Benefit Contact Information
TAYLOR ISD BENEFITS
Financial Benefit Services (800)583-6908
www.mybenefitshub.com/taylorisd
MEDICAL - TRS ACTIVECARE MEDICAL - TRS HMO
BCBSTX (866)355-5999
www.bcbstx.com/trsactivecare
HEALTH SAVINGS ACCOUNT (HSA) TELEHEALTH
Scott & White HMO (844)633-5325
www.trs.swhp.org
DENTAL EECU (817)882-0800
www.eecu.org
VISION
Superior Vision Group #327810 (800)507-3800
www.superiorvision.com
CANCER
American Public Life Group #22339 (800)256-8606
www.ampublic.com
LIFE AND AD&D
OneAmerica Group #G00613656 (800)583-6908
www.oneamerica.com
MDLIVE (888)365-1663
www.mdlive.com/fbs
MetLife Group #5969997 (800)438-6388
www.metlife.com
HOSPITAL INDEMNITY DISABILITY
Aetna Group #802488 (855)513-9865
www.aetna.com
Unum Group #217419001 (800)858-6843
www.unum.com
ACCIDENT CRITICAL ILLNESS
American Public Life Group #22339 (800)256-8606
www.ampublic.com
INDIVIDUAL LIFE
5Star Life Insurance (866)863-9753
www.5starlifeinsurance.com
EMERGENCY MEDICAL TRANSPORT FLEXIBLE SPENDING ACCOUNT (FSA)
MASA
Group #MKTAISD (800)423-3226
www.masamts.com
Higginbotham (800)943-9179
https://flexservices.higginbotham.net/
Voya Group #695246 CCI (888)238-4840
www.voya.com
IDENTITY THEFT
ID Watchdog (800)774-3772
www.idwatchdog.com
EMPLOYEE ASSISTANCE PROGRAM (EAP)
Life Works (888)456-1324
www.lifeworks.com
1
2
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):
Marital Status
Change in Number of Tax Dependents
Change in Status of Employment Affecting Coverage Eligibility
Gain/Loss of Dependents’ Eligibility Status
Judgment/ Decree/Order
Eligibility for Government Programs
QUALIFYING EVENTS
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.
If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual’s plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
Annual Benefit Enrollment
Annual Enrollment
During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.
• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.
• Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
New Hire Enrollment
All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Q&A
Who do I contact with Questions?
For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.
Where can I find forms?
For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/taylorisd
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 Taylor ISD benefit website:
www.mybenefitshub.com/taylorisd. 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.
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 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).
•
•
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
Source Employee and/or employer Employee and/or employer
Permissible Use Of Funds
Cash-Outs of Unused Amounts (if no medical expenses)
Year-to-year rollover of account balance?
Does the account earn interest?
$1,500 single (2023) $3,000 family (2023)
$3,850 single (2023) $7,750 family (2023) 55+ catch up +$1,000 $3,050 (2023)
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).
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65). Not permitted
Yes, will roll over to use for subsequent year’s health coverage.
Yes, portable year-to-year and between jobs.
No. Access to some funds may be extended if your employer’s plan contains a 2 1/2-month grace period
Notes
Medical Insurance
ABOUT MEDICAL
Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis.
For full plan details, please visit your benefit website: www.mybenefitshub.com/taylorisd
•
•
•
•
•
• No
Ask
Being
•
•
•
•
•
•
•
•
•
*Available
•
are still included.
•
•
•
•
• Statewide network
• PCP referrals required
• Not compatible with
• No out-of-network
Each includes a wide range of wellness bene ts.
than the HD and Primary plans services and drugs
required to see specialists with a Health Savings Account (HSA)
• Compatible with a Health Savings Account (HSA)
• Nationwide network with out-of-network
• No requirement for PCPs or
• Must meet your deductible before plan pays for non-preventive care
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
• 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
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.
• Individual maximum-out-of-pocket decreased by $650.
Previous amount was $8,150 and is now $7,500.
• Family maximum-out-of-pocket decreased by $1,300.
