RUSK ISD BENEFIT GUIDE EFFECTIVE: 09/01/2022 8/31/2023 WWW.MYBENEFITSHUB.COM/RUSKISD 2022 - 2023 PlanYear 1
Table of Contents FLIP TO... How to Enroll 4-5 Annual Benefit Enrollment 6-11 1. Annual Enrollment 6 2. Section 125 Cafeteria Plan Guidelines 7 3. Helpful Definitions 8 4. Eligibility Requirements 9 5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 10 Medical 12-17 Health Savings Account (HSA) 18 Telehealth 19 Dental 20 Accident 21 Vision 22 Disability 23-24 Life and AD&D 25-26 Individual Life 27 Flexible Spending Account (FSA) 28-29 Hospital Indemnity 30 Critical Illness 31-32 Emergency Medical Transportation 33 HOW TO ENROLLPG. 4 SUMMARYPAGESPG. 6 BENEFITSYOURPG. 12 2
RUSK ISD BENEFITS MEDICAL TRS ACTIVECARE HEALTH SAVINGS ACCOUNT (HSA) Financial Benefit Services (800) 583 www.mybenefitshub.com/ruskisd6908 (866)BCBSTX355 www.bcbstx.com/trsactivecare5999 (800)EECU 333 www.eecu.org9934 TELEHEALTH DENTAL ACCIDENT (888)MDLIVE365 1663 www.mdlive.com/fbs GroupCigna # (800) 244 6224 www.mycigna.com GroupAetna #802478 (800) 872 3862 www.aetna.com VISION DISABILITY LIFE AND AD&D Superior Vision Group #321860 (800) 507 www.superiorvision.com3800 GroupUnum #125328 (800) 858 www.unum.com6843 The www.thehartford.com(800)GroupHartford#8689615475000 INDIVIDUAL LIFE FLEXIBLE SPENDING ACCOUNT (FSA) HOSPITIAL INDEMNITY 5Star Life Insurance (866) 863 www.5starlifeinsurance.com9753 https://flexservices.higginbotham.net/(866)Higginbotham4193519 GroupAetna #802478 (800) 872 www.aetna.com3862 CRITICAL ILLNESS EMERGENCY MEDICAL TRANSPORT GroupUnum #474091 (866) 679 www.unum.com3054 GroupMASA #MKRUISD (800) 423 www.masamts.com3226 Benefit Contact Information 3
Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS RUSKISD” to (800) 583-6908 App Group #: FBSRUSKISD Text “FBS RUSKISD” 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/ruskisd How to Log In 2 CLICK LOGIN 3 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. 5
Notes 6
Change in Status 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.
Marital Status
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 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.
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.
Section 125 Cafeteria Plan Guidelines Benefit Enrollment CHANGES IN (CIS):STATUS QUALIFYING EVENTS
Gain/Loss EligibilityDependents'ofStatus
SUMMARY PAGESAnnual
Judgment/Decree/Order
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
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Change in Number of Tax Dependents
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.
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
Affecting Coverage Eligibility
Eligibility for Government Programs
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.
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.
For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866 914 5202 for assistance.
For benefit summaries and claim forms, go to your benefit www.mybenefitshub.com/ruskisdwebsite:.
• 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.
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?
Q&A Who do I contact with Questions?
Annual Enrollment
• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.
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.
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.
• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
Where can I find forms?
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.
SUMMARY PAGESAnnual Benefit Enrollment 8
New Hire Enrollment
For benefit summaries and claim forms, go to the Rusk ISD benefit www.mybenefitshub.com/ruskisdwebsite:.
Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week. Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2022 benefits become effective on September 1, 2022, you must be actively at work on September 1, 2022 to be eligible for your new benefits.
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: 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
PLAN
Dependent RequirementsEligibility
AGE Accident To age 26 AD&D To age 25 Critical Illness To age 26 Dental To age 26 FSA To age 24 IndemnityHospital To age 26 HSA To age 24 Individual Life To age 24 Medical To age 26 TransportationMedical To age 26 Telehealth To age 26 Vision To age 26 Voluntary Life To age 25
Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.
SUMMARY PAGES
Enrollment 9
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. 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
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. MAXIMUM
Annual Benefit
Employee RequirementsEligibility
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Calendar Year
Guaranteed Coverage
Actively at Work
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).
