2022 - 2023 Plan Year
LOVEJOY ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2022 - 8/31/2023 WWW.MYBENEFITSHUB.COM/LOVEJOYISD
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Table of Contents How to Enroll Annual Benefit Enrollment 1. Annual Enrollment 2. Section 125 Cafeteria Plan Guidelines 3. Helpful Definitions 4. Eligibility Requirements 5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) Medical Telehealth Health Savings Account (HSA) Dental Vision Disability Basic and Voluntary Life AD&D Cancer Critical Illness Identity Theft Flexible Spending Account (FSA) Employee Assistance Program (EAP) Foundation for Lovejoy Schools
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Catastrophic Sick Leave Bank
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HOW TO ENROLL
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SUMMARY PAGES
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YOUR BENEFITS
Benefit Contact Information LOVEJOY ISD BENEFITS
MEDICAL: TRS ACTIVECARE
MEDICAL: TRS HMO
Financial Benefit Services Blue Cross Blue Shield (469) 385-4685 866-355-5999 www.mybenefitshub.com/lovejoyisd www.bcbstx.com/trsactivecare
Baylor Scott & White (844) 633-5323 https://trs.swhp.org/
LOVEJOY ISD BENEFITS OFFICE
TELEHEALTH
HEALTH SAVINGS ACCOUNT
(469) 742-8013 www.lovejoyisd.net
MDLIVE (888) 365-1663 www.mdlive.com/fbs
EECU (817) 882-0800 www.eecu.org
DENTAL
VISION
DISABILITY
UnitedHealthcare (888) 679-8925 myuhc.com
Avesis Vision Group # 10771-1308 (800) 522-0258 www.avesis.com
Cigna - NY Life Insurance Group #SLH100023 (800) 362-4462 www.mycigna.com
LIFE AND AD&D
CANCER
CRITICAL ILLNESS
Cigna - NY Life Insurance Life Group # FLX965387 (800) 244-6224 www.mycigna.com
American Public Life (800) 256-8606 www.ampublic.com
UNUM Group # 474106 (866) 679-3054 www.unum.com
IDENTITY THEFT
FLEXIBLE SPENDING ACCOUNT (FSA) EMPLOYEE ASSISTANCE PROGRAM (EAP)
ID Watchdog (800) 774-3772 www.idwatchdog.com
National Benefit Services (800) 274-0503 www.nbsbenefits.com
Cigna (800) 538-3543 www.cignalap.com
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All Your Benefits One App Employee benefits made easy through the FBS Benefits App! Text “FBS LOVEJOY” 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 #: FBSLOVEJOY
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Text
“FBS LOVEJOY”
to (800) 583-6908 OR SCAN
How to Log In 1
www.mybenefitshub.com/lovejoyisd
2
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
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Annual Benefit Enrollment
SUMMARY PAGES
Annual Enrollment During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs. •
Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.
•
Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.
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Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ lovejoyisd. 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 Lovejoy ISD benefit website: www.mybenefitshub.com/lovejoyisd. 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
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 if the other individual actually provides the coverage.
Eligibility for Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Government Programs
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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. 8
Out-of-Pocket Maximum The most an eligible or insured person can pay in coinsurance for covered expenses.
Plan Year September 1st through August 31st
Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescription drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).
Annual Benefit Enrollment
SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 15 or more regularly scheduled hours each work week.
Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2022 benefits become effective on September 1, 2022, you must be actively-at-work on September 1, 2022 to be eligible for your new benefits.
PLAN
MAXIMUM AGE
Medical
To age 26
DHMO Dental
To age 26
PPO Dental
To age 26
Vision
To age 26
Cancer
To age 26
Identity Theft
To age 26
Life and AD&D
To age 26
Critical Illness
To age 26
Telehealth
To age 26
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse eligibility. FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance. Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent eligibility. Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee's enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. 9
SUMMARY PAGES
HSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, tax-free. This also allows employees to pay for qualifying dependent care taxfree.
Employer Eligibility
A qualified high deductible health plan.
All employers
Contribution Source
Employee and/or employer
Employee and/or employer
Account Owner
Individual
Employer
Underlying Insurance Requirement
High deductible health plan
None
Minimum Deductible
$1,400 single (2022) $2,800 family (2022)
N/A
Maximum Contribution
$3,650 single (2022) $7,300 family (2022)
$2,850 (2022)
Permissible Use Of Funds
Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Cash-Outs of Unused Amounts (if no medical expenses)
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age Not permitted 65).
Year-to-year rollover of account balance?
Yes, will roll over to use for subsequent year’s health coverage.
You must use your funds by 8/31/22
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
Description
FLIP TO FOR HSA INFORMATION
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FLIP TO FOR FSA INFORMATION
PG. 31
Notes
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Medical Insurance
EMPLOYEE BENEFITS
TRS ABOUT MEDICAL Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis.
