Benefit Contact Information
CITY OF TERRELL BENEFITS ADMINISTRATORS
Higginbotham Public Sector (800) 583-6908 www.mybenefitshub.com/cityofterrell
Sue Pfleging (972) 551- 6600 Ext. 4053 spfleging@cityofterrell.org
Erika Riley (972) 551-6600 Ext.4052 Eriley@cityofterrell.org MEDICAL
Assured Benefits Administrators (800) 247-7114 www.abadmin.com
Sun Life Financial Group #: 962193 (800) 247-6875 www.sunlife.com/us
Assurity Group # 234707 (844) 401-7585 www.assurity.com/
DENTAL VISION DISABILITY
Sun Life Financial Group # 962193 (800) 247-6875 www.sunlife.com/us
Sun Life Financial Group # 962193 (800) 247-6875 www.sunlife.com/us
Sun Life Financial Group # 962193 (800) 247-6875 www.sunlife.com/us
CANCER ACCIDENT CRITICAL ILLNESS
CHUBB (888) 499-0425
Aflac Group Insurance (800) 992-3522 www.aflacgroupinsurance.com
INDIVIDUAL LIFE LEGAL SHIELD
5Star Life Insurance (866) 863-9753 www.5starlifeinsurance.com/
EMPLOYEE ASSISTANCE PROGRAM (EAP)
Resource For living (800) 221-0945 www.resourcesforliving.com
Legal Shield (800) 654-7757 www.legalshield.com/
Aflac Group Insurance (800) 992-3522 www.aflacgroupinsurance.com
FLEXIBLE SPENDING ACCOUNT (FSA)
Higginbotham (866) 419-3519 https://flexservices.higginbotham.net/
Don’t Forget!
• Login and complete your benefit enrollment from 09/17/2024 - 09/20/2024
• Enrollment assistance is available by calling Higginbotham Public Sector 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.
1 www.mybenefitshub.com/cityofterrell
2
3
4
Enter your Information
• Last Name
• Date of Birth
• Last Four (4) of Social Security Number
NOTE: THEbenefitsHUB uses this information to check behind the scenes to confirm your employment status. CLICK LOGIN
Once confirmed, the Additional Security Verification page will list the contact options from your profile. Select either Text, Email, Call, or Ask Admin options to receive a code to complete the final verification step.
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Enter the code that you receive and click Verify. You can now complete your benefits enrollment!
Annual Benefit Enrollment
Annual Enrollment
During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.
• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.
• Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
New Hire Enrollment
All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Q&A
Who do I contact with Questions?
For supplemental benefit questions, you can contact your Benefits Office or you can call Higginbotham Public Sector 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/ cityofterrell. 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 City of Terrell benefit website: www.mybenefitshub.com/cityofterrell. 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
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 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
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefits Office within 30 days of your qualifying event and meet with your Benefits 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.
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
Employee Eligibility Requirements
Medical and 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 2024 benefits become effective on October 1, 2024, you must be actively-at-work on October 1, 2024 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 same employer 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.
To age 26
To age 26
To age 26
To age 26
To age 26
To age 26
To age 26
Illness To age 26
Spending
IRS Dependent status
Dependent Care FSA 12 or younger or qualified individuals unable to care for themselves and claimed as tax dependent
Legal Services To age 26
Individual Life To age 26
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 Higginbotham Public Sector, 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 Higginbotham Public Sector, 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 Higginbotham Public Sector 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 Benefits Office 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 10/1/2024 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
October 1st through September 30th
Pre-Existing Conditions
Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescriptions drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).
Medical Insurance Assured Benefits Administrators
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/cityofterrell
- 9/30/2025
Utilizing United Healthcare Network * Employer contributed FSA, $25.00 per month is applied when enrolled in medical.
INSURANCE PROGRAMS
gives you and your family direct access to a doctor 24 hours a day, seven days a week and 365 days a year to treat common ailments such as colds and flu, sinus infections, allergies, pink eye, etc. The consultation can take place by a phone call, email or a web-based video call, and may include discussing symptoms, treatment options and prescriptions. Telemedicine consultations are a supplement for nonemergency treatment and visits to a primary care physician. And best of all, telemedicine helps make healthcare affordable
• Access to Physicians in your state 24 hours a day, 7 days a week for your entire immediate family, even when you are not in your home state., and always at no cost.
•Treat common ailments such as colds and flu, sinus infections, allergies, pink eye, etc.
•Consult with a doctor via telephone or video.
•Request a doctor to call back within 2 hours or schedule a specific time for a visit.
•When appropriate, the doctor may prescribe a medication for you to pick up at your selected local pharmacy.
•Member activates account by going to https:// com, or calling 1-8
•Members will fill out their Medical Profile by logging into their member portal or over the phone.
•Dependents and their medical profiles can be added through the member portal. Any dependent over 18 will be set up in the member portal, but will have their own log in to fill out their own medical profile.
•Consults may be requested by logging into their member portal at www. .com or calling 1-800- - and a doctor will call back within 2 hours.
•You can also access through the Benefits App.
Disclaimer
* does not guarantee that a prescription will be written. does not prescribe DEA controlled substances, lifestyle drugs and certain other drugs which may be harmful because of their potential for abuse. physicians reserve the right to deny care for potential misuse of services. Telemedicine is not available in Arkansas. Video consults are not available in Arkansas, Iowa, Louisiana and Texas. Only video consults are available in Idaho.
