2023-24 Lake Worth ISD Benefit Guide

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2023 - 2024 Plan Year LAKE WORTH ISD BENEFIT GUIDE EFFECTIVE: 09/01/2023 - 8/31/2024 WWW.MYBENEFITSHUB.COM/LAKEWORTHISD 1
FLIP
PAGES
HOW TO ENROLL 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 12-18 Health Savings Account (HSA) 19 Hospital Indemnity 20 Dental 21 Accident 22-23 Vision 24 Telehealth 25 Disability 26-27 Critical Illness 28-29 Life and AD&D 30-31 Individual Life 32 Identity Theft 33 Flexible Spending Account (FSA) 34-35 Emergency Medical Transport 36 Student Loan Assistance 37 PG. 6 PG. 12 PG. 4 2
Table of Contents
TO... SUMMARY
YOUR BENEFITS

Benefit Contact Information

LAKE WORTH ISD BENEFITS MEDICAL HEALTH SAVINGS ACCOUNT

Financial Benefit Services (800) 583-6908

www.mybenefitshub.com/lakeworthisd

BCBSTX (866) 355-5999

www.bcbstx.com/trsactivecare

Scott & White HMO (844) 633-5325

www.trs.swhp.org

EECU (817) 882-0800

www.eecu.org

HOSPITAL INDEMNITY DENTAL ACCIDENT

Lincoln Financial Group Group #HI-0000566060 (800) 423-2765

www.lincolnfinancial.com

VISION

Superior Vision Group #36245

(800) 507-3800

www.superiorvision.com

CRITICAL ILLNESS

Lincoln Financial Group Group #CI-0000566059

(800) 423-2765

www.lincolnfinancial.com

IDENTITY THEFT

ID Watchdog

(800) 774-3772

www.idwatchdog.com

STUDENT LOAN ASSISTANCE

GotZoom

(866) 314-8888

www.gotzoom.com

Lincoln Financial Group Low: 00001D040758

High: 00001D040759

(800) 423-2765

www.lfg.com

The Hartford Accident Group # VAC893640 (866) 547-4205

www.thehartford.com

TELEHEALTH DISABILITY

MDLIVE (888) 365-1663

www.mdlive.com/fbs

LIFE AND AD&D

Lincoln Financial Group Group #000400275858

(800) 423-2765

www.lincolnfinancial.com

The Hartford Group #893640 (866) 547-9124

www.thehartford.com

INDIVIDUAL LIFE

5Star Life Insurance Group #02485 (866) 863-9753

www.5starlifeinsurance.com

FLEXIBLE SPENDING ACCOUNT (FSA) EMERGENCY MEDICAL TRANSPORT

Higginbotham

Flexclaims@higginbotham.net

(866) 419-3519

https://flexservices.higginbotham.net

MASA Group #MKLAKEW (800) 423-3226

www.masamts.com

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Employee benefits made easy through the FBS Benefits App! All Your BenefitsOne App OR SCAN Text “FBS LWISD” to (800) 583-6908 App Group #: FBSLWISD Text “FBS LWISD” 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

1

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.

www.mybenefitshub.com/lakeworthisd How to Log In 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

Eligibility for Government Programs

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.

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 eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

Q&A

Who do I contact with Questions?

For supplemental benefit questions, you can contact your Benefits/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/ lakeworthisd. 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 Lake Worth ISD benefit website: www.mybenefitshub.com/lakeworthisd. 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.

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Annual Benefit Enrollment

Employee Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.

Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2023 benefits become effective on September 1, 2023, you must be actively-at-work on September 1, 2023 to be eligible for your new benefits.

Dependent Eligibility Requirements

Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.

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.

PLAN MAXIMUM AGE Medical 26 Dental 26 Vision 26 Accident 26 Hospital Indemnity 26 Life and AD&D 26 Telehealth 26 Emergency Medical Transportation 26 Critical Illness 26 Individual Life 24 SUMMARY PAGES
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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 prescription drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).

SUMMARY PAGES
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Description

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

Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.

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

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

Employer Eligibility A qualified high deductible health plan. All employers

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

Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.

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).

permitted Year-to-year rollover

account

will roll over to use for subsequent year’s health coverage.

No. Access to some funds may be extended if your employer’s plan contains a 2 1/2-month grace period or $500 rollover provision.

FLIP TO FOR HSA INFORMATION FLIP TO FOR FSA INFORMATION PG. 20 PG. 34 SUMMARY PAGES HSA vs. FSA
Contribution Source Employee
employer Employee and/or employer Account Owner Individual Employer Underlying Insurance Requirement High deductible health plan None Minimum Deductible $1,500 single (2023) $3,000 family (2023) N/A Maximum Contribution $3,850 single (2023) $7,750 family (2023) 55+ catch up +$1,000 $3,050 (2023)
and/or
Permissible Use Of Funds
Not
of
balance? Yes,
Does the account earn interest? Yes No Portable? Yes, portable year-to-year and between jobs. No 10
Notes 11

Medical Insurance

ABOUT MEDICAL

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

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

TRS EMPLOYEE
Monthly Premium District Contribution Employee Cost TRS ActiveCare HD Employee Only $475.00 $275.00 $200.00 Employee & Spouse $1,283.00 $275.00 $1,008.00 Employee & Child(ren) $808.00 $275.00 $533.00 Employee & Family $1,615.00 $275.00 $1,340.00 TRS ActiveCare 2 Employee Only $1,013.00 $275.00 $738.00 Employee & Spouse $2,402.00 $275.00 $2,127.00 Employee & Child(ren) $1,507.00 $275.00 $1,232.00 Employee & Family $2,841.00 $275.00 $2,566.00 TRS ActiveCare Primary Employee Only $461.00 $275.00 $186.00 Employee & Spouse $1,245.00 $275.00 $970.00 Employee & Child(ren) $784.00 $275.00 $509.00 Employee & Family $1,568.00 $275.00 $1,293.00 TRS ActiveCare Primary+ Employee Only $541.00 $275.00 $266.00 Employee & Spouse $1,407.00 $275.00 $1,132.00 Employee & Child(ren) $920.00 $275.00 $645.00 Employee & Family $1,786.00 $275.00 $1,511.00 Central & North Texas Baylor Scott & White HMO Employee Only $596.96 $275.00 $321.96 Employee & Spouse $1,501.90 $275.00 $1,226.90 Employee & Child(ren) $960.68 $275.00 $685.68 Employee & Family $1,728.86 $275.00 $1,453.86 12
BENEFITS

TRS-ActiveCare Plan Highlights 2023-24

Learn the Terms.

