ALAMO HEIGHTS ISD BENEFIT GUIDE EFFECTIVE: 09/01/2023 - 8/31/2024 WWW.MYBENEFITSHUB.COM/ALAMOHEIGHTSISD 2023 - 2024 Plan Year 1
Table of Contents How to Enroll 4-5 Annual Benefit Enrollment 6-10 1. Section 125 Cafeteria Plan Guidelines 6 2. Annual Enrollment 7 3. Eligibility Requirements 8 4. Helpful Definitions 9 5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 10 Medical 11-12 Health Savings Account (HSA) 13-14 Medical Supplement 15-16 Telehealth 17 Dental PPO 18 Dental DHMO 19 Vision 20 Disability 21-22 Hospital Indemnity 23 Cancer 24 Accident 25-26 Critical Illness 27-28 Life and AD&D 29-30 Individual Life 31 Emergency Medical Transportation 32 Flexible Spending Account (FSA) 33-34 Employee Assistance Program (EAP) 35 Urgent Care 36 FLIP TO... SUMMARY PAGES PG. 6 YOUR BENEFITS PG. 11 HOW TO ENROLL PG. 4 2
Benefit Contact Information
BENEFITS ADMINISTRATORS
Financial Benefit Services
(469) 385-4685
www.mybenefitshub.com/alamoheightsisd
MEDICAL
Texas Schools Health Benefits Program (TSHBP) (888) 803-0081
All Plans: www.tshbp.org
Pharmacy Benefits: SouthernScripts Group #50000
https://tshbp.info/DrugPham
MEDICAL SUPPLEMENT
Avesis
Group #MG-124 OP122615 (800) 522-0258
www.avesis.com
TELEHEALTH
MDLIVE
(888) 365-1663
www.mdlive.com/fbs
DENTAL DHMO VISION
HUMANA
Group #6668322
(800) 233-4013
www.humana.com
Superior Vision Group #334550
(800) 507-3800
www.superiorvision.com
HEALTH SAVINGS ACCOUNT (HSA)
EECU
(817) 882-0800
www.eecu.org
DENTAL PPO
Cigna Group #338077 (800) 244-6224
www.cigna.com
DISABILITY
The Hartford Group #874729 (866) 278-2655
www.TheHartford.com
HOSPITAL INDEMNITY CANCER ACCIDENT
The Hartford Group #VHI-874729 (866) 547-4205
www.TheHartford.com
Bay Bridge Administrators Group #128 (800) 845-7519
www.baybridgeadministrators.com
CRITICAL ILLNESS LIFE AND AD&D
Chubb Claims Assistance: 888-499-0425
The Hartford (888) 563-1124
www.thehartford.com
Bay Bridge Administrators Group #128 (800) 845-7519
www.baybridgeadministrators.com
INDIVIDUAL LIFE
Texas Life (800) 283-9233
www.texaslife.com
EMERGENCY MEDICAL TRANSPORT FLEXIBLE SPENDING ACCOUNT (FSA) EMPLOYEE ASSISTANCE PROGRAM
MASA
Group #MKAHISD (800) 423-3226
www.masamts.com
URGENT CARE
Next Level Prime (281) 783-8162
nextlevelurgentcare.com
Higginbotham (866) 419-3519
www.Flexclaims@higginbotham.com
Deer Oaks EAP Services, LLC (866) 327-2400
eap@deeroaks.com
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Annual Benefit Enrollment
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
Change in Number of Tax Dependents
Change in Status of Employment Affecting Coverage Eligibility
Gain/Loss of Dependents’ Eligibility Status
Judgment/ Decree/Order
Eligibility for Government Programs
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
QUALIFYING EVENTS
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
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.
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.
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
SUMMARY PAGES
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Annual Benefit Enrollment
Annual Enrollment
During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.
• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.
• Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
New Hire Enrollment
All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligibility 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.
Where can I find forms?
For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ alamoheightsisd. 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 Alamo Heights ISD benefit website: www.mybenefitshub.com/alamoheightsisd. 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.
SUMMARY PAGES
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Annual Benefit Enrollment
Employee Eligibility Requirements
Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2023 benefits become effective on September 1, 2023, you must be actively-at-work on September 1, 2023 to be eligible for your new benefits.
Dependent Eligibility Requirements
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.
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Dental (PPO/MAC)
Dental
Voluntary
age 26
26
Hospital
To age 26
Medical To age 26
Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse 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.
PLAN
MAXIMUM AGE
To
To
To
Supplement/Gap To
To
(DHMO) To age
Telehealth To age 26 Vision
age 26 Cancer
age 26 Medical
age 19 or 24 if full-time student Accident
age 26
Life and AD&D To
Illness To age
Life To age
age 26 Critical
26 Individual
26
Transport To
Emergency Medical
age 26
Indemnity
SUMMARY PAGES
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Helpful Definitions HSA vs. FSA
Actively-at-Work
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 9/1/2023 please notify your benefits administrator.
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.
In-Network
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.
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 prescriptions 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).
SUMMARY PAGES
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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, taxfree. This also allows employees to pay for qualifying dependent care tax -free. Employer Eligibility A qualified high deductible health plan. All employers
Source Employee and/or employer Employee and/or employer
Permissible Use Of Funds
Cash-Outs of Unused Amounts (if no medical expenses)
Year-to-year rollover of account balance?
Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
(2023)
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65). Not permitted
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?
Health Savings Account (HSA) (IRC Sec. 223) Flexible Spending Account (FSA) (IRC Sec. 125)
Contribution
Account Owner
Underlying Insurance Requirement High deductible
None Minimum Deductible $1,400
$2,800
N/A Maximum Contribution $3,850
$7,750
$3,050
Individual Employer
health plan
single (2023)
family (2023)
single (2023)
family (2023)
Yes No Portable? Yes,
No FLIP TO FOR HSA INFORMATION FLIP TO FOR FSA INFORMATION PG. 13 PG. 33 SUMMARY PAGES HSA vs. FSA 10
portable year-to-year and between jobs.
Medical Insurance
Texas Schools Health Benefits Program
ABOUT TSHBP
The TSHBP is proud to offer a variety of plans and benefits to meet school district needs. All plans are designed so members can easily navigate through their health medical needs.
