2024 Plan Year
LOS FRESNOS CISD
BENEFIT GUIDE EFFECTIVE: 01/01/2024 - 12/31/2024 WWW.MYBENEFITSHUB.COM/LOSFRESNOSCISD
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Table of Contents How to Enroll
4-5
Annual Benefit Enrollment
6-11
1. Benefit Updates
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2. Section 125 Cafeteria Plan Guidelines
7
3. Annual Enrollment
8
4. Eligibility Requirements
9
5. Helpful Definitions
10
6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA)
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Health Savings Account (HSA)
12
Hospital Indemnity Dental
15
Vision
16
Disability
17-19
Cancer
20-21
Accident
22-23
Critical Illness
24-25
Voluntary Life
26-27
Voluntary AD&D
28
Individual Life
19
Emergency Medical Transportation
30
Flexible Spending Account (FSA)
2
13-14
FLIP TO...
PG. 4
HOW TO ENROLL
PG. 6
SUMMARY PAGES
PG. 12
YOUR BENEFITS
31-32
Benefit Contact Information BENEFIT ADMINISTRATORS
MEDICAL
HEALTH SAVINGS ACCOUNT
Financial Benefit Services Blue Cross Blue Shield of Texas (800) 583-6908 Phone: (972) 766-6900 www.mybenefitshub.com/losfresnoscisd Toll Free: (800) 521-2227 www.bcbstx.com
EECU (817) 882-0800 www.eecu.org
HOSPITAL INDEMNITY
DENTAL
VISION
Lincoln Financial Group (800) 423-2765 www.lfg.com
Blue Cross Blue Shield Group #029511 (800) 521-2227 www.bcbstx.com
Superior Vision Group #320870 (800) 507-3800 www.superiorvision.com
DISABILITY
CANCER
ACCIDENT
The Hartford Group #681501 (866) 278-2655 www.thehartfordatwork.com
American Public Life Group #22636 (800) 256-8606 www.ampublic.com
The Hartford Group #681501 (866) 278-2655 www.thehartfordatwork.com
CRITICAL ILLNESS
LIFE AND AD&D
INDIVIDUAL LIFE
Voya Group #70800-3CCI2 (800) 955-7736 www.voya.com
Lincoln Financial Group Life Group #G617681 AD&D Group #G00616354-0000-000 (800) 423-2765 www.lfg.com
Texas Republic Life (512) 330-0099 www.texasrepubliclife.com
EMPLOYEE ASSISTANCE PROGRAM
EMERGENCY MEDICAL TRANSPORT FLEXIBLE SPENDING ACCOUNT
Lincoln Financial Group (888) 628-4824 www.GuidanceResousces.com
MASA Group #MKLOSF (800) 423-3226 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 LFCISD” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment:
Text “FBS LFCISD” to (800) 583-6908
• Benefit Resources • Online Enrollment • Interactive Tools • And more!
App Group #: FBSLFCISD
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OR SCAN
How to Log In 1
www.mybenefitshub.com/losfresnoscisd
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CLICK LOGIN
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ENTER USERNAME & PASSWORD Your Username Is: Your email in THEbenefitsHUB. (Typically your work email) Your Password Is: Four (4) digits of your birth year followed by the last four (4) digits of your Social Security Number If you have previously logged in, you will use the password that you created, NOT the password format listed above.
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Annual Benefit Enrollment
SUMMARY PAGES
Benefit Updates - What’s New: • • • •
Changes in Medical Premiums New Individual Universal Life Plan New Hospital Indemnity Plan Maximum Annual Increase for FSA and HSA
NOW IS THE TIME to make your supplemental benefit elections for a 01/01/2024 effective date. During your annual enrollment period, you may enroll for additional benefits, change plan options, or change dependents. For supplemental benefits that require Evidence of Insurability, a later effective date may apply. If you experience a special enrollment event outside of the annual enrollment period, call your benefits administrator within 31 days of event. BENEFITS AT A GLANCE Benefit options to fit your needs UNIVERSAL LIFE Universal life insurance is a policy that covers a single person and is intended to meet the financial needs of the individual and is intended to meet the financial needs of the beneficiary in the event of the insured’s death. beneficiary in the event of the insured’s death. This coverage is portable and can continue after leaving employment or retirement.
