2024-25 Shallowater ISD Benefit Guide

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09/01/2024 - 8/31/2025

Benefit Contact Information

Higginbotham Public Sector (800) 583-6908

www.mybenefitshub.com/shallowaterisd

Cigna Group #3335912 (800) 244-6224

www.cigna.com

American Public Life Group #13016 (800) 256-8606 www.ampublic.com

New York Life Group #SGM-603455 (800) 244-6224 www.cigna.com

(866) 355-5999 www.bcbstx.com/trsactivecare

Superior Vision Group #320250 (800) 507-3800

www.superiorvision.com

Blue Essentials (888) 378-1633 www.bcbstx.com/trshmo

American Public Life Group #13016 (800) 256-8606

www.ampublic.com

IDWatchdog (800) 774-3772 www.idwatchdog.com UNUM Group #125360 (866) 679-3054 www.unum.com

5Star Life Insurance Company (866) 863-9753 www.5starlifeinsurance.com

Higginbotham (866) 419-3519 www.higginbotham.net HEALTH SAVINGS ACCOUNT (HSA)

EECU (817) 882-0800 www.eecu.org

MASA (800) 423-3226 www.masamts.com

The Hartford Group #00094735 (866) 547-4205 www.thehartford.com

MDLIVE (888) 365-1663 https://www.mdlive.com/fbs

Voya Group #69511-4CCI (888) 238-4840 www.voya.com

Clever RX Group #1085 (800) 974-3135

https://partner.cleverrx.com/ shallowaterisd

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www.mybenefitshub.com/shallowaterisd

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CLICK LOGIN

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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.

Once confirmed, the Additional Security Verification page will list the contact options from your profile. Select either Text, Email, Call, or Ask Admin options to receive a code to complete the final verification step.

Enter the code that you receive and click Verify. You can now complete your benefits enrollment!

Annual Benefit Enrollment

Annual Enrollment

During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.

• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.

• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.

• Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.

New Hire Enrollment

All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

Q&A

Who do I contact with Questions?

For 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/ shallowaterisd. Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms section.

How can I find a Network Provider?

For benefit summaries and claim forms, go to the Shallowater ISD benefit website: www.mybenefitshub.com/shallowaterisd. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section.

When will I receive ID cards?

If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card.

If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.

Annual Benefit Enrollment

Section 125 Cafeteria Plan Guidelines

A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.

CHANGES IN STATUS

(CIS):

Marital Status

Change in Number of Tax Dependents

Change in Status of Employment Affecting Coverage Eligibility

Gain/Loss of Dependents’ Eligibility Status

Judgment/ Decree/Order

Eligibility for Government Programs

Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 31 days of your qualifying event and meet with your Benefit Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

QUALIFYING EVENTS

A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).

A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.

Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual’s eligibility under an employer’s plan includes commencement or termination of employment.

An event that causes an employee’s dependent to satisfy or cease to satisfy coverage requirements under an employer’s plan may include change in age, student, marital, employment or tax dependent status.

If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual’s plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.

Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.

Annual Benefit Enrollment

Employee Eligibility Requirements

Supplemental Benefits: Eligible employees must work 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-at-work on September 1, 2024 to be eligible for your new benefits.

Dependent Eligibility Requirements

Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.

Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.

Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Higginbotham Public Sector, or contact the insurance carrier for additional information on spouse eligibility.

FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse’s FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance.

Flexible Spending To age 26, IRS Legal Dependent Status

Dependent Flexible Spending To age 26, IRS Legal Dependent Status

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, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee’s enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.

If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your Benefit Office to request a continuation of coverage.

Description

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 Employee

Account Owner Individual Employer

Underlying Insurance Requirement

Minimum Deductible

Maximum Contribution

High deductible health plan

$1,600 single (2024)

Permissible Use Of Funds

None

$3,200 family (2024) N/A

$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).

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.

No. Access to some funds may be extended if your employer’s plan contains a 2 1/2-month grace period.

Does the account earn interest? Yes No

Portable? Yes, portable year-to-year and between jobs. No

Medical Insurance

ABOUT MEDICAL

Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis.

