2022 - 2023 Plan Year
MCKINNEY ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2022 - 8/31/2023 WWW.MYBENEFITSHUB.COM/MCKINNEYISD
1
Table of Contents How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) Medical Health Savings Account (HSA) Flexible Spending Account (FSA) Hospital Indemnity Dental Vision Disability Accident Critical Illness Life and AD&D
2
4-5 6-11 6 7 8 9 10
FLIP TO...
11 12-18 19 20-21 22 23 24-25 26-27 28 29-30 31-32
PG. 4
HOW TO ENROLL
PG. 6
SUMMARY PAGES
PG. 12
YOUR BENEFITS
Benefit Contact Information MCKINNEY ISD BENEFITS
MCKINNEY ISD BENEFITS ADMINISTRATOR
FLEXIBLE SPENDING ACCOUNT (FSA)
Financial Benefit Services (469) 385-4685 www.mybenefitshub.com/mckinneyisd
Amanda Wallace (469) 302‐4029 benefits@mckinneyisd.net
National Benefit Services (800) 274-0503 www.nbsbenefits.com
TRS ACTIVECARE MEDICAL
TRS HMO MEDICAL
HOSPITAL INDEMNITY
BCBSTX (866) 355-5999 www.bcbstx.com/trsactivecare
Scott & White HMO (844) 633-5325 www.trs.swhp.org
Unum Group #R0747188 (866) 679-3054 www.unum.com
DENTAL
VISION
CRITICAL ILLNESS
Delta Dental Group #44-4370 (800) 521-2651 www.deltadental.com
Avesis Group #10771-1205 High Plan #10771-1205-01 Low Plan #10771-1205 (800) 522-0258 www.avesis.com
Unum Group #473073 (866) 679-3054 www.unum.com
LIFE AND AD&D
DISABILITY
ACCIDENT
Unum Group #148506 (866) 679-3054 www.unum.com
Unum Group #125328 (866) 679-3054 www.unum.com
Unum Group #R0747188 (866) 679-3054 www.unum.com
HEALTH SAVINGS ACCOUNT EECU (800) 333-9934 www.eecu.org
3
All Your Benefits One App Employee benefits made easy through the FBS Benefits App! Text “FBS MCKINNEY” 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 #: FBSMCKINNEY
4
Text “FBS MCKINNEY” to (800) 583-6908 OR SCAN
How to Log In 1
www.mybenefitshub.com/mckinneyisd
2
CLICK LOGIN
3
ENTER USERNAME & PASSWORD Your login credentials will be the same as your McKinney ISD login. Username: Employee ID Password: district password If you do not know your username and password please contact the Help Desk at 469-302-4048 or Email support@mckinneyisd.net
5
Annual Benefit Enrollment
SUMMARY PAGES
Benefit Updates - What’s New:
TRS ACTIVE CARE MEDICAL RATES NOW REGIONAL TRS CURRENT ACTIVE CARE RATES REDUCED SLIGHTLY
NEW HOSPITAL INDEMNITY PLAN – SAME CARRIER Your new plan offers cost savings across the board. Rates are based on tier coverage with no maximum age. The rates are lower and are guaranteed for the next three years. The plan still covers a $1000 benefit maximum of 1 day per calendar year and we have added an ICU benefit. Pre-existing Limitations will apply. The plan still has the $50 Wellness plan with a broader list of screenings. All current elections will roll into a matching tier plan for the new plan year. NEW ACCIDENT PLAN – SAME CARRIER Your new Accident plan pays higher benefits based on schedule. With lower rates for some tiers and no maximum age. The rates are guaranteed for 3 years. It still provides a $50 benefit for Wellness per insured per calendar year with broader list of screenings. All current elections will roll into a matching tier plan for the new plan year. LOWER MEDICAL RATES! TRS has moved to regional rates and have lowered your rates slightly for this plan year. NEW NO-COST TRS DIGITAL MENTAL HEALTH PROGRAM! Learn to Live offers digital cognitive behavioral therapy tools to help participants learn new skills and break old patterns.
