ANNA ISD BENEFIT GUIDE EFFECTIVE: 09/01/2023 - 8/31/2024 WWW.MYBENEFITSHUB.COM/ANNAISD 2023 - 2024 Plan Year 1
HOW TO ENROLL PG. 4
SUMMARY PAGES PG. 6
YOUR BENEFITS PG. 12
How to Enroll 4-5 Annual Benefit Enrollment 6-10 1. Annual Enrollment 6 2. Section 125 Cafeteria Plan Guidelines 7 3. Eligibility Requirements 8 4. Helpful Definitions 9 5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 10 Medical 12-18 Basic Life and AD&D 19 Hospital Indemnity 20 Health Savings Account (HSA) 21 Telehealth 22 Dental 23-24 Vision 25-26 Disability 27-28 Accident 29-30 Critical Illness 31 Voluntary Life and AD&D 32-33 Identity Theft 34 Flexible Spending Account (FSA) 35 FLIP
Table of Contents
TO...
2
Benefit Contact Information
BENEFIT ADMINISTRATORS ANNA ISD ADMINISTRATOR
Financial Benefit Services
(800) 583-6908
www.mybenefitshub.com/annaisd
Kimberly Ruiz-Demaree (972) 924-1000 x1047
kimberly.ruiz-demaree@annaisd.org
TRS-ACTIVECARE MEDICAL
Blue Cross Blue Shield of Texas (866) 355-5999
www.bcbstx.com/trsactivecare
HOSPITAL INDEMNITY HEALTH SAVINGS ACCOUNT (HSA) TELEHEALTH
MetLife Group # 1998
(866) 626-3705
Claims: (800) 845-7519
www.mybenefits.metlife.com
EECU (817) 882-0800
www.eecu.org
DENTAL VISION
Cigna Group # 3345042 (800) 244-6224
www.mycigna.com
Superior Vision Group # 36411
(800) 507-3800
www.superiorvision.com
ACCIDENT CRITICAL ILLNESS
The Hartford Policy # 681986
(800) 583-6908/Claims: (866) 547-4205
www.thehartford.com
Claims:
https://benefitsclaims.thehartford.com
Aflac Policy # AGC000165270
(800) 433-3036
www.aflacgroupinsurance.com
IDENTITY THEFT FLEXIBLE SPENDING ACCOUNT (FSA)
iLOCK360 (855) 287-8888
www.ilock360.com
National Benefit Services
(855) 399-3035
www.nbsbenefits.com
Claims: service@nbs.com
Recuro (855) 673-2876
www.recurohealth.com
DISABILITY
The Hartford Policy # 681986 (800) 583-6908/Claims: (866) 547-9124
www.thehartford.com
Claims:
https://benefitsclaims.thehartford.com
LIFE AND AD&D
Lincoln Financial Group Policy # GL 000400266806 (800) 423-2756
www.lfg.com
Claims: custservsupportteam@lfg.com
3
Employee benefits made easy through the FBS Benefits App! All Your BenefitsOne App OR SCAN Text “FBS ANNA” to (800) 583-6908 App Group #: FBSANNA Text “FBS ANNA” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment: • Benefit Resources • Online Enrollment • Interactive Tools • And more! 4
How to Log In
1
www.mybenefitshub.com/annaisd
2
CLICK LOGIN
3 ENTER USERNAME & PASSWORD
Your Username Is: Your email in THEbenefitsHUB. (Typically your work email)
Your Password Is: Four (4) digits of your birth year followed by the last four (4) digits of your Social Security Number
If you have previously logged in, you will use the password that you created, NOT the password format listed above.
5
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 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 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/annaisd 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 Anna ISD benefit website: www.mybenefitshub.com/annaisd. 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
6
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 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 Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
CHANGES IN STATUS (CIS): QUALIFYING EVENTS
Marital Status
Change in Number of Tax Dependents
Change in Status of Employment Affecting Coverage Eligibility
Gain/Loss of Dependents’ Eligibility Status
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
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. Judgment/ Decree/Order
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 Government Programs
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
SUMMARY PAGES
7
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.
AD&D To age 26
Individual Life To age 26
Accident To age 26
ID Theft Protection To age 18
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 Administrator to request a continuation of coverage.
SUMMARY PAGES
PLAN MAXIMUM AGE Medical To age
To age
To age
Vision To age
26 Telehealth
26 Dental
26
26 Life To age 26 Critical Illness To age 26
8
Helpful Definitions
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.
Don’t Forget!
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 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).
• Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202.
• Update your information: home address, phone numbers, email, and beneficiaries.
• REQUIRED!! Due to the Affordable Care Act (ACA) reporting requirements, you must add your dependent’s CORRECT social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator.
SUMMARY
PAGES
9
Description
Health Savings Account (HSA) (IRC Sec. 223)
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.
Flexible Spending Account (FSA) (IRC Sec. 125)
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
Cash-Outs of Unused Amounts (if no medical expenses)
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).
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65). Not permitted
Year-to-year rollover of account balance? Yes, will roll over to use for subsequent year’s health coverage.
No. Access to some funds may be extended if your employer’s plan contains a 2 1/2-month grace period or $500 rollover provision.
FLIP TO FOR HSA INFORMATION FLIP TO FOR FSA INFORMATION PG. 21 PG. 35 SUMMARY PAGES HSA vs. FSA
Contribution Source Employee
employer Employee and/or employer Account Owner Individual Employer Underlying Insurance Requirement High deductible health plan None Minimum Deductible $1,500 single (2023) $3,000 family (2023) N/A Maximum Contribution $3,850 single (2023) $7,750 family (2023) 55+ catch up +$1,000 $3,050 (2023)
and/or
Permissible Use Of Funds
Does the account earn interest? Yes No Portable? Yes,
No 10
portable year-to-year and between jobs.
