Benefit Contact Information
Higginbotham Public Sector (800) 583-6908 www.mybenefitshub.com/mansfieldisd
EECU (817) 882-0800 www.eecu.org
252 Matlock Rd., Suite #130, Mansfield, TX 76063 Phone: (682) 242-8991
Fax: (817) 473-7186
Davis Vision (800) 999-5431 www.davisvision.com
Voya
Group #69514-9 (800) 955-7736 www.voya.com
EMPLOYEE ASSISTANCE PROGRAM (EAP)
ComPsych (855) 387-9727 guidanceresources.com
BCBSTX (866) 355-5999 www.bcbstx.com/trsactivecare
Higginbotham (866) 419-3519 flexservices.higginbotham.net
MDLIVE (888) 365-1663 www.mdlive.com/fbs
The Hartford Group #GLT-681960 (800) 547-5000 www.thehartford.com
Voya Group #69514-9 (800) 955-7736 www.voya.com
5Star Life Insurance (866) 863-9753 www.5starlifeinsurance.com
Cigna (800) 244-6224 www.mycigna.com
Cigna (800) 244-6224 www.mycigna.com
American Public Life Group #18361 (800) 256-8606 www.ampublic.com
OneAmerica Group #614903 (800) 553-5318 www.oneamerica.com
1 www.mybenefitshub.com/mansfieldisd
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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 LOGIN
Once confirmed, the Additional Security Verification page will list the contact options from your profile. Select either Text, Email, Call, or Ask Admin options to receive a code to complete the final verification step.
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Enter the code that you receive and click Verify. You can now complete your benefits enrollment!
Annual Benefit Enrollment
Annual Enrollment
During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.
• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.
• Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
New Hire Enrollment
All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Q&A
Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits department or you can call Higginbotham Public Sector at (866) 914-5202 for assistance.
Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub. com/mansfieldisd.
How can I find a Network Provider? For benefit summaries and claim forms, go to the Mansfield ISD benefit website: www.mybenefitshub.com/mansfieldisd. 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 pre-existing 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 prescription drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/ or consultation services).
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 Dependent’s
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 Benefits Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
QUALIFYING EVENTS
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual’s eligibility under an employer’s plan includes commencement or termination of employment.
An event that causes an employee’s dependent to satisfy or cease to satisfy coverage requirements under an employer’s plan may include change in age, student, marital, employment or tax dependent status.
If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual’s plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
Annual Benefit Enrollment
Employee Eligibility Requirements
Medical and Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2024 benefits become effective on 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.
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Higginbotham Public Sector, or contact the insurance carrier for additional information on spouse eligibility.
FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse’s FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance.
Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Higginbotham Public Sector, or contact the insurance carrier for additional information on dependent eligibility.
Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Higginbotham Public Sector from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee’s enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your Benefit Administrator to request a continuation of coverage.
Description
Health Savings
Account (HSA)
(IRC Sec. 223)
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Flexible
Spending Account (FSA)
(IRC Sec. 125)
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, taxfree. This also allows employees to pay for qualifying dependent care tax- free.
Employer Eligibility A qualified high deductible health plan All employers
Contribution Source Employee and/or employer
Account Owner Individual
Underlying Insurance
Requirement High deductible health plan
Minimum Deductible
Maximum Contribution
Permissible Use Of Funds
$1,600 single (2024)
Employee and/or employer
Employer
None
$3,200 family (2024) N/A
$4,150 single (2024)
$8,300 family (2024)
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).
Cash-Outs of Unused Amounts (if no medical expenses) Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65). Not permitted
Year-to-year rollover of account balance? Yes, will roll over to use for subsequent year’s health coverage.
Does the account earn interest?
Portable?
Yes
Yes, portable year-to-year and between jobs.
No. Access to some funds may be extended if your employer’s plan contains a 2 1/2 –month grace period or $550 rollover provision.
No
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/mansfieldisd
• 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
Compare Prices for Common Medical Services
Basic Life and AD&D
ABOUT LIFE AND AD&D
Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family.
Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.
For full plan details, please visit your benefit website: www.mybenefitshub.com/mansfieldisd
Who is eligible for this coverage? Active employees working 18 hours or more per week
What is the coverage amount? $10,000
What is the guaranteed issue? Full benefit; $10,000 Is it portable (can I keep it if I leave my employer)? Yes
When is the coverage effective? First of the month following date of hire
Additional AD&D Benefits
Matches the basic life benefit at $10,000
Loss of:
• Life
• One hand or one foot
• Sight in one eye
• Both hands or both feet
• Sight in both eyes
• Speech and hearing
What does the Basic AD&D portion pay for?
