ARLINGTON ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2017 - 8/31/2018 WWW.MYAISDBENEFITS.NET
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Table of Contents Contact Information 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) TRS ActiveCare 1-HD & 2 Medical Plans TRS ActiveCare Select Medical Plan TRS ActiveCare Pharmacy Plans TRS Scott & White HMO Medical Plan TRS Scott & White HMO Pharmacy Plan Alex TRS ActiveCare Medical Rates without Wellness Program Incentive TRS ActiveCare Medical Rates with Wellness Program Incentive Wellness Program TRS Teladoc Plan | MDLive Tele-Health Plan Medlink Medical Gap Plan Healthcare Savings Account (HSA) Dental Plans and Rates Vision Plan and Rates Disability Plan Cancer Plan and Rates Group Life and AD&D Individual Life Insurance Long Term Care Insurance Identity Theft Protection Plan and Rates Pet Insurance MetLaw Hyatt Legal Services Catastrophic Sick Leave Bank Medical & Dependent Care Reimbursement Accounts Employee Assistance Program Retirement Planning Online Benefit Enrollment
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3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18-19 20-21 22-25 26-29 30-31 32-35 36-39 40-43 44-47 48-49 50-51 52-53 54-55 56-57 58-59 60-63 64-67 68-69 70-71
FLIP TO... PG. 70 HOW TO HOW TO ENROLL ENROLL
PG. 4 SUMMARY PAGES
PG. 10 YOUR BENEFITS
Program
Phone Number
Vendor
Website/Email
ARLINGTON ISD BENEFITS OFFICE STAFF FBS Client Services Representative
(682) 867-7364
hrbenefits@aisd.net
HR Manager
(682) 867-7700
hrbenefits@aisd.net
Patrice Whiteside
HR Specialist-Leaves and Retirement
(682) 867-7362
hrbenefits@aisd.net
Patrice Simmons
HR Specialist-Benefits and Wellness
(682) 867-7480
hrbenefits@aisd.net
Linda Scott Denebra Sharp
Office Fax (682) 867-4651 Website www.myaisdbenefits.net INSURANCE PLANS PHONE NUMBERS 2017-2018
TRS ActiveCare Medical
Aetna
(800) 222-9205
www.trsactivecareaetna.com
TRS ActiveCare Pharmacy
Caremark
(800) 222-9205
www2.caremark.com/trsactivecare/
Scott & White HMO Medical and Pharmacy
Scott & White
(844) 216-4150
www.trs.swhp.org
Wellness Program
Vivarae
(888) 848-3723
www.AISDWellnessProgram.com
TRS Teladoc
Aetna
(855) 835-2362
www.teladoc.com/aetna
MDLive Tele-health
MDLive
(888) 365-1663
www.consultmdlive.com
Medlink Medical Gap Plan
American Public Life
(800) 256-8606
www.ampublic.com
Healthcare Savings Account (HSA)
HSA Bank
(800) 357-6246
www.hsabank.com
Dental
CIGNA
(800) 244-6224
www.cigna.com
Vision
Davis Vision
(800) 999-5431
www.davisvision.com
Disability
The Hartford
(866) 278-2655
www.thehartford.com
Cancer
American Public Life
(800) 256-8606
www.ampublic.com
Group Life and AD&D
Symetra
(800) 796-3872
www.symetra.com
Individual Life
Texas Life
(800) 283-9233
www.texaslife.com
Long Term Care
Unum
(800) 277-4165
www.unum.com
Pet Insurance
Metlife
(800) 438-6388
www.petinsurance.com/myaisdbenefits
MetLaw Legal Plan
MetLaw
(800) 821-6400
www.legalplans.com
Identity Theft Protection
ID Watchdog
(800) 970-5182
www.idwatchdog.com
Medical & Dependent Care Reimbursement Accounts
National Benefit Services
(800) 274-0503
www.nbsbenefits.com
Employee Assistance
The Hartford
(866) 278-2655
www.guidanceresources.com
Retirement
Teacher Retirement Systems
(800) 223-8778
www. trs.state.tx.us
403(b)
National Benefits Services
(800) 274-0503
www.nbsbenefits.com
457(b) Benefits Third Party Administrator
For contact information please see the Benefits website Financial Benefit Services
(800) 583-6908
www.fbsbenefits.com
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Annual Benefit Enrollment: What’s New The following changes have been made to the TRS Medical Plans:
SUMMARY PAGES
457 Retirement Plan
The vendor for the 457 Retirement Plan is changing. For more information see the 457 link under the Retirement Rates for ActiveCare 2, ActiveCare Select and Scott & White Plan tab on the Benefits website Home page. HMO increased slightly. Family Out-of-Pocket Maximums increased for ActiveCare 2, Health Savings Account (HSA) ActiveCare Select and Scott & White HMO. You MUST re-elect your HSA contribution amount. If you do Emergency Room Copays increased for ActiveCare 2 and not go into the system and make an election you will not ActiveCare Select. have a HSA Account in the 2017-2018 plan year. The Preferred Generic Prescription Drug Copay increased on The maximum annual contribution for the Health Savings the Scott & White HMO Plan. Account has changed to $3,400.
Wellness Program
The AISD Wellness Program will still be available to all eligible employees. Any employee enrolled in a TRS ActiveCare medical plan who opts to participate in the Wellness Program, will be eligible fora $20 reduction in medical premiums each month. Participants have until August 31, 2018 to get 200 points for the 2017-2018 plan year.
Flexible Spending Account (FSA)
Sick Leave Bank
The Dental PPO deductibles and maximums are being changed from a calendar year, (January to December), to the AISD plan year, (September to August).
Dental Insurance
Vision Insurance
You MUST re-elect your FSA contribution amount. If you do not go into the system and make an election you will not have a FSA Account in the 2017-2018 plan year. The maximum annual contribution for themedical Flexible Spending Account has changed to $2,600. If you are currently a member of the Sick Leave Bank you will now be able to see your membership enrollment on the Benefits System. If you are not a member but would like to join you will have an opportunity to join as you make your benefit elections on the Benefit system. Your membership will be effective 9/1/2017.
The vendor for vision insurance is changing from VSP to Davis Vision. THINGS TO REMEMBER… This change brings great benefits and lower premiums. Declining Medical Coverage – If you are declining the TRS If you purchase frames or contacts from a Visionworks ActiveCare Medical Plans for yourself or any of your location they will be absolutely free. dependents for the first time, you are required to complete If you opt to use an Independent Provider you will have a the “Declination Process.” This can be done online at $150 allowance towards the purchase of frames or contacts. www.myaisdbenefits.net. Disability Insurance Updating Beneficiary Information – You can change your beneficiary information anytime, however, Annual Open The vendor for disability insurance has changed from Aetna to The Hartford. Enrollment is a good time to ensure your life insurance beneficiaries are correct in the Benefits System. With this change your premium has been reduced. You will now have the option to choose a percentage of your Voluntary Group Life Insurance: During Open Enrollment you may elect to increase your life insurance by one unit salary instead of a flat rate. ($10,000 for you, $5,000 for your spouse) up to the The elimination periods are changing to a 14, 30, 60 or 90 guaranteed coverage amount without evidence of day waiting period. insurability. Any increases above this will be subject to evidence of insurability.
Login and complete your supplemental benefit enrollment from 7/1/2017 to 7/31/2017 Update your profile information: home address, phone numbers, email. IMPORTANT!! Due to the Affordable Care Act (ACA) reporting requirements, please add your dependent’s social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator. 4
SUMMARY PAGES
Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
CHANGES IN STATUS (CIS):
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 31 days of your qualifying event. Contact your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event. . QUALIFYING EVENTS
Marital Status
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
Change in Number of Tax Dependents
A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Change in Status of Employment Affecting Coverage Eligibility
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.
An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements Gain/Loss of Dependents' under an employer's plan may include change in age, student, marital, employment or tax dependent Eligibility Status 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 Judgment/Decree/Order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage. Eligibility for Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Government Programs
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SUMMARY PAGES
Annual Enrollment During your annual enrollment period, you have the opportunity
Where can I find forms?
to review, change or continue benefit elections each year.
Click on the benefit plan you need information on (i.e.,
Changes are not permitted during the plan year (outside of
Dental) and you can find forms you need under the Benefits
annual enrollment) unless a Section 125 qualifying event occurs.
and Forms section.
Changes, additions or drops may be made only during the
How can I find a Network Provider?
annual enrollment period without a qualifying event.
For benefit summaries and claim forms, go to the Arlington ISD benefit website: www.myaisdbenefits.net. Click on your
Employees must review their personal information and verify
school district, then click on the benefit plan you need
that dependents they wish to provide coverage for are
information on (i.e., Dental) and you can find provider search
included in the dependent profile. Additionally, you must
links under the Quick Links section.
notify your employer of any discrepancy in personal and/or benefit information.
When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to
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.
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
New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 31 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 Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.
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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.
SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 20 or more
Dependent Eligibility: You can cover eligible dependent
regularly scheduled hours each work week.
children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the
Eligible employees must be actively at work on the plan effective
maximum age listed below. Dependents cannot be double
date for new benefits to be effective, meaning you are physically
covered by married spouses within Arlington ISD or as both
capable of performing the functions of your job on the first day of
employees and dependents.
work concurrent with the plan effective date. For example, if your 2017 benefits become effective on September 1, 2017, you must be actively-at-work on September 1, 2017 to be eligible for your new benefits. PLAN
CARRIER
MAXIMUM AGE
Cancer
American Public Life
Through 25
Dental
Cigna
Through 25
Dependent Flex
National Benefit Services
12 or younger or qualified individual unable to care for themselves & claimed as a dependent on your taxes
Healthcare FSA
National Benefit Services
Through 25 or IRS Tax Dependent
Health Savings Account
HSA Bank
IRS Tax Dependent
Medical Supplement Plan
American Public Life
Through 25
Permanent Life
Texas Life
Through 25
Telehealth
MDLIVE
Through 25
Vision
Davis
Through 25
Voluntary Life
Symetra
Through 25
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. 7
SUMMARY PAGES
Helpful Definitions Actively at Work
In-Network
You are performing your regular occupation for the employer
Doctors, hospitals, optometrists, dentists and other providers
on a full-time basis, either at one of the employer’s usual
who have contracted with the plan as a network provider.
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 9/1/2017 please notify your benefits administrator.
Annual Enrollment The period during which existing employees are given the opportunity to enroll in or change their current elections.
Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.
Out of Pocket Maximum The most an eligible or insured person can pay in co-insurance for covered expenses.
Plan Year September 1st through August 31st
Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescriptions drugs or is under a health care provider’s orders to take drugs, or received medical care or services
Calendar Year January 1st through December 31st
Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or pre-existing condition exclusion provisions do apply, as applicable by carrier.
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(including diagnostic and/or consultation services).
SUMMARY PAGES
HSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, tax-free. This also allows employees to pay for qualifying dependent care tax-free.
Employer Eligibility
A qualified high deductible health plan.
All employers
Contribution Source Account Owner Underlying Insurance Requirement
Employee and/or employer Individual
Employee and/or employer Employer
High deductible health plan
None
Description
Minimum Deductible Maximum Contribution
$1,300 single (2017) $2,600 family (2017) $3,400 single (2017) $6,750 family (2017)
N/A Varies per employer
Permissible Use Of Funds
If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Cash-Outs of Unused Amounts (if no medical expenses)
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65).
Not permitted
Year-to-year rollover of account balance?
Yes, will roll over to use for subsequent year’s health coverage.
No. Access to some funds can may be extended if your employer’s plan contains a 2 1/2 –month grace period or $500 rollover provision.
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
FLIP TO FOR HSA INFORMATION
PG. 26
FLIP TO FOR FSA INFORMATION
PG. 60
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2017-2018 TRS-ActiveCare Plan Highlights A list of Aetna Network Physicians can be found at www.trsactivecareaetna.com Benefits
ActiveCare 1-HD
ActiveCare 2
Deductible (per plan year) In-Network Out-of-Network Maximum Out of Pocket (per plan year; medi- cal and prescription drug deductibles, copays, and coinsurance count toward the out-of-pocket maxi- mum) In-Network Out-of-Network
$2,500 employee only / $5,000 family $5,000 employee only / $10,000 family
$1,000 individual/$3,000 family $2,000 individual/$6,000 family
The individual out-of-pocket maximum only includes covered expenses incurred by that individual
$6,550 individual / $13,100 family $13,100 individual / $26,200 family
$7,150 individual/$14,300 family $14,300 individual/$28,600 family
Coinsurance In-Network Participant pays (after deductible) Outof-Network Participant pays (after deductible)
20% - You pay 40% of allowed amount
20% 40% of allowed amount
Doctor Office Visit Copay
20% after deductible
$30 copay for primary $50 copay for specialist
Diagnostic Lab
20% after deductible
Plan pays 100% (deductible waived) if performed at a Quest facility; participant pays 20% after deductible at other facility
Preventive Care
Plan pays 100%
Plan pays 100%
Teladoc Physician Services
$40 consultation fee (counts toward deductible and out-of-pocket maximum)
Plan pays 100%
High-Tech Radiology
20% after deductible
$100 copay plus 20% after deductible
(CT scan, MRI, nuclear medicine)
Inpatient Hospital
20% after deductible
(preauthorization required) (facility charges)
Emergency Room
20% after deductible
(true emergency use)
$150 copay per day plus 20% after deductible ($750 maximum copay per admission; $2,250 maximum copay per plan year) $200 copay plus 20% after deductible (copay waived if admitted)
Outpatient Surgery
20% after deductible
Bariatric Surgery
$5,000 copy (does apply to out-of-pocket max- $5,000 copay (does not apply to outof-pocket maximum) plus 20% after deductible imum) plus 20% after deductible
Physician charges (only covered in performed at an IOQ facility)
Annual Vision Examination
$150 copay per visit plus 20% after deductible
20% after deductible
$50 copay for specialist
20% after deductible
$30 copay for primary $50 copay for specialist
(one per plan year; performed by an ophthalmolo- gist or optometrist using calibrated instruments)
Annual Hearing Examination Preventive Care Some examples of preventive care frequency and services: Routine physicals – annually age 12 and over Mammograms – 1 every year age 35 and over Smoking cessation counseling – 8 visits per 12 months
Well-child care – unlimited up to age 12 Colonoscopy – 1 every 10 years age 50 and over Healthy diet/obesity counseling – unlimited to age 22; age 22 and over – 26 visits per 12 months
Well woman exam & pap smear – annually age 18 andover Prostate cancer screening –1 per year age 50 and over Breastfeeding support – 6 lactation counseling visits per 12 months
Note: Covered services under this benefit must be billed by the provider as “preventive care.” Non-network preventive care is not paid at 100%. If you receive preven- tive services from a non-network provider, you will be responsible for any applicable deductible and coinsurance under the ActiveCare 1-HD and ActiveCare 2. There is no coverage for nonnetwork services under the ActiveCare Select plan or ActiveCare Select Whole Health. For a complete listing of preventive care services, please view the Benefits Booklet at www.trsactivecareaetna.com for the latest list of covered services. TRS-ActiveCare is administered by Aetna Life Insurance Company. Aet- na provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug benefits are administered by Caremark.
