TEMPLE ISD BENEFIT GUIDE EFFECTIVE: 09/01/2022 8/31/2023 WWW.MYBENEFITSHUB.COM/TEMPLEISD 2022 - 2023 PlanYear 1
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 Telehealth 20 Hospital Indemnity 21-22 Dental 23-24 Vision 25 Disability 26-27 Cancer 28-29 Life and AD&D 30 Accident 31-32 Individual Life 33 Emergency Medical Transportation 34 Flexible Spending Account (FSA) 35 36 HOW TO ENROLLPG. 4 SUMMARYPAGESPG. 6 BENEFITSYOURPG. 12 2
TEMPLE ISD BENEFITS TRS ACTIVECARE MEDICAL TRS HMO MEDICAL Financial Benefit Services (800) 583 www.mybenefitshub.com/templeisd6908 (866)BCBSTX355 www.bcbstx.com/trsactivecare5999 Scott & White HMO (844) 633 www.trs.swhp.org5325 HEALTH SAVINGS ACCOUNT (HSA) TELEHEALTH HOSPITIAL INDEMNITY (817)EECU 882 0800 www.eecu.org (888)MDLIVE365 1663 www.mdlive.com/fbs GroupVoya #706108 (877) 236 7564 www.voya.com DENTAL VISION DISABILITY Lincoln Financial Group Group #00001D039506 (800) 423 www.lfg.com2765 Superior Vision Group #34481 (800) 507 www.superiorvision.com3800 Mutual of Omaha Group #GUPR BDW4 (800) 877 www.mutualofomaha.com5176 CANCER LIFE AND AD&D ACCIDENT Colonial Life Level 3 Group #63240 Level 4 Group #63241 (800) 325 www.coloniallife.com4368 Mutual of Omaha Group #G000BDW4 (800) 877 www.mutualofomaha.com5176 Mutual of Omaha Group #G000BDW4 (800) 877 www.mutualofomaha.com5176 INDIVIDUAL LIFE EMERGENCY TRANSPORTATIONMEDICAL FLEXIBLE SPENDING ACCOUNT (FSA) 5Star Life Insurance (866) 863 9753 www.5starlifeinsurance.com (800)MASA423 3226 www.masamts.com (866)Higginbotham4193519 www.higginbotham.net Benefit Contact Information 3
Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS TEMPLE” to (800) 583-6908 App Group #: FBSTEMPLE Text “FBS TEMPLE” 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/templeisd 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
Update your profile information: home address, phone numbers, email. SUMMARY PAGESAnnual Benefit Enrollment 6
• FSA administrator change
TRS ActiveCare moved to regional rating to ensure prices reflect the cost of health care in your area. And now, in the 2022 23 plan year, none of the 20 Education Service Center regions will see a price increase from last year. This is also in part to additional federal COVID 19 funding from the governor and Texas legislative leadership.
pm) Don
Administration office
password this year,
moving forward.
• Please use all of your FSA money before 8/31/2022.
SLIGHT DENTAL RATE INCREASE Dental coverage will remain with Lincoln Financial Group. There have been no changes to coverage or the benefit itself but there is a 3% rate increase on all plans.
12 •
am and
in person during Open Enrollment, you
9 am 4 pm (presentations at
TRS ACTIVECARE RATE DECREASE!
INCREASED VISION BENEFITS Vision will stay with Superior Vision and the rates will not change. The frame allowance will increase from $130 to $150 beginning 9/1/2022.
19 22 If
the following dates: •
9 am 4 pm (presentations at 10 am and 2 pm) •
866 914 5202. •
am and
•
pm) •
The Flexible Spending Account which includes the Healthcare Reimbursement and Dependent Care benefit will be moved to Higginbotham from NBS.
• Your FSA and Dependent Care elections from the past year will roll forward.
5 pm
RESET
about benefits or enrollment assistance, please
10 am
complete your benefit enrollment
following online live presentations: •
9 am 4 pm (presentations at
something you
about your benefits, you
FSA ADMINISTRATOR CHANGE
the
9 am 4 pm (presentations at 10 am and 2 pm) •
& Last Chance:
• Last year for password reset
• You will receive new debit cards at the end of August/beginning of September.
• You can use your FSA funds at www.FSASTORE.com FSA funds not used by 8/31/2022 will be subject to a 75 day grace period administered by NBS YEAR FOR PASSWORD When you reset your make it will remember as passwords will not be reset If you would like to learn more and/or spouse can attend the 7/12/22 https://bit.ly/TISD7 7/19/22 https://bit.ly/TISD7 you would like assistance can visit Temple ISD on 7/26/22 10 2 7/27/22 7/28/22 New Hires 8/1/22 10 2 ’ For questions call the FBS Call Center at Bilingual & from 07/11/2022 08/05/2022.
WHAT’S NEW IN 2022: • TRS ActiveCare Medical RATE DECREASE! • Slight Dental Rate Increase • Increased Vision Benefits no rate change
your
t Forget! •
LAST
assistance is available by calling this number. • Login
Change in Status of Employment
Change in Number of Tax Dependents
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
Section 125 Cafeteria Plan Guidelines Benefit Enrollment CHANGES IN (CIS):STATUS QUALIFYING EVENTS
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.
