2022 - 2023 Plan Year
GALVESTON ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2022 - 8/31/2023 WWW.MYBENEFITSHUB.COM/GALVESTONISD
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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 Health Savings Account (HSA) Hospital Indemnity Telehealth Dental Vision Disability Cancer Accident Critical Illness Life and AD&D Individual Life Identity Theft Legal Services Flexible Spending Account (FSA)
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PG. 4
HOW TO ENROLL
PG. 6
SUMMARY PAGES
PG. 12
YOUR BENEFITS
Benefit Contact Information GALVESTON ISD BENEFITS
TRS ACTIVECARE MEDICAL
HEALTH SAVINGS ACCOUNT (HSA)
Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/galvestonisd
BCBSTX (866) 355-5999 www.bcbstx.com/trsactivecare
EECU (817) 882-0800 www.eecu.org
HOSPITAL INDEMNITY
TELEHEALTH
DENTAL
APL (800) 256-8606 www.ampublic.com
MDLIVE (888) 365-1663 www.mdlive.com/fbsbh
Lincoln Financial Group (800) 423-2765 www.lfg.com
VISION
DISABILITY
CANCER
Humana (800) 233-4013 www.humana.com
The Hartford (866) 547-9124 www.thehartford.com
MetLife/Baybridge (800) 845-7519 www.bbadmin.com
ACCIDENT
CRITICAL ILLNESS
LIFE AND AD&D
The Hartford (866) 547-4205 www.thehartford.com
UNUM (800) 635-5597 www.unum.com
UNUM (800) 445- 0402 www.unum.com
INDIVIDUAL LIFE
IDENTITY THEFT
LEGAL SERVICES
5Star Life Insurance (866) 863-9753 www.5starlifeinsurance.com
Aura - Identity Guard (855) 443-7748 www.identityguard.com
LegalEASE (888) 416-4313 www.legaleaseplan.com
FLEXIBLE SPENDING ACCOUNT (FSA) Higginbotham (866) 419-3519 https://flexservices.higginbotham.net/
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All Your Benefits One App Employee benefits made easy through the FBS Benefits App! Text “FBS GISD” 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 #: FBSGISD
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Text “FBS GISD” to (800) 583-6908 OR SCAN
How to Log In 1
www.mybenefitshub.com/galvestonisd
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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
Benefit Updates - What’s New: Medical Starting September 1st, all medical plan options will be through TRS ActiveCare. New Flex and Dependent Care Administrator GISD is moving to Higginbotham as its administrator. All those who enroll will receive a new Flex card. Employees are encouraged to use up current year funds prior to September 1st to ease the transition.
Don’t Forget! Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202 to speak to a representative. Spanish speaking representatives are also available. Annual Open Enrollment Benefit elections will become effective 9/1/2022 (elections requiring evidence of insurability, such as life Insurance, may have a later effective date, if approved). After annual enrollment closes, benefit changes can only be made if you experience a qualifying event (and changes must be made within 30 days of event).
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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
Enrollment Changes - When a Life Event Occurs Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
QUALIFYING EVENTS A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for 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 30 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 supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.
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Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ galvestonisd. 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 Galveston ISD benefit website: www.mybenefitshub.com/galvestonisd. 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.
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
CARRIER
MAXIMUM AGE
Medical
TRS-BCBS
To age 26
Telehealth
MDLIVE
To age 26
Dental
Lincoln Financial Group
To age 26
Vision
Humana
To age 26
Cancer
MetLife
To age 26
Critical Illness
UNUM
To age 26
Accident
The Hartford
To age 25
Life and AD&D
UNUM
To age 26
Identity Theft
Aura/Identity Guard
To age 26
Individual Life
5STAR Life Insurance Company
To age 24
Legal Services
LegalEASE
To age 26
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 HR/Benefit Administrator to request a continuation of coverage. 9
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 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. 10
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).
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 and/or employer
Employee and/or employer
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. However, Galveston ISD has 75 day grace period provision.