HOSPITAL INDEMNITY Hospital stays are expensive. If you or a family member is admitted to the hospital due to an accident or sudden illness, you may face financial hardship, even if you have a good medical plan If you have a hospital indemnity plan, you can be assured that these additional expenses will not be costly. With a hospital indemnity plan, there are no deductibles to pay. You can apply and begin receiving benefits as soon as you suffer a qualifying event. The plan provides lump sum compensation in a predetermined amount. The money can go toward medical expenses, insurance deductibles, groceries, transportation and child care, depending on your choice. BASIC LIFE: BASIC LIFE AND EMPLOYEE ASSISTANCE (EAP) The $10K Basic Life Insurance (Employer Paid) also offers employee assistance that includes confidential counseling, will preparation, legal support resources and much more.
Don’t Forget!
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Login and complete your benefit enrollment from 10/30/2023 - 11/17/2023
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Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202.
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Update your information: home address, phone numbers, email, and beneficiaries.
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REQUIRED!! Due to the Affordable Care Act (ACA) reporting requirements, you must add your dependent’s CORRECT social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator.
Annual Benefit Enrollment
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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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. •
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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.
Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ losfresnoscisd. 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 Los Fresnos CISD benefit website: www.mybenefitshub.com/losfresnoscisd. 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. All new hire enrollment elections must be completed in the online enrollment system within the first 30 days If you do not receive your ID card, you can call the carrier’s customer service number to request another of benefit eligible employment. Failure to complete card. elections during this timeframe will result in the •
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
forfeiture of coverage.
Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.
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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
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.
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.
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.
PLAN
MAXIMUM AGE
Vision
To age 26
Disability
To age 26
Cancer
To age 26
Life & AD&D
To age 26
Flexible Spending Account
To age 26
Medical Transportation
To age 26
Critical Illness
To age 26
Accident
To age 26
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents. Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse eligibility. FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse’s FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance. Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact 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
SUMMARY PAGES
Helpful Definitions 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 preexisting condition exclusion provisions do apply, as applicable by carrier. 10
Out-of-Pocket Maximum The most an eligible or insured person can pay in coinsurance 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).
SUMMARY PAGES
HSA vs. FSA 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.
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
FLIP TO
FOR HSA INFORMATION
PG. 12
FLIP TO
FOR FSA INFORMATION
PG. 31 11
Health Savings Account (HSA) EECU
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/losfresnoscisd
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.
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.
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.
Opening an HSA
HSA Eligibility
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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 • 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 by the HDHP.
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. To open an account, go to https://www.eecu.org/.
Important HSA Information
• •
How to Use your HSA • •
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 12
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.
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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. – 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 for in-person assistance: www.eecu.org/locations.
Hospital Indemnity
EMPLOYEE BENEFITS
Lincoln Financial Group 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/losfresnoscisd
Benefits at a glance If you or a covered family member have to go to the hospital for an accident or injury, hospital indemnity insurance provides a lump-sum cash benefit to help you take care of unexpected expenses — anything from deductibles to child care to everyday bills. Because you’re selecting this coverage through your company, you can take advantage of group rates. You don’t have to answer medical questions to receive coverage; this is guaranteed coverage. Core hospital benefits Hospital admission For the initial day of admission to a hospital for treatment of an injury Hospital confinement For each day of confinement in a hospital as a result of an injury Hospital intensive care unit (ICU) admission For the initial day of admission toan ICU for treatment as the result of an injury Hospital ICU confinement For each full or partial day of confinement in an ICU as a result of an injury Complications of pregnancy Newborn care For each day of confinement to a hospital for routine post-natal care following birth Health assessment/wellness benefit Health assessment benefit Receive a cash benefit every year you and any of your covered family members complete a single covered exam, screening, or immunization Enhanced benefits Hospital NICU admission Increases the hospital ICU admission benefit for a newbornchild’s ICU or NICU admission bythe percentage shown in the schedule of benefits
Option 10
Option 11
$1,000
$1,500
$100 per day for 30 $200 per day for 30 days per calendar year days per calendar year $2,000
$3,000
$200 per day for 30 days per calendar year
$400 per day for 30 days per calendar year
Included
Included
$100 per day for 2 days $200 per day for 2 days per calendar year per calendar year Your cash benefit (Option 10 & Option 11) $50 Option 10
Option 11
25%
25%
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Hospital Indemnity
EMPLOYEE BENEFITS
Lincoln Financial Group
Hospital NICU confinement Increases the hospital ICU confinement benefit for a newborn child’s ICU or NICU confinement by the percentage shown in the schedule of benefits Additional plan benefit(s) Portability if you leave your employer
25%
25%
Included
Note: See the policy for details and specific requirements for each of these benefits. Hospital Indemnity Insurance Premium Affordable group rates – Monthly premiums As an employee, you can take advantage of this accident insurance plan. Plus, you can add loved ones to the plan for just a little more. Hospital Indemnity Option 10 Employee $18.90 Employee + Spouse $40.70 Employee + Child(ren) $29.57 Family $53.64
Option 11 $30.41 $65.61 $47.26 $86.05
Questions? Call 800-423-2765 and mention ID: 1074604.