For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
Monthly Premium
District Contribution
Employee Cost
TRS ActiveCare HD Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$422.00
$225.00
$197.00
$1,187.00
$225.00
$962.00
$757.00
$225.00
$532.00
$1,419.00
$225.00
$1,194.00
TRS ActiveCare 2 Employee Only
$1,013.00
$225.00
$788.00
Employee & Spouse
$2,402.00
$225.00
$2,177.00
Employee & Child(ren)
$1,507.00
$225.00
$1,282.00
Employee & Family
$2,841.00
$225.00
$2,616.00
TRS ActiveCare Primary Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$410.00
$225.00
$185.00
$1,157.00
$225.00
$932.00
$738.00
$225.00
$513.00
$1,384.00
$225.00
$1,159.00
TRS ActiveCare Primary+ Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$515.00
$225.00
$290.00
$1,259.00
$225.00
$1,034.00
$829.00
$225.00
$604.00
$1,584.00
$225.00
$1,359.00
Central & North Texas Baylor Scott and White HMO Employee Only Employee & Spouse Employee & Child(ren) Employee & Family 12
$543.35
$225.00
$318.35
$1,364.92
$225.00
$1,139.92
$873.57
$225.00
$648.57
$1,570.98
$225.00
$1,345.98
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Telehealth
EMPLOYEE BENEFITS
MDLive ABOUT TELEHEALTH Telehealth provides 24/7/365 access to board-certified doctors via telephone or video consultations that can diagnose, recommend treatment and prescribe medication. Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.
For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd 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
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.
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.
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Health Savings Account (HSA) EECU
EMPLOYEE BENEFITS
ABOUT HSA A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
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 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.
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
Opening an HSA
HSA Eligibility
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 •
Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount. You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit. You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.
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 You can use the money in your HSA to pay for qualified medical How to Use your HSA expenses now or in the future. You can also use HSA funds to pay • Online/Mobile: Sign-in for 24/7 account access to check your health care expenses for your dependents, even if they are not balance, pay bills and more. covered by the HDHP. • Call/Text: (817) 882-0800. EECU’s dedicated member service representatives are available to assist you with any Maximum Contributions questions. Their hours of operation are Monday through Your HSA contributions may not exceed the annual maximum Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. – amount established by the Internal Revenue Service. The annual 1:00 p.m. CT and closed on Sunday. contribution maximum for 2022 is based on the coverage option • Lost/Stolen Debit Card: Call the 24/7 debit card hotline at you elect: (800) 333-9934 • Individual – $3,650 • Stop by: a local EECU financial center for in-person • Family (filing jointly) – $7,300 assistance: www.eecu.org/locations. 20
Dental Insurance
EMPLOYEE BENEFITS
UnitedHealthcare 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/lovejoyisd
About your plan
Find a network dentist
Preventive care: As long as you see your primary care dentist, your plan pays for all or most of your preventive dental care, including routine checkups and cleanings. You can get 2 cleanings in a 12-month period — 1 every 6 months. Some plans cover more cleanings for an additional copay. Preventive visits are important because your dentist can catch problems early when they’re easier to treat. Good oral health helps protect your teeth and gums and is also linked to good overall health. Fillings, crowns and more: Your plan also covers other types of care, including fillings, crowns and braces. You just need to pay a copay (a set dollar amount) at the time of your appointment. Some plans only cover silver fillings for back teeth. If you choose white fillings, you may have a higher copay. Cosmetic procedures: Some cosmetic procedures, such as teeth whitening, are covered by your plan. Refer to your plan documents or call Customer Service for more details.
Finding a dentist is easy. You have 2 options: 1. Log in to myuhc.com and use the Find a Dentist tool to search by name, facility or location. You’ll see a list of dentists who are part of your network. 2. Call the Customer Service number on your ID card If a network dental provider is not available within a reasonable distance of where you live or work, you may be referred to an out-of-network dental provider and still receive services at the network rate. Please see your official dental plan documents for details about your coverage or call the number on your ID card.
Get a referral for a specialist
1.
Your primary care dentist will provide most (if not all) of your care. In some cases, your dentist may refer you to a specialist. After your dentist gives you a specialty referral form, call Customer Service for an authorization number. The representative will give you details about the specialist who will provide your care. Children up to age 8 don’t need a referral to see a pediatric dentist. All children need a referral to see a specialist. Emergency specialty care – Call Customer Service immediately. A representative will help you find a specialist and set up an appointment. Non-emergency specialty care – After you call Customer Service, you’ll receive a document that explains your benefits. The document will include the specialist’s contact information and your authorization number.
Use your dental ID card Print your ID card anytime at myuhc.com. Your card only lists the name of the person who signed up for the plan, but everyone covered by your plan should use the card. Be sure to bring it with you each time you see the dentist.
Get the most from your benefits 2. 3. 4.
5.