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider. Out of Pocket Maximum
Annual Enrollment
January 1st through December 31st Co-insurance
Plan Year
You are performing your regular occupation for the employer on a full time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel If you will not be actively at work beginning 9/1/2022 please notify your benefits administrator.
The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively at work and/or pre existing condition exclusion provisions do apply, as applicable by carrier.
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.
In Network
SUMMARY PAGESHelpful Definitions 10
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.
Pre Existing Conditions
The most an eligible or insured person can pay in co insurance for covered expenses.
September 1st through August 31st
Health Savings Account (HSA) (IRC Sec. 223) Flexible Spending Account (FSA) (IRC Sec. 125) Description 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 tax free. 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 RequirementInsurance 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 65). Not permitted 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 SUMMARY PAGESHSA vs. FSA FLIP TO FOR HSA INFORMATION PG. 18 FLIP TO FOR FSA INFORMATION PG. 28 11
Monthly Premium District Contribution Employee Cost TRS ActiveCare HD Employee Only $423.00 $225.00 $198.00 Employee & Spouse $1,189.00 $225.00 $964.00 Employee & Child(ren) $759.00 $225.00 $534.00 Employee & Family $1,422.00 $225.00 $1,197.00 TRS ActiveCare 2 Employee Only $1,013.00 $225.00 $788.00 Employee & Spouse $2,402.00 $225.00 $2,177.00 Employee & Child(ren) $1,507.00 $225.00 $1,282.00 Employee & Family $2,841.00 $225.00 $2,616.00 TRS ActiveCare Primary Employee Only $408.00 $225.00 $183.00 Employee & Spouse $1,151.00 $225.00 $926.00 Employee & Child(ren) $734.00 $225.00 $509.00 Employee & Family $1,378.00 $225.00 $1,153.00 TRS ActiveCare Primary+ Employee Only $513.00 $225.00 $288.00 Employee & Spouse $1,254.00 $225.00 $1,029.00 Employee & Child(ren) $825.00 $225.00 $600.00 Employee & Family $1,577.00 $225.00 $1,352.00 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/ruskisd Medical Insurance TRS EMPLOYEE BENEFITS 12
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Maximum Contributions 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:
Opening an HSA
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/ruskisd
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Health Savings Account (HSA)
• Not eligible to be claimed as a dependent on someone else’s tax return
• 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.
• Enrolled in an HSA eligible 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.
• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
• Stop by: a local EECU financial center for in person assistance: www.eecu.org/locations
• Not enrolled in a Health Care Flexible Spending Account
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.
HSA
EECU EMPLOYEE BENEFITS
• Online/Mobile: Sign in for 24/7 account access to check your balance, pay bills and more.
• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333 9934
• 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. 1:00 p.m. CT and closed on Sunday.
HSA Eligibility
• Not receiving Veterans Administration benefits
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
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.
You are eligible to open and contribute to an HSA if you are:
ABOUT
• Not enrolled in Medicare or TRICARE
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.
• Individual $3,650 • Family (filing jointly) $7,300 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 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.
• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
How to Use your HSA
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/ruskisd Telehealth MDLive EMPLOYEE BENEFITS Alongside your medical coverage is access to quality telehealth services through MDLIVE. Connect anytime day or night with a board certified doctor via your mobile device or computer. While MDLIVE does not replace your primary care physician, it is a convenient and cost effective option when you need care and: • Have a non emergency issue and are considering a convenience care clinic, urgent care clinic or emergency room for treatment • Are on a business trip, vacation or away from home • Are unable to see your primary care physician When to Use MDLIVE: At a cost that is the same or less than a visit to your physician, use telehealth services for minor conditions such as: • Sore throat • Headache • Stomach ache • Cold • Flu • Allergies • Fever • Urinary tract infections Do not use telemedicine for serious or life threatening emergencies. Registration is Easy • Register with MDLIVE so you are ready to use this valuable service when and where you need it. • Online www.mdlive.com/fbs • Phone 888 365 1663 • Mobile download the MDLIVE mobile app to your smartphone or mobile device • Select “MDLIVE as a benefit” and “FBS” as your Employer/Organization when registering your account. Telehealth Employee + Family $10.00 19
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 Fordisease.fullplan details, please visit your benefit website: www.mybenefitshub.com/ruskisd Dental Insurance Cigna EMPLOYEE BENEFITS Cigna Dental Choice Plan Network Options In Network: Total Cigna DPPO Network** Out of Network: See Non Network Reimbursement Reimbursement Levels Based on Contracted Fees Maximum Reimbursable Charge Calendar Year Benefits Maximum Applies to: Class I, II, III, V & IX expenses $1,200 $1,200 Calendar Year Deductible FamilyIndividual $150$50 $150$50 Benefit Highlights Plan Pays You Pay Plan Pays You Pay Class I: Diagnostic & Preventive Oral Evaluations, Prophylaxis: routine cleanings, X rays: routine, X rays: non routine, Fluoride Application, Sealants: per tooth 100% No Deductible No Charge 100% No Deductible No Charge Class II: Basic Restorative Restorative: fillings, Emergency Care to Relieve Pain, Space Maintainers :non orthodontic, Oral Surgery: minor, Periodontics: minor 80% After Deductible 20% After Deductible 80% After Deductible 20% After Deductible Class III: Major Restorative Inlays and Onlays, Prosthesis Over Implant, Crowns: prefabricated stainless steel / resin, Crowns: permanent cast and porcelain, Bridges and Dentures, Oral Surgery: major, Periodontics: major, Repairs: Bridges, Crowns and Inlays, Repairs: Dentures, Denture Relines: Rebases and Adjustments 50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible Class IV: Orthodontia Coverage for Dependent Children to age 19 Lifetime Benefits Maximum: $1,000 50% No Deductible 50% No Deductible 50% No Deductible 50% No Deductible Dental Employee $32.60 Employee + Spouse $65.16 Employee + Child(ren) $71.86 Family $98.71 20
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/ruskisd Accident Insurance Aetna EMPLOYEE BENEFITS Accidents are nearly impossible to predict, but with accident insurance they’re easy to prepare for. Accident Insurance allows you to concentrate on your health instead of your finances by issuing a lump sum benefit when you suffer a covered accident. Accident prone family members? This affordable benefit may also be available to your spouse and dependent children. Note: For full list of benefits, refer to the certificate of coverage located on the employee benefits portal at www.mybenefitshub.com/ruskisd Covered Benefits Initial Care • Ground/Air Ambulance • Initial Treatment Emergency Room, Physician’s Office and/or Urgent Care • X Rays • Medical Imaging Follow Up Care • Follow Up Treatment Emergency Room, Physician’s Office and/or Urgent Care • Appliances • Prosthetic Device / Artificial Limb • Pain Management • Therapy Services • Chiropractic Services Hospital Care • Inpatient Hospital Admission • Inpatient ICU Admission initial day • Inpatient Hospital Daily • Inpatient ICU Daily • Inpatient Rehabilitation Unit Daily • Observation Unit Surgical Care • Blood/Plasma/Platelets • Eye Injury • Ruptured Disc • Tendon / Ligament / Rotator Cuff • Surgery (with repair) • Surgery (with no repair) Transportation / Lodging • Lodging • Transportation Dislocations / Fractures • Closed reduction • Open reduction AD&D • Accidental Death & Dismemberment and Paralysis Benefits Accident Employee $9.50 Employee + Spouse $16.54 Employee + Child(ren) $20.72 Family $26.87 21