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Dental Insurance
EMPLOYEE BENEFITS
BCBSTX
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/losfresnoscisd
This Plan is offered by your Employer as one of the benefits of your employment. The benefits provided are intended to assist you with many of your dental care expenses for Dentally Necessary services and supplies. There are provisions throughout this Benefit Booklet that affect your dental care coverage. It is important that you read the Benefit Booklet carefully so you will be aware of the benefits and requirements of this Plan. In the event of any conflict between any components of this Plan, the Administrative Service Agreement provided to the Group Health Plan (GHP) by Blue Cross and Blue Shield
Dental Employee Only Employee + Spouse Employee + 1 Child Employee + Child(ren) Employee + Family
$30.00 $58.00 $45.00 $60.00 $87.00
PLAN OVERALL PAYMENT PROVISIONS DENTAL BENEFITS Deductibles $50 – per individual • Calendar Year Deductible $150 – per family • Three month Deductible carryover applies Maximum Calendar Year Benefits per Participant for Categories I, II, III, IV, V, VI, VII, VIII, IX, X $1,250 Does not apply to Orthodontic I. Diagnostic & Preventive Care Services 90% of Allowable Amount II. Miscellaneous Services 80% of Allowable Amount after Calendar Year Deductible III. Restorative Services 80% of Allowable Amount after Calendar Year Deductible IV. General Services 80% of Allowable Amount after Calendar Year Deductible V. Endodontic Services 80% of Allowable Amount after Calendar Year Deductible VI. Periodontal Services 80% of Allowable Amount after Calendar Year Deductible VII. Oral Surgery Services 80% of Allowable Amount after Calendar Year Deductible VIII. Crowns, Inlays/Onlays Services 50% of Allowable Amount after Calendar Year Deductible IX. Prosthodontic Services 50% of Allowable Amount after Calendar Year Deductible OPTIONAL COVERAGE X. Implant Services 50% of Allowable Amount after Calendar Year Deductible XI. Orthodontic Services All Participants 50% of Allowable Amount $1,250 maximum lifetime benefit Predetermination Amount $300 Age 26 Dependent Child Age Limit Dental Customer Service Helpline Customer Service Representatives can: • Give you information about Contracting Dentists • Distribute claim forms • Answer your questions on claims • Assist you in identifying a Contracting Dentist (but will not recommend specific Dentists) • Provide information on the features of the Plan BCBSTX Website Visit the BCBSTX website at www.bcbstx.com or information about BCBSTX, access to forms referenced in this Benefit Booklet, and much more 15
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/losfresnoscisd
Benefits
Monthly Premiums
In-Network
Out-of-Network
Covered in full $130 retail Frames allowance Lenses (standard) per pair
Up to $35 retail
EE Only
$8.30
Up to $70 retail
EE + 1 Dependent EE + Family
$14.15 $20.79
Single Vision
Covered in full
Up to $25 retail
Bifocal
Covered in full
Up to $40 retail
Trifocal
Covered in full
Progressive
See description
Lenticular
Covered in full $150 retail allowance
Up to $80 retail
Covered in full
Up to $150 retail
Exam
Contact Lenses2 Medically Necessary Contact Lenses
Up to $45 retail 1
Up to $45 retail Up to $80 retail
Co-Pays Exam Materials Services/Frequency Exam Frame Lenses Contact Lenses
$10 $10
12 months 12 months 12 months 12 months
(Based on date of service)
Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements. 1. 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 2. Contact lenses and related professional services (fitting, evaluation and follow-up) are covered in lieu of eyeglass lenses and frames benefit
Discount Features
Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.
