Benefit Contact Information
FWISD BENEFITS OFFICE
SAVINGS ACCOUNT (817) 814-2240 www.fwisd.org Email: benefits@fwisd.org
TRS-ACTIVECARE MEDICAL
Blue Cross Blue Shield of Texas (866) 355-5999 www.bcbstx.com/trsactivecare
Higginbotham FSA P: (866) 419-3519 F: (817) 882-9267 flexservices.higginbotham.net
DHMO
Humana Group #573701 (800) 979-4760 www.humanadental.com
EECU (817) 882-0800 www.eecu.org
Humana Group #573701 (800) 979-4760 www.humanadental.com
OPTIONAL LIFE AND AD&D DENTAL INDEMNITY DPPO COBRA (DENTAL, VISION)
MetLife
Group #122673-1-G (800) 638-6420 www.metlife.com
VISION
Humana Group #573701 (866) 537-0229 www.humanavisioncare.com
ACCIDENT
MetLife Group #122673 Network: PDP Plus (800) 438-6388 www.metlife.com
LEGAL SERVICES
Texas Legal (800) 252-9346 www.texaslegal.org
PERMANENT LIFE
National Benefit Services (800) 274-0503 www.nbsbenefits.com
COBRA (TRS-ACTIVECARE MEDICAL)
bswift (833) 682-8972
403(B) PLAN / 457 PLAN CHUBB
Group #BKRC671 (866) 445-8874 www.combinedinsurance.com
CANCER
American Public Life
Group #18296 (800) 256-8606 www.ampublic.com
Texas Life (817) 545-3900 ext. 102 www.texaslife.com
DISABILITY
The Hartford Group #395332 (866) 547-9124 www.thehartford.com/mybenefits
HIGGINBOTHAM PUBLIC SECTOR HIGGINBOTHAM
Higginbotham Public Sector (833) 453-1680 www.mybenefitshub.com/fortworthisd
Higginbotham (817) 347-7031 www.higginbotham.net
TCG Administrators (800) 943-9179 www.tcgservices.com
MEDICAL TRANSPORTATION
MASA Group #MLFWISD (800) 423-3226 www.masamts.com
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 31 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 Department at (817) 814-2240 or you can call Higginbotham Public Sector at (833) 453-1680 for assistance.
Don’t Forget!
Where can I find forms?
For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/fortworthisd. 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 Fort Worth ISD benefit website: www.mybenefitshub. com/fortworthisd. 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.
• Login and complete your benefit enrollment from 07/16/2024 - 8/16/2024
• Login assistance is available by calling the FWISD Benefits Department at (817) 814-2240.
• Enrollment assistance is available 7/29-8/16/24, M-F, 8-5 by calling the Fort Worth ISD Benefit Enrollment Call Center at (817) 710-8135.
• REQUIRED: Provide correct dependent social security numbers.
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 31 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: Employees who are active contributing TRS members are eligible for all benefits. Employees who are not active contributing TRS members are eligible to participate in TRS Active Care. Eligibility criteria may be found at https://www.fwisd.org/Page/2561. Benefits 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-atwork 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 FWISD Benefits Department, 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
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 9/1/2024 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
September 1st through August 31st
Pre-Existing Conditions
Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescriptions drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).
Description
Health Savings Account (HSA) (IRC Sec. 223)
Approved by Congress in 2003, HSAs are actual bank accounts in employees’ names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Employer Eligibility A qualified high deductible health plan
Contribution Source Employee and/or employer
Account Owner Individual
Underlying Insurance
Requirement
Minimum Deductible
Maximum Contribution
High deductible health plan
$1,600 single (2024)
$3,200 family (2024)
$4,150 single (2024)
$8,300 family (2024) 55+ catch up +$1,000
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?
Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
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.
All employers
Employee and/or employer
Employer
None
N/A
$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.
Yes
No. Remaining balances are available through 10/31/2025.
No
Yes, portable year-to-year and between jobs. No
Medical Insurance
ABOUT MEDICAL
Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis.
