PALACIOS ISD BENEFIT GUIDE EFFECTIVE: 09/01/2022 8/31/2023 WWW.MYBENEFITSHUB.COM/PALACIOSISD 2022 - 2023 PlanYear 1
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 12-17 Health Savings Account (HSA) 18 Hospital Indemnity 19 Telehealth 20 Dental 21-22 Vision 23-24 Accident 25-26 Disability 27-28 Cancer 29-30 Critical Illness 31-32 Voluntary Group Life & AD&D 33-34 Individual Life 35 Identity Theft 36 Flexible Spending Account (FSA) 37 38 Emergency Medical Transportation 39 Retirement Plans 40 HOW TO ENROLLPG. 4 SUMMARYPAGESPG. 6 BENEFITSYOURPG. 12 2
PALACIOS ISD BENEFITS TRS ACTIVECARE MEDICAL DENTAL Financial Benefit Services (800) 583 www.mybenefitshub.com/palaciosisd6908 (866)BCBSTX355 www.bcbstx.com/trsactivecare5999 GroupCigna #3337069 (800) 244 www.cigna.com6224 VISION CANCER ACCIDENT United Health Care Group #911573 (800) 638 3120 www.myuhcvision.com American Public Life (APL) Group #14184 (800) 256 8606 www.ampublic.com GroupMetLife#5959277 (800) 638 5433 www.metlife.com IDENTITY THEFT DISABILITY LIFE AND AD&D www.idwatchdog.com(800)IDWatchdog7743772 Lincoln Financial Group Long Term Disability Plan #10255651 Short Term Disability Plan #10255648 (800) 423 www.lfg.com2765 United Health Care Group #305114 (800) 423 www.uhc.com2765 FLEXIBLE SPENDING ACCOUNT (FSA) INDIVIDUAL LIFE HEALTH SAVINGS ACCOUNT (HSA) www.higginbotham.net(866)Higginbotham4193519 (866)5Star 863 www.5starlifeinsurance.com9753 (817)EECU 882 www.eecu.org0800 HOSPITAL INDEMNITY CRITICAL ILLNESS EMERGENCY TRANSPORTATIONMEDICAL (800)Aflac 992 www.aflacgroupinsurance.com3522 GroupUnum #474112 (800) 635 www.unum.com5597 GroupMASA #B2BPALISD (800) 423 www.masamts.com3226 TELEHEALTH RETIREMENT PLANNING MDLIVE (888) 365 1663 www.consultmdlive.com TCG (800) 943 9179 www.tcgservices.com Benefit Contact Information 3
Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS PALACIOSISD” to (800) 583-6908 App Group #: FBSPALACIOSISD Text “FBS PALACIOSISD” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment: • Benefit Resources • Online Enrollment • Interactive Tools • And more! 4
1 www.mybenefitshub.com/palaciosisd How to Log In 2 CLICK LOGIN 3 ENTER USERNAME & PASSWORD Your Username Is: Your email in THEbenefitsHUB. (Typically your work email) Your Password Is: Four (4) digits of your birth year followed by the last four (4) digits of your Social Security Number If you have previously logged in, you will use the password that you created, NOT the password format listed above. 5
Benefit Updates What’s New: Don’t Forget! • Login and complete your benefit enrollment from 07/05/2022 08/18/2022 • Enrollment assistance is available by calling Financial Benefit Services at (866) 914 5202 to speak to a representative Monday Friday 8am 6pm. • 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 CHANGES VISION PLAN RATE INCREASE CANCER PLAN TIER CHANGE NEW FSA ADMINISTRATOR VISION Vision insurance provides coverage for routine eye examinations and helps with covering some of the costs for eyeglass frames, lenses or contact lenses. Eyeglass frames can now be replace every 12 months. CANCER Cancer insurance offers extra insurance protection if you or a family member are diagnosed with cancer. This benefit is meant to help with costs your medical insurance may not cover. High and Low plan options with ICU Benefit available. Critical Illness Rider Lump Sum Benefit of $2500 & $3750 for child. Internal Cancer First Occurrence Lump Sum Benefit of $2500 & $3750 for child. Radiation/ Chemotherapy benefits of $10,000 max per 12 mo. (Plan 1) or $15,000 max per 12 mo. (Plan 2). These plans are fully portable. FSA Flexible Spending Account administration is moving to Higginbotham. You are REQUIRED to enroll and elect the plan at open enrollment every year in order to continue your account participation for each plan year. All employees who enroll in FLEX for September will receive a new FSA debit card. A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre loaded debit card. The annual plan limit is $2,850. This plan contains a 75 day grace period provision. 6
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.
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.
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.
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
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.
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 Benefit Enrollment CHANGES IN (CIS):STATUS QUALIFYING EVENTS
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.
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 31 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.
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.
Change in Status of Employment
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?
SUMMARY PAGESAnnual Benefit Enrollment 8
For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ palaciosisd. Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms
Howsection.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.
All new hire enrollment elections must be completed in the online enrollment system within the first 31 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.
• Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
New Hire Enrollment
Q&A Who do I contact with Questions?
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.
Where can I find forms?
• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
For benefit summaries and claim forms, go to the Palacios ISD benefit www.mybenefitshub.com/palaciosisdwebsite:.
• 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.
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.
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.
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
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 RequirementsEligibility
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.
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
SUMMARY PAGESAnnual Benefit Enrollment PLAN MAXIMUM AGE Medical To age 26 Dental To age 26 Vision To age 26 Cancer To age 26 Voluntary Life To age 26 Identity Theft To age 26 Critical Illness To age 26 IndemnityHospital To age 26 Telehealth To age 26 Accident To age 26 Emergency TransportationMedical To age 26 Individual Life To Age 24 9
Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.
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
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.
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 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.
Actively at Work
January 1st through December 31st Co-insurance
The most an eligible or insured person can pay in co insurance for covered expenses.
Pre Existing Conditions
SUMMARY PAGESHelpful Definitions 10
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.
September 1st through August 31st
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider. Out of Pocket Maximum
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.
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).
