BIG SPRING ISD BENEFIT GUIDE EFFECTIVE: 09/01/2022 8/31/2023 WWW.MYBENEFITSHUB.COM/BIGSPRINGISD 2022 - 2023 PlanYear 1
Table of Contents FLIP TO... How to Enroll 4-5 Annual Benefit Enrollment 6-11 1. Benefit Updates 6 2. Section 125 Cafeteria Plan Guidelines 7 3. Annual Enrollment 8 4. Eligibility Requirements 9 5. Helpful Definitions 10 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 11 Medical 12-18 Health Savings Account (HSA) 19 Hospital Indemnity 20 Dental 21 Vision 22-23 Telehealth 24 Disability 25 Cancer 26-27 Accident 28-29 Critical Illness 30-31 Life and AD&D 32-33 Individual Life 34 Identity Theft 35 Emergency Medical Transportation 36 Flexible Spending Account (FSA) 37-38 HOW TO ENROLLPG. 4 SUMMARYPAGESPG. 6 BENEFITSYOURPG. 12 2
BIG SPRING ISD BENEFITS TRS ACTIVECARE MEDICAL TRS HMO MEDICAL Financial Benefit Services (800) 583 www.mybenefitshub.com/bigspringisd6908 (866)BCBSTX355 www.bcbstx.com/trsactivecare5999 Scott & White HMO (844) 633 www.trs.swhp.org5325 HEALTH SAVINGS ACCOUNT HOSPITIAL INDEMNITY DENTAL (800)EECU 333 9934 www.eecu.org GroupAflac #7710 (800) 992 www.aflacgroupinsurance.com3522 Lincoln Financial Group Group #bigspringisd (800) 423 www.lfg.com2765 VISION TELEHEALTH DISABILITY Superior Vision Group #39335 (800) 507 www.superiorvision.com3800 (888)MDLIVE365 www.mdlive.com/fbs1663 GroupUnum #474635 (866) 679 www.unum.com3054 CANCER ACCIDENT CRITICAL ILLNESS GroupAPL #24229 (800) 256 www.ampublic.com8606 The www.thehartford.com(866)GroupHartford#8910655474205 GroupUnum #47637 (866) 679 www.unum.com3054 LIFE AND AD&D INDIVIDUAL LIFE IDENTITY THEFT GroupUnum #474636 (866) 679 www.unum.com3054 5Star Life Insurance (866) 863 www.5starlifeinsurance.com9753 (855)iLOCK360287 www.ilock360.com8888 EMERGENCY MEDICAL TRANSPORT FLEXIBLE SPENDING ACCOUNT (FSA) (800)MASA423 3226 www.masamts.com (866)Higginbotham4193519 https://flexservices.higginbotham.net/ Benefit Contact Information 3
Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS BSISD” to (800) 583-6908 App Group #: FBSBSISD Text “FBS BSISD” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment: • Benefit Resources • Online Enrollment • Interactive Tools • And more! 4
1 www.mybenefitshub.com/bigspringisd How to Log In 2 CLICK LOGIN 3 ENTER USERNAME & PASSWORD Your Username Is: Your email in THEbenefitsHUB. (Typically your work email) Your Password Is: Four (4) digits of your birth year followed by the last four (4) digits of your Social Security Number If you have previously logged in, you will use the password that you created, NOT the password format listed above. 5
(CIS):STATUS QUALIFYING
Judgment/Decree/Order
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
Gain/Loss
EligibilityDependents'ofStatus
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A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.
Change in Number of Tax Dependents
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. IN EVENTS
Change in Status of Employment Affecting Coverage Eligibility
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.
Eligibility for Government Programs
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.
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.
Section 125 Cafeteria Plan Guidelines SUMMARY PAGESAnnual Benefit Enrollment CHANGES
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.
Marital Status
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.
Annual Enrollment
For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866 914 5202 for assistance.
For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ bigspringisd. Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms
All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Howsection.can I find a Network Provider?
New Hire Enrollment
SUMMARY PAGESAnnual Benefit Enrollment 7
Q&A Who do I contact with Questions?
During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.
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 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.
• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
Where can I find forms?
• 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.
• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.
For benefit summaries and claim forms, go to the Big Spring ISD benefit www.mybenefitshub.com/bigspringisdwebsite:. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section. When will I receive ID cards?
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 Disclaimer:eligibility.
Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week. 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 your 2022 benefits become effective on September 1, 2022, you must be actively at work on September 1, 2022 to be eligible for your new benefits.
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
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 FSA/HSAeligibility.Limitations:
Dependent RequirementsEligibility
SUMMARY PAGES
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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. PLAN MAXIMUM AGE Medical To age 26 Dental To age 26 Vision To age 26 Life To age 26 AD&D To age 26 Individual Life To age 24 HealthAccountSavings To age 26 Critical Illness To age 26 Disability To age 26 IndemnityHospital To age 26 Telehealth To age 26 TransportationEmergency To age 26 Accident To age 26 Cancer To age 26 Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Employee RequirementsEligibility
Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, 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.
Annual Benefit Enrollment
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 Potentialguidance.Dependent
Annual
September
The most an eligible or insured person can pay in co insurance for covered expenses.
