2023 - 2024 Plan Year
LOVEJOY ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2023 - 8/31/2024 WWW.MYBENEFITSHUB.COM/LOVEJOYISD
1
Table of Contents How to Enroll
4-5
Annual Benefit Enrollment
6-11
1. Annual Enrollment
6
2. Section 125 Cafeteria Plan Guidelines
7
3. Helpful Definitions
8
4. Eligibility Requirements
9
5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA)
10
Medical
19
Hospital Cash
20
Health Savings Account (HSA)
21
Dental
22-23
Vision
24-25
Basic and Voluntary Life
27-28 29
Cancer
30
Critical Illness
31-32
Identity Theft
33
HOW TO ENROLL
PG. 6
SUMMARY PAGES
PG. 12
YOUR BENEFITS
34-35
Employee Assistance Program (EAP)
36
Foundation for Lovejoy Schools
37
Catastrophic Sick Leave Bank
PG. 4
26
AD&D
Flexible Spending Account (FSA)
2
12-18
Telehealth
Disability
FLIP TO...
38-39
Benefit Contact Information LOVEJOY ISD BENEFITS
MEDICAL: TRS ACTIVECARE
MEDICAL: TRS HMO
Financial Benefit Services (469) 385-4685 www.mybenefitshub.com/lovejoyisd
Blue Cross Blue Shield 866-355-5999 www.bcbstx.com/trsactivecare
Baylor Scott & White (844) 633-5323 https://trs.swhp.org/
LOVEJOY ISD BENEFITS OFFICE
PHARMACY (ACTIVECARE ONLY)
TELEHEALTH
Terri Martin Benefits Specialist 469-742-8013 terri_martin@lovejoyisd.net
Express Scripts (844) 238-8084 https://www.express-scripts.com/ trsactivecare
MDLIVE (888) 365-1663 www.mdlive.com/fbs
HEALTH SAVINGS ACCOUNT
DENTAL
VISION
EECU (817) 882-0800 www.eecu.org
MetLife (800) 275-4638 Group # 5383775 www.metlife.com/dental
MetLife Network Davis Vision (833) 393-5433 Group #5383775 metlife.com/vision
DISABILITY
LIFE AND AD&D
CANCER
NY Life Insurance Group #LK963740 (800) 362-4462 myNYLGBS.com
NY Life Insurance Life Group # FLX965387 (800) 244-6224 nyl.com/customer-forms
American Public Life (800) 256-8606 www.ampublic.com
HOSPITAL CASH PLAN Chubb Group #100000045 (888) 499-0425 educatorclaims@chubb.com
CRITICAL ILLNESS Chubb Group # 100000045 (888) 499-0425 educatorclaims@chubb.com
IDENTITY THEFT ID Watchdog (800) 774-3772 www.idwatchdog.com
FLEXIBLE SPENDING ACCOUNT (FSA)
EMPLOYEE ASSISTANCE PROGRAM (EAP)
National Benefit Services (800) 274-0503 www.nbsbenefits.com
NYL /Guidance Resources 800-344-9752 Web ID NYLGBS www.guidanceresources.com
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All Your Benefits One App Employee benefits made easy through the FBS Benefits App! Text “FBS LOVEJOY” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment:
Text “FBS LOVEJOY” to (800) 583-6908
• Benefit Resources • Online Enrollment • Interactive Tools • And more!
App Group #: FBSLOVEJOY
4
OR SCAN
How to Log In 1
www.mybenefitshub.com/lovejoyisd
2
CLICK LOGIN
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
5
Annual Benefit Enrollment
SUMMARY PAGES
Annual Enrollment During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs. •
•
Changes, additions or drops may be made only during the annual enrollment period without a qualifying event. Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.
Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/lovejoyisd. 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 Lovejoy ISD benefit website: www.mybenefitshub.com/lovejoyisd. 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. All new hire enrollment elections must be completed in the online enrollment system within the first 30 days If you do not receive your ID card, you can call the carrier’s customer service number to request another of benefit eligible employment. Failure to complete card. elections during this timeframe will result in the •
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
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.
6
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.
Annual Benefit Enrollment
SUMMARY PAGES
Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
Changes in 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
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
Change in Number of Tax Dependents
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Change in Status of Employment Affecting Coverage Eligibility
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual’s eligibility under an employer’s plan includes commencement or termination of employment.
Gain/Loss of Dependents’ Eligibility Status
An event that causes an employee’s dependent to satisfy or cease to satisfy coverage requirements under an employer’s plan may include change in age, student, marital, employment or tax dependent status.
Judgment/ Decree/Order
If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual’s plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.
Eligibility for Government Programs
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
7
SUMMARY PAGES
Helpful Definitions Actively-at-Work
In-Network
You are performing your regular occupation for the employer on a full-time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2023 please notify your benefits administrator.
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.
Annual Enrollment The period during which existing employees are given the opportunity to enroll in or change their current elections.
Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.
Calendar Year January 1st through December 31st
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. 8
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).
Annual Benefit Enrollment
SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 15 or more regularly scheduled hours each work week.
Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2023 benefits become effective on September 1, 2023, you must be actively-at-work on September 1, 2023 to be eligible for your new benefits.
PLAN
MAXIMUM AGE
Medical
To age 26
DHMO Dental
To age 26
PPO Dental
To age 26
Vision
To age 26
Cancer
To age 26
Identity Theft
To age 26
Life and AD&D
To age 26
Critical Illness
To age 26
Telehealth
To age 26
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. 9
SUMMARY PAGES
HSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Description
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, taxfree. This also allows employees to pay for qualifying dependent care tax-free.
Employer Eligibility
A qualified high deductible health plan.
All employers
Contribution Source
Employee and/or employer
Employee and/or employer
Account Owner
Individual
Employer
Underlying Insurance Requirement
High deductible health plan
None
Minimum Deductible
$1,500 single (2023) $3,000 family (2023)
N/A
Maximum Contribution
$3,850 single (2023) $7,750 family (2023) 55+ catch up +$1,000
$3,050 (2023)
Permissible Use Of Funds
Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Cash-Outs of Unused Amounts (if no medical expenses)
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age Not permitted 65).
Year-to-year rollover of account balance?
Yes, will roll over to use for subsequent year’s health coverage.
Most plans require that you use your funds by 8/31/2024. Your plan allows an additional 75 days from 8/31 to spend your remaining funds.
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
FLIP TO
FOR HSA INFORMATION
10
PG. 21
FLIP TO
FOR FSA INFORMATION
PG. 34
Notes
11
Medical Insurance
EMPLOYEE BENEFITS
TRS
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/lovejoyisd
Monthly Premium
District Contribution
Employee Cost
TRS ActiveCare HD Employee Only
$462.00
$275.00
$187.00
Employee & Spouse
$1,248.00
$275.00
$973.00
Employee & Child(ren)
$786.00
$275.00
$511.00
Employee & Family
$1,571.00
$275.00
$1,296.00
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
$450.00
$275.00
$175.00
Employee & Spouse
$1,215.00
$275.00
$940.00
Employee & Child(ren)
$765.00
$275.00
$490.00
Employee & Family
$1,530.00
$275.00
$1,255.00
TRS ActiveCare Primary+ Employee Only
$529.00
$275.00
$254.00
Employee & Spouse
$1,376.00
$275.00
$1,101.00
Employee & Child(ren)
$900.00
$275.00
$625.00
Employee & Family
$1,746.00
$275.00
$1,471.00
Central & North Texas Baylor Scott and White HMO
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Employee Only
$569.76
$275.00
$294.76
Employee & Spouse
$1,432.42
$275.00
$1,157.42
Employee & Child(ren)
$916.49
$275.00
$641.49
Employee & Family
$1,648.78
$275.00
$1,373.78
You bet your boots big things happen here, including TRS-ActiveCare’s large network of doctors and hospitals.
