MIDLAND ISD BENEFIT GUIDE EFFECTIVE: 09/01/2022 8/31/2023 WWW.MYBENEFITSHUB.COM/MIDLANDISD 2022 - 2023 PlanYear 1
Table of Contents FLIP TO... How to Enroll 4-5 Annual Benefit Enrollment 6-11 1. Annual Enrollment 6 2. Section 125 Cafeteria Plan Guidelines 7 3. Helpful Definitions 8 4. Eligibility Requirements 9 Hospital Indemnity 10 Telehealth 11 Vision 12-13 Disability 14 Life and AD&D 15-16 Individual Life 17 Cancer 18 Critical Illness 19-20 Accident 21-22 Emergency Medical Transportation 23 Flexible Spending Account (FSA) 24-25 HOW TO ENROLLPG. 4 SUMMARYPAGESPG. 6 BENEFITSYOURPG. 10 2
5Star Life Insurance (866) 863 www.5starlifeinsurance.com9753 American Public Life (800) 256 www.ampublic.com8606
VISION
MIDLAND ISD BENEFITS HOSPITAL INDEMNITY TELEHEALTH Financial Benefit Services (800) 583 www.mybenefitshub.com/midlandisd6908
GroupUNUM#: 682480 (800) 635 www.unum.com5597
The Hartford Group #: GLT 681451 (866) 294 www.thehartford.com7987
UNUM Basic Life Group #:682481 Voluntary Group Life Group #:682482 (866) 679 www.unum.com3054 CRITICAL ILLNESS
GroupMDLIVE#: FBS (888) 365 www.mdlive.com/fbs1663
FLEXIBLE
INDIVIDUAL LIFE CANCER
ACCIDENT EMERGENCY TRANSPORTATIONMEDICAL
399
SPENDING ACCOUNT (FSA) The GroupHartford#:VAC 681451 (866) 294 www.thehartford.com7987 (800)MASA423 www.masamts.com3226
Superior Vision Group #: 37737 (800) 507 www.superiorvision.com3800
DISABILITY LIFE AND AD&D
Benefit Contact Information Don’t Forget! • Login and complete your benefit enrollment from 07/25/2022 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. 3
The GroupHartford#:VH1 681451 (866) 294 www.thehartford.com7987
GroupNBS #: NBS400240 (855) www.nbsbenefits.com3035
Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS MIDLAND” to (800) 583 6908 App Group #: FBSMIDLAND Text “FBS MIDLAND” to (800) 583 6908 and get access to everything you need to complete your benefits enrollment: • Benefit Resources • Online Enrollment • Interactive Tools • And more! 4
1 www.mybenefitshub.com/midlandisd How to Log In 2 CLICK LOGIN 3
ENTER USERNAME & PASSWORD Your Username Is: The first six (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number. Your Password Is: Four (4) digits of your birth year followed by the last four (4) digits of your Social Security Number If you have previously logged in, you will use the password that you created, NOT the password format listed above.
5
Annual Benefit Enrollment
• 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.
New Hire 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 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.
Where can I find forms?
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.
6
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.
For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ midlandisd. Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms Howsection.can I find a Network Provider?
For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866 914 5202 for assistance.
All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
For benefit summaries and claim forms, go to the Midland ISD benefit www.mybenefitshub.com/midlandisdwebsite:. 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?
Annual Enrollment
Q&A Who do I contact with Questions?
SUMMARY PAGES
Annual Benefit Enrollment
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.
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
7
Eligibility for Government Programs
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.
Marital Status
Change in Status of Employment
Affecting Coverage Eligibility
CHANGES IN (CIS):STATUS QUALIFYING EVENTS
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.
SUMMARY PAGES
Gain/Loss EligibilityDependents'ofStatus
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.
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.
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.
Section 125 Cafeteria Plan Guidelines
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
Change in Number of Tax Dependents
Judgment/Decree/Order
Actively at Work
PAGES
Pre Existing Conditions
SUMMARY
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.
