ESC REGION 20 BENEFITS COOPERATIVE BENEFIT GUIDE EFFECTIVE: 09/01/2022 8/31/2023 WWW.ESC20BC.NET 2022 - 2023 PlanYear
Table of Contents FLIP TO... How to Enroll 4-5 Annual Benefit Enrollment 6-11 1. Benefit Updates 6 2. Section 125 Cafeteria Plan Guidelines 7 3. Annual Enrollment 8 4. Eligibility Requirements 9 5. Helpful Definitions 10 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 11 Medical - Region 20 12-17 Medical - Region 13 18-24 Health Savings Account (HSA) 25 Hospital Indemnity 26 Telehealth 27 Dental 28-29 Vision 30 Disability 31 Cancer 32-33 Accident 34 Critical Illness 35 Life and AD&D 36-37 Individual Life 38 Emergency Medical Transportation 39 Identity Theft 40 Flexible Spending Account (FSA) 41-42 Employee Assistance Program 43 FBS Benefits App Group # Index 44 HOW TO ENROLLPG. 4 SUMMARYPAGESPG. 6 BENEFITSYOURPG. 12
ESC 20 BENEFITS COOP TRS ACTIVECARE MEDICAL TRS HMO MEDICAL Financial Benefit Services (800) 583 www.esc20bc.net6908 (866)BCBSTX355 www.bcbstx.com/trsactivecare5999 Scott & White HMO (844) 633 www.trs.swhp.org5325 HEALTH SAVINGS ACCOUNT HOSPITIAL INDEMNITY TELEHEALTH (817)EECU 882 www.eecu.org0800 GroupAflac #23529 (800) 992 www.aflacgroupinsurance.com3522 (888)MDLIVE365 www.mdlive.com/fbsbh1663 DENTAL VISION DISABILTY GroupCigna #3336975 (800) 244 www.mycigna.com6224 Superior Vision Group #28888 (800) 507 www.superiorvision.com3800 GroupUnumwww.oneamerica.com(855)GroupOneAmerica#G006170545176365numbersonbenefits website (866) 679 www.unum.com3054 CANCER ACCIDENT CRITICAL ILLNESS American Public Life Group #13309 (800) 256 www.ampublic.com8606 American Public Life Group #13309 (800) 256 www.ampublic.com8606 GroupAflac #23529 (800) 992 www.aflacgroupinsurance.com3522 LIFE AND AD&D INDIVIDUAL LIFE EMERGENCY MEDICAL TRANSPORT (800)GroupOneAmerica#6170545535318 www.oneamerica.com 5Star Life Insurance (866) 863 www.5starlifeinsurance.com9753 (800)MASA423 www.masamts.com3226 IDENTITY THEFT FLEXIBLE SPENDING ACCOUNT (FSA) EMPLOYEE ASSISTANCE PROGRAM (EAP) ID www.idwatchdog.com(800)Watchdog7743772 https://flexservices.higginbotham.net/(800)Higginbotham9439179 www.guidanceresources.com(855)ComPsych3879727 Benefit Contact Information
Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS ESC20” to (800) 583-6908 App Group #: Go to PAGE 44 to find your district’s group #. Text “FBS ESC20” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment: • Benefit Resources • Online Enrollment • Interactive Tools • And more!
TheUsername:firstsix (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.
ENTER USERNAME &
PASSWORD
If you have six (6) or less characters in your last 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.
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1 www.esc20bc.net How to Log In 2 CLICK LOGIN 3
Benefit Updates What’s New: Don’t Forget! • Log in and complete your benefit enrollment from 07/05/2022 08/18/2022 • Dates vary by district. Check with your benefits office for your school's exact enrollment time period. • Enrollment assistance is available by calling Financial Benefit Services at (866) 914 5202. • Update your information: home address, phone numbers, email, and beneficiaries. • REQUIRED!! Due to the Affordable Care Act (ACA) reporting requirements, you must add your dependent’s CORRECT social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator. SUMMARY PAGESAnnual Benefit Enrollment • TRS ACTIVECARE MEDICAL RATES reduced for most plans! Your school will provide rate information that includes the employer contribution amounts. • FSA AND HSA new max contribution amounts allowed • CANCER PLAN enhanced policies • DENTAL PLAN Low PPO plan enhanced w/higher benefit amounts • MDLIVE TELEHEALTH PLAN unlimited behavioral health services added to voluntary employee paid plans • VISION PLAN additional plan available with higher level of benefits
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
Change in Number of Tax Dependents
Change in Status of Employment Affecting Coverage Eligibility
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
Section 125 Cafeteria Plan Guidelines SUMMARY PAGESAnnual Benefit Enrollment CHANGES
Marital Status
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.
EligibilityDependents'ofStatus
Eligibility for Government Programs
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your 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. IN EVENTS
Gain/Loss
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.
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.
(CIS):STATUS QUALIFYING
Judgment/Decree/Order
If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.
An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements under an employer's plan may include change in age, student, marital, employment or tax dependent status.
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.
New Hire Enrollment
For benefit summaries and claim forms, go to your benefit website: www.esc20bc.net. Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms section. How can I find a Network Provider?
During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.
Where can I find forms?
For benefit summaries and claim forms, go to the ESC Region 20 BC benefit website: www.esc20bc.net. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section.
When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3 4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.
Q&A Who do I contact with Questions?
• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.
• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866 914 5202 for assistance.
SUMMARY PAGESAnnual Benefit Enrollment
• 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.