Notes 11
Medical Insurance
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/annaisd
TRS Monthly Premium District Contribution Employee Cost TRS-ActiveCare HD Employee Only $462.00 $315.00 $147.00 Employee & Spouse $1,248.00 $315.00 $933.00 Employee & Child(ren) $786.00 $315.00 $471.00 Employee & Family $1,571.00 $315.00 $1,256.00 TRS-ActiveCare 2 Employee Only $1,013.00 $315.00 $698.00 Employee & Spouse $2,402.00 $315.00 $2,087.00 Employee & Child(ren) $1,507.00 $315.00 $1,192.00 Employee & Family $2,841.00 $315.00 $2,526.00 TRS-ActiveCare Primary Employee Only $450.00 $315.00 $135.00 Employee & Spouse $1,215.00 $315.00 $900.00 Employee & Child(ren) $765.00 $315.00 $450.00 Employee & Family $1,530.00 $315.00 $1,215.00 TRS-ActiveCare Primary+ Employee Only $529.00 $315.00 $214.00 Employee & Spouse $1,376.00 $315.00 $1,061.00 Employee & Child(ren) $900.00 $315.00 $585.00 Employee & Family $1,746.00 $315.00 $1,431.00 Central & North Texas Baylor Scott and White HMO Employee Only $569.76 $315.00 $254.76 Employee & Spouse $1,432.42 $315.00 $1,117.42 Employee & Child(ren) $916.49 $315.00 $601.49 Employee & Family $1,648.78 $315.00 $1,333.78 EMPLOYEE BENEFITS 12
TRS-ActiveCare Plan Highlights 2023-24
Learn the Terms.
• Premium: The monthly amount you pay for health care coverage.
• Deductible: The annual amount for medical expenses you’re responsible to pay before your plan begins to pay its portion.
• Copay: The set amount you pay for a covered service at the time you receive it. The amount can vary by the type of service.
• Coinsurance: The portion you’re required to pay for services after you meet your deductible. It’s often a speci ed percentage of the costs; i.e. you pay 20% while the health care plan pays 80%.
• Out-of-Pocket Maximum: The maximum amount you pay each year for medical costs. After reaching the out-of-pocket maximum, the plan pays 100% of allowable charges for covered services.
762373.0523
You bet your boots big things happen here, including TRS-ActiveCare’s large network of doctors and hospitals.
13
Monthly Premiums Employee Only $450 $ $529 Employee and Spouse $1,215 $ $1,376 Employee and Children $765 $ $900 Employee and Family $1,530 $ $1,746 Total Premium Total Premium Your Premium How to Calculate Your Monthly Premium Total Monthly Premium Your District and State Contributions Your Premium Ask your Bene ts Administrator for your district’s speci c premiums. All TRS-ActiveCare participants have three plan options. TRS-ActiveCare Primary TRS-ActiveCare Plan Summary • Lowest premium of all three plans • Copays for doctor visits before you meet your deductible • Statewide network • Primary Care Provider (PCP) referrals required to see specialists • Not compatible with a Health Savings Account (HSA) • No out-of-network coverage • Lower deductible than • Copays for many services • Higher premium • Statewide network • PCP referrals required • Not compatible with • No out-of-network Wellness Bene ts at No Extra Cost* Being healthy is easy with: • $0 preventive care • 24/7 customer service • One-on-one health coaches • Weight loss programs • Nutrition programs • OviaTM pregnancy support • TRS Virtual Health • Mental health bene ts • And much more! *Available for all plans. See the bene ts guide for more details. Immediate Care Urgent Care $50 copay Emergency Care You pay 30% after deductible You TRS Virtual Health-RediMD (TM) $0 per medical consultation $0 TRS Virtual Health-Teladoc® $12 per medical consultation $12 2023-24 TRS-ActiveCare Plan Highlights Sept. 1, 2023 –New Rx Bene ts! • Express Scripts is your new pharmacy bene ts manager! CVS pharmacies and most of your preferred pharmacies and medication are still included. • Certain specialty drugs are still $0 through SaveOnSP. Doctor Visits Primary Care $30 copay Specialist $70 copay Plan Features Type of Coverage In-Network Coverage Only In-Network Individual/Family Deductible $2,500/$5,000 Coinsurance You pay 30% after deductible You Individual/Family Maximum Out of Pocket $7,500/$15,000 Network Statewide Network PCP Required Yes Prescription Drugs Drug Deductible Integrated with medical $200 deductible Generics (31-Day Supply/90-Day Supply)$15/$45 copay; $0 copay for certain generics Preferred You pay 30% after deductible You Non-preferred You pay 50% after deductible You Specialty (31-Day Max) $0 if SaveOnSP eligible; You pay 30% after deductible You Insulin Out-of-Pocket Costs$25 copay for 31-day supply; $75 for 61-90 day supply$25 copay for 31-day 14
This plan is closed and not accepting new enrollees. If you’re currently enrolled in TRS-ActiveCare 2, you can remain in this plan. $ $462 $ $ $1,248 $ $ $786 $ $ $1,571 $ Premium Total Premium Your Premium Your Premium Total Premium Your Premium $1,013 $ $2,402 $ $1,507 $ $2,841 $
a wide
of wellness bene ts. TRS-ActiveCare 2 • Closed to new enrollees • Current enrollees can choose to stay in plan • Lower deductible • Copays for many services and drugs • Nationwide network with out-of-network coverage • No requirement for PCPs or referrals TRS-ActiveCare Primary+ TRS-ActiveCare HD than the HD and Primary plans services and drugs required to see specialists with a Health Savings Account (HSA) coverage • Compatible with a Health Savings Account (HSA) • Nationwide network with out-of-network coverage • No requirement for PCPs or referrals • Must meet your deductible before plan pays for non-preventive care $50 copay You pay 30% after deductibleYou pay 50% after deductible You pay 20% after deductible You pay 30% after deductible $0 per medical consultation $30 per medical consultation $12 per medical consultation $42 per medical consultation $50 copay You pay 40% after deductible You pay a $250 copay plus 20% after deductible $0 per medical consultation $12 per medical consultation Aug. 31, 2024 $15 copay You pay 30% after deductibleYou pay 50% after deductible $70 copay You pay 30% after deductibleYou pay 50% after deductible $30 copay You pay 40% after deductible $70 copay You pay 40% after deductible In-Network Coverage Only In-Network Out-of-Network $1,200/$2,400 $3,000/$6,000 $5,500/$11,000 You pay 20% after deductible You pay 30% after deductibleYou pay 50% after deductible $6,900/$13,800 $7,500/$15,000 $20,250/$40,500 Statewide Network Nationwide Network Yes No In-Network Out-of-Network $1,000/$3,000 $2,000/$6,000 You pay 20% after deductibleYou pay 40% after deductible $7,900/$15,800 $23,700/$47,400 Nationwide Network No deductible per participant (brand drugs only) Integrated with medical $15/$45 copay You pay 20% after deductible; $0 coinsurance for certain generics You pay 25% after deductible You pay 25% after deductible You pay 50% after deductible You pay 50% after deductible $0 if SaveOnSP eligible; You pay 30% after deductible You pay 20% after deductible 31-day supply; $75 for 61-90 day supply You pay 25% after deductible $200 brand deductible $20/$45 copay You pay 25% after deductible ($40 min/$80 max)/ You pay 25% after deductible ($105 min/$210 max) You pay 50% after deductible ($100 min/$200 max)/ You pay 50% after deductible ($215 min/$430 max) $0 if SaveOnSP eligible; You pay 30% after deductible ($200 min/$900 max)/ No 90-day supply of specialty medications $25 copay for 31-day supply; $75 for 61-90 day supply 15
Each includes
range
What’s New and What’s Changing
• Individual maximum-out-of-pocket decreased by $650. Previous amount was $8,150 and is now $7,500.