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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/losfresnoscisd
What is Long-Term Disability Insurance? Long-Term Disability Insurance pays you a portion of your earnings if you cannot work because of a disabling illness or injury. You have the opportunity to purchase Long-Term Disability Insurance through your employer. This highlight sheet is an overview of your Long-Term Disability Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail. Why do I need Long-Term Disability Coverage? Most accidents and injuries that keep people off the job happen outside the workplace and therefore are not covered by worker’s compensation. When you consider that nearly three in 10 workers entering the workforce today will become disabled before retiring1 , it’s protection you won’t want to be without. 1 Social Security Administration, Fact Sheet 200
What is disability? Disability is defined in The Hartford’s* contract with your employer. Typically, disability means that you cannot perform one or more of the essential duties of your occupation due to injury, sickness, pregnancy or other medical condition covered by the insurance, and as a result, your current monthly earnings are 80% or less of your pre-disability earnings. Once you have been disabled for 24 months, you must be prevented from performing one or more of the essential duties of any occupation and as a result, your current monthly earnings are 66 2/3% or less of your pre-disability earnings. Am I eligible? You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis How much coverage would I have? You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $8,000 that cannot exceed 66 2/3% of your current monthly earnings. Your plan includes a minimum benefit, greater of 10% of your elected benefit or $100. Earnings are defined in The Hartford’s contract with your employer.
When can I enroll? If you choose not to elect coverage during your annual enrollment period, you will not be eligible to elect coverage until the next annual enrollment period without a qualifying change in family status. When is it effective? 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. What is does “Actively at Work” mean? 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 How long do I have to wait before I can receive my benefit? You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a Long-Term Disability benefit payment. For those employees electing an elimination period of 30 days or less, if your are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of disability What is an elimination period? 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.
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Disability Insurance
EMPLOYEE BENEFITS
The Hartford
Age Disabled
Benefits Payable
Prior to Age 63
Normal Retirement Age or 48 months if greater
Age 63
Normal Retirement Age or 42 months if greater
Age 64
36 Months
Age 65
30 Months
Age 66
27 Months
Age 67
24 Months
Age 68
21 Months
Age 69 and older
18 Months
Disability
18
Elimination Period
per $100 in benefit
0/7
$3.30
14/14
$2.39
30/30
$1.75
60/60
$1.48
90/90
$1.26
180/180
$0.94
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
APL
ABOUT CANCER Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment. For full plan details, please visit your benefit website: www.mybenefitshub.com/losfresnoscisd
Cancer Insurance provides financial assistance in the form of a cash benefit upon a cancer diagnosis and treatment, ensuring you can concentrate on your health instead of your finances. You can use your benefit to help pay toward costly medicine, medical bills, copays or even travel and lodging associated with cancer treatment. This benefit may also be available to your dependents.
Employee Employee + Spouse Employee + Child(ren) Family
SUMMARY OF BENEFITS Cancer Treatment Policy Benefits Radiation Therapy, Chemotherapy, Immunotherapy - Maximum per 12-month period Hormone Therapy - Maximum of 12 treatments per calendar year Experimental Treatment Surgical Rider Benefits Surgical Anesthesia Bone Marrow Transplant - Maximum per lifetime Stem Cell Transplant - Maximum per lifetime Prosthesis - Surgical Implantation/Non-Surgical (not Hair Piece) 1 device per site, per lifetime Internal Cancer First Occurrence Rider Benefits Lump Sum Benefit - Maximum 1 per Covered Person per lifetime Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime Hospital Intensive Care Unit Rider Benefits Intensive Care Unit Step Down Unit - Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit
Cancer Low $13.42 $28.36 $17.60 $32.50
High $19.68 $41.18 $25.04 $46.56
Plan 1
Plan 2
$10,000
$20,000
$50 per treatment $50 per treatment paid in same manner and under the same maximums as any other benefit Plan 1 Plan 2 $30 unit dollar amount; Max $3,000 per operation 25% of amount paid for covered surgery $6,000 $6,000 $600 $600 $1,000 / $100
$1,000 / $100
Plan 1 $2,500
Plan 2 $5,000
$3,750
$7,500
Plan 1 $600 per day
Plan 2 $600 per day
$300 per day
$300 per day