For full plan details, please visit your benefit website: TRS ActiveCare
18 Checks
24 Checks
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.
Health Savings Account (HSA)
ABOUT HSA
A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP).
For full plan details, please visit your benefit website:
Health Savings Account (HSA)
A Health Savings Account (HSA) is a tax-advantaged medical savings account available to employees who are enrolled in a high-deductible health plan. Health Savings Accounts enable you to save and conveniently pay for qualified healthcare expenses while you earn tax-free interest and pay no monthly service fees. An HSA is always yours even if you change health plans or jobs. There is no “use it or lose it” rule— you do not lose your money if you do not spend it in the calendar year— and there are no vesting requirements or forfeiture provisions.
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
• Enrolled in an HSA-eligible High Deductible Health Plan (HDHP)
• Not enrolled in Medicare, Medicaid, or TRICARE
• Not eligible to be claimed as a dependent on someone else’s tax return.
2024 Annual HSA Contributions Limits
• Individual: $4,150
• Family: $8,300
Catch Up Contribution: If you are 55 or older (regardless of when in the year you turn 55), you may make a yearly catch-up contribution of an additional $1,000.
Important HSA Information
• Annual election required.
• You can use your HSA for a wide range of qualified medical, dental or vision expenses for you and your eligible dependents, even if they are not covered under your medical plan.
• If you enroll in an HSA and FSA, then your FSA becomes a Limited Purpose FSA and may only be used for Dental and Vision, not medical expenses.
• Save your receipts for all qualified medical expenses.
You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
• Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.
• You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for payroll deduction with Fort Worth ISD.
• Funds may be accessed via provided HSA Debit Card, Online Bill Pay, Online Transfers or Check.
• Online/Chat at www.eecu.org for 24/7 account access to check your balance, pay bills and more.
• Call Member Services at (817) 882-0800 for help with your HSA questions. Monday-Friday 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. – 1:00 p.m. CT.
• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333-9934
• Stop by a local EECU financial center for in-person assistance; find EECU locations & service hours at www. eecu.org/locations
Flexible Spending Account (FSA) Higginbotham
ABOUT FSA
A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit.
For full plan details, please visit your benefit website: Flexible Spending Account (FSA)
A Cafeteria Plan is designed to take advantage of Section 125 of the Internal Revenue Code. It allows you to pay certain qualified expenses on a pre-tax basis, thereby reducing your taxable income. You can set aside a preestablished amount of money per plan year in a Flexible Spending Account (FSA).
Funds allocated to the Flexible Spending Account (FSA)/ Limited Purpose FSA (LFSA)/Dependent Care FSA (DCFSA) must be used during the plan year or are forfeited. However, your plan contains an additional two month grace period to spend elected funds through October 31, 2025. Participants have until November 30, 2025 to submit out of pocket expenses incurred September 1, 2024 – October 31, 2025. Annual election required.
Flexible Spending Accounts & What They Reimburse:
• Full Health Care FSA (FSA) – Medical, Dental, Vision expenses and over the counter items
• Limited Health Care FSA (LFSA) – Dental and Vision expenses ONLY
• Dependent Care FSA (DCFSA) – Day care, Before & Afterschool care, Day Camps & Elder Day Care
You do have the option to enroll in both a HSA and a FSA, however doing so will make your FSA a “Limited” FSA, which means it will only be available for dental and vision expenses. All medical expenses would need to be processed through your HSA.
How the Plans Work:
Health Care or Limited Purpose FSA funds may be accessed two different ways:
• Use your Higginbotham Benefits Debit Card to pay for qualified health expenses. Always keep receipts!
Employees remain responsible for substantiating claims and providing receipts in the event of an IRS audit.
• Claims and receipts may be submitted for reimbursement.
Dependent Care FSA funds require claim submission, the Debit Card may not be utilized. Claims are not reimbursed until funds are available in the account and after services are rendered. Claims submitted prior to occurrence date will be denied and need to be resubmitted once incurred.
