01/01/2025 - 12/31/2025 WWW.MYBENEFITSHUB.COM/KELLERISD
Benefit Contact Information
KELLER ISD HUMAN
/ BENEFITS
Keller ISD (817) 744-1080 www.kellerisd.net
Cigna (800) 244-6224
www.mycigna.com
National Benefit Services (855) 399-3035
www.nbsbenefits.com HIGGINBOTHAM PUBLIC SECTOR / ENROLLMENT
Higginbotham Public Sector (833) 453-1680 www.mybenefitshub.com/kellerisd
Voya
Policy #680311 (800) 955-7736
www.voya.com
Voya
Policy #680311 (800) 955-7736 www.voya.com
Superior Vision Policy #31159 (800) 507-3800
www.superiorvision.com
QCD (800) 229-0304
www.qcdofamerica.com
The Hartford Policy #GLT-395309 (800) 523-2233
File a claim: (866) 547-9124 www.thehartford.com
Voya Policy #680311 (800) 955-7736 www.voya.com
The Hartford Policy #GLT-395309 (800) 523-2233 www.thehartford.com
City of Keller (817) 743-4386 www.thekellerpointe.com
Optum Bank (866) 556-8298 option 1 www.uhc.com
Blue Cross Blue Shield TX
BCBS HDHP Group # 361790
BCBS Major Group # 361789
BCBS Essential Group # 361788 (800) 521-2227 www.bcbstx.com
COBRA Services: National Benefit Services nbs.wealthcarecobra.com
Prime Therapeutics (800) 521-2227 www.MyPrime.com
For full details on all your benefits, please visit your benefit website at: www.mybenefitshub.com/kellerisd
Don’t Forget!
• Login and complete your benefit enrollment from 10/07/2024 - 10/28/2024
• Refer to Keller ISD’s Employee Benefit Website “THEbenefitsHUB” for all your benefit plan summaries, rates & options: www.mybenefitshub.com/kellerisd or K-Cloud under human resource icon, then Benefits and Wellness.
• Due to Affordable Care Act (ACA) every employee must decline or elect benefits during open enrollment.
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www.mybenefitshub.com/kellerisd
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CLICK LOGIN
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Enter your Information
• Last Name
• Date of Birth
• Last Four (4) of Social Security Number
NOTE: THEbenefitsHUB uses this information to check behind the scenes to confirm your employment status.
Once confirmed, the Additional Security Verification page will list the contact options from your profile. Select either Text, Email, Call, or Ask Admin options to receive a code to complete the final verification step.
Enter the code that you receive and click Verify. You can now complete your benefits enrollment!
Annual Benefit Enrollment
Annual Enrollment
During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.
• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.
• Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
New Hire Enrollment
All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Q&A
Who do I contact with Questions?
For supplemental benefit questions, you can contact your Human Resources Department at (817) 744-1080.
Where can I find forms?
For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/kellerisd. 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 Keller ISD benefit website: www.mybenefitshub.com/kellerisd. 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 carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.
What is Guaranteed Coverage?
The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or preexisting condition exclusion provisions do apply, as applicable by carrier.
What is a Pre-Existing Conditions?
Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescription drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).
Annual Benefit Enrollment
Section 125 Cafeteria Plan Guidelines
A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
CHANGES IN STATUS (CIS):
Marital Status
Change in Number of Tax Dependents
Change in Status of Employment Affecting Coverage Eligibility
Gain/Loss of Dependents’ Eligibility Status
Judgment/ Decree/Order
Eligibility for Government Programs
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefits Office within 30 days of your qualifying event and meet with your Benefits Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
QUALIFYING EVENTS
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual’s eligibility under an employer’s plan includes commencement or termination of employment.
An event that causes an employee’s dependent to satisfy or cease to satisfy coverage requirements under an employer’s plan may include change in age, student, marital, employment or tax dependent status.
If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual’s plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
Annual Benefit Enrollment
Employee Eligibility Requirements
Medical and Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2025 benefits become effective on January 1, 2025, you must be actively-at-work on January 1, 2025 to be eligible for your new benefits.
