CELINA ISD BENEFIT GUIDE EFFECTIVE: 09/01/2022 8/31/2023 WWW.MYBENEFITSHUB.COM/CELINAISD 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 Life and AD&D 19-20 Hospital Indemnity 21 Telehealth 22 Dental 23 Vision 24 Disability 25-26 Cancer 27 Accident 28-29 Identity Theft 30-31 Emergency Medical Transport 32 Flexible Spending Account (FSA) 33-34 Health Savings Account (HSA) 35 HOW TO ENROLLPG. 4 SUMMARYPAGESPG. 6 BENEFITSYOURPG. 12 2
Benefit Contact Information CELINA ISD BENEFITS TRS ACTIVECARE MEDICAL TRS HMO MEDICAL Financial Benefit Services (800) 583 www.mybenefitshub.com/celinaisd6908 (866)BCBSTX355 www.bcbstx.com/trsactivecare5999 Scott & White HMO (844) 633 www.trs.swhp.org5325 LIFE AND AD&D HOSPITAL INDEMNITY TELEHEALTH The Hartford Group #873302 (888) 277 4767 benefits/employeeswww.thehartford.com/employee The Hartford Group #873302 (866) 547 https://benefitsclaims.thehartford.com4205 MDLive (888) 363 www.mdlive.com/fbs1663 DENTAL VISION DISABILITY FCL GroupDental#M1245 D (877) 493 www.fcldental.com6282 Superior Vision Group #324700 (800) 507 www.superiorvision.com3800 The benefits/claimswww.thehartford.com/employee(888)GroupHartford#8733022774767 CANCER ACCIDENT IDENTITY THEFT American Public Life Group #12697 (800) 256 www.ampublic.com8606 American Public Life Group #12697 (800) 256 www.ampublic.com8606 Ilock (855)360287 customerservice@ilock360.com8888 EMERGENCY MEDICAL TRANSPORT FLEXIBLE SPENDING ACCOUNT (FSA) HEALTH SAVINGS ACCOUNT (HSA) MASA Group #B2BCELISD (800) 643 claims@masaglobal.com9023 Higginbotham (866) 419 3519 https://flexservices.higginbotham.net/ EECU (817) 882 0800 www.eecu.org 3
Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS CISD” to (800) 583-6908 App Group #: FBSCISD Text “FBS CISD” 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/celinaisd How to Log In 2 CLICK LOGIN 3 ENTER USERNAME & PASSWORD Your Username Is: The first Six (6) characters of your last name, followed by the first letter of your first name, followed by the last Four (4) digits of your Social Security Number. Password Reset Date: 01/01/2022 If you HAVE NOT logged in since the Password Reset Date above, your Password is: Last Name (Excluding punctuation) followed by the last four (4) digits of your Social Security Number. 5
Benefit Updates What’s New: Don’t Forget! • For questions about benefits or enrollment assistance, please call the FBS Call Center at 866.914.5202. Bilingual assistance is available. Hours are Monday Friday 8am 6pm. • Login & complete your benefit enrollment from 7/19/2022 ‐ 8/09/2022. • Update your profile information: home address, phone numbers, email. • Update dependent social security numbers and student status for college aged children. SUMMARY PAGESAnnual Benefit Enrollment • TRS ACTIVE CARE MEDICAL RATES NOW REGIONAL • TRS CURRENT ACTIVE CARE RATES REDUCED SLIGHTLY NEW FSA HigginbothamCARRIERisthe new carrier for flexible spending accounts (including Limited) and the Dependent care accounts. Your new FSA plans will continue to offer a 75 day grace period and you can still file claims up to 90 days after the end of the plan year. This applies for both to both flexible and dependent care plans. However, it does not apply to employees that are no longer active with the district. You do not have to re enroll in the new Flex plans but if you wish to change your contribution, you will need to log into THEbenefitsHUB. No medical plan is required to enroll in these benefits. Annual maximum contributions are : • Individual $2,850, • Family $2,500 (married filing joint), • Dependent Care: $5,000 (funds available based on contributions only) NEW TRS DIGITAL MENTAL HEALTH PROGRAM TRS No Cost Digital Mental Health Program Learn to Live offers Digital cognitive behavioral therapy tools to help participants learn new skills and break old patterns. To check our Learn to Live, participants: • Log in to Blue Access for MembersSM • Click Wellness • Choose Digital Mental Health If participants have questions or need help registering for Learn to Live, they should call a Personal Health Guide at (866) 355 5999. 6
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
Section 125 Cafeteria Plan Guidelines SUMMARY PAGESAnnual Benefit Enrollment CHANGES
Marital Status
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.
(CIS):STATUS QUALIFYING
Judgment/Decree/Order
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
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Eligibility for Government Programs
Gain/Loss
Change in Number of Tax Dependents
EligibilityDependents'ofStatus
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.
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.
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.
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.
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 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.
Change in Status of Employment Affecting Coverage Eligibility
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?
• 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
SUMMARY PAGESAnnual Benefit Enrollment 8
For benefit summaries and claim forms, go to your benefit www.mybenefitshub.com/celinaisdwebsite:.
• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
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.
