LAKE WORTH ISD BENEFIT GUIDE EFFECTIVE: 09/01/2022 8/31/2023 WWW.MYBENEFITSHUB.COM/LAKEWORTHISD 2022 - 2023 PlanYear 1
Table of Contents FLIP TO... How to Enroll 4-5 Annual Benefit Enrollment 6-11 1. Benefit Updates 6 2. Section 125 Cafeteria Plan Guidelines 7 3. Annual Enrollment 8 4. Eligibility Requirements 9 5. Helpful Definitions 10 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 11 Medical 12-18 Health Savings Account (HSA) 19 Hospital Indemnity 20 Dental 21 Accident 22-23 Vision 24 Telehealth 25 Disability 26-27 Critical Illness 28-29 Life and AD&D 30 Individual Life 31 Identity Theft 32 Flexible Spending Account (FSA) 33 34 Emergency Medical Transport 35 Student Loan Assistance 36 HOW TO ENROLLPG. 4 SUMMARYPAGESPG. 6 BENEFITSYOURPG. 12 2
LAKE WORTH ISD BENEFITS MEDICAL HEALTH SAVINGS ACCOUNT Financial Benefit Services (800) 583 www.mybenefitshub.com/lakeworthisd6908 (866)BCBSTX355 www.trs.swhp.org(844)Scottwww.bcbstx.com/trsactivecare5999&WhiteHMO6335325 (817)EECU 882 www.eecu.org0800 HOSPITIAL INDEMNITY DENTAL ACCIDENT Aetna Group #802487 (800) 872 www.aetna.com3862 Lincoln Financial Group Low: www.lfg.com(800)High:00001D04075800001D0407594232765 The Hartford (866) 547 www.thehartford.com4205 VISION TELEHEALTH DISABILITY Superior Vision Group #36245 (800) 507 www.superiorvision.com3800 (888)MDLIVE365 www.mdlive.com/fbs1663 The www.thehartford.com(866)GroupHartford#8936405479124 CRITICAL ILLNESS LIFE AND AD&D INDIVIDUAL LIFE GroupAetna #802487 (800) 872 www.aetna.com3862 www.oneamerica.com(800)GroupOneAmerica#G006143625535318 5Star Life Insurance Group #02485 (866) 863 www.5starlifeinsurance.com9753 IDENTITY THEFT FLEXIBLE SPENDING ACCOUNT (FSA) EMERGENCY MEDICAL TRANSPORT ID www.idwatchdog.com(800)Watchdog7743772 https://flexservices.higginbotham.net(866)Higginbotham4193519 GroupMASA #MKLAKEW (800) 423 www.masamts.com3226 STUDENT LOAN ASSISTANCE (866)GotZoom314 www.gotzoom.com8888 Benefit Contact Information 3
Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS LWISD” to (800) 583-6908 App Group #: FBSLWISD Text “FBS LWISD” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment: • Benefit Resources • Online Enrollment • Interactive Tools • And more! 4
1 www.mybenefitshub.com/lakeworthisd How to Log In 2 CLICK LOGIN 3 ENTER USERNAME & PASSWORD Your Username Is: Your email in THEbenefitsHUB. (Typically your work email) Your Password Is: Four (4) digits of your birth year followed by the last four (4) digits of your Social Security Number If you have previously logged in, you will use the password that you created, NOT the password format listed above. 5
Gain/Loss
(CIS):STATUS QUALIFYING
Marital Status
Section 125 Cafeteria Plan Guidelines SUMMARY PAGESAnnual Benefit Enrollment CHANGES
Change in Status of Employment Affecting Coverage Eligibility
Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
Change in Number of Tax Dependents
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.
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event. IN EVENTS
EligibilityDependents'ofStatus
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
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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.
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
Judgment/Decree/Order
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Eligibility for Government Programs
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.
SUMMARY PAGESAnnual Benefit Enrollment 7
• 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.
During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.
Annual Enrollment
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.
• 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.
Q&A Who do I contact with Questions?
Where can I find forms?
For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ lakeworthisd. Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms
• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
Howsection.can I find a Network Provider?
For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866 914 5202 for assistance.
New Hire Enrollment
For benefit summaries and claim forms, go to the Lake Worth ISD benefit www.mybenefitshub.com/lakeworthisdwebsite:. 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.
Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse FSA/HSAeligibility.Limitations:
Enrollment 8
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
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
Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent Disclaimer:eligibility.
Annual Benefit
SUMMARY PAGES
Dependent RequirementsEligibility
RequirementsEligibility
Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further Potentialguidance.Dependent
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2022 benefits become effective on September 1, 2022, you must be actively at work on September 1, 2022 to be eligible for your new benefits.
