Benefit Contact Information
CROWLEY ISD
Higginbotham Public Sector (833) 453-1680 www.mybenefitshub.com/crowleyisd
BCBSTX (866) 355-5999 www.bcbstx.com/trsactivecare
EECU (817) 882-0800 www.eecu.org
Cigna
Group #: 3345114-PPO Group #: 3345114-DHMO (800) 244-6224 www.cigna.com
New York Life Group #: FLX-970170 (800) 238-2125 www.newyorklife.com
Recuro Health (855) 673-2873 www.recurohealth.com
MetLife Group #: 242643 (800) 438-6388 www.metlife.com
Cigna
Group #: A19622356 (800) 754-3207 www.cigna.com
Clever RX Group # 1085 Member ID: 6000 (800) 873-1195 www.cleverrx.com/crowleyisd
Cigna Group # HC962359 (800) 754-3207 www.cigna.com
New York Life Group #: SLH-100030 (800) 362-4462 www.newyorklife.com
Cigna
Group #: C1962358 (800) 754-3207 www.cigna.com FLEXIBLE SPENDING ACCOUNT (FSA)
Higginbotham
Flexclaims@higginbotham.net (866) 419-3519 https://flexservices.higginbotham.net/
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www.mybenefitshub.com/crowleyisd
3 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.
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5
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.
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 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 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/crowleyisd 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 Crowley ISD benefit website: www.mybenefitshub.com/crowleyisd. 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 log in 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 Benefit Office within 30 days of your qualifying event and meet with your Benefit 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
Supplemental Benefits: Eligible employees must work 40 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 September 1, 2024, you must be actively-at-work on September 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 district as both employees and dependents.
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact 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 Benefit Office to request a continuation of coverage.
Description
Employer
Contribution
Account
Minimum Deductible
Maximum Contribution
Health
Savings Account (HSA)
(IRC Sec. 223)
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.
Flexible Spending Account (FSA)
(IRC Sec. 125)
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, taxfree. This also allows employees to pay for qualifying dependent care tax-free.
Permissible Use Of Funds
Cash-Outs of Unused Amounts (if no medical expenses)
Year-to-year rollover of account balance?
Does the account earn interest?
Portable?
$1,600 single (2024)
$3,200 family (2024)
$4,150 single (2024)
$8,300 family (2024)
55+ catch up +$1,000
Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
$3,200 (2024)
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 or $500 rollover provision.
Yes No
Yes, portable year-to-year and between jobs.
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/crowleyisd
Learn the Terms.
• Premium: The monthly amount you pay for health care coverage.
• Deductible: The annual amount for medical expenses you’re responsible to pay before your plan begins to pay.
• Copay: The set amount you pay for a covered service at the time you receive it. The amount can vary based on the service.
• Coinsurance: The portion you’re required to pay for services after you meet your deductible. It’s often a specified percentage of the costs; e.g., you pay 20% while the health care plan pays 80%.
• Out-of-Pocket Maximum: The maximum amount you pay each year for medical costs. After reaching the out-of-pocket maximum, the plan pays 100% of allowable charges for covered services.
www.mybenefitshub.com/crowleyisd
24/7accesstoboard-certifieddoctorsfor treatmentofcommonmedicalconcernswith ongoingcommunicationwithyourdoctor. Accessiblevirtuallythroughphone,web, and desktopcomputer.
Coordinated Ifneeded,urgent carecanseamlessly transitionto Recuro’s ongoing virtualprimarycare toimprovepatient healthandpreempt futureissues.
Convenient
Patientscanseea board-certified physicianwherever theyare,whenever theyneedit.
Personalized
Patientsreceive treatmentplans basedontheir uniqueneeds and canaskfollow-up questionstotheir doctorsafterthe visit,freeofcharge.
Colaborative MentalWelness
Comprehensivebehavioralhealthcare fromtherapyandcounselingto psychiatryandmedication management,alldeliveredvirtually.
Primarycareand behavioral health doctorscollaborate closelytoensure coordinated treatmentplansthat careforthewhole patient.
Targeted
Pharmacogenetic (PGx)testingensures therightbehavioral healthmedicationis prescribed,thefirst time.
Whiletoday behavioralhealthcare isdifficulttoaccess forsomany,at Recuroitisavailable andaffordable.