For full plan details, please visit your benefit website: www.mybenefitshub.com/shallowaterisd

Learn the Terms.

• Premium: The monthly amount you pay for health care coverage.

• Deductible: The annual amount for medical expenses you’re responsible to pay before your plan begins to pay.

• Copay: The set amount you pay for a covered service at the time you receive it. The amount can vary based on the service.

• Coinsurance: The portion you’re required to pay for services after you meet your deductible. It’s often a specified percentage of the costs; e.g., you pay 20% while the health care plan pays 80%.

• Out-of-Pocket Maximum: The maximum amount you pay each year for medical costs. After reaching the out-of-pocket maximum, the plan pays 100% of allowable charges for covered services.

Compare Prices for Common Medical Services

TRS contracts with HMOs in certain regions to bring participants in those areas additional options. HMOs set their own rates and premiums. They’re fully insured products who pay their own claims.

Blue Essentials - South Texas HMOSM Brought to you by TRS-ActiveCare

You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy

Blue Essentials - West Texas HMOSM Brought to you by TRS-ActiveCare

You can choose this plan if you live in one of these counties: Andrews, Armstrong, Bailey, Borden, Brewster, Briscoe, Callahan, Carson, Castro, Childress, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, Fisher, Floyd, Gaines, Garza, Glasscock, Gray, Hale, Hall, Hansford, Hartley, Haskell, Hemphill, Hockley, Howard, Hutchinson, Irion, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Llano, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, San Saba, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Winkler, Yoakum

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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).

www.mybenefitshub.com/shallowaterisd

For full plan details, please visit your benefit website: www.mybeneitshub.com/sampleisd

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 The Hartford

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/shallowaterisd

IS THIS COVERAGE HSA COMPATIBLE?

If you (or any dependent(s)) currently participate in a Health Saving Account (HSA) or if you plan to do so in the future, you should be aware that the IRS limits the types of supplemental insurance you may have in addition to a HSA, while still maintaining the tax- exempt status of the HSA. This plan design was designed to be compatible with Health Savings Accounts (HSAs). However, if you have or plan to open an HSA, please consult your tax and legal advisors to determine which supplemental benefits may be purchased by employees with an HSA.

WHO IS ELIGIBLE?

You, your spouse and child(ren) are eligible for coverage. Any child(ren) must be under age 26.

Hospital Indemnity

The Hartford

CAN I INSURE MY DOMESTIC OR CIVIL UNION PARTNER?

Yes. Any reference to “spouse” includes your domestic partner, civil union partner or equivalent, as recognized and allowed by applicable law.

AM I GUARANTEED COVERAGE?

This insurance is guaranteed issue coverage – it is available without having to provide information about your or your family’s health. All you have to do is elect the coverage to become insured.5

HOW DO I PAY FOR THIS INSURANCE?

Premiums will be automatically paid through payroll deduction, as authorized by you during the enrollment process. This ensures you don’t have to worry about writing a check or missing a payment.

WHEN CAN I ENROLL?

You may enroll during any scheduled enrollment period, within 31 days of the date you have a change in family status, or within 31 days of the completion of any eligibility waiting period established by your employer.

WHEN DOES THIS INSURANCE BEGIN?

The initial effective date of this coverage is September 1, 2024. Subject to any eligibility waiting period established by your employer, if you enroll for coverage prior to this date, insurance will become effective on this date. If you enroll for coverage after this date, insurance will become effective in accordance with the terms of the certificate (usually the first day of the month following the date you elect coverage).

You must be actively at work with your employer on the day your coverage takes effect. Your spouse and child(ren) must be performing normal activities and not be confined (at home or in a hospital/care facility), unless already insured with the prior carrier.

WHEN DOES THIS INSURANCE END?

This insurance will end when you or your dependent(s) no longer satisfy the applicable eligibility conditions, premium is unpaid, you are no longer actively working, you leave your employer, or the coverage is no longer offered.

CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO LONGER A MEMBER OF THIS GROUP?

