 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 nonprescription 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 calendar year Bitewings: 2 per calendar year Complete series of radiographic images and panoramic radiographic images: Limited to a combined total of 1 per 36 months Payable only in conjunction with orthodontic workup 2 per calendar year, including periodontal maintenance procedures following active therapy 1 per calendar 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/toothcolored 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.
Dental PPO - High Option Benefit Exclusions: Covered Expenses will not include, and no payment will be made for the following: Procedures and services not included in the list of covered dental expenses; Diagnostic: cone beam imaging; Preventive Services: instruction for plaque control, oral hygiene and diet; Restorative: veneers of porcelain, ceramic, resin, or acrylic materials on crowns or pontics on or replacing the upper and or lower first, second and/or third molars; Periodontics: bite registrations; splinting; Prosthodontics: precision or semi-precision attachments; initial placement of a complete or partial denture per plan guidelines; Implants: implants or implant related services; 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; services performed primarily for cosmetic reasons; personalization; replacement of an appliance per benefit guidelines; Services that are deemed to be medical in nature; services and supplies received from a hospital; Drugs: prescription drugs Charges in excess of the Maximum Reimbursable Charge. This document provides a summary only. It is not a contract. If there are any differences between this summary and the official plan documents, the terms of the official plan documents will prevail. Cigna Dental PPO plans are insured and/or administered by Cigna Health and Life Insurance Company (CHLIC) or Connecticut General Life Insurance Company (CGLIC), with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. **In Texas, the insured dental plan is known as Cigna Dental Choice, and this plan uses the national Cigna DPPO network. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation “Cigna Home Delivery Pharmacy� refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. Policy forms (for insured dental plans) in OK: HPPOL99 (CHLIC), GM6000 ELI288 et al (CGLIC); OR: HP-POL68; TN: HP-POL69/HC-CER2V1 et al (CHLIC). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
27
DISCRIMINATION IS AGAINST THE LAW Dental coverage Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Cigna does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Cigna: • Provides free aids and services to people with disabilities to communicate effectively with us, such as: – Qualified sign language interpreters – Written information in other formats (large print, audio, accessible electronic formats, other formats) • Provides free language services to people whose primary language is not English, such as: – Qualified interpreters – Information written in other languages If you need these services, contact customer service at the toll-free number shown on your ID card, and ask a Customer Service Associate for assistance. If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by sending an email to ACAGrievance@Cigna.com or by writing to the following address: Cigna Nondiscrimination Complaint Coordinator PO Box 188016 Chattanooga, TN 37422 If you need assistance filing a written grievance, please call the number on the back of your ID card or send an email to ACAGrievance@Cigna.com. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, DC 20201 1.800.368.1019, 800.537.7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., Cigna Health Management, Inc., and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. ATTENTION: If you speak languages other than English, language assistance services, free of charge are available to you. For current Cigna customers, call the number on the back of your ID card. Otherwise, call 1.800.244.6224 (TTY: Dial 711). ATENCIÓN: Si usted habla un idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Si es un cliente actual de Cigna, llame al número que figura en el reverso de su tarjeta de identificación. Si no lo es, llame al 1.800.244.6224 (los usuarios de TTY deben llamar al 711). 28
911105 10/17
© 2017 Cigna.
Proficiency of Language Assistance Services English – ATTENTION: Language assistance services, free of charge, are available to you. For current Cigna customers, call the number on the back of your ID card. Otherwise, call 1.800.244.6224 (TTY: Dial 711). Spanish – ATENCIÓN: Hay servicios de asistencia de idiomas, sin cargo, a su disposición. Si es un cliente actual de Cigna, llame al número que figura en el reverso de su tarjeta de identificación. Si no lo es, llame al 1.800.244.6224 (los usuarios de TTY deben llamar al 711). Chinese – 注意：我們可為您免費提供語言協助服務。對於 Cigna 的現有客戶，請致電您的 ID 卡背面的號碼。其 他客戶請致電 1.800.244.6224 （聽障專線：請撥 711）。 Vietnamese – XIN LƯU Ý: Quý vị được cấp dịch vụ trợ giúp về ngôn ngữ miễn phí. Dành cho khách hàng hiện tại của Cigna, vui lòng gọi số ở mặt sau thẻ Hội viên. Các trường hợp khác xin gọi số 1.800.244.6224 (TTY: Quay số 711). Korean – 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 현재 Cigna 가입자님들께서는 ID 카드 뒷면에 있는 전화번호로 연락해주십시오. 기타 다른 경우에는 1.800.244.6224 (TTY: 다이얼 711)번으로 전화해주십시오. Tagalog – PAUNAWA: Makakakuha ka ng mga serbisyo sa tulong sa wika nang libre. Para sa mga kasalukuyang customer ng Cigna, tawagan ang numero sa likuran ng iyong ID card. O kaya, tumawag sa 1.800.244.6224 (TTY: I-dial ang 711). Russian – ВНИМАНИЕ: вам могут предоставить бесплатные услуги перевода. Если вы уже участвуете в плане Cigna, позвоните по номеру, указанному на обратной стороне вашей
идентификационной карточки участника плана. Если вы не являетесь участником одного из наших планов, позвоните по номеру 1.800.244.6224 (TTY: 711). . الحاليين برجاء االتصال بالرقم المدون علي ظهر بطاقتكم الشخصيةCigna لعمالء. – برجاء االنتباه خدمات الترجمة المجانية متاحة لكمArabic .)711 اتصل ب:TTY( 1.800.244.6224 او اتصل ب
French Creole – ATANSYON: Gen sèvis èd nan lang ki disponib gratis pou ou. Pou kliyan Cigna yo, rele nimewo ki dèyè kat ID ou. Sinon, rele nimewo 1.800.244.6224 (TTY: Rele 711). French – ATTENTION: Des services d’aide linguistique vous sont proposés gratuitement. Si vous êtes un client actuel de Cigna, veuillez appeler le numéro indiqué au verso de votre carte d’identité. Sinon, veuillez appeler le numéro 1.800.244.6224 (ATS : composez le numéro 711). Portuguese – ATENÇÃO: Tem ao seu dispor serviços de assistência linguística, totalmente gratuitos. Para clientes Cigna atuais, ligue para o número que se encontra no verso do seu cartão de identificação. Caso contrário, ligue para 1.800.244.6224 (Dispositivos TTY: marque 711). Polish – UWAGA: w celu skorzystania z dostępnej, bezpłatnej pomocy językowej, obecni klienci firmy Cigna mogą dzwonić pod numer podany na odwrocie karty identyfikacyjnej. Wszystkie inne osoby prosimy o skorzystanie z numeru 1 800 244 6224 (TTY: wybierz 711). Japanese – 注意事項：日本語を話される場合、無料の言語支援サービスをご利用いただけます。現在のCignaの お客様は、IDカード裏面の電話番号まで、お電話にてご連絡ください。その他の方は、1.800.244.6224（TTY: 711） まで、お電話にてご連絡ください。 Italian – ATTENZIONE: Sono disponibili servizi di assistenza linguistica gratuiti. Per i clienti Cigna attuali, chiamare il numero sul retro della tessera di identificazione. In caso contrario, chiamare il numero 1.800.244.6224 (utenti TTY: chiamare il numero 711). German – ACHTUNG: Die Leistungen der Sprachunterstützung stehen Ihnen kostenlos zur Verfügung. Wenn Sie gegenwärtiger Cigna-Kunde sind, rufen Sie bitte die Nummer auf der Rückseite Ihrer Krankenversicherungskarte an. Andernfalls rufen Sie 1.800.244.6224 an (TTY: Wählen Sie 711). لطفا ً با شمارهای که در٬Cigna برای مشتریان فعلی. به صورت رایگان به شما ارائه میشود٬ خدمات کمک زبانی: – توجهPersian (Farsi) را711 شماره: تماس بگیرید (شماره تلفن ویژه ناشنوایان1.800.244.6224 در غیر اینصورت با شماره.پشت کارت شناسایی شماست تماس بگیرید .)کنید شمارهگیری 29 911105 10/17
SUPERIOR VISION YOUR BENEFITS PACKAGE
Vision
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 30 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
Vision Monthly Premiums
Benefits through Superior Select Southwest Network In-Network
Out-of-Network
EE Only
$8.52
Covered in full
Up to $35 retail
EE + Spouse
$14.48
$125 retail allowance
Up to $70 retail
EE + Child(ren)
$15.34
EE + Family
$23.00
Benefits Exam Frames Lenses (Standard) per pair
Co-Pays
Single Vision
Covered in full
Up to $25 retail
Exam
$10
Bifocal
Covered in full
Up to $40 retail
Eyewear
$25
Trifocal
Covered in full
Progressive
See description
Contact Lenses
Services/Frequency
Up to $45 retail
Exam
12 months
Covered in full
Up to $80 retail
Frame
12 months
$150 retail allowance
Up to $80 retail
Lenses
12 months
Covered in full
Up to $150 retail
Contact Lenses
12 months
Lenticular 2
Up to $45 retail 1
Medically Necessary Contact Lenses
(Based on date of service) Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1 Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co -pay 2 Contact lenses and related professional services (fitting, evaluation and follow-up) are covered in lieu of eyeglass lenses and frames benefit
Discount Features Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.
SuperiorVision.com Customer Service 800.507.3800
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 Superior Vision of Texas P.O. Box 967 Rancho Cordova, CA 95741 800.507.3800 SuperiorVision.com 0417-BSv2/TX
31
AUL a ONEAMERICA COMPANY 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 32 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
Disability AGE WHEN TOTAL DISABILITY BEGINS
What you need to know about your Worksite Long Term Disability Benefits Elimination Period This is a period of consecutive days of disability before benefits may become payable under the contract. Maximum Benefit Duration This is the length of time that you may be paid benefits if continuously disabled as outlined in the contract. Pre-Existing Condition Period Certain disabilities are not covered if the cause of the disability is traceable to a condition existing prior to your effective date of coverage.
