Page 1

TEMPLE ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2018 - 8/31/2019 WWW.MYBENEFITSHUB.COM/TEMPLEISD

1


Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 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, FirstCare, & Scott & White Plans HSA Bank Health Savings Account (HSA) MDLIVE Telehealth Voya Hospital Indemnity SunLife Dental Superior Vision Mutual of Omaha Short & Long-Term Disability Colonial Life Cancer Mutual of Omaha Basic & Voluntary Life & AD&D NBS Flexible Spending Account (FSA) 5 Star FPP Individual Life with Quality of Life Rider Mutual of Omaha Employee Assistance Program Mutual of Omaha Identity Theft Protection MASA Medical Transportation 2

3 4-5 6-11 6 7 8 9 10 11 12-19 20-23 24-25 26-27 28-31 32-35 36-37 38-39 40-43 44-47 48-51 52-53 54-55 56-57

FLIP TO... PG. 4 HOW TO HOW TO ENROLL ENROLL

PG. 6 SUMMARY PAGES

PG. 12 YOUR BENEFITS


Benefit Contact Information

Benefit Contact Information TEMPLE ISD BENEFITS Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/templeisd AETNA Aetna (800) 222-9205 www.trsactivecareaetna.com

TEMPLE ISD BENEFITS OFFICE Amy Hayes amy.hayes@tisd.org (254) 215-6776 Linda Hernandez linda.hernandez@tisd.org (254) 215-6774 www.mybenefitshub.com/templeisd SCOTT & WHITE HEALTH PLAN FIRST CARE Group #008500 Group #82C00 (800) 321-7947 (800) 884-4901 https://trs.swhp.org/ https://www.firstcare.com/en/trs

CANCER Colonial Life 800-325-4368 www.coloniallife.com

CAREMARK (800) 222-9205 www.caremark.com

DISABILITY

EAP

Mutual of Omaha (800) 877-5176 www.mutualofomaha.com

Mutual of Omaha (800) 877-5176 www.mutualofomaha.com

DENTAL Group# 911523 SunLife 800-247-6875 www.sunlife.com FAMILY PROTECTION PLAN – WHOLE LIFE WITH QUALITY OF LIFE RIDER 5Star Life Insurance Company (866) 863-9753 www.5starlifeinsurance.com

FLEXIBLE SPENDING ACCOUNT National Benefit Services (800) 274-0503 www.nbsbenefits.com IDENTITY THEFT PROTECTION Mutual of Omaha (800) 877-5176 www.mutualofomaha.com

HEALTH SAVINGS ACCOUNT HSA Bank (800) 357-6246 www.hsabank.com LIFE AND AD&D Mutual of Omaha (800) 877-5176 www.mutualofomaha.com

HOSPITAL INDEMNITY Voya (888) 238-4840 www.voya.com MEDICAL TRANSPORTATION MASA (800) 423-3226 www.masamts.com

TELEHEALTH MDLIVE (888) 365-1663 www.consultmdlive.com

VISION Group# 34481 Superior Vision (800) 507-3800 www.superiorvision.com 3


MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS TEMPLE” to 313131 and get access to everything you need to complete your benefits enrollment: 

Benefit Information

Online Support

Interactive Tools

And more. PLAY VIDEO

4

Text “FBS TEMPLE” to 313131 OR SCAN


How to Log In

1 BENEFIT INFO

2 3

www.mybenefitshub.com/ templeisd

CLICK LOGIN

ENTER USERNAME & PASSWORD

INTERACTIVE TOOLS Username: The first six (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number. If you have less than six (6) characters in your last

ONLIINE SUPPORT

name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.

Default Password: Last Name (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number.

5


Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New: 

New Employee Assistance Plan and Identity Theft Protection by Mutual of Omaha.

New Emergency Medical Transportation benefit by MASA.

New Telehealth carrier in MDLive.

New carrier for FSA in National Benefits Services

New Hospital Indemnity by Voya.

New Critical Illness plan by Unum.

New carrier for Individual Life in 5Star Life.

Update! Dental is moving to SunLife from Lincoln Financial Group.

Update! Voluntary Life/AD&D are moving from Lincoln Financial Group to Mutual of Omaha.

Update! Disability is moving from Standard to Mutual of Omaha.

Update! NBS will be replacing TASC for Section 125 Administration. The FSA maximum will be $2,650 for 2018. Update! Health Savings Account (HSA): The Individual HSA Max has increased. Individual is now $3,450 and Family is $6,900.

Your TRS ActiveCare plans are experiencing a rate increase and some plans have an increased out-ofpocket maximum. Please refer to the TRS Aetna Website for more details visit www.trsactivecareaetna.com.

Benefit elections will become effective 9/1/2018 (elections requiring evidence of insurability, such as life Insurance, may have a later effective date, if approved). After annual enrollment closes, benefit changes can only be made if you experience a qualifying event (and changes must be made within 30 days of event).

If you currently participate in a Health Care or Dependent Care FSA, you MUST re-elect a new contribution amount every year to continue to participate.

If you elect the HSA you are not eligible to participate in the FSA and vice versa.

Social Security Numbers for your dependents are required regardless if they are enrolled in coverage or not. Please make sure you have these items on hand when going through your open enrollment.

Don’t Forget!   

For questions about benefits or enrollment assistance, please call the FBS Call Center at 866-914-5202. Bilingual assistance is available by calling this number. Login & complete your benefit enrollment from 7/16/18-8/17/18. Update your profile information: home address, phone numbers, email.

6


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 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

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

7


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.

For benefit summaries and claim forms, go to your school

Changes are not permitted during the plan year (outside of

district’s benefit website: www.mybenefitshub.com/

annual enrollment) unless a Section 125 qualifying event occurs.

templeisd. Click on the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the

Changes, additions or drops may be made only during the

Benefits and Forms section.

annual enrollment period without a qualifying event. How can I find a Network Provider?

 Employees must review their personal information and verify that dependents they wish to provide coverage for are

district’s benefit website: www.mybenefitshub.com/

included in the dependent profile. Additionally, you must

templeisd. Click on the benefit plan you need information on

notify your employer of any discrepancy in personal and/or benefit information.

For benefit summaries and claim forms, go to your school

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.

(i.e., Dental) and you can find provider search links under the Quick Links section. When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and

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.

verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.

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.

8


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 the Temple 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 2018 benefits become effective on September 1, 2018, you must be actively-at-work on September 1, 2018 to be eligible for your new benefits. PLAN

CARRIER

MAXIMUM AGE

Medical

Aetna

To age 26

Dental

Cigna

To age 26

Vision

Superior Vision

To age 26

Cancer

Philadelphia American

To age 25

Voluntary Life

The Hartford

To age 25

Hospital Indemnity

Voya

To age 26

Emergency Medical Transport

MASA

To age 26

Telehealth

MDLIVE

To age 26

Individual Live

5Star

To age 23

If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage.

9


SUMMARY PAGES

Helpful Definitions Actively at Work

In-Network

You are performing your regular occupation for the employer

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 9/1/2018 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.

10

(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 (2018) $2,600 family (2018) $3,450 single (2018) $6,900 family (2018)

N/A $2,650

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. 20

FLIP TO FOR FSA INFORMATION

PG. 44

11


TRS

Medical

About this Benefit

YOUR BENEFITS PACKAGE

DID YOU KNOW?

Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis. More than 70% of adults across the United States are already being diagnosed with a chronic disease.

