2023 - 2024 Plan Year
ESC REGION 20 BENEFITS COOPERATIVE
BENEFIT GUIDE EFFECTIVE: 09/01/2023 - 8/31/2024 WWW.ESC20BC.NET
1
Table of Contents How to Enroll
4-5
Annual Benefit Enrollment
6-10
1. Section 125 Cafeteria Plan Guidelines
6
2. Annual Enrollment
7
3. Eligibility Requirements
8
4. Helpful Definitions
9
5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA)
10
Medical
11-12
Health Savings Account (HSA)
13-14
Hospital Indemnity
15
Telehealth
16
Dental
17-18
Vision
19
Disability
20
Cancer Accident
23
Critical Illness
24-25
Life and AD&D
26-27
Individual Life
28
Emergency Medical Transportation
29
Identity Theft
32
Flexible Spending Account (FSA)
2
21-22
31-32
Employee Assistance Program
33
FBS Benefits App Group # Index
34
FLIP TO...
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HOW TO ENROLL
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SUMMARY PAGES
PG. 11
YOUR BENEFITS
Benefit Contact Information ESC REGION 20 BC BENEFITS
MEDICAL
PHARMACY
Financial Benefit Services (800) 583-6908 www.esc20bc.net
Texas Schools Health Benefits Program (TSHBP) (888) 803-0081 All Plans: www.tshbp.org
SouthernScripts Group #50000 (800) 710-9341 https://tshbp.info/DrugPham
HEALTH SAVINGS ACCOUNT
HOSPITAL INDEMNITY
TELEHEALTH
EECU (817) 882-0800 www.eecu.org
CHUBB Claims Assistance: (888) 499-0425
MDLIVE (888) 365-1663 www.mdlive.com/fbsbh
DENTAL
VISION
DISABILTY
Cigna Group #3336975 (800) 244-6224 www.mycigna.com
Superior Vision by MetLife Group #28888 (800) 638-5433 www.metlife.com
The Hartford (866) 547-9124 www.thehartford.com
CANCER
ACCIDENT
CRITICAL ILLNESS
American Public Life Group #13309 (800) 256-8606 www.ampublic.com
American Public Life Group #13309 (800) 256-8606 www.ampublic.com
CHUBB Claims Assistance: (888) 499-0425
LIFE AND AD&D
INDIVIDUAL LIFE
EMERGENCY MEDICAL TRANSPORT
CHUBB Claims Assistance: (888) 499-0425
5Star Life Insurance (866) 863-9753 www.5starlifeinsurance.com
MASA (800) 423-3226 www.masamts.com
IDENTITY THEFT
FLEXIBLE SPENDING ACCOUNT (FSA)
EMPLOYEE ASSISTANCE PROGRAM (EAP)
ID Watchdog (800) 774-3772 www.idwatchdog.com
Higginbotham (866) 419-3519 https://flexservices.higginbotham. net/ flexclaims@higginbotham.com
ComPsych (844) 266-0712 www.guidanceresources.com Web ID: CHUBB
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All Your Benefits One App Employee benefits made easy through the FBS Benefits App! Text “FBS ESC20” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment:
Text “FBS ESC20” to (800) 583-6908
• Benefit Resources • Online Enrollment • Interactive Tools • And more!
App Group #:
Go to PAGE 32 to find your district’s group #
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OR SCAN
How to Log In 1
www.esc20bc.net
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SELECT YOUR SCHOOL FROM THE DROP DOWN LIST
3
CLICK LOGIN
4
ENTER USERNAME & PASSWORD Your Username Is: The first six (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number. If you have not logged in recently, your Password is: Last Name (Excluding punctuation) followed by the last four (4) digits of your Social Security Number. If you have logged in recently, your password may the password previously created, NOT the password format listed above.
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Annual Benefit Enrollment
SUMMARY PAGES
Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
CHANGES IN STATUS (CIS):
QUALIFYING EVENTS
Marital Status
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
Change in Number of Tax Dependents
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 Status of Employment Affecting Coverage Eligibility
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual’s eligibility under an employer’s plan includes commencement or termination of employment.
Gain/Loss of Dependents’ Eligibility Status
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
6
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.
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
Annual Benefit Enrollment
SUMMARY PAGES
Annual Enrollment During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs. •
•
Changes, additions or drops may be made only during the annual enrollment period without a qualifying event. Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.
Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.esc20bc.net. 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 ESC Region 20 BC benefit website: www.esc20bc.net. 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 • Employees must confirm on each benefit screen expect to receive those 3-4 weeks after your effective (medical, dental, vision, etc.) that each dependent date. For most dental and vision plans, you can login to be covered is selected in order to be included in to the carrier website and print a temporary ID card the coverage for that particular benefit. 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 All new hire enrollment elections must be completed in the online enrollment system within the first 30 days carrier’s customer service number to request another card. of benefit eligible employment. Failure to complete elections during this timeframe will result in the If the insurance carrier provides ID cards, but there are forfeiture of coverage. no changes to the plan, you typically will not receive a new ID card each year.