Virtual Urgent CARE
Doctors can be hard to reach, illnesses can occur in the middle of the night, and sometimes you just have a question. Get on-demand care when you need it.
Access to licensed, and board-certified physicians 24 / 7 / 365 - Call | TAP | or Click Away
An exceptional benefit that reduces healthcare costs
With the rise in healthcare costs, more employers are turning to telehealth to reduce costs, help offset out-ofpocket expenses for employees, and, importantly, assure that their employees will always have care when they need it.
Multiple Cost-Savings
Healthcare Cost Savings: Re-directing unnecessary doctor, urgent and ER visits can reduce healthcare spending significantly.
Productivity: A typical doctors appointment can take half of the work day. Lyric gives employees easy access to a physician wherever they are located.
Flexible Implementation: Lyric can be implemented into most employee populations anytime of the year and live in under 48 hours*.
*48 Hour implementation for standard telehealth services, additional functionality may increase implementation.
Common Conditions
In some cases, a visit to the doctor’s office can be avoided, saving time and money.
• Flu Symptoms
• Sinus Problems
• Ear infection
• Allergies
• Urinary Tract Infection
• Nausea
• Pink eye
• Stomach viruses
• Rashes
• Sore Throat
• Acne
... and much more
Basic Life and AD&D
Sun Life Financial
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/cityofterrell
PROTECTS YOUR LOVED ONES.
Life insurance provides your loved ones with money they can use for household expenses, tuition, mortgage payments and more.
HELPS PAY YOUR FINAL EXPENSES.
Your beneficiaries may use this money to pay for your burial or cremation, and pay any outstanding medical bills.
PART OF YOUR BENEFIT PACKAGE.
This benefit is completely paid for by your employer. Remember to name your beneficiaries if you haven’t done so already.
For you *
1 times your Basic Annual Earnings, up to a maximum of $200,000. No medical questions asked. Benefits are reduced at age 70 and may reduce again in subsequent years as noted in your Certificate.
*This coverage includes Accidental Death and Dismemberment insurance.
What is my AD&D benefit?
We will pay your beneficiaries an Accidental Death insurance amount that matches your Basic Life insurance amount, if you die from a covered accident. Additional benefits are available for accidental injuries (i.e., dismemberment) such as loss of limbs, fingers or sight. Refer to your Certificate for a full list of covered accidental injuries.
Hospital Indemnity Assurity
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/cityofterrell
A hospital stay can be expensive even with a good health insurance plan. If you or someone in your family gets sick or injured and needs to go to the hospital, the last thing you want to think about is how you will pay for medical care.
Hospital indemnity insurance provides peace of mind and gives you additional cash to pay your health insurance deductible and other expenses resulting from a covered hospital stay.
Group Hospital Indemnity insurance pays a benefit directly to you, starting at admission, for each day of hospital confinement.
Key Features
• Pays a lump-sum benefit starting at admission
• No deductibles, copays, coinsurance or networks (see any doctor)
Group Hospital Indemnity Benefits - Texas
Hospital Admission
• Guaranteed issue – no medical exams or tests
• Portable – coverage continues if you retire or change jobs, as long as you pay the premiums
Group Hospital Indemnity pays a lump-sum benefit of $3,000 for the first hospital confinement in a calendar year for a covered sickness or injury sustained in a covered accident. Confinement means the assignment to a bed as a resident inpatient as prescribed by a physician for a period of at least 20 consecutive hours.
Drug and Alcohol Rehab Rider:
(Form R G1733C)
Mental and Nervous Disorder Rider:
(Form R G1737C)
Pays a $100 daily benefit for up to 30 days confinement in a hospital or residential treatment facility for drug or alcohol rehabilitation. Confinement means the assignment to a bed as a resident inpatient as prescribed by a physician for a period of at least 20 consecutive hours.
Pays a $100 daily benefit for up to 30 days confinement in a hospital or residential treatment facility for treatment of a mental or nervous disorder. Confinement means the assignment to a bed as a resident inpatient as prescribed by a physician for a period of at least 20 consecutive hours.
We are never more than one call away.
as summarized in the proposal. For complete
descriptions, limitations, conditions and exclusions, see the policy/ certificate. Policy availability, features, provisions and rates may vary by state. Customer Service
800-276-7619, Ext. 4210
7:30am - 5:00pm CST
800-869-0355, Ext. 4484
800-869-0355, Ext. 4279 – FAX: 888-255-2060
Assurity P.O. Box 82533 Lincoln, NE 68501-2533
Helping people through difficult times
Email – claimsinfo@assurity.com
Connect Online – assurity.com – linkedin.com/company/ assurity-life
As a mutual organization, Assurity was founded on the simple concept of people coming together to support each other in moments of need. We continue our mission of helping people through difficult times by providing affordable insurance protection that is easy to understand and buy. Our financial stability has stood the test of time. It shows our commitment to be there when our customers need us. Owned by our policyholders, we conduct our business to serve only their best interests. Whether paying benefits, offering service with a human touch, giving back to our community, or practicing sustainable habits that provide for our planet, we embrace our capacity to improve lives. We all share in the future we create, and Assurity believes in using our business as a force for good.
Hospital Indemnity Assurity
Limitations, Conditions and Exclusions
The following represents some policy limitations, conditions and exclusions. For complete details of the coverage, please contact your agent, Assurity or ask to review the policy. Provisions may vary by state.
Limitations
GROUP HOSPITAL INDEMNITY INSURANCE PROVIDES LIMITED BENEFIT COVERAGE.
