TULOSO-MIDWAY ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2021 - 8/31/2022 WWW.MYBENEFITSHUB.COM/TULOSOMIDWAYISD 1
Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) TRS Medical APL Hospital Indemnity EECU Health Savings Account (HSA) MDLive Telehealth Cigna Dental UNUM Vision The Hartford Disability UNUM Life and AD&D APL Cancer The Hartford Accident UNUM Critical Illness 5Star Individual Life iLock360 Identity Theft Protection NBS Flexible Spending Account (FSA)
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3 4-5 6-11 6 7 8 9 10 11
12-13 14-17 18-19 20-21 22-25 26-29 30-33 34-39 40-43 44-47 48-51 52-55 56-59 60-63
FLIP TO... PG. 4
HOW TO ENROLL
PG. 6
SUMMARY PAGES
PG. 12
YOUR BENEFITS
Benefit Contact Information TMISD BENEFIT ADMINISTRATORS
DENTAL
ACCIDENT
Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/tulosomidwayisd
Cigna Policy# 3344346 (800) 244-6224 www.Cigna.com
The Hartford Policy#: 893751 (800) 523-2233 www.thehartford.com
TRS ACTIVECARE MEDICAL
VISION
LIFE AND AD&D
Blue Cross Blue Shield (866) 355-5999 www.bcbstx.com/trsactivecare
UNUM Policy# 445221 (888) 400-9304 www.unumvisioncare.com
UNUM Policy#:445220 (800) 583-6908 www.unum.com
HOSPITAL INDEMNITY
DISABILTY
INDVIDUAL LIFE
APL (800) 256-8606 www.ampublic.com
The Hartford (800) 523-2233 www.thehartford.com
5Star Life Insurance Company Policy # 02484 (866) 863-9753 http://5starlifeinsurance.com
TELEHEALTH
CANCER
IDENTITY THEFT
MDLive (888) 365-1663 www.consultmdlive.com
APL (800) 256-8606 www.ampublic.com
iLock 360 (855) 287-8888 www.iLOCK360.com
HEALTH SAVINGS ACCOUNT (HSA)
CRITICAL ILLNESS
FLEXIBLE SPENDING ACCOUNT
EECU (800) 333-9934 www.eecu.org
UNUM Policy # 445222 (800) 583-6908 www.unum.com
National Benefit Services (800) 274-0503 www.nbsbenefits.com
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MOBILE APP DOWNLOAD Enrollment made simple through the new FBS Benefits App! Text “FBS TMISD” to (800) 583-6908
and get access to everything you need to complete your benefits enrollment: •
Enrollment Resources
•
Online Support
•
Interactive Tools
•
And more!
App Group #: FBSTMISD
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Text “FBS TMISD” to (800) 583-6908 OR SCAN
How to Log In
1 BENEFIT INFO
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www.mybenefitshub.com/ tulosomidwayisd
CLICK LOGIN
ENTER USERNAME & PASSWORD
INTERACTIVE TOOLS 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. If you have six (6) or less 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.
ONLINE SUPPORT
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: •
BASIC LIFE WITH EMPLOYEE ASSISTANCE PROGRAM
•
EDUCATOR DISABILITY
•
CANCER
•
INDIVIDUAL LIFE
BENEFITS AT A GLANCE For a complete list of benefits please visit www.mybenefitshub.com/tulosomidwayisd BASIC LIFE WITH EMPLOYEE ASSISTANCE PROGRAM (EAP) The basic life insurance (employer‐paid) includes a $25K benefit in addition to EAP, which has a bereavement counseling of up to 6 face‐to‐face visits for the beneficiaries. It includes will preparation, bereavement counseling and assistance with funeral planning.
CANCER 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. INDIVIDUAL LIFE Individual life insurance is a policy that covers a single person and is intended to meet the financial needs of the beneficiary, in the event of the insured’s death. This coverage is portable and can continue after you leave employment or retire. Rates are based on your current age and will not change due to a change in your age. Employees do not have to enroll to obtain coverage for dependents.
EDUCATOR DISABILITY Educator Disability insurance can offer an affordable way for protecting your livelihood (and the people closest to you, who depend on it). It is a combination of Short‐ and Long‐Term Disability insurance; it's one plan that covers all bases.
Don’t Forget! • Login and complete your benefit enrollment from 07/14/2021 - 07/28/2021 • Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202, Monday-Friday 8am-7pm. • Update your information: home address, phone numbers, email, and beneficiaries. • REQUIRED!! Due to the Affordable Care Act (ACA) reporting requirements, you must add your dependent’s CORRECT social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator.
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SUMMARY PAGES
Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 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.
CHANGES IN STATUS (CIS):
QUALIFYING EVENTS
Marital Status
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
Change in Number of Tax Dependents
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Change in Status of Employment Affecting Coverage Eligibility
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.
Gain/Loss of Dependents' Eligibility Status
An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements under an employer's plan may include change in age, student, marital, employment or tax dependent 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 Judgment/Decree/Order dependent), you may change your election to provide coverage for the dependent child. If the 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
Eligibility for Government Programs
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
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SUMMARY PAGES
Annual Enrollment During your annual enrollment period, you have the opportunity
Where can I find forms?
to review, change or continue benefit elections each year.
For benefit summaries and claim forms, go to your benefit
Changes are not permitted during the plan year (outside of
website: www.mybenefitshub.com/tulosomidwayisd. Click the
annual enrollment) unless a Section 125 qualifying event occurs.
benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms
•
Changes, additions or drops may be made only during the
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
Midway ISD benefit website: www.mybenefitshub.com/
included in the dependent profile. Additionally, you must
tulosomidwayisd. Click on the benefit plan you need
notify your employer of any discrepancy in personal and/or benefit information.
•
For benefit summaries and claim forms, go to the Tuloso-
Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
information on (i.e., Dental) and you can find provider search links under the Quick Links section. When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and
New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the
carrier’s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.
Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.
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SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 20 or more
Dependent Eligibility: You can cover eligible dependent
regularly scheduled hours each work week.
children under a benefit that offers dependent coverage,
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if
provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.
your 2021 benefits become effective on September 1, 2021, you must be actively-at-work on September 1, 2021 to be eligible for your new benefits. PLAN
CARRIER
MAXIMUM AGE
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Medical
BCBS
To age 26
Hospital Indemnity
APL
To age 26
Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse eligibility.
Health Savings Account
EECU
IRS Tax Dependent
Dental
Cigna
To age 26
Vision
UNUM
To age 26
Cancer
APL
To age 26
Critical Illness
UNUM
To age 26
Life and AD&D
UNUM
To age 26
Individual Life
5Star
To age 23
Accident
The Hartford
To age 26
Identity Theft
iLock
To age 18
FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance. Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent eligibility. Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee's enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. 9
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 9/1/2021 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
Employee and/or employer
Employee and/or employer
Account Owner
Individual
Employer
Underlying Insurance Requirement
High deductible health plan
None
Minimum Deductible
$1,400 single (2021) $2,800 family (2021)
N/A
Maximum Contribution
$3,600 single (2021) $7,000 family (2021)
$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, 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
Description
FLIP TO FOR HSA INFORMATION
PG. 18
FLIP TO FOR FSA INFORMATION
PG. 60 11
2021-22 TRS-ActiveCare Plan Highlights Sept. 1, 2021 — Aug. 31, 2022 All TRS-ActiveCare participants have three plan options. Each includes a wide range of wellness benefits.
