2022 - 2023 Plan Year
BROWNFIELD ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2022 - 8/31/2023 WWW.MYBENEFITSHUB.COM/BROWNFIELDISD
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Table of Contents 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) Medical Dental Vision Cancer Accident Identity Theft Disability Life and AD&D Health Savings Account (HSA) Medical Supplement Critical Illness Emergency Transportation Telehealth Flexible Spending Account (FSA)
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PG. 4
HOW TO ENROLL
PG. 6
SUMMARY PAGES
PG. 12
YOUR BENEFITS
Benefit Contact Information BROWNFIELD ISD BENEFITS
TRS ACTIVECARE MEDICAL
TRS HMO MEDICAL
Financial Benefit Services BCBSTX (800) 583-6908 (866) 355-5999 www.mybenefitshub.com/brownfieldisd www.bcbstx.com/trsactivecare
BCBSTX: Blue Essentials HMO (888) 378-1633 https://www.bcbstx.com/trshmo
DENTAL
VISION
CANCER
Cigna Group #3343634 (800) 224-6224 www.cigna.com
Superior Vision Group #326280 (800) 507-3800 www.superiorvision.com
American Public Life (800) 256-8606 www.ampublic.com
ACCIDENT
IDENTITY THEFT
DISABILITY
American Public Life (800) 256-8606 www.ampublic.com
IDWatchdog (800) 774-3772 www.idwatchdog.com
UNUM Short-Term Disability Plan #474769 Long-Term Disability Plan #474768 (866) 679-3054 www.unum.com
LIFE AND AD&D
HEALTH SAVINGS ACCOUNT (HSA) MEDICAL SUPPLEMENT
OneAmerica Group #614195 www.oneamerica.com
HSA Bank (800) 357-6246 www.hsabank.com
American Public Life Group #14360 (800) 256-8606 www.ampublic.com
CRITICAL ILLNESS
EMERGENCY TRANSPORTATION
TELEHEALTH
Voya Group #69510-6CCI (877) 236-7564 www.voya.com
MASA (800) 423-3226 www.masamts.com
MDLive (888) 365-1663 https://members.mdlive.com/fbs/ landing_home
FLEXIBLE SPENDING ACCOUNT (FSA) Higginbotham (866) 419-3519 www.higginbotham.net
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All Your Benefits One App Employee benefits made easy through the FBS Benefits App! Text “FBS BISD” to (800) 583-6908 and get access to everything you need to complete your
benefits enrollment: •
Benefit Resources
•
Online Enrollment
•
Interactive Tools
•
And more!
App Group #: FBSBISD
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Text “FBS BISD” to (800) 583-6908 OR SCAN
How to Log In 1
www.mybenefitshub.com/brownfieldisd
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CLICK LOGIN
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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.
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Annual Benefit Enrollment
SUMMARY PAGES
Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
CHANGES IN STATUS (CIS): Marital Status
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 31 days of your qualifying event and meet with your Benefit Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
QUALIFYING EVENTS A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for Change in Number of adoption. You can add existing dependents not previously enrolled whenever a dependent Tax Dependents gains eligibility as a result of a valid change in status event. Change in Status of Change in employment status of the employee, or a spouse or dependent of the employee, Employment Affecting that affects the individual's eligibility under an employer's plan includes commencement or Coverage Eligibility termination of employment. Gain/Loss of Dependents' Eligibility Status
Judgment/Decree/ Order
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 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.
Eligibility for Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Government Programs
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Annual Benefit Enrollment
SUMMARY PAGES
Annual Enrollment 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. •
Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
• 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.
•
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.
New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Q&A Who do I contact with Questions? For benefit questions, you can contact your Benefits department or you can call Financial Benefit Services at (866) 914-5202 for assistance.
Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ brownfieldisd. Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms section. How can I find a Network Provider? For benefit summaries and claim forms, go to the Sample ISD benefit website: www.mybenefitshub.com/brownfieldisd. 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? 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.
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Annual Benefit Enrollment
SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.
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.
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.
PLAN
MAXIMUM AGE
Medical
To 26
Medical Supplement
To 26
Health Savings Account
Tax Dependent
Telehealth
Unmarried To 26
Dental
Unmarried To 26
Vision
To 26
Cancer
To 26
Identity Theft Protection
Unmarried To 26
Accident
To 26
Life and AD&D
Unmarried To 26
Critical Illness
To 26
Medical Flex
To 26
Dependent Flex
12 or younger or qualified individual unable to care for themselves & claimed as a dependent on your taxes
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
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. 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 Benefit office to request a continuation of coverage. 8
SUMMARY PAGES
Helpful Definitions Actively-at-Work
In-Network
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.
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.
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.
Calendar Year
Out-of-Pocket Maximum The most an eligible or insured person can pay in coinsurance 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 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).
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 preexisting condition exclusion provisions do apply, as applicable by carrier. 9
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 taxfree.
Employer Eligibility
A qualified high deductible health plan.
All employers
Contribution Source
Employee
Employee
Account Owner
Individual
Employer
Underlying Insurance Requirement
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 Not permitted 65).
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.
