CALALLEN ISD BENEFIT GUIDE EFFECTIVE: 09/01/2023 - 8/31/2024 WWW.MYBENEFITSHUB.COM/CALALLENISD 2023 - 2024 Plan Year 1
HOW TO ENROLL PG. 4
SUMMARY PAGES PG. 6 YOUR BENEFITS PG. 11
How to Enroll 4-5 Annual Benefit Enrollment 6-11 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 Fexible Savings Account (FSA) 15-16 Telehealth 17 Emergency Medical Transportation 18 Dental 19 Vision 20 Disability 21-22 Accident 23 Cancer 24 Critical Illness 25-26 Hospital Indemnity 27 Basic Life 28 Life and AD&D 29 Universal Life 30 Identity Theft 31
Table of Contents
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Benefit Contact Information
BENEFIT ADMINISTRATORS MEDICAL
Financial Benefit Services (800) 583-6908
www.mybenefitshub.com/calallenisd
Texas Schools Health Benefits Program (TSHBP) (888) 803-0081
All Plans: www.tshbp.org
Pharmacy Benefits: SouthernScripts Group #50000
https://tshbp.info/DrugPham
FLEXIBLE SPENDING ACCOUNT (FSA) TELEHEALTH
National Benefit Services (800) 274-0503
www.nbsbenefits.com
MDLIVE (866) 365-1663
www.mdlive.com/fbsbh
HEALTH SAVINGS ACCOUNT (HSA)
EECU (817) 882-0800
www.eecu.org
EMERGENCY MEDICAL TRANSPORT
MASA MTS (800) 423-3226
https://www.masamts.com/
DENTAL VISION DISABILITY
Lincoln Financial Group Group #00001D041379 (800) 423-2765
https://www.lfg.com/
EyeMed Group #VC-146 (844) 225-3107
www.eyemed.com
Lincoln Financial Group STD Group #000010266966
LTD Group #000010266963 (800) 423-2765
https://www.lfg.com/
ACCIDENT CANCER CRITICAL ILLNESS
UNUM
Group #448246011
(866) 679-3054
www.unum.com
American Public Life Group #24837 (800) 256-8606
www.ampublic.com
UNUM Group #448247011 (866) 679-3054
www.unum.com
HOSPITAL INDEMNITY LIFE AND AD&D UNIVERSAL LIFE
American Public Life Group #24837 (800) 256-8606
www.ampublic.com
IDENTITY THEFT
ID Watchdog
(800) 970-5182
www.idwatchdog.com
Lincoln Financial Group
Basic: Group #000010266962
Voluntary: Group #000400266965
(800) 423-2765
https://www.lfg.com/
Texas Republic Life (512) 330-0099
www.texasrepubliclife.com
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Employee benefits made easy through the FBS Benefits App! All Your BenefitsOne App OR SCAN Text “FBS CALALLEN” to (800) 583-6908 App Group #: FBSCALALLEN Text “FBS CALALLEN” 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/calallenisd
2
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.
CLICK LOGIN
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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 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.
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
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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/calallenisd 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 Calallen ISD benefit website: www.mybenefitshub.com/calallenisd. 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.
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26
Critical Illness To age 26
Accident To age 26
Life and AD&D To age 26
Identity Theft To age 25
Individual Life To age 25
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse eligibility.
FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse’s FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance.
Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent eligibility.
Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee’s enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage.
SUMMARY PAGES
PLAN MAXIMUM AGE
To age
To age
To age
To age
To
Medical
26 Telehealth
26 Dental
26 Vision
Cancer
age
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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.
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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Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Description
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, taxfree. This also allows employees to pay for qualifying dependent care tax- free. Employer
Permissible Use Of Funds
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.
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65).
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
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. Does the account earn interest?
Eligibility
All employers Contribution Source Employee and/or employer Employee and/or employer Account Owner Individual Employer Underlying Insurance Requirement High deductible health plan None Minimum Deductible $1,500 single (2023) $3,000 family (2023) N/A Maximum Contribution $3,850 single (2023) $7,750 family (2023) $3,050 (2023)
A qualified high deductible health plan.
FLIP TO FOR HSA INFORMATION FLIP TO FOR FSA INFORMATION PG. 13 PG. 15 SUMMARY PAGES HSA
FSA 10
Yes No Portable? Yes, portable year-to-year and between jobs. No
vs.
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/calallenisd
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
Access the MyTSHBP Digital Wallet for easy access to all your benefit resources.
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 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 (District Contribution of $375) *Plan Year Rate *Plan Year Rate *Plan Year Rate Employee Only $52.00 $100.00 $240.00 Employee/Spouse $793.00 $954.00 $1,232.00 Employee/Child $424.00 $528.00 $669.00 Employee/Family $1,155.00 $1,379.00 $1,599.00
EMPLOYEE BENEFITS 12
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/calallenisd
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 (TSHBP HD or Aetna HD)
• 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.