Do my life insurance benefits decrease with age
• Thumb or index finger For conditions of:
• Quadriplegia or loss of use of upper and lower limbs of the body
• Paraplegia or loss of us of both lower limbs of the body
• Hemiplegia or loss of use of upper and lower limbs on the same side of the body
• Monoplegia or loss of use of one limb of the body
• Severe burns
To 65% at age 70-74
To 50% at age 75+
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: www.mybene itshub.com/mansfieldisd
www.mybenefitshub.com/mansfieldisd
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs – it is also a tax-exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
• Enrolled in an HSA-eligible HDHP (High Deductible Health Plan) 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.
Opening an HSA
If you meet the eligibility requirements, you may open an HSA administered by EECU. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA.
Important HSA Information
• Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.
• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
• You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.
How To Use Your HSA
• Online/Mobile: Sign-in for 24/7 account access to check your balance, pay bills and more.
• Call/Text: (817) 882-0800 EECU’s dedicated member service representatives are available to assist you with any questions. Their hours of operation are Monday through Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. to 1:00 p.m. CT and closed on Sunday.
• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800)333-9934.
• Stop by a local EECU financial center: www.eecu.org/ locations
Hospital Indemnity Cigna
ABOUT HOSPITAL INDEMNITY
This is an affordable supplemental plan that pays you should you be inpatient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance. For full plan details, please visit your benefit website: www.mybenefitshub.com/mansfieldisd
SUMMARY OF BENEFITS
Hospital Care coverage provides a benefit according to the schedule below when a Covered Person incurs a Hospital stay resulting from a Covered Injury or Covered Illness
Who Can Elect Coverage:
• You: All active, Full-time Employees of the Employer who are regularly working in the United States a minimum of 18 hours per week and regularly residing in the United States who are United States citizens or permanent resident aliens and their Spouse and Dependent Children who are United States citizens or permanent resident aliens and are residing in the United States. You will be eligible for coverage on the first of the month following date of hire or Active Service.
• Your Spouse:* Up to age 100, as long as you apply for and are approved for coverage yourself.
• Your Child(ren): Birth to age 26; 26+ if disabled, as long as you apply for and are approved for coverage yourself.
Available Coverage:
The benefit amounts shown 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 the terms, conditions, state variations, exclusions and limitations applicable to these benefits. See your Certificate of Insurance for more information.
Benefit Waiting Period:* None, unless otherwise stated. No benefits will be paid for a loss which occurs during the Benefit Waiting Period.
Chronic Condition Admission - No Elimination Period. Limited to 1 day, 1
Hospital Indemnity Cigna
Benefit-Specific Conditions, Exclusions & Limitations (Hospital Care)
Hospital Admission: Must be admitted as an Inpatient due to a Covered Injury or Covered Illness. Excludes: treatment in an emergency room, provided on an outpatient basis, or for re-admission for the same Covered Injury or Covered Illness (including chronic conditions).
Hospital Chronic Condition Admission: Must be admitted as an Inpatient due to a covered chronic condition and treatment for a covered chronic condition must be provided by a specialist in that field of medicine. Excludes: treatment in an emergency room, provided on an outpatient basis, or for re-admission for the same Covered Injury or Covered Illness (including chronic conditions).
Hospital Stay: Must be admitted as an Inpatient and confined to the Hospital, due to a Covered Injury or Covered Illness, at the direction and under the care of a physician. If also eligible for the ICU Stay Benefit, only 1 benefit will be paid for the same Covered Injury or Covered Illness, whichever is greater. Hospital stays within 30 days for the same or a related Covered Injury or Covered Illness is considered one Hospital Stay.
Intensive Care Unit (ICU) Stay: Must be admitted as an Inpatient and confined in an ICU of a Hospital, due to a Covered Injury or Covered Illness, at the direction and under the care of a physician. If also eligible for the Hospital Stay Benefit, only 1 benefit will be paid for the same Covered Injury or Covered Illness, whichever is greater. ICU stays within 30 days for the same or a related Covered Injury or Covered Illness is considered one ICU stay.
Hospital Observation Stay: Must be receiving treatment for a Covered Injury or Covered Illness in a Hospital, including an observation room, or ambulatory surgical center, for more than 24 hours on a non-inpatient basis and a charge must be incurred. This benefit is not payable if a benefit is payable under the Hospital Stay Benefit or Hospital Intensive Care Unit Stay Benefit.