New Hire Enrollment
Q&A
Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.
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Annual Benefit Enrollment
SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 18.75 or more regularly scheduled hours each work week.
Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 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.
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PLAN
MAXIMUM AGE
Accident
Through 25
Cancer
Through 25
Dental
Through 25
Dependent Flex
12 or younger or qualified individual unable to care for themselves & claimed as a dependent on your taxes
Healthcare FSA
Through 25 or IRS Tax Dependent
Health Savings Account
IRS Tax Dependent
Identity Theft
Through 25
Hospital Indemnity
Through 25
Individual Life
Through 22
Telehealth
Through 25
Vision
Through 25
Voluntary Life
Through 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
Helpful Definitions Actively-at-Work
In-Network
You are performing your regular occupation for the employer on a full-time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2023 please notify your benefits administrator.
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.
Annual Enrollment The period during which existing employees are given the opportunity to enroll in or change their current elections.
Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.
Calendar Year January 1st through December 31st
Out-of-Pocket Maximum The most an eligible or insured person can pay in co insurance 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).
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. 9
SUMMARY PAGES
HSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Description
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, taxfree. This also allows employees to pay for qualifying dependent care tax-free.
Employer Eligibility
A qualified high deductible health plan.
All employers
Contribution Source
Employee and/or employer
Employee and/or employer
Account Owner
Individual
Employer
Underlying 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)
Permissible Use Of Funds
Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Cash-Outs of Unused Amounts (if no medical expenses)
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age Not permitted 65).
Year-to-year rollover of account balance?
Yes, will roll over to use for subsequent year’s health coverage.
No. Access to some funds may be extended if your employer’s plan contains a 2 1/2-month grace period or $500 rollover provision.
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
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FOR HSA INFORMATION
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FOR FSA INFORMATION
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Medical Insurance
Texas Schools Health Benefits Program
EMPLOYEE BENEFITS
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.esc20bc.net
Directed Care Highlights
Aetna Network 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.
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.
Please note, hospitals are excluded from the PPO networks. All hospital and other medical facility-based services are accessed via an assigned Care Coordinator.
With our network, you now have access to over 1.2 million participating doctors, 8,700 hospitals, and strong, negotiated discounts.
It is easy to look up providers in your area by looking up providers in your area by clicking on the link below.
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.
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.
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
Scan the QR code with your mobile device or visit tshbp.org/myrates to view your rates!
PPO Deductible Credits 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! 11
Medical Insurance
EMPLOYEE BENEFITS
Texas Schools Health Benefits Program DIRECTED CARE PLANS TSHBP - HD Plan TSHBP CoPay Plan Directed Care Plan • Use Care Coordinator for Hospital/ Surgical Services • Compatible with an HSA • Embedded Deductible - no coinsurance • Out-of-Network Benefits
PLAN SUMMARY
Coverage
Directed Care Plan • Use Care Coordinator for Hospital/ Surgical Services • Co-payments for Services • Reduce Out-of-Pocket • Out-of-Network Benefits
AETNA NETWORK PLAN Aetna Signature Traditional PPO Plan • PPO Network for all physician/hospital services • Brand Drug Deductible • Care Coordinator is an optional benefit
In-Network Coverage
In-Network Coverage
In-Network Only
Network Plan Deductible Feature Individual/Family Deductible Coinsurance Individual/Family Maximum Out-ofPocket
HealthSmart - National Deductible, then Plan pays 100% $3,500/$10,500 None - Plan Pays 100% after deductible
HealthSmart Copayments, then Plan pays 100% $0/$0 None - Plan Pays 100% after deductible
AETNA Deductible, then Plan pays 70% $4,000/$8,000 You pay 30% after deductible
$3,500/$10,500
$4,000/$11,000
$10,000/$20,000
Health Savings Account (HSA) Eligible Required - Primary Care Provider (PCP) Required - PCP Referral to Specialist
Yes No No
No No No
No No No
Yes - $0 copay $30 per consultation Deductible, then Plan pays 100% Deductible, then Plan pays 100%
Yes - $0 copay $0 per consultation $45 copay $70 copay
Yes - $0 copay $0 per consultation $45 copay $70 copay
Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100%
$5 copay $35 copay $35 copay $110 copay $275 copay
You pay 30% after deductible You pay 30% after deductible $70 copay You pay 30% after deductible You pay 30% after deductible
Deductible, the Plan pays 100% Deductible, the Plan pays 100% Deductible, the Plan pays 100% Deductible, the Plan pays 100% Deductible, the Plan pays 100% Deductible, the Plan pays 100% Deductible, the Plan pays 100%
$75 copay $500 copay $500 copay $275 copay $650 copay $650 copay $200 copay
$75 copay You pay $500 copay + 30% after ded You pay 30% after deductible You pay 30% after deductible You pay 30% after deductible You pay 30% after deductible You pay 30% after deductible
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
Deductible, the Plan pays 100% Deductible, the Plan pays 100% Deductible, the Plan pays 100% Deductible, the Plan pays 100% Deductible, the Plan pays 100%
$55 copay $110 copay $110 copay $55 copay $500 copay
$30 copay You pay 30% after deductible You pay 30% after deductible You pay 30% after deductible You pay 30% after deductible
Doctor Visits Preventive Care Virtual Health - Teladoc Primary Care Specialist
Office Services Allergy Injections Allergy Serum Chiropractic Services Office Surgery MRI's, Cat Scans, and Pet Scans
Care Facilities Urgent Care Facility Freestanding Emergency Room Hospital Emergency Room Ambulance Services Outpatient Surgery Hospital Services Surgeon Fees
Maternity and Newborn Services
Rehabilitation/Therapy Occupational/Speech/Physical Cardiac Rehabilitation Chemotherapy, Radiation, Dialysis Home Health Care Skilled Nursing
Prescription Drug Benefits Drug Deductible
Intergrated into Medical
No Drug Deductible
$500 brand deductible
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
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
Generic
Specialty 12
Health Savings Account (HSA) EECU
EMPLOYEE BENEFITS
ABOUT HSA A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). For full plan details, please visit your benefit website: www.esc20bc.net
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 • 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 • 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 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 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.