For benefit summaries and claim forms, go to the Celina ISD benefit www.mybenefitshub.com/celinaisdwebsite:.
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.
Annual Enrollment
Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866 914 5202 for assistance.
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?
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.
• 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.
Where can I find forms?
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.
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
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
SUMMARY PAGES
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.
Dependent RequirementsEligibility
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 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.
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.
Annual
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 IndemnityHospital To age 26 Cancer To age 26 Dental PPO To age 26 AD&D To age 25 Individual Life To age 24 Vision To age 26 Voluntary Life To age 26 Accident To age 26 IdentityMonitoringTheft To age 18 Telehealth To age 26 Emergency TransportationMedical 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
Benefit Enrollment 9
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
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
Actively at Work
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
Guaranteed
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.
In Network Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider. Out of Pocket Maximum
Plan Year 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).
Annual
After
The most an eligible or insured person can pay in co insurance for covered expenses.
September
SUMMARY PAGESHelpful Definitions 10
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. 35 FLIP TO FOR FSA INFORMATION PG. 33 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/celinaisd Medical Insurance TRS EMPLOYEE BENEFITS Total Monthly Premium District Contribution Employee Cost TRS ActiveCare HD Employee Only $422.00 $417.00 $5.00 Employee & Spouse $1,187.00 $417.00 $770.00 Employee & Child(ren) $757.00 $417.00 $340.00 Employee & Family $1,419.00 $417.00 $1,002.00 TRS ActiveCare 2 Employee Only $1,013.00 $417.00 $596.00 Employee & Spouse $2,402.00 $417.00 $1,985.00 Employee & Child(ren) $1,507.00 $417.00 $1,090.00 Employee & Family $2,841.00 $417.00 $2,424.00 TRS ActiveCare Primary Employee Only $410.00 $417.00 $0.00 Employee & Spouse $1,157.00 $417.00 $740.00 Employee & Child(ren) $738.00 $417.00 $321.00 Employee & Family $1,384.00 $417.00 $967.00 TRS ActiveCare Primary+ Employee Only $515.00 $417.00 $98.00 Employee & Spouse $1,259.00 $417.00 $842.00 Employee & Child(ren) $829.00 $417.00 $412.00 Employee & Family $1,584.00 $417.00 $1,167.00 Scott and White HMO Employee Only $543.35 $417.00 $126.35 Employee & Spouse $1,364.92 $417.00 $947.92 Employee & Child(ren) $873.57 $417.00 $456.57 Employee & Family $1,570.98 $417.00 $1,153.98 12
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Life and AD&D The Hartford 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/celinaisd EMPLOYEE BENEFITS BASIC and SUPPLEMENTAL GROUP TERM LIFE and ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE BENEFIT HIGHLIGHTS Celina Independent School District Group GLT 873302 The group term Life and Accidental Death and Dismemberment (AD&D) insurance available through your employer gives extra protection that you and your family may need. Life and AD&D insurance offers financial protection by providing you coverage in case of an untimely death or an accident that destroys your income earning ability. Life benefits are disbursed to your beneficiaries in a lump sum in the event of your death. COVERAGE INFORMATION APPLICANT BASIC COVERAGE SUPPLEMENTAL COVERAGE Employee Benefit2: $10,000 AD&D: Included Benefit2: Increments of $10,000 Maximum: the lesser of 7x earnings or $500,000 AD&D: Not Included Spouse Not Included Benefit1: Increments of $10,000 Maximum: the lesser of 50% of your supplemental coverage or $250,000 AD&D: Not Included Child(ren) Not Included Benefit: Age 15 days to under 6 months $100; Age 6 months to 26 years $10,000 AD&D: Not Included AD&D BENEFITS PERCENT OF COVERAGE AMOUNT PER ACCIDENT Covered accidents or death can occur up to 365 days after the accident. The total benefit for all losses due to the same accident will not exceed 100% of your coverage amount. LOSS FROM ACCIDENT BASIC COVERAGE SUPPLEMENTAL COVERAGE Life 100% 100% Both Hands or Both Feet or Sight of Both Eyes 100% 100% One Hand and One Foot 100% 100% Speech and Hearing in Both Ears 100% 100% Either Hand or Foot and Sight of One Eye 100% 100% Movement of Both Upper and Lower Limbs (Quadriplegia) 100% 100% Movement of Both Lower Limbs (Paraplegia) 75% 75% Movement of Three Limbs (Triplegia) 75% 75% Voluntary Group Life per $10,000 in coverage Age Employee <29 $0.40 30 34 $0.50 35 39 $0.70 40 44 $1.10 45 49 $1.80 50 54 $2.90 55 59 $4.60 60 64 $6.00 65 69 $9.70 70 74 $17.00 75+ $30.80 Spouse Spouse rates are based on Employee's age and cannot exceed 50% of the employees supplemental life amount. Voluntary Group Life$10,000Child(ren)incoverage 0 26 $2.00 AD&D Rates (per $10,000) Employee Only $0.30 Employee and Family $0.60 19