EECU EMPLOYEE
13
BENEFITS
Health Savings Account (HSA)
Opening an HSA
EMPLOYEE BENEFITS
If you meet the eligibility requirements, you may open an HSA administered by EECU. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA.
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.
EECU
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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 (unless your plan contains a grace period provision).
For full plan details, please visit your benefit website: www.mybenefitshub.com/calallenisd
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).
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
◦ Lost or Stolen Debit Cards Replacement Fee $5.00 (taken from account balance)
◦ Mail: PO Box 6980 West Jordan, UT 84084
Contact NBS
• Hours of Operation: 6:00 AM – 6:00 PM MST, Mon-Fri
• Phone: (800) 274-0503
• Email: service@nbsbenefits.com
• Mail: PO Box 6980 West Jordan, UT 84084
Dependent Care FSA
This account 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.
NBS EMPLOYEE BENEFITS 15
Flexible Spending Account (FSA)
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.
• 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 30 days (up until date).
• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
• The IRS has amended the “use it or lose it rule” to allow you to carry-over up to $610 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 (OTC) Item Rule
Health care reform legislation requires that certain over-the-counter (OTC) items require a prescription to qualify as an eligible Health Care FSA expense. You will only need to obtain a one-time prescription for the current plan year. You can continue to purchase your regular prescription medications with your FSA debit card. However, the FSA debit card may not be used as payment for an OTC item, even when accompanied by a prescription.
Flexible Spending Accounts
Health Care FSA
Dependent Care FSA
FSAstore.Com
Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses and doctor-prescribed over-the -counter medications)
Dependent care expenses (such as day care, after school programs or elder care programs) so you and your spouse can work or attend school full-time
$3,050
$5,000 single $2,500 if married and filing separate tax returns
Saves on eligible expenses not covered by insurance, reduces your taxable income
Reduces your taxable income
Check out the FSAstore at: https://fsastore.com. It offers thousands of FSA-eligible products and services to purchase using your FSA Debit Card or any major credit card. Competitive pricing and free shipping on orders over $50 can save you up to 40% using your FSA pretax dollars.
Account Type Eligible Expenses Annual Contribution Limits Benefit
NBS EMPLOYEE BENEFITS 16
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/calallenisd
Alongside your medical coverage is access to quality telehealth services through MDLIVE. Connect anytime day or night with a board-certified doctor via your mobile device or computer. While MDLIVE does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:
• Have a non-emergency issue and are considering a convenience care clinic, urgent care clinic or emergency room for treatment
• Are on a business trip, vacation or away from home
• Are unable to see your primary care physician
When to Use MDLIVE:
At a cost that is the same or less than a visit to your physician, use telehealth services for minor conditions such as:
• Sore throat
• Headache
• Stomach ache
• Cold
• Flu
• Allergies
• Fever
• Urinary tract infections
Do not use telemedicine for serious or life-threatening emergencies.
MDLIVE Behavioral Health:
Managing stress or life changes can be overwhelming but it’s easier than ever to get help right in the comfort of your own home. Visit a counselor or psychiatrist by phone, secure video, or MDLIVE App.
• Talk to a licensed counselor or psychiatrist from your home, office, or on the go!
• Affordable, confidential online therapy for a variety of counseling needs
• The MDLIVE app helps you stay connected with appointment reminders, important notifications and secure messaging.
Registration is Easy
Register with MDLIVE so you are ready to use this valuable service when and where you need it.
• Online – www.mdlive.com/fbsbh
• Phone – 888-365-1663
• Mobile – download the MDLIVE mobile app to your smartphone or mobile device
• Select –“MDLIVE as a benefit” and “FBS” as your Employer/Organization when registering your account.
Telehealth
Employee & Family $12.00
EMPLOYEE BENEFITS 17
Telehealth MDLive
Emergency Medical Transport
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/calallenisd
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.
Non-Emergency Inter-Facility Transportation
In the event that a member is in stable condition in a medical facility but requires a heightened level of care that is not available at their current medical facility, Members have access to nonemergency air or ground transportation between medical facilities.
Repatriation/Recuperation
Suppose you or a family member is hospitalized more than 100-miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for recuperation.
Should you need assistance with a claim contact MASA at 800-643-9023. You can find full benefit details at: www.mybenefitshub.com/calallenisd.