PLAN MAXIMUM AGE Medical 26 Dental 26 Vision 26 Accident 26 IndemnityHospital 26 Life and AD&D 26 Telehealth 26 EmergencyMedical Transportation 26 Critical Illness 26 Individual Life 24
Employee
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.
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.
The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively at work and/or pre existing condition exclusion provisions do apply, as applicable by carrier.
SUMMARY PAGESHelpful Definitions 9
After
Actively at Work
The period during which existing employees are given the opportunity to enroll in or change their current elections. Deductible The amount you pay each plan year before the plan begins to pay covered expenses. Year 1st through December 31st Co insurance any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
You are performing your regular occupation for the employer on a full time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel If you will not be actively at work beginning 9/1/2022 please notify your benefits administrator. Enrollment
Annual
January
In Network Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider. Out of Pocket Maximum
The most an eligible or insured person can pay in co insurance for covered expenses. Year 1st through August 31st Pre Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescription drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).
Guaranteed Coverage
Plan
Calendar
September
Annual
Health Savings Account (HSA) (IRC Sec. 223) Flexible Spending Account (FSA) (IRC Sec. 125) Description Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax free. Allows employees to pay out of pocket expenses for copays, deductibles and certain services not covered by medical plan, tax free. This also allows employees to pay for qualifying dependent care tax free. Employer Eligibility A qualified high deductible health plan. All employers Contribution Source Employee and/or employer Employee and/or employer Account Owner Individual Employer Underlying RequirementInsurance High deductible health plan None Minimum Deductible $1,400 single (2022) $2,800 family (2022) N/A Maximum Contribution $3,650 single (2022) $7,300 family (2022) $2,850 (2022) Permissible Use Of Funds Employees may use funds any way they wish. If used for non qualified medical expenses, subject to current tax rate plus 20% penalty. Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC). Cash Outs of Unused Amounts (if no medical expenses) Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65). Not permitted Year-to-year rollover of account balance? Yes, will roll over to use for subsequent year’s health coverage. No. Access to some funds may be extended if your employer’s plan contains a 2 1/2 month grace period or $500 rollover provision. Does the account earn interest? Yes No Portable? Yes, portable year to year and between jobs. No SUMMARY PAGESHSA vs. FSA FLIP TO FOR HSA INFORMATION PG. 20 FLIP TO FOR FSA INFORMATION PG. 33 10
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Monthly Premium District Contribution Employee Cost TRS ActiveCare HD Employee Only $429.00 $275.00 $154.00 Employee & Spouse $1,209.00 $275.00 $934.00 Employee & Child(ren) $772.00 $275.00 $497.00 Employee & Family $1,445.00 $275.00 $1,170.00 TRS ActiveCare 2 Employee Only $1,013.00 $275.00 $738.00 Employee & Spouse $2,402.00 $275.00 $2,127.00 Employee & Child(ren) $1,507.00 $275.00 $1,232.00 Employee & Family $2,841.00 $275.00 $2,566.00 TRS ActiveCare Primary Employee Only $417.00 $275.00 $142.00 Employee & Spouse $1,176.00 $275.00 $901.00 Employee & Child(ren) $751.00 $275.00 $476.00 Employee & Family $1,405.00 $275.00 $1,130.00 TRS ActiveCare Primary+ Employee Only $525.00 $275.00 $250.00 Employee & Spouse $1,284.00 $275.00 $1,009.00 Employee & Child(ren) $845.00 $275.00 $570.00 Employee & Family $1,614.00 $275.00 $1,339.00 Central & North Texas Baylor Scott & White HMO Employee Only $569.24 $275.00 $294.24 Employee & Spouse $1,431.08 $275.00 $1,156.08 Employee & Child(ren) $915.65 $275.00 $640.65 Employee & Family $1,647.24 $275.00 $1,372.24 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/lakeworthisd Medical Insurance TRS EMPLOYEE BENEFITS 12
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• Online/Mobile: Sign in for 24/7 account access to check your balance, pay bills and more.
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. Eligibility
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.
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. To open an account, go to https://www.eecu.org/ Important HSA Information
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you elect: •
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• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
Health Savings Account (HSA)
You are eligible to open and contribute to an HSA if you are: Enrolled in an HSA eligible HDHP Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan Not enrolled in a Health Care Flexible Spending Account 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
• 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.
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.
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• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333 9934
How to Use your HSA
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www.mybenefitshub.com/lakeworthisd
Maximum
ABOUT HSA
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You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered by the HDHP. Contributions
A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used.
For
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• You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.
EECU EMPLOYEE BENEFITS
• Stop by: a local EECU financial center for in person assistance: www.eecu.org/locations
• 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.
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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 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.
