EFFECTIVE: 09/01/2023 - 8/31/2024
WWW.MYBENEFITSHUB.COM/JOSHUAISD
2023 - 2024 Plan Year
JOSHUA ISD BENEFIT GUIDE
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HOW TO ENROLL PG. 4 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 Identity Theft 20 Disability 21-23 Cancer 24 Critical Illness 25-26 Life and AD&D 27 Individual Life 28 Emergency Medical Transportation 29 Flexible Spending Account (FSA) 30-31 2
Table of Contents FLIP TO... SUMMARY PAGES PG. 6 YOUR BENEFITS PG. 11
Benefit Contact Information
JOSHUA ISD BENEFITS MEDICAL HEALTH SAVINGS ACCOUNT (HSA)
Financial Benefit Services (866) 914-5202
www.mybenefitshub.com/joshuaisd
Texas Schools Health Benefits Program (TSHBP) (888) 803-0081
All Plans: www.tshbp.org
Pharmacy Benefits: SouthernScripts Group #50000
https://tshbp.info/DrugPham
EECU (817) 882- 0800
www.eecu.org
HOSPITAL INDEMNITY TELEHEALTH
MDLive (888) 365-1663
DENTAL Cigna Group #HC961005 (800) 754-3207
www.cigna.com
https://www.mdlive.com/fbs
Cigna Group #3334575 (800) 244-6224
www.mycigna.com
VISION IDENTITY THEFT DISABILITY
Superior Vision Group #322750 (800) 507-3800
www.superiorvision.com
iLock360 (855) 287-8888
www.ilock360.com
CANCER CRITICAL ILLNESS
American Public Life Group #18186 (800) 256-8606
www.ampublic.com
The Hartford Group #884447 (860) 547-5000
www.thehartford.com
UNUM Group #124509001 (866) 679-3054
www.unum.com
LIFE AND AD&D
The Hartford Group #884447 (860) 547-5000
www.thehartford.com
INDIVIDUAL LIFE EMERGENCY MEDICAL TRANSPORT FLEXIBLE SPENDING ACCOUNT (FSA)
5Star Life Insurance Company Group #2283
(866) 863-9753
https://5starlifeinsurance.com
MASA Group #MKJOSH (800) 423-3226
https://www.masamts.com/
Higginbotham (866) 419-3519
https://flexservices.higginbotham.net
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Employee benefits made easy through the FBS Benefits App! All Your BenefitsOne App OR SCAN Text “FBS JOSHUAISD” to (800) 583-6908 App Group #: FBSJOSHUAISD Text “FBS JOSHUAISD” 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/joshuaisd
2
3 ENTER USERNAME & PASSWORD
Your Username Is: Your email in THEbenefitsHUB. (Typically your work email)
Your Password Is: Four (4) digits of your birth year followed by the last four (4) digits of your Social Security Number
If you have previously logged in, you will use the password that you created, NOT the password format listed above.
CLICK LOGIN
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Annual Benefit Enrollment
Section 125 Cafeteria Plan Guidelines
A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
CHANGES IN STATUS (CIS): QUALIFYING EVENTS
Marital Status
Change in Number of Tax Dependents
Change in Status of Employment Affecting Coverage Eligibility
Gain/Loss of Dependents’ Eligibility Status
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual’s eligibility under an employer’s plan includes commencement or termination of employment.
An event that causes an employee’s dependent to satisfy or cease to satisfy coverage requirements under an employer’s plan may include change in age, student, marital, employment or tax dependent status. Judgment/ Decree/Order
If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual’s plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.
Eligibility for Government Programs
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
SUMMARY PAGES
6
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/joshuaisd 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 Joshua ISD benefit website: www.mybenefitshub.com/joshuaisd. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section.
When will I receive ID cards?
If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card.
If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.
SUMMARY PAGES
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Annual Benefit Enrollment
Employee Eligibility Requirements
Supplemental Benefits: Eligible employees must work 16 or more regularly scheduled hours each work week.
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2023 benefits become effective on September 1, 2023, you must be actively-at-work on September 1, 2023 to be eligible for your new benefits.
Dependent Eligibility Requirements
Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
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 Basic Life N/A Cancer 26 Dental 26 Disability N/A Health Savings Account IRS Dependent covered on your HDHP Medical 26 Hospital Indemnity 26 Medical Flex IRS Dependent Telehealth 26 Vision 26 Voluntary Life 26 Individual Life 24 Critical Illness 26 Medical Transporation 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
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Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Description
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, taxfree. This also allows employees to pay for qualifying dependent care tax- free. Employer
Permissible Use Of Funds
Cash-Outs of Unused Amounts (if no medical expenses)
Year-to-year rollover of account balance?