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. Yes, your plan includes a 75 day grace period. Does the account earn interest? Yes No Portable? Yes, portable year to year and between jobs. No SUMMARY PAGESHSA vs. FSA FLIP TO FOR HSA INFORMATION PG. 18 FLIP TO FOR FSA INFORMATION PG. 37 11
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.mybenefitshub.com/palaciosisd Medical Insurance TRS EMPLOYEE BENEFITS Monthly Premium District Contribution Employee Cost TRS ActiveCare HD Employee Only $427.00 $427.00 $0.00 Employee & Spouse $1,202.00 $500.00 $702.00 Employee & Child(ren) $766.00 $500.00 $266.00 Employee & Family $1,437.00 $500.00 $937.00 TRS ActiveCare Primary Employee Only $417.00 $417.00 $0.00 Employee & Spouse $1,176.00 $500.00 $676.00 Employee & Child(ren) $750.00 $500.00 $250.00 Employee & Family $1,405.00 $500.00 $905.00 TRS ActiveCare Primary+ Employee Only $524.00 $500.00 $24.00 Employee & Spouse $1,280.00 $500.00 $780.00 Employee & Child(ren) $843.00 $500.00 $343.00 Employee & Family $1,610.00 $500.00 $1,110.00 TRS ActiveCare 2 Employee Only $1,013.00 $500.00 $513.00 Employee & Spouse $2,402.00 $500.00 $1,902.00 Employee & Child(ren) $1,507.00 $500.00 $1,007.00 Employee & Family $2,841.00 $500.00 $2,341.00 12
• Individual $3,650
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax free and spends tax free if used to pay for qualified medical expenses. There is no “use it or lose it” rule you do not lose your money if you do not spend it in the calendar year and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
You are eligible to open and contribute to an HSA if you are:
Important HSA Information
• Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.
• Not eligible to be claimed as a dependent on someone else’s tax return
• Online/Mobile: Sign in for 24/7 account access to check your balance, pay bills and more.
• Stop by: a local EECU financial center for in person assistance; find EECU locations & service hours a www.eecu.org/locations HSA A Health Savings Account (HSA) is a personal savings account where the can only be used for eligible medical expenses. Unlike a flexible account (FSA), the money rolls over year to year however only funds that have been deposited in your account can be used. to a Health Savings Account can only be used if you are also High Deductible Health Care Plan (HDHP). your benefit website:
You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered under your HDHP.
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.
Maximum Contributions 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 you elect:
• 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.
Health Savings Account (HSA)
• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
For full plan details, please visit
Opening an HSA If you meet the eligibility requirements, you may open an HSA administered by EECU. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA.
• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
EECU EMPLOYEE BENEFITS 18
• Not receiving Veterans Administration benefits
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.
• Enrolled in an HSA eligible HDHP
• Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account
• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333 9934
• Family (filing jointly) $7,300
• You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions. How to Use your HSA
enrolled in a
• Not enrolled in Medicare or TRICARE
The Aflac Group Hospital Indemnity plan benefits include the following: LOW HIGH HOSPITAL ADMISSION BENEFIT per confinement (once per covered sickness or accident per calendar year for each insured)
Like transportation and meals for family members, help with child care, or time away from work, for instance.
SUCCESSOR INSURED BENEFIT If spouse coverage is in force at the time of the employee’s death, the surviving spouse may elect to continue coverage. Coverage would continue according to the existing plan and would also include any dependent child coverage in force at the time.
• Hospital Confinement Benefit • Hospital Admission Benefit • Successor Insured Benefit and more In order to receive benefits for accidental injuries due to a covered accident, an insured must be admitted within six months of the date of the covered accident (in Washington, twelve months).
The Group Hospital Indemnity plan benefits include the following:
HOSPITAL CONFINEMENT per day (maximum of 31 days per confinement for each covered sickness or accident for each Payableinsured)for each day that an insured is confined to a hospital as an inpatient as the result of a covered accidental injury or covered sickness. If we pay benefits for confinement and the insured becomes confined again within six months because of the same or related condition, we will treat this confinement as the same period of confinement. This benefit is payable for only one hospital confinement at a time even if caused by more than one covered accidental injury, more than one covered sickness, or a covered accidental injury and a covered sickness.
ABOUT HOSPITAL INDEMNITY
It provides financial assistance to enhance your current coverage. It may help avoid dipping into savings or having to borrow to address out of pocket expenses major medical insurance was never intended to cover.
HOSPITAL INTENSIVE CARE BENEFIT per day (maximum of 10 days per confinement for each covered sickness or accident for each Payableinsured)foreach day when an insured is confined in a Hospital Intensive Care Unit because of a covered accidental injury or covered sickness. We will pay benefits for only one confinement in a Hospital's Intensive Care Unit at a time. Once benefits are paid, if an insured becomes confined to a Hospital's Intensive Care Unit again within six months because of the same or related condition, we will treat this confinement as the same period of confinement. This benefit is payable in addition to the Hospital Confinement Benefit.
Payable when an insured is admitted to a hospital and confined as an inpatient because of a covered accidental injury or covered sickness. We will not pay benefits for confinement to an observation unit, or for emergency room treatment or outpatient treatment. We will not pay benefits for admission of a newborn child following his birth; however, we will pay for a newborn’s admission to a Hospital Intensive Care Unit if, following birth, he is confined as an inpatient as a result of a covered accidental injury or covered sickness (including congenital defects, birth abnormalities, and/or premature birth).
The plan that can help with expenses and protect your savings. Does your major medical insurance cover all of your bills? Even a minor trip to the hospital can present you with unexpected expenses and medical bills. And even with major medical insurance, your plan may only pay a portion of your entire stay. That’s how the Group Hospital Indemnity plan can help.
Hospital IndemnityLow High Employee Only $20.24 $35.42
Employee and Family $52.46 $91.90
Employee and Child(ren) $31.56 $55.48
Employee and Spouse $41.14 $71.84
For full plan details, please visit your benefit website: www.mybenefitshub.com/palaciosisd
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.