Yes, you can take this coverage with you. Coverage may be continued for you and your dependent(s) under a group portability policy. Your spouse may also continue insurance in certain circumstances. This insurance coverage includes certain limitations and exclusions. The certificate details all provisions, limitations, and exclusions for this insurance coverage. A copy of the certificate can be obtained from your employer.

On-demand care for illness and injuries is part

of your health plan.

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Convenient and reliable care.

MDLIVE doctors have an average of 15 years of experience and can be reached 24/7 by phone or video.

Affordable alternative to urgent care clinics and the ER. MDLIVE treats 80+ common conditions like flu, sinus infections, pink eye, ear pain, and UTIs (Females, 18+). By talking to a doctor at home, you can avoid long waits and exposure to other sick people. Prescriptions.

Your MDLIVE doctor can order prescriptions1 to the pharmacy of your choice. MDLIVE can also share notes with your local doctor upon request.

MDLIVE cares for more than 80 common, non-emergency conditions, including: • Cough

• Sore Throat

Ear Pain

Headache • Prescriptions • Pink Eye • Sinus Problems

• UTI (Females, 18+)

• Yeast Infections

• And more

1Prescriptions are available at the physician’s discretion when medically necessary. A renewal of an existing prescription can also be provided when your regular physician is unavailable, depending on the type of medication.

Dental Insurance Cigna

ABOUT DENTAL

Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease.

For full plan details, please visit your benefit website: www.mybenefitshub.com/shallowaterisd

Class I: Diagnostic & Preventive Oral Evaluations

Prophylaxis: routine cleanings

X-rays: routine

X-rays: non-routine

Fluoride Application

Sealants: per tooth

Space Maintainers: non-orthodontic Emergency Care to Relieve Pain

Class II: Basic Restorative Restorative: fillings Endodontics: minor and major

Periodontics: minor and major

Oral Surgery: minor and major

Anesthesia: general and IV sedation Repairs: dentures

Class III: Major Restorative Inlays and Onlays

Prosthesis Over Implant

Crowns: prefabricated stainless steel / resin

Crowns: permanent cast and porcelain Bridges and Dentures

Oral Surgery: all except simple extractions

Class IV: Orthodontia

In-Network

Reimbursement: For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule.

Non-Network

Reimbursement: For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Reimbursable Charge. The MRC is calculated at the 90th percentile of all providers submitted amounts in the geographic area. The dentist may balance bill up to their usual fees.

Dental Insurance Cigna EMPLOYEE

How do I find an In-network Dentist? Visit: https:// hcpdirectory.cigna.com/ or call (800) 244-6224 to find an in-network dentist. Your network will be Cigna Dental Care DHMO.

Class I: Diagnostic & Preventive Oral Evaluations

Prophylaxis: routine cleanings

X-rays: routine

Fluoride Application

Sealants: per tooth

Space Maintainers: non-orthodontic

Emergency Care to Relieve Pain

Class II: Basic Restorative Restorative: fillings

Oral Surgery: simple extractions only

Anesthesia: general and IV sedation Repairs: Dentures

Denture Relines, Rebases and Adjustments

Class III: Major Restorative Inlays and Onlays

Prosthesis Over Implant

Crowns: prefabricated stainless steel/resin

Crowns: permanent cast and porcelain Bridges and Dentures

Oral Surgery: all except simple extraction

Anesthesia: general and IV sedation

Class IV: Orthodontia

Coverage for Dependent Children to age 19

$1,000

Class IX: Implants

DPPO Plan

Any amount over the Maximum Allowable Charge

In-Network Reimbursement: For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule.

Non-Network

Reimbursement: For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Allowable Charge. The dentist may balance bill up to their usual fees.

Late Entrant Limitation

Provision: Payment will be reduced by 50% for Class III services for 12 months for eligible members that are allowed to enroll in this plan outside of the designated open enrollment period. This provision does not apply to new hires.

Two levels of benefits are available with the DPPO plan: in-network and out-of-network. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services. You could pay more if you use an out-of-network provider.

How to Find a Dentist

Visit https://hcpdirectory.cigna.com/ or call (800) 244-6224 to find an in-network dentist.