For full plan details, please visit your benefit website: www.mybenefitshub.com/alamoheightsisd
Directed Care Highlights
The TSHBP Directed Care Plans utilize a national network to provide physician and ancillary services access to all members. Enrolled school districts will access the HealthSmart practitioner and ancillary only network to gain access to over 502,309 providers in over 1,421,000 unique locations across the United States.
Please note, hospitals are excluded from the PPO networks. All hospital and other medical facility-based services are accessed via an assigned Care Coordinator.
It is easy to look up providers in your area by looking up providers in your area by clicking on the link below. https://tshbp.info/HSNetwork
Hinge Health
Hinge Health is a digital musculoskeletal management program with custom physical therapy programs designed by physicians and led by board certified Health coaches. You and your eligible family members get free access to Hinge Health’s programs for back, knee, hip, shoulder, or neck pain, which may include: a free tablet computer and wearable sensors, unlimited 1-on-1 health coaching, personalized exercise therapy, etc.
TSHBeFit
TSHBeFit is a Wellness Program, powered by WellRight, is available for members to achieve their personal health and well-being through a collection of holistic activities and is no additional cost to members.
PPO Deductible Credits
Aetna Network Highlights
You want a network that is comprehensive, is easy to use and can help you save on costs. Look no further. You can now find support through our Aetna Signature Administrators® preferred provider organization network. Discover provider options and reduced costs.
With our network, you now have access to over 1.2 million participating doctors, 8,700 hospitals, and strong, negotiated discounts.
We know quality care is important. So we make sure our doctors successfully complete our credentialing requirements. Our credentialing process meets industry standards, as well as state and federal requirements.
You’ll also have access to over 600 Institutes of Excellence™ facilities and Institutes of Quality® facilities. We measure these publicly recognized institutes by clinical performance, outcomes and efficiency. Then, we pass this guidance along to you—so you can choose the best facility.
Ready to search our network? Just visit http://aetna.com/asa
With the Aetna PPO plan, if you choose to utilize the services of a Care Coordinator for a procedure or admission to a facility, you may receive up to a $500 credit toward your deductible. If you have already met your deductible, the $500 credit will apply to your out-of-pocket maximum!
EMPLOYEE BENEFITS
Access the MyTSHBP Digital Wallet for easy access to all your benefit resources. 11
Medical Insurance
Texas Schools Health Benefits Program
PLAN SUMMARY DIRECTED CARE PLANS AETNA NETWORK PLAN TSHBP - HD Plan TSHBP CoPay Plan Aetna Signature Directed Care Plan • Use Care Coordinator for Hospital/ Surgical Services • Compatible with an HSA • Embedded Deductible - no coinsurance • Out-of-Network Benefits Directed Care Plan • Use Care Coordinator for Hospital/ Surgical Services • Co-payments for Services • Reduce Out-of-Pocket • Out-of-Network Benefits Traditional PPO Plan • PPO Network for all physician/hospital services • Brand Drug Deductible • Care Coordinator is an optional benefit Coverage In-Network Coverage In-Network Coverage In-Network Only Network HealthSmart - National HealthSmart AETNA Plan Deductible Feature Deductible, then Plan pays 100% Copayments, then Plan pays 100% Deductible, then Plan pays 70% Individual/Family Deductible $3,500/$10,500 $0/$0 $4,000/$8,000 Coinsurance None - Plan Pays 100% after deductible None - Plan Pays 100% after deductible You pay 30% after deductible Individual/Family Maximum Out-ofPocket $3,500/$10,500 $4,000/$11,000 $10,000/$20,000 Health Savings Account (HSA) Eligible Yes No No Required - Primary Care Provider (PCP) No No No Required - PCP Referral to Specialist No No No Doctor Visits Preventive Care Yes - $0 copay Yes - $0 copay Yes - $0 copay Virtual Health - Teladoc $30 per consultation $0 per consultation $0 per consultation Primary Care Deductible, then Plan pays 100% $45 copay $45 copay Specialist Deductible, then Plan pays 100% $70 copay $70 copay Office Services Allergy Injections Deductible, then Plan pays 100% $5 copay You pay 30% after deductible Allergy Serum Deductible, then Plan pays 100% $35 copay You pay 30% after deductible Chiropractic Services Deductible, then Plan pays 100% $35 copay $70 copay Office Surgery Deductible, then Plan pays 100% $110 copay You pay 30% after deductible MRI's, Cat Scans, and Pet Scans Deductible, then Plan pays 100% $275 copay You pay 30% after deductible Care Facilities Urgent Care Facility Deductible, the Plan pays 100% $75 copay $75 copay Freestanding Emergency Room Deductible, the Plan pays 100% $500 copay You pay $500 copay + 30% after ded Hospital Emergency Room Deductible, the Plan pays 100% $500 copay You pay 30% after deductible Ambulance Services Deductible, the Plan pays 100% $275 copay You pay 30% after deductible Outpatient Surgery Deductible, the Plan pays 100% $650 copay You pay 30% after deductible Hospital Services Deductible, the Plan pays 100% $650 copay You pay 30% after deductible Surgeon Fees Deductible, the Plan pays 100% $200 copay You pay 30% after deductible Maternity and Newborn Services Maternity Charges (prenatal and postnatal care) Deductible, the Plan pays 100% $500 copay You pay 30% after deductible Routine Newborn Care Deductible, the Plan pays 100% $250 copay You pay 30% after deductible Rehabilitation/Therapy Occupational/Speech/Physical Deductible, the Plan pays 100% $55 copay $30 copay Cardiac Rehabilitation Deductible, the Plan pays 100% $110 copay You pay 30% after deductible Chemotherapy, Radiation, Dialysis Deductible, the Plan pays 100% $110 copay You pay 30% after deductible Home Health Care Deductible, the Plan pays 100% $55 copay You pay 30% after deductible Skilled Nursing Deductible, the Plan pays 100% $500 copay You pay 30% after deductible Prescription Drug Benefits Drug Deductible Intergrated into Medical No Drug Deductible $500 brand deductible Generic Deductible, the Plan pays 100%; $0 for certain generics $0 copay CVS/HEB/Walmart/Costco/Sam’s | $10 copay All other net Pharmacies $15/$45 copay; $0 for certain generics Preferred Brand Deductible, the Plan pays 100% $35 copay or 50% copay whichever is greater (max $100) You pay 25% after deductible Non-Preferred Deductible, the Plan pays 100% $70 copay or 50% copay whichever is greater (max $200) You pay 50% after deductible Specialty Full Coverage - PAP Required - Deductible then plan pays 100% Full Coverage - PAP Required - 50% copay (max $500) Full Coverage - PAP Required - You pay 50% after deductible Employee Cost *Plan Year Rate *Plan Year Rate *Plan Year Rate Employee Only $5.00 $53.00 $173.00 Employee/Spouse $739.00 $900.00 $1,126.00 Employee/Child $370.00 $474.00 $580.00 Employee/Family $1,076.00 $1,300.00 $1,455.00
EMPLOYEE BENEFITS 12
Health Savings Account (HSA) EECU
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/alamoheightsisd
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs – it is also a taxexempt 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.