Opening an HSA
If you meet the eligibility requirements, you may open an HSA administered by HSA Bank. 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.
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Health Savings Account (HSA) EECU
EMPLOYEE BENEFITS
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 • •
• •
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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; locations & service hours: www.eecu.org/locations
Hospital Indemnity
EMPLOYEE BENEFITS
CHUBB
ABOUT HOSPITAL INDEMNITY This is an affordable supplemental plan that pays you should you be in patient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance. For full plan details, please visit your benefit website: www.esc20bc.net
It’s not easy to pay hospital bills, especially if you have a high deductible medical plan. Chubb Hospital Cash pays money directly to you if you are hospitalized so you can focus on your recovery. And since the cash goes directly to you, there are no restrictions on how you use your money. Choose from 1 of 2 plans: Hospitalization Benefits
Payable Benefit PLAN 1
PLAN 2
Hospital Admission Benefit This benefit is for admission to a hospital or hospital sub-acute intensive care unit.
• •
$1,000 Maximum Benefit Per Calendar Year: 5
• •
$3,000 Maximum Benefit Per Calendar Year: 5
Hospital Confinement Benefit This benefit is for confinement in hospital or hospital sub-acute intensive care unit.
• •
$100 Per Day Maximum Days Per Calendar Year: 30
• •
$200 Per Day Maximum Days Per Calendar Year: 30
• •
$200 Per Day Maximum Days Per Calendar Year: 30
• •
$400 Per Day Maximum Days Per Calendar Year: 30
• •
$500 Per Day Maximum Days per Confinement - Normal Delivery: 2 Maximum Days per Confinement - Caesarean Section: 2
• •
$500 Per Day Maximum Days per Confinement - Normal Delivery: 2 Maximum Days per Confinement - Caesarean Section: 2
• •
$50 Maximum Benefit Per Calendar Year: 1
• •
$50 Maximum Benefit Per Calendar Year: 1
• •
$500 Maximum Benefit Per Calendar Year: 2
• •
$500 Maximum Benefit Per Calendar Year: 2
Hospital Confinement ICU Benefit The benefit for confinement in a hospital intensive care unit.
Newborn Nursery This benefit is payable for an insured newborn baby receiving newborn nursery care and who is not confined for treatment of a physical illness, infirmity, disease or injury.
Health Screening Benefit Observation Unit This benefit is for treatment in a hospital observation unit for a period of less than 20 hours.
Employee Employee + Spouse Employee + Child(ren) Family
•
Monthly Premiums PLAN 1 $9.72 $21.57 $17.98 $29.84
•
PLAN 2 $19.85 $44.07 $36.73 $60.95 15
Telehealth
EMPLOYEE BENEFITS
MDLive
ABOUT TELEHEALTH Telehealth provides 24/7/365 access to board-certified doctors via telephone or video consultations that can diagnose, recommend treatment and prescribe medication. Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available. For full plan details, please visit your benefit website: www.esc20bc.net Alongside your medical coverage is access to quality telehealth services through MDLIVE. Connect anytime day or night with a board-certified doctor via your mobile device or computer. While MDLIVE does not replace your primary care physician, it is a convenient and cost-effective option when you need care and: • Have a non-emergency issue and are considering a convenience care clinic, urgent care clinic or emergency room for treatment • Are on a business trip, vacation or away from home • Are unable to see your primary care physician
When to Use MDLIVE:
At a cost that is the same or less than a visit to your physician, use telehealth services for minor conditions such as: • Sore throat • Headache • Stomachache • Cold • Flu • Allergies • Fever • Urinary tract infections Do not use telemedicine for serious or life-threatening emergencies.
MDLIVE Behavioral Health:*
Managing stress or life changes can be overwhelming but it’s easier than ever to get help right in the comfort of your own home. Visit a counselor or psychiatrist by phone, secure video, or MDLIVE App. • Talk to a licensed counselor or psychiatrist from your home, office, or on the go! • Unlimited, confidential online consultations for a variety of counseling needs with no copay. • The MDLIVE app helps you stay connected with appointment reminders, important notifications and secure messaging. * Does not apply to those with employer-paid telehealth. Check with your benefits office for details.