Don’t Forget! • Login and complete your benefit enrollment from 07/11/2022 - 08/12/2022 • Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202. • Update your information: home address, phone numbers, email, and beneficiaries. • REQUIRED!! Due to the Affordable Care Act (ACA) reporting requirements, you must add your dependent’s CORRECT social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator. 6
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
7
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.
8
Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ mckinneyisd. 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 McKinney ISD benefit website: www.mybenefitshub.com/mckinneyisd. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section.
When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.
Annual Benefit Enrollment
SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.
Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2022 benefits become effective on September 1, 2022, you must be actively-at-work on September 1, 2022 to be eligible for your new benefits.
MAXIMUM AGE
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Medical
To 26
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.
Dental
To 26
Vision
To 26
FSA
To 26
Life and AD&D
To 26
Accident
Unmarried to 26
PLAN
Hospital Indemnity
Unmarried to 26
Critical Illness
Unmarried to 26
FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance. Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent eligibility. Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee's enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. 9
SUMMARY PAGES
Helpful Definitions Actively-at-Work
In-Network
You are performing your regular occupation for the employer on a full-time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2022 please notify your benefits administrator.
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.
Annual Enrollment The period during which existing employees are given the opportunity to enroll in or change their current elections.
Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.
Calendar Year January 1st through December 31st
Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or preexisting condition exclusion provisions do apply, as applicable by carrier. 10
Out-of-Pocket Maximum The most an eligible or insured person can pay in coinsurance for covered expenses.
Plan Year September 1st through August 31st
Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescription drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).
SUMMARY PAGES
HSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, tax-free. This also allows employees to pay for qualifying dependent care taxfree.
Employer Eligibility
A qualified high deductible health plan.
All employers
Contribution Source
Employee and/or employer
Employee and/or employer
Account Owner
Individual
Employer
Underlying Insurance Requirement
High deductible health plan
None
Minimum Deductible
$1,400 single (2022) $2,800 family (2022)
N/A
Maximum Contribution
$3,650 single (2022) $7,300 family (2022)
$2,850 (2022)
Permissible Use Of Funds
Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Cash-Outs of Unused Amounts (if no medical expenses)
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age Not permitted 65).
Description
Year-to-year rollover of account balance?
Yes, will roll over to use for subsequent year’s health coverage.
No. Access to some funds may be extended if your employer’s plan contains a 2 1/2-month grace period or $500 rollover provision.
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
FLIP TO FOR HSA INFORMATION
PG. 19
FLIP TO FOR FSA INFORMATION
PG. 20
11
Medical Insurance
EMPLOYEE BENEFITS
Carrier Name 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/mckinneyisd
Monthly Premium
District Contribution
Employee Cost
TRS ActiveCare HD Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$422.00
$306.00
$116.00
$1,187.00
$306.00
$881.00
$757.00
$306.00
$451.00
$1,419.00
$306.00
$1,113.00
TRS ActiveCare 2 Employee Only
$1,013.00
$306.00
$707.00
Employee & Spouse
$2,402.00
$306.00
$2,096.00
Employee & Child(ren)
$1,507.00
$306.00
$1,201.00
Employee & Family
$2,841.00
$306.00
$2,535.00
TRS ActiveCare Primary Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$410.00
$306.00
$104.00
$1,157.00
$306.00
$851.00
$738.00
$306.00
$432.00
$1,384.00
$306.00
$1,078.00
TRS ActiveCare Primary+ Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$515.00
$306.00
$209.00
$1,259.00
$306.00
$953.00
$829.00
$306.00
$523.00
$1,584.00
$306.00
$1,278.00
Central and North Texas Baylor Scott and White HMO Employee Only Employee & Spouse Employee & Child(ren) Employee & Family 12
$543.35
$306.00
$237.35
$1,364.92
$306.00
$1,058.92
$873.57
$306.00
$567.57
$1,570.98
$306.00
$1,264.98
13
14
15
16
17
18
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/mckinneyisd
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs – it is also a tax-exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs. A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
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.