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 12 Temple ISD Benefits Website: www.mybenefitshub.com/templeisd


Medical Rates ACTIVECARE 1-HD TRS Amount

Temple ISD Contribution

EE Premium

$0.00

$367.00

$367.00

Employee & Spouse

$635.00

$400.00

$1,035.00

Employee & Child(ren)

$301.00

$400.00

$701.00

Employee & Family

$974.00

$400.00

$1,374.00

TRS Amount

Temple ISD Contribution

EE Premium

Employee Only

$140.00

$400.00

$540.00

Employee & Spouse

$927.00

$400.00

$1,327.00

Employee & Child(ren)

$476.00

$400.00

$876.00

$1,268.00

$400.00

$1,668.00

TRS Amount

Temple ISD Contribution

EE Premium

$382.00

$400.00

$782.00

$1,455.00

$400.00

$1,855.00

$763.00

$400.00

$1,163.00

$1,794.00

$400.00

$2,194.00

TRS Amount

Temple ISD Contribution

EE Premium

Employee Only

$178.36

$400.00

$578.36

Employee & Spouse

$953.40

$400.00

$1,353.40

Employee & Child(ren)

$508.06

$400.00

$908.06

$1,109.56

$400.00

$1,509.56

TRS Amount

Temple ISD Contribution

EE Premium

Employee Only

$134.04

$400.00

$534.04

Employee & Spouse

$948.92

$400.00

$1,348.92

Employee & Child(ren)

$449.76

$400.00

$849.76

Employee & Family

$985.36

$400.00

$1,385.36

Employee Only

ACTIVECARE SELECT

Employee & Family

ACTIVECARE 2 Employee Only Employee & Spouse Employee & Child(ren) Employee & Family

SCOTT & WHITE

Employee & Family

FirstCare

13


2018 – 2019 TRS-ActiveCare Plan Highlights Effective September 1, 2018 through August 31, 2019 | In-Network Level of Benefits1

Deductible (per plan year) In-Network Out-of-Network Out-of-Pocket Maximum (per plan year; medical and prescription drug deductibles, copays, and coinsurance count toward the out-of-pocket maximum) In-Network Out-of-Network Coinsurance In-Network Participant pays (after deductible) Out-of-Network Participant pays (after deductible) Office Visit Copay Participant pays Diagnostic Lab Participant pays Preventive Care See below for examples Teladoc® Physician Services

High-Tech Radiology (CT scan, MRI, nuclear medicine) Participant pays Inpatient Hospital (preauthorization required) (facility charges) Participant pays Freestanding Emergency Room Participant pays

$500 copay per visit plus 20% after deductible

$500 copay per visit plus 20% after deductible

$500 copay per visit plus 20% after deductible

Emergency Room (true emergency use) Participant pays Outpatient Surgery Participant pays Bariatric Surgery Physician charges (only covered if performed at an IOQ facility) Participant pays Annual Vision Examination (one per plan year; performed by an ophthalmologist or optometrist using calibrated instruments) Participant pays Annual Hearing Examination Participant pays Preventive Care Routine physicals – annually age 12 and over Mammograms – 1 every year age 35 and over Smoking cessation counseling– 8 visits per 12 months

14

• Well-child care – unlimited up to age 12 • Colonoscopy – 1 every 10 years age 50 and over •Healthydiet/obesity counseling– unlimited to

• Well woman exam & pap smear – annually age 18 and over • Prostatecancerscreening–1 per year age 50 and over • Breastfeeding support – 6 lactation counseling visits


Drug Deductible Short-Term Supply at a Retail Location 20% coinsurance after deductible, except for certain generic preventive drugs that are covered at 100%.2 20% coinsurance after deductible 50% coinsurance after deductible Extended-Day Supply at Mail Order or Retail-Plus Pharmacy Location (60- to 90-day supply)5 20% coinsurance after deductible

$20 for a 1- to 31-day supply $20 for a 1- to 31-day supply $40 for a 1- to 31-day supply3 $40 for a 1- to 31-day supply3 50% coinsurance for a 1- to 31-day supply3 50% coinsurance for a 1- to 31-day supply (Min. $654; Max. $130)3

$45 for a 60- to 90-day supply

$45 for a 60- to 90-day supply

$105 for a 60- to 90-day supply3 $105 for a 60- to 90-day supply3 3 50% coinsurance for a 60- to 90-day supply 50% coinsurance for a 60- to 90-day supply3 (min. $1804 , max $360)3 Specialty Medications 20% coinsurance after deductible 20% coinsurance 20% coinsurance (up to a 31-day supply) (min. $2004 , max $900) Short-Term Supply of a Maintenance Medication at Retail Location (up to a 31-day supply) 20% coinsurance after deductible 50% coinsurance after deductible

Tier 1 – Generic Tier 2 – Preferred Brand Tier 3 – Non-Preferred Brand

20% coinsurance after deductible 20% coinsurance after deductible 50% 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 50% coinsurance for a 1- to 31-day supply3

What is a maintenance medication? Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes.

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 pharmacy 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. A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. 1 Illustrates benefits when in-network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits under the ActiveCare Select or ActiveCare Select Whole Health Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for this balance bill amount, which maybe considerable. 2 For ActiveCare 1-HD, certain generic preventive drugs are covered at 100%. Participants do not have to meet the deductible ($2,750 - individual, $5,500 - family) and they pay nothing out of pocket for these drugs. Find the list of drugs at info.caremark.com/trsactivecare. 3 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. 4 If the cost of the drug is less than the minimum, you will pay the cost of the drug. 5 Participants can fill 32-day to 90-day supply through mail order.

Full monthly premium*

Premium with min. state/ district contribution**

$367

+Spouse +Children +Family

Individual

Your Monthly Premium***

Full monthly premium*

Premium with min. state/ district contribution**

$142

$540

$1,035

$810

$701

$476

$1,374

$1,149

Your Monthly Premium***

Full monthly premium*

Premium with min. state/ district contribution**

$315

$782

$557

$1,327

$1,102

$1,855

$1,630

$876

$651

$1,163

$938

$1,668

$1,443

$2,194

$1,969

Your Monthly Premium***

* If you are not eligible for the state/district subsidy, you will pay the full monthly premium. Please contact your Benefits Administrator for your monthly premium. ** The premium after state, $75 and district, $150 contribution is the maximum you pay per month. Ask your Benefits Administrator for your monthly cost. (This is the amount you will owe each month after all available subsidies are applied to your premium.) *** Completed by your benefits administrator. The state/district contribution may be greater than $225. 15


2018-2019 TRS-FirstCare Plan Highlights Plan Summary 2018 -2019 Medical Plan Year Deductible Out-of-Pocket Maximum (includes medical & drug deductibles, copayments & coinsurance) Annual Maximum

$750 Individual; $2,250 Family $7,350 Individual: $14,700 Family Unlimited

Primary Care Provider (PCP) Office Visit  Includes routine lab/X-ray services, injectables, and supplies  Other services provided in a physician’s office are subject to additional deductible and copayments/coinsurance

$20 copayment

PCP Office Visit-Dependents, through age 19

$0 copayment

Specialist Office Visit  Includes routine lab/X-ray services  Other services provided in a physician’s office are subject to additional deductible and copayments/coinsurance

$60 copayment

Preventive Care Well-woman exam, immunizations, physicals, mammograms, colorectal cancer screening

No copayment

Surgical Procedures Performed in the Physician's Office

25% copayment1

Minor Emergency/Urgency Care Visit

$75 copayment

Emergency Room

$500 copayment1

Ambulance Air/Ground

25% copayment1

Inpatient Services Facility charges, physician services, surgical procedures, pre-admission testing, operating/recovery room, newborn delivery and nursery, ICU/coronary care units, laboratory tests/X-rays, rehabilitation facility, behavioral health (mental health/chemical dependency)

25% copayment1

Outpatient Services Facility charges, physician services, surgical procedures, observation unit

25% copayment1

MRI, CT Scan, PET Scan (Facility/Physician)

$250 copayment1

Diagnostic Tests Sleep study; Stress test; EKG; Ultrasound; Cardiac imaging; Genetic testing; Non-preventive Colonoscopy (Facility/Physician)

25% copayment1

Home Health Care Limited to 60 visits per plan year

25% copayment1

Hospice Care

25% copayment1

Skilled Nursing Facility Limited to 30 days per plan year

25% copayment1

Accidental Dental Care

25% copayment1

Prosthetics

25% copayment1

Orthotics

25% copayment1

Spinal Manipulation Limited to 10 visits per year

25% copayment1

Durable Medical Equipment

25% copayment1

All Other Covered Services

25% copayment1

16


Prescription Drug Plan Year Deductible

$100 Individual: $300 Family

Annual Maximum

Unlimited

Participating Retail Pharmacy  Select Generic/ACA (Tier 1) deductible waived  Preferred Generic (Tier 2) deductible waived  Preferred Brand/Non-Preferred Generic (Tier 3)  Non-Preferred Brand/Non-Preferred Generic (Tier 4)  Specialty/Injectables (Tier 5)

Standard Drugs/30-day supply $0 per prescription $15 per prescription $40 per prescription2 $100 per prescription2 20% per prescription2

Participating Mail Order Pharmacy  Select Generic/ACA (Tier 1) deductible waived  Preferred Generic (Tier 2) deductible waived  Preferred Brand/Non-Preferred Generic (Tier 3)  Non-Preferred Brand/Non-Preferred Generic (Tier 4)  Specialty/Injectables (Tier 5)

Maintenance Drugs/90-day supply $0 per prescription $45 per prescription $120 per prescription2 $300 per prescription2 20% per prescription2

1

Subject to medical deductible

2

Subject to prescription drug deductible

Gross Monthly Cost for Coverage Effective September 1, 2018 - August 31, 2019 Coverage Category Employee only Employee and spouse Employee and child(ren) Employee and family

Total Cost - Active* $534.04 $1,348.92 $849.76 $1,385.36

*District and state fund are provided each month to active contributing TRS members to use toward the cost of TRS-ActiveCare coverage. State funding is subject to appropriation by the Texas Legislature. Please contact your Benefits Administrator to determine your net monthly cost for your coverage.