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
Description
FLIP TO FOR HSA INFORMATION
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PG. 20
FLIP TO FOR FSA INFORMATION
PG. 33
Notes
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Medical Insurance
EMPLOYEE BENEFITS
TRS ABOUT MEDICAL Grand Major medical Prairie offers insurance 4 medical is a type plans ofadministered health care coverage by Aetnathat andprovides THA. Texas benefits Health for aAetna broadoffers rangeSeveral of medical convenient, expensesaffordable that may be options incurred when you either need on an care inpatient now. Knowing or outpatient the right basis. place to go can save you time, money, and unpleasant financial surprises. The charts that follow provides a plan comparison overview illustrating the plan highlights. For full plan details, please visit your benefit website: www.mybenefitshub.com/brownfieldisd For full plan details, please visit your benefit website: www.mybenefitshub.com/brownfieldisd
Monthly Premium
District Contribution
Employee Cost
TRS ActiveCare HD Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$380.00
$250.00
$130.00
$1,069.00
$250.00
$819.00
$682.00
$250.00
$432.00
$1,279.00
$250.00
$1,029.00
TRS ActiveCare Primary Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$368.00
$250.00
$118.00
$1,038.00
$250.00
$788.00
$662.00
$250.00
$412.00
$1,242.00
$250.00
$992.00
TRS ActiveCare Primary+ Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$462.00
$250.00
$212.00
$1,130.00
$250.00
$880.00
$744.00
$250.00
$494.00
$1,421.00
$250.00
$1,171.00
TRS ActiveCare 2 Employee Only
$1,013.00
$250.00
$763.00
Employee & Spouse
$2,402.00
$250.00
$2,152.00
Employee & Child(ren)
$1,507.00
$250.00
$1,257.00
Employee & Family
$2,841.00
$250.00
$2,591.00
West Texas Blue Essentials HMO Employee Only
$689.60
$250.00
$439.60
Employee & Spouse
$1,672.26
$250.00
$1,422.26
Employee & Child(ren)
$1,083.58
$250.00
$833.58
Employee & Family
$1,775.58
$250.00
$1,525.58
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Dental Insurance
EMPLOYEE BENEFITS
Cigna 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 disease.
For full plan details, please visit your benefit website: www.mybenefitshub.com/brownfieldisd
Dental Coverage Our dental plan helps you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through Cigna Dental.
DPPO Plan Two levels of benefits are available with the DPPO plan: in-network Dental and out-of-network. You may select the dental provider of your Employee Only choice, but your level of coverage may vary based on the provider Employee and 1 Dependent you see for services. You could pay more if you use an out-ofEmployee and 2 or more Dependents network provider. Plan Design Policy Year Benefits Maximum Class I, II, III, IV Expenses Policy Year Deductible Individual Family Class I: Preventive & Diagnostic Care Oral Evaluations Cleanings Routine X-rays Fluoride Application Sealants Space Maintainers (limited to nonorthodontic treatment) Non-Routine X-rays Emergency Care to Relieve Pain Class II: Basic Restorative Care Fillings Oral Surgery Surgical Extractions of Impacted Teeth Anesthetics Repairs - Bridges, Crowns, and Inlays Repairs - Dentures Brush Biopsy
$23.10 $44.99 $77.33
Total Cigna DPPO Network**
Out-of-Network:
$1,000 Class I Applies
$1,000 Class I Applies
$50 No limited
$50 No limited
100% No Deductible
100% No Deductible
80% After Deductible
80% After Deductible
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Dental Insurance
EMPLOYEE BENEFITS
Cigna Plan Design Class III: Major Restorative Care Minor Periodontics Major Periodontics Root Canal Therapy / Endodontics Relines, Rebases, and Adjustments Crowns/Inlays/Onlays Stainless Steep/Resin Crowns Dentures Bridges Class IV: Orthodontia Coverage for Eligible Children Only Annual Maximum Lifetime Maximum Dental Plan Reimbursement Levels Additional Member Responsibility in excess of Coinsurance
Total Cigna DPPO Network**
Out-of-Network:
50% After Deductible
50% After Deductible
50%, No Ortho Deductible $375 $1,000 Based on Contracted Fees
50%, No Ortho Deductible $375 $1,000 90th Percentile of Billed Charges Yes, the difference between Billed Charges and the plan reimbursement
None
** In Texas, the insured dental product offered by CGLIC and CHLIC is referred to as the Cigna Dental Choice Plan, and this plan utilizes the national Cigna Dental PPO network.
How to Find a Dentist Visit https://hcpdirectory.cigna.com/ or call (800) 244-6224 to find an in-network dentist.
How to Request a New ID Card You can request your dental id card by contacting Cigna directly at (800) 244-6224. You can also go to www.mycigna.com and register/login to access your account. In addition, you can download the “MyCigna” app on your smartphone and access your id card right there on your phone.
In-Network Reimbursement: For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule. Non-Network Reimbursement: For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Reimbursable Charge. The dentist may balance bill up to their usual fees.