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TRS ActiveCare Select Plan Effective September 1, 2017 through August 31, 2018 | In-Network Level of Benefits* Important Note regarding ActiveCare Select: When selecting providers in the ActiveCare Select plan, you must choose a network based on where you live (see list at the bottom of this page). Most AISD Employees will be in the Baylor Scott & White Benefits
ActiveCare Select
Deductible (per plan year) In-Network Out-of-Network
$1,200 employee only / $3,600 family Not applicable. This plan does not cover out-of-network services except for emergencies. Maximum Out of Pocket (per plan year; medical and prescription The individual out-of-pocket maximum only includes covered expenses indrug deductibles, copays, and coinsurance count toward the out-ofcurred by that individual
pocket maximum)
In-Network Out-of-Network Coinsurance In-Network Participant pays (after deductible) Out-of-Network Participant pays (after deductible)
Doctor Office Visit Copay Diagnostic Lab
$7,150 individual / $14,300 family Not applicable. This plan does not cover out-of-network services except for emergencies. 20% - You pay Not applicable. This plan does not cover out-of-network services except for emergencies. $30 copay for primary $60 copay for specialist
Preventive Care
Plan pays 100% (deductible waived) if performed at a Quest facility; participant pays 20% after deductible at other facility Plan pays 100%
Teladoc Physician Services High-Tech Radiology
Plan pays 100% $100 copay plus 20% after deductible
(CT scan, MRI, nuclear medicine)
Inpatient Hospital (preauthorization required) (facility charges)
$150 copay per day plus 20% after deductible ($750 maximum copay per admission)
Emergency Room
$200 copay plus 20% after deductible (copay waived if admitted)
(true emergency use)
Outpatient Surgery
$150 copay per visit plus 20% after deductible
Bariatric Surgery
Not Covered
Physician charges (only covered in performed at an IOQ facility)
Annual Vision Examination
$60 copay for specialist
(one per plan year; performed by an ophthalmologist or optometrist using calibrated instruments)
Annual Hearing Examination
$30 copay for primary $60 copay for specialist
If you live in the counties listed below your TRS plan is ActiveCare Select/Aetna Whole Health Plan and the network associated with those counties is the Baylor Scott & White Network.. You MUST choose doctors that are in the Baylor Scott & White Network
·Collin ·Dallas ·Denton ·Tarrant
·Ellis ·Parker ·Rockwall
If you do not live in one of the a counties listed above you will automatically be enrolled in the ActiveCare Select Open Access Network.
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TRS ActiveCare Pharmacy Plans Benefits Deductible (per person per plan year)
ActiveCare 1-HD
ActiveCare 2
Must meet plan- year deductible before plan pays.** $0 generic; $200 brand
ActiveCare Select $0 generic; $200 brand
Short-Term Supply at a Retail Location (up to a 31-day sup- 20% coinsurance after ply) deductible,
Tier 1-Generic copay
except for certain generic preventive drugs that are covered at 100%.**
Tier 2-Preferred Brand Tier 3-Non-Preferred Brand Extended-Day Supply at Mail Order or Retail-Plus Location (60– to 90-day supply)
$20 for a 1-to 31-day supply $20 for a 1-to 31-day supply $40 for a 1-to 31-day supply*** $65 for a 1- to 31-day supply ***
$40 for a 1-to 31-day supply*** 50% coinsurance for a 1– to 31-day supply***
$45 for a 60– to 90-day sup- ply
Tier 1-Generic copay
20% coinsurance after deductible
Tier 2-Preferred
$45 for a 60– to 90-day supply $105 for a 60– to 90-day sup- ply *** $105 for a 60– to 90- day supply ***
Brand $180 for a 60– to 90-day sup- ply 50% coinsurance for a 60– to 90-day supply ***
•Tier 3-Non-Preferred Brand
Specialty Drugs
20% after deductible
$200 per fill (up to 31 day supply) $450 per fill (32- to 90 day supply)
20% Coinsurance per fill
Short-Term Supply of a Maintenance Medication at Retail Location (up to a 31-day supply) The second time a participant fills a short-term supply of a maintenance medication at a retail pharmacy, they will pay a convenience fee. They will be charged the coinsurance and copays in the row below the second time they fill a short- term supply of a maintenance medication. Participants can avoid paying the convenience fee by filling a larger day sup- ply of a maintenance medication through mail order or at a RetailPlus location.
Tier 1 – Generic Tier 2 – Preferred Brand Tier 3 – Non-Preferred Brand
20% coinsurance after deductible
$35 for a 1- to 31-day supply
$35 for a 1- to 31-day supply
$60 for a 1- to 31-day supply
$60 for a 1- to 31-day supply
$90 for a 1- to 31-day supply
50% coinsurance for a 1- to
What is a maintenance medication? Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually re- quire regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and dia- betes.
When does the convenience fee apply? For example, if you are covered under TRS-ActiveCare Select, the first time you fill a 31-day supply of a generic maintenance drug at a retail phar- macy you will pay $20, then you will pay $35 each month that you fill a 31-day supply of that generic maintenance drug at a retail pharmacy. A 90 -day supply of that same generic maintenance medication would cost $45, and you would save $225 over the year by filling a 90-day supply. **For ActiveCare 1-HD, certain generic preventive drugs are covered at 100%. Participants do not have to meet the deductible ($2,500 - individual, $5,000 - family) and they pay nothing out of pocket for these drugs. The list of drugs is on the TRS-ActiveCare website. ***If a participant obtains a brand-name drug when a generic equivalent is available, they are responsible for the generic copay plus the cost difference between the brand-name drug and the generic drug. ****Participants can fill 32-day to 90-day supply through mail order. 12
TRS Scott & White HMO Medical Plan A list of Scott & White HMO Network Physicians can be found at www.trs.swhp.org
Benefits Deductible (per plan year) Maximum Out of Pocket (per plan year; does include medical deducti- bles/any medical copays/coinsurance, plus pharmacy copayments, coinsurance and deductibles)
Scott & White HMO Health Plan $1,000 employee only $3,000 employee and spouse; employee and child(ren); employee and family $6,550 employee only $13,100 employee and spouse; employee and child(ren), employee and family
Coinsurance (after deductible)
80% - Plan pays 20% - You pay
Preventive Care
Plan pays 100%**
Doctor Office Visits
$20 copay for primary: for first visit for illness waived, does not apply to wellness or preventive visits $50 copay for specialist
Services Provided Outside the Doctor’s Office (CT scan, MRI, Nuclear medicine)
20% after deductible
Maternity Care
$150 per day and 20% after deductible
Inpatient Hospital
$150 per day and 20% after deductible
Outpatient Surgery
$150 per day and 20% after deductible
Emergency Room
$150 per day and 20% after deductible
Urgent Care Facility
$55 co-pay
Durable Medical Equipment Coinsurance
20% after deductible
Manipulative Therapy
New Benefit: 20% without office visit $40 plus 20% with office visit (5 visits max per month 35 max visits per year) $5 copay; no deductible
Preferred Diabetic Supplies and Equipment
**Required by the Patient Protection and Affordable Care Act (PPACA). A list of covered services can be found at http://www.healthcare.gov/ law/about/ provisions/services/lists.html
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TRS Scott & White Pharmacy Plan Benefits
Scott & White HMO Health Plan
Deductible (per plan year, does not apply to generic drugs)
$150
Retail Short-Term (up to a 34-day supply) ·Preferred Generic **
$5 co-pay
·Preferred Brand
30% after deductible
·Non-preferred
50% after deductible
·Non-formulary
Greater of $50 or 50% after deductible
Maintenance Quantity SWHP Pharmacies Only (Up to a 90-day supply) ·Preferred Generic **
$6 co-pay
·Preferred Brand
30% after deductible
·Non-preferred
50% after deductible
·Non-formulary
Mail Order Specialty Drugs
Not available Please call 1-800-707-3477 20% after deductible
**If a brand name drug is dispensed when a generic equivalent is available, 50% co-pay applies
Ask a SWHP Pharmacy representative how to save money on your prescriptions 800-321-7947
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ALEX® The Benefit Administrator’s Best Friend What is ALEX®? ALEX is your personal TRS-ActiveCare benefits expert. ALEX is funny, speaks in plain English—not insurance-talk—and is available to help you and TRS-ActiveCare members figure out
Walk you through estimating tax savings with a health savings account (if you’re considering the ActiveCare 1-HD plan)
How can I talk to ALEX?
which ActiveCare plan will best serve you and your families’ needs ALEX is available from any computer with an internet connection (anonymously, of course).
– all you have to do is visit www.myalex.com/trsactivecare to get started. Want to walk through your options with your family? You
Sounds great…but how does it work? How ALEX works is simple. All you have to do is log on and
can talk to ALEX from your home computer or mobile device, 24 hours a day, 7 days a week.
respond to ALEX’s questions. ALEX will prompt you for some basic information about you and your family, ask a few questions about how your personal situation (everything you say remains confidential, of course), and help you figure out what to choose based on your responses.
What else can ALEX do?
Help you and TRS-ActiveCare members understand and compare plan options
Explain complicated health insurance terms in jargon-free language
Show you how different plan features like deductibles, coinsurance and out-of-pocket maximums work
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TRS Medical Rates 2017-2018 TRS ActiveCare Health Insurance Premiums Without Wellness Program Incentive 12 Pay—Administrators and Professionals
Employee Only Employee + Children Employee + Spouse Family
TRS ActiveCare 1-HD
TRS ActiveCare 2
$116.00 $436.00 $756.00 $1,081.00
$479.00 $827.00 $1,459.00 $1,769.00
TRS ActiveCare Select Scott & White HMO $279.00 $599.00 $1,029.00 $1,354.00
$326.04 $653.42 $1,028.08 $1,165.98
12 Pay—Para-Professionals
Employee Only Employee + Children Employee + Spouse Family
TRS ActiveCare 1-HD
TRS ActiveCare 2
$101.00 $421.00 $741.00 $1,066.00
$464.00 $812.00 $1,444.00 $1,754.00
TRS ActiveCare Select Scott & White HMO $264.00 $584.00 $1,014.00 $1,339.00
$311.04 $638.42 $1,013.08 $1,150.98
18 Pay
Employee Only Employee + Children Employee + Spouse Family
TRS ActiveCare 1-HD
TRS ActiveCare 2
$67.33 $280.67 $494.00 $710.67
$309.33 $541.33 $962.67 $1,169.33
TRS ActiveCare Select Scott & White HMO $176.00 $389.33 $676.00 $742.67
$207.36 $425.61 $675.45 $767.32
26 Pay
Employee Only Employee + Children Employee + Spouse Family
TRS ActiveCare 1-HD
TRS ActiveCare 2
$46.62 $194.31 $342.00 $492.00
$214.15 $374.77 $666.46 $809.54
TRS ActiveCare Select Scott & White HMO $121.85 $269.54 $468.00 $514.15
$143.56 $294.66 $467.99 $531.22
AISD contributes the following each month to employees participating in a medical plan: $235 per month for Professional employees $250 per month for all Para‐Professional and Auxiliary employees The rates shown reflect the amount employees will pay if this district contribution amount is approved for the 2017‐2018 plan year.
16
ALEX® The Benefit Administrator’s Best Friend 2017-2018 TRS ActiveCare Health Insurance Premiums With Wellness Program Incentive 12 Pay—Administrators and Professionals TRS ActiveCare SeTRS ActiveCare 1-HD TRS ActiveCare 2 lect
Scott & White HMO
Employee Only
$96.00
$459.00
$259.00
$306.04
Employee + Children
$416.00
$807.00
$579.00
$633.42
Employee + Spouse
$736.00
$1,439.00
$1,009.00
$1,008.08
$1,061.00
$1,749.00
$1,334.00
$1,145.98
Family
12 Pay—Para-Professionals TRS ActiveCare SeTRS ActiveCare 1-HD TRS ActiveCare 2 lect
Scott & White HMO
Employee Only
$81.00
$444.00
$244.00
$291.04
Employee + Children
$401.00
$792.00
$564.00
$618.42
Employee + Spouse
$721.00
$1,424.00
$994.00
$993.08
$1,046.00
$1,734.00
$1,319.00
$1,130.98
Family
18 Pay TRS ActiveCare 1-HD
TRS ActiveCare 2
TRS ActiveCare Select
Scott & White HMO
Employee Only
$54.00
$296.00
$162.67
$194.03
Employee + Children
$267.33
$528.00
$376.00
$412.28
Employee + Spouse
$480.67
$949.33
$662.67
$662.05
Family
$697.33
$1,156.00
$729.33
$753.99
26 Pay TRS ActiveCare 1-HD
TRS ActiveCare 2
TRS ActiveCare Select
Scott & White HMO
Employee Only
$37.39
$204.92
$112.62
$134.33
Employee + Children
$185.08
$365.54
$260.31
$285.44
Employee + Spouse
$332.77
$657.23
$458.77
$458.34
Family
$482.77
$800.31
$504.92
$521.99
AISD contributes the following each month to employees participating in a medical plan: $235 per month for Professional employees $250 per month for all Para‐Professional and Auxiliary employees The rates shown reflect the amount employees will pay if this district contribution amount is approved for the 2017‐2018 plan year.
17
VIVARAE
Wellness
YOUR BENEFITS PACKAGE
About this Benefit Wellness programs include activities such as company-sponsored exercise, weight-loss competitions, educational seminars, tobaccocessation programs and health screenings that are designed to help employees eat better, lose weight and improve their overall physical health.
70% fewer sick days for employees participating in wellness programs than those opting out.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 18 Arlington ISD Benefits Website: www.myaisdbenefits.net
Wellness The AISD Wellness Program is a vital part of our overall benefits program. We have partnered with Viverae, a leading provider of health management services, to bring you the latest health and wellness content, educational programs, and an online community to keep you motivated. The health management program is run on a point system. If you choose to participate in the plan, are enrolled in a TRS medical plan, and earn 200 points before 8/31/2017, you will be eligible for a $20 monthly reduction in your medical premiums. The Wellness Program is available to all employees. The $20 medical premium reduction is only available to TRS ActiveCare medical plan participants.
AISD Wellness Program Assessments
Points
Biometric Screening (Required)
50
Member Health Assessment (Required)
50
PREVENTIVE CARE COMPLIANCE
POINTS
Preventive Care Compliance (Required)
50
PROGRAM ACTIVITIES
POINTS
Employer Challenges
15 each/45 max
Online Courses
10 each/30 max
Webinars
5 each/30 max
Questionnaires
5 each/45 max
Targeted Programs
15 each/45 max
Healthy Events
5 each/15 max
PROGRAM GOAL
200
If you fail to reach the goal of 200 points by 8/31/17, you will not be eligible to enroll in the Wellness Program for the following plan year.