Choose a primary care dentist before you schedule any dental treatment Visit myuhc.com® or call Customer Service to choose or change your dentist Find a network dentist on myuhc.com or by calling Customer Service Get a referral from your primary care dentist if you need to see a specialist. Children up to age 8 don’t need a referral to see a pediatric dentist. Enjoy full coverage for preventive services
Employee Employee + Spouse Employee + Child(ren) Family
Dental DHMO $10.45 $20.25 $21.92 $31.72
Low PPO $36.06 $71.46 $80.27 $120.89
High PPO $41.11 $81.46 $91.51 $137.84 21
Vision Insurance
EMPLOYEE BENEFITS
Avesis 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/lovejoyisd
Here's How It Works When you need to see an eye care professional, simply visit www.avesis.com or contact Avēsis’ Customer Service Monday through Friday, 7 a.m. to 8 p.m. (EST) at 800-828-9341 to receive a listing of providers in your area. Vision Care Services Vision Examination (Includes Refraction)
Materials* Frame Allowance Standard Spectacle Lenses Single Vision Bifocal Trifocal Lenticular Preferred Pricing Options Polycarbonate (Single Vision/Multi-Focal) Standard Scratch-Resistant Coating Ultra-Violet Screening Solid or Gradient Tint Standard Anti-Reflective Coating Level 1 Progressives Level 2 Progressives All Other Progressives Contact Lenses‡ (in lieu of frame and spectacle lenses) Elective Medically Necessary Refractive Laser Surgery Frequency Eye Examination Lenses or contact lenses Frame 22
1. 2. 3. 4.
Select a provider Make an appointment Visit provider for service Pay any copays or additional expenses
In-Network Member Cost Covered in full after $10 copay $15 copay
Employee Paid Rates Per Month Employee
$7.74
Employee + Spouse
$14.01
Employee + Child(ren)
$15.05
Family
$21.58
Out-of-Network Reimbursement Up to $35
(Materials copay applies to frame or spectacle lenses, if applicable.)
Members receive a $50 wholesale allowance Up to $150 retail value†
Up to $45
Covered in full after $15 copay Covered in full after $15 copay Covered in full after $15 copay Covered in full after $15 copay
Up to $25 Up to $40 Up to $50 Up to $80
$40/$44 (Covered in full up to age 19) $17 $15 $17 $45 Covered in full Covered in full $140 allowance + 20% discount
N/A (Up to $10 for ages up to 19) N/A N/A N/A N/A Up to $40 Up to $48 Up to $48
$150 allowance Covered in full
Up to $130 Up to $250 Onetime/lifetime $150 allowance
Onetime/lifetime $150 allowance Provider discount up to 25%
Once every 24 months Once every 24 months Once every 24 months
Disability Insurance
EMPLOYEE BENEFITS
Cigna / New York Life 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/lovejoyisd
SUMMARY OF BENEFITS If you had an unexpected illness or injury and were unable to work, how long would you be able to pay your bills and take care of your family? Disability insurance pays a portion of your salary if you’re unable to work due to a covered disability. By purchasing coverage through your employer, you also benefit from cost-effective group rates and convenient payroll deduction. Eligibility: If you are an active employee working at least 15 hours per week, you will be eligible immediately. Guaranteed Issue*: Initial Enrollment: If you are eligible on or before the policy’s effective date, you may enroll for coverage during the Initial Enrollment without submitting any evidence of good health. New Hires: If you were hired after the policy’s effective date, you may elect coverage once eligible without submitting any evidence of good health. Annual Enrollment: During annual enrollment, you may enroll for the first time or make coverage changes, if already participating, without submitting any evidence of good health. *The Pre-Existing Condition Limitation, as outlined in the Benefit Reductions, Conditions, Limitations and Exclusions section, will apply.
Employee Options Select Monthly Benefit: Option 1: 40% Gross Monthly Benefit1 Option 2: 50% Option 3: 60% Maximum Gross $8,000 Monthly Benefit Select from Five (5) Options: Accident/Sickness Option 1: 0 days/7 days Benefit Waiting Period Option 2: 14 days/14 days Option 3: 30 days/30 days Option 4: 60 days/60 days Option 5: 90 days/90 days Please refer to the “Maximum Maximum Benefit Period Benefit Period” Schedules below for more details 1. Your benefit amount will be reduced by any amounts payable to you by any of the sources listed under the “Effects of Other Income Benefits” section.
Monthly Cost of Coverage: Disability - per $100 in benefit (All Ages) Elimination 40% Benefit 50% Benefit 60% Benefit Period 0/7 $2.63 $2.76 $2.96 14/14 $2.14 $2.25 $2.42 30/30 $1.92 $2.03 $2.18 60/60 $0.83 $0.95 $1.10 90/90 $0.63 $0.73 $0.85 Notes: Benefits available at 40%. 50%, or 60% of covered payroll with a maximum benefit of $8,000. Rates are presented on a per $100 covered monthly payroll basis
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Life Insurance
EMPLOYEE BENEFITS
Cigna / New York Life ABOUT LIFE INSURANCE 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.