Common Exclusions and Limitations
Exclusions:* In addition to any benefit-specific exclusion, benefits will not be paid for any Covered Injury or Covered Illness which is caused by or results from any of the following (unless otherwise provided for in the policy): • Intentionally self-inflicted injury, suicide or any attempted threat while sane or insane;
• Commission or attempt to commit a felony or an assault;
• Declared or undeclared war or act of war;• A Covered Injury or Covered Illness that occurs while on active duty service in the military, naval or air force of any country or international organization. Upon our receipt of proof of service, we will refund any premium paid for this time. Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days;
• Voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage (excludes WA residents);• Operating any type of vehicle while under the
influence of alcohol or any drug, narcotic or other intoxicant including any prescribed drug for which the Covered Person has been provided a written warning against operating a vehicle while taking it. “Under the influence of alcohol”,for purposes of this exclusion, means intoxicated, as defined by the law of the state in which the Covered Injury or Covered Illness occurred. (excludes WA residents);• Those not necessary, as determined by Us in accordance with generally accepted standards of medical practice, for the diagnosis, care or treatment of the physical or mental condition involved. This applies even if they are prescribed, recommended, or approved by the attending physician;• Elective or cosmetic surgery. This does not include reconstructive, cosmetic surgery:
a) incidental to or following surgery for trauma, infection or other disease of the involved part; or b) due to congenital disease or anomaly of a Covered Dependent child which has resulted in a functional defect;• Dental surgery, unless the surgery is the result of an accidental injury. In addition, benefits will not be paid for services or treatment rendered by a Physician, Nurse or any other person who is: employed or retained by the Subscriber or providing homeopathic, aroma- therapeutic or herbal therapeutic services or living in the Covered Person’s household or a parent, sibling, spouse or child of the Covered Person.
Policy Provisions
When your coverage begins: Coverage begins on the later of the program’s effective date, the date you become eligible, the first of the month following the date your completed enrollment form is received or if evidence of insurability is required, the first of the month after we have approved you (or your dependent) for coverage in writing unless otherwise agreed upon by Cigna. Your coverage will not begin unless you are actively at work on the effective date. Coverage for Covered Persons will not begin on the effective date if the covered person is confined to a hospital, facility or at home; disabled or receiving disability benefits or unable to perform activities of daily living. Deferral of the effective date will not apply to the Newborn Nursery Care Admission and Stay Benefit.
When your coverage ends: Coverage for any Covered Person ends on the earliest of the date they 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 Spouse and Dependent Child(ren), if applicable, 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 if you stop working. Be sure to read the Continuation of Insurance provisions in your Certificate.
Mansfield ISD Staff Clinic
ABOUT MANSFIELD ISD STAFF CLINIC
The Mansfield ISD Staff Clinic is a low-cost, convenient health clinic for district employees, spouses and dependents.
For full plan details, please visit your benefit website: www.mybenefitshub.com/mansfieldisd
About the Clinic
Address: 252 Matlock Rd., Suite #130, Mansfield, TX 76063
Phone: (682) 242-8991
The MISD staff clinic, located inside Methodist Family Health Center, is a walk-in clinic meaning employees do not schedule specific appointment times. In December 2019, the clinic began offering call ahead scheduling with limited space availability.
Employees and their dependents can try calling ahead for an appointment or visit the clinic. Clinic personnel will inform the patient of a time to be seen by a provider based upon the number of patients being taken that day. Walk-in patients will then have the option to wait at the clinic to be seen by a provider or return to the clinic at the time designated by the clinic personnel. Occasionally, due to medical personnel availability, there will be days in which not all employees desiring to be seen will be able to visit a medical provider that same day.
Hours of Operation
Monday - Friday | Noon - 7:30 p.m. Offices are closed daily from 3:00 p.m. - 4:00 p.m.
(NOTE: Hours are subject to change with limited notice. It is always a good idea to call ahead before visiting the clinic. The clinic is closed on major holidays.)
Your benefits include reliable 24/7 health care by phone or video. Our national network of board-certified doctors provides personalized care for hundreds of medical and mental health needs. No surprise costs. No hassle. Just create an account to enroll.
URGENT CARE
On-demand care for illness and injuries.
Talk to a board-certified doctor in just minutes when you need care fast, including prescriptions.
Reliable and affordable alternative to urgent care clinics for more than 80 common, non-emergency conditions like flu, sinus infections, ear pain, and UTIs (Females, 18+).
MENTAL HEALTH
Talk therapy and psychiatry from the privacy of home.1
Licensed therapists and board-certified psychiatrists.
Schedule your appointment in as little as five days with after-hours and flexible sessions available.
STEP 2: REQUEST AN APPOINTMENT.
Have an urgent care appointment right away, or schedule a time that works for you.
STEP 3: FEEL BETTER FASTER.
Get a diagnosis, treatment plan, and prescriptions, when appropriate, sent right to your preferred pharmacy.1
Dental Insurance
ABOUT DENTAL
Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease.
For full plan details, please visit your benefit website: www.mybenefitshub.com/mansfieldisd
IMPORTANT HIGHLIGHTS
• This Patient Charge Schedule applies only when covered dental services are performed by your Network Dentist, unless otherwise authorized by Cigna Dental as described in your plan documents. Not all Network Dentists perform all listed services, and it is suggested to check with your Network Dentist in advance of receiving services.