TRS-ActiveCare 2 TRS-ActiveCare Primary • Lowest premium of the
TRS-ActiveCare Primary+
TRS-ActiveCare HD
• Lower deductible than the HD and
• Compatible with a health savings
plans Copays for doctor visits before you meet deductible Statewide network PCP referrals required to see specialists Not compatible with a health savings account (HSA) No out-of-network coverage
Plan summary
Monthly Premiums Employee Only Employee and Spouse Employee and Children Employee and Family
Primary plans • • Copays for many services and drugs • • Higher premium than the other • plans • Statewide network • • PCP referrals required to see specialists • Not compatible with a health • savings account (HSA) • No out-of-network coverage Total Premium Your Premium Total Premium Your Premium $417 $1,176 $751 $1,405
(This plan is closed and not accepting new enrollees. If you’re currently enrolled in TRS-ActiveCare 2, you can remain in this plan.)
$ $ $ $
$542 $1,334 $879 $1,675
$ $ $ $
account (HSA) • Nationwide network with out-ofnetwork coverage • No requirement for PCPs or referrals • Must meet your deductible before plan pays for non-preventive care
• Closed to new enrollees • Current enrollees can choose to
stay in this plan
• Lower deductible • Copays for many drugs and
services
• Nationwide network with out-of-
network coverage
• No requirement for PCPs or
referrals
Total Premium $429 $1,209 $772 $1,445
Your Premium $ $ $ $
Total Premium $1,013 $2,402 $1,507 $2,841
Your Premium $ $ $ $
Plan Features Type of Coverage Individual/Family Deductible
In-Network Coverage Only
In-Network Coverage Only
In-Network
Out-of-Network
In-Network
Out-of-Network
$2,500/$5,000
$1,200/$3,600
$3,000/$6,000
$5,500/$11,000
$1,000/$3,000
$2,000/$6,000
You pay 30% after deductible
You pay 20% after deductible
You pay 30% after deductible
You pay 20% after deductible
$8,150/$16,300
$6,900/$13,800
Statewide Network
Statewide Network
You pay 50% after deductible $20,250/ $7,000/$14,000 $40,500 Nationwide Network
You pay 40% after deductible $23,700/ $7,900/$15,800 $47,400 Nationwide Network
Yes
Yes
No
No
Primary Care
$30 copay
$30 copay
Specialist
$70 copay
$70 copay
$0 per consultation
$0 per consultation
$50 copay
$50 copay
You pay 30% after deductible
You pay 20% after deductible
You pay 30% after deductible
$0 per consultation
$0 per consultation
$30 per consultation
Drug Deductible Generics (30-Day Supply/ 90-Day Supply)
Integrated with medical $15/$45 copay; $0 for certain generics
$200 brand deductible
Integrated with medical You pay 20% after deductible; $0 for certain generics
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
Coinsurance Individual/Family Maximum Out-of-Pocket Network Primary Care Provider (PCP) Required
Doctor Visits
TRS Virtual Health
You pay 30% You pay 50% after deductible after deductible You pay 30% You pay 50% after deductible after deductible $30 per consultation
You pay 40% after deductible You pay 40% $70 copay after deductible $0 per consultation $30 copay
Immediate Care Urgent Care Emergency Care TRS Virtual Health
You pay 30% after deductible
You pay 50% after deductible
You pay 40% after deductible You pay a $250 copay plus 20% after deductible $0 per consultation $50 copay
Prescription Drugs $15/$45 copay
How to Calculate Your Monthly Premium
Wellness Benefits at No Extra Cost
Total Monthly Premium
Being healthy is easy with:
Your District and State Contributions
Your Premium Ask your Benefits Administrator for your district’s premiums.
Things to Know •
•
TRS’s Texas-sized purchasing power creates broad networks without county boundaries. Specialty drug insurance means you’re covered, no matter what life throws at you. 12
• • • • •
$0 preventive care 24/7 customer service One-on-one health coaches Weight loss programs Nutrition programs
$200 brand deductible $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)
• • • •
Ovia® pregnancy support TRS Virtual Health Mental health support And much more!
Available for all plans. See your Benefits Booklet for more details.
2021-22 Health Maintenance Organizations: Premiums for Regional Plans Remember: 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 option. Central and North Texas Scott and White Care Plan
Blue Essentials — South Texas HMOSM
Brought to you by TRS-ActiveCare
Brought to you by TRS-ActiveCare
You can choose this plan if you live in one of these counties: Austin, Bastrop, Bell, Blanco, Bosque, Brazos, 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
Total Monthly Premiums Employee Only Employee and Spouse
Employee and Children Employee and Family
Total Premium
Your Premium
You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy
Total Premium
Your Premium
Blue Essentials — West Texas HMOSM Brought to you by TRS-ActiveCare You can choose this plan if you live in one of 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 Premium
Your Premium
$542.48
$
$524.00
$
$596.54
$
$1,362.70
$
$1,264.28
$
$1,443.66
$
$872.16
$
$819.60
$
$936.18
$
$1,568.42
$
$1,345.58
$
$1,532.74
$
Plan Features Type of Coverage Individual/Family Deductible
In-Network Coverage Only
In-Network Coverage Only
In-Network Coverage Only
$1,150/$3,450
$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
$50 copay
$500 copay after deductible
You pay 20% after deductible
$500 copay before deductible and 25% after deductible
$200 (excl. generics)
$100
$150
30-day supply/90-day supply
30-day supply/90-day supply
30-day supply/90-day supply
Coinsurance Individual/Family Maximum Outof-Pocket
Doctor Visits
Immediate Care Urgent Care Emergency Care
Prescription Drugs Drug Deductible Day Supply Generics
$10/$25 copay
$10/$30 copay
$5/$12.50 copay; $0 for certain generics
Preferred Brand
You pay 30% after deductible
$40/$120 copay
You pay 30% after deductible
Non-preferred Brand
You pay 50% after deductible
$65/$195 copay
You pay 50% after deductible
You pay 15%/25% after deductible (preferred/non-preferred)
You pay 20% after deductible
You pay 15%/25% after deductible (preferred/non-preferred)
Specialty
trs.texas.gov 13
AMERICAN PUBLIC LIFE
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 $10,500 per day.
$9,600
$10,400
$10,700
2008
2012
2018
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 14 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Tuloso-Midway ISD Benefits Website: www.mybenefitshub.com/tulosomidwayisd
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16
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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 18 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Tuloso-Midway ISD Benefits Website: www.mybenefitshub.com/tulosomidwayisd
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 2021 Annual HSA Contribution Limits your HSA questions or transactions. You can also chat with Individual: $3,600 us online at eecu.org or use our secure email. Member Family: $7,200 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 printed statements. 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.
19
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 20 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Tuloso-Midway ISD Benefits Website: www.mybenefitshub.com/tulosomidwayisd
Telehealth Welcome to MDLIVE!
Your virtual doctor is here. Join for free today!