Qualified Expenses You can use your HSA for a wide range of qualified expenses, such as doctor’s visits, prescription drugs, lab work, medical equipment, contacts lenses, dental work, physical therapy…the list goes on! Refer to IRS Publication 502 for comprehensive guidelines.
Important HSA Information
• You will receive a debit card to manage your Health Savings Account. Keep in mind, available funds are limited to the balance in your HSA. HSA Eligibility • Always ask your health care provider to file claims with your You are eligible to open and contribute to an HSA if you are: medical provider so network discounts can be applied. You can • Enrolled in an HSA-eligible High Deductible Health Plan (HDHP) pay the provider with your HSA debit card based on the • Not enrolled in Medicare or TRICARE balance due after discount. • If you enroll in an HSA and FSA, the FSA becomes a Limited • You, not your employer, are responsible for maintaining ALL Purpose FSA and may only be used for Dental and Vision, not records and receipts for HSA reimbursements in the event of medical expenses. an IRS audit. • Not eligible to be claimed as a dependent on someone else’s • You may open an HSA at the financial institution of your choice, tax return but only accounts opened through EECU are eligible for You can use the money in your HSA to pay for qualified medical automatic payroll deduction. 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 questions. Maximum Contributions Their hours of operation are Monday through Friday from 8:00 Your HSA contributions may not exceed the annual maximum a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. to 1:00 p.m. CT and amount established by the Internal Revenue Service. The annual 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 (800) you elect: 333-9934. • Individual – $3,650 • Stop by a local EECU financial center for in-person assistance; • Family (filing jointly) – $7,300 find locations & service hours at www.eecu.org/locations. 19
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/mckinneyisd
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 Lost or Stolen Debit Cards Replacement Fee $5.00 (taken from account balance) 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 This account 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. 20
Flexible Spending Account (FSA) NBS
EMPLOYEE BENEFITS
General Plan Information Plan Year End…………………………….. August 31st Run-out Period…………………………… 90 Days Maximum Medical Limit…………….. Current IRS limit $2,850 See Code Section 125(i)(2) or current enrollment information
Maximum Dependent Care Limit.. $5,000 Health FSA Carryover…………………. Up to $500 following the Plan run-out Amounts exceeding $500 will be forfeited
Deadlines to Use Funds Health FSA………………………………….. November 29 following Plan Year End DCAP………………………………………….. November 29 following Plan Year End FSA Mid-year termination………….. 90 days following termination date DCAP Mid-year termination……….. 90 days following termination date
Over-the-Counter (OTC) Item Rule 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.
FSAstore.Com FSAstore.com offers thousands of FSA-eligible products and services to purchase using your FSA Debit Card or any major credit card. Competitive pricing and free shipping on orders over $50 can save you up to 40% using your FSA pretax dollars. Shop directly at www.FSAstore.com or have your physician submit prescriptions (when required). The FSAstore.com Services Channel allows you to search a database of more than 300,000 health care providers for nearby eligible services, such as acupuncture and chiropractic care. The FSAstore.com Learning Center focuses on answering common questions and keeping you informed about changes to your FSA benefits.
21
Hospital Indemnity
EMPLOYEE BENEFITS
Unum ABOUT HOSPITAL INDEMNITY This is an affordable supplemental plan that pays you should you be inpatient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance.
For full plan details, please visit your benefit website: www.mybenefitshub.com/mckinneyisd
How does it work? Hospital Insurance helps covered employees and their families cope with the financial impacts of a hospitalization. You can receive benefits when you’re admitted to the hospital for a covered accident, illness or childbirth based on the schedule below: Benefit
Description
Coverage
Hospital Admission
Payable for a maximum of 1 day per year
$1,000
ICU Admission
Payable for a maximum of 1 day per year
$1,000
Hospital Indemnity Monthly Rates Employee $12.38 Employee + Spouse $22.42 Employee + Child(ren) $17.54 Family $27.58
Pre-existing Condition defined by the carrier. We will not pay benefits for a claim when the Covered Loss occurs in the first 12 months following an Insured’s Coverage Effective Date and the Covered Loss is caused by, contributed to by, or resulting from any of the following: • a Pre-existing Condition; or complications arising from treatment or surgery for, or medications taken for, a Pre-existing Condition. • An Insured has a Pre-existing Condition if, within the 12 months just prior to their Coverage Effective Date, they have a a disease or physical condition whether diagnosed or not, for which: • medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period; or • drugs or medications were taken, or prescribed to be taken during that period; or • symptoms existed. • Pre-existing Condition requirements are not applicable to: • Children who are newly acquired after your Coverage Effective Date. The Pre-existing Condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage Effective Date refers to the date any initial coverage or increases in coverage become effective.
