2022 - 2023 Plan Year
PINE TREE ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2022 - 8/31/2023 WWW.MYBENEFITSHUB.COM/PINETREEISD
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Table of Contents How to Enroll Annual Benefit Enrollment 1. Annual Enrollment 2. Section 125 Cafeteria Plan Guidelines 3. Helpful Definitions 4. Eligibility Requirements 5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) Medical Basic Life and AD&D Health Savings Account (HSA) Hospital Indemnity Telehealth Dental Vision Disability Cancer Accident Voluntary Life and AD&D Individual Life Flexible Spending Account (FSA)
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PG. 4
HOW TO ENROLL
PG. 6
SUMMARY PAGES
PG. 12
YOUR BENEFITS
Benefit Contact Information PINE TREE ISD BENEFITS
MEDICAL - TRS ACTIVECARE
HEALTH SAVINGS ACCOUNT (HSA)
Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/pinetreeisd
BCBSTX (866) 355-5999 www.bcbstx.com/trsactivecare
EECU (800) 333-9934 www.eecu.org
HOSPITIAL INDEMNITY
TELEHEALTH
DENTAL
Aetna Group #802489 (800) 872-3862 www.aetna.com
MDLIVE (888) 365-1663 www.mdlive.com/fbs
Lincoln Financial Group (800) 423-2765 www.lfg.com
VISION
DISABILITY
CANCER
Superior Vision Group #3628501 (800) 507-3800 www.superiorvision.com
OneAmerica Group #617626 (800) 553-5318 www.oneamerica.com
American Public Life (800) 256-8606 www.ampublic.com
ACCIDENT
LIFE AND AD&D
INDIVIDUAL LIFE
Allstate Group #24707 www.allstate.com
Unum Group #474217 (800) 445-0402 www.unum.com
Texas Life (800) 283-9233 www.texaslife.com
FLEXIBLE SPENDING ACCOUNT (FSA) Higginbotham (866) 419-3519 https://flexservices.higginbotham.net/
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All Your Benefits One App Employee benefits made easy through the FBS Benefits App! Text “FBS PINETREE” 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 #: FBSPINETREE
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Text
“FBS PINETREE”
to (800) 583-6908 OR SCAN
How to Log In 1
www.mybenefitshub.com/pinetreeisd
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CLICK LOGIN
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ENTER USERNAME & PASSWORD Your Username Is: Your email in THEbenefitsHUB. (Typically your work email) Your Password Is: Four (4) digits of your birth year followed by the last four (4) digits of your Social Security Number If you have previously logged in, you will use the password that you created, NOT the password format listed above.
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Annual Benefit Enrollment
SUMMARY PAGES
Annual Enrollment During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs. •
Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.
•
Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.
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Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ pinetreeisd. 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 Pine Tree ISD benefit website: www.mybenefitshub.com/pinetreeisd. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section.
When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.
Annual Benefit Enrollment
SUMMARY PAGES
Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
CHANGES IN STATUS (CIS): Marital Status
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
QUALIFYING EVENTS A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for Change in Number of adoption. You can add existing dependents not previously enrolled whenever a dependent Tax Dependents gains eligibility as a result of a valid change in status event. Change in Status of Change in employment status of the employee, or a spouse or dependent of the employee, Employment Affecting that affects the individual's eligibility under an employer's plan includes commencement or Coverage Eligibility termination of employment. Gain/Loss of Dependents' Eligibility Status
Judgment/Decree/ Order
An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements under an employer's plan may include change in age, student, marital, employment or tax dependent status. If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.
Eligibility for Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Government Programs
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SUMMARY PAGES
Helpful Definitions Actively-at-Work
In-Network
You are performing your regular occupation for the employer on a full-time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2022 please notify your benefits administrator.
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.
Annual Enrollment The period during which existing employees are given the opportunity to enroll in or change their current elections.
Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.
Calendar Year January 1st through December 31st
Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or preexisting condition exclusion provisions do apply, as applicable by carrier. 8
Out-of-Pocket Maximum The most an eligible or insured person can pay in coinsurance for covered expenses.
Plan Year September 1st through August 31st
Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescription drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).