How to Request a New ID Card

You can request your dental ID card by contacting Cigna directly at (800) 244-6224. You can also go to www.mycigna.com and register/login to access your account. In addition, you can download the “MyCigna” app on your smartphone and access your ID card right there on your phone.

Vision Insurance

Superior Vision

ABOUT VISION

Vision insurance helps cover the cost of care for maintaining healthy vision. Similar to an annual checkup at your family doctor, routine eyecare is necessary to ensure that your eyes are healthy and to check for any signs of eye conditions or diseases . Most plans cover your routine eye exam with a copay and provide an allowance for Frames or Contact Lenses.

For full plan details, please visit your benefit website: www.mybenefitshub.com/shallowaterisd

Superior Vision Customer Service 1-800-507-3800

An overview of your vision benefits

• In-network benefits available through network eye care professionals.

• Find an in-network eye care professional at superiorvision.com. Call your eye doctor to verify network participation.

• Obtain a vision exam with either an MD or OD.

• Flexibility to use different eye care professionals for exam and for eyewear.

• Access your benefits through our mobile app – Display member ID card – view your member ID card in full screen or save to wallet .

Our network is built to support you.

• We manage one of the largest eye care professional networks in the country .

• The network includes 50 of the top 50 national retailers . Examples include:

• In-network online retail Providers :

Additional discounts

Members may also receive additional discounts, including 20% off lens upgrades and 30% off additional pairs of glasses.*

Access to LASIK discounts

A LASIK discount is available to all covered members. Our Discounted LASIK services are administered by QualSight. Visit lasik.sv.qualsight.com to learn more.

Access to hearing aid discounts

Members save up to 40% on brand name hearing aids and have access to a nationwide network of licensed hearing professionals through Your Hearing Network.

*Discounts are provided by participating locations. Verify if their eye care professional participates in the discount feature before receiving service.

Vision plan benefits for Shallowater ISD

Not all providers participate in Superior Vision Discounts, including the member out-of-pocket features. Call your provider prior to scheduling an appointment to confirm if he/she offers the discount and member out-of-pocket features. The discount and member out-of-pocket features are not insurance. Discounts and member out-of-pocket are subject to change without notice and do not apply if prohibited by the manufacturer. Lens options may not be available from all Superior Vision providers/all locations.

Disability Insurance UNUM

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/shallowaterisd

Who is eligible?

You are eligible for Disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. The date you are eligible for coverage is the later of: the plan effective date; or the day after you complete the waiting period.

How can I apply for coverage?

To apply for coverage, complete your enrollment form by 9/1. If you were hired after 9/1, check with your plan administrator for your eligibility date, and complete your enrollment form within 31 days of that date.

What if I am out of work when insurance goes into effect?

Insurance will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

What is my monthly benefit amount?

You may purchase a monthly benefit in $100 units, starting at a minimum of $200, up to 66 2/3% of your monthly earnings rounded to the nearest $100, but not to exceed a monthly maximum benefit of $7,500.

Do I have to pay for coverage if I become disabled?

After you have received disability payments under the plan for 90 consecutive days, from that point forward you will not be required to pay premiums as long as you are receiving benefits.

What is considered a pre-existing condition?

You have a pre-existing condition if:

• You received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and

• The disability begins in the first 12 months after your effective date of coverage.

How long do I have to wait to receive benefits?

The elimination period is the length of time of continuous disability, due to sickness or injury, which must be satisfied before you are eligible to receive benefits. You may choose an Elimination Period (injury/sickness) of 0/7, 14/14, 30/30, 60/60, 90/90, or 180/180 days. If because of your disability, you are hospital confined as an impatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours (Applies to Elimination Periods of 30 days or less).

Disability Insurance UNUM

What is my Benefit Duration?

Your duration of benefits is based on the following:

Age at Disability Maximum Duration of Benefits

Less than age 60 To age 65, but not less than 5 years

Age 60 through 64 5 years

Age 65 through 69 To age 70, but not less than 1 year

Age 70 and over 1 year

When does my coverage end?