HSA
Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). full plan details, please visit your benefit website:
Provides a lump sum benefit for the initial day of your stay in a hospital. Maximum 1 stay per plan year
$1,000 $2,000 Hospital stay Daily Pays a daily benefit, beginning on day two of your stay in a non ICU room of a hospital. Maximum 30 days per plan year $100 $200 Hospital stay (ICU) Daily Pays a daily benefit, beginning on day two of your stay in an ICU room of a hospital. Maximum 30 days per plan year
Hospital IndemnityOption 3 Option 4
Employee + Spouse
$200 $400 Newborn routine care Provides a lump sum benefit after the birth of your newborn. This will not pay for an outpatient birth. $100 $200 Observation unit Provides a lump sum benefit for the initial day of your stay in an observation unit as the result of an illness or accidental injury. Maximum 1 day per plan year $100 $200
Hospital stay Admission
Employee $15.89 $31.79 $32.83 $65.67 $22.80 $45.59 $36.87 $73.74
Employee + Child(ren)
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Covered Benefits Option 3 Option 4
Important Note: All daily inpatient stay benefits begin on day two and count toward the plan year maximum.
ABOUT HOSPITAL INDEMNITY This is an affordable supplemental plan that pays you should you be in patient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance. For full plan details, please visit your benefit website: www.mybenefitshub.com/lakeworthisd Hospital Indemnity Aetna EMPLOYEE BENEFITS Our hospital indemnity plan provides fixed payments directly to members when they have a covered inpatient hospital stay. Plan Eligibility • The employee is actively working at least 15 hours per week • Eligible dependents include: Legal spouse, domestic partner, children under age 26 and provided they meet the definition of dependent child as defined by the state • Retirees are not considered actively at work and therefore not eligible for this plan Plan Highlights • Guaranteed Issue • Rate Guarantee for 36 months subject to all other terms in this Proposal • 4 Tier Coverage options include: Employee, Employee & Spouse, Employee & Children, and Family • HSA compatible • Benefits paid to the employee • Pre ex waived • Simplified Claims Process for Aetna medical members • Online claims process for employees not enrolled in an Aetna medical plan Plan Features • Lump sum payment for first day of inpatient stay, when stay begins during the plan year • Daily benefit payment beginning on the second day • Additional per day payment in an intensive care unit (ICU) • Waiver of Premium • Portable Value Added Programs Access to Aetna Discount Programs: Including blood pressure monitors, gym memberships, weight loss programs, books and magazine subscriptions, eye care, hearing and dental products and more.
Family
ABOUT DENTAL Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and Fordisease.fullplan details, please visit your benefit website: www.mybenefitshub.com/lakeworthisd Dental Insurance Lincoln Financial Group EMPLOYEE BENEFITS Visit LincolnFinancial.com/FindADentist You can search by: • Location • Dentist name or office name • Distance you are willing to travel • Specialty, language and more Your search will automatically provide up to 100 dentists that most closely match your criteria. If your search does not locate the dentist you prefer, you can nominate one just click the Nominate a Dentist link and complete the online form. With the Lincoln Dental Mobile App • Find a network dentist near you in minutes • Have an ID card on your phone • Customize the app to get details of your plan • Find out how much your plan covers for checkups and other services • Keep track of your claims Lincoln DentalConnect® Online Health Center • Determine the average cost of a dental procedure • Have your questions answered by a licensed dentist • Learn all about dental health for children, from baby’s first tooth to dental emergencies • Evaluate your risk for oral cancer, periodontal disease and tooth decay Covered Family Members When you choose coverage for yourself, you can also provide coverage for: • Your spouse. • Dependent children, up to age 26. Dental Low High Employee $17.00 $35.04 Employee + Spouse $38.82 $81.54 Employee + Child(ren) $39.18 $73.67 Family $61.02 $117.47 21