Annual Benefit Enrollment
SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.
Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2022 benefits become effective on September 1, 2022, you must be actively-at-work on September 1, 2022 to be eligible for your new benefits.
PLAN
MAXIMUM AGE
Medical
To age 26
Dental
To age 26
Vision
To age 26
Cancer
To age 26
Accident
To age 26
Voluntary Life
To age 26
Telehealth
To age 26
Hospital Indemnity
To age 26
Individual Life
To age 26
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse eligibility. FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance. Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent eligibility. Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee's enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. 9
SUMMARY PAGES
HSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, tax-free. This also allows employees to pay for qualifying dependent care taxfree.
Employer Eligibility
A qualified high deductible health plan.
All employers
Contribution Source
Employee and/or employer
Employee and/or employer
Account Owner
Individual
Employer
Underlying Insurance Requirement
High deductible health plan
None
Minimum Deductible
$1,400 single (2022) $2,800 family (2022)
N/A
Maximum Contribution
$3,650 single (2022) $7,300 family (2022)
$2,850 (2022)
Permissible Use Of Funds
Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Cash-Outs of Unused Amounts (if no medical expenses)
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age Not permitted 65).
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
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PG. 19
FLIP TO FOR FSA INFORMATION
PG. 30
Notes
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Medical Insurance
EMPLOYEE BENEFITS
TRS ABOUT MEDICAL Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis.
For full plan details, please visit your benefit website: www.mybenefitshub.com/pinetreeisd
Monthly Premium
District Contribution
Employee Cost
TRS ActiveCare HD Employee Only Employee & Spouse Employee & Child(ren)
Employee & Family
$423.00
$325.00
$98.00
$1,189.00
$325.00
$864.00
$759.00
$325.00
$434.00
$1,442.00
$325.00
$1,097.00
TRS ActiveCare 2 Employee Only
$1,013.00
$325.00
$688.00
Employee & Spouse
$2,402.00
$325.00
$2,077.00
Employee & Child(ren)
$1,507.00
$325.00
$1,182.00
Employee & Family
$2,841.00
$325.00
$2,516.00
TRS ActiveCare Primary Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$408.00
$325.00
$83.00
$1,151.00
$325.00
$826.00
$734.00
$325.00
$409.00
$1,378.00
$325.00
$1,053.00
TRS ActiveCare Primary+ Employee Only Employee & Spouse Employee & Child(ren) Employee & Family 12
$513.00
$325.00
$188.00
$1,254.00
$325.00
$929.00
$825.00
$325.00
$500.00
$1,577.00
$325.00
$1,252.00
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Basic Life and AD&D Lincoln Financial Group
EMPLOYEE BENEFITS
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/pinetreeisd
Who is eligible for this coverage?
All actively employed employees working at least 15 hours each week for your employer in the U.S.
What is the coverage amount?
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 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?
Please see your plan administrator for your effective date.
What does my AD&D insurance The full benefit amount is paid for loss of: pay for? • Life • Both hands or feet or sight of both eyes • One hand and one foot • One hand and the sight of one eye • Speech and hearing
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Health Savings Account (HSA) EECU
EMPLOYEE BENEFITS
ABOUT HSA A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). For full plan details, please visit your benefit website: www.mybenefitshub.com/pinetreeisd
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs – it is also a tax-exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
Opening an HSA
HSA Eligibility
If you meet the eligibility requirements, you may open an HSA administered by EECU. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA. To open an account, go to https://www.eecu.org/.
Important HSA Information •
Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount. You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit. You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.