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
• Enrolled in an HSA-eligible HDHP (High Deductible Health Plan)
• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
• Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account
• Not eligible to be claimed as a dependent on someone else’s tax return
• Not enrolled in Medicare or TRICARE
• Not receiving Veterans Administration benefits
You can use the money in your HSA to pay for qualified medical 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.
Maximum Contributions
Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2023 is based on the coverage option you elect:
• Individual – $3,850
• Family (filing jointly) – $7,750
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.
EMPLOYEE BENEFITS 13
Health Savings Account (HSA) EECU
Opening an 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.
Important HSA Information
• Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.
• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.
How to Use your HSA
• Online/Mobile: Sign-in for 24/7 account access to check your balance, pay bills and more.
• Call/Text: (817) 882-0800. EECU’s dedicated member service representatives are available to assist you with any questions. Their hours of operation are Monday through Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. –1:00 p.m. CT and closed on Sunday.
• 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 a www.eecu.org/ locations.
EMPLOYEE BENEFITS 14
Supplemental Insurance Avesis
ABOUT SUPPLEMENT INSURANCE
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/alamoheightsisd
High Option
This plan covers up to:
$4,000 In Hospital Confinement expenses associated with deductible, co-pay and coinsurance amounts not covered by your Major Medical plan.
This plan covers up to:
$2,500 Outpatient expenses associated with deductible, co-pay and coinsurance amounts not covered by your Major Medical plan.
Low Option
This plan covers up to:
$1,000 In Hospital Confinement expenses associated with deductible, co-pay and coinsurance amounts not covered by your Major Medical plan.
This plan covers up to:
$1,000 Outpatient expenses associated with deductible, co-pay and coinsurance amounts not covered by your Major Medical plan.
A more effective way to protect you and your dependents
SecureADVANTAGE is designed to complement your existing major medical insurance and provide added coverage that fills the gaps between what your major medical plan will pay and what you owe out of your own pocket if you are hospital confined. It provides added coverage for you and each covered family member, should you be required to pay for expenses associated with each hospital confinement that are applied to your deductible and coinsurance.
Benefits are paid directly to you when you are hospitalized due to an injury or sickness, unless an Assignment of Benefits Form dictates that benefits should be paid to your doctor or the hospital at time of treatment.
Protecting Coverage
Inpatient Services
SecureADVANTAGE pays covered expenses for:
• In-Patient Hospital stays
• In-Patient Surgeries
• In-Patient Tests, Procedures, and Medications (billed through the facility)
• Physician In-Hospital charges
• Emergency Room treatment for Injuries and Sickness (sickness must result in hospital confinement within 24 hours of ER treatment)
Outpatient Services
• SecureADVANTAGE pays covered expenses including but not limited to:
• Hospital Emergency Room Treatment for Injury or Sickness
• Outpatient surgery in an outpatient Surgical Facility, Emergency Facility or Physician’s Office
• Diagnostic Testing including Xrays, Diagnostic Lab, MRI’s and CT scans
• Outpatient Chemotherapy or Radiation Therapy
• Physical Therapy or Chiropractic Care
Outpatient Benefits
The Outpatient I Benefit pays on a per person per Sickness or Injury basis, up to a maximum of four “occurrences” per amily per calendar year. This maximum applies to the entire family unit, regardless of the number of covered persons within the family unit. An “occurrence” is the treatment, or series of treatments, for a specific Sickness. or Injury.
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EMPLOYEE BENEFITS
Supplemental Insurance Avesis
All expenses related to the treatment of the same related Sickness or Injury will accrue toward the outpatient maximum for one occurrence, regardless of whether such treatment is received in more than one calendar year period. If, however, a Covered Person is treatment-free, at any time, for at least 90 consecutive days, they may qualify for an additional outpatient maximum benefit if the family maximum per calendar year has not been met.
Secure Advantage Outpatient Benefits pays for covered expenses including but not limited to:
• Hospital Emergency Room Treatment for Injury or Sickness
• Outpatient Surgery in an outpatient surgical facility, emergency facility or physician’s office
• Diagnostic testing including but not limited to Xrays, diagnostic lab, MRI’s and CT scans
• Outpatient chemotherapy or radiation therapy
• Physical therapy or chiropractic care
All Inpatient and Outpatient Benefits are limited to those expenses that are medically necessary for the treatment of an Injury or Sickness. Further, such expenses must be covered under the major medical comprehensive policy and applied to that plans deductible, copayment, or coinsurance provision.
To file a claim, complete a claim form and mail to carrier. Claim forms can be located on the Employee Benefits Portal.
Medical Supplement Under Age 40 $1,000 $4,000 Employee $22.62 $47.72 Employee + Spouse $40.72 $85.90 Employee + Child(ren) $54.71 $116.07 Family $72.78 $154.20 Ages 40-49 $1,000 $4,000 Employee $28.69 $60.36 Employee + Spouse $51.57 $108.65 Employee + Child(ren) $56.98 $120.62 Family $79.92 $168.85 Ages 50 & Above $1,000 $4,000 Employee $60.75 $123.55 Employee + Spouse $109.33 $222.32 Employee + Child(ren) $103.90 $215.39 Family $152.42 $314.11
EMPLOYEE BENEFITS 16
Telehealth 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/alamoheightsisd
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.