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
Description
FLIP TO FOR HSA INFORMATION
PG. 19
FLIP TO FOR FSA INFORMATION
PG. 37
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Medical Insurance
EMPLOYEE BENEFITS
TRS 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/galvestonisd
Monthly Premium
District Contribution
Employee Cost
TRS ActiveCare HD Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$407.00
$300.00
$107.00
$1,145.00
$300.00
$845.00
$731.00
$300.00
$431.00
$1,370.00
$300.00
$1,070.00
TRS ActiveCare 2 Employee Only
$1,013.00
$300.00
$713.00
Employee & Spouse
$2,402.00
$300.00
$2,102.00
Employee & Child(ren)
$1,507.00
$300.00
$1,207.00
Employee & Family
$2,841.00
$300.00
$2,541.00
TRS ActiveCare Primary Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$395.00
$300.00
$95.00
$1,113.00
$300.00
$813.00
$709.00
$300.00
$409.00
$1,332.00
$300.00
$1,032.00
TRS ActiveCare Primary+ Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
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$496.00
$300.00
$196.00
$1,212.00
$300.00
$912.00
$798.00
$300.00
$498.00
$1,523.00
$300.00
$1,223.00
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Health Savings Account (HSA) EECU
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/galvestonisd
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.
HSA Eligibility You are eligible to open and contribute to an HSA if you are: • Enrolled in an HSA-eligible HDHP (TRS-AC HD) • 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
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.
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.
Important HSA Information •
• •
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 EECU are eligible for automatic payroll deduction and company contributions.
How to Use your HSA • •
• •
Online/Mobile: Sign-in for 24/7 account access to check your balance, pay bills and more. 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. Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333-9934 Stop by: a local EECU financial center for in-person assistance; find EECU locations & service hours a www.eecu.org/locations. 19
Hospital Indemnity
EMPLOYEE BENEFITS
APL ABOUT HOSPITAL INDEMNITY This is an affordable supplemental plan that pays you should you be inpatient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance.
For full plan details, please visit your benefit website: www.mybenefitshub.com/galvestonisd
The Hospital Indemnity Plan provided through MedChoice helps with the high cost of medical care by paying you a set amount when you have an inpatient hospital stay. Unlike traditional insurance, which pays a benefit to the hospital or doctor, this plan pays you directly based on the care or treatment you receive. These costs may include meals and transportation, childcare or time away from work due to a medical issue that requires hospitalization.
Employee Only Employee and Spouse Employee and Child(ren) Employee and Family Summary of Benefits Hospital Admission Benefit Hospital Confinement Benefit Intensive Care Unit Benefit Rehabilitation Benefit
Hospital Indemnity Plan 1 $15.98 $37.04 $20.54 $38.44
Plan 2 $22.40 $46.60 $25.40 $49.84
Plan 1 $1,500 per day; maximum of 1 day $200 per day; maximum of 30 days $200 per day; maximum of 30 days $200 per day; maximum of 5 days
Plan 2 $2,500 per day; maximum of 1 day $200 per day; maximum of 30 days $200 per day; maximum of 30 days $200 per day; maximum of 5 days
Note: Pre-existing conditions waived on this plan
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Telehealth
EMPLOYEE BENEFITS
MDLIVE 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/galvestonisd 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
$10.00
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Dental Insurance
EMPLOYEE BENEFITS
Lincoln Financial Group 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/galvestonisd
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 Lincoln Financial Group.
DPPO Plan
Dental High Employee Only $32.18 Employee and Spouse $60.76 Employee and Child(ren) $65.28 Employee and Family $96.60
Low $17.52 $33.28 $39.98 $60.12
DHMO $12.60 $24.60 $26.60 $38.44
Two levels of benefits are available with the DPPO plan: in-network and out-of-network. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services. You could pay more if you use an out-ofnetwork provider.