Helpful Definitions
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.
The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively at work and/or pre existing condition exclusion provisions do apply, as applicable by carrier.
Out of Pocket Maximum
The period during which existing employees are given the opportunity to enroll in or change their current elections.
January 1st through December 31st Co-insurance
Plan Year September 1st through August 31st
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 Enrollment
Calendar Year
Guaranteed Coverage
The amount you pay each plan year before the plan begins to pay covered expenses.
8
Annual Deductible
In Network Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.
The most an eligible or insured person can pay in co insurance for covered expenses.
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.
PLAN MAXIMUM AGE Accident Through 25 Cancer Through 24 Critical Illness Through 25 Dental Through 25 Dependent Care FSA 12 or younger or qualified individual unable to care for themselves & claimed as a dependent on your taxes Individual Life Issue through 23; Keep to 100 Healthcare FSA Through 25 or IRS Tax Dependent Medical Through 25 HospitalPlanIndemnity Through 25 Telehealth Through 25 Vision Through 25 Basic and Voluntary Life and AD&D Through 25 Through 25
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.
Dependent RequirementsEligibility
Employee RequirementsEligibility
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
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.
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,
TransportationMedical
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.
SUMMARY PAGES
Annual Benefit
Enrollment 9
Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week. 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.
hospital indemnity plans,
WHO IS ELIGIBLE? You are eligible for this insurance if you are an active full time employee who works at least 20 hours per week on a regularly scheduled basis, and are less than age 80. Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26 (or under age None if a full time student). AM I GUARANTEED COVERAGE? This insurance is guaranteed issue coverage it is available without having to provide information about your or your family’s health. All you have to do is elect the coverage to become insured. PLAN INFORMATION LOW PLAN HIGH PLAN Coverage Type On and off job (24 hour) On and off job (24 hour) Covered Events Illness and injury Illness and injury HSA Compatible? Yes Yes BENEFITS LOW PLAN HIGH PLAN HOSPITAL CARE2 First Day Hospital Confinement Up to 1 day per year $1500 $3000 Daily Hospital Confinement (Day 2+) Up to 90 days per year $100 $200 Daily ICU Confinement (Day 1+) Up to 30 days per year $150 $250 AbilityFEATURESAssist® EAP2 24/7/365 access to help for financial, legal or emotional issues Included Included HealthChampionSM2 Administrative & clinical support following serious illness or injury Included Included Hospital IndemnityLow High Employee Only $23.48 $46.80 Employee and Spouse $42.03 $83.76 Employee and Child(ren) $41.36 $82.42 Employee and Family $62.87 $125.28 10
The
ABOUT HOSPITAL INDEMNITY
expenses
This is an affordable supplemental plan that pays you should you be in patient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance. full please visit your benefit website: www.mybenefitshub.com/midlandisd
For
COVERAGE
expenses
Hospital Indemnity
EMPLOYEE BENEFITS
plan details,
insurance
The Hartford Hospital Indemnity (HI) insurance pays a cash benefit if you or an insured dependent (spouse or child) are confined in a hospital for a covered illness or injury. Even with the best primary health insurance plan, out of pocket costs from a hospital stay can add up. benefits are paid in lump sum amounts to you, and can help offset that primary health insurance doesn’t cover (like deductibles, co amounts or co pays), or benefits can be used for any non medical (like housing costs, groceries, car expenses, etc.). INFORMATION You have a choice of two which allows you the flexibility to enroll for the coverage that best meets visit www.thehartford.com/employeebenefits
your needs. To Learn more about Hospital Indemnity Insurance,
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/midlandisd Telehealth MDLIVE EMPLOYEE BENEFITS Alongside your medical coverage is access to quality telehealth services through MDLIVE. Connect anytime day or night with a board certified doctor via your mobile device or computer. While MDLIVE does not replace your primary care physician, it is a convenient and cost effective option when you need care and: • Have a non emergency issue and are considering a convenience care clinic, urgent care clinic or emergency room for treatment • Are on a business trip, vacation or away from home • Are unable to see your primary care physician When to Use MDLIVE: At a cost that is the same or less than a visit to your physician, use telehealth services for minor conditions such as: • Sore throat • Headache • Stomachache • Cold • Flu • Allergies • Fever • Urinary tract infections Do not use telemedicine for serious or life threatening emergencies. Registration is Easy Register with MDLIVE so you are ready to use this valuable service when and where you need it. • Online www.mdlive.com/fbs • Phone 888 365 1663 • Mobile download the MDLIVE mobile app to your smartphone or mobile device • Select “MDLIVE as a benefit” and “FBS” as your Employer/Organization when registering your account. Telehealth Employee and Family $10.00 11
