2022 - 2023 Plan Year
GOOSE CREEK CISD
BENEFIT GUIDE EFFECTIVE: 09/01/2022 - 8/31/2023 WWW.MYBENEFITSHUB.COM/GOOSECREEKCISD
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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 Critical Illness Cancer Accident Life and AD&D Individual Life Flexible Spending Account (FSA)
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11 12-13 14 15 16 17 18 19-20 21-22 23 24-25 26-27 28 29-30
PG. 4
HOW TO ENROLL
PG. 6
SUMMARY PAGES
PG. 12
YOUR BENEFITS
Benefit Contact Information MEDICAL
HEALTH SAVINGS ACCOUNT (HSA)
HOSPITAL INDEMNITY
Texas Schools Health Benefits Program GCEFCU (TSHBP) (800) 683-3863 (888) 803-0081 www.gcefcu.org All Plans: www.tshbp.org Pharmacy Benefits: SouthernScripts Group #50000 https://tshbp.info/DrugPham
Cigna (800) 754-3207 www.cigna.com
TELEHEALTH
DENTAL
VISION
MDLIVE (866) 365-1663 www.consultmdlive.com
Lincoln Financial Group (800) 487-1485 www.lfg.com
EyeMed (866) 939-3633 www.eyemed.com
DISABILITY
CRITICAL ILLNESS
CANCER
The Hartford Group #681973 (866) 547-9124 www.thehartford.com
Unum (866) 679-3054 www.unum.com
Bay Bridge Administrators Group #GP18-BB-SD (800) 845-7519 www.baybridgeadministrators.com/
ACCIDENT
LIFE AND AD&D
INDIVIDUAL LIFE
MetLife (800) 638-5433 www.metlife.com
Lincoln Financial Group Group #997734 (800) 487-1485 www.lfg.com
Texas Life (800) 283-9233 www.texaslife.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 GCCISD” 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 #: FBSGCCISD
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Text “FBS GCCISD” to (800) 583-6908 OR SCAN
How to Log In 1
www.mybenefitshub.com/goosecreekcisd
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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 Benefit Updates - What’s New: Medical Goose Creek CISD will no longer be offering TRS ActiveCare medical insurance. All medical plans will be offered through the Texas Schools Health Benefits Program. Plan options include: • Two Directed Care Plan Options HD Plan Copay Plan • Two Aetna Traditional PPO Options HD Plan Aetna Signature Plan New Flex and Dependent Care Administrator The administration of these plans is moving to Higginbotham. All who enroll will receive new debit cards. Employees are encouraged to use up their current funds prior to September 1st to ease the transition to the new administrator. IRS has established new contribution limits for Flex and HSA! • Flex - $2,850 • HSA - $3,650 Individual, $7,000 Family. Those age 55+ can contribute an additional $1,000
Don’t Forget! • Login and complete your benefit enrollment from 05/02/2022-05/27/2022 • Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202. • Update your information: home address, phone numbers, email, and beneficiaries. • REQUIRED!! Due to the Affordable Care Act (ACA) reporting requirements, you must add your dependent’s CORRECT social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator. 6
SUMMARY PAGES
Annual Benefit Enrollment
SUMMARY PAGES
Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
CHANGES IN STATUS (CIS): Marital Status
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 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
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 eligibility 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/ goosecreekcisd. 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 Goose Creek CISD benefit website: www.mybenefitshub.com/goosecreekcisd. 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
Medical and Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.
Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2022 benefits become effective on September 1, 2022, you must be actively-at-work on September 1, 2022 to be eligible for your new benefits. PLAN
MAXIMUM AGE
TSHBP
To age 26
Cigna
To age 26
MDLIVE
To age 26
Lincoln Financial Group
To age 26
EyeMed
To age 26
MetLife
To age 26
UNUM
To age 26
MetLife
To age 26
Lincoln Financial Group
To age 26
Texas Life
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.
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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 prescriptions 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
Description
Employer Eligibility Contribution Source Account Owner Underlying Insurance Requirement Minimum Deductible Maximum Contribution
Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, tax-free. This also allows employees to pay for qualifying dependent care tax-free.
A qualified high deductible health plan. Employee and/or employer Individual
All employers Employee and/or employer Employer
High deductible health plan
None
$1,400 single (2022) $2,800 family (2022) $3,650 single (2022) $7,300 family (2022)
N/A $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. However, your plan has a 45-day grace period.