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 specified 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 13 maximum, the plan pays 100% of allowable charges for covered services.
762373.0523
2023-24 TRS-ActiveCare Plan Highlights Sept. 1, 2023 – How to Calculate Your Monthly Premium
All TRS-ActiveCare participants have three plan options. E TRS-ActiveCare Primary
Total Monthly Premium Your District and State Contributions
• 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
Plan Summary
Your Premium
TRS-
• Lower deductible t • Copays for many s • Higher premium • Statewide network • PCP referrals requi • Not compatible wit • No out-of-network
Ask your Benefits Administrator for your district’s specific premiums.
Monthly Premiums
Wellness Benefits at No Extra Cost* Being healthy is easy with:
• One-on-one health coaches
Your Premium
Total Premi
Employee Only
$450
$
$529
Employee and Spouse
$1,215
$
$1,376
Employee and Children
$765
$
$900
Employee and Family
$1,530
$
$1,746
Plan Features
• $0 preventive care • 24/7 customer service
Total Premium
Type of Coverage Individual/Family Deductible Coinsurance
In-Network Coverage Only You pay 30% after deductible
Individual/Family Maximum Out of Pocket
$7,500/$15,000
Network
Statewide Network
• Weight loss programs
In
$2,500/$5,000
PCP Required
Yes
Primary Care
$30 copay
Specialist
$70 copay
Urgent Care
$50 copay
You
• Nutrition programs • OviaTM pregnancy support
Doctor Visits
• TRS Virtual Health • Mental health benefits • And much more! *Available for all plans. See the benefits guide for more details.
Immediate Care 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
$1
®
New Rx Benefits!
Prescription Drugs Drug Deductible Generics (31-Day Supply/90-Day Supply)
• Express Scripts is your new pharmacy benefits manager! CVS pharmacies and most of your preferred pharmacies and medication are still included. • Certain specialty drugs are still $0 through SaveOnSP. 14
Integrated with medical
$200 deducti
$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
Insulin Out-of-Pocket Costs
$25 copay for 31-day supply; $75 for 61-90 day supply
You
$25 copay for 3
Aug. 31, 2024
Each includes a wide range of wellness benefits.
-ActiveCare Primary+
TRS-ActiveCare HD
than the HD and Primary plans services and drugs
• 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
k ired to see specialists th a Health Savings Account (HSA) coverage
ium
Your Premium
Total Premium
Your Premium
This plan is closed and not accepting new enrollees. If you’re currently enrolled in TRS-ActiveCare 2, you can remain in this plan.
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
Total Premium
Your Premium
$
$462
$
$1,013
$
$
$1,248
$
$2,402
$
$
$786
$
$1,507
$
$
$1,571
$
$2,841
$
n-Network Coverage Only
In-Network
Out-of-Network
$1,200/$2,400
$3,000/$6,000
$5,500/$11,000
$1,000/$3,000
$2,000/$6,000 You pay 40% after deductible $23,700/$47,400
In-Network
Out-of-Network
u pay 20% after deductible
You pay 30% after deductible
You pay 50% after deductible
You pay 20% after deductible
$6,900/$13,800
$7,500/$15,000
$20,250/$40,500
$7,900/$15,800
Statewide Network
Nationwide Network
Nationwide Network
Yes
No
No
$15 copay
You pay 30% after deductible
You pay 50% after deductible
$30 copay
You pay 40% after deductible
$70 copay
You pay 30% after deductible
You pay 50% after deductible
$70 copay
You pay 40% after deductible
$50 copay
You pay 30% after deductible
You pay 50% after deductible
$50 copay
You pay 40% after deductible
You pay a $250 copay plus 20% after deductible
u pay 20% after deductible
You pay 30% after deductible
0 per medical consultation
$30 per medical consultation
$0 per medical consultation
$42 per medical consultation
$12 per medical consultation
Integrated with medical
$200 brand deductible
12 per medical consultation
ible per participant (brand drugs only) $15/$45 copay
You pay 20% after deductible; $0 coinsurance for certain generics
$20/$45 copay
u pay 25% after deductible
You pay 25% after deductible
u pay 50% after deductible
You pay 50% after deductible
You pay 25% after deductible ($40 min/$80 max)/ You pay 25% after deductible ($105 min/$210 max)
$0 if SaveOnSP eligible; u pay 30% after deductible
You pay 20% after deductible
31-day supply; $75 for 61-90 day supply
You pay 25% after deductible
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
What’s New and What’s Changing 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. 2022-23 Total Premium
TRS-ActiveCare Primary
TRS-ActiveCare HD
TRS-ActiveCare Primary+
TRS-ActiveCare 2 (closed to new enrollees)
New 2023-24 Total Premium
Change in Dollar Amount
Key Plan Changes
Employee Only
$410
$450
$40
Employee and Spouse
$1,157
$1,215
$58
• Individual maximum-out-of-pocket decreased by $650. Previous amount was $8,150 and is now $7,500.
Employee and Children
$738
$765
$27
Employee and Family
$1,384
$1,530
$146
• Family maximum-out-of-pocket decreased by $1,300. Previous amount was $16,300 and is now $15,000.
Employee Only
$422
$462
$40
Employee and Spouse
$1,187
$1,248
$61
Employee and Children
$757
$786
$29
Employee and Family
$1,419
$1,571
$152
• 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.
Employee Only
$515
$529
$14
Employee and Spouse
$1,259
$1,376
$117
Employee and Children
$829
$900
$71
Employee and Family
$1,584
$1,746
$162
Employee Only
$1,013
$1,013
$0
Employee and Spouse
$2,402
$2,402
$0
• No changes.
Employee and Children
$1,507
$1,507
$0
• This plan is still closed to new enrollees.
Employee and Family
$2,841
$2,841
$0
• 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.
At a Glance
16
Primary
HD
Primary+
Premiums
Lowest
Lower
Higher
Deductible
Mid-range
High
Low
Copays
Yes
No
Yes
Network
Statewide network
Nationwide network
Statewide network
PCP Required?
Yes
No
Yes
HSA-eligible?
No
Yes
No
Effective: Sept. 1, 2023
Compare Prices for Common Medical Services
REMEMBER: Benefit
Call a Personal Health Guide (PHG) any time 24/7 to help you find the best price for a medical service. Reach them at 1-866-355-5999. TRS-ActiveCare Primary
TRS-ActiveCare Primary+
In-Network Only
In-Network Only
Office/Indpendent Lab: You pay $0
Office/Indpendent Lab: You pay $0
TRS-ActiveCare HD In-Network
In-Network
Out-of-Network
Office/Indpendent Lab: You pay $0 You pay 30% after deductible
Diagnostic Labs*
Out-of-Network
TRS-ActiveCare 2
You pay 40% after deductible
You pay 50% after deductible
Outpatient: You pay 30% 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
Facility: You pay 30% after deductible
Facility: You pay 20% after deductible
Facility: You pay 20% after deductible ($150 facility copay per day)
Professional Services: Professional Services: You pay $5,000 You pay $5,000 copay + 20% after copay + 30% after deductible deductible
Professional Services: You pay $5,000 copay + 20% after deductible
Bariatric Surgery
Outpatient: You pay 20% after deductible
Not Covered
Not Covered
Not Covered
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 copay
You 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
*Pre-certification for genetic and specialty testing may apply. Contact a PHG at 1-866-355-5999 with questions.
www.trs.texas.gov Revised 05/30/23
17
2023-24 Health Maintenance Organization (HMO) Plans and Premiums for Select Regions of the State
REMEMBER:
Remember that when you choose an HMO, you’re choosing a regional network.
