


BENEFIT ADMINISTRATORS TRS ACTIVECARE MEDICAL
Financial Benefit Services (866) 914-5202
www.mybenefitshub.com/prosperisd
BCBSTX (866) 355-5999
www.bcbstx.com/trsactivecare
TRS HMO MEDICAL PROSPER ISD BENEFITS
Scott & White HMO (844) 633-5325
www.trs.swhp.org
Benefits Department
(469) 219-2000
Benefits@prosper-isd.net
PHARMACY MANAGER FOR ACTIVE CARE PLANS ONLY
Express Scripts (844) 238-8084
https://www.express-scripts.com/ trsactivecare
HEALTH SAVINGS ACCOUNT (HSA)
EECU (800) 333-9934
www.eecu.org
HOSPITAL INDEMNITY DENTAL VISION
The Hartford Group #872784 (866) 547-4205
www.thehartford.com/claims
Lincoln Financial Group (See Benefit Highlights for Group #’s) DPPO: (800) 423-2765
www.lfg.com
Superior Vision Group #322100 (800) 507-3800
www.superiorvision.com
DISABILITY CANCER LIFE AND AD&D
The Hartford Group #872784
866-547-9124
www.thehartford.com
IDENTITY THEFT
ID Watchdog
(800) 774-3772
www.idwatchdog.com
American Public Life Group #24842 (800) 256-8606
www.ampublic.com
EMERGENCY MEDICAL TRANSPORTATION
MASA Group #B2BPROISD
(800) 643 9023
claims@masaglobal.com
www.masamts.com
EMPLOYEE ASSISTANCE PROGRAM (EAP) CRITICAL ILLNESS
Deer Oaks EAP Services
(866) 827-2400
www.deeroakseap.com
The Hartford Group # 872784
(866) 547-4205
benefitsclaims.thehartford.com
The Hartford Group #872784 (888) 563-1124
www.thehartford.com
FLEXIBLE SPENDING ACCOUNT (FSA)
Higginbotham
(866) 419-3519
https://flexservices.higginbotham.net/
ACCIDENT PLAN
The Hartford Group #872784
(866) 547-4205
benefitsclaims.thehartford.com
1 www.mybenefitshub.com/prosperisd
2
3 ENTER USERNAME & PASSWORD
Your 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.
TRS
New Pharmacy Benefits Manager Active Care Plans Only Express Scripts!
• Questions regarding coverage can be addressed at https://www.expresssscripts.com/trsactivecare or by calling (844) 238-8084.
• CVS cards valid through August 31st
• HMO Plans are not impacted by this change.
Other Changes in the Active Care Plans
• Primary Plus Plan: Family Deductible is now $2,400 instead of $3,600.
• Primary Plus Plan PCP for Mental Health Copays are now $15.00.
• Primary and Primary Plus Plans now offer Teladoc virtual Mental Health visits for a $0 copay.
• Primary Plan the Individual out of pocket is now $7,500 and $15,000 for Family
Changes for Supplemental Benefits
Dental - No DHMO Dental Plan will be offered this plan year.
• You must log into the Benefit’s HUB to elect a PPO Dental Plan if you were enrolled in a DHMO plan prior. We did not elect an alternate plan for you.
New Accident Plan! The Hartford
• Offering Accident Coverage by providing a cash payment for each covered injury.
• $75 Health Screening Benefit
• Robust X Ray payouts
• Physical Therapy 10 Visits Included
• Chiropractic -10 Visits
New Disability Carrier! The Hartford
• Pre-Existing Conditions will receive a maximum benefit of 6 weeks.
• If you choose an Elimination Period of 30 days or less and you are confined to a hospital for 24 hours or more due to a disability, the elimination period is waived and benefits are payable from the first day of hospitalization.
• Telephonic claims
• Ability Assist 3 face to face counseling sessions and unlimited phone counseling.
New Critical Illness Plan! The Hartford
• Wellness Benefit $75
• Pays a lump sum benefit based on a schedule of illness.
• Pre-existing limitation is anything 12 months prior to the plan date.
• Login and complete your benefit enrollment from 07/17/2023 - 08/07/2023
• Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202.
• Update your information: home address, phone numbers, email, and beneficiaries.
◊ Update your address here: https://forms.prosper-isd.net/Forms/AddressChange
• 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.
