2023-24 Goose Creek ISD Benefit Guide

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GOOSE
BENEFIT GUIDE EFFECTIVE: 09/01/2023 - 8/31/2024
2023 - 2024 Plan Year 1
CREEK CISD
WWW.MYBENEFITSHUB.COM/GOOSECREEKCISD
HOW TO ENROLL PG. 4 How to Enroll 4-5 Annual Benefit Enrollment 6-11 1. Benefit Updates 6 2. Section 125 Cafeteria Plan Guidelines 7 3. Annual Enrollment 8 4. Eligibility Requirements 9 5. Helpful Definitions 10 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 11 Medical 12 Health Savings Account (HSA) 13 Hospital Indemnity 14 Telehealth 15 Dental 16 Vision 17 Disability 18-19 Critical Illness 20-21 Cancer 22 Accident 23-24 Life and AD&D 25-26 Individual Life 27 Flexible Spending Account (FSA) 28-29 2
Table of Contents FLIP TO... SUMMARY PAGES PG. 6 YOUR BENEFITS PG. 12

Benefit Contact Information

Cigna (800)754-3207

www.cigna.com

MDlive (888)365-1663

www.consultmdlive.com

The Hartford Group #681973 (866)547-9124

www.thehartford.com

Lincoln

www.lfg.com

Unum (866)679-3054

www.unum.com

EyeMed (866)939-3633

www.eyemed.com

Bay Bridge Administrators Group #GP18-BB-SD

(800)845-7519

www.baybridgeadministrators.com/

(800)638-5433

www.metlife.com

Lincoln Financial

Group #997734 (800)487-1485

www.lfg.com

Texas Life (800)283-9233

www.texaslife.com/

Higginbotham

(800)419-3519

https://flexservices.higginbotham.net/

MEDICAL HEALTH SAVINGS ACCOUNT (HSA) HOSPITAL INDEMNITY Allegiance Group
GCEFCU
(855)999-6808
(800)683-3863 www.gcefcu.org
TELEHEALTH DENTAL VISION
Financial
Group (800)487-1485
DISABILITY CRITICAL ILLNESS CANCER
ACCIDENT LIFE AND AD&D INDIVIDUAL LIFE
MetLife
Group
SPENDING ACCOUNT (FSA)
FLEXIBLE
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Employee benefits made easy through the FBS Benefits App! All Your BenefitsOne App OR SCAN Text “FBS GCCISD” to (800) 583-6908 App Group #: FBSGCCISD Text “FBS GCCISD” 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/goosecreekcisd

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

Benefit Updates - What’s New:

• Dental: Rate increase and removal of DHMO plan

◊ If you were previously enrolled in the DHMO, and want to keep dental coverage, please be sure to update your plan election in THEbenefitsHUB

• Special Open Enrollment period for ALL current employees for Voluntary Life:

◊ Voluntary Life – Employee

New Hire GI: $300,000

Open Enrollment GI: $300,000

◊ Voluntary Life – Spouse

New Hire GI: $75,000

Open Enrollment GI: $75,000

◊ Voluntary Life – Child

New Hire GI: $10,000

Open Enrollment GI: $10,000

Don’t Forget!

• IRS has established new contribution limits for Flex and HSA!

◊ Flex - $3,050

◊ HSA - $3,850 Individual, $7,750 Family. Those age 55+ can contribute an additional $1,000

• Login and complete your benefit enrollment from 05/02/2023 - 05/26/2023

• Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202.

• Update your information: home address, phone numbers, email, and beneficiaries.

• REQUIRED!! Due to the Affordable Care Act (ACA) reporting requirements, you must add your dependent’s CORRECT social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator.

SUMMARY PAGES
6

Annual Benefit Enrollment

Section 125 Cafeteria Plan Guidelines

A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.

Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/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
7

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/ goosecreekcisd. 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 Goose Creek CISD benefit website: www.mybenefitshub.com/goosecreekcisd. 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
8

Annual Benefit Enrollment

Employee Eligibility Requirements

Medical and 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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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 26 Cigna To age 26
To age
Financial Group To age
EyeMed To age
To age
TSHBP
MDLIVE
26 Lincoln
26
26 MetLife
Financial Group
Life
UNUM To age 26 MetLife To age 26 Lincoln
To age 26 Texas
To age 26
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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
10

Health Savings Account (HSA) (IRC Sec. 223)

Flexible Spending Account (FSA) (IRC Sec. 125)

Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, taxfree. This also allows employees to pay for qualifying dependent care tax- free. Employer

Permissible Use Of Funds

Cash-Outs of Unused Amounts (if no medical expenses)

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.

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

No. However, your plan has a 45-day grace period. Does

Year-to-year rollover of account balance? Yes, will roll over to use for subsequent year’s health coverage.

Description
Eligibility A
All employers Contribution Source Employee and/or employer Employee and/or employer Account Owner Individual Employer Underlying Insurance Requirement High deductible health plan None Minimum Deductible $1,400 single (2023) $2,800 family (2023) N/A Maximum Contribution $3,850 single (2023) $7,750 family (2023) $3,050 (2023)
qualified high deductible health plan.
Yes
FLIP TO FOR HSA INFORMATION FLIP TO FOR FSA INFORMATION PG. 13 PG. 28 SUMMARY PAGES HSA vs. FSA 11
the account earn interest?
No Portable? Yes, portable year-to-year and between jobs. No

Medical Insurance

Allegiance Group EMPLOYEE BENEFITS

ABOUT MEDICAL

Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis.

For full plan details, please visit your benefit website: www.mybenefitshub.com/goosecreekisd

Employee Monthly Cost Basic HD Employee Only $100.00 Employee & Spouse $814.00 Employee & Child(ren) $452.00 Employee & Family $1,165.00 Standard Employee Only $150.00 Employee & Spouse $993.00 Employee & Child(ren) $572.00 Employee & Family $1,386.00 Enhanced Employee Only $283.00 Employee & Spouse $1,232.00 Employee & Child(ren) $685.00 Employee & Family $1,521.00 12

Health Savings Account (HSA) GCEFCU

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/goosecreekisd

A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs – it is also a tax -exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.

A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows taxfree 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, 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.

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EMPLOYEE BENEFITS

Hospital Indemnity Cigna

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/goosecreekisd

The Hospital Indemnity Plan provided through Cigna 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. If you need to submit a claim you do so by calling 800754-3207.

1 benefit per newborn child. This benefit is payable to the employee even if child coverage is not elected.

Limited to 30 days, 1 benefit per newborn child. This benefit is payable to the employee even if child coverage is not elected.

Portability Feature: You, your spouse, and child(ren) can continue 100% of your coverage at the time your coverage ends. You must be covered under the policy and be under the age of 100 in order to continue your coverage. Rates may change and all coverage ends at age 100. Applies to United States Citizens and Permanent Resident Aliens residing in the United States.

Hospitalization Benefits Plan 1 Plan 2 Hospital Admission No Elimination Period. Limited to 1 day, 1 benefit(s) every 365 days. $1,500 $2,500 Hospital Chronic Condition Admission No Elimination Period. Limited to 1 day, 1 benefit(s) every 90 days. $50 $50 Hospital Stay No Elimination Period. Limited to 30 days, 1 benefit(s) every 90 days. $100 $200 Hospital Intensive Care Unit (ICU) Stay No Elimination Period. Limited to 30 days, 1 benefit(s) every 90 days. $200 $300 Hospital Observation Stay 24 hour Elimination Period. Limited to 72 hours. $100 per 24-hour period $100 per 24-hour period Newborn Nursery Care Admission Limited to 1 day,
$500 $500
Nursery
Newborn
Care Stay
$100 $100 Hospital Indemnity Tier Plan 1 Plan 2 Employee Only $16.86 $27.20 Employee & Spouse $30.12 $47.98 Employee & Child(ren) $27.78 $43.72 Employee & Family $41.04 $64.48
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EMPLOYEE BENEFITS

Telehealth MDLive with Behavioral Health

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/goosecreekisd

Welcome to MDLIVE! Your anytime, anywhere doctor’s office.

