2022 - 2023 Plan Year
WYLIE ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2022 - 8/31/2023 WWW.MYBENEFITSHUB.COM/WYLIEISD
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Table of Contents How to Enroll Annual Benefit Enrollment 1. Annual Enrollment 2. Section 125 Cafeteria Plan Guidelines 3. Helpful Definitions 4. Eligibility Requirements 5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) Medical Health Savings Account (HSA) Hospital Indemnity Medical Supplement Telehealth Dental Vision Disability Cancer Accident Life and AD&D Identity Theft Flexible Spending Account (FSA)
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4-5 6-11 6 7 8 9
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10 12-18 19 20 21 22 23-24 25-26 27-28 29 30 31-32 33 34-35
PG. 4
HOW TO ENROLL
PG. 6
SUMMARY PAGES
PG. 12
YOUR BENEFITS
Benefit Contact Information WYLIE ISD BENEFITS
TRS - ACTIVECARE MEDICAL
TRS - HMO MEDICAL
Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/wylieisd
BCBSTX (866) 355-5999 www.bcbstx.com/trsactivecare
Scott & White HMO (844) 633-5325 www.trs.swhp.org
HEALTH SAVINGS ACCOUNT (HSA)
HOSPITAL INDEMNITY
MEDICAL SUPPLEMENT
EECU (817) 882-0800 www.eecu.org
Symetra Group #12433000 (800) 796-3872 www.symetra.com
Zurich Group #G4200OP122482 (800) 767-6811 www.specialinc.com
TELEHEALTH
DENTAL
VISION
MDLIVE (888) 365-1663 www.mdlive.com/fbsbh
MetLife Group #227177-1-G (800) 638-5433 www.metlife.com
Avesis Group #VC-16 (800) 522-0258 www.avesis.com
DISABILITY
CANCER
ACCIDENT
The Hartford Group #681947 (866) 547-9124 www.thehartford.com
APL Group #19449 (800) 256-8606 www.ampublic.com
Voya Group #70116-5 (888) 238-4840 www.voya.com
LIFE AND AD&D
IDENTITY THEFT
FLEXIBLE SPENDING ACCOUNT (FSA)
Symetra Group #01-020279-00 (800) 796-3872 www.symetra.com
Identity Guard (855) 443-7748 www.identityguard.com
NBS (855) 399-3035 www.nbsbenefits.com
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All Your Benefits One App Employee benefits made easy through the FBS Benefits App! Text “FBS WISD” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment: •
Benefit Resources
•
Online Enrollment
•
Interactive Tools
•
And more!
App Group #: FBSWISD
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Text
“FBS WISD”
to (800) 583-6908 OR SCAN
How to Log In 1
www.mybenefitshub.com/wylieisd
2
CLICK LOGIN
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ENTER USERNAME & PASSWORD Your Username Is: Your email in THEbenefitsHUB. (Typically your work email) Your Password Is: Four (4) digits of your birth year followed by the last four (4) digits of your Social Security Number If you have previously logged in, you will use the password that you created, NOT the password format listed above.
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Annual Benefit Enrollment
SUMMARY PAGES
Annual Enrollment During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs. •
Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information. •
Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.
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Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ wylieisd. Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms section. How can I find a Network Provider? For benefit summaries and claim forms, go to the Wylie ISD benefit website: www.mybenefitshub.com/wylieisd. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section. When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.
Annual Benefit Enrollment
SUMMARY PAGES
Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
CHANGES IN STATUS (CIS): Marital Status
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 31 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
QUALIFYING EVENTS A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for Change in Number of adoption. You can add existing dependents not previously enrolled whenever a dependent Tax Dependents gains eligibility as a result of a valid change in status event. Change in Status of Change in employment status of the employee, or a spouse or dependent of the employee, Employment Affecting that affects the individual's eligibility under an employer's plan includes commencement or Coverage Eligibility termination of employment. Gain/Loss of Dependents' Eligibility Status
Judgment/Decree/ Order
An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements under an employer's plan may include change in age, student, marital, employment or tax dependent status. If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.
Eligibility for Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Government Programs
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SUMMARY PAGES
Helpful Definitions Actively-at-Work
In-Network
You are performing your regular occupation for the employer on a full-time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2022 please notify your benefits administrator.
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.
Annual Enrollment The period during which existing employees are given the opportunity to enroll in or change their current elections.
Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.
Calendar Year January 1st through December 31st
Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or preexisting condition exclusion provisions do apply, as applicable by carrier. 8
Out-of-Pocket Maximum The most an eligible or insured person can pay in coinsurance for covered expenses.
Plan Year September 1st through August 31st
Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescription drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).
Annual Benefit Enrollment
SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.
Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2022 benefits become effective on September 1, 2022, you must be actively-at-work on September 1, 2022 to be eligible for your new benefits.