For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
Employer-Paid Basic Life Who Is Eligible For Coverage? You: All active, Full-time Employees of the Employer working a minimum of 15 hours per week. You will be eligible for coverage the first of the month following date of hire. Available Coverage: Employee: • Benefit Amount $15,000 • Maximum $15,000 • Guaranteed Issue Amount $15,000 Guaranteed Issue means that you may be able to purchase coverage without medical exams or health questions. See “Guaranteed Issue” below for more information. Additional Features: Extended Death Benefit with Waiver of Premium – The extended death benefit continues your coverage without payment of premium, before you’re eligible to qualify for Waiver of Premium, if you are continuously Disabled for 9 months prior to age 60. “Disabled” means, because of injury or sickness, you are unable to perform all the material duties of your regular occupation, or you are receiving disability benefits under a program sponsored by your Employer. Regular Occupation means the occupation you routinely performed at the time your Disability began. We/the insurance company will consider the duties of your occupations as those that are normally performed in the general labor market in the national economy. If you qualify for this benefit and have insured your spouse or children, the insurance company will also extend their coverage if applicable. Waiver of Premium – If you become Disabled prior to age 60, and you remain Disabled continuously for a 9 month period and thereafter, you won’t need to pay premiums for your life insurance coverage, provided we/the Insurance Company determine(s) you are Disabled. “Disabled” for this coverage means, because of injury or sickness, you are unable to perform the material duties of your regular occupation, or are receiving disability benefits under a program sponsored by your employer, for the first 12 months after your Disability began. Thereafter, 24
you must be unable to perform the material duties of any occupation that you are or may reasonably become qualified based on your education, training or experience. If you qualify for this coverage and have insured your spouse or children, the insurance company will also waive their premium if applicable. Accelerated Death Benefit – Terminal Illness – if two unaffiliated doctors diagnose you as terminally ill while the coverage is active, with a life expectancy of 12 months or less, the benefit for Terminal Illness provides up to: • Employee: 80% of your Term Life Insurance coverage amount or $8,000, whichever is less. Conversion – To convert, you must apply for the conversion policy and pay the first premium payment within 31 days after your group coverage ends. Guaranteed Issue: If you are a new hire and you apply within 31 days after you are eligible to elect coverage for yourself, you are entitled to choose any coverage offered up to the Guaranteed Issue Amount, without providing proof of good health. If you apply for an amount of coverage greater than the Guaranteed Issue Amount, coverage in excess of the Guaranteed Issue Amount will not be issued until the insurance company approves acceptable proof of good health. If you apply for coverage for yourself more than 31 days from the date you become eligible to elect coverage under this plan, the Guaranteed Issue Amount will not apply, unless Guaranteed Issue has been approved by your employer for a specific period of time. Coverage will not be issued until the insurance company approves acceptable proof of good health. Important Definitions and Policy Provisions: Benefit Reduction Schedule - If you are still employed, your benefits will reduce to 65% at age 65 and 50% at age 70. Limitations - The Accelerated Death Benefit is payable only once. Using this benefit reduces the life insurance death benefit. The amount payable under the Accelerated Death Benefit may be reduced by the amount of other benefits already paid to the insured under the policy. See your certificate for further details.
Life Insurance
EMPLOYEE BENEFITS
Cigna Employee-Paid Voluntary Life Who Is Eligible For Coverage? You: All active, Full-time Employees of the Employer working a minimum of 15 hours per week. You will be eligible for coverage the first of the month following date of hire. Your Spouse: Up to age 70, as long as you apply for and are approved for coverage yourself. Your Child(ren): Birth to 26, or age 26 if a full-time student, as long as you apply for and are approved for coverage yourself. Available Coverage
Benefit Amount
Maximum
Guaranteed Issue Amount
Employee
Units of $10,000
Lesser of 5 times salary or $500,000
$150,000
Spouse
Units of $5,000
$250,000
$75,000
Children
$10,000
$10,000; under 6 All amounts Months old $500
Guaranteed Issue means that you may be able to purchase coverage without medical exams or health questions. See “Guaranteed Issue” below for more information.
Accelerated Death Benefit – Terminal Illness – if two unaffiliated doctors diagnose you or your spouse as terminally ill while the coverage is active, with a life expectancy of 12 months or less, the benefit for Terminal Illness provides up to: • Employee: 80% of your Term Life Insurance coverage amount or $250,000, whichever is less. • Spouse: 80% of your Term Life Insurance coverage amount or $250,000, whichever is less. Portability – If your employment is terminated, you can continue your life insurance on a direct-bill basis. Coverage may also be continued for your spouse/children. Premiums will increase at this time. Coverage can be continued to age 70, unless the insurance company terminates portability for all insured persons. Refer to your certificate for details. Conversion – To convert, you must apply for the conversion policy and pay the first premium payment within 31 days after your group coverage ends. Voluntary Life Age
Employee Per $10,000
Spouse Per $5,000
>25
$0.44
$0.22
Extended Death Benefit with Waiver of Premium – The extended death benefit continues your coverage without payment of premium, before you’re eligible to qualify for Waiver of Premium, if you are continuously Disabled for 9 months prior to age 60. “Disabled” means, because of injury or sickness, you are unable to perform all the material duties of your regular occupation, or you are receiving disability benefits under a program sponsored by your Employer. Regular Occupation means the occupation you routinely performed at the time your Disability began. We/the insurance company will consider the duties of your occupations as those that are normally performed in the general labor market in the national economy. If you qualify for this benefit and have insured your spouse or children, the insurance company will also extend their coverage if applicable.