Benefits are only payable following a diagnosis of cancer for a loss incurred for the treatment of cancer while covered under the policy. A charge must be incurred for benefits to be payable. When coverage terminates for loss incurred after the coverage termination date, our obligation to pay benefits also terminates for a specified disease that manifested itself while the person was covered under the policy. All benefits are subject to the benefit maximums. 20
Cancer Insurance APL
EMPLOYEE BENEFITS
Cancer Treatment Benefits Eligibility You and your eligible dependents are eligible to be insured under this certificate if you and your eligible dependents meet our underwriting rules and you are actively at work with the policyholder and qualify for coverage as defined in the master application. Limitations and Exclusions No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date regardless of when specified disease was diagnosed. Only Loss for Cancer The policy pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The policy also covers other conditions or diseases directly caused by cancer or the treatment of cancer. The policy does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer. Waiting Period The policy and any attached riders contain a waiting period during which no benefits will be paid. If any covered person has a specified disease diagnosed before the end of the waiting period immediately following the covered person’s effective date, coverage for that person will apply only to loss that is incurred after one year from the covered person’s effective date. If any covered person is diagnosed as having a specified disease during the waiting period immediately following the covered person’s effective date, you may elect to void the certificate from the beginning and receive a full refund of premium. If the policy replaced group specified disease cancer coverage from any company that terminated within 30 days of the certificate effective date, the waiting period will be waived for those covered persons that were covered under the prior coverage. However, the pre-existing condition exclusion provision will still apply
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Accident Insurance
EMPLOYEE BENEFITS
The Hartford
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/losfresnoscisd
Accidents are nearly impossible to predict, but with accident insurance they’re easy to prepare for. Accident Insurance allows you to concentrate on your health instead of your finances by issuing a lump-sum benefit when you suffer a covered accident. While prices vary, the average cost of a trip to the emergency room will run you $1,2331. You can use this money to help pay toward your emergency room fees, co-pays, and hospital bills.
Accident Employee Employee + Spouse Employee + Child(ren) Family
Accident prone family members? This affordable benefit may also be available to your spouse and dependent children. Plan Information Coverage Type Benefits Emergency, Hospital & Treatment Care Accident Follow-Up Acupuncture/Chiropractic Care Ambulance – Air Ambulance – Ground Blood/Plasma/Platelets Child Care Daily Hospital Confinement Daily ICU Confinement Diagnostic Exam Emergency Dental Emergency Room Hospital Admission Initial Physician Office Visit Lodging Medical Appliance Physical Therapy Rehabilitation Facility Transportation Urgent Care X-ray
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Off-job only
Up to 3 visits per accident Up to 10 visits each per accident Once per accident Once per accident Once per accident Up to 30 days per accident while insured is confined Up to 365 days per lifetime Up 30 days per accident Once per accident Once per accident Once per accident Once per accident Once per accident Up to 30 nights per lifetime Once per accident Up to 10 visits each per accident Up to 15 days per lifetime Up to 3 trips per accident Once per accident Once per accident
$150 $75 $2,500 $1,000 $400 $50 $600 $800 $400 Up to $600 $250 $2,000 $150 $175 $300 $100 $450 $800 $200 $200
$11.78 $18.56 $20.12 $31.50
Accident Insurance
EMPLOYEE BENEFITS
The Hartford
Specified Injury & Surgery Abdominal/Thoracic Surgery Arthroscopic Surgery Burn Burn – Skin Graft Concussion Dislocation Eye Injury Fracture Hernia Repair Joint Replacement Knee Cartilage Laceration Ruptured Disc Tendon/Ligament/Rotator Cuff Catastrophic Accidental Death Common Carrier Death Coma Dismemberment Home Health Care Paralysis Prosthesis
Once per accident Once per accident Once per accident Once per accident for third degree burns(s) Up to 3 per year Once per joint per lifetime Once per accident Once per bone per accident Once per accident Once per accident Once per accident Once per accident Once per accident Once per accident Within 90 days. Spouse 50% of employee; Child 25% of employee Within 90 days Once per accident Once per accident Once per accident Once per accident
$4,000 $750 Up to $20,000 50% of burn benefit $250 Up to $12,000 Up to $1,000 Up to $12,000 $600 $6,000 Up to $3,000 Up to $1,500 $3,000 Up to $3,000 $100,000 3 times death benefit Up to $20,000 Up to $100,000 $100 Up to $100,000 Up to $4,000
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. AM I GUARANTEED COVERAGE? The 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.