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/midlandisd Vision Insurance Superior Vision EMPLOYEE BENEFITS How to Print your Vision ID Card: You can request your vision id card by contacting Superior Vision directly at 800 507 3800. You can also go to www.superiorvision.com and register/login to access your account by clicking on “Members” at the top of the page. You can also download the Superior Vision mobile app on your smart phone. Benefits through Superior National Network Co pays apply to in network benefits; co pays for out of network visits are deducted from reimbursements 1 Materials co pay applies to lenses and frames only, not contact lenses 2 Standard Contact Lens Fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty Contact Lens Fitting applies to new contact wearers and/or a member who wear toric, gas permeable, or multi focal lenses. 3 Covered to provider’s in office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co pay. 4 Contact lenses are in lieu of eyeglass lenses and frames benefit Vision Co Pays Services/Frequency Employee Only $10.64 Exam $10 Exam 12 months Employee and Spouse $25.56 Materials1 $0 Frame 12 months Employee and Child(ren) $17.04 Contact Lens Fitting $25 Contact Lens Fitting 12 months Employee and Family $29.80 (standard & specialty) Lenses 12 months Contact Lenses 12 months (Based on date of service) In Network Out of Network Exam (Ophthalmologist) Covered in full Up to $42 retail Exam (Optometrist) Covered in full Up to $37 retail Frames $175 retail allowance Up to $70 retail Contact Lens Fitting (standard2) Covered in full Not covered Contact Lens Fitting (specialty2) $50 retail allowance Not covered Lenses (standard) per pair Single Vision Covered in full Up to $26 retail Bifocal Covered in full Up to $34 retail Trifocal Covered in full Up to $50 retail Progressives lens upgrade See description3 Up to $50 retail Polycarbonate for dependent children Covered in full Not covered Contact Lenses4 $160 retail allowance Up to $100 retail 12
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Discounts
Exam,
and Materials Exams, frames, and prescription lenses:
Disposable contact lenses:
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Vision Insurance Superior Vision EMPLOYEE BENEFITS Discount Features
Disclaimer:
discount.
lens options Specialty Contact Lens Fit:
Lens options, contacts, miscellaneous options:
Discounts on Covered Materials Frames:
Refractive Surgery Superior
Scratch coat $13 $13 Ultraviolet coat $15 $15 Tints, solid or gradients $25 $25 Anti reflective coat $50 $50 High index 1.6 $55 20% off retail Photochromics $80 20% off
offer members
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Discounts on
Look providers in accept discounts, as some do not; please verify their services and discounts (range 10% as they vary. 20% 20% retail 20% off amount retail lined trifocal lens, including 10% off retail, then following options have out of pocket (not brand, or lenses. Discounts and maximums may vary by lens type. Please check with your provider. Non Covered Services 30% off retail 20% off retail 10% off retail $39 maximum out of pocket Vision has a nationwide network of independent refractive and partnerships with leading LASIK networks who a These discounts range from 10% 50%, and are the best possible discounts available to Superior Vision. Plan discount features are not insurance. allowances are retail; the member is responsible for paying the provider directly for all non covered items and/or any amount over the minus available discounts. These are not covered by the plan. are subject to change without notice. All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision check with your Human Resources department if you have any questions. Trifocal retail
premium,
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Progressives:
surgeons
Single Vision Bifocal &
$100 in coverage Elimination Period 30% of Salary 40% of Salary 50% of Salary 60% of Salary 0/3 $1.85 $2.24 $2.96 $3.52 14/14 $1.48 $1.79 $2.35 $2.80 30/30 $1.33 $1.60 $2.11 $2.52 60/60 $1.03 $1.24 $1.65 $1.94 90/90 $0.77 $0.94 $1.23 $1.47 180/180 $0.59 $0.70 $0.93 $1.11 14
Educator Disability insurance is a hybrid that combines features of short term and long term disability into one plan. Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. The plan gives you flexibility to be able to choose an amount of coverage and waiting period that suits your needs.