Questions about your plan or claims? Call or email us. 800-423-2765 Monday – Thursday, 8 a.m. – 8 p.m. ET; Friday, 8 a.m. – 6 p.m. ET Claims@LFG.com
Dental schedule of benefits Plan Deductible Individual Family Deductible applies to: Benefit Levels Type 1 – Diagnostic & Preventative Type 2 – Basic Services Type 3 – Major Services Type 4 – Orthodontic Services (Adults and Children) Benefits Based On Maximum Benefit (per covered person): Types 1, 2 & 3 combined Type 4, while covered by the plan
Low Plan
High Plan Annually on a Calendar Year Basis Contracted Dentist Non Contracted Dentist Contracted Dentist Non Contracted Dentist $50 $50 $50 $50 $150 $150 $150 $150 Type 2 & 3 Type 2 & 3 Type 2 & 3 Type 2 & 3 100% 70% 50%
100% 70% 50%
Negotiated Fees
90th Percentile U&C
$750 Per Plan Year Not Covered
$750 Per Plan Year Not Covered
100% 80% 50%
100% 80% 50%
50%
50%
Negotiated Fees
95th Percentile U&C
$1,250 Per Plan Year $1,250 Per Plan Year $1,000 Lifetime $1,000 Lifetime
DHMO Plan • • • • • •
You choose your primary-care dentist when you enroll. To find a participating dentist, visit http://ldc.lfg.com and select Find a Dentist. (You can also print your dental ID card from this site once your coverage begins.) This dental plan offers a detailed list of covered procedures, each with a dollar copayment (see the Summary of Benefits on Benefits Portal for details). You pay for services provided during your visit. Emergency care away from home is covered up to a set dollar limit. You can change your primary-care dentist at any time by calling the customer service number listed on your dental ID card. Covers most preventive and diagnostic care services at no charge Also22covers a wide variety of specialty services - lowering your out-of-pocket costs with no deductibles or maximums
Vision Insurance
EMPLOYEE BENEFITS
Humana 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/galvestonisd
Vision Employee Only
$8.92
Employee and Spouse Employee and Child(ren) Employee and Family
$17.86 $18.46 $28.12
Vision care services Exam with dilation as necessary 1 • Retinal imaging Contact lens exam options 2 • Standard contact lens fit and follow-up • Premium contact lens fit and follow-up Frames 3 Standard plastic lenses 4 • Single vision • Bifocal • Trifocal • Lenticular Covered lens options 4 • UV coating • Tint (solid and gradient) • Standard scratch-resistance • Standard polycarbonate - adults • Standard polycarbonate - children <19 • Standard anti-reflective coating • Premium anti-reflective coating – Tier 1 – Tier 2 – Tier 3 • Standard progressive (add-on to bifocal)
If you use an IN-NETWORK provider (Member cost) $10 Up to $39
If you use an OUT-OF-NETWORK provider (Reimbursement) Up to $30 Not covered
$0 10% off retail less $55 allowance $160 allowance 20% off balance over $160
Up to $30 Up to $30 $80 allowance
$10 $10 $10 $10
Up to $25 Up to $40 Up to $60 Up to $100
$15 Not covered $15 Not covered $15 Not covered $40 Not covered $0 Not covered $10 Up to $25 Premium anti-reflective coatings as follows: Premium anti-reflective coatings as follows: $22 Up to $25 $33 Up to $25 80% of charge less $35 allowance Up to $25 $10 Up to $40
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Vision Insurance
EMPLOYEE BENEFITS
Humana Vision care services Standard plastic lenses 4 • Premium progressive – Tier 1 – Tier 2 – Tier 3 – Tier 4 Photochromatic / plastic transitions Polarized Contact lenses 5 (applies to materials only) • Conventional • Disposable • Medically necessary Frequency • Examination • Lenses or contact lenses • Frame Diabetic Eye Care: care and testing for diabetic members • Examination - Up to (2) services per year • Retinal Imaging - Up to (2) services per year • Extended Ophthalmoscopy - Up to (2) services per year • Gonioscopy - Up to (2) services per year • Scanning Laser - Up to (2) services per year Optional benefits • 12-month Frame Benefit • Polycarbonate Lenses for Children <19 •
•
1
2
3 4 5
If you use an IN-NETWORK provider (Member cost)
If you use an OUT-OF-NETWORK provider (Reimbursement)
Premium progressives as follows: $45 $55 $70 $25 copay, 80% of charge less $120 allowance $75 80% of charge
Premium progressives as follows: Up to $40 Up to $40 Up to $40 Up to $40
$160 allowance, 15% off balance over $160 $160 allowance $0
$128 allowance $128 allowance $210 allowance
Once every 12 months Once every 12 months Once every 12 months
Once every 12 months Once every 12 months Once every 12 months
$0
Up to $77
$0
Up to $50
$0
Up to $15
$0
Up to $15
$0
Up to $33
Not covered Not covered
Benefit replaces the 24-month frequency of the base plan. Provides for standard polycarbonate lens with $0 copay. Not available in AK, CT, ID, & OH.