With MDLIVE, you can visit with a doctor or counselor 24/7 from your home, office or on-the-go. You have a telehealth benefit giving you virtual care, anywhere. At a price you can afford. • Board-certified doctors • Available anytime, day or night • Consults by mobile app, video or phone • Prescriptions can be sent to your nearest pharmacy if medically necessary We treat over 50 routine medical conditions including: • Acne • Allergies • Cold/flu • Constipation • Cough • Diarrhea • Ear problems • Insect bites • Nausea/vomiting • Pink eye • Rash • Respiratory problems • Sore throats • And more
Download the app. Join for Free. Visit a Doctor. consultmdlive.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/. 21
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 22 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Tuloso-Midway ISD Benefits Website: www.mybenefitshub.com/tulosomidwayisd
Dental PPO - Basic Plan Network Options
Cigna Dental Choice Plan In-Network: Total Cigna DPPO Network
Out-of-Network: See Non-Network Reimbursement
Reimbursement Levels Policy Year Benefits Maximum
Based on Contracted Fees
Maximum Allowable Charge
Applies to: Class I, II & III expenses
$1,500
$1,500
$50 $150
$50 $150
Policy Year Deductible 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
Plan Pays
You Pay
Plan Pays
You Pay
100% No Deductible
No Charge
100% No Deductible
No Charge
Class II: Basic Restorative Space Maintainers: non-orthodontic Emergency Care to Relieve Pain Restorative: fillings Endodontics: minor and major Periodontics: minor and major Oral Surgery: minor and major Repairs: bridges, crowns and inlays Repairs: dentures Crowns: prefabricated stainless steel / resin
80% After Deductible
20% After Deductible
80% After Deductible
20% After Deductible
50% After Deductible
50% After Deductible
50% After Deductible
50% After Deductible
Class III: Major Restorative Anesthesia: general and IV sedation Denture Relines, Rebases and Adjustments Inlays and Onlays Prosthesis Over Implant Crowns: permanent cast and porcelain Bridges and Dentures
Class IV: Orthodontia Coverage for Dependent Children to age 19 Lifetime Benefits Maximum: $1,000
50% 50% 50% No Deductible No Deductible No Deductible
50% No Deductible
Monthly Premium EE Only
$18.85
EE + Spouse
$38.18
EE + Child(ren)
$46.37
EE + Family
$72.56
Cigna Dental Benefit Summary Tuloso Midway ISD Plan Effective Date: 09/01/2021 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. Your plan allows you to see any licensed dentist, but using an in-network dentist may minimize your out-of-pocket expenses.
Benefit Plan Provisions: In-Network Reimbursement Non-Network Reimbursement Cross Accumulation Policy Year Benefits Maximum Policy Year Deductible
Late Entrant Limitation Provision
For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule. For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Allowable Charge. The dentist may balance bill up to their usual fees. 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. The plan will only pay for covered charges up to the yearly Benefits Maximum, when applicable. Benefit -specific Maximums may also apply. This is the amount you must pay before the plan begins to pay for covered charges, when applicable. Benefit-specific deductibles may also apply. Payment will be reduced by 50% for Class III & 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
Pretreatment review is available on a voluntary basis when dental work in excess of $200 is proposed.
Alternate Benefit Provision
When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses. 23
Dental PPO - Low Plan
Oral Health Integration Program (OHIP)
Timely Filing Benefit Limitations: Missing Tooth Limitation Oral Evaluations/Exams 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
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 non-prescription dental products are available through Cigna Home Delivery Pharmacy only, and you are required to pay the entire discounted charge. For more information including how to enroll in this program and a complete list of program terms and eligible medical conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24. Out of network claims submitted to Cigna after 365 days from date of service will be denied. For teeth missing prior to coverage with Cigna, the amount payable is 50% of the amount otherwise payable until covered for 12 months; thereafter, considered a Class III expense. 2 per policy year. Bitewings: 2 per policy year. Complete series of radiographic images and panoramic radiographic images: Limited to a combined total of 1 per 36 months. Payable only in conjunction with orthodontic workup. 2 per policy year, including periodontal maintenance procedures following active therapy. 1 per policy year for children under age 19. Limited to posterior tooth. 1 treatment per tooth every 36 months for children under age 14. Limited to non-orthodontic treatment for children under age 19. Replacement every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth-colored material on molar crowns or bridges. Reviewed if more than once. Covered if more than 6 months after installation. 1 per 36 months. 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 crownsor bridges.
Benefit Exclusions: Covered Expenses will not include, and no payment will be made for the following: main purpose is to change vertical dimension, diagnose or treat • Procedures and services not included in the list of covered dental conditions of dysfunction of the temporomandibular joint (TMJ), expenses; stabilize periodontally involved teeth or restore occlusion; • Diagnostic: cone beam imaging; • Preventive Services: instruction for plaque control, oral hygiene and • Athletic mouth guards; • Services performed primarily for cosmetic reasons; diet; • Restorative: ceramic, resin, or acrylic materials on crowns or bridg- • Personalization or decoration of any dental device or dental work; es on or replacing the upper and or lower first, second and/or third • Replacement of an appliance per benefit guidelines; molars; • Services that are deemed to be medical in nature; • Periodontics: bite registrations; splinting; • Services and supplies received from a hospital; • Prosthodontic: precision or semi-precision attachments; • Drugs: prescription drugs; • Implants: implants or implant related services; • Charges in excess of the Maximum Allowable Charge. • Procedures, appliances or restorations, except full dentures, whose 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. Product availability may vary by location and plan type and is subject to change. All group dental insurance policies and dental benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents or contact a Cigna representative. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company (CHLIC), Connecticut General Life Insurance Company, and Cigna Dental Health, Inc. © 2021 Cigna / version 12152020
24
25
UNUM
Vision
YOUR BENEFITS PACKAGE
About this Benefit Vision insurance provides coverage for routine eye examinations and may cover all or part of the costs associated with contact lenses, eyeglasses and vision correction, depending on the plan.
75% of U.S. residents between age 25 and 64 require some sort of vision correction.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 26 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Tuloso-Midway ISD Benefits Website: www.mybenefitshub.com/tulosomidwayisd
Vision Unum Vision® Quality eye care meets convenience
Plan features: •
• •
Our network offers members access to a large national network, including independent optometrists and retail stores like Walmart, Sam’s Club, Target Optical, America’s Best and many more. Find an in-network provider at unumvisioncare.com Manage benefits online with AlwaysAssist.com and onthe-go with the AlwaysAssist mobile app.
Covered benefits: Exam: Each member is entitled to a comprehensive vision exam. An exam co-pay applies and is outlined in the grid at right. Materials: Each member has coverage for covered services and materials. Purchases are subject to benefit frequencies and co-pays. Plan features include: • Frame benefit: You may choose any frame within a provider’s collection, subject to the retail frame allowance listed at right. If the cost is greater than the plan’s benefits, you are responsible for the difference. • Eyeglass lens benefit: Standard plastic (CR-39 Plastic Material) single vision, bifocal, trifocal, and specialty lenses are generally covered after any applicable materials copay. If covered by plan allowance, you are responsible for any cost greater than the plan’s benefit. • Contact lens benefit: Members electing contact lenses instead of eye glass lenses may apply the contact lens allowance to any lenses in the provider’s collection. If the cost is greater than the plan’s benefits, you are responsible for the difference. • Laser vision correction: Discounts are available with participating surgery providers across the country. (not an insured benefit)
How much does it cost?
In-network Providers
Out-of-network Allowances
Exam (1 per 12 months)
$10 co-pay
Up to $35
Materials
$25 co-pay
See allowances below
Vision Care Services
Standard Plastic Lenses (1 per 12 months) Single Vision
Covered by co-pay
Up to $25
Bifocal
Covered by co-pay
Up to $40
Trifocal
Covered by co-pay
Up to $45
Lenticular
Covered by co-pay
Up to $50
$70 allowance
Up to $45
Covered by co-pay
Not covered
Progressive Lens Options Scratch Resistant Coating
(at Walmart only)
Covered by co-pay
Not covered
$125 allowance
Up to $70
Polycarbonate Lenses Frames (1 per 12 months) Members choose from any frame available at provider locations.
