2024-25 Dripping Springs ISD Benefit Guide

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2024 - 2025 Plan Year DRIPPING SPRINGS ISD BENEFIT GUIDE EFFECTIVE:
WWW.MYBENEFITSHUB.COM/DRIPPINGSPRINGSISD 1
09/01/2024 - 8/31/2025
Table of Contents FLIP TO... SUMMARY PAGES PG. 6 YOUR BENEFITS PG. 12 HOW TO ENROLL PG. 4 How to Enroll 4-5 Annual Benefit Enrollment 6-11 1. Annual Enrollment 6 2. Section 125 Cafeteria Plan Guidelines 7 3. Eligibility Requirements 9 4. Helpful Definitions 10 5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 11 Medical 12-13 Health Savings Account (HSA) 14 Hospital Indemnity 15-16 Telehealth 17 Dental 18-19 Vision 20 Disability 21-22 Cancer 23 Accident 24-25 Critical Illness 26-27 Emergency Medical Transport 28 Voluntary Group Term Life 29-30 Individual Life 31 Identity Theft Protection 32 Flexible Spending Accounts (FSA) 33-34 Health Reimbursement Arrangement (HRA) 35 Employee Assistance Program (EAP) 36 2

Benefit Contact Information

Higginbotham Public Sector (800) 583-6908 www.mybenefitshub.com/ drippingspringsisd

CHUBB (888) 499-0425

Group #: 100000134 educatorclaims@chubb.com

MetLife (800) 438-6388 www.metlife.com

TRS ActiveCare (866) 355-5999

https://www.trs.texas.gov/Pages/ Homepage.aspx

NBS (855) 399-3035 www.nbsbenefits.com

(888) 365-1663 www.mdlive.com/fbs

The Hartford Group # 15301 866-547-9124 www.TheHartford.com

Cigna (800) 244-6224 www.Cigna.com

American Public Life (800) 256-8606 www.ampublic.com ACCIDENT

CHUBB (888) 499-0425

Group #: 100000134 educatorclaims@chubb.com

CHUBB (888) 499-0425

MASA MTS (800) 423-3226 https://www.masamts.com/ VOLUNTARY

CHUBB (888) 499-0425

Group #: 100000134 educatorclaims@chubb.com

NBS

855-399-3035

www.nbsbenefits.com

Group #: 100000134 educatorclaims@chubb.com

5Star (866) 863-9753

https://5starlifeinsurance.com/

Deer Oaks (888) 993-7650 www.deeroakseap.com

ID Watchdog (800) 774-3772 www.IDWatchdog.com

DRIPPING SPRINGS ISD BENEFITS MEDICAL HEALTH SAVINGS ACCOUNT (HSA/HRA)
HOSPITAL INDEMNITY TELEHEALTH DENTAL
MDLIVE
VISION DISABILITY CANCER
CRITICAL ILLNESS EMERGENCY MEDICAL TRANSPORT
GROUP TERM LIFE INDIVIDUAL LIFE IDENTITY THEFT PROTECTION
FLEXIBLE SPENDING ACCOUNTS (FSA) EMPLOYEE ASSISTANCE PROGRAM
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Employee benefits made easy through the HPS Benefits App! All Your BenefitsOne App OR SCAN Text “BENEFITS” to (214)851-0568 App Group #: FBSDSISD Text “BENEFITS” to (214) 851-0568 and get access to everything you need to complete your benefits enrollment: • Benefit Resources • Online Enrollment • Interactive Tools • And more! 4

Login Process

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www.mybenefitshub.com/drippingspringsisd

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4

CLICK LOGIN

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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!

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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 eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

Q&A

Who do I contact with Questions?

For supplemental benefit questions, you can contact your Benefits/HR department or you can call 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/ drippingspringsisd. 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 DSISD benefit website: www.mybenefitshub.com/drippingspringsisd. 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.

SUMMARY PAGES
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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 Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

QUALIFYING EVENTS

A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).

A change in number of dependents includes the following: birth, adoption and placement for 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.

SUMMARY PAGES
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Annual Benefit Enrollment

Employee Eligibility Requirements

Eligible employees must work 15 hours or more per week for supplemental benefits. Medical benefits are subject to eligibility requirements and begin at 10 or more regularly scheduled hours per 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 September 1, 2024, you must be actively-at-work on September 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.

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 HR/Benefit Administrator to request a continuation of coverage.

SUMMARY PAGES
PLAN MAXIMUM AGE Medical To age 26 Hospital Indemnity To age 26 Vision To age 26 Dental To age 26 Accident To age 26 Voluntary Life To age 26 Cancer To age 26 Critical Illness To age 26 AD&D To age 26 Individual Life To age 26 Emergency Transport To age 26
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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 9/1/2024 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

September 1st through August 31st

Pre-Existing Conditions

Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescriptions drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).

SUMMARY PAGES
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Description

Health Savings Account (HSA) (IRC Sec. 223)

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.

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.

Employer Eligibility A qualified high deductible health plan. All employers

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)

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.

Employee and/or employer

Employer

None

N/A

$3,200 (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

Year-to-year rollover of account balance? Yes, will roll over to use for subsequent year’s health coverage.

Does the account earn interest?

Portable?

Yes

Yes, portable year-to-year and between jobs.

No. Access to some funds may be extended if your employer’s plan contains a 2 1/2 –month grace period or $550 rollover provision.