Be Well Benefit Every year, each family member who has Hospital coverage can also receive $50 for getting a covered Be Well screening test, such as: • Annual exams by a physician include sports physicals, wellchild visits, dental and vision exams • Screenings for cancer, including pap smear, colonoscopy • Cardiovascular function screenings • Screenings for cholesterol and diabetes • Imaging studies, including chest X-ray, mammography • Immunizations including HPV, MMR, tetanus, influenza For full coverage details, claim forms and instructions, and limitations/exclusions, go to: www.mybenefitshub.com/mckinneyisd under the Hospital Indemnity Section of the employee benefits portal. 22
Dental Insurance
EMPLOYEE BENEFITS
Delta Dental 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/mckinneyisd
Need to Contact the Carrier? Delta Dental Insurance Company 1130 Sanctuary Parkway, Suite 600 Alpharetta, GA 30009
Customer Service deltadentalins.com/enrollees 800-521-2651
Dental Monthly Rates Enrollee only
$44.44
Enrollee + 1 Dependent
$78.64
Enrollee + 2 or more Dependents
$101.44
Plan Benefit Highlights Eligibility Deductibles
Primary enrollee, spouse, and eligible dependent children to age 26 $50 per person / $150 per family each plan year
Deductibles waived for Diagnostic & Preventive (D & P) and Orthodontics?
Yes
Maximums
$1,500 per person each plan year
D & P counts toward maximum?
Yes
Waiting Period(s) Benefits and Covered Services* Diagnostic & Preventive Services (D&P) Exams, cleanings, x-rays and sealants Basic Services Fillings and denture repair/reline/rebase Endodontics (root canals) Covered Under Basic Services Periodontics (gum treatment) Covered Under Basic Services Oral Surgery Covered Under Basic Services Major Services Crowns, inlays, onlays and cast restorations Prosthodontics Bridges and dentures Orthodontic Benefits Dependent children Orthodontic Maximums
Basic Benefits
Major Benefits
None
None
Prosthodontics
Orthodontics
None
None
Delta Dental DPO dentists**
Non-Delta Dental DPO dentists**
100%
100%
80%
80%
80%
80%
80%
80%
80%
80%
50%
50%
50%
50%
50%
50%
$1,500 Lifetime
$1,500 Lifetime
* Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist’s submitted fees. ** Reimbursement is based on DPO contracted fees for DPO dentists, Premier contracted fees for Premier dentists and program allowance for non-Delta Dental dentists. 23
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/mckinneyisd
Reliable & Dependable Avēsis is a national leader in providing exceptional vision care benefits for millions of commercial members throughout the country. The Avēsis Vision care products give our members an easy-to-use wellness benefit that provides excellent value and protection.
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, 7:00 AM to 8:00 PM (EST) at 800-828-9341 to receive a listing of providers in your area. 1. Select a provider 2. Make an appointment 3. Visit provider for service 4. Pay any copays or additional expenses
Vision Monthly Rates High Employee $8.90 Employee + Spouse $15.80 Employee + Child(ren) $18.34 Family $23.26
Low $5.90 $10.30 $12.14 $15.05
How can we help you? Avēsis website: www.avesis.com Customer Service: 800-828-9341 7:00 AM - 8:00 PM EST LASIK Provider: 877-712-2010
High Plan
Low Plan
Vision Care Services
Vision Examination (Includes Refraction)
Contact Lens Fit and Follow-up Standard Contact Lens Fitting Custom Contact Lens Fitting Materials*
In-Network Member Cost
Out-of-Network Reimbursement
In-Network Member Cost
Out-of-Network Reimbursement
Covered in full after $10 copay
Up to $35
Covered in full after $10 copay
Up to $35
Up to $50 member out-ofpocket maximum Up to $75 member out-ofpocket maximum $ 20 copay
N/A
out-of-pocket maximum: Up to $50
N/A
N/A
Up to $75
N/A
$ 20 copay
(Materials copay applies to frame or spectacle lenses, if applicable.)