Your benefit will be reduced by 35% at age 65 and 50% at age 70. Reductions will be applied to the original amount. LIMITATIONS & EXCLUSIONS This insurance coverage includes certain limitations and exclusions. The certificate details all provisions, limitations, and exclusions for this insurance coverage. A copy of the certificate is listed on the employee portal www.mybenefitshub.com/celinaisd GROUP LIFE INSURANCE GENERAL LIMITATIONS AND EXCLUSIONS • Your benefit will be reduced by 35% at age 65 and 50% at age 70. Reductions will be applied to the original amount. • A supplemental or voluntary life benefit will not be paid if death occurs by suicide within two years (or as allowed by state law) of purchasing this coverage. • You and your dependent(s) must be citizens or legal residents of the United States, its territories and protectorates. DEPENDENT LIMITATIONS AND EXCLUSIONS • Coverage may only be elected for dependents when you elect and are approved for coverage for yourself. • Coverage may not be elected for a dependent who has employee coverage under this certificate. • Coverage may not be elected for a dependent who is in active full time military service. • Child(ren) may only be covered as a dependent of one employee. • Infants may receive a reduced benefit prior to the age of six months. GROUP ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE GENERAL LIMITATIONS AND EXCLUSIONS • Your benefit will be reduced by 35% at age 65 and 50% at age 70. Reductions will be applied to the original amount. • This insurance does not cover losses caused by: • Sickness; disease; or any treatment for either • Any infection, except certain ones caused by an accidental cut or wound • Intentionally self inflicted injury, suicide or suicide attempt • War or act of war, whether declared or not • Injury sustained while in the armed forces of any country or international authority • Injury sustained on aircraft in certain circumstances • Taking prescription or illegal drugs unless prescribed by or administered by a licensed physician • Injury sustained while riding, driving, or testing any motor vehicle for racing • Injury sustained while committing or attempting to commit a felony • Injury sustained while driving while intoxicated • You must be a citizen or legal resident of the United States, its territories and protectorates. DEFINITIONS • Loss means, with regard to hands and feet, actual severance through or above wrist or ankle joints; with regard to sight, speech or hearing, entire and irrecoverable loss thereof; with regard to thumb and index finger, actual severance through or above the metacarpophalangeal joints; with regard to movement, complete and irreversible paralysis of such limbs. • Injury means bodily injury resulting directly from an accident, independent of all other causes, which occurs while you have coverage. Life and AD&D The Hartford EMPLOYEE BENEFITS AD&D BENEFITS PERCENT OF COVERAGE AMOUNT PER ACCIDENT CONTINUED LOSS FROM ACCIDENT BASIC COVERAGE SUPPLEMENTAL COVERAGE Movement of the Upper and Lower Limbs of One Side of the Body (Hemiplegia) 50% 50% Either Hand or Foot 50% 50% Sight of One Eye 50% 50% Speech or Hearing in Both Ears 50% 50% Movement of One Limb (Uniplegia) 25% 25% Thumb and Index Finger of Either Hand 25% 25% 20
HOW DO I FILE A CLAIM? You can go online at https://www.thehartford.com/claims or call 866 547.4205 Group # 87332
Hartford EMPLOYEE
please
ASKED & ANSWERED
IS THIS COVERAGE aware
COVERAGE INFORMATION
The BENEFITS
This is an affordable supplemental plan that pays you should you be in patient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance. full plan details, visit your benefit website:
that the IRS limits the types of supplemental insurance you may have in addition to a HSA, while still maintaining the tax exempt status of the HSA. This plan design was designed to be compatible with Health Savings Accounts (HSAs). However, if you have or plan to open an HSA, please consult your tax and legal advisors to determine which supplemental benefits may be purchased by employees with an WHOHSA. IS ELIGIBLE? You are eligible for this insurance if you are an active full time employee who works at least 20 hours per week on a regularly scheduled basis and are less than age 80. Your spouse and child(ren) are also eligible for coverage. Any child (ren) must be under age 26. AM I GUARANTEED COVERAGE? This insurance is guaranteed issue coverage it is available without having to provide information about your or your family’s health Hospital IndemnityOption 1 Option 2 Employee Only $15.41 $27.00 Employee and Spouse $31.98 $56.14 Employee and Child(ren) $29.68 $51.64 Employee and Family $48.37 $84.38 PLAN INFORMATION OPTION 1 OPTION 2 Coverage Type On and off job (24 hour) On and off job (24 hour) Covered Events Illnessinjuryand Illnessinjuryand HSA Compatible Yes Yes BENEFITS OPTION 1 OPTION 2 HOSPITAL CARE2 First Day ConfinementHospital Up to 1 day per year $1100 $2200 Daily ConfinementHospital(Day 2+) Up to 30 days per year $100 $100 Daily ICU Confinement (Day 2+) Up to 10 days per year $150 $150 FEATURES Ability Assist® EAP3 24/7/365 access to help for financial, legal or emotional issues Included Included HealthChampionSM4 Administrative & clinical support following serious illness or injury Included Included 21
For
www.mybenefitshub.com/celinaisd
Hospital Indemnity (HI) insurance pays a cash benefit if you or an insured dependent spouse or child) are confined in a hospital for a covered illness or injury. Even with the best primary health insurance plan, out of pocket costs from a hospital stay can add up. The benefits are paid in lump sum amounts to you and can help offset expenses that primary health insurance doesn’t cover (like deductibles, co insurance amounts or co pays), or benefits can be used for any non medical expenses (like housing costs, groceries, car expenses, etc.).