• This Patient Charge Schedule applies to Specialty Care when an appropriate referral is made to a Network Specialty Periodontist or Oral Surgeon. You should verify with the Network Specialty Dentist that your treatment plan has been authorized for payment by Cigna Dental. Prior authorization is not required for specialty referrals for Pediatric, Orthodontic and Endodontic services. You may select a Network Pediatric Dentist for your child under the age of 7 by calling Customer Service at 1.800.Cigna24 to get a list of Network Pediatric Dentists in your area. Coverage for treatment by a Pediatric Dentist ends on your child’s 7th birthday; however, exceptions for medical reasons may be considered on an individual basis Your Network General Dentist will provide care upon your child’s 7th birthday.
• Procedures not listed on this Patient Charge Schedule are not covered and are the patient’s responsibility at the dentist’s usual fees. ›~The administration of IV sedation, general anesthesia, and/or nitrous oxide is not covered except as specifically listed on this Patient Charge Schedule. The application of local anesthetic is covered as part of your dental treatment.
• Cigna Dental considers infection control and/or sterilization to be incidental to and part of the charges for services provided and not separately chargeable.
• This Patient Charge Schedule is subject to annual change in accordance with the terms of the group agreement.
• Procedures listed on the Patient Charge Schedule are subject to the plan limitations and exclusions described in your plan book/certificate of coverage and/or group contract.
• All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated.
• The American Dental Association may periodically change CDT Codes or definitions. Different codes may be used to describe these covered procedures. The language in italics is intended to clarify the members’ benefit.
After your enrollment is effective:
Call the dental office identified in your Welcome Kit. If you wish to change dental offices, a transfer can be arranged at no charge by calling Cigna Dental at the toll free number listed on your ID card or plan materials. Multiple ways to locate a (*DHMO) Network General Dentist:
• Online provider directory at Cigna.com
• Online provider directory on myCigna.com
• Call the number located on your ID card to: ◊ Use the Dental Office Locator via Speech Recognition ◊ Speak to a Customer Service Representative
EMERGENCY:
If you have a dental emergency as defined in your group’s plan documents, contact your Network General Dentist as soon as possible. If you are out of your service area or unable to contact your Network Office, emergency care can be rendered by any dental office, dental clinic, or other comparable facility. Definitive treatment (e.g., root canal) is not considered emergency care and should be performed or referred by your Network General Dentist. Consult your group’s plan documents for a complete definition of dental emergency, your emergency benefit and a listing of Exclusions and Limitations.
Dental Insurance
Class II: Basic Restorative Fillings, Oral Surgery and more*
Class III: Major Restorative Inlays and
*For more information on coverage, please review the plan information at www.mybenefitshub.com/mansfieldisd
Vision Insurance Davis Vision
ABOUT VISION
Vision insurance provides coverage for routine eye examinations and can help with covering some of the costs for eyeglass frames, lenses or contact lenses.
For full plan details, please visit your benefit website: www.mybenefitshub.com/mansfieldisd
Frequency
Exam: 12 months
Lenses & lens upgrades: 12 months
Frame: 12 months
Contacts, evaluation & fitting: 12 months
Sign up during open enrollment – for more details about the plan, visit davisvision.com/member and enter your Client Code or call (877) 923-2847 and enter your Client Code when prompted.
Exams and Services
Eye Exam Copay: $10
Contacts evaluations, fitting and follow up:
• Collection Lens: Covered in full
• Non-Collection Lens: $0 copay Plus 15% savings
• Lens copay: $25
Frame
• VisionWorks: $200 + Additional 20% off any overage
• Other Locations: $150 + Additional 20% off any overage
-or-
The Exclusive Collection copay
• Fashion: Covered in full
• Designer: Covered in full
• Premier: Covered in full
Contacts
$150 + Additional 15% off any overage
-or-
The Exclusive Collection of Contact Lenses: Covered in Full
Using Your Client Code: Log in using your client code (Mansfield ISD Client Code: 7511) at davisvision.com/member to find a list of in-network providers near you and access your benefit information.
The Exclusive Collection: The Exclusive Collection of frames is available at nearly 9,000 locations across the U.S. Log in to browns frames, and find a Collection near you.
Free Breakage Warranty: Your glasses are covered with our FREE on-year breakage warranty. Some limitations apply.
Find a network provider…Enter your client code in the “Member Sign In” section of our website at davisvision.com/member to locate a provider near you including Visionworks.