• Family maximum-out-of-pocket decreased by $1,300. Previous amount was $16,300 and is now $15,000.
• Individual maximum-out-of-pocket increased by $450 to match IRS guidelines. Previous amount was $7,050 and is now $7,500.
• Family maximum-out-of-pocket increased by $900 to match IRS guidelines. Previous amount was $14,100 and is now $15,000. These changes apply only to in-network amounts.
• Family deductible decreased by $1,200. Previous amount was $3,600 and is now $2,400.
• Primary care provider copay decreased from $30 to $15.
• No changes.
• This plan is still closed to new enrollees.
2022-23 Total Premium New 2023-24 Total Premium Change in Dollar Amount TRS-ActiveCare Primary Employee Only $410 $450 $40 Employee and Spouse $1,157 $1,215 $58 Employee and Children $738 $765 $27 Employee and Family $1,384 $1,530 $146 TRS-ActiveCare HD Employee Only $422 $462 $40 Employee and Spouse $1,187 $1,248 $61 Employee and Children $757 $786 $29 Employee and Family $1,419 $1,571 $152 TRS-ActiveCare Primary+ Employee Only $515 $529 $14 Employee and Spouse $1,259 $1,376 $117 Employee and Children $829 $900 $71 Employee and Family $1,584 $1,746 $162 TRS-ActiveCare 2 (closed to new enrollees) Employee Only $1,013 $1,013 $0 Employee and Spouse $2,402 $2,402 $0 Employee and Children $1,507 $1,507 $0 Employee and Family $2,841 $2,841 $0 Key Plan Changes At a Glance Primary HD Primary+ Premiums Lowest Lower Higher Deductible Mid-range High Low Copays Yes No Yes NetworkStatewide network Nationwide network Statewide network PCP Required? Yes No Yes HSA-eligible? No Yes No Effective: Sept. 1, 2023
This table shows you the changes between 2022-23 statewide premium price and this year’s 2023-24 regional price for your Education Service Center.
16
Compare Prices for Common Medical Services
*Pre-certi cation for genetic and specialty testing may apply. Contact a PHG
with questions.
Bene t TRS-ActiveCare Primary TRS-ActiveCare Primary+ TRS-ActiveCare HD TRS-ActiveCare 2 In-Network OnlyIn-Network OnlyIn-NetworkOut-of-NetworkIn-NetworkOut-of-Network Diagnostic Labs* Of ce/Indpendent Lab: You pay $0 Of ce/Indpendent Lab: You pay $0 You pay 30% after deductible You pay 50% after deductible Of ce/Indpendent Lab: You pay $0 You pay 40% after deductible Outpatient: You pay 30% after deductible Outpatient: You pay 20% after deductible Outpatient: You pay 20% after deductible High-Tech Radiology You pay 30% after deductible You pay 20% after deductible You pay 30% after deductible You pay 50% after deductible You pay 20% after deductible + $100 copay per procedure You pay 40% after deductible + $100 copay per procedure Outpatient Costs You pay 30% after deductible You pay 20% after deductible You pay 30% after deductible You pay 50% after deductible You pay 20% after deductible ($150 facility copay per incident) You pay 40% after deductible ($150 facility copay per incident) Inpatient Hospital Costs You pay 30% after deductible You pay 20% after deductible You pay 30% after deductible You pay 50% after deductible ($500 facility per day maximum) You pay 20% after deductible ($150 facility copay per day) You pay 40% after deductible ($500 facility per day maximum) Freestanding Emergency Room You pay $500 copay + 30% after deductible You pay $500 copay + 20% after deductible You pay $500 copay + 30% after deductible You pay $500 copay + 50% after deductible You pay $500 copay + 20% after deductible You pay $500 copay + 40% after deductible Bariatric Surgery Facility: You pay 30% after deductible Facility: You pay 20% after deductible Not CoveredNot Covered Facility: You pay 20% after deductible ($150 facility copay per day) Not Covered Professional Services: You pay $5,000 copay + 30% after deductible Professional Services: You pay $5,000 copay + 20% after deductible Professional Services: You pay $5,000 copay + 20% after deductible Only covered if rendered at a BDC+ facility Only covered if rendered at a BDC+ facility Only covered if rendered at a BDC+ facility Annual Vision Exam (one per plan year; performed by an ophthalmologist or optometrist) You pay $70 copayYou pay $70 copay You pay 30% after deductible You pay 50% after deductible You pay $70 copay You pay 40% after deductible Annual Hearing Exam (one per plan year) $30 PCP copay $70 specialist copay $30 PCP copay $70 specialist copay You pay 30% after deductible You pay 50% after deductible $30 PCP copay $70 specialist copay You pay 40% after deductible
www.trs.texas.gov
at 1-866-355-5999
Call a Personal Health Guide (PHG) any time 24/7 to help you nd the best price for a medical service. Reach them at 1-866-355-5999 REMEMBER: Revised 05/30/23 17
2023-24 Health Maintenance Organization (HMO) Plans and Premiums for Select Regions of the State
TRS contracts with HMOs in certain regions to bring participants in those areas additional options. HMOs set their own rates and premiums. They’re fully insured products who pay their own claims.