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 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.
Marital Status
Change in Number of Tax Dependents
Change in Status of Employment Affecting Coverage Eligibility
Gain/Loss of Dependents’ Eligibility Status
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 adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.
Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual’s eligibility under an employer’s plan includes commencement or termination of employment.
An event that causes an employee’s dependent to satisfy or cease to satisfy coverage requirements under an employer’s plan may include change in age, student, marital, employment or tax dependent status. Judgment/ Decree/Order
If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual’s plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.
Eligibility for Government Programs
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
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.
All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
For supplemental benefit questions, you can call Financial Benefit Services at 866-914-5202 for assistance.
For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/prosperisd 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.
For benefit summaries and claim forms, go to the Prosper ISD benefit website: www.mybenefitshub.com/prosperisd. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section.
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.
Supplemental Benefits: Eligible full-time employees must work 20 or more regularly scheduled hours each work week.
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2023 benefits become effective on September 1, 2023, you must be actively-at-work on September 1, 2023 to be eligible for your new benefits.
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.
Medical To age 26
Dental To age 26
Vision To age 26
Cancer To age 26
Life To age 26
AD&D To age 25
Identity Theft To age 26
HSA 26 (benefits terminate at the end of the plan year following the birthday)
FSA 26 (benefits terminate at the end of the plan year following the birthday)
Medical Transportation To age 26 (including disabled children)
Hospital Indemnity To age 26
EAP To age 26
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
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.
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.
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 9/1/2023 please notify your benefits administrator.
The period during which existing employees are given the opportunity to enroll in or change their current elections.
The amount you pay each plan year before the plan begins to pay covered expenses.
Calendar Year
January 1st through December 31st
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.
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.
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.
The most an eligible or insured person can pay in coinsurance for covered expenses.
Plan Year
September 1st through August 31st
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).
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, taxfree. This also allows employees to pay for qualifying dependent care tax- free. Employer
Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
but subject to current tax rate plus 20% penalty (penalty waived after age 65).
will roll over to use for subsequent year’s health coverage.
213(d) of IRC).
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/prosperisd
• Premium: The monthly amount you pay for health care coverage.
• Deductible: The annual amount for medical expenses you’re responsible to pay before your plan begins to pay its portion.
• Copay: The set amount you pay for a covered service at the time you receive it. The amount can vary by the type of service.
• Coinsurance: The portion you’re required to pay for services after you meet your deductible. It’s often a speci ed percentage of the costs; i.e. you pay 20% while the health care plan pays 80%.
• Out-of-Pocket Maximum: The maximum amount you pay each year for medical costs. After reaching the out-of-pocket maximum, the plan pays 100% of allowable charges for covered services.
You bet your boots big things happen here, including TRS-ActiveCare’s large network of doctors and hospitals.
• Individual maximum-out-of-pocket decreased by $650. Previous amount was $8,150 and is now $7,500.
• Family maximum-out-of-pocket decreased by $1,300. Previous amount was $16,300 and is now $15,000.
• Individual maximum-out-of-pocket increased by $450 to match IRS guidelines. Previous amount was $7,050 and is now $7,500.
• Family maximum-out-of-pocket increased by $900 to match IRS guidelines. Previous amount was $14,100 and is now $15,000. These changes apply only to in-network amounts.
• Family deductible decreased by $1,200. Previous amount was $3,600 and is now $2,400.
• Primary care provider copay decreased from $30 to $15.
• No changes.
• This plan is still closed to new enrollees.
This table shows you the changes between 2022-23 statewide premium price and this year’s 2023-24 regional price for your Education Service Center.
*Pre-certi cation for genetic and specialty testing may apply. Contact a PHG
with questions.
TRS contracts with HMOs in certain regions to bring participants in those areas additional options. HMOs set their own rates and premiums. They’re fully insured products who pay their own claims.
