Benefit Contact Information
Allegiance Group (855) 999-6808
Recuro (855) 673-2876 www.recurohealth.com
The Hartford Group #681973 (866) 547-9124 www.thehartford.com
Cigna (800) 754-3207 www.cigna.com
GCEFCU (800) 683-3863 www.gcefcu.org
Cigna (800) 754-3207 www.cigna.com
CHUBB (888) 499-0425 educatorclaims@chubb.com
CHUBB (888) 499-0425 educatorclaims@chubb.com
EyeMed (866) 939-3633 www.eyemed.com
CHUBB (888) 499-0425 educatorclaims@chubb.com
CHUBB (888) 499-0425 educatorclaims@chubb.com
Texas Life (800) 283-9233 www.texaslife.com FLEXIBLE SPENDING ACCOUNT (FSA)
Higginbotham (800) 419-3519 Flexclaims@higginbotham.net https://flexservices.higginbotham.net/
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http://www.mybenefitshub.com/goosecreekcisd
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Enter your Information
• Last Name
• Date of Birth
• Last Four (4) of Social Security Number
NOTE: THEbenefitsHUB uses this information to check behind the scenes to confirm your employment status. CLICK
Once confirmed, the Additional Security Verification page will list the contact options from your profile. Select either Text, Email, Call, or Ask Admin options to receive a code to complete the final verification step.
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Enter the code that you receive and click Verify. You can now complete your benefits enrollment!
Annual Benefit Enrollment
Annual Enrollment
During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.
• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.
• Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
New Hire Enrollment
All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Q&A
Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefit Office or you can call Higginbotham Public Sector at 866-914-5202 for assistance.
Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub. com/goosecreekcisd.
How can I find a Network Provider? For benefit summaries and claim forms, go to the Goose Creek CISD benefit website: www.mybenefitshub.com/goosecreekcisd. 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.
What is 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.
What is a 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).
Don’t Forget!
• Login and complete your benefit enrollment from 05/13/2024 - 05/27/2024
• Enrollment assistance is available by calling Higginbotham Public Sector at (866) 914-5202.
• Update your information: home address, phone numbers, email, and beneficiaries.
• REQUIRED!! Due to the Affordable Care Act (ACA) reporting requirements, you must add your dependent’s CORRECT social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator.
Annual Benefit Enrollment
Section 125 Cafeteria Plan Guidelines
A Cafeteria plan enables you to save money by using pretax 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
Medical and Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2024 benefits become effective on 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.
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.
PLAN MAXIMUM AGE
TSHBP To age 26
Cigna To age 26
MDLIVE To age 26
Lincoln Financial Group To age 26
EyeMed To age 26
MetLife To age 26
UNUM To age 26
MetLife To age 26
Lincoln Financial Group To age 26
Texas Life To age 26
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact 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 HR/Benefit Administrator to request a continuation of coverage.
Annual Benefit Enrollment
Health
Savings
Account (HSA) (IRC Sec. 223)
Description
Employer
Maximum Contribution
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
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?
$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. However, your plan has a 45-day grace period.
Yes No
Portable? Yes, portable year-to-year and between jobs. No
Medical Insurance
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/goosecreekcisd
Health Savings Account (HSA) GCEFCU
ABOUT HSA
A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). For full plan details, please visit your benefit website: www.mybenefitshub.com/goosecreekcisd
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs – it is also a tax -exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows taxfree and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
• Enrolled in an HSA-eligible HDHP (Cigna- High Deductible)
• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
• Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account
• Not eligible to be claimed as a dependent on someone else’s tax return
• Not enrolled in Medicare or TRICARE
• Not receiving Veterans Administration benefits
You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered under your HDHP.
Maximum Contributions
Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2024 is based on the coverage option you elect:
• Individual – $4,150
• Family (filing jointly) – $8,300
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
Hospital Cash
It’s not easy to pay hospital bills, especially if you have a high-deductible medical plan. Chubb Hospital Cash pays money directly to you if you are hospitalized so you can focus on your recovery. And since the cash goes directly to you, there are no restrictions on how you use your money.
