2022 - 2023 Plan Year
TULOSO-MIDWAY ISD
BENEFIT GUIDE EFFECTIVE: 09/01/2022 - 8/31/2023 WWW.MYBENEFITSHUB.COM/TULOSOMIDWAYISD
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Table of Contents How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) Medical Health Savings Account (HSA) Flexible Spending Account (FSA) Telehealth Dental Vision Disability Accident Cancer Critical Illness Hospital Indemnity Life and AD&D Individual Life Identity Theft
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4-5 6-11 6 7 8 9 10
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11 12-17 18 19-20 21 22 23-24 25-26 27 28 29-30 31-32 33-34 35 36
PG. 4
HOW TO ENROLL
PG. 6
SUMMARY PAGES
PG. 12
YOUR BENEFITS
Benefit Contact Information TMISD BENEFIT ADMINISTRATORS
MEDICAL: TRS ACTIVECARE
HEALTH SAVINGS ACCOUNT (HSA)
Financial Benefit Services Blue Cross Blue Shield (800) 583-6908 (866) 355-5999 www.mybenefitshub.com/tulosomidwayisd www.bcbstx.com/trsactivecare
EECU (800) 333-9934 www.eecu.org
FLEXIBLE SPENDING ACCOUNT
TELEHEALTH
DENTAL
National Benefit Services (800) 274-0503 www.nbsbenefits.com
MDLive (888) 365-1663 www.mdlive.com/fbsbh
Cigna Group #3344346 (800) 244-6224 www.Cigna.com
VISION
DISABILTY
ACCIDENT
UNUM Group #445221 (888) 400-9304 www.unumvisioncare.com
The Hartford Group #893751 (800) 523-2233 www.thehartford.com
The Hartford Group #893751 (800) 523-2233 www.thehartford.com
CANCER
CRITICAL ILLNESS
HOSPITAL INDEMNITY
APL Group #24765 (800) 256-8606 www.ampublic.com
UNUM Group #445222 (800) 583-6908 www.unum.com
APL Group #24765 (800) 256-8606 www.ampublic.com
LIFE AND AD&D
INDVIDUAL LIFE
IDENTITY THEFT
UNUM BASIC: Group #445219 VOLUNTARY: Group #445220 (800) 583-6908 www.unum.com
5Star Life Insurance Company Policy # 02484 (866) 863-9753 http://5starlifeinsurance.com
iLock 360 (855) 287-8888 www.iLOCK360.com
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All Your Benefits One App Employee benefits made easy through the FBS Benefits App! Text “FBS TMISD” to (800) 583-6908 and get access to everything you need to complete your
benefits enrollment: •
Benefit Resources
•
Online Enrollment
•
Interactive Tools
•
And more!
App Group #: FBSTMISD
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Text
“FBS TMISD”
to (800) 583-6908 OR SCAN
How to Log In 1
www.mybenefitshub.com/tulosomidwayisd
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CLICK LOGIN
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ENTER USERNAME & PASSWORD Username: The first six (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.
If you have 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.
Default Password: Last Name (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number. 5
Annual Benefit Enrollment
SUMMARY PAGES
Benefit Updates - What’s New: TRS ACTIVECARE BENEFIT AND RATE CHANGES MDLIVE BENEFIT AND RATE CHANGES BASIC LIFE WITH EMPLOYEE ASSISTANCE PROGRAM (EAP) The basic life insurance (employer‐paid) includes a $25K benefit in addition to EAP, which has a bereavement counseling of up to 6 face‐ to‐face visits for the beneficiaries. It includes will preparation, bereavement counseling and assistance with funeral planning. MDLIVE MD Live rate is going from $9.00 to $12.00 monthly but includes unlimited behavioral health care for participants and their dependents listed on their enrollment portal.
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 an annual plan limit of up to $2,850. This plan contains a 75-day grace period provision. 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. HSA A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). 2022 Limits are up to $3,650 for employee only and up to $7,300 for family.
Don’t Forget! • Login and complete your benefit enrollment from 07/13/2022 - 07/28/2022 • 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. 6
Annual Benefit Enrollment
SUMMARY PAGES
Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
CHANGES IN STATUS (CIS): Marital Status
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
QUALIFYING EVENTS A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for Change in Number of adoption. You can add existing dependents not previously enrolled whenever a dependent Tax Dependents gains eligibility as a result of a valid change in status event. Change in Status of Change in employment status of the employee, or a spouse or dependent of the employee, Employment Affecting that affects the individual's eligibility under an employer's plan includes commencement or Coverage Eligibility termination of employment. Gain/Loss of Dependents' Eligibility Status
Judgment/Decree/ Order
An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements under an employer's plan may include change in age, student, marital, employment or tax dependent status. If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.
Eligibility for Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Government Programs
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Annual Benefit Enrollment
SUMMARY PAGES
Annual Enrollment During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs. •
Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.
• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information. •
Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.
New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.
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Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ tulosomidwayisd. Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms section. How can I find a Network Provider? For benefit summaries and claim forms, go to the Tuloso-Midway ISD benefit website: www.mybenefitshub.com/tulosomidwayisd. 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.
Annual Benefit Enrollment
SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.
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.
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.