Does the account earn interest?
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).
Yes, will roll over to use for subsequent year’s health coverage.
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Not permitted
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.
Eligibility
All employers Contribution Source Employee and/or employer Employee and/or employer Account Owner Individual Employer Underlying Insurance Requirement High deductible health plan None Minimum Deductible $1,400 single (2023) $2,800 family (2023) N/A Maximum Contribution $3,850 single (2023) $7,750 family (2023) $3,050 (2023)
A qualified high deductible health plan.
Yes
No FLIP TO FOR HSA INFORMATION FLIP TO FOR FSA INFORMATION PG. 13 PG. 30 SUMMARY PAGES HSA
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No Portable? Yes, portable year-to-year and between jobs.
vs. FSA
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.mybenefitshub.com/joshuaisd
Directed Care Highlights
The TSHBP Directed Care Plans utilize a national network to provide physician and ancillary services access to all members. Enrolled school districts will access the HealthSmart practitioner and ancillary only network to gain access to over 502,309 providers in over 1,421,000 unique locations across the United States.
Please note, hospitals are excluded from the PPO networks. All hospital and other medical facility-based services are accessed via an assigned Care Coordinator.
It is easy to look up providers in your area by looking up providers in your area by clicking on the link below. https://tshbp.info/HSNetwork
Hinge Health
Hinge Health is a digital musculoskeletal management program with custom physical therapy programs designed by physicians and led by board certified Health coaches. You and your eligible family members get free access to Hinge Health’s programs for back, knee, hip, shoulder, or neck pain, which may include: a free tablet computer and wearable sensors, unlimited 1-on-1 health coaching, personalized exercise therapy, etc.
TSHBeFit
TSHBeFit is a Wellness Program, powered by WellRight, is available for members to achieve their personal health and well-being through a collection of holistic activities and is no additional cost to members.
PPO Deductible Credits
Aetna Network Highlights
You want a network that is comprehensive, is easy to use and can help you save on costs. Look no further. You can now find support through our Aetna Signature Administrators® preferred provider organization network. Discover provider options and reduced costs.
With our network, you now have access to over 1.2 million participating doctors, 8,700 hospitals, and strong, negotiated discounts.
We know quality care is important. So we make sure our doctors successfully complete our credentialing requirements. Our credentialing process meets industry standards, as well as state and federal requirements.
You’ll also have access to over 600 Institutes of Excellence™ facilities and Institutes of Quality® facilities. We measure these publicly recognized institutes by clinical performance, outcomes and efficiency. Then, we pass this guidance along to you—so you can choose the best facility.
Ready to search our network? Just visit http://aetna.com/asa
With the Aetna PPO plans, 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 deductible1. If you have already met your deductible, the $500 credit will apply to your out-of-pocket maximum!
1. On the HDHP plan, a member must meet a minimum of $1,500 of the deductible accumulation before receiving the credit to comply with HSA requirements.
the MyTSHBP Digital Wallet for easy access to all your benefit resources. 11
Access
Medical Insurance
Texas Schools Health Benefits Program
EMPLOYEE BENEFITS PLAN SUMMARY DIRECTED CARE PLANS AETNA NETWORK PLANS High Deductible CoPay AETNA HD Aetna Signature Directed Care Plan • Use Care Coordinator for Hospital/Surgical Services • Compatible with an HSA • Embedded Deductible - no coinsurance • Out-of-Network Benefits Directed Care Plan • Use Care Coordinator for Hospital/Surgical Services • Co-payments for Services • Reduce Out-of-Pocket • Out-of-Network Benefits Traditional PPO Plan • Compatible with an HSA • PPO Network for all physician/hospital services • Care Coordinator is an optional benefit Traditional PPO Plan • PPO Network for all physician/hospital services • Brand Drug Deductible • Care Coordinator is an optional benefit Coverage In-Network Coverage In-Network Coverage In-Network Only Individual/Family Deductible $3,500/$10,500 $0/$0 $3,500/$7,000 $4,000/$8,000 Coinsurance None - Plan Pays 100% after deductible None - Plan Pays 100% after out-of-pocket is met You pay 30% after deductible You pay 30% after deductible Individual/Family Maximum Out-of- Pocket $3,500/$10,500 $4,000/$11,000 $8,000/$16,000 $10,000/$20,000 National Network HealthSmart HealthSmart AETNA AETNA Required - Primary Care Provider (PCP) No No No No Required - PCP Referral to Specialist No No No No Doctor Visits Preventive Care Yes - $0 copay Yes - $0 