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
FLIP TO FOR HSA INFORMATION
PG. 14
FLIP TO FOR FSA INFORMATION
PG. 29
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Medical Insurance Texas Schools Health Benefits Program
EMPLOYEE BENEFITS
ABOUT TSHBP The TSHBP is proud to offer a variety of plans and benefits to meet your school district’s needs. All plans are designed so members can easily navigate through their health medical needs.
For full plan details, please visit your benefit website: www.mybenefitshub.com/goosecreekcisd
Directed Care Highlights
Aetna Network Highlights
The TSHBP Directed Care Plans utilize a national network to provide physician and ancillary services access to all members. Enrolled school districts will access the HealthSmart practitioner and ancillary only network to gain access to over 478,000 providers in over 1,222,000 unique locations across the United States, Please note, hospitals are excluded from the PPO networks. All hospital and other medical facility-based services are accessed via an assigned Care Coordinator.
You want a network that is comprehensive, is easy to use and can help you save on costs. Look no further. You can now find support through our Aetna Signature Administrators® preferred provider organization network. Discover provider options and reduced costs.
TSHBP members will experience the lowest out-of-pocket costs for physician and ancillary medical services when utilizing network providers. HealthSmart Network Solutions’ Physician and Ancillary Only Primary PPO contains approximately 478,000 contracted providers in over 1,222,000 unique locations across the country. It is easy to look up providers in your area by looking up providers in your area by clicking on the link below. Your searches can be saved to your computer or sent to your email. https://tshbp.info/HSNetwork
Access the MyTSHBP Digital Wallet for easy access to all your benefit resources.
With our network, you now have access to over 1.2 million participating doctors, 8,700 hospitals, and strong, negotiated discounts. We know quality care is important. So we make sure our doctors successfully complete our credentialing requirements. Our credentialing process meets industry standards, as well as state and federal requirements. You’ll also have access to over 600 Institutes of Excellence™ facilities and Institutes of Quality® facilities. We measure these publicly recognized institutes by clinical performance, outcomes and efficiency. Then, we pass this guidance along to you—so you can choose the best facility. No one likes changing doctors every year. We make it easier, so you don’t have to. Our local network teams work with doctors and hospitals to promote effective member care and better customer satisfaction. As a result, the turnover in our network is remarkably low, year after year. Ready to search our network? Just visit http://aetna.com/asa
PPO Deductible Credits With the Aetna PPO plans, if you choose to utilize the services of a Care Coordinator for a procedure or admission to a facility, you will receive a $500 credit toward your deductible1. If you have already met your deductible, the $500 credit will apply to your out-of-pocket maximum! 1
On the HDHP plan, a member must meet a minimum of $1,400 of the deductible accumulation before receiving the credit to comply with HSA requirements. 12
Medical Insurance
EMPLOYEE BENEFITS
Texas Schools Health Benefits Program DIRECTED CARE PLANS High Deductible CoPay (Current) (Current)
AETNA NETWORK PLANS Aetna HD Aetna Signature (New) (New)
Directed Care Plan • Use CC for Hospital/ Surgical Services • Compatible with an HSA • Lowest HD Premium Plan • Out-of-Network Benefits In-Network
Directed Care Plan • Use CC for Hospital/ Surgical Services • Co-payments for Services • Reduce Out-of-Pocket • Out-of-Network Benefits In-Network
Traditional PPO Plan • Compatible with an HSA • Network for all physician and hospital services
Traditional PPO Plan • Lowest Deductible Plan • Brand Drug Deductible • Network for all physician and hospital services
In-Network
In-Network
$3,000/$9,000
$0 Deductible
$3,000/$6,000
$2,000/$4,000
None - Plan Pays 100% after deductible $3,000/$9,000
None - Plan Pays 100% after out-of-pocket is met $3,500/$10,500
You pay 30% after deductible $7,000/$14,000
You pay 25% after deductible $7,500/$15,000
HealthSmart
HealthSmart
Aetna
Aetna
PCP Required
No
No
No
No
PCP Referral to Specialist
No
No
No
No
Yes - $0 copay Deductible, then Plan pays 100% Deductible, then Plan pays 100% $30 per consultation
Yes - $0 copay
Yes - $0 copay You pay 30% after deductible You pay 30% after deductible $30 per consultation
Yes - $0 Copay
PLAN SUMMARY