This insurance does not provide major medical coverage and does not satisfy the requirement for minimum essential coverage under the Affordable Care Act (ACA).
Availability of this product, and its benefits and premiums as presented, is subject to the approval of Assurity. Some applicants with pre-existing conditions may not be eligible for coverage. Product availability, features and rates may vary by state. All benefits, premiums, conditions, exclusions and limitations are governed by the actual contract as provided by Assurity, not this proposal.
Pre-existing conditions: Assurity will not pay benefits concerning a pre-existing condition until after coverage has been in force for 12 months from the issue date. Pre-existing condition means a covered sickness or physical condition for which, during the 12 months before the issue date, the insured person received medical advice or treatment from a Physician.
Special Endorsement
The pre-existing condition clause and 10-month pregnancy exclusion will be waived during the initial enrollment for employees with the existing carrier’s coverage. Any employee not covered by the prior policy, including new hires, will be subject to the normal pre-existing condition clause and 10-month pregnancy exclusion.
Coverage Conditions
Actively Employed – The employee must be actively employed to be eligible for coverage.
Right to Cancel – The contract contains a 30-day free look period. Termination – Coverage will terminate the earliest of the following: the date policy terminates for any reason; the date employee is no longer an employee (portability available); when premiums are not paid by the end of the grace period; the date Assurity receives written notice to terminate; when the employee establishes residence in a foreign country; or upon the employee’s death.
Exclusions
Assurity will not pay benefits for losses caused by or the result of any Insured Person(s):
• having elective procedures that are not medically necessary (including but not limited to organ donation and elective sterilization);
• voluntarily inhaling gas;
• having cosmetic care, except when the hospital confinement is due to medically necessary reconstructive surgery;
• being confined primarily for rest care or convalescent care;
• having a covered sickness or injury covered under worker’s compensation, an employer’s liability law or similar law;
• being born, unless the loss is the result of a covered sickness or injury;
• being pregnant, experiencing pregnancy related conditions (other than complications of pregnancy), giving birth or otherwise terminating pregnancy during the 10-month period immediately following the issue date;
• receiving routine newborn nursing or well baby care;
• operating, learning to operate, or serving as a crew member of any aircraft;
• engaging in hang-gliding, hot air ballooning, bungee jumping, parachuting, scuba diving, sail gliding, parasailing, parakiting, mountain or rock climbing, B.A.S.E. jumping, sky diving or cave diving;
• riding in or driving any motor-driven vehicle in an organized race, stunt show or speed test;
• officiating, coaching, practicing for or participating in any semi-professional or professional competitive athletic contest for which any type of compensation or remuneration is received;
• being exposed to war or any act of war, declared or undeclared;
• actively serving in any of the armed forces, or units auxiliary thereto, including the National Guard or Army Reserve, except during active duty training of less than 60 days;
• suffering from a mental and nervous disorder;
• being addicted to drugs or suffering from alcoholism;
• being under the influence of an excitant, depressant, hallucinogen, narcotic, or ay other drug or intoxicant, unless administered on the advice of a Physician;
• being intoxicated (as determined by the laws governing the operation of motor vehicles in the jurisdiction where loss occurs) or under the influence of an illegal substance or a narcotic (except for narcotics used as prescribed to the Insured Person by a Physician);
• having dental treatment except as the result of an injury;
• committing or attempting to commit a felony;
• being incarcerated in a penal institution or government detention facility;
• engaging in an illegal occupation;
• intentionally self-inflicting an injury;
• committing or attempting to commit suicide, while sane or insane; or
• receiving treatment by a Physician who is a member of an insured person’s immediate family or business associate.
NOT AVAILABLE IN NEW YORK.
Assurity is a marketing name for the mutual holding company Assurity Group, Inc. and its subsidiaries. Those subsidiaries include but are not limited to: Assurity Life Insurance Company and Assurity Life Insurance Company of New York. Insurance products and services are offered by Assurity Life Insurance Company in all states except New York. In New York, insurance products and services are offered by Assurity Life Insurance Company of New York, Albany, New York. Product availability, features and rates may vary by state.
Dental Insurance Sun Life Financial
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/cityofterrell
What’s covered
Good news! Your plan covers routine services like cleanings and exams at 100%
II, III (Basic and Major Services)
THE PLAN PAYS THE FOLLOWING PERCENTAGE FOR PROCEDURES
SERVICES
Type I Preventive Dental Services, including:
• Oral evaluations – 2 in any calendar year
• Routine dental cleanings – 2 in any calendar year
• Fluoride treatment – 1 in any 6 month period. Only for children under age 19
• Sealants – no more than 1 per tooth in any 36 month period, only for permanent molar teeth. Only for children under age 14
• Bitewing x-rays – 2 in any calendar year
• Intraoral complete series x-rays – 1 in any 36 month period
• Genetic test for susceptibility to oral diseases
Type II Basic Dental Services, including:
• New fillings
• Space maintainers – only for children under age 19
• Simple extractions, incision and drainage
• Surgical extractions of erupted teeth, impacted teeth, or exposed root
• Biopsy (including brush biopsy)
• Endodontics (includes root canal therapy) – 1 per tooth in any 24 month period
• General anesthesia/IV sedation – medically required
Dental Insurance Sun Life Financial
• Minor gum disease (non-surgical periodontics)
• Scaling and root planning – 1 in any 24 month period per area
• Periodontal maintenance – 2 in any calendar year
• Localized delivery of antimicrobial agents
• Stainless steel crowns – only for children under age 19
• Major gum disease (surgical periodontics)
Type III Major Dental Services, including:
• Dentures and bridges – subject to 5 year replacement limit
• Inlay, onlay, and crown restorations – 1 per tooth in any 5 year period
• Dental implants – subject to 5 year replacement limit
Type IV Ortho Services, including:
• Orthodontic treatment is limited to your dependent children
Waiting Periods
For a complete description of services and waiting periods, please review your certificate of insurance. If you were covered under your employer’s prior plan the wait will be waived for any type of service covered under the prior plan and this plan.