You can choose this plan if you live in one of these counties: Austin, Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Collin, Coryell, Dallas, Denton, Ellis, Erath, Falls, Freestone, Grimes, Hamilton, Hays, Hill, Hood, Houston, Johnson, Lampasas, Lee, Leon, Limestone, Madison, McLennan, Milam, Mills, Navarro, Robertson, Rockwall, Somervell, Tarrant, Travis, Walker, Waller, Washington, Williamson
You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy
You can choose this plan if you live in one of these counties: Andrews, Armstrong, Bailey, Borden, Brewster, Briscoe, Callahan, Carson, Castro, Childress, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, Fisher, Floyd, Gaines, Garza, Glasscock, Gray, Hale, Hall, Hansford, Hartley, Haskell, Hemphill, Hockley, Howard, Hutchinson, Irion, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Llano, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, San Saba, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Winkler, Yoakum
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/prosperisd
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.
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:
• Enrolled in an HSA-eligible High Deductible Health Plan (HDHP)
• Not enrolled in Medicare or TRICARE
• If you enroll in an HSA and FSA, the FSA becomes a Limited Purpose FSA and may only be used for Dental and Vision, not medical expenses.
• Not eligible to be claimed as a dependent on someone else’s tax return
You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered by the HDHP.
Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2023 is based on the coverage option you elect:
• Individual – $3,850
• Family (filing jointly) – $7,750
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.
You can use your HSA for a wide range of qualified expenses, such as doctor’s visits, prescription drugs, lab work, medical equipment, contacts lenses, dental work, physical therapy… the list goes on! Refer to IRS Publication 502 for comprehensive guidelines.
• You will receive a debit card to manage your Health Savings Account. Keep in mind, available funds are limited to the balance in your HSA.
• 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.
• Online/Mobile: Sign-in for 24/7 account access to check your balance, pay bills and more.
• 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. to 1:00 p.m. CT and closed on Sunday.
• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333-9934.
• Stop by a local EECU financial center for in-person assistance; find locations & service hours at www.eecu.org/locations
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/prosperisd
Hospital indemnity (HI) insurance pays a cash benefit if you or an insured dependent (spouse or child) are confined in a hospital for a covered illness or injury. It also provides additional daily benefits for related services. The benefits are paid in lump sum amounts to you, and can help offset expenses that primary health insurance doesn’t cover (like deductibles, co-insurance amounts or co- pays), or benefits can be used for any nonmedical expenses (like housing costs, groceries, car expenses, etc.).
You have a choice of two hospital indemnity plans, which allows you the flexibility to enroll for the coverage that best meets your current financial protection needs. Benefit amounts are based on the plan in effect for you or an insured dependent at the time the covered event occurs. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s). There is no limitation for pre-existing conditions. You and your dependents must be citizens or legal residents of the United States.
Ability Assist® Counseling Services provides access to Master’s- and PhD-degreed clinicians for 24/7 assistance if you’re enrolled in coverage. This includes 3 face-to-face visits per occurrence per year for emotional concerns and unlimited phone consultations for financial, legal, and work-life concerns.
For more information on Ability Assist® Counseling Services:
Call 1-800-964-3577
Visit www.guidanceresources.com
Company name: Abili Company ID: HLF90
HealthChampionSM offers unlimited access to benefit specialists and nurses for administrative and clinical support to address medical care and health insurance claims concerns if you’re enrolled in coverage. Service includes: guidance on health insurance claims and billing support, explanation of benefits, cost estimates and fee negotiation, information related to conditions and available treatments, and support to help prepare for medical visits.