Plan Features Individual/Family Deductible Coinsurance Ind/Fam Out of Pocket National Network
Doctor Visits Preventive Care Primary Care
Specialist Virtual Health
$35 copay
$35 copay $0 per consultation
$30 copay
$70 copay $0 per consultation
Care Facilities Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100%
$500 copay
Integrated with medical 30-Day Supply / 90-Day Supply
No deductible 30-Day Supply / 90-Day Supply
Deductible, then Plan pays 100%
$0 at selected pharmacies; others $10/$20 copay
Deductible, then Plan pays 100% Deductible, then Plan pays 100%
$35 copay or 50% copay (max $100) $70 copay or 50% copay (max $200)
Limited - PAP Required
Limited - PAP Required
Employee Cost (District Contribution of $275) Employee Only
$100.00
Employee/Spouse Employee/Child
Urgent Care Emergency Care Outpatient Surgery
$50 copay
$500 copay
You pay 30% after deductible You pay 30% after deductible You pay 30% after deductible
$50 copay You pay $500 copay + 25% after deductible You pay 25% after deductible
Prescriptions Drug Deductible Days Supply
Generics Preferred Brand Non-preferred Brand Specialty
Employee/Family
Integrated with medical 30-Day Supply / 90-Day Supply You pay 20% after deductible; $0 for certain generics You pay 25% after deductible You pay 50% after deductible Full Coverage - PAP Required
$500 brand deductible 30-Day Supply / 90-Day Supply
$142.00
$149.00
$196.00
$750.00
$892.00
$918.00
$957.00
$426.00
$518.00
$487.00
$525.00
$1,068.00
$1,265.00
$1,151.00
$1,237.00
$15/$45 copay You pay 25% after deductible You pay 50% after deductible Full Coverage - PAP Required
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Health Savings Account (HSA) GCEFCU
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/goosecreekcisd
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.
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.
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 taxfree 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.
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
HSA Eligibility You are eligible to open and contribute to an HSA if you are: • Enrolled in an HSA-eligible HDHP (TSHBP HD, Aetna 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 14
Maximum Contributions
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.
Hospital Indemnity
EMPLOYEE BENEFITS
Cigna 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/goosecreekcisd
The Hospital Indemnity Plan provided through Cigna 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. If you need to submit a claim you do so by calling 800-754-3207. Hospitalization Benefits Hospital Admission No Elimination Period. Limited to 1 day, 1 benefit(s) every 365 days. Hospital Chronic Condition Admission No Elimination Period. Limited to 1 day, 1 benefit(s) every 90 days. Hospital Stay No Elimination Period. Limited to 30 days, 1 benefit(s) every 90 days. Hospital Intensive Care Unit (ICU) Stay No Elimination Period. Limited to 30 days, 1 benefit(s) every 90 days. Hospital Observation Stay 24 hour Elimination Period. Limited to 72 hours. Newborn Nursery Care Admission Limited to 1 day, 1 benefit per newborn child. This benefit is payable to the employee even if child coverage is not elected. Newborn Nursery Care Stay Limited to 30 days, 1 benefit per newborn child. This benefit is payable to the employee even if child coverage is not elected.
Plan 1
Plan 2
$1,500
$2,500
$50
$50
$100
$200
$200
$300
$100 per 24-hour period
$100 per 24-hour period
$500
$500
$100
$100
Portability Feature: You, your spouse, and child(ren) can continue 100% of your coverage at the time your coverage ends. You must be covered under the policy and be under the age of 100 in order to continue your coverage. Rates may change and all coverage ends at age 100. Applies to United States Citizens and Permanent Resident Aliens residing in the United States. Hospital Indemnity Tier Plan 1 Employee Only $16.86 Employee & Spouse $30.12 Employee & Child(ren) $27.78 Employee & Family $41.04
Plan 2 $27.20 $47.98 $43.72 $64.48 15
Telehealth
EMPLOYEE BENEFITS
MDLive with Behavioral Health 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/goosecreekcisd
Welcome to MDLIVE! Your anytime, anywhere doctor’s office. Avoid waiting rooms and the inconvenience of going to the doctor’s office. Visit a doctor by phone, secure video, or MDLIVE App. Pediatricians are available 24/7, and family members are also eligible. • U.S. board-certified doctors with an average of 15 years of experience. • Consultations are convenient, private and secure. • Prescriptions can be sent to your nearest pharmacy, if medically necessary.
Need a doctor? No long wait. No big bill. Always open. With MDLIVE, you can visit with a doctor 24/7 from your home, office or on-the-go.