• No waiting period for preventive, basic, or major services
• No waiting period for orthodontic services
How does a PPO work?
PPO stands for Participating Provider Organization. With a dental PPO plan, dental providers agree to participate in a dental network by offering discounted fees on most dental procedures. When you visit a provider in the network, you could see lower out-of-pocket costs because providers in the network agree to these pre- negotiated discounted fees on eligible claims.
How do I find a dentist?
Simply visit www.sunlife.com/findadentist. Follow the prompts to find a dentist in your area who participates in the PPO network. You do not need to select a dentist in advance. The PPO network for your plan is the Sun Life Dental Network® with 130,000+ unique dentists3.
How can using a network dentist help lower my costs?
You are free to use the dentist or specialist of your choice. However, this plan allows you to have access to the Sunlife Dental Network® PPO dentists and to take advantage of their fee discounts. Treatment is available from out-of-network dentists, but their fees are subject to an allowable charge. The allowable amount for out-of- network dentists is based on 45% off the 80th percentile of the amount charged by other dentists in the same geographic area. Patients are responsible for fees in excess of the allowable charge. There can be significant out-of-pocket expenses if an out-of-network dentist is chosen.
Are my dependents eligible for coverage?
Yes. Your plan offers coverage for your spouse4 and dependent children. An eligible child is defined as a child to age 26.5
What if I have already started dental work, like a root canal or braces, that requires several visits?
Your coverage with us may handle these procedures differently than your prior plan. To ensure a smooth transition for work in progress, call our dental claims experts before your next visit at 800-442-7742.
Vision Insurance Sun Life Financial
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/cityofterrell
Laser vision correction
Once per eye per life-time. Average 15% off the regular price or 5% off the promotional price. Discounts only available from contracted facilities.
1 per 12 months $25 (lenses and frame)
Includes a wide selection of frames at Walmart®. 1 per 12 months
Elective contact lenses
Contact lenses are in place of lenses and frame. 1 per 12 months
$150 for the frame of your choice and 20% off the amount over your allowance
$70 allowance at Costco®* Up to $70
$60 for your contact lens exam (fitting and evaluation)
$150 for contact lenses
Additional glasses and sunglasses discount 20% off complete pairs of prescription and non- prescription glasses, including sunglasses. Discounts are unlimited for 12 months following exam. N/A
Coverage with retail providers
*Coverage with retail providers may be different. Check with Costco for VSP member pricing. The Costco allowance is equivalent to the allowance at preferred providers and other retail providers. This chart outlines services for Plan 3.
to $105
Disability Insurance Sun Life Financial
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/cityofterrell
Short Term Disability
PROTECTS YOUR INCOME WHEN YOU CAN’T WORK.
If you’re unable to work because of a covered disability, Short-Term Disability insurance replaces a portion of your income in addition to providing other services and benefits that help you return to work.
PROVIDES YOU WITH A WEEKLY CHECK.
If you are able, Sun Life has benefits and services, including guidance from vocational rehabilitation counselors, to help you return to work.
COMMON CAUSES OF DISABILITY
• Pregnancy
• Injuries
• Joint disorders
• Back disorders
BENEFITS (You can purchase this coverage at a group rate.)
Weekly benefit after your claim is approved
When benefits begin
• Digestive disorders
You will receive a check for your benefits on a weekly basis. It will replace 60% of your Total Weekly Earnings, up to $1,500 each week.
Benefits begin on the first day of disability if you are unable to work due to an injury and as soon as 8 days from the date you are unable to work due to an illness.
Sun Life and Benefits begin on the first day of disability if you are un-able to work due to an injury and as soon as 8 days from the date you are unable to work due to an illness.
Health Insurance Company (U.S.)
Benefits may be paid for Up to 13 weeks, as long as you are still unable to work due to a covered disability.
Additional plan information
This plan provides a benefit for covered disabilities resulting from illness or injury that are not workrelated.
SHORT-TERM DISABILITY FAST FACTS
1 in 4 workers
will miss up to 3 months of work due to disability during their career.1
More than three-quarters of workers are living paycheck to paycheck.2
How do I file a Short-Term Disability claim?
If you become disabled after the effective date of coverage, check with your employer to make sure you are eligible for benefits. You can file a claim with us by downloading forms from our website. We’ll ask you and your doctor to provide information about your medical condition and your expected recovery.
What if I have a pre-existing condition?
If you become disabled within 12 months of your insurance taking effect or 12 months following any increase in your amount of insurance, we will not pay any benefit for any pre-existing condition. A pre-existing condition includes anything you have sought treatment for in the 3 months prior to your insurance becoming effective. Treatment can include consultation, advice, care, services or a prescription for drugs or medicine.
Can I work while I’m disabled?
Your plan is designed to encourage and support your return to work. If you can work part-time, you may receive part of your benefit while working.
Disability Insurance Sun Life Financial
Long Term Disability
HELPS YOU KEEP YOUR LIFE ON TRACK.