Submit claims and receipts to Higginbotham Flex Department by Fax (817) 882-9267, Email flexclaims@ higginbotham.net or Online at https://flexservices. higginbotham.net. For assistance call (866) 419-3519 or email flexsupport@higginbotham.net
Important FSA Information:
• The 2024 plan year maximum contribution to a Health Care FSA or Limited Purpose 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 an eligible Qualifying Life Event.
• Qualified Expenses Examples, Plan Details, Mobile App, Claim Forms and more are located on the Fort Worth ISD Benefit Website Home page. Look to the bottom left and select Flexible Spending Accounts.
• If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Fort Worth ISD Benefits Website: www.mybenefitshub.com/ fortworthisd
Dental Insurance MetLife - Indemnity DPPO
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: Dental Indemnity PPO
• Network: MetLife Preferred Dentist Program Plus Network
• Group Number and Carrier Information on page 3.
• ID Cards will be mailed for new enrollees. Access ID information via the MetLife app or from mybenefits.metlife.com
If a member received one exam and one cleaning in the prior year, the annual maximum for the member will
by $250. If a member does not meet the criteria in a given year, their annual maximum would stay the same from the prior year’s amount. The increase will apply to a maximum of two step increases.
Dental Insurance
Humana - Advantage Plus
Employee
$9.35 Employee + Spouse
Employee + Child(ren)
Family Coverage
• No Annual Maximum or deductibles
$19.44
$31.95
• Choose any participating dentist in Humana Dentals’ Advantage Plus network.
• Except for emergency care, treatment received out-ofnetwork is not covered.
• Group Number and Carrier Information on page 3.
• Office visit copay: $5/15
• View/Print ID information at Humana.com or via the MyHumana app.
Sample of Service Schedule
Review plan documents for complete schedule and plan details at https://www.mybenefitshub.com/fortworthisd/2023-2024/ Benefit/Humana/DPPO
Preventative Member Pays
Periodic oral examination no charge
Comprehensive oral evaluation (limit 1 every 24 months) no charge
X-ray/Bitewing no charge
Panoramic film (limit 1 every 3 years) no charge
Diagnostic casts no charge
Prophylaxis no charge
Topical application of fluoride—child (for child <16) no charge
Sealant—per tooth (limit 1 per tooth every 12 months for child <14) no charge
Basic Member Pays
Space maintainer— (limited to child <14)
Recementation of space maintainer
Amalgam
Resin based composite
Periodontal scaling and root planing— per quadrant, varies by number of teeth (limit 1 per quad every 12 months)
Full mouth debridement to enable comprehensive evaluation and diagnosis (limit 1 every 5 years)
Periodontal maintenance (limit 1 every 6 months, inclusive of D1110 and D1120)
Extraction coronal remnants deciduous tooth
Extraction erupted tooth or exposed root
$53-$91
$12
$24-$46
$24-$56
$21- $39
$26
$23
$20
$26
Major Member Pays
Inlay
$313 -$414
Recement inlay, onlay or part coverage
Sedative filling
Core buildup including any pins
Pin retention—per tooth addition restoration
Cast post and core in addition to crown
Prefabricated post and core in addition to crown $139
Therapeutic pulpotomy $75
Root canal therapy
-$601
Apicoectomy/periradicular surgery $361 - $445
Retrograde filling—per root $109
Gingivectomy/gingivoplasty
Gingival flap proc
Clinical crown lengthening—hard tissue
Osseous surgery—varies per number of teeth
Complete denture—maxillary or mandibular
$153-$358
Immediate denture—maxillary or mandibular $700
Maxillary or Mandibular partial denture
--$709
Adjust complete denture—maxillary $35
Surgical removal of residual tooth roots $114
Alveoloplasty —varies on in conjunction w/ extractions or not conjunction w/extraction and by number of teeth. $97 - 181
Incision and drainage of abscess— intraoral or extraoral $120 - $570
Frenulectomy—separate procedure. $111
Excision of hyperplastic tissue—per arch $272
Palliative treatment dental pain— minor procedure $45
Local anesthesia no charge
IV conscious sedation/analg—1st 30 minute; each addition 15 minutes. $144; $60
Professional consultation by non- treating dentist
Orthodontics
Comprehensive Orthodontic treatment. Up to 24 months of routine orthodontic treatment for class 1 and Class 2 cases.