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Vision Insurance
EMPLOYEE BENEFITS
Superior Vision 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/brownfieldisd
Vision Employee Only Employee and Spouse Employee and Child(ren) Employee and Family
Copays $8.67 $14.80 $14.68 $23.54
Exam Materials
$10 $25
Services/Frequency Exam 12 months Frame 12 months Lenses 12 months Contact lenses 12 months
Benefits through Superior Select Southwest Network In-Network Covered in full $150 retail allowance
Exam Frames Lenses (standard) per pair Single vision Bifocal Trifocal Progressives lens upgrade Contact lenses2 Medically Necessary Contact Lenses
Covered in full Covered in full Covered in full See description1 $150 retail allowance Covered in full
Out-of-Network Up to $40 retail Up to $45 retail Up to $32 retail Up to $46 retail Up to $61 retail Up to $61 retail Up to $105 retail Up to $210 retail
Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements. 1 Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressice and standard retail lined trifocal, plus applicable co-pay. 2 Contact lenses and related professional services (fitting, evaliation and follow-up) are covered in lieu of eyeglass lenses and frames benefit.
Discount features Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses, (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy. The Plan discount features are not insurance. All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan. Discounts are subject to change without notice. Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Benefit Office if you have any questions. 21
Cancer Insurance
EMPLOYEE BENEFITS
American Public Life 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/brownfieldisd
Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-oftown treatments, special diets, daily living and household upkeep. In addition to these non-medical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance through American Public Life helps pay for these direct and indirect treatment costs so you can focus on your health.
Cancer Treatment Policy Benefits Radiation Therapy, Chemotherapy, Immunotherapy Maximum per 12-month period Hormone Therapy - Maximum of 12 treatments per calendar year Experimental Treatment Surgical Rider Benefits Surgical
Cancer Low
High
Employee Only
$21.25
$34.30
Employee and Spouse
$38.10
$61.40
Employee and Child(ren)
$26.25
$42.30
Employee and Family
$39.95
$64.48
Low Plan Level 3
High Plan Level 4
$15,000
$20,000
$50 per treatment
$50 per treatment
Paid in same manner and under the same maximums as any other benefit Level 1 Level 4 $30 unit dollar amount
$60 unit dollar amount
Max per Operation
$3000
$6000
Anesthesia
25% of amount paid for covered surgery
Bone Marrow Transplant - Maximum per lifetime Stem Cell Transplant - Maximum per lifetime Prosthesis - Surgical Implantation / Non-Surgical (not Hair Piece) 1 device per site, per lifetime Miscellaneous Care Rider Benefits Cancer Treatment Center Evaluation or Consultation - 1 per lifetime Evaluation or Consultation Travel and Lodging - 1 per lifetime Second / Third Surgical Opinion - per diagnosis of cancer Drugs and Medicine - Inpatient / Outpatient (maximum $150 per month) Hair Piece (Wig) - 1 per lifetime
$6,000 $600
$12,000 $1,200
$1,000 / $100
$3,000 / $300
Level 4
Level 4
$750
$750
$350
$350
$300 / $300 $150 per confinement $50 per prescription $150
$300 / $300 $150 per confinement $50 per prescription $150
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Cancer Insurance
EMPLOYEE BENEFITS
American Public Life Miscellaneous Care Rider Benefits Transportation - Maximum 12 trips per calendar year for all modes of transportation combined. Travel by bus, plane, or train Travel by car Lodging - up to a maximum of 100 days per calendar year Family Transportation - Maximum 12 trips per calendar year for all modes of transportation combined. Travel by bus, plane or train Travel by car Family Lodging - up to a maximum of 100 days per calendar year Blood, Plasma and Platelets Ambulance - Ground / Air - Maximum of 2 trips per Hospital Confinement for all modes of transportation combined Inpatient Special Nursing Services - per day of Hospital Confinement Outpatient Special Nursing Services - Up to same number of Hospital Confinement days Medical Equipment - Maximum of 1 benefit per calendar year Physical, Occupational, Speech, Audio Therapy & Psychotherapy / Maximum per calendar year Waiver of Premium Internal Cancer First Occurrence Rider Benefits Lump Sum Benefit - Maximum 1 per Covered Person per lifetime Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime Heart Attach/Stroke First Occurrence Rider Benefits Lump Sum Benefit - Maximum 1 per Covered Person per lifetime Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime Hospital Intensive Care Unit Rider Benefits Intensive Care Unit Step Down Unit - Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step-Down Unit
Low Plan Level 4
High Plan Level 4
actual coach fare or $0.75 per mile $0.75 per mile $100 per day
actual coach fare or $0.75 per mile $0.75 per mile $100 per day
actual coach fare or $0.75 per mile $0.75 per mile $100 per day
actual coach fare or $0.75 per mile $0.75 per mile $100 per day
$300 per day
$300 per day
$200 / $2,000 per trip
$200 / $2,000 per trip
$150 per day
$150 per day
$150 per day
$150 per day
Not included
$150
$25 per visit / $1,000
$25 per visit / $1,000
Waive Premium Level 2
Waive Premium Level 4
$5,000
$10,000
$7,500
$15,000
Level 1
Level 1
$2,500
$2,500
$3,750
$3,750
$600 per day
$600 per day
$300 per day
$300 per day
Should you need to file a claim contact APL at (800) 256-8606 or online at www.ampublic.com.