The Hartford EMPLOYEE BENEFITS
Injury 90 days/Sickness 90 days Injury 180 days/Sickness 180 days
Definition of Disability: Disability is defined as The Hartford’s contract with your employer. Typically, disability means that you cannot perform one or more of the essential duties of your occupation due to injury, sickness, pregnancy or other medical conditions covered by the insurance, and as a result, your current monthly earnings are 80% or less of your pre disability earnings.
Disability per
Disability Insurance
Eligibility: You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis. Enrollment: You can enroll in coverage within 31 days of your date of hire or during your annual enrollment period.
Elimination Period Options:
Injury 0 days/ Sickness 3 days first day hospital
Effective Date: Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes Activelyeffect.atWork: You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in Benefitsession.Amount: You may purchase coverage that will pay you a monthly benefit of 30%, 40%, 50% or 60% of your monthly income, to a maximum of $7,500. Earnings are defined in The Hartford’s contract with your employer.
Once you have been disabled for 24 months, you must be prevented from performing one or more essential duties of any occupation, and as a result, your monthly earnings are 60% or less of your pre disability earnings.
For full plan details, please visit your benefit website: www.mybenefitshub.com/midlandisd
Pre Existing Condition Limitation: Your policy limits the benefits you can receive for a disability caused by a pre existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have been insured under this policy for 12 months before your disability begins. If your disability is a result of a pre existing condition, we will pay benefits for a maximum of 4 weeks.
Injury 60 days/Sickness 60 days
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.
What is Educator Disability Insurance?
Elimination Period: For those employees electing an elimination period of 30 days or less, if you are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of Thehospitalization.elimination period is the length of time you must be continuously disabled before you can receive benefits.
Injury 14 days/Sickness 14 days first day hospital Injury 30 days/Sickness 30 days first day hospital
• 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.
•
Who is eligible for this 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
• Life • Both hands or both feet or sight of both eyes • One hand and one foot One hand and the sight of one eye
EMPLOYEE Basic Life Insurance Plan Highlights
• Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $50,000.
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Your employer is providing you with $10,000 of term life insurance. You will also receive $10,000 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 for yourself 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.
When is coverage effective?
Life and AD&D
• Employee: up to 7 times salary in increments of $10,000; not to exceed $700,000.
BENEFITS
• Child: up to 100% of employee coverage amount in increments of $1,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $1,000.
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/midlandisd
Please see your plan administrator for your effective date. What does my AD&D insurance pay for? The full benefit amount is paid for loss of:
• 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 Coverage may not be increased after a reduction. The policy provisions may vary or not be available in all states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage, please refer to www.mybenefitshub.com/midlandisd
UNUM
All actively employed employees working at least 20 hours each week for your employer in the U.S. and their eligible spouses and children up to age 26 What are the Life/AD&D coverage amounts?
Can I be denied coverage?
Voluntary Life and AD&D Insurance Plan Highlights Policy Number 682482 Who is eligible for this 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 $200,000 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.
All actively employed employees working at least 30 hours each week for your employer in the U.S. What is the coverage amount?