Hospital Indemnity Cigna
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/crowleyisd
Even with the best primary health insurance plan, out-of-pocket costs from a hospital stay can add up. Cigna’s Hospital Care plan pays a scheduled benefit if you or an insured dependent (spouse or child) are confined in a hospital for a covered illness or injury.
The benefits are paid to you, and can help offset expenses that primary health insurance doesn’t cover (like deductibles, co-insurance amounts or co-pays), or benefits can be used for any non-medical expenses (like housing costs, groceries, car expenses, etc.).
Plan Highlights
• No Pre-existing Limitations!
• HSA Compatible
Claims
Call 800-754-3207 or email hosptialcare@cigna.com to file a claim. Group number on page 3 of this guide.
The benefit amounts shown in this summary will be paid regardless of the actual expenses incurred and are paid on a per day basis unless otherwise specified. Benefits are only payable when all policy terms and conditions are met. Please read all the information in the plan summary document on the benefit website to understand limitations and conditions.
Chronic Condition Admission
No elimination period. Limited to 1 day, 1 benefit(s) every 90 days.
Hospital Stay
No elimination period. Limited to 30 days, 1 benefit(s) every 90 days.
Hospital Intensive Care Unit (ICU) Stay
No elimination period. Limited to 30 days, , 1 benefit(s) every 90 days.
Hospital Observation Stay
24 hour elimination period. Limited to 72 hours.
Newborn Nursery Care Admission
Limited to 1 day, 1 benefit per newborn child. This benefit is payable to the employee even if child coverage is not elected.
Newborn Nursery Care Stay*
Limited to 30 days, 1 benefit per newborn child. This benefit is payable to the employee even if child coverage is not elected.
per 24-hour period
Hospital Indemnity Cigna
Additional Information:
Hospital Admission: Must be admitted as an Inpatient due to a Covered Injury or Covered Illness. Excludes: treatment in an emergency room, provided on an outpatient basis, or for re-admission for the same Covered Injury or Covered Illness (including chronic conditions).
Hospital Chronic Condition Admission: Must be admitted as an Inpatient due to a covered chronic condition and treatment for a covered chronic condition must be provided by a specialist in that field of medicine. Excludes: treatment in an emergency room, provided on an outpatient basis, or for re-admission for the same Covered Injury or Covered Illness (including chronic conditions).
Hospital Stay: Must be admitted as an Inpatient and confined to the Hospital, due to a Covered Injury or Covered Illness, at the direction and under the care of a physician. If also eligible for the ICU Stay Benefit, only 1 benefit will be paid for the same Covered Injury or Covered Illness, whichever is greater. Hospital stays within 90 days for the same or a related Covered Injury or Covered Illness is considered one Hospital Stay.
Intensive Care Unit (ICU) Stay: Must be admitted as an Inpatient and confined in an ICU of a Hospital, due to a Covered Injury or Covered Illness, at the direction and under the care of a physician. If also eligible for the Hospital Stay Benefit, only 1 benefit will be paid for the same Covered Injury or Covered Illness, whichever is greater. ICU stays within 90 days for the same or a related Covered Injury or Covered Illness is considered one ICU stay.
Hospital Observation Stay: Must be receiving treatment for a Covered Injury or Covered Illness in a Hospital, including an observation room, or ambulatory surgical center, for more than 24 hours on a non-inpatient basis and a charge must be incurred. This benefit is not payable if a benefit is payable under the Hospital Stay Benefit or Hospital Intensive Care Unit Stay Benefit.
Newborn Nursery Care Admission and Newborn Nursery Care Stay: Must be admitted as an Inpatient and confined in a Hospital immediately following birth at the direction and under the care of a physician.
Dental Insurance Cigna
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/crowleyisd
Our dental plan helps you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through Cigna Dental.
How to Find a Dentist
Visit https://hcpdirectory.cigna.com/ or call 800-244-6224 to find an innetwork dentist. Your network will be Total Cigna DPPO.
How to Request a New ID Card
You can request your dental id card by contacting Cigna directly at 800-244-6224. You can also go to www.mycigna.com and register/login to access your account. In addition, you can download the “MyCigna” app on your smartphone and access your id card right there on your phone.