Your coverage under the policy ends on the earliest of the following:

• The date the policy or plan is cancelled

• The date you no longer are in an eligible group

• The date your eligible group is no longer covered

• The last day of the period for which you made any required contributions

• The last day you are in active employment except as provided under the covered layoff or leave of absence provision.

When would I be considered disabled?

You are disabled when Unum determines that due to your sickness or injury:

• you are unable to perform the material and substantial duties of your regular occupation; and

• you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury.

After 24 months of payments, you are disabled when Unum determines that due to the same sickness or injury:

• You are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.

• You must be under the regular care of a physician in order to be considered disabled.

The loss of a professional or occupational license or certification does not, in itself, constitute disability. You must be under the regular care of a physician. Unless the policy specifies otherwise, as part of the disability claims evaluation process, Unum will evaluate your occupation based on how it is normally performed in the national economy, not how work is performed for a specific employer, at a specific location, or in a specific region.

Group Cancer Insurance

American Public Life (APL)

HELP COVER COSTS ASSOCIATED WITH THE DETECTION AND TREATMENT OF CANCER

Even the best major medical insurance may not cover all the out-ofpocket 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/shallowaterisd

Why

buy

cancer insurance

IMAGINE

You or a loved one is diagnosed with cancer Travel for the best treatment Expenses for care Missed work X X X

? The 5-year relative survival rate for all cancers diagnosed is 69% 1

per

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. Policy Form GC14APL Series | Policy Form GC-3 series

*This Cancer Policy provides limited benefits.

Accidents can happen to anyone, anywhere. Even the best medical insurance may have deductibles, copays and co-insurance. APL’s Accident Insurance* may help protect against the high cost of a covered accidental injury.

Benefit funds are paid directly to you for expenses incurred as the result of a covered accident. And these funds can be used for medical and non-medical expenses as you recover, such as loss of income, rent/mortgage, utilities, childcare and more!

For full plan details, please visit your benefit website: www.mybenefitshub.com/sampleisd

www.mybenefitshub.com/shallowaterisd

Why buy accident insurance?

Whether you’re a weekend warrior or couch potato, accidents can happen.

EXPENSES ADD UP

LEADING CAUSE

Falls are the leading cause of injuryrelated medical consultations in 2021.¹

Group Accident Insurance

American Public Life (APL)

Accident Insurance may provide protection to help with the high cost of a covered accidental injury. From a simple physician’s office visit, to x-rays, ambulance transportation or an intensive care admission due to an accidental injury — unexpected expenses can add up.

How it works

CHOOSE the benefit options that best protect you and your family from a covered accident.

RECEIVE treatment for a covered accident.

FILE your claim online or mail it in. You'll receive a cash benefit to use however you wish.

Benefits may help pay expenses related to accidental injury and the associated costs

With Accident Insurance, you may be covered for:

Emergency Treatment

Follow-Up Treatment

Major Diagnostic Screening (MRI)

X-Ray

Emergency Dental Work - Crown/Extraction

Plus, plan options are available to cover you, your spouse or your child(ren).

Your plan may include the following

• Hospital Admission and Confinement, ICU Confinement, Rehabilitation Confinement and Physical, Occupational or Speech Therapy

• Injury and Treatment such as fractures, dislocations, lacerations and burns

• Transportation and Lodging including air and ground ambulance, family member lodging meals

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 long-term nursing unit of geriatrics ward, or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients.

If the accident 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.

This is not intended to be a complete description of the insurance coverage offered. While benefit amounts stated in this summary are specific to your coverage, other items may summarize our standard product features and not the specific features of your coverage. Provisions are provided in the certificate and this summary does not modify those provisions or the insurance in any way. This is not a contract. A certificate will be made available to you that describes the benefits in greater detail. Refer to your certificate for your maximum benefit amounts. Should there be a difference between this summary and the certificate, the certificate will govern.

Underwritten by American Public Life Insurance Company | This is a brief description of the coverage. This product contains limitations and exclusions. For complete benefits and other provisions, please refer to the policy/certificate. This is not a Medicare supplement policy. 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, union 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. | Policy Form GAO21APL Series | Policy

*This Accident Policy provides limited benefits. Underwritten by American Public Life Insurance Company.