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
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$8.00 $16.00
Dental Insurance
EMPLOYEE BENEFITS
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.esc20bc.net
DPPO Plan
Coverage is provided through Cigna, and a High Plan and a Low Plan are offered. Those two levels of benefits are available with the DPPO plan: in-network and out-ofnetwork. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services. You could pay more if you use an outof-network provider.
How to Find an In-network Dentist
To search for a dentist on Cigna.com, visit the site and click “Find a Doctor, Dentist or Facility.” Follow the prompts on screen and when asked to choose your plan, select “DPPO/ EPO > Dental Choice Cigna DPPO.” Or call 800-244-6224 to find an in-network dentist.
How to Request a New ID Card
You can request your dental id card by contacting Cigna directly at 800-244-6224. You can also go to www.mycigna.com and register/login to access your account. In addition you can download the “MyCigna” app on your smartphone and access your ID card right there on your phone.
Employee Employee + Spouse Employee + Child(ren) Family
DHMO – Dental Plan
Coverage is provided through Cigna Dental Care DHMO benefits After you enroll in a plan and receive your ID card, you can manage your plan information on your personal home page on myCigna.com • You have the freedom to select any participating general dentist as your primary care dentist. To select a dental provider from our network, simply visit Cigna.com. Once there, you can also check your benefits, email us and get a new or temporary ID card. If you prefer, contact us at 1-800-244-6224. With the Cigna Dental DHMO plan you pay your dentist directly, when applicable. • Your primary dentist will provide all of your routine dental care and you will pay any copayment or discounted charges at the time of service. • Visit Cigna.com to find a participating specialist. For additional information refer to your benefits at www.esc20bc.net and select your school district and then Dental.
Dental High DPPO $35.09 $86.44 $94.77 $132.11
Low MAC $17.58 $35.72 $41.07 $62.71
DHMO $11.74 $22.16 $25.00 $38.70
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Dental Insurance
EMPLOYEE BENEFITS
The Hartford
Cigna Dental Choice Plan Summary Please see plan documents for details and limitations High PPO Plan
Reimbursement Levels Calendar Year Deductible Individual Family Calendar Year Benefit Maximum Per Individual
PPO Low Plan
In-Network ‘Total Cigna DPPO’
Out-of-Network
In-Network ‘Total Cigna DPPO’
Out-of-Network
Based on Contracted Fees
Maximum Reimbursable Charge
Based on Contracted Fees
Maximum Allowable Charge
$50 $150
$50 $150
$50 $150
$50 $150
Year 1: $1,750 Year 2: $2,000 Year 3: $2,250
$1,000
You Pay
You Pay
Benefit Highlights Class I: Diagnostic & Preventive Oral Evaluations Prophylaxis: routine cleanings X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain
No Charge
No Charge
No Charge
No Charge
Class II: Basic Restorative Restorative: fillings Endodontics: minor and major Periodontics: minor and major Oral Surgery: minor and major Anesthesia: general and IV sedation Repairs: dentures
20% after deductible
20% after deductible
20% after deductible
20% after deductible
Class III: Major Restorative Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures Repairs: bridges, crowns and inlays Denture Relines, Rebases and Adjustments
50% after deductible
50% after deductible
50% after deductible
50% after deductible
50% No Deductible
50% No Deductible
No Coverage
No Coverage
Class IV: Orthodontia Coverage for Dependent Children to age 19 Lifetime Benefits Maximum: $1,000
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Vision Insurance
EMPLOYEE BENEFITS
Superior Vision by MetLife 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.esc20bc.net
Our vision plan provides quality care to help preserve your health and eyesight. In addition to identifying vision and eye problems, regular exams can detect certain medical issues such as diabetes and high cholesterol. You may seek care from any licensed optometrist, ophthalmologist or optician, but plan benefits are better if you use an in-network provider. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through Superior Vision.
How to Find a Vision Provider
Visit www.metlife.com/vision or call (877) 235-5317 to find an in-network vision provider. Your network is the Superior Vision by MetLife network. Copays
Services/frequency Base
Monthly Premiums
Base
Buy-Up
Buy-Up
Base
Buy-Up
Exam
$10
$0
Exam
12 months
Materials
$25
$0
Frame
12 months
Employee
$6.88
$10.97
Employee + Spouse
$13.66
$21.79
Contact Lens Fitting
$25
$0
Lenses
12 months
Employee + Child(ren)
$13.38
$21.34
Contacts
12 months
Family
$20.36
$32.48
Base Plan
Buy-Up Plan
In-network
Out-of-network
In-network
Out-of-network
Lenses • Single Vision • Bifocals • Trifocals • Factory Scratch Coat • Ultraviolet coat
Covered in full Covered in full Covered in full $15/Covered in full $12/Covered in full
Up to $32 Up to $46 Up to $61 Not Covered Not Covered
Covered in full Covered in full Covered in full Covered in full Covered in full
Up to $32 Up to $46 Up to $61 Not Covered Not Covered
Frames
$125 retail allowance
Up to $68
$175 retail allowance
Up to $68
Contacts • Contact lenses
$120 retail allowance
Up to $100
$120 retail allowance
Up to $100
*Contact lenses are in lieu of eyeglass lenses and frames benefit.