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Critical Illness Insurance
EMPLOYEE BENEFITS
Voya
ABOUT CRITICAL ILLNESS Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non-medical costs related to the illness, including transportation, child care, etc. For full plan details, please visit your benefit website: www.mybenefitshub.com/losfresnoscisd What is Critical Illness Insurance? • It pays a lump-sum benefit if you are diagnosed with a covered illness or condition on or after your coverage effective date. • You have the option to elect Critical Illness Insurance. 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. Features of Critical Illness Insurance include: • Guaranteed Issue: No medical questions or tests are required for coverage. • Flexible: You can use the benefit payments for any purpose you like. • Portable: If you leave your current employer or retire, you can take your coverage with you. (Provision may vary by state.) Who is eligible for Critical Illness Insurance and what are the coverage amounts? • You— all active employees working 20+ hours per week. • You may also elect a Critical Illness benefit amount of $5,000-$30,000 in $5,000 increments Your spouse— Coverage is available only if employee coverage is elected. • You may also elect a Critical Illness benefit amount of $5,000-$30,000 in $5,000 increments • You may elect a spouse Critical Illness benefit amount up to 100% of your benefit amount. Your children— birth to age 26. Coverage is available only if employee coverage is elected. Base Module Heart attack
Major organ transplant
Cancer
Coronary artery bypass (25% of critical illness benefit amount)
Stroke
Carcinoma in situ (25% of critical illness benefit amount) Major Organ Module
Type 1 Diabetes
Major organ transplant
Transient ischemic attacks (TIA) (10% of critical illness benefit)
Coronary artery bypass (25% of critical illness benefit amount)
Ruptured or dissecting aneurysm (10% of critical illness benefit)
Carcinoma in situ (25% of critical illness benefit amount)
Abdominal aortic aneurysm (10% of critical illness benefit)
Coronary angioplasty (10% of critical illness benefit)
Thoracic aortic aneurysm (10% of critical illness benefit)
Implantable/internal cardioverter defibrillator (ICD) placement (10% of critical illness benefit)
Open heart surgery for valve replacement or repair (10% of critical illness benefit)
Pacemaker placement (10% of critical illness benefit)
Enhanced Cancer Module Benign brain tumor
Bone marrow transplant (25% of critical illness benefit)
Skin cancer (10% of critical illness benefit)
Stem cell transplant (25% of critical illness benefit)
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Critical Illness Insurance
EMPLOYEE BENEFITS
Voya
Additional Child Diseases Module (This module applies to your insured children only, and is in addition to the other modules available.) Cerebral palsy
Niemann-Pick disease
Congenital birth defects
Pompe disease
Cystic fibrosis
Sickle cell anemia
Down syndrome
Type 1 diabetes
Gaucher disease, type II or III
Type IV glycogen storage disease
Infantile Tay-Sachs
Zellweger syndrome
What additional benefits does my Critical Illness Insurance include? The benefits listed below are also included with your Critical Illness coverage. • Wellness Benefit: This provides an annual benefit payment if you complete a health screening test. ∗ Your annual benefit amount is $50 for completing a health screening test. ∗ Your spouse’s annual benefit amount is $50 for completing a health screening test. ∗ The annual benefit amount for each child is $25 with an annual maximum of $100 for all children.
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Voluntary Life
EMPLOYEE BENEFITS
Lincoln Financial Group ABOUT VOLUNTARY LIFE 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. For full plan details, please visit your benefit website: www.mybenefitshub.com/losfresnoscisd
The Lincoln Term Life Insurance Plan: • Provides a cash benefit to your loved ones in the event of your death or if you die in an accident • Provides a cash benefit to you if you suffer a covered loss in an accident, such as losing a limb or your eyesight • Features group rates for employees • Includes LifeKeys® services, which provide access to counseling, financial, and legal support services • Also includes TravelConnect® services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home
Voluntary Group Life - per $10,000 in coverage Age Employee Under 30 $0.30 30-34 $0.40 35-39 $0.70 40-44 $0.80 45-49 $1.30 50-54 $2.10 55-59 $3.70 60-64 $4.80 65-69 $9.10 70+ $14.70 Voluntary Group Life - Child(ren) - $10,000 in coverage 0-26 $1.00 Spouse rates based on Employee's age.