17


2018-2019 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare Fully Covered Health Care Services

Home Health Services

Preventive Services

No Charge

Home Health Care Visit

Standard Lab and X-ray

No Charge

Worldwide Emergency Care

Disease Management and Complex Case Management

No Charge

Nurse Advice Line

Well Child Care Annual Exams

No Charge

Online Services

Immunizations (age appropriate)

No Charge

After Hours Primary Care Clinics

$70 co-pay

1-877-505-7947 No Charge — go to https://trs.swhp.org $20 co-pay

Plan Provisions Annual Deductible Annual out-of-pocket maximum (including medical and prescription copays and coinsurance)

Lifetime Paid Benefit Maximum

Ambulance and Helicopter

$40 copay plus 20% of charges after deductible

(includes combined Medical and Rx copays, deductibles and coinsurance)

Emergency Room6

$250 copay plus 20% of charges after deductible

None

Urgent Care Facility

$50 copay per visit; deductible does not apply

$1,000 Individual/ $3,000 Family $7,000 Individual/ $14,000 Family

Outpatient Services Primary Care1

Prescription Drugs (Group Value Formulary) $15 co-pay (First Primary Care Visit for Illness $0 Copay2)

Specialty Care

3

20% after deductible

Diagnostic/Radiology Procedures

20% after deductible

Allergy Serum & Injections Outpatient Surgery

No Charge 20% after deductible $150 co-pay and 20% of charges after deductible

Ask an SWHP Pharmacy Retail Quantity representative how to (Up to a 30-day supply) save money on your prescriptions. Preferred Generic7 7

Preferred Brand

Inpatient Delivery

No Charge $150 per day4 and 20% of charges after deductible

Inpatient Services Overnight hospital stay: includes all medical services including semi -private room or intensive care

$150 per day4 and 20% of charges after deductible

Physical and Speech Therapy Manipulative Therapy5

$70 copay 20% without office visit $40 plus 20% with office visit

Equipment and Supplies Preferred Diabetic Supplies and Equipment

$5/$12.50 copay; no deductible

Non-Preferred Diabetic Supplies and Equipment

30% after Rx deductible

Durable Medical Equipment/ Prosthetics 18

Non-preferred Online Refills

(Up to a 90-day supply) Only at BSW Pharmacies, including Mail Order

1-817-388-3090

Specialty Medications

Copay Tier 1: 15% after Rx deductible Tier 2: 15% after Rx deductible Tier 3: 25% after Rx deductible

The SWHP MOMS Program provides you with specialized staff who are notified of the delivery of your baby. These licensed professionals will contact you after you return home and help you with everything from the general well-being of both you and your baby, to breast/bottle feeding, to information on how to add your baby to your health plan. 1 Including all services billed with office visit 2 Does not apply to wellness or preventive visits 3 Includes other services, treatments, or procedures received at time 4 $750 maximum copay per admission and 20% after deductible 5 35 max visits per year 6

Copay waived if admitted within 24 hours

20% after deductible

Maintenance Quantity

$5 copay $12.50 copay 30% after Rx 30% after Rx deductible deductible 50% after Rx 50% after Rx deductible deductible https://trs.swhp.org

Mail Order

(Up to a 30-day supply)

Diagnostic & Therapeutic Services

$150

Does not apply to preferred generic drugs

Maternity Care Prenatal Care

Unlimited

Rx Deductible

$70 co-pay

Other Outpatient Services

Eye Exam (one annually)

Annual Benefit Maximum

of office visit


TRS - Scott & White Health Plan Service Area Finding a health care provider has never been easier.

Our provider search tool allows you to: 

Search by name, specialty, and/or ZIP code

Add filters for gender, board certification, accepting new patients, and more

See practice locations, contact information, and maps

Get details, including network participation and hospital affiliations

Customize your own profile

Try it out. Go to https://www.trs.swhp.org and scroll down the page to “ Find a Provider,” and you will be on your way. Note for members: Counties in orange include additional network providers available to deliver in-network care to members who live or work in our TRS/SWHP HMO network (counties in blue). 19


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 20 Temple ISD Benefits Website: www.mybenefitshub.com/templeisd


HSA (Health Savings Account) HSA Bank has teamed up with your employer 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 participate in the FSA plan if you participate in HSA. Medicare, Medicaid, and Tricare participants are not eligible to participate in an HSA. 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.

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.

Authorized Signers who are 55 or older must have their own HSA in order to make the catch-up contribution Monthly Fee: Your account will be charged a monthly fee of $1.75, waived with an average daily balance at or above $3,000.

Examples of Qualified Medical Expenses      

Surgery Braces Contact lenses Dentures Eyeglasses Vaccines

For a list of sample expenses, please refer to your school district’s benefits website at www.mybenefitshub.com/ templeisd

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.

2018 Annual HSA Contribution Limits Individual: $3,450 Family: $6,900 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 Medicare mid-year, catch-up contributions should be prorated) 21


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. 22

2018 Annual HSA Contribution Limits Individual = $3,450 Family = $6,900

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). 23


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 24 Temple ISD Benefits Website: www.mybenefitshub.com/templeisd


Telehealth When should I use MDLIVE?  If you’re considering the ER or urgent care for a non-emergency medical issue  Your primary care physician is not available  At home, traveling, or at work  24/7/365, even holidays!

What can be treated?         

Allergies Asthma Bronchitis Cold and Flu Ear Infections Joint Aches and Pain Respiratory Infection Sinus Problems And More!

Pediatric Care related to:       

Cold & Flu Constipation Ear Infection Fever Nausea & Vomiting Pink Eye And More!

Are children eligible? Yes. MDLIVE has local pediatricians on-call 24/7/365. Please note, a parent or guardian must be present during any interactions involving minors. We ask parents to establish a child record under their account. Parents must be present on each call for children 18 or younger.

How much does it cost? $0 Covers you, your spouse, and children up to age 26, with unlimited phone consultations.

Download the App Doctor visits are easier and more convenient with the MDLIVE App. Be prepared. Download today. www.mdlive.com/getapp     

Access to a doctor anywhere: at home, at work, or on the go Choose doctors from one of the nation's largest telehealth networks Available 24/7 by video or phone Private, secure and confidential visits Connect instantly with MDLIVE Assist

Who are our doctors? MDLIVE has the nation’s largest network of telehealth doctors. On average, our doctors have 15 years of experience practicing medicine and are licensed in the state where patients are located. Their specialties include primary care, pediatrics, emergency medicine and family medicine. Our doctors are committed to providing convenient, quality care and are always ready to take your call.

Scan with your smartphone to get the app.

Call us at (888) 365-1663 or visit us at www.consultmdlive.com

Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for 25 abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit www.mdlive.com/terms-of-use/ 010113


VOYA YOUR BENEFITS PACKAGE

Hospital Indemnity

PLAY VIDEO

About this Benefit Hospital Confinement Indemnity Insurance pays a daily benefit if you have a covered stay in a hospital*, critical care unit and rehabilitation facility. The benefit amount is determined based on the type of facility and the number of days you stay. Hospital Confinement Indemnity Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

The median hospital costs per stay have steadily grown to over $10,000.

$8,800

9,600

10,400

2003

2008

2012

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 Temple ISD Benefits Website: www.mybenefitshub.com/templeisd


Hospital Indemnity What Hospital Confinement Indemnity Insurance benefits are available?