How to Print your Vision ID Card:
You can request your vision id card by contacting Superior Vision directly at (855) MET-EYE1. You can also go to www.metlife.com/vision and register/login to access your account by clicking on “Members” at the top of the page.
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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.esc20bc.net
What is Disability Insurance?
Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. The plan gives you flexibility to be able to choose an amount of coverage and waiting period that suits your needs. For more information regarding Disability insurance, please review information in your benefits website at www.esc20bc.net and select your school district to review your plan options.
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Cancer Insurance
EMPLOYEE BENEFITS
APL
ABOUT CANCER Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment. For full plan details, please visit your benefit website: www.esc20bc.net
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 800256-8606 or online at www.ampublic.com. You can find additional claim forms and materials at www.esc20bc.net. SUMMARY OF BENEFITS Benefits Internal Cancer First Occurrence* Cancer Screening Rider Benefits Diagnostic Testing- 1 test per calendar year Follow Up-Diagnostic Testing- 1 test per calendar year Medical Imaging- per calendar year Cancer Treatment Policy Benefits Radiation and Chemotherapy, Immunotherapy Maximum Per 12-month period Hormone Therapy- Maximum of 12 treatments per calendar year Surgical Rider Benefits Surgical Anesthesia Bone Marrow Transplant-Maximum per lifetime Stem Cell Transplant- Maximum per lifetime Misc. Care Rider Benefits Hair Piece (Wig)- 1 per lifetime Blood, Plasma &Platelets
Plan 1 $2,500
Plan 2 $2,500
$50 per test
$50 per test
$100 per test
$100 per test
$500 per test/ 1 per calendar year
$500 per test/ 1 per calendar year
$10,000
$20,000
$50 per treatment
$50 per treatment
Plan 1 $30 unit dollar amount Max $3,000 per operation
Plan 2 $45 unit dollar amount Max $4,500 per operation $0.50 per mile per round trip $100 per day, up to 100 days per calendar year
25% of amount paid for covered surgery $6,000
$9,000
$600
$900
Plan 1 $150 $300 per day
Plan 2 $150 $300 per day 21
Cancer Insurance
EMPLOYEE BENEFITS
APL
SUMMARY OF BENEFITS (cont’d) Misc. Care Rider Benefits Plan 1 Ambulance- Ground /Air-Maximum of Ground: $200 per trip 2 trips per Hospital Confinement for all Air: $2000 per trip modes of transportation combined Heart Attack/Stroke First Occurrence Plan 1 Rider Benefits Lump Sum Benefit- Maximum per 1 $2500 covered person per lifetime Hospital Intensive Care Unit Rider Plan 1 Benefits Intensive Care Unit $600 per day *Carcinoma in situ is not considered internal cancer
Plan 2 Ground: $200 per trip Air: $2000 per trip Plan 2 $2500 Plan 2 $600 per day
Pre-Existing Condition Exclusion: Review the Benefit Summary page that can be found at www.esc20bc.net for full details.
Employee Employee + Spouse Employee + Child(ren) Family
Cancer Plan 1 $17.80 $32.70 $24.80 $32.70
Plan 2 $32.40 $57.80 $44.60 $57.80
The plan includes an annual Wellness Benefit. Download a claim form on your benefit website: www.esc20bc.net Should you need to file a cancer claim contact APL at 800-256-8606 or online at www.ampublic.com. You can find additional claim forms and informational materials at www.esc20bc.net under your school district in the Cancer section of the portal.
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Accident Insurance
EMPLOYEE BENEFITS
APL
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.esc20bc.net
The Accident Plan provided through American Public Life (APL) is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or not-so-serious, injury. Accident coverage is low-cost protection available to you and your family without evidence of insurability. 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 on your employee benefits portal. Benefit Description
Summary of Benefits
Accidental Death – per unit
$5,000
Medical Expense Accidental Injury Benefit – per unit
Actual charges up to $500
Daily Hospital Confinement Benefit
$75 per day
Air and Ground Ambulance Benefit
Actual charges up to $1,250
Accidental Dismemberment Benefit • Single finger or toe • Multiple fingers or toes • Single hand, arm, foot or leg • Multiple hands, arms, feet or legs
$500 $500 $2,500 $5,000
Accidental Loss of Sight Benefit – per unit • Loss of sight in one eye • Loss of sight in both eyes
$2,500 $5,000
Accident Employee Employee + Spouse Employee + Child(ren) Family
$10.80 $19.40 $21.20 $29.80
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Critical Illness Insurance
EMPLOYEE BENEFITS
CHUBB
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.esc20bc.net Available Coverage Choices Employee $10,000; $20,000; $30,000; or $40,000 face amounts Spouse $10,000; $20,000; $30,000; or $40,000 face amounts Child Included in the employee rate No benefit will be paid for a date of diagnosis that occurs prior to the coverage effective date. Covered individuals must be treatment free from cancer for 12 months prior to diagnosis date and in complete remission. There is no pre-existing condition limitation. All amounts are Guaranteed Issue- no medical questions are required for coverage to be issued.