Employee Life Coverage options
Increments of $10,000
Maximum coverage amount
This amount may not exceed the lesser of seven times annual earnings (rounded up to the nearest $1,000) or $500,000
Guaranteed Life coverage amount
$250,000
Your coverage amount will reduce by 50% when you reach age 70. Spouse Life The amount of Dependent Life Insurance coverage cannot be greater than 100% of the Employee Benefit. Coverage options
Increments of $5,000
Maximum coverage amount
This amount may not exceed the lesser of seven times Annual Earnings or $500,000
Guaranteed Life coverage amount
$50,000
Coverage amounts are reduced by 50% when an employee reaches age 70 Dependent Child(ren) Life Live Birth but under 26 years
26
$10,000
Voluntary Life
Lincoln Financial Group
EMPLOYEE BENEFITS
WHAT YOUR BENEFITS COVER EMPLOYEE COVERAGE
Guaranteed Life Insurance Coverage Amount • Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $250,000 without providing evidence of insurability. • Annual Limited Enrollment: If you are a continuing employee, you can increase your coverage amount by four levels without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined or withdrawn, 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 Insurance Coverage Amount You can choose a coverage amount up to $500,000. Evidence of Insurability may be required for voluntary life coverage. See the Evidence of Insurability page for details. Spouse Coverage - You can secure term life insurance for your spouse if you select coverage for yourself • Guaranteed Life Insurance Coverage Amount • Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $50,000 for your spouse without providing evidence of insurability. • Annual Limited Enrollment: If you are a continuing employee, you can increase the coverage amount for your spouse by four levels without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined or withdrawn, 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 Insurance Coverage Amount • You can choose a coverage amount up to $500,000 for your spouse. Evidence of Insurability may be required. Dependent Child(ren) Coverage - You can secure term life insurance for your dependent children when you choose coverage for yourself. • Guaranteed Life Insurance Coverage Options: $10,000
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Voluntary AD&D
Lincoln Financial Group
EMPLOYEE BENEFITS
ABOUT VOLUNTARY AD&D 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/losfresnoscisd
The Lincoln Voluntary AD&D Insurance plan: Voluntary AD&D - per $10,000 in coverage • Provides a cash benefit to your loved ones if you die in an accident Child $0.50 • Provides a cash benefit to you if you suffer a covered loss in an accident, such as Spouse $0.20 losing a limb or your eyesight Employee $0.20 • Features group rates for employees • Includes LifeKeys® services, which provide access to counseling, financial, and legal support • Includes TravelConnect® services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home Employee Coverage options
Increments of $10,000
Maximum coverage amount
This amount may not exceed $500,000
Your employee AD&D coverage amount will reduce by 50% when you reach age 70. Benefits end when you retire. Dependent spouse: The amount of dependent AD&D insurance coverage cannot be greater than 100% of the employee benefit Coverage options
Increments of $5,000
Maximum coverage amount
This amount may not exceed the lesser of one times annual earnings or $500,000
• •
You can secure AD&D insurance for your spouse if you select coverage for yourself. Your spouse AD&D coverage amount will reduce by 50% when you reach age 70. Benefits end when you retire.
Dependent child(ren) Live Birth but under 26 years
$10,000
You can secure AD&D insurance for your dependent children if you select coverage for yourself
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Individual Life Insurance
EMPLOYEE BENEFITS
Texas Republic Life ABOUT INDIVIDUAL LIFE
Individual insurance is a policy that covers a single person and is intended to meet the financial needs of the beneficiary, in the event of the insured’s death. This coverage is portable and can continue after you leave employment or retire. For full plan details, please visit your benefit website: www.mybenefitshub.com/losfresnoscisd
FINANCIAL PROTECTION FOR TODAY AND TOMORROW, STARTS AT WORK. The TrueFlex UL with Living Benefits offers you protection if you encounter some hardship along life's journey, or simply would like to leave some resources to those close to you when your journey ends. Employee, spouse, children and grandchildren are eligible. For less than a cup of coffee, a premium of $3.16 a week, a 35-year-old employee can purchase $30,000 of life insurance coverage, through Texas Republic Life’s, TrueFlex Universal life product. (See form: TRLIC-TF-NT52LO) EMPLOYEES CAN EASILY QUALIFY TrueFlex is guaranteed issue up to $50,000 in coverage and for more coverage only answer 3 questions (at right) covering the last six months: NO MEDICAL EXAM! TRUEFLEX IS EASY TO ENROLL IN TrueFlex is easy to enroll in, right at your place of employment. No one coming to your home. TRUEFLEX IS EASY TO FUND TrueFlex is easy to fund by payroll deduction.
