05/01/2024 - 04/30/2025
Benefit Contact Information
Higginbotham Public Sector (800) 583-6908 www.mybenefitshub.com/vanguardac
Higginbotham (866) 419-3519
www.higginbotham.net
LIFE AND AD&D
Lincoln Financial Group (800) 256-8606
Group #: 400266014 www.lfg.com
APL (800) 423-2765
Group #: 24692 www.ampublic.com
Lincoln Financial Group (800) 423-2765 www.lfg.com
Blue Cross Blue Shield of Texas
Phone: (972) 766-6900
Toll Free: (800) 521-2227
Group #: 164044 www.bcbstx.com
MetLife (800) 275-4638
Group #: 5382604
https://online.metlife.com/benefits
5Star (866) 863-9753
https://5starlifeinsurance.com/
EECU (817) 882-0800 www.eecu.org
Unum (866) 635-5597
Group # 309054 www.unum.com
Experian
Toll Free: (888) 397-3742 www.experian.com
Unum (866) 679-3054
Group #: 441261 www.unum.com
Lincoln Financial Group (800) 423-2765
LTD Group #: 10266042
STD Group #: 10266016 www.lfg.com
United Healthcare (888) 299-2070
Group #: 309054 www.myuhc.com
1
www.mybenefitshub.com/vanguardac
2 CLICK LOGIN
3 ENTER USERNAME & PASSWORD
Enter your information: Last Name Date of Birth Last Four (4) of Social Security Number
NOTE: THEbenefitsHUB uses this information to check behind the scenes to confirm your employment status.
Once confirmed, the Additional Security Verification page will list the contact options from your profile. Select either Text, Email, Call, or Ask Admin options to receive a code to complete the final verification step.
Enter the code that you receive and click Verify. You can now complete your benefits enrollment!
Annual Benefit Enrollment
Benefit Updates - What’s New:
• New HSA Maximum Contribution
• New Voluntary Disability Plan Option
• New Hospital Indemnity with Employer Paid Option
• New Medical Plan Modification
NOW IS THE TIME to make your supplemental benefit elections for a 05/01/2024 effective date. During your annual enrollment period, you may enroll for additional benefits, change plan options, or change dependents. For supplemental benefits that require Evidence of Insurability, a later effective date may apply. If you experience a special enrollment event outside of the annual enrollment period, call your benefits administrator within 31 days of event.
MEDICAL
Medical Insurance provides the framework for your good health and well-being. In order to better meet the varying needs of the employees Vanguard Academy offers four medical plans:
• Plan 1 - PPO
$1,000
• Plan 2 - PPO $2,500
• Plan 3 - HSA
$5,000
Blue Cross Blue Shield of Texas Phone: (972) 766-6900 Toll Free: (800) 521-2227 www.bcbstx.com
BENEFITS AT A GLANCE
Benefit options to fit your needs
HSA:
Health Savings Accounts allows you to set aside money for qualified medical expenses, while reducing your overall tax burden. You own the account and can take it with you wherever you go, with funds that you can’t lose. You must be enrolled in a High Deductible Health Care Plan. The 2024 maximum contribution is $4,150 for individual and $ 8,300 for family.
SHORT TERM AND LONG TERM DISABILITY PLANS:
This is a voluntary benefit that protects your most precious asset, your salary. Covers your income up to 60%* if you are unable to work due to an accident, illness, or pregnancy.
HOSPITAL INDEMNITY:
Hospital stays are expensive. If you or a family member is hospitalized as a result of an unexpected accident or sickness, you may face financial difficulties, even if you have an excellent medical plan. With a hospital indemnity plan, you’ll be confident that those unexpected bills will not be a financial strain. The money can be spent for medical expenses, insurance deductibles, food, transportation, or daycare; the choice is yours! It is employer paid for the low plan option - employee only tier and there is no pre-existing condition provisions.
Don’t Forget!
• Login and complete your benefit enrollment from 03/25/2024 - 04/05/2024
• Enrollment assistance is available by calling Higginbotham Public Sector 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.
Annual Benefit Enrollment
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 Office or you can call Higginbotham Public Sector at 866-914-5202 for assistance.
Where can I find forms?
For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ vanguardac. 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 Vanguard Academy benefit website: www.mybenefitshub.com/vanguardac. 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
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
Change in Number of Tax Dependents
Change in Status of Employment Affecting Coverage Eligibility
Gain/Loss of Dependents’ Eligibility Status
Judgment/ Decree/Order
Eligibility for Government Programs
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefits 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 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.