Contact Lenses (1 per 12 months) In lieu of eyeglass lenses and frames (Includes fit*,follow-up and materials) Elective Medically Necessary
$25 co-pay
See allowances below
$150 allowance
Up to $80
Covered after
Up to $150
Monthly premium You
$7.59
You and your spouse
$12.94
You and your children
$13.67
Family
$20.52
*Some providers, such as Walmart, may charge for a contact lens fit and evaluation separately from your contact lens allowance, leaving the entire allowance for materials.
27
Vision Compensation or similar law, or which is work related; Plain or prescription sunglasses Membership provides access to preferred pricing. Transactions are handled directly between members and providers. Refractive or tinted lenses, and no-line bifocals and blended lenses (subject surgery is an elective procedure and may involve potential risks to to allowance); Sub-normal vision aids; Services rendered or matepatients. This is not an insured benefit. Unum cannot and does not rials purchased outside the U.S. or Canada, unless: the insured resides in the U.S. or Canada, and the charges are incurred while guarantee the outcome of any refractive surgical procedure or a on a business or pleasure trip; Charges in excess of Usual and Custotal elimination of the need for glasses or contacts. Providers tomary for services and materials; Experimental or nonmay not be available in all metropolitan areas. Login to www.alwaysassist.com for a list of participating laser vision correc- conventional treatments or devices; Safety eyewear; Spectacle lens styles, materials, treatments or “add-ons” not shown in the tion providers. Schedule of Benefits.
Laser Vision Correction Network
Hearing Savings Plan Unum offers a Hearing Savings Plan at no additional cost, to all of its Unum Dental and Unum Vision members. Partnering with EPIC Hearing Healthcare, the Hearing Savings Plan provides: • 30-60% discounts off MSRP on name brand hearing instruments. • 40% savings on hearing aid batteries shipped directly to members’ homes. • On-call support for member questions, managed by professional hearing counselors.
Other Unum Vision Specifications Dependent children: Dependent age guidelines vary by state. Please refer to your policy certificate or contact customer service at 888-400-9304. Services not listed: If you expect to require a vision service not included on this brochure, it may still be covered. Please contact customer service at 888-400-9304, to confirm your exact benefits. This is a primary vision care benefit and is intended to cover only eye examinations and corrective eyewear. Medical or surgical treatment of eye disease or injury is not provided under this plan. Coverage may not exceed the lesser of actual cost of covered services and materials or the limits of the policy. Some providers at optical and/or retail chains, such as Walmart, may charge for a contact lens fit and evaluation separately and apart from your contact lens allowance, leaving the entire allowance for materials. Covered materials that are lost or broken will be replaced only at normal service intervals indicated in the Plan Design; however, these materials and any items not covered below may be purchased at Preferred Pricing from a Participating Provider. In addition, benefits are payable only for expenses incurred while the Group and individual Member coverage is in force.
This plan will not cover: Orthoptics or vision training and any supplemental testing; Plano (non-prescription) lenses; or two pair of eyeglasses in lieu of bifocals or trifocals; Medical or surgical treatment of the eyes; An eye exam or corrective eye wear required by an employer as a condition of employment; Any injury or illness covered under Workers’ 28
THIS POLICY PROVIDES LIMITED BENEFITS This brochure is not intended to be a complete description of the insurance coverage available. The policies or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form Series VI-2002, VI-2007 and VI-2019 or contact your Unum Vision representative. Starmount Life Insurance Company 8485 Goodwood Boulevard • Baton Rouge, LA 70806 PH: (888) 400-9304 Vision plans are marketed by Unum, administered and underwritten by Starmount Life Insurance Company, Baton Rouge, LA. © 2020 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.
29
UNUM
YOUR BENEFITS PACKAGE
Educator 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 30 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Tuloso-Midway ISD Benefits Website: www.mybenefitshub.com/tulosomidwayisd
Educator Disability BENEFIT HIGHLIGHTS FOR: Tuloso-Midway Independent School District
EDUCATOR DISABILITY INSURANCE OVERVIEW What is Educator Disability Income Insurance? Educator Disability insurance combines the features of a shortterm and long-term disability plan into one policy. The coverage pays you a portion of your earnings if you cannot work because of a disabling illness or injury. The plan gives you the flexibility to choose a level of coverage to suit your need. You have the opportunity to purchase Disability Insurance through your employer. This highlight sheet is an overview of your Disability Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail. Why do I need Disability Insurance Coverage? • More than half of all personal bankruptcies and mortgage foreclosures are a consequence of disability1 1
•
•
Facts from LIMRA, 2016 Disability Insurance Awareness Month
Only 50% of American adults indicate they have enough savings to cover three months of living expenses in the event they’re not earning any income3 3
Benefit Amount You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $8,000 that cannot exceed 66 2/3% of your current monthly earnings. Earnings are defined in The Hartford’s contract with your employer. Elimination Period You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a Disability benefit payment. The elimination period that you select consists of two numbers. The first number shows the number of days you must be disabled by an accident before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin. For those employees electing an elimination period of 30 days or less, if you are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization.
Facts from LIMRA, 2016 Disability Insurance Awareness Month
The average worker faces a 1 in 3 chance of suffering a job loss lasting 90 days or more due to a disability2 2
FEATURES OF THE PLAN
Federal Reserve, Report on the Economic Well-Being of U.S. Households in 2018
ELIGIBILITY AND ENROLLMENT Eligibility You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis.
Maximum Benefit Duration Benefit Duration is the maximum time for which we pay benefits for disability resulting from sickness or injury. Depending on the schedule selected and the age at which disability occurs, the maximum duration may vary. Please see the applicable schedules below based on your election of either the Premium or Select benefit option. Premium Option: For the Premium benefit option – the table below applies to disabilities resulting from sickness or injury. Select Option: For the Select benefit option – the table below applies to disabilities resulting from injury. Age Disabled
Prior to 63 Enrollment Age 63 You can enroll in coverage within 31 days of your date of hire or Age 64 during your annual enrollment period. Age 65 Age 66 Effective Date Age 67 Coverage goes into effect subject to the terms and conditions of Age 68 the policy. You must satisfy the definition of Actively at Work Age 69 and older
with your employer on the day your coverage takes effect.
Actively at Work You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session.
Maximum Benefit Duration To Normal Retirement Age or 48 months if greater To Normal Retirement Age or 42 months if greater 36 months 30 months 27 months 24 months 21 months 18 months
Select Option: For the Select benefit option – the table below applies to disabilities resulting from sickness. Age Disabled
Maximum Benefit Duration
Prior to 67 Age 67-69 Age 70 and older
3 Years To Age 70, but not less than one year 1 Year
Mental Illness, Alcoholism and Substance Abuse: Duration You can receive benefit payments for Long-Term Disabilities resulting from mental illness, alcoholism and substance abuse 31
Educator Disability for a total of 24 months for all disability periods during your lifetime. Any period of time that you are confined in a hospital or other facility licensed to provide medical care for mental illness, alcoholism and substance abuse does not count toward the 24 month lifetime limit. Partial Disability Partial Disability is covered provided you have at least a 20% loss of earnings and duties of your job. Other Important Benefits Survivor Benefit - If you die while receiving disability benefits, a benefit will be paid to your spouse or child under age 26, equal to three times your last monthly gross benefit.
occupation, and as a result, your monthly earnings are 66 2/3% or less of your pre-disability earnings.