Class I: Diagnostic & Preventive Oral Evaluations, Prophylaxis: routine cleanings, X-rays: routine, Xrays: non-routine, Fluoride Application, Sealants: per tooth, Space Maintainers: non-orthodontic Emergency Care to Relieve Pain
Class II: Basic Restorative Restorative: fillings, Endodontics: minor and major, Periodontics: minor and major, Oral Surgery: minor and major, Anesthesia: general and IV sedation, Repairs: dentures
Class III: Major Restorative Inlays and Onlays Prosthesis Over Implant, Crowns: prefabricated stainless steel / resin, Crowns: permanent cast and porcelain, Bridges and Dentures, Repairs: bridges, crowns and inlays, Denture Relines, Rebases and Adjustments
Class IV: Orthodontia Coverage for Dependent Children to age 19 Lifetime
Class IX: Implants
Dental Insurance Cigna
Benefit Plan Provisions:
In-Network Reimbursement For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule.
Non-Network Reimbursement For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Reimbursable Charge. The MRC is calculated at the 90th percentile of all provider submitted amounts in the geographic area. The dentist may balance bill up to their usual fees.
DHMO PLAN
If you enroll in the DHMO plan, you must select a Primary Care Dentist (PCD) from the DHMO network directory to manage your care. Each eligible dependent may choose their own PCD. The Patient Charge Schedule applies only when covered dental services are performed by your network dentist. Not all Network Dentist perform all listed services and it is suggested to check with your Network Dentist in advance of receiving services. Dental services are unlimited; you pay fixed co-pays, there are no deductibles and there are no claim forms to file. There is no coverage for services provided without a referral from your PCD or if you seek care from out-of-network providers. Please refer to the patient charge schedule details located on your benefit website, www.mybenefitshub.com/crowleyisd
How do I find an In-network Dentist?
Visit: https://hcpdirectory.cigna.com/ or call 800-244-6224 to find an in-network dentist. Your network will be Cigna Dental Care DHMO.
Vision Insurance MetLife
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/crowleyisd
Contact Lenses (instead of eyeglasses)
• Once every 12 months
• Contact lens fitting (standard): Covered in full after $25 copay.
• Contact lens fitting (premium): $50 retail allowance after $25 copay.
We’re Here to Help
• Find a Vision provider at www.metlife.com/vision
• Download a claim form at www.metlife.com/mybenefits
• For general questions, go to www.metlife.com/mybenefits or call 1-833-EYE-LIFE (1-833-393-5433)
Eye Exam
• Once every 12 months
• Eye health exam, dilation, prescription, and refraction for glasses: Covered in full after a $10 copay.
• Retinal imaging: Up to a $39 copay on routine retinal screening when performed by a private practice.
Frame
• Once every 12 months
• Allowance: $125 after $20 eyewear copay
• You will receive an additional 20% savings on the amount that you pay over your allowance.
Standard Corrective Lenses
• Once every 12 months
• Single vision, lined bifocal, lined trifocal, lenticular: Covered in full after $20 eyewear copay.
Standard Lens Enhancements
• Once every 12 months
• Standard Polycarbonate (child up to age 18) : Covered in full.
• Progressive lenses, Standard Polycarbonate (adult), UV coating, Scratch-resistant coatings, Tints, Anti-reflective, Photochromic, Blue Light filtering, Digital Single Vision, Polarized, High Index (1.67 / 1.74): Your cost will be limited to a member out of pocket amount (MOOP) that MetLife has negotiated for you. These amounts may be viewed after enrollment at metlife.com/mybenefits.
• Elective lenses: $160 allowance
• Necessary lenses: Covered in full.
In-Network Value Added Features:
Laser vision correction: Savings of 40% -50% off the national average price of traditional LASIK are available at over 1,000 locations across our nationwide network of laser vision correction providers. Contact QualSight LASIK at (877) 201-3602 for more information.
Additional savings on glasses and sunglasses: 20% savings on additional pairs of prescription glasses and nonprescription sunglasses, including lens enhancements.
Additional savings on lens enhancements: Average 20-25% savings on all lens enhancements not otherwise covered under the Superior Vision by MetLife vision benefit program.
Additional savings on frames: 20% off any amount over your frames allowance. Savings on additional exams3: 30% savings on additional exams.
