2024 Plan Year
FRENSHIP ISD
BENEFIT GUIDE EFFECTIVE: 01/01/2024 - 12/31/2024 WWW.MYBENEFITSHUB.COM/FRENSHIPISD
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Table of Contents How to Enroll
4-5
Annual Benefit Enrollment
6-11
1. Annual Enrollment
6
2. Section 125 Cafeteria Plan Guidelines
7
3. Helpful Definitions
8
4. Eligibility Requirements
9
5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA)
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Hospital Indemnity
2
11-12
Health Savings Account (HSA)
13
Telehealth
14
Dental
15
Vision
16
Disability
17-19
Cancer
20-21
Emergency Medical Transportation
22
Accident
23
Life and AD&D
24
Flexible Spending Account (FSA)
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HOW TO ENROLL
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SUMMARY PAGES
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YOUR BENEFITS
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Benefit Contact Information FRENSHIP ISD BENEFITS
MEDICAL BROKER
HOSPITIAL INDEMNITY
Frenship ISD Benefits Department (806) 866-9541 www.frenship.net HEALTH SAVINGS ACCOUNT (HSA)
Marsh & McLennan (806) 798-9050 charlene.hack@marshmma.com TELEHEALTH
The Hartford Group # VHI-888093 (866) 547-4205 www.thehartford.com DENTAL
HSA Bank (800) 357-6246 www.hsabank.com VISION
HealthiestYou (866) 703-1259 www.healthiestyou.com DISABILITY
Marsh & McLennan (972) 608-7300 MGMClaims@higginbotham.net CANCER
Superior Vision Group #31311 (800) 507-3800 www.superiorvision.com LIFE AND AD&D
The Hartford Group #681131 (866) 547-9124 www.thehartford.com ACCIDENT
Loyal American Group #LG-6040 (800) 366-8354
OneAmerica Group #00616354 (800) 553-3522 www.oneamerica.com FLEXIBLE SPENDING ACCOUNT (FSA)
American Public Life (800) 256-8606 www.ampublic.com
EMERGENCY MEDICAL TRANSPORTATION MASA (800) 643-9023 www.masamts.com
National Benefit Services (855) 399-3035 www.nbsbenefits.com
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All Your Benefits One App Employee benefits made easy through the FBS Benefits App! Text “FBS FRENSHIP” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment:
Text “FBS FRENSHIP” to (800) 583-6908
• Benefit Resources • Online Enrollment • Interactive Tools • And more!
App Group #: FBSFRENSHIP
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OR SCAN
How to Log In 1
www.mybenefitshub.com/frenshipisd
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CLICK LOGIN
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ENTER USERNAME & PASSWORD Your Username Is: Your email in THEbenefitsHUB. (Typically your work email) If you HAVE NOT logged in since the Password Reset Date above, your Password is: Four (4) digits of your birth year followed by the last four (4) digits of your Social Security Number
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Annual Benefit Enrollment
SUMMARY PAGES
Annual Enrollment During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs. •
Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
•
Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.
•
Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits department or you can call Financial Benefit Services at (866) 914-5202 for assistance.
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Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ frenshipisd. 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 Frenship ISD benefit website: www.mybenefitshub.com/frenshipisd. 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
SUMMARY PAGES
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 benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR 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.
CHANGES IN STATUS (CIS):
QUALIFYING EVENTS
Marital Status
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
Change in Number of Tax Dependents
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 Status of Employment Affecting Coverage Eligibility
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.
Gain/Loss of Dependents’ Eligibility Status
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.
Judgment/ Decree/Order
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.
Eligibility for Government Programs
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
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Helpful Definitions
SUMMARY PAGES
Actively-at-Work
In-Network
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 1/1/2024 please notify your benefits administrator.
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.
Annual Enrollment The period during which existing employees are given the opportunity to enroll in or change their current elections.
Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.
Calendar Year January 1st through December 31st
Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or pre existing condition exclusion provisions do apply, as applicable by carrier. 8
Out-of-Pocket Maximum The most an eligible or insured person can pay in co insurance for covered expenses.
Plan Year January 1st through December 31st
Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken 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
SUMMARY PAGES
Employee Eligibility Requirements Dependent Eligibility Supplemental Benefits: Eligible employees must work 20 Requirements 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 January 1, 2024, you must be actively-at-work on January 1, 2024 to be eligible for your new benefits.
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.
PLAN
MAXIMUM AGE
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Medical
Through age 25
HSA
Through age 25
Hospital Indemnity
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 Financial Benefit Services, or contact the insurance carrier for additional information on spouse eligibility.