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.
Total Monthly Premiums
Central and North Texas Baylor Scott & White Health Plan
Blue Essentials - South Texas HMO
Brought to you by TRS-ActiveCare
Brought to you by TRS-ActiveCare
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
Total Premium
Your Premium
Total Premium
Your Premium
Blue Essentials - West Texas HMO Brought to you by TRS-ActiveCare 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 Total Premium
Your Premium
Employee Only
$553.45 $569.76
$
N/A
$
N/A
$
Employee and Spouse
$1,390.74 $1,432.42
$
N/A
$
N/A
$
Employee and Children
$889.98 $916.49
$
N/A
$
N/A
$
Employee and Family
$1,600.72 $1,648.78
$
N/A
$
N/A
$
Plan Features Type of Coverage Individual/Family Deductible Coinsurance Individual/Family Maximum Out of Pocket
In-Network Coverage Only
N/A
N/A
$2,400/$4,800
N/A
N/A
You pay 25% after deductible
N/A
N/A
$8,150/$16,300
N/A
N/A
Doctor Visits Primary Care
$20 copay
N/A
N/A
Specialist
$70 copay
N/A
N/A
$45 $40 copay
N/A
N/A
$500 copay after deductible
N/A
N/A
Immediate Care Urgent Care Emergency Care
Prescription Drugs Drug Deductible
$200 (excl. generics)
N/A
N/A
Days Supply
30-day supply/90-day supply
N/A
N/A
$14/$35 copay
N/A
N/A
Preferred Brand
Generics
You pay 35% after deductible
N/A
N/A
Non-preferred Brand
You pay 50% after deductible
N/A
N/A
Specialty
You pay 35% after deductible
N/A
N/A
www.trs.texas.gov Revised 18 05/30/23
Telehealth
EMPLOYEE BENEFITS
MDLive
ABOUT TELEHEALTH Telehealth provides 24/7/365 access to board-certified doctors via telephone or video consultations that can diagnose, recommend treatment and prescribe medication. Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available. For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd 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.
Your district is paying for this benefit so be sure to elect this coverage and all Dependents under the age of 26.
19
Hospital Cash
EMPLOYEE BENEFITS
Chubb
ABOUT HOSPITAL INDEMNITY This is an affordable supplemental plan that pays you should you be in patient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance. For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
Hospitalization Benefits
Benefit $1,500 Plan
Hospital admission benefit - This benefit is for admission to a hospital or hospital sub- • acute intensive care unit. • Hospital confinement benefit - This benefit is for confinement in hospital or hospital sub-acute intensive care unit.
• •
Hospital ICU confinement benefit - The benefit for confinement in a hospital intensive care unit.
• •
Hospital ICU admission benefit - This benefit is for admission to a hospital intensive care unit.
• •
Newborn Nursery - This benefit is payable for an insured newborn baby receiving newborn nursery care and who is not confined for treatment of a physical illness, infirmity, disease or injury. Observation Unit - This benefit is for treatment in a hospital observation unit for a period of less than 20 hours.
• • • •
$1,500 Maximum Benefit Per Calendar Year: 2 $100 Per Day Maximum Days Per Calendar Year: 30 $200 Per Day Maximum Days Per Calendar Year: 30 $1,500 Maximum Benefit Per Calendar Year: 2 $500 Maximum Days Per Calendar Year: 2 $500 Maximum Days Per Calendar Year: 2
$5,000 Plan • • • • • • • • • • • •
$5,000 Maximum Benefit Per Calendar Year: 2 $200 Per Day Maximum Days Per Calendar Year: 30 $400 Per Day Maximum Days Per Calendar Year: 30 $5,000 Maximum Benefit Per Calendar Year: 2 $500 Maximum Days Per Calendar Year: 2 $500 Maximum Days Per Calendar Year: 2
Hospital Cash Plan $1,500 Plan
$5,000 Plan
Employee
$19.93
$50.01
Employee and Spouse
$44.24
$111.03
Employee and Children
$36.87
$92.52
Employee and Family
$61.18
$153.54
This is a summary of the benefits offered under this plan. Please refer to the Certificate located on the employee website www.mybenefitshubcom/lovejoyisd under the Hospital Indemnity Section for details.
20
Health Savings Account (HSA) EECU
EMPLOYEE BENEFITS
ABOUT HSA A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
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.
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.
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.
Opening an HSA
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.
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
• •
How to Use your HSA • •
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
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.
• •
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. 21
Dental Insurance
EMPLOYEE BENEFITS
MetLife
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/lovejoyisd
Network: PDP Plus No ID card is necessary. You can register for by going to www.metlife.com/mybenefits or call MetLife directly at 800-942-0854. Coverage Type: Type A - Preventive Type B - Basic Restorative Type C - Major Restorative Type D - Orthodontia Deductible1 Individual Family Annual Maximum Benefit: Per Individual Orthodontia Lifetime Maximum Ortho applies to Child Only 1. 2. 3. 4.
Type A - Preventive Type B - Basic Restorative Type C - Major Restorative Type D - Orthodontia Deductible3 Individual Family Annual Maximum Benefit: Per Individual Dependent Age:
2. 3. 4.
22
Out-of-Network1 % of Negotiated Fee2 100% 80% 50% 50%
$50 $150
$50 $150
$1,500
$1,500
$1,000 per Person
Child to age 19
$1,000 per Person
“In-Network Benefits” refers to benefits provided under this plan for covered dental services that are provided by a participating dentist. “Out-of-Network Benefits” refers to benefits provided under this plan for covered dental services that are not provided by a participating dentist. Negotiated fees refer to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. Applies to Type B and C services only. Out-of-network benefits are payable for services rendered by a dentist who is not a participating provider. The Reasonable and Customary charge is based on the lowest of: • the dentist’s actual charge (the ‘Actual Charge’), • the dentist’s usual charge for the same or similar services (the ‘Usual Charge’) or • the usual charge of most dentists in the same geographic area for the same or similar services as determined by MetLife (the ‘Customary Charge’). For your plan, the Customary Charge is based on the 90th percentile. Services must be necessary in terms of generally accepted dental standards.
Coverage Type:
1.
Dental High Plan Highlights In-Network1 % of Negotiated Fee2 100% 80% 50% 50%
Dental Low Plan Highlights In-Network1 % of Negotiated Fee2 100% 80% 50% 50% $50 $150 $1,000 Eligible for benefits until the day that he or she turns 26.