Plan Benefits
$30,000
average three-day hospitalization cost.¹ average hospital stay.²
5.4 days
Plan 1
Hospitalization and Rehabilitation Benefits Payable Benefit
First Hospitalization Benefit
This benefit is payable for the first covered hospital confinement per certificate.
Hospital Admission Benefit
This benefit is for admission to a hospital or hospital sub-acute intensive care unit.
Hospital Confinement Benefit
This benefit is for confinement in hospital or hospital sub-acute intensive care unit.
Hospital Confinement ICU Benefit
This benefit is for confinement in a hospital intensive care unit.
Hospital ICU Admission Benefit
This benefit is for admission to a hospital intensive care unit.
Newborn Nursery Benefit
This benefit is payable for an insured newborn baby receiving newborn nursery care and who is not confined for treatment of a physical illness, infirmity, disease, or injury.
Observation Unit Benefit
This benefit is for treatment in a hospital observation unit for a period of less than 20 hours.
Rehabilitation Unit Admission Benefit
This benefit is for admission to a rehabilitation unit as an inpatient.
• $500
• Maximum benefit per calendar year: 1
• $2,500
• Maximum benefit per calendar year: 5
• $100 per day
• Maximum days per calendar year: 30
• $400 per day
• Maximum days per calendar year: 30
• $5,000
• Maximum benefit per calendar year: 2
• $500 per day
• Maximum days per confinement - normal delivery: 2
• Maximum days per confinement - caesarean section: 2
• $500
• Maximum benefit per calendar year: 2
• $500
• Maximum benefit per calendar year: 5
Waiver of Premium for Hospital Confinement
This benefit waives premium when the employee or spouse is confined for more than 30 continuous days.
Exclusions and Limitations*
• Included
We will not pay for any Covered Accident or Covered Sickness that is caused by, or occurs as a result of 1) committing or attempting to commit suicide or intentionally injuring oneself; 2) war or serving in any of the armed forces or units auxiliary; 3) participating in an illegal occupation or attempting to commit or actually committing a felony; 4) sky diving, hang gliding, parachuting, bungee jumping, parasailing, or scuba diving; 5) being intoxicated or being under the influence or any narcotic or other prescription drug unless taken in accordance with Physician’s instructions 6) alcoholism; 7) cosmetic surgery, except for reconstructive surgery needed as the result of an Injury or Sickness or is related to or results from a congenital disease or anomaly of a covered Dependent Child; 8) services related to sterilization, reversal of a vasectomy or tubal ligation, in vitro fertilization, and diagnostic treatment of infertility or other related problems.
A Physician cannot be You or a member of Your Immediate Family, Your business or professional partner, or any person who has a financial affiliation or business interest with You.
Rates
Questions?
Contact the FBS Benefits CareLine via the QR code or (833) 453-1680.
*Please refer to your Certificate of Insurance at https://www.mybenefitshub.com/goosecreekcisd for a complete listing of available benefits, limitations and exclusions. Underwritten by ACE Property & Casualty Company, a Chubb company. This information is a brief description of the important benefits and features of the insurance plan. It is not an insurance contract. This is a supplement to health insurance and is not a substitute for Major Medical or other minimal essential coverage. Hospital indemnity coverage provides a benefit for covered loss; neither the product name nor benefits payable are intended to provide reimbursement for medical expenses incurred by a covered person or to result in any payment in excess of loss.
24/7 Acute Care Access
24/7 access to board-certified doctors for treatment of common medical concerns with ongoing communication with your doctor. Accessible virtually through phone, web, and desktop computer.
If needed, urgent care can seamlessly transition to Recuro’s ongoing virtual primary care to improve patient health and preempt future issues. Coordinated
Patients can see a board-certified physician wherever they are, whenever they need it. Convenient
Patients receive treatment plans based on their unique needs and can ask follow-up questions to their doctors after the visit, free of charge.
Collaborative Mental Wellness
Comprehensive behavioral health care from therapy and counseling to psychiatry and medication management, all delivered virtually.
Primary care and behavioral health doctors collaborate closely to ensure coordinated treatment plans that care for the whole patient.
Targeted
Pharmacogenetic (PGx) testing ensures the right behavioral health medication is prescribed, the first time.
