2023-24 Splendora ISD Benefit Guide

Benefit Contact Information

BENEFITS ADMINISTRATORS SPLENDORA ISD ADMINISTRATOR MEDICAL Financial Benefit Services

(469) 385-4685

Brandon Campbell (281)-689-4004

bcampbell@splendoraisd.org

Texas Schools Health Benefits Program (TSHBP) (888) 803-0081

All Plans: www.tshbp.org

Pharmacy Benefits: SouthernScripts Group #50000

https://tshbp.info/DrugPham

HEALTH SAVINGS ACCOUNT (HSA) FLEXIBLE SPENDING ACCOUNT (FSA) TELEHEALTH EECU

(817) 882-0800

www.eecu.org

Higginbotham

(866) 419-3519

https://flexservices.higginbotham.net

MDLive (888) 365-1663

www.consultmdlive.com

HOSPITAL INDEMNITY DENTAL VISION

Lincoln Financial Group (800) 423-2765

www.lfg.com

Lincoln Financial Group (800) 423-2765

www.lfg.com

Superior Vision Group #34986

(800) 507-3800

www.superiorvision.com

DISABILITY VOLUNTARY LIFE AND AD&D CANCER

OneAmerica Group #00618620

(800) 553-5318

www.oneamerica.com

Lincoln Financial Group Group #1053269

(800) 423-2765

www.lfg.com

American Public Life Group #23457

(800) 256-8606

www.ampublic.com

CRITICAL ILLNESS EMERGENCY MEDICAL TRANSPORT INDIVIDUAL LIFE Unum Group #474092

(866) 679-3054

www.unum.com

MASA

(800) 423-3226

www.masamts.com

5Star (866) 863-9753

https://5starlifeinsurance.com/

How to Log In

1

www.mybenefitshub.com/splendoraisd

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.

Annual Benefit Enrollment

Benefit Updates - What’s New:

New Carrier for Dental Lincoln Financial Group

• Three cleanings available per year

• Max Rewards are available rolling a portion of unused dental benefits to next year

• Adding 31 dental providers to the network

New Carrier for the Hospital Indemnity Plan Lincoln Financial Group

• No pre-existing conditions; increased admission benefit and frequency. (2 admissions per insured per plan year)

• Newborn benefit of $500/day for 2 days; Observation unit paid as hospital admission

• Now includes wellness benefit

IRS has established new contribution limits for Flex and HSA!

• Flex - $3,050

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

Don’t Forget!

• Login and complete your benefit enrollment from 05/08/2023 - 06/05/2023

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

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

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

Annual Benefit Enrollment

Section 125 Cafeteria Plan Guidelines

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

Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

CHANGES IN STATUS (CIS): QUALIFYING EVENTS

Marital Status

Change in Number of Tax Dependents

Change in Status of Employment Affecting Coverage Eligibility

Gain/Loss of Dependents’ Eligibility Status

A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).

A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.

Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual’s eligibility under an employer’s plan includes commencement or termination of employment.

An event that causes an employee’s dependent to satisfy or cease to satisfy coverage requirements under an employer’s plan may include change in age, student, marital, employment or tax dependent status. Judgment/ Decree/Order

If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual’s plan, you may change your election to revoke coverage only for that dependent child and only

Eligibility for Government Programs

Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.

Annual Benefit Enrollment

Annual Enrollment

During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.

• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.

• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.

• Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.

New Hire Enrollment

All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

Q&A

Who do I contact with Questions?

For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.

Where can I find forms?

For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ splendoraisd. 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 Splendora ISD benefit website: www.mybenefitshub.com/splendoraisd. 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.

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.

Medical To age 26

Dental To age 26

Vision To age 26

Life To age 26

AD&D To age 26

Individual Life To age 24

Health Savings Account To age 26

Critical Illness To age 26

Disability To age 26

Hospital

Indemnity To age 26

Telehealth To age 26

Emergency Transportation To age 26

Cancer 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.

Helpful Definitions

Actively-at-Work

You are performing your regular occupation for the employer on a full-time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2023 please notify your benefits administrator.

Annual Enrollment

The period during which existing employees are given the opportunity to enroll in or change their current elections.

Annual Deductible

The amount you pay each plan year before the plan begins to pay covered expenses.

Calendar Year

January 1st through December 31st

Co-insurance

After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.

Guaranteed Coverage

The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or preexisting condition exclusion provisions do apply, as applicable by carrier.

In-Network

Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.

Out-of-Pocket Maximum

The most an eligible or insured person can pay in coinsurance for covered expenses.

Plan Year

September 1st through August 31st

Pre-Existing Conditions

Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescriptions drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).