• Premium: The monthly amount you pay for health care coverage.

• Deductible: The annual amount for medical expenses you’re responsible to pay before your plan begins to pay its portion.

• Copay: The set amount you pay for a covered service at the time you receive it. The amount can vary by the type of service.

• Coinsurance: The portion you’re required to pay for services after you meet your deductible. It’s often a speci ed percentage of the costs; i.e. you pay 20% while the health care plan pays 80%.

• Out-of-Pocket Maximum: The maximum amount you pay each year for medical costs. After reaching the out-of-pocket maximum, the plan pays 100% of allowable charges for covered services.

762374.0523
Where the west begins is where TRS-ActiveCare rides with you on your health care journey.
13
Monthly Premiums Employee Only $461 $ $541 Employee and Spouse $1,245 $ $1,407 Employee and Children $784 $ $920 Employee and Family $1,568 $ $1,786 Total Premium Total Premium Your Premium How to Calculate Your Monthly Premium Total Monthly Premium Your District and State Contributions Your Premium Ask your Bene ts Administrator for your district’s speci c premiums. All TRS-ActiveCare participants have three plan options. TRS-ActiveCare Primary TRS-ActiveCare Plan Summary • Lowest premium of all three plans • Copays for doctor visits before you meet your deductible • Statewide network • Primary Care Provider (PCP) referrals required to see specialists • Not compatible with a Health Savings Account (HSA) • No out-of-network coverage • Lower deductible than • Copays for many services • Higher premium • Statewide network • PCP referrals required • Not compatible with • No out-of-network Wellness Bene ts at No Extra Cost* Being healthy is easy with: • $0 preventive care • 24/7 customer service • One-on-one health coaches • Weight loss programs • Nutrition programs • OviaTM pregnancy support • TRS Virtual Health • Mental health bene ts • And much more! *Available for all plans. See the bene ts guide for more details. Immediate Care Urgent Care $50 copay Emergency Care You pay 30% after deductible You TRS Virtual Health-RediMD (TM) $0 per medical consultation $0 TRS Virtual Health-Teladoc® $12 per medical consultation $12 2023-24 TRS-ActiveCare Plan Highlights Sept. 1, 2023 –New Rx Bene ts! • Express Scripts is your new pharmacy bene ts manager! CVS pharmacies and most of your preferred pharmacies and medication are still included. • Certain specialty drugs are still $0 through SaveOnSP. Doctor Visits Primary Care $30 copay Specialist $70 copay Plan Features Type of Coverage In-Network Coverage Only In-Network Individual/Family Deductible $2,500/$5,000 Coinsurance You pay 30% after deductible You Individual/Family Maximum Out of Pocket $7,500/$15,000 Network Statewide Network PCP Required Yes Prescription Drugs Drug Deductible Integrated with medical $200 deductible Generics (31-Day Supply/90-Day Supply)$15/$45 copay; $0 copay for certain generics Preferred You pay 30% after deductible You Non-preferred You pay 50% after deductible You Specialty (31-Day Max) $0 if SaveOnSP eligible; You pay 30% after deductible You Insulin Out-of-Pocket Costs$25 copay for 31-day supply; $75 for 61-90 day supply$25 copay for 31-day 14

Each

This plan is closed and not accepting new enrollees. If you’re currently enrolled in TRS-ActiveCare 2, you can remain in this plan. $ $475 $ $ $1,283 $ $ $808 $ $ $1,615 $ Premium Total Premium Your Premium Your Premium Total Premium Your Premium $1,013 $ $2,402 $ $1,507 $ $2,841 $
a wide
of wellness
ts. TRS-ActiveCare 2 • Closed to new enrollees • Current enrollees can choose to stay in plan • Lower deductible • Copays for many services and drugs • Nationwide network with out-of-network coverage • No requirement for PCPs or referrals TRS-ActiveCare Primary+ TRS-ActiveCare HD than the HD and Primary plans services and drugs required to see specialists with a Health Savings Account (HSA) coverage • Compatible with a Health Savings Account (HSA) • Nationwide network with out-of-network coverage • No requirement for PCPs or referrals • Must meet your deductible before plan pays for non-preventive care $50 copay You pay 30% after deductibleYou pay 50% after deductible You pay 20% after deductible You pay 30% after deductible $0 per medical consultation $30 per medical consultation $12 per medical consultation $42 per medical consultation $50 copay You pay 40% after deductible You pay a $250 copay plus 20% after deductible $0 per medical consultation $12 per medical consultation Aug. 31, 2024 $15 copay You pay 30% after deductibleYou pay 50% after deductible $70 copay You pay 30% after deductibleYou pay 50% after deductible $30 copay You pay 40% after deductible $70 copay You pay 40% after deductible In-Network Coverage Only In-Network Out-of-Network $1,200/$2,400 $3,000/$6,000 $5,500/$11,000 You pay 20% after deductible You pay 30% after deductibleYou pay 50% after deductible $6,900/$13,800 $7,500/$15,000 $20,250/$40,500 Statewide Network Nationwide Network Yes No In-Network Out-of-Network $1,000/$3,000 $2,000/$6,000 You pay 20% after deductibleYou pay 40% after deductible $7,900/$15,800 $23,700/$47,400 Nationwide Network No deductible per participant (brand drugs only) Integrated with medical $15/$45 copay You pay 20% after deductible; $0 coinsurance for certain generics You pay 25% after deductible You pay 25% after deductible You pay 50% after deductible You pay 50% after deductible $0 if SaveOnSP eligible; You pay 30% after deductible You pay 20% after deductible 31-day supply; $75 for 61-90 day supply You pay 25% after deductible $200 brand deductible $20/$45 copay You pay 25% after deductible ($40 min/$80 max)/ You pay 25% after deductible ($105 min/$210 max) You pay 50% after deductible ($100 min/$200 max)/ You pay 50% after deductible ($215 min/$430 max) $0 if SaveOnSP eligible; You pay 30% after deductible ($200 min/$900 max)/ No 90-day supply of specialty medications $25 copay for 31-day supply; $75 for 61-90 day supply 15
includes
range
bene