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.
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
Annual Benefit Enrollment
Employee Eligibility Requirements
Supplemental Benefits: Eligible 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 2024 benefits become effective on May 1, 2024, you must be actively-at-work on May 1, 2024 to be eligible for your new benefits
Dependent Eligibility Requirements
Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.
Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.
To age 26
To age 26
To age 26
To age 26
To age 26
To age 26
Illness To age 26
and AD&D To age 26
Life To age 24
Theft Protection 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 Higginbotham Public Sector, 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 Higginbotham Public Sector, 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 Higginbotham Public Sector 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 Benefits Office to request a continuation of coverage.
Helpful Definitions
Actively-at-Work
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 05/01/2024 please notify your benefits administrator.
Annual Enrollment
The period during which existing employees are given the opportunity to enroll in or change their current elections.
Annual Deductible
The amount you pay each plan year before the plan begins to pay covered expenses.
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.
In-Network
Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.
Out-of-Pocket Maximum
The most an eligible or insured person can pay in coinsurance for covered expenses.
Plan Year
May 1st through April 30th
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).
Description
Health Savings Account (HSA) (IRC Sec. 223)
Approved by Congress in 2003, HSAs are actual bank accounts in employees’ names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.
Employer Eligibility A qualified high deductible health plan
Contribution Source Employee and/or employer
Account Owner Individual
Underlying Insurance
Requirement
Minimum Deductible
Maximum Contribution
Permissible Use Of Funds
Cash-Outs of Unused Amounts (if no medical expenses)
Year-to-year rollover of account balance?
Does the account earn interest?
Portable?
High deductible health plan
$1,400 single (2024)
$2,800 family (2024)
$4,150 single (2024)
$8,300 family (2024)
Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.
Flexible Spending Account (FSA) (IRC Sec. 125)
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.
All employers
Employee and/or employer
Employer
None
N/A
$1,200 (2024)
Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).
Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65). Not permitted
Yes, will roll over to use for subsequent year’s health coverage.
Yes
Yes, portable year-to-year and between jobs.
Yes. Your employer’s plan contains a $500 rollover provision.
No
No
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/vanguardac
Health Savings Account (HSA)
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/vanguardac
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.
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
• Enrolled in an HSA-eligible HDHP (Plan 4 HSA)
• 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, nor should your spouse be contributing towards 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 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.
Maximum Contributions
Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2024 is based on the coverage option you elect:
• Individual – $4,150
• Family (filing jointly) – $8,300
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.
Opening an HSA
If you meet the eligibility requirements, you may open an HSA administered by EECU. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA.
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.
How to Use your HSA
• 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
Flexible Spending Account (FSA)
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 plan contains a $500 rollover provision.
For full plan details, please visit your benefit website: www.mybenefitshub.com/vanguardac
Important Information
What is a Flexible Spending Account? A Flexible Spending Account (FSA) is a benefit provided by your employer that lets you set aside a certain amount of your paycheck into an account before paying income taxes. Then during the year, you can use the funds in the account to pay for qualified expenses with untaxed dollars.
Why should I participate in the plan? Your biggest benefit is savings on payroll withholding taxes. You will save $25 to $40 on every $100 you budget to pay for qualified expenses.
What expenses qualify for payment? Most qualified expenses are for goods or services that you’ll buy anyway. They include health care costs such as copays, doctors’ fees, over-the-counter items and prescriptions, dental and eye care expenses and day care expenses for dependents so you can work.
How do I know how much is available for me to spend, and how do I file a claim? Your balance and claim forms are available 24/7 online at flexservices.higginbotham.net or by calling 866419-3519. Filing claims is easy. Just complete a claim form, attach a copy of the bill and then send it to us. You’ll receive your taxfree reimbursement within 72 hours.
Must money be deposited in my account before I pay expenses or file a claim? No. The entire annual amount you elect for the Health Care Spending Account (Health FSA) is available on the first day. However, only amounts contributed to date are available for the Dependent Care Spending Account (Dependent Care FSA).
I already have health insurance. Why should I participate in the Health FSA? The Health FSA is used to pay for expenses not covered by insurance. These include copays, over-the-counter medications, glasses, contacts, orthodontics, prescription drugs and more.