Critical Illness Benefits Covered Conditions ALS Alzheimer's Disease Benign Brain Tumor Breast Cancer Carcinoma In Situ Cancer (See below for skin cancer) Carcinoma In Situ Coma Coronary Artery Obstruction End Stage Renal Failure Heart Attack Loss of Sight, Speech, or Hearing Major Organ Failure Multiple Sclerosis Paralysis or Dismemberment Parkinson’s Disease Severe Burns Stroke Sudden Cardiac Arrest Transient Ischemic Attacks Skin Cancer Benefit - Payable once per insured per year 24
Payable Benefit as a Percentage of Face Amount 100% 100% 100% 100% 100% 25% 100% 25% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 10% $500
Critical Illness Insurance
EMPLOYEE BENEFITS
CHUBB
Covered Conditions Occupational Package Pays 100% of the face amount; Benefits payable for HIV or Hepatitis B, C, or D, MRSA, Rabies, Tetanus, or Tuberculosis contracted on the job. Childhood Conditions Pays 100% of the dependent child face amount; Provides benefits for childhood conditions (Autism Spectrum Disorder; Cerebral Palsy; Congenital Birth Defects; Heart, Lung, Cleft Lip, Palate, etc; Cystic Fibrosis; Down Syndrome; Gaucher Disease; Muscular Dystrophy; Type 1 Diabetes). Miscellaneous. Disease Rider + COVID-19 The Miscellaneous Disease Rider is payable once per covered condition. Covered Conditions include: Addison’s Disease, Cerebrospinal Meningitis, Diphtheria, Huntington’s Chorea, Legionnaire’s Disease, Malaria, Myasthenia Gravis, Meningitis, Necrotizing Fasciitis, Osteomyelitis, Polio, Rabies, Scleroderma, Systemic Lupus, Tetanus, Tuberculosis. COVID-19 means a disease resulting in a positive COVID-19 diagnostic screening and 5 consecutive days of hospital confinement. Recurrence Benefit Benefits are payable for a subsequent diagnosis of Benign Brain Tumor, Cancer, Coma, Coronary Artery Obstruction, Heart Attack, Major Organ Failure, Severe Burns, Stroke, or Sudden Cardiac Arrest. Additional Benefits Waiver of Premium Waives premium while the Insured is totally disabled. Wellness Benefit - Payable once per insured per year
Payable Benefit as a Percentage of Face Amount Included
Included
25%
100%
Included $50
25
Life and AD&D
EMPLOYEE BENEFITS
CHUBB
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.esc20bc.net
Educator Group Term Life Insurance
Life insurance is an important part of your employee benefits package. Chubb Term Life and Accidental Death and Dismemberment (AD&D) insurance provides the protection your family needs if something were to happen to you. Your family can receive cash benefits paid directly to them that they can use to help cover expenses like mortgage payments, credit card debt, childcare, college tuition and other household expenses.
Benefit Summary
Voluntary Term Life and AD&D Insurance is made available for purchase by you and your family. Employees must be actively at work for at least 18.75 hours per week.
Life Insurance/AD&D
For You • Life/AD&D: $10,000 to $500,000 in $10,000 increments For Your Spouse Life: $10,000 to $500,000 in $10,000 increments AD&D: 50% of the employee AD&D amount not to exceed $250,000
• •
For Your Dependent Children Life: $10,000 AD&D: 10% of the employee AD&D amount to a maximum of $50,000
• •
Reduction Schedule 50% at age 70 Guaranteed Issue Employee: $300,000 Spouse: $50,000 Child: $10,000 You and your eligible dependents may enroll in amounts up to $300,000 for employee and $50,000 for spouse without
• • •
26
answering health questions. Amounts over the guaranteed issue will require medical underwriting. If you buy at least $10,000 of coverage during initial enrollment, you may buy up to the guaranteed issue in subsequent re-enrollments without medical underwriting.
Additional Plan Benefits Accelerated Death Benefit for Chronic Illness Up to 50% of Death Benefit in payments of 4% per month. Accelerated Death Benefit for Terminal Illness 75% of Death Benefit Employee Assistance Program 6 visits Travel Assistance Services Included AD&D Covered Losses and Benefits The AD&D plan provides additional protection for you and your dependents in the event of an accidental bodily injury resulting in death or dismemberment. In addition to standard dismemberment coverage, the following benefit provisions are included: • Child Care Expense Benefit – 10% of AD&D Benefit up to $4,000 per year for 5 years • Child Education Expense Benefit – 10% of AD&D Benefit up to $4,000 for up to 5 years • Exposure and Disappearance Benefit • Repatriation Expense Benefit – 10% of AD&D Benefit up to $5,000 • Seatbelt Benefit – 10% of AD&D Benefit up to $25,000 • Air Bag Benefit – 10% of AD&D Benefit up to $5,000
Life and AD&D
EMPLOYEE BENEFITS
CHUBB
Definitions and Provisions
Term Life Exclusions*
Conversion When your group coverage ends, you may convert your coverage to an individual life policy without providing evidence of insurability.