You have a choice of two hospital indemnity plans, which allows you the flexibility to enroll for the coverage that best meets your needs. Benefit amounts are based on the plan in effect for you or an insured dependent at the time the covered event occurs. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s).
HSA COMPATIBLE? If you (or any dependent(s)) currently participate in a Health Saving Account (HSA) or if you plan to do so in the future, you should be
ABOUT HOSPITAL INDEMNITY
Hospital Indemnity
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/celinaisd Telehealth MDLive EMPLOYEE BENEFITS Telehealth Employer Paid! 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: 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. • Sore throat • Headache • Stomachache • Cold • Flu • Allergies • Fever • Urinary tract infections Telehealth Employee and Family $0.00 (Employer Paid) 22
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/celinaisd Dental Insurance FCL Dental EMPLOYEE BENEFITS Celina ISD M1245 D Passive PPO Dental Plan (100/80/50) Annual Benefit Per Person….….….….….….….….….….….….….….….….….$1,500 Percentage of Covered Benefits Per PolicyTYPEYearI TYPE II TYPE III* DURING THE 1ST YEAR 100% 80% 0% 2ND YEAR AND THEREAFTER 100% 80% 50% • 12 month waiting period (unless replacing prior coverage as described under “Takeover Benefit”) • (USE NETWORK OFFICES FOR ADDITIONAL SAVINGS) • DENTIST LIST AT DENTEMAX.COM Calendar Year Deductible, Per Person $50/$150 This deductible applies to Type II and III services Unmarried Dependent Children Covered to Age 26 Payment is based upon allowable charges in the area in which service is rendered. Services provided at a non contracting provider are paid at the 90th percentile. Dental Employee Only $33.34 Employee and Spouse $65.92 Employee and Child(ren) $74.08 Employee and Family $113.94 TYPE I (PREVENTIVE SERVICES) Including: • No waiting period • Routine Exams • Prophylaxis (cleanings one per 6 months) • Emergency exams for dental pain (minor procedures) • Fluoride treatments for dependent children under age 19 (one per 12 months) • Bitewing X rays (once per 6 months) TYPE II (BASIC SERVICES) Including: • No waiting period • Periapical X rays • Full mouth or panorex X rays (one per 36 months) • Simple restorative services (fillings) • Simple extractions • Palliative treatment for dental pain, local anesthesia • Sealants for children ages 6 15 (one per tooth) TYPE III (MAJOR SERVICES) Including: • 12 month waiting period (new enrollees) • Major restorative services (crowns and inlays) • Prosthetics (bridges, dentures) • Replacement of prosthodontics, dentures, crowns and inlays • Denture relines • Endodontics/root canal therapy • Periodontics • Space maintainers • Complex Oral Surgery • General anesthesia (for services dentally necessary) ORTHODONTIC SERVICES (12 MONTH WAIT) • 50% coverage • $1,000 lifetime maximum benefit • Children under 19 only For PPO Dental providers, you can visit the FCL Dental Web site at www.fcldental.com then in the drop down menu select Dentemax Plus network to find the most up to date list of DM dentists. You can also call toll free at 800 752 1547 and a representative can help you locate a network provider in your area. Directories are available as well and are current as of the printed date. FCL Dental DHMO or PPO dental providers may be accessed at our website at www.fcldental.com 23
Vision plan benefits for Celina ISD Group # 324700 Vision Copays Services/Frequency Employee Only $9.20 Exam1 $10 Exam 12 months Employee and Spouse $15.70 Eyewear2 $10 Frame 12 months Employee and Child(ren) $23.04 Lenses 12 months Employee and Family $23.04 Contact lenses 12 months (Based on date of service) Benefits through Superior Select Southwest network In network Out of network Exam Covered in full Up to $35 retail Frames $125 allowanceretail Up to $70 retail Lenses (standard) per pair Single vision Covered in full Up to $25 retail Bifocal Covered in full Up to $40 retail Trifocal Covered in full Up to $45 retail Progressive See description3 Up to $45 retail Contact lenses4 $150 allowanceretail Up to $80 retail Medically necessary contact lenses Covered in full Up to $150 retail LASIK vision correction5 $200 allowance Co pays apply to in network benefits; co pays for out of network visits are deducted from reimbursements • Eye exam copay is a single payment due to the provider at the time of service. • Eyewear copay applies to eyeglass lenses / frame and contact lenses. Eyewear copay is a single payment that applies to the entire purchase of eyeglasses (frame and lenses) • 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 • Contact lenses and related professional services (fitting, evaluation, and follow up) are covered in lieu of eyeglass lenses and frames benefit • Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limitations Discount features Non covered eyewear discount: members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy. The national LASIK network of laser vision correction providers, featuring LasikPlus, offers members special program pricing on services. The program pricing should be verified prior to service. Need Help? Call 800 507 3800 Customer Service Log In On Line at www.SuperiorVision.com or create an account on the mobile app. Need to find an in network provider? Use this link: tps://www.superiorvision.com/member/locate_provider?a=1 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/celinaisd Vision Insurance Superior Vision EMPLOYEE BENEFITS 24
Definition of Disability: Disability is defined as The Hartford’s contract with your employer. Typically, disability means that you cannot perform one or more of the essential duties of your occupation due to injury, sickness, pregnancy or other medical conditions covered by the insurance, and as a result, your current monthly earnings are 80% or less of your pre disability earnings. Once you have been disabled for 24 months, you must be prevented from performing one or more essential duties of any occupation, and as a result, your monthly earnings are 66 2/3% or less of your pre disability earnings.
