09/01/2022 8/31/2023 WWW.MYBENEFITSHUB.COM/PROSPERISD 2022 - 2023
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PROSPER ISD BENEFIT GUIDE
EFFECTIVE: PlanYear
Table of Contents FLIP TO... How to Enroll 4-5 Annual Benefit Enrollment 6 11 1. Benefit Updates 6 2. Section 125 Cafeteria Plan Guidelines 7 3. Annual Enrollment 8 4. Eligibility Requirements 9 5. Helpful Definitions 10 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 11 Medical 12-18 Health Savings Account (HSA) 19 Hospital Indemnity 20-21 Telehealth 22 Dental 23-24 Vision 25 Disability 26-27 Cancer 28 Life and AD&D 29-30 Identity Theft 31 Emergency Medical Transportation 32 Flexible Spending Account (FSA) 33-34 Employee Assistance Program (EAP) 35 HOW TO ENROLLPG. 4 SUMMARYPAGESPG. 6 BENEFITSYOURPG. 12 2
Financial Benefit Services (866) 914 www.mybenefitshub.com/prosperisd5202 (866)BCBSTX355 www.bcbstx.com/trsactivecare5999
BENEFIT ADMINISTRATORS
TRS ACTIVECARE MEDICAL
TRS HMO MEDICAL
Benefits Department (469) 219 Benefits@prosper2000 isd.net
Scott & White HMO (844) 633 www.trs.swhp.org5325
www.thehartford.com/claims
Lincoln Financial Group (See Benefit Highlights for Group #’s) DPPO: (800) 423 2765 DHMO: (888) 877 7828 www.lfg.com
IDENTITY THEFT
The www.thehartford.com/claims(888)GroupHartford#8689615631124
Superior Vision Group #322100 (800) 507 www.superiorvision.com3800
American Public Life Group #24842 (800) 256 www.ampublic.com8606
EMERGENCY TRANSPORTATIONMEDICAL
https://flexservices.higginbotham.net/(866)Higginbotham4193519
LIFE AND AD&D
DENTAL
HEALTH SAVINGS ACCOUNT (HSA)
GroupUnum #147312 (866) 679 www.unum.com3054
PROSPER ISD BENEFITS
TELEHEALTH
GroupMASA #B2BPROISD (800) 423 www.masamts.com3226
VISION (888)MDLIVE365 www.mdlive.com/fbs1663
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Benefit Contact Information
CANCER
HOSPITIAL INDEMNITY
(800)EECU 333 www.eecu.org9934
Deer Oaks EAP Services (866) 827 www.deeroakseap.com2400
EMPLOYEE ASSISTANCE PROGRAM (EAP)
DISABILITY
The (866)GroupHartford#VHI8787845474205
FLEXIBLE SPENDING ACCOUNT (FSA) ID www.idwatchdog.com(800)Watchdog7743772
Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS PISD” to (800) 583-6908 App Group #: FBSPISD Text “FBS PISD” 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/prosperisd
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If you have six (6) or less characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.
Your Username:
2 CLICK LOGIN
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How to Log In
ENTER USERNAME & PASSWORD
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.
Default Password: Last Name (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number.
• Update your information: home address, phone numbers, email, and beneficiaries.
NEW FSA HigginbothamCARRIERisthe new carrier for flexible spending and the dependent care accounts. You must re enroll in FSA to continue this benefit. No medical plan required to enroll in this benefit, annual maximum contribution: Individual $2,850, Family $5,700 (married filing joint), Dependent Care: $5,000 (funds available based on contributions only). Higginbotham Funds will be available September 1st
TRS ACTIVECARE MENTAL HEALTH PROGRAM
Standard Plan 80/50/50; $500 Annual maximum Covers many preventive, basic, and major 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 routine cleanings.
Don’t Forget!
Benefit Updates What’s New:
TRS No Cost Digital Mental Health Program Learn to Live offers Digital cognitive behavioral therapy tools to help participants learn new skills and break old patterns. To check our Learn to Live, participants: Log in to Blue Access for Members
Every employee must login to waive or enroll in benefits. Even if you decline coverage, you are required under the Affordable Care Act to list yourself and all dependents.
NEW TELEHEALTH BENEFIT MDLIVE
Annual Benefit Enrollment
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Click ChooseWellnessDigital Mental Health
With telehealth, you can get the treatment you need for minor sicknesses without having to visit your doctor’s office, no medical plan required. By enrolling in this benefit, you’ll gain access to medical consultations through phone call, email, and video chat. Telehealth will typically have you talking to a doctor within 30 minutes of setting up the appointment. You’ll speak to a doctor who can diagnose your minor aches and illnesses, and they can even prescribe medication for the likes of the common cold, flu, pink eye, and many other medical conditions.
SUMMARY PAGES
• Login and complete your benefit enrollment from 07/18/2022 08/5/2022
• Enrollment assistance is available by calling Financial Benefit Services at (866) 914 5202.
If participants have questions or need help registering for Learn to Live, they should call Personal Health Guide at (866) 355 5999
• 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.
NEW DENTAL STANDARD PLAN
Section 125 Cafeteria Plan Guidelines
Gain/Loss EligibilityDependents'ofStatus
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.