EMPLOYEE BENEFITS Plan Features Emergency Plus Membership Platinum Membership Emergency Air Transportation x x Emergent Ground Transportation x x Non-Emergency InterFacility Transportation x x Repatriation/ Recuperation x x Escort Transportation x Visitor Transportation x Return Transportation x Mortal Remains Transportation x Minor Return x Organ Retrieval/Organ Recipient Transportation x Vehicle Return x Pet Return x Worldwide Coverage x Emergency Medical Transportation Emergent Plus Platinum Employee & Family $11.00 $39.00 18
MASA
Dental Insurance Lincoln Financial Group
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/calallenisd
The Lincoln DentalConnect® PPO Plans:
• Plans cover many preventive, basic, and major dental care services
• Also cover orthodontic treatment for children
• Feature group rates for Calallen ISD employees
• Let you choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a contracting dentist
• Do not make you and your loved ones wait six months between routine cleanings
Visit LincolnFinancial.com/FindADentist
You can search by:
• Location
• Dentist name or office name
• Distance you are willing to travel
• Specialty, language and more Your search will automatically provide up to 100 dentists that most closely match your criteria. If your search does not locate the dentist you prefer, you can nominate one—just click the Nominate a Dentist link and complete the online form.
Deductibles are combined for basic and major Contracting Dentists’ services. Deductibles are combined for basic and major Non-Contracting Dentists’ services.
MaxRewards® lets you and your covered family members roll a portion of unused dental benefits from one year into the next. So you have extra benefit dollars available when you need them most.
Rollover Amount $250 per calendar year $350 per calendar year
Rollover Amount with Preferred Provider $350 per calendar year $500 per calendar year
Maximum Rollover Account Balance: $1,000 $1,250 Lifetime Orthodontic Max $850 $1,000
Orthodontic Coverage is available for dependent children and adults.
Waiting Period There are no benefit waiting periods for any service types
Benefit At-a-Glance Low High Calendar (Annual) Deductible Individual:
Family: $150 Waived
Individual: $50 Family: $150 Waived
$50
for Preventive
for Preventive
Annual Maximum $1,000 $1,500
$500 $700
Eligible Range (claim threshold)
Dental Low Plan High Plan Employee Only $18.54 $36.68 Employee and Spouse $36.60 $71.46 Employee and Child(ren) $48.67 $92.55 Employee and Family $66.72 $127.48
EMPLOYEE
19
BENEFITS
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/calallenisd
VISION CARE IN-NETWORK OUT-OF-NETWORK SERVICES MEMBER COST MEMBER REIMBURSEMENT EXAM SERVICES Exam $10 copay Up to $40 Retinal Imaging Up to $39 Not covered CONTACT LENS FIT AND FOLLOW-UP Fit & Follow-up - Standard Up to $40; contact lens fit and two follow-up visits Not covered Fit & Follow-up - Premium 10% off retail price Not covered FRAME Frame $0 copay; 20% off balance over $130 allowance Up to $91 STANDARD PLASTIC LENSES Single Vision $25 copay Up to $30 Bifocal $25 copay Up to $50 Trifocal $25 copay Up to $70 Lenticular $25 copay Up to $70 Progressive - Standard $80 copay Up to $50 Progressive - Premium Tier 1 - 4 $110-200 copay Up to $50 LENS OPTIONS Anti Reflective Coating - Standard $45 copay Up to $23 Anti Reflective Coating - Premium Tier 1-3 $57 - 85 copay Up to $23 Photochromic - Non-Glass $75 Not covered Polycarbonate - Standard $40 Not covered Scratch Coating - Standard Plastic $15 Not covered Tint - Solid and Gradient $15 Not covered UV Treatment $15 Not covered All Other Lens Options 20% off retail price Not covered CONTACT LENSES Contacts - Conventional $0 copay; 15% off balance over $130 allowance Up to $91 Contacts - Disposable $0 copay; 100% of balance over $130 allowance Up to $91 Contacts - Medically Necessary $0 copay; paid-in-full Up to $210 OTHER Hearing Care from Amplifon Network Discounts on hearing exam and aids; call 1.877.203.0675 Not covered Lasik or PRK from U.S. Laser Network 15% off retail or 5% off promo price; call 1.800.988.4221 Not covered FREQUENCY ALLOWED FREQUENCY –ADULTS ALLOWED FREQUENCY –KIDS Exam Once every plan year Once every plan year Frame Once every plan year Once every plan year Lenses Once every plan year Once every plan year Contacts Lenses Once every plan year Once every plan year (Plan allows member to receive either contacts and frame, or frame and lens services) Visit https://eyedoclocator.eyemedvisioncare.com/ or call (866) 939-3633 to find an in-network vision provider. Find an eye doctor (Insight Network) eyemed.com EyeMed Members App For LASIK, call 1.800.988.4221
can request your vision ID
EyeMed
888-581
Vision Employee $7.44 Employee + Spouse $14.14 Employee + Child(ren) $14.88 Family $21.87 20
Insurance EyeMed EMPLOYEE BENEFITS
You
card by contacting
directly at
-3648. You can also go to www.eyemed.com and register/login to access your account
Disability Insurance Lincoln Financial Group 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/calallenisd
Short-Term Disability Options
• Provides a cash benefit when you are out of work for up to 11 weeks due to injury, illness, surgery, or recovery from childbirth
• Provides a partial cash benefit if you can only do part of your job or work part time
• Features group rates for Calallen ISD employees
• Offers a fast, no-hassle claims process
Sickness elimination period
Accident elimination period
You must be out of work for 14 days due to an illness before you can collect disability benefits. You can begin collecting benefits on day 15.