I don’t use my employer’s health insurance. Can I still save? Yes. You can still setaside money before taxes to budget and pay for qualified expenses. But remember, a qualified expense paid from this plan is not eligible for reimbursement from another plan.
If I set aside part of my pay, won’t I make less money? No. For every dollar you set aside to pay qualified expenses, you save FICA and federal income tax withholding. Your net take-home pay will increase by the tax you save. Plus, when you pay for a qualified expense or receive a cash reimbursement, it’s tax-free.
Can I change my contribution during the year? Yes, but only in certain situations. For the Health FSA and Dependent Care FSA, you can change your election if you have a change in status or if there’s a change in employment for you, your spouse or a dependent.
What if I don’t use all the money in my account? Generally, contributions that aren’t used during the plan year are forfeited back to your employer, but changes to IRS may allow extra time to spend your money or to carry over up to $500. Check with your employer to learn your options.
What happens to my accounts if I terminate employment? You may request reimbursement for qualified expenses incurred prior to your termination date.
Flexible Spending Account (FSA)
Higginbotham
How FSAs Work
When you pay for these expenses with pre-tax dollars, you pay no social security or federal income tax on your contributions. Your taxable income and your taxes are reduced.
Case Study
Let’s say you earn $25,000 per year. And you are paid semi-monthly, so each paycheck is for gross compensation of $1,041.67. You have insurance premiums and other expenses eligible for payment through the health FSA of $62.50 per pay period. Here is a comparison of what your paycheck looks like with and without the Flexible Spending Account:
When you pay for your expenses with pre-tax dollars, your net income is increased!
When you incur a medical, dental or vision expense, you’ll be reimbursed the full amount of the expense at that time, up to your yearly contribution election.
For example, you’re going to contribute $500 for the plan year ($41.67 per month). On January 15, you visit your eye doctor and receive your exam and contact lenses for a total charge of $200. Submit that receipt online or by fax, email, mail or the mobile app and receive your full $200 back within 24-72 hours, even though you don’t have the $200 in your account at the time. You are entitled to the entire $500 from day one of the plan year.
Orthodontia Expenses
If you’re currently paying on an orthodontia contract for yourself, your spouse, or your children, you can put that payment aside in your Health FSA and use the WeathCare debit card to make the payment each month to your orthodontist. All we need is a copy of your current contract and the first payment receipt made with the WeathCare debit card. Your monthly orthodontic payments will be substantiated automatically for the current plan year.
Your account information is available online at flexservices.higginbotham.net or by calling 866-419-3519.
Dependent Care FSA Higginbotham
ABOUT DEPENDENT CARE FSA
The Dependent Care FSA covers expenses for caring for elder or child dependents, enabling you or your spouse to work or attend school full-time. Reimbursement is limited to your account balance. Eligibility requires being a single parent or both spouses employed outside the home, disabled, or full-time students.
For full plan details, please visit your benefit website: www.mybenefitshub.com/vanguardac
DEPENDENT CARE SPENDING ACCOUNT
How it Works
You and your spouse must be employed in order to participate, or one of you can be a full-time student, actively looking for work or disabled.
Your care provider cannot be your dependent.
The debit card cannot be used for dependent child care. The maximum flex deduction per family per year is $5,000 when filing jointly or head of household and $2,500 when married filing separately. However, the maximum limit for the child tax credit on your federal income tax return is $6,000 and $3,000 — whatever amount you don’t deduct from your Flexible Spending Account, you may be able to deduct the difference (up to $3,000 or $6,000 total) on your income tax return.
Expenses That Qualify for Reimbursement
• Before and after school care
• Household service if part of the service is for the care of a qualifying person
• Any care for your children whom you claim as tax dependents under the age of 13 (a child may qualify for only part of the year if he/she turns 13 mid-year)
• Care for spouse or dependents of any age who spend at least eight hours a day in your home and are mentally or physically incapable of self-care
Expenses That Do Not Qualify for Reimbursement
• Kindergarten, unless it can be determined that the educational part is incidental and cannot be separated from the cost of care
• Overnight camps (only day camps can be considered)
I take a dependent care credit on Form 1040. Will the Dependent Care Spending Account save more?
The more you earn, the more you’ll save. In addition, you’ll also save social security tax (FICA) with a Dependent Care Spending Account. So, don’t wait until April 15 to take the credit. You can save taxes on every paycheck now.