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/ruskisd Vision Insurance Superior Vision EMPLOYEE BENEFITS How to Print your Vision ID Card: You can request your vision id card by contacting Superior Vision directly at 800 507 3800. You can also go to www.superiorvision.com and register/login to access your account by clicking on “Members” at the top of the page. You can also download the Superior Vision mobile app on your smart phone. Discount Features Non Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchase 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 les “extras” such a tints and coatings. Eyewear purchase from a Walmart Vision Center does not qualify for this addition discount because of Walmart’s “Always Low Prices” policy. Superior Select Southwest Network In network Out of network Exam Covered in full Up to $35 retail Frames $150 retail allowance Up to $70 retail Lenses (standard) per pair Single Vision Covered in full Up to $25 retail Bifocal Covered in full Up to $40 retail Trifocal Covered in full Up to $45 retail Progressive See description3 Up to $45 retail Contact Lenses4 $175 retail allowance Up to $80 retail Medically Necessary Contact Lenses Covered in full Up to $150 retail Lasik Vision Correction5 $200 allowance Co pays apply to in network benefits; co pays for out of network visits are deducted from reimbursements 1. Eye exam copay is a single payment due to the provider at the time of service. 2. Eyewear copay applies to eyeglass lenses / frame and contact lenses. Eyewear copay is a single payment that applies to the entire purchase of eyeglasses (frame and lenses) 3. Covered to provider’s in office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co pay 4. Contact lenses and related professional services (fitting, evaluation and follow up) are covered in lieu of eyeglass lenses and frames benefit 5. Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limitations Copays Services/frequency Monthly Premiums Exam1 $10 Exam 12 months Employee $7.80 Materials2 $10 Frame 24 months Employee + Spouse $19.66 Lenses 12 months Employee + Child(ren) $19.66 Contact lenses 12 months Family $19.66 22
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To apply for coverage, complete your enrollment online by the enrollment deadline. If you were hired after 9/1/2022, check with your plan administrator for your eligibility date, and complete your enrollment online within 31 days of that date.
You have a pre existing condition if:
Disability Insurance Unum
For full plan details, please visit your benefit website: www.mybenefitshub.com/ruskisd
• You are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury;
What is the definition of disability?
What is my monthlybenefitamount? 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. Please see your Plan Administrator for the definition of monthly earnings. The total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 100% of your monthly earnings unless the excess amount is payable as a Cost of Living Adjustment. However, if you are participating in Unum’s Rehabilitation and Return to Work Assistance program, the total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 110% of your monthly earnings (unless the excess amount is payable as a Cost of Living Adjustment).
EMPLOYEE BENEFITS Who is eligible? You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per Howweek.canIapply for coverage?
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.
• You have a 20% or more loss in indexed monthly earnings due to the same sickness or injury; and
• 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
What is considered a pre existing condition?
been paid for 24 months, you are disabled with the carrier determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.
• The disability begins in the first 12 months after your effective date of coverage.
Benefit Integration Your disability benefit will be reduced by deductible source of income and any earnings you have while disabled. Your gross disability payment will be reduced immediately by such items as disability income or other amounts you receive or are entitled to receive from workers compensation or similar occupational benefit laws, sabbatical or assault leave plans and the amount of earnings you receive from an extended sick leave plan as described in Louisiana Revised Statutes or any other act or law with similar intent. For more information, review the plan information posted to the benefits portal.
How long do I have to wait to receive benefits?
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.)
You are disabled with the carrier determines that:
Elimination Period Options (injury/sickness): Option 1: 7 days/7 days Option 2: 14 days/14 days Option 3: 30 days/30 days Option 4: 90 days/90 days Option 5: 180 days/180 days
• During the elimination period you are unable to perform any of the material and substantial duties of your regular Afteroccupationbenefitshave
The elimination period is the length of time you must be continuously disabled before you can receive benefits.
Disability Insurance Unum EMPLOYEE BENEFITS When does my coverage end? Your coverage under the policy ends on the earliest of the following: • 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 except as provided under the covered layoff or leave of absence Pleaseprovision.seeyour plan administrator for further information on these Unumprovisions.willprovide coverage for a payable claim which occurs while you are covered under the policy or plan. Disability Elimination Period Rate per $100 Benefit 0/7 $4.02 14/14 $3.18 30/30 $2.66 60/60 $1.81 90/90 $1.57 180/180 $1.21 24
EMPLOYEE BENEFITS
Am I guaranteed coverage?
When can I enroll? You can enroll during your scheduled enrollment period, within 31 days of the date you have a change in family status, or within 31 days of the completion of your eligibility waiting period as stated in your group policy. How much Voluntary Life Insurance can I purchase? You can purchase Voluntary Life Insurance in increments of $10,000. The maximum amount you can purchase cannot be more than the lesser of 7 times your annual Earnings or $500,000. Annual Earnings are as defined in The Hartford’s contract with your employer.