19
TELEDOC | MDLIVE YOUR BENEFITS PACKAGE
Telehealth
PLAY VIDEO
About this Benefit Telehealth provides 24/7/365 access to boardcertified doctors via telephone consultations that can diagnose, recommend treatment and prescribe medication. Whether you are at home, traveling or at work, Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.
75%
of all doctor, urgent care, and ER visits could be handled safely and effectively via telehealth.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 20 Arlington ISD Benefits Website: www.myaisdbenefits.net
Telehealth TRS ActiveCare Teledoc Plan
MDLIVE Telehealth Plan
Teladoc Services are included with the TRS ActiveCare Medical Plans.
AISD is offering an additional Telehealth Plan administered by MDLive.
Teladoc is an added benefit that gives you 24/7 telephone access Unlike the TRS Teladoc plan, you do not have to be enrolled in to a national network of U.S. board-certified doctors. any of the TRS Medical Plans to utilize this benefit. MDLive voluntary tele-health plan will allow employees to cover Call Teladoc from anywhere-home, work, or on the road-and let themselves and dependents for $10 per month. the doctor come to you! Teladoc doctors diagnose nonemergency medical problems, recommend treatment, and can even call in a prescription to your pharmacy of choice when necessary.
Medical Plan Enrollment Required
What Can Be Treated
Co-Pay
Are family members covered
Quality
Teladoc
MDLive
YES
NO
Respiratory infections Ear Infections Urinary tract infections Allergies Colds and Flu Sore Throat Pink Eye Asthma Bronchitis Joint Aches and Pain And More!
$40 per consultation (waived if enrolled in ActiveCare 2 and ActiveCare Select)
Respiratory infections Ear Infections Urinary tract infections Allergies Colds and Flu Sore Throat Pink Eye Asthma Bronchitis Joint Aches and Pain And More! $0 per consultation
Family members are covered only if they are enrolled as a dependent under the employee’s medical plan
Family members are covered if enrolled in the MDlive plan (no medical plan enrollment needed)
Are U.S. board-certified in internal medicine, family practice, emergency medicine or pediatrics
Are U.S. board-certified in internal medicine, family practice, emergency medicine or pediatrics
21
APL YOUR BENEFITS PACKAGE
MEDlinkÂŽ
PLAY VIDEO
About this Benefit Medical supplement is designed to help supplement your Employer's major medical plan. This plan provides supplemental coverage to help offset outof-pocket costs that you may experience due to deductibles, co-payments and coinsurance of your medical plan.
33% of total healthcare costs are paid out-of-pocket.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 22 Arlington ISD Benefits Website: www.myaisdbenefits.net
MEDlink® IV Enhanced
Limited Benefit Group Medical Expense Supplemental Insurance Arlington ISD
THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.
ENHANCED PLAN SUMMARY OF BENEFITS*
Base Policy
Option 1
Maximum In-Hospital Benefits
$2,500 per Covered Person per Confinement
In-Hospital Ambulance Benefit
Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation where a Covered Person is Confined as an Inpatient. Limited to one trip per day.
In-Hospital Deductible
$0 per Covered Person per Confinement
Outpatient Benefit Rider Maximum Outpatient Benefits
$500 per Covered Person per Occurrence for Covered Outpatient Services
Outpatient Ambulance Benefit
Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation where a Covered Person resides less than 18 hours. Limited to one trip per day.
Outpatient Deductible
$0 per Covered Person Per Occurrence
Covered Outpatient Services Hospital Emergency Room
Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Urgent Care Facility
Maximum of three Urgent Care visits per Covered Person per Calendar Year. Maximum of six Urgent Care visits per Calendar Year for all Covered Persons combined. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Outpatient Surgery
Outpatient Surgery in Hospital Outpatient Facility or Freestanding Outpatient Surgery Center. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Diagnostic Testing
Diagnostic Testing in a Hospital Outpatient Facility or MRI Facility. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Outpatient Treatment for a Serious Mental Illness in a Hospital Outpatient Facility
Maximum of 60 days of treatment per Covered Person per Calendar Year. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Total Monthly Premiums by Plan* Employee
Employee & Spouse
Employee & Child
Employee & Family
Ages 18-54
$30.68
$70.55
$52.15
$92.03
Ages 55+
$46.01
$105.83
$78.22
$138.04
*Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with notice. The premium and amount of benefits vary dependent upon the Plan selected at time of application.
Important Policy Provisions Eligibility
You are eligible to be covered under this Policy/Certificate if you are Actively At Work, qualify for coverage as defined in the Master Application, are covered under your Employer’s Medical Plan and are under age 70 (if you work for an employer employing less than 20 employees). Your Eligible Dependents, as defined in the Policy/Certificate, are eligible for coverage if they are covered under the Employer’s Medical Plan. You must apply for insurance during the Initial Enrollment period or on the date the person first becomes eligible for coverage. If you do not apply during the Initial Enrollment period or on the date you become eligible for coverage, you may be subject to additional underwriting by APL. Evidence of coverage under your Employer’s Medical Plan is required.
When Coverage Begins
Coverage will begin on the requested Certificate Effective Date or the Certificate Effective Date assigned by us, upon approval of your application, if our underwriting rules are met, the premium has been paid and all persons to be insured are covered under your Employer’s Medical Plan and you are Actively At Work on the Certificate Effective Date. If you are not Actively At Work on the Certificate Effective Date due to disability, Injury, Sickness, temporary layoff, leave of absence or Family and Medical Leave of Absence, coverage begins on the date you return to Actively At Work.
23 APSB-22354(TX) MGM/FBS Arlington ISD
Limitations & Exclusions No benefits will be payable for expenses incurred during any period the Covered Person does not have coverage under your Employer’s Medical Plan, except as provided in the Absence of the Insured’s Employer’s Medical Plan provision, described in the Policy. A hospital is not an institution, or part thereof, used as: a place for rehabilitation, a place for rest or for the aged, a nursing or convalescent home, a long term nursing unit or geriatrics ward, or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients.
Pre-Existing Condition Limitation
No benefits are payable during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date for any loss resulting from a Pre-Existing Condition. The Pre-Existing Condition Limitation will apply only if the Covered Person is subject to a Pre-Existing Condition Limitation under the Employer’s Medical Plan. Therefore, any Pre-Existing Condition Limitation applied to the Major Medical plan would, in effect, limit coverage under this plan.
Exclusions
No benefits are payable for any loss resulting from or caused, whether directly or indirectly, by: s war or any act of war, whether declared or undeclared, or active service in the armed forces; (This exclusion includes Accident sustained or Sickness contracted while in the service of any military, naval or air force of any country engaged in war. If coverage is suspended for any Covered Person during a period of military service, APL will refund the pro-rata portion of any premium paid for any such Covered Person upon receipt of your written request) s an intentionally self-inflicted Injury or Sickness; s suicide or attempted suicide, while sane or insane; s rest care or rehabilitative care and treatment; s outpatient routine newborn care; s voluntary abortion except, with respect to you or your covered Eligible Dependent spouse: s where you or your Dependent spouse’s life would be endangered if the fetus were carried to term; or s where medical complications have arisen from abortion; s pregnancy of an Eligible Dependent child; s participating in a riot, insurrection, rebellion, civil commotion, civil disobedience or unlawful assembly; (This does not include a loss which occurs while acting in a lawful manner within the scope of authority.) s committing, or attempting to commit, an illegal act that is defined as a felony; (Felony is as defined by the law of the jurisdiction in which the act takes place.) s participation in a contest of speed in power driven vehicles, parachuting or hang gliding; s air travel, except: s as a fare-paying passenger on a commercial airline on a regularly scheduled route; or s as a passenger for transportation only and not as a pilot or crew member; s being intoxicated or under the influence of any narcotic unless administered by a Physician or taken according to the Physician’s instructions; (Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the event that caused the loss occurred.) s alcoholism or drug addiction; s sex changes; s experimental treatment, drugs or surgery; s Accident or Sickness arising out of, and in the course of, any occupation for compensation, wage or profit; (This does not apply to those sole proprietors or partners not covered by Workers’ Compensation.) s dental or vision services, including treatment, surgery, extractions or x-rays, unless:
s s s s s s s
s resulting from an Accident occurring while the Covered Person’s coverage is in force and if performed within 12 months of the date of such Accident; or s due to congenital disease or anomaly of a covered newborn child. routine examinations, such as health exams, periodic check-ups or routine physicals, except when part of Inpatient routine newborn care; elective cosmetic surgery; drugs (prescription and non-prescription for use outside of a covered facility as defined in this Policy/Certificate or any attached rider); sterilization and reversal of sterilization; an expense that does not meet the definition of Covered Charges; an expense or service that exceeds any of the Maximum Benefits, as shown in the Schedule of Benefits; or any expense for which benefits are not payable under your Other Medical Plan.
Premium Changes
The premium rates may be changed by APL at the first anniversary date of this Policy or any premium due date thereafter. No such increase in rates will be made unless 60 days prior notice is given to the Policyholder. Premiums will not increase during the initial 12 months of coverage.
Optionally Renewable
This Policy is renewable at the option of APL. The Policyholder or APL may terminate this Policy on any premium due date after the first anniversary following the Policy Effective Date, subject to 60 days written notice.
Termination of Certificate
Your insurance coverage under this Certificate and any attached riders will end on the earliest of these dates: s the date the Policy terminates; s the end of the grace period if the premium remains unpaid; s the date you no longer qualify as an Insured; s the date you attain age 70 (if you work for an employer employing less than 20 employees); s the date your coverage under your Employer’s Medical Plan ends; or s the date of your death.
Termination of Coverage
Your insurance coverage under this Certificate and any attached riders for a Covered Person will end as follows: s the date the Policy terminates; s the date the Certificate terminates; s the end of the Certificate Month in which APL receives a written request from you to terminate the Covered Person’s coverage; s the date a Covered Person no longer qualifies as an Insured or Eligible Dependent; or s the date of the Covered Person’s death. APL may end the coverage of any Covered Person who submits a fraudulent claim.
Cobra Continuation of Coverage
This plan may be continued in accordance with the Consolidated Omnibus Reconciliation Act of 1986.
2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606
Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the certificate/policy and riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form MEDlink® Series | Texas | Limited Benefit Group Medical Expense Supplemental Insurance | 24 ISD (10/14) | Arlington
APSB-22354(TX) MGM/FBS Arlington ISD
MEDlinkÂŽ IV Enhanced
Limited Benefit Group Medical Expense Supplemental Insurance Arlington ISD
25
HSA BANK
HSA (Health Savings Account)
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit A Health Savings Account is a tax-advantaged medical savings account available to employees who are enrolled in a high-deductible health plan. The funds contributed to the account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent.
The interest earned in an HSA is tax free.
Money withdrawn for medical spending never falls under taxable income.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 26 Arlington ISD Benefits Website: www.myaisdbenefits.net
HSA (Health Savings Account) HSA Bank has teamed up with AISD to create an affordable health coverage option that helps you save on healthcare expenses. This plan is only available for those who are participating in the Active Care 1-HD medical plan. You may not enroll in the MEDlink® plan if you participate in the HSA. Depending on your district, you may or may not be able to participate in the FSA plan if you participate in HSA. Medicare, Medicaid, and Tricare participants are not eligible to participate in an HSA.
Medicare mid-year, catch-up contributions should be prorated) Authorized Signers who are 55 or older must have their own HSA in order to make the catch-up contribution
You can use your Health Savings Account (HSA) to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free.
Examples of Qualified Medical Expenses
What is an HSA?
A tax-advantaged savings account that you use to pay for eligible medical expenses as well as deductible, co-insurance, prescriptions, vision and dental care. Allows you to save while reducing your taxable income. Unused funds that will roll over year to year. There’s no “use it or lose it” penalty. A way to accumulate additional retirement savings. After age 65, funds can be withdrawn for any purpose without penalty.
Monthly Fee: Your account will be charged a monthly fee of $1.75, waived with an average daily balance at or above $3,000.
Surgery Braces Contact lenses Dentures Eyeglasses Vaccines
For a list of sample expenses, please refer to your school district’s benefits website at www.myaisdbenefits.net
HSA Bank Contact Information 605 N. 8th Street, Ste 320 Sheboygan, WI 53081 Phone: 800-357-6246 www.hsabank.com
Using Funds Debit Card You may use the card to pay merchants or service providers that accept VISA credit cards, so there is no need to pay cash up front and wait for reimbursements. You can make a withdrawal at any time. Reimbursements for qualified medical expenses are tax free. If you are disabled or reach age 65, you can receive non-medical distributions without penalty, but you must report the distributions as taxable income. You may also use your funds for a spouse or tax dependent not covered by your HDHP.
2017 Annual HSA Contribution Limits Individual: $3,400 Family: $6,750 Catch-Up Contributions: Accountholders who meet the qualifications noted below are eligible to make an HSA catch-up contribution of an additional $1,000. Health Savings accountholder Age 55 or older (regardless of when in the year an accountholder turns 55) Not enrolled in Medicare (if an accountholder enrolls in 27
How the HSA Plan Works A Health Savings Account (HSA) is an individually-owned, tax-advantaged account that you can use to pay for current or future IRS-qualified medical expenses. With an HSA, you’ll have the potential to build more savings for healthcare expenses or additional retirement savings through self-directed investment options1.
How an HSA works:
You can contribute to your HSA via payroll deduction, online banking transfer, or by sending a personal check to HSA Bank. Your employer or third parties, such as a spouse or parent, may contribute to your account as well. You can pay for qualified medical expenses with your HSA Bank Debit Card directly to your medical provider or pay out-of-pocket. You can either choose to reimburse yourself or keep the funds in your HSA to grow your savings. Unused funds will roll over year to year. After age 65, funds can be withdrawn for any purpose without penalty (subject to ordinary income taxes). Check balances and account information via HSA Bank’s Internet Banking 24/7.
Are you eligible for an HSA? If you have a qualified High Deductible Health Plan (HDHP) either through your employer, through your spouse, or one you’ve purchased on your own - chances are you can open an HSA. Additionally: You cannot be covered by any other non-HSA-compatible health plan, including Medicare Parts A and B. You cannot be covered by TriCare. You cannot have accessed your VA medical benefits in the past 90 days (to contribute to an HSA). You cannot be claimed as a dependent on another person’s tax return (unless it’s your spouse). You must be covered by the qualified HDHP on the first day of the month. When you open an account, HSA Bank will request certain information to verify your identity and to process your application.