25-29
$0.50
$0.25
30-34
$0.62
$0.31
35-39
$0.88
$0.44
40-44
$1.26
$0.63
45-49
$2.01
$1.01
50-54
$3.19
$1.60
55-59
$4.90
$2.45
60-64
$7.66
$3.83
Waiver of Premium – If you become Disabled prior to age 60, and you remain Disabled continuously for a 9 month period and thereafter, you won’t need to pay premiums for your life insurance coverage, provided we/the Insurance Company determine(s) you are Disabled. “Disabled” for this coverage means, because of injury or sickness, you are unable to perform the material duties of your regular occupation, or are receiving disability benefits under a program sponsored by your employer, for the first 12 months after your Disability began. Thereafter, you must be unable to perform the material duties of any occupation that you are or may reasonably become qualified based on your education, training or experience. If you qualify for this coverage and have insured your spouse or children, the insurance company will also waive their premium if applicable.
65-69
$13.29
$6.65
70-74
$23.87
$11.86
75+
$46.48
$23.24
Additional Features:
Voluntary Life - Child(ren) Ages
Per $10,000 in coverage
0-26
$3.49 Spouse rates based on employee age.
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AD&D Insurance
EMPLOYEE BENEFITS
Cigna ABOUT AD&D INSURANCE 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/lovejoyisd
Employee-Paid Accidental Death & Dismemberment Insurance Who Can Elect Coverage? You: All active, full-time Employees of the Employer working a minimum of 15 hours per week. You will be eligible for coverage the first of the month following date of hire. Your Spouse: Up to age 70, as long as you apply for and are approved for coverage yourself. Your Child(ren): Birth to 26, as long as you apply for and are approved for coverage yourself.
Available Coverage Employee Spouse Children
Benefit Amount Units of $10,000 Units of $5,000 $10,000
Maximum $500,000 $250,000 $10,000
Benefit Details: If, within 365 days of a Covered % Benefit Amount: Accident, bodily injuries result in: Loss of life; Total paralysis of both upper and lower limbs; Loss of two or more hands or feet; Loss of sight in both eyes; 100% or Loss of speech and hearing (both ears) Total paralysis of both lower limbs or 75% both upper limbs Total paralysis of upper and lower limbs on one side of the body; Loss of one hand, one foot, sight in one eye, speech, 50% or hearing in both ears; or Severance and Reattachment of one hand or foot Total paralysis of one upper or one lower limb; Loss of all four fingers of the 25% same hand; or Loss of thumb and index finger of the same hand Loss of all toes of the same foot 20%
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For Comas – You will receive 1% of the full benefit amount each month, for up to a maximum of 11 months, if you or an insured family member are in a coma for 30 days or more as a result of a Covered Accident. If the covered person is still in a coma after 11 months, or dies, the full benefit amount will be paid.
Your Monthly Cost of Coverage: • • •
Employee Cost Per $10,000 units = $.30 Spouse Cost Per $5,000 units = $.15 Child’s Cost Per $1,000 units = $.04 Actual per pay period premiums may differ slightly due to rounding. Benefits will reduce on age (see Benefits Reduction Schedule for details). Rates may be subject to change in the future.
How to Calculate Your Monthly Cost of Coverage: Step 1: Find the above Monthly rate. Step 2: Multiply this rate by your desired coverage amount, in units. Reference the information above to find the appropriate unit amounts for employee and/or dependents. Step 3: The result is the Monthly cost.
Benefit Reductions, Exclusions and Limitations Benefit Reduction Schedule: If you are still employed, your benefits will reduce to 65% at age 65 and 50% at age 70. Your premiums will also reduce to match your benefits. Limitations – For multiple covered losses, benefits are paid for the single largest benefit available. For loss of life, the benefit amount shown will be reduced by the amount of any dismemberment benefits that were previously paid or payable. Exclusions - Please refer to plan certificate for a full list of exclusions.
Cancer Insurance
EMPLOYEE BENEFITS
APL ABOUT CANCER Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.