Through age 25
Telehealth
Through age 25
Dental
Through age 25
Vision
Through age 25
Cancer
Through age 24
Accident
Through age 25
Voluntary Life and AD&D
Through age 25
Individual Life
Issued through age 23
Medical Transportation
Through age 25
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 Financial Benefit Services, 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 Financial Benefit Services, 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 HR/Benefit Administrator to request a continuation of coverage. 9
HSA vs. FSA
SUMMARY PAGES
Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Description
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.
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
Employee and/or employer
Account Owner
Individual
Employer
Underlying Insurance Requirement
High deductible health plan
None
Minimum Deductible
$1,600 single (2024) $3,200 family (2024)
N/A
Maximum Contribution
$4,150 single (2024) $8,300 family (2024) 55+ catch up +$1,000
$3,050 (2024)
Permissible Use Of Funds
Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
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 Not permitted 65).
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 or $550 rollover provision.
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
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Hospital Indemnity
EMPLOYEE BENEFITS
The Hartford
ABOUT HOSPITAL INDEMNITY This is an affordable supplemental plan that pays you should you be in patient 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/frenshipisd
COVERAGE INFORMATION
You have a choice of two hospital indemnity plans, which allows you the flexibility to enroll for the coverage that best meets your needs. Benefit amounts are based on the plan in effect for you or an insured dependent at the time the covered event occurs. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s). Plan Information Coverage Type Covered Events HSA Compatible Benefits Hospital Care2 First Day Hospital Confinement Daily Hospital Confinement (Day 2+)
Up to 3 days per year Up to 360 days per year
Features Ability Assist® EAP3 – 24/7/365 access to help for financial, legal or emotional issues HealthChampionSM4 – Administrative & clinical support following serious illness or injury
Hospital Indemnity Low
High
Employee
$18.24
$26.97
Employee and Spouse
$33.02
$48.68
Employee and Child (ren)
$34.44
$50.37
Family
$51.91
$75.96
Low On and off-job (24 hour) Illness and injury Yes
High On and off-job (24 hour) Illness and injury Yes
Low $1,500 $200
High $2,500 $200
Low
High
Included
Included
Included
Included
Asked & Answered
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 taxexempt 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 are eligible for this insurance if you are an active full-time employee who works at least 20 hours per week on a regularly scheduled basis. Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26. 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. 11
Hospital Indemnity The Hartford
EMPLOYEE BENEFITS
How much does it cost and how do I pay for this insurance? Premiums are provided above. You have a choice of plan options. You may elect insurance for you only, or for you and your dependent(s), by choosing the applicable coverage tier. 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. When does this insurance begin? 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 dependents 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 I no longer a member of this group? Yes, you can take this coverage with you. Your spouse/partner may also continue insurance in certain circumstances.
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Health Savings Account (HSA) HSA Bank
EMPLOYEE BENEFITS
ABOUT HSA A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). For full plan details, please visit your benefit website: www.mybenefitshub.com/frenshipisd 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 • 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 • 55+ years: +$1,000
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 HSABank. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the blance 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 HSABank are eligible for automatic payroll deduction and company contributions.
How to Use your HSA •
• • •
HSA Bank Mobile App – Download to check available balances, view HSA transaction details, save and store receipts, scan items in-store to see if they’re qualified, and access customer service contact information. myHealth PortfolioSM – Track your healthcare expenses, manage receipts and claims from multiple providers, and view expenses by provider, description, and more. Account preferences – Designate a beneficiary, add an authorized signer, order additional debit cards, and keep important information up to date. Access online at: http://www.hsabank.com 13
Telehealth
EMPLOYEE BENEFITS
HealthiestYou
ABOUT TELEHEALTH Telehealth provides 24/7/365 access to board-certified doctors via telephone or video consultations that can diagnose, recommend treatment and prescribe medication. Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available. For full plan details, please visit your benefit website: www.mybenefitshub.com/frenshipisd Alongside your medical coverage is access to quality telehealth services through HealthiestYou. Connect anytime day or night with a board-certified doctor via your mobile device or computer. While HealthiestYou does not replace your primary care physician, it is a convenient and costeffective option when you need care and: • Have a non-emergency issue and are considering a convenience care clinic, urgent care clinic • or emergency room for treatment • Are on a business trip, vacation or away from home • Are unable to see your primary care physician When to Use HealthiestYou: At a cost that is the same or less than a visit to your physician, use telehealth services for minor conditions such as: • Sore throat • Headache • Stomachache • Cold • Flu • Allergies • Fever • Urinary tract infections Do not use telemedicine for serious or life-threatening emergencies. HealthiestYou Confidential Counseling: Managing stress or life changes can be overwhelming but it’s easier than ever to get help right in the comfort of your own home. Visit a counselor or psychiatrist by phone, secure video, or HealthiestYou App. Talk to a licensed counselor or psychiatrist from your home, office, or on the go! Affordable, confidential online therapy for a variety of counseling needs. 14
HealthiestYou Dermatology: Upload photos of your condition to the app and get a treatment plan from a dermatologist within two business days. The HealthiestYou app helps you stay connected with appointment reminders, important notifications and secure messaging. Registration is Easy: Register with HealthiestYou so you are ready to use this valuable service when and where you need it. • Download the app. Search “HealthiestYou” in the app store or on Google Plan • Set up your account. Once you’ve downloaded the app, select “Register” then choose “Employee” as your membership type. • Enter basic contact information. Type in your last name, date of birth and ZIP code. • Type in your security information. Enter a valid email address, password, the best number for our doctors to reach you, your preferred language, and accept terms and conditions. For more information please Call: (866) 703-1259 or Visit: www.Healthiestyou.com Telehealth Employee and Family
$23.00
Dental Insurance
EMPLOYEE BENEFITS
Marsh & McLennan 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/frenshipisd
What will the plan reimburse? You go to the dentist of your choice. You and your dentist determine the best method of treatment. Pre-authorizations are never required and only cosmetic procedures (i.e. teeth whitening), implants and TMJ treatments are excluded.