PLAN
MAXIMUM AGE
Medical
To Age 26
Dental
To Age 26
Medical Gap Supplement
To Age 26 or married
Telehealth
To Age 26
Accident
To Age 26 or Married
Vision
To Age 26
Cancer
To Age 26
Voluntary Life/ AD&D
To Age 26
Health Savings Account (HSA)
To Age 26
Flexible Spending Account (FSA)
To Age 26
Hospital Indemnity
To age 26
Identity Theft
To age 26
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents. Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse eligibility. FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance. Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent eligibility. Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee's enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage.
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SUMMARY PAGES
HSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, tax-free. This also allows employees to pay for qualifying dependent care taxfree.
Employer Eligibility
A qualified high deductible health plan.
All employers
Contribution Source
Employee and/or employer
Employee and/or employer
Account Owner
Individual
Employer
Underlying Insurance Requirement
High deductible health plan
None
Minimum Deductible
$1,400 single (2022) $2,800 family (2022)
N/A
Maximum Contribution
$3,650 single (2022) $7,300 family (2022)
$2,850 (2022)
Permissible Use Of Funds
Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Cash-Outs of Unused Amounts (if no medical expenses)
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age Not permitted 65).
Description
Year-to-year rollover of account balance?
Yes, will roll over to use for subsequent year’s health coverage.
No. Access to some funds may be extended if your employer’s plan contains a 2 1/2-month grace period or $500 rollover provision.
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
FLIP TO FOR HSA INFORMATION
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PG. 19
FLIP TO FOR FSA INFORMATION
PG. 34
Notes
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Medical Insurance
EMPLOYEE BENEFITS
TRS ABOUT MEDICAL Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis.
For full plan details, please visit your benefit website: www.mybenefitshub.com/wylieisd
Monthly Premium
District Contribution
Employee Cost
TRS ActiveCare HD Employee Only Employee & Spouse Employee & Child(ren)
Employee & Family
$422.00
$275.00
$147.00
$1,187.00
$275.00
$912.00
$757.00
$275.00
$482.00
$1,419.00
$275.00
$1,144.00
TRS ActiveCare 2 Employee Only
$1,013.00
$275.00
$738.00
Employee & Spouse
$2,402.00
$275.00
$2,127.00
Employee & Child(ren)
$1,507.00
$275.00
$1,232.00
Employee & Family
$2,841.00
$275.00
$2,566.00
TRS ActiveCare Primary Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$410.00
$275.00
$135.00
$1,157.00
$275.00
$882.00
$738.00
$275.00
$463.00
$1,384.00
$275.00
$1,109.00
TRS ActiveCare Primary+ Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$515.00
$275.00
$240.00
$1,259.00
$275.00
$984.00
$829.00
$275.00
$554.00
$1,584.00
$275.00
$1,309.00
West Texas Blue Essentials HMO Employee Only Employee & Spouse Employee & Child(ren) Employee & Family 12
$543.35
$275.00
$268.35
$1,364.92
$275.00
$1,089.92
$873.57
$275.00
$598.57
$1,570.98
$275.00
$1,295.98
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Health Savings Account (HSA) EECU
EMPLOYEE BENEFITS
ABOUT HSA A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). For full plan details, please visit your benefit website: www.mybenefitshub.com/wylieisd
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.
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: • Individual – $3,650 A type of personal savings account, an HSA is always yours even if • Family (filing jointly) – $7,300 you change health plans or jobs. The money in your HSA If you are 55 or older, you may make a yearly catch-up (including interest and investment earnings) grows tax-free and contribution of up to $1,000 to your HSA. If you turn 55 at any spends tax-free if used to pay for qualified medical expenses. time during the plan year, you are eligible to make the catch-up There is no “use it or lose it” rule — you do not lose your money contribution for the entire plan year. if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account Important HSA Information automatically rolls over year after year. • Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can HSA Eligibility pay the provider with your HSA debit card based on the You are eligible to open and contribute to an HSA if you are: balance due after discount. Enrolled in an HSA-eligible HDHP (TSHBP HD). • You, not your employer, are responsible for maintaining ALL • Not covered by another plan that is not a qualified HDHP, such records and receipts for HSA reimbursements in the event of as your spouse’s health plan an IRS audit. • Not enrolled in a Health Care Flexible Spending Account, nor • You may open an HSA at the financial institution of your choice, should your spouse be contributing towards a Health Care but only accounts opened through EECU are eligible for Flexible Spending Account automatic payroll deduction and company contributions. • Not eligible to be claimed as a dependent on someone else’s tax return How to Use your HSA • Not enrolled in Medicare or TRICARE • Online/Mobile: Sign-in for 24/7 account access to check your • Not receiving Veterans Administration benefits balance, pay bills and more. You can use the money in your HSA to pay for qualified medical • Call/Text: (817) 882-0800 EECU’s dedicated member service expenses now or in the future. You can also use HSA funds to pay representatives are available to assist you with any questions. health care expenses for your dependents, even if they are not Their hours of operation are Monday through Friday from 8:00 covered by the HDHP. a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. to 1:00 p.m. CT and closed on Sunday. Opening an HSA • Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) If you meet the eligibility requirements, you may open an HSA 333-9934. administered by EECU. You will receive a debit card to manage • Stop by a local EECU financial center for in-person assistance; your HSA account reimbursements. Keep in mind, available funds find locations & service hours at www.eecu.org/locations. are limited to the balance in your HSA. 19
Hospital Indemnity
EMPLOYEE BENEFITS
Symetra ABOUT HOSPITAL INDEMNITY This is an affordable supplemental plan that pays you should you be inpatient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance.