copay Yes - $0 copay Yes - $0 copay Primary Care Deductible, then Plan pays 100% $45 copay You pay 30% after deductible $45 copay Specialist Deductible, then Plan pays 100% $70 copay You pay 30% after deductible $70 copay Virtual Health $30 per consultation $0 per consultation $30 per consultation $0 per consultation Care Facilities Urgent Care Deductible, the Plan pays 100% $75 copay You pay 30% after deductible $75 copay Emergency Care Deductible, the Plan pays 100% $500 copay You pay 30% after deductible You pay $500 copay + 30% after ded Outpatient Surgery Deductible, the Plan pays 100% $650 copay You pay 30% after deductible You pay 30% after deductible Prescription Drug Benefits Drug Deductible Intergrated into Medical No Drug Deductible Intergrated into Medical $500 brand deductible Generic Deductible, the Plan pays 100%; $0 for certain generics $0 copay CVS/HEB/ Walmart/Costco/Sam’s | $10 copay All other net Pharmacies You pay 20% after deductible; $0 certain generics $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 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 You pay 50% after deductible Specialty Full Coverage - PAP Required Full Coverage - PAP Required Full Coverage - PAP Required Full Coverage - PAP Required 12
Health Savings Account (HSA)
ABOUT HSA
A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP).
For full plan details, please visit your benefit website: www.mybenefitshub.com/joshuaisd
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs; it is a tax-exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
• Enrolled in an HSA-eligible HDHP (TSHBP HD or Aetna High Deductible)
• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
• Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account
• Not eligible to be claimed as a dependent on someone else’s tax return
• Not enrolled in Medicare or TRICARE
• Not receiving Veterans Administration benefits
You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered under your HDHP.
Maximum Contributions
Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2023 is based on the coverage option you elect:
• Individual – $3,850
• Family (filing jointly) – $7,750
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
EECU EMPLOYEE
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BENEFITS
Health Savings Account (HSA)
Important HSA Information
• Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.
• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
• You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.
How to Use your HSA
• Online/Mobile: Sign-in for 24/7 account access to check your balance, pay bills and more.
• Call/Text: (817) 882-0800. EECU’s dedicated member service representatives are available to assist you with any questions. Their hours of operation are Monday through Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. –1:00 p.m. CT and closed on Sunday.
• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333-9934
• Stop by a local EECU financial center for in-person assistance; find EECU locations & service hours a www.eecu.org/ locations
EECU EMPLOYEE
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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.
EMPLOYEE BENEFITS
For full plan details, please visit your benefit website: www.mybenefitshub.com/joshuaisd
Even with the best primary health insurance plan, out-of-pocket costs from a hospital stay can add up. Cigna’s Hospital Care plan pays a scheduled benefit if you or an insured dependent (spouse or child) are confined in a hospital for a covered illness or injury. The benefits are paid to you, and can help offset expenses that primary health insurance doesn’t cover (like deductibles, coinsurance amounts or co- pays), or benefits can be used for any non-medical expenses (like housing costs, groceries, car expenses, etc.).
Plan Highlights
• No Pre-existing Limitations!
• HSA Compatible
Claims
Call 800-754-3207 or email hosptialcare@cigna.com to file a claim. Group number on page 3 of this guide.
Available Coverage
The benefit amounts shown in this summary will be paid regardless of the actual expenses incurred and are paid on a per day basis unless otherwise specified. Benefits are only payable when all policy terms and conditions are met. Please read all the information in the plan summary document on the benefit website to understand limitations and conditions.
Care Unit (ICU) Stay
No Elimination Period. Limited to 30 days, 1 benefit(s) every 90 days.
Hospital Observation Stay
24 hour Elimination Period. Limited to 72 hours.
Newborn Nursery Care Stay*
Limited to 30 days, 1 benefit per newborn child. This benefit is payable to the employee even if child coverage is not elected.
Additional Information:
per 24-hour period
per 24-hour period
Hospital Admission: Must be admitted as an Inpatient due to a Covered Injury or Covered Illness. Excludes: treatment in an emergency room, provided on an outpatient basis, or for re-admission for the same Covered Injury or Covered Illness (including chronic conditions).