While today behavioral healthcare is difficult to access for so many, at Recuro it is available and affordable.
Cigna Dental Benefit Summary
Goose Creek CISD - TX
Cigna Dental Choice Plan Network Options
Reimbursement Levels Based on Contracted Fees
WellnessPlusSM Progressive Maximum Benefit:
When you or your family members receive any preventive care service during one plan year, the annual
will increase in the following plan year; until it reaches the highest level specified below. Please refer to your plan materials for additional i nformation on this plan feature. Calendar Year Benefits Maximum
Applies to: Class I, II & III expenses
Highlights
Class I: Diagnostic & Preventive
Oral Evaluations
Prophylaxis: routine cleanings
X -rays: routine
Fluoride Application
Sealants: per tooth
Space Maintainers: non-orthodontic
Class II: Basic Restorative
Restorative: fillings
Oral Surgery: minor
X-rays: non-routine
Emergency Care to Relieve Pain (Note: This service is administrated at the in network coinsurance level.)
Class III: Major Restorative
Inlays and Onlays
Prosthesis Over Implant
Crowns: prefabricated stainless steel / resin
Crowns: permanent cast and porcelain Bridges and Dentures
Endodontics: minor and major
Periodontics: minor and major
Oral Surgery: major
Anesthesia: general and IV sedation Repairs: Bridges, Crowns and Inlays Repairs: Dentures
Denture Relines, Rebases and Adjustments
Class IV: Orthodontia
Coverage for Employee and All Dependents Lifetime Benefits
$1,000
Benefit Plan Provisions:
In-Network Reimbursement
Non-Network Reimbursement
Cross Accumulation
Calendar Year Benefits Maximum
For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule.
For services provided by a non -network dentist, Cigna Dental will reimburse according to the Maximum Allowable Charge. The dentist may balance bill up to their usual fees.
All deductibles, plan maximums, and service specific maximums cross accumulate between in -network and out-of-network. Benefit frequency limitations are based on the date of service and cross accumulate between in and out of network.
The plan will only pay for covered charges up to the yearly Benefits Maximum, when applicable. Benefit-specific Maximums may also apply.
Calendar Year Deductible
Pretreatment Review
Alternate Benefit Provision
Oral Health Integration Program®
Timely Filing
Benefit Limitations:
Oral Evaluations/Exams
X -rays (routine)
X -rays (non -routine)
Diagnostic Casts
Cleanings
Fluoride Application
Sealants (per tooth)
Space Maintainers
Crowns, Bridges, Dentures and Partials
Denture and Bridge Repairs
Denture Relines, Rebases and Adjustments
Prosthesis Over Implant
Benefit Exclusions:
This is the amount you must pay before the plan begins to pay for covered charges, when applicable. Benefit-specific deductibles may also apply.
Pretreatment review is available on a voluntary basis when dental work in excess of $200 is proposed.
When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses.
The Cigna Dental Oral Health Integration Program offers enhanced dental coverage for customers with certain medical conditions. There is no additional charge to participate in the program. Those who qualify can receive reimbursement of their coinsurance for eligible dental services. Eligible customers can also receive guidance on behavioral issues related to oral health. Reimbursements under this program are not subject to the annual deductible, but will be applied to the plan annual maximum.
For more information on how to enroll in this program and a complete list of terms and eligible conditions, go to www.mycigna.com or call customer service 24/7 at 1 - 800-Cigna24.
Out of network claims submitted to Cigna after 365 days from date of service will be denied.
2 per calendar year.
Bitewings: 2 per calendar year.
Complete series of radiographic images and panoramic radiographic images: Limited to a combined total of 1 per 36 months.
Payable only in conjunction with orthodontic workup.
2 per calendar year, including periodontal maintenance procedures following active therapy.
1 per calendar year for children under age 19.
Limited to posterior tooth. 1 treatment per tooth every 36 months for children under age 14.
Limited to non -orthodontic treatment for children under age 19.
Replacement every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non -precious metals. No porcelain or white/tooth -colored material on molar crowns or bridges.
Reviewed if more than once.
Covered if more than 6 months after installation.