For full plan details, please visit your benefit website: www.mybenefitshub.com/wylieisd
An injury or illness can land you in the hospital for a night or two—or even longer. If that happens, unexpected costs from deductibles, copays or coinsurance, as well as non-medical expenses like child care or transportation could take a serious toll on your family’s financial health. That’s where hospital indemnity insurance comes in. It’s offered through your work and can reduce the burden of a hospital stay by helping cover the cost.
a maximum number of days each year. Stays in a mental health, substance abuse or nursing facility are also covered. There are no preexisting condition limitations, no health questions to answer and no medical tests to take. You’re paid the full per-day benefit no matter what other insurance you have.
Why hospital indemnity insurance?
If you end up in the hospital, your focus should be on your recovery, not your medical bills. Hospital indemnity insurance can Hospital indemnity insurance pays a fixed dollar amount per day help with the cost of your stay, giving you and your family some for services and supplies you receive during a hospital stay, up to financial peace of mind.
What is it?
Select Benefits Plan Summary for: 12433000 - Wylie Independent School District Fixed-Payment Indemnity Policy Base Plan Inpatient Hospital Benefits 500 days per lifetime unless noted $1,000 initial day, Hospital Confinement $100 day 2+, 30 Days pp/pcy1 $1,000 initial day, Intensive Care Unit $100 day 2+, 30 Days pp/pcy $100 per day, Substance Abuse Facility 30 Days pp/pcy Mental Health Facility $100 per day, 180 days lifetime maximum 30 Days pp/pcy Nursing Facility $100 per day, This benefit is paid only if following a covered 30 Days pp/pcy hospital stay of at least three consecutive days. Health Advocacy Services Included EAP+Work/Life Program Included Wellness Program Included Pharmacy Discount Program Included Survivor Benefit Included Monthly Premium Employee $14.17 Employee + Spouse $30.19 Employee + Children $23.23 Family $42.04
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Classic Plan
Premier Plan
$2,500 initial day, $100 day 2+, 30 Days pp/pcy1 $2,500 initial day, $100 day 2+, 30 Days pp/pcy $100 per day, 30 Days pp/pcy $100 per day, 30 Days pp/pcy
$5,000 initial day, $100 day 2+, 30 Days pp/pcy1 $5,000 initial day, $100 day 2+, 30 Days pp/pcy $100 per day, 30 Days pp/pcy $100 per day, 30 Days pp/pcy
$100 per day, 30 Days pp/pcy
$100 per day, 30 Days pp/pcy
Included Included Included Included Included
Included Included Included Included Included
$28.92 $61.64 $47.41 $85.82
$53.51 $114.04 $87.72 $158.78
Medical Supplement
EMPLOYEE BENEFITS
Zurich ABOUT MEDICAL SUPPLEMENT This plan provides supplemental coverage to help offset out-of-pocket costs that you may experience due to deductibles, co-payments and coinsurance of your employer’s medical plan.
For full plan details, please visit your benefit website: www.mybenefitshub.com/wylieisd
The GAP Plan provides coverage for medically necessary eligible out-of-pocket expenses related to the insured’s major medical plan’s co-insurance and deductibles up to the maximum benefit selected, provided such expenses are the result of treatment for a covered injury or sickness.
Employee Employee + Spouse Employee + Children Family
SIS (GAP) Under 40 $30.93 $56.86 $74.34 $99.57
40-49 $40.72 $74.83 $80.82 $113.21
50+ $85.53 $157.15 $147.38 $217.13
Inpatient Hospital Benefit: The benefit is $1500 In-Hospital benefit per covered person per calendar year. Note: This coverage may not cover 100% of out-of-pocket expenses. Benefits Include: • Coverage for out-of-pocket expenses due to an inpatient hospital confinement • Coverage for inpatient hospital charges for eligible out-of-pocket expenses resulting from the treatment of an accidental injury or sickness • Emergency room treatment and ambulance for a covered injury or sickness when it results in hospital confinement within 24 hours • Durable medical equipment
Outpatient Hospital Benefit: The Outpatient Hospital benefit limit is up to $1500 for 4 outpatient occurrences per family per benefit year. Benefits Include: • Emergency room treatment and ambulance as long as the person is NOT hospitalized within 24 hours of being transported to the hospital and ER Treatment • Outpatient surgery in an outpatient surgical facility, emergency facility or physician’s office • Diagnostic testing, e-rays, labs, MRIs, or CT scans • Outpatient radiation therapy or chemotherapy • Physical therapy or chiropractic care • Durable medical equipment The outpatient benefit does not cover a physician’s office visit charge Please note that in order for a service to be covered under the GAP plan, it needs to be covered under the major medical plan.