Registration is Easy
Register with MDLIVE so you are ready to use this valuable service when and where you need it.
• Online – www.mdlive.com/fbs
• Phone – 888-365-1663
• Mobile – download the MDLIVE mobile app to your smartphone or mobile device
• Select –“MDLIVE as a benefit” and “FBS” as your Employer/Organization when registering your account.
Telehealth Employee & Family $10.00
EMPLOYEE BENEFITS 17
Dental PPO Cigna
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/alamoheightsisd
Coverage is provided through Cigna. Two levels of benefits are available with the DPPO plan: innetwork and out-of-network. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services. You could pay more if you use an outof-network provider.
How to Find an In-network Dentist
To search for a dentist on Cigna. com, visit the site and click “Find a Doctor, Dentist or Facility.” Follow the prompts on screen and when asked to choose your plan, select “DPPO/EPO > Total Cigna DPPO.” Or call 800-244-6224 to find an innetwork dentist.
How to Request a New ID Card
You can request your dental id card by contacting Cigna directly at 800244-6224. You can also go to www.mycigna.com and register/ login to access your account. In addition you can download the “MyCigna” app on your smartphone and access your id card right there on your phone.
Please see plan documents for details and limitations
Class I: Diagnostic & Preventive
Oral Evaluations
Prophylaxis: routine cleanings
X-rays: routine & non-routine
Fluoride Application
Sealants: per tooth
Space Maintainers: non-orthodontic
Emergency Care to Relieve Pain
Endodontics:
Class
Prosthesis Over Implant
Crowns: prefabricated stainless steel / resin
Crowns: permanent cast and porcelain
Bridges and Dentures
Repairs: bridges, crowns and inlays
Denture Relines, Rebases and Adjustments
Dental PPO Dental PPO Low Plan High Plan Employee Only $28.46 $39.99 Employee + 1 $59.33 $84.83 Employee & Family $91.47 $128.44 Cigna Dental Choice Plan Summary
High PPO Plan Low PPO Plan Network Options In-Network ‘Total Cigna DPPO’ Out-of-Network In-Network ‘Total Cigna DPPO’ Out-of-Network Reimbursement Levels Based on Contracted Fees Maximum Reimbursable Charge, you may be balanced billed Based on Contracted Fees Maximum Allowable Charge,you may be balanced billed. Policy Year Deductible Individual Family $50 $150 $50 $150 $50 $150 $50 $150 Calendar Year Benefit Maximum Per Individual $1250 $1000 Benefit Highlights Plan Pays You Pay Plan Pays You Pay
No Charge No Charge No Charge No Charge Class II: Basic
Restorative:
Restorative
fillings
Periodontics:
Oral Surgery: minor and major Anesthesia: general
IV
Repairs: dentures 20% after deductible 20% after deductible 20% after deductible 20% after deductible
minor and major
minor and major
and
sedation
Inlays
Onlays
III: Major Restorative
and
50% after deductible 50% after deductible 50% after deductible 50% after deductible Class IV: Orthodontia Coverage for Dependent Children to age 19 Lifetime Benefits Maximum: $1,000 50% No deductible 50% No deductible 50% after deductible 50% after deductible
EMPLOYEE BENEFITS 18
Dental DHMO
Humana
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/alamoheightsisd
Coverage is provided through HumanaDental benefits. After you enroll in a plan and receive your ID card, you can manage your plan information on your personal home page on Humana.com.
• You have the freedom to select any participating general dentist as your primary care dentist. To select a dental provider from our network, simply visit Humana. com. Once there, you can also check your benefits, email us and get a new or temporary ID card. If you prefer, contact us at 1-800-342-5209.
• Life without claim forms! With the HumanaDental DHMO plan you pay your dentist directly, when applicable.
• Your primary dentist will provide all of your routine dental care and you will pay any copayment or discounted charges at the time of service.
• If you need a specialty dentist, you may receive up to a 25 percent discount by using certain participating specialty dentists from our network. Visit Humana.com to find a participating specialist. Dental PPO
Dental DHMO Employee Only $17.13 Employee +1 $33.92 Employee & Family $60.34
EMPLOYEE BENEFITS 19
Vision Insurance Superior Vision
ABOUT VISION
Vision insurance provides coverage for routine eye examinations and can help with covering some of the costs for eyeglass frames, lenses or contact lenses.
For full plan details, please visit your benefit website: www.mybenefitshub.com/alamoheightsisd
How to Print your Vision ID Card:
You can request your vision id card by contacting Superior Vision directly at 800-507-3800. You can also go to www.superiorvision.com and register/login to access your account by clicking on “Members” at the top of the page. You can also download the Superior Vision mobile app on your smart phone.
1.
2.
3.
4.
daily wear, or extended
and/or
Discount Features
Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.
lenses are in lieu of eyeglass lenses and frames benefit
Non-Covered Eyewear Discount:
Copays Services/frequency Monthly Premiums Exam $10 Exam 12 months Employee Only $9.25 Materials $25 Frame 12 months Employee + 1 $15.75 Lenses 12 months Employee and Family $20.10 Contact lenses 12 months In-network Out-of-network Exam (ophthalmologist) Covered in full Up to $35 retail Frames $150 retail allowance Up to $70 retail Lenses (standard) per pair Single Vision Covered in full Up to $25 retail Bifocal Covered in full Up to $40 retail Trifocal Covered in full Up to $45 retail Progressive See description1 Up to $45 retail Lenticular Covered in full Up to $80 retail Polycarbonate Covered in full Up to $20 retail UV coating Covered in full Up to $20 retail Scratch coating Covered in full Up to $25 retail Contact Lenses2 $150 retail allowance Up to $80 retail Medically Necessary Contact Lenses Covered in full Up to $150 retail Lasik Vision Correction $200 allowance3 Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements
Materials co-pay applies to lenses and frames only, not contact lenses
Standard contact lens
applies to a current contact
who
Specialty
lens fitting
to new contact
a member
wear
gas permeable, or multi-focal lenses.
fitting
lens user
wears disposable,
wear lenses only.
contact
applies
wearers
who
toric,
Covered
standard retail lined trifocal amount; member
difference
to provider’s in-office
pays
between progressive and standard retail lined trifocal, plus applicable co-pay.