Annual Benefit Enrollment
Change in Status of Employment Affecting Coverage Eligibility
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.
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.
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
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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.
Eligibility for Government Programs
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
SUMMARY PAGES
Change in Number of Tax Dependents
Judgment/Decree/Order
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
CHANGES IN (CIS):STATUS
QUALIFYING EVENTS
Marital Status
• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
Howsection.can
When will I receive ID cards?
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.
Who do I contact with Questions?
Where can I find forms?
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• 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.
• 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.
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.
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.
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
I find a Network Provider?
New Hire Enrollment
For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ prosperisd. Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms
Annual Benefit Enrollment
For benefit summaries and claim forms, go to the Prosper ISD benefit www.mybenefitshub.com/prosperisdwebsite:. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section.
SUMMARY PAGES
For supplemental benefit questions, you can call Financial Benefit Services at 866 914 5202 for assistance.
Supplemental Benefits: Eligible full time employees must work 20 or more regularly scheduled hours each work Eligibleweek.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.
Dependent RequirementsEligibility
Annual Benefit Enrollment
Hospital Indemnity To age 26
PLAN MAXIMUM AGE
Identity Theft To age 26
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.
HSA 26 terminate(benefitsatthe end of the plan year followingbirthday)the
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AD&D To age 25
Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further Potentialguidance.Dependent
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Cancer To age 26
SUMMARY PAGES
Dental To age 26
Life To age 26
Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse FSA/HSAeligibility.Limitations:
Employee RequirementsEligibility
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.
Vision To age 26
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.
EAP To age 26
Medical To age 26
TransportationMedical To age 26 (including disabled children)
Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent Disclaimer:eligibility.
FSA 26 terminate(benefitsatthe end of the plan year followingbirthday)the
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.
January 1st through December 31st
The period during which existing employees are given the opportunity to enroll in or change their current elections.
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.
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.
Annual Enrollment
In Network
Guaranteed Coverage
Co-insurance
SUMMARY PAGES
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).
Helpful Definitions
September 1st through August 31st
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 most an eligible or insured person can pay in co insurance for covered expenses.
Calendar Year
Actively at Work
Annual Deductible
Plan Year
Out of Pocket Maximum
Pre Existing Conditions
The amount you pay each plan year before the plan begins to pay covered expenses.
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Employer Eligibility
Year-to-year rollover of account balance?
Does the account earn interest? Yes No
$2,850 (2022)
Employee and/or employer
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65). Not permitted
High deductible health plan None
Employee and/or employer
Flexible Spending Account (FSA) (IRC Sec. 125)
Description
Health Savings Account (HSA) (IRC Sec. 223)
FLIP TO FOR HSA INFORMATION PG. 35 FLIP TO FOR FSA INFORMATION PG. 33 11
Yes, portable year to year and between jobs. No
$1,400 single (2022) $2,800 family (2022)
$3,650 single (2022) $7,300 family (2022)
N/A
Allows employees to pay out of pocket expenses for copays, deductibles and certain services not covered by medical plan, tax free. This also allows employees to pay for qualifying dependent care tax free.
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.
Portable?
Employees may use funds any way they wish. If used for non qualified medical expenses, subject to current tax rate plus 20% penalty.
Yes, will roll over to use for subsequent year’s health coverage.
Permissible Use Of Funds
Minimum Deductible
A qualified high deductible health plan. All employers
Cash Outs of Unused Amounts (if no medical expenses)
Maximum Contribution
Underlying RequirementInsurance
Account Owner Individual Employer
SUMMARY PAGESHSA vs. FSA
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.
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Contribution Source
TRS
Primary
Employee Only $515.00 $433.00 $82.00
Scott
Employee Only $422.00 $351.00 $71.00
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/prosperisd
ActiveCare 2
Employee & Spouse $1,364.92 $433.00 $931.92 Employee & Child(ren) $873.57 $433.00 $440.57
Employee & Spouse $1,187.00 $351.00 $836.00
Primary+
TRS ActiveCare
ABOUT MEDICAL
Employee & Family $1,419.00 $351.00 $1,068.00
Employee Only $1,013.00 $500.00 $513.00 Employee & Spouse $2,402.00 $500.00 $1,902.00 Employee & Child(ren) $1,507.00 $500.00 $1,007.00 Employee & Family $2,841.00 $500.00 $2,341.00
TRS ActiveCare
Employee & Spouse $1,259.00 $433.00 $826.00 Employee & Child(ren) $829.00 $433.00 $396.00 Employee & Family $1,584.00 $433.00 $1,151.00
Employee Only $543.35 $433.00 $110.35
Medical Insurance BENEFITS
TRS ActiveCare
Employee & Child(ren) $757.00 $351.00 $406.00
Monthly Premium District Contribution Employee Cost
HD
Employee Only $410.00 $351.00 $59.00 Employee & Spouse $1,157.00 $351.00 $806.00 Employee & Child(ren) $738.00 $351.00 $387.00 Employee & Family $1,384.00 $351.00 $1,033.00
and White HMO
Employee & Family $1,570.98 $433.00 $1,137.98
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TRS EMPLOYEE
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You are eligible to open and contribute to an HSA if you are:
• Call/Text: (817) 882 0800 EECU’s dedicated member service representatives are available to assist you with any questions. Their hours of operation are Monday through Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. to 1:00 p.m. CT and closed on Sunday.