in benefit Elimination14/14Period $17.90 30/30 $16.15 90/90 $9.80 25
Disability Insurance
ABOUT DISABILITY
Pre Existing Condition Limitation: Your policy limits the benefits you can receive for a disability caused by a pre existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have not received treatment for the disabling condition within 3 months, while insured under this policy, before the disability begins, or You have been insured under this policy for 12 months before your disability begins. If your disability is a result of a pre existing condition, we will pay benefits for a maximum of 4 weeks.
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What is Long Term Disability Insurance?
The Hartford EMPLOYEE BENEFITS
Disability $500
Earnings are defined in The Hartford’s contract with your employer
Coverage Amount:
You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a Disability benefit payment. The elimination period that you select consists of two numbers. The first number shows the number of days you must be disabled by an accident before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin.
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.
Long Term Disability Insurance pays you a portion of your earnings if you cannot work because of a disabling illness or injury. You can purchase Long Term Disability Insurance through your employer. This highlight sheet is an overview of your Long Term Disability Insurance. Once a group policy is issued to your employer; a certificate of insurance will be available to explain your coverage in detail.
For full plan details, please visit your benefit website: www.mybenefitshub.com/celinaisd
Actively at Work: You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session.
Elimination Period:
You may purchase coverage that will pay you a monthly flat dollar benefit: $500, $1,000,$1,500, $2,000, $2,500, $3,000, $4,000, $5,000, $6,000, $7,000, $7,500 that cannot exceed 66 2/3% of your current monthly earnings. Your plan includes a minimum benefit of 25% of your elected benefit.
For those employees electing an elimination period of 30 days or less, if you are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization.
Disability Insurance The Hartford EMPLOYEE BENEFITS Maximum Benefit Duration: Benefit Duration is the maximum time for which we pay benefits for disability resulting from sickness or injury. Depending on the age at which disability occurs, the maximum duration may vary. Please see the applicable schedule below based on the Premium benefit option. Premium Option: For the Premium benefit option the table below applies to disabilities resulting from sickness or injury. Age Disabled Maximum Benefit Duration Prior to 63 To Normal Retirement Age or 48 months if greater Age 63 To Normal Retirement Age or 42 months if greater Age 64 36 months Age 65 30 months Age 66 27 months Age 67 24 months Age 68 21 months Age 69 and older 18 months Benefit Integration: Your benefit may be reduced by other income you receive or are eligible to receive due to your disability, such as: • Social Security Disability Insurance • State Teacher Retirement Disability Plans • Workers’ Compensation • Other employer based disability insurance coverage you may have • Unemployment benefits • Retirement benefits that your employer fully or partially pays for (such as a pension plan) How to file a claim: Claims are now processed telephonically by calling 866 278 2655. Just refer to policy number 873302 and follow these easy steps: 1. If your absence is scheduled, call 30 days prior and if unscheduled, please call as soon as possible. 2. Have your information ready • Name address other key information • Name of department and last day full day of active work • Your Manager’s or HR Representatives name and phone number • The nature of your claim or leave request • Your treating physicians name, address, and fax numbers • With your information handy, you will be assisted by a member who will take your information, answer your questions, and file your claim. 26
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/celinaisd Cancer Insurance APL EMPLOYEE BENEFITS Celina ISD Group # 12697 THIS IS A BRIEF OUTLINE OF BENEFITS. PLEASE REFER TO THE POLICY CERTIFICATE LOCATED AT WWW.MYBENEFITSHUB.COM/CELINAISD UNDER THE CANCER SECTION FOR COMPLETE DETAILS, LIMITATIONS, AND EXCLUSIONS. CancerOption 1 Option 2 Employee Only $13.66 $23.00 Employee and Spouse $29.48 $49.94 Employee and Child(ren) $15.70 $26.50 Employee and Family $31.52 $53.48 SUMMARY OF BENEFITS Benefits Option 1 Option 2 Radiation Therapy/Chemotherapy/Immunotherapy Benefit Maximum per 12 month period $15,000 $20,000 Hormone Therapy Maximum of 12 treatments per Calendar Year $50 per treatment $50 per treatment Experimental Treatment Benefit Paid in the same manner and under the same maximums as any other benefit Waiver of Premium Waive Premium Waive