PLAN
MAXIMUM AGE
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
Medical
To age 26
Hospital Indemnity
To age 26
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 eligibility.
Health Savings Account
IRS Tax Dependent
Dental
To age 26
Vision
To age 26
Cancer
To age 26
Critical Illness
To age 26
Life and AD&D
To age 26
Individual Life
To age 23
Accident
To age 26
Identity Theft
To age 18
FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance.
Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent eligibility. Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify 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 Accounts and Health Savings Accounts.
If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage.
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SUMMARY PAGES
Helpful Definitions Actively-at-Work
In-Network
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.
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.
Annual Enrollment The period during which existing employees are given the opportunity to enroll in or change their current elections.
Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.
Calendar Year January 1st through December 31st
Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or preexisting condition exclusion provisions do apply, as applicable by carrier. 10
Out-of-Pocket Maximum The most an eligible or insured person can pay in coinsurance for covered expenses.
Plan Year September 1st through August 31st
Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken 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).
SUMMARY PAGES
HSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223)
Flexible Spending Account (FSA) (IRC Sec. 125)
Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, tax-free. This also allows employees to pay for qualifying dependent care taxfree.
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 Insurance Requirement
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 Not permitted 65).
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.
Does the account earn interest?
Yes
No
Portable?
Yes, portable year-to-year and between jobs.
No
Description
FLIP TO FOR HSA INFORMATION
PG. 18
FLIP TO FOR FSA INFORMATION
PG. 19
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Medical Insurance
EMPLOYEE BENEFITS
TRS 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/tulosomidwayisd
Monthly Premium
District Contribution
Employee Cost
TRS ActiveCare HD Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$414.00
$300.00
$114.00
$1,163.00
$300.00
$863.00
$742.00
$300.00
$442.00
$1,391.00
$300.00
$1,091.00
TRS ActiveCare 2 Employee Only
$1,013.00
$300.00
$713.00
Employee & Spouse
$2,402.00
$300.00
$2,102.00
Employee & Child(ren)
$1,507.00
$300.00
$1,207.00
Employee & Family
$2,841.00
$300.00
$2,541.00
TRS ActiveCare Primary Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
$401.00
$300.00
$101.00
$1,130.00
$300.00
$830.00
$721.00
$300.00
$421.00
$1,353.00
$300.00
$1,053.00
TRS ActiveCare Primary+ Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
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$504.00
$300.00
$204.00
$1,231.00
$300.00
$931.00
$810.00
$300.00
$510.00
$1,548.00
$300.00
$1,248.00
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Health Savings Account (HSA) EECU
EMPLOYEE BENEFITS
ABOUT HSA A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). For full plan details, please visit your benefit website: www.mybenefitshub.com/tulosomidwayisd
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.
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.
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.
Opening an HSA
HSA Eligibility
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. To open an account, go to https://www.eecu.org/.
Important HSA Information •
Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount. You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit. You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.
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 • Not eligible to be claimed as a dependent on someone else’s • tax return • Not enrolled in Medicare or TRICARE • Not receiving Veterans Administration benefits You can use the money in your HSA to pay for qualified medical How to Use your HSA expenses now or in the future. You can also use HSA funds to pay • Online/Mobile: Sign-in for 24/7 account access to check your health care expenses for your dependents, even if they are not balance, pay bills and more. covered by the HDHP. • Call/Text: (817) 882-0800. EECU’s dedicated member service representatives are available to assist you with any Maximum Contributions questions. Their hours of operation are Monday through Your HSA contributions may not exceed the annual maximum Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. – amount established by the Internal Revenue Service. The annual 1:00 p.m. CT and closed on Sunday. contribution maximum for 2022 is based on the coverage option • Lost/Stolen Debit Card: Call the 24/7 debit card hotline at you elect: (800) 333-9934 • Individual – $3,650 • Stop by: a local EECU financial center for in-person • Family (filing jointly) – $7,300 assistance: www.eecu.org/locations. 18
Flexible Spending Account (FSA) NBS
EMPLOYEE BENEFITS
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.mybenefitshub.com/tulosomidwayisd
Health Care FSA The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $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: • Dental and vision expenses • Medical deductibles and coinsurance • Prescription copays • Hearing aids and batteries You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA).
How the Health Care FSAs Work You can access the funds in your Health Care FSA two different ways: • Use your NBS Debit Card to pay for qualified expenses, doctor visits and prescription copays. • Pay out-of-pocket and submit your receipts for reimbursement: Fax – 844-438-1496 Email – service@nbsbenefits.com Online – my.nbsbenefits.com Call for Account Balance: 855-399-3035 Lost or Stolen Debit Cards Replacement Fee $5.00 (taken from account balance) Mail: PO Box 6980 West Jordan, UT 84084
Contact NBS • • • •
Hours of Operation: 6:00 AM – 6:00 PM MST, Mon-Fri Phone: (800) 274-0503 Email: service@nbsbenefits.com Mail: PO Box 6980 West Jordan, UT 84084
Dependent Care FSA This account 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 19
Flexible Spending Account (FSA) NBS
EMPLOYEE BENEFITS
age 13 and qualifying older dependents, such as dependent parents.
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. • 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 30 days (up until date). • Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses. • The IRS has amended the “use it or lose it rule” to allow you to carry-over up to $570 in your Health Care FSA into the next plan year. The carry-over rule does not apply to your Dependent Care FSA.