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.
January 1st through December 31st Co-insurance 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. Coverage
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.
You are performing your regular occupation for the employer on a full time basis, either at one of the employer’s usual 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 9/1/2022 please notify your benefits administrator. Enrollment
Guaranteed
In Network Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider. Out of Pocket Maximum
Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescription drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).
SUMMARY PAGESHelpful Definitions 9
Plan Year 1st through August 31st Pre Existing Conditions
Actively at Work
Calendar Year
After
SUMMARY PAGESHSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223) Flexible Spending Account (FSA) (IRC Sec. 125) Description 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 RequirementInsurance High deductible health plan None Minimum Deductible $1,400 single (2022) $2,800 family (2022) N/A Maximum Contribution $3,650 single (2022) $7,300 family (2022) $2,850 (2022) Permissible Use Of Funds Employees may use funds any way they wish. 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 FLIP TO FOR HSA INFORMATION PG. 19 FLIP TO FOR FSA INFORMATION PG. 37 10
Notes 11
ABOUT MEDICAL Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis. For full plan details, please visit your benefit website: www.mybenefitshub.com/bigspringisd Medical Insurance TRS EMPLOYEE BENEFITS Monthly Premium District Contribution Employee Cost TRS ActiveCare HD Employee Only $354.00 $354.00 $0.00 Employee & Spouse $996.00 $450.00 $546.00 Employee & Child(ren) $635.00 $450.00 $185.00 Employee & Family $1,190.00 $450.00 $740.00 TRS ActiveCare Primary Employee Only $343.00 $343.00 $0.00 Employee & Spouse $967.00 $450.00 $517.00 Employee & Child(ren) $616.00 $450.00 $166.00 Employee & Family $1,157.00 $450.00 $707.00 TRS ActiveCare Primary+ Employee Only $431.00 $431.00 $0.00 Employee & Spouse $1,053.00 $450.00 $603.00 Employee & Child(ren) $693.00 $450.00 $243.00 Employee & Family $1,324.00 $450.00 $874.00 TRS ActiveCare 2 Employee Only $1,013.00 $450.00 $563.00 Employee & Spouse $2,402.00 $450.00 $1,952.00 Employee & Child(ren) $1,507.00 $450.00 $1,057.00 Employee & Family $2,841.00 $450.00 $2,391.00 West Texas Blue Essentials HMO Employee Only $689.60 $450.00 $239.60 Employee & Spouse $1,672.26 $450.00 $1,222.26 Employee & Child(ren) $1,083.58 $450.00 $633.58 Employee & Family $1,775.58 $450.00 $1,325.58 12
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Health Savings Account (HSA)
• Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.
• Online/Mobile: Sign in for 24/7 account access to check your balance, pay bills and more.
you elect:
• Enrolled in an HSA eligible HDHP (ActiveCare HD)
If you meet the eligibility requirements, you may open an HSA administered by EECU. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA.
Important HSA Information
• Not eligible to be claimed as a dependent on someone else’s tax return
Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2022 is based on the coverage option
Maximum Contributions
• Not enrolled in Medicare or TRICARE
• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
• Call/Text: (817) 882 0800 EECU’s dedicated member service representatives are available to assist you with any questions. Their hours of operation are Monday through Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. to 1:00 p.m. CT and closed on Sunday.
HSA Eligibility
• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333 9934.
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs it is also a tax exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.
If you are 55 or older, you may make a yearly catch up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch up contribution for the entire plan year.
• Stop by a local EECU financial center for in person assistance; find locations & service hours at www.eecu.org/locations. HSA
A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used.
• You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.
• Not receiving Veterans Administration benefits
How to Use your HSA
• Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account
• Individual $3,650
• Family (filing jointly) $7,300
Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). For full plan details, please visit your benefit website: www.mybenefitshub.com/bigspringisd
ABOUT
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax free and spends tax free if used to pay for qualified medical expenses.
EECU EMPLOYEE BENEFITS 19
There is no “use it or lose it” rule you do not lose your money if you do not spend it in the calendar year and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered by the HDHP.
You are eligible to open and contribute to an HSA if you are:
Opening an HSA
HOSPITAL ADMISSION BENEFIT per confinement (once per covered sickness or accident per calendar year for each insured)
$200 $100
High Low
HOSPITAL CONFINEMENT per day (maximum of 31 days per confinement for each covered sickness or accident for each insured) Payable for each day that an insured is confined to a hospital as an in patient as the result of a covered accidental injury or covered sickness. If we pay benefits for confinement and the insured becomes confined again within six months because of the same or related condition, we will treat this confinement as the same period of confinement. This benefit is payable for only one hospital confinement at a time even if caused by more than one covered accidental injury, more than one covered sickness, or a covered accidental injury and a covered sickness.
SUCCESSOR INSURED BENEFIT
If spouse coverage is in force at the time of the employee’s death, the surviving spouse may elect to continue coverage. Coverage would continue according to the existing plan and would also include any dependent child coverage in force at the time.