Dependent Eligibility Requirements
Dependent Eligibility: You can cover eligible dependent
children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.
Actively-at-Work
You are performing your regular occupation for the employer on a full-time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel If you will not be actively at work beginning 1/1/2025 please notify your benefits administrator.
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Keller ISD Benefits, Higginbotham Public Sector, or contact the insurance carrier for additional information on spouse eligibility.
FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse’s FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance.
Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Keller ISD Benefits, Higginbotham Public Sector, or contact the insurance carrier for additional information on dependent eligibility.
Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Higginbotham Public Sector from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee’s enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your Benefits Office to request a continuation of coverage.
Description
Health Savings Account (HSA)
(IRC Sec. 223)
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Flexible Spending Account (FSA)
(IRC Sec. 125)
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, taxfree. This also allows employees to pay for qualifying dependent care tax- free.
Employer Eligibility A qualified high deductible health plan. All employers
Contribution Source Employee and/or employer
Employee and/or employer
Account Owner Individual Employer
Underlying Insurance Requirement
Minimum Deductible
Maximum Contribution
High deductible health plan
$1,600 single (2024)
Permissible Use Of Funds
Cash-Outs of Unused Amounts (if no medical expenses)
Year-to-year rollover of account balance?
Does the account earn interest?
Portable?
None
$3,200 family (2024) N/A
$4,300 single (2025)
$8,550 family (2025)
+$1,000 for 55 or older
Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
$2,400 (2025)
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65). Not permitted
Yes, will roll over to use for subsequent year’s health coverage.
Yes
No. Access to some funds may be extended if your employer’s plan contains a 2 1/2-month grace period.
No
Yes, portable year-to-year and between jobs. No
Keller Pointe
For full plan details, please visit your benefit website: www.mybenefitshub.com/kellerisd
1. What are the prices for The Keller Pointe passes?
4. What does a family consist of?
Those individuals you claim as your dependent on your tax form, can be placed on your family pass. Be ready to give proof of dependency if asked by Keller Pointe.
5. What is a group exercise add-on?
Group exercise add-on allows all members on the pass to participate in both land and water aerobics offered at Keller Pointe.
6. Where is the facility?
The address is 405 Rufe Snow Dr. Keller, TX 76248.
Senior
2. What is the benefit to KISD employees by joining The Keller Pointe through payroll deduction?
The City of Keller and KISD have an agreement to provide KISD employees annual passes to Keller Pointe and you pay through payroll deduction.
3. Who qualifies as a resident vs. non-resident?
A resident is one who lives within the city limits of the City of Keller. Look at your property tax record and see if you pay City of Keller taxes. Your postal address does not necessarily coincide with your city residency.
Sick Leave Bank
For full plan details, please visit your benefit website: www.mybenefitshub.com/kellerisd
• To become a member, a one-time donation of 2 sick days are required, unless the Sick Leave Bank goes below a certain level. Once the donation has been made, the membership will continue the duration of the employment. You can enroll in the Sick Leave Bank during your Annual Open Enrollment.
• The purpose of the Sick Leave Bank is to provide additional sick leave days to members of the bank in the event of the employee or the employee's spouse, parent, son, or daughter experience a catastrophic illness or injury. To request days from the bank, an employee must have exhausted all paid leave and vacation leave.
• Sick leave days from the bank must be approved by the District's Sick Leave Bank Committee.
Basic Life and AD&D
The Hartford
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/kellerisd
The group term Life and Accidental Death and Dismemberment (AD&D) insurance available through your employer gives extra protection that you and your family may need. Life and AD&D insurance offers financial protection by providing you coverage in case of an untimely death or an accident that destroys your income-earning ability. Life benefits are disbursed to your beneficiaries in a lump sum in the event of your death. To learn more about Life and AD&D insurance, visit www. thehartford.com/employeebenefits.
Covered accidents or death can occur up to 365 days after the accident. The total benefits for all losses due to the same accident will not exceed 100% of your coverage amount.