For more information on HealthChampionSM Services
Call 1-800-964-3577
Visit www.guidanceresources.com
Company name: Abili Company ID: HLF902
Exclusions. This insurance does not provide benefits for any loss that results from or is caused by:
• Suicide or attempted suicide, whether sane or insane, or intentional self-infliction
• Voluntary intoxication (as defined by the law of the jurisdiction in which the illness or injury occurred) or while under the influence of any narcotic, drug or controlled substance, unless administered by or taken according to the instruction of a physician or medical professional
• Voluntary intoxication through use of poison, gas or fumes, whether by ingestion, injection, inhalation or absorption
• Voluntary commission of or attempt to commit a felony, voluntary participation in illegal activities (except for misdemeanor violations), voluntary participation in a riot, or voluntary engagement in an illegal occupation
• Incarceration or imprisonment following conviction for a crime
• Travel in or descent from any vehicle or device for aviation or aerial navigation, except as a fare-paying passenger in a commercial aircraft (other than a charter airline) on a regularly scheduled passenger flight or while traveling on business of the policyholder
• Ride in or on any motor vehicle or aircraft engaged in acrobatic tricks/stunts (for motor vehicles), acrobatic/stunt flying (for aircraft), endurance tests, off- road activities (for motor vehicles), or racing
• Participation in any organized sport in a professional or semi-professional capacity
• Participation in abseiling, base jumping, Bossaball, bouldering, bungee jumping, cave diving, cliff jumping, free climbing, freediving, freerunning, hang gliding, ice climbing, Jai Alai, jet powered flight, kite surfing, kiteboarding, luging, missed climbing, mountain biking, mountain boarding, mountain climbing, mountaineering, parachuting, paragliding, parakiting, paramotoring, parasailing, Parkour, proximity flying, rock climbing, sail gliding, sandboarding, scuba diving, sepak takraw, slacklining, ski jumping, skydiving, sky surfing, speed flying, speed riding, train surfing, tricking, wingsuit flying, or other similar extreme sports or high risk activities
• Travel or activity outside the United States or Canada
• Active duty service or training in the military (naval force, air force or National Guard/Reserves or equivalent) for service/training extending beyond 31 days of any state, country or international organization, unless specifically allowed by a provision of the certificate
• Involvement in any declared or undeclared war or act of war (not including acts of terrorism), while serving in the military or an auxiliary unit attached to the military, or working in an area of war whether voluntarily or as required by an employer
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/prosperisd
To be insured under the Policy an Employee must elect coverage for themself and any Dependent(s). The Employee is required to pay a premium for the coverage selected. Payment of premium does not guarantee eligibility for coverage.
Any amount of insurance for a Spouse/Partner or Dependent Child(ren) will be rounded to the next higher multiple of $1,000, if not already an even multiple of $1,000. All Coverage Amount(s) are Guaranteed Issue.
Benefits & Features
•
Without Impairment (including Transient Ischemic Attack (TIA)) •
Critical Illnesses included in the Child Conditions Category must be Diagnosed during Childhood, with the exception of Type 1 Diabetes which may be Diagnosed during Childhood or Adolescence.
You may be able to continue insurance for You and Your Dependent(s) in certain circumstances when You are no longer Actively at Work, with payment of premium and subject to certain conditions. The available continuation option(s) are described in the Certificate.
Extended Continuation
Ability Assist® EAP1
HealthChampionSM1
You or an insured Spouse/Partner, in certain circumstances, may continue coverage under the Policy when insurance would otherwise end under the Termination of Coverage provision, with payment of premium and subject to certain conditions. This provision is fully described in the Certificate.
24/7/365 access to help for financial, legal, or emotional issues
Administrative and clinical support following serious illness or injury
1. ONLINE CLAIMS
• Visit the Supplemental Insurance Claims Portal at TheHartford.com/benefits/myclaim.
• Register for access if you have not done so already. (Please note: We must have current eligibility from your benefits administrator for you and any dependents to be eligible to register on the portal.)
• Log in to the portal.
• Click on “Complete Your Claim Form Online” under the Quick Links section.
• Follow the prompts to complete and submit a claim.
2. FILE A CLAIM OVER THE PHONE
(Applicable to Health Screening Benefit/Accident Protection Benefit Only)
• File your claim by calling 866-547-4205.
• Available Monday through Friday, 8:00 a.m. - 6:00 p.m. EST.
• SUBMIT A CLAIM VIA MAIL OR FAX
• Download a claim form at TheHartford.com/benefits/myclaim.
• Complete the form and mail or fax it to: The Hartford Supplemental Insurance Benefit Department
P.O. Box 99906
Grapevine, TX 76099
Fax Number: 469-417-1952
For assistance filing your claim, call 866-547-4205.
NOTE: Go to www.mybenefitshub.com/prosperisd under the Criical Illness Section for a full rate schedule.
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/prosperisd
You have a choice of two accident plans, which allows you the flexibility to enroll for the coverage that best meets your needs. This insurance provides benefits when injuries, medical treatment and/or services occur as the result of a covered accident. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s).
The claim form is online at https://benefitsclaims.thehartford.com/. If you need assistance completing this form, contact 1-866-547-4205. In addition, they can help you understand how to submit the claim successfully and provide guidance on supporting documents that may be required.