You can choose this plan if you live in one of these counties: Austin, Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Collin, Coryell, Dallas, Denton, Ellis, Erath, Falls, Freestone, Grimes, Hamilton, Hays, Hill, Hood, Houston, Johnson, Lampasas, Lee, Leon, Limestone, Madison, McLennan, Milam, Mills, Navarro, Robertson, Rockwall, Somervell, Tarrant, Travis, Walker, Waller, Washington, Williamson
You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy
You can choose this plan if you live in one of these counties: Andrews, Armstrong, Bailey, Borden, Brewster, Briscoe, Callahan, Carson, Castro, Childress, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, Fisher, Floyd, Gaines, Garza, Glasscock, Gray, Hale, Hall, Hansford, Hartley, Haskell, Hemphill, Hockley, Howard, Hutchinson, Irion, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Llano, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, San Saba, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Winkler, Yoakum
Remember that when you choose an HMO, you’re choosing a regional network. REMEMBER: www.trs.texas.gov Total Monthly Premiums Total PremiumYour PremiumTotal PremiumYour PremiumTotal PremiumYour Premium Employee Only$569.76$ N/A$ N/A$ Employee and Spouse$1,432.42$ N/A$ N/A$ Employee and Children$916.49$ N/A$ N/A$ Employee and Family$1,648.78$ N/A$ N/A$ Central and North Texas Baylor Scott & White Health Plan Brought to you by TRS-ActiveCare Blue Essentials - South Texas HMO Brought to you by TRS-ActiveCare Blue Essentials - West Texas HMO Brought to you by TRS-ActiveCare
Prescription Drugs Drug Deductible $200 (excl. generics) N/A N/A Days Supply30-day supply/90-day supply N/A N/A Generics $14/$35 copay N/A N/A Preferred BrandYou pay 35% after deductible N/A N/A Non-preferred BrandYou pay 50% after deductible N/A N/A SpecialtyYou pay 35% after deductible N/A N/A Immediate Care Urgent Care $40 copay N/A N/A Emergency Care$500 copay after deductible N/A N/A Doctor Visits Primary Care $20 copay N/A N/A Specialist $70 copay N/A N/A Plan Features Type of CoverageIn-Network Coverage Only N/A N/A Individual/Family Deductible $2,400/$4,800 N/A N/A CoinsuranceYou pay 25% after deductible N/A N/A Individual/Family Maximum Out of Pocket $8,150/$16,300 N/A N/A
Revised 05/30/23 Cameron, Eastland, Ector, Fisher, Floyd, Gaines, Garza, $14/$35 copay N/A N/A Emergency Care$500 copay after deductible 18
Basic Life and AD&D
Lincoln Financial Group
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/annaisd
AT A GLANCE
EMPLOYEE BENEFITS
• Anna ISD provides a cash benefit of $20,000 to your loved ones in the event of your death, plus a matching cash benefit if you die in an accident or if you suffer a covered dismemberment loss in an accident, such as losing a limb or your eyesight.
• LifeKeys® services, which provide access to counseling, financial, and legal support.
• TravelConnect® services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home.
You also have the option to increase your cash benefit by securing additional coverage at affordable group rates. See the Volutnary Life and AD&D section for more details.
ADDITIONAL DETAILS
Benefit Reduction: Coverage amounts begin to reduce at age 70. See the plan certificate for details.
For complete benefit descriptions, limitations, and exclusions, refer to the employee portal at www.mybenefitshub.com/annaisd
19
Hospital Indemnity MetLife
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/annaisd
How to file a claim:
• Visit your benefit website for detailed claims instructions and forms: www.mybenefitshub.com/annaisd
• Contact Bay Bridge Administrator’s LLC the Administrators at 800845-7519 for claim status.
Benefits are paid directly to the employee based on flat schedule (not reimbursement) and there is no coordination with other insurance coverage.
Complications of pregnancy and emergency Cesarean section are covered. Routine Childbirth Routine, vaginal delivery of a child or children or delivery of a child or children by non-emergency Cesarean section are covered.
Complications of Pregnancy
Covered Hospital
will begin to be payable the day after Admission.
Plan Summary Coverage Type Hospitalization Reason Sickness/Accident:
24 Hour Coverage Underwriting Offer Guaranteed Issue
Waiting Period for SicknessHospital Admission and Confinement Benefits None
Condition Limitation
Pre-Existing
Not Included.
Elimination Period for Routine Childbirth Not Included.
EMPLOYEE BENEFITS Hospital Indemnity Monthly Premiums Employee $19.48 Employee + Spouse $34.64 Employee + Child(ren) $29.96 Family $45.14
Benefits Subcategory Benefit Limits (Applies to Subcategory) Benefit Benefit Amounts Admission Benefit 1 time(s) per calendar year Admission $1,000 Confinement Benefit 31 days per confinement ICU Supplemental Confinement will pay an additional benefit for 10 of those days Confinement² $150 ICU Supplemental Confinement (up to 10 days per confinement) $150 Inpatient Rehabilitation Benefit* 10 days per calendar year Inpatient Rehabilitation (For Injury or Sickness) $75 Other Benefits Health Screening Benefit 1 time(s) per calendar year per covered person Health Screening $50
or Confinement
*Benefit(s) that requires prior Admission
Complete details and Limitations and Exclusions
Hospital Indemnity Section. 20
2. If the Admission Benefit is payable for a Confinement, the Confinement Benefit
are at www.mybenefitshub.com/annaisd and go to the
Health Savings Account (HSA)
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/annaisd
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs – it is also a tax-exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
• Enrolled in an HSA-eligible High Deductible Health Plan (HDHP)
• Not enrolled in Medicare, Medicaid, or TRICARE
• Not eligible to be claimed as a dependent on someone else’s tax return
You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered by the HDHP.
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
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.