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

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

Description

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

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

Permissible Use Of Funds

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

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

Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65).

Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).

Not permitted

Year-to-year rollover of account balance?

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

No. However, your plan does allow for $500 to be rolled over. Does the account earn interest?

Medical Insurance Texas Schools Health Benefits Program

ABOUT TSHBP

The TSHBP is proud to offer a variety of plans and benefits to meet school district needs. All plans are designed so members can easily navigate through their health medical needs.

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

Directed Care Highlights

The TSHBP Directed Care Plans utilize a national network to provide physician and ancillary services access to all members. Enrolled school districts will access the HealthSmart practitioner and ancillary only network to gain access to over 502,309 providers in over 1,421,000 unique locations across the United States.

Please note, hospitals are excluded from the PPO networks. All hospital and other medical facility-based services are accessed via an assigned Care Coordinator.

It is easy to look up providers in your area by looking up providers in your area by clicking on the link below. https://tshbp.info/HSNetwork

Hinge Health

Hinge Health is a digital musculoskeletal management program with custom physical therapy programs designed by physicians and led by board certified Health coaches. You and your eligible family members get free access to Hinge Health’s programs for back, knee, hip, shoulder, or neck pain, which may include: a free tablet computer and wearable sensors, unlimited 1-on-1 health coaching, personalized exercise therapy, etc.

TSHBeFit

TSHBeFit is a Wellness Program, powered by WellRight, is available for members to achieve their personal health and well-being through a collection of holistic activities and is no additional cost to members.

PPO Deductible Credits

Aetna Network Highlights

You want a network that is comprehensive, is easy to use and can help you save on costs. Look no further. You can now find support through our Aetna Signature Administrators® preferred provider organization network. Discover provider options and reduced costs.

With our network, you now have access to over 1.2 million participating doctors, 8,700 hospitals, and strong, negotiated discounts.

We know quality care is important. So we make sure our doctors successfully complete our credentialing requirements. Our credentialing process meets industry standards, as well as state and federal requirements.

You’ll also have access to over 600 Institutes of Excellence™ facilities and Institutes of Quality® facilities. We measure these publicly recognized institutes by clinical performance, outcomes and efficiency. Then, we pass this guidance along to you—so you can choose the best facility. Ready to search our network? Just visit http://aetna.com/asa

Access the MyTSHBP Digital Wallet for easy access to all your benefit resources.

With the Aetna PPO plan, if you choose to utilize the services of a Care Coordinator for a procedure or admission to a facility, you may receive up to a $500 credit toward your deductible. If you have already met your deductible, the $500 credit will apply to your out-of-pocket maximum!

Medical Insurance Texas Schools Health Benefits Program

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/splendoraisd

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 (TSHBP HD, Aetna HD)

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

• Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account

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

• Not enrolled in Medicare or TRICARE

• Not receiving Veterans Administration benefits

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

Maximum Contributions

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

• Individual – $3,850

• Family (filing jointly) – $7,750

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

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.

Important HSA Information

• Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.

• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.

• You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.

How to Use your HSA

• Online/Mobile: Sign-in for 24/7 account access to check your balance, pay bills and more.

• Call/Text: (817) 882-0800. EECU’s dedicated member service representatives are available to assist you with any questions. Their hours of operation are Monday through Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. – 1:00 p.m. CT and closed on Sunday.

• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333-9934

• Stop by: a local EECU financial center for in-person assistance; find EECU locations & service hours a www.eecu.org/locations

Flexible Spending Account (FSA) Higginbotham

ABOUT FSA

A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (your plan contains a $500 rollover provision).

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

Health Care FSA

The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $3,050 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include:

• Dental and vision expenses

• Medical deductibles and coinsurance

• Prescription copays

• Hearing aids and batteries

You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA).

Higginbotham Benefits Debit Card

The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s).

Dependent Care FSA

The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full-time student.

Things to Consider Regarding the Dependent Care FSA

• Overnight camps are not eligible for reimbursement (only day camps can be considered).

• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.

• You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.

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

Flexible Spending Account (FSA) Higginbotham EMPLOYEE BENEFITS

Important FSA Rules

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

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

• You can continue to file claims incurred during the plan year for another 90 days after August 31st

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

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

Over-the-Counter Item Rule Reminder

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

Higginbotham Portal

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

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

• Update your personal information

• Utilize Section 125 tax calculators

• Look up qualified expenses

• Submit claims

• Request a new or replacement Benefits Debit Card

Register on the Higginbotham Portal

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

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

• Follow the prompts to navigate the site.