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.mybenefitshub.com/palaciosisd 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 • Stomach ache • Cold • Flu • Allergies • Fever • Urinary tract infections Do not use telemedicine for serious or life threatening emergencies. 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/fbs 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 and Family $10.00 20
ABOUT DENTAL Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and Fordisease.fullplan details, please visit your benefit website: www.mybenefitshub.com/palaciosisd Dental Insurance Cigna EMPLOYEE BENEFITS Our dental plan helps you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through Cigna Dental How to Find a Dentist Visit https://hcpdirectory.cigna.com/ or call 800 244 6224 to find an in network dentist. Your network will be Total Cigna DPPO. 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. Dental Employee Only $0.00 Employee and Family $96.56 Cigna Dental Choice Plan Network Options In Network: Total Cigna DPPO Network** Out of Network: See Non Network Reimbursement Reimbursement Levels Based on Contracted Fees Maximum Reimbursable Charge Calendar Year Benefits Maximum Applies to: Class I, II, III & IX expenses $1,500 $1,500 Calendar Year Deductible Individual Family $50 $150 $50 $150 21
Network Options Out of Network: See Non Network Reimbursement In Network: Total Cigna DPPO Network** Benefit Highlights Plan Pays You Pay Plan Pays You Pay Class I: Diagnostic & Preventive Oral Prophylaxis:Evaluationsroutine cleanings X rays: routine X rays: non routine Fluoride SpaceSealants:ApplicationpertoothMaintainers:non orthodontic 100% No Deductible No Charge 100% No Deductible No Charge Class II: Basic Restorative Restorative: Endodontics:fillingsminor and major Periodontics: minor and major Oral Surgery: simple extractions only Emergency Care to Relieve Pain 80% After Deductible 20% After Deductible 80% After Deductible 20% After Deductible Class III: Major Restorative Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures Oral Surgery: all except simple extractions Anesthesia: general and IV sedation Repairs: Bridges, Crowns and Inlays Repairs: Dentures Denture Relines, Rebases and Adjustments 50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible Class IV: CoverageOrthodontiaforDependent Children to age 19 Lifetime Benefits Maximum: $1,500 50% No Deductible 50% No Deductible 50% No Deductible 50% No Deductible Class IX: Implants 50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible Benefit Plan Provisions: In Network Reimbursement For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule. Non Network Reimbursement For services provided by a non network dentist, Cigna Dental will reimburse according to the Maximum Reimbursable Charge. The MRC is calculated at the 95th percentile of all provider charges in the geographic area. The dentist may balance bill up to their usual fees. Dental Insurance Cigna EMPLOYEE BENEFITS 22
ABOUT VISION Vision insurance provides coverage for routine eye examinations and can help with covering some of the costs for eyeglass frames, lenses or contact lenses. For full plan details, please visit your benefit website: www.mybenefitshub.com/palaciosisd Vision Insurance United Health Care EMPLOYEE BENEFITS Vision Benefit Summary Customer Service and Provider Locator: (800) 638 3120 myuhcvision.com Vision Employee Only $0.00 Employee and Family $8.08 Benefit ComprehensiveFrequencyExam(s) Once every 12 months Eyeglass Lenses Once every 12 months Frames Once every 12 months Contact Lenses instead of Eyeglasses Once every 12 months In Network Services Exam(s)Copays $ 10.00 Eyeglasses (lenses and frame) $ 25.00 Contact lenses instead of Eyeglasses $ 25.00 Frame Benefit (for frames that exceed the allowance, an additional 30% discount may be applied to the overage)1 Private Practice Provider $130.00 retail frame allowance Retail Chain Provider $130.00 retail frame allowance Lens ContactOptionsLens Benefit2 (Formulary contact lenses refer to contact lenses available on our formulary contact list. Contact lenses not on this list are referred to as non Formulary. A copy of the list can be found at myuhcvision.com). Formulary contact lenses The fitting/evaluation fees, contact lenses, and up to two follow up visits are covered in full after copay. If you choose disposable contacts, up to 4 boxes are included when obtained from an in network provider. Non Formulary contact lenses An allowance is applied toward the purchase of contact lenses outside the Formulary. Contact lens copay is waived. $125.00 Necessary contact lenses3 Covered in full after copay (if applicable). Children's and Maternity Eye Care Benefit Members age 0 12 and members pregnant or breastfeeding are eligible for a 2nd exam. Members age 0 12 and members pregnant or breastfeeding are also eligible for a replacement frame and lenses if they have a prescription change of 0.5 diopter or more. The 2nd exam and replacement benefits are the same as the initial exam, frame and lens benefits. 23
Vision Insurance United Health Care EMPLOYEE BENEFITS 24
Out of Network Reimbursements (Copays do not apply) Exam(s) Up to $40.00 Frames Up to $45.00 Single Vision Lenses Up to $40.00 Lined Bifocal and Progressive Lenses Up to $60.00 Lined Trifocal Lenses Up to $80.00 Lenticular Lenses Up to $80.00 Elective Contacts instead of Eyeglasses² Up to $125.00 Necessary Contacts instead of Eyeglasses3 Up to $210.00
Additional Material At a participating in network provider you will receive up to a 20% discount on an additional pair of eyeglasses or contact lenses. This program is available after your vision benefits have been exhausted. Please note that this discount shall not be considered insurance, and that UnitedHealthcare shall neither pay nor reimburse the provider or member for any funds owed or spent. Additional materials do not have to be purchased at the time of initial material purchase. Hearing Aids As a UnitedHealthcare vision plan member, you can save on custom programmed hearing aids when you buy them from UnitedHealthcare Hearing. To find out more go to UHCHearing.com. When placing your order use promo code MYVISION to get the special price discount.
UnitedHealthcareLaserDiscountsvision has partnered with QualSight LASIK, the largest LASIK manager in the United States, to provide our members with access to discounted laser vision correction providers. Member savings represent up to 35% off the national average price of Traditional LASIK. Contracted prices start at $945 per eye for Traditional LASIK and $1,395 per eye for Custom LASIK. Discounts are also provided on newer technologies such as Custom Bladeless (all laser) LASIK. For more information, visit myuhcvision.com.