Life and AD&D
Child(ren) Voluntary Life Insurance
Your beneficiary is the person (or persons) or legal entity (entities) who receives a benefit payment if you die while you are covered by the policy. You must select your beneficiary when you complete your enrollment application; your selection is legally Spousebinding.Voluntary
Life Insurance
If you elect Voluntary Life Insurance for yourself, you may choose to purchase Child(ren) Voluntary Life Insurance coverage in the amount(s) of $10,000 for each child no medical information is required. If your dependent child(ren) is confined in a hospital or elsewhere because of disability on the date his or her insurance would normally have become effective, coverage (or an increase in coverage) will be deferred until that dependent is no longer confined and has performed all the normal activities of a healthy person of the same age for at least 15 consecutive days. Does my coverage reduce as I get older? By 35% @ 70, 55% of Original @ 75, 70% of Original @ 80, 80% of Original @ 85, 85% of Original @ 90. All coverage cancels at retirement. 25
What is Voluntary Life Insurance?
Voluntary Life Insurance is coverage that you pay for. Voluntary Life Insurance pays your beneficiary (please see below) a benefit if you die while you are covered. Am I eligible? You are eligible if you are an active full time employee who works at least 20 hours per week on a regularly scheduled basis.
If you elect Voluntary Life Insurance for yourself, you may choose to purchase Spouse Voluntary Life Insurance in increments of $5,000, to a maximum of $100,000. Coverage cannot exceed 50% of the amount of your Employee voluntary/supplemental life insurance coverage. You may not elect coverage for your spouse if they are in active full time military service or is already covered as an employee under this policy. If your spouse is confined in a hospital or elsewhere because of disability on the date his or her insurance would normally have become effective, coverage (or an increase in coverage) will be deferred until that dependent is no longer confined and has performed all the normal activities of a healthy person of the same age for at least 15 consecutive Ifdays.you are newly eligible and elect an amount that exceeds the guaranteed issue amount of $50,000, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you were previously eligible and are electing coverage for the first time or electing to increase your spouse's current coverage, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before coverage can become effective.
What is a beneficiary?
If you are newly eligible and elect an amount that exceeds the guaranteed issue amount of $150,000, you will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you were previously eligible and are electing coverage for the first time or electing to increase your current coverage, you will need to provide evidence of insurability that is satisfactory to The Hartford before coverage can become effective.
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/ruskisd
The Hartford ABOUT LIFE AND AD&D Group term life is the most inexpensive way to purchase life insurance.
Voluntary
You are eligible if you are an active full time employee who works at least 20 hours per week on a regularly scheduled basis
• One quarter (25%) for accidental loss of thumb and index finger of the same hand. Additionally, your employer may have elected optional/ supplemental benefits as part of your AD&D coverage. Refer to the certificate of insurance for further information. Your total benefit for all losses due to the same accident will not be more than 100% of the amount of coverage you purchase. What optional benefits has my employer selected as part of my Voluntary Accidental Death and Dismemberment Insurance?
• 100% of the amount of coverage you purchase in the event of accidental loss of life, or speech and hearing in both ears.
What is Voluntary Accidental Death and Dismemberment Insurance?
Do I have to provide medical information to receive coverage? No medical information is required. You are guaranteed the amount of coverage that you select, subject to maximum amounts defined in your policy.
Life and AD&D The Hartford EMPLOYEE BENEFITS Voluntary Group Life Age perEmployee$10,000 perSpouse$5,000 0 24 $0.40 $0.30 25 29 $0.40 $0.30 30 34 $0.50 $0.35 35 39 $0.70 $0.50 40 44 $1.10 $0.75 45 49 $1.80 $1.15 50 54 $3.00 $1.85 55 59 $4.70 $2.90 60 64 $6.20 $3.85 65 69 $9.90 $6.10 70 74 $17.40 $10.70 75+ $31.50 $19.35 Spouse rates are based on employee age Voluntary Group Life Child(ren) $10,000 in coverage 0 26 $1.25 Voluntary AD&D per $10,000 in coverage Employee Only $0.25 Employee and Family $0.40 26
• 40% if you have child(ren) whom you cover under this Voluntary Accidental Death and Dismemberment Insurance policy. You may not elect coverage for your spouse if your spouse is already covered as an employee under this policy. You may choose guaranteed Voluntary Accidental Death and Dismemberment Insurance for each child at least 15 days but under age 25 in the following amounts:
• Voluntary Accidental Death and Dismemberment Insurance covers losses that occur away from work or at work. Benefits are paid regardless of any worker’s compensation benefits you collect.