Over-the-Counter (OTC) Item Rule 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. Flexible Spending Accounts Account Type
Eligible Expenses
Health Care FSA
Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses and doctor-prescribed over-the -counter medications)
Dependent Care FSA
Dependent care expenses (such as day care, afterschool programs or elder care programs) so you and your spouse can work or attend school full-time
Annual Contribution Limits
Benefit
$2,850
Saves on eligible expenses not covered by insurance, reduces your taxable income
$5,000 single $2,500 if married and filing Reduces your taxable income separate tax returns
FSAstore.Com Check out the FSAstore at: https://fsastore.com. It offers thousands of FSA-eligible products and services to purchase using your FSA Debit Card or any major credit card. Competitive pricing and free shipping on orders over $50 can save you up to 40% using your FSA pretax dollars.
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Telehealth
EMPLOYEE BENEFITS
MDLive 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/tulosomidwayisd 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.
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! • Affordable, confidential online therapy for a variety of counseling needs. • The MDLIVE app helps you stay connected with appointment reminders, important notifications and secure messaging.
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 and Family
$12.00
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Dental Insurance
EMPLOYEE BENEFITS
Cigna ABOUT DENTAL Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease.
For full plan details, please visit your benefit website: www.mybenefitshub.com/tulosomidwayisd
Our dental plans help 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 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 PPO Plans The Dental PPO Plans allow you to visit any dental provider. However, when you use a CIGNA network dentist you usually pay less out of your pocket because the network dentists have agreed to charge pre-negotiated reduced fees. If you visit a dentist outside the network, you may be responsible for additional fees.
How to Find a Dentist Visit https://hcpdirectory.cigna.com/ or call 800-244-6224 to find an in-network dentist. Benefits Reimbursement Levels Policy Year Benefits Maximum Applies to: Class I, II & III expenses Policy Year Deductible Individual Family Family Benefit Highlights Class I: Diagnostic & Preventive Oral Evaluations, Prophylaxis: routine cleanings, Xrays: routine Class II: Basic Restorative Restorative: fillings, Endodontics: minor and major Class III: Major Restorative Inlays and Onlays, Prosthesis Over Implant, Crowns: permanent cast and porcelain, Bridges and Dentures Class IV: Orthodontia Coverage for Dependent Children to age 19 Lifetime Benefits Maximum: $1,000 22
These summaries only show a few of the covered procedures. Please visit http://www.mybenefitshub.com/tulosomidwayisd to obtain a complete summary. Dental Employee Employee + Spouse Employee + Child(ren) Family
$18.84 $38.18 $46.36 $72.56
In-Network: Total Cigna DPPO Based on Contracted Fees
Out-of-Network: See Non-Network Reimbursement Maximum Allowable Charge
$1,500
$1,500
$50 $150
$50 $150
Plan Pays
You Pay
Plan Pays
You Pay
100% No Deductible
No Charge
100% No Deductible
No Charge
80% After Deductible
20% After Deductible
80% After Deductible
20% After Deductible
50% After Deductible
50% After Deductible
50% After Deductible
50% After Deductible
50% No Deductible
50% No Deductible
50% No Deductible
50% No Deductible
Vision Insurance
EMPLOYEE BENEFITS
Unum 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/tulosomidwayisd
Plan features: •
• •
Our network offers members access to a large national network, including independent optometrists and retail stores like Walmart, Sam’s Club, Target Optical, America’s Best and many more. Find an in-network provider at unumvisioncare.com Manage benefits online with AlwaysAssist.com and onthe-go with the AlwaysAssist mobile app.
Covered benefits: Exam: Each member is entitled to a comprehensive vision exam. An exam co-pay applies and is outlined in the grid at right. Materials: Each member has coverage for covered services and materials. Purchases are subject to benefit frequencies and co-pays. Plan features include: • Frame benefit: You may choose any frame within a provider’s collection, subject to the retail frame allowance listed at right. If the cost is greater than the plan’s benefits, you are responsible for the difference. • Eyeglass lens benefit: Standard plastic (CR-39 Plastic Material) single vision, bifocal, trifocal, and specialty lenses are generally covered after any applicable materials copay. If covered by plan allowance, you are responsible for any cost greater than the plan’s benefit. • Contact lens benefit: Members electing contact lenses instead of eye glass lenses may apply the contact lens allowance to any lenses in the provider’s collection. If the cost is greater than the plan’s benefits, you are responsible for the difference. • Laser vision correction: Discounts are available with participating surgery providers across the country. (not an insured benefit)
Vision Employee Employee + Spouse Employee + Child(ren) Family
$7.59 $12.94 $13.67 $20.52
Vision Care Services
In-network Providers
Out-of-network Allowances
Exam (1 per 12mo)
$10 co-pay
Up to $35
Materials $25 co-pay Standard Plastic Lenses (1 per 12 months)
See allowances
Single Vision Bifocal Trifocal Lenticular Progressive Lens Options
Covered by co-pay Covered by co-pay Covered by co-pay Covered by co-pay $70 allowance
Up to $25 Up to $40 Up to $45 Up to $50 Up to $45
Scratch Resistant Coating Polycarbonate Lenses for children to age 19
Covered by co-pay
Not covered
(at Walmart only)
Covered by co-pay
Frames (1 per 12 months) $125 allowance Contact Lenses (1 per 12 months) In lieu of eyeglass lenses and frames (Includes fit*,follow-up and materials) Elective Medically Necessary
Not covered
Up to $70
$25 co-pay
See allowances
$150 allowance Covered after applicable co-pay
Up to $80 Up to $150
*Some providers, such as Walmart, may charge for a contact lens fit and evaluation separately from your contact lens allowance, leaving the entire allowance for materials. 23
Vision Insurance
EMPLOYEE BENEFITS
Unum Laser Vision Correction Network
This plan will not cover:
Membership provides access to preferred pricing. Transactions are handled directly between members and providers. Refractive surgery is an elective procedure and may involve potential risks to patients. This is not an insured benefit. Unum cannot and does not guarantee the outcome of any refractive surgical procedure or a total elimination of the need for glasses or contacts. Providers may not be available in all metropolitan areas. Login to www.alwaysassist.com for a list of participating laser vision correction providers.