No

No

FLIP TO FOR HSA INFORMATION FLIP TO FOR FSA INFORMATION PG. 14 PG. 33 SUMMARY PAGES HSA vs. FSA
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Notes 11

Medical Insurance

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/drippingspringsisd

Employee Only

Employee & Spouse

Employee & Child(ren)

Employee & Family

Employee Only

Employee & Spouse

Employee & Child(ren)

Employee & Family

Employee Only

Employee & Spouse

Employee & Child(ren)

Employee & Family

Employee Only

Employee & Spouse

Employee & Child(ren)

Employee & Family

ABOUT
MEDICAL
TRS Monthly Premium District Contribution Employee Cost TRS ActiveCare HD
TRS ActiveCare 2
TRS ActiveCare Primary
TRS ActiveCare Primary+
EMPLOYEE BENEFITS 12

Medical information and rates will be released by TRS after their board meeting on May 2nd and 3rd. At that time, premiums for next year will be available to all employees.

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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/drippingspringsisd

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 taxfree 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 (ActiveCare HD)

• 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 under your 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 You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch-up contribution for the entire plan year.

Opening an HSA

If you meet the eligibility requirements, you may open an HSA administered by NBS. 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 NBS are eligible for automatic payroll deduction and company contributions.

NBS EMPLOYEE BENEFITS
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Hospital Indemnity CHUBB

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/drippingspringsisd

It’s not easy to pay hospital bills, especially if you have a high deductible medical plan. Chubb Hospital Cash pays money directly to you if you are hospitalized so you can focus on your recovery. And since the cash goes directly to you, there are no restrictions on how you use your money.

This benefit is for admission to a hospital or hospital sub-acute intensive care unit.

Hospital Admission ICU Benefit

This benefit is for admission to a hospital intensive care unit.

Hospital Confinement Benefit

This benefit is for confinement in hospital or hospital sub-acute intensive care unit.

Hospital Confinement ICU Benefit

The benefit for confinement in a hospital intensive care unit.

Newborn Nursery Benefit

This benefit is payable for an insured newborn baby receiving newborn nursery care and who is not confined for treatment of a physical illness, infirmity, disease or injury.

• $100 Per Day

• Maximum Days Per Calendar Year: 30

• $200 Per Day

Health Screening Benefit

Observation Unit

This benefit is for treatment in a hospital observation unit for a period of less than 20 hours.

² data.oecd.org; accessed Jan. 2023

$200 Per Day

Maximum Days Per Calendar Year: 30

• Maximum Days Per Calendar Year: 30 • $400 Per Day • Maximum Days Per Calendar Year: 30

• $500 Per Day

• Maximum Days per Confinement - Normal Delivery: 2

• Maximum Days per ConfinementCaesarean Section: 2

• $50

• Maximum Benefit Per Calendar Year 1

• $500

• Maximum Days Per Calendar Year: 2

• $500 Per Day

• Maximum Days per Confinement - Normal Delivery: 2

• Maximum Days per ConfinementCaesarean Section: 2

• $50

• Maximum Benefit Per Calendar Year 1

• $500

• Maximum Days Per Calendar Year: 2

EMPLOYEE BENEFITS Hospital Indemnity Plan 1 Plan 2 Employee Only $9.72 $19.85 Employee and Spouse $21.57 $44.07 Employee and Child(ren) $17.98 $36.73 Employee and Family $29.84 $60.95 Hospitalization Benefits Payable Benefit Plan 1 Plan 2
Hospital Admission Benefit
• $1,000 • Maximum Benefit Per Calendar Year: 5 • $3,000 • Maximum Benefit Per Calendar Year: 5
• $6,000 •
• $2,000 • Maximum Benefit Per Calendar Year: 5
Maximum Benefit Per Calendar Year: 5
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Hospital Indemnity CHUBB

Exclusions and Limitations*

We will not pay for any Covered Accident or Covered Sickness that is caused by, or occurs as a result of: 1) committing or attempting to commit suicide or intentionally injuring oneself; 2) war, or serving in any of the armed forces or its auxiliary units; 3) participating in an illegal occupation or attempting to commit or committing a felony; 4) sky diving, hang gliding, parachuting, bungee jumping, parasailing, or scuba diving; 5) being intoxicated or being under the influence of narcotics or other prescription drug unless taken in accordance with Physician’s instructions; 6) alcoholism; 7) cosmetic surgery, except for reconstructive surgery needed as the result of an Injury or Sickness or is related to or results from a congenital disease or anomaly of a covered Dependent Child; 8) services related to sterilization or its reversal, in vitro fertilization, and diagnostic treatment of infertility or other related problems.

A Physician cannot be You or a member of Your Immediate Family, Your business or professional partner, or any person who has a financial affiliation or business interest with You.

EMPLOYEE BENEFITS
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ABOUT TELEHEALTH

Telehealth provides 24/7/365 access to board-certified doctors via telephone or video consultations that can diagnose, recommend treatment and prescribe medication. Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.

For full plan details, please visit your benefit website: www.mybenefitshub.com/drippingspringsisd

Alongside your medical coverage is access to quality telehealth services through MDLIVE. Connect anytime day or night with a board-certified doctor via your mobile device or computer. While MDLIVE does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:

• Have a non-emergency issue and are considering a convenience care clinic, urgent care clinic or emergency room for treatment

• Are on a business trip, vacation or away from home

• Are unable to see your primary care physician

When to Use MDLIVE:

At a cost that is the same or less than a visit to your physician, use telehealth services for minor conditions such as:

• Sore throat

• Headache

• Stomachache

• Cold

• Flu

• Allergies

• Fever

• Urinary tract infections Do not use telemedicine for serious or life-threatening emergencies.

Registration is Easy Register with MDLIVE so you are ready to use this valuable service when and where you need it.

• Online – www.mdlive.com/fbs

• Phone – 888-365-1663

• Mobile – download the MDLIVE mobile app to your smartphone or mobile device

• Select –“MDLIVE as a benefit” and “HPS” as your Employer/Organization when registering your account.

This plan is provided at no cost to employees covered under the ActiveCare HD plan.

Telehealth Employee Only $8.00 Employee & Family $16.00
EMPLOYEE BENEFITS 17
Telehealth MDLIVE

Dental Insurance Cigna

ABOUT DENTAL

Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease.