We treat over 50 routine medical conditions including: • • • • • • •
Acne Allergies Cold / Flu Constipation Cough Diarrhea Ear Problems
• • • • • •
Fever Headache Insect Bites Nausea / Vomiting Pink Eye Rash
Introducing the MDLIVE App
• • • • •
Respiratory Problems Sore Throats Urinary Problems / UTI Vaginitis And More
Your Monthly Premium is $12.00 Join for free. Visit a doctor. consultmdlive.com 888-365-1663
Welcome to MDLIVE Behavioral Health! Managing stress or life changes can be overwhelming but it’s easier than ever to get help right in the comfort of your own home. Visit a counselor or psychiatrist by phone, secure video, or MDLIVE App. • Talk to a licensed counselor or psychiatrist from your home, office, or on the go! • Affordable, confidential online therapy for a variety of counseling needs. • The MDLIVE app helps you stay connected with appointment reminders, important notifications and secure messaging.
Confidential, convenient online therapy. With MDLIVE, you can visit with a counselor or psychiatrist 24/7 from your home, office or on-the-go.
We can help you address: • • •
Addictions Bipolar Disorders Child and Adolescent Issues Depression Eating Disorders
• • • • • •
Grief and Loss Life Changes Men’s Issues Panic Disorders Parenting Issues Postpartum Depression
• • • • •
Relationship and Marriage Issues Stress Trauma and PTSD Women’s Issues And more
• Sick in bed? Sick at work? Got a smartphone? Doctor visits are • easier than ever with the MDLIVE App. • Access to a doctor anywhere: at home, at work, or on the go • Choose doctors from one of the nation's largest telehealth Refer to fee schedule for additional visit copays. networks • Available 24/7 by video or phone Private, secure and confiYour doctor will send prescriptions (if medically necessary) to dential visits your nearest pharmacy. • Connect instantly with MDLIVE Assist mdlive.com/getapp
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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/goosecreekcisd
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.
Schedule of Benefits Low Plan
Plan Deductible (Annually on a Plan Year Basis) Individual Family Deductible applies to: Benefit Levels Type 1 – Diagnostic & Preventative Type 2 – Basic Services Type 3 – Major Services Type 4 – Orthodontic Services Benefits Based On Maximum Benefit (per covered person): Types 1, 2 & 3 combined Type 4, while covered by the plan Benefit Waiting Period Type 2 Expenses Type 3 Expenses Type 4 Expenses Late Entrant Limitation Type 2 Expenses Type 3 Expenses Type 4 Expenses
DPPO Plan 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-of-network provider. High Plan
Contracted Dentist
Non Contracted Dentist
Contracted Dentist
Non Contracted Dentist
$50 $150 Type 2 & 3
$50 $150 Type 2 & 3
$50 $150 Type 2 & 3
$50 $150 Type 2 & 3
100% 50% 50% Negotiated Fees
100% 50% 50% U&C
100% 80% 50% 50% Negotiated Fees
100% 80% 50% 50% U&C
$750 Per Plan Year -
$750 Per Plan Year -
$1,500 Per Plan Year $1,000 Lifetime
$1,500 Per Plan Year $1,000 Lifetime
None None None
None None None
None None None
None None None
DHMO Plan If you enroll in the DHMO plan, you must select a Primary Care Dentist (PCD) from the DHMO network directory to manage your care. Each eligible dependent may choose their own PCD. Dental services are unlimited, you pay fixed copays, there are no deductibles and there are no claim forms to file. There is no coverage for services provided without a referral from your PCD or if you seek care from out-of -network providers.