You are eligible to open and contribute to an HSA if you are: • Enrolled in an HSA-eligible HDHP • Not covered by another plan that is not a qualified HDHP, • such as your spouse’s health plan • Not enrolled in a Health Care Flexible Spending Account • Not eligible to be claimed as a dependent on someone else’s • tax return • Not enrolled in Medicare or TRICARE • Not receiving Veterans Administration benefits You can use the money in your HSA to pay for qualified medical How to Use your HSA expenses now or in the future. You can also use HSA funds to pay • Online/Mobile: Sign-in for 24/7 account access to check your health care expenses for your dependents, even if they are not balance, pay bills and more. covered by the HDHP. • Call/Text: (817) 882-0800. EECU’s dedicated member service representatives are available to assist you with any Maximum Contributions questions. Their hours of operation are Monday through Your HSA contributions may not exceed the annual maximum Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. – amount established by the Internal Revenue Service. The annual 1:00 p.m. CT and closed on Sunday. contribution maximum for 2022 is based on the coverage option • Lost/Stolen Debit Card: Call the 24/7 debit card hotline at you elect: (800) 333-9934 • Individual – $3,650 • Stop by: a local EECU financial center for in-person • Family (filing jointly) – $7,300 assistance: www.eecu.org/locations. 19
Hospital Indemnity
EMPLOYEE BENEFITS
Aetna 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/pinetreeisd
The Hospital Indemnity Plan provided through Aetna helps with the high cost of medical care by paying you a set amount when you have an inpatient hospital stay. Unlike traditional insurance, which pays a benefit to the hospital or doctor, this plan pays you directly based on the care or treatment you receive. These costs may include meals and transportation, childcare or time away from work due to a medical issue that requires hospitalization. If you need to submit a claim you do so on the Aetna portal at myaetnasupplemental.com.
Hospital Indemnity Low
High
Employee
$15.89
$31.79
Employee + Spouse
$32.83
$65.67
Employee + Child(ren)
$22.80
$45.59
Family
$36.87
$73.74
Service
Benefit Low
High
$1,000
$2,000
Hospital Stay- Daily- Pays a daily benefit, beginning on day two of your stay in a non-ICU room of a hospital. Maximum 30 days per plan year
$100
$200
Hospital Stay- (ICU) Daily- Pays a daily benefit, beginning on day two of your stay in an ICU room of a hospital. Maximum 30 days per plan year
$200
$400
Newborn routine care- Provides a lump-sum benefit after the birth of your newborn. This will not pay for an outpatient birth.
$100
$200
Observation unit- Provides a lump sum benefit for the initial day of your stay in an observation unit as the result of an illness or accidental injury. Maximum 1 day per plan year.
$100
$200
Hospital Stay Admission- Pays a lump sum benefit for the initial day of your stay in a hospital. Maximum 1 stay per plan year.
Important Note: All daily inpatient stay benefits begin on day two and count toward the plan year maximum.
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Telehealth
EMPLOYEE BENEFITS
MDLive ABOUT TELEHEALTH Telehealth provides 24/7/365 access to board-certified doctors via telephone or video consultations that can diagnose, recommend treatment and prescribe medication. Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.
For full plan details, please visit your benefit website: www.mybenefitshub.com/pinetreeisd
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:
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 + Family
$10.00
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 • Stomach ache • Cold • Flu • Allergies • Fever • Urinary tract infections Do not use telemedicine for serious or life-threatening emergencies.
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Dental Insurance
EMPLOYEE BENEFITS
Lincoln Financial Group ABOUT DENTAL Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease.
For full plan details, please visit your benefit website: www.mybenefitshub.com/pinetreeisd
The Lincoln DentalConnect PPO Program Features: • • • • • •
Dental
Covers many preventative, basic and minor dental care services Features group coverage for employees Allows you to choose any dentist you wish, though you can lower your out-of -pocket costs by selecting a network provider Does not make you and your loved ones wait six months between routing cleanings Deductibles are combines for basic and major in-Network services. Deductibles are combined for basic and major Out-of-Network services.