Consultation no charge Evaluation $35
Records/Treatment Planning
Orthodontic treatment (Children up to 19) $2100
Orthodontic treatment (Adults 19 and up) $2300 Retention $450
Dental Insurance
Humana - DHMO
• No annual maximums, no deductibles and no waiting periods.
• Scheduled costs for services provided by primary care dentist (PCD).
• Initial PCD assigned by residence zip codes, contact Humana to change PCD.
• Group Number and Carrier Information on page 3.
• View/Print ID information at Humana.com or via the MyHumana app.
Sample of Service Schedule
Review plan documents for complete schedule and plan details at https://www.mybenefitshub.com/fortworthisd/2023-2024/
(Gum Treatment)
scaling and root planing
mouth debridement to enable comprehensive
& Maxillofacial Surgery
Comprehensive orthodontic treatment of the transitional/adolescent dentition; Up to 24 months of routine orthodontic treatment for Class I and Class II cases
Vision Insurance
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:
Disability Insurance
The Hartford
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:
Educator Disability
Educator Disability insurance combines the features of a short-term and long-term disability plan into one policy. The coverage pays you a portion of your earnings if you cannot work because of a disabling illness or injury. The plan gives you the flexibility to choose a level of coverage to suit your need. This coverage is provided by The Hartford.
CLAIMS: Call The Hartford Claims at (866) 547-9124 to file a claim, group number on page 3.
Elimination Period (Days)
Sample Premium for 30-34 year old Based on 12 payments per year
*If because of your disability you are hospital confined for 24 hours or more, the elimination period will be waived and benefits will be payable from the first day.
IMPORTANT NOTES
Elimination Period: You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a Disability benefit payment. The elimination period that you select consists of two numbers. The first number shows the number of days you must be disabled by an accident before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin. For those employees electing an elimination period of 30 days or less, if your are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization.
Maximum Benefit Duration Benefit Duration is the maximum time for which the carrier will pay benefits for disability resulting from sickness or injury. Depending on plan option selected and age at which disability occurs, the maximum duration may vary. Age related adjustments may begin after age 60.
• Premium Option: plan max durations are the same for sickness or injury.
• Select Option: max benefits resulting from sickness is 5 years.
For details on Age Disabled variances see the applicable benefit schedules in plan documents at https://www.mybenefitshub. com/fortworthisd/2024-2025/Benefit/Hartford/EducatorLTD
Pre-Existing Condition Limitation Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless you have been insured under this policy for 12 months before your disability begins. You may also be covered if you have already satisfied the pre-existing condition requirement of your previous insurer. If your disability is a result of a pre-existing condition, the carrier will pay benefits for a maximum of 4 weeks.
Cancer Insurance American Public Life (APL)
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: Cancer Insurance
Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town treatments, special diets, daily living, and household upkeep. In addition to these non-medical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance through American Public Life helps pay for these direct and indirect treatment costs so you can focus on your health.
Claims: Claim form is on the Benefit Website, Group Number and Carrier Contact Information is on page 3.
Pre-Existing Condition Exclusion: No benefits are payable for any loss incurred during the first 12 months prior to the effective date of coverage and during the first 12 months of the effective date of coverage.
Optional Life and AD&D
MetLife
ABOUT LIFE AND AD&D
Group Optional 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:
Optional Term Life and AD&D
Life and Accidental Death and Dismemberment (AD&D) insurance through MetLife are important parts of your financial security, especially if others depend on you for support. With Life insurance, your beneficiary(ies) can use the coverage to pay off your debts, such as credit cards, mortgages and other final expenses.