Out-of-Network1 % of R&C Fee4 100% 80% 50% 50% $50 $150 $1,000
“In-Network Benefits” refers to benefits provided under this plan for covered dental services that are provided by a participating dentist. “Out-of-Network Benefits” refers to benefits provided under this plan for covered dental services that are not provided by a participating dentist. Utilizing an out-of-network dentist for care may cost you more than using an innetwork dentist Negotiated fees refer to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. Applies to Type B and C services only. Out-of-network benefits are payable for services rendered by a dentist who is not a participating provider. The Reasonable and Customary charge is based on the lowest of: • the dentist’s actual charge (the ‘Actual Charge’), • the dentist’s usual charge for the same or similar services (the ‘Usual Charge’) or • the usual charge of most dentists in the same geographic area for the same or similar services as determined by MetLife (the ‘Customary Charge’). For your plan, the Customary Charge is based on the 90th percentile. Services must be necessary in terms of generally accepted dental standards.
Dental Insurance
EMPLOYEE BENEFITS
MetLife
Type A - Preventive Oral Examinations Full Mouth X-rays Bitewing X-rays (Adult/Child) Prophylaxis - Cleanings Topical Fluoride Applications Sealants Space Maintainers Type B- Basic Restorative Amalgam and Composite Fillings Oral Surgery (Simple Extractions) Oral Surgery (Surgical Extractions) Other Oral Surgery Emergency Palliative Treatment General Anesthesia Consultations Type C - Major Restorative Crowns/Inlays/Onlays Prefabricated Crowns Repairs Endodontics Root Canal Periodontal Surgery Periodontal Scaling & Root Planing Periodontal Maintenance Bridges Dentures Implant Services Harmful Habits Appliances
How Many/ How Often 2 in 12 months 1 in 36 months 1 in a year 2 in 12 months 2 in 12 months - Children to age 16 1 in 36 months - Children to age 16 No limit - Children up to age 16 How Many/ How Often 1 in 24 months.
1 in 12 months How Many/How Often: 1 per tooth in 60 months 1 per tooth in 60 months 1 in 12 months 1 per tooth per lifetime 1 in 36 months per quadrant 1 in 24 months per quadrant 2 in 1 year, includes 2 cleanings 1 in 60 months 1 in 60 months 1 service per tooth in 60 months - 1 repair per 12 months
*Alternate Benefits: Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. To avoid any misunderstandings, we suggest you discuss treatment options with your dentist before services are rendered, and obtain a pretreatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. DHMO Direct Referral Dental Plan* MET290: Your policy benefit provides a SCHEDULE OF BENEFITS which lists each Covered Service available to You and Your Dependents under your dental plan. You and Your Dependent’s costs may include Co-Payments for a Covered Service. Please refer to www.mybenefitshub.com/lovejoyisd under the Dental DHMO section to review the procedure amounts and copay schedules. No ID card is necessary, and you will be assigned a network dentist before services are rendered. Please call 1-800-880-1800 for benefit questions and support. *Care under this plan is provided through a network of Selected General Dentists. Your Selected General Dentist is responsible for determining when the services of a Specialty Care Dentist are needed and facilitating any necessary referral. You and Your Dependents will be advised of the name, address, and telephone number of the Specialty Care Dentist in Your or Your Dependent’s Service Area. Missed Appointments: If You or Your Dependents need to cancel or reschedule an appointment, please notify the Selected General Dental Office as far in advance as possible. This will allow the Selected General Dental Office to accommodate another person in need of attention. If You or Your Dependents fail to do this in a timely fashion, You or Your Dependents may be charged a missed appointment fee.
Dental Rates High Rates Low Plans Employee Only $39.88 $34.98 Employee and Spouse $79.02 $69.32 Employee and Child(ren) $88.76 $77.86 Employee and Family $133.70 $117.26
DHMO $10.14 $19.64 $21.26 $30.77
How do I find a DPD Plus Dentist? 1. www.metlife.com 2. Select “Find a Dentist” 3. Select PDP Plus 4. Enter Zip, City or State How do I find a DHMO MET290 Dentist? www.metlife.com/dental 5. Find a Dentist 6. Select “Dental HMO/Managed Care 7. Select MET290 8. Enter Zip, City or State 23
Vision Insurance
EMPLOYEE BENEFITS
MetLife Network Davis 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/lovejoyisd
With your Vision Preferred Provider Organization Plan, you can: • •
Go to any licensed Davis vision provider and receive coverage. Just remember your benefit dollars go further when you stay in network. Choose from a large network of ophthalmologists, optometrists and opticians, from private practices to retailers like Costco® Optical, Walmart, Sam’s Club and Visionworks.
In-network benefits
Standard Corrective Lenses • •
Standard Lens Enhancements2 • • •
There are no claims for you to file when you go to an in-network Davis vision provider. Simply pay any copays or member out of pocket amount (MOOP) and, if applicable, any amount over your frame/contact allowance at the time of service
Eye Exam • • •
Once every 12 months Eye health exam, dilation, prescription and refraction for glasses: Covered in full after $10 copay. Retinal imaging: Up to a $40 copay on routine retinal screening when performed by a private practice.
Frame • • •
24
Once every 12 months Allowance: $150 after $15 eyewear copay1. You will receive an additional 20% savings on the amount that you pay over your allowance. Exclusive Collection Frame Copay (in lieu of Allowance) Fashion / Designer / Premier: Covered in full / Covered in full / Covered in full. Participating private practice providers typically do not display the Collection but are contractually required to maintain a comparable selection (in both quantity and quality) of frames that would be covered, with no additional member out-of-pocket expense. Special lens designs, materials, powers and frames may require additional cost. Collection is available at most participating independent provider offices. Collection is subject to change.
Once every 12 months Single vision, lined bifocal, lined trifocal, lenticular: Covered in full after $15 eyewear copay1. Once every 12 months Standard Polycarbonate (child up to age 18)3, Progressive Standard: Covered in full after $15 eyewear copay1. Progressive Premium/Custom, Standard Polycarbonate (adult)3, UV coating, Scratch- resistant coatings, Solid or Gradient Tints, Anti-reflective, Photochromic, Blue Light filtering, Digital Single Vision, Polarized, High Index (1.67 / 1.74): Your cost will be limited to a member out of pocket amount (MOOP) that MetLife has negotiated for you. These amounts may be viewed after enrollment at www.metlife. com/mybenefits.
Contact Lenses (instead of eyeglasses)4 • • • • • • 1
Once every 12 months Contact fitting and evaluation: 15% discount. Elective lenses: $150 allowance. Necessary lenses: Covered in full Conventional contacts: You will receive an additional 15% savings on the amount that you pay over your allowance. Disposable contacts: You will receive an additional 15% savings on the amount that you pay over your allowance.
Materials co-pay applies to lenses and frames only, not contact lenses.
The above list highlights some of the most popular lens enhancements and is not a complete listing.
2
Polycarbonate lenses are covered for dependent children, monocular patients, and patients with prescriptions +/- 6.00 diopters or greater.
3
Not all providers participate in vision program discounts, including the member out-of-pocket features. Call your provider prior to scheduling an appointment to confirm if the discount and member out-of-pocket features are offered at that location. Discounts and member out-of-pocket are not insurance and subject to change without notice.