Contact
EMPLOYEE BENEFITS 20
Disability Insurance
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/alamoheightsisd
EDUCATOR DISABILITY INSURANCE OVERVIEW
What is Educator Disability Income Insurance?
Educator Disability insurance combines the features of a short-term and long-term disability plan into one policy. The coverage pays you a portion of your earnings if you cannot work because of a disabling illness or injury. The plan gives you the flexibility to choose a level of coverage to suit your need.
You have the opportunity to purchase Disability Insurance through your employer. This highlight sheet is an overview of your Disability Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail.
Why do I need Disability Insurance Coverage?
; More than half of all personal bankruptcies and mortgage foreclosures are a consequence of disability
; The average worker faces a 1 in 3 chance of suffering a job loss lasting 90 days or more due to a disability
; Only 50% of American adults indicate they have enough savings to cover three months of living expenses in the event they’re not earning any income
ELIGIBILITY AND ENROLLMENT
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.
Actively at Work
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.
FEATURES OF THE PLAN
Benefit Amount
You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $7,500 that cannot exceed 66 2/3% of your current monthly earnings. Earnings are defined in The Hartford’s contract with your employer.
Elimination Period
You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a disability benefit payment. The elimination period that you select consists of two numbers. The first number shows the number of 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 more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization.
21
EMPLOYEE BENEFITS
Disability Insurance The Hartford
PROVISIONS OF THE PLAN
Definition of Disability
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.
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.
Pre-Existing Condition Limitation
Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have not received treatment for the disabling condition within 3 months, while insured under this policy, before the disability begins, or You have been insured under this policy for 12 months before your disability begins.
If your disability is a result of a pre-existing condition, we will pay benefits for a maximum of 4 weeks.
How to File a Claim
Instructions on how to file a claim can be found on your Employee Benefits Portal under Disability. To File a Claim, Call this Number: 866-278-2655.
Disability (for $200 in benefit) Elimination Period Premium Select 0/3 $8.98 $8.70 14/14 $6.86 $6.60 30/30 $6.02 $5.76 60/60 $3.28 $2.66 90/90 $2.46 $2.02
EMPLOYEE BENEFITS 22
Hospital Indemnity
The Hartford
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/alamoheightsisd
COVERAGE INFORMATION
You have a choice of three hospital indemnity plans, which allows you the flexibility to enroll for the coverage that best meets your current financial protection needs. Benefit amounts are based on the plan in effect for you or an insured dependent at the time the covered event occurs. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent (s).
How to File a Claim:
You can file your claim in different ways depending on what's most convenient to you:
1. ONLINE
• Visit the Supplemental Insurance Claims Portal at TheHartford.com/benefits/myclaim.
• Register for access if you have not done so already. (Please note: We must have current eligibility from your benefits administrator for you and any dependents to be eligible to register on the portal.)
• Log in to the portal.
• Click on "Complete Your Claim Form Online" under the Quick Links section.
• Follow the prompts to complete and submit a claim.
2. FILE A CLAIM OVER THE PHONE
(Applicable to Health Screening Benefit/Accident Protection Benefit Only)
• File your claim by calling 866-547-4205.
• Available Monday through Friday, 8a.m.-6p.m. EST.
3. SUBMIT A CLAIM VIA MAIL OR FAX
• Download a claim form at TheHartford.com/benefits/ myclaim.
• Complete the form and mail or fax it to:
The Hartford Supplemental Insurance Benefit Department P.O. Box 99906 Grapevine, TX 76099
Fax Number: 469-417-1952
For assistance filing your claim, call 866-547-4205.
PLAN INFORMATION LOW PLAN MID PLAN HIGH PLAN Coverage Type On and off-job (24 hour) On and off-job (24 hour) On and off-job (24 hour) Covered Events Illness and Injury Illness and Injury Illness and Injury HSA Compatible Yes Yes Yes Benefits HOSPITAL CARE LOW PLAN MID PLAN HIGH PLAN First Day Hospital Confinement Up to 1 day per year $500 $1,000 $2,000 Daily Hospital Confinement (Day 2+) Up to 90 days per year $100 $150 $2000 Daily ICU Confinement Up to 30 days per year $200 $300 $400 VALUE ADDED SERVICES LOW PLAN MID PLAN HIGH PLAN Ability Assist® EAP: 24/7/265 access to help for financial, legal or emotional issues Included Included Included HealthChampionSM: Administrative & clinical support following serious illness or injury Included Included Included Hospital Indemnity Premiums TIER LOW PLAN MID PLAN HIGH PLAN Employee Only $9.02 $15.99 $27.87 Employee and Spouse $17.14 $30.32 $52.75 Employee and Child(ren) $16.97 $29.89 $51.67 Employee and Family $26.40 $46.52 $80.50
EMPLOYEE
23
BENEFITS
Cancer Insurance
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/alamoheightsisd
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.
Why I Need Cancer Insurance
Cancer kills more than 500,000 Americans each year, making it the second most common cause of death in the United States. Cancer insurance is designed to relieve your financial burden to help you focus on recovering your health. Money received from cancer benefits can help pay for many expenses such as:
• Experimental cancer treatment
• Travel and lodging costs related to treatment
• Routine living expenses like mortgage and utility bills.
• Guaranteed Issue, If Actively at Work on Effective date.
• PreX: 12-month Pre-ex applies, cannot change plans from low to high once diagnosed with any cancer.
• Two Options: High/Low both pay off a schedule of benefits.
• First Diagnosis $2500 both plans
In consideration of additional premium, this coverage will provide you with benefits if you go into a Hospital Intensive Care Unit (ICU). Your benefits start the first day you go into ICU. The benefit is payable for up to 45 days per ICU stay. You may choose the benefit of $325 or $625 per day. It is reduced by one-half at age 75.
Wellness Benefit: $50 annually
How to file a Claim:
1. Complete each section of the first page of the claim form. (Download form through the employee portal)
2. Attach a copy of the pathology report(s) with a positive diagnosis of cancer or a specified disease. Be sure to attach the earliest diagnosis of cancer or specified disease to ensure proper payment of benefits.