Dental LOW Employee Only $19.70 Employee and Spouse $36.76 Employee and Child(ren) $42.90 Employee and Family $50.32
HIGH $28.30 $54.12 $69.48 $80.90
DHMO $12.60 $24.60 $26.60 $38.44
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 17
Vision Insurance
EMPLOYEE BENEFITS
EyeMed 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/goosecreekcisd
VISION CARE SERVICES EXAM SERVICES Exam Retinal Imaging CONTACT LENS FIT AND FOLLOW-UP Fit & Follow-up - Standard Fit & Follow-up - Premium FRAME Frame STANDARD PLASTIC LENSES Single Vision Bifocal Trifocal Lenticular Progressive - Standard Progressive - Premium Tier 1 - 4 LENS OPTIONS Anti Reflective Coating - Standard Anti Reflective Coating - Premium Tier 1-3 Photochromic - Non-Glass Polycarbonate - Standard Polycarbonate - Standard < 19 years of age Scratch Coating - Standard Plastic Tint - Solid and Gradient UV Treatment All Other Lens Options CONTACT LENSES Contacts - Conventional Contacts - Disposable Contacts - Medically Necessary OTHER Hearing Care from Amplifon Network Lasik or PRK from U.S. Laser Network FREQUENCY Exam Frame Lenses Contacts Lenses
IN-NETWORK MEMBER COST
OUT-OF-NETWORK MEMBER REIMBURSEMENT
$10 copay Up to $39
Up to $45 Not covered
Up to $40; contact lens fit and two follow-up visits 10% off retail price
Not covered
$0 copay; 20% off balance over $180 allowance
Up to $126
$10 copay $10 copay $10 copay $10 copay $65 copay $95-185 copay
Up to $30 Up to $50 Up to $70 Up to $70 Up to $50 Up to $50
$45 copay Up to $23 $57 - 85 copay $75 $40 $0 copay $15 $15 $15 20% off retail price
Up to $23 Not covered Not covered Up to $20 Not covered Not covered Not covered Not covered
$0 copay; 15% off balance over $180 allowance $0 copay; 100% of balance over $180 allowance $0 copay; paid-in-full
Up to $126 Up to $126 Up to $210
Discounts on hearing exam and aids; call 1.877.203.0675 15% off retail or 5% off promo price; call 1.800.988.4221 ALLOWED FREQUENCY –ADULTS Once every plan year Once every plan year Once every plan year Once every plan year
Not covered
Not covered
Employee $8.72 Employee + Spouse $18.64 Employee + Child(ren) $18.14 Family $27.48
Not covered ALLOWED FREQUENCY –KIDS Once every plan year Once every plan year Once every plan year Once every plan year
Visit https://eyedoclocator.eyemedvisioncare.com/ or call (866) 939-3633 to find an in-network vision provider. 18
Vision
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/goosecreekcisd
EDUCATOR DISABILITY INSURANCE OVERVIEW What is Educator Disability Income Insurance? Educator Disability insurance combines the features of a short-term and long-term disability plan into one policy. The coverage pays you a portion of your earnings if you cannot work because of a disabling illness or injury. The plan gives you the flexibility to choose a level of coverage to suit your need.
Effective Date 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.
Actively at Work You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing You have the opportunity to purchase Disability Insurance for wage or profit all of your regular duties in the usual way through your employer. This highlight sheet is an overview and for your usual number of hours. If school is not in of your Disability Insurance. Once a group policy is issued to session due to normal vacation or school break(s), Actively your employer, a certificate of insurance will be available to at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your explain your coverage in detail. Occupation in the usual way for your usual number of Why do I need Disability Insurance Coverage? hours as if school was in session. More than half of all personal bankruptcies and mortgage FEATURES OF THE PLAN foreclosures are a consequence of disability1 1 Facts from LIMRA, 2016 Disability Insurance Awareness Month Benefit Amount The average worker faces a 1 in 3 chance of suffering a job You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and loss lasting 90 days or more due to a disability2 $8,000 that cannot exceed 66 2/3% of your current 2 Facts from LIMRA, 2016 Disability Insurance Awareness Month monthly earnings. Only 50% of American adults indicate they have enough Earnings are defined in The Hartford’s contract with your savings to cover three months of living expenses in the employer. event they’re not earning any income3 3 Federal Reserve, Report on the Economic Well-Being of U.S. Households in 2018 Elimination Period You must be disabled for at least the number of days ELIGIBILITY AND ENROLLMENT indicated by the elimination period that you select before Eligibility you can receive a Disability benefit payment. The You are eligible if you are an active employee who works at elimination period that you select consists of two numbers. least 20 hours per week on a regularly scheduled basis. The first number shows the number of days you must be disabled by an accident before your benefits can begin. The Enrollment second number indicates the number of days you must be You can enroll in coverage within 31 days of your date of disabled by a sickness before your benefits can begin. hire or during your annual enrollment period. For those employees electing an elimination period of 30 19
Disability Insurance The Hartford 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. 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 schedules 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
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 4 weeks.
20
EMPLOYEE BENEFITS Disability (per $100 in benefit) Elimination Period Plan 1 $3.10 0/7 $2.64 14/14 $1.98 30/30 $1.12 60/60 $0.86 90/90 $0.68 180/180
Critical Illness Insurance Unum
EMPLOYEE BENEFITS
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/goosecreekcisd Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. Who is eligible for this coverage?
All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status).
What are the Critical Illness coverage amounts?