Which is best for you? Visit flexservices.higginbotham.net and use the easy calculator to determine your savings.
Are there any negatives?
Because you won’t pay social security tax on the amount of gross pay you set aside to pay for qualified expenses, your social security benefits at retirement may be slightly reduced. However, most tax advisors recommend taking advantage of current taxsavings opportunities like the Health FSA and Dependent Care FSA. Also, if disability insurance is paid on a pre-tax basis, any future benefits you receive will be taxable.
Dental Insurance
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/vanguardac
PDP Plus
The Preferred Dentist Program was designed to help you get the dental care you need and help lower your costs. You get benefits for a wide range of covered services — both in and out of the network. The goal is to deliver cost-effective protection for a healthier smile and a healthier you.
Selected Covered Services and Frequency Limitations*
Dental Insurance MetLife
Type B—Basic Restorative
Amalgam and Composite Fillings
How Many/How Often:
1 in 24 months
Prefabricated Crowns 1 in 84 months
Repairs
Periodontal Scaling & Root Planning
Periodontal Maintenance
Oral Surgery (Simple Extractions)
Oral Surgery (Surgical Extractions)
Other Oral Surgery
Emergency Palliative Treatment
General Anesthesia Consultations
Type C—Major Restorative
Crowns/Inlays/Onlays
1 in 12 months
1 in 12 months per quadrant
4 in 1 year, includes 2 cleanings
1 in 12 months
How Many/How Often:
1 per tooth in 84 months
Endodontics Root Canal 1 per tooth per lifetime
Periodontal Surgery
1 in 36 months per quadrant
Bridges 1 in 84 months
Dentures 1 in 84 months
Implant Services 1 service per tooth in 84 months - 1 repair per 84 months
Type C—Major
Restorative How Many/How Often:
• Dependent children up to age 19. Age limitations may vary by state. Please see your Plan description for complete details. In the event of a conflict with this summary, the terms of the certificate will govern.
• All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia.
• Benefits for the initial placement will not exceed 20% of the Lifetime Maximum Benefit Amount for Orthodontia. Periodic followup visits will be payable on a monthly basis during the scheduled course of the orthodontic treatment. Allowable expenses for the initial placement, periodic follow-up visits and procedures performed in connection with the orthodontic treatment, are all subject to the Orthodontia coinsurance level and Lifetime Maximum Benefit Amount as defined in the Plan Summary.
• Orthodontic benefits end at cancellation of coverage
Common Questions… Important Answers
Do I need an ID card?
No, You do not need to present an ID card to confirm that you are eligible. You should notify your dentist that you are enrolled in a MetLife Dental Plan. Your dentist can easily verify information about your coverage through a toll-free automated Computer Voice Response system.
Do my dependents have to visit the same dentist that I select?
No. You and your dependents each have the freedom to choose any dentist.
If I do not enroll during my initial enrollment period, can I still purchase Dental Insurance at a later date?
Yes, employees who do not elect coverage during enrollment period may still elect coverage later. Dental coverage would be subject to the following waiting periods.
• No waiting period on Preventive Services
• 6 months on Basic Restorative (Fillings)
• 12 months on all other Basic Services
• 24 months on Major Services
• 24 months on Orthodontia Services (if applicable)
Vision Insurance 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/vanguardac
Plan features:
Members have the freedom to choose any provider from EyeMed’s Insight Network. Our network offers the right mix of independent, national retail and regional retail providers like Lens Crafters, Pearle Vision, Target Optical and many more. Members can also purchase glasses and contact lenses online at Glasses.com and ContactsDirect.com.
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.
• 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)
Life and AD&D
Lincoln Financial Group
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/vanguardac
Safeguard the most important people in your life.
Think about what your loved ones may face after you’re gone. Term life insurance can help them in so many ways, like helping to cover everyday expenses, pay off debt, and protect savings. AD&D provides additional benefits if you die or suffer a covered loss in an accident, such as losing a limb or your eyesight.
You also have the option to increase your cash benefit by securing additional coverage at affordable group rates. See the enclosed optional life insurance information for details.
AT A GLANCE:
• A cash benefit of $50,000 to your loved ones in the event of your death, plus an additional cash benefit if you die in an accident.
• Includes LifeKeys® services, which provide access to counseling, financial, and legal support services.
• TravelConnect® services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home.