If you’re unable to work because of a covered disability, Long-Term Disability insurances replaces a portion of your income. After your claim is approved, you will receive a monthly check for your benefits that helps you pay every day expenses like your mortgage or rent, childcare and groceries.
HELPS YOU RETURN TO WORK.
If you are able, Sun Life has benefits and services, including guidance from vocational rehabilitation counselors, to help you return to work.
PART OF YOUR BENEFIT PACKAGE.
This benefit is completely paid for by your employer.
BENEFITS
Monthly benefit after your claim is approved
You will receive a check for your benefits on a monthly basis. It will replace 60% of your Total Monthly Earnings, up to $10,000 each month.
When benefits begin Benefits begin as soon as 90 days from the date of your disability.
Benefits may be paid for
Additional plan information
How do I file a Long-Term
Up to age 65, but not less than 5 years, if you are age 60 or under at the start of disability. If you become disabled after age 60, additional benefit duration restrictions apply.
This plan provides a benefit for covered disabilities resulting from illness or injury that occur on or off the job.
Disability claim?
If you become disabled after the effective date of coverage, check with your employer to make sure you are eligible for benefits. You can file a claim with us by downloading forms from our website. We’ll ask you and your doctor to provide information about your medical condition and your expected recovery.
How do I qualify for benefits?
You’ll start receiving disability payments if you satisfy the Elimination Period (see “When benefits begin” in the table) and meet the policy’s definition of disability. Generally, disability is defined as your inability to perform some or all of your job duties due to your injury, illness or pregnancy and may require that you have also had a certain percentage of earnings loss due to your disability. Please see your Certificate for details.
What if I have a pre-existing condition?
If you become disabled within 12 months of your insurance taking effect or 12 months following any increase in your amount of insurance, we will not pay any benefit for any pre-existing condition. A pre-existing condition includes anything you have sought treatment for in the 3 months prior to your insurance becoming effective. Treatment can include consultation, advice, care, services or a prescription for drugs or medicine.
Can I work while I’m disabled?
Your plan is designed to encourage and support your return to work. If you are able to work part-time, for example, you may receive part of your benefit while working.
Disability Insurance
Traditional LTD and STD Disability - Definitions
What is disability insurance? 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.
Pre-Existing Condition Limitations - Please note that all plans will include pre-existing condition limitations that could impact you if you are a first-time enrollee in your employer’s disability plan. This includes during your initial new hire enrollment. Please review your plan details to find more information about pre-existing condition limitations.
How do I choose which plan to enroll in during my open enrollment?
You will enroll in Long Term and Short Term Disability on two separate pages during your open enrollment walkthrough. Generally your short term coverage and long term coverage work together so that once your short term coverage ends, at that time your long term coverage would begin if you are still disabled and approved to remain on your claim. In other words, your short term coverage may continue for up to 12 weeks and your long term coverage begins the 13th week.
Your short term coverage will generally be a weekly benefit. This is the maximum amount of money you will receive from the carrier on a weekly basis once your disability claim is approved by the carrier. This is generally a flat percentage of your salary.
Your long term coverage will generally be a monthly benefit. This is the maximum amount of money you will receive from the carrier on a monthly basis once your disability claim is approved by the carrier. This is generally a flat percentage of your salary.
Cancer Insurance CHUBB
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/cityofterrell
Cash benefits for every step of the way
Cancer Insurance Benefits
First cancer benefit
Diagnosis of cancer
Hospital confinement
Hospital confinement ICU
Radiation
Alternative care
Medical imaging
Skin cancer initial diagnosis
Attending physician
Hospital confinement sub-acute ICU
Family care
Prescription drug in-patient
Private full-time nursing services
U.S. government or charity hospital
Plan 1
$100 paid upon receipt of first covered claim for cancer; only one payment per certificate
$5,000 employee or spouse
$10,000 child(ren)
Waiting period: 0 days
Benefit reduction: None
$200 per day – days 1 through 30 A
dditional days: $400
Maximum days per confinement: 31
$600 per day – days 1 through 30
Additional days: $600
Maximum days per confinement: 31
$75 per visit
Maximum visits per calendar year: 4
$500 per imaging study
Maximum studies per calendar year: 2
$100 per diagnosis
Lifetime maximum: 1
$50 per visit
Maximum visits per calendar year: 4
$300 per day – days 1 through 30
Additional days: $300
Maximum days per confinement: 31
Childcare: $100 per day per child
Maximum days per calendar year: 30
Adult day care or home healthcare: $100 per day
Maximum days per calendar year: 30
Per confinement: $150
Maximum confinements per calendar year: 6
$150 per day
Maximum days per confinement: 5
Days 1 through 30: $100
Additional days: $200
Maximum days per confinement: 31
Cancer Insurance CHUBB
Specialty Care Benefits
Family member transportation and lodging
Home health care
Hospice care
Skilled nursing care facility
Cancer Treatment Benefits
Air ambulance
Ambulance
Anti-nausea medication
Blood, plasma, and platelets
Bone marrow or stem cell donation
Plan 1
Family transportation: $100 per trip
Maximum trips per calendar year: 12
Family lodging: $100 per day
Maximum days per calendar year: 100
$100 per day not to exceed the number of days confined
Maximum days per calendar year: 30
$100 per day
$100 per day
Maximum days per calendar year: 30
Plan 1
$2,000 per trip
Maximum trips per confinement: 2
$250 per trip
Maximum trips per confinement: 2
$100 per month
$300 per transfusion
Maximum transfusions per calendar year: 2
$800 per confinement
Lifetime maximum donations: 2
Portability Employees can keep their coverage if they change jobs or retire.