Qualified Expenses
You can use your HSA for a wide range of qualified expenses, such as doctor’s visits, prescription drugs, lab work, medical equipment, contacts lenses, dental work, physical therapy… the list goes on! Refer to IRS Publication 502 for comprehensive guidelines.
Important HSA Information
• You will receive a debit card to manage your Health Savings Account. Keep in mind, available funds are limited to the balance in your HSA.
• 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.
• 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. to 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 locations & service hours at www.eecu.org/locations.
EMPLOYEE
21
EECU
BENEFITS
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/annaisd
Anna ISD provides Virtual Health Benefits for eligibles employees and their enrolled family members. Family must be enrolled during Open Enrollment to be eligible.
Don’t wait to speak with a doctor, get the care you need when you need it.
24/7/365 Access to U.S. Board Certified, State Licensed Doctors.
Getting sick is never planned. Here at Recuro we provide quality care around the clock to fit within your busy lifestyle.
Common Conditions Treated:
• Acid Reflux
• Allergies
• Sore Throat
• Congestion
• Cough
• Cold & Flu
• Yeast Infection
• Insect Bites
• And MORE
Virtual Health Benefits available at $0 per consult
Optional Virtual Behavior Benefits available with per consult copay:
9 Licensed Counseling $85/consult
9 Psychiatry Initial Visit $225
9 Psychiatry Follow Up Visit $95
Call us, or download our app to speak with a doctor today! Call (855) 673-2876 Visit www.recurohealth.com Scan QR code to download App:
EMPLOYEE
22
Telehealth Recuro
BENEFITS
Dental Insurance 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/annaisd
Your plan allows you to see any licensed dentist but using an in-network dentist may minimize your out-of-pocket expenses.
How to Find a Dentist
Visit https://hcpdirectory.cigna.com/ or call 800-244-6224 to find an innetwork dentist.
Class I: Diagnostic & Preventive Oral Evaluations, Prophylaxis: routine cleanings, X-rays: routine, X-rays: non-routine, Fluoride, Application Sealants: per tooth
Class II: Basic Restorative Restorative: fillings, Oral Surgery: minor, Denture Relines, Rebases and Adjustments, Space Maintainers: non-orthodontic, Emergency Care to Relieve Pain
Class III: Major Restorative Inlays and Onlays, Prosthesis Over Implant, Crowns: prefabricated stainless steel / resin, Crowns: permanent cast and porcelain Bridges and Dentures, Oral Surgery: major, Anesthesia: general and IV sedation, Periodontics: minor and major, Endodontics: minor and major, Repairs: bridges, crowns and inlays, Repairs: dentures
age 19
Cigna Dental Choice Plan Network Options In-Network: Total Cigna DPPO Network Out-of-Network: See Non-Network Reimbursement Reimbursement Levels Based on Contracted Fees Maximum Reimbursable Charge Calendar Year Benefits
Applies to: Class I, II, III & IX expenses $2,000 $2,000 Calendar Year Deductible Individual Family $50 $150 $50 $150 Benefit Highlights Plan Pays You Pay Plan Pays You Pay
100% No Deductible No Charge 100% No Deductible No Charge
Maximum
80% After Deductible 20% After Deductible 80% After Deductible 20% After Deductible
50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible Class
Coverage
Dependent Children to
Lifetime
$1,500 50% No Deductible 50% No Deductible 50% No Deductible 50% No Deductible Class IX: Implants 50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible
IV: Orthodontia
for
Benefits Maximum:
EMPLOYEE BENEFITS Dental Monthly Premiums Employee $36.64 Employee + Spouse $73.04 Employee + Child(ren) $82.82 Family $134.76 23
Dental Insurance Cigna EMPLOYEE BENEFITS
Benefit Plan Provisions:
In-Network Reimbursement
Non-Network Reimbursement
For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule.
For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Reimbursable Charge. The MRC is calculated at the 90th percentile of all provider allowed amounts in the geographic area. The dentist may balance bill up to their usual fees.
Late Entrant Limitation Provision
Oral Health Integration Program®
Payment will be reduced by 50% for Class III, IV and IX services for 12 months for eligible members that are allowed to enroll in this plan outside of the designated open enrollment period. This provision does not apply to new hires.
The Cigna Dental Oral Health Integration Program offers enhanced dental coverage for customers with certain medical conditions. There is no additional charge to participate in the program. Those who qualify can receive reimbursement of their coinsurance for eligible dental services. Eligible customers can also receive guidance on behavioral issues related to oral health. Reimbursements under this program are not subject to the annual deductible but will be applied to the plan annual maximum. For more information on how to enroll in this program and a complete list of terms and eligible conditions, go to www.mycigna.com or call customer service 24/7 at 1-800-Cigna24.
Timely Filing
Benefit Limitations:
Missing Tooth Limitation
Oral Evaluations/Exams
X-rays (routine)
X-rays (non-routine)
Diagnostic Casts
Cleanings
Fluoride Application
Sealants (per tooth)
Space Maintainers
Out of network claims submitted to Cigna after 365 days from date of service will be denied.
For teeth missing prior to coverage with Cigna, the amount payable is 50% of the amount otherwise payable until covered for 12 months; thereafter, considered a Class III expense.
2 per calendar year.
Bitewings: 2 per calendar year.
Complete series of radiographic images and panoramic radiographic images: Limited to a combined total of 1 per 36 months.
Payable only in conjunction with orthodontic workup.
3 per calendar year, including periodontal maintenance procedures following active therapy.
1 per calendar year for children under age 19.
Limited to posterior tooth. 1 treatment per tooth every 36 months for children up to age 14.
Limited to non-orthodontic treatment for children under age 19.
Inlays, Crowns, Bridges, Dentures and Partials Replacement every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/toothcolored material on molar crowns or bridges.
Denture and Bridge Repairs
Denture Adjustments, Rebases and Relines
Prosthesis Over Implant
Reviewed if more than once.
Covered if more than 6 months after installation.
1 every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth colored material on molar crowns or bridges.
This document provides a summary only. It is not a contract. If there are any differences between this summary and the official plan documents, the terms of the official plan documents will prevail. Please visit www.mybenefitshub.com/annaisd under the Dental Section of the employee portal.
24
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/annaisd
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.
Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements
1. Eye exam copay is a single payment due to the provider at the time of service.
2. Eyewear copay applies to eyeglass lenses / frame and contact lenses. Eyewear copay is a single payment that applies to the entire purchase of eyeglasses (frame and lenses)
3. Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay
4. Contact lenses and related professional services (fitting, evaluation and follow-up) are covered in lieu of eyeglass lenses and frames benefit
5. Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limitations.
Copays Services/frequency Vision Monthly Premiums Low High Low High Low High Exam1 $10 $5 Exam 12 months Employee $6.74 $9.46 Materials2 $20 $0 Frame 12 months Employee + Spouse $11.56 $18.46 Lenses 12 months Employee + Child(ren) $12.24 $25.56 Contact Lenses 12 months Family $18.36 $25.56 Benefits through Superior Select Southwest network Low Plan High Plan In-network Out-of-network In-network Out-of-network Exam Covered in full Up to $35 Covered in full Up to $35 Frames $125 retail allowance Up to $70 $150 retail allowance Up to $70 Lenses (standard) per pair Single vision Covered in full Up to $25 Covered in full Up to $25 Bifocal Covered in full Up to $40 Covered in full Up to $40 Trifocal Covered in full Up to $45 Covered in full Up to $45 Progressive See description3 Up to $45 See description3 Up to $45 Contact lenses4 $150 retail allowance Up to $80 $200 retail allowance Up to $80 Medically necessary contact lenses Covered in full Up to $150 Covered in full Up to $150 Laser
5 $200
$200 retail allowance
vision correction
retail allowance
Need to search an in-network provider? Call 800-507-3800 or Visit https://superiorvision.com/locator/ to locate a provider.
25
EMPLOYEE BENEFITS
Vision Insurance Superior Vision
Discount Features
Discounts on covered materials6 (These discounts apply to the glasses and contacts that are covered under the vision benefits.)
6. Discounts and maximums may vary by lens type. Please check with your provider.
* The above table highlights some of the most popular lens type and is not a complete listing. This table outlines member out-of-pocket costs5 and are not available for premium/upgraded options unless otherwise noted.
6
Laser vision correction (LASIK)
Laser vision correction (LASIK) is a procedure that can reduce or eliminate your dependency on glasses or contact lenses. This corrective service is available to you and your eligible dependents at a special discount (20-50%) with your Superior Vision plan. Contact QualSight LASIK at (877) 201-3602 for more information.
Hearing discounts
6
A National Hearing Network of hearing care professionals, featuring Your Hearing Network, offers Superior Vision members discounts on services, hearing aids and accessories. These discounts should be verified prior to service.
Please refer to www.mybenefitshub.com/annaisd under the Vision section for full plan details and limitations.
Frames: 20%
Conventional Contacts: 20% off
over allowance Disposable Contact: 20% off amount over allowance Discounts on non-covered exam, services and materials6 Exams, frames, and prescription lenses: 30% off retail Contacts, miscellaneous options: 20% off retail Disposable contact lenses: 10% off retail Retinal imaging: $39 maximum out-of-pocket Maximum member out-of-pocket6 Scratch Coat $15 Ultraviolet coat $12 Tints, solid $15 Tints, gradient $18 Polycarbonate $40 Blue light filtering $15 Digital single vision $30 Progressive lenses: Standard/Premium/Ultra/Ultimate $55 / $110 /
Anti-reflective coating: Premium/Ultra/Ultimate $50 / $70 / $85
Polarized lenses $75 Plastic photochromic lenses $80 High Index (1.67 / 1.74) $80 / $120
off amount over allowance
amount
$150 / $225
/ $120
26
EMPLOYEE BENEFITS
Disability Insurance
The Hartford EMPLOYEE BENEFITS
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/annaisd
What is Educator Disability Insurance?
Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness.
How to file a Claim: Just call The Hartford at 1-866-5479124
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.
Benefit Amount: You may purchase coverage that will pay you a monthly benefit of 50% or 66 2/3% of your current monthly earnings to a maximum of $7,500. 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. For those employees electing an elimination period of 30 days or less, if you 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.
Definition of Disability: 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.
Maximum Benefit Duration: Benefit Duration is the maximum time for which we pay benefits for disability resulting from sickness or injury. Depending on the age at which disability occurs, the maximum duration may vary.
Age at Disability
Prior to 63
Age 63
To Normal Retirement Age or 48 months if greater
To Normal Retirement Age or 42 months if greater
Age 64 36 months
Age 65 30 months
Age 66 27 months
Age 67
Age 68
Age 69 and older
24 months
21 months
18 months
Maximum Duration of Benefits
27
Disability Insurance The Hartford EMPLOYEE BENEFITS
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)
Survivor Benefit: If you die while receiving disability benefits, a benefit will be paid to your spouse, or in equal shares to your surviving children under the age of 26, equal to three times the last monthly gross benefit.
Extra Value Benefits:
The Hartford's Ability Assist service is included as a part of your group Long Term Disability (LTD) insurance program. You have access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD benefits. Ability Assist services are provided through ComPsych®, a leading provider of employee assistance and work/life services. Includes emotional work life counseling, financial information and resources, Legal Support and Heath benefits services. Call 1-800-964-3577 or visit www.guidanceresources.com
Web ID HLF902 Company Name Field ABILI
Travel Assistance Program: Available 24/7, this program provides assistance to employees and their dependents who travel 100 miles from their home for 90 days or less. Services include pre-trip information, emergency medical assistance and emergency personal services.
Identity Theft Protection: An array of identity fraud support services to help victims restore their identity. Benefits include 24/7 access to an 800 number; direct contact with a certified caseworker who follows the case until it’s resolved; and a personalized fraud resolution kit with instructions and resources for ID theft victims.
Disability Monthly Premiums - per $100 in benefit Elimination Period 50% 67% 7/7 $3.13 $3.64 14/14 $2.66 $3.08 30/30 $1.76 $2.04 60/60 $1.36 $1.56 90/90 $1.00 $1.16 180/180 $0.66 $0.76
28
Accident Insurance The Hartford
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/annaisd
COVERAGE INFORMATION
You have a choice of two accident plans, which allows you the flexibility to enroll for the coverage that best meets your needs. This insurance provides benefits when injuries, medical treatment and/or services occur as the result of a covered accident. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s).