Additional Details
Continuation of Coverage for Ceasing Active Work: You may be able to continue your coverage if you leave your job for reasons including and not limited to Family and Medical Leave, Lay-off, Leave of Absence, or Leave of Absence Due to Disability.
Waiver of Premium: A provision that allows you not to pay premiums during a period of disability that has lasted for a particular length of time.
Continuation of Coverage: You may be able to continue your coverage if you leave your job for any reason other than sickness, injury or retirement.
Accelerated Death Benefit: Enables you to receive a portion of your policy death benefit while you are living. To qualify, a medical professional must diagnose you with a terminal illness with a life expectancy of fewer than 12 months.
Conversion: You may be able to convert your group term life coverage to an individual life insurance policy if your coverage reduces or you lose coverage due to leaving your job or for other reasons outlined in the plan contract.
Benefit Reduction: Your employee Life/AD&D coverage amount will reduce by 50% when you reach age 70.
Life and AD&D Lincoln Financial Group
The Lincoln Term Life and AD&D Insurance Plan:
• Provides a cash benefit to your loved ones in the event of your death or if you die in an accident
• Provides a cash benefit to you if you suffer a covered loss in an accident, such as losing a limb or your eyesight
• Features group rates for employees
• Includes LifeKeys® services, which provide access to counseling, financial, and legal support services
• Also includes TravelConnect® services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home
Employee Life and AD&D
Your coverage will be reduced by 50% when you reach age 70.
This amount may not exceed the lesser of 7 times Annual Earnings (rounded up to the nearest $10,000) or $500,000
Dependent Child(ren) Life
Day 1 but less than 26 years (or under 26 years if unmarried, regardless of student status)
This amount may not exceed the lesser of 7 times Annual Earnings (rounded up to the nearest $5,000) or $500,000
$5,000 or $10,000
Individual Life Insurance
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/vanguardac
Family Protection Plan (5STAR)
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.
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. Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves.
Long-Term Disability Lincoln Financial Group
ABOUT DISABILITY
Long term 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/vanguardac
The Long-Term Disability Insurance Plan:
• Provides a cash benefit after you are out of work for 90 days or more due to injury, illness, or surgery
• Features group rates for eligible employees
Includes EmployeeConnectSM services, which give you and your family confidential access to counselors as well as personal, legal, and financial assistance
Voluntary LTD
Monthly Benefit Amount
Elimination Period
60% of your monthly salary limited to $6,000 per month
After the end of your short-term disability or a period of 90 days of disability, whichever is greater
Coverage Period for your Occupation 24 Months
Maximum Coverage Period
Elimination Period
Up to age 65 or Social Security Normal Retirement Age (SSNRA), whichever is later
• This is the number of days you must be disabled before you can collect disability benefits.
• The 90-day elimination period can be met through either total disability (out of work entirely) or partial disability (working with a reduced schedule or performing different types of duties).
Coverage Period for Your Occupation
• This is the coverage period for the trade or profession in which you were employed at the time of your disability (also known as your own occupation).
• You may be eligible to continue receiving benefits if your disability prohibits you from any employment for which you are reasonably suited through your training, education, and experience. In this case, your benefits are extended through the end of your maximum coverage period.
Maximum Coverage Period
• This is the total amount of time you can collect disability benefits (also known as the benefit duration).
• Benefits are limited to 24 months for mental illness; 24 months for substance abuse. See contract for details on other specified illnesses.
Long-Term Disability Lincoln Financial Group
Benefit Exclusions & Reductions
Like any insurance, this long-term disability insurance policy does have some exclusions. You will not receive benefits if:
• Your disability is the result of a self-inflicted injury or act of war
• You are not under the regular care of a doctor when you request disability benefits
• Your disability is the result of cosmetic surgery, unless related to a disabling condition
• Your disability occurs while you are committing a felony or misdemeanor or participating in a riot
• Your disability occurs while you are committing a felony or participating in a riot
• Your disability occurs while you are imprisoned for committing a felony
• Your disability occurs while you are residing outside of the United States or Canada for more than 12 consecutive months for a purpose other than work
Your benefits may be reduced if you are eligible to receive benefits from:
• A state disability plan or similar compulsory benefit act or law
• A retirement plan
• Social Security
• Any form of employment
• Workers’ Compensation
• Salary continuance
• Sick leave
Pre-existing Condition
• If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 3 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months.