Hands or Both Feet or Sight of Both Eyes
Either Hand or Foot and Sight of One Eye
of Both Upper and Lower Limbs (Quadriplegia)
Movement of Both Lower Limbs (Paraplegia)
Movement of Three Limbs (Triplegia)
Movement of the Upper and Lower Limbs of One Side of the Body (Hemiplegia) 50%
Either Hand or Foot
Sight of One Eye
Speech or Hearing in Both Ears
Movement of One Limb (Uniplegia)
Thumb and Index Finger or Either Hand
Basic Life and AD&D
The Hartford
ASKED & ANSWERED
WHO IS ELIGIBLE?
You are eligible 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?
This insurance is guaranteed issue – it is available without having to provide information about your health.
WHEN CAN I ENROLL?
Your employer automatically enrolled you for this coverage. If you have not already done so, you must designate a beneficiary.
WHEN DOES THIS INSURANCE BEGIN?
This insurance will become effective for you on the date you become eligible. You must be actively at work on the day your coverage takes effect.
WHEN DOES THIS INSURANCE END?
This insurance will end when you no longer satisfy the applicable eligibility conditions, premium is unpaid, you are no longer actively working, you leave your employer or the coverage is no longer offered.
CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO LONGER A MEMBER OF THIS GROUP?
Yes, you can take this life coverage with you. Coverage may be continued for you under and individual conversion life certificate. The specific terms and qualifying events for conversation are described in the certificate. Portability on Basic Life and AD&D is not offered.
Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis.
For full plan details, please visit your benefit website: www.mybenefitshub.com/kellerisd
*Premium adjusted to meet affordability.
KELLER INDEPENDENT SCHOOL DISTRICT
Keller ISD will educate students to achieve, inspire them to dream, and challenge them to grow, so that they are prepared to be productive members of the community in which they learn, live, and work
2025 Keller ISD Benefits Rate Guide
Keller Independent School District’s Benefit Plan Year is from January 1, 2025 to December 31, 2025
Keller ISD Medical Plans –Blue Cross Blue Shield Member Line: 1-800-521-2227; Account # TX361788
➢ Visit www.bcbstx.com for detailed information on covered/non-covered items for medical, benefits, as well as to check on claims, and out of pocket maximums.
➢ All Summary Plan Documents and other benefit information can be found on THEbenefitsHUB at www.mybenefitshub.com/kellerisd or on KCloud under the Human Resources icon, then click on Benefits & Wellness.
➢ 2025 Medical Plan -
• Blue Cross Blue Shield (BCBS) In-Network or Out-of-Network Benefits
• Prime Therapeutics is our Pharmacy Benefit Manager
• www.MyPrime.com or call 1-800-521-2227
• Express Scripts www.express-scripts.com/rx or call 833-715-0942
• Accredo Specialty www.accredo.com or call 833-721-1619
BCBS Major Medical Plan (PPO) (Group #361789)
BCBS Essential Plan (PPO) (Group #361788)
Comparison Table
KELLER INDEPENDENT SCHOOL DISTRICT
Keller ISD will educate students to achieve, inspire them to dream, and challenge them to grow, so that they are prepared to be productive members of the community in which they learn, live, and work
Hospital Indemnity Voya
ABOUT HOSPITAL INDEMNITY
This is an affordable supplemental plan that pays you should you be inpatient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance.
For full plan details, please visit your benefit website: www.mybenefitshub.com/kellerisd
What is Hospital Confinement Indemnity Insurance?
Hospital Confinement Indemnity Insurance pays a daily benefit if you have a covered stay in a hospital*, critical care unit or rehabilitation facility. The benefit amount is determined by the type of facility and the number of days you stay. You have the option to elect Hospital Confinement Indemnity Insurance to meet your needs. Hospital Confinement Indemnity 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 Hospital Confinement Indemnity 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 the policy with you and select from a variety of payment plans.
*A hospital does not include an institution or part of an institution used as: a hospice care unit; a convalescent home; a rest or nursing facility; a free- standing surgical center; a rehabilitative center; an extended care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction.
“Critical care unit” and “rehabilitative facility” are specifically defined in this policy. See the certificate for details.