3. For Intensive Care Coverage claims only – please complete each section of the first page of the claim form and attach a copy of the itemized bill from your hospital stating dates you were billed for intensive care confinement and the diagnosis codes for the confinement.
If you have questions or need assistance, please call us toll free at 1-800-845-7519 and ask to speak with a Claims Examiner about your cancer and specified disease policy Monday – Friday, 8:00AM-5:00PM, (CST) Central Standard Time.
ALL REQUIRED PORTIONS OF THIS CLAIM FORM MUST BE COMPLETED TO AVOID UNNECCESARY DELAY IN THE PROCESSING OF YOUR REQUEST FOR BENEFITS.
Cancer Low Low+ICU $325 High High+ICU $625 Employee $18.38 $23.42 $23.87 $26.49 Employee + Spouse $37.60 $48.08 $48.84 $54.29 Employee + Child(ren) $24.43 $32.45 $31.25 $35.42 Family $43.66 $57.12 $56.23 $63.23
24
Bay Bridge Administrators 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/alamoheightsisd
Why I Need Accident Insurance
• Injuries such as fractures, dislocations, burns, concussions, lacerations, etc.
• Medical services and treatments such as emergency transportation and physical therapy.
Accident insurance will deliver a pre-determined payment to you for various qualifying incidents. These occurrences may include:
• Some plans also include accidental death and dismemberment or common carrier benefits as an add on benefit.
How to File a Claim:
Access claim form through the employee portal or call 800.845.7519
We
the
Charges incurred up to $250 per unit if, as a result of
Accident Hospital Indemnity Benefit
We will pay for each day a Covered Person is Confined during one or more periods of Hospital Confinement if: a) the Confinement is due to Injury; or b) the first day of Confinement occurs within 90 days after the accident.
Regular Ambulance/Air Ambulance
$100/$200 $200/$400 $300/$600
EMPLOYEE BENEFITS 25
Bronze 1 Unit Sliver 2 Units Gold 3 Units Accident Medical Expense Benefit
will pay
Covered
requires
$250 $500 $750
Actual
Injury, a
Person
medical or surgical treatment.
$100 $200 $300
Ambulance Service Benefit
We will pay for regular ambulance service and for air Ambulance if as a result of an injury, a Covered Person requires ambulance service for transfer; a) to a Hospital; or b) from a Hospital. Dislocation and Fracture
Benefit
For Fracture of Bone or Bones of: Bronze Silver Gold For Fracture of Bone or Bones of: Bronze Silver Gold Skull (except Bones of Face or Nose) $1,900 $3,800 $5,7000 One Rib, Finger, or Toe $140 $280 $420 Hip, Thigh (Femur) $2,000 $4,000 $6,000 Coccyx $140 $280 $420 Pelvis (Except Coccyx) $2,000 $4,000 $6,000 Hip Joint $2,000 $4,000 $6,000 Arm, Between Shoulder and Elbow (Shaft) $1,100 $2,200 $3,300 Knee Joint (Except Patella) $800 $1,600 $2,400 Shoulder Blade (Scapula) $1,100 $2,200 $3,300 Bone or Bones of the Foot, Other than Toes $800 $1,600 $2,400 Leg (tibia or Fibula) $1,100 $2,200 $3,300 Ankle Joint $800 $1,600 $2,400 Ankle $800 $1,600 $2,400 Wrist Joint $700 $1,400 $2,100 Knee Cap (Patella) $800 $1,600 $2,400 Elbow Joint $600 $1,200 $1,800 Collar Bone (Clavivle) $800 $1,600 $2,400 Sholulder Joint $400 $800 $1,200 Forearm (Radius or Ulna) $800 $1,600 $2,400 Bone or Bones of the Hand, Other than Fingers $300 $600 $900 Foot (Except Toes) $700 $1,400 $2,100 Collar Bone $300 $600 $900 Hand or Wrist (Except Fingers) $700 $1,400 $2,100 Two or More Fingers $140 $280 $420 Lower Jaw (Except Alveolar Process) $400 $800 $1,200 Two or More Toes $140 $280 $420 Two or More Ribs, Fingers or Toes $300 $600 $900 One Finger or One Toe $60 $120 $180 Bones of Face or Nose $300 $600 $900 Primary Insured Coverage 100%/ Spouse Coverage 50%/ Child Coverage 25%
We will pay the following amount shown based on your selection of coverage:
Accident Insurance Bay Bridge Administrators
Accident Insurance
Bay Bridge Administrators
Accidental Death and Dismemberment
will pay the following amount shown based on Your selection of coverage: For Loss of: Bronze Silver Gold Life $20,000 $40,000 $60,000 Both Hands or Both Feet or Sight of Both Eyes $20,000 $40,000 $60,000 Both Arms or Both Legs $20,000 $40,000 $60,000 One Hand or Arm and One Foot or Leg $20,000 $40,000 $60,000 Sight of One Eye $10,000 $20,000 $30,000 One Hand or One Arm $10,000 $20,000 $30,000 One Foot or One Leg $10,000 $20,000 $30,000 One or More Entire Toes $1,000 $2,000 $3,000 One or More Entire Fingers $800 $1,600 $2,400 Primary Insured Coverage 100%/ Spouse Coverage 50%/ Child Coverage 25% Accident Bronze Bronze with Rider Sliver Silver with Rider Gold Gold with Rider Employee Only $9.40 $12.69 $18.80 $22.09 $28.20 $31.49 Employee and Spouse $16.82 $23.39 $33.64 $40.21 $50.46 $57.03 Employee and Child(ren) $17.46 $24.82 $34.92 $42.28 $52.38 $59.74 Employee and Family $24.89 $35.53 $49.78 $60.42 $74.67 $85.31
We
EMPLOYEE BENEFITS 26
Critical Illness Insurance
Chubb EMPLOYEE BENEFITS
ABOUT CRITICAL ILLNESS
Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non-medical costs related to the illness, including transportation, child care, etc.