Orthoptics or vision training and any supplemental testing; Plano (non-prescription) lenses; or two pair of eyeglasses in lieu of bifocals or trifocals; Medical or surgical treatment of the eyes; An eye exam or corrective eye wear required by an employer as a condition of employment; Any injury or illness covered under Workers’ Compensation or similar law, or which is work related; Plain or prescription sunglasses or tinted lenses, and no-line bifocals and blended lenses (subject to allowance); Sub-normal vision aids; Services rendered or materials purchased outside the U.S. or Canada, unless: the insured resides in the U.S. or Canada, and the charges are incurred while on a business or pleasure trip; Charges in excess of Usual and Customary for services and materials; Experimental or nonconventional treatments or devices; Safety eyewear; Spectacle lens styles, materials, treatments or “add-ons” not shown in the Schedule of Benefits.
Hearing Savings Plan Unum offers a Hearing Savings Plan at no additional cost, to all of its Unum Dental and Unum Vision members. Partnering with EPIC Hearing Healthcare, the Hearing Savings Plan provides: • 30-60% discounts off MSRP on name brand hearing instruments. • 40% savings on hearing aid batteries shipped directly to members’ homes. • On-call support for member questions, managed by professional hearing counselors.
THIS POLICY PROVIDES LIMITED BENEFITS This brochure is not intended to be a complete description of the insurance coverage available. The policies or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benefits payable. For Other Unum Vision Specifications complete details of coverage and availability, please refer to Policy Dependent children: Dependent age guidelines vary by state. Form Series VI-2002, VI-2007 and VI-2019 or contact your Unum Please refer to your policy certificate or contact customer service Vision representative. at 888-400-9304. Starmount Life Insurance Company 8485 Goodwood Boulevard • Baton Rouge, LA 70806 PH: (888) Services not listed: If you expect to require a vision service not 400-9304 included on this brochure, it may still be covered. Please contact customer service at 888-400-9304, to confirm your exact benefits. Vision plans are marketed by Unum, administered and underwritten by Starmount Life Insurance Company, Baton Rouge, This is a primary vision care benefit and is intended to cover only LA. eye examinations and corrective eyewear. Medical or surgical treatment of eye disease or injury is not provided under this plan. © 2020 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring Coverage may not exceed the lesser of actual cost of covered subsidiaries. services and materials or the limits of the policy. Some providers at optical and/or retail chains, such as Walmart, may charge for a contact lens fit and evaluation separately and apart from your contact lens allowance, leaving the entire allowance for materials. Covered materials that are lost or broken will be replaced only at normal service intervals indicated in the Plan Design; however, these materials and any items not covered below may be purchased at Preferred Pricing from a Participating Provider. In addition, benefits are payable only for expenses incurred while the Group and individual Member coverage is in force.
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Disability Insurance
EMPLOYEE BENEFITS
The Hartford 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/tulosomidwayisd
What is Educator Disability Income Insurance? Educator Disability insurance combines the features of a shortterm and long-term disability plan into one policy. The coverage pays you a portion of your earnings if you cannot work because of a disabling illness or injury. The plan gives you the flexibility to choose a level of coverage to suit your need. You have the opportunity to purchase Disability Insurance through your employer. This highlight sheet is an overview of your Disability Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail.
ELIGIBILITY AND ENROLLMENT Eligibility - You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis. Enrollment - You can enroll in coverage within 31 days of your date of hire or during your annual enrollment period. Effective Date - Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.
Elimination Period - You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a Disability benefit payment. The elimination period that you select consists of two numbers. The first number shows the number of days you must be disabled by an accident before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin. For those employees electing an elimination period of 30 days or less, if you are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization. Maximum Benefit Duration - Benefit Duration is the maximum time for which we pay benefits for disability resulting from sickness or injury. Depending on the schedule selected and the age at which disability occurs, the maximum duration may vary. Please see the applicable schedules below based on your election of either the Premium or Select benefit option. Premium Option: For the Premium benefit option – the table below applies to disabilities resulting from sickness or injury.