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Accident Insurance
EMPLOYEE BENEFITS
American Public Life 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/brownfieldisd
Accident Employee Only Employee and Spouse Employee and Child(ren) Employee and Family
1 Unit $10.80 $19.40 $21.20 $29.80
2 Units $17.10 $29.80 $34.90 $47.60
3 Units $21.50 $38.90 $45.20 $62.60
4 Units $24.50 $44.90 $52.00 $72.40
Benefit Description Level 1 - 1 Unit Level 2 - 2 Units Level 3 - 3 Units Level 4 - 4 Units Accidental Death - per unit $5,000 $10,000 $15,000 $20,000 Medical Expenses Accidental Injury Actual charges up to Actual charges up to Actual charges up to Actual charges up to Benefit $500 $1,000 $1,500 $2,000 Daily Hospital Confinement Benefit $75 per day $150 per day $225 per day $300 per day Actual charges up to Actual charges up to Actual charges up to Actual charges up to Air and Ground Ambulance Benefit $1,250 $2,500 $3,750 $5,000 Accidental Dismemberment Benefit Single finger or toe $500 $1,000 $1,500 $2,000 Multiple fingers or toes $500 $1,000 $1,500 $2,000 Single hand, arm, foot, or leg $2,500 $5,000 $7,500 $10,000 Multiple hands, arms, feet, or legs $5,000 $10,000 $15,000 $20,000 Accidental Loss of Sight Benefit Loss of Sight in one eye $2,500 $5,000 $7,500 $10,000 Loss of Sight in both eyes $5,000 $10,000 $15,000 $20,000
Should you need to file a claim contact APL at (800) 256-8606 or online at www.ampublic.com.
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Identity Theft
EMPLOYEE BENEFITS
IDWatchdog 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/brownfieldisd
Identity Theft Is Growing Better Protect You and Your Family Fraud continues to grow more complex. It is becoming harder for consumers and identity theft victims to manage the intricacies on their own. Fraudsters are taking advantage of consumers' increased digital dependence to steal personal and financial information - doubling the amount of identity theft reports to the FTC in 2020.1 Easy & Affordable Identity Protection ID Watchdog helps warn you when your personal information is stolen and helps you better protect yourself and your family from identity fraud-when stolen information is used for illicit gain. You’ll have greater peace of mind knowing you don’t have to face the complexities of identity theft alone.
More for Families. Our family plan helps you better protect the identities of your loved ones of all ages. We offer more features that help protect minors than any other provider. Powerful Features Included in Both ID Watchdog Plans Control & Manage • Financial Accounts & Social Account Monitoring • Registered Sex Offender • Reporting • Customizable Alert Options • Equifax Blocked Inquiry Alerts • National Provider ID Alerts
Plan-Specific Features Credit Report Monitoring Credit Report(s)4 & VantageScore Credit Score(s) Credit Report Lock Identity Theft Insurance 401K/HSA Stolen Funds Reimbursement Subprime Loan Block within the monitored lending network Social Account Takeover Alerts Integrated Fraud Alerts
Identity Theft 1B Employee
$7.95
Employee and Family
$14.95
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Disability Insurance UNUM
EMPLOYEE BENEFITS
ABOUT DISABILITY 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.
For full plan details, please visit your benefit website: www.mybenefitshub.com/brownfieldisd
As long as you continue to meet the definition of disability, you may receive benefits for 12 weeks. When would I be considered disabled? You are disabled when Unum determines that due to your sickness or injury: • you are limited from perform the material and substantial Who is eligible? duties of your regular occupation; and You are eligible for Short Term Disability (STD) coverage if you are • you have a 20% or more loss in weekly earnings due to the an active employee in the United States working a minimum of same sickness or injury. 20 hours per week. You must be under the regular care of a physician in order to be How can I apply for coverage? considered disabled. To apply for coverage, complete your enrollment form by *Unless the policy specifies otherwise, as part of the disability 9/1/2022. If you were hired after 9/1/2022, check with your plan claims evaluation process, Unum will evaluate your occupation administrator for your eligibility date, and complete your based on how it is normally preformed in the national economy, enrollment form within 31 days of that date. not how work is performed for a specific employer, at a specific What if I am out of work when insurance goes into effect? location, or in a specific region. Insurance will be delayed if you are not in active employment Can my benefit be reduced? because of an injury, sickness, temporary layoff, or leave of Your disability benefit may be reduced by deductible sources of absence on the date that insurance would otherwise become income and any earnings you have while disabled. Deductible effective. sources of income may include such items as disability income or What is my weekly benefit amount? other amounts you receive or are entitled to receive under: If you meet the definition of disability, you could receive a weekly workers’ compensation or similar occupational benefit laws; state benefit equal to 70% of your weekly earnings, to a maximum of compulsory benefit laws; automobile liability and no fault $1,500 per week. insurance; legal judgments and settlements; certain retirement What is considered a pre-existing condition? plans; salary continuation or sick leave plans; other group or You have a pre-existing condition if: association disability programs or insurance; and amounts you or • You received medical treatment, consultation, care or your family receive or are entitled to receive from Social Security services including diagnostic measures, or took prescribed or similar governmental programs. drugs or medicines in the 3 months just prior to your When does my coverage end? effective date of coverage; and Your coverage under the policy ends on the earliest of: • The disability begins in the first 12 months after your • The date the policy or plan is cancelled; effective date of coverage. • The date you no longer are in an eligible group; How long do I have to wait to receive benefits? • The date your eligible group is no longer covered; The elimination period is the length of time you must be • The last day of the period for which you made any required continuously disabled before you can receive benefits. If your contributions; disability is the result of a covered injury or sickness, you could • The last day you are in active employment except as begin receiving benefits after 10 days. provided under the covered layoff or leave of absence How long will my benefits last? provision. Disability - per $100 in benefit 45% $1.88 55% $2.05 65% $2.60