What are the annual IRS contribution limits? Contributions made by all parties to an HSA cannot exceed the annual HSA limit set by the Internal Revenue Service (IRS). Anyone can contribute to your HSA, but only the accountholder and employer can receive tax deductions on those contributions. Combined annual contributions for the accountholder, employer, and third parties (i.e., parent, spouse, or anyone else) must not exceed these limits2. 28
2017 Annual HSA Contribution Limits Individual = $3,350 Family = $6,750
Catch-up Contributions Accountholders who meet these qualifications are eligible to make an HSA catch-up contribution of $1,000: Health Savings accountholder; age 55 or older (regardless of when in the year an accountholder turns 55); not enrolled in Medicare (if an accountholder enrolls in Medicare mid-year, catch-up contributions should be prorated). Authorized signers who are 55 or older must have their own HSA in order to make the catch-up contribution. According to IRS guidelines, each year you have until the tax filing deadline to contribute to your HSA (typically April 15 of the following year). Online contributions must be submitted by 2:00 p.m., Central Time, the business day before the tax filing deadline. Wire contributions must be received by noon, Central Time, on the tax filing deadline, and contribution forms with checks must be received by the tax filing deadline.
How can you benefit from tax savings? An HSA provides triple tax savings3. Here’s how: Contributions to your HSA can be made with pre-tax dollars and any after-tax contributions that you make to your HSA are tax deductible. HSA funds earn interest and investment earnings are tax free. When used for IRS-qualified medical expenses, distributions are free from tax.
IRS-Qualified Medical Expenses You can use your HSA to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse, or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free. HSA funds can be used to reimburse yourself for past medical expenses if the expense was incurred after your HSA was established. While you do not need to submit any receipts to HSA Bank, you must save your bills and receipts for tax purposes.
How the HSA Plan Works Examples of IRS-Qualified Medical Expenses4: Acupuncture Alcoholism treatment Ambulance services Annual physical examination Artificial limb or prosthesis Birth control pills (by prescription) Chiropractor Childbirth/delivery Convalescent home (for medical treatment only) Crutches Doctor’s fees Dental treatments (including x-rays, braces, dentures, fillings, oral surgery) Dermatologist Diagnostic services Disabled dependent care Drug addiction therapy Fertility enhancement (including in-vitro fertilization) Guide dog (or other service animal)
Gynecologist Hearing aids and batteries Hospital bills Insurance premiums5 Laboratory fees Lactation expenses Lodging (away from home for outpatient care) Nursing home Nursing services Obstetrician Osteopath Oxygen Pregnancy test kit Podiatrist Prescription drugs and medicines (over-the-counter drugs are not IRSqualified medical expenses unless prescribed by a doctor) Prenatal care & postnatal treatments Psychiatrist Psychologist Smoking cessation programs
Special education tutoring Surgery Telephone or TV equipment to assist the hearing or vision impaired Therapy or counseling Medical transportation expenses Transplants Vaccines Vasectomy Vision care (including eyeglasses, contact lenses, lasik surgery) Weight loss programs (for a specific disease diagnosed by a physician – such as obesity, hypertension, or heart disease) Wheelchairs X-rays
For assistance, please contact the Client Assistance Center 800-357-6246 Monday – Friday, 7 a.m. – 9 p.m., and Saturday, 9 a.m. - 1 p.m., CT www.hsabank.com | 605 N. 8th Street, Ste. 320, Sheboygan, WI 53081
1 Investment accounts are not FDIC insured, may lose value and are not a deposit or other obligation of, or guarantee by the bank. Investment losses which are replaced are subject to the annual contribution limits of the HSA. 2 HSA funds contributed in excess of these limits are subject to penalty and tax unless the excess and earnings are withdrawn prior to the due date, including any extensions for filing Federal Tax returns. Accountholders should consult with a qualified tax advisor in connection with excess contribution removal. The Internal Revenue Service requires HSA Bank to report withdrawals that are considered refunds of excess contributions. In order for the withdrawal to be accurately reported, accountholders may not withdraw the excess directly. Instead, an excess contribution refund must be requested from HSA Bank and an Excess Contribution Removal Form completed. 3 Federal Tax savings are available no matter where you live and HSAs are taxable in AL, CA, and NJ. HSA Bank does not provide tax advice. Consult your tax professional for tax‐related questions. 4 This list is not comprehensive. It is provided to you with the understanding that HSA Bank is not engaged in rendering tax advice. The information provided is not intended to be used to avoid Federal tax penalties. For more detailed information, please refer to IRS Publication 502 titled, “Medical and Dental Expenses”. Publications can be ordered directly from the IRS by calling 1-800-TAXFORM. If tax advice is required, you should seek the services of a professional. 5 Insurance premiums only qualify as an IRS-qualified medical expense: while continuing coverage under COBRA; for qualified long-term care coverage; coverage while receiving unemployment compensation; for any healthcare coverage for those over age 65 including Medicare (except Medicare supplemental coverage). 29
CIGNA
Dental
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, treatment and dental disease.
Good dental care may improve your overall health. Also Women with gum disease may be at greater risk of giving birth to a preterm or low birth weight baby.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 30 Arlington ISD Benefits Website: www.myaisdbenefits.net
Dental PPO and DHMO Dental PPO Plans
DHMO Plan
The Dental PPO Plans allow you to visit any dental provider. However, when you use a CIGNA network dentist you usually pay less out of your pocket because the network dentists have agreed to charge pre-negotiated reduced fees. If you visit a dentist outside the network, you may be responsible for additional fees.
The DHMO plan provides dental care through a network of dentists who charge set fees for their services. You must use a CIGNA network dentist to receive coverage. You will be required to select a DHMO Dental provider within the CIGNA network. For a list of participating providers go to www.cigna.com.
These summaries only show a few of the covered procedures. Please visit www.myaisdbenefits.net to obtain a complete summary.
CIGNA PPO High Plan
CIGNA PPO Low Plan
CIGNA DHMO Plan
Plan Year Maximum (Class I, II and III Expenses)
$1,500
$750
NONE
Plan Year Deductible (Applies to Classes II III and IV only)
$50 per person $150 per family
Benefits
Plan Pays: Class I-Preventive and Diagnostic Care Oral Exams, Routine Cleanings, X-Rays Class II-Basic Restorative Care Fillings, Extractions., Periodontal Scaling Class III-Major Restorative Care Surgical Extractions., Crowns, Dentures Class IVOrthodontia
100%
80%*
50%*
$50 per person $150 per family
Plan You Pay: Pays: No Charge *
20%*
50%*
80%
50%*
50%*
NONE
50%*
$1,000 Lifetime maximum
CIGNA PPO High
CIGNA PPO Low
CIGNA DHMO
Employee Only
$32.93
$21.41
$16.16
Employee + Children
$75.34
$48.62
$29.26
Employee + Spouse
$66.56
$42.96
$27.96
Family
$106.04
$68.32
$39.28
CIGNA PPO High
CIGNA PPO Low
CIGNA DHMO
Employee Only
$21.95
$14.27
$10.77
You Pay:
18 Pay
20%
$5.00
Employee + Children
$50.23
$32.41
$19.51
50%*
$10-$135 See DHMO Patient Charge Schedule for exact costs
Employee + Spouse
$44.37
$28.64
$18.64
$115-$350 See DHMO Patient Charge Schedule for exact costs
Family
$70.69
$45.55
$26.19
CIGNA PPO High
CIGNA PPO Low
CIGNA DHMO
Employee Only
$15.20
$9.88
$7.46
Employee + Children
$34.77
$22.44
$13.50
Employee + Spouse
$30.72
$19.83
$12.90
Family
$48.94
$31.53
$18.13
50%*
Only covers Dependent and No Orthodontia dependent Adult coverage coverage children to age 19 available 50%*
12 Pay
Not 100% Covered
$375-4400 See DHMO Patient Charge Schedule for exact cost
26 Pay
31
DAVIS YOUR BENEFITS PACKAGE
Vision
PLAY VIDEO
About this Benefit Vision insurance provides coverage for routine eye examinations and may cover all or part of the costs associated with contact lenses, eyeglasses and vision correction, depending on the plan.
75% of U.S. residents between age 25 and 64 require some sort of vision correction.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 32 Arlington ISD Benefits Website: www.myaisdbenefits.net
Vision In-Network Benefits
Plan Design Options
Frequency – Once Every: 12 Months/1 12 Months 12 Months 12 Months 12 Months
Eye Examination inclusive of Dilation (when professionally indicated) Spectacle Lenses Frame Contact Lens Evaluation, Fitting & Follow-Up Care (in lieu of eyeglasses) Contact Lenses (in lieu of eyeglasses) Copayments Eye Examination Spectacle Lenses Contact Lens Evaluation, Fitting & Follow-Up Care Eyeglass Benefit – Frame
$10 $10 $0 Up to $150 OR
FREE Frame at Visionworks/3
Frame Allowance (Retail):
Plus a 20% discount on any overage/4 Davis Vision Exclusive Collection/5 (in lieu of Allowance): Fashion / Designer / Premier - member charge (if applicable) Eyeglass Benefit - Spectacle Lenses
$0 / $0 / $0 Member Charges Covered Covered Covered $0 / $30 $12 $35 / $48 / $60 $50 / $90 / $140 $55 $75 $65 $20 / $40
Clear plastic single-vision, lined bifocal, trifocal or lenticular lenses (any size or Rx) Tinting of Plastic Lenses Scratch-Resistant Coating Polycarbonate Lenses (Children/6 / Adults) Ultraviolet Coating Anti-Reflective (AR) Coating (Standard / Premium / Ultra) Progressive Lenses (Standard / Premium / Ultra) High-Index Lenses Polarized Lenses Plastic Photochromic Lenses Scratch Protection Plan: Single Vision / Multifocal Lenses Contact Lens Benefit (in lieu of eyeglasses) Contact Lens: Materials Allowance - Evaluation, Fitting & Follow-Up Care – Standard Lens Types - Evaluation, Fitting & Follow-Up Care – Specialty Lens Types
Up to $150 Plus a 15% discount on any overage/4 Covered Up to $60 allowance Plus a 15% discount on any overage/4
Exclusive Collection Contact Lenses/5 (in lieu of Allowance): Materials: Disposable OR Planned Replacement: up to - Evaluation, Fitting & Follow-up Care Visually Required Contact Lenses (with prior approval) - Materials, Evaluation, Fitting & Follow-Up Care Additional Savings Retinal Imaging – member charge Additional Pairs of Eyeglasses
8 OR 4 boxes Covered Covered $39 30% discount/4
Out-of-Network Reimbursement Schedule: up to Eye Examination: $45 Frame: $70
Single Vision Lenses: $30 Bifocal/Progressive Lenses: $50
Trifocal Lenses: $65 Lenticular Lenses: $100
Elective Contact Lenses: $105 Visually Required CL: $225
1/ Members with a confirmed diabetes diagnosis may have a second in-network exam within the 12 month frequency timeframe for a $20 copayment or a second out-of-network
exam with the $45 out-of-network reimbursement rate. 2/ Copayment applies to Collection Contact Lenses only. 3/ The free frame benefit is available at all Visionworks locations nationwide and includes all frames except Maui Jim eyewear. 4/ Additional discounts not applicable at Walmart, Sam’s Club, or Costco locations or where limited by law or manufacturer restrictions. 5/ Collection is available at most participating independent provider offices. Collection is subject to change. Collection is inclusive of select torics and multifocals. 6/ Polycarbonate lenses are covered for dependent children, monocular patients, and patients with prescriptions +/- 6.00 diopters or greater.
One-year eyeglass breakage warranty included 33
Vision 12 Pay Employee Only
$8.14
Employee + Children
$13.02
Employee + Spouse
$13.32
Family
$21.44
18 Pay Employee Only
$5.43
Employee + Children
$8.68
Employee + Spouse
$8.88
Family
$14.29
26 Pay Employee Only
$3.76
Employee + Children
$6.01
Employee + Spouse
$6.15
Family
$9.90
VALUE-ADDED FEATURES AT NO EXTRA COST MORE COVERED FRAMES: In lieu of the frame allowance, members may choose to select any frame from Davis Vision’s Exclusive Collection. The Collection is available at most participating independent provider offices and features three levels of frames: Fashion, Designer, and Premier, with retail values of $100 - $195. By selecting an Exclusive Collection frame, member eyewear is often completely covered. In fact, over half of our members take advantage of the tremendous savings by selecting a Davis Vision Exclusive Collection frame. /1
FREE ONE-YEAR BREAKAGE WARRANTY: All eyeglasses come with a breakage warranty for repair or replacement of the frame and/or lenses for a period of one year from the date of delivery. The one-year breakage warranty applies to all plan-covered eyeglasses (i.e., all spectacle lenses, Davis Vision Exclusive Collection frames and national retailer frames, where our Exclusive Collection is not displayed).
34
SCRATCH-PROTECTION PLAN: Standard scratch-resistant coating is available for plastic lenses free of charge. Members may also purchase an optional scratch protection plan, which will replace scratched lenses with new lenses of the same material, style and prescription, at no charge for one year from the original date of dispensing. ADDITIONAL PAIR DISCOUNTS : Members will receive 50% off of additional complete pairs of eyeglasses and sunglasses at Visionworks and 30% off at other participating providers on the same transaction. Otherwise, a 20% discount off the providers usual and customary rate is available. Contact lenses are available at a 10% discount. /2
MORE COVERED CONTACT LENSES: In lieu of the allowance, members may be fitted with contact lenses from our Exclusive Collection of contact lenses, which includes torics and multifocals. All Collection contact lenses are dispensed in accordance with the specified plan design and include evaluation, fitting, and follow-up care. Davis Vision also covers the cost in full for contact lenses that are determined Visually Required. They may be prescribed in lieu of eyeglasses when it will result in /1
Vision significantly better visual acuity and/or improved binocular function, including avoidance of diplopia or suppression.
HEARING AID DISCOUNTS: Auditory health and wellness are increasingly important with hearing loss on the rise. Our members have free access to EPIC Hearing Service Plans for a savings of 30% – 60% off of suggested retail prices for brand name hearing aids through the largest, accredited network of audiologists and ENT physicians. Additional savings are available through EPIC’s Listen Hear, Live Well rewards program.
MAIL ORDER REPLACEMENT CONTACT LENSES: Davis Vision’s mail order contact lens replacement service is powered by ABB Optical Group, the nation’s #1 optical distributor and 2nd largest contact lens provider. By accessing www.davisvisioncontacts.com, Davis Vision members can easily order replacement contact lenses at significant savings and have them shipped directly to their doorstep. RETINAL IMAGING DISCOUNT: Members can receive a retinal imaging exam at participating providers at a discounted fee. The exam enables the retina, macula, blood vessels, and optic nerve to be seen in wide angle, digital images without the use of dilation drops. The exam is brief and very comfortable and allows for early detection, diagnosis, and ongoing monitoring of diseases which can affect the eyes and overall health.