Select Option: For the Select benefit option – the table below applies to disabilities resulting from injury. Actively at Work - You must be at work with your Employer on Age Disabled Maximum Benefit Duration your regularly scheduled workday. On that day, you must be To Normal Retirement Age performing for wage or profit all your regular duties in the usual Prior to 63 or 48 months if greater way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at To Normal Retirement Age Age 63 Work shall mean you are able to report for work with your or 42 months if greater Employer, performing all the regular duties of Your Occupation in Age 64 36 months the usual way for your usual number of hours as if school was in Age 65 30 months session. Age 66 27 months Age 67 24 months FEATURES OF THE PLAN Benefit Amount- You may purchase coverage that will pay you a Age 68 21 months monthly flat dollar benefit in $100 increments between $200 and Age 69 and older 18 months $8,000 that cannot exceed 66 2/3% of your current monthly earnings.
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Disability Insurance
EMPLOYEE BENEFITS
The Hartford Select Option: For the Select benefit option – the table below
Select Plan
Age Disabled
Maximum Benefit Duration
0/7
$3.00
$2.62
Prior to 67
3 Years
14/14
$2.72
$2.46
Age 67-69
To Age 70, but not less than one year
30/30
$2.44
$1.78
60/60
$2.04
$1.40
Age 70 and older
1 Year
90/90 180/180
$1.54 $1.14
$0.82 $0.66
PROVISIONS OF THE PLAN Pre-Existing Condition Limitation Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have been insured under this policy for 12 months before your disability begins. If your disability is a result of a pre-existing condition, we will pay benefits for a maximum of 4 weeks.
General Exclusions You cannot receive Disability benefit payments for disabilities that are caused or contributed to by: • War or act of war (declared or not) • Military service for any country engaged in war or other armed conflict • The commission of, or attempt to commit a felony • An intentionally self-inflicted injury • Any case where Your being engaged in an illegal occupation was a contributing cause to your disability • You must be under the regular care of a physician to receive benefits
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Disability - per $100 in benefit Elimination Period Premium Plan
Accident Insurance
EMPLOYEE BENEFITS
The Hartford ABOUT ACCIDENT Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you.
For full plan details, please visit your benefit website: www.mybenefitshub.com/tulosomidwayisd
With Accident insurance, you’ll receive payment(s) associated with a covered injury and related services. You can use the payment in any way you choose – from expenses not covered by your major medical plan to day-to-day costs of living such as the mortgage or your utility bills. To learn more about Accident insurance, visit: thehartford.com/employeebenefits
ASKED & ANSWERED WHO IS ELIGIBLE? You are eligible for this insurance if you are an active full-time employee who works at least 20 hours per week on a regularly scheduled basis. Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26. CAN I INSURE MY DOMESTIC OR CIVIL UNION PARTNER? Yes. Any reference to “spouse” in this document includes your domestic partner, civil union partner or equivalent, as recognized and allowed by applicable law. AM I GUARANTEED COVERAGE? This insurance is guaranteed issue coverage – it is available without having to provide information about your or your family’s health. All you have to do is elect the coverage to become insured. HOW MUCH DOES IT COST AND HOW DO I PAY FOR THIS INSURANCE? Premiums are provided above. You may elect insurance for you only, or for you and your dependent(s), by choosing the applicable coverage tier. Premiums will be automatically paid through payroll deduction, as authorized by you during the enrollment process. This ensures you don’t have to worry about writing a check or missing a payment.
WHEN DOES THIS INSURANCE BEGIN? Insurance will become effective in accordance with the terms of the certificate (usually the first day of the month following the date you elect coverage). You must be actively at work with your employer on the day your coverage takes effect. Your spouse and child(ren) must be performing normal activities and not be confined (at home or in a hospital/care facility), unless already insured with the prior carrier. WHEN DOES THIS INSURANCE END? This insurance will end when you or your dependents no longer satisfy the applicable eligibility conditions, premium is unpaid, you are no longer actively working, you leave your employer, or the coverage is no longer offered. CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO LONGER A MEMBER OF THIS GROUP? Yes, you can take this coverage with you. Coverage may be continued for you and your dependent(s) under a group portability policy. Your spouse may also continue insurance in certain circumstances. The specific terms and qualifying events for portability are described in the certificate. Accident
Employee Employee + Spouse Employee + Child(ren) Family
$9.16 $14.46 $15.52 $24.34
WHEN CAN I ENROLL? You may enroll during any scheduled enrollment period, or within 31 days of the date you have a change in family status. 27
Cancer Insurance
EMPLOYEE BENEFITS
APL 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/tulosomidwayisd
Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town treatments, special diets, daily living and household upkeep. In addition to these nonmedical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance through American Public Life helps pay for these direct and indirect treatment costs so you can focus on your health.