What’s New and What’s Changing

• Individual maximum-out-of-pocket decreased by $650. Previous amount was $8,150 and is now $7,500.

• Family maximum-out-of-pocket decreased by $1,300. Previous amount was $16,300 and is now $15,000.

• Individual maximum-out-of-pocket increased by $450 to match IRS guidelines. Previous amount was $7,050 and is now $7,500.

• Family maximum-out-of-pocket increased by $900 to match IRS guidelines. Previous amount was $14,100 and is now $15,000. These changes apply only to in-network amounts.

• Family deductible decreased by $1,200. Previous amount was $3,600 and is now $2,400.

• Primary care provider copay decreased from $30 to $15.

• No changes.

• This plan is still closed to new enrollees.

2022-23 Total Premium New 2023-24 Total Premium Change in Dollar Amount TRS-ActiveCare Primary Employee Only $417 $461 $44 Employee and Spouse $1,176 $1,245 $69 Employee and Children $751 $784 $33 Employee and Family $1,405 $1,568 $163 TRS-ActiveCare HD Employee Only $429 $475 $46 Employee and Spouse $1,209 $1,283 $74 Employee and Children $772 $808 $36 Employee and Family $1,445 $1,615 $170 TRS-ActiveCare Primary+ Employee Only $525 $541 $16 Employee and Spouse $1,284 $1,407 $123 Employee and Children $845 $920 $75 Employee and Family $1,614 $1,786 $172 TRS-ActiveCare 2 (closed to new enrollees) Employee Only $1,013 $1,013 $0 Employee and Spouse $2,402 $2,402 $0 Employee and Children $1,507 $1,507 $0 Employee and Family $2,841 $2,841 $0 Key Plan Changes At a Glance Primary HD Primary+ Premiums Lowest Lower Higher Deductible Mid-range High Low Copays Yes No Yes NetworkStatewide network Nationwide network Statewide network PCP Required? Yes No Yes HSA-eligible? No Yes No Effective: Sept. 1, 2023
This table shows you the changes between 2022-23 statewide premium price and this year’s 2023-24 regional price for your Education Service Center.
16

Compare Prices for Common Medical Services

*Pre-certi cation for genetic and specialty testing may apply. Contact a PHG

with questions.

Bene t TRS-ActiveCare Primary TRS-ActiveCare Primary+ TRS-ActiveCare HD TRS-ActiveCare 2 In-Network OnlyIn-Network OnlyIn-NetworkOut-of-NetworkIn-NetworkOut-of-Network Diagnostic Labs* Of ce/Indpendent Lab: You pay $0 Of ce/Indpendent Lab: You pay $0 You pay 30% after deductible You pay 50% after deductible Of ce/Indpendent Lab: You pay $0 You pay 40% after deductible Outpatient: You pay 30% after deductible Outpatient: You pay 20% after deductible Outpatient: You pay 20% after deductible High-Tech Radiology You pay 30% after deductible You pay 20% after deductible You pay 30% after deductible You pay 50% after deductible You pay 20% after deductible + $100 copay per procedure You pay 40% after deductible + $100 copay per procedure Outpatient Costs You pay 30% after deductible You pay 20% after deductible You pay 30% after deductible You pay 50% after deductible You pay 20% after deductible ($150 facility copay per incident) You pay 40% after deductible ($150 facility copay per incident) Inpatient Hospital Costs You pay 30% after deductible You pay 20% after deductible You pay 30% after deductible You pay 50% after deductible ($500 facility per day maximum) You pay 20% after deductible ($150 facility copay per day) You pay 40% after deductible ($500 facility per day maximum) Freestanding Emergency Room You pay $500 copay + 30% after deductible You pay $500 copay + 20% after deductible You pay $500 copay + 30% after deductible You pay $500 copay + 50% after deductible You pay $500 copay + 20% after deductible You pay $500 copay + 40% after deductible Bariatric Surgery Facility: You pay 30% after deductible Facility: You pay 20% after deductible Not CoveredNot Covered Facility: You pay 20% after deductible ($150 facility copay per day) Not Covered Professional Services: You pay $5,000 copay + 30% after deductible Professional Services: You pay $5,000 copay + 20% after deductible Professional Services: You pay $5,000 copay + 20% after deductible Only covered if rendered at a BDC+ facility Only covered if rendered at a BDC+ facility Only covered if rendered at a BDC+ facility Annual Vision Exam (one per plan year; performed by an ophthalmologist or optometrist) You pay $70 copayYou pay $70 copay You pay 30% after deductible You pay 50% after deductible You pay $70 copay You pay 40% after deductible Annual Hearing Exam (one per plan year) $30 PCP copay $70 specialist copay $30 PCP copay $70 specialist copay You pay 30% after deductible You pay 50% after deductible $30 PCP copay $70 specialist copay You pay 40% after deductible
www.trs.texas.gov
at 1-866-355-5999
Call a Personal Health Guide (PHG) any time 24/7 to help you nd the best price for a medical service. Reach them at 1-866-355-5999 REMEMBER: Revised 05/30/23 17

2023-24 Health Maintenance Organization (HMO) Plans and Premiums for Select Regions of the State

TRS contracts with HMOs in certain regions to bring participants in those areas additional options. HMOs set their own rates and premiums. They’re fully insured products who pay their own claims.