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/prosperisd
The Lincoln DentalConnect® PPO Plans:
• Cover many preventive, basic, and major dental care services
• Also cover orthodontic treatment for children
• Let you choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a contracting dentist
• Do not make you and your loved ones wait six months between routine cleanings
Calendar (Annual) Deductible
Individual: $50 Family: $150 Waived for Preventive
Individual: $50 Family: $150 Waived for Preventive
Individual: $50 Family: $150 Waived for Preventive
Deductibles are combined for basic and major Contracting Dentists’ services. Deductibles are combined for basic and major Non-Contracting Dentists’ services.
*Orthodontic Coverage is available for dependent children.
Waiting Period
Visit LincolnFinancial.com/FindADentist
You can search by:
• Location
• Dentist name or office name
• Distance you are willing to travel
• Specialty, language and more
There are no benefit waiting periods for any service types
Your search will automatically provide up to 100 dentists that most closely match your criteria. If your search does not locate the dentist you prefer, you can nominate one—just click the Nominate a Dentist link and complete the online form.
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/prosperisd
You can request your vision id card by contacting Superior Vision directly at 800-507-3800. You can also go to www.superiorvision.com and register/login to access your account by clicking on “Members” at the top of the page. You can also download the Superior Vision mobile app on your smart phone.
Need
Need
Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.
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/prosperisd
Disability Insurance pays you a portion of your earnings if you cannot work because of a disabling illness or injury. You can 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. Actively at Work: You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at Work shall mean you are able to report for work with your Employer, performing all the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session.
Coverage Amount: You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $7,500 that cannot exceed 66 2/3% of your current monthly earnings.
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.
Definition of Disability: Disability is defined as The Hartford’s contract with your employer. Typically, disability means that you cannot perform one or more of the essential duties of your occupation due to injury, sickness, pregnancy or other medical conditions covered by the insurance, and as a result, your current
monthly earnings are 80% or less of your pre-disability earnings. Once you have been disabled for 24 months, you must be prevented from performing one or more essential duties of any occupation, and as a result, your monthly earnings are 66 2/3% or less of your pre-disability earnings.
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 not received treatment for the disabling condition within 3 months, while insured under this policy, before the disability begins, or You have been insured under this policy for 12 months before your disability begins.
If your disability is a result of a pre-existing condition, we will pay benefits for a maximum of 6 weeks.
Maximum Benefit Duration: Benefit Duration is the maximum time for which we pay benefits for disability resulting from sickness or injury. Depending on the age at which disability occurs, the maximum duration may vary. Please see the applicable schedule below based on the Premium benefit option. Premium Option: For the Premium benefit option – the table below applies to disabilities resulting from sickness or injury.
Age Disabled Maximum Benefit Duration
Prior to 60 To Age 65
Age 60 -64 60 Months
Age 65 -67 To age 70
Age 68 and over 24 months
Benefit Integration: For the first 6 months your benefit may be reduced by other income due to your disability such as a leave of absence, less the cost of paying a substitute teacher if required to do so, or income received from your Employer’s assault leave plan or similar leave of absence plan resulting from you being physically assaulted while acting in your official capacity.
After 6 months, your benefit may be reduced by other income you receive or are eligible to receive due to your disability, such as:
• Social Security Disability Insurance
• State Teacher Retirement Disability Plans
• Other employer-based disability insurance coverage you may have
• Unemployment benefits
• Retirement benefits that your employer fully or partially pays for (such as a pension plan)
Your plan includes a minimum benefit of 25% of your elected benefit.
Added value services include Ability Assist Counseling Services with three face-to-face counseling sessions per occurrence per year. Call 800-964-3577 or register at: www.guidanceresource.com Company code HLF902 Company
Name ABILI. Other services include Funeral Concierge Services, Estate Guidance Will Services and Beneficiary Counseling Services.
How to file a claim: Claims are now processed telephonically by calling 866-547-9124. Just refer to policy number 872784 and follow these easy steps:
1. If your absence is scheduled, call 30 days prior and if unscheduled, please call as soon as possible.
2. Have your information ready
• Name address other key information
• Name of department and last day full day of active work
• The nature of your claim or leave request.
• Your treating physicians name, address, and fax numbers
With your information handy, you will be assisted by a member who will take your information, answer your questions, and file your claim.