You must be out of work for 14 days due to an accidental injury before you can collect disability benefits. You can begin collecting benefits on day 15.
You must be out of work for 30 days due to an illness before you can collect disability benefits. You can begin collecting benefits on day 31.
You must be out of work for 30 days due to an accidental injury before you can collect disability benefits. You can begin collecting benefits on day 31.
First Day Hospitalization
The elimination period is reduced if you are hospitalized due to an illness or accidental injury. You can begin collecting benefits on the first day of hospitalization.
Pre-existing Condition
If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 3 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months, unless you received no treatment of the condition for 12 consecutive months after your effective date.
Benefits Integration
• Your short-term disability benefits can coordinate with income from other sources, such as continued income or sick pay from your employer, during your disability.
• This allows you to receive up to 100% of your pre-disability income.
Open Enrollment
When you are first offered this coverage (and during approved open enrollment periods), you can take advantage of this important coverage with no health examination.
SHORT-TERM DISABILITY OPTION 1 OPTION 2 Weekly benefit amount 60% of your weekly salary, limited to $1,000 per week 60% of your weekly salary,
to $1,000 per week
limited
First day hospitalization 0 days 0 days Maximum coverage period 11 weeks 11 weeks Additional Plan Benefits Option 1 Option 2 5% Rehabilitation Assistance Included Included Premium Waiver Included Included Family Income Benefit Included Included Portability Included Included
Short-Term Disability (per $10 in benefit) O PTION 1 14/14 O PTION 2 30/30 Employee Only $0.77 $0.58
21
Disability Insurance Lincoln Financial Group
Long-Term Disability
• Provides a cash benefit after you are out of work for 90 days or more due to injury, illness, or surgery
• Features group rates for Calallen ISD employees
• Includes Employee Connect services, which give you and your family confidential access to counselors as well as personal, legal, and financial assistance
LONG-TERM DISABILITY
Monthly benefit amount
60% of your monthly salary, limited to $5,000 per month
Elimination period 90 days
Coverage period for your occupation
Maximum coverage period
Additional Plan Benefits
24 months
Up to age 65 or Social Security Normal Retirement Age (SSNRA), whichever is later
Progressive Income Benefit Included
Family Care Expense Benefit Included
Family Income Benefit Included Portability Included
Elimination Period
• This is the number of days you must be disabled before you can collect disability benefits.
• The 90-day elimination period can be met through either total disability (out of work entirely) or partial disability working with a reduced schedule or performing different types of duties).
Coverage Period for Your Occupation
• This is the coverage period for the trade or profession in which you were employed at the time of your disability (also known as your own occupation).
• You may be eligible to continue receiving benefits if your disability prohibits you from any employment for which you are reasonably suited through your training, education, and experience. In this case, your benefits are extended through the end of your maximum coverage period (benefit duration).
Maximum Coverage Period
• This is the total amount of time you can collect disability benefits (also known as the benefit duration).
• Benefits are limited to 24 months for mental illness; 24 months for substance abuse.
Pre-existing Condition
If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 3 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months.
Open Enrollment
When you are first offered this coverage (and during approved open enrollment periods), you can take advantage of this important coverage with no health examination.
General Disability Insurance Benefit Exclusions & Reductions
Like any insurance, this long-term disability insurance policy does have some exclusions. You will not receive benefits if:
• Your disability is the result of a self-inflicted injury or act of war
• You are not under the regular care of a doctor when you request disability benefits
• Your disability occurs while you are committing a felony or participating in a riot
• Your disability occurs while you are imprisoned for committing a felony
• Your disability occurs while you are residing outside of the United States or Canada for more than 12 consecutive months for a purpose other than work
Your benefits may be reduced if you are eligible to receive benefits from:
• A state disability plan or similar compulsory benefit act or law
• A retirement plan
• Social Security
• Any form of employment
• Workers’ Compensation
• Salary continuance
• Sick leave
A complete list of benefit exclusions and reductions is included in the policy. State restrictions may apply to this plan.