Member costs may exceed $39 with certain providers. Members may contact their participating provider to determine what costs or discounts are available. Standard contact lens exam fit and follow up costs and premium contact lens exam discounts up to 10% may vary by participating provider. Members may contact their participating provider to determine what costs or discounts are available. Discounts may be available on all frames except when prohibited by the manufacturer. Lens option costs may vary by provider. Members may contact their participating provider to determine if listed costs are available. Plan covers contact lenses or frames, but not both.
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Disability Insurance
EMPLOYEE BENEFITS
The Hartford 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/galvestonisd
EDUCATOR DISABILITY INSURANCE OVERVIEW What is Educator Disability Educator Disability insurance combines the features of a short-term and long-term disability plan into one Income Insurance? policy. The coverage pays you a portion of your earnings if you cannot work because of a disabling illness or injury. The plan gives you the flexibility to choose a level of coverage to suit your need.
Why do I need Disability Insurance Coverage?
You have the opportunity to purchase Disability Insurance through your employer. This highlight sheet is an overview of your Disability Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail. More than half of all personal bankruptcies and mortgage foreclosures are a consequence of disability1 1
Facts from LIMRA, 2016 Disability Insurance Awareness Month
The average worker faces a 1 in 3 chance of suffering a job loss lasting 90 days or more due to a disability2 2
Facts from LIMRA, 2016 Disability Insurance Awareness Month
Only 50% of American adults indicate they have enough savings to cover three months of living expenses in the event they’re not earning any income3 3
Federal Reserve, Report on the Economic Well-Being of U.S. Households in 2018
ELIGIBILITY AND ENROLLMENT Eligibility Enrollment Effective Date Actively at Work
You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis. You can enroll in coverage within 31 days of your date of hire or during your annual enrollment period. Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect. 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.
FEATURES OF THE PLAN Benefit Amount
You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $8,000 that cannot exceed 66 2/3% of your current monthly earnings. Earnings are defined in The Hartford’s contract with your employer. Disability - per $200 in benefit Elimination Period Plan 1 0/7 $5.44 14/14 $5.20 30/30 $4.28 60/60 $2.92 90/90 $2.54 180/180 $1.96
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Disability Insurance
EMPLOYEE BENEFITS
The Hartford Elimination Period
Maximum Benefit Duration
You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a Disability benefit payment. The elimination period that you select consists of two numbers. The first number shows the number of days you must be disabled by an accident before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin. For those employees electing an elimination period of 30 days or less, if you are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization. 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 Prior to 63 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 and older
Maximum Benefit Duration To Normal Retirement Age or 48 months if greater To Normal Retirement Age or 42 months if greater 36 months 30 months 27 months 24 months 21 months 18 months
PROVISIONS OF THE PLAN Pre-Existing Condition Limitation
Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have been insured under this policy for 12 months before your disability begins. If your disability is a result of a pre-existing condition, we will pay benefits for a maximum of 90 Days
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Cancer Insurance
EMPLOYEE BENEFITS
MetLife administered by Bay Bridge 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/galvestonisd
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-of-town 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 MetLife/Baybridge Administrators helps pay for these direct and indirect treatment costs so you can focus on your health Cancer Employee Only Employee and Spouse Employee and Child(ren) Employee and Family
Low $18.94 $39.11 $25.40 $45.56
High $30.53 $62.73 $40.10 $72.29
Low $100 per day up to $3,000 $200 per day $5,000 $0 $5,000 $1,000 per month $50 per year
High $100 per day up to $4,500 $500 per day $10,000 $0 $5,000 $1,000 per month $75 per year
Variable Benefit Elections Benefit Hospital Confinement Surgical Radiation/Chemotherapy First Diagnosis Colony Stimulating Factors Miscellaneous Diagnostic Services Self-Administered Drugs Wellness
INTENSIVE CARE UNIT (ICU) BENEFIT | $325 per covered person per day of confinement
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Accident Insurance
EMPLOYEE BENEFITS
The Hartford 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/galvestonisd
With Accident insurance, you’ll receive payment(s) associated with a covered injury and related services. You can use the payment in any way you choose – from expenses not covered by your major medical plan to day-to-day costs of living such as the mortgage or your utility bills. Accident
COVERAGE INFORMATION You have a choice of two accident plans, which allows you the flexibility to enroll for the coverage that best meets your needs. This insurance provides benefits when injuries, medical treatment and/or services occur as the result of a covered accident. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s).