/2
Participating retail providers typically do not display the Collection, but are contractually required to maintain a comparable selection (in both quantity and quality) of frames that would be covered, with no additional member out-of-pocket expense. Collection is subject to change. Additional discounts are not applicable at Costco, Sam’s Club, and Walmart locations, or where limited by law or manufacturer restrictions. Laser vision correction services administered by QualSight, LLC. Terms and conditions are subject to change.
LASER VISION CORRECTION (LASIK): Our members enjoy lower prices on LASIK procedures than other carriers, along with flexible financing options - up to 12 months interest free. These savings are 40% - 50% off the national average price of traditional LASIK and are available at over 900 locations across our nationwide network of laser vision correction providers . /3
LOW VISION COVERAGE: Members who require lowvision services and optical devices are entitled to the following coverage, both in- and out-of-network, with prior approval from Davis Vision: LOW VISION EVALUATION: One comprehensive evaluation, sometimes called a functional vision assessment, every five years with a maximum charge of $300. LOW-VISION AID: Maximum allowance of $600 with a lifetime maximum of $1,200 for items such as high- power spectacles, magnifiers, and telescopes. FOLLOW-UP CARE: Four visits in a five-year period, with a maximum charge of $100 each visit.
35
THE HARTFORD YOUR BENEFITS PACKAGE
Disability
PLAY VIDEO
About this Benefit 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.
Just over 1 in 4 of today's 20 year -olds will become disabled before they retire.
34.6 months is the duration of the average disability claim.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 36 Arlington ISD Benefits Website: www.myaisdbenefits.net
Disability Insurance Disability is designed to provide a monthly income to an individual that is disabled due to an accident or illness. There are different plans available with benefits becoming available from the 1st day of disability to as late as the 180th day. For specific details on how benefits are paid, refer to carrier brochure. Your disability coverage amount and premium can be accessed during your enrollment.
Pre-existing Conditions
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. You may also be covered if you have already satisfied the pre-existing condition requirement of your previous insurer. If your disability is a result of a pre-existing condition we will pay benefits for a maximum of 4 weeks.
Benefit Reductions Your benefit payments may be reduced by other income you receive or are eligible to receive due to your disability, such as: Social Security Disability Insurance (please see www.myaisdbenefits.net for exceptions) Workers' Compensation Other employer-based Insurance coverage you may have Unemployment benefits Settlements or judgments for income loss Retirement benefits that your employer fully or partially pays for (such as a pension plan.)
Mental Illness, Alcoholism and Substance Abuse
You can receive benefit payments for Long-Term Disabilities resulting from mental illness, alcoholism and substance abuse for a total of 24 months for all disability periods during your lifetime. Any period of time that you are confined in a hospital or other facility licensed to provide medical care for mental illness, alcoholism and substance abuse does not count toward the 24 month lifetime limit.
What other benefits are included in my disability coverage?
Your benefit payments will not be reduced by certain kinds of other income, such as: Retirement benefits if you were already receiving them before you became disabled Retirement benefits that are funded by your after-tax contributions Your personal savings, investment, IRAs or Keoghs Profit-sharing Most personal disability policies Social Security increases 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.
Exclusions
You cannot receive Disability benefit payments for disabilities that are caused or contributed to by: War or act of war (declared or not) Military service for any country engaged in war or other armed conflict The commission of, or attempt to commit a felony An intentionally self-inflicted injury
Any case where your being engaged in an illegal occupation was a contributing cause to your disability You must be under the regular care of a physician to receive benefits
Workplace Modification provides for reasonable modifications made to a workplace to accommodate your disability and allow you to return to active full-time employment. Survivor Benefit - If you die while receiving disability benefits, a benefit will be paid to your spouse or in equal shares to your surviving children under the age of 25, equal to three times the last monthly gross benefit. Travel Assistance Program – Available 24/7, this program provides assistance to employees and their dependents who travel 100 miles from their home for 90 days or less. Services include pre-trip information, emergency medical assistance and emergency personal services. The Hartford's Ability Assist service is included as a part of your group Long Term Disability (LTD) insurance program. You have access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD benefits. Once you are covered you are eligible for services to provide assistance with child/elder care, substance abuse, family relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist them with the unique emotional, financial and legal issues that may result from a disability. Ability Assist services are provided through ComPsych®, a leading provider of employee assistance and work/life services. Waiver of Premium – Once your disability claim is approved and you have satisfied your elimination period, your coverage premiums will be waived. Identity Theft Protection – An array of identity fraud support services to help victims restore their identity. Benefits include 24/7 access to an 800 number; direct contact with a certified caseworker who follows the case until it’s resolved; and a personalized fraud resolution kit with instructions and resources for ID theft victims. 37
Disability Insurance For the Premium benefit option – the table below applies to disabilities resulting from injury or sickness: Age Disabled Prior to Age 63 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 and older
Benefits Payable To Normal Retirement Age or 48 months if greater To Normal Retirement Age or 42 months if greater 36 months 30 months 27 months 24 months 21 months 18 months
Premium Option – Monthly Premium Cost (based on 12 payments per year) Rates per $100 of Monthly Benefit 30% Benefit Elimination Period Rates 40% Benefit Elimination Period Rates 50% Benefit Elimination Period Rates 60% Benefit Elimination Period Rates
38
14 days / 14 days
30 days / 30 days
60 days / 60 days
90 days / 90 days
$1.46
$1.20
$.82
$.71
14 days / 14 days
30 days / 30 days
60 days / 60 days
90 days / 90 days
$1.89
$1.56
$1.06
$.92
14 days / 14 days
30 days / 30 days
60 days / 60 days
90 days / 90 days
$2.44
$2.01
$1.37
$1.19
14 days / 14 days
30 days / 30 days
60 days / 60 days
90 days / 90 days
$3.08
$2.54
$1.74
$1.51
How to File a Disability Claim THE HARTFORD MAKES IT EASY TO FILE A CLAIM. JUST FOLLOW THESE STEPS. STEP 1 Know when it’s time to file If you’re absent from work, we can advise you on when to file your claim. If your absence is scheduled, such as an upcoming hospital stay, call us 30 days prior to your last day of work. If unscheduled, please call us as soon as possible. STEP 2 Have this information ready
Name, address, and other key identification information. Name of your department and last day of active full- time work. The nature of your claim. Your treating physician’s name, address, and phone and fax numbers.
GET SUPPORTIVE ASSISTANCE Even after your claim has been filed, we may be in touch to check your progress, answer questions or obtain additional information from you. Our goal is to offer a smooth and hassle free experience until you return to work. Feel free to also call us with anything that’s on your mind. We’re here to help. RELAX AND STAY POSITIVE You have the assurance of our knowledge, experience and understanding of what you are going through. We’re with you all the way, so you can receive the benefits you qualify for and get back to your life. QUICK FACTS The Hartford’s goal is to help get you through your time away from work with dignity and assist you in any way we can. Keep the card below in a safe place for future use. We’ll be there when you need us.
STEP 3
When you call The Hartford will ask you to provide: Name, address, and other key identification information. Name of your department and last day of active full-time With your information handy, call The Hartford at 1-866work. 278-2655. You’ll be assisted by a caring professional who’ll take The nature of your claim. your information, answer your questions and file your claim. Your treating physician’s name, address, and phone and fax numbers. Make the call
Arlington Independent School District Policy #681065
39
APL
Cancer
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit 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.
Breast Cancer is the most commonly diagnosed cancer in women.
If caught early, prostate cancer is one of the most treatable malignancies.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 40 Arlington ISD Benefits Website: www.myaisdbenefits.net
GC3 Limited Benefit Group Cancer Indemnity Insurance Arlington ISD Group #13040 THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.
Summary of Benefits* Benefits
Level 1 Base Plan
Level 2 Base Plan
Radiation Therapy/Chemotherapy/ Immunotherapy Benefit
$500 per calendar month of treatment
$1,500 per calendar month of treatment
Hormone Therapy Benefit
$50 per treatment, up to 12 per calendar year
$50 per treatment, up to 12 per calendar year
Surgical Schedule Benefit
$1,600 max per operation; $15 per surgical unit
$4,800 max per operation; $45 per surgical unit
Anesthesia Benefit
25% of the amount paid for covered surgery
25% of the amount paid for covered surgery
Hospital Confinement Benefit
$100 per day 1-90 days; $100 per day, 91+ days in lieu of other benefits
$300 per day 1-90 days; $300 per day, 91+ days in lieu of other benefits
US Government/Charity Hospital/HMO
$100 per day in lieu of most other benefits
$300 per day in lieu of most other benefits
Outpatient Hospital or Ambulatory Surgical Center Benefit
$200 per day of surgery
$600 per day of surgery
Drugs & Medicine Benefit - Inpatient
$150 per confinement
$150 per confinement
Drugs & Medicine Benefit - Outpatient
$50 per prescription, up to $50 per cal month
$50 per prescription, up to $150 per cal month
Transportation & Outpatient Lodging Benefit
$0.50 per mile per round trip $100 per day, up to 100 days per calendar year
$0.50 per mile per round trip $100 per day, up to 100 days per calendar year
Family Member Transportation & Lodging Benefit
$0.50 per mile per round trip $100 per day, up to 100 days per calendar year
$0.50 per mile per round trip $100 per day, up to 100 days per calendar year
Blood, Plasma & Platelets Benefit
$150 per day, up to $7,500 per calendar year
$250 per day, up to $12,500 per calendar year
Bone Marrow/Stem Cell Transplant
Autologous - $500 per calendar year Non-Autologous - $1,500 per calendar year
Autologous - $1,500 per calendar year Non-Autologous - $4,500 per calendar year
Experimental Treatment Benefit
Pays as any non-experimental benefit
Pays as any non-experimental benefit
Attending Physician Benefit
$30 per day of confinement
$50 per day of confinement
Surgical Prosthesis Benefit
$1,000 per device (includes surgical fee); max 1 device per site, 2 lifetime max
$3,000 per device (includes surgical fee); max 1 device per site, 2 lifetime max
Hair Prosthesis Benefit
$50 per hair prosthetic, 2 lifetime max
$50 per hair prosthetic, 2 lifetime max
Dread Disease Benefit
$100 per day, 1-90 days of hospital confinement
$300 per day, 1-90 days of hospital confinement
Hospice Care Benefit
$50 per day, $9,000 lifetime max
$100 per day, $18,000 lifetime max
Inpatient Special Nursing Services
$150 per day of confinement
$150 per day of confinement
Ambulance Ground Benefit
$200 per ground trip
$200 per ground trip
Ambulance Air Benefit
$2,000 per air trip; up to 2 trips per hospital confinement (any combination of ground/air)
$2,000 per air trip; up to 2 trips per hospital confinement (any combination of ground/air)
Extended Care Benefit
$100 per day
$300 per day
Home Health Care Benefit
$100 per day
$300 per day
Second & Third Surgical Opinions
$300 per diagnosis; additional $300 if third opinion required
$300 per diagnosis; additional $300 if third opinion required
Waiver of Premium
Premium waived after 90 days of primary insured continuous total disability due to cancer
Premium waived after 90 days of primary insured continuous total disability due to cancer
Physical/Speech Therapy Benefit
$25 per visit, up to 4 visits per calendar month, $1,000 lifetime max
$25 per visit, up to 4 visits per calendar month, $1,000 lifetime max
Diagnostic Testing Benefit Rider
$50; 1 person, per calendar year
$50; 1 person, per calendar year
Critical Illness Rider: Cancer
$2,500 lump sum benefit
$2,500 lump sum benefit
Up to $400 max of 30 days per ICU confinement; $100 ambulance per ICU admission
Up to $600 max of 30 days per ICU confinement; $100 ambulance per ICU admission
Riders
Optional Benefit Rider Intensive Care Unit Rider Monthly Premium**
Level 1
Level 1 + ICU Rider
Level 2
Level 2 + ICU Rider
Individual
$13.20
$15.20
$27.80
$30.80
One Parent
$18.40
$21.20
$38.20
$42.40
$23.60
$27.80
$48.70
$55.00
Two Parent
*Premium and amount of benefits provided vary dependent upon the level selected at time of application. **Total premium includes the policy and riders of the option selected.
APSB-22356(TX) MGM/FBS Arlington ISD-0315
41
GC3 Limited Benefit Group Cancer Indemnity Insurance Eligibility
This policy/certificate will be issued only to those persons who meet American Public Life Insurance Company’s insurability requirements. The policy/certificate and the Internal Cancer coverage under the Critical Illness Rider will not be issued to anyone who has been diagnosed or treated for Cancer in the previous ten years. The Heart Attack or Stroke coverage under the Critical Illness Rider will not be issued to anyone who has been diagnosed or treated for any heart or stroke related conditions. The Hospital Intensive Care Unit Rider will not cover heart conditions for a period of two years following the Effective Date of coverage for anyone who has been diagnosed or treated for any heart related condition prior to the 30th day following the Covered Person’s Effective Date of coverage. If You are working either under contract to or as a Full-Time Employee for the Policyholder, or You are a member in or employed by the association, You are eligible for insurance provided You qualify for coverage as defined in the Master Application. You must apply for insurance within thirty (30) days of the Policy Effective Date or the date that You become eligible for coverage. If You do not apply within thirty (30) days of the Policy Effective Date or the date You become eligible for coverage, You may be subject to additional underwriting by Us.
Base Policy
All diagnosis of cancer must be positively diagnosed by a legally licensed doctor of medicine certified by the American Board of Pathology or American Board of Osteopathic Pathology. This policy/certificate pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. This policy/certificate also covers other conditions or diseases directly caused by cancer or the treatment of cancer. No benefits are payable for any covered person for any loss incurred during the first year of this policy/certificate as a result of a Pre-Existing Condition. A PreExisting Condition is a specified disease for which, within 12 months prior to the covered person’s effective date of coverage, medical advice, consultation or treatment, including prescribed medications, was recommended by or received from a member of the medical profession, or for which symptoms manifested in such a manner as would cause an ordinarily prudent person to seek diagnosis, medical advice or treatment. Pre-Existing Conditions specifically named or described as excluded in any part of this contract are never covered. This policy/certificate contains a 30-day waiting period during which no benefits will be paid under this policy/certificate. If any covered person has a specified disease diagnosed before the end of the 30-day 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 effective date of such person’s coverage. If any covered person is diagnosed as having a specified disease during the 30-day period immediately following the effective date, you may elect to void the policy/certificate from the beginning and receive a full refund of premium. All benefits payable only up to the maximum amount listed in the schedule of benefits in the policy/certificate. A Hospital is not an institution, or part thereof, used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a rehabilitative facility; 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.