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

* Phone – 866-419-3519

* Email – flexclaims@higginbotham.net

* Fax – 866-419-3516

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/splendoraisd

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.

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/splendoraisd

Benefits at a glance

If you or a covered family member have to go to the hospital for a sickness or injury, hospital indemnity insurance provides a lump-sum 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.

Hospital admission - For the initial day of admission to 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

Hospital intensive care unit (ICU) admission - For the initial day of admission in an ICU for treatment as the result of a sickness/an injury

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

$1,500 per day for two days per calendar year

$150 per day for 30 days per calendar year starting the 1st day of confinement

$1,500 per day for two days per calendar year

$300 per day for 30 days per calendar year starting the 1st day of confinement

Complications of pregnancy Included

$2,500 per day for two days per calendar year

$200 per day for 30 days per calendar year starting the 1st day of confinement

$2,500 per day for two days per calendar year

$400 per day for 30 days per calendar year starting the 1st day of confinement

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.

Additional confinement benefits

Newborn care - For each day of confinement to a hospital for routine post-natal care following birth, full mouth or panaromic x-rays

$500 per day for two days per calendar year

$500 per day for two days per calendar year

If a newborn baby is confined for treatment of an illness, infirmity, disease, or injury, we will pay the Hospital or ICU confinement benefit instead of the Newborn care benefit.

Health assessment/wellness benefit Your cash benefit

Health assessment benefit - Receive a cash benefit every year you and any of your covered family members complete a single coveredexam, screening, or immunization

Enhanced benefits

Hospital NICU admission- Increases the hospital ICU admission benefit for a newborn child’s ICU or NICU admission by the percentage shown in the schedule of 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

Additional plan benefit(s)

$50

Portability if you leave your employer Included

Note: See the policy for details and specific requirements for each of these benefits.

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/splendoraisd

High Option

The Lincoln DentalConnect® PPO Program:

• Covers many preventive, basic, and major dental care services

• Also covers orthodontic treatment for children and adults

• Features group coverage for employees

• Allows you to choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a network provider

• Does not make you and your loved ones wait six months between routine cleanings

EMPLOYEE BENEFITS

Deductibles are combined for basic and major In-Network services. Deductibles are combined for basic and major Out-of-Network services. Calendar Year Benefit Maximum

Per Individual

Annual Maximums are combined for preventive, basic, and major services. MaxRewards® lets you and your covered family members roll a portion of unused dental benefits from one year into the next, so you have extra benefit dollars available when you need them most.

• Eligible Range (claim threshold): $650

• Rollover Amount: $325 per calendar year

• Rollover Amount with Preferred Provider: $450 per calendar year

• Maximum Rollover Account Balance: $1,000

Preventive Services

Routine oral exams, bitewing X-rays, Other dental x-rays (including periapical films), routine cleanings, flouride treatments

Basic Services

Sealents, problem-focused exams, palliative treatment (including emergency relief of dental pain), injections of antibiotics and other therapuetic medications, fillings, simple extractions, biopsy and examinations of oral tissue (including brush biopsy), endodontics (including root canal treatment), periodontal maintenance procedures, non-surgical periodontal therapy

Major Restorative Care

Space maintainers for children, consultations, prefabricated stainless steel and resin crowns, sugical extractions, oral surgery, general anesthesia and I.V. sedation, prosthetic repair and recementation services, periodntal surgery, bridges, full nad partial dentures, denture relne and rebase services, crown, inlays, onlays, and related services, implants and implant related services

High Plan

Dental Insurance

Lincoln Financial Group

Low Option

The Lincoln DentalConnect® PPO Program:

• Covers many preventive, basic, and major dental care services

• Features group coverage for employees

• Allows you to choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a network provider

• Does not make you and your loved ones wait six months between routine cleanings

DPPO Low Plan

Deductibles are combined for basic and major In-Network services. Deductibles are combined for basic and major Out-of-Network services.

Calendar Year Benefit Maximum Per Individual $1,050

Annual Maximums are combined for preventive, basic, and major services. MaxRewards® lets you and your covered family members roll a portion of unused dental benefits from one year into the next, so you have extra benefit dollars available when you need them most.