Qualified Expenses
• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333 9934.
time during the plan year, you are eligible to make the catch up contribution for the entire plan year.
• You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction.
• If you enroll in an HSA and FSA, the FSA becomes a Limited Purpose FSA and may only be used for Dental and Vision, not medical expenses.
• Individual $3,650
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs it is also a tax exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax free and spends tax free if used to pay for qualified medical expenses. There is no “use it or lose it” rule you do not lose your money if you do not spend it in the calendar year and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
• Not eligible to be claimed as a dependent on someone else’s tax return
Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2022 is based on the coverage option you elect:
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).
EECU
• Online/Mobile: Sign in for 24/7 account access to check your balance, pay bills and more.
Important HSA Information
EMPLOYEE BENEFITS
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
• Not enrolled in Medicare or TRICARE
HSA Eligibility
• Family (filing jointly) $7,300
• Enrolled in an HSA eligible High Deductible Health Plan (HDHP)
• 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 will receive a debit card to manage your Health Savings Account. Keep in mind, available funds are limited to the balance in your HSA.
• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
ABOUT HSA
For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd
Maximum Contributions
How To Use Your HSA
• Stop by a local EECU financial center for in person assistance; find locations & service hours at www.eecu.org/locations
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You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered by the HDHP.
Health Savings Account (HSA)
You can use your HSA for a wide range of qualified expenses, such as doctor’s visits, prescription drugs, lab work, medical equipment, contacts lenses, dental work, physical therapy the list goes on! Refer to IRS Publication 502 for comprehensive guidelines.
PLAN INFORMATION OPTION 1 OPTION 2 Coverage Type On and off job (24 hour) Covered Events Illness and injury Illness and injury HSA Compatible Yes Yes BENEFITS OPTION 1 OPTION 2 HOSPITAL CARE First Day Hospital Confinement Up to 1 day per year $1,100 $2,200 Daily Hospital Confinement (Day 2+) Up to 30 days per year $100 $100 Daily ICU Confinement (Day 2+) Up to 10 days per year $150 $150 FAMILY CARE OPTION 1 OPTION 2 Health Screening Up to 1 day $50 $50 VALUE ADDED SERVICES OPTION 1 OPTION 2 Ability Assist® EAP 24/7/365 access to help for financial, legal or emotional issues Included Included HealthChampionSM Administrative & clinical support following serious illness or injury Included Included ADDITIONAL PLAN FEATURES COVERAGE ENROLLED IN ADDITIONAL SERVICES AVAILABLE Hospital Indemnity Ability Assist® Counseling Services Health ChampionSM 20
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.
You have a choice of two hospital indemnity plans, which allows you the flexibility to enroll for the coverage that best meets your current financial protection needs. Benefit amounts are based on the plan in effect for you or an insured dependent at the time the covered event occurs. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s). There is no limitation for pre existing conditions. You and your dependents must be citizens or legal residents of the United States.
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. It also provides additional daily benefits for related services. The benefits are paid in lump sum amounts to you, and can help offset expenses that primary health insurance doesn’t cover (like deductibles, co insurance amounts or co pays), or benefits can be used for any non medical expenses (like housing costs, groceries, car expenses, etc.).
EMPLOYEE BENEFITS
Hospital Indemnity Monthly Premium
Employee + Child(ren) $26.52 $46.33
For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd
The Hartford
Family $39.74 $69.45
COVERAGE INFORMATION
Employee $14.28 $25.25
ABOUT HOSPITAL INDEMNITY
Hospital Indemnity
Option 1 Option 2
Employee + Spouse $25.48 $44.87
For more information on Ability Assist® Counseling Services: Call 1 800 964 3577
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• Voluntary commission of or attempt to commit a felony, voluntary participation in illegal activities (except for misdemeanor violations), voluntary participation in a riot, or voluntary engagement in an illegal occupation
SM offers unlimited access to benefit specialists and nurses for administrative and clinical support to address medical care and health insurance claims concerns if you’re enrolled in coverage. Service includes: guidance on health insurance claims and billing support, explanation of benefits, cost estimates and fee negotiation, information related to conditions and available treatments, and support to help prepare for medical visits.
Visit Companywww.guidanceresources.comname:AbiliCompanyID: HLF902
Hospital Indemnity
For more information on HealthChampionSM Services
• Participation in any organized sport in a professional or semi professional capacity
Exclusions. This insurance does not provide benefits for any loss that results from or is caused by:
WHAT IS ABILITY ASSIST COUNSELING SERVICES?
Call 1 800 964 3577
The Hartford BENEFITS
Ability Assist® Counseling Services provides access to Master’s and PhD degreed clinicians for 24/7 assistance if you’re enrolled in coverage. This includes 3 face to face visits per occurrence per year for emotional concerns and unlimited phone consultations for financial, legal, and work life concerns.