Policy Number 682481
chart you must purchase life coverage to purchase AD&D coverage Your Life rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective Spousedate. Life rate is based on the Employee’s insurance age. Do my life insurance benefits decrease with age? Coverage amounts will reduce according to the following Age:schedule:
If you retire, reduce your hours or leave your employer, you can continue coverage for yourself your spouse and your dependent children 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. 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. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP 1 et al or contact your Unum representative. band
Age
When is coverage effective?
Life and AD&D UNUM EMPLOYEE BENEFITS complete a medical questionnaire which you can get from your plan administrator.
Please see your plan administrator for your effective date. 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.
For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness, or disorder, your dependent spouse and children: are confined in a hospital or similar institution; or are confined at home under the care of a physician for a sickness or injury. Exception: Infants are insured from live Howbirth.much does the coverage cost?
Term AD&Dliferate
Employee rate per $1,000 Spouse rate per $1,000 <25 $0.052 $0.052 25 29 $0.062 $0.062 30 34 $0.083 $0.083 35 39 $0.093 $0.093 40 44 $0.104 $0.104 45 49 $0.155 $0.155 50 54 $0.238 $0.238 55 59 $0.445 $0.445 60 64 $0.683 $0.683 65 69 $1.315 $1.315 70 74 $2.133 $2.133 75+ $2.133 $2.133 Child life monthly rate is $0.17 per $1,000. One life premium covers all children. AD&D Cost Monthly Cost Employee Per $1,000 $0.016 Employee & Family Per $1,000 $0.024 16
Insurance amount reduces to: 65 65% of original amount 70 50% of original amount Coverage may not be increased after a reduction. Is the coverage portable (can I keep it if I leave my employer)?
The 5Star Life Insurance Company's Family Protection Plan offers both Individual and Group products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your employees
• Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or
Individual Life Insurance 5Star Life Insurance EMPLOYEE BENEFITS Enhanced coverage options for employees. Easy and flexible enrollment for employers.
to choose from, employees select the coverage that best meets the needs of their families.
*Quality of Life not available ages 66 70. Quality of Life benefits not available for children. Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 years) $7.15 monthly for $10,000 coverage per child.
ABOUT INDIVIDUAL LIFE
CoveragePORTABLEcontinues with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly.
WithCUSTOMIZABLEseveraloptions
• Permanent severe cognitive impairment, such as dementia, Alzheimer's disease and other forms of senility, requiring substantial supervision
Optional benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following:
Individual insurance is a policy that covers a single person and is intended to meet the financial needs of the beneficiary, in the event of the insured’s death. This coverage is portable and can continue after you leave employment or retire. For full plan details, please visit your benefit website: www.mybenefitshub.com/midlandisd
EasyCONVENIENCEpayments through payroll deduction.
TERMINAL ILLNESS ACCELERATION OF BENEFITS Coverage that pays 30% (25% in CT and Ml) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL).
PROTECTION TO COUNT ON QUALITY OF LIFE
FAMILY CoveragePROTECTIONisavailable for spouses and financially dependent children, even if the employee doesn't elect coverage on *themselves.Financially dependent children 14 days to 23 years old For further information and rates please visit www.mybenefitshub.com/midlandisd
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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/midlandisd Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non medical expenses, such as out of town treatments, special diets, daily living, and household upkeep. In addition to these non medical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer through American Public Life helps pay for these direct and indirect treatment costs so you can focus on your health. Should you need to file a claim contact APL at 800 256 8606 or online at www.ampublic.com.