Annual Enrollment
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.
SUMMARY PAGESAnnual Benefit Enrollment PLAN MAXIMUM AGE Accident Through 25 Cancer Through 25 Dental Through 25 Dependent Flex 12 or younger or qualified individual unable to care for themselves & claimed as a dependent on your taxes Healthcare FSA Through 25 or IRS Tax Dependent HealthAccountSavings IRS Tax Dependent Identity Theft Through 25 Hospital Indemnity Through 25 Individual Life Through 22 Telehealth Through 25 Vision Through 25 Voluntary Life Through 25
RequirementsEligibility
Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.
Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further Potentialguidance.Dependent
Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent Disclaimer:eligibility.
You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee's enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending
Employee
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Supplemental Benefits: Eligible employees must work 18.75 or more regularly scheduled hours each work week. Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2022 benefits become effective on September 1, 2022, you must be actively at work on September 1, 2022 to be eligible for your new benefits.
Dependent RequirementsEligibility
Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse FSA/HSAeligibility.Limitations:
Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescription drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).
You are performing your regular occupation for the employer on a full time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel If you will not be actively at work beginning 9/1/2022 please notify your benefits administrator. Enrollment
Annual
Calendar Year
Actively at Work
January 1st through December 31st Co-insurance 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. Coverage
In Network Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider. Out of Pocket Maximum
September
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.
After
The most an eligible or insured person can pay in co insurance for covered expenses.
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.
SUMMARY PAGESHelpful Definitions
Guaranteed
Plan Year 1st through August 31st Pre Existing Conditions
SUMMARY PAGESHSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223) Flexible Spending Account (FSA) (IRC Sec. 125) Description Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax free. Allows employees to pay out of pocket expenses for copays, deductibles and certain services not covered by medical plan, 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 Employee and/or employer Employee and/or employer Account Owner Individual Employer Underlying RequirementInsurance High deductible health plan None Minimum Deductible $1,400 single (2022) $2,800 family (2022) N/A Maximum Contribution $3,650 single (2022) $7,300 family (2022) $2,850 (2022) Permissible Use Of Funds Employees may use funds any way they wish. If used for non qualified medical expenses, subject to current tax rate plus 20% penalty. Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC). Cash Outs of Unused Amounts (if no medical expenses) Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 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 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. 25 FLIP TO FOR FSA INFORMATION PG. 41
TRS ActiveCare HD Employee Only $357.00 Employee & Spouse $1,005.00 Employee & Child(ren) $641.00 Employee & Family $1,202.00 TRS ActiveCare 2 Employee Only $1,013.00 Employee & Spouse $2,402.00 Employee & Child(ren) $1,507.00 Employee & Family $2,841.00 TRS ActiveCare Primary Employee Only $346.00 Employee & Spouse $976.00 Employee & Child(ren) $622.00 Employee & Family $1,168.00 TRS ActiveCare Primary+ Employee Only $434.00 Employee & Spouse $1,062.00 Employee & Child(ren) $699.00 Employee & Family $1,336.00 ABOUT MEDICAL Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis. For full plan details, please visit your benefit website: www.esc20bc.net Medical Insurance TRS - Region 20 EMPLOYEE BENEFITS The below rates apply to the following districts: Alameda School for Art and Design Big Springs Charter School Brackett JourdantonCharlotteBRAINATIONISDISDISD Jubilee Academies Katherine Anne Porter School Knippa ISD Legacy Traditional Schools Meadowland Charter School Region 20 Ed Service Center Somerset Academy Southwest Preparatory School
ABOUT MEDICAL Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis. For full plan details, please visit your benefit website: www.esc20bc.net Medical Insurance TRS - Region 13 EMPLOYEE BENEFITS The below rates apply to the following districts: Dime Box ISD Dripping Springs ISD Flatonia ISD Harper ISD Johnson City ISD Nixon Smiley CISD Prairie Lea SchulenburgISDISD Smithville ISD Texas Preparatory Schools Valere Public Schools, Inc Wayside Schools TRS ActiveCare HD Employee Only $376.00 Employee & Spouse $1,058.00 Employee & Child(ren) $675.00 Employee & Family $1,265.00 TRS ActiveCare 2 Employee Only $1,013.00 Employee & Spouse $2,402.00 Employee & Child(ren) $1,507.00 Employee & Family $2,841.00 TRS ActiveCare Primary Employee Only $364.00 Employee & Spouse $1,026.00 Employee & Child(ren) $654.00 Employee & Family $1,228.00 TRS ActiveCare Primary+ Employee Only $458.00 Employee & Spouse $1,117.00 Employee & Child(ren) $735.00 Employee & Family $1,405.00 Central and North Texas Baylor Scott & White HMO Employee Only $491.55 Employee & Spouse $1,232.58 Employee & Child(ren) $789.39 Employee & Family $1,418.42 Blue Essentials West Texas HMO Employee Only $689.60 Employee & Spouse $1,672.26 Employee & Child(ren) $1,083.58 Employee & Family $1,755.58
you
•
• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used.
HSA
• Not eligible to be claimed as a dependent on someone else’s tax return
•
Opening an HSA If you meet the eligibility requirements, you may open an HSA administered by HSA Bank. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA.
•
Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). full plan details, please visit your benefit website:
For
Health Savings Account (HSA)
• You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.
Important HSA Information
How to Use your HSA
• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333 9934
You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered by the HDHP.