Gain/Loss EligibilityDependents'ofStatus
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 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.
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SUMMARY PAGESAnnual
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.
Affecting Coverage Eligibility
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.
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
Eligibility for Government Programs
Marital Status
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Judgment/Decree/Order
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 the Temple ISD benefit www.mybenefitshub.com/templeisdwebsite:.
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.
Enrollment 8
• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
Where can I find forms?
All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
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.
Annual Enrollment
templeisd. Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms
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. Benefit
Q&A Who do I contact with Questions?
SUMMARY PAGESAnnual
• 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.
Howsection.can I find a Network Provider?
For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/
New Hire 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.
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 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.
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
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
Annual Benefit
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.
Enrollment 9
Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.
Dependent RequirementsEligibility
Employee RequirementsEligibility
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining
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 MAXIMUM AGE Medical To age 26 Dental To age 26 Vision To age 26 Cancer To age 26 Voluntary Life To age 26 IndemnityHospital To age 26 EmergencyMedicalTransport To age 26 Telehealth To age 26 Individual Life To age 23 Accident To age 26
coverage for dependents.
Annual Enrollment
The period during which existing employees are given the opportunity to enroll in or change their current elections. Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.
September 1st through August 31st
In Network
January 1st through December 31st Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
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.
You are performing your regular occupation for the employer on a full time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel If you will not be actively at work beginning 9/1/2022 please notify your benefits administrator.
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider. Out of Pocket Maximum
Plan Year
Pre Existing Conditions
Actively at Work
SUMMARY PAGESHelpful Definitions 10
Calendar Year
The most an eligible or insured person can pay in co insurance for covered expenses.
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).
Guaranteed Coverage
SUMMARY PAGESHSA vs. FSA 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 FLIP TO FOR HSA INFORMATION PG. 19 FLIP TO FOR FSA INFORMATION PG. 35 11
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/templeisd Medical Insurance TRS EMPLOYEE BENEFITS Monthly Premium District Contribution Employee Cost TRS ActiveCare HD Employee Only $375.00 $375.00 $0.00 Employee & Spouse $1,055.00 $400.00 $655.00 Employee & Child(ren) $673.00 $400.00 $273.00 Employee & Family $1,261.00 $400.00 $861.00 TRS ActiveCare 2 Employee Only $1,013.00 $400.00 $613.00 Employee & Spouse $2,402.00 $400.00 $2,002.00 Employee & Child(ren) $1,507.00 $400.00 $1,107.00 Employee & Family $2,841.00 $400.00 $2,441.00 TRS ActiveCare Primary Employee Only $365.00 $365.00 $0.00 Employee & Spouse $1,029.00 $400.00 $629.00 Employee & Child(ren) $656.00 $400.00 $256.00 Employee & Family $1,232.00 $400.00 $832.00 TRS ActiveCare Primary+ Employee Only $458.00 $400.00 $58.00 Employee & Spouse $1,120.00 $400.00 $720.00 Employee & Child(ren) $737.00 $400.00 $337.00 Employee & Family $1,409.00 $400.00 $1,009.00 Central and North Texas Baylor Scott & White HMO Employee Only $491.55 $400.00 $91.55 Employee & Spouse $1,232.58 $400.00 $832.58 Employee & Child(ren) $789.39 $400.00 $389.39 Employee & Family $1,418.42 $400.00 $1,018.42 12
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How to Use your HSA
ABOUT HSA
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.
• Their hours of operation are Monday Friday from 8:00a.m. 7:00p.m. CT, Saturday 9:00a.m. 1:00 p.m. CT and closed on Sunday.
• Not enrolled in Medicare or TRICARE
• Not receiving Veterans Administration benefits
Health Savings Account (HSA)
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:
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.
• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333 9934 Stop by a local EECU financial center for in person assistance; find EECU locations & service hours at www.eecu.org/locations
Opening an HSA
• Online/Mobile: Sign in for 24/7 account access to check your balance, pay bills and more.
• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
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• Not eligible to be claimed as a dependent on someone else’s tax return
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.
• 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 under your HDHP.
EECU EMPLOYEE BENEFITS
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/templeisd
Important HSA Information
• Enrolled in an HSA eligible HDHP
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. Who is eligible?
You are eligible to open and contribute to an HSA if you are:
• Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account
• Individual $3,650 • Family (filing jointly) $7,300
• Call/Text: (817) 882 0800. EECU’s dedicated member service representatives are available to assist you with any questions.
• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
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.
• 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.
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/templeisd 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: 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. • Sore throat • Headache • Stomachache • Cold • Flu • Allergies • Fever • Urinary tract infections Telehealth Employee and Family Paid for by Temple ISD 20
you leave your current employer or retire,
as a
• Flexible:
Your children to age 26.
the other parent may apply for children’s coverage. *The
Hospital IndemnityLow
• Coverage if Your children are covered for the same Hospital Confinement Indemnity as are. One premium amount covers all of your eligible children. If both you and spouse are covered under then only one, but not both, may cover the same children for Hospital Confinement Indemnity If who is covering the children stops being insured as then use of “spouse” in document means a insured spouse as described in the certificate insurance rider. Please contact employer
benefits
• Guaranteed issue:
Indemnity
This is an affordable supplemental plan that pays you should you be in patient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance. full plan details, please visit your benefit website: Indemnity
can use the benefit payments for any
Employee and Child(ren) $26.20 $52.42
Insurance.