You can choose this plan if you live in one of these counties: Austin, Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Collin, Coryell, Dallas, Denton, Ellis, Erath, Falls, Freestone, Grimes, Hamilton, Hays, Hill, Hood, Houston, Johnson, Lampasas, Lee, Leon, Limestone, Madison, McLennan, Milam, Mills, Navarro, Robertson, Rockwall, Somervell, Tarrant, Travis, Walker, Waller, Washington, Williamson

You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy

You can choose this plan if you live in one of these counties: Andrews, Armstrong, Bailey, Borden, Brewster, Briscoe, Callahan, Carson, Castro, Childress, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, Fisher, Floyd, Gaines, Garza, Glasscock, Gray, Hale, Hall, Hansford, Hartley, Haskell, Hemphill, Hockley, Howard, Hutchinson, Irion, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Llano, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, San Saba, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Winkler, Yoakum

Remember that when you choose an HMO, you’re choosing a regional network. REMEMBER: www.trs.texas.gov Total Monthly Premiums Total PremiumYour PremiumTotal PremiumYour PremiumTotal PremiumYour Premium Employee Only $596.96$ N/A$ N/A$ Employee and Spouse$1,501.90$ N/A$ N/A$ Employee and Children$960.68$ N/A$ N/A$ Employee and Family$1,728.86$ N/A$ N/A$ Central and North Texas Baylor Scott & White Health Plan Brought to you by TRS-ActiveCare Blue Essentials - South Texas HMO Brought to you by TRS-ActiveCare Blue Essentials - West Texas HMO Brought to you by TRS-ActiveCare
Prescription Drugs Drug Deductible $200 (excl. generics) N/A N/A Days Supply30-day supply/90-day supply N/A N/A Generics $14/$35 copay N/A N/A Preferred BrandYou pay 35% after deductible N/A N/A Non-preferred BrandYou pay 50% after deductible N/A N/A SpecialtyYou pay 35% after deductible N/A N/A Immediate Care Urgent Care $40 copay N/A N/A Emergency Care$500 copay after deductible N/A N/A Doctor Visits Primary Care $20 copay N/A N/A Specialist $70 copay N/A N/A Plan Features Type of CoverageIn-Network Coverage Only N/A N/A Individual/Family Deductible $2,400/$4,800 N/A N/A CoinsuranceYou pay 25% after deductible N/A N/A Individual/Family Maximum Out of Pocket $8,150/$16,300 N/A N/A
Revised 05/30/23 Only$553.45$ Eastland, Ector, Fisher, Floyd, Gaines, Garza, $14/$35 copay N/A N/A CoinsuranceYou pay 25% after deductible N/A N/A 18

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/lakeworthisd

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

A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.

HSA Eligibility

You are eligible to open and contribute to an HSA if you are:

• Enrolled in an HSA-eligible HDHP

• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan

• Not enrolled in a Health Care Flexible Spending Account

• Not eligible to be claimed as a dependent on someone else’s tax return

• Not enrolled in Medicare or TRICARE

• Not receiving Veterans Administration benefits

You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered by the HDHP.

Maximum Contributions

Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2023 is based on the coverage option you elect:

• Individual – $3,850

• Family (filing jointly) – $7,750

EMPLOYEE BENEFITS

You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch-up contribution for the entire plan year.

Opening an HSA

If you meet the eligibility requirements, you may open an HSA administered by EECU. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA. To open an account, go to https://www.eecu.org/.

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: www.eecu.org/locations

EECU
19

Hospital Indemnity Lincoln Financial Group

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/lakeworthisd

Plan Eligibility

If you or a covered family member have to go to the hospital for an accident or injury, hospital indemnity insurance provides a lumpsum cash benefit to help you take care of unexpected expenses — anything from deductibles to child care to everyday bills. Because you’re selecting this coverage through your company, you can take advantage of group rates. You don’t have to answer medical questions to receive coverage; this is guaranteed coverage.

For the initial day of admission toa hospital for treatment of a sickness/an injury

Hospital confinement

For each day of confinement in a hospital as a result of a sickness/ an injury

$1,000 per day for one day per calendar year

$100 per day for 30 days per calendar year starting on first day of confinement

$2,000 per day for one day per calendar year

$200 per day for 30 days per calendar year starting on first day of confinement

Hospital ICU confinement

For each full or partial day of confinement in an ICU as a resultof a sickness/an injury

$200 per day for 30 days per calendar year starting the first day of confinement

$400 per day for 30 days per calendar year starting the first day of confinement Complications of pregnancy

• If both hospital and ICU admission or hospital and ICU confinement become payable for the same day, only the larger of the two benefits will be paid. If the amount of the benefits is the same, only one will be paid.

For each day of confinement to a hospital for routine post-natal care following birth

$500 per day for two days per calendar year

$500 per day for two days per calendar year

For the initial day in an observation unit as the result of a sickness/an injury

$100 per day for one day per calendar year

$200 per day for one day per calendar year Enhanced

Hospital indemnity insurance premium

Affordable group rates – Monthly premiums

As an employee, you can take advantage of this accident insurance plan. Plus, you can add loved ones to the plan for just a little more. Questions? Call 800-423-2765 and mention ID: LAKEWOR

EMPLOYEE BENEFITS
Low Plan High Plan
Core hospital benefits
Hospital admission
Included
Included
Additional confinement benefits Low Plan High Plan Newborn
care
Outpatient benefits Low Plan High Plan Observation
unit
Low Plan benefit percentage High Plan benefit percentage
25% 25% Hospital Indemnity Low High Employee $13.17 $26.35
Spouse $27.22 $54.44 Employee + Child(ren) $18.90 $37.79 Family
$61.13
benefits
Hospital NICU confinement Increases the hospital ICU confinement benefit for a newborn child’s ICU or NICU confinement by the percentage shown in the schedule of benefits
Employee +
$30.57
20

Dental Insurance

Lincoln Financial Group

ABOUT DENTAL

Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease.