Cancer Employee Only Employee and Spouse Employee and Child(ren)
PLAN 1 $17.84 $31.12 $23.46
PLAN 2 $26.58 $46.60 $34.34
Employee and Family
$34.16
$50.32
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 at www.mybenefitshub.com/tulosomidwayisd. Cancer Screening Rider Benefits Plan 1 Plan 2 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 Cancer Treatment Policy benefits Radiation and Chemotherapy, Immunotherapy Maximum Per $10,000 $20,000 12-month period Hormone Therapy- Maximum of 12 treatments per calendar $50 per treatment $50 per treatment year Surgical Rider Benefits Surgical $30 unit dollar amount $30 unit dollar amount Max $3,000 per operation 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 Miscellaneous Care Rider Benefits Prosthesis - Surgical Implantation/Non-Surgical (not Hair $1,000 / $100 $1,000 / $100 Piece) 1 device per site, per lifetime Internal Cancer/First Occurrence Rider Benefits Lump Sum Benefit- Maximum per 1 covered person per $2,500 $5,000 lifetime Hospital Intensive Care Unit Rider Benefits Intensive Care Unit $600 per day $600 per day
Pre-Existing Condition Exclusion: Review the Plan Summary page that can be found at www.mybenefitshub.com/tulosomidwayisd for full details.
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Critical Illness Insurance Unum
EMPLOYEE BENEFITS
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/tulosomidwayisd Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. To file a claim call UNUM at 800-858-6843 or find claim form at www.mybenefitshub.com/tulosomidwayisd. Who is eligible for this coverage?
All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status).
What are the Critical Illness coverage amounts?
The following coverage amounts are available. For you: Select one of the following $10,000, $20,000 or $30,000 For your Spouse and Children: 50% of employee coverage amount
Can I be denied coverage?
Coverage is guarantee issue.
When is coverage effective?
Please see your Plan Administrator for your effective date of coverage. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.
What critical illness conditions are covered?
Covered Conditions* Critical Illnesses Coronary Artery Disease (major) Coronary Artery Disease (minor) End Stage Renal (Kidney) Failure Heart Attack (Myocardial Infarction) Major Organ Failure Requiring Transplant Stroke Cancer Invasive Cancer (including all Breast Cancer) Non-Invasive Cancer Skin Cancer Supplemental Critical Illnesses Benign Brain Tumor Coma Loss of Hearing Loss of Sight Loss of Speech Infectious Disease Occupational Human Immunodeficiency Virus (HIV) or Hepatitis Permanent Paralysis
Percentage of Coverage Amount 50% 10% 100% 100% 100% 100% 100% 25% $500 100% 100% 100% 100% 100% 25% 100% 100% 29
Critical Illness Insurance Unum What critical illness conditions are covered? (cont’d)
Are wellness Screenings covered?
Pre-existing Conditions
EMPLOYEE BENEFITS
Progressive Diseases Amyotrophic Lateral Sclerosis (ALS) 100% Dementia (including Alzheimer’s Disease) 100% Functional Loss 100% Multiple Sclerosis (MS) 100% Parkinson’s Disease 100% Additional Critical Illnesses for your Children Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Down Syndrome 100% Spina Bifida 100% * Please refer to the policy for complete definitions of covered conditions. Each insured is eligible to receive one Be Well Benefit per calendar year. Be Well Benefit For you, your spouse and your children: $50 Be Well Screenings include tests for the following: cholesterol and diabetes, cancer and cardiovascular function. They also include imaging studies, immunizations and annual examinations by a Physician. See certificate for details. We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following: • a pre-existing condition; or • complications arising from treatment or surgery for, or medications taken for, a preexisting condition. An insured has a pre-existing condition if, within the 3 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which: • medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period; • drugs or medications were taken, or prescribed to be taken during that period; or • symptoms existed.
>25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 30
Employee $10,000 $2.00 $2.90 $4.10 $6.10 $8.50 $11.70 $15.40 $21.30 $30.40 $44.70 $70.20 $103.90 $151.50 $244.70
The pre-existing condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date any initial coverage or increases in coverage become effective. Critical Illness Spouse Employee Spouse Employee Spouse $5,000 $20,000 $10,000 $30,000 $15,000 $1.00 $4.00 $2.00 $6.00 $3.00 $1.45 $5.80 $2.90 $8.70 $4.35 $2.05 $8.20 $4.10 $12.30 $6.15 $3.05 $12.20 $6.10 $18.30 $9.15 $4.25 $17.00 $8.50 $25.50 $12.75 $5.85 $23.40 $11.70 $35.10 $17.55 $7.70 $30.80 $15.40 $46.20 $23.10 $10.65 $42.60 $21.30 $63.90 $31.95 $15.20 $60.80 $30.40 $91.20 $45.60 $22.35 $89.40 $44.70 $134.10 $67.05 $35.10 $140.40 $70.20 $210.60 $105.30 $51.95 $207.80 $103.90 $311.70 $155.85 $75.75 $303.00 $151.50 $454.50 $227.25 $122.35 $489.40 $244.70 $734.10 $367.05
Hospital Indemnity
EMPLOYEE BENEFITS
APL ABOUT HOSPITAL INDEMNITY This is an affordable supplemental plan that pays you should you be inpatient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance.