4
Vision Insurance
EMPLOYEE BENEFITS
MetLife Network Davis Vision In-network value added features:
Additional savings on lens enhancements:5 Average 20- 25% savings over retail on all lens enhancements not otherwise covered under the Davis Vision Insurance program. Additional savings on glasses and sunglasses:5 Members may receive 50% off of additional complete pairs of eyeglasses and sunglasses at Visionworks or 30% off at other participating providers on the same transaction. Otherwise, a 20% discount off the provider’s usual and customary rate may be available. Additional savings on frames:5 20% off any amount over your frames allowance. Additional savings on contacts:5 15% off any amount over your contact lens allowance. 15% discount on additional contacts beyond your covered amount. Free one-year breakage warranty: All eyeglasses come with a breakage warrenty for repair or replacement of the frame and/or lenses for a period of one year from the date of delivery. The one-year breakage warranty applies to all plan-covered eyeglasses (ie., all spectacle lenses, Davis Vision Exclusive Collection frames and national retailer frames, where our Exclusive Collection is not displayed). Warranty does not apply to Glasses.com. Hearing discounts:5 A National Hearing Network of hearing care professionals, featuring Your Hearing Network, offers Davis Vision members discounts on services, hearing aids and accessories. These discounts should be verified prior to service. These features may not be available in all states and with all in-network vision providers. Discounts are not available at Walmart and Sam’s Club. Please check with your in-network vision provider.
5
We’re here to help Find a Davis Vision provider at: www.metlife.com/vision and select Davis Vision by MetLife’. For general questions, go to www.metlife.com/mybenefits or call 1-833-EYE-LIFE (1-833-393-5433).
Vision Employee Only
$7.37
Employee and Spouse
$13.33
Employee and Children
$14.32
Employee and Family
$20.54
25
Disability Insurance
EMPLOYEE BENEFITS
New York Life 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/lovejoyisd
SUMMARY OF BENEFITS If you had an unexpected illness or injury and were unable to work, how long would you be able to pay your bills and take care of your family? Disability insurance pays a portion of your salary if you’re unable to work due to a covered disability. By purchasing coverage through your employer, you also benefit from cost-effective group rates and convenient payroll deduction. Eligibility: If you are an active employee working at least 15 hours per week, you will be eligible immediately. Guaranteed Issue*: Initial Enrollment: If you are eligible on or before the policy’s effective date, you may enroll for coverage during the Initial Enrollment without submitting any evidence of good health. New Hires: If you were hired after the policy’s effective date, you may elect coverage once eligible without submitting any evidence of good health. Annual Enrollment: During annual enrollment, you may enroll for the first time or make coverage changes, if already participating, without submitting any evidence of good health. *The Pre-Existing Condition Limitation, as outlined in the Benefit Reductions, Conditions, Limitations and Exclusions section, will apply.
Employee Options Select Monthly Benefit: Option 1: 40% Gross Monthly Benefit1 Option 2: 50% Option 3: 60% Maximum Gross $8,000 Monthly Benefit Select from Five (5) Options: Accident/Sickness Option 1: 0 days/7 days Benefit Waiting Period Option 2: 14 days/14 days Option 3: 30 days/30 days Option 4: 60 days/60 days Option 5: 90 days/90 days Please refer to the “Maximum Maximum Benefit Period Benefit Period” Schedules below for more details 1. Your benefit amount will be reduced by any amounts payable to you by any of the sources listed under the “Effects of Other Income Benefits” section.
Monthly Cost of Coverage: Disability - per $100 in benefit (All Ages) Elimination 40% Benefit 50% Benefit 60% Benefit Period 0/7 $2.63 $2.76 $2.96 14/14
$2.14
$2.25
$2.42
30/30
$1.92
$2.03
$2.18
60/60
$0.83
$0.95
$1.10
90/90
$0.63
$0.73
$0.85
Notes: Benefits available at 40%. 50%, or 60% of covered payroll with a maximum benefit of $8,000. Rates are presented on a per $100 covered monthly payroll basis
26
Life Insurance
EMPLOYEE BENEFITS
New York Life
ABOUT LIFE INSURANCE 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.
For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
Employer-Paid Basic Life
Who Is Eligible For Coverage? You: All active, Full-time Employees of the Employer working a minimum of 15 hours per week. You will be eligible for coverage the first of the month following date of hire. Available Coverage: Employee: • Benefit Amount $15,000 • Maximum $15,000 • Guaranteed Issue Amount $15,000 Guaranteed Issue means that you may be able to purchase coverage without medical exams or health questions. See “Guaranteed Issue” below for more information. Additional Features: Extended Death Benefit with Waiver of Premium – The extended death benefit continues your coverage without payment of premium, before you’re eligible to qualify for Waiver of Premium, if you are continuously Disabled for 9 months prior to age 60. “Disabled” means, because of injury or sickness, you are unable to perform all the material duties of your regular occupation, or you are receiving disability benefits under a program sponsored by your Employer. Regular Occupation means the occupation you routinely performed at the time your Disability began. We/the insurance company will consider the duties of your occupations as those that are normally performed in the general labor market in the national economy. If you qualify for this benefit and have insured your spouse or children, the insurance company will also extend their coverage if applicable. Waiver of Premium – If you become Disabled prior to age 60, and you remain Disabled continuously for a 9 month period and thereafter, you won’t need to pay premiums for your life insurance coverage, provided we/the Insurance Company determine(s) you are Disabled. “Disabled” for this coverage means, because of injury or sickness, you are unable to perform the material duties of your regular occupation, or are receiving disability benefits under a program sponsored by your employer, for the first 12 months after your Disability began. Thereafter, you
must be unable to perform the material duties of any occupation that you are or may reasonably become qualified based on your education, training or experience. If you qualify for this coverage and have insured your spouse or children, the insurance company will also waive their premium if applicable. Accelerated Death Benefit – Terminal Illness – if two unaffiliated doctors diagnose you as terminally ill while the coverage is active, with a life expectancy of 12 months or less, the benefit for Terminal Illness provides up to: • Employee: 80% of your Term Life Insurance coverage amount or $8,000, whichever is less. Conversion – To convert, you must apply for the conversion policy and pay the first premium payment within 31 days after your group coverage ends. Guaranteed Issue: If you are a new hire and you apply within 31 days after you are eligible to elect coverage for yourself, you are entitled to choose any coverage offered up to the Guaranteed Issue Amount, without providing proof of good health. If you apply for an amount of coverage greater than the Guaranteed Issue Amount, coverage in excess of the Guaranteed Issue Amount will not be issued until the insurance company approves acceptable proof of good health. If you apply for coverage for yourself more than 31 days from the date you become eligible to elect coverage under this plan, the Guaranteed Issue Amount will not apply, unless Guaranteed Issue has been approved by your employer for a specific period of time. Coverage will not be issued until the insurance company approves acceptable proof of good health. Important Definitions and Policy Provisions: Benefit Reduction Schedule - If you are still employed, your benefits will reduce to 65% at age 65 and 50% at age 70. Limitations - The Accelerated Death Benefit is payable only once. Using this benefit reduces the life insurance death benefit. The amount payable under the Accelerated Death Benefit may be reduced by the amount of other benefits already paid to the insured under the policy. See your certificate for further details. 27
Life Insurance
EMPLOYEE BENEFITS
New York Life
Employee-Paid Voluntary Life
Who Is Eligible For Coverage? You: All active, Full-time Employees of the Employer working a minimum of 15 hours per week. You will be eligible for coverage the first of the month following date of hire. Your Spouse: Up to age 70, as long as you apply for and are approved for coverage yourself. Your Child(ren): Birth to 26, or age 26 if a full-time student, as long as you apply for and are approved for coverage yourself. Available Coverage Employee Spouse Children
Benefit Amount Units of $10,000 Units of $5,000
Maximum
Guaranteed Issue Amount
Lesser of 5 times salary or $500,000
$150,000
$250,000
$75,000
$10,000
$10,000; under 6 Months old $500
All amounts
Accelerated Death Benefit – Terminal Illness – if two unaffiliated doctors diagnose you or your spouse as terminally ill while the coverage is active, with a life expectancy of 12 months or less, the benefit for Terminal Illness provides up to: • Employee: 80% of your Term Life Insurance coverage amount or $250,000, whichever is less. • Spouse: 80% of your Term Life Insurance coverage amount or $250,000, whichever is less. Portability – If your employment is terminated, you can continue your life insurance on a direct-bill basis. Coverage may also be continued for your spouse/children. Premiums will increase at this time. Coverage can be continued to age 70, unless the insurance company terminates portability for all insured persons. Refer to your certificate for details. Conversion – To convert, you must apply for the conversion policy and pay the first premium payment within 31 days after your group coverage ends.