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Telehealth
EMPLOYEE BENEFITS
MDLIVE ABOUT TELEHEALTH Telehealth provides 24/7/365 access to board-certified doctors via telephone or video consultations that can diagnose, recommend treatment and prescribe medication. Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.
For full plan details, please visit your benefit website: www.mybenefitshub.com/wylieisd
Alongside your medical coverage is access to quality telehealth services through MDLIVE. Connect anytime day or night with a board-certified doctor via your mobile device or computer. While MDLIVE does not replace your primary care physician, it is a convenient and cost-effective option when you need care and: • Have a non-emergency issue and are considering a convenience care clinic, urgent care clinic or emergency room for treatment • Are on a business trip, vacation or away from home • Are unable to see your primary care physician
When to Use MDLIVE: At a cost that is the same or less than a visit to your physician, use telehealth services for minor conditions such as: • • •
• • •
Sore throat Headache Stomachache
Cold Flu Allergies
• •
Fever Urinary tract infections
Do not use telemedicine for serious or life-threatening emergencies.
MDLIVE Behavioral Health: Managing stress or life changes can be overwhelming but it’s easier than ever to get help right in the comfort of your own home. Visit a counselor or psychiatrist by phone, secure video, or MDLIVE App. • • •
Talk to a licensed counselor or psychiatrist from your home, office, or on the go! Affordable, confidential online therapy for a variety of counseling needs. The MDLIVE app helps you stay connected with appointment reminders, important notifications and secure messaging.
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/fbsbh Phone—888-365-1663 Mobile—download the MDLIVE mobile app to your smartphone or mobile device Select “MDLIVE as a benefit” and “FBS” as your Employer/Organization when registering your account. Telehealth Employee and Family 22
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Dental Insurance
EMPLOYEE BENEFITS
MetLife ABOUT DENTAL Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease.
For full plan details, please visit your benefit website: www.mybenefitshub.com/wylieisd
Dental
Dental Plan
Low Plan
Medium Plan
High Plan
Employee Only
$24.27
$36.02
$50.53
Employee and Spouse
$48.56
$76.18
$109.34
Employee and Child(ren)
$43.61
$69.37
$100.53
Employee and Family
$82.17
$121.90
$176.35
Low Medium High 1 1 1 1 In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network1 % of Negotiated % of R&C Fee** % of Negotiated % of R&C Fee** % of Negotiated % of R&C Fee** Fee2 Fee2 Fee2 1
Coverage Type Type A: Preventive (cleanings, exams, X-rays)
100%
100%
100%
100%
100%
100%
Type B: Basic Restorative (fillings, extractions)
50%
50%
70%
70%
80%
80%
Type C: Major Restorative (bridges, dentures)
25%
25%
40%
40%
50%
50%
Type D: Orthodontia
50%
50%
-
-
50%
50%
Deductible† Individual Family
$50 $150
$50 $150
$50 $150
$50 $150
$50 $150
$50 $150
$950
$950
$1,250
$1,250
$1,450
$1,450
$1,000
$1,000
-
-
$1,000
$1,000
Annual Maximum Benefit Per Person Orthodontia Lifetime Maximum Per Person***
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Dental Insurance MetLife
EMPLOYEE BENEFITS
Q. Who is a participating dentist? A. A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for covered services provided to plan members. Negotiated fees typically range from 30% – 45% below the average fees charged in a dentist’s community for the same or substantially similar services.†
Q. How do I find a participating dentist? A. There are thousands of general dentists and specialists to choose from nationwide --so you are sure to find one that meets your needs. You can receive a list of these participating dentists online at www.metlife.com/mybenefits or call 1-800-942- 0854 to have a list faxed or mailed to you.
Q. What services are covered under this plan? A. The Plan documents set forth the services covered by your plan. The List of Primary Covered Services & Limitations herein contains a summary of covered services. In the event of a conflict between the Plan documents and this summary, the terms of the Plan documents shall govern. Please review the enclosed plan benefits to learn more.
Q. May I choose a non-participating dentist? A. Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating dentist your out-ofpocket costs may be higher.