Option 1
0 Days / 7 Days
Option 2
14 Days / 14 Days
Option 3
30 Days / 30 Days
Option 4
60 Days / 60 Days
Option 5
90 Days / 90 Days
Option 6
180 Days /180 Days
Payroll Deduction Illustration: Monthly To estimate your payroll deduction amount:
Worksite Long Term Disability Coverage You may select a benefit of 40%, 50% or 60% of your monthly pre-disability earnings, up to a maximum monthly benefit of $7,500. MAXIMUM BENEFIT DURATION
Age When Total Disability Begins
Maximum Duration
Greater of Social Security Full Retirement Age or:
Example* Your Premium Calculation 1. Benefit percentage
.40
2. Maximum monthly benefit
$7,500
3. Multiply your monthly salary by Step 1
$1,000
4. Enter the lesser of Step 2 $1,000 or Step 3.
Less than age 60
To age 65
60
5 years
61
4 years
62
3.5 years
63
3 years
64
2.5 years
65
2 years
66
21 months
67
18 months
Elimination Period
40%
50%
60%
68
15 months
0/7
$2.50
$2.77
$3.26
69 and over
12 months
14/14
$2.20
$2.44
$2.87
PRE-EXISTING CONDITION PERIOD
30/30
$1.87
$2.07
$2.44
3 months / 12 months
60/60
$1.21
$1.34
$1.58
90/90
$1.05
$1.16
$1.37
180/180
$0.77
$0.85
$1.00
5. Divide Step 4 by 100
10
6. Enter the rate for the elected option from the chart below
$2.50
7. Multiply Step 5 by Step 6 $25.00 *Example based on an employee with a monthly salary of $2,500 electing a 40% benefit and 0/7 Elimination Period
ÂŽ
OneAmerica is the marketing name for the companies of OneAmerica. G 00615889-0000-000 Hillsboro Independent School D Class: 1 Rate Effective Date: 9/1/2017
33
APL
Cancer
About this Benefit Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.
YOUR BENEFITS PACKAGE
Breast Cancer is the most commonly diagnosed cancer in women.
If caught early, prostate cancer is one of the most treatable malignancies.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 34 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
GC14 Limited Benefit Group Cancer Indemnity Insurance Hillsboro ISD THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NONSUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.
SUMMARY OF BENEFITS
Plan 1
Plan 2
Cancer Treatment Policy Benefits
Level 1
Level 4
Radiation Therapy, Chemotherapy, Immunotherapy - Maximum per 12-month period
$10,000
$20,000
Hormone Therapy - Maximum of 12 treatments per calendar year Experimental Treatment Cancer Screening Rider Benefits Diagnostic Testing - 1 test per calendar year Follow-Up Diagnostic Testing - 1 test per calendar year Medical Imaging - per calendar year Surgical Rider Benefits Surgical Anesthesia Bone Marrow Transplant - Maximum per lifetime Stem Cell Transplant - Maximum per lifetime Prosthesis - Surgical Implantation/Non-Surgical (not Hair Piece) 1 device per site, per lifetime
$50 per treatment
$50 per treatment
paid in same manner and under the same maximums as any other benefit Level 1
Not Available
$50per test
Not Available
$100 per test
Not Available
$500 per test / 1 per calendar year Level 1
Not Available
$30 unit dollar amount Max $3,000 per operation 25% of amount paid for covered surgery $6,000
Not Available
$600
Not Available
$1,000 / $100
Not Available
Not Available Not Available
Patient Care Rider Benefits
Level 2
Hospital Confinement Per day of Hospital Confinement (1-30 days) Per day for Eligible Dependent Children (1-30 days) Per day of Hospital Confinement (31+ days) Per day for Eligible Dependent Children (31+ days) Outpatient Facility - Per day surgery is performed
$100 $200 $200 $400 $200
Not Available
Attending Physician - Per day of Hospital Confinement
$30
Not Available
Dread Disease - Per day of Hospital Confinement (1-30 days / 31+ days)
$100 / $200
Not Available
Extended Care Facility - Up to the same number of Hospital Confinement Days
$100 per day
Not Available
Not Available
Donor
$100 per day
Not Available
Home Health Care - Up to the same number of Hospital Confinement Days
$100 per day
Not Available
Hospice Care - Up to maximum of 365 days per lifetime
$100 per day
Not Available
US Government, Charity Hospital or HMO Per day of Hospital Confinement (1-30 days / 31+ days) Miscellaneous Care Rider Benefits
$100 / $200 Level 1
Not Available
Cancer Treatment Center Evaluation or Consultation - 1 per lifetime
Not Included
Not Available
Evaluation or Consultation Travel and Lodging - 1 per lifetime
Not Included
Not Available
Second / Third Surgical Opinion - per diagnosis of cancer
$300 / $300
Not Available
$150 per confinement $50 per prescription $150
Not Available
Drugs and Medicine - Inpatient / Outpatient (maximum $150 per month) Hair Piece (Wig) - 1 per lifetime Transportation - Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car Lodging - up to a maximum of 100 days per calendar year Family Transportation - Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car Family Lodging - up to a maximum of 100 days per calendar year
actual coach fare or $0.40 per mile $0.40 per mile $50 per day actual coach fare or $0.40 per mile $0.40 per mile $50 per day
Not Available Not Available
Not Available
35
APSB-22339(TX)-0615 MGM/FBS Hillsboro ISD
GC14 Limited Benefit Group Cancer Indemnity Insurance Level 1
Miscellaneous Care Rider Benefits Con’t. Blood, Plasma and Platelets
$300 per day
Not Available
$200 / $2,000 per trip $150 per day
Not Available Not Available
Outpatient Special Nursing Services - Up to same number of Hospital Confinement days
$150 per day
Not Available
Medical Equipment - Maximum of 1 benefit per calendar year
Not Included
Not Available
$25 per visit / $1,000
Not Available
Waive Premium
Not Available
Ambulance - Ground/Air - Maximum of 2 trips per Hospital Confinement for all modes of transportation combined Inpatient Special Nursing Services - per day of Hospital Confinement
Physical, Occupational, Speech, Audio Therapy & Psychotherapy / Maximum per calendar year Waiver of Premium Internal Cancer First Occurrence Rider Benefits
Level 1
Level 4
Lump Sum Benefit - Maximum 1 per Covered Person per lifetime
$2,500
$10,000
Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime
$3,750
$15,000
Heart Attack/Stroke First Occurrence Rider Benefits
Level 4
Lump Sum Benefit - Maximum 1 per Covered Person per lifetime
Not Available
$10,000
Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime
Not Available
$15,000
Intensive Care Unit
$600 per day
$600 per day
Step Down Unit - Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit
$300 per day
$300 per day
Hospital Intensive Care Unit Rider Benefits
TOTAL MONTHLY PREMIUMS BY PLAN** Issue Ages 18 +
Individual
Individual & Spouse
1 Parent Family
2 Parent Family
Plan 1
Plan 2
Plan 1
Plan 2
Plan 1
Plan 2
Plan 1
Plan 2
$19.90
$24.80
$41.96
$53.70
$25.96
$30.40
$47.96
$59.34
**Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with notice. The premium and amount of benefits vary dependent upon the Plan selected at time of application.
Benefits are only payable following a diagnosis of cancer for a loss incurred for the treatment of cancer while covered under the policy. A charge must be incurred for benefits to be payable. When coverage terminates for loss incurred after the coverage termination date, our obligation to pay benefits also terminates for a specified disease that manifested itself while the person was covered under the policy. All benefits are subject to the benefit maximums.
Pre-Existing Condition Exclusion
Cancer Treatment Benefits
No benefits are payable for any loss incurred during the pre-existing condition exclusion period, following the covered person’s effective date as the result of a pre-existing condition. Pre-existing conditions specifically named or described as excluded in any part of the policy are never covered. If any change to coverage after the certificate effective date results in an increase or addition to coverage, the time limit on certain defenses and pre-existing condition exclusion for such increase will be based on the effective date of such increase.
Eligibility
Waiting Period
You and your eligible dependents are eligible to be insured under this certificate if you and your eligible dependents meet our underwriting rules and you are actively at work with the policyholder and qualify for coverage as defined in the master application.
Limitations and Exclusions
No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date regardless of when specified disease was diagnosed.
Only Loss for Cancer
The policy pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The policy also covers other conditions or diseases directly caused by cancer or the treatment of cancer. The policy does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer. 36
APSB-22339(TX)-0615 MGM/FBS Hillsboro ISD
The policy and any attached riders contain a waiting period during which no benefits will be paid. If any covered person has a specified disease diagnosed before the end of the waiting period immediately following the covered person’s effective date, coverage for that person will apply only to loss that is incurred after one year from the covered person’s effective date. If any covered person is diagnosed as having a specified disease during the waiting period immediately following the covered person’s effective date, you may elect to void the certificate from the beginning and receive a full refund of premium. If the policy replaced group specified disease cancer coverage from any company that terminated within 30 days of the certificate effective date, the waiting period will be waived for those covered persons that were covered under the prior coverage. However, the pre-existing condition exclusion provision will still apply.
GC14 Limited Benefit Group Cancer Indemnity Insurance Termination of Certificate
Insurance coverage under the certificate and any attached riders will end on the earliest of these dates: the date the policy terminates; the end of the grace period if the premium remains unpaid; the date insurance has ceased on all persons covered under this certificate; the end of the certificate month in which the policyholder requests to terminate this coverage; the date you no longer qualify as an insured; or the date of your death.
Termination of Coverage
Insurance coverage for a covered person under the certificate and any attached riders for a covered person will end as follows: the date the policy terminates; the date the certificate terminates; the end of the grace period if the premium remains unpaid; the end of the certificate month in which the policyholder requests to terminate the coverage for an eligible dependent; the date a covered person no longer qualifies as an insured or eligible dependent; or the date of the covered person’s death. We may end the coverage of any Covered Person who submits a fraudulent claim.
Cancer Screening Benefits Limitations and Exclusions
No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.
Surgical Benefits Limitations and Exclusions
No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.
Patient Care Benefits
You must remain disabled for 60 continuous days before this benefit will begin. The waiver of premium will begin on the next premium due date following the 60 consecutive days of disability. This benefit will continue for as long as you remain disabled until the earliest of either of the following: the date you are no longer disabled; the date coverage ends according to the termination provisions in the certificate; or the date coverage ends according to the termination provisions in this rider. Proof of disability must be provided for each new period of disability before a new waiver of premium benefit is payable.
Limitations and Exclusions
No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.
Termination of Cancer Screening, Surgical, Patient Care & Miscellaneous Benefit Rider(s) The above listed rider(s) will terminate and coverage will end for all covered persons on the earliest of: the end of the grace period if the premium for the rider remains unpaid; the date the policy or certificate to which the rider is attached terminates; the end of the certificate month in which APL receives a request from the policyholder to terminate the rider; or the date of your death. Coverage on an eligible dependent terminates under the rider when such person ceases to meet the definition of eligible dependent.
Internal Cancer First Occurrence Benefits Pays a lump sum benefit amount when a covered person receives a first diagnosis of internal cancer and the date of diagnosis occurs after the waiting period. Only one benefit per covered person, per lifetime is payable under this benefit and the lump sum benefit amount will reduce by 50% at age 70.
Limitations and Exclusions
We will not pay benefits for a diagnosis of internal cancer received outside the territorial limits of the United States or a metastasis to a new site of any cancer diagnosed prior to the covered person’s effective date, as this is not considered a first diagnosis of an internal cancer.