*Carcinoma in situ is not considered internal cancer Pre Existing Condition Exclusion: Review the Benefit Summary page that can be found at www.mybenefitshub.com/midlandisd for full details Low High Internal Cancer First Occurrence* $2,500 $2,500 Cancer Screening Rider Benefits Diagnostic Testing 1 test per calendar year $50 per test $50 per test Follow Up Diagnostic Testing 1 test per calendar year $100 per test $100 per test Medical Imaging per calendar year $500 per test/ 1 per calendar year $500 per test/ 1 per calendar year Cancer Treatment Policy Benefits Radiation and Chemotherapy, Immunotherapy Maximum Per 12 month period $10,000 $20,000 Hormone Therapy Maximum of 12 treatments per calendar year $50 per treatment $50 per treatment Surgical Rider Benefits Surgical $45 unit dollar amount Max $4,500 per operation $45 unit dollar amount Max $4,500 per operation Anesthesia 25% of amount paid for covered surgery Bone Marrow Transplant Maximum per lifetime $9,000 $9,000 Stem Cell Transplant Maximum per lifetime $900 $900 Miscellaneous Care Rider Benefits Hair Piece (Wig) 1 per lifetime $150 $150 Blood, Plasma & Platelets $300 per day $300 per day Ambulance Ground /Air Maximum of 2 trips per Hospital Confinement for all modes of transportation combined $200/$2000 per trip $200/$2000 per trip Heart Attack/Stroke First Occurrence Rider Benefits Lump Sum Benefit Maximum per 1 covered person per lifetime $2500 $2500 Hospital Intensive Care Unit Rider Benefits Intensive Care Unit $600 per day $600 per day Cancer Low High Employee Only $21.20 $28.96 Employee and Spouse $41.68 $57.29 Employee and Child(ren) $29.88 $41.44 Employee and Family $47.20 $64.82 18
insurance
ABOUT CANCER
Cancer Insurance American Public Life EMPLOYEE BENEFITS
For you: Select one of the following Choice $10,000, $20,000 or $30,000
For your Spouse and Children: 100% of employee coverage amount. Can I be coverage?denied Coverage is guarantee issue. When is effective?coverage 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. Are wellness Screenings covered? Each insured is eligible to receive one Be Well Benefit per calendar year. Be Well Benefit For you, your spouse and your children: $50 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.
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The following coverage amounts are available.
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/midlandisd Critical Illness Insurance UNUM EMPLOYEE BENEFITS Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. Critical Illness Age $10,000 Plan $20,000 Plan $30,000 Plan 18 24 $3.82 $6.02 $8.22 25 29 $4.82 $8.02 $11.22 30 34 $6.02 $10.42 $14.82 35 39 $8.02 $14.42 $20.82 40 44 $10.42 $19.92 $28.02 45 49 $13.52 $25.42 $37.32 50 54 $17.12 $32.62 $48.12 55 59 $23.12 $44.62 $66.12 60 64 $31.92 $62.22 $92.52 65 69 $46.12 $90.62 $135.12 70 74 $71.72 $141.82 $211.92 75 79 $105.52 $209.42 $313.32 80 84 $153.52 $305.42 $457.32 85+ $247.04 $492.42 $737.82 Who is eligible for this coverage? All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status). Your domestic partner is considered a spouse. What are the Critical Illness amounts?coverage
Non Invasive Cancer 25% Skin Cancer 500%
If your spouse’s coverage ends as a result of your death, divorce or annulment, your spouse may elect to continue spouse and children coverage, as long as premium is paid as required.
Pre existing Condition requirements are not applicable to:
We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following:
Critical Illness Insurance
Benign Brain Tumor 100% Coma 100% Loss of Hearing 100%
Is the coverage portable (can I keep it if I leave my employer)?
• complications arising from treatment or surgery for, or medications taken for, a pre existing condition.
*Please refer to the policy for complete definitions of covered conditions.
Covered Conditions* Percentage of Coverage Amount Critical Illnesses
• medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period;
Progressive AmyotrophicDiseasesLateral Sclerosis (ALS) 100%
• Children who are newly acquired after your Coverage Effective Date.
Additionally, no benefits will be paid for a Date of Diagnosis that occurs prior to the coverage effective date
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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.
An insured has a pre existing condition if, within the 3 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which:
If your employment with your employer ends or you are no longer in an eligible group you can apply for ported coverage and pay the first premium within 31 days to continue coverage for yourself, your spouse and your children.