For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
Treatment for cancer is often lengthy and expensive. While your health insurance Cancer 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 Employee Only for paying your health plan deductibles and/or coinsurance. Cancer insurance through American Public Life helps pay for these direct and indirect treatment costs Employee and Spouse so you can focus on your health. Employee and Child(ren) Should you need to file a claim contact APL at 800-256-8606 or online at Employee and Family www.ampublic.com. You can find additional claim forms and materials at www.mybenefitshub.com/lovejoyisd. Benefit Highlights Internal Cancer First Occurrence* Cancer Treatment Policy Benefits Radiation and Chemotherapy, ImmunotherapyMaximum Per 12-month period Hormone TherapyMaximum of 12 treatments per calendar year Miscellaneous Care Rider Benefits Hair Piece (Wig)- 1 per lifetime Blood, Plasma &Platelets Ambulance- Ground /AirMaximum of 2 trips per Hospital Confinement for all modes of transportation combined Heart Attack/Stroke First Occurrence Rider Benefits Lump Sum Benefit- Maximum per 1 covered person per lifetime
Plan 1
Plan 2
$15.00
$23.96
$32.44
$52.06
$17.30
$27.66
$34.72
$55.82
Plan 1 $5,000
Plan 2 $10,000
$15,000
$20,000
$50 per treatment
$50 per treatment
$150 $300 per day
$150 $300 per day
$200/$2,000 per trip
$200/$2,000 per trip
$5,000
$10,000
Pre-Existing Condition Exclusion: Review the Benefit Summary page that can be found at www.mybenefitshub.com/lovejoyisd for full details. *Carcinoma in situ is not considered internal cancer
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Critical Illness Insurance
EMPLOYEE BENEFITS
Unum ABOUT CRITICAL ILLNESS Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non-medical costs related to the illness, including transportation, child care, etc.
For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
Who is eligible for this coverage? All employees in active employment in the United States working at least 15 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: $10,000, $20,000 or $30,000 For your Spouse: 50% of employee coverage amount For your Children: 50% of employee coverage amount
Progressive Diseases Amyotrophic Lateral Sclerosis (ALS) Dementia (including Alzheimer’s Disease) Functional Loss Multiple Sclerosis (MS) Parkinson’s Disease Additional Critical Illnesses for your Children Cerebral Palsy Cleft Lip or Palate Cystic Fibrosis Down Syndrome Spina Bifida
100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
*Please refer to the policy for complete definitions of covered conditions.
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 Cancer Invasive Cancer (including all Breast Cancer) Non-Invasive Cancer Skin Cancer 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 28
Percentage of Coverage Amount 50% 10% 100% 100% 100% 100%
100% 25% $500 100% 100% 100% 100% 100% 25% 100% 100%
Covered Condition Benefit The covered condition benefit is payable once per covered condition per insured. Unum will pay a covered condition benefit for a different covered condition if: —the new covered condition is medically unrelated to the first covered condition; or —the dates of diagnosis are separated by more than 180 days. Reoccurring Condition Benefit We will pay the reoccurring condition benefit for the diagnosis of the same covered condition if the covered condition benefit was previously paid and the new date of diagnosis is more than 180 days after the prior date of diagnosis. The benefit amount for any reoccurring condition benefit is 100% of the percentage of coverage amount for that condition. The following Covered Conditions are eligible for a reoccurring condition benefit: • Benign Brain Tumor • Major Organ Failure Requiring Transplant • Heart Attack (Myocardial Infarction) • Coronary Artery Disease (Minor) • Coma • Non-Invasive Cancer • Invasive Cancer (includes all Breast Cancer) • End Stage Renal (Kidney) Failure • Coronary Artery Disease (Major) • Stroke
Critical Illness Insurance
EMPLOYEE BENEFITS
Unum
Critical Illness Option 1 $10,000 EE, $5,000 SP
Option 2 $20,000 EE, $10,000 SP
Option 3 $30,000 EE, $15,000 SP
Age
Employee Cost
Spouse Cost
Employee Cost
Spouse Cost
Employee Cost
Spouse Cost
Less than age 25
$1.80
$0.90
$3.60
$1.80
$5.40
$2.70
25-29
$2.60
$1.30
$5.20
$2.60
$7.80
$3.90
30-34
$3.60
$1.80
$7.20
$3.60
$10.80
$5.40
35-39
$5.30
$2.65
$10.60
$5.30
$15.90
$7.95
40-44
$7.50
$3.75
$15.00
$7.50
$22.50
$11.25
45-49
$10.40
$5.20
$20.80
$10.40
$31.20
$15.60
50-54
$13.80
$6.90
$27.60
$13.80
$41.40
$20.70
55-59
$19.30
$9.65
$38.60
$19.30
$57.90
$28.95
60-64
$27.60
$13.80
$55.20
$27.60
$82.80
$41.40
65-69
$40.50
$20.25
$81.00
$40.50
$121.50
$60.75
70-74
$63.50
$31.75
$127.00
$63.50
$190.50
$95.25
75-79
$93.60
$46.80
$187.20
$93.60
$280.80
$140.40
80-84
$136.10
$68.05
$272.20
$136.10
$408.30
$204.15
85 or over
$219.40
$109.70
$438.80
$219.40
$658.20
$329.10
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Identity Theft
EMPLOYEE BENEFITS
ID Watchdog 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/lovejoyisd
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.
our U.S.-based customer care team is available 24/7/365 at 866.513.1518.