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Disability Insurance UNUM Who is eligible? You are eligible for Long Term Disability (LTD) coverage if you are an active employee in the United States working a minimum of 20 hours per week. How can I apply for coverage? To apply for coverage, complete your enrollment form by 9/1/2022. If you were hired after 9/1/2022, check with your plan administrator for your eligibility date, and complete your enrollment form within 31 days of that date. What if I am out of work when insurance 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. What is my monthly benefit amount? You can elect to purchase a benefit of 45% 55% or 65% of your monthly earnings to a maximum of $6,000. 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. However, if you are participating in Unum’s Rehabilitation and Return to Work Assistance program, your total monthly benefit (including all benefits provided under this plan) will not exceed 110% of your monthly earnings (unless the excess amount is payable as a Cost-of-Living Adjustment). Do I have to pay for coverage if I become disabled? You will not be required to pay LTD premiums as long as you are receiving LTD benefits. What is considered a pre-existing condition? You have a pre-existing condition if: • You received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and The disability begins in the first 12 months after your effective date of coverage. How long do I have to wait to receive benefits? The elimination period is the length of time you must be continuously disabled before you can receive benefits. You could begin receiving LTD benefits if, after 90 days of disability, you are still disabled (as described in the definition of disability). If you return to work while satisfying the elimination period and are no longer disabled, you may satisfy the elimination period within the accumulation period – you don’t have to be continuously disabled through the elimination period, if you are satisfying the elimination period under this provision. If you don’t satisfy the elimination period within the accumulation period, a new period of disability will begin. Accumulation Period is the period of time from the date the disability begins during which you must satisfy the elimination period. The accumulation
EMPLOYEE BENEFITS period is two times your elimination period. 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, and you are under the regular care of a physician. You are not required to have a 20% or more earnings loss to be considered disabled during the elimination period due to the same sickness or injury. When does my coverage end? Your coverage under the policy 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 except as provided under the covered layoff or leave of absence provision. When would I be considered disabled? You are disabled when Unum determines that due to your sickness or injury: • you are unable to perform the material and substantial duties of your regular occupation; and • you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury. After 24 months of payments, you are disabled when Unum determines that due to the same sickness or injury: • You are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience. • You must be under the regular care of a physician in order to be considered disabled. The loss of a professional or occupational license or certification does not, in itself, constitute disability. You must be under the regular care of a physician. Unless the policy specifies otherwise, as part of the disability claims evaluation process, Unum will evaluate your occupation based on how it is normally performed in the national economy, not how work is performed for a specific employer, at a specific location, or in a specific region.
Please see your plan administrator for further information on these provisions. Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan.
27
Life and AD&D
EMPLOYEE BENEFITS
OneAmerica 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 occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered. For full plan details, please visit your benefit website: www.mybenefitshub.com/brownfieldisd Voluntary Group Life - per $10,000 in coverage Age Employee 18-24 $0.65 25-29 $0.75 30-34 $0.90 35-39 $1.00 40-44 $1.30 45-49 $2.10 50-54 $3.80 55-59 $5.10 60-64 $6.30 65-69 $8.00 70-74 $7.45 75+ $13.20 Spouse rates based on Employee's age.
Spouse $1.05 $1.05 $1.35 $1.35 $2.10 $3.30 $6.15 $8.70 $10.65 $13.65 $12.90 $22.80
Voluntary Group Life - Child(ren) per $10,000 in coverage Age 0-26 $1.00
A cash benefit of $10,000 to your loved ones in the event of your death, plus a matching cash benefit if you die in an accident.1 Guaranteed coverage amount for Self $200,000 Maximum coverage amount 7 times your annual salary not to exceed $500,000 in increments of $10,000 AD&D coverage amount Equal to the life insurance amount chosen Guaranteed coverage amount for Spouse $50,000 Maximum coverage amount for Spouse 100% of the employee coverage amount Additional life insurance benefits may be payable in the event of an accident Accidental Death and Dismemberment which results in death or dismemberment as defined in the contract. Additional (AD&D) AD&D benefits include seat belt, air bag, repatriation, child higher education, child-care, paralysis/loss of use, severe burns, disappearance, and exposure. AD&D coverage amount Equal to the life insurance amount chosen Guaranteed coverage amount for $1,000 dependent children live birth to 6 months Guaranteed coverage amount for $10,000 dependent children 6 months to 26 years2 Basic Life
1 2
The cash benefit increases to $50,000 for an eligible employee who waives medical coverage. Dependent children must be full-time student to remain eligible ages 19 to 26 years. 28
Life and AD&D OneAmerica
EMPLOYEE BENEFITS
Guaranteed Employee Life and AD&D Insurance Coverage Amount Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $200,000 without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability. If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense. Maximum Life Insurance Coverage Amount: You can choose a coverage amount up to 7 times your annual salary ($500,000 maximum) with evidence of insurability. See the Evidence of Insurability page for details. Your coverage will reduce to 65% of the original amount when you reach age 65; 50% of the original amount when you reach age 70. Guaranteed Spouse Life and AD&D Insurance Coverage Amount Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to 100% of your coverage amount ($50,000 maximum) for your spouse without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability. If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense. You can increase this amount by up to $10,000 during the next limited open enrollment period. Maximum Life Insurance Coverage Amount You can choose a coverage amount up to 100% of your coverage amount ($500,000 maximum) for your spouse with evidence of insurability. Coverage will reduce to 65% of the original amount when you reach age 65; 50% of the original amount when you reach age 70.