Options & upgrades
Lens options
Clear plastic single-vision, bifocal, trifocal or lenticular lenses (any RX)
Polycarbonate Lenses (Children / Adults)
High-Index Lenses 1.67
High-Index Lenses 1.74
Polarized Lenses
Progressive Lenses
(Standard / Premium / Ultra / Ultimate)
$0
$0 or $30
$55
$120
$75
$50 / $90 / $140 / $175
Anti-Reflective (AR) Coating
(Standard / Premium / Ultra / Ultimate)
$35 / $48 / $60 / $85
Ultraviolet Coating
$12
Tinting of Plastic Lenses (Solid / Gradient) $0
Plastic Photochromic Lenses (Transitions® Signature™) $65
Scratch-Resistant Coating $0
Premium Scratch-Resistant Coating $30
Scratch-Protection Plan (Single-Vision/Multifocal) $20 | $40
Trivex Lenses $50
Blue Light Filtering
Vision Insurance Davis Vision
Additional savings
Retinal imaging (Member charge) $39
Additional pairs of eyeglasses 30% discount2
Out-of-network benefits
You may receive services from an out-of-network provider, although you will receive the greatest value and maximize your benefit dollars if you select a provider who participates in the network.
Out-of-network reimbursement schedule (up to)
• Eye Examination: $40
• Frame: $70
• Single-Vision Lenses: $40
• Bifocal / Progressive Lenses: $60
• Trifocal Lenses: $80
• Lenticular Lenses: $100
• Elective Contact Lenses: $105
• Visually Required Contacts: $225
1. Excludes Maui Jim® eyewear.
2. Some limitations apply to additional discounts; discounts not applicable at all in-network providers.
3. Contact lens coverage varies by product selection. Visually Required contacts are covered in full with prior approval.
4. The Davis Vision Exclusive Collection of Contact Lenses is available at participating providers. Evaluation, fitting and follow-up care for Collection contacts are covered in full. Davis Vision has done its best to accurately reflect plan coverage herein. If differences exist between this document and the plan contract, the contract will prevail. all in-network providers. 3. Contact lens coverage varies by product selection. Visually Required contacts are covered in full with prior approval. 4. The Davis Vision Exclusive Collection of Contact Lenses is available at participating providers. Evaluation, fitting and follow-up care for Collection contacts are covered in full. Davis Vision has done its best to accurately reflect plan coverage herein. If differences exist between this document and the plan contract, the contract will prevail.
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: www.mybenefitshub.com/mansfieldisd
Educator Disability Insurance Overview
What is Educator Disability
Income Insurance?
Educator Disability insurance combines the features of a shortterm and long-term disability plan into one policy. The coverage pays you a portion of your earnings if you cannot work because of disabling illness or injury. The plan gives you the flexibility to choose a level 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 disability.
• The average worker faces a 1 in 3 chance of suffering a job loss lasting 90 days or more due to a disability
• 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 income.
Eligibility and Enrollment
Eligibility
You are eligible if you are an active employee who works at least 18 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 $7,500 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 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
Partial Disability
Partial Disability is covered provided you have at least a 20% loss of earnings and duties of your job.
Other Important Benefits
Survivor Benefit - If you die while receiving disability benefits, a benefit will be paid to your spouse or child under age 26, equal to three times your last monthly gross benefit.
The Hartford’s Ability Assist service is included as a part of your group Long Term Disability (LTD) insurance program. You have access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD benefits. Once you are covered you are eligible for services to
Disability Insurance The Hartford
provide assistance with child/elder care, substance abuse, family relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist them with the unique emotional, financial and legal issues that may result from a disability. Ability Assist services are provided through
ComPsych®, a leading provider of employee assistance and work/ life services.
Travel Assistance Program – Available 24/7, this program provides assistance to employees and their dependents who travel 100 miles from their home for 90 days or less. Services include pre-trip information, emergency medical assistance and emergency personal services.
Identity Theft Protection – An array of identity fraud support services to help victims restore their identity. Benefits include 24/7 access to an 800 number; direct contact with a certified caseworker who follows the case until it’s resolved; and a personalized fraud resolution kit with instructions and resources for ID theft victims.
Workplace Modification provides for reasonable modifications made to a workplace to accommodate your disability and allow you to return to active full-time employment.
Provisions of the Plan
Definition of Disability
Disability is defined as The Hartford’s contract with your employer. Typically, disability means that you cannot perform one or more of the essential duties of your occupation due to injury, sickness, pregnancy or other medical conditions covered by the insurance, and as a result, your current monthly earnings are 80% or less of your pre-disability earnings.
One you have been disabled for 24 months, you must be prevented from performing one or more essential duties of any occupation, and as a result, your monthly earnings are 66 2/3% or less of your pre-disability earnings.
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.
Continuity of Coverage
If you were insured under your district’s prior plan and not receiving benefits the day before this policy is effective, there will not be a loss in coverage, and you will get credit for your prior carrier’s coverage.
Recurrent Disability - What happens if I Recover but become Disabled again?