ABOUT ACCIDENT Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you. For full plan details, please visit your benefit website: www.mybenefitshub.com/palaciosisd Accident Insurance MetLife EMPLOYEE BENEFITS Accident Insurance Plan Summary ACCIDENT INSURANCE BENEFITS You’ll have a choice of two comprehensive plans which provide payments in addition to any other insurance payments you may receive. Here are just some of the covered events/services. AccidentLow Plan High Plan Employee Only $5.95 $10.21 Employee and Spouse $12.18 $21.09 Employee and Child(ren) $12.39 $21.12 Employee and Family $15.52 $26.44 Benefit Type1 Low Plan Accident Insurance Pays YOU High Plan Accident Insurance Pays YOU FracturesInjuries2 $50 $3,000 $100 $6,000 Dislocations2 $50 $3,000 $100 $6,000 Second and Third Degree Burns $50 $5,000 $100 $10,000 Concussions $200 $400 Cuts/Lacerations $25 $200 $50 $400 Eye Injuries $200 $300 Medical Services & Treatment Ambulance $200 $750 $300 $1,000 Emergency Care $25 $50 $50 $100 Non Emergency Care $25 $50 Physician Follow Up $50 $75 Therapy Services (including physical therapy) $15 $25 Medical Testing Benefit $100 $200 Medical Appliances $50 $500 $100 $1,000 Inpatient Surgery $100 $1,000 $200 $2,000 Hospital3 Coverage (Accident) Admission $500 (non ICU) $1,000 (ICU) per accident $1,000 (non ICU) $2,000 (ICU) per accident Confinement $100 a day (non ICU) up to 31 days $200 a day (ICU) up to 31 days $200 a day (non ICU) up to 31 days $400 a day (ICU) up to 31 days Inpatient Rehab (paid per accident) $100 a day, up to 15 days $200 a day, up to 15 days 25
Benefit Type1 Low Plan MetLife InsuranceAccidentPaysYOU High Plan MetLife InsuranceAccidentPaysYOU Accidental Death Employee receives 100% of amount shown, spouse receives 50% and children receive 20% of amount shown. $25,000 $75,000 for common carrier5 $50,000 $150,000 for common carrier5 Dismemberment, Loss & Paralysis Dismemberment, Loss & Paralysis $250 $10,000 per injury $500 $50,000 per injury Other LodgingBenefits 6 Pays for lodging for companion up to 30 nights per calendar year Health Screening Benefit (Wellness)7 benefit provided if the covered insured takes one of the covered screening/prevention tests $100 per night, up to 31 nights $50 Payable 1x per calendar year $200 per night, up to 31 nights $50 Payable 1x per calendar year Accident Insurance MetLife EMPLOYEE BENEFITS QUESTIONS & ANSWERS Who is eligible to enroll for this accident coverage? You are eligible to enroll yourself and your eligible family members!9 You need to enroll during your Enrollment Period and be actively at work for your coverage to be effective. How do I pay for my accident coverage? Premiums will be conveniently paid through payroll deduction, so you don’t have to worry about writing a check or missing a Whatpayment.happens if my employment status changes? Can I take my coverage with me? Yes, you can take your coverage with you.10 You will need to continue to pay your premiums to keep your coverage in force. Your coverage will only end if you stop paying your premium or if your employer offers you similar coverage with a different insurance Whocarrier.do I call for assistance? Contact a MetLife Customer Service Representative at 1 800 GET MET8 (1 800 438 6388), Monday through Friday from 8:00 a.m. to 8:00 p.m., EST. 26
ADDITIONAL DETAILS Coverage Period for Your Occupation: 24 months. After this initial period, you may be eligible to continue receiving benefits if your disability prohibits you from performing any employment for which you are reasonably suited through your training, education, and experience. In this case, your benefits may be extended through the end of your maximum coverage period (benefit duration).
Disability Insurance Lincoln
• A cash benefit of 66.67% of your monthly salary (up to $5,000) starting 180 days after you are out of work and continuing up to age 65 or Social Security Normal Retirement Age (SSNRA), whichever is later
AT A GLANCE:
Pre existing Condition: If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 3 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months. Disability per $10 in benefit Elimination Period Plan 1 14/14 $0.57 30/30 $0.46
• EmployeeConnectSM services, which give you and your family confidential access to counselors as well as personal, legal, and financial assistance.
ABOUT DISABILITY Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time. For full plan details, please visit your benefit website: www.mybenefitshub.com/palaciosisd
• Program Services include: Unlimited, 24/7 access to information and referrals In person help for short term issues; up to four sessions with a counselor per person, per issue, per year. One free consultation with a network attorney (with subsequent meetings at a reduced fee) Online tools, tutorials, videos and much more
Long term Disability Insurance Keep getting a check when you’re hurt or sick. You always have bills to pay, even when you can’t get to work due to injury, illness, or surgery. Long term disability insurance helps you make ends meet during this difficult time.
Financial Group EMPLOYEE BENEFITS
• Provides a cash benefit when you are out of work for up to 24 weeks due to injury, illness, surgery, or recovery from childbirth
First day hospitalization 0 days 0 days
• Features group rates for Palacios ISD employees
Disability Insurance Lincoln Financial Group EMPLOYEE BENEFITS Short term Disability Insurance
• Provides a partial cash benefit if you can only do part of your job or work part time
Accident Elimination Period You must be out of work for 14 days due to an accidental injury before you can collect disability benefits. You can begin collecting benefits on day 15. You must be out of work for 30 days due to an accidental injury before you can collect disability benefits. You can begin collecting benefits on day 31.
The elimination period is reduced if you are hospitalized due to an illness or accidental injury. You can begin collecting benefits on the first day of hospitalization.
• Provides a cash benefit when you are out of work for up to 22 weeks due to injury, illness, surgery, or recovery from childbirth
• Features group rates for Palacios ISD employees
First Day Hospitalization
Benefits Integration Your short term disability benefits can coordinate with income from other sources, such as continued income or sick pay from your employer, during your disability. This allows you to receive up to 100% of your pre disability income. Your short term disability benefits can coordinate with income from other sources, such as continued income or sick pay from your employer, during your disability. This allows you to receive up to 100% of your pre disability income.
