2023 Los Fresnos CISD Benefit Guide

Benefit Contact Information

BENEFIT ADMINISTRATORS

Financial Benefit Services (800) 583 6908 www.mybenefitshub.com/losfresnoscisd

HEALTH SAVINGS ACCOUNT DENTAL

EECU (817) 882 0800 www.eecu.org

VISION DISABILITY

Superior Vision Group #320870 (800) 507 3800 www.superiorvision.com

ACCIDENT

The Hartford Group #681501 (866) 278 2655 www.thehartfordatwork.com

EMPLOYEE ASSISTANCE PROGRAM

Lincoln Financial Group (888) 628 4824 www.GuidanceResousces.com

The Hartford Group #681501 (866) 278 2655 www.thehartfordatwork.com

CRITICAL ILLNESS

Voya Group #70800 3CCI2 (800) 955 7736 www.voya.com

Blue Cross Blue Shield Group #029511 (800) 521 2227 www.bcbstx.com

CANCER

American Public Life Group #22636 (800) 256 8606 www.ampublic.com

LIFE AND AD&D

Lincoln Financial Group Life Group #G617681 AD&D Group #G00616354 0000 000 (800) 423 2765 www.lfg.com

EMERGENCY MEDICAL TRANSPORT

MASA Group #MKLOSF (800) 423 3226 www.masamts.com

FLEXIBLE SPENDING ACCOUNT

National Benefit Services (855) 399 3035 www.nbsbenefits.com

Annual Benefit Enrollment

Benefit Updates What’s New:

• New Medical Rates

• Group Life Products Carrier Change

• New Employee Assistance Provider

BASIC LIFE: BASIC LIFE AND EMPLOYEE ASSISTANCE (EAP)

The $10K Basic Life Insurance (Employer Paid) also offers employee assistance that includes confidential counseling, will preparation, legal support resources and much more.

GROUP LIFE PRODUCTS: New group life insurance will be offered by Lincoln Financial Group. “True Open enrollment this year” This means that if an employee has not been declined before they can enroll in the guaranteed issue amount.

• Login and complete your benefit enrollment from 10/31/2022 11/18/2022

• 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

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 Status of Employment Affecting Coverage Eligibility

Gain/Loss of Dependents' Eligibility Status

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

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

Judgment/Decree/ Order

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

Eligibility for Government Programs Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.

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/ losfresnoscisd. 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 Los Fresnos CISD benefit website: www.mybenefitshub.com/losfresnoscisd. 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 January 1, 2023, you must be actively at work on January 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.

PLAN MAXIMUM AGE

Vision To age 26

Disability To age 26

Cancer To age 26

Life & AD&D To age 26

Flexible Spending Account To age 26

Medical Transportation To age 26

Critical Illness To age 26

Accident 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 1/1/2023 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 pre existing 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 co insurance for covered expenses.

Plan Year

January 1st through December 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).

Minimum Deductible

Maximum Contribution

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, tax free. This also allows employees to pay for qualifying dependent care tax free.

$1,400 single (2022) 2,800 family (2022) N/A

$3,650 single (2022) $7,300 family (2022) $2,850 (2022)

Permissible Use Of Funds

Cash Outs of Unused Amounts (if no medical expenses)

Year-to-year rollover of account balance?

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.

No. Access to some funds may be extended if your employer’s plan contains a 2 1/2 month grace period.

Does the account earn interest? Yes No

Portable?

Yes, portable year to year and between jobs. No

Health Savings Account (HSA)

EECU

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/losfresnoscisd

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 2022 is based on the coverage option you elect:

• Individual $3,650

• Family (filing jointly) $7,300

BENEFITS

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

Opening an HSA

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

Important HSA Information

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

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

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

How to Use your HSA

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

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

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

• Stop by: a local EECU financial center for in person assistance: www.eecu.org/locations

Dental

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/losfresnoscisd

Dental Employee Only $30.00 Employee + Spouse $58.00 Employee + 1 Child $45.00 Employee + Child(ren) $60.00 Employee + Family $87.00

Three month

ABOUT VISION

Disability Insurance The Hartford EMPLOYEE BENEFITS

ABOUT DISABILITY

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

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

What is Long Term Disability Insurance?