Periods of Recovery during the Elimination Period will not interrupt the Elimination Period, if the number of days You return to work as an Active Employee are less than one-half (1/2) the number of days of Your Elimination Period.
Any day within such period of Recovery, will not count toward the Elimination Period.
Benefit Integration
Your benefit may be reduced by other income your receive or are eligible to receive due to your disability, such as: Social Security Disability Insurance, State Teacher Retirement Disability plans, Worker’s Compensation, Other employer-based disability insurance coverage you may have, unemployment benefits, retirement benefits that your employer fully or partially pays for (such as a pension plan), etc.
Group Cancer Insurance
HELP COVER COSTS ASSOCIATED WITH THE DETECTION AND TREATMENT OF CANCER
Even the best major medical insurance probably doesn’t cover all the out-of-pocket costs related to cancer treatment. APL’s Cancer Insurance* may help cover some of the expenses related to the treatment of covered cancer, daily living expenses and routine cancer screenings to help with early detection.
For full plan details, please visit your benefit website: www.mybenefitshub.com/sampleisd
www.mybenefitshub.com/mansfieldisd
IMAGINE
You or a loved one is diagnosed with cancer
for the best treatment
11 of 12 cancer drugs approved by the FDA in 2012 were priced at more than $100,000 per year. 2
Group Cancer Insurance
American Public Life (APL)
If you or a family member are diagnosed with cancer, APL’s Cancer Insurance may help cover the costs associated with the detection and treatment of cancer and help you be more financially prepared.
How it works
CHOOSE the benefit options that best protect you and your family.
RECEIVE treatment for a covered benefit.
FILE your claim online or mail it in.
Benefits may help pay expenses related to cancer and routine screenings
With Cancer Insurance, you may be covered for:
Radiation Therapy, Chemotherapy, Immunotherapy
Experimental Treatments
Prescriptions
Transportation Benefits and more Plus, plan options are available to cover you, your spouse or your child(ren).
Your plan may Include the following options
• Surgical Benefit Rider provides: Anesthesia, Skin Cancer, Reconstructive Surgery, Bone Marrow and Stem Cell Transplant benefits and more
• Patient Care Benefit Rider provides: Hospital Confinement, Outpatient Facility, Extended Care Facility, Donor Benefits, Home Health Care, Hospice benefits and more
• Miscellaneous Benefit Rider offers: Second/Third surgical opinion, drugs and medicine, patient and family transportation, blood, plasma and platelets and more
• Internal Cancer First Occurrence Optional Benefit Rider
• Heart Attack/Stroke Optional Rider
• ICU Optional Rider
A Hospital is a place that is not an institution, or part thereof, used as a place for rehabilitation, a place for rest or for the aged, a nursing or convalescent home, a longterm nursing unit of geriatrics ward, or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients.
If the cancer insurance premium is paid on a pre-tax basis, the benefit may be taxable. Please contact your tax or legal advisor regarding tax treatment of your policy benefits.
Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. This product contains Limitations, Exclusions and Waiting Periods. For complete benefits and other provisions, please refer to your policy/certificate. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines.
*This Cancer Policy provides limited benefits. Underwritten by American Public Life Insurance Company.
Accident Insurance
Voya Financial
ABOUT ACCIDENT
Accident Insurance pays you benefits for specific injuries and events resulting from a covered accident that occurs on or after your coverage effective date. The amounts paid depend on the type of injury and care received. Accident Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.
For full plan details, please visit your benefit website: www.mybenefitshub.com/mansfieldisd
Have you ever dislocated a joint or gotten a deep cut?
How about something more severe, like a concussion or broken bone? Most of us have experienced an accident that needed medical attention at least once in our lives. In these situations, your injuries may keep you from performing normal activities, like cooking, cleaning, or even working. Then there are the medial costs because of your injury, which are piled on to your everyday expenses. Accident Insurance can help minimize the financial impact of an accident.
What types of benefits are available?
The following list is an example summary of the benefits provided by Accident Insurance. Benefit types and amounts are determined by the plan selected, the circumstances of your accident and the care you receive. You may be required to seek care for your injury within a set amount of time and you may be required to be insured under the policy for a specified amount of time before benefits are payable. For a complete description of your available benefits, exclusions, and limitations, see your certificate of insurance.
• Surgery
• Blood, plasma, platelets
• Hospital Admission
• Hospital Confinement
• Coma
• Transportation
• Medical Equipment
• Physical therapy
• Prosthetic Device
• Burns
• Concussion
How can Accident Insurance Help?
You can use the benefit however you like. Below are a few examples of how you can use your benefit:
• Medical deductibles and copays
• Child care
• House cleaning
• Everyday expenses like utilities and groceries
• Torn knee cartilage
• Lacerations / sutures
• Ruptured disk surgical repair
• Tendon, ligament, or rotator cuff surgical repair
• Paralysis
• Dislocations
• Fractures
• Eye Injury
Why should I enroll through my employer?