A hospital is not an institution, or part thereof, used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a rehabilitative facility; an extended-care facility; or a facility primarily affording custodial, educational care, or care of treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction.
Pre-Existing Condition Exclusion
Limitations and Exclusions
This rider contains a 30-day waiting period during which no benefits will be paid. If any internal cancer is diagnosed before the end of the waiting period immediately following the covered person’s effective date of this rider, coverage will apply only to loss that is incurred after one year from the covered person’s effective date of this rider.
No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.
Only Loss for Cancer or Dread Disease
Pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. This rider also covers other conditions or diseases directly caused by cancer or the treatment of cancer. This rider does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer except for conditions specifically provided in the dread disease benefit.
Miscellaneous Benefits Waiver of Premium
When the certificate is in force and you become disabled, we will waive all premiums due including premiums for any riders attached to the certificate. Disability must be due to cancer and occur while receiving treatment for such cancer.
APSB-22339(TX)-0615 MGM/FBS Hillsboro ISD
No benefits are payable for any loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as the result of a pre-existing condition.
Waiting Period
Termination
This rider will terminate and coverage will end for all covered persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the policy or certificate to which this rider is attached terminates; the end of the certificate month in which we receive a request from the policyholder to terminate this rider; the date of covered person’s death or the date the lump sum benefit amount for internal cancer has been paid for all covered persons under this rider. Coverage on an eligible dependent terminates under this rider when such person ceases to meet the definition of eligible dependent.
Heart Attack/Stroke First Occurrence Benefits Pays a lump sum benefit amount when a covered person receives a first diagnosis of heart attack or stroke and the date of diagnosis occurs after the waiting period. Only one benefit per covered person per lifetime is payable under this benefit and the lump sum benefit amount will reduce by 50% at age 70.
37
GC14 Limited Benefit Group Cancer Indemnity Insurance Limitations and Exclusions
We will not pay benefits for any loss caused by or resulting from any of the following: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces, or military service for any country at war [(if coverage is suspended for any covered person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the policyholder’s written request)]; participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions; or participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place).
Pre-Existing Condition Exclusion
No benefits are payable for any loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as the result of a Pre-Existing Condition.
Waiting Period
This rider contains a 30-day waiting period during which no benefits will be paid. If any heart attack or stroke is diagnosed before the end of the waiting period immediately following the covered person’s effective date of this rider, coverage will apply only to loss that is incurred after one year from the covered person’s effective date.
Termination
This rider will terminate and coverage will end for all covered persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the policy or certificate to which this rider is attached terminates; the end of the certificate month in which we receive a request from the policyholder to terminate this rider; the date of a covered person’s death or the date the lump sum benefit amount for heart attack or stroke has been paid for all covered persons under this rider. Coverage on an eligible dependent terminates under this rider when such person ceases to meet the definition of eligible dependent, as defined in the policy.
Hospital Intensive Care Unit Benefits Pays a daily benefit amount, up to the maximum number of days for any combination of confinement, for each day charges are incurred for room and board in an intensive care unit (ICU) or step-down unit due to an accident or sickness. Benefits will be paid beginning on the first day a covered person is confined in an ICU or step-down unit due to an accident or sickness that begins after the effective date of this rider. This benefit will reduce by 50% at age 70.
Termination
This rider will terminate and coverage will end for all covered persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the policy or certificate to which this rider is attached terminates; the end of the certificate month in which we receive a request from the policyholder to terminate this rider or the date of the covered person’s death. Coverage on an eligible dependent terminates under this rider when such person ceases to meet the definition of eligible dependent.
Optionally Renewable This policy/riders are optionally renewable. The policyholder or we have the right to terminate the policy/riders on any premium due date after the first anniversary following the policy/riders effective date. We must give at least 60 days written notice to the policyholder prior to cancellation.
Portability (Voluntary Plans Only) When you no longer meet the definition of Insured, you will have the option to continue this coverage, including any attached riders. No Evidence of Insurability will be required. Portability must meet all of the following conditions: the certificate has been continuously in force for the last 12 months; we receive a request and payment of the first premium for the portability coverage no later than 30 days after the date you no longer qualify as an eligible insured; and the policy, under which this certificate was issued, continues to be in force on the date you cease to qualify for coverage. All future premiums due will be billed directly to you. You are responsible for payment of all premiums for the portability coverage. The benefits, terms and condition of the portability coverage will be the same as those elected under the certificate immediately prior to the date you exercised portability. Portability coverage may include any eligible dependents who were covered under the certificate at the time you ceased to qualify as an eligible insured. No new eligible dependents may be added to the portability coverage except as provided in the New Born and Adopted Children provision. No increases in coverage will be allowed while you are exercising your rights under this rider. The premium for the portability coverage will be based on the premium tables used for such coverage at the time of the portability request. Coverage under this rider will terminate in accordance with the provisions of the Termination of Coverage in the certificate. If the policy is no longer in force, then portability coverage is not available.
Limitations and Exclusions
For a newborn child born within the 10-month period following the effective date, no benefits under this rider will be provided for confinements that begin within the first 30 days following the birth of such child. No benefits under this rider will be provided during the first two years following the effective date for confinements caused by any heart condition when any heart condition was diagnosed or treated prior to the end of the 30-day period following the covered person’s effective date. The heart condition causing the confinement need not be the same condition diagnosed or treated prior to the effective date. We will not pay benefits for any loss caused by or resulting from any of the following: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces, or military service for any country at war [(if coverage is suspended for any covered person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the policyholder’s written request)]; participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions; participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place).
2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606
Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For detailed benefits, limitations, exclusions and other provisions, please refer to the policy/certificate/riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GC14 Series | TX | Limited Benefit Group Cancer Indemnity Insurance | (10/14) | MGM/FBS | Hillsboro ISD 38
APSB-22339(TX)-0615 MGM/FBS Hillsboro ISD
39
VOYA YOUR BENEFITS PACKAGE
Accident
About this Benefit Accident insurance is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or a not-soserious, injury. Accident coverage is low cost protection available to you and your family without evidence of insurability.
2/3 of disabling injuries suffered by American workers are not work related. American workers 36% ofreport they always or
usually live paycheck to paycheck.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 40 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
Accident Compass Accident Insurance A limited benefit policy
Enrollment at a Glance Affordable insurance that can help you pay for the out-of-pocket costs you may experience after an accident.
What is Accident Insurance? Accident Insurance pays you benefits for specific injuries and events resulting from a covered accident while off-job and must be on or after your coverage effective date. The amount paid depends on the type of injury and care received. You have the option to elect Accident Insurance to meet your needs. Accident 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. You may qualify to receive benefits for items listed below, as long as they are the result of a covered accident. See the certificate of insurance and any riders for specific details. • Accident hospital care • Follow-up care • Common Injuries Other features of Accident Insurance include: • Guaranteed Issue: No medical questions or tests required for coverage. • Flexible: You can use the benefit money for any purpose you like. • Payroll deductions: Premiums are paid through convenient payroll deductions. • Portable: Should you leave your current employer or retire, you can take your coverage with you.
How can Accident Insurance help? Below are a few examples of how your Accident Insurance benefits could be used: • Medical expenses, such as deductibles and copays • Home healthcare costs • Lost income due to lost time at work • Everyday expenses like utilities and groceries
Who is eligible for Accident Insurance? You—all active employees working 20+ hours per week**. Your spouse*— under age 70. Coverage is available only if employee coverage is elected. Your child(ren)— to age 26. Coverage is available only if employee coverage is elected. *The use of “spouse” in this document means a person insured as a spouse as described in the certificate of insurance or rider. This may include domestic partners or civil union partners as defined by the group policy. Please contact your employer for more information.
What accident benefits are available? The following list includes the benefits provided by Accident Insurance. The benefit amounts paid depend on the type of injury and care received. You may be required to seek care for your injury within a set amount of time. Note that there may be some variation by state. For a list of standard exclusions and limitations, go to the end of this document. For a complete description of your available benefits, along with applicable provisions, exclusions and limitations, see your certificate of insurance and any riders.
Event Benefit Accident Hospital Care Surgery open abdominal, thoracic $800 Surgery exploratory or without repair $125 Blood, plasma, platelets $400 Hospital admission $1,000 Hospital confinement per day, up to 365 $300 days Critical care unit confinement per day, up to $475 15 days Rehabilitation facility confinement per day $125 up to 90 days Coma duration of 14 or more days $11,500 Transportation per trip, up to 3 per accident $500 Lodging per day, up to 30 days $120 Family care per child per day, up to 45 days $15 Accident Care Initial doctor visit $60 Urgent care facility treatment $150 Emergency room treatment $150 Ground ambulance $240 Air ambulance $1,000 Follow-up doctor treatment $60 Chiropractic treatment up to 6 per accident $30 Medical equipment $40 Physical or occupational therapy up to 6 per $30 accident Speech therapy up to 6 per accident $30 Prosthetic device (one) $500 Prosthetic device (two or more) $800 Major diagnostic exam $80 Outpatient surgery (1 per accident) $150 X-ray $30 Common Injuries Burns second degree, at least 36% of the $1,000 body Burns 3rd degree, at least 9 but less than 35 $4,500 square inches of the body Burns 3rd degree, 35 or more square inches $10,000 of the body 25% of the burn benefit Skin grafts $250 crown, $60 Emergency dental work extraction $60 Eye injury removal of foreign object $225 Eye injury surgery Torn knee cartilage $150 surgery with no repair or if cartilage is shaved $500 Torn knee cartilage surgical repair Laceration1 treated no sutures $20 $40 Laceration1 sutures up to 2” 1 $160 Laceration sutures 2” – 6” $320 Laceration1 sutures over 6” 41
Accident 1
Common Injuries (cont.)
Ruptured disk surgical repair Tendon/ligament/rotator cuff exploratory arthroscopic surgery with no repair Tendon/ligament/rotator cuff one, surgical repair Tendon/ligament/rotator cuff two or more, surgical repair Concussion Paralysis - paraplegia Paralysis - quadriplegia Dislocations Hip joint
$500 $275 $550 $800 $150
Ankle or foot bone(s) other than toes
$1,000/$2,000
Shoulder
$1,000/$2,000
Elbow
$750/$1,500
Wrist
$750/$1,500 $750/$1,500
Lower jaw
$750/$1,500
Fractures Hip Leg Ankle Kneecap Foot excluding toes, heel Upper arm Forearm, hand, wrist except fingers Finger, toe Vertebral body Vertebral processes Pelvis except coccyx Coccyx Bones of face except nose Nose Upper jaw Lower jaw Collarbone Rib or ribs Skull – simple except bones of face Skull – depressed except bones of face Sternum Shoulder blade Chip fractures
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Wellness Benefit: This provides an annual benefit payment if you complete a health screening test. You may only receive a benefit payment once per year, even if you complete multiple health screening tests. Examples of health screening tests include but are not limited to: Pap test, serum cholesterol test for HDL and LDL levels, mammography, colonoscopy, and stress test on bicycle or treadmill. The annual benefit amount is $50 for completing a health screening test. If your spouse and/or children are covered for Accident Insurance, they are also covered for the Wellness Benefit. Your spouse’s benefit amount is also $50. The benefit for child coverage is 50% of your benefit amount per child with an annual maximum of $100 for all children.