How can Hospital Confinement Indemnity Insurance help? Below are a few examples of how your Hospital Confinement Indemnity Insurance benefit could be used (coverage amounts may vary):
• Medical expenses, such as deductibles and copays
• Travel, food, and lodging expenses for family members
• Childcare
• Everyday expenses like utilities and groceries
Who is eligible for Hospital Confinement Indemnity Insurance?
• You - all active employees working 20+ hours per week.
• Your spouse* - coverage is available only if employee coverage is elected.
• Your children - to age 26. Coverage is available only if employee coverage is elected
*The use of “spouse” in this document means a person insured as a spouse as described in the certificate of insurance or rider. Please contact your employer for more information
What Hospital Confinement Indemnity Insurance benefits are available?
The following list is a summary of the benefits provided by Hospital Confinement Indemnity Insurance. For a list of standard exclusions and limitations, go to the end of this document. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any riders.
• You have the option to purchase a daily benefit amount of $100, $200, or $300
• The benefit amounts paid depend on the type of facility and the number of days of confinement:
• Hospital Admission—The initial hospital confinement benefit ($500 for Plan 1, $750 for Plan 2 or $1,000 for Plan 3.
• Hospital—The benefit is 1x the daily benefit amount ($100, $200 or $300), up to 30 days per confinement.
• Intensice Care Unit (ICU)—The benefit is 2x the daily benefit amount ($200, $400 or $600), up to 15 days per confinement.
• Rehabilitation facility—The benefit is one-half of the daily benefit amount ($50, $100 or $150), up to 30 days per confinement.
Critical Illness Insurance 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/kellerisd
What is Critical Illness Insurance?
Critical Illness Insurance pays a lump -sum benefit if you are diagnosed with a covered illness or condition. Critical Illness Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.
For what critical illnesses and conditions are benefits available?
Base Module
• Heart attack
• Stroke
• Coronary artery bypass (25%)
• Coma
• Cancer
• Skin cancer (10%)
• Benign brain tumor
• Deafness
• Major organ failure
• Permanent paralysis
• End stage renal (kidney) failure Cancer Module
• Carcinoma in situ (25%)
Module A
• Occupational HIV
• Blindness
Who is eligible for Critical Illness Insurance?
• You—all active employees working 20 hours per week
• Your spouse*— coverage is available only if employee coverage is elected.
• Your child(ren)— to age 26. coverage is available only if employee coverage is elected
*The use of “spouse” in this document means a person insured as a spouse as described in the certificate of insurance or rider. This may include domestic partners or civil union partners as defined by the group policy. Please contact your employer for more information.
What Maximum Critical Illness Benefit am I eligible for?
• For you: $5,000-$30,000 in $5,000 increments.
• For your spouse: $5,000-$15,000 in $5,000 increments, not to exceed 100% of employee election.
• For each covered child(ren): $1,000, $2,500, $5,000 or $10,000, not to exceed 50% of employee election. How many times can I receive the Maximum Critical Illness Benefit?
Usually you are only able to receive the Maximum Critical Illness Benefit for one covered illness or disease within each module.
Your plan includes the Restoration Benefit*, which provides a one-time restoration of 100% of the maximum benefit amount in order to pay an additional benefit if you experience a second covered illness for a different condition
Your plan also includes the Recurrence Benefit*, which allows you to receive a benefit for the same condition a second time. It’s important to note that in order for the second covered illness or the second occurrence of the illness to be covered, it must occur after 12 consecutive months without the occurrence of any covered critical illness named in your certificate, including the illness from the first benefit payment
If a partial benefit is paid out, it will not reduce the available maximum benefit amount for the illnesses or diseases in that same module. If you have reached the benefit limit by receiving the maximum benefit in each module, you may choose to end your coverage; however, if you have coverage for your spouse and/or child(ren), you must continue your coverage in order to keep their coverage active. Please see the certificate of coverage for details.
*This benefit does not apply to the cancer module.
Accident Insurance Voya
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/kellerisd
What is Accident Insurance?
Accident Insurance pays you benefits for specific injuries and events resulting from a covered accident. The amount paid depends on the type of injury and care received. Accident Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act. You may qualify to receive benefits for items listed below, as long as they are the result of a covered accident. See the certificate of insurance and any riders for specific details.