Dental Reimbursement Employee
$23.00
Employee and Spouse
$47.00
Employee and Child (ren)
$50.00
Annual maximum benefit paid per covered person is: $1,600.00. Child and Adult Family Orthodontia is limited to $1,500.00 lifetime maximum per insured. Exclusions include: cosmetic dentistry, implants, TMJ.
$73.00
How does this plan work? 1. Pay for your service (cash, check, credit card or other credit arrangement). 2. Complete the Dental Claim form on your benefit website and obtain an invoice for the services provided to send in your claim for reimbursement. Submit completed forms to: MGM Benefits Group - TPA Services Department: • By Mail: 2185 N. Glenville Dr., Richardson, Texas 75082 • By Fax: (888) 975-9030 • By Email: MGMClaims@higginbotham.net For questions, please contact MGM Benefits Group: • Phone: (972) 881-2255 • Toll Free: (866) 881-2255 • Email us at: MGMClaims@higginbotham.net You can also ask your dental office to submit your completed claim forms by mail or email. Amount of Expense First $200.00 Next $250.00 Next $2,400.00
Plan Share 100% ($200.00) 80% ($200.00) 50% ($1,200.00)
Participant Share 0% ($0.00) 20% ($50.00) 50% ($1,200.00)
Paid Benefit $200.00 $200.00 $1,200.00
For questions call: (972) 881-2255 or Fax: (888) 975-9030
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Vision Insurance
EMPLOYEE BENEFITS
Superior 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/frenshipisd
Copays Exam Materials1 Contact lens fitting
Services/Frequency * $10 $20 $25
Superior National network Exam (ophthalmologist) Exam (optometrist) Frames Contact lens fitting (standard2) Contact lens fitting (specialty2) Lenses (standard) per pair Single vision Bifocal Trifocal Progressives lens upgrade Contact lenses4
Exam Frame Contact lens fitting Lenses Contact lenses
12 months 12 months 12 months 12 months 12 months
Monthly Premiums Employee Employee and Spouse Employee and Child(ren) Family
In-network Covered in full Covered in full $125 retail allowance Covered in full $50 retail allowance
Out-of-network Up to $42 retail Up to $37 retail Up to $68 retail Not covered Not covered
Covered in full Covered in full Covered in full See description3 $150 retail allowance
Up to $32 retail Up to $46 retail Up to $61 retail Up to $61 retail Up to $100 retail
Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements. 1. Materials co-pay applies to lenses and frames only, not contact lenses 2. Standard contact lens fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty contact lens fitting applies to new contact wearers and/or a member who wear toric, gas permeable, or multi-focal lenses. 3. Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay. 4. Contact lenses are in lieu of eyeglass lenses and frames benefit
Discounts on covered materials Frames: 20% off amount over allowance Lens options: 20% off retail Progressives: 20% off amount over retail lined trifocal lens, including lens options Specialty contact lens fit: 10% off retail, then apply allowance
*Based on date of service 16
$7.57 $14.35 $14.54 $22.32
How to Print your Vision ID Card: You can request your vision id card by contacting Superior Vision directly at (800) 507-3800. You can also go to www.superiorvision.com and register/ login to access your account by clicking on “Members” at the top of the page. You can also download the Superior Vision mobile app on your smart phone. Discount Features Look for providers in the provider directory who accept discounts, as some do not; please verify their services and discounts (range from 10%-30%) prior to service as they vary.
Discounts on non-covered exam, services, and materials Exams, frames, and prescription lenses: 30% off retail Lens options, contacts, misc options: 20% off retail Disposable contact lenses: 10% off retail Retinal imaging: $39 maximum out-of-pocket Refractive surgery Superior Vision has a nationwide network of independent refractive surgeons and partnerships with leading LASIK networks who offer members a discount. These discounts range from 10% 50%, and are the best possible discounts available to Superior Vision.