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.

www.mybenefitshub.com/shallowaterisd

For full plan details, please visit your benefit website: www.mybenefitshub.com/sampleisd

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.

Life and AD&D

New York Life

ABOUT LIFE AND AD&D

Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family.

Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

For full plan details, please visit your benefit website: www.mybenefitshub.com/shallowaterisd

Under age 19 (or under age 26 if they are full-time students), as long as you apply for and are approved for coverage for yourself. Premium includes all eligible children.

Life and AD&D

New York Life

Basic and Voluntary Accidental Death & Dismemberment (AD&D)

Eligibility Active, full-time Employees of the Employer regularly working a minimum of 20 hours per week. Eligibility Waiting Period No waiting period.

Basic Accidental Death & Dismemberment (AD&D) – paid by your employer

Employee

Benefit Amount and Maximum

Benefit Reduction Schedule

Voluntary Accidental Death & Dismemberment (AD&D) – paid by you

Benefit Amount

Maximum

Employee

Spouse

Dependent Children

Benefit Reduction Schedule

$30,000

Benefits will reduce to 65% at age 70, 45% at age 75, 30% at age 80, and 20% at age 85.

Units of $10,000

$250,000

Benefits will reduce to 65% at age 70, 45% at age 75, 30% at age 80, and 20% at age 85.

Spouse is eligible provided that you apply for and are approved for coverage for yourself

Maximum

$250,000

Under age 19 (or under age 26 if they are full-time students), as long as you apply for and are approved for coverage for yourself.

Maximum

Guaranteed Coverage for Voluntary Term Life Insurance Coverage

Guaranteed Coverage Amount is the amount of coverage you can elect without answering any medical questions or taking a health exam.

Guaranteed Coverage is only available during Initial Enrollment and other times as approved. If you apply for coverage that is above the Guaranteed Coverage Amount, or if you are applying for coverage after 31 days after you become eligible, you must fill out a Medical Evidence of Insurability form. All dependent child benefits are guaranteed issue.

Accelerated Death Benefit – Terminal Illness If you or your spouse is diagnosed by two unaffiliated physicians as terminally ill with a life expectancy of 12 months or less, the benefit for terminal illness provides for up to 50% of the Basic Term Life Insurance coverage amount in-force and up to 50% of the Voluntary Term Life Insurance coverage amount in-force to be paid to the insured. This benefit is payable only once in the insured’s lifetime and will reduce the life insurance death benefit.

Continuation for Disability for Employees Aged 60 or over - If your active service ends due to disability, at age 60 or over, your coverage will continue while you are disabled. Benefits will remain in force until the earliest of: the date you are no longer disabled, the date the policy terminates, the date you are Disabled for 12 consecutive months, or the day after the last period for which premiums are paid. You are considered disabled if, because of injury or sickness, you are unable to perform all the material duties of your Regular Occupation, or you are receiving disability benefits under your Employer’s plan.

Extended Death Benefit - The extended death benefit ensures that if you become disabled prior to age 60, and die before it is determined if you qualify for Waiver of Premium, we will pay the life insurance benefit if you remain disabled during that period. If you qualify for this benefit and have insured your spouse or children, their coverage is also extended. No additional premium payment is required for the extended coverage. Waiver of Premium - If you are totally disabled prior to age 60 and can’t work for at least 9 months, you won’t need to pay premiums for your coverage while you are disabled, provided the insurance company approves you for this benefit. You are considered totally disabled when you are completely unable to engage in any occupation for wage or profit because of injury or sickness. This benefit will remain in force until age 65, subject to proof of continuing disability each year. If you qualify and have insured your spouse or children, their premium is also waived.

$10,000

Rehabilitation During a Period of Disability - If the insurance company determines that you are a suitable candidate for rehabilitation, the insurance company may require you to participate in an assessment and rehabilitation plan, not to exceed 18 months. A rehabilitation plan may consist of educational, vocational or physical rehabilitation or may include modified work or work on a part-time basis. If you refuse such assistance without good cause (a medical reason preventing participation, in whole or in part, in the rehabilitation plan), insurance under this plan will end.