• Provides a partial cash benefit if you can only do part of your job or work part time
Accident elimination period 14 days 30 days
Weekly benefit amount 60% of your weekly salary, limited to $1,000 per week 60% of your weekly salary, limited to $1,000 per week
Sickness Elimination Period You must be out of work for 14 days due to an illness before you can collect disability benefits. You can begin collecting benefits on day 15. You must be out of work for 30 days due to an illness before you can collect disability benefits. You can begin collecting benefits on day 31.
Short term Disability Insurance Plan
• Offers a fast, no hassle claims process
The elimination period is reduced if you are hospitalized due to an illness or accidental injury. You can begin collecting benefits on the first day of hospitalization.
Maximum coverage period 24 weeks 22 weeks
Sickness elimination period 14 days 30 days
OPTION ONE OPTION TWO
Pre existing Condition If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 3 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months. If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 3 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months.
• Offers a fast, no hassle claims process
ABOUT CANCER Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment. For full plan details, please visit your benefit website: www.mybenefitshub.com/palaciosisd Cancer Insurance American Public Life EMPLOYEE BENEFITS LimitedGC14 Benefit Group Specified Disease Cancer Indemnity Insurance THE INSURANCE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. YOU SHOULD CONSULT YOUR EMPLOYER TO DETERMINE WHETHER YOUR EMPLOYER IS A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM. Cancer Plan 1 Plan 2 Employee Only $17.10 $25.30 Employee and Spouse $31.20 $45.40 Employee and Child(ren) $23.60 $34.80 Employee and Family $31.20 $45.40 Summary of Benefits Low High Cancer Treatment Policy Benefits Level 1 Level 3 Radiation Therapy, Chemotherapy, Immunotherapy Maximum per 12 month period $10,000 $15,000 Hormone Therapy Maximum of 12 treatments per calendar year $50 per treatment $50 per treatment Experimental Treatment paid in same manner and under the same maximums as any other benefit Cancer Screening Rider Benefits Level 1 Level 1 Diagnostic Testing 1 test per calendar year $50 per test $50 per test Follow Up Diagnostic Testing 1 test per calendar year $100 per test $100 per test Medical Imaging per calendar year $500 per test/ 1 per calendar year $500 per test/ 1 per calendar year Surgical Rider Benefits Level 1 Level 1 Surgical $30 unit dollar amount Max $3,000 per operation $30 unit dollar amount Max $3,000 per operation Anesthesia 25% of amount paid for covered surgery Bone Marrow Transplant Maximum per lifetime $6,000 $6,000 Stem Cell Transplant Maximum per lifetime $600 $600 Prosthesis Surgical Implantation/Non Surgical (not Hair Piece) 1 device per site, per lifetime $1,000/$100 $1,000/$100 Patient Care Rider Benefits Level 1 Level 3 Hospital Confinement Per day of Hospital Confinement (1 30 days) Per day for Eligible Dependent Children (1 30 days) Per day of Hospital Confinement (31+ days) Per day for Eligible Dependent Children (31+ days) $200$100 $200$100 $400$200 $800$400 Outpatient Facility Per day surgery is performed $200 $400 Attending Physician Per day of Hospital Confinement $30 $40 29
actual coach fare or $0.40 per mile $0.40 per mile $50 per day actual coach fare or $0.75 per mile $0.75 per mile $100 per actual coach fare or $0.40 per mile $0.40 per mile $50 per actual coach fare or $0.75 per mile $0.75 per mile
day Family Transportation Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car Family Lodging up to a maximum of 100 days per calendar year
Summary of Benefits Low High Patient Care Rider Benefits Continued Level 1 Level 3 Dread Disease Per day of Hospital Confinement (1 30 days / 31+ days) $100/$100 $200/$400 Extended Care Facility Up to the same number of Hospital Confinement Days $100 per day $200 per day Donor $100 per day $200 per day Home Health Care Up to the same number of Hospital Confinement Days $100 per day $200 per day Hospice Care Up to maximum of 365 days per lifetime $100 per day $200 per day US Government, Charity Hospital or HMO Per day of Hospital Confinement (1 30 days / 31+ days) $100/$100 $200/$400 Miscellaneous Care Rider Benefits Level 1 Level 4 Cancer Treatment Center Evaluation or Consultation 1 per lifetime Not Included $750 Evaluation or Consultation Travel and Lodging 1 per lifetime Not Included $350 Second / Third Surgical Opinion per diagnosis of cancer
$100 per day Blood, Plasma and Platelets $300 per day $300 per day Ambulance Ground/Air Maximum of 2 trips per Hospital Confinement for all modes of transportation combined $200/$2,000 per trip $200/$2,000 per trip Inpatient Special Nursing Services per day of Hospital Confinement $150 per day $150 per day Miscellaneous Care Rider Benefits Con’t. Level 1 Level 4 Outpatient Special Nursing Services Up to same number of Hospital Confinement days $150 per day $150 per day Medical Equipment Maximum of 1 benefit per calendar year Not Included $150 Physical, Occupational, Speech, Audio Therapy & Psychotherapy / Maximum per calendar year $25 per visit/$1,000 $25 per visit/$1,000 Waiver of Premium Waive Premium Waive Premium Internal Cancer First Occurrence Rider Benefits Level 1 Level 1 Lump Sum Benefit Maximum 1 per Covered Person per lifetime $2,500 $2,500 Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime $3,750 $3,750 Heart Attack/Stroke First Occurrence Rider Benefits Level 1 Level 1 Lump Sum Benefit Maximum 1 per Covered Person per lifetime $2,500 $2,500 Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime $3,750 $3,750 Hospital Intensive Care Unit Rider Benefits Intensive Care Unit $600 per day $600 per day Step Down Unit Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit $300 per day $300 per day Cancer Insurance American Public Life EMPLOYEE BENEFITS 30
Drugs and Medicine Inpatient / Outpatient (maximum $150 per month) $150 per confinement $50 per prescription $150 per confinement $50 per prescription Hair Piece (Wig) 1 per lifetime $150 $150 Transportation Maximum 12 trips per calendar year for all modes of transportation combinedTravel by bus, plane or train Travel by car Lodging up to a maximum of 100 days per calendar year
$144.08 $215.18 80 $124.28 $246.68 $369.08 85 $226.08 $450.28 $674.48 ABOUT CRITICAL ILLNESS Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non medical costs related to the illness, including transportation, child care, etc. For full plan details, please visit your benefit website: www.mybenefitshub.com/palaciosisd Critical Illness Insurance Unum EMPLOYEE BENEFITS 31
payout for one illness, you
How does it work?