Exclusions and Limitations

Exclusions in the Certificate, Initial Confinement Benefit, Spouse Hospital Confinement Indemnity Insurance and Child Hospital The following list includes the benefits provided by Hospital Confinement Indemnity Insurance are listed below. (These may Confinement Indemnity Insurance. The benefit amounts paid vary by state.) Benefits are not payable for any loss caused in depend on the type of facility and number of days of confinement. For a list of standard exclusions and limitations, go whole or directly by any of the following*: to the end of this document. For a complete description of your  Participation or attempt to participate in a felony or illegal activity. available benefits, along with applicable provisions, conditions  Operation of a motorized vehicle while intoxicated. on benefit determination, exclusions and limitations, see your  Suicide, attempted suicide or any intentionally self-inflicted certificate of insurance and any riders. injury, while sane or insane. You employer offers you the opportunity to purchase a daily  War or any act of war, whether declared or undeclared, benefit amount of $100 or $200. The benefit amount is other than acts of terrorism. determined by the type of facility in which you are confined:  Loss that occurs while on full-time active duty as a member of the armed forces of any nation. We will refund, upon  Hospital—The benefit is 1x the daily benefit amount, up to written notice of such service, any premium which has been 30 days per confinement. accepted for any period not covered as a result of this  Critical care unit (CCU)—The benefit is 2x the daily benefit exclusion. amount, up to 15 days per confinement.  Alcoholism, drug abuse, or misuse of alcohol or taking of  Rehabilitation facility—The benefit is one-half of the daily drugs, other than under the direction of a doctor. benefit amount, up to 30 days per confinement.  Elective surgery, except when required for appropriate care as a result of the covered person’s injury or sickness.** How much does Hospital Confinement  Riding in or driving any motor-driven vehicle in a race, stunt Indemnity Insurance cost? show or speed test.  Operating, or training to operate, or service as a crew All employees pay the same rate, no matter their age. See the member of, or jumping, parachuting or falling from, any chart below for the premium amounts. aircraft or hot air balloon, including those which are not Rates shown are guaranteed until September 1, 2021. motor-driven. Flying as a fare-paying passenger is not excluded. Low Option:  Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar Tier Daily Benefit Monthly Rate activities. Employee $100 $17.80  Practicing for, or participating in, any semiprofessional or professional competitive athletic contests for which any EE +Spouse $100 $34.66 type of compensation or remuneration is received. EE + Children $100 $26.20 EE + Family

$100

$43.06

Tier

Daily Benefit

Monthly Rate

Employee

$200

$35.60

EE +Spouse

$200

$69.34

EE + Children

$200

$52.42

EE + Family

$200

$86.16

High Option:

*See the certificate of insurance and any riders for a complete list of available benefits, along with applicable provisions, exclusions and limitations.

27


SUNLIFE

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 28 Temple ISD Benefits Website: www.mybenefitshub.com/templeisd


Dental PPO– Basic Plan Benefit Waiting Periods  

Calendar year deductible Procedure Type

No waiting periods for exams, cleanings, and fillings. A Benefit Waiting Period of 12 months for Type III Services applies to all employees who enroll in this dental plan within 31 days of becoming eligible. A Late Entrant Benefit Waiting Period of 12 months for Type III Major Services will apply to employees who enroll in this dental plan more than 31 days after becoming eligible.

In-Network

Type I Preventive Services Type II Basic Services Type IV Ortho Services

Calendar Year Maximum Benefit

Out-of-Network

Not applicable $50 individual/ $50 individual/ $150 family $150 family Not applicable

Coinsurance

Types I and II (Preventive and Basic) Services for In & Out-of-Network is $750 per person

In-Network

Out-of-Network

Type I Preventive Services

100%

100%

Type II Basic Services

80%

80%

Type III Major Services

0%

0%

Basic Plan covered expenses Type I Preventive

Coverage limitations

Oral Evaluations

2 in any calendar year

Dental Prophylaxis (Cleanings)

2 per calendar year - is limited to 2 of these services in any calendar year

Fluoride Treatments

Full Mouth X-Rays

Covered Persons under age 16 1 in any 6 consecutive months Covered Persons under age 16. Once per tooth per 36 consecutive months on permanent first and second molars 1 in 60 consecutive months

Bite Wing X-Rays

1 in 12 consecutive months

Intraoral X-Rays

4 Films in any 12 month period

Space Maintainers

Covered Persons under age 19 Once per tooth in any 3 year period

Type II Basic

Simple Extractions

Coverage limitations Paid as a separate benefit only if no treatment, except x-rays, was rendered during the visit No Limitation

Amalgam Restorations

Once per tooth surface in any 24 consecutive months

Sealants

Palliative Treatment

Composite and Silicate Restorations Once per tooth surface in any 24 consecutive months and excluding posterior teeth Benefits payable as a separate expense only when required for the surgical extracGeneral Anesthesia tion of an impacted tooth Type III Major Coverage limitations Full or Partial Dentures

Once in any 10 years

Fixed Bridges

Once in any 10 years 29


Dental PPO– Enhanced Plan Benefit Wai ng Periods

Calendar year deduc ble

 

No wai ng periods for exams, cleanings, and fillings. A Benefit Wai ng Period of 12 months for Type III Services applies to all employees who enroll in this dental plan within 31 days of becoming eligible.  A Late Entrant Benefit Wai ng Period of 12 months for Type III Major Services will apply to employees who enroll in this dental plan more than 31 days a er becoming eligible.

Calendar Year Maximum Benefit Types I, II, & III is $1,000 per person for both In & Out‐of‐Network Type IV for In & Out of Network is $1,000 per child under 26 Type I Preven ve Oral Evalua ons Dental Prophylaxis (Cleanings) Fluoride Treatments Sealants Full Mouth X‐Rays Bite Wing X‐Rays Intraoral X‐Rays Space Maintainers Type II Basic Pallia ve Treatment Simple Extrac ons Amalgam Restora ons Composite and Silicate Restora ons General Anesthesia Type III Major Type IV Ortho Orthodon c Treatment

Procedure Type

In‐Network

Type I Preven ve Services Type II & III Basic & Major Services

Not applicable $50 individual/ $150 family

Type IV Ortho Services

30

$50 individual/ $150 family

Not applicable Coinsurance In‐Network

Out‐of‐Network

Type I Preven ve Services

100%

100%

Type II Basic Services

80%

80%

Type III Major Services

50%

50%

Type IV Ortho Services

50%

50%

Basic Plan Covered Expenses Coverage Limita ons 2 in any calendar year 2 per calendar year ‐ is limited to 2 of these services in any calendar year Covered Persons under age 16 1 in any 6 consecu ve months Covered Persons under age 16. Once per tooth per 36 consecu ve months on permanent first and second molars 1 in 60 consecu ve months 1 in 12 consecu ve months 4 Films in any 12 month period Covered Persons under age 19 Once per tooth in any 3 year period Coverage Limita ons Paid as a separate benefit only if no treatment, except x‐rays, was rendered during the visit No limita on Once per tooth surface in any 24 consecu ve months Once per tooth surface in any 24 consecu ve months and excluding posterior teeth Benefits payable as a separate expense only when required for the surgical extrac on of an impacted tooth Not Covered Coverage Limita ons Orthodon c treatment is limited to the Dependent Children or student age listed above

Monthly PPO Premiums Tier

Out‐of‐Network

Basic Plan 

Enhanced Plan 

EE Only 

$13.31

$28.48

EE + Spouse 

$37.07

$59.47

EE + Child(ren) 

$37.07

$59.47

Family Coverage 

$55.58

$92.93


31


SUPERIOR VISION 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 Temple ISD Benefits Website: www.mybenefitshub.com/templeisd


Vision Benefits

In-Network

Out-of-Network

Covered in full $130 retail allowance

Up to $42 retail Up to $52 retail

Contact Lenses Fitting

Covered in full

Not covered

Contact Lenses Fitting (Speciality)2

Covered in full

Up to $150 retail

Exam Frames

$7.32 $13.91 $14.60

EE + Family

$22.47

Co-Pays

Lenses (standard) per pair Single Vision Bifocal Trifocal Progressive Contact Lenses4

Monthly Premiums EE Only EE + Spouse EE + Child(ren)

Covered in full Covered in full Covered in full See description3 $150 retail allowance

Up to $26 retail Up to $34 retail Up to $50 retail Up to $50 retail Up to $100 retail

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements. 1 Materials co-pay applies to lenses and frames only, not contact lenses 2 See your benefits materials for definitions of standard and specialty contact lens fittings 3 Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co -pay. 4 Contact lenses are in lieu of eyeglass lenses and frames benefit

Exam Materials1

$10 $25

Services/Frequency Exam Frame Lenses Contact Lenses

12 months 24 months 12 months 12 months

(Based on date of service)

SuperiorVision.com Customer Service 800.507.3800

Discount Features Look for providers in the Provider Directory who accept discounts, as some do not; please verify their services and discounts (range from 10%-30%) prior to service as they vary.