Long Term Disability Insurance pays you a portion of your earnings if you cannot work because of a disabling illness or injury. You have the opportunity to purchase Long Term Disability Insurance through your employer. This highlight sheet is an overview of your Long Term Disability Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail.

Why do I need Long Term Disability Coverage?

Most accidents and injuries that keep people off the job happen outside the workplace and therefore are not covered by worker’s compensation. When you consider that nearly three in 10 workers entering the workforce today will become disabled before retiring1 , it’s protection you won’t want to be without. 1

Social Security Administration, Fact Sheet 200

What is disability?

Disability is defined in The Hartford’s* contract with your employer. Typically, disability means that you cannot perform one or more of the essential duties of your occupation due to injury, sickness, pregnancy or other medical condition covered by the insurance, and as a result, your current monthly earnings are 80% or less of your pre disability earnings. Once you have been disabled for 24 months, you must be prevented from performing one or more of the essential duties of any occupation and as a result, your current monthly earnings are 66 2/3% or less of your pre disability earnings.

Am I eligible?

You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis

How much coverage would I have?

You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $8,000 that cannot exceed 66 2/3% of your current monthly earnings. Your plan includes a minimum benefit, greater of 10% of your elected benefit or $100. Earnings are defined in The Hartford’s contract

with your employer.

When can I enroll?

If you choose not to elect coverage during your annual enrollment period, you will not be eligible to elect coverage until the next annual enrollment period without a qualifying change in family status.

When is it effective?

Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.

What is does “Actively at Work” mean?

You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session

How long do I have to wait before I can receive my benefit?

You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a Long Term Disability benefit payment. For those employees electing an elimination period of 30 days or less, if your are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of disability

What is an elimination period?

The elimination period that you select consists of two numbers. The first number shows the number of days you must be disabled by an accident before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin.

Disability Insurance The Hartford

Age Disabled Benefits Payable

Prior

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/losfresnoscisd

Cancer Insurance provides financial assistance in the form of a cash benefit upon a cancer diagnosis and treatment, ensuring you can concentrate on your health instead of your finances. You can use your benefit to help pay toward costly medicine, medical bills, co pays or even travel and lodging associated with cancer treatment. This benefit may also be available to your dependents.

SUMMARY OF

Benefits are only payable following a diagnosis of cancer for a loss incurred for the treatment of

while covered under the policy. A charge must be incurred for benefits to be payable. When coverage terminates for loss incurred after the coverage termination date, our obligation to pay benefits also terminates for a specified disease that manifested itself while the person was covered under the policy. All benefits are subject to the benefit maximums.

Cancer Insurance

APL

Cancer Treatment Benefits

Eligibility

You and your eligible dependents are eligible to be insured under this certificate if you and your eligible dependents meet our underwriting rules and you are actively at work with the policyholder and qualify for coverage as defined in the master application.

Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date regardless of when specified disease was diagnosed.

Only Loss for Cancer

The policy pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The policy also covers other conditions or diseases directly caused by cancer or the treatment of cancer. The policy does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer.

Waiting Period

The policy and any attached riders contain a waiting period during which no benefits will be paid. If any covered person has a specified disease diagnosed before the end of the waiting period immediately following the covered person’s effective date, coverage for that person will apply only to loss that is incurred after one year from the covered person’s effective date. If any covered person is diagnosed as having a specified disease during the waiting period immediately following the covered person’s effective date, you may elect to void the certificate from the beginning and receive a full refund of premium.