Permanent Paralysis 100%
Additional Critical Illnesses for your Children
Dementia (including Alzheimer’s Disease) 100% Functional Loss 100% Multiple Sclerosis (MS) 100% Parkinson’s Disease 100%
Infectious Disease 25%
Coronary Artery Disease (major) 50%
Loss of Sight 100% Loss of Speech 100%
Cerebral Palsy 100%
Pre existing Conditions
Heart Attack (Myocardial Infarction) 100%
End Stage Renal (Kidney) Failure 100%
Supplemental Critical Illnesses
InvasiveCancer Cancer (including all Breast Cancer) 100%
Major Organ Failure Requiring Transplant 100% Stroke 100%
• symptoms existed.
• drugs or medications were taken, or prescribed to be taken during that period; or
To file a claim call UNUM at 800 858 6843.
UNUM EMPLOYEE BENEFITS
What critical illness conditions are covered?
Cleft Lip or Palate 100% Cystic Fibrosis 100% Down Syndrome 100% Spina Bifida 100%
Coronary Artery Disease (minor) 10%
• a pre existing condition; or
Occupational Human Immunodeficiency Virus (HIV) or Hepatitis 100%
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/midlandisd Accident Insurance The Hartford EMPLOYEE BENEFITS PLAN INFORMATION LOW PLAN HIGH PLAN Coverage Type On and off job (24 hour) On and off job (24 hour) BENEFITS LOW PLAN HIGH PLAN EMERGENCY, HOSPITAL & TREATMENT CARE Accident Follow Up Up to 3 visits per accident $50 $50 Acupuncture/Chiropractic Care/PT Up to 10 visits each per accident $25 $25 Ambulance Air Once per accident 1500 1500 Blood/Plasma/Platelets Once per accident $250 $250 Child Care Up to 30 days per accident while insured is confined $25 $25 Daily Hospital Confinement Up to 365 days per lifetime $100 $200 Daily ICU Confinement Up to 30 days per accident $300 $600 Diagnostic Exam Once per accident $200 $200 Emergency Dental Once per accident Up to $150 Up to $150 Emergency Room Once per accident $150 $200 Hospital Admission Once per accident $500 $1,000 Initial Physician Office Visit Once per accident $75 $100 Lodging Up to 30 nights per lifetime $100 $100 Medical Appliance Once per accident $100 $100 Rehabilitation Facility Up to 15 days per lifetime $50 $150 Transportation Up to 3 trips per accident $300 $300 Urgent Care Once per accident $50 $50 X ray Once per accident $50 $100 You have a choice of two accident plans, which allows you the flexibility to enroll for the coverage that best meets your needs. This insurance provides benefits when injuries, medical treatment and/or services occur as the result of a covered accident. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s). To learn more about Accident insurance, visit thehartford.com/employeebenefits. AccidentLowOption High Option Employee Only $8.18 $10.36 Employee and Spouse $12.95 $16.35 Employee and Child(ren) $13.92 $16.93 Employee and Family $21.83 $26.83 21
LOW PLAN HIGH PLANBENEFITS Cont’d. SPECIFIED INJURY & SURGERY Abdominal/Thoracic Surgery Once per accident $1,000 $1,000 Arthroscopic Surgery Once per accident 250 250 Burn Once per accident Up to $10,000 Up to $10,000 Burn Skin Graft Once per accident for third degree burn(s) 25% of burn benefit 25% of burn benefit Concussion Up to 3 per year $200 $200 Dislocation Once per joint per lifetime Up to $4,000 Up to $4,000 Eye Injury Once per accident $250 $250 Fracture Once per bone per accident Up to $6,000 Up to $6,000 Hernia Repair Once per accident $100 $100 Knee Cartilage Once per accident Up to $500 Up to $500 Laceration Once per accident Up to $400 Up to $400 Ruptured Disc Once per accident $500 $500 Tendon/Ligament/Rotator Cuff Up to 2 per accident 750 750 AccidentalCATASTROPHICDeath Within 90 days; Spouse @ 50% and child @ 25% $15,000 $30,000 Common Carrier Death Within 90 days 3.33 times benefitdeath 3.33 times benefitdeath Coma Once per accident Up to $5,000 Up to $5,000 Dismemberment Once per accident Up to $15,000 Up to $30,000 Paralysis Once per accident Up to $10,000 Up to $10,000 Prosthesis Up to 2 per accident Up to $1,000 Up to $1,000 AbilityFEATURESAssist® EAP2 24/7/365 access to help for financial, legal or emotional issues Included Included Accident Insurance The Hartford EMPLOYEE BENEFITS 22
For full plan details, please visit your benefit website: www.mybenefitshub.com/midlandisd
ABOUT MEDICAL TRANSPORT Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out of pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan.