Discounts on Covered Materials Frames: Lens options: Progressives:

20% off amount over allowance 20% off retail 20% off amount over standard progressive retail

The following options have out-of-pocket maximums5 on standard (not premium, brand, or progressive) lenses.

Scratch coat Ultraviolet coat Tints, solid or gradients Anti-reflective coat Polycarbonate High index 1.6 Photochromics

Maximum Member Out-of-Pocket Single Vision Bifocal & Trifocal $13 $13 $15 $15 $25 $25 $50 $50 $40 20% off retail $55 20% off retail $80 20% off retail

Refractive Surgery Superior Vision has a nationwide network of refractive surgeons and leading LASIK networks who offer members a discount. These discounts range from 15%-50%, and are the best possible discounts available to Superior Vision.

The Plan discount features are not insurance. All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan. Discounts are subject to change without notice. Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions

Discounts on Non-Covered Exam and Materials Exams, frames, and prescription lenses: 30% off retail Lens options, contacts, other prescription materials: 20% off retail Disposable contact lenses: 10% off retail 5 Discounts and maximums may vary by lens type. Please check with your provider. 33


Vision– Lasik Offering

SEE BETTER AND SKIP THE FRAMES

Laser Vision Correction Our nationwide network of more than 800 independent refractive surgeons offer Superior Vision members a 20% discount off the usual and customary surgeon’s fees for laser vision correction.

QualSight offers members a savings of 20% to 50% off the national average price of LASIK vision correction.

TruVision offers members 10% off the entire laser vision correction procedure.

LasikPlus offers members a free LASIK exam, enhancements, significant discounts, and all LASIK procedures are blade-free.

With all of our laser vision correction providers, there are:  No claims filed  No authorization required by Superior Vision  No co-payments needed  No middleman—discounts are handled directly between Superior Vision members and the provider. Participating providers can be found by conducting an Advanced Provider Search on SuperiorVision.com.

Superior Vision does not make any warranty or assume any legal liability or responsibility for the surgical outcomes or medical management of any laser vision correction procedures. All responsibility lies with the specific provider and/or vision correction facility.

34


35


MUTUAL OF OMAHA 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 Temple ISD Benefits Website: www.mybenefitshub.com/templeisd


Disability ELIGIBILITY - ALL ELIGIBLE EMPLOYEES Eligibility Requirement Premium Payment BENEFITS

You must be actively working a minimum of 20 hours per week to be eligible for coverage. The premiums for this insurance are paid in full by you.

Elimination Period

If you become disabled, there is an elimination period before benefits are payable. Your benefits will begin on the 8th, 15th, or 31st* day of your disabling injury or the 8th day of your disabling illness. *Period Based on Plan Selection Your benefit is equivalent to 40%, 50% or 60% of your before-tax monthly earnings, not to exceed the plan’s maximum monthly benefit amount less other income sources. $8,000 a month/$1,846 a week. Benefits will be paid on a weekly basis for 12 weeks, then will move to a monthly basis after that. $100 If you become disabled prior to age 62, benefits are payable to age 65, your Social Security Normal Retirement Age or 3.5 years, whichever is longest. At age 62 (and older), the benefit period will be based on a reduced duration schedule. If you become disabled and can work part-time (but not full-time), you may be eligible for partial disability benefits. Additional benefits for family care expenses for eligible family members are also available while receiving partial disability benefits.

Monthly Benefit Maximum Benefit Minimum Monthly Benefit Maximum Benefit Period

Partial Disability Benefits

DEFINITIONS Own Occupation Own Occupation Earnings Test Definition of Monthly Earnings

2 Years 99% Monthly earnings for salaried employees is the gross annual salary in effect immediately prior to the date disability begins, divided by 12. Monthly earnings for hourly employees is the hourly rate of pay multiplied by the average number of hours worked during the 12 month period immediately prior to the date disability begins. If employed for part of the prior 12 month period, monthly earnings is the hourly rate of pay multiplied by the average number of hours worked.

FEATURES Vocational Rehabilitation Benefit If you become disabled and participate in the vocational rehabilitation program, you will be eligible for a monthly benefit increase of 5%. Survivor Benefit If you pass away while receiving disability benefits, a lump sum equal to 3 times your monthly benefit will be paid to your eligible survivor. First Day Hospitalization/ Outpa- The elimination period for this coverage is waived if you are admitted as an in-patient in a hospital tient at the onset of disability (when your disability begins). If you receive outpatient surgery and you are disabled for at least 5 days during your recovery, benefits begin on the day of the surgery. Minimum Indemnity Provides an additional benefit if you lose a limb or your sight due to an accidental injury. SERVICES Hearing Discount Program The Hearing Discount Program provides you and your family discounted hearing products, including hearing aids and batteries. Call 1-888-534-1747 or visit www.amplifonusa.com/ mutualofomaha to learn more.

Rate/$100 Montly Benefit Elimination Period

7/7

14/14

30/30

< 20

$1.74

$1.55

$1.19

20 - 29

$1.80

$1.61

$1.25

30 - 39

$2.09

$1.90

$1.54

40 - 49

$2.29

$2.10

$1.74

50 - 59

$2.79

$2.60

$2.24

60 - 69

$2.96

$2.77

$2.41

70+

$3.08

$2.89

$2.53 37


COLONIAL LIFE

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 38 Temple ISD Benefits Website: www.mybenefitshub.com/templeisd


Cancer Featured Benefits of Policy 1.

Pays benefits to help with the cost of cancer screening and cancer treatment. Provides benefits to help pay for the indirect costs associated with cancer, such as:  Loss of wages or salary  Deductibles and coinsurance  Travel expenses to and from treatment centers  Lodging and meals  Child care Pays regardless of any other insurance you have with other insurance companies. Provides a cancer screening benefit that you can use even if you are never diagnosed with cancer. Benefits paid directly to you unless you specify otherwise. Flexible coverage options for employees and their families.

2.

3. 4. 5. 6.

Cancer Screening Benefit Tests This benefit is payable once per calendar year per covered  Pap Smear  ThinPrep Pap Test1  CA125 (Blood test for ovarian cancer)  Mammography  Breast Ultrasound  CA 15-3 (Blood test for breast cancer)  PSA (Blood test for prostate cancer)  Chest X-ray  Biopsy of Skin Lesion  Colonoscopy

   

Virtual Colonoscopy Hemoccult Stool Analysis Flexible Sigmoidoscopy CEA (Blood test for colon cancer)  Bone Marrow Aspiration/ Biopsy  Thermography  Serum Protein Electrophoresis (Blood test for Myeloma)

person. To file a claim for a covered cancer screening/wellness test, it is not necessary to complete a claim form. Call our toll-free Customer Service number, 1.800.325.4368, with the medical information

Inpatient Benefits    

Hospital and Hospital Intensive Care Unit Confinement Ambulance Private Full-Time Nursing Services Attending Physician

Treatment Benefits (In-or Outpatient)      

Radiation/Chemotherapy Anti-nausea Medication Blood/Plasma/Platelets/Immunoglobulins Experimental Treatment Hair Prosthesis/External Breast/Voice Box Prosthesis Supportive/Protective Care Drugs and Colony Stimulating Factors  Bone Marrow Stem Cell Transplant  Peripheral Stem Cell Transplant

Surgery Benefits      

Surgery Procedures (including skin cancer) Anesthesia (including skin cancer) Second Medical Opinion Reconstructive Surgery Prosthesis/Artificial Limb Outpatient Surgical Center

Transportation/Lodging Benefits  Transportation  Transportation for Companion  Lodging

Extended Care Benefits  Skilled Nursing Care Facility  Hospice  Home Health Care Service

Waiver of Premium Initial Diagnosis of Cancer Rider This rider pays a lump sum benefit for the initial diagnosis of internal (not skin) cancer. Use the benefit any way you choose, such as to help pay for deductibles and coinsurance on your major medical insurance or settle any outstanding debts. Some exclusions apply. Rider Features  Guaranteed renewable as long as your cancer insurance policy is in force.  Covers the same family members as your cancer insurance policy.  Pays benefits regardless of any other insurance you have with other insurance companies.  Pays benefits directly to you, unless you specify otherwise.

Cancer Plan Rates

Level 3

Level 4

Employee Only

$19.40

$29.85

Employee + Family

$32.25

$49.55 39


MUTUAL OF OMAHA 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 40 Temple ISD Benefits Website: www.mybenefitshub.com/templeisd


Basic Life and AD&D We’ve Got You Covered As an active employee of Temple Independent School District, you have access to a life insurance policy from United of Omaha Life Insurance Company. It replaces the income you would have provided, and helps pay funeral costs, manage debt and cover ongoing expenses.