LTD - DISABILITY 90 DAY -PER $100 IN BENEFIT Age Rates 0 $0.173 30 $0.27 35 $0.45 40 $0.686 45 $0.957 50 $1.236 55 $1.577 60 $1.321 65 $1.037 70 $0.90
EMPLOYEE
22
BENEFITS
Accident Insurance Unum
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/calallenisd
How does it work?
Can pay a set benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur on and off the job. And it includes a range of incidents, from common injuries to more serious events.
Why is this coverage so valuable?
• It can help you with out-of-pocket costs that your medical plan doesn’t cover, like co-pays and deductibles.
• You’re guaranteed base coverage, without answering health questions.
• The cost is conveniently deducted from your paycheck
• You can keep your coverage if you change jobs or retire. You’ll be billed directly.
Who can get coverage?
• You - If you’re actively at work*
• Your spouse - Can get coverage as long as you have purchased coverage for yourself.
• Your children - Dependent children from birth until their 26th birthday, regardless of marital or student status.
How to file a Claim:
www.unum.com/employees/file-a-claim
AVAILABLE 24/7/365
• On the web: First time filing a claim? Go to our secure website, unum.com/claims, and register for an account. You can file and manage all your claims on this site, or on your mobile device.
• Using your mobile device: After you’ve registered online, you can download the Unum Customer App for Apple or Android devices (available wherever you get your apps). You can use the app to manage your claim or file new claims.
DIGITALLY FILE ALL TYPES OF CLAIMS
• Disability Insurance
• Leaves of absence (disability, maternity, FMLA)
• Life Insurance
• Accident, Critical Illness, Hospital, Dental and Vision Insurance
• Wellness benefits for screening tests
Not sure which type of claim to file? No problem. Just answer a few questions on the website or app, and we’ll help you figure everything out.
Other ways to file
BY PHONE
• Disability Insurance: Check with your HR department at work to find out whether you can file a disability claim over the phone.
• All other benefits: Call 1-800-635-5597.
BY PAPER FORM
• Get a claim form at unum.com/claims, or contact your HR department at work.
• Follow the instructions on the form to mail or fax your completed form.
Accident Low Plan High Plan Employee $5.81 $10.04 Employee + Spouse $10.03 $17.29 Employee + Child(ren) $13.87 $23.71 Family $18.09 $30.96
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/calallenisd
Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town treatments, special diets, daily living and household upkeep. In addition to these non medical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance through American Public Life helps pay for these direct and indirect treatment costs so you can focus on your health.
Should you need to file a claim contact APL at 800-256-8606 or online at www.ampublic.com . You can find additional claim forms and materials at www.mybenefitshub.com/calallenisd .
Pre-Existing Condition Exclusion: Review the Plan Summary page that can be found at
for full details.
Cancer Treatment Policy benefits Plan 1 Plan 2 Radiation and Chemotherapy, Immunotherapy Maximum Per 12-month period $10,000 $20,000 Hormone Therapy- Maximum of 12 treatments per calendar year $50 per treatment $50 per treatment Surgical Rider Benefits Plan 1 Plan 2 Surgical $30 unit dollar amount Max $3,000 per operation $30 unit dollar amount Max $3,000 per operation Anesthesia 25% of amount paid for covered surgery Bone Marrow Transplant-Maximum per lifetime $6,000 $6,000 Stem Cell Transplant- Maximum per lifetime $600 $600 Miscellaneous Care Rider Benefits Hair Piece (Wig)- 1 per lifetime $150 $150 Blood, Plasma & Platelets $300 per day $300 per day Ambulance- Ground /Air-Maximum of 2 trips per Hospital Confinement for all modes of transportation combined $200/$2000 per trip $200/$2000 per trip Heart Attack/Stroke First Occurrence Rider Benefits Plan 1 Plan 2 Lump Sum Benefit- Maximum per 1 covered person per lifetime $2,500 $2,500 Hospital Intensive Care Unit Rider Benefits Plan 1 Plan 2 Intensive Care Unit $600 per day $600 per day
www.mybenefitshub.com/calallenisd
APL EMPLOYEE
Cancer PLAN 1 PLAN 2 Employee Only $5.81 $10.04 Employee + Spouse $10.03 $17.29 Employee + Child(ren) $13.87 $23.71 Employee + Family $18.09 $30.96 24
BENEFITS
Critical Illness Insurance Unum 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/calallenisd
Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. To file a claim call UNUM at 800-858-6843 or find claim form at www.mybenefitshub.com/calallenisd.
Who is eligible for this coverage? All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status).
What are the Critical Illness coverage amounts?
The following coverage amounts are available.
For you: Select one of the following $10,000, $20,000 or $30,000
For your Spouse and Children: 50% of employee coverage amount
Can I be denied coverage? Coverage is guarantee issue.