Pre-Existing Condition Limitation Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have been insured under this policy for 12 months before your disability begins. If your disability is a result of a pre-existing condition, we will pay benefits for a maximum of 4 weeks.
Continuity of Coverage If you were insured under your district’s prior plan and not The Hartford's Ability Assist service is included as a part of your receiving benefits the day before this policy is effective, there will group Long Term Disability (LTD) insurance program. You have access to Ability Assist services both prior to a disability and after not be a loss in coverage and you will get credit for your prior carrier’s coverage. you’ve been approved for an LTD claim and are receiving LTD benefits. Once you are covered you are eligible for services to provide assistance with child/elder care, substance abuse, family Recurrent Disability What happens if I Recover but become Disabled again? relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist Periods of Recovery during the Elimination Period will not interrupt the Elimination Period, if the number of days You them with the unique emotional, financial and legal issues that return to work as an Active Employee are less than one-half (1/2) may result from a disability. Ability Assist services are provided the number of days of Your Elimination Period. through ComPsych®, a leading provider of employee assistance Any day within such period of Recovery, will not count toward and work/life services. the Elimination Period. Travel Assistance Program – Available 24/7, this program Benefit Integration provides assistance to employees and their dependents who Your benefit may be reduced by other income you receive or are travel 100 miles from their home for 90 days or less. Services include pre-trip information, emergency medical assistance and eligible to receive due to your disability, such as: • Social Security Disability Insurance emergency personal services. • State Teacher Retirement Disability Plans Identity Theft Protection – An array of identity fraud support • Workers’ Compensation services to help victims restore their identity. Benefits include • Other employer-based disability insurance coverage you 24/7 access to an 800 number; direct contact with a certified may have caseworker who follows the case until it’s resolved; and a • Unemployment benefits personalized fraud resolution kit with instructions and resources • Retirement benefits that your employer fully or partially for ID theft victims. pays for (such as a pension plan) Your plan includes a minimum benefit of 10% of your elected Workplace Modification provides for reasonable modifications benefit. made to a workplace to accommodate your disability and allow you to return to active full-time employment. General Exclusions You cannot receive Disability benefit payments for disabilities that are caused or contributed to by: Definition of Disability • War or act of war (declared or not) Disability is defined as The Hartford’s contract with your • Military service for any country engaged in war or other employer. Typically, disability means that you cannot perform armed conflict one or more of the essential duties of your occupation due to • The commission of, or attempt to commit a felony injury, sickness, pregnancy or other medical conditions covered • An intentionally self-inflicted injury by the insurance, and as a result, your current monthly earnings • Any case where Your being engaged in an illegal occupation are 80% or less of your pre-disability earnings. was a contributing cause to your disability One you have been disabled for 24 months, you must be • You must be under the regular care of a physician to receive prevented from performing one or more essential duties of any benefits
PROVISIONS OF THE PLAN
32
Educator Disability Termination Provisions Your coverage under the plan will end if: • The group plan ends or is discontinued • You voluntarily stop your coverage • You are no longer eligible for coverage • You do not make the required premium payment • Your active employment stops, except as stated in the continuation provision in the policy The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including underwriting company Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. All benefits are subject to the terms and conditions of the policy. Policies underwritten by the underwriting company listed above detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued. This Benefit Highlights Sheet 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 Benefit Highlights Sheet and the policy, the terms of the policy apply. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the policyholder. Benefits are subject to state availability. © 2020 The Hartford.
33
UNUM
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 34 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Tuloso-Midway ISD Benefits Website: www.mybenefitshub.com/tulosomidwayisd
Basic Life and AD&D Tuloso-Midway Independent School District Life and AD&D Insurance Plan Highlights Who is eligible for this coverage?
All actively employed employees working at least 20 hours each week for your employer in the U.S.
What is the coverage amount?
Your employer is providing you with $25,000 of term life insurance. You will also receive $25,000 of Accidental Death and Dismemberment insurance.
If you retire, reduce your hours or leave your employer, you can continue coverage for yourself Is it portable (can I keep it if I leave at the group rate. Portability is not available for people who have a medical condition that my employer)? could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy.
When is coverage effective?*
Your coverage is effective on 9/1/2021.
What does my AD&D insurance pay for?
The full benefit amount is paid for loss of: • Life • Both hands or both feet or sight of both eyes • One hand and one foot • One hand and the sight of one eye • Speech and hearing Coverage amounts will reduce according to the following schedule:
Do my life insurance benefits decrease with age?
Age: 70
Insurance amount reduces to: 50% of original amount
Coverage may not be increased after a reduction.
Does this plan include help with work-life balance?
Yes. Our work-life balance employee assistance program (EAP) provides professional advice for a wide range of personal and work-related issues. The service is available to you and your family members 24 hours a day, 365 days a year. It provides resources to help you find solutions to everyday issues — such as financing a car or selecting child care — as well as more serious problems, such as alcohol or drug addiction, divorce or relationship problems. There is no additional charge for using the program, and you do not have to have filed a disability claim or be receiving benefits to use the program.
What else is included with this policy?
Worldwide emergency travel assistance is included with this Life plan. Emergency travel assistance is available to you, your spouse* and your dependent children when you travel to any foreign country, including Canada or Mexico. It is also available anywhere in the United States when you travel just 100 or more miles from home. * A spouse traveling on business for his or her employer is not covered by the program.
*Delayed effective date of coverage Insurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. The Work-life Balance Employee Assistance Program, provided by HealthAdvocate, is available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details. The policy provisions may vary or not be available in all states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage, please refer to Policy Form C.FP-1 et al or contact your Unum representative. Worldwide emergency travel assistance services, provided by Assist America, Inc., are available with select Unum insurance offerings. Terms and availability of service are subject to change and prior notification requirements. Services are not valid after coverage terminates. Please contact your Unum representative for details. Underwritten by Unum Life Insurance Company of America, Portland, Maine © 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. EN-1771 (6-18) FOR EMPLOYEES 35
Voluntary Life and AD&D Tuloso-Midway Independent School District Voluntary Life and AD&D Insurance Plan Highlights Who is eligible for this coverage?
All actively employed employees working at least 20 hours each week for your employer in the U.S. and their eligible spouses and children to age 26.
What are the Life/AD&D coverage amounts?
Employee: up to 5 times salary in increments of $10,000; not to exceed $500,000. Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $250,000. Child: up to 100% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $500. Note: In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself.
If you and your eligible dependents enroll during before the enrollment deadline, you may apply for any amount of coverage up to $200,000 for yourself and any amount of coverage up to $50,000 for your spouse, without answering any medical questions.
Can I be denied coverage?
If you want coverage over the amount you are guaranteed, you will need to provide answers to health questions. In addition, if you and your eligible dependents do not enroll during this enrollment period, you will have to wait for a future annual enrollment period to apply — and then you will need to answer health questions for the entire amount of coverage you apply for. New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense.
Why buy now?
As long as you buy $10,000 of life coverage now, you can buy more coverage later - up to $200,000 without answering any medical questions.
How do I apply?
To apply for coverage, complete your enrollment form by 9/1/2021. If you were hired after 9/1/2021, complete your enrollment form within 31 days of your eligibility date determined by your employer. If you apply for coverage after your effective date or if you choose coverage over the guaranteed issue amount, you will need to complete a medical questionnaire, which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense. Your coverage is effective 9/1/2021 or the date your application is approved by underwriting, if health questions were required.