Hospital Stay: Must be admitted as an Inpatient and confined to the Hospital, due to a Covered Injury or Covered Illness, at the direction and under the care of a physician. If also eligible for the ICU Stay Benefit, only 1 benefit will be paid for the same Covered Injury or Covered Illness, whichever is greater. Hospital stays within 90 days for the same or a related Covered Injury or Covered Illness is considered one Hospital Stay.
Hospitalization Benefits Plan 1 Plan 2 Hospital Admission No Elimination Period. Limited to 1 day, 1 benefit(s) every 90 days. $500 $1,000 Hospital Chronic Condition Admission No Elimination Period. Limited to 1 day, 1 benefit(s) every 90 days. $50 $100 Hospital Stay No Elimination Period. Limited to 30 days, 1 benefit(s) every 90 days. $100 $100 Hospital Intensive
$200 $200
$100
$100
$100 $100
Hospital Indemnity Plan 1 Plan 2 Employee $7.00 $14.10 Employee + Spouse $13.40 $25.35 Employee + Child(ren) $13.70 $24.56 Family $20.75 $38.80 15
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/joshuaisd
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!
• Affordable, confidential online therapy for a variety of counseling needs.
• The MDLIVE app helps you stay connected with appointment reminders, important notifications and secure messaging.
Registration is Easy
Register with MDLIVE so you are ready to use this valuable service when and where you need it.
• Online – www.mdlive.com/fbsbh
• Phone – 888-365-1663
• Mobile – download the MDLIVE mobile app to your smartphone or mobile device
• Select –“MDLIVE as a benefit” and “FBS” as your Employer/ Organization when registering your account.
Telehealth
Employee & Family Paid fully by Joshua ISD
EMPLOYEE
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BENEFITS
Dental Insurance Cigna
ABOUT DENTAL
Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease.
For full plan details, please visit your benefit website: www.mybenefitshub.com/joshuaisd
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 Cigna Dental.
How to Find a Dentist Visit https://hcpdirectory.cigna.com/ or call 800-244-6224 to find an in-network dentist. Your network will be Total Cigna DPPO.
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.
DENTAL - HIGH PLAN Network Options In-Network: Total Cigna DPPO Network Out-of-Network: See Non-Network Reimbursement Reimbursement Levels Based on Contracted Fees Maximum Reimbursable Charge Policy Year Benefits Maximum Applies to: Class I, II & III expenses $1,000 $1,000 Policy Year Deductible Individual Family $50 $150 $50 $150 Benefit Highlights Plan Pays You Pay Plan Pays You Pay 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 100% No Deductible No Charge 100% No Deductible 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 80% After Deductible 20% After Deductible 80% After Deductible 20% After Deductible Class III: Major Restorative Inlays and Onlays
Over Implant Crowns:
Bridges and Dentures Repairs: bridges,
Denture Relines, Rebases and Adjustments 50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible Class IV: Orthodontia Coverage for Dependent Children to age 19 Lifetime Benefits Maximum: $1,000 50% No Deductible 50% No Deductible 50% No Deductible 50% No Deductible 17
EMPLOYEE BENEFITS
Prosthesis
prefabricated stainless steel/resin Crowns: permanent cast and porcelain
crowns and inlays
Endodontics: minor and major Periodontics: minor and major
Class III: Major Restorative
Prosthesis Over Implant
Crowns: prefabricated stainless steel/resin
Crowns: permanent cast and porcelain
Bridges and Dentures
Repairs: bridges, crowns and inlays
Denture Relines, Rebases and Adjustments
DENTAL - LOW PLAN Network Options In-Network: Total Cigna DPPO Network Out-of-Network: See Non-Network Reimbursement Reimbursement Levels Based on Contracted Fees Maximum Reimbursable Charge Policy Year Benefits Maximum Applies to: Class I, II & III expenses $1,000 $1,000 Policy Year Deductible Individual Family $50 $150 $50 $150 Benefit Highlights Plan Pays You Pay Plan Pays You Pay 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 100% No Deductible No Charge 100% No Deductible No Charge Class II: Basic Restorative Restorative:
fillings
Oral Surgery:
60% After Deductible 40% After Deductible 60% After Deductible 40% After Deductible
minor and major Anesthesia: general and IV sedation Repairs: Dentures
Inlays and Onlays
Not Covered 100% of your Dentist’s usual fees Not Covered 100% of your Dentist’s usual fees Dental Rates High Low Employee Only $33.52 $29.61 Employee & Spouse $73.35 $64.78 Employee & Child(ren) $80.72 $71.28 Employee & Family $107.58 $95.05
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Dental Insurance Cigna EMPLOYEE BENEFITS
Vision Insurance Superior Vision EMPLOYEE BENEFITS
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/joshuaisd
How to Print your Vision ID Card:
You can request your vision id card by contacting Superior Vision directly at 800-507-3800. You can also go to www.superiorvision.com and register/login to access your account by clicking on “Members” at the top of the page. You can also download the Superior Vision mobile app on your smart phone.