• Accident hospital care
• Follow-up care
• Common Injuries
Other features of Accident Insurance include:
• Guaranteed Issue: No medical questions or tests required for coverage.
• Flexible: You can use the benefit money for any purpose you like.
• Payroll deductions: Premiums are paid through convenient payroll deductions.
How can Accident Insurance help?
Below are a few examples of how your Accident Insurance benefits could be used:
• Medical expenses, such as deductibles and copays
• Home healthcare costs
• Lost income due to lost time at work
• Everyday expenses like utilities and groceries
Who is eligible for Accident Insurance?
• You—all active employees working 20+ hours per week**.
• Your spouse*— coverage is available only if employee coverage is elected.
• Your child(ren)— to age 26. Coverage is available only if employee coverage is elected.
*The use of “spouse” in this document means a person insured as a spouse as described in the certificate of insurance or rider. Please contact your employer for more information.
What accident benefits are available?
The following list includes the benefits provided by Accident Insurance. The benefit amounts paid depend on the type of injury and care received. You may be required to seek care for your injury within a set amount of time. Note that there may be some variation by state. For a list of standard exclusions and limitations, go to the end of this document. For a complete description of your available benefits, along with applicable provisions, exclusions and limitations, see your certificate of insurance and any riders.
Accident Insurance
Dental Insurance Cigna
ABOUT DENTAL
Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease.
For full plan details, please visit your benefit website: www.mybenefitshub.com/kellerisd
Our dental plan helps you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through Cigna Dental.
How to Find a Dentist Visit hcpdirectory.cigna.com/ or call (800) 244-6224 to find an innetwork dentist. Your network will be Total Cigna DPPO.
How to Request a New ID Card
You can access your ID Card by downloading the “MyCigna” app. Visit www.mycigna.com or contact Cigna directly at (800) 244-6224 for more information.
Calendar Year Benefits Maximum (Class I, II, III, V and IX expenses)
Calendar Year Deductible
Highlights
Class I - Preventive & Diagnostic Care
- HIGH PLAN
Oral Evaluations, Prophylaxis: routine, cleanings, X-rays: routine, X-rays: non-routine, Fluoride, Application, Sealants: per tooth, Space Maintainers: nonorthodontic , Emergency Care to Relieve Pain
Class II - Basic Restorative Care
Restorative: fillings, Endodontics: minor and major , Periodontics: minor and major , Oral Surgery: minor and major, Anesthesia: general and IV sedation, Repairs: dentures
Class III - Major Restorative Care
Inlays and Onlays, Prosthesis Over Implant, Crowns: prefabricated stainless steel / resin, Crowns: permanent cast and porcelain, Bridges and Dentures, Repairs: bridges, crowns and inlays, Denture Relines, Rebases and Adjustments
Plan Provisions:
or Discoa Dental PPOunt
Dental Insurance Cigna
DENTAL - LOW PLAN
Year Benefits Maximum (Class I, II, III, V and IX expenses)
Highlights
Class I - Preventive & Diagnostic Care
Oral Evaluations, Prophylaxis: routine cleanings , X-rays: routine, Fluoride Application Sealants: per tooth, Space Maintainers: non-orthodontic, Emergency Care to Relieve Pain
Class II - Basic Restorative Care
Restorative: fillings, Oral Surgery: minor, X-rays: non-routine
Class III - Major Restorative Care
Inlays and Onlays, Prosthesis Over Implant, Crowns: prefabricated stainless steel / resin, Crowns: permanent cast and porcelain, Bridges and Dentures, Oral Surgery: major,
Anesthesia: general and IV sedation, Periodontics: minor and major, Endodontics: minor and major, Repairs: bridges, crowns and inlays, Repairs: dentures, Denture Relines, Rebases and Adjustments
Class V - TMJ Occlusal
Class IX - Implants
Benefit Plan Provisions:
In-Network Reimbursement For services provided by a Cigna Dental PPO network dentist, Cigna Dental wi Discount Schedule. ll reimburse the dentist according to a Fee Schedule or
Non-Network Reimbursement For services provided by a non-network dentist, Cigna Dental will reimburse dentist may balance bill up to their usual fees. according to the Maximum Allowable Charge. The Late Entrant Limitation Provision Payment will be reduced by 50% for Class III services for 12 months for e outside of the designated open enrollment period. This provision does not apply to new hires. ligible members that are allowed to enroll in this plan
DHMO PLAN
If you enroll in the DHMO plan, you must select a Primary Care Dentist (PCD) from the DHMO network directory to manage your care. Each eligible dependent may choose their own PCD. The Patient Charge Schedule applies only when covered dental services are performed by your performed by your in -network dentist through Cigna. Not all Network Dentists perform all listed services and it is suggested to check with your Network Dentist in advance of receiving services. Dental services are unlimited; you pay fi xed copays, there are no deductibles and there are no claim forms to file. There is no coverage for services provided without a ref erral from your PCD or if you seek care from out-of-network providers. Please refer to link below for patient charge schedule details on your benefit website.