Premium amounts are deducted from your paycheck, so you don’t have to worry about paying another bill.
Are there any exclusions or limitations?
See the certificate of insurance and riders for a complete list of available benefits, exclusions, and limitations.
Are you ready to file a claim? Submitting a claim is as easy as 1,2,3
This is a summary of benefits only. A complete description of benefits, limitations, exclusions, and termination of coverage will be provided in the certificate of insurance and riders. All coverage is subject to the terms and conditions of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern. To keep coverage in force, premiums are payable up to the date of coverage termination. Critical Illness Insurance is underwritten by ReliaStar Life Insurance Company (Minneapolis, MN), a member of the Voya® family of companies. Policy form #RL-CI4-POL-16; Certificate form #RL-CI4-CERT-16. Form numbers, provisions and availability may vary by state.
Critical Illness Insurance
Voya Financial
ABOUT CRITICAL ILLNESS
Critical Illness Insurance pays a lump-sum benefit if you are diagnosed with a covered illness or condition. Critical Illness Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.
For full plan details, please visit your benefit website: ww w.mybenefitshub.com/mansfieldeisd
Do you know someone who has had a serious illness like a heart attack, cancer or a stroke?
When faced with a critical illness, the emotions and finances associated with it can be stressful. From thoughts of your loved ones and their financial future to the changes you need to make towards your own recovery, how you will pay for unexpected medical bills and every day expenses should be the least of your worries. Critical Illness Insurance offers financial protection for you and your family during the difficult and confusing time following the diagnosis of serious illness or condition.
What types of benefits are available?
The following list is an example summary of the benefits provided by Critical Illness Insurance. Benefit modules and amounts are determined by your employer’s plan offerings. For a complete description of your available benefits, exclusions, and limitations, see your certificate of insurance.
How can Critical Illness Insurance Help?
You can use the benefit however you would like. Below are a few examples of how you can use your benefit:
• Medical deductibles and copays
• Child care
• House cleaning
• Everyday expenses like utilities and groceries
Critical Illness Insurance
Is Critical Illness Insurance guaranteed?
Yes. This is guaranteed issue coverage. Pre-existing conditions may apply.
Why should I enroll through my employer?
Premium amounts are deducted from your paycheck, so you don’t have to worry about paying another bill.
Are there any exclusions or limitations?
Benefits are not payable for any critical illness resulting from a pre-existing condition if the date of diagnosis for the critical illness occurs during a pre-determined amount of time (ex: the first 6 or 12 months) following the insured person’s coverage effective date (varies by employer’s plan offerings). Pre-existing condition means a sickness, injury, or physical condition which, within the predetermined time period prior to the insured person’s coverage effective date, resulted in the insured person receiving medical treatment, consultation, care or services (including diagnostic measures).
Are you ready to file a claim? Submitting a claim is as easy as 1,2,3
This is a summary of benefits only. A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the certificate of insurance and riders. All coverage is subject to the terms and conditions of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern. To keep coverage in force, premiums are payable up to the date of coverage termination. Critical Illness Insurance is underwritten by ReliaStar Life Insurance Company (Minneapolis, MN), a member of the Voya® family of companies. Policy form #RL-CI4-POL-16; Certificate form #RL-CI4-CERT-16. Form numbers, provisions and availability may vary by state.
Voluntary Life and AD&D OneAmerica
ABOUT LIFE AND AD&D
Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family.
Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.
For full plan details, please visit your benefit website: www.mybenefitshub.com/mansfieldisd
Flexible Options:
• Employee: $10,000 to $500,000, in $10,000 increments
• Spouse: $10,000 to $250,000, in $5,000 increments, not to exceed 100% of the employee’s amount
Guaranteed Issue:
• Employee: $200,000
• Spouse: $50,000
• Child: $10,000
Dependent Life Coverage: Optional dependent life coverage is available to eligible employees. You must select employee coverage in order to cover your spouse and/or child(ren).
Accelerated Life Benefit: If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose.
Reductions: Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule. The amounts of dependent life insurance will reduce according to the employee's reduction schedule.
What you need to know about your Voluntary AD&D Benefits
Flexible AD&D Options:
• Employee: Up to $500,000, in $10,000 increments
• Spouse: 50% of the employee AD&D benefit
• Child: 10% of the employee AD&D benefit
AD&D Guaranteed Issue:
• Employee: $500,000
• Spouse: $250,000
• Child: $50,000
Accidental Death and Dismemberment (AD&D) : If AD&D is selected, additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as
defined in the contract.