1 every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non -precious metals. No porcelain or white/tooth colored material on molar crowns or bridges.
Covered Expenses will not include, and no payment will be made for the following:
• Procedures and services not included in the list of covered dental expenses;
• Diagnostic: cone beam imaging;
• Preventive Services: instruction for plaque control, oral hygiene and diet;
• Restorative: veneers of porcelain, ceramic, resin, or acrylic materials on crowns or pontics on or replacing the upper and or lower first, second and/or third molars;
• Periodontics: bite registrations; splinting;
• Prosthodontic: precision or semi-precision attachments;
• Implants: implants or implant related services;
• Procedures, appliances or restorations, except full dentures, whose main purpose is to change vertical dimension, diagnose or treat conditions of dysfunction of the temporomandibular joint (TMJ), stabilize periodontally involved teeth or restore occlusion;
• Athletic mouth guards;
• Services performed primarily for cosmetic reasons;
• Personalization or decoration of any dental device or dental work;
• Replacement of an appliance per benefit guidelines;
• Services that are deemed to be medical in nature;
• Services and supplies received from a hospital;
• Drugs: prescription drugs;
• Charges in excess of the Maximum Allowable Charge.
Vision Insurance
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/goosecreekcisd
Frame
- Premium Tier 1 - 4
copay
copay
copay
copay
$50 LENS OPTIONS
Anti Reflective Coating - Standard $45 copay
Anti Reflective Coating - Premium Tier 1-3 $57 - 85 copay
Photochromic - Non-Glass
$75
Polycarbonate - Standard $40
Polycarbonate - Standard <19 years of age
Scratch Coating - Standard Plastic
Tint - Solid and Gradient
UV Treatment
$0 copay
to $23
to $23
to $20
$15 Not covered
$15 Not covered
$15 Not covered
All Other Lens Options 20% off retail price Not covered
CONTACT LENSES
Contacts - Conventional
Contacts - Disposable
$0 copay; 15% off balance over $180 allowance
$0 copay; 100% of balance over $180 allowance
Contacts - Medically Necessary $0 copay; paid-in-full
OTHER
Hearing Care from Amplifon Network
to $126
to $126
to $210
Discounts on hearing exam and aids; call 1.877.203.0675 Not covered
Lasik or PRK from U.S. Laser Network 15% off retail or 5% off promo price; call 1.800.988.4221
FREQUENCY ALLOWED FREQUENCY –ADULTS
Exam Once every plan year
Frame Once every plan year
Lenses Once every plan year
Contacts Lenses Once every plan year
(Plan allows member to receive either contacts and frame, or frame and lens services)
Once every plan year
Once every plan year
Once every plan year
Once every plan year
Visit https://eyedoclocator.eyemedvisioncare.com/ or call (866) 939-3633 to find an in-network vision provider.
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/goosecreekcisd
EDUCATOR DISABILITY INSURANCE OVERVIEW
What is Educator Disability Income Insurance?
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.
You have the opportunity to purchase Disability Insurance through your employer. This highlight sheet is an overview of your Disability Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail.
Why do I need Disability Insurance Coverage?
More than half of all personal bankruptcies and mortgage foreclosures are a consequence of disability1
1 Facts from LIMRA, 2016 Disability Insurance Awareness Month
The average worker faces a 1 in 3 chance of suffering a job loss lasting 90 days or more due to a disability2
2 Facts from LIMRA, 2016 Disability Insurance Awareness Month
Only 50% of American adults indicate they have enough savings to cover three months of living expenses in the event they’re not earning any income3
3 Federal Reserve, Report on the Economic Well-Being of U.S. Households in 2018
ELIGIBILITY AND ENROLLMENT
Eligibility
You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis.
Enrollment
You can enroll in coverage within 31 days of your date of hire or during your annual enrollment period.
Effective Date
Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.
Actively at Work
You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session.
FEATURES OF THE PLAN
Benefit Amount
You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $8,000 that cannot exceed 66 2/3% of your current monthly earnings. Earnings are defined in The Hartford’s contract with your employer.