(Materials copay applies to frame or spectacle lenses, if applicable.)
Frame Allowance (Up to 20% discount above frame allowance.)
24
$150 allowance
Up to $45
$150 allowance
Up to $45
Vision Insurance
EMPLOYEE BENEFITS
Avesis High Plan Vision Care Services
In-Network Member Cost
Low Plan Out-of-Network Reimbursement
In-Network Member Cost
Out-of-Network Reimbursement
Standard Spectacle Lenses Single Vision
Covered in full after $20 copay Covered in full after $20 copay Covered in full after $20 copay Covered in full after $20 copay
Up to $25
Covered in full
Up to $10
Standard Scratch-Resistant Coating
Covered in full
Up to $5
$17
N/A
Ultra-Violet Screening
Covered in full
Up to $6
$15
N/A
Solid or Gradient Tint
Covered in full
Up to $4
$17
N/A
Standard Anti-Reflective Coating
Covered in full
Up to $24
$45
N/A
Level 1 Progressives
Covered in full
Up to $40
$75
Up to $40
Level 2 Progressives
Covered in full
Up to $48
$110
Up to $40
$140 allowance + 20% discount
Up to $48
$50 allowance + 20% discount
Up to $40
$70/$80
N/A
$70/$80
N/A
Polarized
$75
N/A
$75
N/A
PGX/PBX
$40
N/A
$40
N/A
Up to 20% discount
N/A
Up to 20% discount
N/A
Bifocal Trifocal Lenticular Preferred Pricing Options Level 7 Option Package Polycarbonate (Single Vision/Multi-Focal)
All Other Progressives Transitions® (Single Vision/MultiFocal)
Other Lens Options
Up to $40 Up to $50 Up to $80
Covered in full after $20 copay Covered in full after $20 copay Covered in full after $20 copay Covered in full after $20 copay
Up to $25 Up to $40 Up to $50 Up to $80
$40/$44 (Covered in full up N/A (Up to $10 for ages to age 19) up to 19)
Contact Lenses† (in lieu of frame and spectacle lenses) Elective
$150 allowance
Up to $128
$150 allowance
Up to $128
Medically Necessary
Covered in full
Up to $250
Covered in full
Up to $250
Refractive Laser Surgery
Onetime/lifetime $150 allowance Provider discount up to 25%
Onetime/lifetime $150 allowance
Onetime/lifetime $150 allowance Provider discount up to 25%
Onetime/lifetime $150 allowance
Frequency Eye Examination
Once every 12 months
Lenses or Contact Lenses
Once every 12 months
Frame
Once every 12 months
* Discounts are not insured benefits. † Prior authorization is required for medically necessary contacts. *At participating Walmart/Sam's locations, retail pricing for your plan is $82 . At participating Costco locations, retail pricing is $84.99 .
25
Disability Insurance
EMPLOYEE BENEFITS
Unum 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/mckinneyisd
Eligibility
•
You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. The date you are eligible for coverage is the later of: the plan effective date; or the day after you complete the waiting period.
Survivor Benefit: Unum will pay your eligible survivor a lump sum benefits equal to 3 months of your gross disability payment.
•
Dependent Care Expense Benefit: If you are disabled and participating in Unum’s Rehabilitation and Return to Work Assistance program, Unum will pay a Dependent Care Expense $350 per month per dependent, to a maximum of $1,000 per month for all dependent care expenses combined.