AD&D Exclusions*
Portability You can elect portable coverage, at group rates, if you terminate employment, reduce hours or retire from the employer.
Monthly Costs for Voluntary Term Life/AD&D Insurance You have the option to purchase Supplemental Term life Insurance. Listed below are the monthly rates.
Voluntary Group Life Employee Spouse Monthly Age Band Monthly Life Rate Life Rate per per $10,000 $10,000 <25 $0.50 $0.50 25-29 $0.50 $0.50 30-34 $0.70 $0.70 35-39 $0.80 $0.80 40-44 $1.00 $1.00 45-49 $1.40 $1.40 50-54 $2.40 $2.40 55-59 $3.90 $3.90 60-64 $5.90 $5.90 65-69 $8.30 $8.30 70-74 $10.30 $10.30 75+ $14.70 $14.70 Child Life $10,000 $1.80 One premium covers all children
No benefits will be paid for losses that are caused by, contributed to, or result from: 1) suicide, while sane or insane, occurring within 12 months after a Covered Person’s initial effective date of coverage; and 2) suicide, while sane or insane, occurring within two years after the date any increases in or additional coverage applied for becomes effective for a Covered Person. No benefits will be paid for any loss caused or contributed to by: 1) attempted suicide; 2) intentionally self-inflicted harm; 3) travel if Insured is other than passenger; 4) war; 5) active participation in a riot, insurrection, or terrorist activity; 6) committing or attempting to commit a felony; 7) voluntary intake or use by any means of any drug, unless taken in accordance with instructions; 8) any poison, gas or fumes, unless a direct result of an occupational accident; 9) being intoxicated; 10) bungee jumping; 11) participation in an illegal occupation/activity; 12) rock or mountain climbing; and 13) aeronautics.
Voluntary AD&D - $10,000 in coverage
Employee Family
$0.25 $0.40
27
Individual Life Insurance 5Star
EMPLOYEE BENEFITS
ABOUT INDIVIDUAL LIFE Individual insurance is a policy that covers a single person and is intended to meet the financial needs of the beneficiary, in the event of the insured’s death. This coverage is portable and can continue after you leave employment or retire. For full plan details, please visit your benefit website: www.esc20bc.net
Enhanced coverage options for employees. Easy and flexible enrollment for employers. The 5Star Life Insurance Company’s Family Protection Plan offers both Individual and Group products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your employees. CUSTOMIZABLE With several options to choose from, employees select the coverage that best meets the needs of their families. TERMINAL ILLNESS ACCELERATION OF BENEFITS Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL). PORTABLE Coverage continues with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly. CONVENIENCE Easy payments through payroll deduction. FAMILY PROTECTION Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves. * Financially dependent children 14 days to age 23. PROTECTION TO COUNT ON Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two-year contestability period and/or under investigation. This coverage has no war or terrorism exclusions. QUALITY OF LIFE Optional benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following: • Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or • Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision. Find full details and rates at www.esc20bc.net Should you need to file a claim, contact 5Star directly at (866) 863-9753. * Quality of Life not available ages 66-70. Quality of Life benefits not available for children Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 years).$7.15 monthly for $10,000 coverage per child.
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Emergency Medical Transport MASA
EMPLOYEE BENEFITS
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.esc20bc.net
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 non-emergency 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 benefit Emergency Transportation Emergent Plus Employee and Family
$14.00
29
Identity Theft
EMPLOYEE BENEFITS
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.esc20bc.net
Easy & Affordable Identity Protection
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!
Features • •
Credit Lock- helps provide additional protection against unauthorized access to your credit More For Families- helps better protect your loved ones no matter the age. Resolution Specialist- manage the case for you until your identity is restored
Manage & Alert • Child Credit Lock*| 1Bureau • Credit Report Lock | 1Bureau* • Financial Accounts Monitoring • Social Network Alerts* • Registered Sex Offender Reporting* • Customizable Alert Options • Breach Alert Emails • Mobile App • National Provider ID Alerts
Call 866-513-1518 or download the app to additional services.
Support & Restore • Identity Theft Resolution Specialists (Resolution for Pre existing Conditions)* • 24/7/365 U.S.-based Customer Care Center • Up to $1M Identity Theft Insurance* • Lost Wallet Vault & Assistance • Deceased Family Member Fraud Remediation • Fraud Alert & Credit Freeze Assistance
IDENTITY THEFT PROTECTION
*Helps better protect children
•
ID watchdog Monitors: social media, transaction records, public records, and more.