Diagnostic Testing Benefit Rider
We will pay the indemnity amount for one generally medically recognized internal cancer screening test per covered person per calendar year. Screening test include, but limited to: mammogram; breast ultrasound; breast thermography; breast cancer blood test (CA15-3); colon cancer blood test (CEA); prostate-specific antigen blood test (PSA); flexible sigmoidoscopy; colonoscopy; virtual colonoscopy; ovarian cancer blood test (CA-125); pap smear (lab test required); chest x-ray; hemocult stool specimen; serum protein electrophoresis (blood test for myeloma); thin prep pap test. Screening tests payable under this benefit will only be paid under this benefit. Benefits will only be paid for tests performed after the 30-day period following the covered person’s effective date of coverage. 42 APSB-22356(TX) MGM/FBS
Arlington ISD-0315
Critical Illness Rider
Benefits will only be paid for a covered critical illness as shown on the policy/ certificate schedule page in the policy. No benefits will be provided for any loss caused by or resulting from: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; or alcoholism or drug addiction; or any act of war, declared or undeclared , or any act related to war; or military service for any country at war; or a pre-existing condition; or a covered critical illness when the date of diagnosis occurs during the waiting period; or participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions; or participation in, or attempting to participate in a felony, riot or insurrection (a felony is as defined by the law of the jurisdiction in which the activity takes place). Internal cancer does not include: other conditions that may be considered pre-cancerous or having malignant potential such as: acquired immune deficiency syndrome (AIDS); or actinic keratosis; or myelodysplastic and non-malignant myeloproliferative disorders; or aplastic anemia; or atypia; or non-malignant monoclonal gamopathy; or Leukoplakia; or Hyperplasia; or Carcinold; or Polycythemia; or carcinoma in situ or any skin cancer other than invasive malignant melanoma into the dermis or deeper. For a pre-existing condition no benefits are payable. Pre-Existing Condition, as used in this rider means any sickness or condition for which prior to the Effective Date of coverage, medical advice, consultation or treatment, including prescribed medications, was recommended by or received from a member of the medical profession, or for which symptoms manifested in such a manner as would cause an ordinarily prudent person to seek diagnosis, medical advice or treatment.
Hospital Intensive Care Unit Rider
No benefits will be provided during the first two years of this rider for hospital intensive care unit confinement caused by any heart condition when any heart condition was diagnosed or treated prior to the 30th day following the covered person’s effective date of this rider. The heart condition causing the confinement need not be the same condition diagnosed or treated prior to the effective date. No benefits will be provided if the loss results from: attempted suicide, whether sane or insane; or intentional self-injury; or alcoholism or drug addiction; or any act of war, declared or undeclared, or any act related to war; or military service for a country at war. No benefits will be paid for confinements in units such as surgical recovery rooms, progressive care, burn units, intermediate care, private monitored rooms, observation units, telemetry units or psychiatric units not involving intensive medical care; or other facilities which do not meet the standards for intensive care unit as defined in the rider. For a newborn child born within the tenmonth period following the effective date of this rider, no benefits will be provided for hospital intensive care unit confinement that begins within the first 30 days following the birth of such child.
GC3 Limited Benefit Group Cancer Indemnity Insurance Conditionally Renewable
This policy/certificate is conditionally renewable. This means that We have the right to terminate your policy/certificate on any premium due date after the first Policyholder’s Anniversary Date. We must give the Policyholder at least 60 days written notice prior to cancellation. We cannot cancel Your coverage because of a change in Your age or health. We can change Your premiums if We change premiums for all similar Certificates issued to the Policyholder. We must give the Policyholder at least 60 days written notice before We change Your premiums.
Continuation Rider Continuation
Coverage is continued when the Insured (You) cease employment with the employer through whom You originally became insured under the Policy. You will have the option to continue this Certificate (including any Riders, if applicable) by paying the premiums directly to Us at Our home office. Premiums must be paid within thirty-one (31) days after employment with your employer terminates. Premium rates required under this Continuation provision will be the same rates as those charged under the Employer’s Policy as if You had continued employment. We will bill You for these premiums after You notify Us to continue this coverage. Coverage will continue until the earlier of: (1) the Policy under which You originally became insured ends; or (2) You stop paying premiums under this option (subject to the terms of the Grace Period).
Termination of Coverage
Your Insurance coverage will end on the earliest of these dates: (a) the date You no longer qualify as an Insured; (b) the last day of the period for which a premium has been paid, subject to the Grace Period; (c) the date the Policy terminates (See Conversion provision); (d) the date You retire; (e) the date You cease employment, or terminate Your contract with the employer through whom You originally became insured under the Policy (See Conversion provision); or (f) the date We receive Your written request for termination. Termination of Dependent(s) Insurance coverage on Your Dependent(s) will end on the earliest of these dates: (a) the date the coverage under the Certificate terminates; (b) the date the Dependent no longer meets the definition of Dependent, as defined in the Policy/Certificate (See Conversion provision); (c) the date We receive Your written request for termination.
Termination of Rider Coverage
This rider terminates: (a) when Your coverage terminates under the Policy/ Certificate to which this Rider is attached; or, (b) when any premium for this rider is not paid before the end of the Grace Period; or, (c) when You give Us a written request to do so. Coverage on a Dependent terminates under this rider when such person ceases to meet the definition of Dependent, as defined in the Policy.
Conversion
If the Employer’s Policy is terminated, this Certificate will terminate. Upon termination of the Employer’s Policy, the employee (You) will be entitled to convert to an individual policy of insurance issued by Us without evidence of insurability provided the required premiums have been paid on your behalf and You notified Us in writing within thirty-one (31) days of the Employer’s Policy termination. Premiums for the individual policy of insurance will be figured from the premium rate table in effect on the date of conversion. Subject to the terms of this provision, a covered child who ceases to be eligible may convert to an individual policy of insurance and a covered spouse who ceases to be eligible for coverage because of divorce or annulment may convert to an individual policy. Terms of this provision include: (1) Application for the individual policy and payment of the first premium must be made within 60 days after coverage ceases under the Policy/Certificate. Premiums will be figured from the premium rate table in effect on the date of conversion. (2) The individual policy will be issued without proof of insurability. It will provide benefits that most nearly approximates those of the Policy/Certificate. (3) The individual policy will take effect the day after coverage ceases under the Policy/Certificate. However, no benefits will be payable under the individual policy for any loss for which benefits are payable under the Policy/Certificate. (4) The Pre-Existing Condition Limitation and Time Limit on Certain Defenses provisions for the individual policy will be figured from the Covered Person’s Effective Date of coverage under the Policy/ Certificate. (5) Any benefit maximums will be figured from the Effective Date of the Policy/Certificate. This rider is subject to all the provisions of the Policy and Certificate to which it is attached that are not in conflict with this rider.
2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606
Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the policy/certificate/ riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GC-3 Series | Texas | Limited Benefit Group Cancer Indemnity Insurance Policy | (11/14) | Arlington ISD
43
APSB-22356(TX) MGM/FBS Arlington ISD-0315
SYMETRA YOUR BENEFITS PACKAGE
Life and AD&D
PLAY VIDEO
About this Benefit 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.
Motor vehicle crashes are the
#1
cause of accidental deaths in the US, followed by poisoning, falls, drowning, and choking.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 44 Arlington ISD Benefits Website: www.myaisdbenefits.net
Symetra Group Life and AD&D Basic Life Insurance AISD provides each eligible employee with $10,000 in life insurance at no cost. This benefit is reduced if you are age 65 or older.
*You must elect life insurance for yourself in order to cover your spouse or children.
Guaranteed Coverage and Evidence of Insurability
As a new hire, if you and your dependents are eligible and you apply during the initial enrollment period (within 31 days of your hire date), you are entitled to choose up to the guaranteed coverage amount without having to provide evidence of good health.
During Open Enrollment each year, if you have at least the minimum amount of coverage, you may elect to increase your life insurance by one unit ($10,000 for you, $5,000 for your spouse) up to the guaranteed coverage amount without evidence of good health.
If you are applying for the first time, or for an amount of coverage for yourself and any dependents greater than the guaranteed coverage amount, you will be required to submit evidence of good health. Coverage above the guaranteed amount will not be issued until the insurance company approves the evidence of good health.
Voluntary Group Term Life Insurance You can purchase this insurance for you, and your eligible spouse and children.
Levels of Coverage
For You – You can elect coverage in units of $10,000 up to a maximum of 7 times your annual salary or $500,000. For newly hired employees, the guaranteed coverage amount that can be elected without having to provide evidence of good health is the lesser of 4 times your salary or $300,000. This benefit is reduced if you are 70 years of age or older.
For Your Spouse – You may elect coverage for your spouse in units of $5,000 up to a maximum of $100,000. The guaranteed coverage amount for your spouse is $50,000.
For Your Dependent Children – You may select coverage for your eligible dependent children in units of $1,000 up to a maximum of $10,000. You may only elect a maximum of $1,000 for children under 6 months of age.
he Employee/Spouse Age
Employee Monthly Cost Per $10,000 Unit
Spouse Monthly Cost per $5,000 Unit
<25
$.27
$.27
25-29
$.34
$.34
30-34
$.43
$.43
35 to 39
$.58
$.58
40 to 44
$.82
$.82
45 to 49
$1.30
$1.30
50 to 54
$1.99
$1.99
55 to 59
$3.06
$3.06
60 to 64
$3.83
$3.83
65 to 69
$5.45
$5.45
70-74
$11.69
$11.69
75+
$18.17
$18.17
The monthly cost for children is $.80 per $10,000 of coverage. One premium will insure all your eligible children, regardless of the number of children you enroll.
When enrolling online for group life insurance, the cost for each level of coverage is pre-calculated based on your age and payroll class. For a complete list of benefits and exclusions, please see the plan summary located at www.myaisdbenefits.net
45
Symetra Group Life and AD&D Accidental Death & Dismemberment (AD&D) Plan & Rates Accidental Death and Dismemberment Insurance can help ensure that tragedy doesn’t take both an emotional and a financial toll on you and your family. The coverage will pay in the event of a serious injury to you or your covered spouse or children. Levels of Coverage For You – You may select coverage up to 10 times your salary in increments of $10,000 not to exceed $500,000. You may purchase AD&D coverage for yourself regardless of whether you purchase Life coverage. For Your Family – Your spouse’s benefit amount will be 50% of yours. Each of your covered children’s benefit will be 10% of your benefit. In order to purchase AD&D coverage for your spouse and/or child, you must purchase AD&D coverage for yourself. Benefits will pay according to the following: You will receive this % of the benefit amount: Employee, Spouse and Child Loss of life (including exposure and disappearance)
100%
Loss of any two: hand, feet Sight of both eyes Loss of both speech and hearing Quadriplegia Third degree burn covering 75% or more of the body
100%
Loss of both speech or loss of hearing Loss of one hand or one foot Loss of sight of one eye Paraplegia, or hemiplegia Third degree burn covering 50-74% of the body
50%
Loss of thumb and index finger of the same hand
25%
Your Benefit Amount
Monthly Cost for You and your Family
Monthly Cost for You Only
$500,000
$15.00
$12.50
$400,000
$12.00
$10.00
$250,000
$7.50
$6.25
$200,000
$6.00
$5.00
$150,000
$4.50
$3.75
$100,000
$3.00
$2.50
$50,000
$1.50
$1.25
$10,000
$.30
$.25
Your cost will depend on the benefit amount and coverage option you select. This rate chart shows the most common benefit amounts. A complete list of the coverage amounts and rates can be seen when you enroll online.
46
Symetra Group Life and AD&D
47
TEXAS LIFE
Individual Life
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.
Experts recommend at least
x 10 your gross annual income in coverage when purchasing life insurance.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 48 Arlington ISD Benefits Website: www.myaisdbenefits.net
Individual Life Life Insurance Highlights Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. Designed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually costs more and declines in death benefit. The policy, PureLife-plus, is underwritten by Texas Life Insurance Company, and it has these outstanding features:
High Death Benefit. With one of the highest death benefit available at the worksite,1 PureLife-plus gives your loved ones peace of mind, knowing there will be significant life insurance in force should you die prematurely.
Minimal Cash Value. Designed to provide high death benefit, PureLife-plus does not compete with the cash accumulation in your employer-sponsored retirement plans.
Long Guarantees. Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time (after the guaranteed period, premiums may go down, stay the same, or go up).
Refund of Premium. Unique in the marketplace, PureLife-plus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.)
Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.)
You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, minor children and grandchildren. Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details. 1
Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 2008
49
UNUM
Long Term Care
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit Long Term Care insurance is designed to help create a safety net if you are no longer able to care for yourself. If you suffer from an eligible prolonged illness, disability or cognitive disorder, long term care insurance will provide financial support.
60% of Americans do not have a â&#x20AC;&#x153;rainy dayâ&#x20AC;? fund to cover three months of unanticipated financial emergencies.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 50 Arlington ISD Benefits Website: www.myaisdbenefits.net
Long Term Care Whether it’s due to a motorcycle accident or serious illness, it is the type of care you may need if you couldn’t independently perform the basic activities of daily living.
Guaranteed Coverage and Long Term Care Application
Long term care insurance may help you avoid a far more difficult decision: whether to exhaust your savings or liquidate your assets to pay for a period of long term care. This policy may help you maintain control of some important decisions, such as: Who would take care of me? Where can I choose to receive care? Would I be a burden on my children if my savings couldn’t cover my care?
Plan
Plan 1
Plan 2
Plan 3
Elimination Period
As a new hire, you are eligible for benefit amounts on a Guarantee Issue basis of up to and including $4,000 and a Facility Benefit Duration of 3 or 4 years without being required to complete a Long Term Care Insurance Application (medical questionnaire). Long Term Care Insurance Application: required if you enroll after your initial new hire eligibility period. Spouses and all Family Members must complete the Long Term Care Insurance Applications and be approved for coverage in order to enroll in the Long Term Care Plan.
Benefit Long Term Care Facility - 100% of Facility Monthly Benefit Amount Professional Home and Community Care - 75% of Facility Monthly Benefit Amount Facility Monthly Benefit Amount of $2,000 Facility Benefit Duration of 3 years Lifetime Maximum of $72,000 Long Term Care Facility - 100% of Facility Monthly Benefit Amount Professional Home and Community Care - 75% of Facility Monthly Benefit Amount Facility Monthly Benefit Amount of $3,000 Facility Benefit Duration of 4 years Lifetime Maximum of $144,000 Long Term Care Facility - 100% of Facility Monthly Benefit Amount Professional Home and Community Care - 75% of Facility Monthly Benefit Amount 5% Simple Inflation Protection Facility Monthly Benefit Amount of $4,000 Facility Benefit Duration of 4 years Lifetime Maximum of $192,000 90 accumulated days. The Elimination Period need only be satisfied once during the lifetime of the insured, but must be completed within a period of 730 consecutive dates.