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,
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 provider. Dedicated 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.
WHAT YOU NEED TO KNOW Plan Options Credit Report(s) & VantageScore Credit Score(s) Credit Score Tracker
1 Bureau Monthly
ID WATCHDOG® PLATINUM 1 Bureau Daily & 3 Bureau Annually 1 Bureau Daily
Credit Report Monitoring
1 Bureau
Multi-Bureau
Credit Report Lock
1 Bureau
$54.40
Up to $1M
Up to $1M
-
Up to $500k
Identity Theft Insurance 401K/HSA Stolen Funds Reimbursement
ID WATCHDOG® 1B 1 Bureau Monthly
MONTHLY PREMIUMS
30
Employee
$7.95
$11.95
Employee and Family
$14.95
$22.95
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 Preexisting Conditions)✓ • 24/7/365 U.S.-based Customer Care Center • Lost Wallet Vault & Assistance • Deceased Family Member Fraud Remediation • Fraud Alert & Credit Freeze Assistance ✓ 1 2 3
Helps better protect children Bureau = Equifax® Multi-Bureau = Equifax, TransUnion® Bureau = Equifax, Experian®, TransUnion
Flexible Spending Account (FSA) NBS
EMPLOYEE BENEFITS
ABOUT FSA A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (unless your plan contains a $500 rollover or grace period provision).
For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd 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). How the Health Care FSAs Work You can access the funds in your Health Care FSA two different ways: • Use your NBS Debit Card to pay for qualified expenses, doctor visits and prescription copays. • Pay out-of-pocket and submit your receipts for reimbursement: • Fax – 844-438-1496 • Email – service@nbsbenefits.com • Online – my.nbsbenefits.com • Call for Account Balance: 855-399-3035 • Mail: PO Box 6980 West Jordan, UT 84084 Contact NBS • • • •
Hours of Operation: 6:00 AM – 6:00 PM MST, Mon-Fri Phone: (800) 274-0503 Email: service@nbsbenefits.com Mail: PO Box 6980 West Jordan, UT 84084
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. 31
Flexible Spending Account (FSA)
EMPLOYEE BENEFITS
NBS
Dependent Care FSA Guidelines • 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.
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. • You can continue to file claims incurred during the plan year for another 30 days (up until date). • 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 (OTC) 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. 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) 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
$2,850
Saves on eligible expenses not covered by insurance, reduces your taxable income
$5,000 single $2,500 if married and filing separate tax returns
Reduces your taxable income
Dependent Care FSA
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Employee Assistance Program (EAP) Cigna
EMPLOYEE BENEFITS
ABOUT EAP An Employee Assistance Program (EAP) is a program that assists you in resolving problems such as finding child or elder care, relationship challenges, financial or legal problems, etc. This program is provided by your employer at no cost to you.
For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
Life. Just when you think you’ve got it figured out, along comes a challenge. Whether your needs are big or small, your Life Assistance & Work/Life Support Program is there for you. It can help you and your family find solutions and restore your peace of mind. Call us anytime, any day. We’re just a phone call away whenever you need us. At no extra cost to you. An advocate can help you assess your needs and develop a solution. He or she can also direct you to community resources and online tools. Visit a specialist. You have three face-to-face sessions with a behavioral counselor available to you - and your household members. Call us to request a referral. Monthly Webinars Educational seminars on a variety of relevant topics such as managing your life, work, money and health, are available in a quarterly calendar of monthly webcasts distributed to your employer. Achieve work/life balance. For help handling life’s challenges go on line for articles and resources including on family, care giving, pet care, aging, grief, balancing, working smarter, and more. • Legal consultation and referrals - Receive a free 30-minute consultation with a network attorney. And up to a 25% discount on select fees. • Financial consultations - Receive a free 30-minute consultation and 25% discount on tax planning and preparation.
Life Assistance Program – 24/7 support Phone: 800.538.3543 website: www.cignalap.com
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Foundation for Lovejoy Schools LISD
EMPLOYEE BENEFITS
ABOUT THE FOUNDATION The Foundation for Lovejoy Schools benefits the students, faculty, graduates, and staff of LISD by involving the community in generating and distributing funds that enhance the educational experience.
For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
The Foundation for Lovejoy Schools awards grants to teachers for projects that enhance and augment educational opportunities for students in Lovejoy ISD. Grants that have creative teaching approaches and innovative projects that will showcase the exceptional learning available in Lovejoy.
We have granted more than five million dollars to the teachers and staff during the past 17 years! Your donation will help us provide grants for classroom enhancements teachers request, allowing them to go above and beyond in the classroom.