Continuity of coverage Included
Pre-existing conditions limitation
A condition for which a covered person received medical advice or treatment within the 12 months preceding the certificate effective date.
Waiver of premium Included
Exclusions
and limitations
No benefits will be paid for a date of diagnosis or treatment of cancer prior to the coverage effective date, except where continuity of coverage applies.
No benefits will be paid for services rendered by a member of the immediate family of a covered person.
We will not pay benefits for other conditions or diseases, except losses due directly from cancer or skin cancer.
We will not pay benefits for cancer or skin cancer if the diagnosis or treatment of cancer is received outside of the territorial limits of the United States and its possessions. Benefits will be payable if the covered person returns to the territorial limits of the United States and its possessions, and a physician confirms the diagnosis or receives treatment.
Accident Insurance
ABOUT ACCIDENT
Do you have kids playing sports, are you a weekend warrior, or maybe you’re 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/cityofterrell
Initial Accident Treatment Category - High (Custom)
Initial Treatment - once per accident, within 7 days of the accident
ER/Urgent Care
ER/Urgent Care with X-Ray Doctor's Office
Ambulance - once per day, within 90 days of the accident
Maximum number of payments per covered accident: No Maximum
Major Diagnostic Testing - within six months of the accident
Maximum number of diagnostic tests per covered accident: 1
Emergency Room Observation - within 7 days of the accident
Maximum number of 24-hour periods of observation per covered accident: No Maximum Short Observation Period (4-24 Hours)
Observation Period (24+ Hours)
accident: 1
- within six months of the accident
Maximum number of days per covered accident: 3
Concussion - once per accident, within six months of the accident
Traumatic Brain Injury - once per accident, within six months of the accident
Coma - once per accident
We will pay the amount shown if the insured is in a coma lasting 30 days or more as a result of a covered accident
Burns - once per accident, within six months of the accident
Second Degree Burns Less than 10%
At least 10%, but less than 25%
At least 25%, but less than 35%
35% or more
Third Degree Burns
Less than 10%
At least 10%, but less than 25%
At least 25%, but less than 35%
35% or more
Emergency Dental Work - once per accident, within six months of the accident
Repair with Crown Extraction
Eye Injury - removal of a foreign body
Dislocations - once per accident, within 90 days of the accident
Accident Insurance Aflac Group Insurance
Voluntary Life and AD&D
Sun Life Financial
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/cityofterrell
For you *
For your spouse*
For your child(ren)*
You can choose from $10,000 to $500,000—in increments of $10,000 not to exceed 5 times your Basic Annual Earnings. No medical questions asked up to the Guaranteed Issue amount of $100,000.
Benefits are reduced at age 70 and may reduce again in subsequent years as noted in your Certificate.
If you elect coverage for yourself, you can choose from $5,000 to $150,000—in increments of $5,000. No medical questions asked up to the Guaranteed Issue amount of $30,000
The amount you select for your spouse cannot exceed 50% of your coverage amount. Coverage ends when you turn age 70.
If you elect coverage for yourself, you can choose $1,000 to $10,000—in $1,000 increments. No medical questions asked.
The amount you select for your child(ren) cannot exceed 50% of your coverage amount. Benefits may reduce as noted in your Certificate. Child(ren) must primarily depend on the employee for 50% or more of their support.
A full benefit is payable for a dependent child who is 6 months to 25. A reduced benefit of $500 is payable for a child from 14 days to 6 months. (No benefit is payable for a child from birth to 14 days).
What is my AD&D benefit?
We will pay your beneficiaries an Accidental Death insurance amount that matches your Voluntary Life, if you die from a covered accident. Additional benefits are available for accidental injuries (i.e., dismemberment) such as loss of limbs, fingers or sight. Refer to your Certificate for a full list of covered accidental injuries. This plan includes AD&D coverage for your dependents.
Do I need to answer any health questions to enroll?
Yes, if you request an initial amount higher than the Guaranteed Issue amount or if you want to increase coverage in excess of one increment annually. To answer health questions, please fill out our Evidence of Insurability application. Health questions must be approved by Sun Life before coverage takes effect. Please see your Certificate for details.
Can I increase my coverage at a later date?
Yes. You may increase your coverage by one increment amount annually, without having to answer health questions, even if the increase means that your coverage exceeds the Guaranteed Issue amount. Your benefits administrator can advise you on how to increase coverage annually. The maximum benefit amount still applies.
Can I access my life insurance if I become terminally ill?
You may apply to receive a portion of your life insurance to help cover medical and living expenses. This is called an “Accelerated Benefit” and there are some important things to know about it, including that it is not long-term-care insurance, it may be taxable and it may affect your eligibility for public assistance programs. It will also reduce the total amount of the life insurance payment we pay to your beneficiary(ies).
What
happens if I become Totally
Disabled?
If we determine that you are Totally Disabled and cannot work, your life insurance coverage may continue at no cost. You must meet certain requirements, as detailed in the Certificate.
How
does my beneficiary file a death claim?
Your beneficiary(ies) and your employer will complete the appropriate claims forms and submit them to us. We will notify your beneficiaries when the decision is made and if we have any questions. If approved, beneficiaries may elect to receive a lump sum payment or to have the benefit paid into an account where the funds accumulate interest and can be withdrawn at any time. (State restrictions apply and options may vary by state.) If your AD&D claim for an accidental
Critical Illness Insurance
Aflac Group Insurance
ABOUT CRITICAL ILLNESS
Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non-medical costs related to the illness, including transportation, child care, etc.