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

Visit LincolnFinancial.com/FindADentist

You can search by:

• Location

• Dentist name or office name

• Distance you are willing to travel

• Specialty, language and more

Your search will automatically provide up to 100 dentists that most closely match your criteria. If your search does not locate the dentist you prefer, you can nominate one—just click the Nominate a Dentist link and complete the online form.

With the Lincoln Dental Mobile App

• Find a network dentist near you in minutes

• Have an ID card on your phone

• Customize the app to get details of your plan

• Find out how much your plan covers for checkups and other services

• Keep track of your claims

Lincoln DentalConnect® Online Health Center

• Determine the average cost of a dental procedure

• Have your questions answered by a licensed dentist

• Learn all about dental health for children, from baby’s first tooth to dental emergencies

• Evaluate your risk for oral cancer, periodontal disease and tooth decay

Covered Family Members

When you choose coverage for yourself, you can also provide coverage for:

• Your spouse.

• Dependent children, up to age 26.

EMPLOYEE BENEFITS Dental Low High Employee $17.00 $35.04 Employee + Spouse $38.82 $81.54 Employee + Child(ren) $39.18 $73.67 Family $61.02 $117.47 21

Accident Insurance The Hartford

ABOUT ACCIDENT

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

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

With Accident insurance, you’ll receive payment(s) associated with a covered injury and related services. You can use the payment in any way you choose – from expenses not covered by your major medical plan to day-to-day costs of living such as the mortgage or your utility bills.

COVERAGE INFORMATION

You have a choice of two accident plans, which allows you the flexibility to enroll for the coverage that best meets your needs. This insurance provides benefits when injuries, medical treatment and/or services occur as the result of a covered accident. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s).

EMPLOYEE BENEFITS PLAN INFORMATION LOW PLAN HIGH PLAN Coverage Type On and off-job (24 hour) BENEFITS LOW PLAN HIGH PLAN EMERGENCY, HOSPITAL & TREATMENT CARE Accident Follow-Up Up to 3 visits per accident $100 $150 Accident Prevention Benefit Once per year for each covered person $75 $75 Acupuncture/Chiropractic Care/PT Up to 10 visits each per accident Up to $75 Up to $100 Ambulance – Air Once per accident $2,000 $2,500 Ambulance – Ground Once per accident $750 $1,000 Blood/Plasma/Platelets Once per accident $300 $400 Child Care Up to 30 days per accident while insured is confined $35 $50 Daily Hospital Confinement Up to 365 days per lifetime $400 $600 Daily ICU Confinement Up to 30 days per accident $600 $800 Diagnostic Exam Once per accident $300 $400 Emergency Dental Once per accident Up to $600 Up to $600 Emergency Room Once per accident $200 $250 Hospital Admission Once per accident $1,500 $2,000 Initial Physician Office Visit Once per accident $200 $250 Lodging Up to 30 nights per lifetime $150 $175 Medical Appliance Once per accident $200 $300 Rehabilitation Facility Up to 15 days per lifetime $300 $450 Transportation Up to 3 trips per accident $600 $800 Urgent Care Once per accident $200 $250 X-ray Once per accident $150 $200 22

Accident Insurance The Hartford EMPLOYEE

BENEFITS LOW PLAN HIGH PLAN SPECIFIED INJURY & SURGERY Abdominal/Thoracic Surgery Once per accident $3,000 $4,000 Arthroscopic Surgery Once per accident $500 $750 Burn Once per accident Up to $15,000 Up to $20,000 Burn – Skin Graft Once per accident for third degree burn(s) 50% of burn benefit Concussion Up to 3 per year $200 $250 Dislocation Once per joint per lifetime Up to $8,000 Up to $12,000 Eye Injury Once per accident Up to $750 Up to $1,000 Fracture Once per bone per accident Up to $10,000 Up to $12,000 Hernia Repair Once per accident $400 $600 Joint Replacement Once per accident $4,000 $6,000 Knee Cartilage Once per accident Up to $2,000 Up to $3,000 Laceration Once per accident Up to $1,000 Up to $1,500 Ruptured Disc Once per accident $2,000 $3,000 Tendon/Ligament/Rotator Cuff Once per accident Up to $2,000 Up to $3,000 CATASTROPHIC Accidental Death Within 90 days; Spouse @ 50% and child @ 25% $150,000 $300,000 Common Carrier Death Within 90 days 2 times death benefit Coma Once per accident Up to $15,000 Up to $20,000 Dismemberment Once per accident Up to $75,000 Up to $100,000 Home Health Care Up to 30 days per accident $75 $100 Paralysis Once per accident Up to $75,000 Up to $100,000 Prosthesis Once per accident Up to $3,000 Up to $4,000 FEATURES Ability Assist® EAP – 24/7/365 access to help for financial, legal or emotional issues Included Included HealthChampionSM – Administrative & clinical support following serious illness or injury Included Included Accident LOW PLAN HIGH PLAN Employee $11.48 $15.94 Employee + Spouse $17.95 $24.71 Employee + Child(ren) $19.50 $26.59 Family $30.48 $41.65
BENEFITS 23

Vision Insurance Superior Vision

ABOUT VISION

Vision insurance provides coverage for routine eye examinations and can help with covering some of the costs for eyeglass frames, lenses or contact lenses.

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

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.

Medically Necessary Contact Lenses

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements

All allowances are at a retail value; the insured is responsible for any charges in excess of this retail allowance.

1. Materials co-pay applies to lenses and frames only, not contact lenses.

2. Standard Contact Lens Fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty Contact Lens Fitting applies to new contact wearers and/or a member who wears toric, gas permeable, or multi-focal lenses.