If the policy replaced group specified disease cancer coverage from any company that terminated within 30 days of the certificate effective date, the waiting period will be waived for those covered persons that were covered under the prior coverage. However, the pre existing condition exclusion provision will still apply

Accident Insurance The Hartford

ABOUT ACCIDENT

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

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

Accidents are nearly impossible to predict, but with accident insurance they’re easy to prepare for. Accident Insurance allows you to concentrate on your health instead of your finances by issuing a lump sum benefit when you suffer a covered accident.

While prices vary, the average cost of a trip to the emergency room will run you $1,2331. You can use this money to help pay toward your emergency room fees, co pays, and hospital bills.

Accident Employee $11.78 Employee + Spouse $18.56 Employee + Child(ren) $20.12 Family $31.50

20

Emergency, Hospital & Treatment Care

Accident Follow Up

Up to 3 visits per accident $150

Acupuncture/Chiropractic Care Up to 10 visits each per accident $ 75

Ambulance Air Once per accident $2,500

Ambulance Ground Once per accident $1,000

Blood/Plasma/Platelets Once per accident $400

Child Care Up to 30 days per accident while insured is confined $50

Daily Hospital Confinement

Up to 365 days per lifetime $600

Daily ICU Confinement Up 30 days per accident $800

Diagnostic Exam Once per accident $400

Emergency Dental Once per accident Up to $600

Emergency Room Once per accident $250

Hospital Admission Once per accident $2,000

Initial Physician Office Visit Once per accident $150

Lodging

Up to 30 nights per lifetime $175

Medical Appliance Once per accident $300

Physical Therapy

Rehabilitation Facility

Transportation

Up to 10 visits each per accident $100

Up to 15 days per lifetime $450

Up to 3 trips per accident $800

Urgent Care Once per accident $200

Accident Insurance

The Hartford

Specified Injury & Surgery

Abdominal/Thoracic Surgery Once per accident $4000 Arthroscopic Surgery Once per accident $750 Burn Once per accident Up to $20,000

BENEFITS

Burn Skin Graft Once per accident for third degree burns(s) 50% of burn benefit Concussion Up to 3 per year $250

Dislocation Once per joint per lifetime Up to $12,000 Eye Injury Once per accident Up to $1,000 Fracture Once per bone per accident Up to $12,000 Hernia Repair Once per accident $600

Joint Replacement Once per accident $6,000 Knee Cartilage Once per accident Up to $3,000

Laceration Once per accident Up to $1,500 Ruptured Disc Once per accident $3,000 Tendon/Ligament/Rotator Cuff Once per accident Up to $3,000

Catastrophic

Accidental Death

Within 90 days. Spouse 50% of employee; Child 25% of employee $100,000

Common Carrier Death Within 90 days 3 times death benefit Coma Once per accident Up to $20,000 Dismemberment Once per accident Up to $100,000

Home Health Care $100 Paralysis Once per accident Up to $100,000 Prosthesis Once per accident Up to $4,000

WHO IS ELIGIBLE?

You are eligible for this insurance if you are an active full time employee who works at least 20 hours per week on a regularly scheduled basis.

AM I GUARANTEED COVERAGE?

The insurance is guaranteed issue coverage it is available without having to provide information about your or your family’s health. All you have to do is elect the coverage to become insured.

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/losfresnoscisd

What is Critical Illness Insurance?

• It pays a lump sum benefit if you are diagnosed with a covered illness or condition on or after your coverage effective date.

• You have the option to elect Critical Illness Insurance. 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. Features of Critical Illness Insurance include:

• Guaranteed Issue: No medical questions or tests are required for coverage.

• Flexible: You can use the benefit payments for any purpose you like.

• Portable: If you leave your current employer or retire, you can take your coverage with you. (Provision may vary by state.)

Who is eligible for Critical Illness Insurance and what are the coverage amounts?

• You all active employees working 20+ hours per week.

• You may also elect a Critical Illness benefit amount of $5,000 $30,000 in $5,000 increments Your spouse Coverage is available only if employee coverage is elected.