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/lakeworthisd Accident Insurance The Hartford EMPLOYEE BENEFITS 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. 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). PLAN INFORMATION LOW PLAN HIGH PLAN Coverage Type On and off job (24 hour) BENEFITS LOW PLAN HIGH PLAN EMERGENCY, HOSPITAL & TREATMENT CARE Accident Follow Up Up to 3 visits per accident $100 $150 Accident Prevention Benefit Once per year for each covered person $75 $75 Acupuncture/Chiropractic Care/PT Up to 10 visits each per accident Up to $75 Up to $100 Ambulance Air Once per accident $2,000 $2,500 Ambulance Ground Once per accident $750 $1,000 Blood/Plasma/Platelets Once per accident $300 $400 Child Care Up to 30 days per accident while insured is confined $35 $50 Daily Hospital Confinement Up to 365 days per lifetime $400 $600 Daily ICU Confinement Up to 30 days per accident $600 $800 Diagnostic Exam Once per accident $300 $400 Emergency Dental Once per accident Up to $600 Up to $600 Emergency Room Once per accident $200 $250 Hospital Admission Once per accident $1,500 $2,000 Initial Physician Office Visit Once per accident $200 $250 Lodging Up to 30 nights per lifetime $150 $175 Medical Appliance Once per accident $200 $300 Rehabilitation Facility Up to 15 days per lifetime $300 $450 Transportation Up to 3 trips per accident $600 $800 Urgent Care Once per accident $200 $250 X ray Once per accident $150 $200 22
BENEFITS LOW PLAN HIGH PLAN SPECIFIED INJURY & SURGERY Abdominal/Thoracic Surgery Once per accident $3,000 $4,000 Arthroscopic Surgery Once per accident $500 $750 Burn Once per accident Up to $15,000 Up to $20,000 Burn Skin Graft Once per accident for third degree burn(s) 50% of burn benefit Concussion Up to 3 per year $200 $250 Dislocation Once per joint per lifetime Up to $8,000 Up to $12,000 Eye Injury Once per accident Up to $750 Up to $1,000 Fracture Once per bone per accident Up to $10,000 Up to $12,000 Hernia Repair Once per accident $400 $600 Joint Replacement Once per accident $4,000 $6,000 Knee Cartilage Once per accident Up to $2,000 Up to $3,000 Laceration Once per accident Up to $1,000 Up to $1,500 Ruptured Disc Once per accident $2,000 $3,000 Tendon/Ligament/Rotator Cuff Once per accident Up to $2,000 Up to $3,000 CATASTROPHIC Accidental Death Within 90 days; Spouse @ 50% and child @ 25% $150,000 $300,000 Common Carrier Death Within 90 days 2 times death benefit Coma Once per accident Up to $15,000 Up to $20,000 Dismemberment Once per accident Up to $75,000 Up $100,000to Home Health Care Up to 30 days per accident $75 $100 Paralysis Once per accident Up to $75,000 Up $100,000to Prosthesis Once per accident Up to $3,000 Up to $4,000 FEATURES Ability Assist® EAP 24/7/365 access to help for financial, legal or emotional issues Included Included HealthChampionSM Administrative & clinical support following serious illness or injury Included Included Accident Insurance The Hartford EMPLOYEE BENEFITS AccidentLOWPLAN HIGH PLAN Employee $11.48 $15.94 Employee + Spouse $17.95 $24.71 Employee + Child(ren) $19.50 $26.59 Family $30.48 $41.65 23
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/lakeworthisd Vision Insurance Superior Vision EMPLOYEE BENEFITS How to Print your Vision ID Card: You can request your vision id card by contacting Superior Vision directly at 800 507 3800. You can also go to www.superiorvision.com and register/login to access your account by clicking on “Members” at the top of the page. You can also download the Superior Vision mobile app on your smart phone. In network Out of network Exam (Ophthalmologist) Covered In Full Up to $42 Exam (Optometrist) Covered In Full Up to $37 Frames $150 retail allowance Up to $60 Contact Lens Fitting (Standard2) Covered In Full Not Covered Contact Lens Fitting (Specialty2) $50 retail allowance Not Covered Lenses (standard) per pair Single Vision Covered In Full Up to $26 Bifocal Covered In Full Up to $34 Trifocal Covered In Full Up to $50 Progressive Covered at lined trifocal level Up to $50 Lenticular Covered In Full Up to $80 Ultraviolet Coat Covered In Full Not Covered Factory Scratch Coat Covered In Full Not Covered Polycarbonate for Dependent Children Covered In Full Not Covered Contact Lenses2 $120 retail allowance Up to $100 retail Medically Necessary Contact Lenses Covered in full Up to $210 retail Co pays apply to in network benefits; co pays for out of network visits are deducted from reimbursements All allowances are at a retail value; the insured is responsible for any charges in excess of this retail allowance. 1. Materials co pay applies to lenses and frames only, not contact lenses. 2. Standard Contact Lens Fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty Contact Lens Fitting applies to new contact wearers and/or a member who wears toric, gas permeable, or multi focal lenses. 3. Contact lenses are in lieu of eyeglass lenses and frames benefit. Copays Services/frequency Monthly Premiums Exam $10 Exam 12 months Employee $8.45 Materials1 $25 Frame 24 months Employee + Spouse $13.51 Contact lens fitting $25 Lenses 12 months Employee + Child(ren) $13.79 Contact lenses 12 months Family $22.24 Contact lens fitting 12 months 24
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/lakeworthisd Telehealth MDLive EMPLOYEE BENEFITS 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. 25
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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.