Receive free tickets to Denim & Diamonds! On ticket with a $10/month donation Two tickets with a $20/month donation
WECHAMPIONLOVEJOY
34
Catastrophic Sick Leave Bank
EMPLOYEE BENEFITS
ABOUT SICK LEAVE BANK The Lovejoy ISD Catastrophic Sick Leave Bank is a voluntary employee benefit program developed to provide up to 45 paid days to members who have suffered a catastrophic illness or injury.
For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
Open Enrollment
• Employees may join the Catastrophic Sick Leave Bank during the annual open enrollment period, or if a new employee, during the first 30 calendar days from hire date. •
Who Is Eligible? All Full time employees of the Lovejoy Independent School District eligible for leave benefits from the District are eligible for membership in the Sick Leave Bank.
How To Enroll To become a member of the Bank, an employee must contribute two days from his/ her accrued or anticipated local leave for the current school calendar year. New employees have the first 30 calendar days from their hire date to join the bank. The two contributed days will be acquired within the first 60 days of employment from the member’s local leave record and become the property of the Lovejoy ISD Catastrophic Sick Leave Bank. Existing employees who wish to join the Bank must do so during the district’s annual open enrollment.
Membership The effective date of membership will be the 9/1 date of the year in which the employee signed up during open enrollment. All sick leave days donated remain in the Bank and Cannot be returned even upon cancellation of the membership. Membership continues from year to year, without any additional contributions, unless: • The member uses one or more days from the Bank
•
during the year; OR A member decides to cancel his/her membership in the Bank; OR A member terminates employment with the District; OR The days paid to members during the school year cause the number of days remaining in the bank to fall below two times the number of members. Then, depending on the need, current members will give an additional day to replenish the Bank. (If a current member is unable to donate the emergency request due to that member’s leave being exhausted, the member’s ability to use the sick leave bank is not affected.)
Qualifying For Catastrophic Sick Leave Bank Days A member may request days from the Catastrophic Sick Leave Bank only after he/she has exhausted all accumulated state and local leave days, plus the 10 extended sick leave days. Catastrophic Sick Leave Bank days can be granted only for absences for working days and will not be granted for holidays, vacation days, or other such days for which the member is not paid. A member may receive days from the Bank ONLY after the two day membership donation has been contributed. Anyone who joins the sick leave bank with a pre-existing, diagnosed condition or illness for which they have received treatment within the last 90 days, shall not be allowed to utilize the sick leave bank for an illness resulting from or related to that specific condition until the member has been treatment free for 90 days or has been a member of the sick leave bank for one full year (365 days).
35
Catastrophic Sick Leave Bank Days from the Bank are granted only for a catastrophic illness or injury that necessitates an absence from work based on the Catastrophic Sick Leave Bank guidelines.
• •
EMPLOYEE BENEFITS
surgery or injury (proof of room & board charges will be required) Organ transplant Cancer with chemotherapy treatment
The application for Catastrophic Sick Leave Bank days must be received in the Human Resources office as early as Exclusions include normal pregnancy and/or post-natal possible, but no later than 30 work days from the date the care; elective or routine surgery; outpatient procedures; employee returns to work. mental disability that is not considered a “serious mental illness” as defined by Texas law; and workers’ A member who suffers a catastrophic illness or injury may compensation income eligibility. initially apply for up to 30 days from the Bank. If the employee is unable to return to work after the initial 30 When an employee has suffered a catastrophic illness or days are exhausted, he/she may apply for up to 15 injury, the member may submit to the Benefits Specialist a additional days. A lifetime maximum number of days an request for days from the Bank. This request will include employee can use is 90 days. the “Application for Catastrophic Sick Leave Bank Days” and the Catastrophic Sick Leave Bank Physician’s Statement”. The forms can be obtained from the Business and Use Of Catastrophic Sick Leave Bank for Employee Services Office. A copy of inpatient room and Immediate Family board charges will also be required. Applications will be The Bank may be used for members whose immediate processed by the Benefits Specialist and the Leave Bank family has suffered a catastrophic illness or injury. Executive Officer. Immediate family is defined in Board Policy DEC (Local).
The maximum number of Catastrophic Sick Leave Bank days that may be granted to an employee during the year (July 1 through June 30) is 45 days.
What Is Considered Catastrophic? A catastrophic illness or injury is a severe condition or combination of conditions affecting the mental or physical health of the employee or a member of the employee’s immediate family that requires the services of a licensed practitioner for a prolonged period of time and that forces the employee to exhaust all leave time earned by that employee and to lose compensation from the District. Complications resulting from pregnancy shall be treated the same as any other condition. Such conditions typically require in-patient hospitalization or are expected to result in disability or death. Determination of “catastrophic” is based upon the physician’s statement with diagnosis, and any complications, in accordance with the Catastrophic Sick Leave Bank guidelines. A few examples of conditions that may be considered catastrophic are: • Inpatient hospitalization due to major non-elective 36
See Sick Leave Bank on the Staff Resources page of the Lovejoy ISD website for more detailed information .
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2022 - 2023 Plan Year
Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the Lovejoy 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 Lovejoy 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.
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