For full plan details, please visit your benefit website: www.mybenefitshub.com/alamoheightsisd
for HIV or
B, C, or D, MRSA, Rabies, Tetanus, or Tuberculosis contracted on the job.
Childhood
- Pays 100% of the dependent child face amount;
benefits for childhood conditions (Autism Spectrum Disorder; Cerebral Palsy; Congenital Birth Defects; Heart, Lung, Cleft Lip, Palate, etc; Cystic Fibrosis; Down Syndrome; Gaucher Disease; Muscular Dystrophy; Type 1 Diabetes).
Benefits are payable for a subsequent diagnosis of Benign Brain Tumor, Cancer, Coma, Coronary Artery Obstruction, Heart Attack, Major Organ Failure, Severe Burns, Stroke, or Sudden Cardiac Arrest.
Benefits and Features COVERAGE AMOUNTS Employee Coverage Amount $10,000; $20,000; or $30,000 face amounts Spouse Coverage Amount $10,000; $20,000; or $30,000 face amounts Child(ren) Coverage Amount Included in the employee rate COVERED CONDITIONS BENEFIT AMOUNT ALS 100% Alzheimer’s Disease 100% Benign Brain Tumor 100% Breast Cancer Carcinoma In Situ 100% Cancer (See below for skin cancer) 100% Carcinoma In Situ 25% Coma 100% Coronary Artery Obstruction 25% End Stage Renal Failure 100% Heart Attack 100% Loss of Sight, Speech, or Hearing 100% Major Organ Failure 100% Multiple Sclerosis 100% Paralysis or Dismemberment 100% Parkinson’s Disease 100% Severe Burns 100% Stroke 100% Sudden Cardiac Arrest 100% Transient Ischemic Attacks 10% Skin Cancer Benefit - Payable once per insured per year $500 Occupational Package - Pays 100%
amount;
Included
Provides
Included RECURRENCE BENEFIT
of the face
Benefits payable
Hepatitis
Conditions
100% 27
Critical Illness Insurance
Chubb
ADDITIONAL BENEFITS
Miscellaneous Disease Rider + COVID-19
The Miscellaneous Disease Rider is payable once per covered condition.
Covered Conditions include: Addison’s Disease, Cerebrospinal Meningitis, Diphtheria, Huntington’s Chorea, Legionnaire’s Disease, Malaria, Myasthenia Gravis, Meningitis, Necrotizing Fasciitis, Osteomyelitis, Polio, Rabies, Scleroderma, Systemic Lupus, Tetanus, Tuberculosis.
COVID-19 means a disease resulting in a positive COVID-19 diagnostic screening and 5 consecutive days of hospital confinement
Waiver of Premium - Waives premium while the Insured is totally disabled. Included
Wellness Benefit - Payable once per insured per year $50
No benefit will be paid for a date of diagnosis that occurs prior to the coverage effective date. Covered individuals must be treatment free from cancer for 12 months prior to diagnosis date and in complete remission. There is no pre-existing condition limitation. All amounts are Guaranteed Issue- no medical questions are required for coverage to be issued.
View your benefit website at www.mybenefitshub.com/alamoheightsisd for full details and rates.
EMPLOYEE BENEFITS
25%
28
Life and AD&D
The Hartford
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/alamoheightsisd
EMPLOYEE BENEFITS
Applicant Life Coverage AD&D Coverage Employee Benefit2: Increments of $10,000 Maximum: the lesser of 5x earnings or $500,000 AD&D: Included Spouse Benefit2: Increments of $5,000. Maximum: the lesser of 50% of your supplemental coverage or $300,000 AD&D: Included Child(ren) Benefit: $5,000;
AD&D: Included AD&D Benefits – Percent of coverage amount per accident Covered accidents or death
Loss From Accident Coverage Life 100% Both Hands or Both Feet or Sight of Both Eyes 100% One Hand and One Foot 100% Speech and Hearing in Both Ears 100% Either Hand or Foot and Sight of One Eye 100% Movement of Both Upper and Lower Limbs (Quadriplegia) 100% Movement of Both Lower Limbs (Paraplegia) 75% Movement of Three Limbs (Triplegia) 75% Movement of the Upper and Lower Limbs of One Side of the Body (Hemiplegia) 50% Either Hand or Foot 50% Sight of One Eye 50% Speech or Hearing in Both Ears 50% Movement of One Limb (Uniplegia) 25% Movement of One Limb (Uniplegia) 25%
benefit will be reduced by 35% at age 65 and 50% at age 70. Reductions will be applied to the original amount. 29
$10,000
can occur up to 365 days after the accident. The total benefit for all losses due to the same accident will not exceed 100% of your coverage amount.
2Your
Life and AD&D The Hartford
AM I GUARANTEED COVERAGE?
If you enroll during your annual enrollment period or are newly eligible and elect an amount that exceeds the guaranteed issue amount of $200,000, you will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you enroll after your annual or initial enrollment period, evidence of insurability will be required for all coverage amounts.
If you enroll during your annual enrollment period or are newly eligible and elect an amount that exceeds the guaranteed issue amount of $30,000, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you enroll after your annual or initial enrollment period, evidence of insurability will be required for all coverage amounts.
This insurance is guaranteed issue coverage – it is available without having to provide information about your child(ren)’s health.
AD&D is available without having to provide information about your or your family’s health.
GROUP LIFE INSURANCE
General Limitations and Exclusions
• Your supplemental/voluntary life benefit will be reduced by 35% at age 65 and 50% at age 70. Reductions will be applied to the original amount.
• A supplemental or voluntary life benefit will not be paid if death occurs by suicide within two years (or as allowed by state law) of purchasing this coverage.
• ou and your dependent(s) must be citizens or legal residents of the United States, its territories and protectorates.
Dependent Limitations and Exclusions
• Coverage may only be elected for dependents when you elect and are approved for coverage for yourself.
• Coverage may not be elected for a dependent who has employee coverage under this certificate.
• Coverage may not be elected for a dependent who is in active full-time military service.
• Child(ren) may only be covered as a dependent of one employee.
• Infants may receive a reduced benefit prior to the age of six months.
5962a NS 05/21 Life Form Series includes GBD-1000, GBD-1100, or state equivalent.