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How can Hospital Confinement Indemnity Insurance help? are a few examples of how your Hospital Confinement Indemnity Insurance benefit could be used (coverage amounts may vary):
an employee,
person
of
spouse
www.mybenefitshub.com/templeisd Hospital
medical questions or tests are required for
What is Hospital Confinement Indemnity Insurance?
is available only
this
extended care
for more information.
or
Hospital Confinement Indemnity Insurance pays a daily benefit if you have a covered stay in a hospital*, critical care unit or rehabilitation facility. The benefit amount is determined by the type of facility and the number of days you stay. You have the option to elect Hospital Confinement Indemnity Insurance to meet your needs. Hospital Confinement Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.
your
Employee and Spouse $34.66 $69.34
Employee and Family $43.06 $86.16
the policy as an employee,
rehabilitative center;
For
the parent
Features of Hospital Confinement Indemnity Insurance include: No coverage. You purpose like. If you can take the policy with you and select from a variety hospital does not include an institution or part of an institution used as: a hospice care unit; a convalescent home; a rest or nursing facility; a free standing surgical a an facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction. “Critical care unit” and “rehabilitative facility” are specifically defined in this policy. See the certificate for details.
Your spouse* Coverage is available only if employee coverage is elected.
Voya EMPLOYEE BENEFITS
•
the same Hospital Confinement Indemnity benefits as you do.
your
You all active employees working 20+ hours per week.
• Portable:
of payment plans. *A
High Employee Only $17.80 $35.60
• Medical expenses, such as deductibles and copays • Travel, food, and lodging expenses for family members • Childcare • Everyday expenses like utilities and groceries Who is eligible for Hospital Confinement Indemnity Insurance?
you
center;
Below
employee coverage is elected.
ABOUT HOSPITAL INDEMNITY
• Your will have
you
• Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor driven. Flying as a fare paying passenger is not excluded.
The following list is a summary of the benefits provided by Hospital Confinement Indemnity Insurance. For a list of standard exclusions and limitations, go to the end of this document. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any riders.
• War or any act of war, whether declared or undeclared, other than acts of terrorism.
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• Rehabilitation facility The benefit payment is one half of the daily benefit amount, up to 30 days per confinement.
*See the certificate and any riders for a complete list of available benefits, along with applicable provisions, exclusions and limitations.
• Practicing for, or participating in, any semiprofessional or professional competitive athletic contests for which any type of compensation or remuneration is received.
• Suicide, attempted suicide or any intentionally self inflicted injury, while sane or insane.
Hospital Indemnity BENEFITS
• Riding in or driving any motor driven vehicle in a race, stunt show or speed test.
How much does Hospital Confinement Indemnity Insurance cost?
What Hospital Confinement Indemnity Insurance benefits are available?
• You have the option to purchase a daily benefit amount of $100 or $200.
• Loss that occurs while on full time active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.
• Hospital The benefit payment is 1x the daily benefit amount, up to 30 days per confinement.
Voya EMPLOYEE
All employees pay the same rate, no matter their age. See the chart above for the premium amounts. Rates shown are guaranteed until September 1, 2023.
• Initial Confinement Benefit: This provides an additional payment of 10x the daily benefit amount after confinement in a hospital, critical care unit or rehabilitation center. This benefit is limited to a maximum of four Initial Confinement Benefits per calendar year for all covered persons, but no more than one for each covered person.
• Operation of a motorized vehicle while intoxicated.
• Critical care unit (CCU) The benefit payment is 2x the daily benefit amount, up to 15 days per confinement.
• The benefit amounts paid depend on the type of facility and the number of days of confinement:
• Participation or attempt to participate in a felony or illegal activity.
• Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor.
• Elective surgery, except when required for appropriate care as a result of the covered person’s injury or sickness.
Exclusions and limitations Exclusions for the certificate, Initial Confinement Benefit, Spouse Hospital Confinement Indemnity Insurance and Children’s Hospital Confinement Indemnity Insurance are listed below. (These may vary by state.) Benefits are not payable for any loss caused in whole or directly by any of the following*:
• Engaging in hang gliding, bungee jumping parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar activities.