How do I find an In-network Dentist? Visit: https://hcpdirectory.cigna.com/ or call (800) 244-6224 to find an in-network dentist. Your network will be Cigna Dental Care DHMO
Dental Rates
Vision Insurance 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/kellerisd
How to Print your Vision ID Card:
To obtain your Superior Vision ID card, log onto www.mybenefitshub.com/KellerISD and download a generic card from the vision tab. Once you have printed your card, simply write your name on the front of the card.
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Dental & Vision Discount Program
For full plan details, please visit your benefit website: www.mybenefitshub.com/kellerisd
Dental Discount Program
The QCD of America Dental & Vision Benefit Program is a managed cost program offering a large selection of highly qualified private practice dental and optical professionals.
The QCD Philosophy
QCD believes that you should pay the lowest monthly cost possible for comprehensive dental and vision benefit coverage for your family. The member benefits from significant cost savings when and if services are used.
Why Select QCD?
When selecting dental benefits, QCD makes good financial sense. QCD allows you to allocate more of your benefit expenditures to your rising medical costs. A single dental procedure (Root Canal and Crown) could cost you as much as $2000 with no coverage. The QCD program will allow you to save up to 60% on the total cost – that could be as much as $1200 in savings and enough to fund your family ’s monthly dental and vision benefit costs for several years.
• No Claim Forms, Deductibles or Coverage Maximums
• Immediate Coverage for all Pre-Existing Conditions
• Orthodontics (Braces) for Children and Adults
Need more information?
• Contact QCD Membership Services Department
• (972) 726-0444 or (800) 229-0304
• See the last page for your enrollment form
• Visit the QCD website at www.qcdofamerica.com
• Print ID cards at: https://www.qcdofamerica.com/ printcard/
• Find a dentist at: https://www.qcdofamerica.com/find-adentist/
• Please enter Group ID KELLR to print ID cards. You will also need your subscriber ID#. Contact the QCD office if you do not have this information.
• Please select any dentist within the QCD Affiliated Dentist Team and make an appointment.
• Please be sure to identify yourself as a QCD member and the reduced fee schedule will apply to all charges.
• Please call the QCD Member Services Department at (972) 726-0444 or (800) 229-0304 for assistance.
• Information may be obtained from the web site at www.qcdofamerica.com
Dental & Vision Discount Program
Dental & Vision Discount Program
Vision Discount Program
Davis Vision is pleased to provide you with a no -cost, traditional vision Discount Program that provides significant discounts on eye exams, lenses, frames and additional eyewear options. For more details, see the Accessing Provider Information section on the reverse side.
The Discount Program entitles you to the following discounts off usual and customary fees:
Comprehensive Eye Exam
Complete Eye Examination 15% Discount off Usual & Customary
Contact Lens Examination 15% Discount off Usual & Customary
Value Added Features
Lens 1-2-3! Membership – Free Membership Up to 50% Laser Vision Correction Discount Up to 25% off Provider ’s U & C Up to 25%
Eye Examination – Members will receive a 15% discount on their comprehensive eye examination including dilation (when professionally indicated).
