01/01/2025 - 12/31/2025 WWW.MYBENEFITSHUB.COM/LOSFRESNOSCISD
Benefit Contact Information
Higginbotham Public Sector (800) 583-6908 www.mybenefitshub.com/losfresnoscisd
EECU (817) 882-0800 www.eecu.org
Blue Cross Blue Shield Group #029511 (800) 521-2227 www.bcbstx.com
The Hartford Group #681501 (866) 278-2655 www.thehartfordatwork.com
HOSPITAL INDEMNITY
Lincoln Financial Group (800) 423-2765 www.lfg.com
EMPLOYEE ASSISTANCE PROGRAM
Lincoln Financial Group (888) 628-4824 www.GuidanceResousces.com
Don’t Forget!
Blue Cross Blue Shield of Texas Phone: (972) 766-6900 Toll Free: (800) 521-2227 www.bcbstx.com
National Benefit Services (855) 399-3035 www.nbsbenefits.com
Superior Vision Group #320870 (800) 507-3800 www.superiorvision.com
American Public Life Group #22636 (800) 256-8606 www.ampublic.com
Lincoln Financial Group Life Group #G617681 AD&D Group #G00616354-0000-000 (800) 423-2765 www.lfg.com
Clever RX (800) 974-3135 https://cleverrx.com/
Group # MKLFCISD (800) 423-3226 www.masamts.com
The Hartford Group #681501 (866) 278-2655 www.thehartfordatwork.com
Voya Group #70800-3CCI2 (800) 955-7736 www.voya.com
INDIVIDUAL LIFE
Texas Republic Life (512) 330-0099 www.texasrepubliclife.com
• Login and complete your benefit enrollment from 11/04/2024 - 11/22/2024
• Enrollment assistance is available by calling Higginbotham Public Sector at (866) 914-5202.
• Update your information: home address, phone numbers, email, and beneficiaries.
• 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.
1 www.mybenefitshub.com/losfresnoscisd
2
3 Enter your Information
• Last Name
• Date of Birth
• Last Four (4) of Social Security Number
NOTE: THEbenefitsHUB uses this information to check behind the scenes to confirm your employment status. CLICK LOGIN
4
5
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 eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Q&A
Who do I contact with Questions?
For supplemental benefit questions, you can contact your Benefits Office or you can call Higginbotham Public Sector at (866) 914-5202 for assistance.
Where can I find forms?
For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ 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. If you do not receive your ID card, you can call the carrier’s customer service number to request another card.
If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.
What is Guaranteed Coverage?
The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or 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 prescriptions 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 Benefit Office within 30 days of your qualifying event and meet with your Benefits Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
QUALIFYING EVENTS
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual’s eligibility under an employer’s plan includes commencement or termination of employment.
An event that causes an employee’s dependent to satisfy or cease to satisfy coverage requirements under an employer’s plan may include change in age, student, marital, employment or tax dependent status.
If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual’s plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
Annual Benefit Enrollment
Employee Eligibility Requirements
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 Higginbotham Public Sector, or contact the insurance carrier for additional information on spouse eligibility.
FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse’s FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance.
Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Higginbotham Public Sector, or contact the insurance carrier for additional information on dependent eligibility.
Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Higginbotham Public Sector from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee’s enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your 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
Account Owner Individual
Underlying Insurance Requirement High deductible health plan
Minimum Deductible
Maximum Contribution
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?
Employee and/or employer
Employer
None
$1,650 single (2025)
$3,300 family (2025) N/A
$4,300 single (2025)
$8,550 family (2025) 55+ catch up +$1,000
Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
$3,300 (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
ABOUT MEDICAL
For full plan details, please visit your benefit website: www.mybenefitshub.com/losfresnoscisd
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Health Savings Account (HSA)
ABOUT HSA
A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). 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.
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 – $4,300
• Family (filing jointly) – $8,550
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
Opening an HSA
If you meet the eligibility requirements, you may open an HSA administered by EECU. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA.
Important HSA Information
• Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.
• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
• You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.
How To Use Your HSA
• Online/Mobile: Sign-in for 24/7 account access to check your balance, pay bills and more.
• Call/Text: (817) 882-0800 EECU’s dedicated member service representatives are available to assist you with any questions. Their hours of operation are Monday through Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. to 1:00 p.m. CT and closed on Sunday.
• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333-9934.
• Stop by a local EECU financial center: www.eecu.org/ locations.
Flexible Spending Account (FSA)
National Benefit Services (NBS)
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
Health Care FSA
The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $3,300 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).
Important FSA Rules
• The maximum per plan year you can contribute to a Health Care FSA is $3,300. 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.
• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
• No. Access to some funds may be extended If your employer’s plan contains a 2 ½-month grace period.
Over-the-Counter Item Rule Reminder
Health care reform legislation requires that certain over the counter (OTC) items require a prescription to qualify as an eligible Health Care FSA expense. You will only need to obtain a one-time prescription for the current plan year. You can continue to purchase your regular prescription medications with your FSA debit card. However, the FSA debit card may not be used as payment for an OTC item, even when accompanied by a prescription.