The following coverage amounts are available. For you: Select one of the following $10,000, $20,000 or $30,000 For your Spouse and Children: 100% of employee coverage amount
Can I be denied coverage?
Coverage is guarantee issue.
When is coverage effective?
Please see your Plan Administrator for your effective date of coverage. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.
What critical illness conditions are covered?
Covered Conditions* Critical Illnesses Coronary Artery Disease (major) Coronary Artery Disease (minor) End Stage Renal (Kidney) Failure Heart Attack (Myocardial Infarction) Major Organ Failure Requiring Transplant Stroke Supplemental Critical Illnesses Benign Brain Tumor Coma Loss of Hearing Loss of Sight Loss of Speech Infectious Disease Occupational Human Immunodeficiency Virus (HIV) or Hepatitis Permanent Paralysis Progressive Diseases Amyotrophic Lateral Sclerosis (ALS) Dementia (including Alzheimer’s Disease) Functional Loss Multiple Sclerosis (MS) Parkinson’s Disease
Percentage of Coverage Amount 50% 10% 100% 100% 100% 100% 100% 100% 100% 100% 100% 25% 100% 100% 100% 100% 100% 100% 100% 21
Critical Illness Insurance
EMPLOYEE BENEFITS
Unum What critical illness conditions are covered? (cont’d)
Pre-existing Conditions
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. We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following: • a pre-existing condition; or • complications arising from treatment or surgery for, or medications taken for, a preexisting condition. An insured has a pre-existing condition if, within the 3 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which: • medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period; • drugs or medications were taken, or prescribed to be taken during that period; or • symptoms existed. The pre-existing condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date any initial coverage or increases in coverage become effective.
Critical Illness
22
Employee and Spouse
$10,000.00
$20,000.00
$30,000.00
<25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84
$1.10 $1.40 $1.80 $2.50 $3.40 $4.80 $6.60 $8.50 $12.50 $19.90 $37.10 $64.00 $110.60
$2.20 $2.80 $3.60 $5.00 $6.80 $9.60 $13.20 $17.00 $25.00 $39.80 $74.20 $128.00 $221.20
$3.30 $4.20 $5.40 $7.50 $10.20 $14.40 $19.80 $25.50 $37.50 $59.70 $111.30 $192.00 $331.80
85>
$202.90
$405.80
$608.70
Cancer Insurance
EMPLOYEE BENEFITS
Bay Bridge Administrators ABOUT CANCER INSURANCE 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/goosecreekcisd
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 Bay Bridge Administrators helps pay for these direct and indirect treatment costs so you can focus on your health. Cancer Plan Features Benefit
Low
High
Hospital Confinement
$100 per day
$200 per day up
Surgical
up to $1,500
to $3,000
Radiation/Chemotherapy
$500 per day
$500 per day
$2,500
$5,000
$500 per month
$1,000 per month
$5,000
$5,000
$1,000 per month
$1,000 per month
$50 per year
$50 per year
First Diagnosis Colony Stimulating Factors Miscellaneous Diagnostic Services Self-Administered Drugs Wellness
Combined Premiums Base Plan + Intensive Care Rider (ICR- $325 per day) Coverage Tier
Low + $325 ICR
High + $325 ICR
Employee
$16.28
$21.84
Employee + Spouse
$33.17
$44.54
Employee + Child(ren)
$22.80
$29.74
Family
$39.66
$52.42
23
Accident Insurance
EMPLOYEE BENEFITS
MetLife ABOUT ACCIDENT INSURANCE 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/goosecreekcisd
Benefits that may help cover costs such as those not covered by your medical plan. Q. Who do I call for assistance? A. Contact a MetLife Customer Service Representative at 1 800- GET-MET8 (1-800-438-6388), Monday through Friday from 8:00 a.m. to 8:00 p.m., EST. Or visit our website: mybenefits.metflife.com. Benefit Type
Low Plan Benefits
High Plan Benefits
$100 – $8,000
$200 – $10,000
$100 – $8,000
$200 – $10,000
$75 – $10,000 $250 $7,500
$100 – $15,000 $500 $10,000
$50 – $400 Crown: $200 / Filling: $25 / Extraction: $100 $300
$75 – $700 Crown: $300 / Filling: $50 / Extraction: $150 $400
Ground: $300 / Air: $1,000 $75 – $150 $75 $75 $35 $150 $75 – $750 $300 $75 One device: $750 More than one device: $1,500 $1,000 $400
Ground: $400 / Air: $1,250 $100 – $200 $100 $100 $50 $200 $150 – $1,000 $400 $100 One device: $1,000 More than one device: $2,000 $1,500 $500
$150-$1,500 $150 $300
$200-$2,000 $200 $400