Claims: Please contact the Fort Worth ISD Benefits office at 817814-2240 for assistance in filing a life claim.
Basic Life
$15,000 of Basic Life insurance is provided to eligible employees at Fort Worth ISD at no cost to you.
Optional Life and AD&D
You may purchase additional Life and AD&D insurance for you and your eligible dependents. If you decline Optional Life when first eligible and wish to elect later, Evidence of Insurability (EOI) – proof of good health – may be required before coverage is approved. You must be covered to obtain coverage for your dependents. Optional Life Plans may be ported. Porting and conversion options are available upon termination. Please see plan documents for details and limitations.
Employee Paid Optional Life Available Coverage Employee
• Increments of $10,000 not to exceed $500,000.
• New Hire Guaranteed Issue $250,000 Spouse
• Increments of $10,000 up to 100% of employee amount, not to exceed $100,000
• New Hire Guaranteed Issue $50,000 Child(ren)
• Birth to age 26 - $5000, $10,000, or $15,000
Supplemental AD&D Coverage is equal to Optional Term Life amount.
Evidence of Insurability
If your coverage pends during open enrollment, you must complete and Statement of Health (SOH). Watch for an email from MetLife providing instructions or print the form at the end of the HUB walk-through. SOH must be completed within 30 days of enrollment or your election will be closed as incomplete. Questions on SOH should be directed to MetLife, contact information on page 3.
Designating a Beneficiary
A beneficiary is the person or entity you designate to receive the death benefits of your life policies. You can name more than one beneficiary and you can change beneficiaries at any time. If you name more than one beneficiary, you must identify the share for each.
*Covers all eligible children.
Permanent Life Insurance Texas Life Insurance Company
ABOUT PERMANENT LIFE INSURANCE
Permanent life insurance is a type of life insurance policy that provides coverage for the insured’s entire lifetime, as long as the premiums are paid. It complements term life insurance, which covers the insured for a specified period of time. Permanent life insurance is the coverage you can keep when your employment ends.
For full plan details, please visit your benefit website: www.mybenefitshub.com/sampleisd
Individual Life Insurance
Voluntary permanent life insurance can be an ideal complement to the group term and voluntary term life insurance your employer might provide. This voluntary permanent universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term life insurance may be portable if you change jobs, but even if you can keep them after you retire, they usually cost more and decline in death benefit.
The contract, PureLife-plus, is underwritten by Texas Life Insurance Company, and it has the following features:
• HIGH DEATH BENEFIT. Written on a minimal cash-value Universal Life frame, PureLife-plus features one of the highest death benefits per payroll-deducted dollar offered at the worksite.1
• REFUND OF PREMIUM. Unique in the workplace, PureLife-plus offers you a refund of 10 years’ premium, should you surrender the contract if initial specified premium paid for ever increases. (Conditions apply.)
• ACCELERATED DEATH BENEFIT DUE TO TERMINAL ILLNESS RIDER. Should you be diagnosed as terminally ill with the expectation of death within 12 months, you will have the option to receive 92% of the death benefit, minus a $150 ($100 in Florida) administrative fee. Included with your contract at no additional cost, this valuable living benefit helps give you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.) (Form ICC07-ULABR-07 or Form Series ULABR-07)
• MINIMAL CASH VALUE. Designed to provide a high death benefit at a reasonable premium, PureLife-plus helps provide peace of mind for you and your beneficiaries while freeing investment dollars to be directed toward such tax-favored retirement plans as 403(b), 457 and 401(k).
• LONG GUARANTEES. Enjoy the assurance of a contract that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time (after the guaranteed period, premiums may go down, stay the same, or go up).2
1 Voluntary Whole and Universal Life Products, Eastbridge Consulting Group, March 2022
2 As long as you pay the necessary premium. Guarantees are subject to product terms, limitations, exclusions, and the insurer’s claims paying ability and financial strength. 45 years average for all ages based on our actuarial review.
Permanent Life Insurance
Texas Life Insurance Company
WHO CAN APPLY FOR COVERAGE?