DPPO Benefits Calendar (Annual) Deductible Waived for Preventative Annual Maximum Preventative Services Routine oral exams, Bitewing X-rays, Full mount or panoramic X-rays, Other dental X-rays (including periapical films), Routing cleanings, Fluoride treatments, Space maintainers for children, Sealants, Biopsy and examination of oral tissue (including brush biopsy), FSA approved oral cancer screening, Palliative treatment (including emergency relief of dental pain)
Basic Services Problem-focused exams, Consultations, Injections of antibiotics and other medications, Fillings, Simple extractions, Biopsy and examination of oral tissue (including brush biopsy), Prosthetic repair and recementation services, Periodontal maintenance procedures
Major Services Prefabricated stainless steel and resin crowns, Surgical extractions, Oral surgery, general anasthesia and IV sedation, Bridges
Orthodontics Orthodontic exams, X-rays, Extractions, Study Models, Appliances
Lifetime Orthodontic Maximum
Employee Employee + Spouse Employee + Child(ren) Family
Low $22.09 $51.11 $46.09 $71.24
Low DPPO In-Network Out-of-Network Individual: $50 Individual: $50 Family: $150 Family: $150 $500 $500 In-Network Out-of-Network
High DPPO In-Network Out-of-Network Individual: $50 Individual: $50 Family: $150 Family: $150 $500 $500 In-Network Out-of-Network
100% No Deductible
100% No deducible
100% No Deductible
100% No deducible
In-Network
Out-of-Network
In-Network
Out-of-Network
70% After Deductible
70% After Deductible
80% After Deductible
80% After Deductible
In-Network
Out-of-Network
In-Network
Out-of-Network
40% After Deductible
40% After Deductible
50% After Deductible
50% After Deductible
In-Network
Out-of-Network
In-Network
Out-of-Network
No Coverage
No Coverage
50%
50%
--
--
$1,500
$1,500
(Note: this list is not exhaustive. For more comprehensive detail, refer to the Certificate of Coverage) 22
High $34.06 $78.82 $78.03 $114.56
Dental Insurance Vision Insurance
EMPLOYEE BENEFITS
Carrier Name Superior Vision 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/pinetreeisd
You may choose from two plans: High Plan Option, or Low Plan Option Copays Exam Materials
Benefit Summary
Services/frequency
High $25 $25
Low $25 $25
Exam Frame Lenses Contacts
High DPPO In-network Out-of-network
Exam
Covered in full $175 retail Frames allowance Lenses (standard) per pair Single Vision Covered in full Bifocal Covered in full Trifocal Covered in full
Up to $35
Monthly Premiums
High Low 12 months 12 months 24 months 12 months 12 months
Employee Employee + 1 Dependent Employee + Family
Low DPPO In-network Out-of-network Covered in full $175 retail allowance
Up to $35
Up to $25 Up to $40 Up to $45
Covered in full Covered in full Covered in full
Up to $25 Up to $40 Up to $45
Up to $70
Up to $70
Progressive Polycarbonate Tints
See description1 Covered in full Covered in full
Up to $45 Up to $20 Up to $15
See description1 Covered in full Not covered
Up to $45 Up to $20 Not covered
Photochromic Lenticular
Covered in full Covered in full $175 retail allowance
Up to $40 Up to $80
Not covered Covered in full $150 retail allowance
Not covered Up to $80
Covered in full
Up to $150
Contact Lenses2
Up to $80
Medically Necessary Contact Covered in full Up to $150 Lenses Lasik Vision $200 allowance3 Correction
High $10.52 $15.25 $27.33
Low $7.62 $11.04 $19.80
Discount Features Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and cus tomary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies ). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “ extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.
Up to $80
$200 allowance3
Co-pays apply to in-network benefits; Co-pays for out-of-network visits are deducted from reimbursements 1. 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 2. Contact lenses and related professional services (fitting, evaluation and follow-up) are covered in lieu of eyeglass lenses and frames benefit 3. Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limitation 23
Disability Insurance
EMPLOYEE BENEFITS
OneAmerica 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/pinetreeisd
Partial Disability: You may be paid a partial disability benefit, if Educator Disability insurance is a hybrid that combines features because of injury or sickness, you are unable to perform every material and substantial duty of your regular occupation on a full of short-term and long-term disability into one plan. Disability insurance provides partial income protection if you are unable to -time basis, are performing at least one of the material and substantial duties of your regular occupation, or another work due to a covered accident or illness. The plan gives you occupation, on a full or parttime basis, and are earning less than flexibility to be able to choose an amount of coverage and 80% of your pre-disability earnings due to the same injury or waiting period that suits your needs. sickness.
What is Educator Disability Insurance?
Group Educator Disability Terms and Definitions Eligible Employees: This benefit is available for employees who are actively at work on the effective date and working a minimum of 15 hours per week.