•
Sports Accident Benefit: If your accident occurs while participating in an organized sporting activity as defined in the certificate, the Accident Hospital Care, Accident Care or Common Injuries benefit will be increased by 25%, to a maximum additional benefit of $1000. If your spouse and/or children are covered for Accident Insurance, their coverage includes this benefit. This benefit only applies to the events in the table above. It does not apply to any of the additional benefits/coverage outlined in this section.
•
Accidental Death and Dismemberment (AD&D) Benefit: If you are severely injured or die as a result of a covered accident, an AD&D benefit may be payable to you or your beneficiary. If your spouse and/or children are covered for Accident Insurance, their coverage includes this benefit.
$175/$350
Hand bone(s) other than fingers
Partial dislocations
•
$16,000 Closed/open reduction2 $2,550/$5,100 $1,600/$3,200
Collarbone
What other benefits are included in my Accident Insurance policy?
$10,750
Knee
Finger/toe
Laceration benefits are a total of all lacerations per accident. Closed Reduction of Dislocation = Non-surgical reduction of a completely separated joint. Open Reduction of Dislocation = Surgical reduction of a completely separated joint. 3 Closed Reduction of Fracture = Non-surgical. Open Reduction of Fracture = Surgical. 2
$750/$1,500 25% of the closed reduction amount Closed/open reduction3 $2,000/$4,000 $1,500/$3,000 $1,200/$2,400 $1,200/$2,400 $1,200/$2,400 $1,400/$2,800 $1,200/$2,400 $160/$320 $2,240/$4,480 $960/$1,920 $2,250/$4,500 $200/$400 $800/$1,600 $400/$800 $1,000/$2,000 $960/$1,920 $960/$1,920 $300/$600 $1,000/$2,000
$2,000/$4,000 $240/$480 $1,200/$2,400 25% of the closed reduction amount
Accidental Death Benefits Low Option Common Carrier: If the death occurs as a result of a covered accident on a common carrier a higher benefit will be paid. Common carrier means any commercial transportation that operates on a regularly scheduled basis between predetermined points or cities. Employee $65,000 Spouse $30,000 Children $15,000 Other Accident Employee $30,000 Spouse $12,500 Children $6,000
Accident Who do I contact with questions?
Accidental Dismemberment Benefits
Loss of both hand or both feet or sight in both eyes Loss of one hand or one foot AND the sight of one eye Loss of one hand AND one foot Loss of one hand OR one foot Loss of Two or more fingers or toes Loss of one finger or one toe
$20,000 $14,000 $14,000 $7,500 $1,200 $750
How much does Accident Insurance cost? All employees pay the same rate, no matter their age. See the chart below for the premium amounts. Monthly Rates Employee
Employee and Spouse
Employee and Children
Family
$10.41
$17.43
$20.15
$27.17
For more information, please call the Voya Employee Benefits Customer Service Team at (877) 236-7564 This is a summary of benefits only. A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the certificate of insurance and riders. All coverage is subject to the terms and conditions of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern. To keep coverage in force, premiums are payable up to the date of coverage termination. Accident Insurance is underwritten by ReliaStar Life Insurance Company, a member of the Voya® family of companies. Policy Form #RL-ACC2-POL-12; Certificate Form #RL-ACC2-CERT-12; and Rider Forms: Spouse Accident Rider Form #RL-ACC2-SPR-12, Children's Accident Rider Form #RL-ACC2-CHR-12, Wellness Benefit Rider Form #RL-ACC2-WELL12, Accidental Death & Dismemberment (AD&D) Rider Form #RL-ACC2-ADR-12, Form numbers, provisions and availability may vary by state. CN0322-23036-0317 Hillsboro Independent School District, Acct #0001, 04/26/2017
Exclusions and Limitations Exclusions in the Certificate, Spouse Accident Insurance, Children’s Accident Insurance and AD&D Benefit are listed below. (These may vary by state.) Benefits are not payable for any loss caused in whole or directly by any of the following*: • Participation or attempt to participate in a felony or illegal activity. • An accident while the covered person is operating a motorized vehicle while intoxicated. Intoxication means the covered person’s blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the accident occurred. • Suicide, attempted suicide or any intentionally 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. • 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 farepaying 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. • Any sickness or declining process caused by a sickness. • Work for pay, profit or gain, if the employer elects to exclude workrelated sicknesses or accidents under the policy. *See the certificate of insurance and riders for a complete list of available benefits, along with applicable provisions, exclusions and limitations. 43
UNUM
Critical Illness
Critical illness insurance is designed to supplement your medical and disability coverage easing the financial impacts by covering some of your additional expenses. It providesisadesigned benefit payable directly to the Critical illness insurance to supplement of a covered condition yourinsured medicalupon and diagnosis disability coverage easing the or event,impacts like a heart attack or stroke. financial by covering some of your additional
YOUR BENEFITS PACKAGE
About this Benefit
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 44 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
Critical Illness Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. Who is eligible for this coverage? What are the Critical Illness coverage amounts?
All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status). The following coverage amounts are available. For you: Select one of the following Choice $10,000, $15,000 or $30,000
Can I be denied coverage? When is coverage effective?
What critical illness conditions are covered?
For your Spouse and Children: 50% of employee coverage amount Coverage is guarantee issue. Please see your Plan Administrator for your effective date of coverage. 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. Covered Conditions* Percentage of Coverage Amount Critical Illnesses Coronary Artery Disease (major) 50% Coronary Artery Disease (minor) 10% End Stage Renal (Kidney) Failure 100% Heart Attack (Myocardial Infarction) 100% Major Organ Failure Requiring Transplant 100% Stroke 100% Cancer Invasive Cancer (including all Breast Cancer) 100% Non-Invasive Cancer 25% Skin Cancer $500 Additional Critical Illnesses for your Children Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Down Syndrome 100% Spina Bifida 100% *Please refer to the policy for complete definitions of covered conditions. Covered Condition Benefit The covered condition benefit is payable once per covered condition per insured. Unum will pay a covered condition benefit for a different covered condition if: • the new covered condition is medically unrelated to the first covered condition; or • the dates of diagnosis are separated by more than 180 days. Reoccurring Condition Benefit We will pay the reoccurring condition benefit for the diagnosis of the same covered condition if the covered condition benefit was previously paid and the new date of diagnosis is more than 180 days after the prior date of diagnosis. The benefit amount for any reoccurring condition benefit is 100% of the percentage of coverage amount for that condition. The following Covered Conditions are eligible for a reoccurring condition benefit:
• • • • •
Benign Brain Tumor Coma
Coronary Artery Disease (Major) Coronary Artery Disease (Minor) End Stage Renal (Kidney) Failure
• • • • •
Heart Attack (Myocardial Infarction) Invasive Cancer (includes all Breast Cancer)
Major Organ Failure Requiring Transplant Non-Invasive Cancer Stroke
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Critical Illness How much does the coverage cost?
Age Less than age 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 or over
Option 1: $10,000 EE, $5,000 SP Employee Cost $1.40 $2.20 $3.20 $5.10 $7.30 $10.30 $14.30 $20.40 $29.40 $42.10 $60.90 $79.00 $91.00 $114.20
Spouse Cost $0.70 $1.10 $1.60 $2.55 $3.65 $5.15 $7.15 $10.20 $14.70 $21.05 $30.45 $39.50 $45.50 $57.10
Age Less than age 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 or over
Option 2: $15,000 EE, $7,500 SP Employee Cost $2.10 $3.30 $4.80 $7.65 $10.95 $15.45 $21.45 $30.60 $44.10 $63.15 $91.35 $118.50 $136.50 $171.30
Spouse Cost $1.05 $1.65 $2.40 $3.83 $5.48 $7.73 $10.73 $15.30 $22.05 $31.58 $45.68 $59.25 $68.25 $85.65
Age Less than age 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 or over
Option 3: $20,000 EE, $10,000 SP Employee Cost $2.80 $4.40 $6.40 $10.20 $14.60 $20.60 $28.60 $40.80 $58.80 $84.20 $121.80 $158.00 $182.00 $228.40
Spouse Cost $1.40 $2.20 $3.20 $5.10 $7.30 $10.30 $14.30 $20.40 $29.40 $42.10 $60.90 $79.00 $91.00 $114.20
Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date.
46
Spouse rate is based on your Spouse’s insurance age, which is their age immediately prior to and including the anniversary/effective date.
Critical Illness Do my critical illness insurance benefits decrease with age? Are there any exclusions or limitations?
Is the coverage portable (can I keep it if I leave my employer)? When does my coverage end?
Critical Illness benefits do not decrease due to age.
We will not pay benefits for a claim that is caused by, contributed to by, or occurs as a result of any of the following: • committing or attempting to commit a felony; • being engaged in an illegal occupation or activity; • injuring oneself intentionally or attempting or committing suicide, whether sane or not; • active participation in a riot, insurrection, or terrorist activity. This does not include civil commotion or disorder, injury as an innocent bystander, or Injury for self-defense; • participating in war or any act of war, whether declared or undeclared; • combat or training for combat while serving in the armed forces of any nation or authority, including the National Guard, or similar government organizations; • voluntary use of or treatment for voluntary use of any prescription or nonprescription drug, alcohol, poison, fume, or other chemical substance unless taken as prescribed or directed by the Insured’s Physician; • being intoxicated; and • a Date of Diagnosis that occurs while an Insured is legally incarcerated in a penal or correctional institution. Additionally, no benefits will be paid for a Date of Diagnosis that occurs prior to the coverage effective date. Pre-existing Conditions We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following: • a pre-existing condition; or • complications arising from treatment or surgery for, or medications taken for, a pre-existing condition. An insured has a pre-existing condition if, within the 12 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which: • medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period; • drugs or medications were taken, or prescribed to be taken during that period; or • symptoms existed. Pre-existing Condition requirements are not applicable to: -Children who are newly acquired after your Coverage Effective Date. The pre-existing condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date any initial coverage or increases in coverage become effective. If you have been insured for at least 12 months and your employment with your employer ends or you are no longer in an eligible group you can apply for ported coverage and pay the first premium within 31 days to continue coverage for yourself, your spouse and your children. If your spouse’s coverage ends as a result of your death, divorce or annulment, your spouse may elect to continue spouse and children coverage, as long as premium is paid as required. If you choose to cancel coverage, it will end on the first of the month following the date you provide notification to your employer. Otherwise, coverage ends on the earliest of: - the date the policy is cancelled by your employer; - the date you no longer are in an eligible group; - the date your eligible group is no longer covered; - the date of your death - the last day of the period any required contributions are made; - the last day you are in active employment. If you choose to cancel your Spouse’s coverage, it will end on the first of the month following the date you provide notification to your employer. Otherwise, your spouse’s coverage will end on the earliest of: - the date your coverage ends; - the date your spouse is no longer eligible for coverage; - the date your spouse no longer meets the definition of a spouse; - the date of your spouse’s death; or - the date of divorce or annulment. Your children’s coverage will end on the earliest of: - the date your coverage ends; - the date your children are no longer eligible for coverage; or - the date your children no longer meet the definition of children.