How much insurance is enough? When determining how much life insurance you need, think about the expenses you may encounter now and through every stage of your life. Coverage guidelines and benefits are outlined in the chart below.

feature allows you to secure additional life insurance protection in the event your needs change (ex. you get married or have a child). Amounts over the Guarantee Issue will require evidence of insurability (information about your health). Conversion— If your employment ends, you may apply for an individual life insurance policy from Mutual of Omaha without having to provide evidence of insurability (information about your health). You will be responsible for the premium for the coverage. Additional AD&D Benefits— In addition to basic AD&D benefits, you are protected by the following benefits: Child Education, Seat Belt, Airbag, Common Carrier.

Services

Benefits

Travel Assistance— The Travel Assistance program is an added benefit that provides assistance for your travels over 100 miles away from home or outside the country. Employee Assistance Program (EAP)—The EAP program provides you and your loved ones access to trained professionals and resources for assistance with personal and workplace issues. Hearing Discount Program— The Hearing Discount Program provides you and your family discounted hearing products, including hearing aids and batteries. Call 1-888-534-1747 or visit www.amplifonusa.com/mutualofomaha to learn more. Will Prep— We work with Willing® to offer employees discounted online will preparation tools. In just a few clicks you can complete a customized plan to protect your family and property (valid in all Living Care/ Accelerated Death Benefit— 80% of the amount of the life insurance benefit is available to you if terminally ill, not to 50 states). To get started visit www.willing.com/mutualofomaha exceed $8,000. Waiver of Premium— If it is determined that you are totally disabled, your life insurance benefit will continue without Insurance benefits and guarantee issue amounts are subject to payment of premium, subject to certain conditions. age reductions: Annual Benefit Amount Increase— If you enroll for even the - At age 75, amounts reduce to 45% minimum amount of coverage during your initial enrollment, you Information about the AD&D exclusions for this plan will be have the ability to enroll for additional coverage at your next included in the summary of coverage, which you will receive after enrollment by up to $10,000, provided the total amount of enrolling. insurance does not exceed your maximum benefit amount. This Life Insurance Benefit Amount For You: $10,000 In the event of death, the benefit paid will be equal to the benefit amount after any age reductions less any living care/accelerated death benefits previously paid under this plan. Accidental Death & Dismemberment (AD&D) Benefit Amount For You: The Principal Sum amount is equal to the amount of your life insurance benefit.

Features

Age Reductions and Exclusions

Eligibility Requirement Premium Payment

ELIGIBILITY - ALL ELIGIBLE EMPLOYEES You must be actively working a minimum of 20 hours per week to be eligible for coverage. The premiums for this insurance are paid in full by the policyholder. There is no cost to you for this insurance.

41


Voluntary Life Portability— Allows you to continue this insurance program for yourself and your dependents should you leave your employer Life Insurance Benefit Amount for any reason, without having to provide evidence of insurability  Within the coverage guidelines defined above, you select the (information about your health). You will be responsible for the amount of life insurance coverage you want. premium for the coverage.  This plan includes the option to select coverage for your Conversion— If your employment ends, you may apply for an spouse and dependent children. Children include those, up individual life insurance policy from Mutual of Omaha without to age 26. having to provide evidence of insurability (information about  In the event of death, the benefit paid will be equal to the your health). You will be responsible for the premium for the benefit amount after any age reductions less any living care/ coverage. accelerated death benefits previously paid under this plan. Additional AD&D Benefits— In addition to basic AD&D benefits, you are protected by the following benefits: Child Education, Seat Accidental Death & Dismemberment (AD&D) Benefit Amount Belt, Airbag, Common Carrier.  For you, your spouse and your dependent child(ren): The Principal Sum amount is equal to the amount of the life insurance benefit. Hearing Discount Program— The Hearing Discount Program  AD&D coverage is available if you or your dependents are provides you and your family discounted hearing products, injured or die as a result of an accident, and the injury or including hearing aids and batteries. Call 1-888-534-1747 or visit death is independent of sickness and all other causes. The benefit amount depends on the type of loss incurred, and is www.amplifonusa.com/mutualofomaha to learn more. Will Prep— We work with Willing® to offer employees discounted either all or a portion of the Principal Sum. online will preparation tools. In just a few clicks you can complete a customized plan to protect your family and property (valid in all 50 states). To get started visit www.willing.com/mutualofomaha Living Care/ Accelerated Death Benefit— 80% of the amount of

Benefits

Services

Features

the life insurance benefit is available to you if terminally ill, not to exceed $250,000. Waiver of Premium— If it is determined that you are totally disabled, your life insurance benefit will continue without payment of premium, subject to certain conditions. Annual Benefit Amount Increase— If you enroll for even the minimum amount of coverage during your initial enrollment, you have the ability to enroll for additional coverage at your next enrollment by up to $10,000, provided the total amount of insurance does not exceed your maximum benefit amount. This feature allows you to secure additional life insurance protection in the event your needs change (ex. you get married or have a child). Amounts over the Guarantee Issue will require evidence of insurability (information about your health).

Eligibility Requirement

Age Reductions and Exclusions Insurance benefits and guarantee issue amounts are subject to age reductions: - At age 75, amounts reduce to 45% Life insurance benefits will not be paid if the insured’s death is the result of suicide within two years from the date coverage begins. If this occurs, the sum of the premiums paid will be returned to the beneficiary. The same applies for any future increases in coverage under this plan. Information about the AD&D exclusions for this plan will be included in the summary of coverage, which you will receive after enrolling.

ELIGIBILITY - ALL ELIGIBLE EMPLOYEES You must be actively working a minimum of 20 hours per week to be eligible for coverage.

Dependent Eligibility Requirement

To be eligible for coverage, your dependents must be able to perform normal activities, and not be confined (at home, in a hospital, or in any other care facility), and any child(ren) must be under age 26. In order for your spouse and/or children to be eligible for coverage, you must elect coverage for yourself.

Premium Payment

The premiums for this insurance are paid in full by you. COVERAGE GUIDELINES

For You

Minimum $10,000

Spouse

$5,000

Children

$10,000

42

Guarantee Issue 5 times annual salary, up to $250,000 100% of employee’s benefit, up to $30,000 100% of employee’s benefit

Maximum $500,000, in increments of $10,000, but no more than 5 times annual salary 100% of employee’s benefit, up to $250,000 100% of employee’s benefit, up to $10,000


Voluntary Life Voluntary Life and AD&D Coverage Selection and Premium Calculation Please note that the premium amounts presented below may vary slightly from the amounts provided on your enrollment form, due to rounding.

Your premium amount is found in the box where the row (your age) and the column (benefit amount) intersect. 4) Enter the benefit and premium amounts into their respective areas in the Voluntary Life and AD&D section of your To select your benefit amount and calculate your premium, do enrollment form. the following: If the benefit amount you want to select is greater than any 1) Locate the benefit amount you want from the top row of amount in the table below, select the benefit amount from the the employee premium table. Your benefit amount must be top row that when multiplied by another number results in the in an increment of $10,000. Refer to the Coverage Guidebenefit amount you want. For example, if you want $150,000 in lines section for minimums and maximums, if needed. coverage, you obtain your premium amount by multiplying the 2) Find your age bracket in the far left column. rate for $50,000 times 3. Age 0 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80+

$10,000

3)

EMPLOYEE PREMIUM TABLE (12 PAYROLL DEDUCTIONS PER YEAR) $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000

$0.70

$1.40

$2.10

$2.80

$3.50

$1.10 $1.60 $2.40 $4.30 $6.70 $7.20 $13.10 $26.90 $77.90 $170.60

$2.20 $3.20 $4.80 $8.60 $13.40 $14.40 $26.20 $53.80 $155.80 $341.20

$3.30 $4.80 $7.20 $12.90 $20.10 $21.60 $39.30 $80.70 $233.70 $511.80

$4.40 $6.40 $9.60 $17.20 $26.80 $28.80 $52.40 $107.60 $311.60 $682.40

$5.50 $8.00 $12.00 $21.50 $33.50 $36.00 $65.50 $134.50 $389.50 $853.00

$4.20

$4.90

$5.60

$90,000

$100,000

$6.30

$7.00

$6.60 $7.70 $8.80 $9.90 $11.00 $9.60 $11.20 $12.80 $14.40 $16.00 $14.40 $16.80 $19.20 $21.60 $24.00 $25.80 $30.10 $34.40 $38.70 $43.00 $40.20 $46.90 $53.60 $60.30 $67.00 $43.20 $50.40 $57.60 $64.80 $72.00 $78.60 $91.70 $104.80 $117.90 $131.00 $161.40 $188.30 $215.20 $242.10 $269.00 $467.40 $545.30 $623.20 $701.10 $779.00 $1,023.60 $1,194.20 $1,364.80 $1,535.40 $1,706.00