Q. How are claims processed? A. Dentists may submit your claims for you which means you have little or no paperwork. You can track your claims online and even receive email alerts when a claim has been processed. If you need a claim form, visit www.metlife.com/mybenefits or request one by calling 1-800-942-0854
Q. Do I need an ID card? A. No. You do not need to present an ID card to confirm that you are eligible. You should notify your dentist that you are enrolled in the MetLife Preferred Dentist Program. Your dentist can easily verify information about your coverage through a toll-free automated Computer Voice Response system.
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Vision Insurance
EMPLOYEE BENEFITS
Avesis 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/wylieisd
Reliable & Dependable Avesis is a national leader in providing exceptional vision care benefits for millions of commercial members throughout the country. The Avesis vision care products give our members an easy-to-use wellness benefit that provides excellent value and protection.
Vision High Plan Employee Only $10.76 Employee and Spouse $19.73 Employee and Child(ren) $21.76 Employee and Family $30.05
Low Plan $6.44 $11.27 $12.45 $17.64
High Option Vision Care Services Vision Examination
In-Network Member Cost Covered in full after $10 copay
Out-of-Network Reimbursement Up to $35
Up to $50 member out-of-pocket maximum Up to $75 member out-of-pocket maximum $15 copay
N/A N/A
(Includes Refraction)
Contact Lens Fit and Follow-up Standard Contact Lens Fitting Custom Contact Lens Fitting Materials*
(Materials copay applies to frame or spectacle lenses, if applicable.)
Frame Allowance
$175 allowance
Up to $60
Covered in full after $15 copay Covered in full after $15 copay Covered in full after $15 copay Covered in full after $15 copay
Up to $25 Up to $40 Up to $50 Up to $80
Covered in full
Up to $10
Covered in full Covered in full Covered in full Covered in full Covered in full Covered in full $140 allowance + up to 20% discount $70/$80 $75 $40 Up to 20% discount
Up to $5 Up to $6 Up to $4 Up to $24 Up to $40 Up to $48 Up to $48 N/A N/A N/A N/A
$150 allowance
Up to $128
Covered in full Onetime/lifetime $150 allowance Provider discount up to 25%
Up to $250 Onetime/lifetime $150 allowance
(Up to 20% discount above frame allowance.)
Standard Spectacle Lenses Single Vision Bifocal Trifocal Lenticular Preferred Pricing Options Level 7 Option Package Polycarbonate (Single Vision/Multi-Focal)
Standard Scratch-Resistant Coating Ultra-Violent Screening Solid or Gradient Tint Standard Anti-Reflective Coating Level 1 Progressives Level 2 Progressives All Other Progressives Transitions® (Single Vision/Multi-Focal) Polarized PGX/PBX Other Lens Options Contact Lenses† (in lieu of frame and spectacle lenses)
Elective (10% discount on amount exceeding allowance)
Medically Necessary Refractive Laser Surgery
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Vision Insurance
EMPLOYEE BENEFITS
Avesis Low Option Vision Care Services Vision Examination
In-Network Member Cost Covered in full after $10 copay
Out-of-Network Reimbursement Up to $35
Up to $50 member out-of-pocket maximum Up to $75 member out-of-pocket maximum $15 copay
N/A N/A
(Includes Refraction)
Contact Lens Fit and Follow-up Standard Contact Lens Fitting Custom Contact Lens Fitting Materials*
(Materials copay applies to frame or spectacle lenses, if applicable.)
Frame Allowance
$175 allowance
Up to $60
Covered in full after $15 copay Covered in full after $15 copay Covered in full after $15 copay Covered in full after $15 copay
Up to $25 Up to $40 Up to $50 Up to $80
$40/$44 (Covered in full up to age 19)
N/A (Up to $10 for ages up to 19)
$17 $15 $17 $45 $75 $110 $50 allowance + up to 20% discount $70/$80 $75 $40
N/A N/A N/A N/A Up to $40 Up to $40 Up to $40 N/A N/A N/A
$150 allowance
Up to $128
Covered in full Onetime/lifetime $150 allowance Provider discount up to 25%
Up to $250 Onetime/lifetime $150 allowance
(Up to 20% discount above frame allowance.)
Standard Spectacle Lenses Single Vision Bifocal Trifocal Lenticular Preferred Pricing Options Level 1 Option Package Polycarbonate (Single Vision/Multi-Focal)
Standard Scratch-Resistant Coating Ultra-Violent Screening Solid or Gradient Tint Standard Anti-Reflective Coating Level 1 Progressives Level 2 Progressives All Other Progressives Transitions® (Single Vision/Multi-Focal) Polarized PGX/PBX Other Lens Options Contact Lenses† (in lieu of frame and spectacle lenses)
Elective (10% discount on amount exceeding allowance)
Medically Necessary Refractive Laser Surgery
Frequency Eye Examination Lenses or Contact Lenses Frame
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Once Every 12 months Once Every 12 months Once Every 12 months
Disability Insurance
EMPLOYEE BENEFITS
The Hartford 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/wylieisd
What is Educator Disability Insurance? Educator Disability insurance is a hybrid that combines features of short-term and long-term disability into one plan. Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. The plan gives you flexibility to be able to choose an amount of coverage and waiting period that suits your needs.
days you must be disabled by an accident before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin. For those employees electing an elimination period of 30 days or less, if your are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization.