• Eligible Range (claim threshold): $600

• Rollover Amount: $250 per calendar year

• Rollover Amount with Preferred Provider: $350 per calendar year

• Maximum Rollover Account Balance: $1,050

Preventive Services

Routine oral exams, bitewing X-rays, full mouth or panoramic x-rays, other dental x-rays (including periapical films), routine cleanings, flouride treatments

Basic Services

Sealents, problem-focused exams, palliative treatment (including emergency relief of dental pain), injections of antibiotics and other therapuetic medications, fillings, simple extractions, biopsy and examinations of oral tissue (including brush biopsy), endodontics (including root canal treatment), periodontal maintenance procedures, non-surgical periodontal therapy

Major Restorative Care

Space maintainers for children, consultations, prefabricated stainless steel and resin crowns, sugical extractions, oral surgery, general anesthesia and I.V. sedation, prosthetic repair and recementation services, periodntal surgery, bridges, full and partial dentures, denture reline and rebase services, crown, inlays, onlays, and related services, implants and implant related services

DHMO Plan

Trips to the dentist are a little less upsetting when you know how much you’ll pay ahead of time. And easier, too, with no claim forms or deductibles.

Here’s how this imporant coverage works. You choose your primary-care dentist when you enroll. To find a participating dentist, visit http://ldc.lfg.com and select “Find a Dentist”.

$44.17 $81.24 $23.50

$33.98

• If you need to visit your dentist after your coverage begins, but before receiving your Dental ID card, please call 888-877-7828 to arrange your care.

*Note, the Member ID Number contains nine digits. Please use all proceeding zeros when entering your Member ID.

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/splendoraisd

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.

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

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 wear toric, gas permeable, or multi-focal lenses.

3. Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay.

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

Vision Insurance Superior Vision EMPLOYEE BENEFITS

Discount Features

Look for providers in the provider directory who accept discounts, as some do not; please verify their services and discounts (range from 10%-30%) prior to service as they vary.

Discounts on covered materials

Frames: 20% off amount over allowance

Lens options: 20% off retail

Progressives: 20% off amount over retail lined trifocal lens, including lens options

Speciality contact lens fit: 10% off retail, then apply allowance

Discounts on non-covered exam, services and materials

Exams, frames, and prescription lenses: 30% off retail

Lens options, contacts, miscellaneous options: 20% off retail

Disposable contact lenses: 10% off retail

Retinal imaging: $39 maximum out-of-pocket

Maximum member out-of-pocket

The following options have out-of-pocket maximums5 on standard (not premium, brand, or progressive) lenses.

1.6

5. Discounts and maximums may vary by lens type. Please check with your provider.

Refractive Surgery

Superior Vision has a nationwide network of independent refractive surgeons and partnerships with leading LASIK networks who offer members a discount. These discounts range from 10%-50%, and are the best possible discounts available to Superior Vision.

Disability Insurance OneAmerica 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/splendoraisd

What is Educator Disability Insurance?

Educator Disability insurance is a hybrid that combines features of short-term and long-term disability into one plan. Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. The plan gives you flexibility to be able to choose an amount of coverage and waiting period that suits your needs. We offer Educator Disability insurance for you to purchase through Splendora ISD. If you need to file a claim, please contact OneAmerica at 855-517-6365 and provide group #00618620.

Eligibility: This benefit is available for employees who are actively at work on the effective date and working a minimum of 20 hours per week.

Benefit Amount: You may select a minimum monthly benefit of $200 up to a maximum monthly benefit of $8,000, in increments of $100, not to exceed 66.67% of your monthly pre-disability earnings.

Maximum Benefit Duration: Accident: 3 years to age 70/ Sickness: 65/5/70

Elimination Period: This is a period of consecutive days of disability before benefits may become payable under the contract.

Elimination Period Options: Option 1 - 7/7, Option 2 - 14/14, Option 3 - 30/30, Option 4 - 60/60

First Day Hospital: If a Person is Totally Disabled and hospital confined for 24 hours or more with room and board charges during the Elimination Period due to an Injury or Sickness resulting in a covered Disability, benefits are payable from the first day of that confinement. Applies to plans with Elimination Periods of 30 days or less.

Total Disability: You are considered disabled if, because of injury or sickness, you cannot perform the material and substantial duties of your regular occupation, you are not working in any occupation and are under the regular attendance of a physician for that injury or sickness.

Partial Disability: You may be paid a partial disability benefit, if because of injury or sickness, you are unable to perform every material and substantial duty of your regular occupation on a full time basis, are performing at least one of the material and substantial duties of your regular occupation, or another occupation, on a full or part-time basis, and are earning less than 80% of your pre-disability earnings due to the same injury or sickness.