Visit Companywww.guidanceresources.comname:AbiliCompanyID: HLF90
• Voluntary intoxication (as defined by the law of the jurisdiction in which the illness or injury occurred) or while under the influence of any narcotic, drug or controlled substance, unless administered by or taken according to the instruction of a physician or medical professional
• Ride in or on any motor vehicle or aircraft engaged in acrobatic tricks/stunts (for motor vehicles), acrobatic/stunt flying (for aircraft), endurance tests, off road activities (for motor vehicles), or racing
• Travel or activity outside the United States or Canada
• Travel in or descent from any vehicle or device for aviation or aerial navigation, except as a fare paying passenger in a commercial aircraft (other than a charter airline) on a regularly scheduled passenger flight or while traveling on business of the policyholder
• Involvement in any declared or undeclared war or act of war (not including acts of terrorism), while serving in the military or an auxiliary unit attached to the military, or working in an area of war whether voluntarily or as required by an employer
• Active duty service or training in the military (naval force, air force or National Guard/Reserves or equivalent) for service/training extending beyond 31 days of any state, country or international organization, unless specifically allowed by a provision of the certificate
• Suicide or attempted suicide, whether sane or insane, or intentional self infliction
• Voluntary intoxication through use of poison, gas or fumes, whether by ingestion, injection, inhalation or absorption
LIMITATIONS & EXCLUSIONS
EMPLOYEE
WHAT IS HealthChampionHEALTHCHAMPION?
• Participation in abseiling, base jumping, Bossaball, bouldering, bungee jumping, cave diving, cliff jumping, free climbing, freediving, freerunning, hang gliding, ice climbing, Jai Alai, jet powered flight, kite surfing, kiteboarding, luging, missed climbing, mountain biking, mountain boarding, mountain climbing, mountaineering, parachuting, paragliding, parakiting, paramotoring, parasailing, Parkour, proximity flying, rock climbing, sail gliding, sandboarding, scuba diving, sepak takraw, slacklining, ski jumping, skydiving, sky surfing, speed flying, speed riding, train surfing, tricking, wingsuit flying, or other similar extreme sports or high risk activities
• Incarceration or imprisonment following conviction for a crime
• Select “MDLIVE as a benefit” and as Employer/ Organization
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.
Telehealth Monthly Premium Employee + Family $10.00 22
•
Insect
MDLIVE treats over 50 routine medical conditions including:
• Nausea/vomiting
• Mobile download the MDLIVE mobile app to your smartphone or mobile device
• eye Rash problems
• Are on vacation or away from home?
•
“FBS”
•
ABOUT TELEHEALTH
• Diarrhea • Earache
EMPLOYEE BENEFITS
Registration is Easy
• Online www.mdlive.com/fbs
Telehealth
After your benefit becomes effective, set up your account with MDLIVE by providing medical history and pharmacy choices so you are ready to use this valuable service when and where you need it.
Do not use telemedicine for serious or life threatening emergencies.
• And more
MDLIVE provides you access to Board certified doctors 24/7 from your mobile device or computer. Prescriptions can be sent to your nearest pharmacy if medically necessary. While MDLIVE does not replace your primary care physician, it is a convenient and cost effective option when you need care and:
• Constipation Cough
•
• Respiratory
• throats
• Acne Allergies Cold/flu
Sore
Pink
• Have a non emergency issue and are considering a convenience care clinic, urgent care clinic or emergency room for treatment?
MDLIVE
For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd
• Are unable to see your primary care physician?
• Phone 888 365 1663
• bites
Employee Only $47.10 $32.89 $20.93 $11.52 Employee and Spouse $97.78 $66.84 $40.75 $21.57 Employee and Child(ren) $104.86 $80.05 $46.06 $24.31 Employee and Family $165.94 $126.92 $72.78 $33.73
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Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and Fordisease.fullplan details, please visit your benefit website: www.mybenefitshub.com/prosperisd Dental Insurance Lincoln Financial Group EMPLOYEE BENEFITS DPPO Benefit Highlights High DPPO Group #00001D040883 Low DPPO Group #00001D040882 Standard DPPO Group #00001D041861 Calendar Deductible(Annual) Individual: $50 Family: $150 Waived for Preventive Individual: $50 Family: $150 Waived for Preventive Individual: $50 Family: $150 Waived for Preventive Deductibles are combined for basic and major Contracting Dentists’ services. Deductibles are combined for basic and major Non Contracting Dentists’ services. Plan Year Maximum $1,500 $1,000 $500 $1,000 N/A Lifetime Orthodontic Max N/A Orthodontic Coverage is available for dependent children. Waiting Period There are no benefit waiting periods for any service types Visit LincolnFinancial.com/FindADentist You can search by: • Location • Dentist name or office name • Distance you are willing to travel • Specialty, language and more Your search will automatically provide up to 100 dentists that most closely match your criteria. If your search does not locate the dentist you prefer, you can nominate one just click the Nominate a Dentist link and complete the onlineTheform.Lincoln DentalConnect® PPO Plans: • Cover many preventive, basic, and major dental care services • Also cover orthodontic treatment for children • Let you choose any dentist you wish, though you can lower your out of pocket costs by selecting a contracting dentist • Do not make you and your loved ones wait six months between routine cleanings
ABOUT DENTAL
Dental Monthly Premium
DPPOHigh DPPOLow StandardDPPO DHMO
• You choose your primary care dentist when you enroll. To find a participating dentist, visit http://ldc.lfg.com and select Find a Dentist. (You can also print your dental ID card from this site once your coverage begins.)