Employee Only Employee and Spouse Employee and Child(ren) Employee and Family
PLAN INFORMATION Coverage Type BENEFITS EMERGENCY, HOSPITAL & TREATMENT CARE Accident Follow-Up Up to 3 visits per accident Acupuncture/Chiropractic Care Up to 10 visits each per accident Ambulance – Air Once per accident Ambulance – Ground Once per accident Blood/Plasma/Platelets Once per accident Child Care Up to 30 days per accident while insured is confined Daily Hospital Confinement Up to 365 days per lifetime Daily ICU Confinement Up to 30 days per accident Diagnostic Exam Once per accident Emergency Dental Once per accident Emergency Room Once per accident Health Screening Benefit Once per year for each covered person Hospital Admission Once per accident Initial Physician Office Visit Once per accident Lodging Up to 30 nights per lifetime Medical Appliance Once per accident Physical Therapy Up to 10 visits each per accident Rehabilitation Facility Up to 15 days per lifetime Transportation Up to 3 trips per accident Urgent Care Once per accident X-ray Once per accident 28
Plan 2 $5.56 $8.72 $9.20 $14.50
Plan 3 $8.76 $13.78 $14.64 $23.02
LOW PLAN On and off-job (24 hour) LOW PLAN
HIGH PLAN On and off-job (24 hour) HIGH PLAN
$75 $25 $1,500 $500 $200 $25 $200 $400 $200 Up to $300 $150 $50 $1,000 $75 $125 $100 $50 $150 $400 $100 $100
$100 $50 $2,000 $750 $300 $35 $400 $600 $300 Up to $450 $200 $50 $1,500 $100 $150 $200 $75 $300 $600 $150 $150
Accident Insurance
EMPLOYEE BENEFITS
The Hartford BENEFITS SPECIFIED INJURY & SURGERY Abdominal/Thoracic Surgery Arthroscopic Surgery Burn Burn – Skin Graft Concussion Dislocation Eye Injury Fracture Hernia Repair Joint Replacement Knee Cartilage Laceration Ruptured Disc Tendon/Ligament/Rotator Cuff CATASTROPHIC Accidental Death
LOW PLAN Once per accident Once per accident Once per accident Once per accident for third degree burn(s) Up to 3 per year Once per joint per lifetime Once per accident Once per bone per accident Once per accident Once per accident Once per accident Once per accident Once per accident Once per accident
Common Carrier Death
Within 90 days
Within 90 days; Spouse @ 50% and child @ 25%
Coma Once per accident Dismemberment Once per accident Home Health Care Up to 30 days per accident Paralysis Once per accident Prosthesis Once per accident FEATURES Ability Assist® EAP2 – 24/7/365 access to help for financial, legal or emotional issues HealthChampionSM3 – Administrative & clinical support following serious illness or injury
HIGH PLAN
$2,000 $3,000 $250 $500 Up to $10,000 Up to $15,000 50% of burn benefit 50% of burn benefit $150 $200 Up to $4,000 Up to $8,000 Up to $500 Up to $750 Up to $8,000 Up to $10,000 $200 $400 $2,000 $4,000 Up to $1,000 Up to $2,000 Up to $500 Up to $1,000 $1,000 $2,000 Up to $1,500 Up to $2,000 $50,000 1.5 times death benefit $10,000 Up to $50,000 $50 Up to $50,000 Up to $2,000
$75,000 1.5 times death benefit $15,000 Up to $75,000 $75 Up to $75,000 Up to $3,000
Included Included
Included Included
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Critical Illness Insurance
EMPLOYEE BENEFITS
UNUM 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/galvestonisd
Critical Illness Employee & Spouse
$10,000
$20,000
$30,000
<25
$1.10
$2.20
$3.30
25-29
$1.40
$2.80
$4.20
30-34
$1.80
$3.60
$5.40
35-39
$2.60
$5.20
$7.80
40-44
$3.50
$7.00
$10.50
45-49
$5.00
$10.00
$15.00
50-54
$6.90
$13.80
$20.70
55-59
$9.00
$18.00
$27.00
60-64
$13.20
$26.40
$39.60
65-69
$20.80
$41.60
$62.40
70-74
$38.40
$76.80
$115.20
75-79
$65.50
$131.00
$196.50
80-84
$112.50
$225.00
$337.50
85 or over
$206.10
$412.20
$618.30
Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. Who is eligible for All employees in active employment in the United States working at least 18.75 hours per week and their this coverage? eligible spouses and children (up to age 26 regardless of student or marital status). What are the Critical The following coverage amounts are available. Illness coverage For you: Select one of the following amounts? $10,000, $20,000 or $30,000
Can I be denied coverage? When is coverage effective? 30
For your Spouse: 100% of employee coverage amount For your Children: 100% of employee coverage amount *Children added at no additional cost when the employee enrolls in coverage Coverage is guarantee issue. Please see your Plan Administrator for your effective date of coverage. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.
Critical Illness Insurance UNUM What critical illness conditions are covered?
EMPLOYEE BENEFITS
Covered Conditions*
Percentage of Coverage Amount Critical Illnesses Coronary Artery Disease (major) 50% Coronary Artery Disease (minor) 10% End Stage Renal (Kidney) Failure 100% Heart Attack (Myocardial Infarction) 100% Major Organ Failure Requiring Transplant 100% Stroke 100% Supplemental Critical Illnesses Benign Brain Tumor 100% Coma 100% Loss of Hearing 100% Loss of Sight 100% Loss of Speech 100% Infectious Disease 25% Occupational Human Immunodeficiency Virus (HIV) or Hepatitis 100% Permanent Paralysis 100% Progressive Diseases Amyotrophic Lateral Sclerosis (ALS) 100% Dementia (including Alzheimer’s Disease) 100% Functional Loss 100% Multiple Sclerosis (MS) 100% Parkinson’s Disease 100% Additional Critical Illnesses for your Children Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Down Syndrome 100% Spina Bifida 100% *Please refer to the policy for complete definitions of covered conditions. Covered Condition Benefit The covered condition benefit is payable once per covered condition per insured. Unum will pay a covered condition benefit for a different covered condition if: • the new covered condition is medically unrelated to the first covered condition; or • the dates of diagnosis are separated by more than 180 days. Reoccurring Condition Benefit We will pay the reoccurring condition benefit for the diagnosis of the same covered condition if the covered condition benefit was previously paid and the new date of diagnosis is more than 180 days after the prior date of diagnosis.
The benefit amount for any reoccurring condition benefit is 100% of the percentage of coverage amount for that condition. The following Covered Conditions are eligible for a reoccurring condition benefit: Benign Brain Tumor Heart Attack (Myocardial Infarction) Coma Major Organ Failure Requiring Transplant Coronary Artery Disease (Major) Stroke Coronary Artery Disease (Minor) End Stage Renal (Kidney) Failure
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Life and AD&D
EMPLOYEE BENEFITS
UNUM 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/galvestonisd
Age <25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
Voluntary Group Life Employee per $10K $0.30 $0.40 $0.50 $0.70 $1.10 $1.80 $2.80 $4.70 $5.90 $10.30 $16.50 $25.40
Spouse per $5K $0.15 $0.20 $0.25 $0.35 $0.55 $0.90 $1.40 $2.35 $2.95 $5.15 $8.25 $12.70
Voluntary Group Life - Child(ren) $2,000 in coverage 0-26 $0.20 Basic Life and AD&D $10,000.00 Employer Paid
Employee Spouse Child
AD&D per $10,000 per $5,000 per $2,000
$0.15 $0.08 $0.03
Galveston Independent School District Voluntary Life and AD&D Insurance Plan Highlights Who is eligible for this All actively employed employees working at least 18.75 hours each week for your employer in the U.S. coverage? and their eligible spouses and children to age 26. What are the Life coverage Employee: up to 10 times salary in increments of $10,000; not to exceed $500,000. amounts? Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $250,000.