•
•
• Stop by: a local EECU financial center for in person assistance; find EECU locations & service hours a www.eecu.org/locations.
• Not enrolled in Medicare or TRICARE
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs it is also a tax exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.
• Call/Text: (817) 882 0800. EECU’s dedicated member service representatives are available to assist you with any questions. Their hours of operation are Monday through Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. 1:00 p.m. CT and closed on Sunday.
• Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.
• Online/Mobile: Sign in for 24/7 account access to check your balance, pay bills and more.
Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2022 is based on the coverage option elect: Individual $3,650 Family (filing jointly) $7,300 You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are 55 or older, you may make a yearly catch up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch up contribution for the entire plan year.
EECU EMPLOYEE BENEFITS
ABOUT HSA
You are eligible to open and contribute to an HSA if you are: Enrolled in an HSA eligible HDHP Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan Not enrolled in a Health Care Flexible Spending Account
There is no “use it or lose it” rule you do not lose your money if you do not spend it in the calendar year and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year. Eligibility
• Not receiving Veterans Administration benefits
www.esc20bc.net
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax free and spends tax free if used to pay for qualified medical expenses.
Maximum Contributions
ABOUT HOSPITAL INDEMNITY
LOW HIGH
Hospital Stay Admission Pays a lump sum benefit for the initial day of your stay in a hospital. Maximum 1 stay per plan year. $1,000 $2,000 Hospital Stay Daily Pays a daily benefit, beginning on day two of your stay in a non ICU room of a hospital. Maximum 31 days per plan year $100 $200 Health Screening Benefit Payable once per calendar year for health screening tests performed as the result of preventative care, including tests and diagnostic procedures ordered in connection with routine examinations. This benefit is payable for each insured.
$50 calendarperyear $50 calendarperyear HospitalLowIndemnity High Employee $17.44 $32.42 Employee + Spouse $33.09 $65.48 Employee + Child(ren) $26.78 $51.04 Family $42.42 $84.10
This is an affordable supplemental plan that pays you should you be in patient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance. full plan details, please visit your benefit website: www.esc20bc.net
The Hospital Indemnity Plan provided through AFLAC helps with the high cost of medical care by paying you a set amount when you have an inpatient hospital stay. Unlike traditional insurance, which pays a benefit to the hospital or doctor, this plan pays you directly based on the care or treatment you receive. These costs may include meals and transportation, childcare or time away from work due to a medical issue that requires hospitalization.
Hospital Indemnity Aflac EMPLOYEE BENEFITS
If you need to submit a claim you do so on the AFLAC portal at groupclaimfiling@aflac.com Benefit
For
Service
ABOUT TELEHEALTH Telehealth provides 24/7/365 access to board certified doctors via telephone or video consultations that can diagnose, recommend treatment and prescribe medication. Telehealth makes care more convenient and accessible for non emergency care when your primary care physician is not available. For full plan details, please visit your benefit website: www.esc20bc.net Telehealth MDLive EMPLOYEE BENEFITS Alongside your medical coverage is access to quality telehealth services through MDLIVE. Connect anytime day or night with a board certified doctor via your mobile device or computer. While MDLIVE does not replace your primary care physician, it is a convenient and cost effective option when you need care and: • Have a non emergency issue and are considering a convenience care clinic, urgent care clinic or emergency room for treatment • Are on a business trip, vacation or away from home • Are unable to see your primary care physician When to Use MDLIVE: At a cost that is the same or less than a visit to your physician, use telehealth services for minor conditions such as: • Sore throat • Headache • Stomachache • Cold • Flu • Allergies • Fever • Urinary tract infections Do not use telemedicine for serious or life threatening emergencies. MDLIVE Behavioral Health:* Managing stress or life changes can be overwhelming but it’s easier than ever to get help right in the comfort of your own home. Visit a counselor or psychiatrist by phone, secure video, or MDLIVE App. • Talk to a licensed counselor or psychiatrist from your home, office, or on the go! • Unlimited, confidential online consultations for a variety of counseling needs with no copay. • The MDLIVE app helps you stay connected with appointment reminders, important notifications and secure messaging. * Does not apply to those with employer paid telehealth. Check with your benefits office for details. Registration is Easy Register with MDLIVE so you are ready to use this valuable service when and where you need it. • Online www.mdlive.com/fbsbh • Phone 888 365 1663 • Mobile download the MDLIVE mobile app to your smartphone or mobile device • Select “MDLIVE as a benefit” and “FBS” as your Employer/Organization when registering your account. Telehealth Employee $8.00 Family $16.00
Coverage is provided through Cigna Dental Care DHMO After you enroll in a plan and receive your ID card, you can manage your plan information on your personal home page on myCigna.com You have the freedom to select any participating general dentist as your primary care dentist. To select a dental provider from our network, simply visit Cigna.com. Once there, you can also check your benefits, email us and get a new or temporary ID card. If you prefer, contact us at 1 800 244 6224. With the Cigna Dental DHMO plan you pay your dentist directly, when applicable. Your primary dentist will provide all of your routine dental care and you will pay any copayment or discounted charges at the time of service. Visit Cigna.com to find a participating specialist. additional information refer to your benefits at www.esc20bc.net and select your school district and then
DHMO Dental Plan
Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and Fordisease.fullplan details, please visit your benefit website: www.esc20bc.net
benefits
To search for a dentist on Cigna.com, visit the site and click “Find a Doctor, Dentist or Facility.” Follow the prompts on screen and when asked to choose your plan, select “DPPO/ EPO > Dental Choice Cigna DPPO.” Or call 800 244 6224 to find an in network dentist. How to Request a New ID Card You can request your dental id card by contacting Cigna directly at 800 244 6224. You can also go to www.mycigna.com and register/login to access your account. In addition you can download the “MyCigna” app on your smartphone and access your ID card right there on your phone.