Disability Insurance
EMPLOYEE BENEFITS
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/frenshipisd
Educator Disability insurance combines the features of a short term and long-term disability plan into one policy. The coverage pays you a portion of your earnings if you cannot work because of a disabling illness or injury. The plan gives you the flexibility to choose a level of coverage to suit your need. You have the opportunity to purchase Disability Insurance through your employer. This highlight sheet is an overview of your Disability Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail. Eligibility You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis. Enrollment You can enroll in coverage within 31 days of your date of hire or during your annual enrollment period. Effective Date Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect Actively at Work You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session. Benefit Amount You may purchase coverage that will pay you a monthly benefit of 30%, 40%, 50% or 60% of your monthly income, to a maximum of $7,500. 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. Benefit Duration is the maximum time for which we pay benefits for disability resulting from sickness or injury. Depending on the age at which disability occurs, the maximum duration may vary. Please see the applicable schedules below based on the Premium benefit option. Premium Option: For the Premium benefit option – the table below applies to disabilities resulting from sickness or injury. Age Disabled Prior to 63 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69+
Maximum Benefit Duration To Normal Retirement Age or 48 mo. if greater To Normal Retirement Age or 42 mo. if greater 36 months 30 months 27 months 24 months 21 months 18 months
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. Benefit Integration Your benefit may be reduced by other income you receive or are eligible to receive due to your disability, such as: • Social Security Disability Insurance • State Teacher Retirement Disability Plans • Workers’ Compensation • Other employer-based disability insurance coverage you may have • Unemployment benefits 17
Disability Insurance
EMPLOYEE BENEFITS
The Hartford • •
Retirement benefits that your employer fully or partially pays for (such as a pension plan) Your plan includes a minimum benefit of 10% of your elected benefit.
Survivor Benefit - If you die while receiving disability benefits, a benefit will be paid to your spouse or child under age 25, 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 provide assistance with child/elder care, substance abuse, family relati onships 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. Disability - per $100 in benefit Elimination Period 30% 40% 50% 0/7 $2.17 $2.82 $3.69 14/14 $1.74 $2.24 $2.94 30/30 $1.44 $1.85 $2.43 60/60 $0.98 $1.27 $1.66 90/90 $0.85 $1.09 $1.44 180/180 $0.66 $0.85 $1.10
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60% $4.38 $3.50 $2.89 $1.97 $1.70 $1.32
Disability
EMPLOYEE BENEFITS
The Hartford
Educator Disability - Definitions
The first number indicates the number of days you must be disabled due to Injury and the second number indicates the number of days you must be disabled due to Sickness.
What is disability insurance? Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time. This type of disability plan is called an educator disability plan and includes both long and short term coverage into one convenient plan. Pre-Existing Condition Limitations - Please note that all plans will include pre-existing condition limitations that could impact you if you are a first-time enrollee in your employer’s disability plan. This includes during your initial new hire enrollment. Please review your plan details to find more information about preexisting condition limitations.
How do I choose which plan to enroll in during my open enrollment? 1.
First choose your elimination period. The elimination period, sometimes referred to as the waiting period, is how long you are disabled and unable to work before your benefit will begin. This will be displayed as 2 numbers such as 0/7, 14/14, 30/30, 60/60, 90/90, etc.
When choosing your elimination period, ask yourself, “How long can I go without a paycheck?” Based on the answer to this question, choose your elimination period accordingly. Important Note- some plans will waive the elimination period if you choose 30/30 or less and you are confined as an inpatient to the hospital for a specific time period. Please review your plan details to see if this feature is available to you. 2.
Next choose your benefit amount. This is the maximum amount of money you would receive from the carrier on a monthly basis once your disability claim is approved by the carrier. When choosing your monthly benefit, ask yourself, “How much money do I need to be able to pay my monthly expenses?” Based on the answer to this question, choose your monthly benefit accordingly.
Choose your Benefit Amount from the drop down box.