Guaranteed Issue means that you may be able to purchase coverage without medical exams or health questions. See “Guaranteed Issue” below for more information.
Age
Employee Per $10,000
Spouse Per $5,000
Additional Features:
>25
$0.44
$0.22
25-29
$0.50
$0.25
30-34
$0.62
$0.31
35-39
$0.88
$0.44
40-44
$1.26
$0.63
45-49
$2.01
$1.01
50-54
$3.19
$1.60
55-59
$4.90
$2.45
60-64
$7.66
$3.83
65-69
$13.29
$6.65
70-74
$23.87
$11.86
75+
$46.48
$23.24
Extended Death Benefit with Waiver of Premium – The extended death benefit continues your coverage without payment of premium, before you’re eligible to qualify for Waiver of Premium, if you are continuously Disabled for 9 months prior to age 60. “Disabled” means, because of injury or sickness, you are unable to perform all the material duties of your regular occupation, or you are receiving disability benefits under a program sponsored by your Employer. Regular Occupation means the occupation you routinely performed at the time your Disability began. We/the insurance company will consider the duties of your occupations as those that are normally performed in the general labor market in the national economy. If you qualify for this benefit and have insured your spouse or children, the insurance company will also extend their coverage if applicable. Waiver of Premium – If you become Disabled prior to age 60, and you remain Disabled continuously for a 9 month period and thereafter, you won’t need to pay premiums for your life insurance coverage, provided we/the Insurance Company determine(s) you are Disabled. “Disabled” for this coverage means, because of injury or sickness, you are unable to perform the material duties of your regular occupation, or are receiving disability benefits under a program sponsored by your employer, for the first 12 months after your Disability began. Thereafter, you must be unable to perform the material duties of any occupation that you are or may reasonably become qualified based on your education, training or experience. If you qualify for this coverage and have insured your spouse or children, the insurance company will also waive their premium if applicable. 28
Voluntary Life
Voluntary Life - Child(ren) Ages
Per $10,000 in coverage
0-26
$3.49 Spouse rates based on employee age.
AD&D Insurance
EMPLOYEE BENEFITS
New York Life
ABOUT AD&D INSURANCE 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/lovejoyisd
Employee-Paid Accidental Death & Dismemberment Insurance
Who Can Elect Coverage? You: All active, full-time Employees of the Employer working a minimum of 15 hours per week. You will be eligible for coverage the first of the month following date of hire. Your Spouse: Up to age 70, as long as you apply for and are approved for coverage yourself. Your Child(ren): Birth to 26, as long as you apply for and are approved for coverage yourself. Available Coverage Employee Spouse Children
Benefit Details:
Benefit Amount Units of $10,000 Units of $5,000 $10,000
Maximum $500,000 $250,000 $10,000
If, within 365 days of a Covered % Benefit Amount: Accident, bodily injuries result in: Loss of life; Total paralysis of both upper and lower limbs; Loss of two or more 100% hands or feet; Loss of sight in both eyes; or Loss of speech and hearing (both ears) Total paralysis of both lower limbs or both 75% upper limbs Total paralysis of upper and lower limbs on one side of the body; Loss of one hand, one foot, sight in one eye, speech, 50% or hearing in both ears; or Severance and Reattachment of one hand or foot Total paralysis of one upper or one lower limb; Loss of all four fingers of the same 25% hand; or Loss of thumb and index finger of the same hand Loss of all toes of the same foot 20%
For Comas – You will receive 1% of the full benefit amount each month, for up to a maximum of 11 months, if you or an insured family member are in a coma for 30 days or more as a result of a Covered Accident. If the covered person is still in a coma after 11 months, or dies, the full benefit amount will be paid.
Your Monthly Cost of Coverage: • • •
Employee Cost Per $10,000 units = $.30 Spouse Cost Per $5,000 units = $.15 Child’s Cost Per $1,000 units = $.04
Actual per pay period premiums may differ slightly due to rounding. Benefits will reduce on age (see Benefits Reduction Schedule for details). Rates may be subject to change in the future.
How to Calculate Your Monthly Cost of Coverage: Step 1: Step 2:
Step 3:
Find the above Monthly rate. Multiply this rate by your desired coverage amount, in units. Reference the information above to find the appropriate unit amounts for employee and/or dependents. The result is the Monthly cost.
Benefit Reductions, Exclusions and Limitations
Benefit Reduction Schedule: If you are still employed, your benefits will reduce to 65% at age 65 and 50% at age 70. Your premiums will also reduce to match your benefits. Limitations – For multiple covered losses, benefits are paid for the single largest benefit available. For loss of life, the benefit amount shown will be reduced by the amount of any dismemberment benefits that were previously paid or payable. Exclusions - Please refer to plan certificate for a full list of exclusions.
29
Cancer Insurance
EMPLOYEE BENEFITS
APL
ABOUT CANCER Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment. For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
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.
Cancer Plan 1
Plan 2
Employee Only
$15.00
$23.96
Employee and Spouse
$32.44
$52.06
Employee and Child(ren)
$17.30
$27.66
Employee and Family
$34.72
$55.82
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/lovejoyisd. Benefit Highlights
Plan 1
Plan 2
Internal Cancer First Occurrence*
$5,000
$10,000
$15,000
$20,000
$50 per treatment
$50 per treatment
$150
$150
$300 per day
$300 per day
$200/$2,000 per trip
$200/$2,000 per trip
$5,000
$10,000
Cancer Treatment Policy Benefits Radiation Therapy, Chemotherapy, Immunotherapy Maximum per 12-month period Hormone Therapy Maximum of 12 treatments per calendar year Miscellaneous Care Rider Benefits Hair Piece (Wig)- 1 per lifetime Blood, Plasma &Platelets Ambulance- Ground /AirMaximum of 2 trips per Hospital Confinement for all modes of transportation combined Heart Attack/Stroke First Occurrence Rider Benefits Lump Sum Benefit- Maximum per 1 covered person per lifetime Note: APL has added a $50 Screening Benefit per calendar year on either plan. Pre-Existing Condition Exclusion: Review the Benefit Summary page that can be found at www.mybenefitshub.com/lovejoyisd for full details. *Carcinoma in situ is not considered internal cancer
30
Critical Illness Insurance CHUBB
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/lovejoyisd
Benefits and Features
COVERAGE AMOUNTS Employee $10,000; $20,000; or $30,000 face amounts Spouse $5,000; $10,000; or $15,000 face amounts Child Included in the employee rate No benefit will be paid for a date of diagnosis that occurs prior to the coverage effective date. Covered individuals must be treatment free from cancer for 12 months prior to diagnosis date and in complete remission. There is no pre-existing condition limitation. All amounts are Guaranteed Issue- no medical questions are required for coverage to be issued. Covered Conditions Payable Benefit as a Percentage of Face Amount ALS 100% Alzheimer's Disease 100% Benign Brain Tumor 100% Breast Cancer Carcinoma In Situ 100% Cancer (Except Skin Cancer) 100% Carcinoma In Situ 25% Coma 100% Coronary Artery Obstruction 50% Covered Conditions Payable Benefit as a Percentage of Face Amount Heart Attack 100% Loss of Sight, Speech, or Hearing 100% Major Organ Failure 100% Multiple Sclerosis 100% Paralysis or Dismemberment 100% Parkinson’s Disease 100% Stroke 100% Skin Cancer Benefit - Payable once per insured per year $500 End Stage Renal Failure 100% RECURRENCE BENEFIT Benefits are payable for a subsequent diagnosis of Benign Brain Tumor, Cancer, Coma, Coronary Artery Obstruction, Heart Attack, Major Organ 100% Failure, Severe Burns, Stroke, or Sudden Cardiac Arrest.