Premium Internal Cancer First Occurrence Benefit Lump Sum Benefit Maximum 1 per Covered Person per lifetime $5,000 $10,000 Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime $7,500 $15,000 Heart Attack/Stroke First Occurrence Benefit Lump Sum Benefit Maximum 1 per Covered Person per lifetime $5,000 $10,000 Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime Riders : $7,500 $15,000 Heart Attack/Stroke First Occurrence Benefit Rider Pays a lump sum amount when a Covered Person receives a first diagnosis of Heart Attack/Stroke and the Date of Diagnosis occurs after the Waiting Period. The Heart Attack/Stroke lump sum benefit amount will reduce by 50% at age 70. Internal Cancer First Occurrence Benefit Rider Pays a lump sum benefit amount when a Covered Person receives a first diagnosis of a covered Internal Cancer and the Date of Diagnosis occurs after the Waiting Period. The Internal Cancer lump sum benefit amount will reduce by 50% at age 70. How to file a Claim: Here is the link for the claim YouDocID=4338703&InBrowser=1https://docs.mgmbenefits.com/external.aspx?formcanalsocontactAPLat8002568606oronline at www.ampublic.com 27
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/celinaisd Accident Insurance APL EMPLOYEE BENEFITS GA13 Series Limited Benefit Group Accident Only Insurance for the Employees of Celina ISD Group # 12697 THIS POLICY IS A LIMITED PLAN AND ONLY COVERS ACCIDENTS. THIS IS NOT A POLICY FOR WORKERS’ COMPENSATION INSURANCE. PLEASE REFER TO THE EMPLOYEE PORTAL AT WWW.MYBENEFITSHUB.COM/ CELINAISD UNDER THE ACCIDENT SECTION FOR COMPLETE DETAILS AND LIMITATIONS. Accident Employee Only $10.36 Employee and Spouse $15.14 Employee and Child(ren) $21.00 Employee and Family $25.86 Summary of Benefits 24 Hour Plan 1 Emergency Treatment 1 Unit Initial Treatment within 72 hours of a Covered Accident in Emergency Room $150 Initial Treatment within 72 hours of a Covered Accident in Physician’s Office $50 Initial Treatment after 72 hours but within 30 days after a Covered Accident $25 Follow Up Treatment Maximum of 6 visits $25 Major Diagnostic Screening (MRI) $100 X Ray $25 Emergency Dental Work Crown/Extraction $75/$25 Patient Care 2 Units Hospital Admission per admission $1,000 Hospital Confinement per day Maximum of 365 days $200 Intensive Care Unit Confinement per day Maximum of 15 days $400 Step Down Unit Confinement per day Maximum of 15 days $300 Rehabilitation Unit Confinement per day Maximum of 90 days $100 Therapy Physical, Occupational or Speech per visit Maximum of 8 visits $50 28
Summary of Benefits 24 Hour Plan 1 Injuries & Treatment 1 Unit Fractures* up to $1,500 Dislocation* up to $1,200 Internal Injuries $250 Tendons, Ligaments, Rotator Cuff up to $187.50 Burns up to $12,500 Skin Grafts up to $6,250 Ruptured Disc or Torn Knee Cartilage 25% if occurs during first 12 months $125 Eye Injury up tp $62.50 Concussion $50 Lacerations up to $200 Epidural Pain Management $25 Blood, Plasma and Platelets $62.50 Exploratory Surgery without Repair $62.50 Hernia 25% if occurs during first 12 months $25 Prosthesis $125 Appliances $25 Coma Due to a Covered Accident $2,500 Transportation & Lodging 1 Unit Ambulance Ground/Air $400/$1,200 Transportation per round trip Maximum of 3 round trips $300 Family Member Lodging & Meals per day Maximum of 30 days $100 Accidental Death & Dismemberment 1 Unit Accidental Death Common Carrier/Other* $100,000/$25,000 Accidental Dismemberment* up to $15,000 Catastrophic Loss* up to $30,000 Accident Insurance APL EMPLOYEE BENEFITS *Amounts shown are for individuals; amounts for spouse and child(ren) may vary. Please refer to your Schedule of Benefits for details. How to file a Claim Click on the link to get the claim Contacthttps://docs.mgmbenefits.com/external.aspx?DocID=7320016&InBrowser=1form:APLat8002568606oronlineatwww.ampublic.com 29
Monitors the subscriber’s medical ID’s using CyberAlert®. If a Medical ID number is found compromised, the subscriber has access to a Restoration Specialist who will make contact with the healthcare provider where the compromised account is located and report it as fraud. EssentialTheft Plan $6.95 $11.95 Family $13.95 $22.95
Provides the subscriber with the ability to limit access to the amount of personal information that is public to reduce their exposure to fraud and declutter their mailbox and phone line. This service allows the subscriber to opt out of direct marketing campaigns including utilizing the National Do Not Call Registry.
• Lost wages or income
Payday Loan
CONTACT US customerservice@ilock360.com | (855) 287 8888 30
Solicitation Reduction
Gives the subscriber access to a U.S. based certified Identity Restoration Specialist to assist subscribers in restoring their identity. Assists in quickly and effectively terminating and re ordering wallet contents. Users are not required to pre register wallet contents before using this service.