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/templeisd Dental Insurance Lincoln Financial Group EMPLOYEE BENEFITS The Lincoln Dental Connect® PPO Plan: Enhanced Plus Option In Network Out of Network Calendar (Annual) Deductible 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. Annual Maximum $2,500 $2,500 Lifetime Orthodontic Max $1,000 $1,000 Orthodontic Coverage is available for dependent children. DentalBasicPlan EnhansedPlan EnhansedPlanPlus Employee Only $14.17 $30.33 $36.64 Employee and Spouse $39.48 $63.33 $77.25 Employee and Child(ren) $39.48 $63.33 $75.09 Employee and Family $59.19 $98.97 $118.34 Preventive Services In Network Out of Network Routine oral exams Bitewing X rays Full mouth or panoramic X rays Other dental X rays (including periapical films) Routine SpaceFluoridecleaningstreatmentsmaintainersfor children Sealants, Labs, & other services 100% No Deductible 100% No Deductible Basic Services In Network Out of Network Problem focused exams PalliativeConsultationstreatment (including emergency relief of dental pain) Injections of antibiotics and other therapeutic medications SimpleFillings BiopsyOralSurgicalextractionsextractionssurgeryandexamination of oral tissue (including brush biopsy) General anesthesia and I.V. sedation Prosthetic repair and recementation services Endodontics (including root canal treatment) Periodontal repair and recementation services Non surgical periodontal therapy Periodontal surgery 80% After Deductible 80% After Deductible Major Services In Network Out of Network Prefabricated stainless steel and resin crowns Bridges Full and partial dentures Denture Reline and rebase services 50% After Deductible 50% After Deductible Orthodontics In Network Out of Network Orthodontic exams X AppliancesStudyExtractionsraysmodels 50% 50% Contracting Dentists/Non Contracting Dentists: betweenareexpensefee,50%aNonknownfee50%deductibleContractingcrownForyoucostsHowever,youdentistFindADentistwww.LincolnFinancial.com/Visittofindacontractingnearyou.Thisplanletschooseanydentistyouwish.youroutofpocketarelikelytobelowerwhenchooseacontractingdentist.example,ifyouneedaDentists:youpaya(ifapplicable),thenoftheremainingdiscountedforPPOmembers.ThisisasaPPOcontractedfee.ContractingDentists:youpaydeductible(ifapplicable),thenoftheusualandcustomarywhichisthemaximumcoveredbytheplan.Youresponsibleforthedifferenttheusualandcustomary fee and the dentist’s billed charge. 23
The Lincoln Dental Connect® PPO Plan: Enhanced Option: Contracting Dentists /Non Contracting Dentists Basic Option: Contracting Dentists /Non Contracting Dentists Calendar (Annual) Deductible 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. Annual Maximum $1,250 $750 Lifetime Orthodontic Max $1,000 N/A Orthodontic Coverage is available for children.dependent N/A Preventive Services Contracting Dentists /Non Contracting Dentists Contracting Dentists /Non Contracting Dentists Routine oral exams Bitewing X rays Full mouth or panoramic X rays Other dental X rays (including periapical films) Routine SpaceFluoridecleaningstreatmentsmaintainersfor children Sealants, Labs, & other services 100% No Deductible 100% No Deductible Basic Services *Not included in the Basic Option Contracting Dentists /Non Contracting Dentists Contracting Dentists /Non Contracting Dentists Problem focused exams PalliativeConsultationstreatment (including emergency relief of dental pain) Injections of antibiotics & other therapeutic medications SimpleFillings BiopsyOralSurgicalextractionsextractionssurgeryandexamination of oral tissue (including brush biopsy) * General anesthesia and I.V. sedation* Prosthetic repair and recementation services* Endodontics (including root canal treatment) * Periodontal repair and recementation services* Non surgical periodontal therapy* Periodontal surgery* 80% After Deductible 80% After Deductible Major Services Contracting Dentists /Non Contracting Dentists Contracting Dentists /Non Contracting Dentists Prefabricated stainless steel and resin crowns FullBridgesand partial dentures Denture Reline and rebase services 50% After Deductible N/A Orthodontics Contracting Dentists /Non Contracting Dentists Contracting Dentists /Non Contracting Dentists Orthodontic exams X Extractionsrays Study Appliancesmodels 50% N/A Dental Insurance Lincoln Financial Group EMPLOYEE BENEFITS 24
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. Vision Copays Services/Frequency Employee Only $7.32 Exam $10 Exam 12 months Employee and Spouse $13.91 Materials1 $25 Frame 24 months Employee and Child(ren) $14.60 Contact lens fitting $25 Contact lens fitting 12 months Employee and Family $22.47 (standard & specialty) Lenses 12 months Benefits through Superior National Network In Network Out of Network Exam (ophthalmologist) Covered in full Up to $42 retail Exam (optometrist) Covered in full Up to $37 retail Frames $150 retail allowance Up to $52 retail Contact lens fitting (standard2) Covered in full Not covered Contact lens fitting (specialty2) $50 retail allowance Not covered Lenses (standard) per pair Single vision Covered in full Up to $26 retail Bifocal Covered in full Up to $34 retail Trifocal Covered in full Up to $50 retail Scratch coat (factory) See description3 Not covered Progressives lens upgrade See description3 Up to $50 retail Contact lenses4 $150 retail allowance Up to $100 retail
has a nationwide network of independent refractive surgeons and partnerships with leading LASIK networks who offer members a discount. These discounts range from 10% 50%, and are the best possible discounts available to Superior Vision. How
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/templeisd Vision Insurance Superior Vision EMPLOYEE BENEFITS Discount features Look for providers in the provider directory who accept discounts, as some do not; please verify their services and discounts (range from 10% 30%) prior to service as they vary. Discounts on covered materials Frames: 20% off amount over allowance Lens options: 20% off retail Progressives: 20% off amount over retail lined trifocal lens, including lens options Specialty contact lens fit: 10% off retail, then apply allowance Discounts on non covered exam, services, and materials Exams, frames, and prescription lenses: 30% off retail Lens options, contacts, miscellaneous options: 20% off retail Disposable contact lenses: 10% off retail Retinal imaging: $39 maximum out of pocket
Refractive
benefits;
3 Covered to provider’s in office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co pay. 4 Contact lenses are in lieu of eyeglass lenses and frames benefit
Co pays apply to in network co pays for out of network visits are deducted from 1reimbursements.Materialscopay applies to lenses and frames only, not contact lenses 2 Standard contact lens fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty contact lens fitting applies to new contact wearers and/or a member who wear toric, gas permeable, or multi focal lenses.