Residual: The elimination period can be satisfied by total disability, partial disability, or a combination of both.
Flexible Choices: Since everyone’s needs are different, these plans offer flexibility for you to choose a benefit option that fits your income replacement needs and budget.
Return to Work: You may be able to return to work for a specified time period without having your partial disability benefits reduced according to the contract. The Return-to-Work Benefit is offered up to a maximum of 12 months.
Timely Enrollment: Enrolling timely means you have enrolled during the initial enrollment period when benefits were first offered by AUL, or as a newly hired employee within 31 days following completion of any applicable waiting period.
Benefit Amount: Maximum benefit amounts are based upon a percentage of covered earnings. Potential benefits are reduced by other income offsets including but not limited to Social Security benefits.
Portability: Should your coverage terminate, you may be eligible to take this disability insurance with you without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible.
Pre-Existing Condition Limitation: The pre-existing period is 3/12. Certain disabilities are not covered if the cause of the disability is traceable to a condition existing prior to your effective date of coverage. A pre-existing condition is any condition for which a person has received medical treatment or consultation, taken or were prescribed drugs or medicine, or received care or services, including diagnostic measures, within a time-frame specified in the contract. You must also be treatment-free for a time-frame specified in some contracts following your individual effective date of coverage.
Waiver of Premium: If approved, this benefit waives your Disability insurance premium in the case you become disabled and are unable to collect a paycheck. Elimination Period: This is a period of consecutive days of disability before benefits may become payable under the contract. Total Disability: You are considered disabled if, because of injury or sickness, you cannot perform the material and substantial duties of your regular occupation, you are not working in any occupation and are under the regular attendance of a physician for that injury or sickness. 24
Disability Elimination Period 0/7 14/14 30/30 60/60 90/90
per $100 in benefit $4.14 $3.49 $2.79 $1.87 $1.62
Cancer Insurance
EMPLOYEE BENEFITS
American Public Life ABOUT CANCER Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.
For full plan details, please visit your benefit website: www.mybenefitshub.com/pinetreeisd
Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town treatments, special diets, daily living, and household upkeep. In addition to these non-medical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance through American Public Life helps pay for these direct and indirect treatment costs so you can focus on your health.
Cancer Employee Only
$19.38
Employee & Spouse
$41.82
Employee & Child(ren)
$22.56
Employee & Family
$44.96
Should you need to file a claim contact APL at 800-256-8606 or online at www.ampublic.com. You can find additional claim forms and materials at www.mybenefitshub.com/pinetreeisd
Summary of Benefits
Coverage
Cancer Treatment Policy Benefits Radiation Therapy, Chemotherapy, Immunotherapy - Maximum per 12-month period Hormone Therapy - Maximum of 12 treatments per calendar year Experimental Treatment
$15,000 $50 per treatment Paid in same manner and under the same maximums as any other benefit
Cancer Screening Rider Benefits Diagnostic Testing – 1 test per calendar year
$50 per test
Follow-UP Diagnostic Testing – 1 test per calendar year
$100 per test
Medical Imaging – per calendar year
$500 per test / 1 per calendar year
Internal Cancer First Occurrence Rider Benefits
Lump Sum Benefit - Maximum 1 per Covered Person per lifetime
$5,000
Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime
$7,500
Heart Attack/Stroke First Occurrence Rider Benefits Lump Sum Benefit - Maximum 1 per Covered Person per lifetime
$5,000
Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime
$7,500
Hospital Intensive Care Unit Benefit Rider Intensive Care Unit $600 per day Step Down Unit - Maximum of 45 days per Confinement for any combination of $300 per day Intensive Care Unit or Step Down Unit Pre-Existing Condition Exclusion: Review the Benefit Summary page that can be found at www.mybenefitshub.com/pinetreeisd for full details. 25
Accident Insurance
EMPLOYEE BENEFITS
Allstate 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/pinetreeisd