• Be sure that you elect network DHMO Texas LDC Plans 5,6,7 and 8 when electing a provider during enrollment.
Benefits At A Glance
• This dental plan offers a detailed list of covered procedures, each with a dollar copayment (see the Summary of Benefits on your benefit website for details). You pay for services provided during your visit.
• Emergency care away from home is covered up to a set dollar limit.
• You can change your primary care dentist at any time by calling the customer service number (888) 877 7828.
Dental Insurance Lincoln Financial Group
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DHMO Plan
Group # DHMO LDCTXC5/LDCTXV5
Trips to the dentist are a little less scary when you know how much you’ll pay ahead of time. And easier, too, with no claim forms or deductibles.
EMPLOYEE BENEFITS
DPPO Plan Coverage High DPPO Group #00001D040883 Low DPPO Group #00001D041861 Standard DPPO Group #0001D040882 In Network Out Networkof In Network Out Networkof In Network Out Networkof Preventive Services* 100% No Deductible 100% No Deductible 100% No Deductible 100% No Deductible 80% No Deductible 80% No Deductible Basic Services* 80% DeductibleAfter 80% DeductibleAfter 80% DeductibleAfter 80% DeductibleAfter 50% DeductibleAfter 50% DeductibleAfter Major Services* 50% DeductibleAfter 50% DeductibleAfter 50% DeductibleAfter 50% DeductibleAfter 50% DeductibleAfter 50% DeductibleAfter Orthodontics* 50% 50% No Coverage No Coverage No Coverage No Coverage *Services included in each category vary by plan. Refer to your benefit website for a full list of details for each plan.
Exam
Vision insurance provides coverage for routine eye examinations and can help with covering some of the costs for eyeglass frames, lenses or contact lenses.
Single Vision
Covered in full Up to $35 retail Frames $125 retail allowance Up to $70 retail Lenses (standard) per pair
Covered in full Up to $25 retail Bifocal Covered in full Up to $40 retail
How to Print your Vision ID Card:
Need Help?
Discount Features
Call 800 507 3800 or Visit https://superiorvision.com/locator/ to locate a provider.
Copays
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.
Need to search an in network provider?
EMPLOYEE BENEFITS
Benefits: Superior Select Southwest National network In network Out of network
For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd
Trifocal Covered in full Up to $45 retail Progressive See description Up to $45 retail
Contact lenses 12 months Family $20.74
Vision Insurance Superior Vision
Non Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary 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.
Exam $10 Exam 12 months Employee $7.72 Materials $25 Frame 12 months Employee + Spouse $13.06
Services/frequency
Lenticular Covered in full Up to $80 retail Contact Lenses $150 retail allowance Up to $80 retail Medically Necessary Contact Lenses Covered in full Up to $150 retail Lasik Vision Correction $200 allowance
Call 800 507 3800 Customer Service, log in online at www.SuperiorVision.com, or create an account on the app.
ABOUT VISION
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Vision Monthly Premiums
Lenses 12 months Employee + Child(ren) $13.84
You may choose an Elimination Period (injury/sickness) of 0/7, 14/14, 30/30, 60/60, 90/90 or 180/180 days. If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.)
Age at
60 To age 65,
Age 70 and over 1 year26
Elimination Period
• Wavier of Premium available after disability of 90 consecutive days
Maximum Duration of Benefits
64
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• you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and
• unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training, or experience.
EMPLOYEE BENEFITS
• Dependent Care Expense Benefit: If you are disabled and participating in Unum’s Rehabilitation and Return to Work Assistance program, Unum will pay a Dependent Care Expense $350 per month per dependent, to a maximum of $1,000 per month for all dependent care expenses combined.
Benefit Amount
• Survivor Benefit: Unum will pay your eligible survivor a lump sum benefits equal to 3 months of your gross disability payment.
Pre Existing Condition Exclusion: Benefits will not be paid for disabilities caused by, contributed to by, or resulting from a pre existing condition. You have a pre existing condition if:
Less than age but not less than 5 years
ABOUT DISABILITY
The Elimination Period is the length of time of continuous disability, due to sickness or injury, which must be satisfied before you are eligible to receive benefits.
Your Plan Eligibility
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.
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Other Important Provisions
After benefits have been paid for 24 months, you are disabled when Unum determines that due to the same sickness or injury, you are
Age through To age 70, but not less than 1 year
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For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd
You may purchase a monthly benefit in $100 units, starting at a minimum of $200, up to 66 2/3% of your monthly earnings rounded to the nearest $100, but not to exceed a monthly maximum benefit of $7,500.
Disability Insurance UNUM
Age through 5 years
• the disability begins in the first 12 months after your effective date of coverage.