You will see plan rates applicable to you when you enroll or you can visit the Benefits website for a complete list of plan rates
51
ID WATCHDOG
Identity Theft
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered. An identity is stolen every 2 seconds, and takes over
300 hours
to resolve, causing an average loss of $9,650.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 52 Arlington ISD Benefits Website: www.myaisdbenefits.net
Identity Theft Here’s how it works:
Basic Identity Monitoring: Standard monthly scans of public records databases searching for new information associated with your Social Security Number. Advanced Identity Monitoring: Additional scans of the National Change of Address (NCOA) database, which identifies new addresses associated with your personal information as well as Non-Credit Loan (“Payday Loan”) databases which provide high-interest, quick cash transactions and generally require minimal personal information to obtain. Cyber Monitoring: Scans underground websites and other illicit online sources which buy, trade and sell personal information including (but not limited to) credit card numbers, passwords and Social Security Numbers.
Full-Service Identity Restoration: A dedicated team of trained and certified resolution specialists who work on your behalf to restore your identity by addressing record-keeping and reporting agencies and removing erroneous and fraudulent records that appear in your name while under the protection of a qualified identity monitoring service.
Credit Report Monitoring: Monitors your credit and notifies you when changes such as new accounts, delinquent accounts and other credit-related information is recorded.
Credit Reports & Scores: Access to your credit reports and scores from the three primary credit reporting agencies; Equifax, Experian and TransUnion.
At the end of the open enrollment period, ID Watchdog will contact you via email (if available), or by letter, with instructions on activating your account. The activation process only takes about two minutes, and can be done online or over the phone with the ID Watchdog customer service center.
ID Watchdog Plus
ID Watchdog Platinum
Basic Identity Monitoring
√
√
Advanced Identity Monitoring
√
√
√
√
Full-Service Identity Restoration
√
√
Credit Report Monitoring
√
√
Cyber Monitoring
Credit Report & Scores
√
INDIVIDUAL PLAN
$7.95 / MO
$11.95 / MO
FAMILY PLAN
$14.95 / MO
$22.95 / MO
For more information, go to: www.idwatchdog.com or call: 1-800-970-5182
53
METLIFE
Pet Insurance
YOUR BENEFITS PACKAGE
About this Benefit Pet insurance is a tool to help pet parents avoid a financial crisis due to unexpected veterinary expenses from accidents and illnesses.
1 in 3 pets may need urgent vet care every year
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 54 Arlington ISD Benefits Website: www.myaisdbenefits.net
Pet Insurance
90% cash back—Use any vet and get
Open to all ages—
More than justaccident & illnesscoverage Spay/neuter, hereditary, Rx therapeutic diets, dental and more
Exclusive - Available only for employees, not to the general public Easy enrollment—Just a few simple questions to get coverage Biggersavings—
premium increases
Accidents, including poisonings and allergic reactions Injuries, including cuts, sprains and broken bones Common illnesses, including ear infections, vomiting and diarrhea Serious/chronic illnesses, including cancer and diabetes Hereditary and congenital conditions Surgeries and hospitalization X-rays, MRIs and CT scans Prescription medications and therapeutic diets Wellness exams Dental cleaning Vaccinations Spay/neuter Flea and tick prevention Heartworm testing and prevention Routine blood tests
Starting at $66/month
Starting at $40/month
55
METLAW YOUR BENEFITS PACKAGE
Legal Services
About this Benefit Having an affordable, qualified lawyer on your side can be an invaluable asset. Legal plans provide valuable benefits that cover the most common legal needs you may encounter - like creating a standard will, living will, healthcare power of attorney or buying a home. This plan also provides access to quality law firms for advice, consultation and representation.
55% of American adults do not have a will or other estate plan in place.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 56 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Arlington ISD Benefits Website: www.myaisdbenefits.net
Legal Services MetLaw Legal Plan provides you with telephone and office consultations for an unlimited number of matters with the network attorney of your choice.
$16.50 Per Month & Covers Employee, Spouse and Dependents. Legal Representation Trials for covered matters are covered from beginning to end, regardless of length, when using a network attorney. Estate Planning Documents
Financial Matters
Real Estate Matters
Elder Law Matters
Sale, Purchase or Refinancing of your Primary, Second or Vacation Home Home
Consultation and Document Review for Issues Related to your Parents:
Simple Wills Personal Bankruptcy/Wage Earner Plan Complex Wills Revocable Trusts Irrevocable Trusts Powers of Attorney Debt Collection Defense (Healthcare, Financial, Childcare) Equity Loans for your Primary, Second or Healthcare Proxies Foreclosure Defense Vacation Home Living Wills Codicils
Medicare Medicaid
Repossession Defense
Tenant Negotiations (Tenant Only)
Prescription Plans
Garnishment Defense
Eviction Defense
Nursing Home Agreements
Identity Theft Defense
Security Deposit Assistance (Tenant Only)
Leases
Tax Collection Defense
Notes Boundary or Title Disputes
Negotiations with Creditors Tax
Deeds Property Tax Assessments
Audit Representation (Municipal, State, Federal)
Wills Zoning Applications Powers of Attorney
Family Law
Traffic Offenses*
Document Preparation
Immigration Assistance
Adoption
Defense of Traffic Tickets (Excludes DUI)
Affidavits
Advice and Consultation Review of Immigration Documents
Guardianship
Driving Privileges Restoration (Includes License Suspension due to DUI)
Deeds Preparation of Affidavits
Conservatorship
Demand Letters
Name Change
Mortgages
Prenuptial Agreement
Notes
Protection from Domestic Violence
Review of Any Personal Legal Document
Preparation of Powers of Attorney
Juvenile Matters Personal Property Protection
Consumer Protection
Defense of Civil Lawsuits
Property Protection
Juvenile Court Defense (Including Criminal Matters)
Disputes over Consumer Goods and Services
Litigation Defense
Consultation and Document Review for Personal Property Issues
Incompetency Defense Parental Responsibility Matters
Small Claims Assistance Administrative Hearings
Assistance for Disputes over Goods and Services
School Hearings Pet Liabilities
For more information, visit the employee benefits website: www.myaisdbenefits.net 57
BANK
Catastrophic Sick Leave Bank
YOUR BENEFITS PACKAGE
About this Benefit Catastrophic Sick Leave Banks is a voluntary employee benefit program developed to provide up to 75 additional paid days to members who have suffered a catastrophic illness or injury.
34.6
months Is the average group long-term disability claim .
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 58 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Arlington ISD Benefits Website: www.myaisdbenefits.net
Catastrophic Sick Leave Bank
The purpose of the Catastrophic Sick Leave Bank is to provide additional sick leave days to members of the Bank who are in the event of a catastrophic illness or injury and have exhausted all paid leave days. The request for additional days may only be made when a member has exhausted all accumulated state, local and vacation leave days.
Bank days can only be used for employees for their own catastrophic illness and must be approved.
A catastrophic illness or injury is defined as a severe condition or combination of conditions affecting the mental or physical health of an employee that requires the services of a licensed practitioner for a prolonged period of time and that causes an employee to exhaust all leave time earned and lose compensation from the District.
To become a member of the Bank, you must contribute three days from your local leave balance for the current school year. Once you have contributed your three days you cannot request to have them refunded.
You can join the Sick Leave Bank during the open enrollment period or, if you are a new employee, during the first 31 calendar days of employment.
Enrollment is conducted online at www.myaisdbenefits.netthrough the employee benefits portal.
For more information, visit the employee benefits website: www.myaisdbenefits.net 59
NBS
FSA (Flexible Spending Account)
YOUR BENEFITS PACKAGE
PLAY VIDEO
About this Benefit A Cafeteria Plan is designed to take advantage of Section 125 of the Internal Revenue Code. It allows you to pay certain qualified expenses on a pre-tax basis, thereby reducing your taxable income. You can set aside a pre-established amount of money per plan year in a Healthcare Flexible Spending Account (FSA). Funds allocated to a healthcare FSA must be used during the plan year or are forfeited unless your plan contains a $500 rollover or grace period provision.
Unlimited FSA (Non HSA Compatible) The funds in the unlimited healthcare FSA can be used to pay for eligible medical expenses like deductibles, co-payments, orthodontics, glasses and contacts.
FLIP TOâ&#x20AC;Ś PG. 9 FOR HSA VS. FSA COMPARISON
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 60 Arlington ISD Benefits Website: www.myaisdbenefits.net
FSA (Flexible Spending Account) NBS Flexcard
When Will I Receive My Flex Card?
You may use the card to pay merchants or service providers that accept MasterCard® credit cards, so there is no need to pay cash up front, then wait for reimbursement. If you are participating in the Dependent Care portion, the money isn’t loaded to the card. You must file web or paper claims or enroll in continual reimbursement.
NBS Prepaid MasterCard® Debit Card
Current plan participants: KEEP YOUR CARDS! NBS debit cards are good for 3 years. If you need a replacement card please contact NBS directly at (800) 274-0503.
New Plan Participants NBS will mail out your new benefit cards to the address listed in THEbenefitsHUB. They will be sent in unmarked envelopes so please watch for them as they should arrive within 21 business days of effective date. NBS debit cards are good for 3 years.
Expect Flex Cards to be delivered to the address listed in THEbenefitsHUB near the end of September. Don’t forget, Flex Cards Are Good For 3 Years!
For a list of sample expenses, please refer to the Arlington ISD benefit website: www.myaisdbenefits.net
NBS Contact Information: 8523 South Redwood Road West Jordan, UT 84088 Phone (800) 274‐0503 Fax (800) 478‐1528 Email: claims@nbsbenefits.com
DID YOU KNOW? FSAs use tax-free funds to help pay for your Health Care Expenses.
FSA Annual Contribution Max: $2,550
Dependent Care Annual Max: $5,000
Account Information: Participant Account Web Access: www.participant.nbsbenefits.com Participants may call NBS and talk to a representative during regular business hours, Monday-Friday, 8 am to 7 pm Central Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to the NBS website: www.NBSbenefits.com
Detailed claim history and processing status Health Care and Dependent Care account balances Claim forms, Direct Deposit form, worksheets, etc. Online claim FAQs 61
FSA Frequently Asked Questions What is a Flexible Spending Account? A Flexible Spending Account allows you to save money by paying out-of-pocket health and/or dependent care related expenses with pre-tax dollars. Your contributions are deducted from your pay before taxes are withheld and your account is up fronted with an annual amount. Because you are taxed on a lower amount of pay, you pay less in taxes and you have more to spend.
How does a Flexible Spending Account Benefit Me? A Cafeteria plan enables you to save money on group insurance, health-related expenses, and dependent-care expenses. You may save as much as 35 percent on the cost of each benefit option! Eligible expenses must be incurred within the plan year and contributions are use-it-or- lose-it. Remember to retain all your receipts.
Health Care Expense Account Example Expenses:
Acupuncture Body scans Breast pumps Chiropractor Co-payments Deductible Diabetes Maintenance Eye Exam & Glasses Fertility treatment First aid
Hearing aids & batteries Lab fees Laser Surgery Orthodontia Expenses Physical exams Pregnancy tests Prescription drugs Vaccinations Vaporizers or humidifiers
Dependent Care Expense Account Example Expenses:
Before and After School and/or Extended Day Programs The actual care of the dependent in your home. Preschool tuition. The base costs for day camps or similar programs used as care for a qualifying individual.
What Can I Use My Flexible Spending Account On? For a full list of eligible expenses, please refer to www.myaisdbenefits.net
62
What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)? Eligible expenses must be incurred within the plan year +75 day grace period. Contributions are use-it-or- lose-it. Remember to retain all your receipts (including receipts for card swipes). Please contact your benefits admin to determine if your district has the grace period or the $500 Roll-Over option. If your district does not have the roll-over, your plan contributions are use-it-or-lose-it.
How Do I File A Claim? In most situations, you will be able to swipe your card however, in the event you lose your card or are waiting to receive one, you can visit www.myaisdbenefits.net and complete the “Claim Form” to send to NBS or use the web or phone app to file online.
How To Receive Your Dependent Care Reimbursement Faster. A Direct Deposit form is available on the Benefits Website which will help you get reimbursed quicker!
How the FSA Plan Works You designate an annual election of pre-tax dollars to be deposited into your health and dependent-care spending accounts. Your total election is divided by the number of pay periods in the Plan year and deducted equally from each paycheck before taxes are calculated. By the end of the Plan year, your total election will be fully deposited. However, you may make a claim for eligible health FSA expenses as soon as they are incurred during the Plan year. Eligible claims will be paid up to your total annual election even if you have not yet contributed that amount to your account.
Get Your Money 1. 2. 3. 4.
Complete and sign a claim form (available on our website) or an online claim. Attach documentation; such as an itemized bill or an Explanation of Benefits (EOB) statement from a health insurance provider. Fax or mail signed form and documentation to NBS. Receive your non-taxable reimbursement after your claim is processed either by check or direct deposit.
NBS Flexcard—FSA Pre-paid Benefit Card Your employer may sponsor the use of the NBS Flexcard, making access to your flex dollars easier than ever. You may use the card to pay merchants or service providers that accept credit cards, so there is no need to pay cash up front then wait for reimbursement.
Account Information Participants may call NBS and talk to a representative during our regular business hours, Monday–Friday, 7am to 6pm Mountain Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to our website: www.NBSbenefits.com Information includes: Detailed claim history and processing status Health Care and Dependent Care account balances Claim forms, worksheets, etc. Online Claim Submission
Enrollment Considerations After the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying “change of status” (marriage status, employment change, dependent change). Be conservative in the total amount you elect to avoid forfeiting money that may be left in your account at the end of the year. Your employer may allow a short grace period or rollover after the Plan year ends for you to submit qualified claims for any unused funds.
63
THE HARTFORD
EAP (Employee Assistance Program)
YOUR BENEFITS PACKAGE
About this Benefit An Employee Assistance Plan (EAP) is an employee benefit program offered to help employees manage personal and professional problems that might adversely impact their work performance, health, and well-being. Employee Assistance Plans generally include short-term counseling and referral services for employees and their household members. Your Employee Assistance Program benefit is provided to you by your employer.
38%
of employees have missed life events because of bad worklife balance.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 64 Arlington ISD Benefits Website: www.myaisdbenefits.net
Employee Assistance Program Ability Assist® Counseling Services
COMPASSIONATE SOLUTIONS FOR COMMON CHALLENGES
For employees covered under The Hartford’s Disability insurance, Critical Illness insurance or Leave Management Services.
From the everyday issues like job pressures, relationships, retirement planning or personal impact of grief, loss, or a disability, Ability Assist can be your resource for professional support.
GETTING SUPPORT SHOULD BE EASY. Life presents complex challenges. If the unexpected happens, you want to know that you and your family have simple solutions to help you cope with the stress and life changes that may result. That’s why the Hartford’s Ability Assist Counseling Services, offered by ComPsych®,¹ can play such an important role. Our straightforward approach takes the complexity out of benefits when life throws you a curve.
You and your family, including spouse and dependents, can access Ability Assist, at any time, as long as you are covered under The Hartford’s Disability insurance, Critical Illness insurance or Leave Management Services.