Meeting your needs – Our accident coverage helps offer peace of mind when an accidental injury occurs. • Coverage that is guaranteed issue; there are no medical exams to take • Benefits that correspond with treatment for off-the-job accidental injuries including hospitalization, emergency treatment, intensive care, fracturs, plus more • Off-the-job accident coverage for yourself or your entire family • Affordable premiums • Benefits paid directly to you, unless you assign them to someone else • An additional benefit has been added to the plan to enhance your coverage • Continuation of coverage Your benefit coverage – coverage includes but is not limited to: • Accidental death – pays a benefit for accidental death. • Common Carrier Accidental Death – pays a benefit for death while riding as a fare-paying passenger on a scheduled common carrier. • Dismemberment – Pays a benefit for dismemberment. For multiple dismemberments during the same injury, see schedule of benefits for detailed information. • Dislocation or fracture – Pays a benefit for dislocation or fracture. For multiple dislocations or fractures during the same injury, see schedule of benefits for detailed information. • Hospital Confinement – Pays a benefit when you are confined in a hsoptial for the first time after your effective date. Paid once per year. • Daily Hospital Confinement – Pays a benefit when you are confined in a hospital up to 90 days for each accident. • Intensive Care – Pays a benefit when you are confined in a hospital intensive-care up to 90 days for each accident. • Ambulance – Pays a benefit for you to be transferred by ambulance service to or from a hospital. Please review the accident plan as posted to the employee benefits portal at www.mybenefitshub.com/pinetreeisd. 26
Coverage Specifications Conditions and limits – when an injury results in a covered loss within 90 days (180 days for dismemberment or accidental death) unless otherwise stated, from the date of an accident, and is diagnosed by a physician, Allstate Benefits will pay benefits according to the schedule of benefits. Eligibility – Your employer decides who is eligible for your group (such as length of hours worked each week). Issue ages are 18 and over. Dependent Eligibility/Termination – (a) Coverage may include you, your spouse or domestic partner, your children. (b) Coverage for children ends when the child reaches age 26, unless he or she continues to meet the requirements of an eligible dependent. (c) Spouse coverage ends upon valid decree of divorce or your death. (d) Domestic partner coverage ends upon termination of domestic partnership or your death. When Coverage Ends – Coverage under the policy ends on the earliest of: (a) the date the policy is canceled; (b) the last day of the period for which you made any required contributions; (c) the last day your are in active employment, except as provider under the Temporary Layoff, Leave of Absence, or Family and Medical Leave of Absence provision; (d) the date you are no longer in an eligible class; (e ) the date your class is no longer eligible; (f) upon discovery of fraud or material representation when filing a claim. Continuation of Coverage – You may be eligible to continue coverage when coverage under the policy ends. You have 60 days after coverage under the policy ends to let Allstate Benefits know you wish to continue coverage. Accident Employee
$12.52
Employee + Spouse
$18.36
Employee + Child(ren) Family
$25.26 $31.58
Voluntary Life and AD&D Unum
EMPLOYEE BENEFITS
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/pinetreeisd Who is eligible for this coverage? the plan, you may apply for coverage on or before the enrollment All actively employed employees working at least 15 hours each deadline and will be required to answer health questions for any week for your employer in the U.S. and their eligible spouses and amount of coverage. children to age 26. New employees: To apply for coverage, complete your What are the coverage amounts? enrollment within 31 days of your eligibility period. If you apply • Employee: up to 5 times salary in increments of $10,000; not for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical to exceed $500,000. questionnaire which you can get from your plan administrator. • Spouse: up to 100% of employee amount in increments of You may also be required to take certain medical tests at Unum’s $5,000; not to exceed $500,000. expense. • Child: up to 100% of employee coverage amount in increments of $5,000; not to exceed $10,000. The maximum How do I apply? death benefit for a child between the ages of live birth and To apply for coverage, please see your Plan Administrator. six months is $5,000. If you apply for coverage after your effective date or if you choose coverage over the guaranteed issue amount, you will What are the AD&D coverage amounts? • Employee: up to 5 times salary in increments of $10,000; not need to complete a medical questionnaire, which you can get from your plan administrator. You may also be required to take to exceed $500,000. certain medical tests at Unum’s expense. • Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $500,000. When is coverage effective? • Child: up to 100% of employee coverage amount in Please see your Plan Administrator. increments of $5,000; not to exceed $10,000. The maximum Insurance coverage will be delayed if you are not in active death benefit for a child between the ages of live birth and employment because of an injury, sickness, temporary layoff, or six months is $5,000. leave of absence on