PLAN INFORMATION LOW PLAN HIGH PLAN Coverage Type On and off-job (24 hour) BENEFITS EMERGENCY, HOSPITAL & TREATMENT CARE LOW PLAN HIGH PLAN Accident Follow-Up Up to 3 visits per accident $100 $150 Acupuncture/Chiropractic Care Up to 10 visits each per accident $50 $75 Ambulance – Air Once per accident $2,000 $2,500 Ambulance – Ground Once per accident $750 $1,000 Blood/Plasma/Platelets Once per accident $300 $400 Child Care Up to 30 days per accident while insured is confined $35 $50 Daily Hospital Confinement Up to 365 days per lifetime $400 $600 Daily ICU Confinement Up to 30 days per accident $600 $800 Diagnostic Exam Once per accident $300 $400 Emergency Dental Once per accident Up to $450 Up to $600 Emergency Room Once per accident $200 $250 Health Screening Benefit Once per year for each covered person $75 $75 Hospital Admission Once per accident $1,500 $2,000 Initial Physician Office Visit Once per accident $100 $150 Lodging Up to 30 nights per lifetime $150 $175 Medical Appliance Once per accident $200 $300 Physical Therapy Up to 10 visits each per accident $75 $100 Rehabilitation Facility Up to 15 days per lifetime $300 $450 Transportation Up to 3 trips per accident $600 $800 Urgent Care Once per accident $150 $200 X-ray Once per accident $150 $200
EMPLOYEE BENEFITS Accident Low High Employee $12.36 $17.10 Employee + Spouse $19.48 $26.94 Employee + Child(ren) $20.58 $28.52 Family $32.42 $44.88 29
Accident Insurance The Hartford EMPLOYEE BENEFITS
THIS POLICY PROVIDES GROUP ACCIDENT INSURANCE ONLY. Please refer to the benefit website for complete plan details, limits and exclusions, and claim instructions at www.mybenefitshub.com/annaisd
SPECIFIED INJURY & SURGERY LOW PLAN HIGH PLAN Abdominal/Thoracic Surgery Once per accident $3,000 $4,000 Arthroscopic Surgery Once per accident $500 $750 Burn Once per accident Up to $15,000 Up to $20,000 Burn – Skin Graft Once per accident for third degree burn(s) 50% of burn benefit Concussion Up to 3 per year $200 $250 Dislocation Once per joint per lifetime Up to $8,000 Up to $12,000 Eye Injury Once per accident Up to $750 Up to $1,000 Fracture Once per bone per accident Up to $10,000 Up to $12,000 Hernia Repair Once per accident $400 $600 Joint Replacement Once per accident $4,000 $6,000 Knee Cartilage Once per accident Up to $2,000 Up to $3,000 Laceration Once per accident Up to $1,000 Up to $1,500 Ruptured Disc Once per accident $2,000 $3,000 Tendon/Ligament/Rotator Cuff Once per accident Up to $2,000 Up to $3,000 CATASTROPHIC LOW PLAN HIGH PLAN Accidental Death Within 90 days; Spouse @ 50% and child @ 25% $75,000 $100,000 Common Carrier Death Within 90 days 1.5 times death benefit Coma Once per accident $15,000 $20,000 Dismemberment Once per accident Up to $75,000 Up to $100,000 Home Health Care Up to 30 days per accident $75 $100 Paralysis Once per accident Up to $75,000 Up to $100,000 Prosthesis Once per accident Up to $3,000 Up to $4,000 FEATURES LOW PLAN HIGH PLAN Ability Assist® EAP – 24/7/365 access to help for financial, legal or emotional issues Included Included HealthChampionSM – Administrative & clinical support following serious illness or injury Included Included
30
Critical Illness Insurance
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/annaisd
Please refer to the benefits portal at www.mybenefitshub.com/annaisd under the Critical Illness Section for full benefit provisions and descriptions.
* Rates shown are for employee only options. More plan and age bands on your benefit website, including spouse coverage.
Critical Illness Monthly Premiums* Employee $10,000.00 $20,000.00 18-29 $5.44 $9.48 30-39 $8.15 $14.90 40-49 $11.80 $22.21 Benefits Overview Covered Critical Illnesses Heart Attack (Myocardial Infarction) 100% Sudden Cardiac Arrest 100% Coronary Artery Bypass Surgery 25% Major Organ Transplant (25%
Insureds placed
100% Bone Marrow Transplant (Stem Cell Transplant) 100% Kidney Failure (End-Stage Renal Failure) 100% Stroke (Ischemic or Hemorrhagic) 100% Cancer Benefits Cancer (Internal or Invasive) 100% Non-Invasive Cancer 25% Skin Cancer $250 per calendar year Health Screening Benefit Health Screening (payable for employee and spouse only) $50 per calendar year Additional Benefits Coma 100% Severe Burns 100% Paralysis 100% Loss of Sight 100% Loss of Speech 100% Loss of Hearing 100% Optional Benefits Rider Advanced Alzheimer's Disease 25% Advanced Parkison's Disease 25% Benign Brain Tumor 100% Progressive Diseases Rider Amyotraphic Lateral Sclerosis (ALS) 100% Multiple Sclerosis (MS) 100% 31
Aflac EMPLOYEE BENEFITS
of this benefit is payable for
on a transplant list for a major organ transplant)
Life and AD&D Lincoln Financial Group
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/annaisd
Voluntary Life Benefits At-A-Glance
without providing evidence of insurability . If you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability.
• If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense.
Maximum Life Insurance Coverage Amount
• You can choose a coverage amount up to 5 times your annual salary or ($500,000 maximum) with evidence of insurability. See the Evidence of Insurability page for details.
• Your coverage amount will reduce by 50% when you reach age 70
Spouse Coverage
You can secure term life insurance for your spouse if you select coverage for yourself.
Guaranteed Life Insurance Coverage Amount
• Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to 50% of your coverage amount or ($30,000 maximum) for your spouse without providing evidence of insurability.
• Annual Limited Enrollment: If you are a continuing employee, you can increase the coverage amount for your spouse by four levels without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability.