Provides a report of all registered sex offenders living within the subscriber’s immediate area, and notifies them when a new sex offender has been added. Notifies the subscriber of privacy or reputational risks with the content they are sharing on social media. Enrolled subscribers can also monitor their child’s social media presence. Monitoring Monitors transactional data from payday and quick cash loan providers to help subscribers determine if fraudulent activity has occurred. Alerts subscribers if a non credit loan has been opened using an element of their identity.
Social Security Number Trace (Child) Provides the subscriber with a report of all names and aliases associated with their child’s Social Security number, and notifies them if a new one is added.
Essential Plan Feature Descriptions Identity
Social Media Monitoring
$1M Identity Theft Insurance Offers up to $1M reimbursement with $0 deductible, for expenses associated with the subscriber’s identity theft recovery. Covers costs including:
Employee and
• Attorney and legal fees
Medical ID Monitoring
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/celinaisd Identity Theft Ilock 360 EMPLOYEE BENEFITS CyberAlert™️ monitors: • one Social Security Number • two Medical ID Numbers • two Phone Numbers • five Bank Accounts • two Email Addresses • one Drivers License Number • five Credit/Debit Cards • one Passport Scours Internet properties, including the dark web, websites, blogs, bulletin boards, peer to peer sharing networks and chat rooms to identify the illegal trading and selling of a subscriber’s personal information. Bank Account Takeover & Credit Card Application Monitoring Notifies subscribers when their Social Security number and personal information have been used to apply for or open a new bank or credit card account; or if changes have been made to their existing bank account. Change of Address Monitoring Reports if a subscriber’s mail has been redirected through the U.S. Postal Service. Sex Offender Alerts
Elite Employee
• Costs of childcare and/or elderly care incurred as a result of identity restoration
Full Restoration & Lost Wallet Protection
Daily Monitoring of Experian Credit Bureau Provides the subscriber with notifications for changes in a credit report such as loan data, inquiries, new accounts, judgments, liens and more.
• Expenses incurred for refiling of loans, grants and other lines of credit
Sex Offender Alerts
ScoreTracker
Provides the subscriber with access to their credit report as recorded with each credit bureau Experian, Equifax & TransUnion. This service is available once per year.
Notifies the subscriber of privacy or reputational risks with the content they are sharing on social media. Enrolled subscribers can also monitor their child’s social media presence. transactional data from payday and quick cash loan providers to help subscribers deter mine if fraudulent activity has occurred. Alerts subscribers if a non credit loan has been opened using an element of their identity.
•
CyberAlert™️ Monitors: • one Social Security Number • two Medical ID Numbers • two Phone Numbers • five Bank Accounts • two Email Addresses • one Drivers License Number • five Credit/Debit Cards • one Passport Scours Internet properties, including the dark web, websites, blogs, bulletin boards, peer to peer sharing networks and chat rooms to identify the illegal trading and selling of a subscriber’s personal information. Bank Account Takeover & Credit Card Application Monitoring
Experian Score Variance Alerts Provides alerts when a subscriber’s member benefit Experian credit score increases or decreases by a certain amount, changes risk level/score rank, or reaches a target score value.
•
Experian Positive Activity Notifications
3 Bureau Credit Report
Medical ID Monitoring Monitors the subscriber’s medical ID’s using CyberAlert®. If a Medical ID number is found com promised, the subscriber has access to a Restoration Specialist who will make contact with the healthcare provider where the compromised account is located and report it as fraud.
•
Tracks municipal court systems and notifies the subscriber if a criminal act has been committed under their name, including bookings data from law enforcement agencies to find any criminal offenses under the subscriber’s name and date of birth.
•
Daily Monitoring of all 3 Credit Bureaus
Social
$1M Identity Theft Insurance Offers up to $1M reimbursement with $0 deductible, for expenses associated with the subscriber’s identity theft recovery. Covers costs including: Lost wages or income Attorney and legal fees Expenses incurred for refiling of loans, grants and other lines of credit Costs of childcare and/or elderly care incurred as a result of identity restoration
Provides the subscriber with the ability to limit access to the amount of personal information that is public to reduce their exposure to fraud and declutter their mailbox and phone line. This service allows the subscriber to opt out of direct marketing campaigns including utilizing the National Do Not Call Registry.
Full Restoration & Lost Wallet Protection
3 Bureau Credit Score Provides the subscriber with access to their credit score reported by each credit bureau Experian, Equifax & TransUnion. Credit score is reported once a year.
Social Security Number Trace (Child) Provides the subscriber with a report of all names and aliases associated with their child’s Social Security number, and notifies them if a new one is added.
Gives the subscriber access to a U.S. based certified Identity Restoration Specialist to assist the subscriber in restoring their identity. Assists in quickly and effectively terminating and re ordering wallet contents. Users are not required to pre register wallet contents before using this service.
Identity Theft Ilock 360 EMPLOYEE BENEFITS Elite Plan Feature Descriptions 31
Subscribers receive a monthly report that provides relevant information to help them understand how their credit score has trended over time and what is impacting it with credit score insight.
Change of Address Monitoring
Payday Loan Monitoring Monitors
Daily Monitoring of Experian Credit Bureau Provides the subscriber with notifications for changes in a credit report such as loan data, inquiries, new accounts, judgments, liens and more.