Actively at work employees at issue ages 17-70 are eligible. Spouses, issue age 17-60, children ages 15 days to 26 years, and grandchildren ages 15 days to 18 years are eligible to apply for this coverage as well3. Employees do not have to participate in order to apply for coverage on eligible dependents.
SAMPLE RATES
You can qualify by answering just 3 questions4 –no exams or needles.
During the last six months, has the proposed insured:
Been actively at work on a full time basis, performing usual duties?
Been absent from work due to illness or medical treatment for a period of more than 5 consecutive working days?
Been disabled or received tests, treatment or care of any kind in a hospital or nursing home or received chemotherapy, hormonal therapy for cancer, radiation, dialysis treatment, or treatment for alcohol or drug abuse?
3 Coverage not available on children in WA or on grandchildren in WA or MD. In MD, children must reside with the applicant to be eligible for coverage.
4 Issuance of coverage will depend on the answer to these questions.
Important Note: Texas Life does not offer legal or financial advice. Contact an attorney and a financial advisor in your state for legal and financial information on wills, estates and trusts.
PureLife-plus is a Flexible Premium Adjustable Life Insurance to Age 121. As with most life insurance products, Texas Life contracts and riders contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative or see the Purelife-plus brochure for costs and complete details. Contract Form ICC18-PRFNG-NI-18, Form Series PRFNG-NI-18 or PRFNGNI-20-OHIO.
Accident Insurance CHUBB
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: Accident Insurance
Chubb Accident pays cash benefits directly to you for covered accidents and Chubb Accident pays extra benefits for injuries resulting from participating in organized sports. Let Chubb Accident help take care of your bills so you can take care of yourself and your family.
Claims: Claim form is on the Benefit Website, Group Number and Carrier Contact Information is on page 3
Sample of Benefit Schedule--24-Hour Coverage
Review plan documents for complete schedule and plan details at https://www.mybenefitshub.com/fortworthisd/2023-2024/ Benefit/Chubb/Accident
Legal Services
Texas Legal
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: Legal Services
Save Money and Protect your Family.
Legal insurance from Texas Legal lets you save money on legal services that everyone needs, such as estate planning, while protecting you from serious legal challenges that can come with life’s unknowns, including family, civil, consumer, and criminal issues.
Texas Legal is a non-profit founded by the State Legislature of Texas over 40 years ago. Our charter is simple - protect everyday Texans from financial hardship that can come with legal challenges. Available only to Texans, we offer the most comprehensive legal insurance plan on the market. As a member of Texas Legal, you can get high-quality legal help without the high price tag.
Legal Insurance Plans Cover:
• Estate Planning
• Divorce
• Bankruptcy
• Consumer Law
• Criminal Defense
• And Much More!
Two Plans are offered. Plan details and enrollment links are on the benefit website home page under Legal Services.
Questions/Claims:
Carrier Contact information is on Page 3.
Emergency Medical Transport MASA
ABOUT MEDICAL TRANSPORT
Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out-of-pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan.
For full plan details, please visit your benefit website: Emergency Medical Transport
A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. If a member has a high deductible health plan that is compatible with a health savings account, benefits will become available under the MASA membership for expenses incurred for medical care (as defined under Internal Revenue Code (“IRC”) section 213 (d)) once a member satisfies the applicable statutory minimum deductible under IRC section 223(c) for high-deductible health plan coverage that is compatible with a health savings account.
Emergent Air Transportation
In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities.
Emergent Ground Transportation
In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities.
Non-Emergency Inter-Facility Transportation
In the event that a member is in stable condition in a medical facility but requires a heightened level of care that is not available at their current medical facility, Members have access to non-emergency air or ground transportation between medical facilities.
Repatriation/Recuperation
Suppose you or a family member is hospitalized more than 100 miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for recuperation.
Claims
For claims assistance contact MASA, Carrier Contact information on page 3.
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 Fort Worth 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 Fort Worth 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.