When is coverage effective?
What critical illness conditions are covered?
Please see your Plan Administrator for your effective date of coverage. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.
all
Covered Conditions* Percentage of Coverage Amount Critical Illnesses Coronary Artery Disease (major) 50% Coronary Artery Disease (minor) 10% End Stage Renal (Kidney) Failure 100% Heart Attack (Myocardial Infarction) 100% Major Organ Failure Requiring Transplant 100% Stroke 100% Cancer Invasive Cancer (including
Breast
100% Non-Invasive Cancer 25% Skin Cancer $500 Supplemental Critical Illnesses Benign Brain Tumor 100% Coma 100% Loss of Hearing 100% Loss of Sight 100% Loss of Speech 100% Infectious Disease 25% Occupational Human Immunodeficiency Virus (HIV) or Hepatitis 100% Permanent Paralysis 100%
Cancer)
25
Critical Illness Insurance
What critical illness conditions are covered?
* Please refer to the policy for complete definitions of covered conditions.
Are wellness Screenings covered? Each insured is eligible to receive one Be Well Benefit per calendar year. Be Well Benefit For you, your spouse and your children: $50 Be Well Screenings include tests for the following: cholesterol and diabetes, cancer and cardiovascular function. They also ixnclude imaging studies, immunizations and annual examinations by a Physician. See certificate for details.
Pre-existing Conditions
We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following:
• a pre-existing condition; or
• complications arising from treatment or surgery for, or medications taken for, a pre-existing condition.
An insured has a pre-existing condition if, within the 3 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which:
• medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period;
• drugs or medications were taken, or prescribed to be taken during that period; or
• symptoms existed.
The pre-existing condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date any initial coverage or increases in coverage become effective.
(cont’d) Progressive Diseases Amyotrophic Lateral Sclerosis (ALS) 100% Dementia (including Alzheimer’s Disease) 100% Functional Loss 100% Multiple Sclerosis (MS) 100% Parkinson’s Disease 100% Additional Critical Illnesses for your Children Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Down Syndrome 100% Spina Bifida 100%
Illness Employee $10,000 Spouse $10,000 Employee $20,000 Spouse $20,000 Employee $30,000 Spouse $30,000 >25 $3.02 $3.02 $5.12 $5.12 $7.22 $7.22 25-29 $4.02 $4.02 $7.12 $7.12 $10.22 $10.22 30-34 $5.22 $5.22 $9.52 $9.52 $13.82 $13.82 35-39 $7.12 $7.12 $13.32 $13.32 $19.52 $19.52 40-44 $9.52 $9.52 $18.12 $18.12 $26.72 $26.72 45-49 $12.62 $12.62 $24.32 $24.32 $36.02 $36.02 50-54 $16.22 $16.22 $31.52 $31.52 $46.82 $46.82 55-59 $22.12 $22.12 $43.32 $43.32 $64.52 $64.52 60-64 $30.92 $30.92 $60.92 $60.92 $90.92 $90.92 65-69 $45.02 $45.02 $89.12 $89.12 $133.22 $133.22 70-74 $70.12 $70.12 $139.32 $139.32 $208.52 $208.52 75-79 $103.32 $103.32 $205.72 $205.72 $308.12 $308.12 80-84 $150.22 $150.22 $299.52 $299.52 $448.82 $448.82 85+ $242.02 $242.02 $483.12 $483.12 $724.22 $724.22
Critical
Unum EMPLOYEE BENEFITS 26
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/calallenisd
The Hospital Indemnity Plan provided through American Public Life (APL) helps with the high cost of medical care by paying you a set amount when you have an inpatient hospital stay. Unlike traditional insurance, which pays a benefit to the hospital or doctor, this plan pays you directly based on the care or treatment you receive. These costs may include meals and transportation, childcare or time away from work due to a medical issue that requires hospitalization.
Should you need to file a claim contact APL at 800-256-8606 or online at www.ampublic.com. You can find additional claim forms and materials at http://www.mybenefitshub.com/Calallenisd
Service Benefit 1500 Plan 2000 Plan 3000 Plan Hospital Admission Benefit $1,500 per day Maximum 1 day $2,500 per day Maximum 1 day $3,000 per day Maximum 1 day Hospital Confinement Benefit $200 per day, Maximum 30 days Intensive Care Unit Benefit $200 per day, Maximum 15 days Rehabilitation Benefit $200 per day, Maximum 5 days Portability Rider Included Hospital Indemnity 1500 Plan 2000 Plan 3000 Plan Employee Only $16.76 $20.14 $26.26 Employee and Spouse $38.46 $41.64 $54.26 Employee and Child(ren) $22.28 $23.52 $30.40 Employee and Family $40.92 $45.44 $58.88
APL EMPLOYEE
27
Hospital Indemnity
BENEFITS
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/calallenisd
EMPLOYEE BENEFITS
Employer Paid that Safeguards the most important people in your life. Term life insurance can help your loved ones in so many ways, like covering everyday expenses, paying off debt, and protecting savings. AD&D provides even more coverage if you die or suffer a covered loss in an accident.