Eyewear (Frames and Spectacle Lenses or Contact Lenses) –Members will be entitled to substantial and verifiable savings on all of their eyewear needs. Discounts are uniform nationally and represent pricing well below Average Retail Prices. These discounts are based on published industry standard costs, not markdowns from artificially inflated prices
Significant Savings – Client surveys indicate that programs providing discounts off retail prices of eyeglasses are subject to abuse due to the high associated markups of over 300% throughout the optical industry. Consequently, these programs do not result in a true “value-add” for the beneficiary. The proposed fixed-fee discounted pricing schedule provides both verifiable savings and benefit uniformity for all members from coast to coast.
Disability Insurance
The Hartford
ABOUT DISABILITY
Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.
For full plan details, please visit your benefit website: www.mybenefitshub.com/kellerisd
EDUCATOR DISABILITY INSURANCE OVERVIEW
What is Educator Disability Income Insurance?
Why do I need Disability Insurance Coverage?
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.
• More than half of all personal bankruptcies and mortgage foreclosures are a consequence of disability
• The average worker faces a 1 in 3 chance of suffering a job loss lasting 90 days or more due to a disability
• Only 50% of American adults indicate they have enough savings to cover three months of living expenses in the event they ’re not earning any income
ELIGIBILITY AND ENROLLMENT
Eligibility
Enrollment
You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis.
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
FEATURES OF THE PLAN
Benefit Amount
Elimination Period
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.
You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $8,000 that cannot exceed 66 2/3% of your current monthly earnings. Earnings are defined in The Hartford’s contract with your employer.
You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a disability benefit payment. The elimination period that you select consists of two numbers. The first number shows the number of days you must be disabled by an accident before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin.
For those employees electing an elimination period of 30 days or less, if your are confined to a hospital for 24 hours more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization.
Disability Insurance
The Hartford
PROVISIONS OF THE PLAN
Definition of Disability Disability is defined as The Hartford’s contract with your employer. Typically, disability means that you cannot perform one or more of the essential duties of your occupation due to injury, sickness, pregnancy, or other medical conditions covered by the insurance, and as a result, your current monthly earnings are 80% or less of your pre-disability earnings.
One you have been disabled for 24 months, you must be prevented from performing one or more essential duties of any occupation, and as a result, your monthly earnings are 66 2/3% or less of your predisability earnings.
Pre-Existing Condition Limitation
Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have not received treatment for the disabling condition within 3 months, while insured under this policy, before the disability begins, or you have been insured under this policy for 12 months before your disability begins.
If your disability is a result of a pre-existing condition, we will pay benefits for a maximum of 4 weeks.
How to File a Claim
Instructions on how to file a claim can be found on your Employee Benefits Portal under Disability. To File a Claim, Call thi s Number: (866) 278-2655.
Voluntary Life Insurance
The Hartford
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.
For full plan details, please visit your benefit website: www.mybenefitshub.com/kellerisd
Voluntary Life Coverage
Guaranteed coverage amount for Self $250,000
Maximum coverage amount for Self 7 times your annual salary ($500,000 maximum in increments of $10,000)
Minimum coverage amount for Self $10,000
Guaranteed coverage amount for Spouse $20,000
Maximum coverage amount for Spouse 100% of the employee coverage amount ($350,000 maximum in increments of $10,000)
Minimum coverage amount for Spouse $10,000
Guaranteed coverage amount for dependent children to 26 years $10,000
AM I GUARANTEED COVERAGE?
If you are newly eligible and elect an amount that exceeds the guaranteed issue amount of $250,000, you will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective.