In order to receive benefits for accidental injuries due to a covered accident, an insured must be admitted within six months of the date of the covered accident (in Washington, twelve months).
supplemental plan that pays you should you be in patient hospital confined. This plan complements your health insurance by
Payable when an insured is admitted to a hospital and confined as an in patient because of a covered accidental injury or covered sickness. We will not pay benefits for confinement to an observation unit, or for emergency room treatment or outpatient treatment. We will not pay benefits for admission of a newborn child following his birth; however, we will pay for a newborn’s admission to a Hospital Intensive Care Unit if, following birth, he is confined as an inpatient as a result of a covered accidental injury or covered sickness (including congenital defects, birth abnormalities, and/or premature birth).
unpaid by your health insurance. For
please
your benefit website: www.mybenefitshub.com/bigspringisd
Hospital
Indemnity Aflac EMPLOYEE BENEFITS 20
How to File a Claim: Call (800) 433 3036 or go to www. aflacgroupinsurance.com
HOSPITAL INTENSIVE CARE BENEFIT (maximum of 10 days per confinement for each covered sickness or accident for each insured) Payable for each day when an insured is confined in a Hospital Intensive Care Unit because of a covered accidental injury or covered sickness. We will pay benefits for only one confinement in a Hospital's Intensive Care Unit at a time. Once benefits are paid, if an insured becomes confined to a Hospital's Intensive Care Unit again within six months because of the same or related condition, we will treat this confinement as the same period of confinement. This benefit is payable in addition to the Hospital Confinement Benefit.
The plan has limitations and exclusions that may affect benefits payable. This brochure is for illustrative purposes only. Refer to www.mybenefitshub.com/bigspringisd and review the plan summary for complete details, definitions, limitations and exclusions. is an affordable helping pay for costs left full details, visit
plan
$2,000 $1,500
you
Hospital Indemnity High Low Employee $35.42 $20.24 Employee + Spouse $71.84 $41.14 Employee + Child(ren) $55.48 $31.56 Family $91.90 $52.46 ABOUT HOSPITAL INDEMNITY This
$200 $100
Dental High Low Employee $36.30 $20.92 Employee + Spouse $70.99 $40.99 Employee + Child(ren) $93.26 $53.65 Family $138.99 $80.14 ABOUT DENTAL Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and Fordisease.fullplan details, please visit your benefit website: www.mybenefitshub.com/bigspringisd Dental Insurance Lincoln Financial Group EMPLOYEE BENEFITS • Plan cover many preventive, basic, and major dental care services. (See Below) • Both plans allow you to choose any dentist you wish. However, your out of pocket costs are likely to be lower when you choose a contracting dentist. To find a contracting dentist near you, visit www.LincolnFinancial.com/FindADentist • You can request your dental id card by contacting Lincoln Financial Dental directly at 800 423 2765 or visit www.lfg.com and register/login to access your account. Benefits At A Glance High and Low Plan Options Effective 9/01/2022 Contracting Dentists Non Contracting Dentists Calendar (Annual) Deductible Individual: $50; Family: $150 Waived for: Preventive Individual: $50; Family: $150 Waived for: Preventive Deductibles are combined for basic and major Contracting Dentist’s services. Deductibles are combined for basic and major Non Contracting Dentist’s services. Annual Maximum $1,500 $1,500 MaxRewards® lets you and your covered family members roll a portion of unused dental benefits from one year into the next. So you have extra benefit dollars available when you need them most. Lifetime Orthodontic Max $1,500 $1,500 Orthodontic Coverage is available for dependent children. Waiting Period There are no benefit waiting periods for any service types. High Option Low Option Preventive Services ContractingDentists NonDentistsContracting ContractingDentists NonDentistsContracting Routine oral exams, Bitewing X rays, Other dental X rays (including periapical films); Flouride treatments, Space maintainers for children; Sealants; Palliative treatment (including emergency relief of dental pain) 100% No Deductible 100% No Deductible 90% No Deductible 90% No Deductible Basic Services Full mouth or panoramic X rays; Problem focused exams; Injections of antibiotics and other therapeutic medications; Fillings; Simple extractions; General anesthesia and I.V. sedation 80% After Deductible 80% After Deductible 50% After Deductible 50% After Deductible Major Services Consultations; Prefabricated stainless steel and resin crowns; Surgical extractions; Oral surgery; Biopsy and examination of oral tissue; Endodontics (including root canal treatment); periodontal maintenance procedures; Non surgical periodontal therapy Periodontal surgery; Bridges; Full and partial dentures; Denture reline and rebase; Crowns, inlays, onlays and related services; Implants & implant related services 50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible Orthodontics Orthodontic exams; X rays; Extractions; Study models; Appliances 50% 50% 50% 50% 21