Accidental Death and Dismemberment Insurance pays your beneficiary (please see below) a death benefit if you die due to a covered accident while you are insured. It also pays you a benefit for certain accidental losses. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail.
• Death benefits are paid in addition to any life insurance benefits.
You can purchase Voluntary Accidental Death and Dismemberment Insurance in increments of $10,000. The maximum amount you can purchase cannot be more than 10 times your annual Earnings or $500,000. Earnings are as defined in The Hartford’s contract with your employer. Does my coverage reduce as I get older? By 35% @ 70, 55% @ 75, 75% @ 80, 85%@ 85.
You may also choose Voluntary Accidental Death and Dismemberment Insurance for your spouse and/or dependent child(ren). You may choose Voluntary Accidental Death and Dismemberment Insurance for your spouse in the following amounts:
• 50% of the amount you select for yourself if you do not have any child(ren) whom you cover under this Voluntary Accidental Death and Dismemberment Insurance policy.
What does Voluntary Accidental Death and Dismemberment Insurance cover? You may receive benefits due to certain losses or death from an accident. The covered losses or death can occur up to 365 days after that accident. The policy pays for:
How much Voluntary Accidental Death and Dismemberment Insurance can I purchase?
• 10% if you have a spouse whom you cover under this Voluntary Accidental Death and Dismemberment Insurance policy
• One half (50%) for accidental loss of one hand or foot, sight of one eye, or speech or hearing in both ears.
• 10% of the amount you select for yourself if you do not have a spouse whom you cover under this Voluntary Accidental Death and Dismemberment Insurance policy
• Voluntary Accidental Death and Dismemberment Insurance pays benefits for accidental loss of limbs, thumb and index finger, speech, hearing, and sight.
• Seat Belt & Air Bag Am I eligible?
Voluntary Accidental Death and Dismemberment Insurance for your dependents
• Paralysis Benefit • Repatriation Benefit
Company’s Family Protection Plan offers both Individual and Group products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your employees.
ILLNESS ACCELERATION OF BENEFITS Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL).
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* Financially dependent children 14 days to 23 years old.
QUALITY OF LIFE Optional benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following: • Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or • Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision. Find full details and rates at www.mybenefitshub.com/ruskisd Should you need to file a claim, contact 5Star directly at (866) 863 9753.
Individual Life Insurance Star EMPLOYEE
*Quality of Life not available ages 66 70. Quality of Life benefits not available for children Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 years).$7.15 monthly for $10,000 coverage per child.
FAMILY PROTECTION Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves.
PROTECTION TO COUNT ON Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two year contestability period and/or under investigation. This coverage has no war or terrorism exclusions.
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/ruskisd
Enhanced coverage options for employees. Easy and flexible enrollment for employers. The 5Star Life Insurance
BENEFITS
CUSTOMIZABLE With several options to choose from, employees select the coverage that best meets the needs of their TERMINALfamilies.
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PORTABLE Coverage continues with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly. CONVENIENCE Easy payments through payroll deduction.
For full plan details, please visit your benefit website: www.mybenefitshub.com/ruskisd
• You can continue to file claims incurred during the plan year for another 90 days after August 31st
• You cannot change your election during the year unless you experience a Qualifying Life Event.
• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
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Flexible Spending Account (FSA)
Dependent Care FSA
The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full time
Higginbotham Benefits Debit Card
Thingsstudent.to Consider Regarding the Dependent Care FSA
• 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.
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 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:
• 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.
• Prescription copays
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).
• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
The 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).
• Dental and vision expenses
• Hearing aids and batteries
ABOUT FSA
Higginbotham BENEFITS Health Care FSA
• Medical deductibles and coinsurance
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
• Overnight camps are not eligible for reimbursement (only day camps can be considered).