ABOUT DENTAL
•
DPPO Plan
•
•
For
Dental Insurance Cigna EMPLOYEE BENEFITS
Coverage is provided through Cigna, and a High Plan and a Low Plan are offered. Those two levels of benefits are available with the DPPO plan: in network and out of network. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services. You could pay more if you use an out of network provider. How to Find an In network Dentist
DentalDental. High DPPO Low DPPO DHMO Employee $35.81 $17.94 $11.98 Employee + Spouse $88.20 $36.45 $22.61 Employee + Child(ren) $96.70 $41.91 $25.51 Family $134.81 $63.99 $39.49
Dental Insurance Cigna EMPLOYEE BENEFITS Cigna Dental Choice Plan Summary Please see plan documents for details and limitations High PPO Plan PPO Low Plan In Network ‘TotalDPPOCigna ’ Out of Network In Network ‘TotalDPPOCigna ’ Out of Network Reimbursement Levels Based ContractedonFees ReimbursableMaximumCharge Based ContractedonFees AllowableMaximumCharge Calendar Year Deductible FamilyIndividual $150$50 $150$50 $150$50 $150$50 Calendar Year Benefit Maximum Per Individual $1,750 $1000 Benefit Highlights You Pay You Pay Class I: Diagnostic & Preventive Oral Prophylaxis:Evaluationsroutine cleanings X rays: routine X rays: non routine Fluoride Application Sealants: per tooth Space Maintainers: non orthodontic Emergency Care to Relieve Pain No Charge No Charge No Charge No Charge Class II: Basic Restorative Restorative: Endodontics:fillingsminor and major Periodontics: minor and major Oral Surgery: minor and major Anesthesia: general and IV sedation Repairs: dentures 20% deductibleafter 20% deductibleafter 20% deductibleafter 20% deductibleafter Class III: Major Restorative Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures Repairs: bridges, crowns and inlays Denture Relines, Rebases and Adjustments 50% deductibleafter 50% deductibleafter 50% deductibleafter 50% deductibleafter Class IV: CoverageOrthodontiaforDependent Children to age 19 Lifetime Benefits Maximum: $1,000 50% No Deductible $50% No Deductible No Coverage No Coverage
ABOUT VISION Vision insurance provides coverage for routine eye examinations and can help with covering some of the costs for eyeglass frames, lenses or contact lenses. For full plan details, please visit your benefit website: www.esc20bc.net Vision Insurance Superior Vision EMPLOYEE BENEFITS Our vision plan provides quality care to help preserve your health and eyesight. In addition to identifying vision and eye problems, regular exams can detect certain medical issues such as diabetes and high cholesterol. You may seek care from any licensed optometrist, ophthalmologist or optician, but plan benefits are better if you use an in network provider. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through Superior Vision. How to Find a Vision Provider Visit https://superiorvision.com/locator/ or call 800 507 3800 to find an in network vision provider. Your network is the Superior National network. How to Print your Vision ID Card: You can request your vision id card by contacting Superior Vision directly at 800 507 3800. You can also go to www.superiorvision.com and register/ login to access your account by clicking on “Members” at the top of the page. You can also download the Superior Vision mobile app on your smart phone. Copays Services/frequency Monthly Premiums Base Buy Up Base Buy Up Base Buy Up Exam $10 $0 Exam 12 months Employee $6.88 $10.97 Materials $25 $0 Frame 12 months Employee + Spouse $13.66 $21.79 Contact Lens Fitting $25 $0 Lenses 12 months Employee + Child(ren) $13.38 $21.34 Contacts Family $20.36 $32.4812 months Base Plan Buy Up Plan In network Out of network In network Out of network Lenses • Single Vision • Bifocals • Trifocals • Factory Scratch Coat • Ultraviolet coat Covered in full Covered in full Covered in $12/Covered$15/Coveredfullinfullinfull Up to $32 Up to $46 Up to $61 Not Covered Not Covered Covered in full Covered in full Covered in full Covered in full Covered in full Up to $32 Up to $46 Up to $61 Not Covered Not Covered Frames $125 allowanceretail Up to $68 $175 allowanceretail Up to $68 Contacts • Contact lenses *Contact lenses are in lieu of eyeglass lenses and frames benefit. $120 retail allowance Up to $100 $120 retail allowance Up to $100
ABOUT DISABILITY Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time. For full plan details, please visit your benefit website: www.esc20bc.net Disability Insurance OneAmerica | Unum EMPLOYEE BENEFITS What is Disability Insurance? Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. The plan gives you flexibility to be able to choose an amount of coverage and waiting period that suits your needs. For more information regarding Disability insurance, please review information in your benefits website at www.esc20bc.net and select your school district to review your plan options.