Additional Benefits
Disability
Benefit Duration
Your duration of benefits is based on your age when the disability occurs. Plan: ADEA II: Your duration of benefits is based on the following table:
You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. The date you are eligible for coverage is the later of: the plan effective date; or the day after you complete the waiting period.
• Work/Life Balance Employee Assistance Program: Work life balance is a comprehensive resource providing access to professional assistance for a wide range of personal and work related issues.
0/7 $4.51 14/14 $3.60 30/30 $2.97 60/60 $2.03 90/90 $1.76 180/180 $1.36
• To file a claim https://www.unum.com/employees/fileonline: a claim
Disability Insurance UNUM EMPLOYEE BENEFITS
• To check the status of a https://unum.com/claimsclaim:
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Benefit Integration: Your disability benefit will be reduced by deductible sources of income and any earnings you have while disabled. After you have received monthly disability payments for 6 months, your gross disability payment will be reduced by such items as additional deductible sources of income you receive or are entitled to receive under state compulsory benefit laws.
The lifetime cumulative maximum benefit period for all disabilities due to mental illness and disabilities based primarily on self reported symptoms is 24 months. Only 24 months of benefits will be paid for any combination of such disabilities even if the disabilities are not continuous and/or are not related. Payments would continue beyond 24 months only if you are confined to a hospital or institution because of the disability. Limitations apply.
How to file a claim and Other Important Resources
Disability Monthly Premium Elimination Period per $100 in benefit
Mental Illness/Self Reported Symptoms
• You must be under the regular care of a physician to be considered disabled.
Summary of Benefits
Cancer Treatment Policy Radiation Therapy, Chemotherapy, Immunotherapy Maximum per 12 month period $20,000 Hormone Therapy Maximum of 12 treatments per calendar year $50 per treatment Experimental Treatment paid in same manner and under the same maximums as any other benefit unit dollar amount Max $3,000 per operation of amount paid for covered surgery per lifetime Cell Transplant per lifetime Surgical (not Hair Piece) device site, per
Bone Marrow Transplant Maximum
THIS IS ONLY A SUMMARY OF BENEFITS. PLEASE REFER TO THE CERTIFICATE OF COVERAGE FOR LIMITATIONS AND EXCLUSIONS TO DETERMINE ACTUAL COVERAGES. GO TO WWW.MYBENEFITSHUB.COM/PROSPERISD UNDER THE CANCER SECTION FOR COMPLETE DETAILS.
Plan 1
1
Cancer Insurance APL EMPLOYEE BENEFITS
$6,000 Stem
Benefits Level 4
Maximum
per
lifetime $1,000 / $100 Internal Cancer First Occurrence Rider Benefits Level 2 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 Rider Benefits Intensive Care Unit $600 per day Step Down Unit Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit $300 per day Cancer Monthly Premium Employee $21.88 Employee + Spouse $35.50 Employee + Child(ren) $27.24 Family $37.96 28
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.
Surgical Rider Benefits Level 1 Surgical $30
For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd
$600 Prosthesis Surgical Implantation/Non
Anesthesia 25%
ABOUT CANCER
The Hartford
Life Insurance Coverage Information
Employee Benefit2: Increments of $10,000 Maximum: the lesser of 5x earnings or $500,000 will your
AD&D: Included Benefit: Increments of $10,000 Maximum: the lesser of 5x earnings or $500,000
SUPPLEMENTAL COVERAGE
ABOUT LIFE AND AD&D
Life and AD&D
Group Voluntary Accidental Death & Dismemberment (AD&D) insurance pays your beneficiary a death benefit if you die due to a covered accident or pays you if you are unexpectedly injured in a covered accident. The benefits are paid in lump sum amounts to you (or your beneficiary) and can be used to pay for health care expenses not covered by your major medical insurance, help replace income lost while not working, funeral expenses, or however you choose. Accidental death benefits are paid in addition to any life insurance.
EMPLOYEE
Child(ren) Not Included Benefit: Increments of $5,000 Maximum: $10,000
For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd BENEFITS
The Group Term Life and Accidental Death and Dismemberment (AD&D) insurance available through your employer gives extra protection that you and your family may need. Life and AD&D insurance offers financial protection by providing you coverage in case of an untimely death or an accident that destroys your income earning ability. Life benefits are disbursed to your beneficiaries in a lump sum in the event of your death.
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.
Employee Benefit: $10,000
Accidental Death and Dismemberment (AD&D) Coverage Information
Dependent(s) Your dependent(s)
be covered at a percentage of your coverage amount. COVERAGE TIER SPOUSE PERCENTAGE CHILD(REN) PERCENTAGE Spouse 50% 0% Child(ren) 0% 15% Spouse & Child(ren) 40% 10% AD&D BENEFITS PERCENT OF COVERAGE AMOUNT PER ACCIDENT Covered accidents or death can occur up to 365 days after the accident. The total benefit for all losses due to the same accident will not exceed 100% of
coverage amount. LOSS FROM ACCIDENT BASIC COVERAGE VOLUNTARY COVERAGE Life 100% 100% Both Hands or Both Feet or Sight of Both Eyes 100% 100% 29
Spouse Not Included Benefit: Increments of $10,000 Maximum: the lesser of 100% of your supplemental coverage or $250,000
APPLICANT BASIC ReductionsCOVERAGEatage 65 and 70
APPLICANT AD&D COVERAGE
this insurance coverage.