The limited benefits provided are a supplement to major medical coverage and are not a substitute for major medical coverage or other minimal essential coverage as required by federal law. Lack of minimal essential coverage may result in an additional tax payment being due. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form GCIP16-1 et al or contact your Unum representative. 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. Underwritten by Unum Insurance Company, Portland, Maine
47
AUL a ONEAMERICA COMPANY
Basic and Term Life and AD&D
YOUR BENEFITS PACKAGE
About this Benefit Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family. Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.
Motor vehicle crashes are the
#1
cause of accidental deaths in the US, followed by poisoning, falls, drowning, and choking.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 48 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
Basic and Term Life and AD&D What you need to know about your Basic Life and AD&D Benefits Guaranteed Issue: Employee: $10,000 Accidental Death and Dismemberment (AD&D): Additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract. Additional AD&D benefits include seat belt, air bag, repatriation, child higher education, child care, paralysis/loss of use, severe burns, disappearance, and exposure. Accelerated Life Benefit: If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose. Reductions: Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule. Age:
70
Reduces To:
50%
Guaranteed Increase In Benefit: You may be eligible to increase your coverage annually until you reach your maximum amount without providing evidence of insurability. Reductions: Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule. The amounts of dependent life insurance and dependent AD&D principal sum will reduce according to the employee's reduction schedule. Age:
70
Reduces To:
50%
Basic Employee Life and AD&D Coverage Your Life and AD&D insurance coverage amount is $10,000. Coverage is provided at no cost to you.
What you need to know about your Voluntary Term Life and AD&D Benefits Flexible Options: • Employee: $10,000 to $500,000, in $10,000 increments • Spouse: $5,000 to $250,000, in $5,000 increments, not to exceed 50% of the employee’s amount Guaranteed Issue: • Employee: $150,000 • Spouse: $50,000 • Child: $10,000 Dependent Life Coverage: Optional dependent life coverage is available to eligible employees. You must select employee coverage in order to cover your spouse and/or child(ren). Accidental Death and Dismemberment (AD&D): You must select Life coverage in order to select any AD&D coverage. Additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract. Accelerated Life Benefit: If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose.
49
Life and AD&D Payroll Deduction Illustration: Monthly Employee Options Life & AD&D
0-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75+
$10,000
$.80
$.80
$.90
$1.10
$1.30
$1.80
$2.80
$4.40
$7.00
$8.70
$14.90
$24.00
$36.70
$20,000
$1.60
$1.60
$1.80
$2.20
$2.60
$3.60
$5.60
$8.80
$14.00
$17.40
$29.80
$48.00
$73.40
$30,000
$2.40
$2.40
$2.70
$3.30
$3.90
$5.40
$8.40
$13.20
$21.00
$26.10
$44.70
$72.00
$110.10
$40,000
$3.20
$3.20
$3.60
$4.40
$5.20
$7.20
$11.20
$17.60
$28.00
$34.80
$59.60
$96.00
$146.80
$50,000
$4.00
$4.00
$4.50
$5.50
$6.50
$9.00
$14.00
$22.00
$35.00
$43.50
$74.50
$120.00 $183.50
$80,000
$6.40
$6.40
$7.20
$8.80
$10.40
$14.40
$22.40
$35.20
$56.00
$69.60
$119.20 $192.00 $293.60
$100,000
$8.00
$8.00
$9.00
$11.00
$13.00
$18.00
$28.00
$44.00
$70.00
$87.00
$149.00 $240.00 $367.00
$120,000
$9.60
$9.60
$10.80
$13.20
$15.60
$21.60
$33.60
$52.80
$84.00
$104.40 $178.80 $288.00 $440.40
$130,000
$10.40
$10.40
$11.70
$14.30
$16.90
$23.40
$36.40
$57.20
$91.00
$113.10 $193.70 $312.00 $477.10
$150,000
$12.00
$12.00
$13.50
$16.50
$19.50
$27.00
$42.00
$66.00
$105.00 $130.50 $223.50 $360.00 $550.50
Spouse Options Life & AD&D
0-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75+
$5,000
$.40
$.40
$.45
$.55
$.65
$.90
$1.40
$2.20
$3.50
$4.35
$7.45
$12.00
$18.35
$10,000
$.80
$.80
$.90
$1.10
$1.30
$1.80
$2.80
$4.40
$7.00
$8.70
$14.90
$24.00
$36.70
$15,000
$1.20
$1.20
$1.35
$1.65
$1.95
$2.70
$4.20
$6.60
$10.50
$13.05
$22.35
$36.00
$55.05
$20,000
$1.60
$1.60
$1.80
$2.20
$2.60
$3.60
$5.60
$8.80
$14.00
$17.40
$29.80
$48.00
$73.40
$25,000
$2.00
$2.00
$2.25
$2.75
$3.25
$4.50
$7.00
$11.00
$17.50
$21.75
$37.25
$60.00
$91.75
Child Options Life & AD&D
Child(ren) 6 months to age 26
Child(ren) live birth to 6
Deduction amount Child(ren)
Option 1:
$10,000
$1,000
$2.00
Note: Employee and Spouse premiums are based on your age as of 09/01 and amount of coverage chosen. Child premiums are for all eligible children combined.
OneAmericaÂŽ is the marketing name for the companies of OneAmerica. G 00615889-0000-000 Hillsboro Independent School District Class: 1 Rate Effective Date: 9/1/2017
50
ComPsych GuidanceResources® Program “Employee Assistance Program" this benefit is provided by the district at no additional charge to the employee.
Call Your ComPsych® GuidanceResources® program anytime for confidential assistance. Call: 855.387.9727 TDD: 800.697.0353 Go online: guidanceresources.com Your company Web ID: ONEAMERICA3 Personal issues, planning for life events or simply managing daily life can affect your work, health and family. Your GuidanceResources program provides support, resources and information for personal and work-life issues. The program is company-sponsored, confidential and provided at no charge to you and your dependents. This flyer explains how GuidanceResources can help you and your family deal with everyday challenges.
Confidential Counseling
Work-Life Solutions
3 Session Plan This no-cost counseling service helps you address stress, relationship and other personal issues you and your family may face. It is staffed by GuidanceConsultantsSM—highly trained master’s and doctoral level clinicians who will listen to your concerns and quickly refer you to in-person counseling (up to 3 sessions per year) and other resources for: › Stress, anxiety and depression › Job pressures › Relationship/marital conflicts › Grief and loss › Problems with children › Substance abuse
Delegate your “to-do” list. Our Work-Life specialists will do the research for you, providing qualified referrals and customized resources for: › Child and elder care › College planning › Moving and relocation › Pet care › Making major purchases › Home repair
Financial Information and Resources Discover your best options. Speak by phone with our Certified Public Accountants and Certified Financial Planners on a wide range of financial issues including: › Getting out of debt › Retirement planning › Credit card or loan problems › Estate planning › Tax questions › Saving for college
Legal Support and Resources Expert info when you need it. Talk to our attorneys by phone. If you require representation, we’ll refer you to a qualified attorney in your area for a free 30minute consultation with a 25% reduction in customary legal fees thereafter. Call about: › Divorce and family law › Real estate transactions › Debt and bankruptcy › Civil and criminal actions › Landlord/tenant issues › Contracts
GuidanceResources® Online Knowledge at your fingertips. GuidanceResources Online is your one stop for expert information on the issues that matter most to you… relationships, work, school, children, wellness, legal, financial, free time and more. › Timely articles, HelpSheetsSM, tutorials, streaming videos and self-assessments › “Ask the Expert” personal responses to your questions › Child care, elder care, attorney and financial planner searches
Free Online Will Preparation Get peace of mind. EstateGuidance® lets you quickly and easily write a will on your computer. Just go to www.guidanceresources.com and click on the EstateGuidance link. Follow the prompts to create and download your will at no cost. Online support and instructions for executing and filing your will are included. You can: › Name an executor to manage your estate › Choose a guardian for your children › Specify your wishes for your property › Provide funeral and burial instructions
Your ComPsych® GuidanceResources® Program CALL ANYTIME Call: 855.387.9727 TDD: 800.697.0353 Online: guidanceresources.com Your company Web ID: ONEAMERICA3 OneAmerica is the marketing name for American United Life Insurance Company® (AUL). AUL markets ComPsych services. ComPsych Corporation is not an affiliate of AUL and is not a OneAmerica company. Copyright © 2016 ComPsych Corporation. All rights reserved. To view the ComPsych HIPAA privacy notice, please go to www.guidanceresources.com/privacy.
51
5STAR
Individual Life
About this Benefit Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.
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 52 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
Term Life with Terminal Illness and Quality of Life Rider Individual and Group Term Life Insurance with Terminal Illness coverage to age 121 Enhanced coverage options for employees. Easy and flexibile enrollment for employers. The 5Star Life Insurance Company’s Family Protection Plan offers both Individual and Group products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your employees. CUSTOMIZABLE With several options to choose from, select the coverage that best meets the needs of your family. TERMINAL ILLNESS ACCELERATION OF BENEFITS Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL). PORTABLE Coverage continues with no loss of benefits or increase in cost if you terminate employment after the first premium is paid. We simply bill you directly.
Nearly
85%
of people said they thought most people need life insurance.
Yet only
59%
said that they have coverage themselves.