Previous amount was $16,300 and is now $15,000.
• Individual maximum-out-of-pocket increased by $450 to match IRS guidelines. Previous amount was $7,050 and is now $7,500.
• Family maximum-out-of-pocket increased by $900 to match IRS guidelines. Previous amount was $14,100 and is now $15,000. These changes apply only to in-network amounts.
• Family deductible decreased by $1,200.
Previous amount was $3,600 and is now $2,400.
• Primary care provider copay decreased from $30 to $15.
• No changes.
• This plan is still closed to new enrollees.
Effective: Sept. 1, 2023
2023-24 Health Maintenance Organization (HMO) Plans and Premiums for Select Regions of the State
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.
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.
Central and North Texas
Central and North Texas
Baylor Scott & White Health Plan
Blue Essentials - South Texas HMO
Blue Essentials - South Texas HMO
Blue Essentials - West Texas HMO
Blue Essentials - West Texas HMO
Brought to you by TRS-ActiveCare
Brought to you by TRS-ActiveCare
Baylor Scott & White Health Plan
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: 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
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: Cameron, Hildalgo, Starr, Willacy
You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy
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
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
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/taylorisd
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs – it is also a tax-exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
• Enrolled in an HSA-eligible HDHP
• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
• Not enrolled in a Health Care Flexible Spending Account
• Not eligible to be claimed as a dependent on someone else’s tax return
• Not enrolled in Medicare or TRICARE
• Not receiving Veterans Administration benefits
You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered by the HDHP.
Maximum Contributions
Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2023 is based on the coverage option you elect:
• Individual – $3,850
• Family (filing jointly) – $7,750
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 HSA Bank. 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
Telehealth
MD Live
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/taylorisd
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.
Dental Insurance 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/taylorisd
How do I request a new ID Card?
You can request your dental id card by contacting MetLife directly at 800-942-0854. You can also go to www.metlife.com and register/login to access your account.
How do I find an in-network Dentist?
1. Go to www.metlife.com
2. Select “Find a Dentist”
3. Select PDP Plus next to “Choose a network”
Up
1. “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.
2. 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.
3. Applies to Type B and C services only.
4. 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.
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/taylorisd
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.
Discount Features
Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.
Hospital Indemnity
Aetna
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/taylorisd
The Hospital Indemnity Plan provided through Aetna helps with the high cost of medical care by paying you a set amount when you have an inpatient hospital stay. Unlike traditional insurance, which pays a benefit to the hospital or doctor, this plan pays you directly based on the care or treatment you receive. These costs may include meals and transportation, childcare or time away from work due to a medical issue that requires hospitalization.
If you need to submit a claim you do so on the Aetna portal at myaetnasupplemental.com
Important Note: All daily inpatient stay benefits begin on day two and count toward the plan year maximum.
$50 $100
Disability Insurance
Unum
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/taylorisd
Your Plan Eligibility
You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. The date you are eligible for coverage is the later of: the plan effective date; or the day after you complete the waiting period.
Benefit Amount
You may purchase a monthly benefit in $100 units, starting at a minimum of $200, up to 66 2/3% of your monthly earnings rounded to the nearest $100, but not to exceed a monthly maximum benefit of $8,000.
Elimination Period
The Elimination Period is the length of time of continuous disability, due to sickness or injury, which must be satisfied before you are eligible to receive benefits.
You may choose an Elimination Period (injury/sickness) of 14/14, 30/30, 60/60, 90/90 or 180/180 days.
If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.)
Benefit Duration
Your duration of benefits is based on your age when the disability occurs. Plan: ADEA II: Your duration of benefits is based on the following table:
Age at Disability Maximum Duration of Benefits
Less than age 60 To age 65, but not less than 5 years
Age 60 through 64 5 years
Age 65 through 69 To age 70, but not less than 1 year
Age 70 and over 1 year
Other Important Provisions
Pre-Existing Condition Exclusion: Benefits will not be paid for disabilities caused by, contributed to by, or resulting from a pre-existing condition. You have a pre-existing condition if:
• you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and
• the disability begins in the first 12 months after your effective date of coverage.