Copays Services/frequency Monthly Premiums Exam $10 Exam 12 months Employee Only $9.99 Materials1 $25 Frame 12 months Employee & Spouse $17.04 Lenses 12 months Employee & Child(ren) $18.02 Contact lenses 12 months Employee & Family $27.03 (based on date of service)
through Superior Select National Network In-network Out-of-network Exam Covered in full Up to $35 retail Frames $150 retail allowance Up to $70 retail Lenses (standard) per pair Single Vision Covered in full Up to $25 retail Bifocal Covered in full Up to $40 retail Trifocal Covered in full Up to $45 retail Progressive lens upgrade See description3 Up to $45 retail Contact Lenses4 $175 retail allowance Up to $80 retail Medically necessary contact lenses Covered in full Up to $150 retail LASIK vision correction $200 allowance $200 allowance
Benefits
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Identity Theft iLock360
ABOUT IDENTITY THEFT PROTECTION
Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered.
For full plan details, please visit your benefit website: www.mybenefitshub.com/joshuaisd
HAVE YOU EVER?
Been a victim of a data breach?
• Data breaches increased by 133% in 2018. • 1 in 3 notifed breach victims experience fraud.
Known someone that has been a victim of identity theft?
ID theft is the fastest growing crime, occurring once every 2 seconds
Been concerned about your childrens’ and loved ones’ identities being stolen?
Child identity theft is projected to affect 25% of kids before turning 18.
Had your credit impacted by financial fraud?
If a criminal gains access to your personal information, they can open new accounts in your name that you may not learn of until the damage is done.
HOW iLOCK360 HELPS DEFEND
Your personal information is monitored 24/7/365
PROTECT
Alerts inform you of potential threats for immediate action
RESTORE
iLOCK360 does the work to restore your identity
FULL-SERVICE IDENTITY RESTORATION. Rest assured that iLOCK360 will work on your behalf to restore your identity. Our experts can complete all restoration activities for you, and we can even help you with pre-existing conditions.
PEACE OF MIND. 56% of victims have to take time off work to resolve an identity theft case on their own. With iLOCK360, you have experienced professionals in your corner to restore your identity, so you can spend your time doing what you do best.
EMPLOYEE BENEFITS
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Identity Theft
Employee $6.95 Employee & Family $13.95
Disability Insurance UNUM EMPLOYEE BENEFITS
ABOUT DISABILITY
Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.
For full plan details, please visit your benefit website: www.mybenefitshub.com/joshuaisd
What is Educator Disability Insurance?
Educator Disability insurance is a hybrid that combines features of short-term and long-term disability into one plan. 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. We offer Educator Disability insurance for you to purchase through UNUM.
If you need to file a claim, please contact UNUM at 800858-6843.
Benefit Amount: You may purchase a monthly benefit in $100 units, starting at a minimum of $200, up to 66 2/3% of your monthly earnings rounded to the nearest $100, but not to exceed a monthly maximum benefit of $7,500. Please see your Plan Administrator for the definition of monthly earnings.
Eligibility: You are eligible for disability coverage if you are an active employee in the United States working a minimum of 16 hours per week. The date you are eligible for coverage is the later of: the plan effective date; or the day after you complete the waiting period.
Elimination Period: The Elimination Period is the length of time of continuous disability, due to sickness or injury, which must be satisfied before you are eligible to receive benefits.
You may choose an Elimination Period (injury/sickness) of 0/7, 14/14, 30/30, 60/60, 90/90 or 180/180 days.
If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.)
Definition of Disability: You are disabled when Unum determines that:
• you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury;
• you have a 20% or more loss in indexed monthly earnings due to the same sickness or injury; and
• during the elimination period you are unable to perform any of the material and substantial duties of your regular occupation.
After benefits have been paid for 24 months, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience. You must be under the regular care of a physician in order to be considered disabled.
Pre-Existing Condition Limitation: Benefits will not be paid for disabilities caused by, contributed to by, or resulting from a pre-existing condition. You have a pre-existing
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Disability Insurance UNUM EMPLOYEE BENEFITS
condition if:
• you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and
• the disability begins in the first 12 months after your effective date of coverage.
Maximum Benefit Duration: Your duration of benefits is based on your age when the disability occurs.