Benefits through Superior National network In network Out of network Exam (ophthalmologist) Covered in full Up to $42 retail Exam (optometrist) Covered in full Up to $42 retail Frames $150 retail allowance Up to $60 retail Contact lens fitting (standard2) Covered in full Not covered Contact lens fitting (specialty2) $50 retail allowance Not covered Lenses (standard) per pair Single vision Covered in full Up to $26 retail Bifocal Covered in full Up to $34 retail Trifocal Covered in full Up to $50 retail Progressives lens upgrade See description3 Up to $50 retail Ultraviolet coat Covered in full Not covered Factory scratch coat Covered in full Not covered Polycarbonate for dependent children Covered in full Not covered Contact lenses4 $130 retail allowance Up to $100 retail Co pays apply to in network benefits; co pays for out of network visits are deducted from reimbursements 1 Materials co pay applies to lenses and frames only, not contact lenses 2 Standard contact lens fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty contact lens fitting applies to new contact wearers and/or a member who wear toric, gas permeable, or multi focal lenses. 3 Covered to provider’s in office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co pay. 4 Contact lenses are in lieu of eyeglass lenses and frames benefit Monthly Premiums Copays Services/Frequency Employee $7.28 Exam $10 Exam 12 months Employee + Spouse $14.57 Materials1 $25 Frame 12 months Employee + Child(ren) $17.17 Contact lens fitting (standard & specialty) Contact lens fitting 12 months$25Family $26.29 Lenses 12 months Contact lenses 12 months How to Print your Vision ID Card: You can request your vision id card by contacting Superior Vision directly at 800 507 3800. You can also go to www.superiorvision.com and register/login to access your account by clicking on “Members” at the top of the page. You can also download the Superior Vision mobile app on your smart phone. ABOUT VISION Vision insurance provides coverage for routine eye examinations and can help with covering some of the costs for eyeglass frames, lenses or contact lenses. For full plan details, please visit your benefit website: www.mybenefitshub.com/bigspringisd Vision Insurance Superior Vision EMPLOYEE BENEFITS 22
Vision Insurance Superior Vision EMPLOYEE BENEFITS Discount Features Look for providers in the provider directory who accept discounts, as some do not; please verify their services and discounts (range from 10% 30%) prior to service as they vary. Discounts on covered materials Frames: 20% off amount over allowance Lens options: 20% off retail Progressives: 20% off amount over retail lined trifocal lens, including lens options Specialty contact lens fit: 10% off retail, then apply allowance Discounts on non covered exam, services and materials Exams, frames, and prescription lenses: 30% off retail Lens options, contacts, miscellaneous options: 20% off retail Disposable contact lenses: 10% off retail Retinal imaging: $39 maximum out of pocket Maximum member out of pocket The following options have out of pocket maximums5 on standard (not premium, brand, or progressive) lenses. Single Vision Bifocal & Trifocals Scratch coat $13 $13 Ultraviolet coat $15 $15 Tints, solid or gradients $25 $25 Anti reflective coat $50 $50 Polycarbonate for adults $40 20% off retail High index 1.6 $55 20% off retail Photochromics $80 20% off retail 5. Discounts and maximums may vary by lens type. Please check with your provider. LASIK Laser vision correction (LASIK) is a procedure that can reduce or eliminate your dependency on glasses or contact lenses. This corrective service is available to you and your eligible dependents at a special discount (20 50%) with your Superior Vision plan. Contact QualSight LASIK at (877) 201 3602 for more information. 23
MDLIVE provides you access to Board certified doctors 24/7 from your mobile device or computer. Prescriptions can be sent to your nearest pharmacy if medically necessary. While MDLIVE does not replace your primary care physician, it is a convenient and cost effective option when you need care and: • Have a non emergency issue and are considering a convenience care clinic, urgent care clinic or emergency room for treatment? • Are on vacation or away from home? • Are unable to see your primary care physician? MDLIVE treats over 50 routine medical conditions including: • Acne • Allergies • Cold/flu • Constipation • Cough • Diarrhea • Earache • Insect bites • Nausea/vomiting • Pink eye • Rash • Respiratory problems • Sore throats • And more Do not use telemedicine for serious or life threatening emergencies. Registration is Easy After your benefit becomes effective, set up your account with MDLIVE by providing medical history and pharmacy choices so you are ready to use this valuable service when and where you need it. • Online www.mdlive.com/fbs • Phone 888 365 1663 • Mobile download the MDLIVE mobile app to your smartphone or mobile device • Select “MDLIVE as a benefit” and “FBS” as Employer/ Organization Telehealth Employee and Family $9.00 ABOUT TELEHEALTH Telehealth provides 24/7/365 access to board certified doctors via telephone or video consultations that can diagnose, recommend treatment and prescribe medication. Telehealth makes care more convenient and accessible for non emergency care when your primary care physician is not available. For full plan details, please visit your benefit website: www.mybenefitshub.com/bigspringisd Telehealth MDLIVE EMPLOYEE BENEFITS 24
What is considered a pre existing condition?
If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. First day hospital applies to Elimination Periods of 7/7, 14/14 and 30/30.
• The date your eligible group is no longer covered;
• The last day of the period for which you made any required contributions;
ABOUT DISABILITY
• The date the policy or plan is cancelled;
• The last day you are in active employment except as provided under the covered layoff or leave of absence provision.
To apply for coverage, complete your enrollment online by the enrollment deadline. If you were hired after 9/1/2022, check with your plan administrator for your eligibility date, and complete your enrollment online within 31 days of that date.
The elimination period is the length of time you must be continuously disabled before you can receive Eliminationbenefits.Period Options: Option 1: 7 days/7 days first day hospital Option 2: 14 days/14 days first day hospital Option 3: 30 days/30 days first day hospital Option 4: 90 days/90 days Option 5: 180 days/180 days During your elimination period, you will be considered disabled if you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury, you are under the regular care of a physician and you are unable to perform any of the material and substantial duties of your regular occupation due to the same sickness or injury.