Blood, Plasma
per calendar year Bone Marrow/Stem Cell Transplant Autologous $500 per calendar year Non Autologous $1,500 per calendar year Autologous $1,500 per calendar year Non Autologous $4,500 per calendar year Experimental Treatment Benefit Pays as any non experimental benefit Pays as any non experimental benefit Attending Physician Benefit $30 per day of confinement $50 per day of confinement Surgical Prosthesis Benefit $1,000 per device (includes surgical fee); max 1 device per site, 2 lifetime max $3,000 per device (includes surgical fee); max 1 device per site, 2 lifetime max Cancer Low High Employee $17.80 $32.40 Employee + Spouse $32.70 $57.80 Employee + Child(ren) $24.80 $44.60 Family $32.70 $57.80
Family Member Transportation & Lodging Benefit
ABOUT CANCER Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment. For full plan details, please visit your benefit website: www.esc20bc.net Cancer Insurance APL EMPLOYEE BENEFITS SUMMARY OF BENEFITS Benefits Level 1 Plan Level 2 Plan Radiation ImmunotherapyTherapy/Chemotherapy/Benefit $500 per calendar month of treatment $1,500 per calendar month of treatment Hormone Therapy Benefit $50 per treatment, up to 12 per calendar year $50 per treatment, up to 12 per calendar year Surgical Schedule Benefit $1,600 max per operation; $15 per surgical unit $4,800 max per operation; $45 per surgical unit Anesthesia Benefit 25% of the amount paid for covered surgery 25% of the amount paid for covered surgery Hospital Confinement Benefit $100 per day 1 90 days; $100 per day, 91+ days in lieu of other benefits $300 per day 1 90 days; $300 per day, 91+ days in lieu of other benefits US Government/Charity Hospital/ HMO $100 per day in lieu of most other benefits $300 per day in lieu of most other benefits Outpatient Hospital or Ambulatory Surgical Center Benefit $200 per day of surgery $600 per day of surgery Drugs & Medicine Benefit Inpatient $150 per confinement $150 per confinement Drugs & Medicine Benefit Outpatient $50 per prescription, up to $50 per cal month $50 per prescription, up to $150 per cal month Transportation & Outpatient Lodging Benefit
$0.50 per mile per round trip $100 per day, up to 100 days per calendar year $0.50 per mile per round trip $100 per day, up to 100 days per calendar year $0.50 per mile per round trip $100 per day, up to 100 days per calendar year $0.50 per mile per round trip $100 per day, up to 100 days per calendar year & to $12,500
Platelets Benefit $150 per day, up to $7,500 per calendar year $250 per day, up
Cancer Insurance APL EMPLOYEE BENEFITS Benefits Level 1 Plan Level 2 Plan Hair Prosthesis Benefit $50 per hair prosthetic, 2 lifetime max $50 per hair prosthetic, 2 lifetime max Dread Disease Benefit $100 per day, 1 90 days of hospital confinement $300 per day, 1 90 days of hospital confinement Hospice Care Benefit $50 per day, $9,000 lifetime max $100 per day, $18,000 lifetime max Inpatient Special Nursing Services $150 per day of confinement $150 per day of confinement Ambulance Ground Benefit $200 per ground trip $200 per ground trip Ambulance Air Benefit $2,000 per air trip; up to 2 trips per hospital confinement (any combination of ground/air) $2,000 per air trip; up to 2 trips per hospital confinement (any combination of ground/air) Extended Care Benefit $100 per day $300 per day Home Health Care Benefit $100 per day $300 per day Second & Third Surgical Opinions $300 per diagnosis; additional $300 if third opinion required $300 per diagnosis; additional $300 if third opinion required Waiver of Premium Premium waived after 90 days of primary insured continuous total disability due to cancer Premium waived after 90 days of primary insured continuous total disability due to cancer Physical/Speech Therapy Benefit $25 per visit, up to 4 visits per calendar month, $1,000 lifetime max $25 per visit, up to 4 visits per calendar month, $1,000 lifetime max DiagnosticRiders Testing Benefit Rider $50; 1 person, per calendar year $50; 1 person, per calendar year Critical Illness Rider: Heart Attack/ Stroke $2,500 lump sum benefit $2,500 lump sum benefit Optional Benefit Rider Intensive Care Unit Rider $600 up to a max of 30 days per confinement $600 up to a max of 30 days per confinement The plan includes an annual Wellness Benefit. Download a claim form on your benefit website: www.esc20bc.net Should you need to file a cancer claim contact APL at 800 256 8606 or online at www.ampublic.com You can find additional claim forms and informational materials at www.esc20bc.net under your school district in the Cancer section of the portal.
ABOUT ACCIDENT Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you. For full plan details, please visit your benefit website: www.esc20bc.net Accident Insurance APL EMPLOYEE BENEFITS The Accident Plan provided through American Public Life (APL) is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or not so serious, injury. Accident coverage is low cost protection available to you and your family without evidence of insurability. Should you need to file a claim contact APL at 800 256 8606 or online at www.ampublic.com. You can find additional claim forms and materials on your employee benefits portal. Benefit Description Summary of Benefits Accidental Death per unit $5,000 Medical Expense Accidental Injury Benefit per unit Actual charges up to $500 Daily Hospital Confinement Benefit $75 per day Air and Ground Ambulance Benefit Actual charges up to $1,250 Accidental Dismemberment Benefit Single finger or toe Multiple fingers or toes Single hand, arm, foot or leg Multiple hands, arms, feet or legs $5,000$2,500$500$500 Accidental Loss of Sight Benefit per unit Loss of sight in one eye Loss of sight in both eyes $5,000$2,500 Accident Employee $10.80 Employee + Spouse $19.40 Employee + Child(ren) $21.20 Family $29.80
Why I Need Critical Illness Insurance
✓ Critical illness plans complement high deductible health plans (HDHP) by reducing the worry of having to pay a large medical deductible while suffering from a major illness.