Dependent Children Coverage You can secure term life insurance for your dependent children when you choose coverage for yourself. Guaranteed Life Insurance Coverage Options $10,000
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Health Savings Account (HSA) HSA Bank
EMPLOYEE BENEFITS
ABOUT 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. 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/brownfieldisd
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. 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. 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 decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. 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.
Who is eligible?
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. You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit. You may open an HSA at the financial institution of your choice, but only accounts opened through HSA Bank are eligible for automatic payroll deduction and company contributions.
You are eligible to open and contribute to an HSA if you are: • Enrolled in an HSA-eligible HDHP • Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan • Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account • Not eligible to be claimed as a dependent on someone else’s tax return • Not enrolled in Medicare or TRICARE • Not receiving Veterans Administration benefits • 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 under your HDHP.
Maximum Contributions 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 you elect: Individual – $3,650 Family (filing jointly) – $7,300 30
Opening an HSA If you meet the eligibility requirements, you may open an HSA administered by HSA Bank. 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
How to Use your HSA HSA Bank Mobile App: Download to check available balances, view HSA transaction details, save and store receipts, scan items in-store to see if they’re qualified, and access customer service contact information. myHealth PortfolioSM: Track your healthcare expenses, manage receipts and claims from multiple providers, and view expenses by provider, description, and more. Account preferences: Designate a beneficiary, add an authorized signer, order additional debit cards, and keep important information up to date. Access online at: http://www.hsabank.com
Medical Supplement
EMPLOYEE BENEFITS
American Public Life ABOUT MEDICAL SUPPLEMENT This plan provides supplemental coverage to help offset out-of-pocket costs that you may experience due to deductibles, co-payments and coinsurance of your employer’s medical plan.
For full plan details, please visit your benefit website: www.mybenefitshub.com/brownfieldisd
18-54 Employee Only Employee and Spouse Employee and Child(ren) Employee and Family 55+ Employee Only Employee and Spouse Employee and Child(ren) Employee and Family In-Hospital Benefit Description In-Hospital Benefit Maximum In-Hospital Benefit
MEDlink Low/$1,500 $15.15 $30.31 $29.56 $44.71 $22.73 $45.47 $37.13 $59.86
High/$2,500 $20.36 $40.74 $39.72 $60.08 $30.55 $61.10 $49.90 $80.45
Low Plan High Plan $1,500 per covered person $2,500 per covered person per confinement per confinement Benefits include in-hospital confinement, ambulance, and in-hospital treatment for a serious mental illness (subject to a maximum of 45 days of a serious mental illness treatment per covered person per calendar year). All benefits are subject to the in-hospital benefit maximum.
Outpatient Rider Outpatient Benefit Maximum $200 per covered person per occurrence for covered services Outpatient Benefit Covered outpatient services include: • Ambulance • Hospital Emergency Room • Urgent Care Facility • Physical Therapy Facility • Diagnostic testing in a hospital outpatient facility or MRI facility • Surgery in a hospital outpatient facility or freestanding outpatient surgery center • Outpatient treatment for a serious mental illness in a hospital outpatient facility (subject to a maximum of 60 days of a serious mental illness treatment er covered person per calendar year). All benefits are subject to the outpatient benefit maximum.
31
Medical Supplement American Public Life
EMPLOYEE BENEFITS
In-Hospital Benefit The covered person must be covered by the other medical plan at the time any In-Hospital covered charges are incurred. A covered person is a person who is eligible for coverage under the certificate and for whom the coverage is in force. Eligible dependents include a lawful spouse who is covered as a dependent under the Other Medical Plan and/or a child (natural, adopted or step) who is covered as a dependent under the Other Medical Plan and who is under 26 years of age and/or any minor under the insured’s charge, care and control, who has been place for adoption and is under 26 years of age. Eligible dependent also includes; any child under 26 years of age for who the insured must provide medical support under an order issued under Section 14.061, Family Code, or enforceable by a court in Texas; grandchildren if those children are dependents for federal income tax purposes at the time of application and/or any minor if the insured is a party in a suit in which the adoption of the child is sought. The in-hospital benefit pays the out-of-pocket amount for inpatient covered charges incurred by a covered person for treatment while confined in a hospital as an inpatient. A hospital is not an institution, or part thereof, used as: a place for rehabilitation, a place for rest or for the aged, a nursing or convalescent home, a long-term nursing unit or geriatrics ward, or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients. The ambulance benefit pays the out-of-pocket amount for air or ground transportation of a covered person by ambulance to a hospital or from one medical facility to another where a covered person is confined as an inpatient. A licensed ambulance company must provide the ambulance service.