Elimination Period 30% 40% 50% 60% 7/7 $2.41 $2.61 $2.70 $2.91 14/14 $2.10 $2.27 $2.35 $2.53 30/30 $1.37 $1.48 $1.52 $1.64 90/90 $0.89 $0.91 $0.93 $1.01 180/180 $0.62 $0.66 $0.76 $0.85
For full plan details, please visit your benefit website: www.mybenefitshub.com/bigspringisd
Who is eligible? You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week.
Your coverage under the policy ends on the earliest of the following:
Please see your plan administrator for further information on these Unumprovisions.willprovide coverage for a payable claim which occurs while you are covered under the policy or plan.
How can I apply for coverage?
You have a pre existing condition if:
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.
Disability Insurance
• You received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and
Unum EMPLOYEE BENEFITS
• The disability begins in the first 12 months after your effective date of Benefitscoverage.underthis provision are payable for no more than 90 days of benefit from the date of disability. After 90 days, benefits are subject to a 3/12 pre existing condition exclusion. In no event will benefits be paid beyond the applicable benefit duration. This applies to the 9/1/2020 enrollment only and new hires. Late entrants will be subject to a 3/12 pre Whenex.does my coverage end?
• The date you no longer are in an eligible group;
How long do I have to wait to receive benefits?
Disability
What is my monthly benefit amount? You can elect to purchase a benefit of 30%, 40%, 50% or 60% of your monthly earnings. What is my maximum monthly benefit amount? Your total monthly benefit (including all benefits provided under this plan) will not exceed 100% of your monthly earnings unless the excess amount is payable as a Cost of Living Adjustment.
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What if I am out of work when the coverage goes into effect? Insurance 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.
Summary of Benefits Low Option High Option Cancer Treatment Policy Benefits Level 1 Level 2 Radiation Therapy, Chemotherapy, Immunotherapy Maximum per 12 month period $10,000 $15,000 Hormone Therapy Maximum of 12 treatments per calendar year $50 per treatment $50 per treatment Experimental Treatment paid in same manner and under the same maximums as any other benefit Miscellaneous Care Rider Benefits Level 1 Level 2 Cancer Treatment Center Evaluation or Consultation 1 per lifetime not included $750 Evaluation or Consultation Travel and Lodging 1 per lifetime not included $350 Second / Third Surgical Opinion per diagnosis of cancer $300 / $300 $300 / $300 Drugs and Medicine Inpatient / Outpatient (maximum $150 per month) $150 per confinement $50 per prescription Hair Piece (Wig) 1 per lifetime $150 $150 Transportation Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car Lodging up to a maximum of 100 days per calendar year actual coach fare or $.40 per mile $.40 per mile $50 per day actual coach fare or $.75 per mile $.75 per mile $100 per day Family Transportation Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car Family Lodging up to a maximum of 100 days per calendar year actual coach fare or $.40 per mile $.40 per mile $50 per day actual coach fare or $.75 per mile $.75 per mile $100 per day Blood, Plasma and Platelets $300 per day $300 per day Ambulance Ground/Air Maximum of 2 trips per Hospital Confinement for all modes of transportation combined $200 / $2,000 per trip Inpatient Special Nursing Services per day of Hospital Confinement $150 per day $150 per day Outpatient Special Nursing Services Up to same number of Hospital Confinement days $150 per day $150 per day Medical Equipment Maximum of 1 benefit per calendar year not included $150 Physical, Occupational, Speech, Audio Therapy & Psychotherapy / Maximum per calendar year $25 per visit / $1,000 Waiver of Premium Waive Premium ABOUT 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. For full plan details, please visit your benefit website: www.mybenefitshub.com/bigspringisd Cancer Insurance APL EMPLOYEE BENEFITS 26
Cancer Low High Employee $11.34 $16.60 Employee + Spouse $24.16 $35.22 Employee + Child(ren) $14.90 $21.04 Family $27.66 $39.64 Internal Cancer First Occurrence Rider Benefits Level 1 Level 2 Lump Sum Benefit Maximum 1 per Covered Person per lifetime $2,500 $5,000 Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime $3,750 $7,500 Hospital Intensive Care Unit Rider Benefits Level 1 Level 2 Intensive Care Unit $600 per day $600 per day Step Down Unit Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit $300 per day $300 per day Cancer Insurance APL EMPLOYEE BENEFITS **Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with notice. The premium and amount of benefits vary dependent upon the Plan selected at time of application. Should you need to file a claim contact APL at 800 256 8606 or online at www.ampublic.com. You can find additional claim forms and materials at www.mybenefitshub.com/bigspringisd 27