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/prosperisd
THIS IS ONLY A SUMMARY OF BENEFITS. PLEASE REFER TO THE CERTIFICATE OF COVERAGE FOR LIMITATIONS AND EXCLUSIONS TO DETERMINE ACTUAL COVERAGES. GO TO WWW.MYBENEFITSHUB.COM/PROSPERISD UNDER THE CANCER SECTION FOR COMPLETE DETAILS.
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/prosperisd
The Group Term Life and Accidental Death and Dismemberment (AD&D) insurance available through your employer gives extra protection that you and your family may need. Life and AD&D insurance offers financial protection by providing you coverage in case of an untimely death or an accident that destroys your income- earning ability. Life benefits are disbursed to your beneficiaries in a lump sum in the event of your death.
APPLICANT BASIC COVERAGE
Reductions at age 65 and 70
Employee Benefit: $10,000
AD&D: Included
Spouse Not Included
Child(ren) Not Included
Note: Basic Life is Employer Paid
SUPPLEMENTAL COVERAGE
Benefit: Increments of $10,000
Maximum: the lesser of 5x earnings or $500,000
Benefit: Increments of $10,000
Maximum: the lesser of 100% of your supplemental coverage or $250,000
Benefit: Increments of $5,000 Maximum: $10,000
Group Voluntary Accidental Death & Dismemberment (AD&D) insurance pays your beneficiary a death benefit if you die due to a covered accident or pays you if you are unexpectedly injured in a covered accident. The benefits are paid in lump sum amounts to you (or your beneficiary) and can be used to pay for health care expenses not covered by your major medical insurance, help replace income lost while not working, funeral expenses, or however you choose. Acci-dental death benefits are paid in addition to any life insurance.
APPLICANT AD&D COVERAGE
Employee Benefit2: Increments of $10,000
Maximum: the lesser of 5x earnings or $500,000
Coverage Information
Your dependent(s) will be covered at a percentage of your coverage amount.
Dependent(s)
Covered accidents or death can occur up to 365 days after the accident. The total benefit for all losses due to the same accident will not exceed 100% of your coverage amount.
If you are enrolled in insurance coverage with The Hartford, you may also be eligible to receive additional services at no cost to you. These services help with challenges that come before and after a claim. Be sure to read the information provided below; The Hartford wants to be there when you need us.
COVERAGE ENROLLED IN
Life & Accidental Death and Dismemberment
LIMITS AND EXCLUSIONS
ADDITIONAL SERVICES AVAILABLE
• Beneficiary Assist® Counseling Services
• EstateGuidance® Will Services
• Funeral Planning and Concierge Services
• Travel Assistance Services with ID Theft Protection and Assistance Refer to your benefit website for details on these additional services.
This insurance coverage includes certain limitations and exclusions. The certificate details all provisions, limitations, and exclusions for this insurance coverage. A copy of the certificate can be obtained at www.mybenefitshub.com/prosperisd com under the Basic Life and Voluntary Life Sections.
Spouse rates are based on Employee’s age and cannot exceed 100% of the employees supplemental life amount.
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/prosperisd
ID Watchdog is everywhere you can’t be — monitoring credit 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.
Monitor & Detect
• Dark Web Monitoring*
• High-Risk Transactions Monitoring*
• Subprime Loan Monitoring*
• Public Records Monitorin*
• USPS Change of Address Monitoring
• Identity Profile Report
Manage & Alert
• Child Credit Lock | 1 Bureau*
• Financial Accounts Monitoring
• Social Network Alerts*
• Registered Sex Offender Reporting*
• Customizable Alert Options
• Breach Alert Emails
• Mobile App
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
*Helps better protect children
1 Bureau = Equifax® | Applies to the 1B plan and includes monthly monitoring
Multi-Bureau = Equifax, TransUnion® | Applies to the Platinum Plan to lock your credit report to avoid fraud
3 Bureau = Equifax, Experian®, TransUnion | Applies to the Platinum Plan and allows monitoring for all 3 credit bureaus listed
Please refer to the website, www.mybenefitshub.com/prosperisd for more details.
Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out-of-pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan.
For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd
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.
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.
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.
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 nonemergency air or ground transportation between medical facilities.
Repatriation/Recuperation 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.
Should you need assistance with a claim contact MASA at 800-643-9023. You can find full benefit details www.mybenefitshub.com/prosperisd
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 $570 rollover or grace period provision).