For full plan details, please visit your benefit website: www.mybenefitshub.com/drippingspringsisd

How to Find an In-network Dentist

To search for a dentist on Cigna.com, visit the site and click “Find a Doctor, Dentist or Facility.” Follow the prompts on screen and when asked to choose your plan, select “DPPO/ EPO > Total Cigna DPPO.” Or call 800-244-6224 to find an in-network dentist.

How to Request a New ID Card

DPPO Plan

Coverage is provided through Cigna. Two levels of benefits are available with the DPPO plan: in-network and out-ofnetwork. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services. You could pay more if you use an outof-network provider.

You can request your dental id card by contacting Cigna directly at 800-244-6224. You can also go to www.mycigna. com and register/login to access your account. In addition you can download the “MyCigna” app on your smartphone and access your id card right there on your phone.

EMPLOYEE BENEFITS Dental High Plan Low Plan Employee Only $39.78 $19.93 Employee and Spouse $97.99 $40.49 Employee and Child(ren) $107.43 $46.56 Employee and Family $149.76 $71.09
Cigna Dental Choice Plan Summary Please see plan documents for details and limitations High PPO Plan PPO Low MAC Plan In-Network ‘Total Cigna DPPO’ Out-of-Network In-Network ‘Total Cigna DPPO’ Out-of-Network Reimbursement Levels Based on Contracted Fees Maximum Reimbursable Charge Based on Contracted Fees Maximum Allowable Charge Calendar Year Deductible • Individual • Family $50 $150 $50 $150 $50 $150 $50 $150 Calendar Year Benefit Maximum Per Individual $1200 $750 18

Dental Insurance Cigna

Highlights

Class I: Diagnostic & Preventive

Oral Evaluations

Prophylaxis: routine cleanings

X-rays: routine

X-rays: non-routine

Fluoride Application

Sealants: per tooth

Space Maintainers: non-orthodontic

Emergency Care to Relieve Pain

Class II: Basic Restorative

Restorative: fillings

Endodontics: minor and major

Periodontics: minor and major

Oral Surgery: minor and major

Anesthesia: general and IV sedation

Repairs: dentures

Class III: Major Restorative Inlays and Onlays

Prosthesis Over Implant

Crowns: prefabricated stainless steel / resin

Crowns: permanent cast and porcelain

Bridges and Dentures

Repairs: bridges, crowns and inlays

Denture Relines, Rebases and Adjustments

Class IV: Orthodontia

for Dependent Children to age 19

EMPLOYEE BENEFITS Benefit
You Pay You Pay
No Charge No Charge No Charge No Charge
20% after deductible 20% after deductible 40% after deductible 40% after deductible
50% after deductible 50% after deductible 60% after deductible 60% after deductible
Coverage
Lifetime Benefits Maximum: $1,000 $50% No Deductible $50% No Deductible No Coverage No Coverage 19

Vision Insurance

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/drippingspringsisd

Our vision plan provides quality care to help preserve your health and eyesight. In addition to identifying vision and eye problems, regular exams can detect certain medical issues such as diabetes and high cholesterol. You may seek care from any licensed optometrist, ophthalmologist or optician, but plan benefits are better if you use an in-network provider. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through MetLife

lenses are in lieu of eyeglass

and

EMPLOYEE BENEFITS
MetLife
Vision Plan Base Plan Buy-up Plan Exam Materials Contact Lens Fitting $10 $25 $25 $0 $0 $25 In-Network Out-of-network In-Network Out-of-network Lenses Single Vision Bifocals Trifocals Covered in full Covered in full Covered in full Up to 30 Up to $50 Up to $65 Covered in full Covered in full Covered in full Up to 30 Up to $50 Up to $65 Frames $125 retail allowance Up to $70 $175 retail allowance Up to $70 Contacts Elective Lenses Contact lens fitting (specialty) Necessary Lenses *Contact
benefit. $120 $50 retail allowance Covered in full $105 Not covered Up to $105 $175 $50 retail allowance Covered in full Up to $105 Not covered Up to $201 Benefit Frequency Exam Lenses Frames Contacts Once every 12 months Once every 12 months Once every 12 months Once every 12 months Dental Base Buy Up Employee Only $6.88 $10.97 Employee and Spouse $13.66 $21.79 Employee and Child(ren) $13.38 $21.34 Employee and Family $20.36 $32.48 20
lenses
frames

Disability Insurance

ABOUT DISABILITY

Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.

For full plan details, please visit your benefit website: www.mybenefitshub.com/drippingspringsisd

What is Educator Disability Insurance?

Educator Disability insurance is a hybrid that combines features of short-term and long-term disability into one plan. Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. The plan gives you flexibility to be able to choose an amount of coverage and waiting period that suits your needs. We offer Educator Disability insurance for you to purchase through The Hartford.

If you need to file a claim, contact TheHartford at 866-278-2655. Full instructions can be found at www.mybenefitshub.com/ drippingspringsisd

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 of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session.

Benefit Amount: You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $8,000 that cannot exceed 66 2/3% of your current monthly earnings. Earnings are defined in The Hartford’s contract with your employer.

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. One 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 1 month.

Maximum Benefit Duration: Benefit Duration is the maximum time for which we pay benefits for disability resulting from sickness or injury. Depending on the schedule selected and the age at which disability occurs, the maximum duration may vary. Please see the applicable schedules on the plan summary at www.mybenefitshub.com/drippingspringsisd for full details.

Benefit Integration: 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

• Workers’ Compensation

• 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)

EMPLOYEE BENEFITS
The Hartford
21

Disability Insurance The Hartford

Educator Disability - Definitions

What is disability insurance? 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. This type of disability plan is called an educator disability plan and includes both long and short term coverage into one convenient plan.