Additional savings on contacts: 10% off any amount over your disposable contact lens allowance or 20% off any amount over your conventional contact lens allowance. 10% -20% discount on additional contacts.
Hearing discounts: A National Hearing Network of hearing care professionals, featuring Your Hearing Network, offers Superior Vision members discounts on services, hearing aids and accessories. These discounts should be verified prior to service.
Disability Insurance
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/crowleyisd
Eligibility: All active Full-time Employees of the Employer who are citizens or permanent resident aliens of the United States and working a minimum of 40 hours per week in the United States.
Employee Options
Select from Four Options: Accident/Sickness
14 days/14 days
Lesser of 66.7% of your monthly covered earning or $8000
Important Definitions and Policy Provisions:
30 days/30 days
60 days/60 days
90 days/90 days
150 days/150 days
Please refer to the “Maximum Benefit Period” Schedules below for more details
Disability – “Disability” or “Disabled” means that, solely because of a covered injury or sickness, you are unable to perform the material duties of your regular occupation and you are unable to earn 80% or more of your indexed earnings from working in your regular occupation. After benefits have been payable for 24 months, you are considered disabled if solely due to your injury or sickness, you are unable to perform the material duties of any occupation for which you are (or may reasonably become) qualified by education, training or experience, and you are unable to earn 60% or more of your indexed earnings. We will require proof of earnings and continued disability.
Covered Earnings – “Covered Earnings” means your wages or salary, not including bonuses, commissions, and other extra compensation.
When Benefits Begin – You must be continuously Disabled for your elected benefit waiting period before benefits will be payable for a covered Disability. For any selected Benefit Waiting Period of 30 days or less, the Benefit Waiting Period will end of the date you are admitted as an inpatient in a hospital if that date is before the end of the time period specified.
Maximum Benefit Period – Once you qualify for benefits under this plan, you continue to receive them until the end of the benefit or until you no longer qualify for benefits, whichever occurs first. Should you remain Disabled, your benefits continue according to one of the following schedules, depending on your age at the time you become Disabled and the plan you select.
When Coverage Takes Effect - Your coverage takes effect on the later of the policy’s effective date, the d21ate you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. If you’re not actively at work on the date your coverage would otherwise take effect, your coverage will take effect on the date you return to work. If you have to submit evidence of good health, your coverage takes effect on the date we agree, in writing, to cover you.
Disability Insurance
New York Life
Benefit Reductions, Conditions, Limitations and Exclusions: Effects of Other Income Benefits - This plan is structured to prevent your total benefits and post-disability earnings from equaling or exceeding pre-disability earnings. Therefore, we reduce this plan’s benefits by Other Income Benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Disability benefits will be reduced by amounts received through Social Security disability benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Your disability benefits will not be reduced by any Social Security disability benefits you are not receiving as long as you cooperate fully in efforts to obtain them and agree to repay any overpayment when and if you do receive them. Disability benefits will also be reduced by amounts received through other government programs, employer’s sabbatical leave, employer’s assault leave plan, employer funded retirement benefits, workers’ compensation, franchise/group insurance, auto no-fault, and damages for wage loss. For details, see your outline of coverage, policy certificate, or your employer’s summary plan description. Note: Some of the Other Income Benefits, as defined in the group policy, will not be considered until after disability benefits are payable for 6 months.
Earnings While Disabled - During the first 24 months that benefits are payable, benefits will be reduced if benefits plus income from employment exceeds 100% of pre-disability Covered Earnings. After that, benefits will be reduced by 50% of earnings from employment.
Limited Benefit Period - Disabilities caused by or contributed to by any one or more of the following conditions are subject to a lifetime limit of 24 months for outpatient treatment: Anxietydisorders, delusional (paranoid) or depressive disorders, eating disorders, mental illness, somatoform disorders (including psychosomatic illnesses) ,alcoholism, drug addiction or abuse. Benefits are payable during periods of hospital confinement for these conditions for hospitalizations lasting more than 14 consecutive days that occur before the 24-month lifetime outpatient limit is exhausted.
Pre-existing Condition Waiver - The Insurance Company will waive the Pre-Existing Condition Limitation for the first eight weeks of Disability even if the Employee has a Pre-Existing Condition. The Disability Benefits as shown in the Schedule of Benefits will continue beyond 8 weeks only if the PreExisting Condition Limitation does not apply.