Disability Insurance
Unum
• After benefits have been paid for 24 months, you are disabled when Unum determines that due to the same sickness or injury, you are
• unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training, or experience.
• You must be under the regular care of a physician to be considered disabled.
Benefit Integration: Your disability benefit will be reduced by deductible sources of income and any earnings you have while disabled.
After you have received monthly disability payments for 12 months, your gross disability payment will be reduced by such items as additional deductible sources of income you receive or are entitled to receive under state compulsory benefit laws.
Mental Illness/Self-Reported Symptoms
The lifetime cumulative maximum benefit period for all disabilities due to mental illness and disabilities based primarily on self-reported symptoms is 24 months. Only 24 months of benefits will be paid for any combination of such disabilities even if the disabilities are not continuous and/or are not related. Payments would continue beyond 24 months only if you are confined to a hospital or institution because of the disability. Limitations apply.
How to File a Claim and Other Important Resources
To get the claim form go to your benefit website, www.mybenefitshub.com/taylorisd
To file a claim online: https://www.unum.com/employees/file-a-claim
To check the status of a claim:
• https://unum.com/claims
• (800) 858-6843 M-F 8-8 EST
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/taylorisd
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/taylorisd .
ABOUT ACCIDENT
Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you. For full plan details, please visit your benefit
THIS POLICY IS A LIMITED PLAN ANDONLY COVERS ACCIDENTS. IS NOT A POLICY FOR WORKERS’ COMPENSATION INSURANCE. PLEASE REFER TO THE EMPLOYEE PORTAL AT TAYLOR ISD UNDER THE
Accident Insurance
*Amounts shown are for individuals; amounts for spouse and child(ren) may vary. Please refer to your Schedule of Benefits for details.
Critical Illness Insurance Voya 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/taylorisd
An affordable way to help protect against the financial stress of a serious illness.
What is Critical Illness Insurance?
Critical Illness Insurance pays a lump-sum benefit if you are diagnosed with a covered illness or condition. Your employer provides Critical Illness Insurance at no cost to you. You also have the option to elect additional coverage. Critical Illness Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.
For what critical illnesses and conditions are benefits available?
Base Module
• Heart attack
• Stroke
• Coronary artery bypass (25%)
• Coma
• Cancer
• Skin cancer (10%)
• Major organ failure
• Permanent paralysis
• End stage renal (kidney) failure
Cancer Module
• Carcinoma in situ (25%)
Who is eligible for Critical Illness Insurance?
• You—all active employees working 15+ hours per week.
• Your spouse*— under age 70. If you are covered for Basic employee coverage, you may elect spouse coverage, even if you do not elect Supplemental coverage on yourself.
• Your child(ren)— to age 26. If you are covered for Basic employee coverage, you may elect child(ren) coverage, even if you do not elect Supplemental coverage on yourself.
*The use of “spouse” in this document means a person insured as a spouse as described in the certificate of insurance or rider. This may include domestic partners or civil union partners as defined by the group policy. Please contact your employer for more information.
What Maximum Critical Illness Benefit am I eligible for?
• Taylor ISD provides its employees with a $5,000 Critical Illness Benefit at no cost to you.
• For you: You also have the opportunity to purchase an additional Maximum Critical Illness Benefit of $5,000$30,000 in $5,000 increments
• For your spouse: You have the opportunity to purchase a Maximum Critical Illness Benefit $5,000-$15,000 in $5,000 increments.
• For your children: You have the opportunity to purchase a Maximum Critical Illness Benefit of $1,000, $2,500, $5,000 or $10,000 for each covered child.
How many times can I receive the Maximum Critical Illness Benefit?
Usually you are only able to receive the Maximum Critical Illness Benefit for one covered illness or disease within each module. Your plan includes the Restoration Benefit*, which provides a one-time restoration of 100% of the maximum benefit amount in order to pay an additional benefit if you experience a second covered illness for a different condition.
Your plan also includes the Recurrence Benefit*, which allows you to receive a benefit for the same condition a second time.