Avoid waiting rooms and the inconvenience of going to the doctor’s office. Visit a doctor by phone, secure video, or MDLIVE App. Pediatricians are available 24/7, and family members are also eligible.

• U.S. board-certified doctors with an average of 15 years of experience.

• Consultations are convenient, private and secure.

• Prescriptions can be sent to your nearest pharmacy, if medically necessary.

Need a doctor? No long wait. No big bill.

Always open.

With MDLIVE, you can visit with a doctor 24/7 from your home, office or on-the-go.

We treat over 50 routine medical conditions including:

• Acne

• Allergies

• Cold / Flu

• Constipation

• Cough

• Diarrhea

• Ear Problems

• Fever

• Headache

• Insect Bites

• Nausea / Vomiting

• Pink Eye

• Rash

Introducing the MDLIVE App

• Respiratory Problems

• Sore Throats

• Urinary Problems / UTI

• Vaginitis

• And More

Sick in bed? Sick at work? Got a smartphone? Doctor visits are easier than ever with the MDLIVE App.

• Access to a doctor anywhere: at home, at work, or on the go

• Choose doctors from one of the nation’s largest telehealth networks

• Available 24/7 by video or phone Private, secure and confidential visits

• Connect instantly with MDLIVE Assist mdlive.com/getapp

Welcome to 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.

Confidential, convenient online therapy.

With MDLIVE, you can visit with a counselor or psychiatrist 24/7 from your home, office or on-the-go.

We can help you address:

• Addictions

• Bipolar Disorders

• Child and Adolescent Issues

• Depression

• Eating Disorders

• Grief and Loss

• Life Changes

• Men’s Issues

• Panic Disorders

• Parenting Issues

• Postpartum Depression

• Relationship and Marriage Issues

• Stress

• Trauma and PTSD

• Women’s Issues

• And more

Refer to fee schedule for additional visit copays.

Your doctor will send prescriptions (if medically necessary) to your nearest pharmacy.

Your Monthly Premium is $12.00 Join for free. Visit a doctor. consultmdlive.com 888-365-1663
EMPLOYEE BENEFITS 15

Dental Insurance Lincoln Financial Group EMPLOYEE BENEFITS

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/goosecreekisd

Our dental plan helps you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through Lincoln Financial Group.

Two levels of benefits are available with the DPPO plan: in-network and out-of-network. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services. You could pay more if you use an out-of-network provider.

Questions about your plan or claims? Call or email us. 800-423-2765 Monday – Thursday, 8 a.m. – 8 p.m. ET; Friday, 8 a.m. – 6 p.m. ET Claims@LFG.com

DPPO Plan
Schedule of Benefits Plan Low Plan High Plan Deductible (Annually on a Plan Year Basis) Contracted Dentist Non Contracted Dentist Contracted Dentist Non Contracted Dentist Individual $50 $50 $50 $50 Family $150 $150 $150 $150 Deductible applies to: Type 2 & 3 Type 2 & 3 Type 2 & 3 Type 2 & 3 Benefit Levels Type 1 – Diagnostic & Preventative 100% 100% 100% 100% Type 2 – Basic Services 50% 50% 80% 80% Type 3 – Major Services 50% 50% 50% 50% Type 4 – Orthodontic Services - - 50% 50% Benefits Based On Negotiated Fees U&C Negotiated Fees U&C Maximum Benefit (per covered person): Types 1, 2 & 3 combined $750 Per Plan Year $750 Per Plan Year $1,500 Per Plan Year $1,500 Per Plan Year Type 4, while covered by the plan - - $1,000 Lifetime $1,000 Lifetime Benefit Waiting Period Type 2 Expenses None None Type 3 Expenses None None Type 4 Expenses None None Late Entrant Limitation Type 2 Expenses None None Type 3 Expenses None None Type 4 Expenses None None
Dental LOW HIGH Employee $20.88 $30.00 Employee & Spouse $38.87 $57.37 Employee & Child(ren) $45.47 $73.65 Employee & Family $53.34 $85.75 16