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
Disability Insurance
days or less, if you 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 we pay benefits for disability resulting from sickness or injury. Depending on the age at which disability occurs, the maximum duration may vary. Please see the applicable schedules below based on the Premium benefit option.
Premium Option: For the Premium benefit option – the table below applies to disabilities resulting from sickness or injury.
Age Disabled
Maximum Benefit Duration
Prior to 63 To Normal Retirement Age or 48 months if greater
Age 63 To Normal Retirement Age or 42 months if greater
Age 64 36 months
Age 65 30 months
Age 66 27 months
Age 67 24 months
Age 68 21 months
Age 69 and older 18 months
PROVISIONS OF THE PLAN
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. If your disability is a result of a pre-existing condition, we will pay benefits for a maximum of 4 weeks.
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/goosecreekcisd
Critical Illness
Heart attacks, cancer, and strokes happen every day and often unexpectedly. They don’t give you time to prepare and can take a serious toll on both your physical and financial well-being. Chubb Critical Illness pays cash benefits directly to you that you can use to help with your bills, your mortgage, your rent, your childcare—you name it—so you can focus on recovery.
Available Coverage
Employee
Spouse
Child coverage
$30,000 face amounts
$30,000 face amounts
Every 40 seconds someone has a heart attack.¹
1 in 3
Americans don’t have enough money readily available to cover an unexpected $400 expense.²
Included in the employee rate
No benefits will be paid for a date of diagnosis that occurs prior to the coverage effective date. There is no pre-existing conditions limitation. All amounts are Guaranteed Issue — no medical questions are required for coverage to be issued.
Benefits
Sudden cardiac arrest
Transient
¹ Centers for Disease Control and Prevention, Jan. 2023
² The Federal Reserve, June 2022
Critical Illness Chubb
Covered Conditions
Occupational Package
Pays 100% of the face amount; benefits payable for HIV or Hepatitis B, C, or D, MRSA, Rabies, Tetanus, or Tuberculosis contracted on the job.
Childhood Conditions
Pays 100% of the dependent child face amount; Provides benefits for childhood conditions (Autism Spectrum Disorder; Cerebral Palsy; Congenital Birth Defects; Heart, Lung, Cleft Lip, Palate, etc; Cystic Fibrosis; Down Syndrome; Gaucher Disease; Muscular Dystrophy; Sickle Cell Disease; and Type 1 Diabetes).
Miscellaneous Diseases Rider + COVID-19
The Miscellaneous Disease Rider is payable once per covered condition. Covered conditions include: Addison’s disease; cerebrospinal meningistis; diptheria; Hungtington’s chorea; Legionnaire’s disease; malaria; myasthenia gravis; meningitis; necrotizing fasciitis; osteomyelitis; polio; rabies; sclerodema; systematic lupus; tetanus; tuberculosis.
COVID-19 means a disease resulting in a positive COVID-19 diagnostic screening and 5 consecutive days of hospital confinement.
Recurrence Benefit
Benefits are payable for a subsequent diagnosis of Aneurysm – Cerebral or Aortic, Benign Brain Tumor, Cancer, Coma, Coronary Artery Obstruction, Heart Attack, Major Organ Failure, Severe Burns, or Stroke.
Advocacy Package
Best doctors
Physician referrals
Ask the Expert Hotline provides 24 hour advice from experts about a particular medical condition.
In-Depth Medical review offers a full review of diagnosis and treatment plan.
Diabetes benefit
Diabetes diagnosis benefit
Pays a benefit once for covered person’s diabetes diagnosis.
Additional Benefits
Waiver of premium
Waives premium while the insured is totally disabled.
Wellness
–payable once per insured per year.
Rates Riders are included in all the rates listed below: Best Doctors, Diabetes Benefit, Waiver of Premium, Wellness Benefit
Cancer Insurance CHUBB
ABOUT CANCER
Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.
For full plan details, please visit your benefit website: www.mybenefitshub.com/goosecreekcisd
A cancer diagnosis and treatment can be an emotionally and physically difficult time. Chubb is there to help support you by providing cash benefits paid directly to you. Benefits are paid if you are diagnosed with cancer, but also help cover many other cancer-related services such as doctor’s visits, treatments, specialty care, and recovery. However, there are no restrictions on how to use these cash benefits—so you can use them as you see fit.