Pre-existing Condition Limitation - Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, received medical treatment, care or services (including diagnostic measures,) during the 3 months just prior to the most recent effective date of insurance. Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after you have been insured under this plan for at least 12 months after your most recent effective date of insurance.
Termination of Disability Benefits - Your benefits will terminate when your Disability ceases, when your benefit duration period is exceeded, or on the following events: (1) the date you earn from any occupation more than 80% of your Covered Earnings, or the date you fail to cooperate with us in a rehabilitation plan, or transitional work arrangement, or the administration of the claim.
Rehabilitation Requirement - To be eligible for Disability benefits under this plan, you may be required to participate in a rehabilitation plan at the sole discretion and expense of the insurance company or company administering benefits under this plan. If you fail to fully cooperate with the rehabilitation plan, no Disability benefits will be paid, and coverage will end. For details, see your Certificate of Insurance. Exclusions - This plan does not pay benefits for a Disability which results, directly or indirectly, from any of the following: • Suicide, attempted suicide, or intentionally self-inflicted injury while sane or insane. ─ war or any act of war, whether or not declared. ─ active participation in a riot; • commission of a felony; • the revocation, restriction or non-renewal of an Employee’s license, permit or certification necessary to perform the duties of his or her occupation unless due solely to Injury or Sickness otherwise covered by the Policy. ─ any cosmetic surgery or surgical procedure that is not Medically Necessary. ─ an Injury or Sickness for which the Employee is entitled to benefits from Workers’
Compensation or occupational disease law - an Injury or Sickness that is work related. In addition, the plan does not pay disability benefits any period of Disability during which you are incarcerated in a penal or corrections institution.
Disability
New York Life
Educator 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. This type of disability plan is called an educator disability plan and includes both long and short term coverage into one convenient plan.
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 preexisting condition limitations.
How do I choose which plan to enroll in during my open enrollment?
1. First choose your elimination period. The elimination period, sometimes referred to as the waiting period, is how long you are disabled and unable to work before your benefit will begin. This will be displayed as 2 numbers such as 0/7, 14/14, 30/30, 60/60, 90/90, etc.
The first number indicates the number of days you must be disabled due to Injury and the second number indicates the number of days you must be disabled due to Sickness
When choosing your elimination period, ask yourself, “How long can I go without a paycheck?” Based on the answer to this question, choose your elimination period accordingly.
Important Note- some plans will waive the elimination period if you choose 30/30 or less and you are confined as an inpatient to the hospital for a specific time period. Please review your plan details to see if this feature is available to you.
2. Next choose your benefit amount. This is the maximum amount of money you would receive from the carrier on a monthly basis once your disability claim is approved by the carrier.
When choosing your monthly benefit, ask yourself, “How much money do I need to be able to pay my monthly expenses?” Based on the answer to this question, choose your monthly benefit accordingly.
Choose your Benefit Amount from the drop down box.
Choose your desired elimination period.
Choose your desired elimination period.
Life and AD&D
New York Life
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/crowleyisd
Summary of Benefits
Eligibility: All active, Full-time Employees of the Employer regularly working a minimum of 40 hours per week in the United States, who are citizens or permanent resident aliens of the United States.
• Employee: You will be eligible for coverage the first of the month coincident with or following date of hire.
• Spouse: As long as you apply for and are approved for coverage yourself.
• Child(ren): Birth to age 26, as long as you apply for and are approved for coverage yourself.
Available Coverage: You, your spouse, and children will receive equal amounts of Term Life and Accidental Death and Dismemberment insurance.
You, your spouse and dependent children will receive the same amount of Voluntary Accidental Death and Dismemberment insurance under Policy OK 971523, underwritten by Life Insurance Company of North America.
Guaranteed Issue means that you may be able to purchase coverage without medical exams or health questions. See “Guaranteed Issue” below for more information.