Pre-Existing Condition Limitations - Please note that all plans will include pre-existing condition limitations that could impact you if you are a first-time enrollee in your employer’s disability plan. This includes during your initial new hire enrollment. Please review your plan details to find more information about preexisting condition limitations.

How do I choose which plan to enroll in during my open enrollment?

1. First choose your elimination period. The elimination period, sometimes referred to as the waiting period, is how long you are disabled and unable to work before your benefit will begin. This will be displayed as 2 numbers such as 0/7, 14/14, 30/30, 60/60, 90/90, etc.

The first number indicates the number of days you must be disabled due to Injury and the second number indicates the number of days you must be disabled due to Sickness

When choosing your elimination period, ask yourself, “How long can I go without a paycheck?” Based on the answer to this question, choose your elimination period accordingly.

Important Note- some plans will waive the elimination period if you choose 30/30 or less and you are confined as an inpatient to the hospital for a specific time period. Please review your plan details to see if this feature is available to you.

2. Next choose your benefit amount. This is the maximum amount of money you would receive from the carrier on a monthly basis once your disability claim is approved by the carrier.

When choosing your monthly benefit, ask yourself, “How much money do I need to be able to pay my monthly expenses?” Based on the answer to this question, choose your monthly benefit accordingly.

Choose your desired elimination period.

Choose your Benefit Amount from the drop down box.

EMPLOYEE BENEFITS
22

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/drippingspringsisd

Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town treatments, special diets, daily living, and household upkeep. In addition to these non-medical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance through American Public Life helps pay for these direct and indirect treatment costs so you can focus on your health.

Should you need to file a claim contact APL at 800-256-8606 or online at www.ampublic.com. You

and materials at www.mybenefitshub.com/drippingspringsisd

APL EMPLOYEE BENEFITS
can
additional claim forms
Summary of Benefits Plan 1 Plan 2 Internal Cancer First Occurrence* $2,500 $2,500 Cancer Screening Rider Benefits Plan 1 Plan 2 Diagnostic Testing- 1 test per calendar year $50 per test $50 per test Follow Up-Diagnostic Testing- 1 test per calendar year $100 per test $100 per test Medical Imaging- per calendar year $500 per test/ 1 per calendar year Cancer Treatment Policy benefits Plan 1 Plan 2 Radiation and Chemotherapy, Immunotherapy Max. Per 12-month period $10,000 $20,000 Hormone Therapy- Maximum of 12 treatments per calendar year $50 per treatment $50 per treatment Surgical Rider Benefits Plan 1 Plan 2 Surgical $30 unit dollar amount Max $3,000 per operation $45 unit dollar amount Max $4,500 per operation Anesthesia 25% of amount paid for covered surgery Bone Marrow Transplant-Maximum per lifetime $6,000 $9,000 Stem Cell Transplant- Maximum per lifetime $600 $900 Miscellaneous Care Rider Benefits Plan 1 Plan 2 Hair Piece (Wig)- 1 per lifetime $150 $150 Blood, Plasma &Platelets $300 per day $300 per day Ambulance- Ground /Air-Maximum of 2 trips per Hospital Confinement for all modes of transportation combined $200/$2000 per trip $200/$2000 per trip Heart Attack/Stroke First Occurrence Rider Benefits Plan 1 Plan 2 Lump Sum Benefit- Maximum per 1 covered person per lifetime $2500 $2500 Hospital Intensive Care Unit Rider Benefits Plan 1 Plan 2 Intensive Care Unit $600 per day $600 per day *Carcinoma in situ is not considered internal cancer Pre-Existing Condition Exclusion: Review the Benefit Summary that can be found at mybenefitshub.com/drippingspringsisdspringsisd Cancer High Plan Low Plan Employee Only $32.40 $17.80 Employee and Spouse $57.80 $32.70 Employee and Child(ren) $44.60 $24.80 Employee and Family $57.80 $32.70 23
find

Accident Insurance CHUBB

ABOUT ACCIDENT

Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you.

For full plan details, please visit your benefit website: www.mybenefitshub.com/drippingspringsisd

You do everything you can to stay active and healthy, but accidents happen every day. An injury that hurts an arm or a leg can hurt your finances too. Chubb Accident pays cash benefits directly to you regardless of any other coverage you have. Benefits can be used to help cover health plan gaps for out-ofpocket expenses like deductibles, copays, and coinsurance.

Choose 1 of 2 plans

EMPLOYEE BENEFITS
Plan 1 Plan 2 Coverage Type 24-Hour 24-Hour Sports Package Up to $1,000 per person/ per year First Accident $100 payable benefit $100 payable benefit Initial Care Benefits Payable Benefit Payable Benefit Emergency Room $150 $200 Urgent Care $100 $150 Initial Dr. Visit ICU $100 $150 Hospital/Facility Benefits Payable Benefit Payable Benefit Standard Hospital Admission $1,000 $1,500 Hospital Admission $1,000 $2,000 Hospital Confinement (per day, up to 365 days) $200 $400 ICU Confinement (per day, up to 30 days) $400 $600 Rehab Confinement (per day, up to 30 days) $150 $300 Recovery Benefit (per day) No. of Days $25 7 $25 7 Additional Benefits Payable Benefit Payable Benefit Accidental Death Employee Spouse as a % of Employee Child as a % of Employee $50,000 $50,000 $20,000 $75,000 $75,000 $20,000 Ambulance (air) $1,500 $2,000 Ambulance (ground) $500 $750 Appliance $100 $200 Blood, Plasma, Platelets $200 $200 Accident Plan 1 Plan 2 Employee Only $6.28 $9.65 Employee and Spouse $9.87 $15.20 Employee and Child(ren) $10.42 $16.03 Employee and Family $15.91 $26.17 24

Accident Insurance CHUBB

- Abdominal, or Thoracic

– Hernia

Tendon, Ligament, Rotator Cuff

Therapy – Physical, Occupational, or Speech

Traumatic Brain Injury

Exclusions and Limitations*

No benefits will be paid for an injury that is caused by, contributed to, or occurs as a result of: 1) being intoxicated, or under the influence of alcohol, narcotic or other prescription drug unless taken in accordance with Physician’s instructions; 2)participating in an illegal activity or attempting to commit or committing a felony; 3) committing or attempting to commit suicide or intentionally injuring oneself; 4) having dental treatment; 5) war, or serving in any of the armed forces or its auxiliary units; 6) participation in any contest using a motorized vehicle. No benefits will be payable for sickness or infection including physical or mental condition.