3. Contact lenses are in lieu of eyeglass lenses and frames benefit.

In-network Out-of-network Exam (Ophthalmologist) Covered In Full Up to $42 Exam (Optometrist) Covered In Full Up to $37 Frames $150 retail allowance Up to $60 Contact Lens Fitting (Standard2) Covered In Full Not Covered Contact Lens Fitting (Specialty2) $50 retail allowance Not Covered Lenses (standard) per pair Single Vision Covered In Full Up to $26 Bifocal Covered In
Up to $34 Trifocal Covered In
Up to $50 Progressive Covered at lined trifocal level Up to $50 Lenticular Covered In
Up to $80
Covered
Not Covered
Covered
Not Covered
Covered
Not Covered Contact Lenses
$120 retail allowance Up to $100 retail
Covered in
Up to $210 retail
EMPLOYEE BENEFITS
Full
Full
Full
Ultraviolet Coat
In Full
Factory Scratch Coat
In Full
Polycarbonate for Dependent Children
In Full
2
full
Copays Services/frequency Monthly Premiums Exam $10 Exam 12 months Employee $8.45 Materials1 $25 Frame 24 months Employee + Spouse $13.51 Contact lens fitting $25 Lenses 12 months Employee + Child(ren) $13.79 Contact lenses 12 months Family $22.24 Contact lens fitting 12 months 24

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/lakeworthisd

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.

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/fbs

• 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 MDLive EMPLOYEE BENEFITS 25

Disability Insurance The Hartford EMPLOYEE BENEFITS

ABOUT DISABILITY

Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.

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

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

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 $7,500 that cannot exceed 67% 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 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

Age 69 and older

21 months

18 months

26

Disability Insurance The Hartford EMPLOYEE BENEFITS

Mental Illness, Alcoholism and Substance Abuse

Duration: You can receive benefit payments for Long-Term Disabilities resulting from mental illness, alcoholism and substance abuse for a total of 24 months for all disability periods during your lifetime. Any period of time that you are confined in a hospital or other facility licensed to provide medical care for mental illness, alcoholism and substance abuse does not count toward the 24 month lifetime limit.

Partial Disability: Partial Disability is covered provided you have at least a 20% loss of earnings and duties of your job.

Other Important Benefits

Survivor Benefit - If you die while receiving disability benefits, a benefit will be paid to your spouse or child under age 26, equal to three times your last monthly gross benefit.

The Hartford's Ability Assist service is included as a part of your group Long Term Disability (LTD) insurance program. You have access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD benefits. Once you are covered you are eligible for services to provide assistance with child/ elder care, substance abuse, family relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist them with the unique emotional, financial and legal issues that may result from a disability. Ability Assist services are provided through ComPsych®, a leading provider of employee assistance and work/life services.

Travel Assistance Program – Available 24/7, this program provides assistance to employees and their dependents who travel 100 miles from their home for 90 days or less. Services include pre-trip information, emergency medical assistance and emergency personal services.

Identity Theft Protection – An array of identity fraud support services to help victims restore their identity. Benefits include 24/7 access to an 800 number; direct contact with a certified caseworker who follows the case until it’s resolved; and a personalized fraud resolution kit with instructions and resources for ID theft victims.

Workplace Modification provides for reasonable modifications made to a workplace to accommodate your disability and allow you to return to active full-time employment.

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 12 weeks.

Disability -
Elimination Period Minimum $200 Benefit 14/14 $2.62 30/30 $2.10 60/60 $1.78 90/90 $1.44 180/180 $1.12
per $100 in benefit
27

Critical Illness Insurance

ABOUT CRITICAL ILLNESS

Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non-medical costs related to the illness, including transportation, child care, etc.

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

Critical Illness

• Provides cash benefits if you or a covered family member is diagnosed with a critical illness or event

• Benefits are paid in addition to what is covered under your health insurance

• Features group rates for employees

• There are no waiting periods or overall plan maximums

BENEFITS

Lincoln Financial Group EMPLOYEE

Options of $10,000, $20,000, or $30,000

Guaranteed coverage amounts

• If this is your first opportunity to enroll for coverage, you can choose from the coverage amounts above

Coverage for your spouse

You can secure Critical Illness Insurance for your spouse when you choose coverage for yourself.

Guaranteed

amount

Guaranteed coverage amounts

• You can choose from the coverage amount(s) for your spouse

Coverage for your dependent children

of $10,000, $20,000 or $30,000 (up to 100% of the employee coverage amount)

of the employee coverage amount up to $15,000 maximum

You can elect Critical Illness Insurance for your dependent children when you choose coverage for yourself.

Critical Illness Insurance | Employee
Guaranteed coverage amounts
Critical Illness Insurance | Spouse
coverage
Options
Critical Illness Insurance | Spouse Maximum
50%
Coverage Amount
Age Range (Attained Age) Critical Illness Premium Rate per $1,000 0-24 $0.274 25-29 $0.344 30-34 $0.432 35-39 $0.563 40-44 $0.779 45-49 $1.161 50-54 $1.794 55-59 $2.626 60-64 $4.078 65-69 $5.974 70+ $8.147 28

Critical Illness Insurance

Lincoln Financial Group

You receive a cash benefit every year you and any of your covered family members complete a single covered exam, screening or immunization

Level: $50

EMPLOYEE
Core Benefits Covered Conditions Benefit Percentage Heart attack 100% Stroke 100% Invasive Cancer 100% End Stage Renal (kidney) Failure 100% Major organ failure (heart, lung, liver, pancreas, or intestine) 100% Arterial/vascular disease 25% Mitral or aortic valve disease 10% Noninvasive cancer (in situ) 25% Skin Cancer $1,000 per lifetime Supplemental Conditions Advanced ALS/Lou Gehrig’s disease 25% Advanced Alzheimer’s disease 25% Advanced Parkinson’s disease 25% Advanced multiple sclerosis 25% Benign brain tumor 100% Loss of sight, hearing and/or speech 100% Accidental Injuries Benefit Benefit Percentage Severe burns, permanent paralysis or
brain injuries (includes coma) 100% Additional Childhood Conditions Benefit Percentage Cerebral palsy 100% Cleft lip, cleft palate 100% Cystic Fibrosis 100% Down syndrome 100% Muscular dystrophy 100% Spina bifida 100% Type 1 Diabetes 100% Health Assessment / Wellness Benefit Your Cash Benefit
BENEFITS
traumatic
29

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/lakeworthisd

Safeguard the most important people in your life.