For full plan details, please visit your benefit website: www.mybenefitshub.com/tulosomidwayisd
Summary of Benefits Hospital Admission Benefit Hospital Confinement Benefit Intensive Care Unit Benefit Rehabilitation Benefit Accident Surgery Benefit Surgery in a Hospital, Hospital Outpatient Facility or Freestanding Outpatient Surgery Center Surgery in a Physician’s Office Outpatient Accident Treatment Benefit Emergency Room Urgent Care Physician’s Office Physical, Speech or Occupational Therapy Facility Additional Rider Portability Rider
Plan 1 $1,500 per day; maximum of 1 day $100 per day; maximum of 30 days $200 per day; maximum of 15 days $200 per day; maximum of 5 days
Plan 2 $2,000 per day; maximum of 1 day $150 per day; maximum of 30 days $300 per day; maximum of 15 days $200 per day; maximum of 5 days
$250 per day; maximum of 1 day
$250 per day; maximum of 1 day
$250 per day; maximum of 1 day
$250 per day; maximum of 1 day
$200 per day; maximum of 1 day $50 per day; maximum of 5 days $50 per day; maximum of 5 days $30 per day; maximum of 5 days
$200 per day; maximum of 1 day $50 per day; maximum of 5 days $50 per day; maximum of 5 days $30 per day; maximum of 5 days
Included
Included
Hospital Indemnity Employee Only Employee and Spouse Employee and Child(ren)
PLAN 1 $17.08 $34.46 $20.24
PLAN 2 $22.98 $46.64 $26.88
Employee and Family
$36.50
$48.84
a party in a suit in which adoption of the child is sought; or any child under the age of 26 for whom you must provide medical support under an order issued under Chapter 154 of the Texas Family Code, or enforceable by a court in Texas; or grandchildren under the age of 26 if those grandchildren are your dependents for federal income tax purposes at the time application for coverage of the grandchild is made.
Hospital Admission Benefit - Pays a benefit when a covered person is admitted and confined as an inpatient in a hospital due to an injury or covered sickness. APL will not pay this benefit for Benefits are per day, up to the maximum number of days per outpatient treatment, emergency room treatment or a stay less calendar year, per covered person. Benefit amounts may vary than 18 hours in an observation unit. This benefit is only payable based upon place of service. Benefits will only be paid for a once per period of confinement. A hospital is not an institution, covered loss incurred while covered under the certificate. A covered person is a person who is eligible for coverage under the or part thereof, used as a place for rehabilitation, a place for rest or for the aged, a nursing or convalescent home, a long-term certificate and for whom the coverage is in force. An eligible nursing unit or geriatrics ward or an extended care facility for the dependent means your lawful spouse; your natural, adopted or stepchild who is under the age of 26; and/or any child under the care of convalescent, rehabilitative or ambulatory patients. age of 26 who is under your charge, care and control, and who has been placed in your home for adoption, or for whom you are
Benefits
31
Hospital Indemnity APL Hospital Confinement Benefit - Pays a per day benefit when a covered person is confined as an inpatient to a hospital due to an injury or covered sickness. Intensive Care Unit Benefit - Pays a per day benefit when a covered person is confined in an ICU due to an injury or covered sickness. Benefits will be paid beginning the first day of ICU confinement when the ICU confinement begins after the covered person’s effective date. Rehabilitation Benefit - Pays a per day benefit when a covered person is receiving rehabilitation care services while confined in a rehabilitation unit or skilled nursing facility immediately after a covered period of confinement due to an injury or covered sickness. This benefit is not payable in addition to any other confinement benefit provided under the policy on the same day. If more than one confinement occurs on the same day, the higher benefit will be paid. Accident Surgery Benefit - Pays the applicable per day benefit when a surgical procedure is performed on a covered person in a hospital, hospital outpatient facility, a freestanding outpatient surgery center or a physician’s office due to an injury. Outpatient Accident Treatment Benefit - Pays the applicable per day benefit when a covered person receives treatment in an emergency room, urgent care facility, physician’s office, or physical/speech/occupational therapy facility due to an injury.
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EMPLOYEE BENEFITS
Life and AD&D Unum
EMPLOYEE BENEFITS
ABOUT LIFE AND AD&D 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/tulosomidwayisd BASIC LIFE AND AD&D Who is eligible for this coverage?
All actively employed employees working at least 20 hours each week for your employer in the U.S.
What is the coverage amount?
Your employer is providing you with $25,000 of term life insurance. You will also receive $25,000 of Accidental Death and Dismemberment insurance.
If you retire, reduce your hours or leave your employer, you can continue coverage for yourself at the Is it portable (can I keep group rate. Portability is not available for people who have a medical condition that could shorten their life it if I leave my employer)? expectancy — but they may be able to convert their term life policy to an individual life insurance policy.
When is coverage effective?
What does my AD&D insurance pay for?
Do my life insurance benefits decrease with age?