Elimination Period: 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.
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More than half of all personal bankruptcies and mortgage foreclosures are a consequence of disability 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 disability 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
Prior to
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/lakeworthisd Disability Insurance The Hartford EMPLOYEE BENEFITS 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. 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. Why do I need Disability Insurance Coverage? •
2 2
2018
Premium Option: For the Premium benefit option the table below applies to disabilities resulting from sickness or injury.
FEATURES OF THE PLAN
Age Disabled Maximum Benefit Duration 63 To Normal Retirement
Benefit Amount: You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $7,500 that cannot exceed 67% of your current monthly earnings. Earnings are defined in The Hartford’s contract with your employer.
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 Maximumhospitalization.Benefit
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 26
The Hartford EMPLOYEE BENEFITS Mental Illness, Alcoholism and Substance Abuse Duration:
You can receive benefit payments for Long Term Disabilities resulting from mental illness, alcoholism and substance abuse for a total of 24 months for all disability periods during your lifetime. Any period of time that you are confined in a hospital or other facility licensed to provide medical care for mental illness, alcoholism and substance abuse does not count toward the 24 month lifetime limit.
Travel Assistance Program Available 24/7, this program provides assistance to employees and their dependents who travel 100 miles from their home for 90 days or less. Services include pre trip information, emergency medical assistance and emergency personal services.
Disability Insurance
Identity Theft Protection An array of identity fraud support services to help victims restore their identity.
Benefits include 24/7 access to an 800 number; direct contact with a certified caseworker who follows the case until it’s resolved; and a personalized fraud resolution kit with instructions and resources for ID theft victims.
Workplace Modification provides for reasonable modifications made to a workplace to accommodate your disability and allow you to return to active full time employment.
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 12 weeks.
Disability per $100 in benefit Elimination Period Minimum $200 Benefit 14/14 $2.62 30/30 $2.10 60/60 $1.78 90/90 $1.44 180/180 $1.12 27
Partial Disability: Partial Disability is covered provided you have at least a 20% loss of earnings and duties of your job.
You have access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD benefits. Once you are covered you are eligible for services to provide assistance with child/ elder care, substance abuse, family relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist them with the unique emotional, financial and legal issues that may result from a disability. Ability Assist services are provided through ComPsych®, a leading provider of employee assistance and work/life services.
Thebenefit.Hartford's Ability Assist service is included as a part of your group Long Term Disability (LTD) insurance program.
Other Important Benefits Survivor Benefit If you die while receiving disability benefits, a benefit will be paid to your spouse or child under age 26, equal to three times your last monthly gross
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/lakeworthisd Critical Illness Insurance Aetna EMPLOYEE BENEFITS Critical Illness Plan Benefits Face Amounts $10,000, $20,000 or $30,000 Spouse Face Amount 100% of EE Face Amount Child(ren) Face Amount 100% of EE Face Amount Critical Illness Benefits Percent of Face Amount (Employee): Heart Attack (Myocardial Infarction) 100% Stroke 100% Coronary Artery Condition Requiring Bypass Surgery 25% Major Organ Failure 100% End Stage Renal Failure 100% Paralysis 100% Loss of Sight (Blindness) 100% Loss of Speech 100% Loss of Hearing 100% Occupational HIV 100% Coma 100% Benign Brain Tumor 100% Third Degree Burns 100% Alzheimer's Disease 25% Parkinson's Disease 25% Lupus 25% Multiple Sclerosis 25% Muscular Dystrophy 25% Childhood Critical Illness Benefits Percent of Face Amount (Employee): Cerebral Palsy 25% Cleft Lip or Cleft Palate 25% Cystic Fibrosis 25% Down Syndrome 25% Spina Bifida 25% Cancer Benefits Percent of Face Amount (Employee): Cancer (invasive) 100% Carcinoma in Situ (non invasive) 25% Skin Cancer $1,000 Skin cancer benefit provides coverage for invasive malignant melanoma in the dermis or deeper or skin malignancies that have become metastatic 28