Follow the method described above to select a benefit amount and calculate premiums for optional dependent spouse and/or child (ren) coverage. Your spouse’s rate is based on your age, so find your age bracket in the far left column of the Spouse Premium Table. Your spouse’s premium amount is found in the box where the row (the age) and the column (benefit amount) intersect. Your spouse’s benefit amount must be in an increment of $5,000. Refer to the Coverage Guidelines section for minimums and maximums, if needed. Age 0 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80+

$5,000 $0.35 $0.55 $0.80 $1.20 $2.15 $3.35 $3.60 $6.55 $13.45 $38.95 $85.30

$10,000 $0.70 $1.10 $1.60 $2.40 $4.30 $6.70 $7.20 $13.10 $26.90 $77.90 $170.60

SPOUSE PREMIUM TABLE (12 PAYROLL DEDUCTIONS PER YEAR) $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $1.05 $1.40 $1.75 $2.10 $2.45 $2.80 $1.65 $2.20 $2.75 $3.30 $3.85 $4.40 $2.40 $3.20 $4.00 $4.80 $5.60 $6.40 $3.60 $4.80 $6.00 $7.20 $8.40 $9.60 $6.45 $8.60 $10.75 $12.90 $15.05 $17.20 $10.05 $13.40 $16.75 $20.10 $23.45 $26.80 $10.80 $14.40 $18.00 $21.60 $25.20 $28.80 $19.65 $26.20 $32.75 $39.30 $45.85 $52.40 $40.35 $53.80 $67.25 $80.70 $94.15 $107.60 $116.85 $155.80 $194.75 $233.70 $272.65 $311.60 $255.90 $341.20 $426.50 $511.80 $597.10 $682.40

ALL CHILDREN PREMIUM TABLE (12 PAYROLL DEDUCTIONS PER YEAR)* $10,000

$45,000 $3.15 $4.95 $7.20 $10.80 $19.35 $30.15 $32.40 $58.95 $121.05 $350.55 $767.70

$50,000 $3.50 $5.50 $8.00 $12.00 $21.50 $33.50 $36.00 $65.50 $134.50 $389.50 $853.00

*Regardless of how many children you have, they are included in the "All Children" premium amounts listed in the table above.

$2.00

43


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.

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 Temple ISD Benefits Website: www.mybenefitshub.com/templeisd


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 Temple ISD benefit website: www.mybenefitshub.com/templeisd

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: $2,650

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 45


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.mybenefitshub.com/templeisd

46

What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)? Contributions are use-it-or-lose-it. Remember to retain all your receipts (including receipts for card swipes).

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.mybenefitshub.com/templeisd 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. If you choose to enroll in the HSA you are not eligible to enroll in the FSA.

47


5 STAR

Permanent 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 Temple ISD Benefits Website: www.mybenefitshub.com/templeisd


Term Life with Terminal Illness and Quality of Life Rider The Family Protection Plan: Term Life Insurance with Terminal Illness Coverage to Age 100 Nearly 85% of Americans say most people need life insurance; unfortunately only 62% have coverage and a staggering 33% say they don’t have enough life insurance, including one-fourth who already have life insurance coverage.** Nobody wants to be a statistic - especially during a period of grief. That’s why 5Star Life Insurance Company developed its FPP policy - to ensure you and your loved ones are covered during a period of loss.

Affordability - With several options to choose from, select the coverage that best meets the needs of your family. Terminal Illness - This plan pays the insured 30% (25% in Connecticut and Michigan) of the policy coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months. Portability - You and your family continue coverage with no loss of benefits or increase in cost should you terminate employment after the first premium is paid. If this happens, we can simply bill you directly. Coverage can never be cancelled by the insurance company or your employer unless you stop paying premiums.

DID YOU KNOW? Protecting your financial well being is easier than you think. It’s like trading in a daily latte for peace of mind.

$4.30 per day to start your morning with a $1.75

gourmet coffee OR per day to enrich your employee benefits package

It’s less expensive than you think.

Family Protection - Individual policies can be purchased on the employee, their spouse, children and grandchildren (ages 15 days to age 24). Quality of Life Benefit - Following a diagnosis of either a chronic illness or cognitive impairment, this rider accelerates a portion of the death benefit on a monthly basis – 4%; up to 75% of your benefit, and payable directly to you on a tax favored basis for the following:  Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or  Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision. Convenience - Premiums are taken care of simply and easily through payroll deductions. Protection You Can Count On - Within 24 hours after receiving notice of an insured’s death, an emergency death benefit of the lesser of 50% of the coverage amount, or $10,000, will be mailed to the insured’s beneficiary, unless the death is within the twoyear contestability period and/or under investigation. This product also contains no war or terrorism exclusions. * Life insurance product underwritten by 5Star Life insurance Company (a Baton Rouge, Louisiana company) with an administrative office at 909 N. Washington Street, Alexandria, VA 22314

49


Family Protection Plan - Terminal Illness MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT

18-25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45

$10,000 $7.56 $7.59 $7.65 $7.74 $7.88 $8.07 $8.27 $8.50 $8.73 $9.01 $9.30 $9.64 $10.02 $10.41 $10.85 $11.31 $11.83 $12.41 $13.00 $13.63 $14.27

$20,000 $10.78 $10.83 $10.97 $11.15 $11.43 $11.80 $12.20 $12.65 $13.11 $13.67 $14.27 $14.95 $15.70 $16.48 $17.35 $18.29 $19.33 $20.48 $21.66 $22.91 $24.22

$30,000 $14.01 $14.09 $14.28 $14.56 $14.99 $15.53 $16.14 $16.81 $17.51 $18.34 $19.23 $20.26 $21.39 $22.56 $23.86 $25.26 $26.83 $28.56 $30.34 $32.21 $34.16

Employee Coverage Amounts $40,000 $50,000 $75,000 $17.24 $20.46 $28.53 $17.33 $20.59 $28.71 $17.60 $20.92 $29.21 $17.96 $21.38 $29.90 $18.54 $22.09 $30.96 $19.27 $23.00 $32.34 $20.06 $24.00 $33.84 $20.97 $25.12 $35.52 $21.90 $26.29 $37.27 $23.00 $27.67 $39.33 $24.20 $29.17 $41.59 $25.57 $30.88 $44.15 $27.07 $32.76 $46.96 $28.64 $34.71 $49.89 $30.37 $36.87 $53.15 $32.23 $39.21 $56.65 $34.33 $41.83 $60.58 $36.63 $44.71 $64.90 $39.00 $47.67 $69.33 $41.50 $50.79 $74.02 $44.10 $54.05 $78.90

46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65

$14.97 $15.70 $16.43 $17.22 $18.08 $19.04 $20.16 $21.40 $22.79 $24.26 $25.94 $27.66 $29.42 $31.23 $33.12 $35.08 $37.12 $39.31 $41.68 $44.34

$25.60 $27.05 $28.51 $30.10 $31.82 $33.75 $35.98 $38.46 $41.25 $44.20 $47.53 $50.98 $54.50 $58.12 $61.90 $65.82 $69.91 $74.29 $79.04 $84.33

$36.24 $38.41 $40.61 $42.98 $45.56 $48.46 $51.81 $55.54 $59.71 $64.13 $69.14 $74.31 $79.58 $85.01 $90.69 $96.56 $102.71 $109.26 $116.38 $124.34

$46.87 $49.77 $52.70 $55.87 $59.30 $63.17 $67.63 $72.60 $78.17 $84.06 $90.73 $97.63 $104.67 $111.90 $119.46 $127.30 $135.50 $144.23 $153.73 $164.33

Age on Eff. Date

50

$57.51 $61.13 $64.79 $68.75 $73.04 $77.88 $83.46 $89.67 $96.63 $104.00 $112.34 $120.96 $129.75 $138.79 $148.25 $158.04 $168.29 $179.21 $191.09 $204.34

$84.09 $89.52 $95.03 $100.96 $107.39 $114.65 $123.02 $132.33 $142.77 $153.83 $166.33 $179.27 $192.46 $206.02 $220.21 $234.90 $250.27 $266.65 $284.46 $304.33