Choose your desired elimination period. 19
Cancer Insurance
EMPLOYEE BENEFITS
Loyal American ABOUT CANCER
Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment. For full plan details, please visit your benefit website: www.mybenefitshub.com/frenshipisd
Employee Employee and Spouse Employee and Child(ren) Family
High Plan $19.92 $31.97 $22.56 $31.97
Cancer High Plan w/ICU $25.06 $43.26 $31.38 $43.26
Low Plan $11.56 $18.36 $13.03 $18.36
ADDITIONAL BENEFIT AMOUNTS
Low Plan w/ICU $16.70 $29.65 $21.85 $29.65 High Plan Maximum
Low Plan Maximum
$50 Per Calendar Year
$50 Per Calendar Year
$100 Per Calendar Year
$100 Per Calendar Year
$2,000 Once/ Lifetime
$500 Once/Lifetime
$3,000 Once/ Lifetime DAILY RADIATION, CHEMOTHERAPY, IMMUNOTHERAPY and EXPERIMENTAL TREATMENT BENEFIT RIDER (form LG-6046) $400/Day We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule for each day that an Insured Person receives one or more of the following treatments for Cancer: (1) Chemotherapy (including Hormonal Therapy) or Immunotherapy; (2) Selfinjected Chemotherapy or Immunotherapy drugs, limited to the maximum daily benefit amount per treatment; (3) Chemotherapy or Immunotherapy drugs dispensed by a pump or implant, limited to the maximum daily benefit amount for the initial prescription and an equal amount for each refill; (4) Oral Chemotherapy or Immunotherapy, limited to the maximum daily benefit amount per prescription; (5) Radiation Treatment. Benefits payable for interstitial or intracavitary applications of Radiation Treatments are payable on the day of insertion only and not for each day the Radiation Treatment remains in the body; or (6) Experimental Treatment. The benefit amount shown on the Certificate Schedule is the maximum daily benefit available per Insured Person regardless of the number or types of Cancer treatments received on the same day.
$750 Once/Lifetime
ANNUAL CANCER SCREENING BENEFIT RIDER (form LG-6041) A. Basic Benefit We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule, once per calendar year per Insured Person for screening tests performed to determine whether Cancer exists in an Insured Person. Covered annual Cancer screening tests include but are not limited to: mammogram, pap smear, breast ultrasound, ThinPrep, biopsy, chest x-ray, thermography, colonoscopy, flexible sigmoidoscopy, hemocult stool specimen, PSA (blood test for prostate cancer), CEA (blood tests for colon cancer), CA125 (blood test for ovarian cancer), CA15-3 (blood test for breast cancer), serum protein electrophesis (blood test for myeloma). B. Additional Benefit We will pay the expense incurred, but not to exceed two times the maximum benefit amount per calendar year as shown on the Certificate Schedule, for one additional invasive diagnostic procedure required as the result of an abnormal cancer screening test for which benefits are payable under the Basic Benefit above for an Insured Person. This additional benefit is payable regardless of the results of the additional diagnostic procedure. However, the amount payable will be reduced dollar for dollar for any amount payable under the Positive Diagnosis Benefit contained in the base Certificate. FIRST OCCURRENCE BENEFIT RIDER (form LG-6043) If an Insured Person receives a positive diagnosis of Internal Cancer, We will pay the First Occurrence benefit amount shown on the Certificate Schedule. If the Insured Person receiving the positive diagnosis of Internal Cancer is a child under the age of 21, we will pay one and one-half times the First Occurrence benefit amount shown on the Certificate Schedule.
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$200/Day
Cancer Insurance
EMPLOYEE BENEFITS
Loyal American
SURGICAL BENEFIT RIDER (form LG-6048) Surgical Expense We will pay the Surgical Expense benefit for a surgical procedure for the treatment of an Insured Person’s Cancer (except Skin Cancer) according to the Surgical Schedule shown in this rider. However, in no event will the amount payable exceed the maximum Surgical Expense benefit shown on the Certificate Schedule, nor will it exceed the expense incurred. Anesthesia Expense We will pay the anesthesia expense incurred, not to exceed 25% of the covered Surgical Expense benefit for the operation performed. This includes the services of an anesthesiologist or of an anesthetist under supervision of a physician for the purpose of administering anesthesia. Breast Reconstruction with transverse rectus adominis myocutaneous flap (TRAM), single pedicle, including closure of donor site, with microvascular anastomosis (supercharging) is one of the surgical procedures listed in the Surgical Schedule. If this procedure is performed on an Insured Person as the result of a mastectomy for which We paid a Surgical Expense benefit for the treatment of Breast Cancer, We will pay the expense incurred not to exceed $900 per $1,000 of the Surgical Benefit issued.
$5,000 Procedure Maximum
$500 Procedure Maximum
$1,250 Procedure Maximum
$125 Procedure Maximum
$4,500 Procedure Maximum
$450 Procedure Maximum
Skin Cancer Surgery Expense We will pay the expense incurred, not to exceed the procedure amount listed in this rider ($125 to $750 depending on the procedure) when a surgical operation is performed on an Insured Person for treatment of a diagnosed Skin Cancer. This benefit is payable in lieu of any benefits for Surgical Expense and Anesthesia Expense which are not applicable to Skin Cancer. DAILY HOSPITAL CONFINEMENT BENEFIT RIDER (form LG-6042) Confinements of 30 Days or Less We will pay the Daily Hospital Confinement benefit amount shown on the Certificate Schedule for each of the first 30 days in each period of hospital confinement during which an Insured Person is confined to a hospital, including a government or charity hospital, for the treatment of Cancer.