EMPLOYEE BENEFITS Burns Skin Graft Up to $10,000 25% Up to $15,000 50% Coma $10,000 $15,000 Dislocations (up to) $4,000 $8,000 Emergency Dental Crown Extraction Dentures Implants $200 $50 $200 $200 $450 $50 $450 $450 Eye Injury $500 $800 Family Care (up to 30 days) $25 per day, per child in child care center $35 per day, per child in child care center Follow-up Treatment (per visit) $75 $100 Fractures (up to) $8,000 $10,000 Herniated Disc Surgery $400 $1,200 Joint Replacement Up to $2,000 Up to $4,000 Knee
– Torn $400 $400 Lacerations $30-$500 $60-$1,000 Lodging
night) $125 $150 Loss of Hands, Feet, Sight $50,000 $50,000
of Fingers or Toes $5,000 $5,000 Major Diagnostic Exam (CT, MRI, etc.) $100 $300 Outpatient Physician Treatment & Preventive Care Benefit $50 $50 Paralysis
Four
$5,000 $7,500 $7,500 $10,000 Prosthetics $500 $1,500 Surgery
$2,000 $3,000
$250 $400
$400 $400
$50 $75 Transportation $400 $400
Cartilage
(per
Loss
Two limbs (paraplegia or hemiplegia)
limbs (quadriplegia)
Surgery
$150 $200
$100 $150
X-Ray
25

Critical Illness Insurance CHUBB

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/drippingspringsisd

Heart attacks and strokes happen every day and often unexpectedly. They don’t give you time to prepare and can take a serious toll on both your physical and financial well-being. Chubb Critical Illness pays cash benefits directly to you that you can use to help with your bills, your mortgage, your rent, your childcare— you name it—so you can focus on recovery. There is no pre-existing condition limitation. All amounts are guarantee issue – no medical questions are required for coverage to be issued.

Employee: $10,000; $20,000; $30,000; or $40,000 face amounts

Spouse: $10,000; $20,000; $30,000; or $40,000 face amounts

Child: Included in the employee rate

EMPLOYEE BENEFITS
Covered Conditions Payable Benefit as a % of Face Amount ALS 100% Alzheimer's Disease 100% Benign Brain Tumor 100% Breast Cancer Carcinoma In Situ 100% Cancer (See below for skin cancer) 100% Carcinoma In Situ 25% Coma 100% Coronary Artery Obstruction 25% End Stage Renal Failure 100% Heart Attack 100% Loss of Sight, Speech, or Hearing 100% Major Organ Failure 100% Multiple Sclerosis 100% Paralysis or Dismemberment 100% Parkinson’s Disease 100% Severe Burns 100% Stroke 100% Sudden Cardiac Arrest 100% Transient Ischemic Attacks 10% Skin Cancer Benefit - Payable once per insured per year $500 26

Critical Illness Insurance CHUBB

Occupational Package

Pays 100% of the face amount; Benefits payable for HIV or Hepatitis B, C, or D, MRSA, Rabies, Tetanus, or Tuberculosis contracted on the job.

Childhood Conditions

Pays 100% of the dependent child face amount; Provides benefits for childhood conditions (Autism Spectrum Disorder; Cerebral Palsy; Congenital Birth Defects; Heart, Lung, Cleft Lip, Palate, etc; Cystic Fibrosis; Down Syndrome; Gaucher Disease; Muscular Dystrophy; and Type 1 Diabetes).

Recurrence Benefit

Benefits are payable for a subsequent diagnosis of Benign Brain Tumor, Cancer, Coma, Coronary Artery Obstruction, Heart Attack, Major Organ Failure, Severe Burns, Sudden Cardiac Arrest, or Stroke.

Additional Benefits

Miscellaneous Diseases Rider + COVID-19

Pays a benefit when a covered person is diagnosed with a covered condition: Addison’s Disease, Cerebrospinal Meningitis, COVID-19, Diphtheria, Huntington’s Chorea, Legionnaire’s Disease, Malaria, Myasthenia Gravis, Meningitis, Necrotizing Fasciitis, Osteomyelitis, Polio, Rabies, Scleroderma, Systemic Lupus, Tetanus, Tuberculosis

Waiver of Premium

Included

Included

Waives premium while the insured is totally disabled. Included Wellness Benefit - Payable once per insured per year. $50

Exclusions and Limitations*

No benefits will be paid for losses that are caused by, contributed, or occur as a result of a Covered Person’s: 1) injuring oneself intentionally or committing or attempting to commit suicide; 2) committing or attempting to commit a felony or engaging in an illegal occupation or activity. A Physician cannot be You or a member of Your Immediate Family, Your business or professional partner, or any person who has a financial affiliation or business with you.

Questions?

Contact the Higginbotham Public Sector Benefits CareLine at (833) 453-1680.

EMPLOYEE BENEFITS
100%
Payable Benefit as a Percentage of Face Amount
25%
27

Emergency Medical Transport MASA

ABOUT MEDICAL TRANSPORT

Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out-of-pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan.