When is coverage effective?
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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. For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness, or disorder, your dependent spouse and children: are confined in a hospital or similar institution; or are confined at home under the care of a physician for a sickness or injury. Exception: Infants are insured from live birth.
Life and AD&D Term Life
How much does the coverage cost?
Age band
Employee rate per $1,000
Spouse rate per $1,000
<25
$0.06
$0.12
25-29
$0.07
$0.12
30-34
$0.09
$0.15
35-39
$0.10
$0.17
40-44
$0.11
$0.18
45-49
$0.17
$0.26
50-54
$0.25
$0.38
55-59
$0.47
$0.60
60-64
$0.73
$1.04
65-69
$1.40
$1.97
70-74
$2.27
$1.97
75+
$2.27
$1.97
Child Life monthly rate is $0.22 for $1,000. One Life premium covers all children. Your rate is based on your age as of 9/1/2021 — your coverage-anniversary date. Insurance age is calculated by subtracting your year of birth from the year your coverage becomes effective or the current anniversary date. Spouse rate is based on the employee’s insurance age as outlined above. Coverage amounts will reduce according to the following schedule: Do my life insurance benefits decrease with age?
Age: 70
Insurance amount reduces to: 50% of original amount
Coverage may not be increased after a reduction. If you retire, reduce your hours or leave your employer, you can continue coverage for yourself your Is the coverage portable spouse and your dependent children at the group rate. Portability is not available for people who have a (can I keep it if I leave medical condition that could shorten their life expectancy — but they may be able to convert their term my employer)? life policy to an individual life insurance policy.
Are there any life insurance exclusions or limitations?
Life insurance benefits will not be paid for deaths caused by suicide within the first 24 months after the date your coverage becomes effective. If you increase or add coverage, these enhancements will not be paid for deaths caused by suicide within the first 24 months after you make these changes.
Will my premiums be waived if I’m disabled?
If you become disabled (as defined by your plan) and are no longer able to work, your life premium payments will be waived until your disability period ends.
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Life and AD&D
What does my AD&D insurance pay for?
The full benefit amount is paid for loss of: • life; • both hands or both feet or sight of both eyes; • one hand and one foot; • one hand or one foot and the sight of one eye; • speech and hearing. Other losses may be covered as well. Please contact your plan administrator.
Are there any AD&D exclusions or limitations?
When does my coverage end?
Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from: • disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM); • suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane; • war, declared or undeclared, or any act of war; • active participation in a riot; • committing or attempting to commit a crime under state or federal law; • the voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol; • intoxication – “being intoxicated” means you or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred. You and your dependents’ coverage under the Summary of Benefits ends on the earliest of: • the date the policy or plan is cancelled; • the date you no longer are in an eligible group; • the date your eligible group is no longer covered; • the last day of the period for which you made any required contributions; • the last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness, as described in the certificate of coverage. In addition, coverage for any one dependent will end on the earliest of: • the date your coverage under a plan ends; • the date your dependent ceases to be an eligible dependent; • for a spouse, the date of a divorce or annulment; • for dependent coverage, the date of your death. Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.
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 C.FP-1 et al or contact your Unum representative. © 2017 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. Underwritten by Unum Life Insurance Company of America, Portland, Maine EN-1773 (8-17) FOR EMPLOYEES
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AMERICAN PUBLIC LIFE
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 40 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Tuloso-Midway ISD Benefits Website: www.mybenefitshub.com/tulosomidwayisd
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42
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THE HARTFORD 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
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 Tuloso-Midway ISD Benefits Website: www.mybenefitshub.com/tulosomidwayisd
Accident GROUP VOLUNTARY ACCIDENT INSURANCE BENEFIT HIGHLIGHTS Tuloso-Midway Independent School District With Accident insurance, you’ll receive payment(s) associated with a covered injury and related services. You can use the payment in any way you choose – from expenses not covered by your major medical plan to day -to-day costs of living such as the mortgage or your utility bills. To learn more about Accident insurance, visit thehartford.com/employeebenefits
More than 3.5 million children ages 14 and younger get hurt annually playing sports or participating in recreational activities.1
COVERAGE INFORMATION This insurance provides benefits when injuries, medical treatment and/or services occur as the result of a covered accident. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s). PLAN INFORMATION Coverage Type On and off-job (24 hour) BENEFITS EMERGENCY, HOSPITAL & TREATMENT CARE Accident Follow-Up Up to 3 visits per accident $100 Acupuncture/Chiropractic Care/PT Up to 10 visits each per accident $50 Ambulance – Air Once per accident $1,200 Ambulance – Ground Once per accident $400 Blood/Plasma/Platelets Once per accident $300 Child Care Up to 30 days per accident while insured is confined $30 Daily Hospital Confinement Up to 365 days per lifetime $300 Daily ICU Confinement Up to 30 days per accident $600 Diagnostic Exam Once per accident $300 Emergency Dental Once per accident Up to $450 Emergency Room Once per accident $200 Health Screening Benefit Once per year for each covered person $50 Hospital Admission Once per accident $1,500 Initial Physician Office Visit Once per accident $100 Lodging Up to 30 nights per lifetime $150 Medical Appliance Once per accident $150 Rehabilitation Facility Up to 15 days per lifetime $150 Transportation Up to 3 trips per accident $100 Urgent Care Once per accident $100 X-ray Once per accident $75 SPECIFIED INJURY & SURGERY Abdominal/Thoracic Surgery Once per accident $3,000 Arthroscopic Surgery Once per accident $500 Burn Once per accident Up to $15,000 Burn – Skin Graft Once per accident for third degree burn(s) 50% of burn benefit Concussion Up to 3 per year $200 Dislocation Once per joint per lifetime Up to $8,000 Eye Injury Once per accident Up to $750 Fracture Once per bone per accident Up to $9,000 Hernia Repair Once per accident $400 Joint Replacement Once per accident $4,000 Knee Cartilage Once per accident Up to $2,000 Laceration Once per accident Up to $1,000 Ruptured Disc Once per accident $2,000 Tendon/Ligament/Rotator Cuff Once per accident Up to $2,000 45
Accident CATASTROPHIC Accidental Death Within 90 days; Spouse @ 50% and child @ 25% Common Carrier Death Within 90 days Coma Once per accident Dismemberment Once per accident Home Health Care Up to 30 days per accident Paralysis Once per accident Prosthesis Once per accident FEATURES Ability Assist® EAP2 – 24/7/365 access to help for financial, legal or emotional issues HealthChampionSM3 – Administrative & clinical support following serious illness or injury
$50,000 3 times death benefit Up to $15,000 Up to $50,000 $50 Up to $15,000 Up to $2,000 Included Included
PREMIUMS The amounts shown are MONTHLY amounts (12 payments/deductions per year):4 COVERAGE TIER Employee Only
$9.16 ($0.30 per day)
Employee & Spouse
$14.46 ($0.48 per day)
Employee & Child(ren)
$15.52 ($0.51 per day)
Employee & Family
$24.34 ($0.80 per day)
ASKED & ANSWERED 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. CAN I INSURE MY DOMESTIC OR CIVIL UNION PARTNER? Yes. Any reference to “spouse” in this document includes your domestic partner, civil union partner or equivalent, as recognized and allowed by applicable law. 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. HOW MUCH DOES IT COST AND HOW DO I PAY FOR THIS INSURANCE? Premiums are provided above. 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, or within 31 days of the date you have a change in family status. 46
WHEN DOES THIS INSURANCE BEGIN? 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), unless already insured with the prior carrier. 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“Sports Injury Statistics.” Stanford Children’s Health, n.d. Web. 30 June 2017. http://www.stanfordchildrens.org/en/topic/default?id=sports-injury-statistics-90 -P02787 2AbilityAssist® services are offered through The Hartford by ComPsych®. ComPsych is not affiliated with The Hartford and is not a provider of insurance services. The Hartford is not responsible and assumes no liability for the goods and services provided by ComPsych and reserves the right to discontinue any of these services at any time. Ability Assist is a registered trademark of The Hartford. Services may not be available in all states. Visit https://
Accident www.thehartford.com/employee-benefits/value-added-services for more information. 3HealthChampion services are provided through The Hartford by ComPsych®. ComPsych is not affiliated with The Hartford and is not a provider of insurance services. The Hartford doesn’t provide basic hospital, basic medical, or major medical insurance. HealthChampion specialists are only available during business hours. Inquiries outside of this timeframe can either request a call-back the next day or schedule an appointment. The Hartford is not responsible and assumes no liability for the goods and services provided by ComPsych and reserves the right to discontinue any of these services at any time. Health Champion is a service mark of ComPsych. Services may not be available in all states. Visit https://www.thehartford.com/employee-benefits/value-added-services for more information. 4Rates 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. 5962g 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. Accident Form Series includes GBD-2000, GBD-2300, 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.