Actively at Work
Definition of Disability
You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session.
Disability is defined as The Hartford’s contract with your employer. Typically, disability means that you cannot perform one or more of the essential duties of your occupation due to injury, sickness, pregnancy or other medical conditions covered by the insurance, and as a result, your current monthly earnings are 80% or less of your pre-disability earnings.
Benefit Amount
One you have been disabled for 24 months, you must be prevented from performing one or more essential duties of any occupation, and as a result, your monthly earnings are 66 2/3% or less of your pre-disability earnings.
You may purchase coverage that will pay you a monthly benefit of 35%, 45%, 55% or 65% of your monthly income, to a maximum Pre-Existing Condition Limitation monthly benefit of $8,000. Earnings are defined in The Hartford’s Your policy limits the benefits you can receive for a disability contract with your employer. caused by a pre-existing condition. In general, if you were Disability- Monthly Benefit per $100 diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, Elimation Period 35% 45% 55% 65% your benefit payment will be limited, unless: You have not 0/7 $1.33 $1.71 $2.21 $2.72 received treatment for the disabling condition within 3 months, 14/14 $1.20 $1.54 $1.99 $2.45 while insured under this policy, before the disability begins, or 30/30 $1.07 $1.38 $1.79 $2.20 You have been insured under this policy for 12 months before 60/60 $0.82 $1.05 $1.35 $1.67 your disability begins. 90/90 $0.61 $0.78 $1.01 $1.25
Elimination Period
If your disability is a result of a pre-existing condition, we will pay benefits for a maximum of 4 weeks.
You must be disabled for at least the number of days indicated by Maximum Benefit Duration the elimination period that you select before you can receive a Benefit Duration is the maximum time for which we pay benefits Disability benefit payment. The elimination period that you select for disability resulting from sickness or injury. Depending on the consists of two numbers. The first number shows the number of 27
Disability Insurance The Hartford
EMPLOYEE BENEFITS
age at which disability occurs, the maximum duration may vary. Please see the applicable schedules below based on the Premium benefit option. Premium Option: For the Premium benefit option – the table below applies to disabilities resulting from sickness or injury.
Age Disabled
Maximum Benefit Duration
Prior to 63 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 and older
To Normal Retirement Age or 48 months if greater To Normal Retirement Age or 42 months if greater 36 months 30 months 27 months 24 months 21 months 18 months
Benefit Integration Your benefit may be reduced by other income you receive or are eligible to receive due to your disability, such as: • Social Security Disability Insurance • State Teacher Retirement Disability Plans • Workers’ Compensation • Other employer-based disability insurance coverage you may have • Unemployment benefits • Retirement benefits that your employer fully or partially pays for (such as a pension plan)
Your plan includes a minimum benefit of 25% of your elected benefit.
Eligibility You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis.
Enrollment You can enroll in coverage within 31 days of your date of hire or during your annual enrollment period.
Effective Date Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.
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Cancer Insurance
EMPLOYEE BENEFITS
APL 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/wylieisd
Treatment for cancer is often lengthy and expensive. While your health Cancer insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town Employee Only treatments, special diets, daily living, and household upkeep. In addition to these non-medical expenses, you are responsible for Employee and Spouse paying your health plan deductibles and/or coinsurance. Cancer Employee and Child(ren) insurance through American Public Life helps pay for these direct and Employee and Family indirect treatment costs so you can focus on your health.
Low
High
$10.48
$21.14
$22.40
$46.30
$12.04
$24.24
$23.94
$49.42
Should you need to file a claim contact APL at 800-256-8606 or online at www.ampublic.com. You can find additional claim forms and materials at www.mybenefitshub.com/wylieisd. Internal Cancer First Occurrence* Cancer Treatment Policy benefits Radiation and Chemotherapy, Immunotherapy Maximum Per 12-month period Hormone Therapy- Maximum of 12 treatments per calendar year Heart Attack/Stroke First Occurrence Rider Benefits Lump Sum Benefit- Maximum per 1 covered person per lifetime
Plan 1 $5,000
Plan 2 $10,000
$10,000
$15,000
$50 per treatment
$50 per treatment
Not Available
$10,000
*Carcinoma in situ is not considered internal cancer Pre-Existing Condition Exclusion: Review the Benefit Summary page that can be found at www.mybenefitshub.com/wylieisd for full details
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Accident Insurance
EMPLOYEE BENEFITS
Voya 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/wylieisd
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 Employee Only Employee and Spouse Employee and Child(ren) Employee and Family
Other features of Accident Insurance include: • Guaranteed issue: No medical questions or tests are required for coverage. • Flexible: You can use the benefit payments for any purpose you like. • Payroll deductions: Premiums are paid through convenient payroll deductions. • Portable: If you leave your current employer, you can take your coverage with you.