AD&D Benefit Details:
of life; Quadriplegia; Loss of two or more hands or feet; Loss of sight in both eyes; or Loss of speech and hearing (both ears)
Hemiplegia; Loss of one hand, one foot, sight in one eye, speech, or hearing in both ears; or Severance and Reattachment of one hand or foot
Uniplegia; Loss of all four fingers of the same hand; or Loss of thumb and index finger of the same hand
Loss of all toes of the same foot
Life and AD&D
For Comas – You will receive 1% of the full benefit amount each month, for up to a maximum of 11 months, if you or an insured family member are in a coma for 30 days or more as a result of a Covered Accident. If the covered person is still in a coma after 11 months, or dies, the full benefit amount will be paid.
Conversion – If group accident coverage ends (except due to nonpayment of premium), your employment is terminated, membership in an eligible class is terminated, or insurance coverage is reduced based on attained age, you can convert to an individual non-term policy. To convert, you must apply for the conversion policy and pay the first premium payment within 31 days after your group coverage ends. Dependents may convert their coverage as well if applicable. Premiums may change at this time, and terms of coverage will be subject to change. You can also convert to an individual policy of up to $10,000 if you have been insured for at least 5 years and the policy is terminated or amended, provided coverage is not replaced and you are not covered under a different conversion policy issued by Life Insurance Company of North America. Refer to your certificate for details.
Accelerated Death Benefit – Terminal Illness – if two unaffiliated doctors diagnose you or your spouse as terminally ill while the coverage is active, with a life expectancy of 12 months or less, the benefit for Terminal Illness provides up to:
Employee: 75% of your Term Life Insurance coverage amount or $375,000, whichever is less. Spouse: 75% of your Term Life Insurance coverage amount or $75,000, whichever is less.
Portability – If your employment is terminated, you can continue your life insurance on a direct-bill basis. Coverage may also be continued for your spouse/children. Premiums will increase at this time. Coverage can be continued to age 70, unless the insurance company terminates portability for all insured persons. Refer to your certificate for details.
Conversion – To convert, you must apply for the conversion policy and pay the first premium payment within 31 days after your group coverage ends.
Term Life Benefit Reductions, Exclusions and Limitations
Benefit Reduction Schedule - If you are still employed, your benefits will reduce to 50% at age 70. Spouse reductions are based on employee age.
Exclusions - Voluntary life insurance will not be paid if you commit suicide, while sane or insane, within the first two years of coverage. Limitations - The Accelerated Death Benefit is payable only once. Using this benefit reduces the life insurance death benefit. The amount payable under the Accelerated Death Benefit may be reduced by the amount of other benefits already paid to the insured under the policy. See your certificate for details. After premiums have been waived for 12 months, they will be waived for future periods of 12 months if you remain Disabled. This benefit will remain active until age 65 subject to proof of continuing disability each year.
Guaranteed Issue for Term Life Insurance Coverage: If you are a new hire and you apply within 31 days after you are eligible to elect coverage for yourself, you are entitled to choose any coverage offered up to the Guaranteed Issue Amount, without providing proof of good health. If you apply for an amount of coverage greater than the Guaranteed Issue Amount, coverage in excess of the Guaranteed Issue Amount will not be issued until the insurance company approves acceptable proof of good health. If you apply for coverage for yourself more than 31 days from the date you become eligible to elect coverage under this plan, the Guaranteed Issue Amount will not apply, unless Guaranteed Issue has been approved by your employer for a specific period of time. Coverage will not be issued until the insurance company approves acceptable proof of good health.
These are summarized definitions only. To be eligible for coverage, the covered illness or event must meet the definitions and other terms and conditions set forth in the group policy.
Accident Insurance Cigna
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/crowleyisd
Accidental Injury coverage provides a fixed cash benefit according to the schedule below when a Covered Person suffers certain Injuries or undergoes a broad range of medical treatments or care resulting from a Covered Accident.
Who Can Elect Coverage:
You: All active, full-time Employees of the Employer who are regularly working in the United States a minimum of 17 hours per week and regularly residing in the United States and who are United States citizens or permanent resident aliens and their Spouse, and Dependent Children who are United States citizens or permanent resident aliens and who are residing in the United States. You will be eligible to elect coverage on the first of the month coinciding with or next following your date of hire or Active Service.
Your Spouse*: Up to age 100, as long as you apply for and are approved for coverage yourself.
Your Child(ren): Birth to age 26; 26+ if disabled, as long as you apply for and are approved for coverage yourself.