Per Procedure
Per Procedure
$200/Day
$100/Day
Confinements of 31 Days or More If an Insured Person is continuously confined to a hospital, including a government or charity hospital, for longer than 30 consecutive days for the treatment of Cancer, We will pay two times the Daily Hospital Confinement benefit amount shown on the Certificate Schedule. This benefit payment will begin on the 31st continuous day of such confinement and continue for each day of confinement until the Insured Person is discharged from the Hospital.
$400/Day
$200/Day
Benefits for an Insured Dependent Child under Age 21 The amount payable under this benefit will be double the Daily Hospital Confinement benefit shown on the Certificate Schedule if the Insured Person so confined is a dependent child under the age of 21. OPTIONAL BENEFITS YOU MAY SELECT FOR ADDITIONAL PREMIUM HOSPITAL INTENSIVE CARE UNIT BENEFIT RIDER (form LG-6047) Intensive Care Unit Benefit We will pay the daily Hospital Intensive Care Unit Benefit shown on the Certificate Schedule for an Insured Person’s confinement in an ICU for sickness or injury.
$400/$800/Day
$200/$400/Day
$1,000/Day
Not Included
Double Intensive Care Unit Benefit We will pay double the daily Hospital Intensive Care Unit benefit amount shown on the Certificate Schedule for an Insured Person’s confinement in an ICU as a result of Cancer. We will also double this ICU benefit for only the initial ICU confinement resulting from an Insured Person’s travel related injury, provided that the ICU confinement begins within 24 hours of the accident causing the travel related injury. A travel related injury includes being struck by an automobile, bus, truck, van, motorcycle, train or airplane; or being involved in an accident where the Insured Person was the operator or passenger in or on such vehicle.
$2,000/Day
Not Included
Step Down Unit Benefit We will pay one-half of the daily Hospital Intensive Care Unit benefit amount $500/Day Not Included shown on the Certificate Schedule for an Insured Person’s confinement in a Step Down Unit for a sickness or injury. Additional Limitations and Exclusions for the Hospital Intensive Care Unit Benefit Rider If the rider is issued benefits if an Insured Person goes into a hospital Intensive Care Unit (including a Cardiac Intensive Care Un Benefits start the first day of confinement in an ICU for sickness or injury. Any combination of benefits pay maximum of 45 days per each period of confinement. ALL BENEFITS CONTAINED IN THIS HOSPITAL INTENSIVE CARE UNIT BENEFIT RIDER REDUCE BY ONE-HALF Benefits are not payable for any ICU or Step Down Unit confinement that results from intentional self-infli intoxicated or under the influence of alcohol, drugs or any narcotics, unless administered on and accordin THIS IS A LIMITED RIDER. and coverage is in foit or Neonatal Intensable under this rider AT AGE 75. cted injury; or the Insg to the advice of a mrce, it will provide ive Care Unit). is limited to a ured Person’s being edical practitioner.
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Emergency Medical Transport MASA
EMPLOYEE BENEFITS
ABOUT MEDICAL TRANSPORT Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out-of-pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan. For full plan details, please visit your benefit website: www.mybenefitshub.com/frenshipisd
A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. After the group health plan pays its portion, MASA MTS works with providers to deliver our members’ $0 in out-of-pocket costs for emergency transport. If a member has a high deductible health plan that is compatible with a health savings account, benefits will become available under the MASA membership for expenses incurred for medical care (as defined under Internal Revenue Code (“IRC”) section 213 (d)) once a member satisfies the applicable statutory minimum deductible under IRC section 223(c) for high-deductible health plan coverage that is compatible with a health savings account. Emergent Air Transportation*
Member is hereby entitled to Emergent Air Transportation services, if necessitated by a Serious Emergency, to be rendered by a duly-licensed emergency transportation provider, subject to the terms, conditions and limitations herein. In the event that such services result in an outstanding balance due by the Member, MASA shall reimburse Member's reasonable and customary outof-pocket expenses, equal to the lesser of (i) the outstanding balance, following any payment by Member's health and/or other insurance coverage(s) and/or membership(s) or (ii) three (3) times the applicable Medicare-allowable rate for such transportation, less any payment by Member's health and/or other insurance coverage(s) and/ or membership(s). MASA shall attempt to fully resolve the outstanding balance, as described above, on behalf of the Member. However, in the event that such payment does not satisfy the outstanding balance, MASA shall make a payment directly to the Member in the amount of $20,000. Reimbursement for such services shall be limited to transportation to the nearest and most appropriate Medical Facility, readily capable of receiving Member and providing the necessary level of care, as may be required by the Serious Emergency. Transport must result from the request or recommendation of a first-responder or treating/transferring physician, who deems Emergent Air Transportation medically necessary. Services must be provided by a medically-equipped helicopter or fixed-wing aircraft, subject to the limitations herein, that is provided by a common air ambulance carrier. Coverage for Emergent Air Transport by fixed-wing aircraft shall only be covered, exclusively, in the event of (i) the unavailability and/or inefficiency of transport by rotary aircraft or ground transport and (ii) necessity of specialized, immediate, life and/or limb-saving treatment not available locally. Transports covered under this Agreement must originate and end within the United States or Canada.