Choose the right level of coverage during the enrollment period to better protect your family.
First cancer benefit
Diagnosis of cancer
Hospital confinement
Hospital confinement ICU
Radiation therapy, chemotherapy, immunotherapy
Alternative care
Medical imaging
Skin cancer initial diagnosis
Attending physician
$100 paid upon receipt of first covered claim for cancer; only one payment per covered person per certificate per calendar year
$5,000
Waiting period: 0 days
Benefit reduction: none
$300 per day – days 1 through 30
Additional days: $600
Maximum days per confinement: 31
$600 per day – days 1 through 30
Additional days: $600
Maximum days per confinement: 31
Maximum per covered person per calendar year
12-month period: $10,000
$75 per visit
Maximum visits per calendar year: 4
$500 per imaging study
Maximum studies per calendar year: 2
$100 per diagnosis
Lifetime maximum: 1
$50 per visit
Maximum visits per calendar year: 4 Renewability
Conditionally Renewable Coverage is automatically renewed as long as the insured is an eligible employee, premiums are paid as due, and the Policy is in force. Portability Portability Employees can keep their coverage if they change jobs or retire while the Policy is in-force. Continuity of coverage
Pre-existing conditions limitation A condition for which a covered person received medical advice or treatment within the 12 months preceding the certificate effective date. Waiver of premium
Cancer Insurance CHUBB
Hospital confinement sub-acute ICU
Family care
Prescription drug in-patient
Private full-time nursing services
U.S. government or charity hospital
Family member transportation and lodging
Home health care
Hospice care
Skilled nursing care facility
$300 per day – days 1 through 30
Additional days: $300
Maximum days per confinement: 31
Childcare: $100 per day per child
Maximum days per calendar year: 30
Adult day care or home healthcare: $100 per day
Maximum days per calendar year: 30
Per confinement: $150
Maximum confinements per calendar year: 6
$150 per day
Maximum days per confinement: 5
Days 1 through 30: $300
Additional days: $600
Maximum days per confinement: 15
Family transportation: $100 per trip
Maximum trips per calendar year: 12
Family lodging: $100 per day
Maximum days per calendar year: 100
$100 per day not to exceed the number of days confined
Maximum days per calendar year: 30
$100 per day
$300 per day
Maximum days per calendar year: 30
No benefits will be paid for a date of diagnosis or treatment of cancer prior to the coverage effective date, except where continuity of coverage applies.
No benefits will be paid for services rendered by a member of the immediate family of a covered person.
We will not pay benefits for other conditions or diseases, except losses due directly from cancer or skin cancer.
We will not pay benefits for cancer or skin cancer if the diagnosis or treatment of cancer is received outside of the territorial limits of the United States and its possessions. Benefits will be payable if the covered person returns to the territorial limits of the United States and its possessions, and a physician confirms the diagnosis or receives treatment.
ACCIDENTAL INJURY INSURANCE
SUMMARY OF BENEFITS
Prepared for: Goose Creek Consolidated Independent School District
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:
Eligibility for You, Your Spouse and Your Children will be considered by Your employer.
You: All active, Full-time Employees of the Employer who are regularly working in the United States a minimum of 20 hours per week and regularly residing in the United States and who are United States citizens or permanent resident aliens or non-United States citizens legally working and living in the United States (Inpats) and their Spouse, Domestic Partner, or Civil Union Partner and Dependent Children who are United States citizens or permanent resident aliens or Spouse, Domestic Partner, or Civil Union Partner or Dependent Child Inpats and who are legally residing in the United States.
You will be eligible for coverage the first of the month after 30 days from date hire or Active Service.
Your Spouse/Domestic Partner: 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 off the job only 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.
Concussion
Coma (lasting 7 days with no response)
$350
$8,000
Additional Accidental Injury benefits included - See certificate for details, including limitations & exclusions. Virtual Care accepted for Initial Physician Office Visit and Follow-Up Care.