•
BASIC COVERAGE
One Hand and One Foot 100% 100% Speech and Hearing in Both Ears 100% 100% Either Hand or Foot and Sight of One Eye 100% 100% Movement of Both Upper and Lower Limbs (Quadriplegia) 100% 100% Movement of Both Lower Limbs (Paraplegia) 75% 75% Movement of Three Limbs (Triplegia) 75% 75% Movement of the Upper and Lower Limbs of One Side of the Body (Hemiplegia) 50% 50%
Life and AD&D
you
Refer to your benefit website for details on these additional services.
Funeral
COVERAGE
LOSS FROM ACCIDENT (cont’d)
cost to you. These services help with challenges that come before and after a claim. Be sure to read the information provided below; The Hartford wants to be there when you need us.
Life & Accidental Death and Dismemberment
If Hartford, may also be eligible to receive additional services at no
• Assistance Services with ID Theft Protection and Assistance
ADDITIONAL SERVICES AVAILABLE
•
VOLUNTARY COVERAGE
you are enrolled in insurance coverage with The
EMPLOYEE
AND EXCLUSIONS This insurance coverage includes
Your benefit will be reduced by 35% at age 65 and 50% at age 70. Reductions will be applied to the original amount.
• Planning and Concierge Services
and Voluntary Life VoluntarySections.GroupLife per $10,000 in coverage Monthly Premium Age Employee Spouse <24 $0.40 $0.50 25 29 $0.50 $0.60 30 34 $0.65 $0.80 35 39 $0.70 $0.90 40 44 $0.80 $1.00 45 49 $1.20 $1.50 50 54 $1.80 $2.30 55 59 $3.40 $4.20 60 64 $5.20 $6.50 65 69 $12.50 $12.50 70+ $20.30 $20.30 Spouse rates are based on Employee's age and cannot exceed 100% of the employees supplemental life amount. Voluntary Group Life Child(ren) Monthly Premium Age $5,000 $10,000 0 26 $1.00 $2.00 AD&D (per $10,000) Monthly Premium Employee Only $0.20 Family $0.40 30
Travel
ENROLLED IN
Either Hand or Foot 50% 50% Sight of One Eye 50% 50% Speech or Hearing in Both Ears 50% 50% Movement of One Limb (Uniplegia) 25% 25% Thumb and Index Finger of Either Hand 25% 25%
LIMITS certain limitations and exclusions. The certificate details all provisions, limitations, and exclusions for A copy of the certificate can be obtained at www.mybenefitshub.com/prosperisd.com under the Basic Life
Beneficiary Assist® Counseling Services
ADDITIONAL SERVICES
The Hartford BENEFITS
EstateGuidance® Will Services
UNIQUE FEATURES INCLUDED IN ALL ID WATCHDOG PLANS
Identity Theft ID Watchdog
• Registered Sex Offender Reporting*
For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd
EMPLOYEE BENEFITS
Monitor & Detect
• Identity Profile Report
Identity Theft Monthly Premium 1B Platinum Employee $7.95 $11.95 Employee and Family $14.95 $22.95
Multi Bureau = Equifax, TransUnion® | Applies to the Platinum Plan to lock your credit report to avoid fraud
• Fraud Alert & Credit Freeze Assistance
• 24/7/365 U.S. based Customer Care Center
• Financial Accounts Monitoring
• USPS Change of Address Monitoring
• High Risk Transactions Monitoring*
• Public Records Monitorin*
• Identity Theft Resolution Specialists (Resolution for Pre existing Conditions)*
• Deceased Family Member Fraud Remediation
*Helps better protect children
Please refer to the website, www.mybenefitshub.com/prosperisd for more details.
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3 Bureau = Equifax, Experian®, TransUnion | Applies to the Platinum Plan and allows monitoring for all 3 credit bureaus listed
1 Bureau = Equifax® | Applies to the 1B plan and includes monthly monitoring
• Social Network Alerts*
• Lost Wallet Vault & Assistance
• Subprime Loan Monitoring*
ID Watchdog is everywhere you can’t be monitoring credit reports, social media, transaction records, public records and more to help you better protect your identity. And don’t worry, we’re always here for you. In fact, our U.S. based customer care team is available 24/7/365 at 866.513.1518.
ABOUT IDENTITY THEFT PROTECTION
• Dark Web Monitoring*
• Mobile App
Support & Restore
• Breach Alert Emails
• Child Credit Lock | 1 Bureau*
Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered.
Manage & Alert
• Customizable Alert Options
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.
EMPLOYEE
Shouldrecuperation.youneed assistance
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 with a claim contact MASA at 800 643 9023. You can find full benefit details
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.
Emergency Medical Transport MASA BENEFITS
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.
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.
For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd
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.
ABOUT MEDICAL TRANSPORT
www.mybenefitshub.com/prosperisdEmergencyMedicalTransportMonthlyPremiumEmployeeandFamily$14.00 32
The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s).