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/goosecreekisd

Vision Employee $8.72 Employee + Spouse $18.64 Employee + Child(ren) $18.18 Family $27.48 VISION CARE IN-NETWORK OUT-OF-NETWORK SERVICES MEMBER COST MEMBER REIMBURSEMENT EXAM SERVICES Exam $10 copay Up to $45 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 $180 allowance Up to $126 STANDARD PLASTIC LENSES Single Vision $10 copay Up to $30 Bifocal $10 copay Up to $50 Trifocal $10 copay Up to $70 Lenticular $10 copay Up to $70 Progressive - Standard $65 copay Up to $50 Progressive - Premium Tier 1 - 4 $95-185 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 Polycarbonate - Standard <19 years of age $0 copay Up to $20 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 $180 allowance Up to $126 Contacts - Disposable $0 copay; 100% of balance over $180 allowance Up to $126 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. 17
Vision Insurance EyeMed EMPLOYEE BENEFITS

Disability Insurance

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/goosecreekisd

EDUCATOR DISABILITY INSURANCE OVERVIEW

What is Educator Disability Income Insurance?

Educator Disability insurance combines the features of a short-term and long-term disability plan into one policy. The coverage pays you a portion of your earnings if you cannot work because of a disabling illness or injury. The plan gives you the flexibility to choose a level of coverage to suit your need.

You have the opportunity to purchase Disability Insurance through your employer. This highlight sheet is an overview of your Disability Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail.

Why do I need Disability Insurance Coverage?

More than half of all personal bankruptcies and mortgage foreclosures are a consequence of disability1

1 Facts from LIMRA, 2016 Disability Insurance Awareness Month

The average worker faces a 1 in 3 chance of suffering a job loss lasting 90 days or more due to a disability2

2 Facts from LIMRA, 2016 Disability Insurance Awareness Month

Only 50% of American adults indicate they have enough savings to cover three months of living expenses in the event they’re not earning any income3

3 Federal Reserve, Report on the Economic Well-Being of U.S. Households in 2018

ELIGIBILITY AND ENROLLMENT Eligibility

You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis.

Enrollment

You can enroll in coverage within 31 days of your date of hire or during your annual enrollment period.

Effective Date

Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.

Actively at Work

You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session.

FEATURES OF THE PLAN Benefit Amount

You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $8,000 that cannot exceed 66 2/3% of your current monthly earnings. Earnings are defined in The Hartford’s contract with your employer.

Elimination Period

You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a Disability benefit payment. The elimination period that you select consists of two numbers. The first number shows the number of days you must be disabled by an accident before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin. For those employees electing an elimination period of 30

18
The Hartford EMPLOYEE BENEFITS

Disability Insurance The Hartford EMPLOYEE BENEFITS

days or less, if you are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization.

Maximum Benefit Duration

Benefit Duration is the maximum time for which we pay benefits for disability resulting from sickness or injury. Depending on the age at which disability occurs, the maximum duration may vary. Please see the applicable schedules below based on the Premium benefit option.

Premium Option: For the Premium benefit option – the table below applies to disabilities resulting from sickness or injury.

Age Disabled Maximum Benefit Duration

Prior to 63 To Normal Retirement Age or 48 months if greater

Age 63 To Normal Retirement Age or 42 months if greater

Age 64 36 months

Age 65 30 months

Age 66 27 months

Age 67 24 months

Age 68 21 months

Age 69 and older 18 months

PROVISIONS OF THE PLAN

Pre-Existing Condition Limitation

Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have been insured under this policy for 12 months before your disability begins.

If your disability is a result of a pre-existing condition, we will pay benefits for a maximum of 4 weeks.

Disability
Elimination Period Plan 1 0/7 $3.10 14/14 $2.64 30/30 $1.98 60/60 $1.12 90/90 $0.86 180/180 $0.68
(per $100 in benefit)
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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/goosecreekisd

Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness.