•
• •
medically necessary While a covered person is on any aircraft: as a pilot, crewmember or student pilot; as a flight instructor or examiner; if it is owned, operated or leased by or on behalf of the policyholder, or any employer or organization whose eligible persons are covered under the policy; or being used for tests, experimental purposes, stunt flying,racing or endurance tests Operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft Riding in or driving any motor-driven vehicle in a race, stunt show or speed test
All exclusions may not be applicable, or may be adjusted, as required by state regulations in the situs state of a group. NOTICES THIS IS A LIMITED ACCIDENT ONLY BENEFIT POLICY IMPORTANT NOTICE – THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS. This limited 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. For New York Residents: This policy provides ACCIDENT insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services. IMPORTANT NOTICE — THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS
GROUP ACCIDENT INSURANCE LIMITATIONS AND EXCLUSIONS The benefits payable are based on the insurance in effect on the date of the covered accident, subject to the definitions, 5962g NS 08/16 © 2016.The Hartford Financial Services Group, Inc. All rights reserved. Accident Form Series includes GBD-2000, GBD-2300, or state limitations, exclusions and other provisions of the policy. equivalent.
You and your dependent(s) must be citizens or legal residents of the United States, its territories and protectorates. 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 intentionally self-inflicted injury • War or act of war, whether declared or undeclared, or a nuclear, chemical, biological, or radiological event • A covered person's participation in a felony, riot or insurrection • A covered person's service in the armed forces or units auxiliary to it • A covered person's taking drugs, unless as prescribed by or administered by a physician, or being intoxicated as defined by the jurisdiction in which the cause of loss was incurred • A covered person’s sickness or bacterial infection • A covered person’s participation in bungee jumping or hang gliding • A covered person’s participation or competition in semiprofessional or professional sports • Cosmetic surgery or any other elective procedure that is not
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.
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UNUM
Critical Illness
YOUR BENEFITS PACKAGE
About this Benefit Critical illness insurance is designed to supplement your medical and disability coverage easing the financial impacts by covering some of your additional expenses. It provides a benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke.
$16,500 Is the aggregate cost of a hospital stay for a heart attack.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 48 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Tuloso-Midway ISD Benefits Website: www.mybenefitshub.com/tulosomidwayisd
Critical Illness Tuloso-Midway Independent School District Critical Illness Plan Highlights 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?
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).
What are the Critical The following coverage amounts are available. Illness coverage amounts? For you: Select one of the following Choice $10,000, $20,000 or $30,000 For your Spouse and Children: 50% of employee coverage amount Can I be denied coverage?
Coverage is guarantee issue.
When is coverage effective?
Please see your Plan Administrator for your effective date of coverage.
What critical illness conditions are covered?
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 Cancer Invasive Cancer (including all Breast Cancer) 100% Non-Invasive Cancer 25% Skin Cancer $500 Supplemental Critical Illnesses Benign Brain Tumor 100% Coma 100% Loss of Hearing 100% Loss of Sight 100% Loss of Speech 100% Infectious Disease 25% Occupational Human Immunodeficiency Virus (HIV) or Hepatitis 100% Permanent Paralysis 100% Progressive Diseases Amyotrophic Lateral Sclerosis (ALS) 100% Dementia (including Alzheimer’s Disease) 100% Functional Loss 100% Multiple Sclerosis (MS) 100% Parkinson’s Disease 100% 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.
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 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.
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Critical Illness What critical illness conditions are covered?
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 Heart Attack (Myocardial Infarction) Coma Invasive Cancer (includes all Breast Cancer) Coronary Artery Disease (Major) Major Organ Failure Requiring Transplant Coronary Artery Disease (Minor) Non-Invasive Cancer End Stage Renal (Kidney) Failure Stroke
How much does the coverage cost?
Monthly Critical Illness Cost
Age
Option 1 $10,000 EE, $5,000 SP Employee Cost Spouse Cost
Option 2 $20,000 EE, $10,000 SP Employee Cost Spouse Cost
Option 3 $30,000 EE, $15,000 SP Employee Cost Spouse Cost
Less than age 25
$2.00
$1.00
$4.00
$2.00
$6.00
$3.00
25-29
$2.90
$1.45
$5.80
$2.90
$8.70
$4.35
30-34
$4.10
$2.05
$8.20
$4.10
$12.30
$6.15
35-39
$6.10
$3.05
$12.20
$6.10
$18.30
$9.15
40-44
$8.50
$4.25
$17.00
$8.50
$25.50
$12.75
45-49
$11.70
$5.85
$23.40
$11.70
$35.10
$17.55
50-54
$15.40
$7.70
$30.80
$15.40
$46.20
$23.10
55-59
$21.30
$10.65
$42.60
$21.30
$63.90
$31.95
60-64
$30.40
$15.20
$60.80
$30.40
$91.20
$45.60
65-69
$44.70
$22.35
$89.40
$44.70
$134.10
$67.05
70-74
$70.20
$35.10
$140.40
$70.20
$210.60
$105.30
75-79
$103.90
$51.95
$207.80
$103.90
$311.70
$155.85
80-84
$151.50
$75.75
$303.00
$151.50
$454.50
$227.25
85 or over
$244.70
$122.35
$489.40
$244.70
$734.10
$367.05
Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date. Spouse rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date. Do my critical illness insurance benefits Critical Illness benefits do not decrease due to age. decrease with age? Are there any exclusions or limitations?
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 non- prescription 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. 50
Critical Illness Are there any exclusions or limitations?
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 3 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.
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. Is the coverage portable (can I keep it if I leave my employer)?
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.
When does my coverage end?