For full plan details, please visit your benefit website: www.esc20bc.net
Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non medical costs related to the illness, including transportation, child care, etc.
Serious medical conditions can affect not only your heath, but also your bank account. Medical expenses reportedly lead to more than half of all bankruptcies in the United States. When faced with a severe illness, a critical illness policy can help in many ways.
Critical Illness Insurance Aflac EMPLOYEE BENEFITS
Critical Illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non medical costs related to the illness, including transportation, child care, etc.
✓ Plan includes a $50 wellness benefit that pays covered employees for having certain annual screenings performed.
ABOUT CRITICAL ILLNESS
or
1.866.849.2970. Critical Illness Employee $5,000.00 $10,000.00 $15,000.00 $20,000.00 > 29 $2.71 $3.90 $5.09 $6.28 30 39 $3.62 $5.71 $7.81 $9.91 40 49 $4.85 $8.17 $11.50 $14.82 50 59 $7.82 $14.11 $20.41 $26.71 60 64 $18.91 $36.31 $53.70 $71.10 Spouse $5,000.00 $10,000.00 $15,000.00 $20,000.00 > 29 $2.71 $3.90 $5.09 $6.28 30 39 $3.62 $5.71 $7.81 $9.91 40 49 $4.85 $8.17 $11.50 $14.82 50 59 $7.82 $14.11 $20.41 $26.71 60 64 $18.91 $36.31 $53.70 $71.10
Complete claim form located in Benefits Portal/Critical Illness and mail in, or email to groupclaimfiling@aflac.com fax to
✓ Plans are designed to pay a benefit specific to the diagnosis usually ranging from $5,000 to $20,000.
Group term life is the most inexpensive way to purchase life insurance.
OR Conversion: Should your life insurance coverage, or a portion of it, cease for any reason, you may be eligible to convert your Group Term Coverage to Individual Coverage without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible.
ABOUT
Accidental Death and Dismemberment (AD&D): Additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract. Additional AD&D benefits include seat belt, air bag, repatriation, child higher education, childcare, paralysis/loss of use, severe burns, disappearance, and exposure.
Guaranteed Issue: Amount varies by district
• Employee must select coverage to select any Dependent coverage.
You have the freedom to select an amount of life insurance coverage you need to help protect the well being of your family.
Voluntary Term Life Insurance Terms and Definitions
For full plan details, please visit your benefit website: www.esc20bc.net
Guaranteed Increase In Benefit: You may be eligible to increase your coverage annually until you reach your maximum amount without providing evidence of insurability.
Guaranteed Issue Amounts: This is the most coverage you can purchase without having to answer any health questions. If you decline insurance coverage now and decide to enroll later, you will need to provide Evidence of Insurability.
EMPLOYEE BENEFITS
About your benefit options:
Evidence of Insurability: If you elect a benefit amount over the Guaranteed Issue Amount shown above, or you do not enroll timely, you will need to submit a Statement of Insurability form for review. Based on health history, you will be approved or declined for insurance coverage by AUL.
• You may select a minimum Life benefit of $10,000 up to a maximum amount of $500,000, in increments of $10,000.
Life and AD&D
Employee Guaranteed Issue Amount: $200,000 Spouse Guaranteed Issue Amount: $50,000 Child Guaranteed Issue Amount: $10,000
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.
Eligible Employees: This benefit is available for employees who are actively at work on the effective date and working a minimum of 18.75 hours per week.
• Dependent coverage cannot exceed 100% of the Voluntary Term Life amount selected by the Employee.
• Life amounts requested above $200,000 for an Employee, $50,000 for a Spouse, and $10,000 for a Child(ren) or any amount not requested timely will require Evidence of Insurability.
Timely Enrollment: Enrolling timely means you have enrolled during the initial enrollment period when benefits were first offered by AUL, or as a newly hired employee within 31 days following completion of any applicable waiting period.
What you need to know about your Basic Life and AD&D Benefits
Flexible Choices: Since everyone's needs are different, this plan offers flexibility for you to choose a benefit amount that fits your needs and budget.
Accelerated Life Benefit: If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose.
If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose.
Portability: Should your coverage terminate for any reason, you may be eligible to take this term life insurance with you without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible. The Portability option is available until you reach age 70.