AT A GLANCE:
• A cash benefit of $25,000 to your loved ones in the event of your death, plus a matching cash benefit if you die in an accident
• A cash benefit to you if you suffer a covered loss in an accident, such as losing a limb or your eyesight
• Life Keys® services, which provide access to counseling, financial, and legal support
• Travel Connect® services, which give you and your family access to emergency medical assistance when you're on a trip 100+ miles from home
• Employee Connect services, which give you and your family confidential access to counselors as well as personal, legal, and financial assistance
Additional Details
Conversion: You can convert your group term life coverage to an individual life insurance policy without providing evidence of insurability if you lose coverage due to leaving your job or for another reason outlined in the plan contract. AD&D benefits cannot be converted.
Benefit Reduction: Coverage amounts begin to reduce at age 70 and benefits terminate at retirement. See the plan certificate for details.
How to File a Claim
Call Customer Service Center: 800-423-2765
Step 1: Press “1” to indicate that you’re an insured member
Step 2: Enter your Social Security number (SSN) or the policyholder’s SSN (if different). If your SSN cannot be located or is not yet in the system, you can select from the following options:
• Claims and verification of benefits
• Member service (enrollment status, evidence of insurability and continuation of options)
Step 3: Select the type of coverage you are calling about:
• Press “1” for Absence Management, Disability, Accident, or Critical Illness
• Press “2” for Dental
• Press “3” for Life
• Press “4” for Vision
28
Voluntary 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/calallenisd
Voluntary Life Insurance
• Provides a cash benefit to your loved ones in the event of your death
• A cash benefit to you if you suffer a covered loss in an accident, such as losing a limb or your eyesight
• LifeKeys® services, which provide access to counseling, financial, and legal support services
• Also includes TravelConnect® services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home
• To file a claim contact Lincoln Financial at (800) 423-2765
Benefit Exclusions
Like any insurance, this term life insurance policy does have exclusions. A suicide exclusion may apply. In addition, the AD&D insurance policy does not cover sickness or disease, including the medical and surgical treatment of a disease. A complete list of benefit exclusions is included in the policy. State variations apply.
Note: You must be an active Calallen Independent School District employee to select coverage for a spouse and/or dependent children. To be eligible for coverage, a spouse or dependent child cannot be confined to a health care facility or unable to perform the typical activities of a healthy person of the same age and gender.
Employee Your coverage amount will reduce by 50% when you reach age 70
Guaranteed coverage amount during initial offering or approved special enrollment period
Newly hired employee guaranteed coverage amount
$250,000
$250,000
Continuing employee guaranteed coverage annual increase amount Choice of $10,000 or $20,000
Maximum coverage amount 7 times your annual salary ($500,000 maximum in increments of $10,000)
Minimum coverage amount $10,000
AD&D coverage amount Equal to the life insurance amount chosen
Spouse Coverage amounts are reduced by 50% when an employee reaches age 70
Guaranteed coverage amount during initial offering or approved special enrollment period
$50,000
Newly hired employee guaranteed coverage amount $50,000
Continuing employee guaranteed coverage annual increase amount Choice of $5,000 or $10,000
Maximum coverage amount 50% of the employee coverage amount ($250,000 maximum in increments of $5,000)
Minimum coverage amount $5,000
AD&D coverage amount Equal to the life insurance amount chosen
Dependent Children
Day 1 to age 26 guaranteed coverage amount $10,000
Additional Plan Benefits
Accelerated Death Benefit
Premium Waiver
Included
Included
Included Portability Included Seat
& Airbag Included with AD&D Common
Included with AD&D
Conversion
Belt
Carrier
Voluntary Group Life Age Employee or Spouse (per $1,000) 18-24 $0.06 25-29 $0.07 30-34 $0.09 35-39 $0.109 40-44 $0.119 45-49 $0.168 50-54 $0.248 55-59 $0.447 60-64 $0.676 65-69 $1.281 70-74 $2.066 75+ $31.40 Child(ren) (per $1,000 in coverage) 0-26 $0.20
EMPLOYEE BENEFITS
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Universal Life Insurance Texas Republic Life
ABOUT UNIVERSAL LIFE
Universal 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/calallenisd
EMPLOYEES CAN EASILY QUALIFY
TrueFlex is guaranteed issue up to $50,000 in coverage and for more coverage only answer 3 questions (at right) covering the last six months: NO MEDICAL EXAM!