And
33%
wish their spouse or partner had more life insurance.*
FAMILY PROTECTION Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves. • Financially dependent children 14 days to 23 years old. CONVENIENCE Easy payment through payroll deduction. PROTECTION YOU CAN COUNT ON Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two-year contestability period and/or under investigation. This coverage has no war or terrorism exclusions. QUALITY OF LIFE Benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following: • Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or • Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision. Underwritten by 5Star Life Insurance Company (a Lincoln, Nebraska company); Administered by NTT Data at 777 Research Drive, Lincoln, NE 68521 FPPi product available in all states and some U.S. Territories except: CA, DE, FL, NY, ND. SD. Quality of Life rider not available in CA. FPPg product available in all states and some U.S. Territories except: CA, DE, FL, NY, ND. SD, VI FPPi/gQOLFlyerR1119 FPPduoQOL_MKT_FLYER_1119
53
Family Protection Plan - Terminal Illness MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT
Age on Eff. Date 18-25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 54
$10,000 $9.90 $9.91 $9.98 $10.08 $10.23 $10.43 $10.64 $10.87 $11.11 $11.40 $11.72 $12.08 $12.46 $12.88 $13.33 $13.83 $14.38 $14.98 $15.60 $16.26 $16.93 $17.67 $18.43 $19.19 $20.02 $20.93 $21.94 $23.11 $24.42 $25.88 $27.44 $29.19 $30.99 $32.84 $34.74 $36.71 $38.77 $40.93 $43.22 $45.72 $48.50
$20,000 $13.28 $13.34 $13.46 $13.66 $13.95 $14.35 $14.76 $15.23 $15.72 $16.30 $16.93 $17.65 $18.44 $19.25 $20.17 $21.15 $22.25 $23.46 $24.70 $26.02 $27.37 $28.83 $30.35 $31.88 $33.55 $35.36 $37.39 $39.74 $42.33 $45.27 $48.37 $51.87 $55.49 $59.19 $62.97 $66.94 $71.05 $75.37 $79.95 $84.93 $90.50
$30,000 $16.68 $16.75 $16.96 $17.26 $17.68 $18.28 $18.90 $19.61 $20.33 $21.20 $22.16 $23.23 $24.40 $25.63 $27.00 $28.48 $30.13 $31.96 $33.81 $35.78 $37.80 $40.00 $42.28 $44.58 $47.08 $49.81 $52.83 $56.35 $60.26 $64.65 $69.31 $74.56 $79.98 $85.53 $91.21 $97.15 $103.33 $109.80 $116.68 $124.16 $132.51
Employee Coverage Amounts $40,000 $50,000 $75,000 $20.07 $23.46 $31.94 $20.16 $23.59 $32.13 $20.44 $23.92 $32.62 $20.84 $24.42 $33.37 $21.40 $25.13 $34.44 $22.20 $26.12 $35.94 $23.04 $27.16 $37.50 $23.97 $28.34 $39.25 $24.93 $29.55 $41.06 $26.10 $31.00 $43.26 $27.37 $32.59 $45.63 $28.80 $34.37 $48.31 $30.36 $36.34 $51.25 $32.00 $38.38 $54.32 $33.83 $40.67 $57.76 $35.80 $43.13 $61.44 $38.00 $45.87 $65.57 $40.44 $48.92 $70.12 $42.90 $52.00 $74.75 $45.53 $55.30 $79.69 $48.23 $58.67 $84.75 $51.17 $62.33 $90.26 $54.20 $66.13 $95.94 $57.27 $69.96 $101.69 $60.60 $74.13 $107.94 $64.24 $78.67 $114.75 $68.26 $83.71 $122.32 $72.96 $89.59 $131.13 $78.17 $96.09 $140.87 $84.03 $103.42 $151.88 $90.23 $111.17 $163.50 $97.23 $119.92 $176.63 $104.46 $128.96 $190.19 $111.86 $138.21 $204.06 $119.43 $147.67 $218.25 $127.36 $157.59 $233.13 $135.60 $167.88 $248.57 $144.23 $178.67 $264.75 $153.40 $190.13 $281.94 $163.37 $202.59 $300.62 $174.50 $216.50 $321.50
$100,000 $40.42 $40.66 $41.34 $42.34 $43.75 $45.75 $47.84 $50.17 $52.58 $55.50 $58.67 $62.25 $66.16 $70.25 $74.83 $79.75 $85.25 $91.34 $97.50 $104.08 $110.83 $118.17 $125.75 $133.42 $141.75 $150.84 $160.91 $172.66 $185.67 $200.33 $215.83 $233.33 $251.41 $269.91 $288.83 $308.66 $329.25 $350.83 $373.75 $398.67 $426.50
$125,000 $48.89 $49.21 $50.04 $51.29 $53.07 $55.56 $58.16 $61.09 $64.11 $67.75 $71.71 $76.18 $81.09 $86.19 $91.92 $98.06 $104.94 $112.54 $120.25 $128.48 $136.92 $146.09 $155.56 $165.15 $175.57 $186.92 $199.52 $214.21 $230.46 $248.80 $268.17 $290.04 $312.64 $335.77 $359.42 $384.21 $409.94 $436.92 $465.56 $496.71 $531.50
$150,000 $57.38 $57.75 $58.76 $60.26 $62.38 $65.38 $68.50 $72.01 $75.63 $80.00 $84.76 $90.13 $96.00 $102.13 $109.00 $116.38 $124.63 $133.76 $143.01 $152.88 $163.00 $174.00 $185.38 $196.88 $209.38 $223.01 $238.13 $255.75 $275.26 $297.25 $320.51 $346.76 $373.88 $401.63 $430.01 $459.75 $490.63 $523.00 $557.38 $594.76 $636.51
Family Protection Plan - Terminal Illness MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT
Age on Eff. Date 66* 67* 68* 69* 70*
$10,000 $49.13 $52.62 $56.58 $61.09 $66.18
$20,000 $91.75 $98.73 $106.67 $115.68 $125.85
$30,000 $134.38 $144.85 $156.75 $170.28 $185.53
Employee Coverage Amounts $40,000 $50,000 $75,000 $177.00 $219.63 $326.19 $190.97 $237.08 $352.38 $206.83 $256.92 $382.13 $224.87 $279.46 $415.94 $245.20 $304.88 $454.06
$100,000 $432.75 $467.67 $507.33 $552.42 $603.25
$125,000 $539.31 $582.96 $632.54 $688.90 $752.44
$150,000 $645.88 $698.25 $757.75 $825.38 $901.63
*Quality of Life not available ages 66 - 70. Quality of Life benefits not available for children. Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 years).$7.15 monthly for $10,000 coverage per child.
FPPiDBQOLMonthlyRates
9/18
55
IDENTITY GUARD
Identity Theft
YOUR BENEFITS PACKAGE
About this Benefit Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered.
An identity is stolen every 2 seconds, and takes over
300 hours
to resolve, causing an average loss of $9,650.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 56 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
Identity Theft industry1. By delivering more alerts than competitors and alerting customers to suspicious activity within minutes – We’re always on alert … so you don’t have to instead of hours, like competing solutions – Identity Guard empowers employees to stop identity theft before it be. spirals out of control, and more easily recover from the For nearly 25 years, Identity Guard’s industry-leading products and services have made it easier for customers to fallout. manage their identity and faster for them to recover from Identity Guard delivers nearly 15% more alerts (on cybertheft. By coupling superior technology with average) than industry competitors2 operational excellence, Identity Guard delivers solutions • Identity Guard: 4 minutes that help employees save time and reduce stress … so they • LifeLock: >9 hours can focus on the things that matter. • InfoArmor: >18 hours • CSID: > 29 hours Why Identity Guard? • Best-in-class cyber protection that’s never offline … Comprehensive safe browsing tools. even when you are Identity Guard is one of the only identity theft solution to • Breach-free track record of excellence spanning more include a comprehensive safe browsing suite, including than two decades malware monitoring, anti-phishing tools, and HTTPS/flash/ • Intuitive technology – powered by IBM® Watson™ – ad blockers. These solutions help protect both personal that thinks for you and corporate computers against malware attacks, and • Proactive, user-friendly solution requiring minimal hacks that may lead to catastrophic data breaches. This ongoing maintenance from users added layer of protection can save your organization • Around-the-clock, U.S.-based customer support and headaches, money and – in extreme cases – years of clean remediation -up. Identity Guard is different. Exclusive partnership with IBM® Watson™ artificial Phishing scams run through Office 365 intelligence. Identity Guard is the only solution in the increased by 250% from 2018 to 2019.3 market that combines the power of IBM® Watson™ AI with best-in-class cyber wellness solutions to deliver Features available in Q1 2020 comprehensive coverage and impactful, tailored cybersecurity insights that meet each employee’s unique • Property deed monitoring needs. By harnessing IBM® Watson™ capabilities, Identity • Address monitoring • Criminal record monitoring Guard offers: • Sexual offense monitoring • Unparalleled family and cyberbullying protection that Customer • Transaction monitoring enables easier social media monitoring and more Retention Rate • SSN trace monitoring for children accurate alerts that help to ensure that your kids are • Fictitious identity monitoring safe online. • Enhanced risk management tools that provide Save up to 24% annually by switching to Identity Guard tailored, personalized insights, best practices, and suggestions to help employees mitigate their personal FBS Special Pricing Total Premier risks and improve their cybersecurity. Individual $7.70 /month $9.60 /month • Personalized threat alerts based on curated content tailored to each user’s cyberthreat profile, ensuring Individual + Family $13.55 /month $17.40 /month that employees only receive high-value communication applicable to their lives.
Cybersecurity. Simplified.
98%
Fastest speed and largest breadth of alerts. The only cyber wellness solution that’s fully integrated with all three credit bureaus, Identity Guard has the fastest alert speeds and largest breadth of coverage in the
1Ath Power Consulting. “Review of Speed and Coverage Study.” January 2019. 2Ath Power Consulting. “Review of Speed and Coverage Study.” January 2019. 3Digital Trends. “Microsoft Security reports a massive increase in malicious phishing scams.” March 5, 2019.
57
LEGALSHEILD
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 58 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
Legal Services Protecting the legal rights of millions of North Americans, LegalShield is the largest legal plan provider. With 45 years of experience in customer centric legal plans, we hold our lawyers and employees to high service standards. We've replaced the traditional provider network approach, with a modernized service network that places the participant's needs first and provides a high-tech, high-touch service experience.