GUARANTEED ISSUE UP TO $50,000 QUALIFICATION QUESTIONS FROM $50,001 - $150,000 During the last six months, has the proposed insured: 1. Been actively at work on a full-time basis,performing usual duties? 2. Been absent from work due to illness or medical treatment for a period of more than five consecutive working days? 3. Been disabled or received tests, treatment or care of any kind in a hospital or nursing home or received chemotherapy, hormonal therapy for cancer, radiation therapy, dialysis treatment, or treatment for alcohol or drug abuse?
Age 25 35 45
MONTHLY PREMIUM RATE LIFE WITH ADB • NON-TOBACCO Face Amount $25,000 $50,000 $75,000 $10.75 $19.25 $27.75 $13.79 $25.33 $36.88 $25.17 $48.08 $71.00
TRUEFLEX IS EASY TO PORT TrueFlex policies are easy to port, you keep the same premium, your payment simply changes from a payroll deduction to a bank draft. No requalifying, no conversions and no decreasing face amounts. TRUEFLEX IS EASY TO KEEP AND MAINTAIN TrueFlex is easy to keep, (See form: TRLIC-WFUL1) you have permanent life insurance coverage to age 121 as long as you pay the required premiums. Texas Republic Life has a service desk to address any questions you may have, or policy services that you may need. 29
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/losfresnoscisd
A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. If a member has a high deductible health plan that is compatible with a health savings account, benefits will become available under the MASA membership for expenses incurred for medical care (as defined under Internal Revenue Code (“IRC”) section 213 (d)) once a member satisfies the applicable statutory minimum deductible under IRC section 223(c) for highdeductible health plan coverage that is compatible with a health savings account. Emergency Air Ambulance Coverage MASA MTS covers out-of-pocket expenses associated with emergency air transportation to a medical facility for serious medical emergencies deemed medically necessary for you or your dependent family member. Emergency Ground Ambulance Coverage MASA MTS covers out-of-pocket expenses associated with emergency ground transportation to a medical facility for serious medical emergencies deemed medically necessary for you or your dependent family member. Hospital to Hospital Ambulance Coverage MASA MTS covers out-of-pocket expenses that you or a dependent family member may incur for hospital transfers, due to a serious emergency, to the nearest and most appropriate medical facility when the current medical facility cannot provide the required level of specialized care by air ambulance to include medically equipped helicopter or fixed-wing aircraft.
30
Repatriation to Hospital Near Home Coverage MASA MTS provides services and covers out-ofpocket expenses for the coordination of a Member’s nonemergency transportation by a medically equipped, air or ground ambulance in the event of hospitalization more than one hundred (100) miles from the Member’s home if the treating physician and MASA MTS’ Medical Director says it’s medically appropriate and possible to transfer the Member to a hospital nearer to home for continued care and recuperation. What does MASA MTS guarantee? • No health questions • No age limits • No claim forms (bills must be submitted within 180 days) • No deductibles • No network limitations How do I file a claim? Filing a claim with MASA MTS is easy. Simply send the ambulance bill to MASA MTS with your member number clearly written on the front. You can either email your bill to ambulanceclaims@masaglobal.com, fax it to 817-681-2399, or mail the invoice to: MASA MTS –Claims Department, 1250 S. Pine Island Road, Suite 500, Plantation, FL 33324. You can also log in and upload your bill or check the status of an existing claim in the “Members” section of our MASA MTS Website. Should you need assistance with a claim contact MASA at 800-643-9023
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 grace period provision). For full plan details, please visit your benefit website: www.mybenefitshub.com/losfresnoscisd 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 not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA). 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. 31
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 30 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 payment for an OTC item, even when accompanied by a prescription.
Flexible Spending Accounts Account Type
Health Care FSA
Dependent Care FSA
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Eligible Expenses 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) 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
Annual Contribution Limits
Benefit
$3,050
Saves on eligible expenses not covered by insurance, reduces your taxable income
$5,000 single $2,500 if married and filing separate tax returns
Reduces your taxable income
Notes
33
Notes
34
Notes
35
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 Los Fresnos CISD Benefits Website. This summary does not replace or amend the underlying plan documentation. In the event of a discrepancy between this summary and the plan documentation the plan documentation governs. All plans and benefits described in this summary may be discontinued, increased, decreased, or altered at any time with or without notice. Rate Sheet General Disclaimer: The rate information provided in this guide is subject to change at any time by your employer and/or the plan provider. The rate information included herein, does not guarantee coverage or change or otherwise interpret the terms of the specific plan documentation, available at the Los Fresnos CISD Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.
WWW.MYBENEFITSHUB.COM/LOSFRESNOSCISD 36