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 PLANdependent(s).INFORMATION CORE PLAN Coverage Type On and off job (24 hour) BENEFITS EMERGENCY, HOSPITAL & TREATMENT CARE CORE PLAN Accident Follow Up Up to 3 visits per accident $75 Acupuncture/Chiropractic Care/PT Up to 10 visits each per accident $25 Ambulance Air Once per accident $900 Ambulance Ground Once per accident $300 Blood/Plasma/Platelets Once per accident $200 Child Care Up to 30 days per accident while insured is confined $25 Daily Hospital Confinement Up to 365 days per lifetime $200 Daily ICU Confinement Up to 30 days per accident $400 Diagnostic Exam Once per accident $200 Emergency Dental Once per accident Up to $300 Emergency Room Once per accident $150 Hospital Admission Once per accident $1,000 Initial Physician Office Visit Once per accident $75 Lodging Up to 30 nights per lifetime $125 Medical Appliance Once per accident $100 Rehabilitation Facility Up to 15 days per lifetime $100 Transportation Up to 3 trips per accident $300 Urgent Care Once per accident $75 X ray Once per accident $50 SPECIFIED INJURY & SURGERY CORE PLAN Abdominal/Thoracic Surgery Once per accident $1,500 Arthroscopic Surgery Once per accident $300 Burn Once per accident Up to $10,000 Burn Skin Graft Once per accident for third degree burn(s) 25% of burn benefit Accident Employee $6.24 Employee + Spouse $9.84 Employee + Child(ren) $10.63 Family $16.66 ABOUT ACCIDENT Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you. For full plan details, please visit your benefit website: www.mybenefitshub.com/bigspringisd Accident Insurance The Hartford EMPLOYEE BENEFITS 28
CORE PLANSPECIFIED INJURY & SURGERY (cont’d.) Concussion Up to 3 per year $150 Dislocation Once per joint per lifetime Up to $4,000 Eye Injury Once per accident Up to $400 Fracture Once per bone per accident Up to $6,000 Hernia Repair Once per accident $150 Joint Replacement Once per accident $2,000 Knee Cartilage Once per accident Up to $750 Laceration Once per accident Up to $600 Ruptured Disc Once per accident $750 Tendon/Ligament/Rotator Cuff Up to 2 per accident Up to $1,000 CATASTROPHIC LOW PLAN Accidental Death Within 90 days; Spouse @ 50% and child @ 25% $30,000 Common Carrier Death Within 90 days; Spouse @ 50% and child @ 25% $90,000 Coma Once per accident $10,000 Dismemberment Once per accident Up to $30,000 Home Health Care Up to 30 days per accident $50 Paralysis Once per accident Up to $10,000 Prosthesis Up to 2 per accident Up to $1,500 FEATURES LOW PLAN Ability Assist® EAP 24/7/365 access to help for financial, legal or emotional issues Included HealthChampionSM Administrative & clinical support following serious illness or injury Included Accident Insurance The Hartford EMPLOYEE BENEFITS 29
Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. To file a claim call UNUM at 800 858 6843 or find claim form at www.mybenefitshub.com/bigspringisd. 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 Illness coverage amounts? The following coverage amounts are available. For you: Select one of the following $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. 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. What critical illness conditions are covered? Covered Conditions* Percentage of Coverage Amount CriticalCoronaryIllnessesArtery Disease (major) 50% Coronary Artery Disease (minor) 10% End Stage Renal (Kidney) Failure 100% Heart Attack (Myocardial Infarction) 100% Major Organ Failure Requiring Transplant 100% Stroke 100% CancerInvasive 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% ABOUT CRITICAL ILLNESS Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non medical costs related to the illness, including transportation, child care, etc. For full plan details, please visit your benefit website: www.mybenefitshub.com/bigspringisd Critical Illness Insurance Unum EMPLOYEE BENEFITS 30
•
Employee$30,000
Progressive DiseasesWhat critical illness conditions are covered? (cont’d) 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. Are wellness Screenings covered? Each insured is eligible to receive one Be Well Benefit per calendar year. Be Well Benefit For you, your spouse and your children: $50 Be Well Screenings include tests for the following: cholesterol and diabetes, cancer and cardiovascular function. They also include imaging studies, immunizations and annual examinations by a Physician. See certificate for details. 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.Critical Illness Employee$10,000 $10,000Spouse $15,000Spouse $3.84 $7.84
Spouse$5,000 Employee$20,000
<25 $3.84 $2.84 $5.84
$4.84 25 29 $4.74 $3.29 $7.64 $4.74 $10.54 $6.19 30 34 $5.84 $3.84 $9.84 $5.84 $13.84 $7.84 35 39 $7.84 $4.84 $13.84 $7.84 $19.84 $10.84 40 44 $10.24 $6.04 $18.64 $10.24 $27.04 $14.44 45 49 $13.44 $7.64 $25.04 $13.44 $36.64 $19.24 50 54 $16.94 $9.39 $32.04 $16.94 $47.14 $24.49 55 59 $22.74 $12.29 $43.64 $22.74 $64.54 $33.19 60 64 $31.74 $16.79 $61.64 $31.74 $91.54 $46.69 65 69 $45.64 $23.74 $89.44 $45.64 $133.24 $67.54 70 74 $70.74 $36.29 $139.64 $70.74 $208.54 $105.19 75 79 $103.94 $52.89 $206.04 $103.94 $308.14 $154.99 80 84 $150.80 $76.34 $229.84 $150.84 $448.84 $225.34 85+ $242.54 $122.19 $483.24 $242.54 $723.94 $362.89 Critical Illness Insurance Unum EMPLOYEE BENEFITS 31
•
Monthly Life/ AD&D rate per $10,000 Spouse Monthly Life/ AD&D rate per $10,000 <25 $0.70 $0.70 25 29 $0.85 $0.85 30 34 $1.10 $1.10 35 39 $1.55 $1.55 40 44 $2.19 $2.19 45 49 $3.19 $3.19 50 54 $4.53 $4.53 55 59 $6.20 $6.20 60 64 $7.67 $7.67 65 69 $10.90 $10.90 70 74 $20.90 $20.90 75+ $61.50 $61.50 Child Life/AD&D monthly rate is $0.56 per $2,000. One Life/AD&D premium covers all children. Life and AD&D Unum EMPLOYEE BENEFITS ABOUT LIFE AND AD&D 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
due
How much does the coverage cost?