EMPLOYEE BENEFITS

Consider what your loved ones may face after you’re gone. Term life insurance can help them in so many ways, like helping to cover everyday expenses, pay off debt, and protect savings. Accidental death and dismemberment (AD&D) insurance provides additional benefits if you die or suffer a covered loss in an accident, such as losing a limb or your eyesight.

AT A GLANCE:

• A cash benefit of $50,000 to your loved ones in the event of your death, plus an additional cash benefit if you die in an accident

• AD&D Plus: If you suffer an AD&D-covered loss in an accident, you may also receive benefits for the following in addition to your core AD&D benefits: coma, plegia, education, childcare, spouse training. Additional conditions are outlined in your policy.

• Includes LifeKeys® services, which provide access to counseling, financial, and legal support services.

• TravelConnect® services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home.

• Includes EmployeeConnectSM EAP services, which give you and your family confidential access to counselors as well as personal, legal, and financial assistance.

• Program Services include:

* Unlimited, 24/7 access to information and referrals

* In-person help for short-term issues; up to five sessions with a counselor per person, per issue, per year.

* One free consultation with a network attorney (with subsequent meetings at a reduced fee)

* One free consultation with a financial counselor

* Online tools, tutorials, videos and much more

You also have the option to increase your cash benefit by securing additional coverage at affordable group rates. See the enclosed optional life insurance information for details.

ADDITIONAL DETAILS

Continuation of coverage for ceasing active work: You may be able to continue your coverage if you leave your job for reasons including and not limited to Family and Medical Leave, lay-off, leave of absence, and leave of absence due to disability.

Waiver of premium: This provision relieves you from paying premiums during a period of disability that has lasted for a specified length of time.

Continuation of coverage: You may be able to continue your coverage if you leave your job for any reason other than sickness, injury, or retirement.

Accelerated death benefit: Enables you to receive a portion of your policy death benefit while you are living. To qualify, a medical professional must diagnose you with a terminal illness with a life expectancy of fewer than 12 months.

Conversion: You may be able to convert your group term life coverage to an individual life insurance policy if your coverage decreases or you lose coverage due to leaving your job or for other reasons outlined in the plan contract.

Benefit reduction: Your employee Life/AD&D coverage amount will reduce by 50% when you reach age 70. Benefits end when you retire.

This is an incomplete list of benefit exclusions. A complete list is included in the policy. State variations apply.

30

Life and AD&D Lincoln Financial Group

The Lincoln Term Life and AD&D Insurance Plan:

• Provides a cash benefit to your loved ones in the event of your death or if you die in an accident

• Provides a cash benefit to you if you suffer a covered loss in an accident, such as losing a limb or your eyesight

• Features group rates for employees

• Includes LifeKeys® services, which provide access to counseling, financial, and legal support services

• Also includes TravelConnect® services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home

Employee Life and AD&D

Coverage Options

Maximum coverage amount

Increments of $10,000

This amount may not exceed the lesser of 5 times Annual Earnings (rounded up to the nearest $10,000) or $500,000

Equal to the life insurance amount chosen

Your coverage will be reduced by 55% when you reach age 75

Spouse Life and AD&D

The amount of Dependent Life Insurance coverage cannot be greater than 100% of the Employee Benefit. Coverage Options

Increments of $5,000 Maximum coverage amount

This amount may not exceed the lesser of 5 times Annual Earnings (rounded up to the nearest $5,000) or $500,000

EMPLOYEE
BENEFITS
Guaranteed Life coverage amount
Minimum coverage amount $10,000
$200,000 Optional AD&D coverage amount
Minimum coverage amount $5,000 Guaranteed Life coverage amount $50,000 Optional AD&D coverage amount Equal to the life insurance amount
Dependent Child(ren) Life At least one day but under 26 years $10,000 31
chosen

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/lakeworthisd

Family Protection Plan with 5Star Life Insurance offers individual insurance coverage to age 121. The plan includes a Terminal Illness Acceleration of Benefit and a Qualify of Life Benefit.

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).

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.

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.

Find full details and rates at www.mybenefitshub.com/lakeworthisd.

Should you need to file a claim, contact 5Star directly at (866) 863-9753.

*Quality of Life not available ages 66-70. Quality of Life benefits not available for children

Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 years).$7.15 monthly for $10,000 coverage per child.

5Star EMPLOYEE BENEFITS 32

Identity Theft ID Watchdog

ABOUT IDENTITY THEFT PROTECTION

Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered.

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

Your identity is important — it’s what makes you, you. You’ve spent a lifetime building your name and financial reputation. Let us help you better protect it. And, we’ll even go one step further and help you better protect the identities of your family.

EASY & AFFORDABLE IDENTITY PROTECTION

With ID Watchdog®, you have an easy and affordable way to help better protect and monitor the identities of you and your family. You’ll be alerted to potentially suspicious activity and enjoy the peace of mind that comes with the support of dedicated resolution specialists. And, a customer care team that’s available any time, every day.

ID WATCHDOG IS HERE FOR YOU

ID Watchdog is everywhere you can’t be — monitoring credit reports, social media, transaction records, public records and more — to help you better protect your identity. And don’t worry, we’re always here for you. In fact, our U.S.-based customer care team is available 24/7/365 at 866.513.1518.

WHY CHOOSE ID WATCHDOG Credit Lock

With our online and in-app feature, lock your Equifax® credit report — and your child’s Equifax credit report — to help provide additional protection against unauthorized access to your credit.

More for Families

Our family plan helps you better protect your loved ones, with each adult getting their own account with all plan features. And, we offer more features that help protect minors than any other provider.