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Superior Vision to
surgery
• 14/14: 11 weeks, then will move to a monthly basis after that
Monthly
Maximum
• 30/30: 9 weeks, then will move to a monthly basis after that
ABOUT DISABILITY Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time. For full plan details, please visit your benefit website: www.mybenefitshub.com/templeisd Disability Insurance Mutual of Omaha EMPLOYEE BENEFITS ELIGIBILITY ALL ELIGIBLE EMPLOYEES Eligibility Requirement You must be actively working a minimum of 20 hours per week to be eligible for coverage. Payment The premiums for this insurance are paid in full by you. EliminationBENEFITS
• 14/14 If you become disabled, there is an elimination period before benefits are payable. Your benefits will begin on the 15th day of your disabling injury or the 15th day of your disabling illness.
Minimum Monthly Benefit $100
• 7/7: 12 weeks, then will move to a monthly basis after that
Periods
• 7/7 If you become disabled, there is an elimination period before benefits are payable. Your benefits will begin on the 8th day of your disabling injury or the 8th day of your disabling illness.
Maximum Benefit Period If you become disabled prior to age 62, benefits are payable to age 65, your Social Security Normal Retirement Age or 3.5 years, whichever is longest. At age 62 (and older), the benefit period will be based on a reduced duration schedule.
Partial Disability Benefits If you become disabled and can work part time (but not full time), you may be eligible for partial disability benefits. Additional benefits for family care expenses for eligible family members are also available while receiving partial disability benefits.
• 30/30 If you become disabled, there is an elimination period before benefits are payable. Your benefits will begin on the 31st day of your disabling injury or the 31st day of your disabling illness. Benefit Your benefit is equivalent to 40%, 50% or 60% of your before tax monthly earnings, not to exceed the plan’s maximum monthly benefit amount less other income sources. Benefit $8,000 a month/$1,846 a week. Benefits will be paid on a weekly basis for:
OwnDEFINITIONSOccupation 2 Years Own Occupation Earnings Test 99% Disability per $100 in benefit Age EP 7/7 EP 14/14 EP 30/30 <19 $1.92 $1.71 $1.31 20 29 $1.98 $1.77 $1.37 30 39 $2.30 $2.09 $1.69 40 49 $2.52 $2.31 $1.91 50 59 $3.07 $2.86 $2.46 60 69 $3.26 $3.05 $2.65 70+ $3.39 $3.18 $2.78 26
• Disabilities related to mental disorders are only payable for up to 24 months while insured under the policy.
Survivor Benefit If you pass away while receiving disability benefits, a lump sum equal to 3 times your monthly benefit will be paid to your eligible survivor.
• Results from alcohol and drug abuse and/or substance abuse, except as noted above
Definition of Monthly Earnings Monthly earnings for salaried employees is the gross annual salary in effect immediately prior to the date disability begins, divided by 12. Monthly earnings for hourly employees is the hourly rate of pay multiplied by the average number of hours worked during the 12 month period immediately prior to the date disability begins. If employed for part of the prior 12 month period, monthly earnings is the hourly rate of pay multiplied by the average number of hours worked.
• Occurs while incarcerated or imprisoned for any period exceeding 31 days
Does this plan cover me if I become disabled due to an injury at work?
In the event this insurance ends due to a change in your employment/ membership status with the group, or for certain other reasons, you have the right to port your coverage to a group trust plan, subject to certain Thisconditions.information describes some of the features of the benefits plan.
• Results from a mental disorder, except as noted above
Benefits may not be available in all states. Please refer to the certificate booklet for a full explanation of the plan’s benefits, exclusions, limitations and reductions. Should there be any discrepancy between the certificate booklet and this summary, the certificate booklet will prevail. Benefits availability is subject to final acceptance and approval of the group application by the underwriting company. Disability insurance is underwritten by United of Omaha Life Insurance Company, 3300 Mutual of Omaha Plaza, Omaha, NE 68175, 1 800 769 7159. United of Omaha Life Insurance Company is licensed nationwide, except in New York.
• All exclusions may not be applicable, or may be adjusted, as required by state regulations.
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The benefits payable are subject to the following:
• Results from participation in a riot or commission of or attempt to commit a felony
Hearing Discount Program The Hearing Discount Program provides you and your family discounted hearing products, including hearing aids and batteries. Call 1 888 534 1747 or visit www.amplifonusa.com/mutualofomaha to learn more.
Yes, your LTD insurance provides benefits for both on the job and off the job coverage for disabilities due to injury or sickness. Your STD insurance only provides benefits for off the job coverage for disabilities due to injury or sickness Are there any limitations or exclusions?
Yes, depending on the type of income you receive. Your benefit amount may be reduced by other sources of income such as retirement/ government plans, other group disability plans, salary continuance/sick leave, settlements on payments received and no fault benefits.