Emergency Medical Transport MASA
EMPLOYEE BENEFITS
Emergent Air Transportation In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities. Emergent Ground Transportation In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities. Non Emergency Inter Facility Transportation In the event that a member is in stable condition in a medical facility but requires a heightened level of care that is not available at their current medical facility, Members have access to non emergency air or ground transportation between medical facilities. Repatriation/Recuperation Suppose you or a family member is hospitalized more than 100 miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for recuperation. Should you need assistance with a claim contact MASA at 800 643 9023.
Emergent MembershipPlus MembershipPlatinum Emergent TransportationAir ✓ ✓ Emergent TransportationGround ✓ ✓ Non Emergency Inter Facility Transportation ✓ ✓ Repatriation/Recuperation ✓ ✓ Escort Transportation ✓ Visitor Transportation ✓ Return Transportation ✓ Mortal TransportationRemains ✓ Minor Return ✓ Organ RecipientRetrieval/OrganTransportation ✓ Vehicle Return ✓ Pet Return ✓ Worldwide Coverage ✓ $14/month $39/month 23
A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. If a member has a high deductible health plan that is compatible with a health savings account, benefits will become available under the MASA membership for expenses incurred for medical care (as defined under Internal Revenue Code (“IRC”) section 213 (d)) once a member satisfies the applicable statutory minimum deductible under IRC section 223(c) for high deductible health plan coverage that is compatible with a health savings account.
contribute
• 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.
Spending
Dependent Care FSA Guidelines
are entitled
covers qualified medical, dental and vision expenses for you or your eligible dependents.
ABOUT FSA
• Overnight camps are not eligible for reimbursement (only day camps can be considered).
expenses
Important FSA Rules
election
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
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
annual
• 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.
• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
• Funds allocated to the HealthCare FSA, Limited Purpose FSA or Dependent Care FSA must be used during the plan year or are forfeited, this is known as the “use it or lose it” rule.
• You cannot change your election during the year unless you experience a Qualifying Life Event.
(unless your
annually
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For full plan details, please visit your benefit website: www.mybenefitshub.com/midlandisd Flexible Spending Account (FSA) NBS EMPLOYEE BENEFITS Health Care FSA The Health Care
• You do not have to be enrolled in a medical plan to enroll in FSA
• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
A Flexible Account allows you to pay for eligible healthcare with a pre loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s plan limit. This money is use it or lose it within the plan year plan contains a $500 rollover or grace period provision). FSA You may up to $2,850 to a Health Care FSA and you to the full from day one of your plan year. Dependent Care FSA 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.
helps pay for expenses associated with caring for elder or child dependents so you
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.
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NBS EMPLOYEE BENEFITS
Flexible Spending Account (FSA)
Dependent care expenses (such as day care, after school programs or elder care programs) so you and your spouse can work or attend school full time $5,000 single $2,500 if married and filing separate tax returns Reduces your taxable income
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 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.
FSAstore.Com
Flexible Spending Accounts
Account Type Eligible Expenses Annual Contribution Limits Benefit Health Care FSA
Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses and doctor prescribed over the counter medications) $2,850 Saves on eligible expenses not covered by insurance, reduces your taxable income Dependent Care FSA
Over the Counter Item Rule Reminder (OTC)
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Notes 27
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 Midland 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/MIDLANDISD 2022 - 2023 PlanYear
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 Midland 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.
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