benefit level you
if
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.
Current employees: If you and your eligible dependents are enrolled in the plan and wish to increase your life insurance coverage, you may apply on or before the enrollment deadline for any amount of additional coverage up to $200,000 for yourself and any amount of additional coverage up to $50,000 for your spouse. Any life insurance coverage over the guaranteed amount(s) will be subject to answers to health questions.
Who is eligible for this coverage?
dismembered. For full plan details, please visit your benefit website: www.mybenefitshub.com/bigspringisd 32
Spouse: up to 100% of employee amount in increments of $10,000; not to exceed $250,000.
If you and your eligible dependents are not currently enrolled in the plan, you may apply for coverage on or before the enrollment deadline and will be required to answer health questions for any amount of Newcoverage.employees:
Age band Employee occur to according to the select, accidentally
a covered accident. Dismemberment benefits are paid to you,
Employee: up to 7 times salary in increments of $10,000; not to exceed $500,000.
All actively employed employees working at least 30 hours each week for your employer in the U.S. and their eligible spouses and children to age 26.
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 the Spouse’s insurance age, which is their age immediately prior to and including the anniversary/effective date.
Child: up to 100% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $1,000.
Note: In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself. Can I be denied coverage?
What are the Life/AD&D coverage amounts?
Term Life/AD&D
What does my AD&D insurance pay for?
If you retire, reduce your hours or leave your employer, you can continue coverage for yourself your spouse and your dependent children at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy but they may be able to convert their term life policy to an individual life insurance policy.
• 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.
• 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;
Is the coverage portable (can I keep it if I leave my employer)?
• suicide, self destruction while sane, intentionally self inflicted injury while sane or self inflicted injury while insane;
• 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.
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• life; • both hands or both feet or sight of both eyes; • one hand and one foot;
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.
• 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);
• active participation in a riot;
Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from:
• committing or attempting to commit a crime under state or federal law;
• war, declared or undeclared, or any act of war;
Life and AD&D Unum EMPLOYEE BENEFITS
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.
The full benefit amount is paid for loss of:
Are there any AD&D exclusions or limitations?
Are there any life insurance exclusions or limitations?
Will my premiums be waived if I’m disabled?
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 www.mybenefitshub.com/bigspringisd benefit portal.
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
Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 monthly for $10,000 coverage per child. 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. For full plan details, please visit your benefit website: www.mybenefitshub.com/bigspringisd
Individual
QUALITY OF LIFE Optional 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:
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).
*Quality of Life not available ages 66 70. Quality of Life benefits not available for children
years).$7.15
FAMILY
Enhanced coverage options for employees. Easy and flexible enrollment for employers.
PORTABLE Coverage continues with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly.
ABOUT
•
Individual Life Insurance 5Star EMPLOYEE BENEFITS 34
Find
* Financially dependent children 14 days to 23 years old. full details and rates at www.mybenefitshub.com/bigspringisd
• 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.
CONVENIENCE Easy payments through payroll deduction. PROTECTION Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves.
CUSTOMIZABLE With several options to choose from, employees select the coverage that best meets the needs of their TERMINALfamilies.
ABOUT IDENTITY THEFT PROTECTION Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered. For full plan details, please visit your benefit website: www.mybenefitshub.com/bigspringisd Identity Theft iLock360 EMPLOYEE BENEFITS iLOCK360 is a comprehensive identity and credit monitoring service that helps you maintain control over your identity. This protection is an important step in remaining vigilant against the increasing threat of identity theft and data breaches. iLOCK360’s proprietary technology scours malicious websites 24/7/365 to identify if your personal information has been bought or sold online. If you are a victim of identity theft, you will be automatically alerted via email so action may be taken to address the issue. As an iLOCK360 subscriber, you will be assisted by a U.S. based Certified Identity Theft Restoration Specialist who will work on your behalf to restore your good name. SAVES YOU TIME • Automatic email alerts when credentials are found on malicious websites • Certified U.S. based Identity Theft Restoration Specialists to work on your behalf • Minimize time away from work dealing with identity theft & related fraud • Assistance in terminating & re ordering lost wallet SAVEScontentsYOUMONEY • $1M insurance policy for covered expenses to restore your name • For example, lost wages or income; attorney & legal fees; expenses incurred refiling loans & other lines of credit; costs of child/elderly care incurred as result of identity restoration • 42% lower costs for identity theft victims with identity protection (Javelin Strategy & Research, 2017) SAVES YOU STRESS • 24/7/365 real time identity monitoring • Peace of mind knowing your identity is being COMPROMISEDmonitored DATA INCLUDES: • Social Security Numbers • Date of Births • Addresses • Some Drivers License Numbers • Some Credit Cards PROTECT YOURSELF TODAY • Enroll now during open enrollment to take advantage of special educator only pricing • For more information please contact customer service at 512 600 5202 or customerservice@ilock360.com Identity TheftEssential Elite Employee $6.95 $11.95 Employee + Family $13.95 $22.95 35
Emergent Air Transportation
A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. If a member has a high deductible health plan that is compatible with a health savings account, benefits will become available under the MASA membership for expenses incurred for medical care (as defined under Internal Revenue Code (“IRC”) section 213 (d)) once a member satisfies the applicable statutory minimum deductible under IRC section 223(c) for high deductible health plan coverage that is compatible with a health savings account.