• Disabilities related to alcohol and drug abuse are only payable for up to 24 months while insured under the policy.
Disability Insurance Mutual of Omaha EMPLOYEE BENEFITS
Minimum Indemnity Provides an additional benefit if you lose a limb or your sight due to an accidental injury.
Can I take this insurance with me if I change jobs/am no longer a member of this group?
• Is solely a result of a loss of a professional license, occupation license or certification.
DEFINITIONS CONTINUED
• Your plan is subject to a pre existing condition limitation. A pre existing condition is one for which you have received medical treatment, consultation, care or services including diagnostic measures, or if you were prescribed or took prescription medications in the predetermined time frame prior to your effective date of coverage. There is no pre existing condition on the STD.
Policy form number 7000GM U EZ 2010.
Rehabilitation Benefit If you become disabled and participate in the vocational rehabilitation program, you will be eligible for a monthly benefit increase of 5%.
How long will my benefits be paid?
VocationalFEATURES
• Results, whether the insured person is sane or insane, from an intentionally self inflicted injury or illness, suicide, or attempted suicide
The pre existing condition exclusion is a 3/12 on the LTD, which means any condition that you receive medical attention for in the 3 months prior to your effective date of coverage that results in a disability during the first 12 months of coverage, would not be covered. Benefits are not payable for any disability or loss that:
• Is caused by alcohol and drug abuse and/or substance abuse, while not being actively supervised by and receiving continuing treatment from a rehabilitation center or designated institution approved for such treatment by an appropriate body in the governing jurisdiction
• Results from an act of declared or undeclared war or armed aggression
Benefits begin after the end of the elimination period and can be payable up to the maximum benefit period as long as you remain disabled. Will my benefits be reduced by other sources of income?
First Day OutpatientHospitalization/ The elimination period for this coverage is waived if you are admitted as an in patient in a hospital at the onset of disability (when your disability begins). If you receive outpatient surgery and you are disabled for at least 5 days during your recovery, benefits begin on the day of the surgery.
ABOUT CANCER Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment. For full plan details, please visit your benefit website: www.mybenefitshub.com/templeisd Cancer Insurance Colonial Life EMPLOYEE BENEFITS If diagnosed with cancer, how will you pay for what your health insurance won’t? Nearly everyone has experienced or knows somebody who has experienced a cancer diagnosis in their family. The good news is that cancer screenings and cancer fighting technologies have gotten a lot better in recent years. However, with advanced technology come high costs. Major medical health insurance is a great start, but even with this essential safety net, cancer sufferers can still be hit with unexpected medical and non medical expenses. Cancer coverage from Colonial Life offers the protection you need to concentrate on what is most important your care. Features of Colonial Life’s Cancer Insurance: 1. Pays benefits to help with the cost of cancer screening and cancer treatment. 2. Provides benefits to help pay for the indirect costs associated with cancer, such as: • Loss of wages or salary • Deductibles and coinsurance • Travel expenses to and from treatment centers • Lodging and meals • Child care 3. Pays regardless of any other insurance you have with other insurance companies. 4. Provides a cancer screening benefit that you can use even if you are never diagnosed with cancer. 5. Benefits paid directly to you unless you specify otherwise. 6. Flexible coverage options for employees and their families. CancerLevel 3 Level 4 Employee Only $19.40 $29.85 Employee and Family $32.25 $49.55 28
Cancer Insurance Colonial Life EMPLOYEE BENEFITS This is a brief description of some available benefits. We will pay benefits if one of the following routine cancer screening tests is performed or if cancer is diagnosed while your coverage is in force. Cancer Screening Benefit Tests This benefit is payable once per calendar year per covered person. • Pap Smear • ThinPrep Pap Test1 • CA125 (Blood test for ovarian cancer) • Mammography • Breast Ultrasound • CA 15 3 (Blood test for breast cancer) • PSA (Blood test for prostate cancer) • Chest X ray • Biopsy of Skin Lesion • Colonoscopy • Virtual Colonoscopy • Hemoccult Stool Analysis • Flexible Sigmoidoscopy • CEA (Blood test for colon cancer) • Bone Marrow Aspiration/Biopsy • Thermography • Serum Protein Electrophoresis (Blood test for Myeloma) To file a claim for a covered cancer screening/wellness test, it is not necessary to complete a claim form. Call our toll free Customer Service number, 1.800.325.4368, with the medical information Inpatient Benefits • Hospital and Hospital Intensive Care Unit Confinement • Ambulance • Private Full Time Nursing Services • Attending Physician Treatment Benefits (In or Outpatient) • Radiation/Chemotherapy • Antinausea Medication • Blood/Plasma/Platelets/Immunoglobulins • Experimental Treatment • Hair Prosthesis/External Breast/Voice Box Prosthesis • Supportive/Protective Care Drugs and Colony Stimulating Factors • Bone Marrow Stem Cell Transplant • Peripheral Stem Cell Transplant Surgery Benefits • Surgery Procedures (including skin cancer) • Anesthesia (including skin cancer) • Second Medical Opinion • Reconstructive Surgery • Prosthesis/Artificial Limb • Outpatient Surgical Center Transportation/Lodging Benefits • Transportation • Transportation for Companion • Lodging Extended Care Benefits • Skilled Nursing Care Facility • Hospice • Home Health Care Service Waiver of Premium THIS IS A CANCER ONLY POLICY. This policy has exclusions and limitations. For cost and complete details of the coverage, see your Colonial Life benefits counselor. Coverage may vary by state and may not be available in all states. Applicable to policy form GCAN MP and certificate form GCAN C (including state abbreviations where used, for example GCAN C TX.) 1ThinPrep is a registered trademark of Cytyc Corporation. 29
Life and AD&D Mutual of Omaha
Guaranteed Spouse Life and AD&D Insurance Coverage Amount: Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to 100% of your coverage amount ($30,000 maximum) for your spouse without providing evidence of insurability. Annual Limited Enrollment. If you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability. If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense. You can increase this amount by up to $10,000 during the next limited open enrollment period.