• If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense.
What your benefits cover
Employee Coverage
Guaranteed Life Insurance Coverage Amount
• Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $250,000 without providing evidence of insurability.
• Annual Limited Enrollment: If you are a continuing employee, you can increase your coverage amount by four levels
Maximum Life Insurance Coverage Amount
• You can choose a coverage amount up to 50% of your coverage amount or ($250,000 maximum) for your spouse with evidence of insurability.
Employee Guaranteed coverage amount during initial offering or approved special enrollment period $250,000 Newly hired employee guaranteed coverage amount $250,000 Maximum coverage amount 5 times your annual salary ($500,000 maximum in increments of $10,000) Minimum coverage amount $10,000 Spouse Guaranteed coverage amount during initial offering or approved special enrollment period $30,000 Newly hired employee guaranteed coverage amount $30,000 Maximum coverage amount
$5,000) Minimum coverage amount $5,000 Dependent Children Day 1 months to age 26 guaranteed coverage amount $10,000 EMPLOYEE BENEFITS
50% of the employee coverage amount ($250,000 maximum in increments of
32
Life and AD&D Lincoln Financial Group
• Coverage amounts are reduced by 50% when an employee reaches age 70.
Dependent Children Coverage
You can secure term life insurance for your dependent children when you choose coverage for yourself to age 26
• Guaranteed Life Insurance Coverage Options: $10,000.
Voluntary AD&D Benefits At-A-Glance
• Provides a cash benefit to your loved ones if you die in an accident
• Provides a cash benefit to you if you suffer a covered loss in an accident
• Features group rates for Anna Independent School District employees
• Includes LifeKeys® services, which provide access to counseling, financial, and legal support
• Also includes TravelConnectSM services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home
Employee
• Maximum coverage amount: 5 times your annual salary ($500,000 maximum) in $10,000 increments
• Minimum coverage amount: $10,000
• Your employee AD&D coverage amount will reduce by 50% when you reach age 70. Benefits end when you retire.
Spouse
• You can secure AD&D insurance for your spouse if you select coverage for yourself.
• Maximum coverage amount: 50% of the employee coverage amount ($250,000 maximum) in $5,000 increments
• Minimum coverage amount: $5,000
• The spouse AD&D coverage amount will reduce by 50% when you reach age 70. Benefits end when you retire.
Dependent Children
• You can secure AD&D insurance for your dependent children when you choose coverage for yourself.
• 6 months to age 26 Maximum coverage amount: Up to $100,000 in $1,000 increments
• Minimum coverage amount: $1,000
• Age 1 Day to 6 months Maximum coverage amount: $1,000.
This is a summary of limited benefits and complete details can be found at www.mybenefitshub.com/annaisd under the AD&D section of the portal.
Spouse Rates are based on Employee’s age and cannot exceed 50% of the employees supplemental life amount.
Voluntary Group Life Monthly Premiums (per $10,000 in coverage) Age Employee <20-29 $0.60 30-34 $0.80 35-39 $0.90 40-44 $1.10 45-49 $1.66 50-54 $2.62 55-59 $4.30 60-64 $6.60 65-69 $12.70 70+ $22.28
Voluntary Group Life: Child(ren) Monthly Premiums ($10,000 in coverage) 0-26 $2.50 AD&D Monthly Premiums Per $10,000 $0.19
EMPLOYEE BENEFITS
33
Identity Theft iLOCK360
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/annaisd
Plus Plan Covers:
Social Security number trace, Change of address, Sex offender alerts, Payday loans, Court/criminal records, Full service restoration and lost wallet protection up to $1M insurance, Daily Monitoring of TransUnion Credit Bureau
Premium Plan Covers All of the Above and In Addition:
Daily monitoring of TransUnion credit bureau, Daily monitoring of Experian credit bureau, Daily monitoring of Equifax credit bureau, ScoreTracker
CyberAlertTM Internet Surveillance
Get peace of mind knowing that our exclusive technology scours websites, chat rooms and bulletin boards 24/7/365 to identify trading or selling of your personal information online. CyberAgent monitors:
• one Social Security number
• two email addresses
• two phone numbers
• one driver’s license
• two medical ID numbers
• five credit/debit cards
• five bank accounts
• one passport
$1 Million of Identity Theft Insurance
For even more peace of mind, you are insured with a one-milliondollar insurance policy against expenses in the event that your identity is compromised.
Lost Wallet Protection
If you lose your wallet, iLOCK360 agents will make all the calls necessary to replace missing cards and IDs: quick, easy, and less stress for you.
Full-Service Identity Restoration
Contact an iLOCK360 Certified Identity Theft Restoration
Management Specialist, who’ll work on your behalf to restore your ID, and let you get on with your life.
Change of Address
Prevent criminals from accessing your bank statements, credit card statements, and other identifying information by monitoring any changes to your address.
Sex Offender Reports
Understand if and when any sex offenders reside or move into your zip code and ensure that your identity isn’t being used fraudulently in the sex offender registry.
Court Records
Know if and when your name, date of birth and Social Security number appear in court records for an offense or crime that you did not commit.
Credit Report Monitoring
Find out your credit score, analyze your credit report, and monitor your identity for credit-related activity.
Social Security Number Trace
Know if your Social Security number becomes associated with another individual’s name or address.
Non-Credit Loans
See if your personal information becomes linked to payday loans that do not require hard credit inquiries.
ScoreTrackerTM
Receive a month-after-month report that provides relevant information with trends and credit score insight.
EMPLOYEE BENEFITS Identity Theft Monthly Premiums Plus Premium Employee $8.00 $15.00 Employee + Spouse $15.00 $22.00 Employee + Child(ren) $13.00 $20.00 Family $20.00 $27.00 34
Flexible Spending Account (FSA)
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. Anna ISD offers a 75 day grace period.
For full plan details, please visit your benefit website: www.mybenefitshub.com/annaisd
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 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
EMPLOYEE BENEFITS
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.
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 selfcare.
• 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 $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.
• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
NBS
35
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 Anna 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 Anna 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.
2023 - 2024 Plan
WWW.MYBENEFITSHUB.COM/ANNAISD
36