When Your Coverage Begins and Ends -Coverage becomes effective on the later of the program’s effective date, the date you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. Your coverage will not begin unless you are actively at work on the effective date. Dependent coverage will not begin for any dependent who on the effective date is hospital or home confined; receiving chemotherapy or radiation treatment; or disabled and under the care of a physician. Coverage will continue while you and your dependents remain eligible, the group policy is in force, and required premiums are paid.

Conversion - If group life coverage ends (except due to nonpayment of premium), your employment is terminated, membership in an eligible class is terminated, or insurance coverage is reduced based on attained age, you can convert to an individual non-term policy. To convert, you must apply for the conversion policy and pay the first premium payment within 31 days after your group coverage ends. Dependents may convert their coverage as well. Premiums may change at this time, and terms of coverage will be subject to change.

Portability - If your employment is terminated and you are under age 70, you can continue your [employee-paid] life insurance on a directbill basis. Coverage may also be continued for your spouse/children. Premiums will increase at this time. Coverage can be continued to age 70, unless the insurance company terminates portability for all insured persons. Refer to your certificate for details.

No one is immune to identity theft.

Better Protect What Matters Most.

Identity theft can affect anyone—from infants to seniors. Each generation has habits that savvy criminals know how to exploit—resulting in over $43 billion lost to identity fraud in the U.S. in 2022. Take action with award-winning ID Watchdog identity theft protection.

Greater Peace of Mind

With ID Watchdog as an employee benefit, you have a more convenient and affordable way to help better protect and monitor your identity. You’ll be alerted to potentially suspicious activity and enjoy greater peace of mind knowing you don't have to face identity theft alone.

Why Choose ID Watchdog?

We scour billions of data points— public records, transaction records, social media and more—to search for signs of potential identity theft.

We've got you covered with lock features for added control over your credit report(s) to help keep identity thieves from opening new accounts in your name.

Awarded Best in Class

If you become a victim, you don’t have to face it alone. One of our certified resolution specialists will personally manage the case for you until your identity is restored.

Our family plan helps you better protect your loved ones with personalized accounts for adult family members, family alert sharing, and exclusive features for children.

Javelin Strategy & Research, "2023 Identity Fraud Study: The Butterfly Effect", Mar 2023. Refer to your employer or ID Watchdog for family plan eligibility.

Powerful Features Included in Both ID Watchdog Plans

Financial Accounts Monitoring

Social Accounts Monitoring

Registered Sex Offender Reporting

Blocked Inquiry Alerts | 1 Bureau

Customizable Alert Options

National Provider ID Alerts

Integrated Fraud Alerts

With a fraud alert, potential lenders are encouraged to take extra steps to verify your identity before extending credit.

Dark Web Monitoring

Data Breach Notifications

High-Risk Transactions Monitoring

Subprime Loan Monitoring

Public Records Monitoring

USPS Change of Address Monitoring

Telecom & Utility Alerts | 1 Bureau

Credit Score Tracker | 1 Bureau

Personalized Identity Restoration

including Pre-Existing Conditions

Online Resolution Tracker

Lost Wallet Vault & Assistance

Deceased Family Member Fraud

Remediation (Family Plan only)

Credit Freeze Assistance

Solicitation Reduction

Help better protect children with Equifax Child Credit Lock & Equifax Child Credit Monitoring PLUS features marked with this icon

Plan-Specific Features

Credit Report Monitoring

Credit Report(s) & VantageScore Credit Score(s)

Credit Report Lock

Subprime Loan Block

within the monitored lending network

Personal VPN and Password Manager

Device Security & Online Privacy

Personal Data Scans & Removal

to $1 Million Up to $1M Stolen Funds Reimbursement -

Essentials

to $1 Million Up to $1M Stolen Funds Reimbursement -

and savings accounts

Essentials Up to $2 Million Up to $2M Stolen Funds Reimbursement - Checking and savings accounts -401k/HSA/ESOP accounts

Home Title Fraud NEW Cyber Extortion

Professional Identity Fraud Deceased Family Member Fraud

What You Need to Know

The credit scores provided are based on the VantageScore 3.0 model. For three-bureau VantageScore credit scores, data from Equifax, Experian, and TransUnion are used respectively. Any one-bureau VantageScore uses Equifax data. Third parties use many different types of credit scores and are likely to use a different type of credit score to assess your creditworthiness.