For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd
The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $3,050 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).
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 FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full-time student.
• Overnight camps are not eligible for reimbursement (only day camps can be considered).
• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
• You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
• The maximum per plan year you can contribute to a Health Care FSA is $3,050. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately.
• You cannot change your election during the year unless you experience a Qualifying Life Event.
• You can continue to file claims incurred during the plan year for another 90 days after August 31st
• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
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.
Higginbotham Portal
The Higginbotham Portal provides information and resources to help you manage your FSAs.
• Access plan documents, letters and notices, forms, account balances, contributions and other plan information
• Update your personal information
• Utilize Section 125 tax calculators
• Look up qualified expenses
• Submit claims
• Request a new or replacement Benefits Debit Card
Register on the Higginbotham Portal
Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information.
• Enter your Employee ID, which is your Social Security number with no dashes or spaces.
• Follow the prompts to navigate the site.
• If you have any questions or concerns, contact Higginbotham:
* Phone – 866-419-3519
* Email – flexclaims@higginbotham.net
* Fax – 866-419-3516
An Employee Assistance Program (EAP) is a program that assists you in resolving problems such as finding child or elder care, relationship challenges, financial or legal problems, etc. This program is provided by your employer at no cost to you.
For full plan details, please visit your benefit website: www.mybenefitshub.com/prosperisd
The Deer Oaks Employee Assistance Program (EAP) is a free service provided for you, your dependents, and household members by your employer. This program offers a wide variety of counseling, referral, and consultation services, which are all designed to assist you and your family in resolving work and life issues to live happier, healthier, more balanced lives. From stress, addiction, and change management, to locating childcare facilities, legal assistance, and financial challenges, our qualified professionals are here to help. These services are completely confidential and can be easily accessed 24/7, offering you aroundthe-clock assistance for all of life’s challenges.
Program Access: You may access the EAP by calling the tollfree Helpline number, using our iConnectYou App, or instant messaging with a work-life consultant through our online instant messaging system.
Telephonic Assessments & Support: In-the-moment telephonic support and crisis intervention are available 24/7 along with intake and clinical assessments.
Short-term Counseling: Counseling sessions with a qualified counselor to assist with issues such as stress, anxiety, grief, marital/family challenges, relationship issues, addiction, etc. Counseling is available via structured telephonic sessions, video, and in-person at local provider offices.
Referrals & Community Resources: Our team provides referrals to local community resources, member health plans, support groups, legal resources, and child/elder care/daily living resources.
Advantage Legal Assist: Free 30 minute telephonic or in-person consultation with a plan attorney; 25% discount on hourly attorney fees if representation is required; unlimited online access to a wealth of educational legal resources, links, tools and forms; and interactive online Simple Will preparation.
Advantage Financial Assist: Unlimited telephonic consultation with an Accredited Financial Counselor qualified to advise on a range of financial issues such as bankruptcy prevention, debt reduction, financial planning, and identity theft; supporting educational materials available; unlimited online access to a wealth of educational financial resources, links, tools and forms (i.e. tax guides, financial calculators, etc.).
Alternate Modes of Support: Your EAP offers support alternatives in addition to traditional short-term counseling including telephonic life coaching, AWARE stress reduction sessions, and virtual group counseling. During your call with one of our counselors, ask if these programs would be right for you.
Work-life Services: Our work-life consultants are available to assist you with a wide range of daily living resources such as locating pet sitters, event planners, home repair, tutors, travel planning, and moving services. Simply call the Helpline for resource and referral information.
Child & Elder Care Referrals: Our child and elder care specialists can help you with your search for licensed child and elder care facilities in your area. They will discuss your needs, provide guidance, resources, and qualified referral packets. Searchable databases and other resources are also available on the Deer Oaks member website.
Take the High Road Ride Reimbursement Program: Deer Oaks reimburses members for their cab, Lyft and Uber fares in the event that they are incapacitated due to impairment by a substance or extreme emotional condition. This service is available once per year per participant, with a maximum reimbursement of $45.00 (excludes tips).
Contact Us:
Toll-Free: (888) 993-7650
Website: www.deeroakseap.com
Email: eap@deeroaks.com
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 Prosper 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 Prosper 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.