•
Education Benefit: If you are disabled and receiving monthly disability benefits, you may receive an additional monthly Education Benefit of $200 for each child who is an eligible student.
•
Medical Treatment Benefit: A Medical Treatment Benefit will be paid when you receive treatment by a doctor as a result of a sickness or injury, provided no other benefits are payable under the plan as a result of the condition for which the treatment was rendered.
Benefit Amount You may purchase a monthly benefit in $100 units, starting at a minimum of $200, up to 66 2/3% of your monthly earnings rounded to the nearest $100, but not to exceed a monthly maximum benefit of $8,000.
Elimination Period The Elimination Period is the length of time of continuous disability, due to sickness or injury, which must be satisfied before you are eligible to receive benefits. You may choose an Elimination Period (injury/sickness) of 14/14, 30/30, 60/60, 90/90 or 180/180 days. If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.)
Other Important Provisions
Pre-Existing Condition Exclusion: Benefits will not be paid for disabilities caused by, contributed to by, or resulting from a pre-existing condition. You have a pre-existing condition if: • you received medical treatment, consultation, care or Benefit Duration services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your Your duration of benefits is based on your age when the disability effective date of coverage; and occurs. • the disability begins in the first 12 months after your Age at Disability Maximum Duration of Benefits effective date of coverage. Less than age 60 To age 65, but not less than 5 years • After benefits have been paid for 24 months, you are Age 60 through 64 5 years disabled when Unum determines that due to the same Age 65 through 69 To age 70, but not less than 1 year sickness or injury, you are Age 70 and over 1 year • unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training, or Additional Benefits experience. • Work/Life Balance Employee Assistance Program: Work-life • You must be under the regular care of a physician to be balance is a comprehensive resource providing access to considered disabled. professional assistance for a wide range of personal and work-related issues. 26
Disability Insurance Unum
EMPLOYEE BENEFITS
Benefit Integration: Your disability benefit will be reduced by deductible sources of income and any earnings you have while disabled. After you have received monthly disability payments for 12 months, your gross disability payment will be reduced by such items as additional deductible sources of income you receive or are entitled to receive under state compulsory benefit laws.
Mental Illness/Self-Reported Symptoms The lifetime cumulative maximum benefit period for all disabilities due to mental illness and disabilities based primarily on self-reported symptoms is 24 months. Only 24 months of benefits will be paid for any combination of such disabilities even if the disabilities are not continuous and/or are not related. Payments would continue beyond 24 months only if you are confined to a hospital or institution because of the disability. Limitations apply.
How to file a claim and Other Important Resources To file a claim online: https://www.unum.com/employees/file-a-claim To check the status of a claim: https://unum.com/claims (800) 858-6843 M-F 8-8 EST
Disability Monthly Rates per $100 in benefit Elimination Period ($200 Minimum) 14/14 $3.93 30/30 $3.21 60/60 $2.15 90/90 $1.84 180/180 $1.38
27
Accident Insurance Unum
EMPLOYEE BENEFITS
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/mckinneyisd
How does it work? Accident Insurance can pay a set benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur on and off the job. And it includes a range of incidents, from common injuries to more serious events. In addition, it covers loss of life for you and your family as well as dismemberment for loss of limb. Included are benefits for Hospitalization, ER Room, Ambulance and Urgent Care in a Physician’s Office. Please refer to schedule located in the plan summary of the employee benefits portal: www.mybenefitshub.com/mckinneyisd under the Accident Section for a complete list and limitations and exclusions.
What’s Included? Be Well Benefit Every year, each family member who has Accident coverage can also receive $50 for getting a covered Be Well screening test, such as: • Annual exams by a physician include sports physicals, well-child visits, dental and vision exams • Screenings for cancer, including pap smear, colonoscopy • Cardiovascular function screenings • Screenings for cholesterol and diabetes • Imaging studies, including chest X-ray, mammography • Immunizations including HPV, MMR, tetanus, influenza
How do I file a Claim? You can call 800-635-5597 or go online: https://www.unum.com/employees/file-a-claim For full coverage details and limitations and exclusions, please go to: www.mybenefitshub.com/mckinneyisd under the Accident Section of the employee benefits portal. Accident Monthly Rates Employee $13.24 Employee + Spouse $23.36 Employee + Child(ren) $29.82 Family $39.94
28
Critical Illness Insurance Unum
EMPLOYEE BENEFITS
ABOUT CRITICAL ILLNESS Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non-medical costs related to the illness, including transportation, child care, etc.