If you are currently participating in this coverage you may increase your current coverage by 2 increments, not to exceed $250,000 providing evidence of insurability. If you were previously eligible and are electing coverage for the first time, you may elect coverage in the amount of 2 increments, without providing evidence of insurability. Additional coverage amounts will require evidence of insurability that is satisfactory to The Hartford before the excess can become effective
For your spouse coverage, if you are newly eligible and elect an amount that exceeds the guaranteed issue amount of $20,000, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective
If your spouse is currently participating in this coverage you may increase your spouse’s current coverage by 1 Increments, not to exceed $20,000 without providing evidence of insurability. If you were previously eligible and are electing spouse coverage for the first time, you may elect coverage in the amount of 2 Increments. Additional coverage amounts will require your spouse to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective
GROUP LIFE INSURANCE REDUCTION
To 65% at age 65; 45% at age 70; 30% at age 75; 20% at age 80
Voluntary AD&D Insurance
The Hartford
ABOUT LIFE AND 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/kellerisd
Covered accidents or death can occur up to 365 days after the accident. The total benefi not exceed 100% of your coverage amount. t for all losses due to the same accident will LOSS FROM ACCIDENT
age 65; 45% at age 70; 30% at age 75; 20% at age 80
Flexible Spending Accounts
National Benefit Services (NBS)
returns); (b) your taxable compensation; (c) your spouse’s actual or deemed earned income.
“Register” in the top right corner, and follow the
Health Savings Account (HSA) Optum Bank
Health Account (HSA) Optum
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).
savings the can expenses. a flexible money only used. Health Account can be you Care Plan
For full plan details, please visit your benefit website: www.mybeneitshub.com/kellerisd
For full plan details, please visit your benefit website: www.mybenefitshub.com/kellerisd
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs – it is also a tax-exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
• Enrolled in an HSA-eligible HDHP (High Deductible Health Plan) Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
• Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account
• Not eligible to be claimed as a dependent on someone else’s tax return
• Not enrolled in Medicare or TRICARE
• Not receiving Veterans Administration benefits
You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered under your HDHP.
Maximum Contributions
Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2025 is based on the coverage option you elect:
• Individual – $4,150
• Family (filing jointly) – $8,300
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch-up contribution for the entire plan year
Opening an HSA
If you meet the eligibility requirements, you may open an HSA administered by Optum Bank. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA.
Important HSA Information
• Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.
• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
• You may open an HSA at the financial institution of your choice, but only accounts opened through Optum Bank are eligible for automatic payroll deduction and company contributions.
How To Use Your HSA
• Online/Mobile: Sign-in for 24/7 account access to check your balance, pay bills and more.
• Call/Text: (866) 556-8298 dedicated member service representatives are available to assist you with any questions. Their hours of operation are Monday through Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. to 1:00 p.m. CT and closed on Sunday.
• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (866)556-8298.
Wellness Programs
KISD Wellness Center
ABOUT WELLNESS PROGRAMS
A Wellness Program is designed to assist in improving your overall health and wellness. This program is provided by your employer at no cost to you.
For full plan details, please visit your benefit website: www.mybenefitshub.com/kellerisd
KISD Employee Health and Wellness Center (K-Well) - Employees, spouses, and children over the age of two are eligible to go the KISD Employee Health and Wellness Center for acute, wellness, coaching or behavioral visits. The Wellness Center is run by Marathon Health.
If you elect the BCBS Essential or Major Medical Plan, there is no cost for any of the visits; if you elect the BCBS High Deductible Plan there will be a $10.00 fee per visit for acute care visits. K-Well offers in-person, virtual and telephonic visits. Sometimes there may be a fee for different lab draws depending on what you have done at the Wellness Center. The Wellness Center information is below:
• Wellness Center Address: 5308 N. Tarrant Parkway Fort Worth, TX 76244
• Phone Number: (817) 993-6889
• Marathon Health Website: my.marathon-health.com
• Hours of Operation:
◊ Monday, Wednesday, and Friday: 7 am to 4 pm
◊ Tuesday and Thursday: 9 am to 7 pm
• Modified Hours for 1st week of each month:
◊ Monday and Wednesday: 7 am to 4 pm
◊ Tuesday and Thursday: 9 am to 7 pm
◊ Friday and Saturday: 8 am to Noon
Virtual Visits – Log into www.bcbstx.com and choose from provider sites where you can register for a virtual visit; payments are $35.00 for the Major Medical and $30.00 for the Essential Plan or call K-Well.
2025 Plan Year
Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the Keller 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 Keller 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.