Accidental Death and Dismemberment Benefit Plan
Examples of benefits include (but are not limited to) payment for death from Automobile accident; total and permanent loss of speech or hearing in both ears. Actual benefit amount paid depends on the type of Covered Loss. The Spouse and Child benefit is 100% and 100% respective of the benefit shown.
Wellness Treatment,
Health
Screening Test &
Loss of Life: $25,000 - $75,000
Dismemberment: $1,000 - $20,000
Preventive
Care Benefit* Plan
Wellness Treatment, Health Screening Test and Preventive Care Benefit:* Benefit paid for all covered persons is 100% of the benefit shown. Also includes COVID-19 Immunization, Tests, and Screenings. Virtual Care accepted. $75
Sports Accident Benefit Plan
Organized and Personal Sports Activity Limited to 10 per year
50% of the qualified benefit
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 Only available to United States Citizens, Permanent Resident Aliens and non-United States Citizens working in the United States lawfully (Inpats) while residing in the United States.
Employee’s Monthly Cost of Coverage:
Costs are subject to change. Actual per pay period premiums may differ slightly due to rounding
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.
| Workplace Benefits
Educator Group Term Life Insurance
Benefit Summary
Life insurance is an important part of your employee benefits package. Chubb Term Life and Accidental Death and Dismemberment (AD&D) insurance provides the protection your family needs if something were to happen to you. Your family can receive cash benefits paid directly to them that they can use to help cover expenses like mortgage payments, credit card debt, childcare, college tuition, and other household expenses.
Voluntary Term Life and AD&D Insurance is made available for purchase by you and your family. Employees must be actively at work for at least 20 hours per week.
Life Insurance/AD&D
For
You
$10,000 increments up to a maximum of the lesser of 7 x annual salary or $500,000
For Your Spouse
$5,000 increments up to a maximum of $500,000 not to exceed 100% of employee amount
For Your Dependent Children
Live birth to 6 months: $500 6 months to age 26: $10,000
Reduction Schedule
50% at age 75
Additional Plan Benefits
Losses and Benefits
Guaranteed Issue
Employee: $300,000 Spouse: $75,000 Child: $10,000
Newly eligible employees and dependents: You and your eligible dependents may elect coverage up to the guaranteed issue amounts without answering health questions. Elections over the guaranteed issue amounts will require medical underwriting.
Current employees: At subsequent annual enrollments if you or your eligible dependents are currently enrolled in the plan, you may increase your coverage up to the guaranteed issue amounts without answering health questions. All amounts over the guaranteed issue will require medical underwriting.
*Please note that if you or your dependents did not elect coverage when first eligible, then you are considered a late entrant. Late entrants will be medically underwritten and will have to answer health questions for any amount of coverage elected.
The AD&D plan provides additional protection for you and your dependents in the event of an accidental bodily injury resulting in death or dismemberment. In addition to standard dismemberment coverage, the following benefit provisions are included:
• Air Bag Benefit – The lesser of 5% of AD&D benefit or $5,000
• Child Care Expense Benefit – 5% of employee’s AD&D benefit up to $12,000 per year for 4 years
• Child Education Expense Benefit – 6% of AD&D benefit up to $6,000 for 6 years; maximum benefit of $24,000
• Common Carrier Benefit – Included
• Elder Care Expense Benefit – The lesser of 1% of AD&D benefit or $500
• Exposure and Disappearance Benefit– Included
• Repatriation Expense Benefit – The lesser of $1,000 or the actual expense incurred
• Seatbelt Benefit – The lesser of 10% of AD&D benefit or $25,000
• Spouse Education Benefit – The lesser of 1% of AD&D benefit, $1,000, or the actual tuition expenses incurred
• Workplace Felonious Assault Benefit – 5% of AD&D benefit up to $10,000
Definitions and Provisions
Portability You can elect portable coverage, at group rates, if you terminate employment, reduce hours or retire from the employer.
Conversion When your group coverage ends, you may convert your coverage to an individual life policy without providing evidence of insurability.
Monthly Costs for Voluntary Term Life
You have the option to purchase Supplemental Term life Insurance. Listed below are the monthly rates.