This is an incomplete list of benefit exclusions. A complete list is included in the policy. State variations apply.
Voluntary Long-Term Disability Insurance Calculate Your Premium
Use the employee voluntary long-term disability premium rate table provided below to calculate your cost and benefit. The following example calculates the monthly cost for a 36-year-old employee with annual earnings of $35,400.
Note: The maximum monthly covered earnings are equal to the maximum monthly benefit divided by the benefit percentage.
Step
Step 3
Step 4
If your monthly earnings are greater than the maximum monthly covered earnings of $10,000t, indicate $10,000. Otherwise, indicate the amount from Step 2. $2,950
Calculate your monthly benefit. Multiply Step 3 by 0.60. $1,770
Step 5 Enter your monthly earnings in increments of $100 of monthly covered payroll. To calculate, divide the amount in Step 3 by $100. 29.50
Step 6
Calculate your monthly cost. Multiply Step 1 by Step 5.
Short-Term Disability Lincoln Financial Group
ABOUT DISABILITY
Short term 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/vanguardac
Voluntary Short-Term Disability Insurance
• Provides a cash benefit when you are out of work for up to 13 weeks due to injury, illness, surgery, or recovery from childbirth
• Features group rates for employees
• Provides a partial cash benefit if you can only do part of your job or work part-time
• Offers a fast, no-hassle claims process
Voluntary STD
Weekly Benefit Amount
60% of your monthly salary limited to $2,000 per month
Sickness elimination period 7 days Accident elimination period
Sickness Elimination Period: You must be out of work for 7 days due to an illness before you can collect disability benefits. You can begin collecting benefits on day 8.
Accident Elimination Period: You must be out of work for 7 days due to an accidental injury before you can collect disability benefits. You can begin collecting benefits on day 8.
Hospitalization Elimination Period: If you are hospitalized in the first 7 days of the absence, you can begin collecting benefits on day 1.
Recurrent Disability Benefits
If you become disabled for the same condition within 14 days following your prior disability, your benefits will continue under the same claim.
Short-Term Disability Lincoln Financial Group
Benefit Exclusions & Reductions
Like any insurance, this short-term disability insurance policy does have some exclusions. You will not receive benefits if:
• Your disability is the result of a self-inflicted injury or act of war
• Your disability occurs while you are committing a felony or misdemeanor or participating in a riot
Your benefits may be reduced if you are eligible to receive benefits from:
• Sick pay from your employer
• A state disability plan or similar compulsory benefit act or law
• A retirement plan
• Social Security
• Any form of employment
• Workers’ Compensation
This is an incomplete list of benefit exclusions. A complete list is included in the policy. State variations apply. Additional Plan Benefits
Pre-existing Condition
If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 6 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 6 months, unless you received no treatment of the condition for 3 consecutive months after your effective date. Voluntary Short-term Disability Premium Here’s how little you pay with group rates.
Use the employee voluntary long-term disability premium rate table provided below to calculate your cost and benefit. The following example calculates the monthly cost for a 36-year-old employee with annual earnings of $35,400.
Note: The maximum monthly covered earnings are equal to the maximum monthly benefit divided by the benefit percentage.
Step 2 Enter your weekly earnings. Divide your annual earnings by 52. $680.77
Step 3
If your weekly earnings are greater than the maximum weekly covered earnings of $3,333, indicate $3,333. Otherwise, indicate the amount from Step 2. $680.77
Step 4 Calculate your weekly benefit. Multiply Step 3 by 0.60. $408.46
Step 5
Enter your weekly benefit in increments of $10. To calculate, divide the amount in Step 4 by 10. 40.846
Step 6 Calculate your monthly cost. Multiply Step 1 by Step 5. $20.83
This worksheet allows you to approximate your monthly contributions for voluntary short-term disability insurance coverage. Cost of insurance may change in the future due to salary changes.
Cancer Insurance
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/vanguardac
Cancer
Cancer Insurance provides financial assistance in the form of a cash benefit upon a cancer diagnosis and treatment, ensuring you can concentrate on your health instead of your finances.
Cancer is one of the most debilitating diseases to bounce back from financially. So much so, that 42% of cancer patients drain their life savings within two years of diagnosis. You can use your benefit to help pay toward costly medicine, medical bills, co-pays or even travel and lodging associated with cancer treatment.