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: 100% of employee coverage amount

Can I be denied coverage? Coverage is guarantee issue.

When is coverage effective? 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.

What critical illness conditions are covered?

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% 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% Progressive Diseases Amyotrophic Lateral Sclerosis (ALS) 100% Dementia (including Alzheimer’s Disease) 100% Functional Loss 100% Multiple Sclerosis (MS) 100% Parkinson’s Disease 100%
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Critical Illness Insurance

Pre-existing Conditions

* Please refer to the policy for complete definitions of covered 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.

Additional Critical Illnesses for your Children Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Down Syndrome 100% Spina Bifida 100%
Critical Illness Employee and Spouse $10,000.00 $20,000.00 $30,000.00 <25 $1.10 $2.20 $3.30 25 - 29 $1.40 $2.80 $4.20 30 - 34 $1.80 $3.60 $5.40 35 - 39 $2.50 $5.00 $7.50 40 - 44 $3.40 $6.80 $10.20 45 - 49 $4.80 $9.60 $14.40 50 - 54 $6.60 $13.20 $19.80 55 - 59 $8.50 $17.00 $25.50 60 - 64 $12.50 $25.00 $37.50 65 - 69 $19.90 $39.80 $59.70 70 - 74 $37.10 $74.20 $111.30 75 - 79 $64.00 $128.00 $192.00 80 - 84 $110.60 $221.20 $331.80 85> $202.90 $405.80 $608.70
Unum EMPLOYEE BENEFITS 21

Cancer Insurance

Bay Bridge Administrators

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/goosecreekisd

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 Bay Bridge Administrators helps pay for these direct and indirect treatment costs so you can focus on your health.

Combined Premiums Base Plan + Intensive Care Rider (ICR- $325 per day) Coverage Tier Low + $325 ICR High + $325 ICR Employee $16.28 $21.84 Employee + Spouse $33.17 $44.54 Employee + Child(ren) $22.80 $29.74 Family $39.66 $52.42
EMPLOYEE
Cancer Plan Features Benefit Low High Hospital Confinement $100 per day $200 per day Surgical up to $1,500 up to $3,000 Radiation/Chemotherapy $500 per day $500 per month First Diagnosis $2,500 $5,000 Colony Stimulating Factors $500 per month $1,000 per month Miscellaneous Diagnostic Services $5,000 $5,000 Self-Administered Drugs $1,000 per month $1,000 per month Wellness $50 per year $50 per year 22
BENEFITS

Accident Insurance MetLife EMPLOYEE BENEFITS

ABOUT ACCIDENT

Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you.

For full plan details, please visit your benefit website: www.mybenefitshub.com/goosecreekisd

Benefits that may help cover costs such as those not covered by your medical plan.

Q. Who do I call for assistance?

A. Contact a MetLife Customer Service Representative at 1 800- GET-MET8 (1-800-438-6388), Monday through Friday from 8:00 a.m. to 8:00 p.m., EST. Or visit our website: mybenefits.metflife.com.

on the length of the cut and type of repair)

Benefit Type Low Plan Benefits High Plan Benefits Accidental Injury Benefits Fracture* (depending
$100 – $8,000 $200 – $10,000 Dislocation* (depending
$100 – $8,000 $200 – $10,000 Second- or
Degree Burn (depending
$75 – $10,000 $100 – $15,000 Concussion $250 $500 Coma $7,500 $10,000 Laceration (depending
$50 – $400 $75 – $700 Broken Tooth Crown: $200 / Filling: $25 / Extraction: $100 Crown: $300 / Filling: $50 / Extraction: $150 Eye Injury $300 $400 Accident - Medical Services & Treatment Benefits Ambulance Ground: $300 / Air: $1,000 Ground: $400 / Air: $1,250 Emergency Care (depending on location of care) $75 – $150 $100 – $200 Non-Emergency Initial Care $75 $100 Physician Follow-Up $75 $100 Therapy Services (including physical therapy) $35 $50 Medical Testing $150 $200 Medical Appliances (depending on the appliance) $75 – $750 $150 – $ $150 – $1,0001,000 Transportation $300 $400 Pain Management (for epidural anesthesia) $75 $100 Prosthetic Device One device: $750 More than one device: $1,500 One device: $1,000 More than one device: $2,000 Modification $1,000 $1,500 Blood/Plasma/Platelets $400 $500 Surgical Repair (depending on
type of surgery) $150 – $1,500 $200 – $2,000 Exploratory Surgery $150 $200 Other Outpatient Surgery $300 $400
on the fracture and type of repair)
on the dislocation and type of repair)
Third-
on degree of burn and percentage of burnt skin)
the
23