GROUP ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE
General Limitations and Exclusions
• Your supplemental/voluntary AD&D benefit will be reduced by 35% at age 65 and 50% at age 70. Reductions will be applied to the original amount.
• Exclusions: (Applicable to all benefits except the Life Insurance Benefit and the Accelerated Benefit) What is not covered under The Policy?
• The Policy does not cover any loss caused or contributed to by:
EMPLOYEE BENEFITS
Employee Coverage Age (per $10,000) Under 25 -64 $2.01 65-69 $5.98 70+ $14.19 Spouse Coverage (Cost per $10,000) $1.71 Child Coverage (Cost per $10,000) $1.00 30
Individual Life Insurance
Texas Life
ABOUT INDIVIDUAL LIFE
Individual insurance is a policy that covers a single person and is intended to meet the financial needs of the beneficiary, in the event of the insured’s death. This coverage is portable and can continue after you leave employment or retire.
For full plan details, please visit your benefit website: www.mybenefitshub.com/alamoheightsisd
Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. Designed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually cost more and decline in death benefit. The policy, purelifeplus, is underwritten by Texas Life Insurance Company, and it has the following features:
• High Death Benefit. With one of the highest death benefits available at the worksite,1 purelife-plus gives your loved ones peace of mind.
• Minimal Cash Value. Designed to provide a high death benefit at a reasonable premium, purelife-plus provides peace of mind for you and your beneficiaries while freeing investment dollars to be directed toward such tax favored retirement plans as 403(b), 457 and 401(k).
• Long Guarantees. Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time.
• Refund of Premium. Unique in the marketplace, purelife-plus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.)
• Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you
can take the large majority of your death benefit while still alive. (Conditions apply.) (Form ICC07-ULABR-07 or Form Series ULABR-07)
You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, children and grandchildren by answering just 3 questions.
During the last six months, has the proposed insured:
1. Been actively at work on a full time basis, performing usual duties?
2. Been absent from work due to illness or medical treatment for a period of more than five consecutive working days?
3. Been disabled or received tests, treatment or care of any kind in a hospital or nursing home or received hemotherapy, hormonal therapy for cancer, radiation therapy, dialysis treatment, or treatment for alcohol or drug abuse?
EMPLOYEE BENEFITS 31
Emergency Medical Transport
MASA
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.
For full plan details, please visit your benefit website: www.mybenefitshub.com/alamoheightsisd
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.
• Emergent Air Transportation In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities.
• Emergent Ground Transportation In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities.
Should you need assistance with a claim contact MASA at 800-643-9023. You can find full benefit details at benefit website.
EMPLOYEE
Emergency Medical Transportation Employee & Family $14.00 32
BENEFITS
Flexible Spending Account (FSA)
Higginbotham
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/alamoheightsisd
Health Care FSA
The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $3,050 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).
Higginbotham Benefits Debit Card
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).
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.
Things to Consider Regarding the Dependent Care FSA
• Overnight camps are not eligible for reimbursement (only day camps can be considered).
• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child 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.
EMPLOYEE BENEFITS 33
Flexible Spending Account (FSA)
Higginbotham
Important FSA Rules
• The maximum per plan year you can contribute to a Health Care FSA is $3,050. 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 90 days after August 31st
• 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
Health care reform legislation requires that certain over-the-counter (OTC) items require a prescription to qualify as an eligible Health Care FSA expense. You will only need to obtain a one-time prescription for the current plan year. You can continue to purchase your regular prescription medications with your FSA debit card. However, the FSA debit card may not be used as payment for an OTC item, even when accompanied by a prescription.
Higginbotham Portal
The Higginbotham Portal provides information and resources to help you manage your FSAs.
• Access plan documents, letters and notices, forms, account balances, contributions and other plan information
• Update your personal information
• Utilize Section 125 tax calculators
• Look up qualified expenses
• Submit claims
• Request a new or replacement Benefits Debit Card
Register on the Higginbotham Portal
Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information.
• Enter your Employee ID, which is your Social Security number with no dashes or spaces.
• Follow the prompts to navigate the site.
• If you have any questions or concerns, contact Higginbotham:
* Phone – 866-419-3519
* Email – flexclaims@higginbotham.net
* Fax – 866-419-3516
EMPLOYEE BENEFITS 34
Employee Assistance Program (EAP)
Dear Oaks
ABOUT EAP
An Employee Assistance Program (EAP) is a program that assists you in resolving problems such as finding child or elder care, relationship challenges, financial or legal problems, etc. This program is provided by your employer at no cost to you.
For full plan details, please visit your benefit website: www.mybenefitshub.com/alamoheightsisd
Why I Need Employee Assistance
Balancing work and life is difficult sometimes. Your EAP option covers trouble areas such as:
• Substance abuse
• Stress management
• Financial problems
For full plan details, please visit your benefit website: www.mybenefitshub.com/alamoheightsisd
EMPLOYEE BENEFITS 35
Urgent Care
Carrier Name EMPLOYEE BENEFITS
For full plan details, please visit your benefit website: www.mybenefitshub.com/alamoheightsisd
TAKING YOUR HEALTHCARE TO THE NEXT LEVEL
Your employer is partnering with Next Level Medical to offer employees PLUS their spouse and dependents access to a NEW healthcare benefit with a Next Level PRIME membership.
WHAT IS NEXT LEVEL PRIME?
Next Level PRIME offers all of these amazing benefits:
• Access to 20+ Next Level clinic locations
• Direct primary, preventive & chronic care 7 days a week from 9 a.m. – 9 p.m.
• Urgent care 7 days a week from 9 a.m. – 9 p.m.
• Telemedicine/Virtual visits 24 hour 7 days a week
• Nurse Care Navigators to assist with all healthcare concerns/questions Health & Wellness Coaching
• NO CO-PAYS AT THE TIME OF SERVICE!
• NO ADDITIONAL OUT OF POCKET EXPENSES!
• Unlimited access to medical care
Download the app and push the ORANGE PRIME BUTTON!
nextlevelurgentcare.com
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2023 - 2024 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 Alamo Heights 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 Alamo Heights 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.
W WW.M YB EN EF IT SH UB .C OM /A LA MO HE IG HT SI SD
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