Auto Motor Vehicle Services • Non-criminal moving traffic violation assistance • Motor vehicle-related criminal charge assistance for manslaughter, involuntary manslaughter, negligent homicide or vehicular homicide • Up to 2.5 hours of help with driver’s license reinstatement and property damage collection assistance of $5,000 or less Advice & Consultation per claim • Advice: Toll-free phone consultations with your Provider • Available only if member has a valid driver’s license and is Law Firm for any personal legal matter, even on pre-existing driving a noncommercial motor vehicle conditions • Letters and Phone Calls on Your Behalf: Available at the IRS discretion of your IRS Audit Legal Services • Provider Lawyer: Contract and Document Review Contract/ • One hour of consultation, advice or assistance when you are document review up to 15 pages each notified of an audit by the IRS • 24/7 Emergency Assistance: After-hours legal consultation • An additional 2.5 hours if a settlement is not achieved for covered legal emergencies. Specific coverage depends within 30 days on plan, such as: if you’re arrested or detained, if you’re • If your case goes to trial, you’ll receive 46.5 hours of your seriously injured, if you’re served with a warrant, or if the Provider Law Firm’s services • Coverage for this service begins with the tax return due state tries to take your child(ren). April 15 of the year you enroll Family Matters • Uncontested Name Change Assistance*: Uncontested name Additional Benefits change prepared by Provider Law Firm 25% Preferred Member Discount: You may continue to use your • Uncontested Adoption Representation*: Representation by Provider Law Firm for legal situations that extend beyond plan your Provider Law Firm for uncontested adoption coverage. The additional services are 25% off the law firm's proceedings standard hourly rates. Your Provider Law Firm will let you know • Uncontested Separation/Divorce Representation*: when the 25% discount applies, and go over these fees Representation by your Provider Law Firm for uncontested Your Plan Cover: legal separation, uncontested civil annulment and Family Plan: uncontested divorce proceedings • The member • Assistance if you or your spouse are named defendant or • The member’s spouse/ domestic partner respondent in a covered civil action filed in court • Never-married dependent children under age 26 living at Representation home • Trial Defense Services: Assistance if you or your spouse are • Dependent children under age 18 for whom the member is named defendant in a covered civil action filed in court legal guardian • Never married, dependent, children who are full-time YEAR PRE-TRIAL TIME TRIAL TIME TOTAL college students up to age 26 1 2.5 57.5 60 2 3 117 120 • Physically or mentally disabled children living at home 3 4 5
3.5 4 4.5
176.5 236 295.5
180 240 300
Document Preparation • Standard Will Preparation: Will preparation and annual reviews and updates for covered members Other documents available: Living Will, Health Care Power of Attorney and Financial Power of Attorney • Residential Loan Document Assistance: Mortgage documents (as required of the borrower by the lending institution) prepared by your Provider Law Firm for the purchase of your primary residence
Family Plan Rate
$15.95/mo
*These services are available 90 consecutive days from the effective date of your membership. For detailed information about the legal services provided by the LegalShield contract, go to http://www.legalshield.com/info/legalplan. Business issues are not included; however, plans providing those services are available. Specific exclusions apply. See plan contract for complete terms, coverage, amounts, conditions and exclusions. Access LegalShield on the go! The LegalShield app puts your law firm in the palm of your hand. Tap to call your law firm directly, access free legal forms, and send info directly to your law firm with features like Prepare Your Will and Snap (for speeding tickets). The LegalShield app makes it easy to access legal guidance you can trust. Download the free app from the App Store or Google Play. Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc., registered in the U.S. and other countries. Android is a trademark of Google Inc.
59
MASA YOUR BENEFITS PACKAGE
Medical Transport
About this Benefit Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out-of-pocket costs that are not covered by insurance. It includes emergency transportation via ground ambulance, air ambulance and helicopter.
A ground ambulance can cost up to
$2,400
and a helicopter transportation fee can cost
over $30,000
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 60 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
Medical Transport EMERGENCY TRANSPORTATION COSTS •
•
•
MASA MTS is here to protect its members and their families from the shortcomings of health insurance coverage by providing them with comprehensive financial protection for lifesaving emergency transportation services, both at home and away from home. Many American employers and employees believe that their health insurance policies cover most, if not all ambulance expenses. The truth is, they DO NOT! Even after insurance payments for emergency transportation, you could receive a bill up to $5,000 for ground ambulance and as high as $70,000 for air ambulance. The financial burdens for medical transportation costs are very real.
HOW MASA IS DIFFERENT Across the US there are thousands of ground ambulance providers and hundreds of air ambulance carriers. ONLY MASA offers comprehensive coverage since MASA is a PAYER and not a PROVIDER!
A MASA Membership prepares you for the unexpected and gives you the peace of mind to access vital emergency medical transportation no matter where you live, for a minimal monthly fee. • One low fee for the entire family • NO deductibles • NO health questions • Easy claim process
For more information, please contact Financial Benefit Services (469) 385-4640
EVERY FAMILY DESERVES A MASA MEMBERSHIP
ONLY MASA provides over 1.6 million members with coverage for BOTH ground ambulance and air ambulance transport, REGARDLESS of which provider transports them. Members are covered ANYWHERE in all 50 states and Canada! Additionally, MASA provides a repatriation benefit: if a member is hospitalized more than 100 miles from home, MASA can arrange and pay to have them transported to a hospital closer to their place of residence.
Our Benefits Benefit
Emergent Plus
Emergent Ground Transportation
U.S./Canada
Emergent Air Transportation
U.S./Canada
Non-Emergent Air Transportation
U.S./Canada
Repatriation
U.S./Canada
Any Ground. Any Air. Anywhere
61
NBS
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 unless your plan contains a $500 rollover or grace period provision.
Unlimited FSA (Non HSA Compatible) The funds in the unlimited healthcare FSA can be used to pay for eligible medical expenses like deductibles, co-payments, orthodontics, glasses and contacts.
FLIP TO‌
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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 62 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
FSA (Flexible Spending Account) How do I receive reimbursements? During the course of the plan year, you may submit requests for reimbursement of expenses you have incurred. Expenses are Congratulations! considered "incurred" when the service is performed, not Your employer has established a "flexible benefits plan" to help necessarily when it is paid for. You can get submit a claim online you pay for your out-of-pocket health and daycare expenses. at: my.nbsbeneits.com One of the most important features of the plan is that the Please note: Policies other than company sponsored policies (i.e. benefits being offered are paid for with a portion of your pay spouse’s or dependents’ individual policies) may not be paid before federal income or social security taxes are withheld. This through the flexible beneits plan. Furthermore, qualified longmeans that you will pay less tax and have more money to spend term care insurance plans may not be paid through the flexible and save. However, if you receive a reimbursement for an benefits plan. expense under the plan, you cannot claim a federal income tax NBS Benefits Card credit or deduction on your return. Your employer may Health Flexible spending account: sponsor the use of the The health flexible spending account (FSA) enables you to pay NBS Benefits Card, for expenses allowed under Section 105 and 213(d) of the making access to your Internal Revenue Code which are not covered by our insured flex dollars easier than medical plan. ever. You may use the The most that you can contribute to your Health FSA each plan card to pay merchants year is set by the IRS. This amount can be adjusted for increases or service providers in cost-of-living in accordance with Code Section 125(i)(2). that accept credit cards such as hospitals and pharmacies, so there is no need to pay cash up front then wait for Premium expense plan: reimbursement. A premium expense portion of the plan allows you to use preOrthodontic expenses that are paid fully up-front at the time of tax dollars to pay for specific premiums under various insurance initial service are reimbursable in full after the initial service has programs we offer you. been performed and payment has been made. Ongoing orthodontia payments are reimbursable only as they are paid. Dependent care Flexible spending account: The dependent care flexible spending account (DCFSA) enables Account Information you to pay for out-of-pocket, work-related dependent daycare Participants may call NBS and talk to a representative during our costs. Please see the Summary Plan Description for the regular business hours, Monday-Friday, 7 a.m. to 7 p.m. Central definition of an eligible dependent. The law places limits on the Time. Participants can also obtain account information using the amount of money that can be paid to you in a calendar year. Automated Voice Response Unit, 24 hours a day, 7 days a week Generally, your reimbursement may not exceed the lesser of: at (385) 988-6423 or toll free at (800) 274-0503. For immediate (a) $5,000 (if you are married filing a joint return or you are access to your account information at any time, log on to our head of a household) or $2,500 (if you are married filing website at my.nbsbenefits.com or download the NBS Mobile separate returns); (b) your taxable compensation; (c) your App. spouse's actual or deemed earned income. Also, in order to have the reimbursements made to you and be What can I save with an FSA? excluded from your income, you must provide a statement from FSA No FSA the service provider including the name, address and, in most cases, the taxpayer identification number of the service Annual taxable income $24,000 $24,000 provider as well as the amount of such expense and proof that Health FSA $1,500 $0 the expense has been incurred. Dependent care FSA $1,500 $0 Determining contributions Total pre-tax contributions -$3,000 $0 Before each plan year begins, you will select the benefits you want and how much contributions should go toward each Taxable income after FSA $21,000 $24,000 benefit. It is very important that you make these choices Income taxes -$6,300 -$7,200 carefully based on what you expect to spend on each covered benefit or expense during the plan year. After-tax income $14,700 $16,800 Generally, you cannot change the elections you have made after After-tax health and welfare expenses $0 -$3,000 the beginning of the plan year. However, there are certain limited situations when you can change your elections if you Take-home pay $14,700 $13,800 have a "change in status". Please refer to your Summary Plan You saved $900 $0 Description for a change in status listing.
Plan Highlights Flexible Spending Plans
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FSA (Flexible Spending Account) NBS Mobile App When you're on the go, save time and hassle with the NBS Mobile App. Submit claims, check your balances, view transactions, and submit documentation using your device's camera.
Easy and convenient •
•
Designed to work just as other iOS and Android apps which makes it easy to learn and use. Shares user authentication with the NBS portal. Registered users can download the app and log in immediately to gain access to their benefit accounts, with no need to register their phone or your account.
It's secure •
No sensitive account information is ever stored on your mobile device and secure encryption is used to protect all transmissions.
Mobile app features The NBS mobile app supports a wide variety of features, empowering you to proactively manage your account. • View account balances • View claims • View reimbursement history • Submit claims • Submit documentation using your device's camera • Pay providers • Setup a variety of SMS alerts • Edit your personal information • View contribution details • View plan information • View calendar deadlines • Contact a service representative • View Benefits Card information
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FSA (Flexible Spending Account) Sample Expenses Medical expenses • • • • • • • • • • •
Acupuncture Addiction programs Adoption (medical expenses for baby birth) Alternative healer fees Ambulance Body scans Breast pumps Care for mentally handicapped Chiropractor Copayments Crutches
Dental expenses • • • • • • • •
Artificial teeth Copayments Deductible Dental work Dentures Orthodontia expenses Preventative care at dentist office Bridges, crowns, etc.