Important FSA Rules
EMPLOYEE
Higginbotham EMPLOYEE BENEFITS 29
• Log in using the same username and password you use to log in to the Higginbotham Portal. Note: You must register on the Higginbotham Portal in order to use the mobile www.FSAstore.comFSAstore.Comapp. offers thousands of FSA eligible products and services to purchase using your Higginbotham Benefits Debit Card or any major credit card. Competitive pricing and free shipping on orders over $50 can save you up to 40% using your FSA pretax dollars. Shop directly at FSAstore.com or have your physician submit prescriptions (when required). The FSAstore.com Services Channel allows you to search a database of more than 300,000 health care providers for nearby eligible services, such as acupuncture and chiropractic care. The FSAstore.com Learning Center focuses on answering common questions and keeping you informed about changes to your FSA benefits. Spending Account (FSA)
Flexible
Over the Counter Item Rule Reminder 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. Higginbotham Portal The Higginbotham Portal provides information and resources to help you manage your FSAs. • Access plan documents, letters and notices, forms, 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
• Manage Subscriptions Set up email notifications to keep up to date on all account and Health Care FSA debit card activity
Questions and Answers
Please call Aetna at 1 800 607 3366, Monday through Friday, 8 a.m. to 6 p.m.. Aetna wants you to understand your benefits before you decide to enroll and are available to answer questions before and/or after you enroll.
What is considered a hospital stay?
Hospital Indemnity Aetna EMPLOYEE BENEFITS
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
Yes, you can still enroll int eh Aetna Hospital Indemnity plan if you have a Health Savings Account.
A stay is a period during which your are admitted as an impatient; and are confined in a hospital or non hospital residential facility; and are charged for room, board and general nursing services. A stay doe=s not include time in the hospital because of custodial or personal needs that do not require medical skills or training. A stay specifically excludes time in the hospital for observation or in the emergency room unless this leads to a stay.
ABOUT HOSPITAL INDEMNITY
Yes, you must be actively at work in order to enroll and for coverage to take effect. You are actively at work if you are working, or are available to work, and meet the criteria set by our employer to be eligible to enroll.
two
Employee $16.48 $38.48 Employee + Spouse $33.54 $77.49 Employee + Child(ren) $23.57 $54.77 Family $37.77 $87.51 30
year
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. For full plan details, please visit your benefit website: www.mybenefitshub.com/ruskisd
Do I have to be actively at work to enroll in coverage?
If I lose my employment, can I take the Hospital Indemnity Plan with me? Yes, you care able to continue coverage under the Portability provision. You will need to pay premiums directly to Aetna. What should I do in case of an emergency? In case of emergency, call 911 or your local emergency hotline, or go directly to an emergency care facility. What if I don’t understand something or have more questions?
LowBenefitHigh Hospital Stay Admission Pays a lump sum benefit for the initial day of your stay in a hospital. Maximum 1 stay per plan year. $1,000 $2,500 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 $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 Important Note: All daily inpatient stay benefits begin on day and count toward the plan year maximum. Hospital Indemnity Low High
Service
Can I enroll in the Aetna Hospital Indemnity plan even though I have a Health Savings Account (HSA)?
Covered Conditions* Percentage of Coverage Amount CriticalCoronaryIllnessesArtery Disease (major) 50% Coronary Artery Disease (minor) 10% End Stage Renal (Kidney) Failure 100% Heart Attack (Myocardial Infarction) 100% Major Organ Failure Requiring Transplant 100% Stroke 100% CancerInvasive Cancer (including all Breast Cancer) 100% Non Invasive Cancer 25% Skin Cancer $500 Supplemental Critical Illnesses Benign Brain Tumor 100% Coma 100% Loss of Hearing 100% Loss of Sight 100% Loss of Speech 100% Infectious Disease 25% Occupational Human Immunodeficiency Virus (HIV) or Hepatitis 100% Permanent Paralysis 100% 31
Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non medical costs related to the illness, including transportation, child care, etc. For full plan details, please visit your benefit website: www.mybenefitshub.com/ruskisd
Insurance Unum EMPLOYEE BENEFITS
ABOUT CRITICAL ILLNESS
Critical Illness
Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. To file a claim call UNUM at 800 858 6843 or find claim form at www.mybenefitshub.com/ ruskisd.