For full plan details, please visit your benefit website: www.mybenefitshub.com/cityofterrell
Voluntary Critical Illness with Cancer
About 1 in every 6 healthcare dollars is spent on cardiovascular disease. Chances are you know someone who’s been diagnosed with a critical illness such as cancer, a heart attack (myocardial infarction), or stroke. You can’t help but notice the strain it’s placed on the person’s life–both physically and emotionally. What’s not so obvious is the impact on that person’s personal finances. While the person is busy getting well, the bills may continue to pile up.
Plan Highlights:
• Pays a lump sum percentage benefit for a covered critical illness
• Coverage is guaranteed-issue regardless of health
• No pre-existing condition limitations
• Spouse eligible for 100% of what employee chooses
• Children are covered at no additional cost at 50%
• Additional and Re-occurrence benefits with 6 month separation
• Wellness benefit of $50 paid each year for every family member covered including children
(End-Stage Renal Failure)
BONE MARROW TRANSPLANT (Stem Cell Transplant)
CARDIAC ARREST
PLACED ON A TRANSPLANT LIST FOR A
Coma, Paralysis, or Type 1 Diabetes
Loss of Sight, Hearing, or Speech
Multiple Sclerosis, Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease), or benign brain tumor
Advanced Alzheimer’s or Parkinson’s Disease
Childhood Diseases: Down Syndrome,
Spouse Rates Per Paycheck
Family Protection Plan
Group Term Life Insurance to age 121 with Quality of Life
Make a smart choice to help protect your loved ones and your future.
Life doesn’t come with a lesson plan
Help protect your family with the Family Protection Plan Group Level Term Life Insurance to age 121. You can get coverage for your spouse even if you don’t elect coverage on yourself. And you can cover your financially dependent children and grandchildren (14 days to 26 years old). The coverage lasts until age 121 for all insured,* so no matter what the future brings, your family is protected.
Why buy life insurance when you’re young?
Buying life insurance when you’re younger allows you to take advantage of lower premium rates while you’re generally healthy, which allows you to purchase more insurance coverage for the future. This is especially important if you have dependents who rely on your income, or you have debt that would need to be paid off.
Portable
Coverage continues with no loss of benefits or increase in cost if you terminate employment after the first premium is paid. We simply bill you directly.
Why is portability important?
Life moves fast so having a portable life insurance allows you to keep your coverage if you leave your school district. Keeping the coverage helps you ensure your family is protected even into your retirement years.
44% of American households would encounter significant financial difficulties within six months if they lost the primary family wage earner. 28% would reach this point in one month or less.
Family Protection Plan
Group Term
Terminal illness acceleration of benefits
Coverage 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).
Protection you can 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.
Convenient
Easy payment through payroll deduction.
Quality of Life benefit
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.
How does Quality of Life help?
Many individuals who can’t take care of themselves require special accommodations to perform ADLs and would need to make modifications to continue to live at home with physical limitation. The proceeds from the Quality of Life benefit can be used for any purpose, including costs for infacility care, home healthcare professionals, home modifications, and more.
2024 Enrollment Plan Year
Guaranteed Issue is offered to all eligible applicants regardless of health status. No Doctor exams or physicals.
Employee: $100,000 | Spouse: $30,000 | Child: $10,000
Enroll to provide peace of mind for your family
To do an initial enrollment or if you have questions please call our customer service at 866-914-5202. Monday - Friday | 8:00 am-6:00 pm CST
About the coverage
The Family Protection Plan offers a lump-sum cash benefit if you die before age 121. The initial death benefit is guaranteed to be level for at least the first ten policy years. Afterward, the company intends to provide a nonguaranteed death benefit enhancement which will maintain the initial death benefit level until age 121. The company has the right to discontinue this enhancement. The death benefit enhancement cannot be discontinued on a particular insured due to a change in age, health, or employment status.
Legal Services Legal Shield
ABOUT LEGAL SERVICES
Legal plans provide benefits that cover the most common legal needs you may encounter - like creating a standard will, living will, healthcare power of attorney or buying a home.
For full plan details, please visit your benefit website: www.mybenefitshub.com/cityofterrell
Have You Ever...
□ Needed your Will prepared or updated?
□ Signed a contract?
□ Received a moving traffic violation?
□ Worried about being a victim of identity theft?
□ Been concerned about your child’s identity?
□ Had social media accounts? (Facebook, Instagram, Twitter, Linkedin, Youtube) The LegalShield
Membership Includes:
• Dedicated Law Firm Direct access, no call center
• Legal Advice/Consultation On unlimited personal issues
• Letters/Calls Made on your behalf
• Contracts/Documents Reviewed Up to 15 pages
• Residential Loan Document Assistance For the purchase of your primary residence
• Will Preparation - Living Will, Health Care Power of Attorney
• Speeding Ticket Assistance Upload your speeding ticket from the mobile app directly to law firm
• IRS Audit Assistance (Begins with the tax return due April 15th of the year you enroll)
• Trial Defense (If named defendant/respondent in a covered civil action suit)
• Uncontested Divorce, Separation, Adoption and/or Name Change Representation (Available 90 days after enrollment)
• 25% Preferred Member Discount (Bankruptcy, criminal charges, DUI, personal injury, etc.)