FSAstore.com
FSAstore.com offers thousands of FSA-eligible products and services to purchase using your FSA Debit Card or any major credit card. Competitive pricing and free shipping on orders over $50 can save you up to 40% using your FSA pretax dollars. Shop directly at FSAstore.com or have your physician submit prescriptions (when required). The FSAstore.com Services Channel allows you to search a database of more than 300,000 health care providers for nearby eligible services, such as acupuncture and chiropractic care. The FSAstore.com Learning Center focuses on answering common questions and keeping you informed about changes to your FSA benefits.
Stay prepared with MASA® AccessSM
Comprehensive coverage and care for emergency transport.
Our Emergent Plus membership plan includes:
Emergency Ground Ambulance Coverage1
Your out-of-pocket expenses for your emergency ground transportation to a medical facility are covered with MASA.
Emergency Air Ambulance Coverage1
Your out-of-pocket expenses for your emergency air transportation to a medical facility are covered with MASA.
Hospital to Hospital Ambulance Coverage1
When specialized care is required but not available at the initial emergency facility, your out-of-pocket expenses for the ground or air ambulance transfer to the nearest appropriate medical facility are covered with MASA.
Repatriation Near Home Coverage1
Should you need continued care and your care provider has approved moving you to a hospital nearer to your home, MASA coordinates and covers the expense for ambulance transportation to the approved medical facility.
Did you know?
51.3 million emergency responses occur each year
MASA protects families against uncovered costs for emergency transportation and provides connections with care services.
Source: NEMSIS, National EMS Data Report, 2023
About MASA
MASA is coverage and care you can count on to protect you from the unexpected. With us, there is no “out-of-network” ambulance. Just send us the bill when it arrives and we’ll work to ensure charges are covered. Plus, we’ll be there for you beyond your initial ride, with expert coordination services on call to manage complex transport needs during or after your emergency — such as transferring you and your loved ones home safely.
Protect yourself, your family, and your family’s financial future with MASA.
Dental Insurance
ABOUT DENTAL
Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease. For full plan details, please visit your benefit website: www.mybenefitshub.com/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
• Calendar Year Deductible
• Three month Deductible carryover applies
Maximum Calendar Year Benefits per Participant for Categories I, II, III, IV, V, VI, VII, VIII, IX, X Does not apply to Orthodontic
– per individual $150 – per family
• Give you
• 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
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/losfresnoscisd
Single Vision Covered in full Up to $25 retail
Bifocal Covered in full Up to $40 retail
Trifocal Covered in full Up to $45 retail
Progressive See description1 Up to $45 retail
Lenticular Covered in full Up to $80 retail
Contact Lenses2 $150 retail allowance Up to $80 retail
Medically Necessary
Contact Lenses Covered in full Up to $150 retail
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.
Disability Insurance
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.
Disability Insurance The Hartford
Educator Disability - Definitions
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.
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
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 desired elimination period.
Choose your Benefit Amount from the drop down box.
Accident Insurance
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 prone family members? This affordable benefit may also be available to your spouse and dependent children.
Accident Insurance The Hartford
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.
Cancer Insurance
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.
SUMMARY OF BENEFITS
A charge
All
are subject to the
Cancer Insurance
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
Critical Illness Insurance
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
Cancer
Stroke
Type 1 Diabetes
Major organ transplant
Coronary artery bypass (25% of critical illness benefit amount)
Carcinoma in situ (25% of critical illness benefit amount)
Major Organ Module
Transient ischemic attacks (TIA) (10% of critical illness benefit)
Ruptured or dissecting aneurysm (10% of critical illness benefit)
Abdominal aortic aneurysm (10% of critical illness benefit)
Thoracic aortic aneurysm (10% of critical illness benefit)
Open heart surgery for valve replacement or repair (10% of critical illness benefit)
Benign brain tumor
Skin cancer (10% of critical illness benefit)
Major organ transplant
Coronary artery bypass (25% of critical illness benefit amount)
Carcinoma in situ (25% of critical illness benefit amount)
Coronary angioplasty (10% of critical illness benefit)
Implantable/internal cardioverter defibrillator (ICD) placement (10% of critical illness benefit)
Pacemaker placement (10% of critical illness benefit)
Enhanced Cancer Module
Bone marrow transplant (25% of critical illness benefit)
Stem cell transplant (25% of critical illness benefit)
Critical Illness Insurance
Additional Child Diseases Module
(This module applies to your insured children only, and is in addition to the other modules available.)
Cerebral palsy
Congenital birth defects
Cystic fibrosis
Down syndrome
Gaucher disease, type II or III
Infantile Tay-Sachs
Niemann-Pick disease
Pompe disease
Sickle cell anemia
Type 1 diabetes
Type IV glycogen storage disease
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.
Hospital Indemnity Lincoln Financial Group
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/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.
For each full or partial day of confinement in an ICU as a result of an injury
of
Hospital Indemnity 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 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.
Indemnity
Questions? Call (800) 423-2765 and mention ID: 1074604.
Voluntary Life 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 Employee
of $10,000
Spouse rates based on Employee's age.
amount may not exceed the lesser of seven times annual earnings (rounded up to the nearest $1,000) or $500,000
will reduce by 50% when you reach age 70.
Voluntary Life Lincoln Financial Group
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
Voluntary AD&D Lincoln Financial Group
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:
• Provides a cash benefit to your loved ones 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
• Includes TravelConnect® services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home
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Individual Life Insurance 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.
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.
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?
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 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.