Basic Life Coverage Provided to eligible employee of Temple ISD. A cash benefit of $10,000 to your loved ones in the event of your death, plus a matching cash benefit if you die in an accident. coverage amount for Self $250,000 coverage amount 5 times your annual salary ($500,000 maximum in increments of $10,000) coverage amount Equal to the life insurance amount chosen coverage amount for $30,000 amount Choice of $5,000 or $10,000 coverage amount for Spouse100% of the employee coverage amount ($250,000 maximum in increments of $5,000) coverage amount Equal to the life insurance amount chosen amount for children birth 26 years $10,000
Spouse
AD&D
Guaranteed coverage
Coverage: You can secure term life insurance for your dependent children when you choose coverage for yourself.
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ABOUT LIFE AND AD&D Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well being of your family. Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered. For full plan details, please visit your benefit website: www.mybenefitshub.com/templeisd
Guaranteed Employee Life and AD&D Insurance Coverage Amount: Initial Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $250,000 without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability. If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense. You can increase this amount by up to $20,000 during the next limited open enrollment period.
Guaranteed
Voluntary Group Life per $10,000 in coverage Age Employee & Spouse 0 34 $0.70 35 39 $1.10 40 44 $1.60 45 49 $2.40 50 54 $4.30 55 59 $6.70 60 64 $7.20 65 69 $13.10 70 74 $26.90 75 79 $77.90 80+ $170.60 Voluntary
Maximum Life Insurance Coverage Amount: You can choose a coverage amount up to 100% of your coverage amount ($250,000 maximum) for your spouse with evidence of insurability. Coverage amounts are reduced by 45% of the original amount when you reach age Dependent75.Children
dependent
Guaranteed
Maximum
Spouse
Maximum
Guaranteed Life Insurance Coverage Options: $10,000 Group Life$10,000Child(ren)incoverage $2.00 rates based on Employee's age.
Maximum Life Insurance Coverage Amount: You can choose a coverage amount up to 5 times your annual salary ($500,000 maximum) with evidence of insurability. See the Evidence of Insurability page for details. Your coverage amount will reduce by 45% of the original amount when you reach age 75.
0 26
Continuing employee guaranteed coverage annual increase
AD&D
EMPLOYEE BENEFITS
ABOUT ACCIDENT Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you. For full plan details, please visit your benefit website: www.mybenefitshub.com/templeisd Accident Insurance Mutual of Omaha EMPLOYEE BENEFITS Accident Insurance pays you benefits for specific injuries and events resulting from a covered accident that occurs, on or after your coverage effective date. The benefit amount depends on the type of injury and care received. You have the option to elect Accident Insurance to meet your needs. Accident Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act. Accident 1 Unit Employee Only $11.15 Employee and Spouse $18.18 Employee and Child(ren) $24.56 Employee and Family $32.85 ELIGIBILITY ALL ELIGIBLE EMPLOYEES Eligibility Requirement You must be actively working a minimum of 30 hours per week to be eligible for coverage. Dependent Eligibility Requirement To be eligible for coverage, your dependents must be able to perform normal activities, and not be confined (at home, in a hospital, or in any other care facility), and any child(ren) must be under age 26. In order for your spouse and/or children to be eligible for coverage, you must elect coverage for yourself. Premium Payment The premiums for this insurance are paid in full by you. PLAN INFORMATION INFORMATION / AMOUNT(S) Coverage Type Non occupational (Off job only) Express Benefit $100 Annual Benefit Maximum (ABM) Not Included Portability Included How can Accident Insurance help? • Medical expenses, such as deductibles and copays • Home healthcare costs • Lost income due to lost time at work • Everyday expenses like utilities and groceries How to File a Claim: www.mutualofomaha.com/my benefits • Register for an account by filling out the necessary information. Click Sign Up • Users will be notified when they have completed the first step of creating an account • An email will be sent with the final steps to finish setting up an account. If you have any questions about the claim process, call (800) 877 5176 31
Accident Insurance Mutual of Omaha EMPLOYEE BENEFITS BENEFITS AMOUNTS Initial Care & Emergency1 Most treatment / service required within 72 hours of accident; Once per accident per insured person Emergency Room $200 Urgent Care Center $125 Initial Physician Office Visit $100 Ambulance Up to $1,500 Specified Injuries1,2 Fractures (Surgical / Non surgical) Up to $6,000/Up to $3,000 Dislocations (Surgical / Non surgical) Up to $9,000/Up to $4,500 Lacerations Up to $800 Burns Up to $15,000 Dental Up to $300 Hospital, Surgical & Diagnostic1,3 Admission $1,500 Daily Confinement (Up to 365 days per accident) $300 per day ICU Confinement (Up to 15 days per accident) $600 per day Rehab. Facility Confinement (Up to 30 days per accident) $150 per day Surgical Up to $2,000 Diagnostic Up to $300 Follow Up Care1 Treatment / service required within 365 days of accident; Medical device is once per accident per insured person Physician Follow Up Office Visit $100; Up to 6 per accident Therapy Services $50; Up to 6 per accident Medical Device $200 Prosthetic Device(s) $1,000; Up to 2 per accident Additional Benefits1 Benefits are payable within 365 days of accident Transportation (Up to 3 trips per accident) $450 per trip Lodging (Up to 30 nights per accident) $150 per night Childcare (Up to 30 days per accident) $30 per day Catastrophic Benefits1,4 Benefits are payable within 365 days of accident; Once per accident per insured person Principal Sum (PS) You: Child(ren):Spouse:$50,000$25,000$10,000 Common Carrier Accidental Death 300% of PS Transportation of Remains Up to $5,000 Dismemberment & Paralysis Up to 100% of PS Reasonable Modifications Up to 10% of PS Coma 25% of PS HearingSERVICESDiscount Program The Hearing Discount program provides you and your family discounted hearing products, including hearing aids and batteries. Call 1 888 534 1747 or visit www.amplifonusa.com/mutualofomaha to learn more. 1Additional limitations apply as described in the certificate. 