• Overnight camps are not eligible for reimbursement (only day camps can be considered).
• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
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).
Health Care FSA
• Dental and vision expenses
• Hearing aids and batteries
ABOUT FSA
EMPLOYEE BENEFITS
• 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.
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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).
The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full time student.
Higginbotham
Things to Consider Regarding the Dependent Care FSA
• Prescription copays
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
• Medical deductibles and coinsurance
Higginbotham Benefits Debit Card
For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd
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:
Flexible Spending Account (FSA)
Dependent Care FSA
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• The maximum per plan year you can contribute to a Health Care FSA is $2,850. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately.
• You can continue to file claims incurred during the plan year for another 90 days after August 31st
Higginbotham BENEFITS
• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
• Access plan documents, letters and notices, forms, account balances, contributions and other plan information
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.
Important FSA Rules
• You cannot change your election during the year unless you experience a Qualifying Life Event.
• Update your personal information
• Look up qualified expenses
Flexible Spending Account (FSA)
• If you have any questions or concerns, contact Higginbotham: Phone 866 419 3519 Email flexclaims@higginbotham.net Fax 866 419 3516
• Utilize Section 125 tax calculators
• The IRS has amended the “use it or lose it rule” to allow you to carry over up to $570 in your Health Care FSA into the next plan year. The carry over rule does not apply to your Dependent Care FSA.
Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information.
EMPLOYEE
Higginbotham Portal
The Higginbotham Portal provides information and resources to help you manage your FSAs.
• Submit claims
• Request a new or replacement Benefits Debit Card Register on the Higginbotham Portal
• Follow the prompts to navigate the site.
• Enter your Employee ID, which is your Social Security number with no dashes or spaces.
Over the Counter Item Rule Reminder
Take the High Road Ride Reimbursement Program: Deer Oaks reimburses members for their cab, Lyft and Uber fares in the event that they are incapacitated due to impairment by a substance or extreme emotional condition. This service is available once per year per participant, with a maximum reimbursement of $45.00 (excludes tips).
EMPLOYEE ASSITANCE PROGRAM AT NO COST TO YOU!
An Employee Assistance Program (EAP) is a program that assists you in resolving problems such as finding child or elder care, relationship challenges, financial or legal problems, etc. This program is provided by your employer at no cost to you.
Employee Assistance Program (EAP)
Deer Oaks EMPLOYEE BENEFITS
Short term Counseling: Counseling sessions with a qualified counselor to assist with issues such as stress, anxiety, grief, marital/family challenges, relationship issues, addiction, etc. Counseling is available via structured telephonic sessions, video, and in person at local provider offices.
Advantage Financial Assist: Unlimited telephonic consultation with an Accredited Financial Counselor qualified to advise on a range of financial issues such as bankruptcy prevention, debt reduction, financial planning, and identity theft; supporting educational materials available; unlimited online access to a wealth of educational financial resources, links, tools and forms (i.e. tax guides, financial calculators, etc.).
Alternate Modes of Support: Your EAP offers support alternatives in addition to traditional short term counseling including telephonic life coaching, AWARE stress reduction sessions, and virtual group counseling. During your call with one of our counselors, ask if these programs would be right for you.
& Support: In the moment telephonic support and crisis intervention are available 24/7 along with intake and clinical assessments.
ABOUT EAP
Contact Us: Toll Free: (888) 993 7650 Website: www.deeroakseap.com Email: eap@deeroaks.com
The Deer Oaks Employee Assistance Program (EAP) is a free service provided for you, your dependents, and household members by your employer. This program offers a wide variety of counseling, referral, and consultation services, which are all designed to assist you and your family in resolving work and life issues to live happier, healthier, more balanced lives. From stress, addiction, and change management, to locating childcare facilities, legal assistance, and financial challenges, our qualified professionals are here to help. These services are completely confidential and can be easily accessed 24/7, offering you around the clock assistance for all of life’s challenges.
Referrals & Community Resources: Our team provides referrals to local community resources, member health plans, support groups, legal resources, and child/elder care/daily living resources.
Child & Elder Care Referrals: Our child and elder care specialists can help you with your search for licensed child and elder care facilities in your area. They will discuss your needs, provide guidance, resources, and qualified referral packets. Searchable databases and other resources are also available on the Deer Oaks member website.
Advantage Legal Assist: Free 30 minute telephonic or in person consultation with a plan attorney; 25% discount on hourly attorney fees if representation is required; unlimited online access to a wealth of educational legal resources, links, tools and forms; and interactive online Simple Will preparation.
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For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd
Program Access: You may access the EAP by calling the toll free Helpline number, using our iConnectYou App, or instant messaging with a work life consultant through our online instant messaging Telephonicsystem.Assessments
Work life Services: Our work life consultants are available to assist you with a wide range of daily living resources such as locating pet sitters, event planners, home repair, tutors, travel planning, and moving services. Simply call the Helpline for resource and referral information.
2022 - 2023 PlanYear WWW.MYBENEFITSHUB.COM/PROSPERISD
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 Prosper 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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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 Prosper 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.