re still covered
180 days apart or the conditions
Spouse $10,000.00 $20,000.00 $30,000.00 18 $3.08 $4.28 $5.48 25 $3.38 $4.88 $6.38 30 $3.88 $5.88 $7.88 35 $4.58 $7.28 $9.98 $5.58 $9.28 $12.98 $7.28 $12.68 $18.08 $9.28 $16.68 $24.08 $11.48 $21.08 $16.08 $30.28 $24.28 $46.68 $43.38 $84.88 $72.98
If you’re diagnosed with an illness that is covered by this insurance, you can receive a lump sum benefit payment. You can use the money however you want. is this coverage so The money can help you pay out of pocket expenses, like co pays and deductibles. You can use this Even after you receive a payout for illness, you’ for for the any with after receive a ’ must be at least can’t be related $69.08 $43.38 $84.88 $126.38 $72.98 $144.08 $215.18 $124.28 $246.68 $369.08 $226.08 $450.28 $674.48
the remaining conditions and
coverage more than once.
the exception of skin cancer. Even
re still covered for the remaining conditions. Diagnoses
to each other. What’s covered? Critical illnesses • Heart attack • Stroke • Major organ failure • End stage kidney failure • Coronary artery disease Major Coronary(50%): artery bypass graft or valve replacement Minor Balloon(10%): angioplasty or stent placement Progressive diseases • Amyotrophic Lateral Sclerosis (ALS) • Dementia, including Alzheimer’s disease • Multiple Sclerosis (MS) • Parkinson’s disease • Functional loss Supplemental conditions • Loss of sight, hearing, or speech • Benign brain tumor • Coma • Permanent Paralysis • Occupational HIV, Hepatitis B, C, or D • Infectious Diseases (15%) Critical Illness Employee $10,000.00 $20,000.00 $30,000.00 18 $3.08 $4.28 $5.48 25 $3.38 $4.88 $6.38 30 $3.88 $5.88 $7.88 35 $4.58 $7.28 $9.98 40 $5.58 $9.28 $12.98 45 $7.28 $12.68 $18.08 50 $9.28 $16.68 $24.08 55 $11.48 $21.08 $30.68 60 $16.08 $30.28 $44.48 65 $24.28 $46.68
Critical Illness Insurance Unum EMPLOYEE BENEFITS Why should I buy coverage now? • It’s more affordable when you buy it through your employer and the premiums are conveniently deducted from your paycheck • If you apply during your initial enrollment, you can get coverage without a health exam or medical questions. • Coverage is portable. You may take the coverage with you if you leave the company or retire. You’ll be billed at home. Who can get coverage Be Well Benefit Every year, each family member who has Critical Illness coverage can also receive $50 for getting a covered Be Well Benefit screening test, such as: • Annual exams by a physician (including sports physicals) for adults, and well child visits • Screenings for cancer, including pap smear, colonoscopy • Cardiovascular function screenings • Screenings for cholesterol and diabetes • Imaging studies, including chest X ray, mammography • Immunizations including HPV, MMR, tetanus, influenza You Choose $10,000, $10,000 or $30,000 of coverage with no medical questions if you apply during this enrollment. Your spouse Spouses can get 100% of the employee coverage amount as long as you have purchased coverage for yourself. Your children Children from live birth to age 16 are automatically covered at no extra cost. Their coverage amount is 100% of yours. They are covered for all the same illnesses plus these specific childhood conditions: cerebral palsy, cleft lip or palate, cystic fibrosis, Down syndrome, and spina bifida. The diagnosis must occur after the child’s coverage effective date. 32
Life and AD&D United Health Care ABOUT LIFE AND AD&D
New EmployeeHire: You may elect up to $130,000. Amounts greater will require evidence of good health/insurability. Spouse You may elect up to $50,000. Amounts greater will require evidence of good health/insurability. Child(ren) You may elect up to $10,000. Life Child(ren) on
How much company paid Basic Life and AD&D do I have?
If you elect Supplemental Life and AD&D Insurance for yourself, you may choose to purchase Child(ren)* Supplemental Life and AD&D Insurance in increments of $1,000, $1,000 minimum to a maximum of $10,000 for each child. However, coverage cannot exceed 50% of the employee’s Supplemental Life and AD&D amount.
Note: Paid benefit is limited to $500 for a child age live birth to 6 *months. Eligible Child(ren) are from live birth to age 26.
How much AD&DSupplementalChild(ren)LifeandcanIpurchase?
Your employer provides, at no cost to you, Employee Basic Life and AD&D Insurance in an amount equal to 2 times your Annual Earnings, rounded to the next higher $1,000, to a maximum of $100,000. Annual Earnings are defined in UnitedHealthcare’s contract with your employer.
Am I eligible? You are eligible if you are an active, full time Employee who works at least 20 hours per week on a regularly scheduled basis.
What is the highest amount of Supplemental Life I can buy without filling out a (Guaranteequestionnaire?medicalIssue
If you elect Employee Supplemental Life and AD&D Insurance for yourself, you may choose to purchase Spouse Supplemental Life and AD&D Insurance in increments of $5,000, $5,000 minimum to a maximum of $250,000. However, coverage cannot exceed 50% of the employee’s Supplemental Life and AD&D amount. You may not elect coverage for your Spouse if they are already covered as an Employee under this policy.