2Fractures and dislocations require treatment within 90 days of accident, burns and lacerations within 72 hours of an accident, and dental care within 30 days. If an insured person sustains both a fracture and dislocation as the result of the same accident, the maximum amount payable is up to 200% of the amount payable for the injury with the highest applicable benefit amount. 3Daily confinement must begin with 90 days of accident and ICU confinement within 30 days. Surgical treatment timeframes vary. If applicable, diagnostic services must be received within 90 days of accident. Except for confinement benefits, most benefits are payable once per accident per insured person. If any surgery occurs concurrently with an open reduction for a fracture or dislocation of the same bone or joint as a result of the same accident, only the highest applicable benefit is payable. 4The principal sum for you and your spouse reduces by 50% when you reach the age of 70. 32
• 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.
Quality of Life benefits not available for children Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 years). $7.15 monthly for $10,000 coverage per child.
ABOUT INDIVIDUAL LIFE
Individual Life Insurance 5Star Life Insurance
For full plan details, please visit your benefit website: www.mybenefitshub.com/templeisd
Convenience Easy payments through payroll deduction.
* Quality of Life not available ages 66 70.
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.
Find full details and rates at www.mybenefitshub.com/ Shouldtempleisdyou need to file a claim, contact 5Star directly at (866) 863 9753.
Financially dependent children 14 days to 23 years old.
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.
Customizable With several options to choose from, employees select the coverage that best meets the needs of their families.
Family Protection Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves.*
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:
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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.
EMPLOYEE BENEFITS
Terminal Illness Acceleration of Benefits
Enhanced coverage options for employees. Easy and flexible enrollment for employers. The 5Star Life Insurance Company’s Family Protection Plan offers both Individual and Group products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your employees.
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).
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
Employee $14.00 Employee and Family $14.00 34
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 ground transportation into a medical facility or between medical facilities.
Emergency Medical Transport MASA EMPLOYEE
Emergent
In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities.
For full plan details, please visit your benefit website: www.mybenefitshub.com/templeisd
BENEFITS
Non Emergency Inter Facility Transportation
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/templeisd Transportation
Emergent Ground Transportation
Emergency
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. Air Transportation
• 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.
• If your child turns 13 mid year, you may only request reimbursement for the part of the year when the child is under age 13.
Dependent Care FSA
• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
Higginbotham EMPLOYEE BENEFITS Health Care FSA
ABOUT FSA
The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $2,850 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include:
• Overnight camps are not eligible for reimbursement (only day camps can be considered).
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 babysitter 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.
Flexible Spending Account (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.
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
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).
Important FSA Rules
• 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.
• Dental and vision expenses
• Prescription copays Hearing aids and batteries You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA).
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).
• Medical deductibles and coinsurance
Things to Consider Regarding the Dependent Care FSA
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.
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Higginbotham Benefits Debit Card
For full plan details, please visit your benefit website: www.mybenefitshub.com/templeisd
• You cannot change your election during the year unless you experience a Qualifying Life Event.
Flexible Spending Account (FSA) Higginbotham EMPLOYEE BENEFITS 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 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 to use the mobile app. Flexible Spending Accounts Account Type Eligible Expenses Annual Contribution Limits Benefit Health Care FSA Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses and doctor prescribed over the counter medications) $2,850 Saves on eligible expenses not covered by insurance, reduces your taxable income Dependent Care FSA Dependent care expenses (such as day care, after school programs or elder care programs) so you and your spouse can work or attend school full time $5,000 single $2,500 if married and filing separate tax returns Reduces your incometaxable 36
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WWW.MYBENEFITSHUB.COM/TEMPLEISD
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 Temple 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.
2022 - 2023 PlanYear
Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the Temple 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.