What are the AD&D coverage amounts?
Child: up to 100% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $250. Employee: up to 10 times salary in increments of $10,000; not to exceed $500,000. Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $250,000. Child: up to 100% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $250. Note: You may purchase AD&D coverage for yourself regardless of whether you purchase term life coverage. In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself.
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Life and AD&D
EMPLOYEE BENEFITS
UNUM Can I be denied coverage?
If you and your eligible dependents enroll before the enrollment deadline, you may apply for any amount of coverage up to guarantee issue for yourself and any amount of coverage up to the guarantee issue for your spouse, without answering any medical questions. Guarantee issue amounts are as follows:
New Hire Guarantee Issue Amounts
Employee: $250,000 Spouse: $50,000 Child: $10,000 New Hires: If you want coverage over the amount you are guaranteed, you will need to provide answers to health questions. In addition, if you and your eligible dependents do not enroll during this enrollment period, you will have to wait for a future annual enrollment period to apply — and then you will need to answer health questions for the entire amount of coverage you apply for.
Do my life insurance benefits decrease with age?
New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense. Coverage amounts will reduce according to the following schedule: Age: 70
Insurance amount reduces to: 50% of original amount
Coverage may not be increased after a reduction.
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Individual Life Insurance 5Star Life Insurance
EMPLOYEE BENEFITS
ABOUT INDIVIDUAL LIFE Individual insurance is a policy that covers a single person and is intended to meet the financial needs of the beneficiary, in the event of the insured’s death. This coverage is portable and can continue after you leave employment or retire.
For full plan details, please visit your benefit website: www.mybenefitshub.com/galvestonisd
The 5Star Life Insurance Company’s Family Protection Plan Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy. CUSTOMIZABLE With several options to choose from, employees select the coverage that best meets the needs of their families. TERMINAL ILLNESS ACCELERATION OF BENEFITS Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL). PORTABLE Coverage continues with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly. CONVENIENCE Easy payments through payroll deduction. FAMILY PROTECTION Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves. * Financially dependent children 14 days to 23 years old.
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PROTECTION TO COUNT ON Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two-year contestability period and/or under investigation. This coverage has no war or terrorism exclusions.
QUALITY OF LIFE Optional benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following: • Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or • Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.
Identity Theft
EMPLOYEE BENEFITS
Aura - Identity Guard 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/galvestonisd
Identity Theft Is Growing Better Protect You and Your Family Fraud continues to grow more complex. And, 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. Identity Secure Near Real-Time Alerts Auto-On Monitoring Credit and debit card monitoring Bank account transaction monitoring 401(k) investment account monitoring Student loan activity alerts High Risk Transaction Monitoring Bank Account Opening & Takeover Monitoring Address Monitoring Criminal Record Monitoring Fictious Identity Monitoring Home Title Monitoring Sex Offender Monitoring Dark Web Monitoring Human-sourced intelligence Compromised credentials Stolen fund reimbursement 401(k) and HSA reimbursement $1,000,000 Identity Theft Insurance Security Freeze Assistance Threat Alerts Risk Management Score Social Insight Report Lost Wallet Protection 1-Bureau Credit Monitoring 3-Bureau Credit Monitoring 3-Bureau Annual Credit Report Monthly Credit Score Credit Score Tracker Device Secure Safe Browsing Software Anti-virus VPN Anti-adware Privacy Secure Robo-call/robo-text protection Device/cookie tracking protection E-mail solicitation/junk mail prevention Data broker list monitoring/removal
Identity Theft Premier Employee $7.50 Employee and Family $13.50 Total ✓ ✓
Ultimate $9.50 $18.50
Premier ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Ultimate ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓ ✓
✓ ✓ ✓ ✓
✓ ✓ ✓ ✓
✓
✓
✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓
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Legal Services
EMPLOYEE BENEFITS
LegalEASE ABOUT LEGAL SERVICES Legal plans provide benefits that cover the most common legal needs you may encounter - like creating a standard will, living will, healthcare power of attorney or buying a home.