Accidental Injury Benefits Fracture* (depending on the fracture and type of repair) Dislocation* (depending on the dislocation and type of repair) Second- or Third- Degree Burn (depending on degree of burn and percentage of burnt skin) Concussion Coma Laceration (depending on the length of the cut and type of repair) Broken Tooth Eye Injury
Accident - Medical Services & Treatment Benefits Ambulance Emergency Care (depending on location of care) Non-Emergency Initial Care Physician Follow-Up Therapy Services (including physical therapy) Medical Testing Medical Appliances (depending on the appliance) Transportation Pain Management (for epidural anesthesia) Prosthetic Device Modification Blood/Plasma/Platelets Surgical Repair (depending on the type of surgery) Exploratory Surgery Other Outpatient Surgery 24
Accident Insurance
EMPLOYEE BENEFITS
MetLife Benefit Type
Low Plan Benefits
High Plan Benefits
$1,000 for the day of admission $1,000 for the day of admission $200 per day
$1,500 for the day of admission $1,500 for the day of admission $300 per day
$200 per day
$300 per day
$150 per day
$200 per day
$25,000 $75,000 for accidental death on common carrier*
$50,000 $150,000 for accidental death on common carrier*
Hospital Benefits* Admission Intensive Care Unit (ICU) Supplemental Admission Confinement (paid for up to 15 days per accident) ICU Supplemental Confinement (paid for up to 15 days per accident) Inpatient Rehabilitation (paid for up to 15 days per accident)
Accidental Death Benefit Accidental Death Benefit*
Accidental Dismemberment, Functional Loss & Paralysis Benefits Dismemberment/Functional Loss (depending on the injury) Paralysis (depending on the number of limbs)
$750 - $20,000
$1,000 - $40,000
$10,000 - $20,000
$20,000 - $40,000
$100 per day
$200 per day
Other Benefits Lodging Benefit* - for a companion of a covered person who is hospitalized
Organized Sports Activity Injury Benefit Rider This coverage includes an Organized Sports Activity Benefit Rider. The rider increases the amount payable under the Certificate for certain benefits by 25% for injuries resulting from an accident that occurred while participating as a player in an organized sports activity. The rider sets forth terms, conditions and limitations, including the covered persons to whom the rider applies. Covered Event3 Ambulance (ground) Emergency Care Physician Follow-Up ($100 x 2) Medical Testing Concussion Broken Tooth (repaired by crown) Benefits paid by MetLife Group Accident Insurance
Accident Insurance Coverage Options Employee Employee & Spouse Employee & Child(ren) Employee & Spouse/Child(ren)
Benefit Amount $400 $200 $200 $200 $500 $300 $1,800
Monthly Cost to You Low Plan High Plan $5.22 $7.48 $10.32 $14.70 $12.04 $17.06 $14.68 $20.84
25
Life and AD&D
EMPLOYEE BENEFITS
Lincoln Financial Group 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/goosecreekcisd
The Lincoln Term Life Insurance Plan: • Provides a cash benefit to your loved ones in the event of your death • Features group rates for Goose Creek CISD employees • Includes LifeKeys® services, which provide access to counseling, financial, and legal support services • Also includes TravelConnect® services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home • To file a claim contact Lincoln Financial at (800) 423-2765
Benefits At-A-Glance Employee Newly hired employee guaranteed coverage amount Continuing employee guaranteed coverage annual increase amount Maximum coverage amount Minimum coverage amount
$300,000 Choice of $10,000 or $20,000 7 times your annual salary ($500,000 maximum in increments of $10,000) $10,000
Spouse Newly hired employee guaranteed coverage amount Continuing employee guaranteed coverage annual increase amount Maximum coverage amount Minimum coverage amount
$75,000 Choice of $5,000 or $10,000 50% of the employee coverage amount ($500,000 maximum in increments of $5,000) $5,000
Dependent Children 6 months to age 19 (to age 25 if full-time student) guaranteed coverage amount
$10,000
Additional Plan Benefits Accelerated Death Benefit Premium Waiver Conversion Portability
26
Included Included Included Included
Life and AD&D
EMPLOYEE BENEFITS
Lincoln Financial Group Benefit Exclusions
Like any insurance, this term life insurance policy does have exclusions. A suicide exclusion may apply. A complete list of benefit exclusions is included in the policy. State variations apply. Note: You must be an active employee to select coverage for a spouse and/or dependent children. To be eligible for coverage, a spouse or dependent child cannot be confined to a health care facility or unable to perform the typical activities of a healthy person of the same age and gender.