For full plan details, please visit your benefit website: www.mybenefitshub.com/drippingspringsisd

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 non-emergency 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 at www.mybenefitshub.com/drippingspringsisd

EMPLOYEE BENEFITS
Emergency Medical Transport Employee & Family $14.00 28

Life and AD&D CHUBB

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/drippingspringsisd

Life insurance is an important part of your employee benefits package. Chubb Term Life and Accidental Death and Dismemberment (AD&D) insurance provides the protection your family needs if something were to happen to you. Your family can receive cash benefits paid directly to them that they can use to help cover expenses like mortgage payments, credit card debt, childcare, college tuition and other household expenses.

Benefit Summary

Voluntary Term Life and AD&D Insurance is made available for purchase by you and your family. Employees must be actively at work for at least 20 hours per week.

Life Insurance/AD&D

For You:

• Life/AD&D: $10,000 to a maximum of $500,000 in $10,000 increments

For Your Spouse:

• Life: Up to 100% of employee’s benefit amount to a maximum of $500,000 in $10,000 increments

• AD&D: 50% of employee amount not to exceed $250,000

For Your Dependent Children:

• Life: Live birth to 6 months: $1,000; 6 months to age 26: $10,000 AD&D: 10% of employee amount not to exceed $50,000

Reduction Schedule: 50% at age 70

Guaranteed Issue

• Employee: $300,000

• Spouse: $50,000

• Child: $10,000

Newly eligible employees and dependents: You and your eligible dependents may elect coverage up to the guaranteed issue amounts without answering health questions. Elections over the guaranteed issue amounts will require medical underwriting.

Current employees: At subsequent annual enrollments if you or your eligible dependents are currently enrolled in the plan, you may increase your coverage up to the guaranteed issue amounts

without answering health questions. All amounts over the guaranteed issue will require medical underwriting.

* Please note that if you or your dependents did not elect coverage when first eligible, then you are considered a late entrant. Late entrants will be medically underwritten and will have to answer health questions for any amount of coverage elected.

Additional Plan Benefits

Accelerated Death Benefit for Long Term Care:

4% per month up to 50% of the Death Benefit not to exceed $100,000

Accelerated Death Benefit for Terminal Illness:

75% of Death Benefit

AD&D Covered Losses and Benefits:

The AD&D plan provides additional protection for you and your dependents in the event of an accidental bodily injury resulting in death or dismemberment. In addition to standard dismemberment coverage, the following benefit provisions are included:

• Child Education Expense Benefit – 10% of the AD&D Benefit up to $4,000 per child per year, not to exceed $20,000 for 5 years

• Child Care Expense Benefit – 10% of the AD&D Benefit up to $4,000 per child per year, not to exceed $20,000 for 5 years

• Exposure and Disappearance Benefit

• Repatriation Expense Benefit – 10% of AD&D Benefit up to $5,000

• Seatbelt Benefit – 10% of AD&D benefit up to $25,000

• Air Bag Benefit – 10% of AD&D benefit up to $5,000

Definitions and Provisions

Portability: You can elect portable coverage, at group rates, if you terminate employment, reduce hours or retire from the employer.

Conversion: When your group coverage ends, you may convert your coverage to an individual life policy without providing evidence of insurability.

EMPLOYEE BENEFITS
29

Life and AD&D CHUBB

Questions?

Contact the Higginbotham Public Sector Benefits CareLine at (833) 453-1680.

Term Life Exclusions*

No benefits will be paid for losses that are caused by, contributed to, or result from: 1) suicide, while sane or insane, occurring within 24 months after a Covered Person’s initial effective date of coverage; and 2) suicide, while sane or insane, occurring within two years after the date any increases in or additional coverage applied for becomes effective for a Covered Person.

AD&D Exclusions*

No benefits will be paid for any loss caused or contributed to by: 1) attempted suicide; 2) intentionally self-inflicted harm; 3) travel if Insured is other than passenger; 4) war; 5) active participation in a riot, insurrection, or terrorist activity; 6) committing or attempting to commit a felony; 7) voluntary intake or use by any means of any drug, unless taken in accordance with instructions; 8) any poison, gas or fumes, unless a direct result of an occupational accident; 9) being intoxicated; 10) bungee jumping; 11) participation in an illegal occupation/activity; 12) rock or mountain climbing; and 13) aeronautics.

Child LIfe Premium is $1.80 for $10,000

One Life premium covers all children.

Employee AD&D Monthly Rate is $0.25 per $10,000.

Family AD&D Monthly Rate is $0.04 per $1,000

EMPLOYEE BENEFITS
Age Band Employee Monthly Life Rate per $10,000 Spouse Monthly Life Rate per $10,000 <25 $0.50 $0.50 25-29 $0.50 $0.50
$0.70 $0.70
$0.80 $0.80 40-44 $1.00 $1.00 45-49 $1.40 $1.40 50-54 $2.40 $2.40 55-59 $3.90 $3.90 60-64 $5.90 $5.90 65-69 $8.26 $8.26 70-74 $10.30 $10.30 75> $14.70 $14.70
30-34
35-39
30

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/drippingspringsisd

Enhanced coverage options for employees. Easy and flexible enrollment for employers. The 5Star Life Insurance Company’s Family Protection Plan offers both Individual and Group products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your employees

CUSTOMIZABLE:

With several options to choose from, employees select the coverage that best meets the needs of their families.

TERMINAL ILLNESS ACCELERATION OF BENEFITS:

Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL).

PORTABLE:

Coverage continues with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly.

FAMILY PROTECTION:

Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves.

* Financially dependent children 14 days to 25 years old.

PROTECTION TO COUNT ON:

Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two-year contestability period and/or under investigation. This coverage has no war or terrorism exclusions.

QUALITY OF LIFE:

Optional benefit that accelerates a portion of the death benefit monthly, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following:

• Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or

• Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.