Your duration of benefits is based on the following tables: For disabilities due to injury:
to sickness: Age at Disability Maximum Duration of Benefits Less than age 60 To age 65, but not less than 5 years Age 60-64 5 years Age 65-69 To age 70, but not less than 1 year Age 70 and over 1 year Disability Elimination Period Monthly Benefit per $100 0/7 $4.02 14/14 $3.18 30/30 $2.66 60/60 $1.81 90/90 $1.57 180/180 $1.21 Age at Disability Maximum Duration of Benefits Less than age 65 5 years Age 65 through 68 To age 70, but not less than 1 year Age 69 and over 1 year
For disabilities due
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How do I choose which plan to enroll in during my open enrollment?
1. First choose your elimination period. The elimination period, sometimes referred to as the waiting period, is how long you are disabled and unable to work before your benefit will begin. This will be displayed as 2 numbers such as 0/7, 14/14, 30/30, 60/60, 90/90, etc.
The first number indicates the number of days you must be disabled due to Injury and the second number indicates the number of days you must be disabled due to Sickness
When choosing your elimination period, ask yourself, “How long can I go without a paycheck?” Based on the answer to this question, choose your elimination period accordingly.
Important Note- some plans will waive the elimination period if you choose 30/30 or less and you are confined as an inpatient to the hospital for a specific time period. Please review your plan details to see if this feature is available to you.
2. Next choose your benefit amount. This is the maximum amount of money you would receive from the carrier on a monthly basis once your disability claim is approved by the carrier.
When choosing your monthly benefit, ask yourself, “How much money do I need to be able to pay my monthly expenses?” Based on the answer to this question, choose your monthly benefit accordingly.
Choose your Benefit Amount from the drop down box. Choose your desired elimination period. EMPLOYEE
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BENEFITS Disability Insurance UNUM
Cancer Insurance
ABOUT CANCER
Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.
For full plan details, please visit your benefit website: www.mybenefitshub.com/joshuaisd
Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town treatments, special diets, daily living and household upkeep. In addition to these non-medical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance through American Public Life helps pay for these direct and indirect treatment costs so you can focus on your health.
Should you need to file a claim contact APL at 800-256-8606 or online at www.ampublic.com. You can find additional claim forms and materials at www.mybenefitshub.com/joshuaisd
Sample of Plan Benefits
Please review plan documents on the benefit website for complete list of benefits, preexisting condition exclusions and other plan details.
Cancer Plan Monthly Premiums PLAN 1 PLAN 2 Employee Only $19.80 $33.80 Employee & Spouse $41.70 $70.78 Employee & Child(ren) $25.78 $43.16 Employee & Family $47.62 $80.18
APL EMPLOYEE BENEFITS
Plan 1 Plan 2 Internal Cancer First Occurrence* $2,500 $5,000 Cancer Screening Rider Benefits Plan 1 Plan 2 Diagnostic Testing- 1 test per calendar year $50 per test $50 per test Follow Up-Diagnostic Testing- 1 test per calendar year $100 per test $100 per test Medical Imaging- per calendar year $500 per test/1 per calendar year Cancer Treatment Policy Benefits Plan 1 Plan 2 Radiation and Chemotherapy, Immunotherapy Maximum Per 12-month period $10,000 $20,000 Hormone Therapy- Maximum of 12 treatments per calendar year $50 per treatment $50 per treatment Surgical Rider Benefits Plan 1 Plan 2 Surgical $30 unit dollar amount Max $3,000 per operation $60 unit dollar amount Max $6,000 per operation Anesthesia 25% of amount paid for covered surgery Bone Marrow Transplant-Maximum per lifetime $6,000 $12,000 Stem Cell Transplant- Maximum per lifetime $600 $1,200 Miscellaneous Care Rider Benefits Plan 1 Plan 2 Hair Piece (Wig) - 1 per lifetime $150 $150 Blood, Plasma & Platelets $300 per day $300 per day Ambulance- Ground /Air-Maximum of 2 trips per Hospital Confinement for all modes of transportation combined $200/$2000 per trip $200/$2000 per trip Hospital Intensive Care Unit Rider Benefits Plan 1 Plan 2 Intensive Care Unit $600 per day $600 per day 24
Critical Illness Insurance The Hartford 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/joshuaisd
COVERAGE INFORMATION
Benefit amounts for covered illnesses are based on the coverage amount in effect for you or an insured dependent at the time of diagnosis.