Age $1,000 in coverage 0 26 $0.18 Spouse rates based
Employee'sVoluntaryage.Group Life per $1,000 in coverage Age Employee Spouse 18 24 $0.031 $0.031 25 34 $0.057 $0.057 35 39 $0.082 $0.082 40 44 $0.135 $0.135 45 49 $0.196 $0.196 50 54 $0.362 $0.362 55 59 $0.671 $0.671 60 64 $0.98 $0.98 65 69 $1.60 $1.60 70 74 $2.86 $2.86 75+ $10.452 $10.452 33
You can purchase Supplemental Life and AD&D Insurance in increments of $10,000, $10,000 minimum to a $500,000 maximum. However, coverage cannot exceed 5 times your Annual Earnings. Annual Earnings are defined in UnitedHealthcare’s contract with your employer. How much AD&DSupplementalSpouseLifeandcanIpurchase?
SupplementalEmployeeLifeand AD&D can I purchase?
Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well being of your family. Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered. For full plan details, please visit your benefit website: www.mybenefitshub.com/palaciosisd
Spouse If your Spouse has never been denied* spouse coverage, you may increase that coverage by one incremental of $5,000 up to $50,000. Amounts greater will require evidence of good health/insurability.
Employee If you are enrolled in coverage, you may increase your amount by one increment level of $10,000 up to $130,000. Amounts greater will require evidence of good health/insurability.
• If you leave your employer, Portability is an option that allows you to continue your Supplemental Life Insurance coverage. To be eligible, you must terminate your employment prior to age 70. This option allows you to continue all or a portion of your Life Insurance coverage under a separate Portability term policy. Portability is subject to a minimum of $5,000 and a maximum of $500,000 and does include coverage for your Spouse and Children. You must elect portability for your own coverage in order to elect portability for your Spouse and or Children. To elect Portability, you must apply and pay the premium within 30 days of the termination of your Life Insurance. Dependent Spouse Portability is subject to a maximum of $250,000. Dependent Child Portability is subject to a maximum of $10,000.
Life and AD&D United Health Care EMPLOYEE BENEFITS 34
For Employee and Spouse coverage, evidence of good health/insurability is required for any requested amount.
continued Annual Enrollment
Are there enrollment?limitationsotherto
Spouse Supplemental Life and AD&D coverage reduces the same as the employee’s. All coverage terminates upon employee’s retirement.
Do I still pay my Life Insurance premiums if I become disabled?
What is Accelerated Death Benefit?
Your beneficiary is a person (or persons) or legal entity (entities) who receives a benefit payment if you die while you are covered under the policy. You, as the employee, must select your beneficiary when you complete your enrollment application; your selection is legally binding. You are automatically the beneficiary for any Spouse or Child(ren) coverage.
You must be Actively at Work with your employer on the day your coverage takes effect. This coverage, like most group benefit insurance, requires that a certain percentage of eligible employees participate. If that group participation minimum is not met, the insurance coverage that you have elected may not be in effect. Does my coverage reduce as I get older?
Late Entrant (did not enroll within 31 days of initial eligibility):
What is beneficiary?a
Are any availableresourcesfor beneficiaries?
Yes, Employee Basic Life and AD&D and Supplemental Life and AD&D coverage reduces to 67% of the face amount at age 70; to 45% of the original amount at age 75.
Can I keep my Life coverage if I leave my employer?
If you are diagnosed as terminally ill with a 12 month or less life expectancy, you may receive payment of a portion of your Life Insurance. The remaining amount of your Life Insurance would be paid to your beneficiary when you die.
Accidental Death & Dismemberment (AD&D) provides benefits due to certain injuries or death from an accident.* The covered injuries or death can occur up to 365 days after the accident. The AD&D Insurance pays certain percentages of the benefit amount based on the injury sustained. Refer to the certificate of coverage for the complete AD&D Benefit schedule. Coverage includes 10% additional benefit for use of Seatbelt only or Seatbelt and Air Bag for loss of life. Your total benefit for all losses due to the same accident will not be more than 100% of the amount of coverage provided to you.
*Some state variations may apply.
What does AD&D provide me?
Yes, subject to the contract, you have the option of:
If you become totally disabled before age 60 and your disability lasts for at least 9 months, your Employee Supplemental Life Insurance premium may be waived.
• Converting your group Life coverage to your own individual policy (policies).
Beneficiary Services: Provides beneficiaries with services for grief consultation, financial/legal assistance and referral to community resources. For more information, call 866 302 4480. See below for more details.
TERMINAL 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).
* Financially dependent children 14 days to 23 years old.
ABOUT INDIVIDUAL LIFE Individual insurance is a policy that covers a single person and is intended to meet the financial needs of the beneficiary, in the event of the insured’s death. This coverage is portable and can continue after you leave employment or retire. For full plan details, please visit your benefit website: www.mybenefitshub.com/palaciosisd
• Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.
• Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or
5Star EMPLOYEE BENEFITS
*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.
Individual Life Insurance Individual Life and Accidental Death and Dismemberment coverage options for employees. Easy and flexible enrollment for employers. The 5Star Life Insurance ’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. Find full details and rates at 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.
FAMILY PROTECTION Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves.
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 QUALITYexclusions.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:
CUSTOMIZABLE With several options to choose from, employees select the coverage that best meets the needs of their families.
Because There’s Only One You. 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.
1 Monitor & Detect • Dark Web Monitoring1 • High Risk Transactions Monitoring2 • Subprime Loan Monitoring2 • Public Records Monitoring • USPS Change of Address Monitoring • Identity Profile Report Manage & Alert • Child Credit Lock3 | 1 Bureau • Financial Accounts Monitoring • Social Network Alerts • Registered Sex • Offender Reporting • Customizable Alert Options • Breach Alert Emails Support & Restore • Identity Theft Resolution Specialists (Resolution for Pre existing Conditions) • 24/7/365 U.S. based Customer Care Center • Lost Wallet Vault & Assistance • Deceased Family Member Fraud Remediation • Fraud Alert & Credit Freeze Assistance Identity Theft1B Platinum Employee $7.95 $11.95 Employee and Family $14.95 $22.95 36
UNIQUE FEATURES INCLUDED IN ALL PLANS Credit Lock With our online and in app feature, lock your Equifax® credit report2 and your child’s Equifax to help your More for Families Our family plan helps you better protect your loved ones, with each adult getting their own account with all plan features. And we offer more features that help protect minors than any other provider. Dedicated Resolution Specialists If you become a victim, you don’t have to face it alone. One of our certified resolution specialists will fully manage the case for you until your identity is restored. 1 in 18 consumers were victims of identity theft in 2018.