Dedicated Resolution Specialists

If you become a victim, you don’t have to face it alone. One of our certified resolution specialists will fully manage the case for you until your identity is restored.

UNIQUE FEATURES INCLUDED IN ALL ID WATCHDOG PLANS

Monitor & Detect

• Dark Web Monitoring1 

• High-Risk Transactions Monitoring2 

• Subprime Loan Monitoring2 

• Public Records Monitoring 

• USPS Change of Address Monitoring

• Identity Profile Report

Manage & Alert

• Child Credit Lock3 | 1 Bureau 

• Financial Accounts Monitoring

• Social Network Alerts 

• Registered Sex Offender Reporting 

• Customizable Alert Options

• Breach Alert Emails

• Mobile App

Support & Restore

• Identity Theft Resolution Specialists (Resolution for Preexisting Conditions) 

• 24/7/365 U.S.-based Customer Care Center

• Lost Wallet Vault & Assistance

• Deceased Family Member Fraud Remediation

• Fraud Alert & Credit Freeze Assistance

 Helps better protect children

1 Bureau = Equifax®

2 Multi-Bureau = Equifax, TransUnion®

3 Bureau = Equifax, Experian®, TransUnion

EMPLOYEE BENEFITS Identity Theft 1B Platinum Employee $7.95 $11.95 Employee + Family $14.95 $22.95 33

Flexible Spending Account (FSA) Higginbotham EMPLOYEE BENEFITS

ABOUT FSA

A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (unless your plan contains a $610 rollover or grace period provision).

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

Higginbotham Benefits Debit Card

The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care or Limited Purpose 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 replace-ment 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 selfcare.

• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.

Important FSA Rules

• The maximum per plan year you can contribute to a Health Care or Limited Purpose FSA is $3,050. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately.

• You cannot change your election during the year unless you experience a Qualifying Life Event.

• Your Health Care or Limited Purpose FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.

Over-the-Counter Item Rule Reminder

Health care reform legislation requires that certain over-thecounter (OTC) items require a prescription to qualify as an eligi-ble 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.

34

Flexible Spending Account (FSA) Higginbotham

• 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

Health Care FSA

Limited Purpose

Health Care FSA

Dependent Care FSA

Flexible Spending Accounts

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)

Dental and vision care expenses that are not covered by your health plan (such as eyeglasses, contacts, LASIK eye surgery, fillings, x-rays and braces)

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

Higginbotham Flex Mobile App

$3,050

Saves on eligible expenses not covered by insurance, reduces your taxable income

$3,050

$5,000 single $2,500 if married and filing separate tax returns

Saves on eligible expenses not covered by insurance, reduces your taxable income

Reduces your taxable income

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.

Account Type Eligible Expenses Annual Contribution Limits Benefit
35
EMPLOYEE BENEFITS

Emergency Medical Transport MASA EMPLOYEE BENEFITS

ABOUT MEDICAL TRANSPORT

Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out-of-pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan.

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

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/lakeworthisd

Emergency Medical Transportation Emergent Plus Platinum Employee + Family $14.00 $39.00 36

Student Loan Assistance GotZoom

ABOUT STUDENT LOAN ASSISTANCE

Student Loan debt in the United States currently exceeds $1.4 trillion dollars. If you are one of the millions of Americans that are stressed and struggling with high levels of student loan debt, this is a program that may provide student loan relief to those who qualify.

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

The Facts

• Educators and Public Service employees enjoy special status with the Department of Education (DOE) and are eligible for the best available student loan repayment and loan forgiveness programs

• Only 2 in 10 borrowers take advantage of the programs

• $350 Million of additional DOE funding became available in Mar. 2018 (first come, first serve)

The Best Solution

• GotZoom was created to fill a critical void. Student loan debt is our country’ second largest debt class behind mortgages

• With nearly 70 federal student loan repayment and forgiveness programs in place today the options to reduce your student debt are exceptional

• GotZoom finds the best program options that suit your needs, confirms eligibility and facilitates all the administration

Better Results:

GotZoom delivers. The savings realized by our clients increased to 65% last year (ave. debt reduction).

Multiple Benefits:

Reducing your monthly payment is important but many GotZoom clients can also benefit from a shorter loan term and/or reduced total debt level.

What’s GotZoom?

The leader in student debt reduction services

An established company with a seven year track record of performance and customer satisfaction

Where to Start

Go to the enrollment page: https://mystudentloan2.net/1/?

broid=00002000 Click on Enroll Now

Employee Benefits

• Average student debt reduction of 65%

• All administrative details are managed by GotZoom for the employee

• GotZoom monitors DOE programs and reviews the employee’s status annually to find any additional debt reduction options

Service Fee

• Employee’s loan analysis and Benefits Summary are free (no obligation)

• Service fees apply only after the employee has reviewed and approved repayment/forgiveness programs

• Application Fee: $307. Annual Fee: $359.40 (Monthly Option: $32.95)

Benefit Analysis

A GotZoom On-boarding Manager contacts each employee with the results of their no cost loan analysis including which of these benefits are available:

• Reduced monthly loan payment

• Shortened loan term

• Loan forgiveness (aka loan)

DOE Program Enrollment

GotZoom prepares the Department of Education (DOE) case file for enrollment in the federal subsidy and/or forgiveness program.

• Employees submit required documentation

• Employees can stop paying their federal loans courtesy of 60-90 abatement provision while GotZoom is processing the case file. There are no fees, penalties or interest.

Long-Term Customer Support

Employees can relax with the knowledge that GotZoom manages all the required administrative work throughout the term of the repayment program including any annual re-certifications. GotZoom also monitors the DOE programs for changes that can result in additional savings.

EMPLOYEE BENEFITS 37
Notes 38
Notes 39

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 Lake Worth 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 Lake Worth 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.

WWW.MYBENEFITSHUB.COM/LAKEWORTHISD

2023
- 2024 Plan Year
40

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