the date that insurance would otherwise Note: You may purchase AD&D coverage for yourself regardless become effective. of whether you purchase term life coverage. In order to purchase For your dependent spouse and children, insurance coverage will life and AD&D coverage for your dependents, you must buy be delayed if that dependent is totally disabled on the date that coverage for yourself. insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness, or disorder, your dependent Can I be denied coverage? spouse and children: are confined in a hospital or similar Current employees: If you and your eligible dependents are institution; or are confined at home under the care of a physician enrolled in the plan and wish to increase your life insurance for a sickness or injury. Exception: Infants are insured from live coverage, you may apply on or before the enrollment deadline birth. for any amount of additional coverage up to $250,000 for yourself and any amount of additional coverage up to $50,000 Is the coverage portable (can I keep it if I leave my employer)? for your spouse. Any life insurance coverage over the guaranteed If you retire, reduce your hours or leave your employer, you can amount(s) will be subject to answers to health questions. continue coverage for yourself your spouse and your dependent If you and your eligible dependents are not currently enrolled in children at the group rate. Portability is not available for people 27
Life and AD&D
EMPLOYEE BENEFITS
Unum 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. 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. Are there any AD&D exclusions or limitations? Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from: • disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM); • suicide, self-destruction while sane, intentionally selfinflicted injury while sane or self-inflicted injury while insane; • war, declared or undeclared, or any act of war; • active participation in a riot; • committing or attempting to commit a crime under state or federal law; • the voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol; • intoxication – “being intoxicated” means you or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.
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When does my coverage end? You and your dependents’ coverage under the Summary of Benefits ends on the earliest of: • the date the policy or plan is cancelled; • the date you no longer are in an eligible group; • the date your eligible group is no longer covered; • the last day of the period for which you made any required contributions; • the last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness, as described in the certificate of coverage. In addition, coverage for any one dependent will end on the earliest of: • the date your coverage under a plan ends; • the date your dependent ceases to be an eligible dependent; • for a spouse, the date of a divorce or annulment; • for dependent coverage, the date of your death. Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan. Voluntary Group Life - per $10,000 in coverage Age Employee or Spouse 0-29
$0.80
30-34
$0.90
35-39
$1.00
40-44
$1.50
45-49
$2.00
50-54
$3.30
55-59
$5.40
60-64
$8.20
65-69
$13.60
70-74
$21.49
Voluntary Group Life - Child(ren) - $10,000 in coverage 0-26
$1.80
Spouse rates based on Employee's age.
Individual Life Insurance Texas Life
EMPLOYEE BENEFITS
ABOUT INDIVIDUAL LIFE 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/pinetreeisd
Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. Designed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually cost more and decline in death benefit. The policy, purelife-plus, is underwritten by Texas Life Insurance Company, and it has the following features: • High Death Benefit. With one of the highest death benefits available at the worksite,1 purelife-plus gives your loved ones peace of mind. • Minimal Cash Value. Designed to provide a high death benefit at a reasonable premium, purelife-plus provides peace of mind for you and your beneficiaries while freeing investment dollars to be directed toward such tax-favored retirement plans as 403(b), 457 and 401(k). • Long Guarantees.2 Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time.3 • Refund of Premium. Unique in the marketplace, purelife-plus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.) • Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.) You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, children and grandchildren by answering just 3 questions:4 During the last six months, has the proposed insured: 1. Been actively at work on a full time basis, performing usual duties? 2. Been absent from work due to illness or medical treatment for a period of more than five consecutive working days? 3. Been disabled or received tests, treatment or care of any kind in a hospital or nursing home or received chemotherapy, hormonal therapy for cancer, radiation therapy, dialysis treatment, or treatment for alcohol or drug abuse? Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. 1. 2. 3. 4.
Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 2012 Guarantees are subject to product terms, exclusions and limitations and the insurer’s claims-paying ability and financial strength. After the guaranteed period, premiums may go down, stay the same, or go up. Coverage and spouse/domestic partner eligibility may vary by state. Texas Life complies with all state laws regarding marriages, domestic and civil union partnerships, and legally recognized familial relationships. Coverage not available on children and grandchildren in Washington.
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Flexible Spending Account (FSA) Higginbotham
EMPLOYEE BENEFITS
ABOUT FSA A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (unless your plan contains a $500 rollover or grace period provision).
For full plan details, please visit your benefit website: www.mybenefitshub.com/pinetreeisd 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
Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full-time student.
Things to Consider Regarding the Dependent Care FSA • Overnight camps are not eligible for reimbursement (only day camps can be considered). • If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child You may not contribute to a Health Care FSA if you enrolled is under age 13. in a High Deductible Health Plan (HDHP) and contribute to • You may request reimbursement for care of a spouse a Health Savings Account (HSA). or dependent of any age who spends at least eight hours a day in your home and is mentally or physically Higginbotham Benefits Debit Card incapable of self-care. The Higginbotham Benefits Debit Card gives you immediate • The dependent care provider cannot be your child access to funds in your Health Care FSA when you make a under age 19 or anyone claimed as a dependent on purchase without needing to file a claim for your income taxes. reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an Important FSA Rules itemized receipt or an Explanation of Benefits (EOB). If you • The maximum per plan year you can contribute to a do not submit your receipts, you will receive a request for Health Care FSA is $2,850. The maximum per plan year substantiation. You will have 60 days to submit your you can contribute to a Dependent Care FSA is $5,000 receipts after receiving the request for substantiation when filing jointly or head of household and $2,500 before your debit card is suspended. Check the expiration when married filing separately. date on your card to see when you should order a • You cannot change your election during the year unless replacement card(s). you experience a Qualifying Life Event. Dependent Care FSA • You can continue to file claims incurred during the plan The Dependent Care FSA helps pay for expenses associated year for another 90 days after August 31st. with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the • Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for account to pay for day care or baby sitter expenses for your dependent care expenses. children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your 30
Flexible Spending Account (FSA) Higginbotham
EMPLOYEE BENEFITS
Over-the-Counter Item Rule Reminder • Manage Subscriptions – Set up email notifications to Health care reform legislation requires that certain overkeep up-to-date on all account and Health Care FSA the-counter (OTC) items require a prescription to qualify as debit card activity an eligible Health Care FSA expense. You will only need to • Log in using the same username and password you use obtain a one-time prescription for the current plan year. to log in to the Higginbotham Portal. Note: You must You can continue to purchase your regular prescription register on the Higginbotham Portal in order to use the medications with your FSA debit card. However, the FSA mobile app. debit card may not be used as payment for an OTC item, even when accompanied by a prescription. FSAstore.Com www.FSAstore.com offers thousands of FSA-eligible Higginbotham Portal products and services to purchase using your The Higginbotham Portal provides information and Higginbotham Benefits Debit Card or any major credit card. resources to help you manage your FSAs. Competitive pricing and free shipping on orders over $50 • Access plan documents, letters and notices, forms, can save you up to 40% using your FSA pretax dollars. account balances, contributions and other plan information • Update your personal information • Utilize Section 125 tax calculators • Look up qualified expenses • Submit claims • Request a new or replacement Benefits Debit Card Register on the Higginbotham Portal Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information. • Enter your Employee ID, which is your Social Security number with no dashes or spaces. • Follow the prompts to navigate the site. • If you have any questions or concerns, contact Higginbotham: Phone – 866-419-3519 Email – flexclaims@higginbotham.net Fax – 866-419-3516
Higginbotham Flex Mobile App Easily access your Health Care FSA on your smartphone or tablet with the Higginbotham mobile app. Search for Higginbotham in your mobile device’s app store and download as you would any other app. • View Accounts – Includes detailed account and balance information • Card Activity – Account information • SnapClaim – File a claim and upload receipt photos directly from your smartphone
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2022 - 2023 Plan Year
Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the Pine Tree 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 Pine Tree 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/PINETREEISD 32