It’s important to note that in order for the second covered illness or the second occurrence of the illness to be covered, it must occur after 12 consecutive months without the occurrence of any covered critical illness named in your certificate, including the illness from the first benefit payment.
If a partial benefit is paid out, it will not reduce the available maximum benefit amount for the illnesses or diseases in that same module. If you have reached the benefit limit by receiving the maximum benefit in each module, you may choose to end your coverage; however, if you have coverage for your spouse and/or child(ren), you must continue your coverage in order to keep their coverage active. Please see the certificate of coverage for details.
*This benefit does not apply to the cancer module.
Critical Illness Insurance Voya
How much does Critical Illness Insurance cost?
Limitations
Benefits reduce 50% for the employee and/or covered spouse on the policy anniversary following the 70th birthday, however, premiums do not reduce as a result of this benefit change.
Who do I contact with questions?
For more information, please call the Voya Employee Benefits Customer Service Team at (800) 955-7736.
Life and AD&D OneAmerica
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/taylorisd
• Provides a cash benefit to your loved ones in the event of your death.
• To file a claim contact One America at (800) 833-5569
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 Taylor ISD 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.
Reduction
Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule. The amounts of dependent life insurance will reduce according to the employee’s reduction schedule.
What you need to know about your Basic Life and AD&D Benefits
Guaranteed Issue: Employee: $10,000
Accidental Death and Dismemberment (AD&D): Additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract. Additional AD&D benefits include seat belt, air bag, repatriation, child higher education, childcare, paralysis/loss of use, severe burns, disappearance, and exposure. If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose.
What you need to know about your Voluntary AD&D Benefits
AD&D is a very inexpensive form of life insurance that can give you additional protection in the event of an accidental death or dismemberment.
Flexible AD&D Options:
• Employee: Up to $750,000, in $10,000 increments
• Spouse: 60% of the employee AD&D benefit
• Child: 15% of the employee AD&D benefit AD&D
Guaranteed Issue:
• Employee: $750,000
• Spouse: $450,000
• Child: $30,000
Accidental Death and Dismemberment (AD&D): If AD&D is selected, additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract.
Dependent AD&D Coverage: Optional dependent AD&D coverage is available to eligible employees. You must select employee coverage in order to cover your spouse and/or child(ren). If employee AD&D is declined, no dependent AD&D will be included.
Reductions: Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule. The amounts of dependent AD&D principal sum will reduce according to the employee’s reduction schedule.
0-26 $2.00
Spouse rates based on Employee’s age.
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/taylorisd
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/taylorisd
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.
Identity Theft ID Watchdog
ABOUT IDENTITY THEFT PROTECTION
Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered.
For full plan details, please visit your benefit website: www.mybenefitshub.com/taylorisd
Easy & Affordable Identity Protection
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!
Features
• Credit Lock - helps provide additional protection against unauthorized access to your credit
• More For Families - helps better protect your loved ones no matter the age.
• Resolution Specialist - manage the case for you until your identity is restored
ID watchdog Monitors: social media, transaction records, public records, and more.
How to file a claim:
Call 866-513-1518 or download the app to additional services.
IDENTITY THEFT PROTECTION
The Powerful Features You Want — All at an Affordable Price Monitor & Detect
• Credit Report & VantageScore
• Credit Score | 1 Bureau Monthly
• Credit Score Tracker | 1 Bureau Monthly
• Credit Report Monitoring1 | 3 Bureau
• Dark Web Monitoring*
• High-Risk Transactions Monitoring*
• Subprime Loan Monitoring*
• Public Records Monitoring*
• USPS Change of Address Monitoring
• Identity Profile Report
Manage & Alert
• Child Credit Lock*| 1 Bureau
• Credit Report Lock | 1 Bureau*
• Financial Accounts Monitoring
• Social Network Alerts*
• Registered Sex Offender Reporting*
• Customizable Alert Options
• Breach Alert Emails
• Mobile App
• National Provider ID Alerts
Support & Restore
• Identity Theft Resolution Specialists (Resolution for Preexisting Conditions)*
• 24/7/365 U.S.-based Customer Care Center
• Up to $1M Identity Theft Insurance*
• Lost Wallet Vault & Assistance
• Deceased Family Member Fraud Remediation
• Fraud Alert & Credit Freeze Assistance
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/taylorisd
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 non-emergency 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 benefit website at www.mybenefitshub.com/taylorisd and select your school district.