Find full details and rates at www.mybenefitshub.com/ drippingspringsisd.

Should you need to file a claim, contact 5Star directly at (866) 863-9753.

*Quality of Life not available ages 66-70. Quality of Life benefits not available for children

Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 25 years). $7.15 monthly for $10,000 coverage per child.

EMPLOYEE BENEFITS
5Star
31

Identity Theft ID Watchdog

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/drippingspringsisd

Identity Theft Is Growing Better Protect You and Your Family Fraud continues to grow more complex. And it is becoming harder for consumers and identity theft victims to manage the intricacies on their own. Fraudsters are taking advantage of consumers’ increased digital dependence to steal personal and financial information - doubling the amount of identity theft reports to the FTC in 2020.

Easy & Affordable Identity Protection ID Watchdog helps warn you when your personal information is stolen and helps you better protect yourself and your family from identity fraud— when stolen information is used for illicit gain. You’ll have greater peace of mind knowing you don’t have to face the complexities of identity theft alone.

More for Families. Our family plan helps you better protect the identities of your loved ones of all ages. We offer more features that help protect minors than any other provider.

Powerful Features Included in Both ID Watchdog Plans

Control & Manage

• Financial Accounts & Social Account Monitoring

• Registered Sex Offender

• Reporting

• Customizable Alert Options

• Equifax Blocked Inquiry Alerts

• National Provider ID Alerts

Monitor & Detect

• Dark Web Monitoring

• Data Breach Notifications

• High-Risk Transactions Monitoring

• Subprime Loan Monitoring

• Public Records Monitoring

• USPS Change of Address Monitoring

• Identity Profile Report

• Credit Score Tracker

Support & Restore

• Fully Managed Resolution Services including Pre-Existing Conditions

• Online Resolution Tracker

• Lost Wallet Vault & Assistance

• Deceased Family Member Fraud Remediation

• Credit Freeze Assistance

Report Lock Multi-Bureau

Theft Insurance Up to $1 Million

Stolen Funds Reimbursement

Subprime Loan Block within the monitored lending network

Social Account Takeover Alerts

Fraud Alerts

IDWatchdog is here for you 24/7/365. Reach our in-house customer care team at (866) 513-1518.

EMPLOYEE BENEFITS
Plan-Specific Features Platinum Credit Report Monitoring 3 Bureau Credit Report(s)
Credit Score(s) 1 Bureau Daily & 3 Bureau
Credit
& VantageScore
Annually
Identity
401K/HSA
 Integrated
Identity Theft Employee only $8.30 Employee & Family $14.40 32

Flexible Spending Account (FSA)

National Benefit Services (NBS)

ABOUT FSA

A Flexible Spending Account (FSA) lets you set aside a portion of your paycheck—before taxes—into an account to help you pay for medical, dental, vision, and dependent care expenses. An FSA is a planning tool with great tax benefits. With an FSA, you must use the account balance in full before the end of the plan year or it will be forfeited. *

For full plan details, please refer to your Summary Plan Description (SPD) and visit the NBS Participant Portal: mynbsbenefits.com

There are three types of Flexible Spending Accounts you may be able to choose from. Make sure you understand the purpose of each account before you make your elections!

Health Flexible Spending Account (FSA)

The Health FSA allows you to pay for medical, dental, and vision expenses for yourself and your eligible dependents. For plan years that start in 2024, you may contribute up to $3,200.00 to your Health FSA. This benefit is funded up-front, so you will have access to your whole annual election on the first day of the plan year. You can use your NBS Smart Debit Card to pay for expenses or pay out of pocket and submit claims for reimbursement.

Some examples of common eligible expenses are co-pays and deductibles, orthodontia, eyeglasses, prescription medicines, menstrual care products, over-the-counter medicines, chiropractor, hearing aids, monitoring devices (blood pressure, cholesterol), physical therapy, laser eye surgery, and many more. Complete lists of eligible and non-eligible expenses can be found in IRS Publication 502

*The FSA is a “use-it-or-lose-it” benefit, so plan carefully to ensure you don’t forfeit funds. Your employer may offer you a grace period or rollover option. Refer to your Summary Plan Description (SPD) for more information.

Limited-Purpose Flexible Spending Account (LFSA)

If you contribute to a Health Savings Account, you cannot participate in the Health FSA. However, your employer may offer you the option to participate in a Limited Health Flexible Spending Account (LFSA). The LFSA is similar to the Health FSA but is designed to be paired with a Health Savings Account. The LFSA will allow you to be reimbursed for out-of-pocket dental and vision expenses incurred by you and your dependents.

NBS Smart Debit Card

If you participate in the FSA or LFSA benefits, you will receive a card in the mail. You can use this card to pay for eligible expenses, thus avoiding out-of-pocket expenses and submitting claim forms. Please make sure you keep any bills, receipts, statements, and/or explanations of benefits (EOBs) corresponding to your card purchases. You may be asked to substantiate your purchase to show it was an eligible expense.

EMPLOYEE BENEFITS
33

Flexible Spending Account (FSA)

National Benefit Services (NBS)

Dependent Care FSA aka Dependent Care Assistance Program (DCAP)

The Dependent Care Flexible Spending Account (DCAP) enables you to pay for out-of-pocket, work-related dependent daycare expenses using pre-tax funds. Please see your Summary Plan Description (SPD) for the definition of eligible dependent. Generally, your reimbursement may not exceed the lesser of: (a) $5,000 (if you are married filing a joint return or you are head of a household) or $2,500 (if you are married filing separate returns); (b) your taxable compensation; (c) your spouse’s actual or deemed earned income.