Who is eligible for this coverage? All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status). What are the Critical Illness coverage amounts? The following coverage amounts are available. For you: Select one of the following $10,000, $15,000 or $20,000 For your Spouse and Children: 50% of employee coverage amount Can I be denied coverage? Coverage is guarantee issue. When is coverage effective? Please see your Plan Administrator for your effective date of coverage. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. What critical illness conditions are covered?
An insured has a pre existing condition if, within the 3 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which: treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period;
Are wellness Screenings covered? Each insured is eligible to receive one Be Well Benefit per calendar year. Be Well Benefit For you, your spouse and your children: $50 Be Well Screenings include tests for the following: cholesterol and diabetes, cancer and cardiovascular function. They also include imaging studies, immunizations and annual examinations by a Physician. See certificate for details.
•
Pre existing Conditions We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following: a pre existing condition; or complications arising from treatment or surgery for, or medications taken for, a pre existing condition.
The pre existing condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date any initial coverage or increases in coverage become effective.Critical
Critical Illness Insurance Unum EMPLOYEE BENEFITS Progressive DiseasesWhat critical illness conditions are covered? (cont’d) Amyotrophic Lateral Sclerosis (ALS) 100% Dementia (including Alzheimer’s Disease) 100% Functional Loss 100% Multiple Sclerosis (MS) 100% Parkinson’s Disease 100% Additional Critical Illnesses for your Children Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Down Syndrome 100% Spina Bifida 100% * Please refer to the policy for complete definitions of covered conditions.
•
• medical
• drugs or medications were taken, or prescribed to be taken during that period; or • symptoms existed.
Illness Employee$10,000 $15,000.00Employee Employee$20,000 Spouse$5,000 Spouse$7,500 $10,000Spouse < 25 $3.96 $5.01 $6.06 $2.91 $3.44 $3.96 25 29 $4.86 $6.36 $7.86 $3.36 $4.11 $4.86 30 34 $6.16 $8.31 $10.46 $4.01 $5.09 $6.16 35 39 $8.26 $11.46 $14.66 $5.06 $6.66 $8.26 40 44 $10.76 $15.21 $19.66 $6.31 $8.54 $10.76 45 49 $13.96 $20.01 $26.06 $7.91 $10.94 $13.96 50 54 $17.56 $25.41 $33.26 $9.71 $13.64 $17.56 55 59 $23.56 $34.41 $45.26 $12.71 $18.14 $23.56 60 64 $32.76 $48.21 $63.66 $17.31 $25.04 $32.76 65 69 $47.16 $69.81 $92.46 $24.51 $35.84 $47.16 70 74 $73.16 $108.81 $144.46 $37.51 $55.34 $73.16 75 79 $107.66 $160.56 $213.46 $54.76 $81.21 $107.66 80 84 $156.76 $234.21 $311.66 $79.31 $118.04 $156.76 85+ $252.26 $377.46 $502.66 $127.06 $189.66 $252.26 32
For full plan details, please visit your benefit website: www.mybenefitshub.com/ruskisd
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.
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.
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 SupposeRepatriation/Recuperationfacilities.youorafamilymember is hospitalized more than 100 miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for recuperation. Should you need assistance with a claim contact MASA at 800 643 9023. You can find full benefit details at: www.mybenefitshub.com/ruskisd
Non Emergency Inter Facility Transportation
Emergency Medical Transportation Emergent Plus Platinum Employee & Family $14.00 $39.00 Plan FeaturesEmergentMembershipPlus MembershipPlatinum Emergency TransportationAir x x Emergent TransportationGround x x Non Emergency Inter Facility Transportation x x RecuperationRepatriation/ x x Escort Transportation x Visitor Transportation x Return Transportation x Mortal TransportationRemains x Minor Return x Organ RecipientRetrieval/OrganTransportation x Vehicle Return x Pet Return x Worldwide Coverage x 33
Emergent Air Transportation
Emergency Medical Transport MASA EMPLOYEE
BENEFITS
ABOUT MEDICAL TRANSPORT Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out of pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan.
In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities.
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WWW.MYBENEFITSHUB.COM/RUSKISD
2022 - 2023 PlanYear
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 Rusk 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.
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 Rusk 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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