Available Coverage: This Accidental Injury plan provides 24 hour coverage. The benefit amounts shown in this summary will be paid regardless of the actual expenses incurred and are paid on a per day basis unless otherwise specified. Benefits are only payable when all policy terms and conditions are met. Please read all the information in this summary to understand terms, conditions, state variations, exclusions and limitations applicable to these benefits. See your Certificate of Insurance for more information.
Coma (lasting 7 days with no response) $15,000
Additional Accidental Injury benefits included - See certificate for details including limitations & exclusions. Virtual Care accepted for Initial Physician Office Visit and Follow-Up Care.
Accident Insurance Cigna
Wellness Treatment, Health Screening Test & Preventive Care Benefit Plan
Wellness Treatment, Health Screening Test and Preventive Care Benefit: Examples include (but are not limited to) routine gynecological ex-ams, general health exams, mammography and certain blood tests. Benefit paid for all covered persons is 100% of the benefit shown. Also includes COVID-19 Immunization. Virtual Care accepted.
$50
Portability Feature: You, your spouse, and child(ren) can continue 100% of your coverage at the time your coverage ends. You must be under the age of 100 in order to continue your coverage. Rates may change and all coverage ends at age 100. Applies to United States Citizens and Permanent Resident Aliens residing in the United States.
Important Definitions and Policy Provisions:
Coverage Type: Benefits are paid when a Covered Injury results, directly and independently of all other causes, from a Covered Accident.
Covered Accident: A sudden, unforeseeable, external event that results, directly and independently of all other causes, in a Covered Injury or Covered Loss and occurs while the Covered Person is insured under this Policy; is not contributed to by disease, sickness, mental or bodily infirmity; and is not otherwise excluded under the terms of this Policy.
Covered Injury: Any bodily harm that results directly and independently of all other causes from a Covered Accident.
Covered Person: An eligible person who is enrolled for coverage under this Policy.
Covered Loss: A loss that is the result, directly and independently of other causes, from a Covered Accident suffered by the Covered Person within the applicable time period described in the Policy.
Hospital: An institution that is licensed as a hospital pursuant to applicable law; primarily and continuously engaged in providing medical care and treatment to sick and injured persons; managed under the supervision of a staff of medical doctors; provides 24-hour nursing services by or under the supervision of a graduate registered Nurse (R.N.); and has medical, diagnostic and treatment facilities with major surgical facilities on its premises, or available to it on a prearranged basis, and charges for its services. The term Hospital does not include a clinic, facility, or unit of a Hospital for: rehabilitation, convalescent, custodial, educational, or nursing care; the aged, treatment of drug or alcohol addiction.
When your coverage begins: Coverage begins on the later of the program’s effective date, the date you become eligible, or the first of the month following the date your completed enrollment form is received unless otherwise agreed upon by Cigna. Your coverage will not begin unless you are actively at work on the effective date. Coverage for all Covered Persons will not begin on the effective date if hospital, facility or home confined, disabled or receiving disability benefits or unable to perform activities of daily living.
When your coverage ends: Coverage ends on the earliest of the date you and your dependents are no longer eligible, the date the group policy is no longer in force, or the date for the last period for which required premiums are paid. For your dependent, coverage also ends when your coverage ends, when their premiums are not paid or when they are no longer eligible. (Under certain circumstances, your coverage may be continued. Be sure to read the provisions in your Certificate.)
30 Day Right To Examine Certificate: If a Covered Person is not satisfied with the Certificate for any reason, it may be returned to us within 30 days after receipt. We will return any premium that has been paid and the Certificate will be void as if it had never been issued.
Critical Illness 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/crowleyisd
Who Can Elect Coverage:
You: All active, Employees of the Employer who are regularly working a minimum of 40 hours per week who are United States citizens or permanent resident aliens regularly working in the United States.
You will be eligible to elect coverage on the first of the month after 30 days from date of hire or Active Service.
Your Spouse: Up to age 100, as long as you apply for and are approved for coverage yourself.
Your Child(ren): Birth to age 26; 26+ if disabled, as long as you apply for and are approved for coverage yourself.
Available Coverage:
The benefit amounts shown will be paid regardless of the actual expenses incurred. The benefit descriptions are a summary only. There are terms, conditions, state variations, exclusions and limitations applicable to these benefits. Please read all of the infor-mation in this Summary and your Certificate of Insurance for more information. All Covered Critical Illness Conditions must be due to disease or sickness.