Additional Plan Benefits Percent of Face Amount (Employee): Subsequent Critical Illness Diagnosis Benefit 100% after 180 days Recurrence Critical Illness Diagnosis Benefit 100% after 180 days Recurrence Cancer (invasive) Diagnosis Benefit 100% after 180 days Recurrence Carcinoma in Situ Diagnosis Benefit (non invasive) 100% after 180 days *Health Screening Optional at the Employer Level Maximum 1 day per plan year $50 Critical Illness Insurance Aetna EMPLOYEE BENEFITS Critical Illness With Cancer Employee Age Employee Only Employee and Spouse andEmployeeChild(ren) Family $10,000 <20 $3.30 $7.53 $3.30 $7.53 20 24 $3.76 $8.53 $3.76 $8.53 25 29 $4.47 $9.90 $4.47 $9.90 30 34 $5.34 $11.77 $5.34 $11.77 35 39 $6.65 $14.69 $6.65 $14.69 40 44 $8.81 $19.90 $8.81 $19.90 45 49 $12.63 $28.51 $12.63 $28.51 50 54 $18.96 $42.75 $18.96 $42.75 55 59 $27.28 $63.10 $27.28 $63.10 60 64 $41.80 $89.35 $41.80 $89.35 65 69 $60.76 $122.13 $60.76 $122.13 70+ $82.49 $153.59 $82.49 $153.59 $20,000 <20 $5.08 $11.84 $5.08 $11.84 20 24 $6.00 $13.84 $6.00 $13.84 25 29 $7.40 $16.58 $7.40 $16.58 30 34 $9.15 $20.31 $9.15 $20.31 35 39 $11.77 $26.15 $11.77 $26.15 40 44 $16.09 $36.58 $16.09 $36.58 45 49 $23.74 $53.79 $23.74 $53.79 50 54 $36.38 $82.29 $36.38 $82.29 55 59 $53.04 $122.98 $53.04 $122.98 60 64 $82.07 $175.48 $82.07 $175.48 65 69 $119.98 $214.03 $119.98 $214.03 70+ $163.45 $303.96 $163.45 $303.96 <20 $6.85 $16.16 $6.85 $16.16 $30,000 20 24 $8.23 $19.15 $8.23 $19.15 25 29 $10.33 $23.26 $10.33 $23.26 30 34 $12.96 $28.85 $12.96 $28.85 35 39 $16.89 $37.61 $16.89 $37.61 40 44 $23.37 $53.26 $23.37 $53.26 45 49 $34.84 $79.08 $34.84 $79.08 50 54 $53.81 $121.82 $53.81 $121.82 55 59 $78.79 $182.85 $78.79 $182.85 60 64 $122.34 $261.61 $122.34 $261.61 65 69 $179.21 $359.93 $179.21 $359.93 70+ $244.41 $454.33 $244.41 $454.33 29
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. full plan details, please visit your benefit website: www.mybenefitshub.com/lakeworthisd
Guaranteed Issue: • Employee: $50,000
For
Accelerated Life Benefit: If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose.
What you need to know about your Voluntary Term Life Benefits
Guaranteed Increase
Death and Dismemberment (AD&D): Additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract. Additional AD&D benefits include seat belt, air bag, repatriation, child higher education, child care, paralysis/loss of use, severe burns, disappearance, and exposure.
Life and AD&D OneAmerica EMPLOYEE BENEFITS ABOUT LIFE AND AD&D
Age: 65 70 Reduces To: 65% 50% Age: 65 70 Reduces To: 65% 50% Voluntary Life and AD&D (per
Reductions: Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule.
Reductions:insurability.
Guaranteed Issue: Employee: $200,000, Spouse: $50,000, Child: $10,000
Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule. The amounts of dependent life insurance will reduce according to the employee's reduction schedule. $10,000)
What you need to know about your Basic Life and AD&D Benefits
Group term life is the most inexpensive way to purchase life insurance.
Accidental
Flexible Options: Employee: $10,000 to $500,000, in $10,000 increments, not to exceed 5 times your annual salary Spouse under age 99: $10,000 to $500,000, in $5,000 increments, not to exceed 100% of the employee’s amount
Dependent Life Coverage: Optional dependent life coverage is available to eligible employees. You must select employee coverage in order to cover your spouse and/ or Acceleratedchild(ren).Life
Benefit: If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose. In Benefit: You may be eligible to increase your coverage annually until you reach your maximum amount without providing evidence of
Employee Age Employee Spouse 0 29 $0.70 $0.70 30 34 $0.80 $0.80 35 39 $0.90 $0.90 40 44 $1.50 $1.50 45 49 $2.20 $2.20 50 54 $3.80 $3.80 55 59 $6.40 $6.40 60 64 $8.60 $8.60 65+ $14.80 $14.80 Children Voluntary Life and AD&D Age 0 25 $10,000 $1.50 Spouse rates based on employee age. 30
You have the freedom to select an amount of life insurance coverage you need to help protect the well being of your family.
31
5Star
Individual Life Insurance EMPLOYEE BENEFITS Family Protection Plan with 5Star Life Insurance offers individual insurance coverage to age 121. The plan includes a Terminal Illness Acceleration of Benefit and a Qualify of Life Benefit.
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.
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. full details and rates at www.mybenefitshub.com/lakeworthisd.