TRUEFLEX IS EASY TO ENROLL IN
TrueFlex is easy to enroll in, right at your place of employment. No one coming to your home.
TRUEFLEX IS EASY TO FUND
TrueFlex is easy to fund by payroll deduction.
TRUEFLEX IS EASY TO PORT
TrueFlex policies are easy to port, you keep the same premium, your payment simply changes from a payroll deduction to a bank draft. No requalifying, no conversions and no decreasing face amounts.
TRUEFLEX IS EASY TO KEEP AND MAINTAIN
TrueFlex is easy to keep, {See form: TRLIC-WFUL7) you have permanent life insurance coverage to age 27 as long as you pay the required premiums. Texas Republic Life has a service desk to address any questions you may have, or policy services that you may need.
GUARANTEED ISSUE UP TO $50,000
QUALIFICATION QUESTIONS FROM $50,001 - $150,000
During the last six months, has the proposed insured:
a. Been actively at work on a full time basis, performing usual duties?
b. Been absent from work due to illness or medical treatment for a period of more than five consecutive working days?
c. Been disabled or received tests, treatment or care of any kind in a hospital or nursing home or received chemotherapy, hormonal therapy for cancer, radiation therapy, dialysis treatment, or treatment for alcohol or drug abuse?
EMPLOYEE
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BENEFITS
Identity Theft ID Watchdog
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/calallenisd
Your identity is important — it’s what makes you, you. You’ve spent a lifetime building your name and financial reputation. Let us help you better protect it. And, we’ll even go one step further and help you better protect the identities of your family.
EASY & AFFORDABLE IDENTITY PROTECTION
With ID Watchdog®, you have an easy and affordable way to help better protect and monitor the identities of you and your family. You’ll be alerted to potentially suspicious activity and enjoy the peace of mind that comes with the support of dedicated resolution specialists. And, a customer care team that’s available any time, every day.
ID WATCHDOG IS HERE FOR YOU
ID Watchdog is everywhere you can’t be — monitoring credit reports, social media, transaction records, public records and more — to help you better protect your identity. And don’t worry, we’re always here for you. In fact,
our U.S.-based customer care team is available 24/7/365 at 866.513.1518.
WHY CHOOSE ID WATCHDOG
Credit Lock
With our online and in-app feature, lock your Equifax® credit report — and your child’s Equifax credit report — to help provide additional protection against unauthorized access to your credit.
More for Families
Our family plan helps you better protect your loved ones, with each adult getting their own account with all plan features. And, we offer more features that help protect minors than any other provider.
Dedicated Resolution Specialists
If you become a victim, you don’t have to face it alone. One of our certified resolution specialists will fully manage the case for you until your identity is restored.
UNIQUE FEATURES INCLUDED IN ALL ID WATCHDOG PLANS
Monitor & Detect
• Dark Web Monitoring1
• High-Risk Transactions Monitoring2
• Subprime Loan Monitoring2
• Public Records Monitoring
• USPS Change of Address Monitoring
• Identity Profile Report
Manage & Alert
• Child Credit Lock3 | 1 Bureau
• Financial Accounts Monitoring
• Social Network Alerts
• Registered Sex Offender Reporting
• Customizable Alert Options
• Breach Alert Emails
• Mobile App
Support & Restore
• Identity Theft Resolution Specialists (Resolution for Preexisting Conditions)
• 24/7/365 U.S.-based Customer Care Center
• Lost Wallet Vault & Assistance
• Deceased Family Member Fraud Remediation
• Fraud Alert & Credit Freeze Assistance
Helps better protect children
1. Bureau = Equifax®
2. Multi-Bureau = Equifax, TransUnion®
3. Bureau = Equifax, Experian®, TransUnion
WHAT YOU NEED TO KNOW Plan Options ID WATCHDOG® 1B ID WATCHDOG® PLATINUM Credit Report(s) & VantageScore Credit Score(s) 1 Bureau Monthly 1 Bureau Daily & 3 Bureau Annually Credit Score Tracker 1 Bureau Monthly 1 Bureau Daily Credit Report Monitoring 1 Bureau Multi-Bureau Credit Report Lock 1 Bureau $54.40 Identity Theft Insurance Up to $1M Up to $1M 401K/HSA Stolen Funds Reimbursement, Subprime Loan Block, Social Account Takeover Alerts, Personal VPN & Safe Browsing, Password Manager - Included MONTHLY PREMIUMS Employee $5.90 $7.50 Employee and Family $10.90 $13.50
EMPLOYEE BENEFITS 31
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 Calallen 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 Calallen 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 Year WWW.MYBENEFITSHUB.COM/CALALLENISD
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