31
Critical Illness Insurance
EMPLOYEE BENEFITS
CHUBB
Critical Illness Option 1 $10,000 EE, $5,000 SP, $5,000 CH
Option 2 $20,000 EE, $10,000 SP, $10,000 CH
Option 3 $30,000 EE, $15,000 SP, $15,000 CH
Age
Employee Cost
Spouse Cost
Children Cost
Family Cost
Employee Cost
Spouse Cost
Children Cost
Family Cost
Employee Cost
Spouse Cost
Children Cost
Family Cost
18-25
$1.62
$2.43
$1.62
$2.43
$3.24
$4.86
$3.24
$4.86
$4.86
$7.29
$4.86
$7.29
26-30
$2.34
$3.51
$2.34
$3.51
$4.68
$7.02
$4.68
$7.02
$7.02
$10.53
$7.02
$10.53
31-35
$3.24
$4.86
$3.24
$4.86
$6.48
$9.72
$6.48
$9.72
$9.72
$14.58
$9.72
$14.58
36-40
$4.77
$7.16
$4.77
$7.16
$9.54
$14.31
$9.54
$14.31
$14.31
$21.47
$14.31
$21.47
41-45
$6.75
$10.13
$6.75
$10.13
$13.50
$20.25
$13.50
$20.25
$20.25
$30.38
$20.25
$30.38
46-50
$9.36
$14.04
$9.36
$14.04
$18.72
$28.08
$18.72
$28.08
$28.08
$42.12
$28.08
$42.12
51-55
$12.42
$18.63
$12.42
$18.63
$24.84
$37.26
$24.84
$37.26
$37.26
$55.89
$37.26
$55.89
56-60
$17.37
$26.06
$17.37
$26.06
$34.74
$52.11
$34.74
$52.11
$52.11
$78.17
$52.11
$78.17
Questions?
Contact the FBS Benefits Careline at (833) 453-1680. Please refer to your Certificate of Insurance at https://www.mybenefitshub.com/lovejoyisd for a complete listing of available benefits, limitations, and exclusions.
HOW TO FILE YOUR CRITICAL ILLNESS CLAIM
SIGN and DATE the claim form on the website, then submit using one of the methods shown below. The Authorization to Obtain and Disclose Information must be completed and signed. The Attending Physician’s Statement must be completed and signed by the Attending Physician and submitted. Attach a copy of the pathology report or operative report along with all itemized bills related to condition. Mail To: Chubb Workplace Benefits Claim Department PO Box 6700 Scranton, PA 18505-0700 Email to: educatorclaims@chubb.com Fax to: 312-351-7114 If you have any questions about the claim process or how to complete this form, please call 888-499-0425.
32
Identity Theft
EMPLOYEE BENEFITS
ID Watchdog
ABOUT IDENTITY THEFT PROTECTION Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered. For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
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.
WHAT YOU NEED TO KNOW Plan Options ID WATCHDOG® 1B Credit Report(s) & 1 Bureau Monthly VantageScore Credit Score(s) Credit Score Tracker 1 Bureau Monthly Credit Report Monitoring 1 Bureau Credit Report Lock 1 Bureau Identity Theft Insurance Up to $1M 401K/HSA Stolen Funds Reimbursement MONTHLY PREMIUMS Employee $7.95 Employee and Family $14.95
ID WATCHDOG® PLATINUM 1 Bureau Daily & 3 Bureau Annually 1 Bureau Daily Multi-Bureau $54.40 Up to $1M Up to $500k $11.95 $22.95
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 9 Helps better protect children 1. Bureau = Equifax® 2. Multi-Bureau = Equifax, TransUnion® 3. Bureau = Equifax, Experian®, TransUnion
33
Flexible Spending Account (FSA) NBS
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/lovejoyisd Health Care FSA The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $3,050 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include: • Dental and vision expenses • Medical deductibles and coinsurance • Prescription copays • Hearing aids and batteries You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA). How the Health Care FSAs Work You can access the funds in your Health Care FSA two different ways: • Use your NBS Debit Card to pay for qualified expenses, doctor visits and prescription copays. • Pay out-of-pocket and submit your receipts for reimbursement: • Fax – 844-438-1496 • Email – service@nbsbenefits.com • Online – my.nbsbenefits.com • Call for Account Balance: 855-399-3035 • Mail: 430 W 7th St. Suite 219393 Kansas City Mo 64105-1407 Contact NBS • Hours of Operation: 6:00 AM – 6:00 PM MST, Mon-Fri • Phone: (800) 274-0503 • Email: service@nbsbenefits.com • Mail: 430 W 7th St. Suite 219393 Kansas City Mo 64105-1407 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. 34
Flexible Spending Account (FSA) NBS
EMPLOYEE BENEFITS
Dependent Care FSA Guidelines • 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 30 days (up until date). • Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses. • The IRS has amended the “use it or lose it rule” to allow you to carry-over up to $570 in your Health Care FSA into the next plan year. The carry-over rule does not apply to your Dependent Care FSA. Over-the-Counter Item Rule Reminder (OTC) Health care reform legislation requires that certain over-the-counter (OTC) items require a prescription to qualify as an eligible Health Care FSA expense. You will only need to obtain a one-time prescription for the current plan year. You can continue to purchase your regular prescription medications with your FSA debit card. However, the FSA debit card may not be used as payment for an OTC item, even when accompanied by a prescription. Flexible Spending Accounts Account Type
Health Care FSA
Dependent Care FSA
Eligible Expenses
Annual Contribution Limits
Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, $3,050 coinsurance, deductibles, eyeglasses and doctor-prescribed over-thecounter medications) Dependent care expenses (such as $5,000 single day care, after-school programs or elder care programs) so you and your $2,500 if married and filing spouse can work or attend school separate tax returns full-time
Benefit Saves on eligible expenses not covered by insurance, reduces your taxable income
Reduces your taxable income
35
Employee Assistance Program (EAP) New York Life
EMPLOYEE BENEFITS
ABOUT EAP An Employee Assistance Program (EAP) is a program that assists you in resolving problems such as finding child or elder care, relationship challenges, financial or legal problems, etc. This program is provided by your employer at no cost to you. For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
Life: just when you think you’ve got it figured out, along comes a challenge. Whether your needs are big or small, New York Life Group Benefit Solutions is there for you with our Employee Assistance & Wellness Support program1. It can help you and your family find solutions and restore your peace of mind. This is just another example of how we are committed to Putting Benefits To Work For PeopleSM.