How to file a claim:
The Powerful Features You Want — All at an Affordable Price Monitor & Detect • Credit Report & VantageScore • Credit Score | 1 Bureau Monthly • Credit Score Tracker | 1 Bureau Monthly • Credit Report Monitoring1 | 3 Bureau • Dark Web Monitoring* • High-Risk Transactions Monitoring* • Subprime Loan Monitoring* • Public Records Monitoring* • USPS Change of Address Monitoring • Identity Profile Report
30
Identity Theft Employee Family
$7.95 $14.95
Flexible Spending Account (FSA) Higginbotham
EMPLOYEE BENEFITS
ABOUT FSA A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (unless your plan contains a $610 rollover or grace period provision). For full plan details, please visit your benefit website: www.esc20bc.net Health Care FSA The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $3,050 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include: • Dental and vision expenses • Medical deductibles and coinsurance • Prescription copays • Hearing aids and batteries You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA). Higginbotham Benefits Debit Card The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s). Dependent Care FSA The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full-time student. Things to Consider Regarding the Dependent Care FSA • Overnight camps are not eligible for reimbursement (only day camps can be considered). • If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13. • You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care. • The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes. 31
Flexible Spending Account (FSA) Higginbotham
EMPLOYEE BENEFITS
Important FSA Rules • The maximum per plan year you can contribute to a Health Care FSA is $3,050. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately. • You cannot change your election during the year unless you experience a Qualifying Life Event. • You can continue to file claims incurred during the plan year for another 90 days after August 31st. • Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses. Higginbotham Portal The Higginbotham Portal provides information and resources to help you manage your FSAs. • Access plan documents, letters and notices, forms, account balances, contributions and other plan information • Update your personal information • Utilize Section 125 tax calculators • Look up qualified expenses • Submit claims • Request a new or replacement Benefits Debit Card Register on the Higginbotham Portal Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information. • Enter your Employee ID, which is your Social Security number with no dashes or spaces. • Follow the prompts to navigate the site. • If you have any questions or concerns, contact Higginbotham: ◊ Phone – 866-419-3519 ◊ Email – flexclaims@higginbotham.net ◊ Fax – 866-419-3516 Higginbotham Flex Mobile App Easily access your Health Care FSA on your smartphone or tablet with the Higginbotham mobile app. Search for Higginbotham in your mobile device’s app store and download as you would any other app. • View Accounts – Includes detailed account and balance information • Card Activity – Account information • SnapClaim – File a claim and upload receipt photos directly from your smartphone • Manage Subscriptions – Set up email notifications to keep up-to-date on all account and Health Care FSA debit card activity • Log in using the same username and password you use to log in to the Higginbotham Portal. Note: You must register on the Higginbotham Portal in order to use the mobile app.
32
Employee Assistance Program (EAP) ComPsych
EMPLOYEE BENEFITS
ABOUT EAP An Employee Assistance Program (EAP) is a program that assists you in resolving problems such as finding child or elder care, relationship challenges, financial or legal problems, etc. This program is provided by your employer at no cost to you. For full plan details, please visit your benefit website: www.esc20bc.net
Why I Need Employee Assistance
Balancing work and life is difficult sometimes. Your EAP option covers trouble areas such as: • Substance abuse • Stress management • Financial problems EAP Employee Assistance Program: This is an added value of your Basic Life Insurance plan with the district that offers no cost counseling up to 6 Sessions in- person per plan year. For full plan details, please visit your benefit website, www.esc20bc.net and select your school district.
33
ESC20BC Mobile App Login Group #’s Use your District’s group # to login to the FBS Benefits app. District
GROUP #
District
GROUP #
Alameda School for Art and Design
ESC20A
Knippa ISD
ESC20S
Big Springs Charter School
ESC20B
Leakey ISD
ESC20U
Brackett ISD
ESC20C
Legacy Traditional Schools - Texas
ESC20AD
BRAINATION (Charter)
ESC20D
Meadowland Charter School
ESC20AV
Charlotte ISD
ESC20F
Meridian World School
ESC20AW
Dime Box ISD
ESC20G
New Frontiers Public Schools
ESC20AX
Divide ISD
ESC20V
Nixon-Smiley CISD
ESC20AY
Doral ISD
ESC20AZ
Prairie Lea ISD
ESC20AA
Dripping Springs ISD
ESC20H
Prelude Preparatory
ESC20AK
Eleanor Kolitz Hebrew Language Academy
ESC20I
Promesa Public Schools
ESC20AB
ESC Region 20
ESC20J
San Antonio Preparatory
ESC20AC
Fayetteville ISD
ESC20L
Schulenburg ISD
ESC20AE
Flatonia ISD
ESC20M
Smithville ISD
ESC20AF
Harper ISD
ESC20N
Somerset Academy Inc.
ESC20AG
Johnson City ISD
ESC20O
Southwest Preparatory School
ESC20AH
Jourdanton ISD
ESC20P
Texas Preparatory School
ESC20AI
Jubilee Academies
ESC20Q
Utopia ISD
ESC20AJ
Katherine Anne Porter School
ESC20R
Wayside Schools
ESC20AL
34
Notes
35
2023 - 2024 Plan Year
Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the ESC Region 20 BC 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 ESC Region 20 BC 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.
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