Voluntary AD&D Employee Only AD&D
This coverage provides a cash benefit to the beneficiary/beneficiaries you name if you die in an accident, or to you if you suffer a covered loss in an accident, such as losing a limb or your eyesight Maximum coverage amount
Up to 7 times your annual salary ($500,000 maximum) in $10,000 increments
Minimum coverage amount
$10,000
Your employee AD&D coverage amount will reduce by 50% when you reach age 75. Benefits end when you retire. Spouse AD&D Maximum coverage amount
Up to $500,000 not to exceed 100% of employee’s benefit amount.
Minimum coverage amount
$5,000
The spouse AD&D coverage amount will reduce by 50% when you reach age 70. Benefits end when you retire. Dependent Child AD&D Maximum coverage amount
Age
$10,000
Voluntary Group Life Employee Spouse (per $10,000) (per $10,000)
0-24
$0.41
$0.21
25-29
$0.52
$0.26
30-34
$0.74
$0.37
35-39
$0.86
$0.43
40-44
$0.97
$0.49
45-49
$1.52
$0.76
50-54
$2.40
$1.20
55-59
$4.61
$2.31
60-64
$7.15
$3.58
65-69
$13.89
$6.95
70-74
$22.62
$11.31
Age
Per $5,000
Per $2,500
75-79
$11.31
$5.66
80-99
$11.31
$5.66
Voluntary Group Life - Child(ren) (per $10,000 in coverage) 0-26
$1.23
Voluntary Group AD&D (per $10,000 in coverage) Employee/Spouse/Child
$0.15
27
Individual Life Insurance Texas Life
EMPLOYEE BENEFITS
ABOUT INDIVIDUAL LIFE INSURANCE 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/goosecreekcisd
Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. Designed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually cost more and decline in death benefit. The policy, purelife-plus, is underwritten by Texas Life Insurance Company, and it has the following features: •
High Death Benefit. With one of the highest death benefits available at the worksite, purelife-plus gives your loved ones peace of mind.
•
Minimal Cash Value. Designed to provide a high death benefit at a reasonable premium, purelife-plus provides peace of mind for you and your beneficiaries while freeing investment dollars to be directed toward such tax-favored retirement plans as 403(b), 457 and 401(k).
•
Long Guarantees. Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time.
•
Refund of Premium. Unique in the marketplace, purelife-plus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.)
•
Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.) (Form ICC07ULABR-07 or Form Series ULABR-07)
You may apply for this permanent coverage, not only for yourself, but also for your spouse, children and grandchildren. DURING THE LAST SIX MONTHS, HAS THE PROPOSED INSURED: 1. Been actively at work on a full time basis, performing usual duties? 2. Been absent from work due to illness or medical treatment for a period of more than 5 consecutive working days? 3. Been disabled or received tests, treatment or care of any kind in a hospital or nursing home or received chemotherapy, hormonal therapy for cancer, radiation, dialysis treatment, or treatment for alcohol or drug abuse?
28
Flexible Spending Account (FSA) NBS Higginbotham
EMPLOYEE BENEFITS
ABOUT FSA A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (your (unless plan contains your plan a 45-day contains grace a $500 period). rollover or grace period provision). For full plan details, please visit your benefit website: For full plan details, please visit your benefit website: www.mybenefitshub.com/goosecreekcisd www.mybenefitshub.com/goosecreekcisd
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). Higginbotham Benefits Debit Card The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s). Dependent Care FSA 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. Things to Consider Regarding the Dependent Care FSA • Overnight camps are not eligible for reimbursement (only day camps can be considered). • If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13. • You may request reimbursement for care of a spouse or 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. 29
Flexible Spending Account (FSA) Higginbotham
EMPLOYEE EMPLOYEE BENEFITS BENEFITS
Important FSA Rules • The maximum per plan year you can contribute to a Health Care FSA is $2,850. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately. • You cannot change your election during the year unless you experience a Qualifying Life Event. st • You can continue to file claims incurred during the plan year for another 90 days after August 31 . • Your Health Care 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-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
30
Notes
31
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 Goose Creek CISD 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 Goose Creek CISD 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/GOOSECREEKCISD 32