Critical Illness Insurance
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/vanguardac
Critical Illness
Critical illness insurance is a policy that provides a lump-sum benefit when you are diagnosed with a covered critical illness like a heartattack, stroke, and other serious conditions – even cancer if it’s included in your policy.
Who is eligible? All employees in active employment in the United States working at least 30 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? For you: Select one of the following Choices $10,000, $20,000 or $30,000; For your Dependent(s): 100% of employee coverage amount.
Critical Illness Insurance Unum
Covered Condition Benefit
The covered condition benefit is payable once per covered condition per insured. Unum will pay a covered condition benefit for a different covered condition if:
• the new covered condition is medically unrelated to the first covered condition; or
• the dates of diagnosis are separated by more than 180 days.
Reoccurring Condition Benefit
We will pay the reoccurring condition benefit for the diagnosis of the same covered condition if the covered condition benefit was previously paid and the new date of diagnosis is more than 180 days after the prior date of diagnosis.
The benefit amount for any reoccurring condition benefit is 100% of the percentage of coverage amount for that condition.
The following Covered Conditions are eligible for a reoccurring condition
Be Well Screenings include tests for the following: cholesterol and diabetes, cancer
Accident Insurance United Healthcare
ABOUT ACCIDENT
Do you have kids playing sports, are you a weekend warrior, or maybe you’re 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/vanguardac
Accident Protection Plan
Even with health insurance, an accidental injury can cost you thousands of dollars. Lost wages from missing work, health insurance deductibles and daily living expenses can create long-term financial problems. Accident insurance helps cover the added costs that you may face following an injury.
The plan covers more than 80 injuries and services. Here is a short list of injuries and services that may qualify for a benefit payment:
• Ambulance services
• Emergency room and urgent care
• Doctor visits
• Hospital admissions and stays
• Medical appliances (e.g., crutches, wheelchair, walker)
• Rehabilitation
• Burns
• Concussion
• Fractures/dislocations
• Lacerations (cuts)
• Prescriptions
• Organized sports injuries
• Lodging, travel and child care
Accident Insurance
Hospital Indemnity Lincoln Financial Group
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/vanguardac
Benefits at a Glance
If you or a covered family member have to go to the hospital for an accident or injury, hospital indemnity insurance provides a lumpsum cash benefit to help you take care of unexpected expenses — anything from deductibles to child care to everyday bills. Because you’re selecting this coverage through your company, you can take advantage of group rates. You don’t have to answer medical questions to receive coverage; this is guaranteed coverage.
Care Hospital Benefits
Hospital admission
For the initial day of admission to a hospital for treatment of a sickness/an injury
Hospital confinement
For each day of confinement in a hospital as a result of a sickness/ an injury
Hospital intensive care unit (ICU) admission
For the initial day of admission to an ICU for treatment as the result of a sickness/an injury
Hospital ICU confinement
For each full or partial day of confinement in an ICU as a result of a sickness/an injury
$1,000 per day up to one day per calendar year
$150 per day up to 30 days per calendar year starting on the second day of confinement
$1,000 per day up to one day per calendar year
$300 per day up to 30 days per calendar year starting on the second day of confinement
$1,500 per day up to one day per calendar year
$150 per day up to 30 days per calendar year starting on the second day of confinement
$1,500 per day up to one day per calendar year
$300 per day up to 30 days per calendar year starting on the second day of confinement
Complications of pregnancy Included Included
• Admission or Admitted means accepted for inpatient services in a hospital or intensive care unit for a period of more than 20 hours.
• If admitted to a hospital or ICU within 90 days after being discharged from a preceding stay for the same or related cause, the subsequent admission will be considered part of the first admission.