For full plan details, please visit your benefit website: www.mybenefitshub.com/mckinneyisd Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. This is a overview of coverage and does not provide all the conditions and terms of the plan. Please refer to the district website www.mybenefitshub.com/mckinneyisd under the Critical Illness section for complete details. How to file a Claim: Call 800-635-5597 or online at https://www.unum.com/employees/file-a-claim Who is eligible for this coverage? What are the Critical Illness coverage amounts?
Can I be denied coverage? When is coverage effective?
What critical illness conditions are covered?
All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status). The following coverage amounts are available. For you: Select one of the following $10,000, $20,000 or $30,000 For your Spouse and Children: 100% of employee coverage amount Coverage is guarantee issue. Please see your Plan Administrator for your effective date of coverage. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. Covered Conditions* % of Coverage Amount 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
50% 10% 100% 100% 100% 100%
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
100% 100% 100% 100% 100% 25% 100% 100%
Progressive Diseases Amyotrophic Lateral Sclerosis (ALS) Dementia (including Alzheimer’s Disease) Functional Loss Multiple Sclerosis (MS) Parkinson’s Disease
100% 100% 100% 100% 100% 29
Critical Illness Insurance
EMPLOYEE BENEFITS
Unum What critical illness conditions are covered? (cont’d)
Covered Condition Benefit
Reoccurring Condition Benefit
Additional Critical Illnesses for your Children Cerebral Palsy Cleft Lip or Palate Cystic Fibrosis Down Syndrome Spina Bifida
* Please refer to the policy for complete definitions of covered conditions. 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. 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:
Are wellness screenings covered?
100% 100% 100% 100% 100%
Benign Brain Tumor Coma Coronary Artery Disease (Major) Coronary Artery Disease (Minor) End Stage Renal (Kidney) Failure
Heart Attack (Myocardial Infarction) Invasive Cancer (includes all Breast Cancer) Major Organ Failure Requiring Transplant Non-Invasive Cancer Stroke
Each insured is eligible to receive one Be Well Benefit per calendar year. If the employee’s Critical Illness Coverage Amount is: $10,000 $20,000 $30,000
Be Well Benefit The Be Well Benefit Amount for you, your spouse and your children is: $50 $75 $100
Be Well Screenings include tests for the following: cholesterol and diabetes, cancer and cardiovascular function. They also include imaging studies, immunizations and annual examinations by a Physician. See certificate for details. Critical Illness Monthly Rates Age
Employee $10,000
Employee $20,000
Employee $30,000
Spouse $10,000
Spouse $20,000
Spouse $30,000
> 25
$3.52
$7.05
$10.57
$3.52
$7.05
$10.57
25-29
$4.42
$8.85
$13.27
$4.42
$8.85
$13.27
30-34
$5.62
$11.25
$16.87
$5.62
$11.25
$16.87
35-39
$7.42
$14.85
$22.27
$7.42
$14.85
$22.27
40-44
$9.72
$19.45
$29.17
$9.72
$19.45
$29.17
45-49
$12.72
$25.45
$38.17
$12.72
$25.45
$38.17
50-54
$16.02
$32.05
$48.07
$16.02
$32.05
$48.07
55-59
$21.52
$43.05
$64.57
$21.52
$43.05
$64.57
60-64
$29.72
$59.45
$89.17
$29.72
$59.45
$89.17
65-69
$42.82
$85.65
$128.47
$42.82
$85.65
$128.47
70-74
$66.72
$133.45
$200.17
$66.72
$133.45
$200.17
75-79
$98.42
$196.85
$295.27
$98.42
$196.85
$295.27
80-84
$143.62
$287.25
$430.87
$143.62
$287.25
$430.87
85+
$231.42
$462.85
$694.27
$231.42
$462.85
$694.27
30
Life and AD&D
EMPLOYEE BENEFITS
Unum ABOUT LIFE AND AD&D Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family. Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered. For full plan details, please visit your benefit website: www.mybenefitshub.com/mckinneyisd
Basic Life and AD&D
Voluntary Life and AD&D
Who is eligible for this coverage? All actively employed employees working at least 20 hours each week for your employer in the U.S.