Monthly Costs for Voluntary AD&D Insurance
Term Life Exclusions* Exclusions and Limitations*
No benefits will be paid for losses that are caused by, contributed to, or result from: 1) suicide, while sane or insane, occurring within 24 months after a covered person’s initial effective date of coverage; and 2) suicide, while sane or insane, occurring within two years after the date any increases in or additional coverage applied for becomes effective for a covered person.
No benefits will be payable for any loss that is the result of a Covered Accident that is due to or results from: 1) war or any act of war or Your active duty in any armed service during a time of war (this does not include acts of terrorism); 2) intoxication, as defined by the jurisdiction where the Covered Accident occurred; 3) committing of or attempting to commit an assault, felony or other criminal act; 4) active participation in a riot, rebellion or insurrection; 5) committing or attempting to commit suicide, whether sane or insane, or injuring oneself intentionally; 6) use of any drug, unless used as prescribed by a Physician or as directed; and 7) a Sickness or infection including physical or mental condition which is not caused solely by or as a direct result of a Covered Accident.
Questions?
Contact the FBS Benefits CareLine via the QR code or (833) 453-1680
*Please refer to your Certificate of Insurance at https://www.mybenefitshub.com/goosecreekcisd for a complete listing of available benefits, limitations and exclusions. Underwritten by ACE Property & Casualty Company, a Chubb company.
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
www.mybenefitshub.com/goosecreekcisd
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.
Flexible Spending Account (FSA)
Flexible (FSA)
Higginbotham
ABOUT FSA
A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year.
For full plan details, please visit your benefit website: www.mybenefitshub.com/
www.mybenefitshub.com/goosecreekcisd
Health Care FSA
The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $3,200 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include:
• Dental and vision expenses
• Medical deductibles and coinsurance
• Prescription copays
• Hearing aids and batteries
You may not contribute to a Health Care FSA if you contribute to a Health Savings Account (HSA)
Higginbotham Benefits Debit Card
The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB).
Dependent Care FSA
The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Depend ent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full-time student.
Things to Consider Regarding the Dependent Care FSA
• Overnight camps are not eligible for reimbursement (only day camps can be considered).
• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
• You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
Flexible Spending Accounts
Flexible Spending Accounts
Higginbotham
Higginbotham
Important FSA Rules
• The maximum per plan year you can contribute to a Health Care FSA is $3,200. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately.
• You cannot change your election during the year unless you experience a Qualifying Life Event.
• In most cases, you can continue to file claims incurred during the plan year for another 90 days after the plan year ends.
• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
• Review your employer's Summary Plan Document for full details. FSA rules vary by employer.
Over-the-Counter Item Rule Reminder
Health care reform legislation requires that certain over-the-counter (OTC) items require a prescription to qualify as an eligible Health Care FSA expense. You will only need to obtain a one-time prescription for the current plan year. You can continue to purchase your regular prescription medications with your FSA debit card. However, the FSA debit card may not be used as payment for an OTC item, even when accompanied by a prescription.
Higginbotham Portal
The Higginbotham Portal provides information and resources to help you manage your FSAs.
• Access plan documents, letters and notices, forms, account balances, contributions and other plan information
• Update your personal information
• Utilize Section 125 tax calculators
• Look up qualified expenses
• Submit claims
• Request a new or replacement Benefits Debit Card
Register on the Higginbotham Portal
Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information.
• Enter your Employee ID, which is your Social Security number with no dashes or spaces.
• Follow the prompts to navigate the site.
• If you have any questions or concerns, contact Higginbotham:
∗ Phone – 866-419-3519
∗ Questions – flexsupport@higginbotham.net
∗ Fax – 866-419-3516
∗ Claims- flexclaims@higginbotham.net
2024 Short 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 Goose Creek CISD Benefits Website. This summary does not replace or amend the underlying plan documentation. In the event of a discrepancy between this summary and the plan documentation the plan documentation governs. All plans and benefits described in this summary may be discontinued, increased, decreased, or altered at any time with or without notice.
Rate Sheet General Disclaimer: The rate information provided in this guide is subject to change at any time by your employer and/or the plan provider. The rate information included herein, does not guarantee coverage or change or otherwise interpret the terms of the specific plan documentation, available at the Goose Creek CISD Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.