Critical Illness Insurance Cigna
*For Childhood Conditions please refer to the beginning of the Available Coverage section above for details on how much coverage is available for covered children.
Health Screening Test Benefit
Examples includes (but are not limited to) mammography, and certain blood tests. The benefit amount shown will be paid regardless of the actual expenses incurred and is paid on a per day basis. Virtual Care accepted.
Benefits
Initial Critical Illness Benefit
Recurrence Benefit
Maximum Lifetime Limit
Skin Cancer Benefit
Guaranteed Issue:
Benefit for a diagnosis made after the effective date of coverage for each Covered Condition shown above.
The amount payable per Covered Condition is the Initial Benefit Amount multiplied by the applicable percentage shown. Each Covered Condition will be payable one time per Covered Person, subject to the Maximum Lifetime Limit. A 90 days separation period between the dates of diagnosis is required.*
Benefit for the diagnosis of a subsequent and same Covered Condition for which an Initial Critical Illness Benefit has been paid, payable after a 6 month separation period from diagnosis of a previous Covered Condition, subject to the Maximum Lifetime Limit.
The maximum benefit payable per Covered Person is the lesser of 5 times the elected Benefit Amount or $150,000.
Pays benefit stated above
If you are a new hire you are not required to provide proof of good health if you enroll during your employer’s eligibility waiting period and you choose an amount of coverage up to and including the Guaranteed Issue Amount. If you apply for an amount of coverage greater than the Guaranteed Issue Amount, coverage in excess of the Guaranteed Issue Amount will not be issued until the insurance company approves acceptable proof of good health. Guaranteed Issue coverage may be available at other specified periods of time. Your employer will notify you when these periods of time are available. Your Spouse must be age 18 or older to apply if evidence of insurability is required.
www.mybenefitshub.com/crowleyisd
(866) 419-3519
(866) 419-3516
Identity Theft Identity Guard
ABOUT IDENTITY THEFT PROTECTION
Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered.
For full plan details, please visit your benefit website: www.mybenefitshub.com/crowleyisd
THE ULTIMATE PLAN
Safeguarding you, your family, and your finances with identity protection, financial tracking, and online security. Have you wondered:
• How do I know if my information has been comprised?
• What do I do if my personal information has been stolen?
• Can I protect myself and my family on social media?
• Can I protect my children from identity theft?
Aura Identity Guard protects you and your family against cybercrime.
COMPREHENSIVE IDENTITY PROTECTION
• $1M in insurance protection1 from financial losses and legal fees
• 24/7 expert guidance, if a threat is detected
• Protect your loved ones for one low price with our family plan
FASTEST SPEED AND LARGEST BREADTH OF ALERTS
• Around-the-clock scan of billions of online resources
• Reduce exposure to cybertheft
• Be alerted within seconds of possible cyberthreats
POWERFUL FINANCIAL TOOLS
• Keep an eye on your spending and get alerted to suspicious transactions
• Access to your credit report and real-time alerts to changes that impact your credit
• Complete protection and monitoring of online accounts and passwords
COMPREHENSIVE IDENTITY PROTECTION
$1 Million insurance with stolen funds reimbursement
401(k) & HSA reimbursement
Address monitoring
Auto-on monitoring
Compromised credentials scan
Court records monitoring
Criminal record monitoring
Cyberbullying monitoring
Dark web monitoring
Data broker list monitoring/removal
Device/cookie tracking protection
Fictitious identity monitoring
Home title monitoring
Human-sourced intelligence
Social security and ID authentication monitoring
card monitoring
card monitoring
accounts monitoring
transaction monitoring
Lost wallet protection
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 Crowley ISD Benefits Website. This summary does not replace or amend the underlying plan documentation. In the event of a discrepancy between this summary and the plan documentation the plan documentation governs. All plans and benefits described in this summary may be discontinued, increased, decreased, or altered at any time with or without notice.
Rate Sheet General Disclaimer: The rate information provided in this guide is subject to change at any time by your employer and/or the plan provider. The rate information included herein, does not guarantee coverage or change or otherwise interpret the terms of the specific plan documentation, available at the Crowley ISD Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.