Should you need assistance with a claim contact MASA at 800 643 9023. You can find full benefit details at:
Emergent Ground Transportation
Medical Transport MASA EMPLOYEE BENEFITS 36
www.mybenefitshub.com/bigspringisd Emergency MedicalEmergentTransportationPlusPlatinum Employee & Family $14.00 $39.00 Plan FeaturesEmergentMembershipPlus MembershipPlatinum Emergency TransportationAir x x Emergent TransportationGround x x Non Emergency Inter Facility Transportation x x RecuperationRepatriation/ x x Escort Transportation x Visitor Transportation x Return Transportation x Mortal TransportationRemains x Minor Return x Organ RecipientRetrieval/OrganTransportation x Vehicle Return x Pet Return x Worldwide Coverage x ABOUT MEDICAL TRANSPORT Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out of pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan. For full plan details, please visit your benefit website: www.mybenefitshub.com/bigspringisd
In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities.
In the event that a member is in stable condition in a medical facility but requires a heightened level of care that is not available at their current medical facility, Members have access to non emergency air or ground transportation between medical
Emergency
In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities.
Non Emergency Inter Facility Transportation
SupposeRepatriation/Recuperationfacilities.youorafamilymember is hospitalized more than 100 miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for recuperation.
EMPLOYEE BENEFITS
Health Care FSA
For full plan details, please visit your benefit website: www.mybenefitshub.com/bigspringisd
Higginbotham
The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full time student.
• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
37
and batteries You
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
Dependent Care FSA
Spending Account (FSA)
• You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self care.
Eligible expenses include: • Dental and vision expenses • Medical deductibles and coinsurance • Prescription copays • Hearing
Flexible
The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $2,850 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. aids may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA).
A Spending Account allows you to pay for eligible healthcare expenses with a pre loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (unless your plan contains a $500 rollover or grace period provision).
ABOUT FSA
Flexible
Higginbotham Benefits Debit Card
The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s).
Things to Consider Regarding the Dependent Care FSA
• Overnight camps are not eligible for reimbursement (only day camps can be considered).
your
• You
•
Higginbotham Portal The Higginbotham Portal provides information and resources to
continue to
• Access plan documents, letters and notices, forms, account balances, contributions and other plan information • Update your personal information • Utilize Section 125 tax calculators • Look up qualified expenses • Submit claims • Request a new or replacement Benefits Debit Card Register on the Higginbotham Portal Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information. • Enter your Employee ID, which is your Social Security number with no dashes or spaces. • If you have any questions or concerns, contact Higginbotham: Phone 866 419 3519 Email flexclaims@higginbotham.net Fax 866 419 3516 38
The maximum per plan year you can contribute to a Health Care FSA is $2,850. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately. cannot change your election during the year unless you experience a Qualifying Life Event. Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses. IRS has amended the “use it or lose it rule” to allow you to carry over up to $570 in your Health Care FSA into the next plan year. The carry over rule does not apply to your Dependent Care FSA.
• The
Health care reform legislation requires that certain over the counter (OTC) items require a prescription to qualify as an eligible Health Care FSA expense. You will only need to obtain a one time prescription for the current plan year. You can purchase regular prescription medications with your FSA debit card. However, the FSA debit card may not be used as payment for an OTC item, even when accompanied by a prescription. help you manage your FSAs.
Flexible Spending Account (FSA) Higginbotham EMPLOYEE BENEFITS Important FSA Rules •
Over the Counter Item Rule Reminder
Notes 39
Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the Big Spring ISD Benefits Website. This summary does not replace or amend the underlying plan documentation. In the event of a discrepancy between this summary and the plan documentation the plan documentation governs. All plans and benefits described in this summary may be discontinued, increased, decreased, or altered at any time with or without notice.
Rate Sheet General Disclaimer: The rate information provided in this guide is subject to change at any time by your employer and/or the plan provider. The rate information included herein, does not guarantee coverage or change or otherwise interpret the terms of the specific plan documentation, available at the Big Spring ISD Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.
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2022 - 2023 PlanYear
WWW.MYBENEFITSHUB.COM/BIGSPRINGISD