For full plan details, please visit your benefit website: www.mybenefitshub.com/galvestonisd
LegalEASE offers an insurance plan that provides support and protection from unexpected personal legal issues.
Plan Details: $7.45 per pay-period*, via payroll deduction
FAMILY Separation, Divorce, Post-Divorce Proceedings, Prenuptial Agreement, Name Change, Guardianship/Conservatorship, Adoptions, Juvenile Court Proceedings
Who’s covered: • Employee • Spouse • Dependent Children (Up to age 26) *Based on a 26 pay-period deduction schedule. Legal Employee and Family
$16.15
The value of a LegalEASE insurance plan. Being a member saves costly legal fees and provides coverage for: HOME & RESIDENTIAL Purchase of Primary Residence, Sale of Primary Residence, Refinancing of Primary Residence, Vacation or Investment Home Sale/Purchase/ Refinancing, Tenant Dispute, Tenant Security Deposit Dispute, Landlord Dispute with Tenant, Security Deposit Dispute with Tenant, Construction Defect Dispute, Neighbor Dispute, Noise Reduction Dispute, Foreclosure AUTO & TRAFFIC Traffic Ticket, Serious Traffic Matters (Resulting in Suspension or Revocation of License), Administrative Proceeding (Regarding Suspension or Revocation of License), First-time Vehicle Buyer, Vehicle Repair and Lemon Law Litigation, DUI/DWI Defense ESTATE PLANNING & WILLS Will or Codicil, Living Will, Health Care Power of Attorney, Living Trust Document, Probate of Small Estate FINANCIAL & CONSUMER Debt Collection: Pre-litigation Defense & Trial Defense, Bankruptcy (Chapter 7 or 13), Tax Audits, Student Loan 36
Refinancing/Collection Defense, Document Preparation, Consumer Dispute, Small Claims Court, Financial Advisor, Mail Order or Internet Purchase Dispute, Bank Fee Dispute, Cell Phone Contract Dispute, Warranty Dispute, Healthcare Coverage Disputes and Records, Identity Theft Defense
GENERAL Civil Litigation Defense, Incompetency Defense, Initial Law Office Consultation, Review of Simple Documents, Discounted Contingency Fees, Mediation, Misdemeanor Defense Limitations apply. Please visit https://www.legaleaseplan.com/gisd for specific plan benefits. For more information, visit: https://www.legaleaseplan.com/gisd To learn more, call: 1(800) 248-9000 and reference “Galveston ISD”
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 plan also allows employees to pay for qualifying daycare expenses tax-free. This money is use it or lose it within the plan year (your plan contains a 75-day grace period provision). For full plan details, please visit your benefit website: www.mybenefitshub.com/galvestonisd
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).
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).
Important FSA Rules •
Limited Purpose Health Care FSA A Limited Purpose Health Care FSA is available if you 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: • Dental and orthodontia care (i.e., fillings, X-rays and braces) • • Vision care (e.g., eyeglasses, contact lenses and LASIK surgery)
How the Health Care and Limited Purpose FSAs Work You can access the funds in your Health Care or Limited Purpose FSA two different ways: • Use your Higginbotham Benefits Debit Card to pay for qualified expenses, doctor visits and prescription copays. • Pay out-of-pocket and submit your receipts for reimbursement: Fax – 866-419-3516 Email – flexclaims@higginbotham.net Online – https://flexservices.higginbotham.net
Higginbotham Benefits Debit Card
•
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. You cannot change your election during the year unless you experience a Qualifying Life Event. You can continue to file claims incurred during the plan year for another xx days (up until date). Your Health Care or Limited Purpose FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses. 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-thecounter (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.
The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care or Limited Purpose FSA when 37
Flexible Spending Account (FSA) Higginbotham
EMPLOYEE BENEFITS
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
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Notes
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2022 - 2023 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 Galveston 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 Galveston 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/GALVESTONISD 40