OneAmerica LIFE AND AD&D
Continuation of Coverage Options:
Life and AD&D OneAmerica EMPLOYEE BENEFITS Waiver of Premium: If approved, this benefit waives your insurance premium in case you become totally disabled and are unable to collect a paycheck. Reductions: Upon reaching certain ages, your original benefit amount will reduce to a percentage as shown in the following schedule. The amounts of Dependent Life Insurance Principal Sum will reduce according to the Employee's reduction schedule. AD&D It’s nearly impossible to predict and avoid accidents. It’s a lot easier to prepare yourself for one, though. Accidental Death & Dismemberment is life insurance coverage that pays a lump sum 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 you are accidentally dismembered. AD&D is a very inexpensive form of life insurance that can give you additional protection in the event of an accidental death or dismemberment. What you need to know about your Voluntary AD&D Benefits Flexible AD&D Options: • Employee: Up to $500,000, in $10,000 increments • Spouse: 50% of the employee AD&D benefit • Child: 10% of the employee AD&D benefit AD&D Guaranteed Issue: • Employee: $500,000 • Spouse: $250,000 • Child: $50,000 Accidental Death and Dismemberment (AD&D): If AD&D is selected, additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract. Dependent AD&D Coverage: Optional dependent AD&D coverage is available to eligible employees. You must select employee coverage in order to cover your spouse and/or child(ren). If employee AD&D is declined, no dependent AD&D will be included. Reductions: Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule. The amounts of dependent AD&D principal sum will reduce according to the employee's reduction schedule. Voluntary Group Life per $10,000 in coverage Age Employee Spouse 18 24 $0.50 $0.50 25 29 $0.50 $0.50 30 34 $0.70 $0.70 35 39 $0.80 $0.80 40 44 $1.00 $1.00 45 49 $1.40 $1.40 50 54 $2.40 $2.40 55 59 $3.90 $3.90 60 64 $5.90 $5.90 65 69 $8.26 $8.26 70 74 $10.30 $10.30 75+ $14.70 $14.70 Voluntary Group Life Child(ren) $10,000 in coverage 0 26 $1.80 Spouse rates based on Employee's age. Voluntary AD&D per $10,000 in coverage Employee $0.25 Employee and Family $0.40 Age: 65 70 75 Reduces To: 65% 50% 25% Age: 65 70 75 Reduces To: 65% 50% 25%
QUALITY OF LIFE Optional benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is 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.
* Financially dependent children 14 days to age 23.
ILLNESS ACCELERATION OF BENEFITS Coverage that pays 30% (25% in CT and MI) of the 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 (24 months in IL).
*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 application date: 14 days through 23 years).$7.15 monthly for $10,000 coverage per child.
PROTECTION TO COUNT ON Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two year contestability period and/or under investigation. This coverage has no war or terrorism exclusions.
ABOUT INDIVIDUAL LIFE Individual insurance is a policy that covers a single person and is intended to meet the financial needs of the beneficiary, in the event of the insured’s death. This coverage is portable and can continue after you leave employment or retire. For full plan details, please visit your benefit website: www.esc20bc.net Individual Life Insurance 5Star EMPLOYEE BENEFITS Enhanced coverage options for employees. Easy and flexible enrollment for employers. The 5Star Life Insurance Company’s Family Protection Plan offers both Individual and Group products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your employees.
TERMINALfamilies.
FAMILY PROTECTION Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves.
Find full details and rates at www.esc20bc.net
CUSTOMIZABLE With several options to choose from, employees select the coverage that best meets the needs of their
Should you need to file a claim, contact 5Star directly at (866) 863 9753.
PORTABLE Coverage continues with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly. CONVENIENCE Easy payments through payroll deduction.
Should you need assistance with a claim contact MASA at 800 643 9023. You can find full benefit details at benefit Emergency Transportation Emergent Emergent Plus Employee and Family $9.00 $14.00
In the event that a member is in stable condition in a medical facility but requires a heightened level of care that is not available at their current medical facility, Members have access to non emergency air or ground transportation between medical Repatriation/Recuperationfacilities.
MASA EMPLOYEE BENEFITS
ABOUT MEDICAL TRANSPORT
Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out of pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan.
Emergent Ground Transportation (Emergent & Emergent Plus)
Air Transportation (Emergent & Emergent Plus)
For full plan details, please visit your benefit website: www.esc20bc.net
Non Emergency Inter Facility Transportation (Emergent Plus Only)
Emergency Medical Transport
In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities.
Suppose you or a family member is hospitalized more than 100 miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for recuperation.
A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. If a member has a high deductible health plan that is compatible with a health savings account, benefits will become available under the MASA membership for expenses incurred for medical care (as defined under Internal Revenue Code (“IRC”) section 213 (d)) once a member satisfies the applicable statutory minimum deductible under IRC section 223(c) for high deductible health plan coverage that is compatible with a health savings Emergentaccount.
(Emergent Plus Only)
In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities.
ABOUT IDENTITY THEFT PROTECTION Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered. For full plan details, please visit your benefit website: www.esc20bc.net Identity Theft ID Watchdog EMPLOYEE BENEFITS Easy & Affordable Identity Protection Your identity is important it’s what makes you, you. You’ve spent a lifetime building your name and financial reputation. Let us help you better protect it. And we’ll even go one step further and help you better protect the identities of your family! Features • Credit Lock helps provide additional protection against unauthorized access to your credit • More For Families helps better protect your loved ones no matter the age. • Resolution Specialist manage the case for you until your identity is restored ID watchdog Monitors: social media, transaction records, public records, and more. How to file a claim: Call 866 513 1518 or download the app to additional services. IDENTITY THEFT PROTECTION The Powerful Features You Want All at an Affordable Price Monitor & Detect • Credit Report & VantageScore • Credit Score | 1 Bureau Monthly • Credit Score Tracker | 1 Bureau Monthly • Credit Report Monitoring1 | 3 Bureau • Dark Web Monitoring* • High Risk Transactions Monitoring* • Subprime Loan Monitoring* • Public Records Monitoring* • USPS Change of Address Monitoring • Identity Profile Report Manage & Alert • Child Credit Lock*| 1Bureau • Credit Report Lock | 1Bureau* • Financial Accounts Monitoring • Social Network Alerts* • Registered Sex Offender Reporting* • Customizable Alert Options • Breach Alert Emails • Mobile App • National Provider ID Alerts Support & Restore • Identity Theft Resolution Specialists (Resolution for Pre existing Conditions)* • 24/7/365 U.S. based Customer Care Center • Up to $1M Identity Theft Insurance* • Lost Wallet Vault & Assistance • Deceased Family Member Fraud Remediation • Fraud Alert & Credit Freeze Assistance *Helps better protect children Identity Theft Employee $7.95 Family $14.95
• You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self care.