• You may also elect a Critical Illness benefit amount of $5,000 $30,000 in $5,000 increments

• You may elect a spouse Critical Illness benefit amount up to 100% of your benefit amount. Your children birth to age 26. Coverage is available only if employee coverage is elected.

Base Module

Heart attack

Cancer

Stroke

Type 1 Diabetes

Major organ transplant

Coronary artery bypass (25% of critical illness benefit amount)

Carcinoma in situ (25% of critical illness benefit amount)

Major Organ Module

Transient ischemic attacks (TIA) (10% of critical illness benefit)

Ruptured or dissecting aneurysm (10% of critical illness benefit)

Abdominal aortic aneurysm (10% of critical illness benefit)

Thoracic aortic aneurysm (10% of critical illness benefit)

Open heart surgery for valve replacement or repair (10% of critical illness benefit)

Benign brain tumor

Skin cancer (10% of critical illness benefit)

Major organ transplant

Coronary artery bypass (25% of critical illness benefit amount)

Carcinoma in situ (25% of critical illness benefit amount)

Coronary angioplasty (10% of critical illness benefit)

Implantable/internal cardioverter defibrillator (ICD) placement (10% of critical illness benefit)

Pacemaker placement (10% of critical illness benefit)

Enhanced Cancer Module

Bone marrow transplant (25% of critical illness benefit)

Stem cell transplant (25% of critical illness benefit)

Critical Illness Insurance

Voya

Cerebral palsy

BENEFITS

Additional Child Diseases Module

(This module applies to your insured children only, and is in addition to the other modules available.)

Niemann Pick disease

Congenital birth defects Pompe disease

Cystic fibrosis Sickle cell anemia

Down syndrome Type 1 diabetes

Gaucher disease, type II or III Type IV glycogen storage disease

Infantile Tay Sachs Zellweger syndrome

What additional benefits does my Critical Illness Insurance include?

The benefits listed below are also included with your Critical Illness coverage.

• Wellness Benefit: This provides an annual benefit payment if you complete a health screening test. 

Your annual benefit amount is $50 for completing a health screening test.

Your spouse’s annual benefit amount is $50 for completing a health screening test.

The annual benefit amount for each child is $25 with an annual maximum of $100 for all children.

Voluntary Life Lincoln Financial Group

ABOUT VOLUNTARY LIFE

Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well being of your family.

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

The Lincoln Term Life Insurance Plan:

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

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

• Features group rates for employees

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

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

Voluntary Group Life per $10,000 in coverage Age Employee Under 30 $0.30 30 34 $0.40 35 39 $0.70 40 44 $0.80 45 49 $1.30 50 54 $2.10 55 59 $3.70 60 64 $4.80 65 69 $9.10 70+ $14.70

Voluntary Group Life Child(ren) $10,000 in coverage 0 26 $1.00

Spouse rates based on Employee's age.

Voluntary Life Lincoln Financial Group

WHAT YOUR BENEFITS COVER EMPLOYEE COVERAGE

Guaranteed Life Insurance Coverage

Amount

• Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $250,000 without providing evidence of insurability.

• Annual Limited Enrollment: If you are a continuing employee, you can increase your coverage amount by four levels without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined or withdrawn, you may be required to submit evidence of insurability.

• If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense.

Maximum Insurance Coverage Amount

You can choose a coverage amount up to $500,000. Evidence of Insurability may be required for voluntary life coverage. See the Evidence of Insurability page for details.

Spouse Coverage You can secure term life insurance for your spouse if you select coverage for yourself

• Guaranteed Life Insurance Coverage Amount

• Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $50,000 for your spouse without providing evidence of insurability.

• Annual Limited Enrollment: If you are a continuing employee, you can increase the coverage amount for your spouse by four levels without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined or withdrawn, you may be required to submit evidence of insurability.

• If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense. Maximum Insurance Coverage Amount

• You can choose a coverage amount up to $500,000 for your spouse. Evidence of Insurability may be required.