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.voya.com Click contact and services Select Claims and then “start a claim” Complete the questionnaire so that a custom claim form package can be generated for you. Download your claim forms. Fill out each form by the appropriate party. Father additional supporting documents. Submit your completed and signed forms and supporting documents. • Upload at voya.com • Click on the contact and services • Select “Upload a form” Mail and or Fax information provided on the top of your claim form package.
If you have any questions about the claim process, call 1-888-238-4840 30
$9.82 $15.98 $18.92 $25.08
Life and AD&D
EMPLOYEE BENEFITS
Symetra 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/wylieisd Effective Date: September 1, 2021 Policy Number:01-020279-00 The information in this summary may be replaced by any subsequently issued summary or policy amendment. Employee Amount Minimum Amount Employee Amount Minimum Amount Employee Amount Minimum Amount Maximum Amount Guaranteed Issue Spouse Spouse Amount Minimum Amount Maximum Amount Guaranteed Issue Child Child Amount Employee Amount Minimum Amount Maximum Amount Spouse Spouse Amount Minimum Amount Maximum Amount Child Child Amount
Basic Life Benefit $15,000 $15,000 Basic AD&D Benefit $15,000 $15,000 Life Benefit Increments of $10,000 $10,000 Lesser of $500,000 or 7 x Earnings Guaranteed Issue Amount: Age 70 and below: $350,000 Age 70 and up: $250,000 Life Benefit Increments of $5,000 $5,000 $500,000 not to exceed 100% of Supplemental Employee Coverage $50,000 Life Benefit Live Birth to age 26 year(s): $10,000 AD&D Benefit Increments of $10,000 $10,000 Lesser of $500,000 or 7 x Earnings AD&D Benefit Increments of $5,000 $5,000 $500,000 not to exceed 100% of Supplemental Employee Coverage AD&D Benefit Live Birth to age 26 year(s): $10,000
Voluntary Group Life - per $10,000 in coverage Age Employee 18-24 $0.48 25-29 $0.48 30-34 $0.57 35-39 $0.76 40-44 $1.05 45-49 $1.81 50-54 $3.04 55-59 $4.85 60-64 $7.41 65-69 $13.40 70-74 $24.13 75+ $24.13 Voluntary Group Life - Child(ren) Per $10,000 in coverage 0-26 Spouse rates based on Employee's age.
Employee Spouse Child
Symetra AD&D- per $10,000 $0.20 $0.20 $0.20
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Life and AD&D Symetra
EMPLOYEE BENEFITS
Eligibility All Active Full Time Employees working a minimum of 20 hours per week and their eligible dependents. Evidence of Insurability Evidence of Insurability is required for all amounts of insurance selected after the initial 31 day eligibility period and for any amount in excess of the Guarantee Issue amount. Additional Benefit Details Accelerated Death If an employee has been diagnosed as terminally ill, Symetra Life Insurance Company may pay a portion of the Benefit death benefit in advance to the employee. Please refer to your employee certificate for additional information. Conversion
A conversion benefit is available that allows you to convert your group coverage to an individual policy if certain conditions apply. Please refer to your employee certificate for additional information.
Portability
This coverage may be continued at group rates upon termination of employment. Certain restrictions apply. Please refer to your employee certificate for additional information.
Waiver of Premium
With proof of disability, Symetra Life Insurance Company will waive Life Insurance premiums for a employee that becomes disabled. Certain restrictions apply. Please refer to your employee certificate for additional information.
AD&D Riders
Includes Seat Belt, Airbag, Repatriation, Child Education, Day Care, Rehabilitation, Spouse Education, Adaptive Home and Vehicle and Coma benefits. Please refer to your employee certificate for additional information.
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Identity Theft
EMPLOYEE BENEFITS
Identity Guard ABOUT IDENTITY THEFT PROTECTION Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered.