Examples of eligible expenses:

¾ Before and after school/extended day programs

¾ Daycare in your home or elsewhere

¾ Base cost of day camps or similar programs

Examples of ineligible expenses:

¾ Schooling for a child in kindergarten or above

¾ Babysitter while you go to the movies or dinner

¾ Cost of overnight camps

DCAPs are not funded up-front like Health FSAs. You will gain access to your contributions only after they are deducted from your paycheck. You may choose to be reimbursed automatically each pay period by filling out and submitting the Continual Reimbursement form at the beginning of the plan year. Alternatively, you can choose to submit individual claims for reimbursement. Some employers may allow you to use your NBS Smart Debit card to pay your dependent care provider.

Review your Summary Plan Description (SPD)

Your Summary Plan Description (SPD) will give you important information about these benefits that is specific to your employer’s plan. Please read your SPD so you understand your spending deadline, deadline to submit claims, whether you have a grace period and if so, when it ends, whether you have the option to carryover some remaining FSA funds and if so, how much, which qualifying life events may allow you to change your elections outside of open enrollment, and more.

NBS Participant Portal and Mobile App

To get the most out of your benefits, register for our participant portal and/or download our mobile app. On the portal and app, you can submit claims, pay providers, check your balance, set up direct deposit, order cards for your dependents and replacement cards, review transactions and spending deadlines, manage your alerts, and more.

To register, visit http://mynbsbenefits.com/, click “Register” in the top right corner, and follow the prompts. Your employee ID is your SSN.

NBS Service Center

Our dedicated service center is available to help with any of your individual needs, including accessing your account, questions about your benefits, and requesting new debit cards.

Phone: 855-399-3035, option 2

Fax: (844) 438-1496

Email: service@nbsbenefits.com

Hours of Operation:

7:00 a.m. - 7:00 p.m. CT Mon - Fri

Scan to access the NBS portal!

EMPLOYEE BENEFITS
34

HEALTH REIMBURSEMENT ARRANGEMENT

Dripping Springs Independent School District Employer ID NBS 854153

PLAN HIGHLIGHTS

Login at: my.nbsbenefits.com

Congratulations! Your Employer, Dripping Springs Independent School District , has established a Health Reimbursement Arrangement "HRA Plan" to help you pay for your out-of-pocket medical expenses. The Plan is funded by Employer Contributions. No Employee Salary Deductions are allowed in this plan. If you received a reimbursement for an expense under the Plan, you cannot claim a Federal income tax credit or deduction on your return .

GENERAL PLAN INFORMATION

Coverage Period End August 31st

Run-out Period 45 Days

QUALIFIED EXPENSES

The plan allows you to be reimbursed for certain out -of-pocket medical, dental and vision expenses which are incurred by you and your dependents. These would include drugs obtained through a prescription. The expenses, which qualify, are those permitted by Section 213 of the Internal Revenue Code. A list of some of the expenses that qualify is available from the Administrator.

WHEN AM I ELIGIBLE TO PARTICIPATE

You must be enrolled in a group medical plan offered by the district (other than a high-deductible plan) in order to participate. If you work 20 hours or more each week for the district, you will be eligible to join the Plan following your date of employment.

You will begin participation in the Plan on the first day of the month following the day in which you meet the above eligibility requirements.

BENEFIT

The maximum Employer contribution allowed each year is $900 per Participant.

All Contributions will be pro-rated based on the Employee’s eligibility date to join the plan.

Any monies left at the end of the Coverage Period will be forfeited. You must submit claims no later than 45 days after the end of the Coverage Period.

You may not, however, be reimbursed for the cost of other health care coverage maintained outside of the Plan, or for longterm care expenses.

HOW DO I RECEIVE REIMBURSEMENTS?

During the course of the Coverage Period, you may submit requests for reimbursement of expenses you have incurred. However, you must make your requests for reimbursements no later than 45 days after the end of the Coverage Period. The Administrator will provide you with accep table forms for submitting these requests for reimbursement. In addition, you must submit to the Administrator proof of the expenses you have incurred and that they have not been paid by any other health plan coverage. If the request qualifies as a benefit or expense that the Plan has agreed to pay, you will receive a reimbursement payment soon thereafter. Remember, reimbursements made from the Plan are generally not subject to federal income tax or withholding. Nor are they subject to Social Security taxes

Expenses are considered “incurred” when the service is performed, not necessarily when it is paid for. You can get a claim form at www.participant.nbsbenefits.com for reimbursement.

WHO ARE HIGHLY COMPENSATED & KEY EMPLOYEES?

Under the Internal Revenue Code, "highly compensated employees" and "key employees" generally are Participants who are officers, shareholders or highly paid.

If you are within these categories, the amount of contributions and benefits for you may be limited so that the Plan as a whole does not unfairly favor those who are highly paid, their spouses or their dependents. Please refer to your Summary Plan Description for more information. You will be notified of these limitations if you are affected.

NBS Welfare Benefit Service Center

(801) 532-4000 or 800-274-0503

Fax: 800-478-1528

service@nbsbenefits.com

Dripping Springs Independent School District HRA Plan

Dripping Springs Independent School District

Plan Contact Person: Linda Hall 510 West Mercer Street Dripping Springs, Texas 78620 (512) 858-3007

35

Employee Assistance Program (EAP) Deer Oaks

ABOUT EAP

An Employee Assistance Program (EAP) is a program that assists you in resolving problems such as finding child or elder care, relationship challenges, financial or legal problems, etc. This program is provided by your employer at no cost to you.

For full plan details, please visit your benefit website: www.mybenefitshub.com/drippingspringsisd

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 in order to live happier, healthier, more balanced lives. From stress, addiction, and change management, to locating child care 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 around-the-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

EMPLOYEE BENEFITS
36
Notes 37
Notes 38
Notes 39

2024 - 2025 Plan Year

Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the Dripping Springs 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 Dripping Springs ISD Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.

WWW.MYBENEFITSHUB.COM/DRIPPINGSPRINGSISD
40

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