Our suite of value-add resources includes:
Employee Assistance Program1 Are you feeling overwhelmed by the demands of balancing work and family life? Maybe you have questions about a legal or financial concern. You and your family members now have access to various counseling services including legal, financial, and work-life balance assistance. All counseling calls are answered by a Master’s or PhD-level counselor who will collect some general information and will discuss your needs. The Employee Assistance Program provides a maximum of three sessions, per issue, per year. Guidance Resources®1 When you need information quickly to help handle life’s challenges, you can visit guidanceresources.com for resources and tools on topics such as health and wellness, legal regulations, family and relationships, work and education, money and investments, and home and auto. You will also have access to articles, podcasts, videos, slideshows, on-demand trainings and “Ask the Expert” which provides personal responses to your questions. Well-being Coaching1 Sometimes you may need help with personal challenges and physical issues that can be overwhelming. To help you achieve your goals, you will have access to a certified coach who will work with you, one on one, to address health and well-being issues such as burnout, time management and coping with stress. You have access to five sessions per year. All sessions are conducted telephonically. Family Source®1 Managing the everyday concerns of home, work and family can be difficult. To help resolve those concerns, you have access to family care service specialists that provide customized research, educational materials and prescreened referrals for childcare, adoption, elder care, education, and pet care.
Contact Info:
Employee Assistance and Wellness Support 24/7 Phone: (800) 344-9752 Website: guidanceresources.com
36
Foundation for Lovejoy Schools LISD
EMPLOYEE BENEFITS
ABOUT THE FOUNDATION The Foundation for Lovejoy Schools benefits the students, faculty, graduates, and staff of LISD by involving the community in generating and distributing funds that enhance the educational experience. For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
The Foundation for Lovejoy Schools awards grants to teachers for projects that enhance and augment educational opportunities for students in Lovejoy ISD. Grants that have creative teaching approaches and innovative projects that will showcase the exceptional learning available in Lovejoy.
We have granted more than five million dollars to the teachers and staff during the past 17 years! Your donation will help us provide grants for classroom enhancements teachers request, allowing them to go above and beyond in the classroom.
Receive free tickets to Denim & Diamonds! On ticket with a $10/month donation Two tickets with a $20/month donation
WECHAMPIONLOVEJOY
The Foundation for Lovejoy Schools is a 501(c)3 tax exempt organization. All donations are tax deductible as allowed by law
37
Catastrophic Sick Leave Bank
EMPLOYEE BENEFITS
ABOUT SICK LEAVE BANK The Lovejoy ISD Catastrophic Sick Leave Bank is a voluntary employee benefit program developed to provide up to 45 paid days to members who have suffered a catastrophic illness or injury.
For full plan details, please visit your benefit website: www.mybenefitshub.com/lovejoyisd
Open Enrollment
Employees may join the Catastrophic Sick Leave Bank during the annual open enrollment period, or if a new employee, during the first 30 calendar days from hire date.
Who Is Eligible?
All Full time employees of the Lovejoy Independent School District eligible for leave benefits from the District are eligible for membership in the Sick Leave Bank.
How To Enroll
To become a member of the Bank, an employee must contribute two days from his/ her accrued or anticipated local leave for the current school calendar year. New employees have the first 30 calendar days from their hire date to join the bank. Enrollment usually takes place in August. The two contributed days will be acquired within the first 60 days of employment from the member’s local leave record and become the property of the Lovejoy ISD Catastrophic Sick Leave Bank. Existing employees who wish to join the Bank must do so during the district’s annual open enrollment.
Membership The effective date of membership will be the 9/1 date of the year in which the employee signed up during open enrollment. All sick leave days donated remain in the Bank and Cannot be returned even upon cancellation of the membership. Membership continues from year to year, without any additional contributions, unless: • The member uses one or more days from the Bank during the year; OR • A member decides to cancel his/her membership in the 38
• •
Bank; OR A member terminates employment with the District; OR The days paid to members during the school year cause the number of days remaining in the bank to fall below two times the number of members. Then, depending on the need, current members will give an additional day to replenish the Bank. (If a current member is unable to donate the emergency request due to that member’s leave being exhausted, the member’s ability to use the sick leave bank is not affected.)
Qualifying For Catastrophic Sick Leave Bank Days
A member may request days from the Catastrophic Sick Leave Bank only after he/she has exhausted all accumulated state and local leave days, plus the 10 extended sick leave days. Catastrophic Sick Leave Bank days can be granted only for absences for working days and will not be granted for holidays, vacation days, or other such days for which the member is not paid. A member may receive days from the Bank ONLY after the two day membership donation has been contributed. Anyone who joins the sick leave bank with a pre-existing, diagnosed condition or illness for which they have received treatment within the last 90 days, shall not be allowed to utilize the sick leave bank for an illness resulting from or related to that specific condition until the member has been treatment free for 90 days or has been a member of the sick leave bank for one full year (365 days).
Catastrophic Sick Leave Bank
EMPLOYEE BENEFITS
A member who suffers a catastrophic illness or injury may initially apply for up to 30 days from the Bank. If the employee is unable to return to work after the initial 30 days are exhausted, he/she may apply for up to 15 additional days. A lifetime maximum number of days an employee can use is 90 days.
Exclusions include normal pregnancy and/or post-natal care; elective or routine surgery; outpatient procedures; mental disability that is not considered a “serious mental illness” as defined by Texas law; and workers’ compensation income eligibility. When an employee has suffered a catastrophic illness or injury, the member may submit to the Benefits Specialist a request for days from the Bank. This request will include the “Application for Catastrophic Sick Leave Bank Days” and the Catastrophic Sick Leave Bank Physician’s Statement”. The forms can be obtained from the Human Resources Department. A copy of inpatient room and board charges will also be required. Applications will be processed by the Benefits Specialist and the Leave Bank Executive Officer.
Use Of Catastrophic Sick Leave Bank for Immediate Family
See Sick Leave Bank on the Staff Resources page of the Lovejoy ISD website for more detailed information .
Days from the Bank are granted only for a catastrophic illness or injury that necessitates an absence from work based on the Catastrophic Sick Leave Bank guidelines. The application for Catastrophic Sick Leave Bank days must be received in the Human Resources office as early as possible, but no later than 30 work days from the date the employee returns to work.
The Bank may be used for members whose immediate family has suffered a catastrophic illness or injury. Immediate family is defined in Board Policy DEC (Local). The maximum number of Catastrophic Sick Leave Bank days that may be granted to an employee during the year (July 1 through June 30) is 45 days.
What Is Considered Catastrophic?
A catastrophic illness or injury is a severe condition or combination of conditions affecting the mental or physical health of the employee or a member of the employee’s immediate family that requires the services of a licensed practitioner for a prolonged period of time and that forces the employee to exhaust all leave time earned by that employee and to lose compensation from the District. Complications resulting from pregnancy shall be treated the same as any other condition. Such conditions typically require in-patient hospitalization or are expected to result in disability or death. Determination of “catastrophic” is based upon the physician’s statement with diagnosis, and any complications, in accordance with the Catastrophic Sick Leave Bank guidelines. A few examples of conditions that may be considered catastrophic are: • Inpatient hospitalization due to major non-elective surgery or injury (proof of room & board charges will be required) • Organ transplant • Cancer with chemotherapy treatment • Serious extended illness 39
2023 - 2024 Plan Year
Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the Lovejoy 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 Lovejoy 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/LOVEJOYISD 40