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
Flexible
• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
Things to Consider Regarding the Dependent Care FSA
Higginbotham Care FSA
The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full time student.
• Overnight camps are not eligible for reimbursement (only day camps can be considered).
Eligible expenses include: • Dental and vision expenses • Medical deductibles and coinsurance • Prescription copays • Hearing aids and batteries You
The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s).
dental
EMPLOYEE BENEFITS Health
ABOUT FSA A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (unless your plan contains a $500 rollover or grace period provision). For full plan details, please visit your benefit website: www.esc20bc.net
Spending Account (FSA)
Dependent Care FSA
The Health Care FSA covers qualified medical, and vision expenses for you or your eligible dependents. You may contribute up to $2,850 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA).
Higginbotham Benefits Debit Card
Flexible Spending Account (FSA) Higginbotham EMPLOYEE BENEFITS Important FSA Rules • The maximum per plan year you can contribute to a Health Care FSA is $2,850. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately. • You cannot change your election during the year unless you experience a Qualifying Life Event. • You can continue to file claims incurred during the plan year for another 90 days after August 31st • Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care TheHigginbothamexpenses.PortalHigginbothamPortal provides information and resources to help you manage your FSAs. • Access plan documents, letters and notices, forms, account balances, contributions and other plan information • Update your personal information • Utilize Section 125 tax calculators • Look up qualified expenses • Submit claims • Request a new or replacement Benefits Debit Card Register on the Higginbotham Portal Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information. • Enter your Employee ID, which is your Social Security number with no dashes or spaces. • Follow the prompts to navigate the site. • If you have any questions or concerns, contact Higginbotham: Phone 866 419 3519 Email flexclaims@higginbotham.net Fax 866 419 3516 Higginbotham Flex Mobile App Easily access your Health Care FSA on your smartphone or tablet with the Higginbotham mobile app. Search for Higginbotham in your mobile device’s app store and download as you would any other app. • View Accounts Includes detailed account and balance information • Card Activity Account information • SnapClaim File a claim and upload receipt photos directly from your smartphone • Manage Subscriptions Set up email notifications to keep up to date on all account and Health Care FSA debit card activity • Log in using the same username and password you use to log in to the Higginbotham Portal. Note: You must register on the Higginbotham Portal in order to use the mobile app.
ABOUT EAP An Employee Assistance Program (EAP) is a program that assists you in resolving problems such as finding child or elder care, relationship challenges, financial or legal problems, etc. This program is provided by your employer at no cost to you. For full plan details, please visit your benefit website: www.esc20bc.net Employee Assistance Program (EAP) ComPsych EMPLOYEE BENEFITS Why I Need Employee Assistance Balancing work and life is difficult sometimes. Your EAP option covers trouble areas such as: • Substance abuse • Stress management • Financial problems EAP Employee Assistance Program: This is an added value of your Basic Life Insurance plan with the district that offers no cost counseling up to 6 Sessions in person per plan year. Call 855. 387.9727 or go online to: https://www.guidanceresources.com with your Company Web ID: ONEAMERICA3 For full plan details, please visit your benefit website, www.esc20bc.net and select your school district.
District GROUP # Alameda School for Art and Design ESC20A Big Springs Charter School ESC20B Brackett ISD ESC20C BRAINATION (Charter) ESC20D Charlotte ISD ESC20F Dime Box ISD ESC20G Divide ISD ESC20V Doral DrippingISDSprings ISD ESC20H Eleanor Kolitz Hebrew Language Academy ESC20I ESC Region 20 ESC20J Fayetteville ISD ESC20L Flatonia ISD ESC20M Harper ISD ESC20N Johnson City ISD ESC20O Jourdanton ISD ESC20P Jubilee Academies ESC20Q Katherine Anne Porter School ESC20R District GROUP # Knippa ISD ESC20S Leakey ISD ESC20U Legacy SchoolsTraditionalTexas ESC20AD Meadowland Charter School ESC20AV Meridian World School ESC20AW New Frontiers Public Schools ESC20AX Nixon Smiley CISD ESC20AY Prairie Lea ISD ESC20AA Prelude Preparatory ESC20AK Promesa Public Schools ESC20AB San Antonio Preparatory ESC20AC Schulenburg ISD ESC20AE Smithville ISD ESC20AF Somerset Academy Inc. ESC20AG Southwest Preparatory School ESC20AH Texas Preparatory School ESC20AI Utopia ISD ESC20AJ Wayside Schools ESC20AL ESC20BC Mobile App Login Group #’s Use your District’s group # to login to the FBS Benefits app.
Notes
Notes
Notes
Rate Sheet General Disclaimer:
2022 - 2023 PlanYear
The rate information provided in this guide is subject to change at any time by your employer and/or the plan provider. The rate information included herein, does not guarantee coverage or change or otherwise interpret the terms of the specific plan documentation, available at the ESC Region 20 BC Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.
WWW.ESC20BC.NET
Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the ESC Region 20 BC Benefits Website. This summary does not replace or amend the underlying plan documentation. In the event of a discrepancy between this summary and the plan documentation the plan documentation governs. All plans and benefits described in this summary may be discontinued, increased, decreased, or altered at any time with or without notice.