Pre-Existing Condition Limitation: The pre-existing period is 3/12. Certain disabilities are not covered if the cause of the disability is traceable to a condition existing prior to your effective date of coverage. A pre-existing condition is any condition for which a person has received medical treatment or consultation, taken or were prescribed drugs or medicine, or received care or services, including diagnostic measures, within a time-frame specified in the contract. You must also be treatment-free for a time-frame specified in some contracts following your individual effective date of coverage. A limited benefit will be paid if the Person’s Disability begins in the first 12 months following the Person’s Individual Effective Date of Insurance; and the Person’s Disability is caused by, contributed to by, or the result of a condition for which the Person received medical advice or treatment in the 3 months just prior to the Person’s Individual Effective Date of Insurance

Return to Work: You may be able to return to work for a specified time period without having your partial disability benefits reduced according to the contract. The Return to Work Benefit is offered up to a maximum of 12 months.

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/splendoraisd

Voluntary Life Insurance

• Provides a cash benefit to your loved ones in the event of your death

• Features group rates for Splendora ISD 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

• To file a claim contact Lincoln Financial at (800) 423-2765

Life and AD&D Lincoln Financial Group EMPLOYEE BENEFITS

Benefit Exclusions

Like any insurance, this term life insurance policy does have exclusions. A suicide exclusion may apply. A complete list of benefit exclusions is included in the policy. State variations apply.

Note: You must be an active Splendora Independent School District employee to select coverage for a spouse and/or dependent children. To be eligible for coverage, a spouse or dependent child cannot be confined to a health care facility or unable to perform the typical activities of a healthy person of the same age and gender.

Voluntary AD&D

This coverage provides a cash benefi covered loss in an accident, such ast to the beneficiary/beneficiaries you name if you die in an accident, or to you if you suffer a losing a limb or your eyesight

Maximum coverage amount $500,000 maximum in $10,000 increments

Minimum coverage amount $10,000

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

Maximum coverage amount Up to $500,000 not to exceed 100% of employee’s benefit amount.

The spouse AD&D coverage amount will reduce by 50% when you reach age 70. Benefits end when you retire.

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/splendoraisd

Enhanced coverage options for employees. Easy and flexible enrollment for employers. The 5Star Life Insurance Company’s Family Protection Plan offers both Individual and Group products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your employees.

CUSTOMIZABLE With several options to choose from, employees select the coverage that best meets the needs of their families.

TERMINAL ILLNESS ACCELERATION OF BENEFITS Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL).

PORTABLE Coverage continues with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly.

CONVENIENCE Easy payments through payroll deduction.

FAMILY PROTECTION Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves.

*Financially dependent children 14 days to 23 years old.

PROTECTION TO COUNT ON Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two-year contestability period and/or under investigation. This coverage has no war or terrorism exclusions.

QUALITY OF LIFE Optional benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following:

• Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or

• Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.

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

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.

Cancer Insurance

ABOUT CANCER

Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.

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

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 nonmedical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance through American Public Life helps pay for these direct and indirect treatment costs so you can focus on your health.

Should you need to file a claim contact APL at 800-256-8606 or online at www.ampublic.com. You can find additional claim forms and materials at www.mybenefitshub.com/splendoralisd

Pre-Existing Condition Exclusion: Review the Plan Summary page that can be found at www.mybenefitshub.com/splendoraisd for full details

Critical Illness Insurance Unum EMPLOYEE BENEFITS

ABOUT CRITICAL ILLNESS

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

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

Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. To file a claim call UNUM at 800-858-6843 or find claim form at www.mybenefitshub.com/splendoraisd.

Who is eligible for this coverage? All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status).

What are the Critical Illness coverage amounts?

The following coverage amounts are available.

For you: Select one of the following $10,000, $20,000 or $30,000

For your Spouse and Children: 50% of employee coverage amount

Can I be denied coverage? Coverage is guarantee issue.

When is coverage effective?

What critical illness conditions are covered?

Please see your Plan Administrator for your effective date of coverage. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

all

Critical Illness Insurance

What critical illness conditions are covered?

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

Are wellness Screenings covered? Each insured is eligible to receive one Be Well Benefit per calendar year. Be Well Benefit For you, your spouse and your children: $50 Be Well Screenings include tests for the following: cholesterol and diabetes, cancer and cardiovascular function. They also ixnclude imaging studies, immunizations and annual examinations by a Physician. See certificate for details.

Pre-existing Conditions

We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following:

• a pre-existing condition; or

• complications arising from treatment or surgery for, or medications taken for, a pre-existing condition.

An insured has a pre-existing condition if, within the 3 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which:

• medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period;

• drugs or medications were taken, or prescribed to be taken during that period; or

• symptoms existed.

The pre-existing condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date any initial coverage or increases in coverage become effective.

Emergency Medical Transport MASA

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/splendoraisd

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 at www.mybenefitshub.com/splendoraisd

Emergency Medical Transport Employee and Family $14.00

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 Splendora 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 Splendora 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.