$100,000 $36.59 $36.83 $37.50 $38.41 $39.84 $41.67 $43.66 $45.92 $48.25 $51.00 $54.00 $57.42 $61.17 $65.09 $69.42 $74.08 $79.33 $85.08 $91.00 $97.25 $103.75

$125,000 $44.65 $44.96 $45.80 $46.94 $48.71 $51.01 $53.50 $56.31 $59.23 $62.67 $66.42 $70.69 $75.37 $80.27 $85.68 $91.52 $98.08 $105.27 $112.67 $120.48 $128.60

$150,000 $52.71 $53.09 $54.08 $55.46 $57.59 $60.33 $63.34 $66.71 $70.21 $74.34 $78.83 $83.96 $89.59 $95.46 $101.96 $108.96 $116.83 $125.46 $134.34 $143.71 $153.46

$110.67 $117.92 $125.25 $133.17 $141.75 $151.42 $162.58 $175.00 $188.92 $203.66 $220.33 $237.58 $255.17 $273.25 $292.16 $311.75 $332.25 $354.08 $377.83 $404.33

$137.25 $146.32 $155.48 $165.37 $176.10 $188.19 $202.15 $217.67 $235.07 $253.50 $274.34 $295.89 $317.87 $340.48 $364.13 $388.60 $414.23 $441.52 $471.21 $504.34

$163.84 $174.71 $185.71 $197.58 $210.46 $224.96 $241.71 $260.34 $281.21 $303.33 $328.34 $354.21 $380.58 $407.71 $436.09 $465.46 $496.21 $528.96 $564.58 $604.34


Family Protection Plan - Terminal Illness MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT Age on Eff. Date 66* 67* 68* 69* 70*

$10,000 $44.93 $48.25 $52.03 $56.33 $61.17

$20,000 $85.52 $92.17 $99.73 $108.32 $118.00

$30,000 $126.11 $136.08 $147.43 $160.31 $174.83

Employee Coverage Amounts $40,000 $50,000 $75,000 $166.70 $207.29 $308.77 $180.00 $223.92 $333.71 $195.13 $242.83 $362.08 $212.30 $264.29 $394.27 $231.67 $288.50 $430.58

$100,000 $410.25 $443.50 $481.33 $524.25 $572.67

$125,000 $511.73 $553.29 $600.58 $654.23 $714.75

$150,000 $613.21 $663.08 $719.83 $784.21 $856.83

*Quality of Life not available ages 66 - 70. Quality of Life benefits not available for children. Child life coverage available only on children and grandchildren of employee (age on effective date: age 14 days to 23 years). $4.98 monthly for $10,000 coverage and $9.97 monthly for $20,000 coverage.

51


MUTUAL OF OMAHA

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 52 Temple ISD Benefits Website: www.mybenefitshub.com/templeisd


Employee Assistance Program Your Employee Assistance Program (EAP) can be the answer for you and your family. Mutual of Omaha’s EAP assists employees and their eligible dependents with personal or job-related concerns, including:  Emotional well-being  Family and relationships  Legal and financial matters  Healthy lifestyles  Work and life transitions

EAP Benefits     

Unlimited telephone access to EAP professionals 24 hours a day, seven days a week Telephone assistance and referral Service for employees and eligible dependents Robust network of licensed mental health professionals Three face-to-face sessions* with a counselor (per household per calendar year)  *Face-to-face visits can also be used toward legal consultations Legal assistance and financial services  Online will preparation  Legal library & online forms  Telephonic financial consultation Resources for:  Financial tools & resources  Substance abuse and other addictions  Dependent and elder care assistance & referral services Access to a library of educational articles, handouts and resources via mutualofomaha.com/eap

Your EAP benefits are provided through your employer. There is no cost to you for utilizing EAP services. If additional services are needed, your EAP will help locate appropriate resources in your area. Don’t delay if you need help. Visit mutualofomaha.com/eap or call 800-316-2796 for confidential consultation and resource services.

Life’s not always easy. Sometimes a personal or professional issue can get in the way of maintaining a healthy, productive life.

What to Expect You can trust your EAP professional to assess your needs and handle your concerns in a confidential, respectful manner. Our goal is to collaborate with you and find solutions that are responsive to your needs.

53


MUTUAL OF OMAHA

Identity Theft

YOUR BENEFITS PACKAGE

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 54 Temple ISD Benefits Website: www.mybenefitshub.com/templeisd


Identity Theft Each year millions of Americans become victims of identity theft. Identity Theft protection is offered at no extra charge for Temple ISD employees. Information that personally identifies you, such as your name, Social Security number or credit card numbers can be stolen and used to commit fraud or other crimes. Identity Theft Assistance, provided by AXA Assistance, helps you and your dependents understand the risks of identity theft, learn how to prevent it, and most importantly, assist you if your information is compromised.

local law enforcement agencies and filing reports and

Access ID Theft Assistance services by calling AXA Assistance toll-free at (800) 856-9947.

complaints

ID Theft Assistance is available as part of your overall Travel Assistance package offered by your employer. Services include: AWARENESS AND EDUCATION We help you understand the growing threat of identity theft by:  Promoting awareness of identity theft  Answering your questions about identity theft and how to recognize if you’ve become a victim  Educating you on how to avoid having your identity stolen RECOVERY ASSISTANCE If your identity is compromised, the most important thing to do is respond quickly. We assist you by:  Connecting you to the fraud departments at your bank(s) and credit card companies  Facilitating access to credit bureaus and obtaining a complimentary credit report  Guiding you in contacting federal government and

Brought to you by Mutual of Omaha Insurance Company. Travel Assistance Services provided by AXA Assistance USA © AXA Assistance USA, Inc. All Rights Reserved. AXA Assistance is a trade name of AXA Assistance USA, Inc. Reproduction or use of AXA Assistance USA, Inc.’s trade names, logos, brands, proprietary images or marks or those of its parent or affiliates are expressly prohibited without prior written permission. Travel Assistance Services are independently offered and administered by AXA Assistance USA, Inc. (AXA). Insurance benefits provided as part of Travel Assistance underwritten by a third party. Mutual of Omaha does not warrant or guarantee, or make any representation as to the quality of the services provided by AXA, or any provider to whom a referral is made by AXA. There may be times when circumstances beyond AXA Assistance USA’s control hinder its endeavors to provide services. AXA Assistance USA will, however, make all reasonable efforts to provide such services and help you resolve the emergency situation. 55


MASA YOUR BENEFITS PACKAGE

Medical Transport

About this Benefit Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out-of-pocket costs that are not covered by insurance. It includes emergency transportation via ground ambulance, air ambulance and helicopter.

A ground ambulance can cost up to

$2,400

and a helicopter transportation fee can cost

over $30,000

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 56 Temple ISD Benefits Website: www.mybenefitshub.com/templeisd


Medical Transport MASA provides medical emergency transportation solutions and covers your out of pocket medical transport cost when your insurance falls short. MASA does not use a network, which means you are covered anywhere.

THE TRUTH... Americans today suffer from a false sense of security that their medical coverage will pay for all costs associated with emergency or critical care transport. The reality is that a majority of Americans are only partially covered for these high costs. Most healthcare policies will only pay based off of the “Usual and Customary Charges” while Medicare pays based off a set fee schedule, both leaving you with the remainder of the bill.

EMERGENT PLUS $14/mo.

PLATINUM $39/mo.

Emergency Air Medical Transport

MASA provides medical emergency transportation solutions AND cover your out of pocket medical transport cost when your insurance falls short.

Emergency Ground Ambulance Transport

Non-Emergent Air Transport

“All I had to do was send the bill which was never paid by Medicare and TriCare for Life --- and the rest is history. When MASA received that bill, it was paid and all amounts owed satisfied.” --- MASA Member, 2015

Minor Child/Grandchild Return

Organ Recipient Transport

Organ Retrieval

MASA MTS for Employees Ensures...

Repatriation/Recuperation

BENEFIT You face the possibility that your medical coverage will deny the claim leaving you responsible for the ENTIRE bill.

     

NO health questions NO age limits NO claim forms NO deductibles NO provider network limitations NO dollar limits on emergency transport costs

Non-injury Transport

Pet Return

Vehicle Return

Return Transportation

Escort Transportation

Mortal Remains Transport

Worldwide Coverage

57


NOTES

58


NOTES

59


WWW.MYBENEFITSHUB.COM/ TEMPLEISD 60

Profile for FBS

2018 Benefit Guide Temple ISD  

2018 Benefit Guide Temple ISD