Non-Duplication of Benefits Duplication of benefits is not allowed under the policy and/or any attached riders. If a covered charge is payable under more than one benefit, only one benefit, the largest, will be payable.
Premium Changes The premium rates may be changed by APL at the first anniversary date of the policy or any premium due date thereafter.
Optionally Renewable The policy is renewable at the option of APL. The policyholder or APL may terminate this policy on any premium due date after the first anniversary following the policy effective date, subject to 60 days notice.
Termination of Certificate Insurance coverage under the certificate, including any attached riders, will end on the earliest of these dates: the date the policy terminates; the end of the grace period if the premium remains unpaid; the date you no longer qualify as an insured; the date your coverage under the other medical plan ends; or the date of your death. Termination of Coverage Insurance coverage under the certificate and/or any attached riders for a covered person will end as follows: the date the policy terminates; the date the certificate terminates; the end of the grace period if the premium remains unpaid; the end of the certificate month in which we receive a written request from you to terminate the covered person’s coverage; the date a covered person no longer qualifies as an insured or eligible dependent; or the date of the covered person’s death. APL may end the coverage of any covered person who submits a fraudulent claim.
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Critical Illness Insurance
EMPLOYEE BENEFITS
Voya 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/brownfieldisd
Employee > 29 30-39 40-49 50-59 60-64 65-69 70+
$5,000.00 $1.50 $2.10 $3.95 $6.45 $9.70 $13.20 $25.00
Critical Illness $10,000.00 $15,000.00 $20,000.00 $25,000.00 $30,000.00 $3.00 $4.50 $6.00 $7.50 $9.00 $4.20 $6.30 $8.40 $10.50 $12.60 $7.90 $11.85 $15.80 $19.75 $23.70 $12.90 $19.35 $25.80 $32.25 $38.70 $19.40 $29.10 $38.80 $48.50 $58.20 $26.40 $39.60 $52.80 $66.00 $79.20 $50.00 $75.00 $100.00 $125.00 $150.00
Child
$5,000.00 $0.65
$10,000.00 $1.30
What is Critical Insurance? Critical Illness Insurance pays a lump-sum benefit if you are diagnosed with a covered illness or condition on or after your effective date of coverage. You have the option to elect Critical Illness insurance to meet your needs. Critical Illness insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirements of minimum essential coverage under the Affordable Care Act. Who is eligible for Critical Illness Insurance? Active employees working at least 15 hours per week, your spouse, and your child(ren) to age 26. Other features of Critical Illness Insurance include: Guaranteed issue: No medical questions or tests are required for coverage. Flexible: You can use the benefit payments for any purpose you like. Payroll deductions: Premiums are paid through convenient payroll deductions. Portable: If you leave your current employer, you can take your coverage with you.
Spouse > 29 30-39 40-49 50-59 60-64 65-69 70+
$5,000.00 $2.15 $3.05 $6.00 $10.75 $14.95 $20.30 $21.90
$10,000.00 $15,000.00 $4.30 $6.45 $6.10 $9.15 $12.00 $18.00 $21.50 $32.25 $29.90 $44.85 $40.60 $60.90 $43.80 $65.70
How can Critical Illness Insurance help? Below are a few examples of how your Critical Illness Insurance benefit could be used (coverage amounts may vary): • Medical expenses, such as deductibles and copays • Child-care • Home healthcare costs • Mortgage payment/rent and home maintenance How to File a Claim: www.voya.com • Click contact and services • Select Claims and then “start a claim” • Complete the questionnaire so that a custom claim form package can be generated for you. • Download your claim forms. • Fill out each form by the appropriate party. • Father additional supporting documents. • Submit your completed and signed forms and supporting documents. • Upload at www.voya.com • Click on the contact and services • Select “Upload a form” • Mail and or Fax information provided on the top of your claim form package.
For what critical illnesses and conditions are benefits available? Critical Illness Insurance provides a benefit for the following illnesses and conditions. Covered illnesses/conditions are broken out into For a complete description of your benefits, along with applicable groups called “modules”. Benefits are paid at 100% of the Maximum provisions, conditions on benefit determination, exclusions and Critical Illness Benefit amount unless otherwise stated. limitations, see your certificate of insurance and any riders. • Heart attach • Major organ failure • Stroke • Permanent paralysis For questions regarding the claims process, please call (888) 238 • Coronary artery bypass (25%) • End stage renal (kidney) 4840 • Coma failure 33
Emergency Medical Transport
EMPLOYEE BENEFITS
MASA 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/brownfieldisd
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. After the group health plan pays its portion, MASA MTS works with providers to deliver our members’ $0 in out-of-pocket costs for emergency transport. Emergent Air Transportation In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities. Emergent Ground Transportation In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities.