Accident Insurance MetLife

This coverage includes an Organized Sports Activity Benefit Rider. The rider increases the amount payable under the Certificate for certain benefits by 25% for injuries resulting from an accident that occurred while participating as a player in an organized sports activity. The rider sets forth terms, conditions and limitations, including the covered persons to whom the rider applies.

Benefit Type Low Plan Benefits High Plan Benefits Hospital Benefits* Admission $1,000 for the day of admission $1,500 for the day of admission Intensive Care Unit (ICU) Supplemental Admission $1,000 for the day of admission $1,500 for the day of admission Confinement (paid for up to 15 days per accident) $200 per day $300 per day ICU Supplemental Confinement (paid for up to 15 days per accident) $200 per day $300 per day Inpatient Rehabilitation (paid for up to 15 days per accident) $150 per day $200 per day Accidental Death Benefit Accidental Death Benefit* $25,000 $75,000 for accidental death on common carrier* $50,000 $150,000 for accidental death on common carrier* Accidental Dismemberment, Functional Loss & Paralysis Benefits Dismemberment/Functional Loss (depending on the injury) $750 - $20,000 $1,000 - $40,000 Paralysis (depending on the number of limbs) $10,000 - $20,000 $20,000 - $40,000 Other Benefits Lodging Benefit* - for a companion of a covered person who is hospitalized $100 per day $200 per day Organized Sports Activity Injury Benefit Rider
Covered Event3 Benefit Amount Ambulance (ground) $400 Emergency Care $200 Physician Follow-Up ($100 x 2) $200 Medical Testing $200 Concussion $500 Broken Tooth (repaired by crown) $300 Benefits paid by MetLife Group Accident Insurance $1,800 Accident Insurance Monthly Cost to You Coverage Options Low Plan High Plan Employee $5.22 $7.48 Employee & Spouse $10.32 $14.70 Employee & Child(ren) $12.04 $17.06 Employee & Spouse/Child(ren) $14.68 $20.84
EMPLOYEE
24
BENEFITS

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/goosecreekisd

Benefits At-A-Glance

What’s your benefits coverage

Employee Coverage

Guaranteed Life Insurance Coverage Amount:

• Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $300,000 without providing evidence of insurability.

• Annual Limited Enrollment: If you are a continuing employee, you can increase your coverage amount by $10,000 or

• $20,000 without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability.

• If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense.

• You can increase this amount by up to $20,000 during the next limited open enrollment period.

Employee Guaranteed coverage amount during initial offering or approved special enrollment period $300,000 Newly hired employee guaranteed coverage amount $300,000 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 Spouse Guaranteed coverage amount during initial offering or approved special enrollment period $75,000 Newly hired employee guaranteed coverage amount $75,000 Continuing employee guaranteed coverage annual increase amount Choice of $5,000 or $10,000 Maximum coverage amount 100% of the employee coverage amount ($500,000 maximum in increments of $5,000) Minimum coverage amount $5,000 Dependent Children 6 months to age 26 guaranteed coverage amount $10,000 Age 14 days to 6 months guaranteed coverage amount $500
EMPLOYEE BENEFITS
25

Life and AD&D Lincoln Financial Group EMPLOYEE BENEFITS

Maximum Life Insurance Coverage Amount:

• You can choose a coverage amount up to 7 times your annual salary ($500,000 maximum) with evidence of insurability. See the Evidence of Insurability page for details.