For full plan details, please visit your benefit website: www.mybenefitshub.com/wylieisd
Aura Identity Guard protects you and your family against cybercrime. COMPREHENSIVE IDENTITY PROTECTION • $1M in insurance protection1 from financial losses and legal fees • 24/7 expert guidance, if a threat is detected • Protect your loved ones for one low price with our family plan FASTEST SPEED AND LARGEST BREADTH OF ALERTS1 • Around-the-clock scan of billions of online resources • Reduce exposure to cybertheft • Be alerted within seconds of possible cyberthreats POWERFUL FINANCIAL TOOLS • Keep an eye on your spending and get alerted to suspicious
transactions
• Access to your credit report and real-time alerts to • changes that impact your credit • Complete protection and monitoring of online accounts and passwords Identity Theft
Employee Employee and Family
$9.95 $18.50
Features that are included in the Aura Identity Guard Ultimate Plan: PROACTIVE DEVICE & PRIVACY PROTECTION Anti-adware Anti-virus E-mail solicitation/junk mail prevention Robo-call/robo-text protection Safe browsing extension Safe browsing: anti-ransomware & anti-malware VPN / WiFi security COMPREHENSIVE IDENTITY PROTECTION $1 Million insurance with stolen funds reimbursement1 401(k) & HSA reimbursement Address monitoring Auto-on monitoring Compromised credentials scan Court records monitoring Criminal record monitoring Cyberbullying monitoring Dark web monitoring Data broker list monitoring/removal Device/cookie tracking protection Fictitious identity monitoring Home title monitoring Human-sourced intelligence Medical ID monitoring Social media monitoring Social security and ID authentication monitoring
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
FINANCIAL FRAUD PROTECTION Bank account transaction monitoring Credit card monitoring Debit card monitoring Financial accounts monitoring High-risk transaction monitoring Lost wallet protection Online accounts monitoring POWERFUL FINANCIAL TOOLS Annual credit report Credit bureau monitoring Credit report lock Credit score tracker Monthly credit score Near real-time alerts Security freeze assistance Student loan activity alerts CUSTOMER CARE End-to-end remediation Mobile App Online identity dashboard U.S.-based customer care
✓ ✓ ✓ ✓ ✓ ✓ ✓ Up to 3-Bureau Up to 3-Bureau 1-Bureau ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓
Customer Service Concierge customercare@identityguard.com 855-443-7748 33
Flexible Spending Account (FSA) NBS
EMPLOYEE BENEFITS
ABOUT FSA A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (unless your plan contains a $500 rollover or grace period provision).
For full plan details, please visit your benefit website: www.mybenefitshub.com/wylieisd
Health Care FSA
Flexible Spending Accounts (FSA) The Health Care FSA covers qualified medical, dental and vision Individual $2,850.00 expenses for you or your eligible dependents. You may contribute up to Dependent Care $5,000.00 $2,850 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include: • Dental and vision expenses • Medical deductibles and coinsurance • Prescription copays • Hearing aids and batteries You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA).
How the Health Care FSAs Work You can access the funds in your Health Care FSA two different ways: • Use your NBS Debit Card to pay for qualified expenses, doctor visits and prescription copays. • Pay out-of-pocket and submit your receipts for reimbursement: Fax – 844-438-1496 Email – service@nbsbenefits.com Online – my.nbsbenefits.com Call for Account Balance: 855-399-3035 Mail: PO Box 6980 West Jordan, UT 84084
Contact NBS • • • • •
Hours of Operation: 6:00 AM – 6:00 PM MST, Mon-Fri Phone: (800) 274-0503 Email: service@nbsbenefits.com Mail: PO Box 6980 West Jordan, UT 84084
Dependent Care FSA The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full-time student.
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Flexible Spending Account (FSA) NBS
EMPLOYEE BENEFITS
Dependent Care FSA Guidelines • • • •
Overnight camps are not eligible for reimbursement (only day camps can be considered). If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13. 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.
Important FSA Rules •
• • • •
The maximum per plan year you can contribute to a Health Care FSA is $2,850. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately. You cannot change your election during the year unless you experience a Qualifying Life Event. You can continue to file claims incurred during the plan year for another 30 days (up until date). 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 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.
Over-the-Counter Item Rule Reminder (OTC) 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.
Flexible Spending Accounts Account Type
Eligible Expenses
Annual Contribution Limits
Benefit
$2,850
Saves on eligible expenses not covered by insurance, reduces your taxable income
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)
Dependent Care FSA
Dependent care expenses (such as day $5,000 single care, after-school programs or elder care $2,500 if married and filing programs) so you and your spouse can separate tax returns work or attend school full-time
Reduces your taxable income
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2022 - 2023 Plan Year
Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the Wylie ISD Benefits Website. This summary does not replace or amend the underlying plan documentation. In the event of a discrepancy between this summary and the plan documentation the plan documentation governs. All plans and benefits described in this summary may be discontinued, increased, decreased, or altered at any time with or without notice. Rate Sheet General Disclaimer: The rate information provided in this guide is subject to change at any time by your employer and/or the plan provider. The rate information included herein, does not guarantee coverage or change or otherwise interpret the terms of the specific plan documentation, available at the Wylie ISD Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.
WWW.MYBENEFITSHUB.COM/WYLIEISD 36