Dependent Child(ren) Coverage You can secure term life insurance for your dependent children when you choose coverage for yourself.

• Guaranteed Life Insurance Coverage Options: $10,000

ABOUT VOLUNTARY AD&D

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/losfresnoscisd

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/losfresnoscisd

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.

Emergency Air Ambulance Coverage MASA MTS covers out of pocket expenses associated with emergency air transportation to a medical facility for serious medical emergencies deemed medically necessary for you or your dependent family member.

Emergency Ground Ambulance Coverage MASA MTS covers out of pocket expenses associated with emergency ground transportation to a medical facility for serious medical emergencies deemed medically necessary for you or your dependent family member.

Hospital to Hospital Ambulance Coverage MASA MTS covers out of pocket expenses that you or a dependent family member may incur for hospital transfers, due to a serious emergency, to the nearest and most appropriate medical facility when the current medical facility cannot provide the required level of specialized care by air ambulance to include medically equipped helicopter or fixed wing aircraft.

Repatriation to Hospital Near Home Coverage MASA MTS provides services and covers out of pocket expenses for the coordination of a Member’s nonemergency transportation by a medically equipped, air or ground ambulance in the event of hospitalization more than one hundred (100) miles from the Member’s home if the treating physician and MASA MTS’ Medical Director says it’s medically appropriate and possible to transfer the Member to a hospital nearer to home for continued care and recuperation. What does MASA MTS guarantee?

• No health questions

• No age limits

• No claim forms (bills must be submitted within 180 days)

• No deductibles

• No network limitations

How do I file a claim?

Filing a claim with MASA MTS is easy. Simply send the ambulance bill to MASA MTS with your member number clearly written on the front. You can either email your bill to ambulanceclaims@masaglobal.com, fax it to 817 681 2399, or mail the invoice to: MASA MTS Claims Department, 1250 S. Pine Island Road, Suite 500, Plantation, FL 33324. You can also log in and upload your bill or check the status of an existing claim in the “Members” section of our MASA MTS Web site.

Should you need assistance with a claim contact MASA at 800 643 9023

Flexible Spending Account (FSA) NBS

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 grace period provision).

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

BENEFITS

The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $2,850 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include:

• Dental and vision expenses

• Medical deductibles and coinsurance

• Prescription copays

• Hearing aids and batteries

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

How the Health Care FSAs Work

You can access the funds in your Health Care FSA two different ways:

• Use your NBS Debit Card to pay for qualified expenses, doctor visits and prescription copays.

• Pay out of pocket and submit your receipts for reimbursement:

• Fax (844) 438 1496

• Email service@nbsbenefits.com

• Online my.nbsbenefits.com

• Call for Account Balance: 855 399 3035

• Mail: PO Box 6980 West Jordan, UT 84084

Contact NBS

• Hours of Operation: 6:00 AM 6:00 PM MST, Mon Fri

• Phone: (800) 274 0503

• Email: service@nbsbenefits.com

• Mail: PO Box 6980 West Jordan, UT 84084

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.

Dependent Care FSA Guidelines

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

• If your child turns 13 mid year, 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

Flexible Spending Account (FSA)

NBS

• home and is mentally or physically incapable of self care.

BENEFITS

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

Important FSA Rules

• The maximum per plan year you can contribute to a Health Care FSA is $2,850. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately.

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

• You can continue to file claims incurred during the plan year for another 30 days (up until date).

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

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

Over the Counter Item Rule Reminder (OTC)

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

Flexible Spending Accounts

Account Type

Health Care FSA

Dependent Care FSA

Eligible Expenses

Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses and doctor prescribed over the counter medications)

Dependent care expenses (such as day care, after school programs, or elder care programs) so you and your spouse can work or attend school full time

Annual Contribution Limits Benefit

$2,850

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

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

Reduces your taxable income

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 Los Fresnos CISD 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 Los Fresnos CISD 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.