ABILITY ASSIST COUNSELING SERVICES Emotional or Work Helps address stress, relationship or other personal issues you or your family members may face. It’s staffed by GuidanceExperts℠ – highly trained master’s and doctoral level clinicians – who listen to concerns and quickly make referrals to in-person counseling or other valuable -Life Counseling resources. Situations may include: Job pressures. Work/school disagreements. Relationship/marital conflicts. Substance abuse.
Financial Information and Resources
Provides support for the complicated financial decisions you or your family members may face. Speak by phone with a Certified Public Accountant and Certified Financial Planner ™ Professionals on a wide range of financial issues. Topics may include: Managing a budget. Tax questions. Retirement. Saving for college. Getting out of debt.
Legal Support and Offers assistance if legal uncertainties arise. Talk to an attorney by phone about the issues that are important to you or your family members. If you require representation, you’ll be referred to a qualified attorney in your area with a 25% reduction in customary legal fees thereafter. Resources Topics may include: Debt and bankruptcy. Power of attorney. Guardianship. Divorce. Buying a home.
Health Champion® A service that supports you through all aspects of your health care issues by helping to ensure that you’re fully supported with employee assistance programs and/or work-life services. HealthChampion is staffed by both administrative and clinical experts who understand the nuances of any given health care concern. Situations may include:
Coordination with appropriate health care plan provider(s) Guidance on claims and billing issues Fee/payment plan negotiation
SERVICE FEATURES LThe service includes up to three face-to-face emotional or work-life counseling sessions per occurrence per year. This means you and your family members won’t have to share visits. Each individual can get counseling help for his/her own unique needs. Legal and financial counseling are also available by telephone during business hours. HealthChampion℠ offers unlimited access to services.2
GETTING IN TOUCH IS EASY. On the phone: Just one simple call. For access over the phone, simply call toll-free 1-800-96-HELPS (1-800-964-3577). Online: The point is simplicity. You’ll also have 24/7 access to GuidanceResources® Online (offered by ComPsych).1 This resource provides trusted information, resources, referrals and answers to
everyday questions right from your desktop or the privacy of your home. It includes: Chat sessions with professional moderators. Access to hundreds of personal health topics and resources for child care, elder care, attorneys or financial planners. Visit WWW.GUIDANCERESOURCES.COM to create your own personal username and password. If you’re a first-time user, you’ll be asked to provide the following information on the profile page: 1. In the Company/Organization field, use: HLF902 2. Then, create your own confidential user name and password. 3. Finally, in the Company Name field at the bottom of personalization page, use: ABILI
Travel Assistance and ID Theft Protection Services EVEN THE BEST PLANNED TRIPS CAN BE FULL OF SURPRISES. The best laid travel plans can go awry, leaving you vulnerable and, possibly, unable to communicate your needs. When the unexpected happens far from home, it’s important to know whom to call for assistance.
SERVICES FROM HERE TO THERE. Travel Assistance begins even before you embark, with pre-trip information, and continues throughout your trip. See the list of services in the chart on the back of this page.
IDENTITY THEFT ASSISTANCE, TOO.
Identity theft, America’s fast growing crime, victimizes almost If you are covered under a Hartford Group Policy, you and your 10 million American consumers each year.5 Europ Assistance family have access to Travel Assistance Services provided by USA helps protect you and your family from its consequences Europ Assistance USA.1 24/7,2 at home and when you travel. With a local presence in 200 countries and territories around the world, and numerous 24/7 assistance centers, they are available to help you anytime, anywhere.
In addition to prevention education, this service provides advice and help with administrative tasks resulting from identity theft.
GOOD TO GO: MULTILINGUAL ASSISTANCE 24/7. Whether you’re traveling for business or pleasure, Travel Assistance services are available when you’re more than 100 miles from home for 90 days or less.2,3 As long as you contact Europ Assistance USA at the time of need, you could be approved for up to $1 million in covered services.4
TRAVEL ASSISTANCE AND ID THEFT PROTECTION SERVICES EMERGENCY MEDICAL ASSISTANCE6
PRE-TRIP INFORMATION
Medical referrals Medical monitoring Medical evacuation Repatriation Traveling companion assistance Dependent children assistance Visit by a family member or friend Emergency medical payments Return of mortal remains
EMERGENCY PERSONAL SERVICES7
Visa and passport requirements Inoculation and immunization requirements Foreign exchange rates Embassy and consular referrals
Medication and eyeglass prescription assistance Emergency travel arrangements9 Emergency cash9 Locating lost items Bail advancement
IDENTITY THEFT ASSISTANCE
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Prevention Services - Education - Identity Theft Resolution Kit Detection Services - Fraud alert to three credit bureaus Resolution Guidance and Assistance - Credit information review - ID Theft Affidavit Assistance - Card replacement Personal Services - Translation - Emergency cash advance*
Travel Assistance and ID Theft Protection Services
CASE ILLUSTRATION: HELP A WORLD AWAY.8 As a Human Resource Professional, Tammy had always been on the coordinating end of travel services helping her company’s employees; but when her daughter was hurt while traveling with her school group in Italy, she suddenly found herself in a different position. Using the travel assistance medical referral, medical monitoring, and repatriation services from Europ Assistance USA, Tammy’s daughter was able to receive immediate medical treatment and was evacuated within 48 hours. The Europ Assistance USA Case Manager helped Tammy through some of the most stressful days she’s experienced as a mother and provided care for her daughter when she couldn’t.
What to have ready: Your employer’s name, a phone number where you can be reached, nature of the problem, Travel Assistance Identification Number and your company policy number, which can be Have a serious medical emergency? Please obtain emergency medical services first (contact the local “911”), and then contact Europ Assistance USA to alert them to your situation. Travel Assistance Identification Number:
The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home office is Hartford, CT. 1 Travel Assistance and Identity Theft services are provided by Europ Assistance USA Europ Assistance USA is not affiliated with The Hartford and is not a provider of insurance services. Europ Assistance USA may modify or terminate all or any part of the service at any time without prior notice. None of the benefits provided to you by Europ Assistance USA as a part of the Travel Assistance and Identity Theft service are insurance. This brochure, the Travel Assistance and Identity Theft service Terms and Conditions of Use, and the Identity Theft Resolution Kit constitute your benefit materials and contain the terms, conditions, and limitations relating to your benefits. These services may not be used for business or commercial purposes or by any person other than the individual insured under The Hartford’s group insurance policy . The Hartford is not responsible and assumes no liability for the goods and services described in these materials. 2 Coverage includes spouse (or domestic partner) and dependent children under age 26. 3 Services are available in every country of the world. Depending on the current political situation in the country to which you are traveling, EA may experience difficulties providing assistance, which may result in delays or even the inability to render certain services. It is your responsibility to inquire, prior to departure, whether assistance service is available in the countries where you are traveling. 4 The Combined Single Limit (CSL), or amount of money available to the insured under a Hartford Group policy the Travel Assistance Program, is $1 million. One service or a combination of the services may exceed the CSL. The insured is responsible for payment of any expenses that exceed the CSL. Note: Certain Accidental Death and Dismemberment programs may offer different CSLs. Please consult with your Human Resources Manager for more details. 5 www.transunion.com/personal-credit/identity-theft-and-fraud/identity-theft-facts.page, viewed on 6/25/15. 6 In a medical emergency, Europ Assistance USA pays for assistance as described herein, but you are personally responsible for paying your medical/hospital expenses. 7 Europ Assistance USA provides the described personal services to you in an emergency, but you are personally responsible for the cost of air fare not approved as medically necessary by the attending physician; food, hotel and car expenses; and attorney fees. Emergency cash advances and bail advancement require your personal satisfactory guarantee of reimbursement provided through a valid credit card. 8 This case illustration is fictitious and for illustrative purposes only. 9 Emergency cash is charged as a cash advance, and emergency airline tickets are charged as a purchase to your credit card account and are all subject to that account’s finance rates. DISCLAIMER: Service Exclusions and Limitations: Europ Assistance USA (EA) services are eligible for payment or reimbursement by EA only if EA was contacted at the time of the services and arranged and/or preapproved the services. Certain terms, conditions and exclusions apply; for further information refer to the Web site listed or call EA at the number provided.
NBS - 403(b) | Russ Ross Financial - 457
Retirement Planning
YOUR BENEFITS PACKAGE
About this Benefit A 403(b) plan is a U.S. tax-advantaged retirement savings plan available for public education organizations. A 457(b) plan is a tax-deferred compensation plan provided for employees of certain tax-exempt, governmental organizations or public education institutions.
38% of Americans donâ&#x20AC;&#x2122;t actively save for retirement at all.
This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 68 Arlington ISD Benefits Website: www.myaisdbenefits.net
Retirement Planning 403(b) Plan
457(b) Plan
Invest Tax Deferred income in Annuities or Mutual Funds. Company must be on the AISD list of approved 403(b) companies—list available at www.myaisdbenefts.net. District Contact-National Benefit Services (NBS)800-274-0503 There is a 10% penalty on any funds withdrawn prior to age 59 1/2 Investment Options Annuities Offered by Insurance Companies Fixed and variable annuities
For more information see the 457 Link under the Retirement Plan tab on the Benefits website.
No Penalty for Early Withdrawal (upon separation of service)
Investment Options
Mutual Funds Offered by Mutual Fund Companies directly Risk varies by fund Surrender charges may apply
Fixed Annuities Offered by Life of the Southwest
Retirement Funds can begin to be withdrawn at age 59 1/2 but no later than 70 1/2. Distributions are available upon termination of employment, death, disability, retirement or certain types of hardships. Distributions can or could be: Rolled into an IRA, 403(b) or 401(k) plan, or funds can be used to buy TRS service. Earn interest or appreciation on your investment TAX DEFERRED No matching by Arlington ISD at this time Enrollment can be done at anytime during the year Maximum contribution: Employees that wish to maximize their contributions can elect to participate in both plans. Calendar Year 2016
Annual Maximum Age 50 Catch Up Total Calendar Year Maximum $18,000 $6,000 $24,000
Special Catch-Up for 403(b) only—if you have 15 or more years with Arlington ISD, you may contribute up to $3,000 more per calendar year for up to five years. If the participant is eligible to elect the 15-year Catch-Up and the 50+ Catch0Up, the 15-year Catch-Up MUST be utilized first. For more information see the 457 link under the Reimbursement Plan tab on the Benefits website Home page
Enrollment Instructions
Please make sure to indicate if your child is a full-time student and/or claimed on your tax return as this could affect eligibility on some benefit plans. To revisit any of the sections mentioned select the button to return to the previous section.
Employee Guide to Enroll in Benefits with THEbenefitsHUB THEbenefitsHUB gives you access to your benefits 24 hours a day, 7 days a week from anywhere that you have Internet access. This guide is meant to see you through the simple enrollment process page-by-page, taking you through your enrollment screens and providing information on how to efficiently complete your enrollment walkthrough.
Logging In Employee Usage Agreement: The Employee Usage Agreement is displayed when you login to the system as an employee. Read this section carefully as it contains disclaimer information and requires an “Electronic Signature”. By clicking the button, you are agreeing to the terms. If you have login issues, you will need to contact the FISD Benefits office at 469-633-6369 or 6360.
Benefits Enrollment When you have completely entered all of your personal and dependent information, you will begin your online enrollment for any of the benefits in which you are eligible. Each benefit will appear on individual pages for your review. Choose your election and then click the button to proceed to the next benefit.
Demographic Information The Employee Information Entry process requires you to enter demographic information. You will need to review any pre-filled information for accuracy. Complete new or missing information and click on the button when you are ready to proceed to the next step. Please Note: All
fields in BOLD are required.
Personal Information: Enter an email address if you have one. If you need to use the Forgot Password link on the Login page, the system will deliver your new login credentials to this email address. Emergency Information: Enter an emergency contact and the preferred contact method. Dependent Information: To add a dependent, click on the icon. To edit an existing dependent, click on the icon or the name of the dependent listed. Click on the button after successfully adding information for each dependent. Dependents name in THEbenefitsHUB must match 70 exactly the name on the social security card.
HOW TO ENROLL
View Benefit Descriptions: To view, click on the View Plan Outline of Benefit link or the icon next to the name of the plan you would like to review. This shows a plan summary and any available links or documentation related to this plan. View Plan Cost: Click on the checkbox next to each eligible family member or choose the coverage level you would like. The cost will automatically appear in the box to the right of the members’ names. Additionally, the “Election Summary” box will be updated as coverage adjustments are made. View Total Plan Cost: While selecting plans, the cost will automatically adjust in the “Election Summary” box in response to your selections. The amount shown is the amount that will deducted from each pay check. Forms: One or more of your Benefit Plans may require a paper form to be submitted with the Insurance Carrier. If this is the case, THEbenefitsHUB will prompt you to print the necessary forms during your online enrollment session. View Important Plan Information: Your benefits administrator will spotlight the importance of specific features in a plan or add any disclaimers that may be necessary in the “Plan Information” section. You may expand/collapse this information by clicking anywhere on the section. Product Summary Video: Videos are placed throughout the benefit election process. You can access product videos that explain the purpose, function and importance by clicking on the icon when available.
HOW TO ENROLL
Beneficiary Information Beneficiaries are required if you enroll in any of the life plans only. The designation page will come up only if you elect a plan that requires it.
Consolidated Enrollment Form Consolidated Enrollment Form: This form signals the end of your enrollment walkthrough and will display information from each of the sections listed above, including personal and enrollment information. If you need to make changes after you’ve clicked finished, you will need to click on the Benefit Plan information icon on your home page and then select the Benefit Plan Enrollment and click on the plan you wish to change. If you need assistance, please call 866-914-5202. Once you are finished with the enrollment process, you will be sent to the “Employee Menu” where you may make changes. (See Employee Menu section) When you have completed your benefit selections, click the button and you will be redirected to the Employee Menu screen.
Navigation and Information Entry Tips Below are tips to help you familiarize yourself with the THEbenefitsHUB:
HELP? If you need assistance during the enrollment process, select HELP located at the upper right corner of the screen. BACK & FORTH: Please do not use the web browser’s “back” or “forward” arrows while in the system. Use the navigation buttons in the THEbenefitsHUB instead: REQUIRED INFORMATION: As noted on each screen, the BOLD items are required to allow continuation to the next page. The more information entered, the better the system will work for you; but you may skip non-bolded items if they do not apply. MOVING ON: When each election page is complete, go to the bottom of the page and select the button. UNABLE TO FINISH? If for any reason you are unable to complete the enrollment process you may LOGOUT and
login at a later time. When you login again, you will walk through the same process. The information previously entered will be stored. WHAT ARE THOSE SYMBOLS? If you “toggle” the cursor/ arrow on the icons, the definition of the icons will be revealed. = Edit = View LINKS… Any words, names or phrases with your company’s primary color that becomes underlined when you click the highlighted link it will take you to designated section. SCREEN NAVIGATOR: This line is at the top of your screen. You may click on the links to quickly jump back to those previous screens.
WWW.MYAISDBENEFITS.NET 72