Emergent Ground Transportation*
Member is hereby entitled to Emergent Ground Transportation services, if necessitated by a Serious Emergency, to be rendered by a duly-licensed emergency transportation provider, at no additional expense to the Member. Such transportation shall be to the nearest and most appropriate Medical Facility, readily capable of receiving Member and providing the necessary level of care, as may be required by the Serious Emergency. Transport must result from the request or recommendation by a first-responder or transferring physician who deems Emergent Ground Transportation medically necessary. Emergent Ground Transportation shall also include any ground transportation associated with Emergent Air Transportation. Transports covered under this Agreement must originate and end within the United States or Canada. * All coverage provided by this membership is limited to the continental United States, Alaska, Hawaii, and Canada, and must originate and conclude therein.
Emergency Medical Transportation Emergency Medical Transportation Employee and Family $9.00 22
Accident Insurance
EMPLOYEE BENEFITS
APL
ABOUT ACCIDENT Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you. For full plan details, please visit your benefit website: www.mybenefitshub.com/frenshipisd
Employee Only Employee and Spouse Employee and Child(ren) Employee and Family Benefit Description Accidental Death - per unit Medical Expense Accidental Injury Benefit - per unit Daily Hospital Confinement Benefit Air and Ground Ambulance Benefit Accidental Dismemberment Benefit Single finger or 1 toe Multiple fingers or toes Single hand, arm, foot or leg Multiple hands, arms, feet or legs Accidental Loss of Sight Benefit - per unit Loss of Sight in one eye Loss of Sight in both eyes
Accident 1 Unit 2 Units $10.80 $17.10 $19.40 $29.80 $21.20 $34.90 $29.80 $47.60 Summary of Benefits Level 1 - 1 Unit Level 2 - 2 Units $5,000 $10,000 actual charges up to actual charges up to $500 $1,000 $75 per day $150 per day actual charges up to actual charges up to $1,250 $2,500
3 Units $21.50 $38.90 $45.20 $62.60
4 Units $24.50 $44.90 $52.00 $72.40
Level 3 - 3 Units $15,000 actual charges up to $1,500 $225 per day actual charges up to $3,750
Level 4 - 4 Units $20,000 actual charges up to $2,000 $300 per day actual charges up to $5,000
$500 $500 $2,500 $5,000
$1,000 $1,000 $5,000 $10,000
$1,500 $1,500 $7,500 $15,000
$2,000 $2,000 $10,000 $20,000
$2,500 $5,000
$5,000 $10,000
$7,500 $15,000
$10,000 $20,000
Eligibility - This policy will be issued to only those persons who meet American Public Life Insurance Company’s insurability requirements. Persons not meeting APL’s insurability requirements will be excluded from coverage by an endorsement attached to the policy.
Air and Ground Ambulance Benefit - Emergency transportation must occur within 21 calendar days of the accident causing such Injury.
Base Policy and Optional Benefits - No benefits are payable for a pre existing condition. Pre-existing condition means an Injury that pertains solely to an Accidental Bodily Injury which resulted from an accident sustained before the Effective Date of coverage. Pre-Existing Conditions specifically named or described as permanently excluded in any part of this contract are never covered. A Hospital is not an institution which is primarily a place for alcoholics or drug addicts; the aged; a nursing, rest or convalescent nursing home; a mental institution or sanitarium; a facility contracted for or operated by the US Government for treatment of members or ex-members of the armed forces (unless You are legally required to pay for services rendered in the absence of insurance); or, a long-term nursing unit or geriatrics ward.
Accidental Death - Accidental Death must result within 90 days of the covered accident causing the injury.
Medical Expense Accidental Injury Benefit- Expenses must commence within 60 days of the covered accident. The max benefit amount payable for any one accident for the Insured Person shall not exceed the Medical Expense Benefit.
Daily Hospital Confinement Benefit - The maximum benefit period for this benefit is 30 days per covered accident.