Non-Emergency Inter-Facility Transportation 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 nonemergency air or ground transportation between medical facilities. Repatriation/Recuperation Suppose you or a family member 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. Should you need assistance with a claim contact MASA at (800) 643-9023. You can find full benefit details at www.mybenefitshub.com/brownfieldisd Membership Benefits Emergency Air Transportation Emergent Ground Transportation Non-Emergency Inter-Facility Transportation Repatriation/Recuperation Escort Transportation Visitor Transportation Return Transportation Mortal Remains Transportation Minor Return Organ Retrieval/Organ Recipient Transportation Vehicle Return Pet Return Worldwide Coverage 34
Emergency Transportation Emergent Plus Employee and Family $14.00 Emergent Plus Membership ✓ ✓ ✓ ✓
Platinum $39.00
Platinum Membership ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Telehealth MDLive
EMPLOYEE BENEFITS
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/brownfieldisd
Telehealth Alongside your medical coverage is access to quality telehealth services through MDLIVE. Connect anytime day or night with a board-certified doctor via your mobile device or computer. 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 a business trip, vacation or away from home • Are unable to see your primary care physician
When to Use MDLIVE: At a cost that is the same or less than a visit to your physician, use telehealth services for minor conditions such as: • Sore throat • Headache • Stomachache • Cold • Flu • Allergies • Fever • Urinary tract infections Do not use telemedicine for serious or life-threatening emergencies.
Registration is Easy Register with MDLIVE 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 your Employer/Organization when registering your account. Telehealth Employee and Family $0.00
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Flexible Spending Account (FSA) Higginbotham
EMPLOYEE BENEFITS
ABOUT FSA A Flexible 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 or grace period provision).
For full plan details, please visit your benefit website: www.mybenefitshub.com/brownfieldisd
Health Care FSA 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. Eligible expenses include: • Dental and vision expenses • Medical deductibles and coinsurance • Prescription copays Hearing aids and batteries You 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).
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.
Things to Consider Regarding the Dependent Care FSA
Overnight camps are not eligible for reimbursement (only day camps can be considered). If your child turns 13 mid-year, you may only request reimbursement for the part of the year when the child is under age 13. You may request reimbursement for care of a spouse or Higginbotham Benefits Debit Card dependent of any age who spends at least eight hours a The Higginbotham Benefits Debit Card gives you immediate day in your home and is mentally or physically incapable of access to funds in your Health Care FSA when you make a self-care. purchase without needing to file a claim for The dependent care provider cannot be your child under reimbursement. If you use the debit card to pay anything age 19 or anyone claimed as a dependent on your income other than a copay amount, you will need to submit an taxes. itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for Important FSA Rules substantiation. You will have 60 days to submit your Flexible Spending Accounts (FSA) receipts after receiving the request for substantiation $2,850.00 Individual before your debit card is suspended. Check the expiration $5,000.00 Dependent Care date on your card to see when you should order a The maximum per plan year you can contribute to a Health replacement card(s). Care FSA is $2,850. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing Dependent Care FSA The Dependent Care FSA helps pay for expenses associated jointly or head of household and $2,500 when married filing separately. with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the You cannot change your election during the year unless you account to pay for day care or babysitter expenses for your experience a Qualifying Life Event. Your Health Care FSA debit card can be used for health care children under age 13 and qualifying older dependents, expenses only. It cannot be used to pay for dependent care such as dependent parents. Reimbursement from your expenses. Dependent Care FSA is limited to the total amount 36
Flexible Spending Account (FSA) Higginbotham
EMPLOYEE BENEFITS
The 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.
Over-the-Counter Item Rule Reminder 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 continue to purchase your 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.
Higginbotham Portal The Higginbotham Portal provides information and resources to help you manage your FSAs. 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. Follow the prompts to navigate the site. If you have any questions or concerns, contact Higginbotham: Phone – (866) 419-3519 Email – flexclaims@higginbotham.net Fax – (866) 419-3516 Account Type Health Care FSA
Dependent Care FSA
Flexible Spending Accounts Eligible Expenses Annual Contribution Limits Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, $2,850 deductibles, eyeglasses and doctorprescribed over-the-counter medications) Dependent care expenses (such as day care, $5,000 single after-school programs or elder care $2,500 if married and programs) so you and your spouse can work filing separate tax returns or attend school full-time
Benefit Saves on eligible expenses not covered by insurance, reduces your taxable income Reduces your taxable income
Higginbotham Flex Mobile App Easily access your Health Care FSA on your smartphone or tablet with the Higginbotham mobile app. Search for Higginbotham in your mobile device’s app store and download as you would any other app. • View Accounts – Includes detailed account and balance information • Card Activity – Account information • SnapClaim – File a claim and upload receipt photos directly from your smartphone • Manage Subscriptions – Set up email notifications to keep up-to-date on all account and Health Care FSA debit card activity Log in using the same username and password you use to log in to the Higginbotham Portal. Note: You must register on the Higginbotham Portal to use the mobile app. 37
Notes
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Notes
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2022 - 2022 Plan Year
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 Brownfield 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 Brownfield 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.
WWW.MYBENEFITSHUB.COM/BROWNFIELDISD 40