• Your coverage amount will reduce by 50% when you reach age 75

Spouse Coverage

You can secure term life insurance for your spouse if you select coverage for yourself.

Guaranteed Life Insurance Coverage Amount:

• Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to 100% of your coverage amount ($75,000 maximum) for your spouse without providing evidence of insurability.

• Annual Limited Enrollment: If you are a continuing employee, you can increase the coverage amount for your spouse by

• $5,000 or $10,000 without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability.

• If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense.

• You can increase this amount by up to $10,000 during the next limited open enrollment period.

Maximum Life Insurance Coverage Amount

• You can choose a coverage amount up to 100% of your coverage amount ($500,000 maximum) for your spouse with evidence of insurability.

• Coverage amounts are reduced by 50% when an employee reaches age 75

Dependent Children Coverage

You can secure term life insurance for your dependent children when you choose coverage for yourself.

Guaranteed Life Insurance Coverage Options:

• $10,000

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Individual Life Insurance

ABOUT INDIVIDUAL LIFE

Individual insurance is a policy that covers a single person and is intended to meet the financial needs of the beneficiary, in the event of the insured’s death. This coverage is portable and can continue after you leave employment or retire.

For full plan details, please visit your benefit website: www.mybenefitshub.com/goosecreekisd

Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. Designed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually cost more and decline in death benefit.

The policy, purelife-plus, is underwritten by Texas Life Insurance Company, and it has the following features:

• High Death Benefit. With one of the highest death benefits available at the worksite, purelife-plus gives your loved ones peace of mind.

• Minimal Cash Value. Designed to provide a high death benefit at a reasonable premium, purelife-plus provides peace of mind for you and your beneficiaries while freeing investment dollars to be directed toward such tax-favored retirement plans as 403(b), 457 and 401(k).

• Long Guarantees. Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time.

• Refund of Premium. Unique in the marketplace, purelife-plus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.)

• Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.) (Form ICC07ULABR-07 or Form Series ULABR-07)

You may apply for this permanent coverage, not only for yourself, but also for your spouse, children and grandchildren.

DURING THE LAST SIX MONTHS, HAS THE PROPOSED INSURED:

1. Been actively at work on a full time basis, performing usual duties?

2. Been absent from work due to illness or medical treatment for a period of more than 5 consecutive working days?

3. 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, dialysis treatment, or treatment for alcohol or drug abuse?

Texas Life EMPLOYEE BENEFITS 27

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 (your plan contains a 45-day grace period).

For full plan details, please visit your benefit website: www.mybenefitshub.com/goosecreekisd

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.

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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.

• The IRS has amended the “use it or lose it rule” to allow you to carry-over up to $570 in your Health Care FSA into the next plan year. The carry-over rule does not apply to your Dependent Care FSA.

Over-the-Counter Item Rule Reminder

Health care reform legislation requires that certain over-the-counter (OTC) items require a prescription to qualify as an eligible Health Care FSA expense. You will only need to obtain a one-time prescription for the current plan year. You can continue to purchase your regular prescription medications with your FSA debit card. However, the FSA debit card may not be used as payment for an OTC item, even when accompanied by a prescription.

Higginbotham Portal

The Higginbotham Portal provides information and resources to help you manage your FSAs.

• Access plan documents, letters and notices, forms, account balances, contributions and other plan information

• Update your personal information

• Utilize Section 125 tax calculators

• Look up qualified expenses

• Submit claims

• Request a new or replacement Benefits Debit Card Register on the Higginbotham Portal

Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information.

• Enter your Employee ID, which is your Social Security number with no dashes or spaces.

• Follow the prompts to navigate the site.

• If you have any questions or concerns, contact Higginbotham:

* Phone – 866-419-3519

* Email – flexclaims@higginbotham.net

* Fax – 866-419-3516

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Notes 30
31
Notes

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 Goose Creek CISD 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 Goose Creek CISD 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/GOOSECREEKCISD
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