Your coverage is effective on 9/1/2021. The full benefit amount is paid for loss of: • Life • Both hands or both feet or sight of both eyes • One hand and one foot • One hand and the sight of one eye • Speech and hearing Coverage amounts will reduce according to the following schedule: Age: 70
Insurance amount reduces to: 50% of original amount
Coverage may not be increased after a reduction. Yes. Our work-life balance employee assistance program (EAP) provides professional advice for a wide range of personal and work-related issues. The service is available to you and your family members 24 Does this plan include hours a day, 365 days a year. It provides resources to help you find solutions to everyday issues — such as help with work-life financing a car or selecting child care — as well as more serious problems, such as alcohol or drug balance? addiction, divorce or relationship problems. There is no additional charge for using the program, and you do not have to have filed a disability claim or be receiving benefits to use the program. Worldwide emergency travel assistance is included with this Life plan. Emergency travel assistance is available to you, your spouse* and your dependent children when you travel to any foreign country, What else is included including Canada or Mexico. It is also available anywhere in the United States when you travel just 100 or with this policy? more miles from home. * A spouse traveling on business for his or her employer is not covered by the program. The Work-life Balance Employee Assistance Program, provided by HealthAdvocate, is available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details 33
Life and AD&D
EMPLOYEE BENEFITS
Unum
When is coverage effective? Your coverage is effective 9/1/2021 or the date your application Who is eligible for this coverage? is approved by underwriting, if health questions were required. All actively employed employees working at least 20 hours each week for your employer in the U.S. and their eligible spouses and Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or children to age 26. leave of absence on the date that insurance would otherwise become effective. What are the Life/AD&D coverage amounts? • Employee: up to 5 times salary in increments of $10,000; not For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that to exceed $500,000. insurance would otherwise be effective. Totally disabled means • Spouse: up to 100% of employee amount in increments of that as a result of an injury, sickness, or disorder, your dependent $5,000; not to exceed $250,000. spouse and children: are confined in a hospital or similar • Child: up to 100% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum institution; or are confined at home under the care of a physician for a sickness or injury. Exception: Infants are insured from live death benefit for a child between the ages of live birth and birth. six months is $500. Note: In order to purchase life and AD&D coverage for your Do my life insurance benefits decrease with age? dependents, you must buy coverage for yourself. Coverage amounts will reduce according to the following schedule: Can I be denied coverage? Age: Insurance amount reduces to: If you and your eligible dependents enroll during before the 70 50% of original amount enrollment deadline, you may apply for any amount of coverage Coverage may not be increased after a reduction. up to $200,000 for yourself and any amount of coverage up to $50,000 for your spouse, without answering any medical Is the coverage portable (can I keep it if I leave my employer)? questions. If you retire, reduce your hours, or leave your employer, you can If you want coverage over the amount you are guaranteed, you continue coverage for yourself your spouse and your dependent will need to provide answers to health questions. In addition, if children at the group rate. Portability is not available for people you and your eligible dependents do not enroll during this who have a medical condition that could shorten their life enrollment period, you will have to wait for a future annual expectancy enrollment period to apply — and then you will need to answer — but they may be able to convert their term life policy to an health questions for the entire amount of coverage you apply for. individual life insurance policy. New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply Voluntary Group Life - per $1,000 in coverage for coverage after 31 days, or if you choose coverage over the Age Employee Spouse amount you are guaranteed, you will need to complete a medical <25 $0.06 $0.12 questionnaire which you can get from your plan administrator. 25-29 $0.07 $0.12 You may also be required to take certain medical tests at Unum’s expense. 30-34 $0.09 $0.15
Voluntary Life and AD&D
Why buy now? As long as you buy $10,000 of life coverage now, you can buy more coverage later - up to $200,000 - without answering any medical questions. How do I apply? To apply for coverage, complete your enrollment form by 9/1/2021. If you were hired after 9/1/2021, complete your enrollment form within 31 days of your eligibility date determined by your employer. If you apply for coverage after your effective date or if you choose coverage over the guaranteed issue amount, you will need to complete a medical questionnaire, which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense. 34
35-39
$0.10
$0.17
40-44 45-49
$0.11 $0.17
$0.18 $0.26
50-54 55-59
$0.25 $0.47
$0.38 $0.60
60-64 65-69
$0.73 $1.40
$1.04 $1.97
70-74 75+
$2.27 $2.27
$1.97 $1.97
Voluntary Group Life - Child(ren) Age $1,000 in coverage 0-26 $0.22 Spouse rates based on Employee's age.
Individual Life Insurance
EMPLOYEE BENEFITS
5Star 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/tulosomidwayisd
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. CUSTOMIZABLE With several options to choose from, employees select the coverage that best meets the needs of their families.
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.
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 Find full details and rates at: that will result in a limited life span of less than 12 months www.mybenefitshub.com/tulosomidwayisd. (24 months in IL). 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.
*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.
*Financially dependent children 14 days to 23 years old.
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.
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Identity Theft
EMPLOYEE BENEFITS
iLock360 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.mybenefitshub.com/tulosomidwayisd
What is iLOCK360? This benefit is Protection for your identity and your families. Make sure to Take advantage of special EDUCATOR PRICING during open enrollment!
Did you know that: 39 seconds is how often cyber-attacks to occur. 25% of kids are projected to be affected by identity theft before turning 18. 17% increase in data breaches 2018 to 2019 Please note: • A valid email address is required for enrollment in iLOCK360. All iLOCK360 alerts and/or notifications are sent via email. Consider utilizing an email address that you check regularly. • Account activation & setup of monitored elements is required upon the start of your new benefit plan year. For more information on what will be monitored visit your employee portal website.
Employee Employee and Family
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Identity Theft Essential $5.75 $7.50
Elite $10.75 $13.25
Notes
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Notes
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Notes
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2022 - 2023 Plan Year
Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the Tuloso-Midway 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. 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 Tuloso-Midway 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.
WWW.MYBENEFITSHUB.COM/TULOSOMIDWAYISD 40