*Quality
For full plan details, please visit your benefit website: www.mybenefitshub.com/lakeworthisd
*
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:
Should you need to file a claim, contact 5Star directly at (866) 863 9753. of Life not available ages 66 70. Quality of Life benefits not available for children Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 years).$7.15 monthly for $10,000 coverage per child.
Find
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.
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.
ABOUT INDIVIDUAL LIFE
• 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.
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).
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/lakeworthisd Identity Theft ID Watchdog EMPLOYEE BENEFITS Your identity is important it’s what makes you, you. You’ve spent a lifetime building your name and financial reputation. Let us help you better protect it. And, we’ll even go one step further and help you better protect the identities of your family. EASY & AFFORDABLE IDENTITY PROTECTION With ID Watchdog®, you have an easy and affordable way to help better protect and monitor the identities of you and your family. You’ll be alerted to potentially suspicious activity and enjoy the peace of mind that comes with the support of dedicated resolution specialists. And, a customer care team that’s available any time, every day. ID WATCHDOG IS HERE FOR YOU ID Watchdog is everywhere you can’t be monitoring credit reports, social media, transaction records, public records and more to help you better protect your identity. And don’t worry, we’re always here for you. In fact, our U.S. based customer care team is available 24/7/365 at 866.513.1518. WHY CHOOSE ID WATCHDOG Credit Lock With our online and in app feature, lock your Equifax® credit report and your child’s Equifax credit report to help provide additional protection against unauthorized access to your credit. More for Families Our family plan helps you better protect your loved ones, with each adult getting their own account with all plan features. And, we offer more features that help protect minors than any other Dedicatedprovider. Resolution Specialists If you become a victim, you don’t have to face it alone. One of our certified resolution specialists will fully manage the case for you until your identity is restored. UNIQUE FEATURES INCLUDED IN ALL ID WATCHDOG PLANS Monitor & Detect • Dark Web Monitoring1 ✓ • High Risk Transactions Monitoring2 ✓ • Subprime Loan Monitoring2 ✓ • Public Records Monitoring ✓ • USPS Change of Address Monitoring • Identity Profile Report Manage & Alert • Child Credit Lock3 | 1 Bureau ✓ • Financial Accounts Monitoring • Social Network Alerts ✓ • Registered Sex Offender Reporting ✓ • Customizable Alert Options • Breach Alert Emails • Mobile App Support & Restore • Identity Theft Resolution Specialists (Resolution for Pre existing Conditions)✓ • 24/7/365 U.S. based Customer Care Center • Lost Wallet Vault & Assistance • Deceased Family Member Fraud Remediation • Fraud Alert & Credit Freeze Assistance ✓ Helps better protect children 1 Bureau = Equifax® 2 Multi Bureau = Equifax, TransUnion® 3 Bureau = Equifax, Experian®, TransUnion Identity1BTheft Platinum Employee $7.95 $11.95 Employee + Family $14.95 $22.95 32
Important FSA Rules
The information new or replacement Benefits Debit the click Register. the instructions and scroll down to enter information. your Employee ID, which is your Social Security
A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (unless your plan contains a $500 rollover or grace period provision). please visit your benefit website:
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
ABOUT FSA
For full plan details,
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
Higginbotham Portal • Visit https://flexservices.higginbotham.net and
• 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.
Follow
your
num33
• 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.
Dependent Care FSA
EMPLOYEE BENEFITS
Higginbotham Benefits Debit Card
Higginbotham Portal
www.mybenefitshub.com/lakeworthisd
• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
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.
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.
• You cannot change your election during the year unless you experience a Qualifying Life Event.
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
Spending Account (FSA)
Card Register on
• Enter
•
The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care or Limited Purpose FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s).
Things to Consider Regarding the Dependent Care FSA
Flexible
• Overnight camps are not eligible for reimbursement (only day camps can be considered).
Over the Counter Item Rule Reminder
Higginbotham Portal provides
Flexible Spending Account (FSA) Higginbotham EMPLOYEE BENEFITS ber 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 Higginbotham Flex Mobile App Easily access your Health Care FSA on your smartphone or tablet with the Higginbotham mobile app. Search for Higginbotham in your mobile device’s app store and download as you would any other app. • View Accounts Includes detailed account and balance information • Card Activity Account information • SnapClaim File a claim and upload receipt photos directly from your smartphone • Manage Subscriptions Set up email notifications to keep up to date on all account and Health Care FSA debit card activity • Log in using the same username and password you use to log in to the Higginbotham Portal. Note: You must register on the Higginbotham Portal in order to use the mobile app. Flexible Spending Accounts Account Type Eligible Expenses Annual Contribution Limits Benefit Health Care FSA Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses and doctor prescribed over the counter medications) $2,850 Saves on eligible expenses not covered by insurance, reduces your incometaxable Limited Purpose Health Care FSA Dental and vision care expenses that are not covered by your health plan (such as eyeglasses, contacts, LASIK eye surgery, fillings, x rays and braces) $2,850 Saves on eligible expenses not covered by insurance, reduces your incometaxable Dependent Care FSA Dependent care expenses (such as day care, after school programs or elder care programs) so you and your spouse can work or attend school full time $5,000 single $2,500 if married and filing separate tax returns Reduces your taxable income 34
A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. If a member has a high deductible health plan that is compatible with a health savings account, benefits will become available under the MASA membership for expenses incurred for medical care (as defined under Internal Revenue Code (“IRC”) section 213 (d)) once a member satisfies the applicable statutory minimum deductible under IRC section 223(c) for high deductible health plan coverage that is compatible with a health savings account.