(1)The Integrated Fraud Alert feature is made available to consumers by Equifax Information Services LLC and fulfilled on its behalf by Identity Rehab Corporation. (2)There is no guarantee that ID Watchdog is able to locate and scan all deep and dark websites where consumers' personal information is at risk of being traded. (3)The monitored network does not cover all businesses or transactions. (4)For low Family Plans, applicable for enrolled family members only. (5)Monitoring from Equifax will begin on your plan start date. TransUnion and Experian will take several days to begin after you create an online account. (6)Locking your Equifax or TransUnion credit report will prevent access to it by certain third parties. Locking your Equifax or TransUnion credit report will not prevent access to your credit report at any other credit reporting agency. Entities that may still have access to your Equifax or TransUnion credit report include: companies like ID Watchdog and TransUnion Interactive, Inc. which provide you with access to your credit report or credit score, or monitor your credit report as part of a subscription or similar service; companies that provide you with a copy of your credit report or credit score, upon your request; federal, state, and local government agencies and courts in certain circumstances; companies using the information in connection with the underwriting of insurance, or for employment, tenant or background screening purposes; companies that have a current account or relationship with you, and collection agencies acting on behalf of those whom you owe; companies that authenticate a consumer’s identity for purposes other than granting credit, or for investigating or preventing actual or potential fraud; and companies that wish to make pre approved offers of credit or insurance to you. To opt out of preapproved offers, visit www.optoutprescreen.com.

(7)Available for simultaneous use on up to 6 devices. (8)Equip up to 5 devices; 10 with a Family Plan. (10)May be subject to delay or change. To review ID Watchdog Terms & Conditions, go to idwatchdog.com/terms. (9)The Identity Theft Insurance is underwritten and administered by American Bankers Insurance Company of Florida, an Assurant company. Please refer to the actual policies for terms, conditions, and exclusions of coverage. Coverage may not be available in all jurisdictions. Review the Summary of Benefits (www.idwatchdog.com/terms/insurance).

Stay prepared with MASA® Access

Comprehensive coverage and care for emergency transport.

Our Emergent Plus membership plan includes:

Emergency Ground Ambulance Coverage1

Your out-of-pocket expenses for your emergency ground transportation to a medical facility are covered with MASA.

Emergency Air Ambulance Coverage1

Your out-of-pocket expenses for your emergency air transportation to a medical facility are covered with MASA.

Hospital to Hospital Ambulance Coverage1

When specialized care is required but not available at the initial emergency facility, your out-of-pocket expenses for the ground or air ambulance transfer to the nearest appropriate medical facility are covered with MASA.

Repatriation Near Home Coverage1

Should you need continued care and your care provider has approved moving you to a hospital nearer to your home, MASA coordinates and covers the expense for ambulance transportation to the approved medical facility.

Did you know?

51.3 million emergency responses occur each year

MASA protects families against uncovered costs for emergency transportation and provides connections with care services.

Source: NEMSIS, National EMS Data Report, 2023

About MASA

MASA is coverage and care you can count on to protect you from the unexpected. With us, there is no “out-of-network” ambulance. Just send us the bill when it arrives and we’ll work to ensure charges are covered. Plus, we’ll be there for you beyond your initial ride, with expert coordination services on call to manage complex transport needs during or after your emergency — such as transferring you and your loved ones home safely.

Protect yourself, your family, and your family’s financial future with MASA.

Stay prepared with MASA®

protects families against out-of-pocket costs for emergency transportation and provides connections with care. Gain peace of mind and shield your finances knowing there’s a MASA plan best suited for your needs.

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/sampleisd

www.mybenefitshub.com/shallowaterisd

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

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 - 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 Shallowater 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 Shallowater 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.

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