– Pays a benefit for a subsequent diagnosis of conditions marked with an asterisk (*)
COVERAGE AMOUNTS Employee Coverage Amount $10,000; $20,000; or $30,000 Spouse Coverage Amount Greater of $5,000 or 50% of your coverage amount Child(ren) Coverage Amount $5,000 COVERED ILLNESS BENEFIT AMOUNTS CANCER CONDITIONS Benign Brain Tumor*; Invasive Cancer* 100% of coverage amount Non-Invasive Cancer 25% of coverage amount VASCULAR CONDITIONS Heart Attack*; Heart Transplant*; Stroke* 100% of coverage amount Aneurysm; Angioplasty/Stent; Coronary Artery Bypass Graft 25% of coverage amount OTHER SPECIFIED CONDITIONS
100% of coverage amount Bone Marrow Transplant 25% of coverage amount
BENEFITS BENEFIT AMOUNTS Recurrence
100% of original benefit amount Health Screening Benefit $50 one time FEATURES DETAILS Coverage Maximum – Primary Insured & Spouse 500% of coverage amount Coverage Maximum – Child(ren) 300% of coverage amount
Coma*; End Stage Renal Failure; Loss of Hearing; Loss of Speech; Loss of Vision; Major Organ Transplant*; Paralysis
ADDITIONAL
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Critical Illness Insurance
Critical Illness with Wellness Rider Age Employee Employee and Spouse Employee and Child(ren) Employee and Family $10,000 18-29 $3.66 $5.92 $6.07 $8.72 30-39 $5.11 $8.11 $7.04 $10.35 40-49 $10.18 $15.92 $11.85 $17.86 50-59 $19.55 $30.47 $21.14 $32.33 60-69 $37.77 $58.57 $39.35 $60.40 70-79 $66.60 $102.58 $68.18 $104.41 $20,000 18-29 $6.39 $10.01 $8.79 $12.81 30-39 $9.24 $14.29 $11.17 $16.53 40-49 $19.29 $29.69 $20.95 $31.63 50-59 $37.98 $58.70 $39.57 $60.56 60-69 $74.42 $114.89 $76.00 $116.73 70-79 $132.08 $202.90 $133.66 $204.74 $30,000 18-29 $9.11 $14.09 $11.52 $16.90 30-39 $13.37 $20.47 $15.30 $22.71 40-49 $28.39 $43.46 $30.05 $45.40 50-59 $56.41 $86.94 $58.00 $88.80 60-69 $111.07 $171.21 $112.65 $173.05 70-79 $197.56 $303.23 $199.13 $305.07
EMPLOYEE BENEFITS 26
The Hartford
Life and AD&D The Hartford
ABOUT LIFE AND AD&D
Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family.
Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.
For full plan details, please visit your benefit website: www.mybenefitshub.com/joshuaisd
BASIC LIFE/AD&D COVERAGE INFORMATION
• Applicant: Employee Only
• Coverage: $10,000 with AD&D included BASIC LIFE AND AD&D PREMIUMS
Your employer pays 100% of the premium for your coverage..
VOLUNTARY LIFE COVERAGE INFORMATION
Employee: Benefit: Increments of $10,000
Maximum: $500,000
Spouse: Benefit: Increments of $10,000.
Maximum: the lesser of 100% of your supplemental coverage or $500,000
Child(ren): Live Birth to 6 months - $1,000
6 months to 26 - $10,000
VOLUNTARY AD&D COVERAGE INFORMATION
You (the primary insured) may enroll for one of the following AD&D coverage amounts: increments of $10,000. The maximum amount you can elect is the lesser of 10 x earnings or $500,000.
You may also enroll your dependent(s) for AD&D coverage. Your dependent(s) will be covered at a percentage of your coverage amount
COVERAGE TIER SPOUSE PERCENTAGE CHILD(REN) PERCENTAGE Spouse 50% 0% Child(ren) 0% 10% Spouse & Child(ren) 50% 10% EMPLOYEE
BENEFITS
AD&D BENEFITS PERCENT OF COVERAGE AMOUNT PER ACCIDENT Covered accidents or death can occur up to 365 days after the accident. The total benefit for all losses due to the same accident will not exceed 100% of your coverage amount. LOSS FROM ACCIDENT COVERAGE AMOUNT Life 100% Both Hands or Both Feet or Sight of Both Eyes 100% One Hand and One Foot 100% Speech and Hearing in Both Ears 100% Either Hand or Foot and Sight of One Eye 100% Movement of Both Upper and Lower Limbs (Quadriplegia) 100% Movement of Both Lower Limbs (Paraplegia) 75% Movement of Three Limbs (Triplegia) 75% Movement of the Upper and Lower Limbs of One Side of the Body (Hemiplegia) 50% Either Hand or Foot 50% Sight of One Eye 50% Speech or Hearing in Both Ears 50% Movement of One Limb (Uniplegia) 25% Thumb and Index Finger of Either Hand 25% Group Life (per $10,000) Employee Age Employee and Spouse 18-29 $0.50 30-34 $0.70 35-39 $0.80 40-44 $0.80 45-49 $1.40 50-54 $2.20 55-59 $4.30 60-64 $6.60 65-69 $12.70 70-74 $20.60 75+ $32.20 Spouse rates based on Employee's age. Child Group Life (AGE 0-26) $10,000.00 $1.80 AD&D (per $10,000) Employee Only $0.20 Employee and Family $0.40 27
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/joshuaisd
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 23 years old.