Court/Criminal Records
Provides higher level protection with monitoring from all three credit bureaus: Experian, Equifax & TransUnion. Provides the subscriber with notifications for changes in a credit report such as loan data, inquiries, new accounts, judgments, liens and more.
Solicitation Reduction
Notifies subscribers when their Social Security number and personal information have been used to apply for or open a new bank or credit card account; or if changes have been made to their existing bank account. Reports if a subscriber’s mail has been redirected through the U.S. Postal Service. Provides a report of all registered sex offenders living within the subscriber’s immediate area, and notifies them when a new sex offender has been added. Media Monitoring
Provides alerts when positive activity affects an Experian credit file. The service triggers on positive credit improvements such as paid collection accounts, closed accounts by the customer, and public records (liens released/civil action satisfied).
ABOUT MEDICAL TRANSPORT
For full plan details, please visit your benefit website: www.mybenefitshub.com/celinaisd
Should you need assistance with a claim contact MASA at 800 643 9023 or refer to your benefit website for more detailed claims instructions.
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 non emergency air or ground transportation between medical facilities.
If you need to review additional information or coverages, you can find that under the employee benefits portal at www.mybenefitshub.com/celinaisd under the Emergency Transportation section.
Emergency Medical Transportation Employee and Family $14.00
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.
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.
32
Emergency Medical Transport
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.
MASA EMPLOYEE BENEFITS
Repatriation/Recuperation
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.
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 Therecuperation.costisonly $14 for you and your entire family!
Things to Consider Regarding the Dependent Care FSA
A
• Prescription copays
• You cannot change your election during the year unless you experience a Qualifying Life Event.
• The maximum per plan year you can contribute to a Health Care or Limited Purpose 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.
• Medical deductibles and coinsurance
Higginbotham Benefits Debit Card
Health Care FSA
ABOUT
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.
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).
• 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.
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
• Vision care (e.g., eyeglasses, contact lenses and LASIK surgery)
EMPLOYEE BENEFITS 33
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.
• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
• Overnight camps are not eligible for reimbursement (only day camps can be considered).
Limited Purpose Health Care FSA
Eligible expenses include:
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).
Flexible Spending Account (FSA)
Higginbotham
• Dental and vision expenses
• Hearing aids and batteries
• Dental and orthodontia care (i.e., fillings, X rays and braces)
Dependent Care FSA
Important FSA Rules
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 $500 rollover or grace period provision). For full plan details, please visit your benefit website: www.mybenefitshub.com/celinaisd
• You cannot change your election during the year unless you experience a Qualifying Life Event. FSA
The Limited Health Care FSA covers qualified dental and vision expenses for you or your eligible dependents. You may contribute up to $2,850 annually to a Limited Health Care FSA and you are entitled to the full election from day one of your plan year. A Limited Purpose Health Care FSA is only available if you elect it as Limited or enrolled in the HDHP medical plan and contribute to an HSA. You can use a Limited Purpose Health Care FSA to pay for eligible out of pocket dental and vision expenses only, such as:
Flexible Spending Account (FSA) Higginbotham EMPLOYEE BENEFITS • You can continue to file claims incurred during the plan year for up to 90 days after 8/31/2023. • You will continue to have a 75 day grace period where funds can be utilized up to 11/14/2023 • 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. 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 Flexible Spending Accounts Account Type Eligible Expenses Annual Contribution Limits Benefit Health Care FSA Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses and doctor prescribed over the counter medications) $2,850 Saves on expenseseligiblenotcovered by insurance, reduces your taxable income Limited Purpose Health Care FSA Dental and vision care expenses that are not covered by your health plan (such as eyeglasses, contacts, LASIK eye surgery, fillings, x rays and braces) $2,850 Saves on expenseseligiblenotcovered by insurance, reduces your taxable income Dependent Care FSA Dependent care expenses (such as day care, after school programs or elder care programs) so you and your spouse can work or attend school full time $5,000 single $2,500 if married and filing separate tax returns Reduces your taxable income 34
• Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account
you
Important HSA Information
• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
How to Use your HSA
www.mybenefitshub.com/celinaisd
• Not eligible to be claimed as a dependent on someone else’s tax return
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HSA Eligibility
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.
Opening an HSA 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.
• Not enrolled in Medicare or TRICARE
Maximum
• Online/Mobile: Sign in for 24/7 account access to check your balance, pay bills and more.
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.
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.
• Stop by: a local EECU financial center for in person assistance; find EECU locations & service hours a www.eecu.org/locations
Health Savings Account (HSA)
• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
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 elect: Individual $3,650 Family (filing jointly) $7,300
• Not receiving Veterans Administration benefits
• 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. 1:00 p.m. CT and closed on Sunday.
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.
ABOUT HSA
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Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). full plan details, please visit your benefit website:
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. Contributions
You are eligible to open and contribute to an HSA if you are: Enrolled in an HSA eligible HDHP (TSBP HD)
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• 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.
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.
• 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.
For
EECU EMPLOYEE BENEFITS
• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333 9934
2021 - 2022 PlanYear
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 Celina 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.
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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 Celina 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/CELINAISD