• 24/7 Emergency Access For covered situations
IDShield Membership Includes:
• Credit Monitoring and Alerts Continuously monitors your data and sends an alert via push notification to the IDShield mobile app, email and member portal if any discrepancies are found.
• Social Media Monitoring We watch over your Facebook, Twitter, Youtube, Linkedin and Instagram accounts, monitoring for privacy concerns and reputational risks.
• High Risk Application and Transaction Monitoring We can detect fraud up to 90 days earlier than traditional credit monitoring services; we carefully watch all your accounts, reorders, loans and more. If a new account is opened, you will receive an alert.
• $3 Million Protection Policy Coverage for lost wages, legal defense fees, stolen funds and more
• Unlimited Service Guarantee Ensures that we won’t give up until your identity is restored!
• Identity Restoration Performed by Licensed Private Investigators to restore your identity to its pre-theft status.
• 24/7 Emergency Access In the event of an identity theft emergency
Flexible Spending Account (FSA)
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.
For full plan details, please visit your benefit website: www.mybenefitshub.com/cityofterrell
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 $3,200 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
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).
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 Depend ent 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 Accounts
Higginbotham
Flexible Spending Accounts Higginbotham
Important FSA Rules
• The maximum per plan year you can contribute to a Health Care FSA is $3,200. 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.
• In most cases, you can continue to file claims incurred during the plan year for another 90 days after the plan year ends.
• 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 $640 in your Health Care FSA into the next plan year for eligible employers The carry-over rule does not apply to your Dependent Care FSA.
• Review your employer's Summary Plan Document for full details. FSA rules vary by employer.
Over-the-Counter Item Rule Reminder
Health care reform legislation requires that certain over-the-counter (OTC) items require a prescription to qualify as an eligible Health Care FSA expense. You will only need to obtain a one-time prescription for the current plan year. You can continue to purchase your regular prescription medications with your FSA debit card. However, the FSA debit card may not be used as payment for an OTC item, even when accompanied by a prescription.
Higginbotham Portal
The Higginbotham Portal provides information and resources to help you manage your FSAs.
• Access plan documents, letters and notices, forms, account balances, contributions and other plan information
• Update your personal information
• Utilize Section 125 tax calculators
• Look up qualified expenses
• Submit claims
• Request a new or replacement Benefits Debit Card
Register on the Higginbotham Portal
Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information.
• Enter your Employee ID, which is your Social Security number with no dashes or spaces.
• Follow the prompts to navigate the site.
• If you have any questions or concerns, contact Higginbotham:
∗ Phone – (866) 419-3519
∗ Questions – flexsupport@higginbotham.net
∗ Fax – (866) 419-3516
∗ Claims- flexclaims@higginbotham.net
Employee Assistance Program (EAP) Resource For living
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/cityofterrell
Resources for Living
To access services:
800-221-0945, TTY: 711 / resourcesforliving.com
Username: Terrell TX / Password: EAP
City of Terrell
Resources for Living is an employer-sponsored program, available at no cost to you and all members of your household. Children living away from home can access services up to age 26. Services are confidential and available 24 hours a day, 7 days a week.
Emotional wellbeing support
You can access up to 3 counseling sessions per issue each year. You can also call us 24 hours a day for in-the-moment emotional well-being support.
Counseling sessions are available face-to-face, online with televideo or by phone. Services are free and confidential. We’re always here to help with a wide range of issues including:
• Anxiety
• Relationship support
• Depression
• Stress management
• Work/life balance
Daily life assistance
• Family issues
• Grief and loss
• Self-esteem and personal development
• Substance misuse and more
Competing day-to-day needs can make it tough to know where to start. Call us for personalized guidance. We’ll help you find resources for:
• Child care, parenting and adoption
• Care for older adults
• Caregiver support
• School and financial aid research
• Special needs
Legal services
• Pet care
• Community resources/ basic needs
• Home repair and improvement
• Summer programs for kids
• Household services and more
You can get a free 30-minute consultation with a participating attorney for each new legal topic. Some of the areas of law and issues covered include:
• Family or domestic law
• Civil and criminal law
• Wills and estate planning
• Real estate and more
If you opt for services beyond the initial consultation you can get a 25 percent discount. You also have free access to legal documents and forms on your member website.
*Services must be related to the employee or an eligible household member. Exclusions include work-related and lack of merit issues. Discount does not include flat legal fees, contingency fees and plan mediator services.
Financial services
Simply call for a free 30-minute phone consultation for each new financial topic related to:
• Budgeting
• Retirement or other financial planning
• Mortgages and refinancing
• Credit and debt issues
• College funding
• Tax and IRS questions
You can get a 25 percent discount on standard tax preparation services. You also have access to financial articles, calculators and a financial assessment on your member website.
*Services must be for financial matters related to the employee or an eligible household member.
Online resources
Your member website offers a full range of tools and resources to help with emotional wellbeing, work/life balance and more. You’ll find:
• Videos and podcasts
• Articles, blogs and selfassessments
• Mobile app
Discount Center
• Child and adult care provider search tool
• Live and on-demand webinars and more
Find deals on brand name products and services including electronics, entertainment, gifts and flowers, travel, fitness, nutrition and more.
Mind Companion Self-care
You have access to evidence-based support tools to help manage depression, anxiety, stress, substance misuse and more.
Additional services
Identity theft services — One hour fraud resolution phone consultation or coaching about ID theft prevention and credit restoration. Services include a free emergency kit for victims.
2024 - 2025 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 City of Terrell 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 City of Terrell 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.