EmergentTransportationPlus Platinum Employee + Family $14.00 $39.00 35
MASA EMPLOYEE BENEFITS
Non Emergency Inter Facility Transportation In the event that a member is in stable condition in a medical facility but requires a heightened level of care that is not available at their current medical facility, Members have access to non emergency air or ground transportation between medical facilities.
Suppose you or a family member is hospitalized more than 100 miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for Shouldrecuperation.youneed assistance with a claim contact MASA at 800 643 9023. You can find full benefit details www.mybenefitshub.com/lakeworthisd.EmergencyMedical
ABOUT MEDICAL TRANSPORT
Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out of pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan. full plan details, please visit your benefit website:
For
Emergency Medical Transport
www.mybenefitshub.com/lakeworthisd
Emergent Air Transportation In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities.
Emergent Ground Transportation In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities.
Repatriation/Recuperation
•
services An
GotZoom
Multiple ReducingBenefits:yourmonthly
•
Service fees apply only after the employee has reviewed and approved repayment/forgiveness programs Application Fee: $307. Annual Fee: $359.40 (Monthly Option: $32.95)
What’s GotZoom? The leader in
•
Shortened loan term
•
Employees can relax with the knowledge that GotZoom manages all the required administrative work throughout the term of the repayment program including any annual re certifications.
GotZoom prepares the Department of Education (DOE) case file for enrollment in the federal subsidy and/or forgiveness program.
details, please visit your
year track record of performance and customer satisfaction Where to Start Go to the enrollment page: https://mystudentloan2.net/1/? broid=00002000 Click on Enroll Now Employee Benefits • Average student debt reduction of 65% • All administrative details are managed by GotZoom
ABOUT STUDENT LOAN ASSISTANCE
Student Loan debt in the United States currently exceeds $1.4 trillion dollars. If you are one of the millions of Americans that are stressed and struggling with high levels of student loan debt, this is a program that may provide student loan relief to those who qualify. plan benefit website: Educators and Public Service employees enjoy special status with the Department of Education (DOE) and are eligible for the best available student loan repayment and loan forgiveness programs Only 2 in 10 borrowers take advantage of the programs $350 Million of additional DOE funding became available in Mar. 2018 (first come, first serve) Solution GotZoom was created to fill a critical void. Student loan debt is our country' second largest debt class behind mortgages With nearly 70 federal student loan repayment and forgiveness programs in place today the options to reduce your student debt are exceptional GotZoom finds the best program options that suit your needs, confirms eligibility and facilitates all the savings realized by our clients increased to 65% last year (ave. debt reduction). payment is important but many GotZoom can also benefit from a shorter loan term and/or reduced total debt level. student debt reduction established company with a seven for
•
• Loan forgiveness (aka loan)
•
GotZoomBetteradministrationResults:delivers.The
GotZoom also monitors the DOE programs for changes that can result in additional savings.
Benefit Analysis
•
GotZoom monitors DOE programs and reviews the employee's status annually to find any additional debt reduction options
•
Service Fee Employee's loan analysis and Benefits Summary are free (no obligation)
• Employees submit required documentation
36
• Employees can stop paying their federal loans courtesy of 60 90 abatement provision while GotZoom is processing the case file. There are no fees, penalties or interest.
www.mybenefitshub.com/lakeworthisd Student Loan Assistance GotZoom EMPLOYEE BENEFITS The Facts •
For full
On boarding Manager contacts each employee with the results of their no cost loan analysis including which of these benefits are available: Reduced monthly loan payment
The Best
DOE Program Enrollment
•
•
Long Term Customer Support
A
clients
the employee •
Notes 37
Notes 38
Notes 39
Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the Lake Worth 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 Lake Worth 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.
2022 - 2023 PlanYear
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WWW.MYBENEFITSHUB.COM/LAKEWORTHISD