Dependent AD&D Coverage: Optional dependent AD&D coverage is available to eligible employees. You must select employee coverage in order to cover your spouse and/or child(ren). If employee AD&D is declined, no dependent AD&D will be included.
Reductions: Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule. The amounts of dependent AD&D principal sum will reduce according to the employee’s reduction schedule.
Family Protection Plan
5Star Life Insurance Company
Individual and Group Term Life Insurance with Terminal Illness coverage to age 121
including Quality of Life benefit
Enhanced coverage options for employees.
Easy and flexibile enrollment for employers.
The 5Star Life Insurance Company’s Family Protection Plan offers both Individual and Group products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your employees.
CUSTOMIZABLE
With several options to choose from, employees select the coverage that best meets the needs of their families.
TERMINAL ILLNESS ACCELERATION OF BENEFITS
Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL).
PORTABLE
Coverage continues with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly.
CONVENIENCE
Easy payments through payroll deduction.
FAMILY PROTECTION
Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves.
* Financially dependent children 14 days to 23 years old.
PROTECTION TO COUNT ON
Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two-year contestability period and/or under investigation. This coverage has no war or terrorism exclusions.
QUALITY OF LIFE
Optional benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following:
• Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or
• Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.
*Quality of Life not available ages 66-70. Quality of Life benefits not available for children.
Sick Leave Bank
For full plan details, please visit your benefit website: www.mybenefitshub.com/mansfieldisd
Section I Purpose and Definition
The purpose of the Sick Leave Bank (SLB) is to provide additional paid sick leave days for members of the Bank who have exhausted all available paid leave in the event of the catastrophic illness or injury of the employee or the employee’s immediate family member. Immediate family member is defined as the employee’s spouse, dependent children, and the employee’s parents.
Section II Membership
Eligibility is limited to all full-time personnel of the Mansfield Independent School District. Full-time shall be defined as thirty or more hours of duty per week.
Application for membership must be made during the open enrollment period prior to September 1 or within 30 days of employment.
An employee must be able to donate two (2) local leave days to become a member. Their application for membership in the Bank will become active when the two (2) days are earned. If a member uses any days during the Bank year, he/she will be required to remain a member the next Bank year and two (2) local days will be subtracted from their leave balance.
If the number of days in the bank falls below the number of SLB members, each member will be required to contribute one (1) extra day at the beginning of the next SLB year.
The Sick Leave Bank year runs from September 1 until August 31 of the following year.
The Sick Leave Bank Committee will determine whether the request for sick leave days is approved or denied in accordance with the SLB Guidelines and Procedures.
For additional information, review the MISD Sick Leave Bank Guidelines and Procedures.
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. This money is use it or lose it within the plan year.
For full plan details, please visit your benefit website: www.mybenefitshub.com/mansfieldisd
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 have the option to enroll in both a HSA and 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.
Higginbotham Benefits Debit Card
The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB).
Dependent Care FSA
The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Depend ent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full-time student.
Things to Consider Regarding the Dependent Care FSA
• Overnight camps are not eligible for reimbursement (only day camps can be considered).
• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
• You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
Flexible Spending Accounts
Higginbotham
Important FSA Rules
•The maximum per plan year you can contribute to a Health Care FSA is $3,200. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately.
• You cannot change your election during the year unless you experience a Qualifying Life Event.
• In most cases, you can continue to file claims incurred during the plan year for another 90 days after the plan year ends.
• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
•The IRS has amended the “use it or lose it rule” to allow you to carry-over up to $500 in your Health Care FSA into the next plan year for eligible employers. The carry-over rule does not apply to your Dependent Care FSA.
•Review your employer's Summary Plan Document for full details. FSA rules vary by employer.
Over-the-Counter Item Rule Reminder
Health care reform legislation requires that certain over-the-counter (OTC) items require a prescription to qualify as an eligible Health Care FSA expense. You will only need to obtain a one-time prescription for the current plan year. You can continue to purchase your regular prescription medications with your FSA debit card. However, the FSA debit card may not be used as payment for an OTC item, even when accompanied by a prescription.
Higginbotham Portal
The Higginbotham Portal provides information and resources to help you manage your FSAs.
• Access plan documents, letters and notices, forms, account balances, contributions and other plan information
• Update your personal information
• Utilize Section 125 tax calculators
• Look up qualified expenses
• Submit claims
• Request a new or replacement Benefits Debit Card
Register on the Higginbotham Portal
Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information.
•Enter your Employee ID, which is your Social Security number with no dashes or spaces.
•Follow the prompts to navigate the site.
•If you have any questions or concerns, contact Higginbotham:
∗ Phone – 866-419-3519
∗ Questions – flexsupport@higginbotham.net
∗ Fax – 866-419-3516
∗ Claims- flexclaims@higginbotham.net
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 Mansfield 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 Mansfield 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.