Vision expenses • • • • • • • •
Braille - books & magazines Contact lenses Contact lens solutions Eye exams Eye glasses Laser surgery Office fees Guide dog and upkeep/other animal aid
Diabetes (insulin, glucose monitor) Eye patches Fertility treatment First aid (i.e. bandages, gauze) Hearing aids & batteries Hypnosis (for treatment of illness) Incontinence products (i.e. Depends, Serene) Joint support bandages and hosiery Lab fees Monitoring device (blood pressure, cholesterol)
• • • • • • • • • •
Physical exams Pregnancy tests Prescription drugs Psychiatrist/psychologist (for mental illness) Physical therapy Speech therapy Vaccinations Vaporizers or humidifiers Weight loss program fees (if prescribed by physician) Wheelchair
• • • • • • • • • •
Items that generally do not qualify for reimbursement • • • • • • • • • • • •
• • •
Personal hygiene (deodorant, soap, body powder, sanitary products) Addiction products Allergy relief (oral meds, nasal spray) Antacids and heartburn relief Anti-itch and hydrocortisone creams Athlete's foot treatment Arthritis pain relieving creams Cold medicines (i.e. syrups, drops, tablets) Cosmetic surgery Cosmetics (i.e. makeup, lipstick, cotton swabs, cotton balls, baby oil) Counseling (i.e. marriage/family) Dental care - routine (i.e. toothpaste, toothbrushes, dental floss, anti-bacterial mouthwashes, fluoride rinses, teeth whitening/ bleaching) Exercise equipment Fever & pain reducers (i.e. Aspirin, Tylenol) Hair care (i.e. hair color, shampoo, conditioner, brushes, hair loss
• • • • • • • •
• • • • • • • •
products) Health club or fitness program fees Homeopathic supplement or herbs Household or domestic help Laser hair removal Laxatives Massage therapy Motion sickness medication Nutritional and dietary supplements (i.e. bars, milkshakes, power drinks, Pedialyte) Skin care (i.e. sun block, moisturizing lotion, lip balm) Sleep aids (i.e. oral meds, snoring strips) Smoking cessation relief (i.e. patches, gum) Stomach & digestive relief (i.e. Pepto- Bismol, Imodium) Tooth and mouth pain relief (Orajel, Anbesol) Vitamins Wart removal medication Weight reduction aids (i.e. Slimfast, appetite suppressant
These expenses may be eligible if they are prescribed by a physician (if medically necessary for a specific condition).
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NBS
403(b) Plan
YOUR BENEFITS PACKAGE
About this Benefit A 403(b) plan is a U.S. tax-advantaged retirement savings plan available for public education organizations. 38% of Americans don’t actively save for retirement at all.
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 66 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
403(b) Plan Universal Availability Notice Hillsboro Independent School District PLAN HIGHLIGHTS Visit NBSbenefits.com/403b for additional information Congratulations! You are eligible to participate in the 403(b) retirement plan provided by the Hillsboro Independent School District 403(b). Contributing to a 403(b) plan will give you peace of mind through financial security during your retirement. A 403(b) plan allows you to contribute a portion of your compensation as a pre-tax or post-tax (Roth) contribution (if allowed by your Employer) in order to save for retirement. Participation in the 403(b) plan is completely voluntary. If you are already contributing to the 403(b) plan, now is a perfect time to increase your contributions.
What is a 403(b) Plan? A 403(b) plan, also known as a Tax-Sheltered Annuity (TSA), is a taxdeferred retirement plan provided for employees of certain taxexempt, governmental organizations or public education institutions.
What are the benefits of contributing to a 403(b) Plan? LOWER TAXES The 403(b) contributions you make can be on a pre-tax basis. This means that the money used to invest in the 403(b) plan is not taxed until the funds are withdrawn. For example, if your federal marginal income tax rate is 25%, and you contribute $100 a month to a 403(b) plan, you have reduced your federal income taxes by nearly $25. In effect, your $100 contribution costs you only $75. The tax savings grow with the size of your 403(b) contribution. TAX-DEFERRED GROWTH In your 403(b) plan, interest and earnings grow tax-deferred. This means that your interest will grow tax-free until the time of your withdrawal. The compounding interest on your 403(b) plan allows your account to grow more quickly than money saved in a taxable account where interest and earnings are taxed each year. TAKING THE INITIATIVE Contributing to a 403(b) retirement plan helps you take control of your future retirement needs. Other sources of retirement income, including state pension plans and Social Security, often do not adequately replace a person’s salary upon retirement. A 403(b) plan can be a great way to supplement your income at retirement. POSSIBLE TAX CREDITS Pre-tax contributions may put you in a lower tax bracket reducing your overall tax rate. DISTRIBUTIONS FROM THE PLAN You or your beneficiary will be able to withdraw your vested balance when one of the following occurs: • Retirement • Termination of Employment • Attainment of Age 59 ½ • Total Disability • Death The vendors may require additional paperwork. LOANS You may borrow up to 50% of your vested balance up to $50,000 (whichever is less). Contact your current vendor about their specific loan provisions.
REQUIRED MINIMUM DISTRIBUTIONS (RMD) Distributions are required at age 72. Exceptions may apply.
HIGHER LIMITS Annual contribution limits are much higher than those of an IRA.
How much can you contribute to a 403(b) Plan? You may elect to save: • 100% of your income up to $19,500 (2020) • Extra $6,500 if age 50+ HOW TO ENROLL IN THE PLAN Your employer has provided investment option(s) for you. A list of approved vendor(s) and the Salary Reduction Agreement (“SRA”) can be found by visiting the National Benefit Services website at http:// www.nbsbenefits.com/non-erisa-403b-forms/ or by contacting NBS (contact information below). Once you have chosen an approved vendor, please open a 403(b) account directly with them. To begin investing, send the completed SRA form to NBS who will work with your employer to begin contributions. INVESTMENT CHOICES Annuity contracts made available through insurance companies or custodial accounts through a retirement account custodian are allowed in 403(b) plans. You will need to contact the vendor for a comprehensive listing and information regarding the available investment options.
EXCHANGES As a participant in the 403(b) plan, you have the option to move funds, or “exchange” tax-free between different vendors within the same plan. ROLLOVERS You also have the option of rolling retirement funds from previous employers to your current employer’s plan thus simplifying retirement management. ROTH You may also choose to invest part of your income on an after-tax (Roth) basis. Roth contributions are taxed at the time of the investment though contributions and earnings grow tax-free until withdrawn. Qualified distributions will allow you to withdraw your money tax-free. HARDSHIP DISTRIBUTIONS An in-service hardship distribution may be allowed if you satisfy certain criteria. Contact NBS for more information about the requirements NBS Retirement Service Center 8523 S. Redwood Rd. West Jordan, UT 84088 800.274.0503 ext. 5 Fax - 1.800. 597.8206 Contact NBS if you have questions about the retirement plan Hillsboro Independent School District Plan Contact Person: Beckie Rosenbaum 121 East Franklin Hillsboro, TX 76645 1.254.582.8585
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NBS
457(b) Plan
YOUR YOUR BENEFITS BENEFITS PACKAGE PACKAGE
About this Benefit A 457(b) plan is a tax-deferred compensation plan provided for employees of certain tax-exempt, governmental organizations or public education institutions.
Only 22% of workers are very confident they will have enough money in retirement.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 68 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd
457(b) Plan 457(b) Plan Highlights Hillsboro Independent School District Visit NBSbenefits.com/403b for additional information Congratulations! You are eligible to participate in the 457 retirement plan provided by the Hillsboro Independent School District 457(b). Contributing to a 457 plan will give you peace of mind through financial security during your retirement. A 457 plan allows you to contribute a portion of your compensation as a pre-tax or post-tax (Roth) contribution (if allowed by your Employer) in order to save for retirement. Participation in the 457 plan is completely voluntary. If you are already contributing to the 457 plan, now is a perfect time to increase your contributions.
HIGHER LIMITS Annual contribution limits are much higher than those of an IRA.
How much can you contribute to a 457 Plan? You may elect to save: • 100% of your income up to $19,500.00 in 2020 • Extra 6500 if age 50+ • Limits are completely separate from those made to 403(b) or 401(k) accounts REQUIRED MINIMUM DISTRIBUTIONS (RMD) Distributions are required at age 70 ½. Exceptions may apply.
HOW TO ENROLL IN THE PLAN Your employer has provided investment option(s) for you. A list of A 457 plan is a tax-deferred compensation plan provided for employees approved vendor(s) and the Salary Reduction Agreement (“SRA”) can be of certain tax-exempt, governmental organizations or public education found by visiting the National Benefit Services website at institutions. http://www.nbsbenefits.com/non-erisa-403b-forms/ or by contacting NBS (contact information below). What are the benefits of contributing to a 457 Plan? Once you have chosen an approved vendor, please open a 457 account LOWER TAXES directly with them. To begin investing, send the completed SRA form to The 457 contributions you make can be on a pre-tax basis. This means NBS who will work with your employer to begin contributions. that the money used to invest in the 457 plan is not taxed until the funds are withdrawn. For example, if your federal marginal income tax INVESTMENT CHOICES Annuity contracts made available through insurance companies or rate is 25%, and you contribute $100 a month to a 457 plan, you have custodial accounts through a retirement account custodian are allowed reduced your federal income taxes by nearly $25. In effect, your $100 in 457 plans. You will need to contact the vendor for a comprehensive contribution costs you only $75. The tax savings grow with the size of listing and information regarding the available investment options. your 457 contribution.
What is a 457 Plan?
TAX-DEFERRED GROWTH In your 457 plan, interest and earnings grow tax-deferred. This means that your interest will grow tax-free until the time of your withdrawal. The compounding interest on your 457 plan allows your account to grow more quickly than money saved in a taxable account where interest and earnings are taxed each year. TAKING THE INITIATIVE Contributing to a 457 plan helps you take control of your future retirement needs. Other sources of retirement income, including state pension plans and Social Security, often do not adequately replace a person’s salary upon retirement. A 457 plan can be a great way to supplement your income at retirement. POSSIBLE TAX CREDITS Pre-tax contributions may put you in a lower tax bracket reducing your overall tax rate. TRANSFERS As a participant in the 457 plan, you have the option to move funds, or “transfer” tax-free between different vendors within the same plan. ROLLOVERS You also have the option of rolling retirement funds from previous employers to your current employer’s plan thus simplifying retirement management. DISTRIBUTIONS FROM THE PLAN You or your beneficiary will be able to withdraw your vested balance when one of the following occurs: • Retirement • Termination of Employment • Attainment of Age 70 ½ • Total Disability • Death The vendors may require additional paperwork.
UNFORESEEABLE EMERGENCY An in-service unforeseeable emergency distribution may be allowed if you satisfy certain criteria. Contact NBS for more information about the requirements. ROTH You may also choose to invest part of your income on an after-tax (Roth) basis. Roth contributions are taxed at the time of the investment though contributions and earnings grow tax-free until withdrawn. Qualified distributions will allow you to withdraw your money tax-free. LOANS You may borrow up to 50% of your vested balance up to $50,000 (whichever is less). Contact your current vendor about their specific loan provisions. NBS Retirement Service Center 8523 S. Redwood Rd. West Jordan, UT 84088 800.274.0503 ext. 5 Fax - 1.800. 597.8206 Contact NBS if you have questions about the retirement plan Hillsboro Independent School District Plan Contact Person: Beckie Rosenbaum 121 East Franklin Hillsboro, TX 76645 1.254.582.8585
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