Accidental Dismemberment Benefit - The total amount payable for all Losses resulting from the same accident will not exceed the Maximum Dismemberment Benefit of $5,000 cumulative per unit, per Accident. Loss must be within 90 days of the accident causing such Injury. Exclusions - See policy limits and exclusions on your benefit website, www.mybenefitshub.com/frenshipisd Guaranteed Renewable - You have the right to renew this Policy until the first premium due date on or after Your 69th birthday, if you pay the correct premium when due or within the Grace Period. When an Insured’s coverage terminates at age 70, coverage for other Insured Persons, if any, shall continue under this Policy. We have the right to change premium rates by class. 23
Life and AD&D
EMPLOYEE BENEFITS
One America
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/frenshipisd Basic Life and AD&D Coverage
$20,000 is provided by Frenship ISD to full-time, benefits eligible employees.
Employee Voluntary Life Guaranteed Issue
$200,000
Employee Voluntary Life Maximum
$500,000 In increments of $10,000
Spouse Voluntary Life Guaranteed Issue $50,000 Spouse Voluntary Life Maximum $250,000 maximum in increments of $5,000 or 50% of employee’s election. Dependent Child(ren) Voluntary Life $10,000 Guaranteed Issue 6 months - 26 years Employee Voluntary AD&D Coverage Amount Up to $500,000 in increments of $10,000 Spouse AD&D Coverage: 50% of the employee AD&D benefit, 40% if child included. Child AD&D Coverage: 15% of the employee AD&D benefit, 10% if child included. Guaranteed Life Insurance Coverage Amount: Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $200,000 without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability. If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense. Maximum Life Insurance Coverage Amount: You can choose a coverage amount up to $500,000 with evidence of insurability. See the Evidence of Insurability page for details. Your coverage amount will reduce by 65% of the original amount when you reach age 70; 45% of the original amount when you reach age 75; 30% of the original amount when you reach age 80; 20% of the original amount when you reach age 85; and 15% of the original amount when you reach age 90. Dependent Children Coverage: You can secure term life insurance for your dependent children when you choose coverage for yourself. Voluntary Life - per $10,000 in coverage Age Employee 18-29 $0.50 30-34 $0.70 35-39 $0.90 40-44 $1.40 45-49 $2.00 50-54 $3.30 55-59 $4.10 60-64 $6.20 65-69 $10.50 70-74 $17.30 75+ $25.60 Spouse rates based on Employee's age. 24
Voluntary Life - Child(ren) -$10,000 in coverage 6 months -26 $2.00 Voluntary AD&D - per $10,000 in coverage Employee Only $0.20 Employee and Family $0.38
Flexible Spending Account (FSA) NBS
EMPLOYEE BENEFITS
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 (unless your plan contains a $500 rollover or grace period provision). For full plan details, please visit your benefit website: www.mybenefitshub.com/frenshipisd The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $3,050 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 contribute the a Limited Health Care FSA if you enroll in a High Deductible Health Plan and contribute to a Health Savings Account (HSA). Limited purpose Health Care FSA funds may be used for Dental and Vision expenses only. How the Health Care FSAs Work You can access the funds in your Health Care FSA two different ways: • Use your NBS Debit Card to pay for qualified expenses, doctor visits and prescription copays. • Pay out-of-pocket and submit your receipts for reimbursement: » Fax – (844) 438-1496 » Email – service@nbsbenefits.com » Online – my.nbsbenefits.com » Call for Account Balance: (855) 399-3035 » Mail: PO Box 6980 West Jordan, UT 84084 Contact NBS • Hours of Operation: 6:00 AM – 6:00 PM MST, Mon-Fri • Phone: (800) 274-0503 • Email: service@nbsbenefits.com • Mail: PO Box 6980 West Jordan, UT 84084 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 Dependent 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. Dependent Care FSA Guidelines • Overnight camps are not eligible for reimbursement (only day camps can be considered). • If your child turns 13 mid-year, 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. 25
Flexible Spending Account (FSA) NBS
EMPLOYEE BENEFITS
The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
•
Important FSA Rules • The maximum per plan year you can contribute to a Health Care FSA is $3,050. 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. • You can continue to file claims incurred during the plan year for another 75 days (up until date). • Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses. Over-the-Counter Item Rule Reminder (OTC) 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 payme nt for an OTC item, even when accompanied by a prescription.
Flexible Spending Accounts Annual Contribution Limits
Benefit
Health Care FSA
Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses and doctor prescribed over-thecounter medications)
$3,050
Saves on eligible expenses not covered by insurance, reduces your taxable income
Dependent Care FSA
Dependent care expenses (such as day care, after-school programs, or elder care programs) so you and your spouse can work or attend school full-time
$5,000 single $2,500 if married and filing separate tax returns
Reduces your taxable income
26
Account Type
Eligible Expenses
Notes
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2024 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 Frenship 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 Frenship 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.
WWW.MYBENEFITSHUB.COM/FRENSHIPISD 28