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 (unless your plan contains a $610 rollover or grace period provision).
For full plan details, please visit your benefit website: www.mybenefitshub.com/taylorisd
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
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.
Higginbotham Portal
The Higginbotham Portal provides information and resources to help you manage your FSAs.
• Access plan documents, letters and notices, forms, account balances, contributions and other plan information
• Update your personal information
• Utilize Section 125 tax calculators
• Look up qualified expenses
• Submit claims
• Request a new or replacement Benefits Debit Card
Register on the Higginbotham Portal
Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information.
• Enter your Employee ID, which is your Social Security number with no dashes or spaces.
• Follow the prompts to navigate the site.
• If you have any questions or concerns, contact Higginbotham:
◊ Phone – 866-419-3519
◊ Email – flexclaims@higginbotham.net
◊ Fax – 866-419-3516
Higginbotham Flex Mobile App
Easily access your Health Care FSA on your smartphone or tablet with the Higginbotham mobile app. Search for Higginbotham in your mobile device’s app store and download as you would any other app.
• View Accounts – Includes detailed account and balance information
• Card Activity – Account information
• SnapClaim – File a claim and upload receipt photos directly from your smartphone
• Manage Subscriptions – Set up email notifications to keep up-to-date on all account and Health Care FSA debit card activity
• Log in using the same username and password you use to log in to the Higginbotham Portal. Note: You must register on the Higginbotham Portal in order to use the mobile app.
Employee Assistance Program (EAP)
Life Works
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/taylorisd
Taylor ISD employees and their families have anytime access to LifeWorks Integrated EAP and Work-life services in a variety of ways that fit their preferences and unique needs.
888-456-1324 | www.lifeworks.com
Username: tisd; Password: lifeworks
Taylor ISD employees and their families will have access to confidential assistance and support on a wide range of issues in the areas of life, health, family, work and money.
TELEPHONE
• All calls are answered live by Ceridian employees who are trained clinical consultants with master’s/doctorate degrees.
• LifeWorks is a 24/7 operation, so there are no changes in our service delivery during non-business hours — your employees will not be directed to leave messages.
• A fully staffed bilingual clinical consultant team answers calls from service centers in St. Petersburg, FL; Minneapolis, MN; Blue Bell, PA; Toronto, Winnipeg and Montreal, Canada.
MOBILE
• An app for mobile devices makes the LifeWorks.com site accessible from anywhere at any time for iPhone, Android and Blackberry users.
IN-PERSON
• Taylor ISD employees and their families will have access to “6 face-to-face sessions”
• totally focused on short-term, solution-focused counseling with EAP clinicians.
• Ceridian develops close relationships and carefully evaluates the national network of EAP providers who deliver in-person counseling to your employees. This cohesive team includes consultants that complete the initial screening assessment and connect participants to the EAP provider and EAP affiliate managers to ensure a high quality experience. Ceridian also employs a Clinical Supervisor within Provider Network Services for case consultation and assistance to the local EAP affiliate.
• Our North American network of 11,300 EAP providers includes all 50 U.S. states, Puerto Rico, the Virgin Islands, Mexico, Canada and U.S. Territories.
• Our entire network is composed of licensed mental health professionals. Minimum qualifications include a license to practice independently in the state in which services are provided along with five years post graduate experience and three years providing EAP services.
• Our counselors and providers possess strong EAP and work-life skills, and we aggressively recruit Certified Employee Assistance Professionals (CEAPs) whose focus is on helping employees quickly resolve issues that may interfere with their work.
Notes
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 Taylor 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 Taylor 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/TAYLORISD