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.mybenefitshub.com/ joshuaisd
Should you need to file a claim, contact 5Star directly at (866) 863-9753.
Important Notes
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.
5Star EMPLOYEE BENEFITS 28
Emergency Medical Transport
ABOUT MEDICAL TRANSPORT
Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out-of-pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan.
For full plan details, please visit your benefit website: www.mybenefitshub.com/joshuaisd
A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. If a member has a high deductible health plan that is compatible with a health savings account, benefits will become available under the MASA membership for expenses incurred for medical care (as defined under Internal Revenue Code (“IRC”) section 213 (d)) once a member satisfies the applicable statutory minimum deductible under IRC section 223(c) for high-deductible health plan coverage that is compatible with a health savings account.
Emergent Air Transportation In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities.
Emergent Ground Transportation In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities.
Non-Emergency Inter-Facility Transportation In the event that a member is in stable condition in a medical facility but requires a heightened level of care that is not available at their current medical facility, Members have access to nonemergency air or ground transportation between medical facilities.
Repatriation/Recuperation Suppose you or a family member is hospitalized more than 100-miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for recuperation.
Should you need assistance with a claim contact MASA at 800-643-9023. You can find full benefit details www.mybenefitshub.com/joshuaisd
MASA EMPLOYEE BENEFITS Emergency Transportation Employee and Family $14.00 29
Flexible Spending Account (FSA)
ABOUT FSA
A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (unless your plan contains a $500 rollover or grace period provision).
For full plan details, please visit your benefit website: www.mybenefitshub.com/joshuaisd
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.
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 90days from 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.
• Benefits are ‘use-it-or-lose-it’! Eligible expenses must be incurred within the plan year, however JISD provides an additional 75 day grace period to spend elected funds.
Higginbotham EMPLOYEE BENEFITS 30
Flexible Spending Account (FSA) Higginbotham EMPLOYEE BENEFITS
Over-the-Counter Item Rule Reminder
Health care reform legislation requires that certain overthe-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
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.
FSAstore.Com
FSAstore.com offers thousands of FSA-eligible products and services to purchase using your Higginbotham Benefits Debit Card or any major credit card. Competitive pricing and free shipping on orders over $50 can save you up to 40% using your FSA pretax dollars. Shop directly at FSAstore.com or have your physician submit prescriptions (when required). The FSAstore.com Services Channel allows you to search a database of more than 300,000 health care providers for nearby eligible services, such as acupuncture and chiropractic care. The FSAstore.com Learning Center focuses on answering common questions and keeping you informed about changes to your FSA benefits.
single
if married and filing separate tax returns Reduces your taxable income
Flexible Spending Accounts Account Type Eligible Expenses Annual Contribution Limits Benefit Health Care FSA Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses and doctor-prescribed over-thecounter medications) $3,050 Saves on eligible expenses not covered by insurance, reduces your taxable income Dependent Care FSA Dependent care expenses (such as day care, after-school programs or elder care programs) so you and your spouse can work or attend school full-time $5,000
$2,500
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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 Joshua ISD Benefits Website. This summary does not replace or amend the underlying plan documentation. In the event of a discrepancy between this summary and the plan documentation the plan documentation governs. All plans and benefits described in this summary may be discontinued, increased, decreased, or altered at any time with or without notice.
Rate Sheet General Disclaimer: The rate information provided in this guide is subject to change at any time by your employer and/or the plan provider. The rate information included herein, does not guarantee coverage or change or otherwise interpret the terms of the specific plan documentation, available at the Joshua ISD Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.
2023
- 2024 Plan Year WWW.MYBENEFITSHUB.COM/JOSHUAISD
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