Newborn care
For each day of confinement to a hospital for routine post-natal care following birth $150 per day up to two days per calendar year
per day up to two days per calendar year
if you leave your
Hospital Indemnity Lincoln Financial Group
Benefit Exclusions
General exclusions
The policy covers only sicknesses and injuries that occur while insurance is in force. No indemnities will be paid for a sickness or injury that occurs before the effective date of the insurance. Benefits are not payable for any loss caused or contributed to by:
1. Suicide, attempted suicide, or any intentionally self-inflicted injury, while sane or insane*
2. Voluntary intake or use by any means of any drugs, poison, gas, or fumes, except when:
a. Prescribed or administered by a physician
b. Taken in accordance with the physician’s instructions
3. Committing or attempting to commit a felony
4. War or any act of war, declared or undeclared
5. Participation in a riot, insurrection, or rebellion of any kind
6. Participation in an act of terrorism
7. Military duty, including the Reserves or National Guard
8. Travel or flight in or on any aircraft, except as a fare-paying passenger on a regularly scheduled commercial flight, or as a passenger, pilot, or crew member in the group policyholder’s aircraft while flying for group policyholder business, provided:
a. The aircraft has a valid U.S. airworthiness certificate (or foreign equivalent)
b. The pilot has a valid pilot’s certificate with a non-student rating authorizing them to fly the aircraft
9. Driving a vehicle while intoxicated, as defined by the jurisdiction where the accident occurred
10. Cosmetic surgery, unless the treatment is the result of a covered event
11. Treatment for dental care or dental procedures, unless the treatment is the result of a covered event
12. Treatment of a mental illness*
13. Treatment of alcoholism, drug addiction, chemical dependency, or complications thereof*
14. Treatment through experimental procedures
15. Travel outside the United States and its possessions for the sole purpose of receiving medical care or treatment
16. Participating in, practicing for, or officiating any semi-professional or professional sport
17. Riding in or driving in any motor driven vehicle for race, stunt show, or speed test
18. Being incarcerated in any type of penal or detention facility
19. Scuba diving
20. Mountaineering or spelunking
21. Bungee cord jumping, hang gliding, sail gliding, parasailing, parakiting, kitesurfing, base jumping, or any similar activities
22. Skydiving, parachuting, jumping, or falling from any aircraft for recreational purposes
23. Residing outside the United States, U.S. Territories, Canada, or Mexico for more than 12 months
24. Injury arising out of or during employment for wage or profit
*Exceptions to the exclusions are accepted when substance abuse and mental disorder benefits are selected. This is a partial list of benefit exclusions. A complete list is included in the policy. State variations apply.
Hospital Indemnity Insurance Premium
As an employee, you can take advantage of this accident insurance plan. Your employer will contribute $14.11 towards your premium. Plus, you can add loved ones to the plan for just a little more.
Identity Theft Experian
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/vanguardac
Elite Plan
Achieve your credit & financial goals sooner with unique insights
With features like Digital Financial Management you will have tools to help manage your finances and credit profile in a single experience.
Digital Financial Management
360° view of financial accounts
Link your financial accounts to generate unique insights that can help improve your financial health and build good credit habits. Stay on top of your daily spending with recommended budgets powered by AI and machine learning of past transactional behavior.
Exclusive credit insights
Combine the power of financial transaction and credit data to unlock 50+ unique insights and recommendations to help achieve financial goals. Insights are displayed in your personalized feed and categories include account activity, spending and budgeting, VantageScore®* improvements, financial updates, and more.
Industry leading monitoring & alerts
Consistent monitoring of your credit report and VantageScore* can help you better understand your current credit profile and personal finances. Financial Alerts will notify you, via push notifications and emails, when certain financial events are detected.
Features to assist you
• Budgeting & Cashflow
• Tracking Spending
• Investments & New Worth
Identity protection for the whole family
As identity theft continues to increase, an evolving suite of identity products helps you monitor any potential threats to your identity and alerts you if there are any areas of concern. In addition, you’ll have access to a suite of proactive digital privacy tools to help you keep passwords and other personal information private and secure while surfing the web.
An evolving suite of identity products to help you guard against the rising threat of fraud.
Identity Restoration
Get back on track with support from an expert restoration agent that will walk you through the process of reclaiming what’s rightfully yours.
Dark Web Monitoring
If we detect any threats on the thousands of websites and millions of data points we scan, we’ll alert you so you can keep your family’s personal information safe.
Medical Identity Monitoring
If your insurance information is used to receive medical care or fill prescriptions, we’ll send you an alert to verify the service or act if you suspect identity theft.
CreditLock™
Block fraudsters from using your information to get new credit and act quickly to help prevent identity theft. Unlock it when you want to apply for credit.
Proactive Digital Privacy features to help keep your family’s personal data secure and reduce the threat of potential fraud
Secure VPN
Helps to prevent people and companies from seeing and collecting your data.
Password Manager
Safely store and protect your logins and payment information in one place.
Safe Browser
Get alerted of unsafe websites, block ads and help prevent the tracking of your data.
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 Vanguard Academy 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 Vanguard Academy 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.