Who is eligible for this coverage? All actively employed employees working at least 20 hours each week for your employer in the U.S. and their eligible spouses and children to age 26.
What is the coverage amount? Your employer is providing you with $5,000 of Term Life insurance. You will also receive $5,000 of Accidental Death and Dismemberment insurance.
Is it portable (can I keep it if I leave my employer)? If you retire, reduce your hours or leave your employer, you can continue coverage at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy. What does my AD&D insurance pay for? The full benefit amount is paid for loss of: • Life • Both hands or both feet or sight of both eyes • One hand and one foot • One hand and the sight of one eye • Speech and hearing Do my life insurance benefits decrease with age? Coverage amounts will reduce according to the following schedule: Age: Insurance amount reduces to: 65 65% of original amount 70 50% of original amount 75 30% of original amount Coverage may not be increased after a reduction.
What are the coverage amounts? Employee: up to 5 times salary in increments of $10,000; not to exceed $500,000. Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $500,000. Child: up to 100% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $1,000. What are the AD&D coverage amounts? Employee: up to 5 times salary in increments of $10,000; not to exceed $500,000. Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $500,000. Child: up to 100% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $1,000. Note: You may purchase AD&D coverage for yourself regardless of whether you purchase term life coverage. In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself.
31
Life and AD&D Unum What does my AD&D insurance pay for? The full benefit amount is paid for loss of: • life; • both hands or both feet or sight of both eyes; • one hand and one foot; • one hand or one foot and the sight of one eye; • speech and hearing. Other losses may be covered as well. Please contact your plan administrator.
Can I be denied coverage? Current Employees: If you and your eligible dependents are enrolled in the plan and wish to increase your life insurance coverage, you may apply on or before the enrollment deadline for any amount of additional coverage up to the plan max for yourself and any amount of additional coverage up to $50,000 for your spouse. Any life insurance coverage over the guaranteed amount(s) will be subject to answers to health questions. If you and your eligible dependents are not currently enrolled in the plan, you may apply for coverage on or before the enrollment deadline and will be required to answer health questions for any amount of coverage. New Employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense. Are there any life insurance exclusions or limitations? Life insurance benefits will not be paid for deaths caused by suicide within the first 24 months after the date your coverage becomes effective. If you increase or add coverage, these enhancements will not be paid for deaths caused by suicide within the first 24 months after you make these changes. Will my premiums be waived if I’m disabled? If you become disabled (as defined by your plan) and are no longer able to work, your life premium payments will be waived until your disability period ends.
32
EMPLOYEE BENEFITS Term Life Monthly Rates (Per $1,000) Age Employee or Spouse <25 $0.019 25-29 $0.019 30-34 $0.028 35-39 $0.048 40-44 $0.057 45-49 $0.085 50-54 $0.143 55-59 $0.247 60-64 $0.323 65-69 $0.599 70-74 $0.960 75+ $0.960 Child life monthly rate is $0.26 per $1,000. One life premium covers all children. Spouse rates based on Employee’s Age AD&D Monthly Rate Chart (Per $1,000) Employee $0.02 Spouse $0.02 Child $0.02 This is a brief overview of this benefit. All conditions and limitations can be found on your benefit website, www.mybenefitshub.com/mckinneyisd, under the Life Insurance and AD&D sections.
Notes
33
Notes
34
Notes
35
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 McKinney 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 McKinney ISD Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.
WWW.MYBENEFITSHUB.COM/MCKINNEYISD 36