Easy & Affordable Identity Protection
provide additional protection against unauthorized access to
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.mybenefitshub.com/palaciosisd
Identity Theft IDWatchdog
With ID Watchdog®, you have an easy and affordable way to help better protect and monitor the identities of you and your family. You’ll be alerted to potentially suspicious activity and enjoy the peace of mind that comes with the support of dedicated resolution specialists. And a customer care team that’s available any time, every day. Here for MonitoringYoucredit reports, social media, transaction records, public records and more to help you better protect your identity. And don’t worry, we’re always here for you. In fact, our U.S. based customer care team is available 24/7/365 at 866.513.1518. The Powerful Features You Want All at an Affordable Price
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).
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes. Dental and vision expenses Medical deductibles and coinsurance batteries
• 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.
• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
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 babysitter 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. Things to Consider Regarding the Dependent Care FSA
The Health Care FSA covers qualified medical, dental 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. Eligible expenses include: You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA).
• Prescription copays • Hearing aids and
Higginbotham EMPLOYEE BENEFITS Health Care FSA
A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (unless your plan contains a grace period provision). For full plan details, please visit your benefit website: www.mybenefitshub.com/palaciosisd
Higginbotham Benefits Debit Card
• Overnight camps are not eligible for reimbursement (only day camps can be considered).
Flexible Spending Account (FSA)
Dependent Care 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 can continue to file claims incurred during the plan year for another 90 days (up until date).
The Higginbotham Portal provides information and resources to help you manage your
Over the Counter Item Rule Reminder Health care reform legislation requires that certain over the counter (OTC) items require a prescription to qualify as an eligible Health Care FSA expense. You will only need to obtain a one time prescription for the current plan year. You can continue to purchase your regular prescription medications with your FSA debit card. However, the FSA debit card may not be used as payment for an OTC item, even when accompanied by a prescription. Portal 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 email@example.com • Fax 866 419 3516 38
Flexible Spending Account (FSA)
• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
• You cannot change your election during the year unless you experience a Qualifying Life Event.
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 account.
Non Emergency Inter Facility Transportation 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 facilities.
Emergent Ground Transportation In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities.
benefit details at www.mybenefitshub.com/palaciosisd Emergent Plus Membership Platinum Membership Emergency Air Transportation x x Emergent Ground Transportation x x Non Emergency Inter Facility Transportation x x Repatriation/Recuperation x x Escort Transportation x Visitor Transportation x Return Transportation x Mortal Remains Transportation x Minor Return x Organ Retrieval/Organ Recipient Transportation x Vehicle Return x Pet Return x Worldwide Coverage x Emergency TransportationEmergent+ Platinum Employee and Family $14.00 $39.00 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
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. you need assistance with a claim contact MASA at 800 643 9023. You can find full on
the plan. For full plan details, please visit your benefit website: www.mybenefitshub.com/palaciosisd Emergency Medical Transport MASA EMPLOYEE BENEFITS 39
Emergent Air Transportation In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities.
Plan Comparison Feature 457(b) 403(b) Contribution maximum limits (can contribute to both plans) 2022: $27,000$20,500;age50+ 2022: $27,000$20,500;age50+ Retirement Contributions Tax Credit Up to ($2,000$1,000iffiling jointly) Up to ($2,000$1,000iffiling jointly) Early withdrawal penalty tax None 10% Investment options Managed allocations or self directed mutual funds. Fixed/Variable interest annuities or mutual funds/custodial accounts Investment committee/advisor oversight Yes, managed by TCG Advisors and Investment Advisory Committee (comprised of superintendents & CFO’s). No Distribution restrictions Funds can be requested upon: • Age 59 • Separation from employer • Disability • Death • Unforeseeable emergency Funds can be requested upon: • Age 59 • Age 55 and/or leaving employer • Disability • Death • Financial hardship Financial EmergencyHardship/UnforeseeableDistributions Must be an unforeseeable Emergency. Can include the following criteria is met: • Medical expenses • Funeral expenses • Foreclosure/eviction • Certain hurricanes and natural disasters Qualified for the following causes: • Medical care • Foreclosure/eviction • Tuition payment • Buying a home • Funeral costs • Home repair costs • Disaster relief Loans Permitted; loans from all qualified plans limited to the lesser of 50,000 or 50% of vested account balance. Permitted; loans from all qualified plans limited to the lesser of $50,000 or 50% of vested account balance. Required minimum distributions RMD rules apply at age 72 or later, severance from service, or after death. RMD rules apply at age 72 or later, severance from service, or after death ABOUT RETIREMENT PLANS A 403(b) plan is a U.S. tax advantaged retirement savings plan available for public education organizations. A 457(b) plan is a tax deferred compensation plan provided for employees of certain tax exempt, governmental organizations or public education institutions. For full plan details, please visit your benefit website: www.mybenefitshub.com/palaciosisd Retirement Plans TCG EMPLOYEE BENEFITS 40
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 Palacios ISD Benefits Website. This summary does not replace or amend the underlying plan documentation. In the event of a discrepancy between this summary and the plan documentation the plan documentation governs. All plans and benefits described in this summary may be discontinued, increased, decreased, or altered at any time with or without notice.
2022 - 2023 PlanYear
Rate Sheet General Disclaimer: The rate information provided in this guide is subject to change at any time by your employer and/or the plan provider. The rate information included herein, does not guarantee coverage or change or otherwise interpret the terms of the specific plan documentation, available at the Palacios ISD Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.