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 AE-1226
FOR EMPLOYEES
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5 STAR
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 Tuloso-Midway ISD Benefits Website: www.mybenefitshub.com/tulosomidwayisd
Term Life with Terminal Illness and Quality of Life Rider 5Star Life Insurance Company Individual and Group Term Life Insurance with Terminal Illness coverage to age 121 including Quality of Life Benefit 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
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Family Protection Plan - Terminal Illness MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT
18-25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46
$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
$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
$30,000 $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
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
47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64
$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
$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
$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
$54.20 $57.27 $60.60 $64.24 $68.26 $72.96 $78.17 $84.03 $90.23 $97.23 $104.46 $111.86 $119.43 $127.36 $135.60 $144.23 $153.40 $163.37
$66.13 $69.96 $74.13 $78.67 $83.71 $89.59 $96.09 $103.42 $111.17 $119.92 $128.96 $138.21 $147.67 $157.59 $167.88 $178.67 $190.13 $202.59
$95.94 $101.69 $107.94 $114.75 $122.32 $131.13 $140.87 $151.88 $163.50 $176.63 $190.19 $204.06 $218.25 $233.13 $248.57 $264.75 $281.94 $300.62
$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
$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
$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
65
$48.50
$90.50
$132.51
$174.50
$216.50
$321.50
$426.50
$531.50
$636.51
Age on Eff. Date
54
$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
$125,000 $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
$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
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
ILOCK360
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 Tuloso-Midway ISD Benefits Website: www.mybenefitshub.com/tulosomidwayisd
Identity Theft Protection YOUR IDENTITY IS YOUR MOST VALUABLE ASSET. IS YOURS PROTECTED? 39 seconds
is how often cyber-attacks to occur
25% of kids
are projected to be affected by identity theft before turning 18
17% increase
in data breaches 2018 to 2019
HOW iLOCK360 HELPS DEFEND Your personal information is monitored 24/7/365 PROTECT Alerts inform you of potential threats for immediate action RESTORE iLOCK360 does the work to restore your identity PLEASE NOTE: A valid email address is required for enrollment in iLOCK360. All
iLOCK360 alerts and/or notifications are sent via email. Consider utilizing an Identity theft is the fastest growing crime. With iLock360, you email address that you check regularly. can rest easier knowing you have experienced professionals in your corner restoring your identity. MONTHLY PAYROLL DEDUCTION PROTECT YOUR IDENTITY TODAY COVERAGE PLAN ESSENTIAL ELITE TAKE ADVANTAGE OF SPECIAL EDUCATOR *Plans with children include coverage for up to 10 PRICING DURING OPEN ENROLLMENT! Employee $6.95 $11.95 Children under the age of 18. Employee + Family $13.95 $22.95
PLAN FEATURES SERVICE DESCRIPTION IDENTITY THEFT RESOLUTION SERVICES Full-Service Identity Restoration & Lost Wallet Protection
MOST VALUABLE SERVICE. Dependable help that’s just a phone call away! $1M Identity Theft Insurance
If your identity is compromised, a U.S.-based certified Identity Theft Restoration Specialist will work on your behalf to restore your good name, so that you can get on with your life. All restoration activities can be completed for you, and your case will be managed until your identity is fully restored. Even preexisting conditions can be dealt with. Restoration Specialists offer robust case knowledge in both credit and non-credit fraud situations and can help you with closing accounts, re-ordering cards, placing a fraud alert with each of the three credit bureaus, and removing fraudulent activity from your credit report. If you incur expenses associated with your identity theft recovery, you will be covered with $1M reimbursement ($0 deductible). Covered costs include: lost wages or income; attorney and legal fees; expenses incurred for refiling of loans; grants and other lines of credit; costs of childcare and/or elderly care incurred as a result of identity restoration
ESSENTIAL
ELITE
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COMPREHENSIVE IDENTITY MONITORING
CyberAlert™️ Monitors
Change of Address Monitoring Payday Loan Monitoring Social Security Number Trace Medical ID Monitoring
Court/Criminal Records Monitoring
• one Social Security Number • two Medical ID Numbers • two Phone Numbers
• two Email Addresses • one Passport • five Bank Accounts
• one Drivers License Number • five Credit/Debit Cards
We scour Internet properties, including the Dark Web, as well as hacker websites, blogs, bulletin boards, peer-to-peer sharing networks and chat rooms to identify the illegal trading and selling of your personal information. A thief may try to establish “your” new identity by changing your address. Receive an alert if your mail is redirected in the USPS National Change of Address (NCOA) Registry. High-interest, easy-to-obtain payday loans can negatively impact your credit score. Alerts you if a noncredit loan was opened in your name at a payday/quick cash loan provider. Provides you with a report of all names and/or aliases as well as current and reported addresses associated with your Social Security number. If there are findings that you don’t recognize, this could be a sign of possible identity theft. If your Medical ID number is found compromised by CyberAlertTM, a Restoration Specialist can help you report it as fraud. Tracks municipal court systems and notifies you if a crime has been committed under your name and date of birth.
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CREDIT MONITORING SERVICES Bank Account Takeover & Credit Card Application Monitoring Daily Monitoring of Experian Credit Daily Monitoring of all 3 Credit Bureaus ScoreTracker 3-Bureau Credit Score & Report Experian Positive Activity Notifications Experian Score Variance Alerts
Notifies you when your Social Security number and personal information have been used to apply for or open a new bank or credit card account; or if changes have been made to your existing bank account - such as an attempt to add a new account holder. Provides you with notifications for changes in a credit report such as loan data, inquiries, new accounts, judgments, liens and more. Provides higher-level credit protection with monitoring from all three credit bureaus: Experian, Equifax & TransUnion. You receive notifications for changes in your credit report such as loan data, inquiries, new accounts, judgments, liens and more. Receive a monthly report that helps you understand how your credit score has trended over time and what is impacting it with credit score insight. Provides you with access to your credit score and report reported by each credit bureau - Experian, Equifax & TransUnion. These are reported once a year. Alerts you when positive activity is reported on your Experian credit file, a key indicator that your credit may be improving. Receive alerts when your Experian credit score increases or decreases by a certain amount, changes risk level/score rank, or reaches a target score value.
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Identity Theft Protection ADVANCED TOOLS Sex Offender Alerts Social Media Monitoring Solicitation Reduction
Keep your family safe with awareness of where registered sex offenders live in your immediate area. You’ll also be notified when a new one moves to your area. Receive notifications if the content you share on social media could pose a privacy or rep- utational risk. With Family coverage, you can monitor your child’s social media presence. Limit access to the amount of personal information that is public to reduce your ex- posure to fraud and declutter your mailbox and phone line. Also, opt-out of direct marketing campaigns including utilizing the National Do Not Call Registry.
✔ adults ✔ children to age 18
900 S Capital of TX HWY • Suite 350, Austin, TX 78746 • www.iLOCK360.com
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59
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.
FLIP TO… FOR HSA VS. FSA COMPARISON
PG. 11
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 Tuloso-Midway ISD Benefits Website: www.mybenefitshub.com/tulosomidwayisd
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 Annual taxable income $24,000 $24,000 cases, the taxpayer identification number of the service 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 Taxable income after FSA $21,000 $24,000 want and how much contributions should go toward each Income taxes -$6,300 -$7,200 benefit. It is very important that you make these choices carefully based on what you expect to spend on each covered After-tax income $14,700 $16,800 benefit or expense during the plan year. $0 -$3,000 Generally, you cannot change the elections you have made after After-tax health and welfare expenses Take-home pay $14,700 $13,800 the beginning of the plan year. However, there are certain limited situations when you can change your elections if you You saved $900 $0 have a "change in status". Please refer to your Summary Plan Description for a change in status listing.
Plan Highlights Flexible Spending Plans
61
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
62
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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WWW.MYBENEFITSHUB.COM/TULOSOMIDWAYISD 64